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PubMedDate not supplied

Health insurance trends are contributing to growing health care inequality.

A health plan chief medical officer comments on several trends underscoring the conclusion reached by Robert Hurley and colleagues that disparities in health care are widening. Growing use of new technology is driving up premiums, increasing the ranks of the uninsured and underinsured. Cost shifting by hospitals because of inadequate public program reimbursements drives premiums even higher. Although disparities in health care can never be eliminated, access to essential services can-and must-be made universal. That goal can be accomplished if insurance coverage is mandated and responsibility for its cost is spread broadly.

Health Services Accessibility↗
PubMed2005

France tries to save its ailing national health insurance system.

France has provided universal health care through employment-based health insurance funds. As its governments have increasingly used tax revenues to supplement payroll levies, they have assumed a larger role. Faced with widening deficits in the funds' accounts, the National Assembly adopted in August 2004 legislation designed to decrease health expenses, increase revenues to the funds, and improve quality of care. The apparent impacts of the so-called Douste-Blazy law are to reaffirm social solidarity and equality of access; to reinforce central control rather than relying more on decentralized and market forces; to give the now-unified funds a stronger director, shielded not only from labor and business but also, possibly, from the central government; to allow French private physicians to retain their unrivaled freedom of prescription; and to continue France's reliance on taxes as well as payroll levies to finance its health care.

Delivery of Health Care↗
PubMed2005

Physicians' Plan for a healthy Minnesota. The MMA proposal for health care reform. The report of the Minnesota Medical Association Health Care Reform Task Force.

The health care system in the United States, according to some, is on the verge of imploding. The rapidly rising cost of services is causing more and more Minnesotans to forego needed care. At the same time, the increasing costs are placing additional pressure on families, businesses, and state and local government budgets. The Minnesota Medical Association's (MMA) Health Care Reform Task Force has proposed a bold new approach that seeks to ensure affordable health care for all Minnesotans. The proposal is a roadmap to provide all Minnesotans with affordable insurance for essential health care services. In creating this plan, the task force strove to achieve three common reform goals: expand access to care, improve quality, and control costs. To achieve those ends, it has proposed a model built on four key features: (1) A strong public health system, (2) A reformed insurance market that delivers universal coverage, (3) A reformed health care delivery market that creates incentives for increasing value, (4) Systems that fully support the delivery of high-quality care. The task force believes that these elements will provide the foundation for a system that serves everyone and allows Minnesotans to purchase better health care at a relatively lower price. Why health care reform again? The average annual cost of health care for an average Minnesota household is about 11,000 dollars--an amount that's projected to double by 2010, if current trends continue. Real wages are not growing fast enough to absorb such cost increases. If unabated, these trends portend a reduction in access to and quality of care, and a heavier economic burden on individuals, employers, and the government. Furthermore, Minnesota and the United States are not getting the best value for their health care dollars. The United States spends 50 percent more per capita than any other country on health care but lags far behind other countries in the health measures of its population.

Advisory Committees↗
PubMedDate not supplied

Alternatives for expanding health insurance coverage.

In March 1990, nearly 14 percent of the U.S. population was without health insurance. This article examines five approaches to increase coverage: tax credits for the purchase of private insurance; changes in the regulation of the private insurance market; additional requirements on employers to provide employment-based insurance; expansion of Medicaid to selected groups; and a universal public health insurance program. Coverage would be most improved under a universal public insurance plan, and least improved by regulatory changes in the private insurance market. Significant but incomplete increases in coverage could be achieved through either new employer mandates or expansion of Medicaid. A tax credit could increase coverage appreciably only if it was substantial relative to the cost of insurance, and even then most of the credits would go to those who would have purchased insurance anyway.

Data Collection↗
PubMed2006

Health insurance system and payments provided to patients for the management of severe acute pancreatitis in Japan.

The health insurance system in Japan is based upon the Universal Medical Care Insurance System, which gives all citizens the right to join an insurance scheme of their own choice, as guaranteed by the provisions of Article 25 of the Constitution of Japan, which states: "All people shall have the right to maintain the minimum standards of wholesome and cultured living." The health care system in Japan includes national medical insurance, nursing care for the elderly, and government payments for the treatment of intractable diseases. Medical insurance provisions are handled by Employee's Health Insurance (Social Insurance), which mainly covers employees of private companies and their families, and by National Health Insurance, which provides for the needs of self-employed people. Both schemes have their own medical care service programs for retired persons and their families. The health care system for the elderly covers people 75 years of age and over and bedridden people 65 years of age and over. There is also a system under which the government pays all or part of medical expenses, and/or pays medical expenses not covered by insurance. This is referred to collectively as the "medical expenses payment system" and includes the provision of medical assistance for specified intractable diseases. Because severe acute pancreatitis has a high mortality rate, it is specified as an intractable disease. In order to lower the mortality rate of various diseases, including severe acute pancreatitis, the specification system has been adopted by the government. The cost of treatment for severe acute pancreatitis is paid in full by the government from the date the application is made for a certificate verifying that the patient has an intractable disease.

Acute Disease↗
PubMed2002

[How do we heal the Argentine health care system?].

This article proposes a set of measures to reform the Argentine health care system and turn the country's current crisis into an opportunity for progressive, sustainable change. The proposal consists of a model for the intergovernmental division of health responsibilities. The national government would be responsible for strengthening its leadership role and for developing national insurance for low-prevalence high-cost diseases. With the provincial governments, the insurance role would be strengthened, with public health insurance making certain that there is universal coverage. Public hospitals would function as autonomous entities financed by social insurance, private insurance, and provincial public insurance. Municipalities would have an active role in disease prevention and health promotion, principally through primary care.

Argentina↗
PubMed2006

Leveling the play field: providing equal access to health insurance to all District of Columbia residents and workers.

A unique law has been proposed that aims to level the playing field for individuals who work for small employers, are self-employed, and are unemployed, in the District of Columbia. The proposal would create one large group made up of all persons who live, work, or go to school in the District of Columbia, thus providing these individuals with the opportunity to be insured on the same terms and conditions as those who work for the government or for large employers.

District of Columbia↗
PubMed2006

Universal health care and reform of the health care system: views of medical students in the United States.

PURPOSE: Nearly 46 million Americans did not have health insurance in 2004. Recent studies have documented physicians' support for various remedies, including universal health care. The authors undertook this study to assess medical students' views on these topics. METHOD: In 2002, the authors surveyed a national random sample of first-year and fourth-year medical students (from the American Medical Association Masterfile) to determine their views about health care reform options, including universal health care. Response data were weighted and compared using chi-squared tests; statistical significance was set at p < or = .05. RESULTS: Of 1,363 medical students, 770 completed the questionnaire (response rate = 56.5%). In rating the importance of several health care issues, more than 80% of both first-year and fourth-year students rated the expansion of health care coverage as important. Nearly all first-year (90%) and fourth-year (88%) students agreed with the statement, "Everyone is entitled to adequate medical care regardless of ability to pay." Most students favored health care reform that would achieve universal health care, with first-year students (70%) somewhat more likely than fourth-year students (61%) to support universal health care (p = .012). Students were less likely to believe that physicians support universal health care, and more likely to believe that the public does. CONCLUSIONS: Both groups of students generally support the expansion of health coverage to the uninsured and some form of universal health care. This may be relevant both to policymakers in their considerations of health care reform and to medical educators concerned with teaching students about health policy issues.

Attitude of Health Personnel↗
PubMed2001

The impact of universal access to dental care on disparities in caries experience in children.

BACKGROUND: The authors investigated the association between socioeconomic status and the severity of dental caries in 6- and 7-year-old children who had had access to dental care throughout their lives. The children had lived since birth in Nova Scotia, Canada, a province with a universal publicly financed dental care program. METHODS: The authors selected a representative sample of first-grade children using a stratified multistage sampling method of primary schools (n = 1,614). The response rate was 78.8 percent. Two dentists were trained to diagnose dental caries using modified World Health Organization criteria. Intra- and interexaminer reliability was excellent (kappa > or = 0.88). Of the children who were examined (n = 1,271), 955 were lifelong residents of Nova Scotia, Canada, and so were included in this analysis. Data were weighted and adjusted for clustering (design) effects. RESULTS: Only 8.4 percent of the children had visited a dental office before the age of 2 years, and 88.5 percent of the children had their first dental visit between the ages of 2 and 5 years. Children whose parents had completed a university education had a significantly lower mean number of decayed, missing and filled surfaces, or dmfs, in their primary teeth than did children whose parents had a lower education level. A Poisson regression model indicated that parents' high education status, optimal fluoride concentration in schools' water supplies, daily toothbrushing and dental visits for checkup were significantly associated with low dmfs scores. CONCLUSION: Having access to a universal publicly financed dental insurance program since birth did not eliminate the disparities in caries experience. PRACTICE IMPLICATIONS: This analysis of a highly utilized universal dental insurance program suggests that disparities in oral health status cannot be reduced solely by providing universal access to dental care. Focused efforts by professional and governmental organizations should be directed toward understanding the socioeconomic, behavioral and community determinants of oral health disparities.

Age Factors↗
PubMed2003

The aftermath of health sector reform in the Republic of Georgia: effects on people's health.

After the collapse of the Former Soviet Union a health reform process was undertaken in Georgia beginning in 1994. This process was intended to encompass all aspects of the health-care sector and to transform the Soviet-style health system into one that was directed towards quality of care, improved access, efficiency, and a strengthened focus on Primary Health Care (PHC). Health sector reform fundamentally changed the ways health care is financed in Georgia. There has been a transition to program-based financing, and payroll-tax-based social insurance schemes have been introduced. Despite these measures, the performance of the health system is still disappointing. All health programs are severely under-funded, and when the majority of the population is unemployed or self-employed, collection of taxes seems impossible. Overall, Georgian consumers are uninformed about the basic principles of health reforms and their entitlements and therefore do not support them. The analysis introduced in this paper of the current situation in Georgia establishes that the rush to insurance-based medicine was more a rush from the previous system than a well-thought-out policy direction. After 70 years of a Soviet rule, the country had no institutional capacity to provide insurance-based health care. To achieve universal coverage, or at least ensure that the majority of the population has access to basic health services, government intervention is essential. In addition, educating the public on reforms would allow the reform initiators to fundamentally change the nature of the reform process from a "top-down" centralized process to one that is demand-driven and collaborative.

Cause of Death↗
PubMedDate not supplied

National health insurance.

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National Health Insurance, United States↗