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PubMedDate not supplied

Private medical services in acute-care hospitals in Israel.

The objective of this study was to assess the proposed introduction of out-of-pocket funded inpatient and outpatient services (abbreviated as PMS) into government acute-care hospitals in Israel. This issue of public-private mix in not-for-profit hospitals is discussed in terms of the experience with PMS gained in selected advanced market economies. Then, the major contours of the Israeli system of health care, and the gradual evolving of patient-financed medical services within government acute-care hospitals in Israel, is described. The experience gained in the few public hospitals in Jerusalem that have been operating PMS is assessed critically. The concluding part reviews the advantages and disadvantages of these developments in public and government acute-care hospitals in Israel. It is concluded that PMS in public hospitals in Israel represents a policy aimed primarily at benefiting a select group of senior physicians in those hospitals.

Financing, Personal↗
PubMedDate not supplied

Decentralizing EPI services and prospects for increasing coverage: the case of Tanzania.

Primary health Care (PHC) strategies were adopted widely in 1978 after the Alma Ata declaration to improve accessibility to health services and the health of the people. Of the strategies of PHC was the decentralization of health services to lower levels in order to enhance participation and responsiveness of the health system to local problems. While PHC was being promoted vertical programmes such as the expanded programme on immunization (EPI) were also being promoted and achieved substantial benefits. However, almost 25 years later many countries have not been able to achieve these health goals. This study addressed the question: Can we make the process of health care decentralization more likely to support health system and EPI goals? This study analysed the experience of EPI decentralization at national, regional and district levels. Several stakeholders were identified who were supportive and others who were non-supportive of the process. Community support to EPI measured by using willingness to pay (WTP) for kerosene (to keep vaccines cool) was low. It was significantly (p < 0.05) associated with whether providers in the nearest health facility properly attended the target population and whether the providers in the facility were available when needed. There was a substantial stakeholder support and opposition to the process of decentralization at the district level. Community support was not high possibly due to the perceived non-availability of the service providers and their lack of awareness of the population they serve. It was proposed that reforms should give priority to the involvement of communities and peripheral health facility providers in the process.

Delivery of Health Care↗
PubMedDate not supplied

The role of user charges and structural attributes of quality on the use of maternal health services in Morocco.

Health care decision makers in settings with low levels of utilization of primary services are faced with the challenge of balancing the sometimes competing goals of increasing coverage and utilization of maternity services, particularly among the poor, with that of ensuring the financial viability of the health system. Morocco is a case in point where this policy dilemma is currently being played out. This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. A nested logit model is estimated, and the coefficient estimates are used to carry out policy simulations of the impact of changes in the levels of out-of-pocket fees and structural attributes of quality in order to help guide policy makers responsible for the design of pending social insurance programs. The results of the paper suggest that social insurance strategies that involve increases in out-of-pocket charges in the form of copayments could be implemented without untoward effects on appropriate use of maternity care for non-poor women, but would be contraindicated for poorer and rural households.

Adolescent↗
PubMedDate not supplied

Assessing progressivity of out-of-pocket payment: with illustration to Malaysia.

Throughout the world, policy makers are considering or implementing financing strategies that are likely to have a substantial impact on the equity of health financing. The assessment of the equity implication is clearly important, given the potential impact that alternative finance sources have on households. Households incur out-of-pocket payment directly from their budget, apart from their public or private insurance. Out-of-pocket payment is the primary concern, given their undesirable impact on households. Progressivity measures departures from proportionality in the relationship between out-of-pocket payment and ability to pay. It is the most frequently used yardstick to assess the equity of out-of-pocket payments in empirical studies. This paper provides an evaluation of such progressivity measures, undertaken using four approaches (proportion approach, tabulation approach, concentration curve and Kakwani's index), in order to reveal their usefulness and underlying notion. It is illustrated empirically with data on out-of-pocket payment for health care in Malaysia for 1998/ 1999, based on the nationally representative Household Expenditure Survey. Results indicate that out-of-pocket payments are mildly progressive, whilst the four approaches have their benefits and limitations in assessing equity implications. This analysis is of interest from a policy perspective, given Malaysia's heavy reliance on out-of-pocket payments to finance health care.

Cost Sharing↗
PubMedDate not supplied

Urban employee health insurance reform and the impact on out-of-pocket payment in China.

Since the middle of the 1990s, China has undertaken a significant reform in urban employee health insurance programs. Using data from the pilot experiment conducted in Zhenjiang, this study examines changes in the pre- and post-reform distributions of out-of-pocket (OOP) expenditures across four representative groups by chronic disease, income, education, and job status. Major findings suggested increased OOP expenditures for all groups after the reform. However, the redistributions in OOP appear to be in favor of the disadvantaged groups, suggesting a more equitable change led by the reform. This study concludes that the post-reform insurance model did not compromise equity in cost-sharing while containing cost inflation and increasing insurance coverage for the urban population.

China↗
PubMed2006

Direct costs of managing Parkinson's disease in India: concerns in a developing country.

Medicines and surgical interventions improve the quality of life of Parkinson's disease (PD) patients. These are still expensive options and are unaffordable to those living in developing countries. Managing PD in Indians who have a low annual gross national income (GNI; 450-540 US dollars) and for whom only a few (3%) have health insurance is a challenge. We interviewed 175 consecutive PD patients regarding health insurance and money spent for treatment. The annual income of nearly half the patients was less than rupees 50,000 (1,148.63 US dollars). Patients in this study spend nearly 16% to 41.7% of the average Indian GNI to buy medicines. Costs of treating PD in India are lower than those in developed nations but are still out of reach for most Indian patients.

Adult↗
PubMed2005

Income related inequality in prescription drugs in Denmark.

PURPOSE: To examine income-related inequity in utilisation of prescription drugs in Funen County, Denmark after a new reimbursement system was implemented. METHODS: An individual level prescription database was merged with a health survey of 2927 respondents interviewed in 2000 and 2001 about their health status and socio-economic and socio-demographic characteristics. An index of horizontal inequity was used to estimate the degree of inequity in drug utilisation across income groups, using the indirect method of standardisation to control for age, gender and health status as a proxy for need. The results were compared to estimates from a traditional regression analysis. RESULTS: The least advantaged with respect to income consume a bigger share of the prescription drugs than the most advantaged. After standardisation for age, gender and health status the least advantaged have a lower share of the drug consumption than expected. However, traditional regression analysis showed no signs of an income effect on the level of consumption of prescription drugs. CONCLUSIONS: The index of horizontal inequity suggests that some horizontal inequity favouring the better off is present. However, the results deviate from what can be found by traditional regression analysis.

Adolescent↗
PubMed1994

Expenditures of time and money by families of people with severe mental illness and substance use disorders.

Families are typically a major source of support for people with mental illness, but substance abuse places an additional burden on family relations and could reduce the amount of direct support they give. Data from families of 169 people with co-occurring mental illness and substance abuse indicate that they give a substantial amount of time and money to their relatives with dual disorders. More severe current substance abuse appeared to reduce family spending but not direct caregiving. Clients with more severe alcohol problems were more likely to live with parents than with other family members.

Adult↗
PubMed1998

The formal mental health care burden among recently deinstitutionalized patients.

This article examines the extent to which the costs of formal health care are shifted from third-party payers to the patient and his or her family, especially during the transition to the community after discharge from a state hospital. Findings indicate that patients residing in the community are as likely to receive some care as their counterparts in institutions, but are at higher risk for uncovered care. Uncovered care is more likely to manifest as an unmet need for patients who have been recently discharged, especially for racial minorities, and as an out-of-pocket expense for patients who are established in the community.

Cost of Illness↗
PubMed1994

How families of children with severe disabilities choose to allocate a cash subsidy.

This study examines how families raising children with severe developmental disabilities use a cash subsidy. Eighty-one families were interviewed prior to receiving the $225 monthly subsidy and again 1 year later. Families reported no change in the number of services they used, nor did they significantly increase the amount spent on services. Although families did not spend significantly more on purchases in the month prior to each interview, there was a significant increase in the amount spent on major purchases made in the year after receipt of the subsidy. The pattern and amount of expenditures are described. Lower income families reported the subsidy as significantly more helpful than higher income families. The implications of the findings for social policy are discussed and recommendations are made.

Budgets↗
PubMed1997

Assessing community values in health care: is the 'willingness to pay' method feasible?

In this paper an economics approach to assessing community values in health care priority setting is examined. The approach is based on the concept of 'willingness to pay' (WTP). Eighty two parents were interviewed with regard to three aspects of provision of child health services. For each aspect a choice of two courses of action was presented. Parents were asked which course of action they preferred and what was the maximum amount of money they would be prepared to pay for this rather than their less preferred option. WTP responses are acceptable to the majority of respondents and appear to 'behave' in accordance with a priori expectations. A method of assessing the influence of ability to pay on preferences and WTP is outlined. Preferences and WTP do not appear to have been unduly distorted by ability to pay. Use of WTP data does have the potential to provide health care purchasers and providers with information on intensity as well as direction of the preferences of members of the community.

Child↗
PubMedDate not supplied

The financial cost to patients of visiting a GP in Ireland: a cross-sectional survey.

BACKGROUND: Future general practice funding is much debated but public opinion has not previously been reported. AIM: To survey public opinion on existing fee structures in general practice and on an insurance-based primary care scheme that would entitle members to free GP services at the point of use, upon payment of an annual premium. METHODS: An interviewer administered questionnaire-based cross-sectional survey in four locations: Dublin north city; Dublin south city; Dublin suburban; and a rural town centre. RESULTS: Of 384 people surveyed, 83% had visited a GP in the previous year, and 79% usually paid for consultations. The median fee was IEP20.00. Almost 50% felt that this was excessive. Of those who did not have to pay, 91% expressed willingness to pay (median IEP15.00). Sixty-two per cent had medical insurance and 83% said they would be willing to join an insurance-based primary care scheme. The amount people would pay to join this scheme exceeded what interviewees were currently paying for general practice services. CONCLUSIONS: There is dissatisfaction with existing GP fees and support for a scheme entitling free primary care. The amount of money people are willing to pay exceeds their current annual expenditure on GP services.

Adult↗
PubMed2004

Patient willingness to pay for preventive measures in primary care: a study of five GPs in a German community.

OBJECTIVE: To explore the willingness of patients in a usual primary care setting to pay out-of-pocket fees for their own health promotion, in correlation with risk factors and net income, and compared to patients of an educational programme. METHODS: A standardised health survey carried out in five general practices (GPs) of a small community with a special GP-based health education programme was combined with a questionnaire to explore the special attitudes of patients from a practice sample (n = 973) and from educational courses (n = 202): covering, in addition to cardiovascular risk factors, the sociodemographic factors, net income, and out-of-pocket fees that could be spent for own health promotion. RESULTS: After attending an educational programme, the patient's willingness to spend 15-40 euros/month for their own health promotion was high but there was no correlation with the income (p < 0.56), in contradiction to the patients of the practice sample who would pay more money the more they earn (p < 0.001). High levels of cardiovascular risk were associated with low education (p < 0.001), but net income and willingness to pay for preventive measures did not significantly correlate with cardiovascular risk factors. CONCLUSION: Participants of educational courses are willing to pay a rational out-of-pocket fee for preventive measures without correlation with their incomes, thus reducing the social gradient; future preventive measures should take into account that reasonable cost sharing is well accepted by well-informed patients.

Adult↗
PubMed2005

[Cost-of-illness study in patients suffering from atopic eczema in Germany].

BACKGROUND: Atopic eczema is one of the most common skin diseases. In Germany, the economic burden is estimated to be EUR 1.2-3.5 billion yearly. The aim of this study was to show the resource utilization and costs for outpatient care and the out-of-pocket expenses for the patients. PATIENTS AND METHODS: This study was a multi-center, retrospective and prospective cost-of-illness study. Patient characteristics and data on resource utilization were collected with a semi-structured patient questionnaire and by chart abstraction. 193 patients filled in the patient questionnaire; data from 169 patients were obtained by chart abstraction. RESULTS: Average direct medical costs of a disease flare were EUR 123 per patient. Average annual total costs were EUR 1,425 per patient, increasing with severity from EUR 956 (mild) to EUR 2,068 (severe). CONCLUSION: Prolongation of flare-free time and reduction in severity are not only desirable for the patients but also of economic interest.

Adolescent↗