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PubMed1997

Restorative treatments received by children covered by a universal, publicly financed, dental insurance plan.

OBJECTIVES: This study sought to identify risk markers associated with the provision of new restorations in children and to investigate whether the carious status of a tooth surface is associated with the restorative decisions of dentists. METHODS: A total of 911 schoolchildren in grades one, two, and three were randomly selected from the island of Montreal, Quebec, Canada. Dental examinations were carried out in 1990, 1991, and 1992. Tooth surfaces of first permanent molars were classified as sound, noncavitated, and cavitated. The carious status of a tooth was matched with restorative decisions reported to the insurance board. RESULTS: The presence of a carious cavity was a strong risk marker for placement of new restorations (odds rations > or = 4.11). After one year, less than 2 percent of sound tooth surfaces of first permanent molars were restored and about 21 percent of noncavitated tooth surfaces were restored. When new class I restorations placed in maxillary first permanent molars within 3-6 months after the baseline examination were evaluated, we found that between 73 percent and 86 percent of these new restorations were placed in sound or noncavitated tooth surfaces. A similar trend also was observed in mandibular first permanent molars. Poor agreement between epidemiologic diagnosis and restorative decisions was found. The restorative profile of dentists was a significant risk marker for placement of new restorations. CONCLUSION: The majority of new restorations in first permanent molars were placed in sound and noncavitated tooth surfaces because of the ubiquitous prevalence of these tooth surfaces and the validity problems of current caries diagnosis methods.

Child↗
PubMed2000

Provision of health care: how much, if any, are we entitled to?

Over 45 million Americans currently lack health insurance, and this number continues to rise. In light of convincing evidence that being uninsured or underinsured produces adverse health outcomes, it is incumbent upon us to define our ethical standards in terms of providing health care. This essay considers the ethical arguments for and against providing universal health care, and considers what possible goals a policy of universal care should aim for. Ultimately, an ethical commitment to securing basic opportunity in the realms of employment, personal life, and social life requires us to provide health care to all Americans. The paper further concludes that the goal of such a plan must be a guarantee of access to basic health care, although not necessarily equal care, for all Americans.

Delivery of Health Care↗
PubMed2006

Optional deductibles in social health insurance systems: findings from Germany.

A fundamental aspect of the German health insurance system is the principle of solidarity. At the same time, it is possible for certain socio-economic groups to opt out of the otherwise compulsory system. To determine whether rates incorporating deductibles are compatible with the principles of solidarity and have the ability to heighten the appeal of statutory health insurance (SHI) funds compared with private health insurance companies, Germany's third largest SHI fund, Techniker Krankenkasse, implemented a pilot scheme involving the use of deductibles. Preliminary scientific evaluations of the pilot scheme indicate three main results for these deductibles: Firstly, they are compatible with the principles of solidarity in the statutory health insurance system; secondly, they provide an effective means of preventing defection to private health insurance companies and thirdly, they reduced the volume of insurance claims (moral hazard).

Adult↗
PubMed1998

Is insurance for children enough? The link between parents' and children's health care use revisited.

Parents' own use of physician services is known to be a strong predictor of their children's use of such services. This paper contrasts the relationship between parents' and children's use of services among uninsured and privately insured children. Parents' utilization is found to have a larger impact upon service use among privately insured children than among uninsured children. Even if all children were universally insured, parents' health care utilization would remain a key determinant in children's use of services. Policies that integrate financing and delivery systems for all family members deserve attention among efforts to foster better access for children. Neglecting financial access to care for adults may have the unintended effect of diminishing the impact of targeted health insurance programs for children.

Adolescent↗
PubMed2002

Medical fees. Medibank and Medicare.

Because paying the doctor was often a financial burden, many ways were devised to help pay the doctor's bill. This article looks at how private medical insurance began to merge into a government funded medical practice. Recent experiences suggest that payment for general practitioners is about to undergo further change.

Australia↗
PubMed2006

Users' perceptions of health care reforms: quality of care and patient rights in four regions in the Russian Federation.

In the early 1990s, the government of the Russian Federation (RF) decided to depart from the centralised and integrated model of health service delivery and financing in favour of mandatory social health insurance (MHI). The rationale for introducing social health insurance in Russia in the early 1990s was primarily to secure a reliable source of funding but also to improve the quality of care and introduce user entitlements known as patient rights. This paper discusses findings of a survey carried out in 1999-2000 to explore users' perceptions of reforms, changes in quality of care and their satisfaction with patient rights in Murmansk, Yaroslavl, Moscow Region and Moscow City, using a structured questionnaire and metric scales. Nearly half of the respondents thought that the quality of services had not changed significantly since the introduction of the MHI, although the majority accepted the necessity for reforms. Many reported having little or no information about health insurance or patient rights. While there were many similarities among the regions studied, a number of considerable differences existed which could be linked to different ways of implementing the insurance scheme and different levels of funding health care.

Consumer Behavior↗
PubMed2000

Medicare, fee-for-service subsidies, and market outcomes: a partial description of Australia's health care financing labyrinth.

In Australia, both in-hospital and out-of-hospital services are subsidized via a national, social health insurance scheme, referred to as "Medicare." Revenue for the scheme is raised via general taxation and an earmarked "tax," which is presently 1.5 percent of taxable income. Members are entitled to the subsidized consumption of a broad range of medical practitioner services provided on both an in-hospital and an out-of-hospital basis, in both private and public facilities. Moreover, the range of services subsidized by the Australian scheme is broad, and includes the types of medical care that are available only to those U.S. Medicare patients who have opted for the Supplementary Medical Insurance Program. The purpose of this article is to provide a descriptive account of the Australian Medicare arrangements, particularly those that pertain to private, fee-for-service, medical practice. This article emphasizes the fact that, although the provisions are nationally uniform in application, these arrangements do not give rise to homogeneity of consumer payments and medical practitioner revenue. The article's theme is that, just as the simple terms "Medicare" and "Medicaid" belie the complexity of U.S. social health insurance, the Australian application of the term "Medicare" also describes a health care financing labyrinth.

Ambulatory Care↗
PubMed1995

Just health care system reform.

America spends almost one trillion dollars on health care, a larger percentage of its gross national product than other industrialized nations, and yet millions are without adequate health care insurance. The current system gives neither providers, patients, nor insurers incentives to seek cost-effective care; at the same time, individuals with the greatest health care needs are excluded from the system. The answer is not, as some suggest, an expanded federal bureaucracy, but society must address the plight of the underinsured. This papers offers 11 policies which build on the strengths of the private market to offer to all citizens the benefits of the world's best medical system. Universal catastrophic health insurance, along with the necessary changes in the legal and tax systems, would shift resources to patients who are currently under-utilizing the system and also toward necessary and cost-effective treatments.

Cost Control↗
PubMed2002

Managed competition and consumer price sensitivity in social health insurance.

This paper examines whether the introduction of managed competition in Dutch social health insurance has resulted in effective price competition among insurance funds. We find evidence of limited price competition, which may be caused by low consumer price sensitivity. Using aggregate panel data from all insurance funds over the period 1996-1998, estimated premium elasticities of market share are -0.3 for compulsory coverage and -0.8 for supplementary coverage. These elasticities are much smaller than in managed competition settings in US group insurance. This may be explained by differences in switching experience and higher search costs associated with individual insurance.

Actuarial Analysis↗
PubMed1998

The impact of National Health Insurance on the volume and severity of emergency department use.

National Health Insurance (NHI) was introduced in Taiwan on March 1, 1995. To evaluate the Influence of NHI on the volume and severity of emergency department (ED) visits, a retrospective analysis was conducted. The results showed that NHI did not result in a substantial increase in ED volume (P > .05), but the severity as measured by triage nurses did increase (P < .01). There was no change in the number of admissions to the intensive care units of patients transferred from smaller hospitals, but its percentage significantly decreased (P < .05), which may be a result of the significant increase in the total number of interhospital transfers. It was hypothesized that the universal coverage and a copayment contributed to these changes.

Emergency Service, Hospital↗
PubMed2001

Do factors other than need determine utilization of physicians' services in Ontario?

BACKGROUND: Universal health care systems seek to ensure access to care on the basis of need, rather than income, but there are concerns about preferential access to cardiovascular and specialist care for high income patients. In this study, I used population-based, individual-level health, income and utilization data to determine whether whether there is evidence for differential access to physician care in relation to household income. METHODS: I studied data for 2170 Ontario respondents to the 1995 National Population Health Survey (aged 40 to 79 years) who had approved linkage of their survey responses to the administrative databases of the Ontario Health Insurance Plan and for whom income data were available. I used linear and generalized linear regression to model the mean per capita expenditures on physician care and the probability of referral to a specialist in relation to income and self-reported health status. RESULTS: Residents of higher income households incurred lower per capita expenditures for physicians' services than those in lower income households; for example, the mean per capita expenditure in the upper middle income group was $220 less (95% confidence interval -$87 to -$334) than the mean per capita expenditure in the lowest income group. Expenditures were significantly related to self-reported health status; for example, the mean per capita expenditure among those reporting fair health status was $590 higher (95% confidence interval $465 to $737) than among those reporting excellent health. After adjustment for health status, there was no association between income and the expenditures on all physician services, out-of-hospital services or specialist care. INTERPRETATION: Utilization of physicians' services in Ontario is based on need, rather than income.

Adult↗
PubMed2006

The Massachusetts health insurance law: providing health insurance to all.

There have been increasing rates of uninsured patients in the United States over the past few decades. Despite this growing problem, little progress has been made to decrease the rate of growth of uninsured patients or to provide affordable insurance coverage to those who are unable to maintain insurance coverage throughout the year. The legislature in the Commonwealth of Massachusetts has enacted legislation that requires health insurance for all in the same manner that automobile insurance is required in many states. This bold comprehensive legislation augments current Medicaid and state child health insurance program coverage and expands coverage options for part-time workers, those employed by small companies or those employed at lower-income jobs.

Health Behavior↗
PubMed2006

States step up.

In the absence of an ambitious federal effort to reduce the number of Americans without health care insurance-45 million and climbing-states around the country are considering their own solutions. The details and scope of these proposals vary widely, and in all cases, the implications for hospitals are enormous.

Health Care Reform↗
PubMed2003

Health care and the labor market: learning from the German experience.

Many observers have begun to question the U.S. reliance on an employment-based private health insurance system. In thinking about the future of this system, it is instructive to examine the German experience. The German health insurance system is almost entirely organized and financed around the labor market. In recent years, the German labor market has changed in several ways. Among other changes, more German women now work, the proportion of retirees in the population has increased, the share of manufacturing in employment has declined, and the economy has become more open. These labor market changes have made it more difficult to organize health insurance around employment in Germany. Recent changes in the German health insurance system have, to some extent, decoupled health insurance from employment. This decoupling is likely to continue as the labor market changes further. We explore the implications of this experience for the United States.

Economic Competition↗
PubMed2006

The third wave of Massachusetts health care access reform.

In April 2006, Massachusetts passed its third major health care access reform law since 1988. This law establishes new structures and requirements that have never been attempted by any state. Key features include a shift of federal Medicaid dollars from institutional support to individual insurance subsidies, establishment of an insurance "Connector," individual and employer responsibility, a small-firm and individual insurance market merger, and provisions to address racial and ethnic health disparities. Massachusetts will engage in a multiyear implementation process. Only after this process is complete will the law's significance be clear.

Health Benefit Plans, Employee↗
PubMed2006

Massachusetts health reform: beauty is in the eye of the beholder.

The Massachusetts plan to extend health insurance coverage to nearly all of the state's residents offers several lessons related to health reform, including the following: Bipartisan cooperation is possible; multiple policy mechanisms must be employed to achieve meaningful change; the starting point-in terms of the rate of uninsurance, the degree of insurance market regulation, and so on-matters; and implementation details are critical. In addition to these lessons, we argue that objective analysis and a comprehensive framework for evaluating alternative policy options are needed for similar reforms to be enacted elsewhere.

Cooperative Behavior↗
PubMedDate not supplied

Taiwan's new national health insurance program: genesis and experience so far.

In 1995, after a planning effort of about half a decade, the Republic of China (Taiwan) replaced a previous patchwork of separate social health insurance funds with one single-payer, national health insurance scheme that is administered by an agency of the central government's Department of Health. Within a year this bold legislative act brought the health care utilization rates of the 41 percent of Taiwan's hitherto uninsured population up to par with those of the previously insured population. This paper describes the achievements of this policy initiative so far, along with the growing pains it has encountered, and seeks to extract lessons from the experience for health policymakers in other countries.

Cost Sharing↗