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Universal health insurance and high-risk groups in West Germany: implications for U.S. health policy.

Access to West Germany's broad-based health-insurance system is geared to the country's occupational structure. People who qualify, however, may seek coverage from alternative sources, including local "sickness funds." The changing nature of the German job market is leading to concentration of high-risk groups in the local funds, some of which could in turn face serious financial problems. Proponents of a universal health-insurance program for the United States need to take account of the growing segmentation of risk groups in the current German experience, which may ultimately threaten the concept of solidarity on which the system is founded.

Economic Competition↗

Preparing health educators for the workplace: a university-health insurance company alliance.

The workplace is a relatively recent and an increasingly recognized setting for health education. In this article, philosophical and economic reasons for this movement of health education in the workplace are cited. Currently the workplace is one of the fastest growing markets for health education. In most institutions, preparing health educators for the workplace has not been adequately addressed. Consequently, an experimental course entitled "Health Promotion and Educational Strategies for the Workplace" was developed and taught at The Ohio State University in the summer of 1981. Besides an extensive reading list and lively class discussions, the course was team-taught primarily by a health education faculty member and a health insurance program manager/health educator.

Health Education↗

A consumer-choice health plan for the 1990s. Universal health insurance in a system designed to promote quality and economy (1).

America's health care economy is a paradox of excess and deprivation. We spend more than 11 percent of the gross national product on health care, yet roughly 35 million Americans have no financial protection from medical expenses. To an increasing degree, the present financing system is inflationary, unfair, and wasteful. In its place we need a strategy that addresses the whole system, offers financial protection from health care expenses to all, and promotes the development of economical financing and delivery arrangements. Such a strategy must be designed to be broadly acceptable in our society. To remedy the deprivation, we propose that everyone not covered by Medicare, Medicaid, or some other public program be enabled to buy affordable coverage, either through their employers or through a "public sponsor." To attack the excess, we propose a strategy of managed competition in which collective agents, called sponsors, such as the Health Care Financing Administration and large employers, contract with competing health plans and manage a process of informed cost-conscious consumer choice that rewards providers who deliver high-quality care economically.

Centers for Medicare and Medicaid Services, U.S.↗

An evaluation of universal health insurance in the elderly: burden of disease, utilization, and costs in the Republic of Korea.

OBJECTIVE: This article evaluates Korea's national health insurance system for the elderly by simultaneously examining disease patterns, demand for care, utilization, costs of care, and facility type. METHODS: Claim records (N = 8,306,976) for 1995 to 1997 were obtained from the Youndeoung-Po district for four insurance categories. Utilization is examined using a probit model; a linear regression model is used to compare costs. FINDINGS: Insurees averaged 10.6 medical visits per year, most commonly for acute respiratory diseases. The elderly were more likely to seek care for circulatory problems, use more inpatient services, and rely on hospitals for outpatient care. Insurance costs for the elderly poor were markedly higher, and overall care for the elderly was higher per visit. DISCUSSION: By simultaneously analyzing utilization rates, disease patterns, and relative costs of care, policymakers may be able to avert a financing crisis. Stronger pricing strategies and better disease targeting would adjust utilization and increase efficiency of health expenditures.

Age Distribution↗

Universal health insurance that really works: foreign lessons for the United States.

The United States has serious and worsening problems in the delivery and financing of health. The debate about reform has inspired many schemes that are persuasive in their presentation, but they are unrealistic: some cannot be enacted by Congress, others would not improve existing arrangements, most are imaginary inventions with uncertain outcomes. The most politically prudent and the most effective course is to emulate the methods used successfully and available for full analysis in other developed countries. America created its successful social security system in this fashion, and statutory health insurance should be added now. All or most groups would be required to join. Financing would come from social security payroll taxes, supplemented by government subsidies. Basic acute care services would be equally available to all. The existing insurance companies would remain as fiscal intermediaries. Doctors and hospitals would continue to work much as they do now. They would prosper from more utilization, few bad debts, and less administrative trouble. The payment and work of doctors would be governed by collective negotiations between the insurance carriers and the medical associations. The payment and work of hospitals would be governed by a mixture of government regulations and negotiations with the carriers. Costs would be controlled by coordinated decision making by the payers, the providers, and government. The system would not turn over services and financing to government.

Canada↗