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PubMed2005

Financing and reimbursement of elders' oral health care: lessons from the present, opportunities for the future.

This article describes current financing and reimbursement for elders' oral health care and presents innovative options and opportunities for the future. Current health and dental care financing data from the Centers for Medicare and Medicaid Services and Agency for Health Care Research and Quality are reviewed. Existing and potential reimbursement options for the future are presented. Options for future financing and reimbursement include extending dental insurance into retirement, inclusion of oral health care into existing comprehensive health care plans, developing retiree plans for selected, well-defined (by the sponsor) groups of retirees, pre-paying dental care during employment, development of an Elders Health Insurance Program for the poor and near poor, and developing optional "Part D (for Dental)" plans within the Medicare program. Given the absence of universal oral health insurance, a mix of financing options and reimbursement schema will be required to cover the costs of oral health care and eliminate disparities in oral health access and outcomes for the growing elderly population.

Aged↗
PubMed2004

Does universal comprehensive insurance encourage unnecessary use? Evidence from Manitoba says "no".

BACKGROUND: Many argue that "free" medical care leads to unnecessary use of health resources. Evidence suggests that user fees do discourage physician use, at least by those of low socioeconomic status. In this study, we compare health care utilization and health among socioeconomic groups to determine whether people of low socioeconomic status see physicians more than would be expected given their health status. METHODS: We examined the use of health care services (physicians and hospitals) by residents of Winnipeg, Manitoba, in 1999. The cost of physician services was drawn directly from the claims filed, and the cost of hospital services was estimated using the Case Mix Group and Day Procedure Group methods linked to resource intensity weights and Manitoba hospital costs. We used neighbourhood indicators of socioeconomic status from the 1996 census and measured health status by examining rates of premature mortality, acute myocardial infarction, hip fracture (1995-1999) and diabetes (1999). Using these measures, we compared health status and health care use of residents living in areas with low average household incomes with those living in areas with high average household incomes. All rates were age- and sex-adjusted across the groups. RESULTS: The province spent 44% more providing hospital and physician services to residents of Winnipeg neighbourhoods with the lowest household incomes (820 dollars/person annually v. 596 dollars/person for residents of the neighbourhoods with highest household incomes). However, expenditures were strongly related to health status. The 70% of the population on which the province spends 10% of its health care dollars scored well on all health indicators, and the 10% of the population on which 74% of the dollars are spent scored poorly. In each expenditure group, those with lower socioeconomic status had poorer health. In the highest expenditure group, those with lowest socioeconomic status had 82% higher premature mortality rates (23.0 v. 12.6 per 100,000 population) and 53% higher hip fracture rates (5.5 v. 3.6 per 100,000 population) than those with the highest socioeconomic status. Despite their poorer health, in each expenditure group, residents of the neighbourhoods with the lowest household incomes incurred physician expenditures that were similar to those of residents of wealthier neighbourhoods. INTERPRETATION: Most people use little health care; high-cost users are a small group of very sick people drawn from all neighbourhoods and all income groups. People living in areas with low average household incomes use fewer physician services than might be expected, despite their poor health status.

Adolescent↗
PubMedDate not supplied

Chipping away at the uninsured.

Although the State Children's Health Insurance Program (SCHIP) has accomplished a great deal, more than nine million children-many of whom are eligible for public health insurance-remain uninsured. In this commentary I propose that coverage for children should be universal, with eligibility systems operating behind the scenes in a way that relieves individual families of the burden of enrollment. States, the federal government, employers, and families would have to reconsider their roles in providing coverage, but starting with the appropriate vision would put the focus on practical problems and overcome the inherently limited approach of layered, incremental programs.

Child↗
PubMed2004

Ability to pay and geographical proximity influence access to liver transplantation even in a system with universal access.

Ireland, in common with many countries, has a mixed private and public health care system. Concern has been expressed that this system may lead to inequity in access to medical treatment. To investigate this concern, all contacts and first admissions to the national liver transplant unit were identified between April 1, 2000, and March 31, 2002. The effects of private health insurance and area of residence on the likelihood of receiving a liver transplant were assessed. A total of 202 patients were admitted. Forty-three patients from this cohort received a liver transplant (21.3%). Of patients with private health insurance, 17 of 50 (34.0%) were transplanted, compared with 26 of 152 (17.1%) without private health insurance (relative risk [RR] = 1.99; 95% CI, 1.18-3.35; P = .01). For residents of the Eastern (close to the liver transplant unit), patients with private health insurance were no more likely to be transplanted (RR = 0.95; 95% CI, 0.35-2.54; P = 1.0), whereas for residents of other areas, patients with private insurance were 3 times more likely to receive a transplant than those without health insurance (RR = 3.11; 95% CI, 1.59-6.08; P = .001). Patients living outside the Eastern region without private health insurance were only half as likely as all other patient types combined to receive a transplant (RR = 0.52; 95% CI, 0.29-0.92; P = .02). In this study the possession of private health insurance appeared to increase the chances of receiving a liver transplant. Patients without private health insurance living distant from the liver transplant unit appeared particularly disadvantaged. In conclusion, these findings suggest significant inequity in liver transplant allocation in Ireland and deserve further assessment.

Adult↗