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PubMedDate not supplied

Health care for all.

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Delivery of Health Care↗
PubMed2003

Health insurance for all.

It's a pleasure to report that when school nurses in a part of western Massachusetts were asked to identify barriers to healthcare for children, they did not mention health insurance. This was not always the case. Thanks to an innovative collaboration between a community hospital and a regional school district, almost all school children in the three-town area have health insurance. Fewer children are without healthcare, allowing them access to healthcare more freely and minimizing acute and primary care in the local emergency department, which is typically an outcome for the uninsured.

Child↗
PubMed2003

Sick system.

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Delivery of Health Care↗
PubMedDate not supplied

Public long-term care insurance in Japan.

A public long-term care (LTC) insurance program is likely to be introduced to Japan in the year 2000. A consensus on the need for more LTC resources in the rapidly aging society and dissatisfaction with the current system are some of the factors that have contributed to its introduction. Half the costs will be paid by premiums that will be levied on all those older than 40 years, and half will be covered by general taxation. The insurer will be the municipalities with a pooling mechanism at the national level to balance the differences in their demographic structure. The benefits will include institutional care, respite care, day care, home help, visiting nurses, and loan of devices. Eligibility status will be classified into 6 levels that will be determined by assessment of functional and cognitive status. However, there are few mechanisms to limit benefits and contain costs. Problems also exist in the design of the eligibility classification and in the assessment instrument. The proposed LTC insurance system highlights the need for defining what should be included in a "basic package" of LTC as an entitlement for every citizen, for an organizational mechanism and an assessment instrument to deliver services efficiently and equitably, and for physicians to work outside the traditional medical model. To what degree the Japanese public in general, and physicians in particular, is willing to deal with these issues is a challenge for the 21 st century.

Aged↗
PubMed2004

Can health care utilization explain the association between socioeconomic status and back pain?

STUDY DESIGN: Cross-sectional population-based study. OBJECTIVES: To assess whether the association between socioeconomic status and severe back pain can be explained by the preceding health care utilization for back pain. SUMMARY OF BACKGROUND DATA: The ways in which socioeconomic status affects the occurrence of back pain are unclear. METHODS: Age- and gender-adjusted odds ratios with 95% confidence intervals for the association between indicators of socioeconomic status and severe current back pain (high intensity and/or high disability: no/yes) were investigated in an interview among 770 study participants out of 1113 study participants with a recent history of back pain in a survey among 2731 adults. RESULTS: The point prevalence of severe current back pain (39.8%) was related to educational level and health insurance status. Prior health care utilization for back pain was about 2-fold more prevalent in adults with severe current back pain. Members of private health insurance (odds ratio 0.60, 95% confidence interval 0.37-0.99) were less likely to report prior consultation of a general practitioner for back pain. Members of sick funds for white-collar workers (odds ratio 2.81, 95% confidence interval 1.43-5.51) and private insurance (odds ratio 2.81, 95% confidence interval 1.02-6.24) and individuals with intermediate educational level (odds ratio 1.76, 95% confidence interval 1.05-2.95) utilized more physical therapy for the treatment of back pain. After additionally adjusting for health care utilization, the associations between educational level or health insurance status and severe current back pain remained unchanged. CONCLUSIONS: The data suggest that education, health insurance status, and health care utilization are independently associated with severe current back pain in a society with universal access to health care.

Adult↗
PubMed2003

APHA policies on universal health care: health for a few or health for all?

The American Public Health Association (APHA) has long advocated the development of a system of universal health care for all US residents. APHA has adopted several policies on this topic that stress the financing of the system of universal health care under a single-payer mechanism. However, this approach has never been adopted by US policymakers. The need for universal health coverage in the United States is growing more acute, and failure to provide such coverage threatens the health status of the public. I propose an alternative approach to the single-payer system that is based on incremental extension of existing coverage mechanisms, accompanied by fundamental reform of the health care delivery system. This approach is in keeping with the traditional methods of policy development in the United States, and I urge APHA to assume leadership in advocating it.

Health Care Reform↗
PubMed2006

Social health insurance in a developing country: the case of the Philippines.

Very little is known about the Philippine health care system, and in particular its experience with social health insurance (SHI). Having initiated an SHI programme 35 years ago, the Philippines hold many lessons for the development of such schemes in other low and middle-income countries. We analyse the challenges currently facing PhilHealth, the national health insurer. PhilHealth was formed in 1995 as a successor to the Medicare programme and was given a mandate to achieve universal coverage by 2010. To date, PhilHealth has been quite successful in some areas (e.g. enrollment), but lags behind in others (e.g. quality and price control). We conclude that SHI in the Philippines has been a success story so far and provides lessons for countries in a similar situation. For example: (i) SHI is based on value decisions and the clear statement of societal goals can give guidance in the technical execution, (ii) SHI is a financing institution and needs to be treated accordingly, (iii) SHI can be implemented independently of the current economic situation and might actually contribute to economic development, (iv) community-based health care financing schemes should be merged with the national SHI in the long run, and (v) there is a strong need to push for high quality care and improved physical access. No clear suggestions can be given with respect to the benefit catalogue and the balance between economies of scale and decentralisation. Although riddled with many inadequacies, PhilHealth was set up as a strong and largely politically independent institution for the development of SHI. SHI can act as a stabilizing institution in a politically and economically volatile environment.

Developing Countries↗