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Results for “Universal Health Insurance”

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PubMed1999

Regional variation in Russian medical insurance: lessons from Moscow and Nizhny Novgorod.

The implementation of Russia's 1993 legislation on obligatory medical insurance has been characterized by wide regional variation. Two areas in particular illustrate this phenomenon: for the last five years Moscow has enjoyed a sophisticated, well-developed insurance system, while the Nizhny Novgorod region has only recently taken the most rudimentary steps toward implementation of the law. Despite their radically differing approaches to the market-based insurance reforms, however, Moscow and Nizhny Novgorod continue to enjoy roughly the same quality of available health care services, at similar costs to consumers. They also suffer some of the same continued systemic defects inherited from the Soviet era. A comparison of the two regions demonstrates that, while reform of the Soviet health care system was desperately needed, the Russian version of obligatory medical insurance has not proved to be the panacea its architects intended. In fact, even its original pioneers are now moving forward with new schemes to correct some of its deficiencies.

Adult↗
PubMedDate not supplied

The drug budget silo mentality: the French case.

OBJECTIVES: The objectives of this study were to give a review of the complex system of budgetary constraints to which the French health-care system has been committed since 1996 and to evaluate the consequences on drug policy and on efficient use of pharmaceuticals. METHODS: Literature review, legal texts analysis, and interviews with policy makers and companies managers were performed. RESULTS: The budgeting process applies to health insurance expenditures as a whole, but also to each of its components, especially hospital expenditures and pharmaceutical expenditures. Because the targets are set by reference to the gross domestic product growth while health-care expenditure is driven by demographic factors, technology, and expectations, there is inevitably a gap between the top-down budget and the bottom-up cost pressures. The pharmaceutical budget is achieved by a payback system that "taxes" companies when the growth target for aggregated pharmaceutical expenditure is exceeded. The government is now seeking to set more realistic overall global budgets and for pharmaceuticals in particular. It is also encouraging generics, delisting from reimbursement drugs of limited therapeutic value, making a special budget for new drug purchases available to hospitals, and replacing price control for innovative products with a more selective process of intervention in the expectation that companies will seek to price at a European level. CONCLUSION: The budgetary system produces a perverse incentive for companies to heavily promote new products in the knowledge that the budget overruns will be spread across all companies, as well as lacking incentives for using pharmaceuticals efficiently. Although the new drug policy will increase the efficiency of pharmaceutical expenditure, it is not apparent that they change the poor incentives facing doctors, hospitals, and insurers to use pharmaceuticals cost-effectively to achieve the optimal gain in health care. They will not remove "silo budgeting" at the national level for pharmaceuticals, which inhibits the efficient substitution of drug therapy for hospital treatment.

Budgets↗
PubMedDate not supplied

Experience with providing drugs for seniors in Canada.

The provincial and territorial governments in Canada are responsible for the provision of health care to all Canadians and, as part of this mandate, they provide drug coverage to all hospitalized patients regardless of age, and to seniors and patients with certain diagnoses, dependent on some forms of means testing. The federal government is responsible for regulation and setting standards for health care. It provides financial subsidies to the provincial programs as well as direct funding for specific groups of individuals. This article reviews the roles of each level of government in the provision of pharmaceuticals to seniors in Canada.

Aged↗
PubMed2003

Principles of child health care financing. American Academy of Pediatrics Committee on Child Health Financing.

Child health care financing must maximize access to quality, comprehensive pediatric and prenatal health care. This policy statement replaces the 1998 policy statement by the same title. Changes reflect recent state and federal legislation that affect child health care financing. The principles outlined in the statement will be used to evaluate the changing structure of child health care financing.

Adolescent↗
PubMed2006

The ethical and practical aspects of acceptance and universal patient acceptance.

"Acceptance" is an often presupposed, hidden core value and ethic focused on how dental and other health practitioners first accept people as possible patients. The three basic styles of patient acceptance are random, selective, and universal. Reduced public access to care results from the practice of random and selective acceptance. Only universal acceptance creates a potential pathway for improved access to care. The notion of Universal Patient Acceptance (UPA) is discussed here as one kind of applied ethical tool or clinical practice that allows for the ethic of acceptance to be more effectively pursued in daily practice. We suggest that health providers falsely surmise that they already understand and practice Universal Patient Acceptance. That myth and perspective are partly what keeps Acceptance hidden as an ethic and overlooked as a potential way to foster dialogue and indirectly promote better access to care. Without Universal Patient Acceptance, dental and health providers will continue to silently engage in practice patterns that adversely affect public access to care. The actual benefits of Universal Patient Acceptance are the subject of ongoing review and debate. Whatever those benefits might be will not likely be realized until Acceptance and Universal Patient Acceptance are included as part of dental and other health professional codes of ethics and training curricula. That is what we argue for here.

Codes of Ethics↗
PubMed2000

An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii.

OBJECTIVES: Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii. METHODS: Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each person's residence at the time of diagnosis were taken from population censuses. RESULTS: Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women. CONCLUSIONS: Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaii's employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system.

Adult↗