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Results for “Universal Health Insurance”

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At least 649 records · Page 36Linked to original sources
PubMed1996

Reminding and monitoring: new uses of administrative data for preventive care.

This article illustrates how administrative data can be used to improve population health in an environment of fiscal constraint. In our universal single-payer health system, health care providers submit standardized data. This allows provinces to create health information utilities that generate population-based data that can be used for research and health care delivery. Although more study is needed to determine the cost-effectiveness of using such data to raise the rates of primary and secondary prevention, it appears that appropriately designed information systems could improve population health with relatively little additional cost.

Aged↗
PubMed2002

Universal coverage and its impact on reproductive health services in Thailand.

Thailand has recently introduced universal health care coverage for 45 million of its people, financed by general tax revenue. A capitation contract model was adopted to purchase ambulatory and hospital care, and preventive care and promotion, including reproductive health services, from public and private service providers. This paper describes the health financing system prior to universal coverage, and the extent to which Thailand has achieved reproductive health objectives prior to this reform. It then analyses the potential impact of universal coverage on reproductive health services. Whether there are positive or negative effects on reproductive health services will depend on the interaction between three key aspects: awareness of entitlement on the part of intended beneficiaries of services, the response of health care providers to capitation, and the capacity of purchasers to monitor and enforce contracts. In rural areas, the district public health system is the sole service provider and the contractual relationship requires trust and positive engagement with purchasers. We recommend an evidence-based approach to fine-tune the reproductive health services benefits package under universal coverage, as well as improved institutional capacity for purchasers and the active participation of civil society and other partners to empower beneficiaries.

Financing, Government↗
PubMed2002

Parkinsonism in Ontario: physician utilization.

BACKGROUND: Patients with Parkinsonism have a progressive disorder requiring substantial expertise to manage effectively. METHODS: Over a six-year period we evaluated physician utilization and related costs for a large, unselected cohort of 15,304 Parkinsonian patients from the general population, comparing them to 30,608 age- and sex-matched controls within a universal health care system in Ontario, Canada. RESULTS: On average, 45% of Parkinsonian patients saw neurologists annually. The cumulative rate of at least one neurological consultation was only 59.5% over the six years. Patients aged < 65 had a much greater likelihood of consulting a neurologist (73.3%) compared to those > or = 65 (37.2%). Most Parkinsonian patients (97.2%), regardless of age, saw family physicians/general practitioners each year; 50.4% saw internal medicine consultants. CONCLUSIONS: Parkinsonian patients had increased likelihood of utilizing neurologists, primary care physicians and internists compared to controls; related costs of physicians' services were higher. Further research is necessary to evaluate differences in outcomes and costs between neurologists and other physician service providers.

Case-Control Studies↗
PubMed1999

The Canadian health care system. An analytical perspective.

The Canadian health care system is a publicly funded system based on the philosophy that health is a right, not a commodity. The implementation of this perspective is hampered by the fact that the Canadian Constitution makes health care a matter of provincial jurisdiction, while most taxing powers lie in the hands of the federal government. Further problems arise because of Canada's geographic nature and a move to regionalization of provincial health care administration. The issue is compounded by recent developments in reproductive technologies, aboriginal health, changes in consent law, etc.

Canada↗
PubMed2002

Inpatient hospital care for lumbar intervertebral disc disorders in Finland in relation to education, occupational class, income, and employment.

The object of the study was to describe socioeconomic and demographic determinants of inpatient hospital care for lumbar intervertebral disc disorders (LIDD) in Finland. Information from the 1996 Finnish Hospital Discharge Register was linked with the 1995 Population Census. Poisson regression analyses were made with the total and the gainfully employed workforce aged 20-64 y as reference. All 48 public and seven private acute care general hospitals treating LIDD patients in Finland. In the workforce, 4643 patients aged 20-64 y (3692 among the gainfully employed) were admitted to the hospital due to LIDD (ICD-10: M51.1-M51.9) in 1996. About one-half were treated surgically. The duration of unemployment in 1995 was inversely associated with hospitalisation for LIDD in 1996, allowing for age, sex, education and personal income (unemployed for 12 months vs 0 months: rate ratio 0.66; 95% CI 0.57-0.77). Among those employed for 12 months in 1995, the level of education was inversely associated with the hospital admission rate. The rate was also higher in manual occupations as compared with the upper white-collar employees. The associations were clearer among the medically than the surgically treated patients. Hospitalisation for back disorder was, however, less common in the lowest income group as compared with the highest (0.65; 0.57-0.77) allowing for education, occupational class, age and sex. Women were less often admitted to the hospital than men, allowing for the socioeconomic factors (0.83; 0.77-0.90). When indicated by education or occupation, low socioeconomic status was associated with a relatively high rate of inpatient hospital care for LIDD. When indicated by personal income, the situation was the reverse. Unemployment and female gender predicted a relatively low rate of hospitalisation.

Adult↗
PubMed2001

Universal vs. selective services: the case of British health visiting.

AIMS: This paper discusses whether there should be universal or selective provision of health visiting services. The aim is to show the central relevance of the work of the late epidemiologist, Geoffery Rose, to arguments advocating the retention of a universal health visiting service. BACKGROUND: In the United Kingdom (UK), health visiting moved, in the early years of the twentieth century, from being focused on the needs of poor families to becoming a universally provided service. Recent debates about the future of British health visiting have again raised the issue of whether health visiting remains a universal service, or should be targeted only on the most needy. STRUCTURE: Following an exposition of Rose's work, two kinds of problems with which health visitors are concerned, depression and child abuse, are used to illustrate the ways in which Rose's approach can be applied to health visiting. CENTRAL THESIS: Rose argued that the bulk of problems in society arise in the many who are not at especially high risk, rather than in the few who are at high risk. This is because of a very large number of people who are not at especially high risk. Consequently, following Rose, this paper argues that in relation to such problems as depression or child abuse, to target health visiting services only on those at high risk would be to leave untouched a vast burden of health and social problems. In the context of identifying people who are at greatest risk, Rose argued that no screening instrument can ever be sufficiently precise to accurately identify those most likely to suffer problems. In corroboration of Rose's argument, this paper illustrates the pitfalls of health visitors' attempts to screen for families at greatest risk through the use of such instruments as checklists of risk factors. CONCLUSIONS: It is concluded that it is neither possible to screen accurately for those at greatest risk, nor desirable to target services only on those at greatest risk. Therefore, it is advocated that health visiting should remain a universal service. However, it is recognized that within a universally provided service, some clients will require a greater intensity of input than others. In assessing the need for services, it is argued that the professional judgements of health visitors are crucial.

Child↗
PubMed1997

Problems in counting and paying for multidisciplinary outpatient clinics.

Policy-makers have always found it problematic to formulate fair and consistent counting rules for public hospital outpatient activities. In the context of output-based funding, such rules have consequences which can affect patient care. This paper reviews the rationale for organising multidisciplinary clinics and reports on a series of focus groups convened in four Melbourne teaching hospitals to consider funding policy for such clinics. It discusses issues of targeting outpatient services, along with implications for payment policy. It evaluates counting rules in terms of intended and unintended consequences in the context of Victoria's introduction of output-based funding for outpatient services.

Accounting↗
PubMed2001

Universal health care for children: why every self-interested person should support it.

By comparison to other developed nations, both the health care and the health status of children in the U.S. are poor. Ethical arguments for covering all children for health services are numerous, but most of them require the suppression of self-interested motivations. Drawing from and developing the arguments of David Hume, this essay argues that self-interested motives need not work against an inclusive system, and can strengthen the case for covering children in particular. Anyone who hopes to benefit from the inter-generational transfers currently required by Social Security and Medicare policies should be an advocate for health care for all children.

Bioethics↗
PubMed2003

How compatible are liberty and equality in structuring a health care system?

In their normative role in shaping the basic structure of a health care system, liberty and equality are often thought to conflict so sharply that health policy is condemned to remain an ideological battleground. In this paper, I will articulate my own view of why much of the apparently fundamental conflict between individual liberty and responsibility, on the one hand, and equality and equality's related concern for cost-efficiency, on the other hand, is less intractable than it is usually assumed to be. The result will be to break the rigid and stereotypical association of liberty-emphasizing social philosophies with the pluralistic market paradigm for a health care system and egalitarian, equity-emphasizing social philosophies with the unitary public system paradigm. Understanding better the moral ingredients of liberty and equitable distribution as well as the complexity of how liberty and equality actually intersect in a health care system opens the door to seeing the possibility of significant reconciliation. I will conclude, among other things, that even semi-libertarian views of distributive justice should strongly embrace compulsory, universal coverage of health care for some significant level of care, and that egalitarian views ought not to regard different levels of coverage for people of different income levels as necessarily unjust.

Cost-Benefit Analysis↗