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Results for “Universal Health Insurance”

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PubMed2006

A proposal to cover the uninsured in California.

The lack of health coverage for millions of Californians is a major societal problem. In the absence of federal action, we propose a state-based approach that leverages existing systems to create near-universal coverage within two years. We describe several subsidized benefit options for low-income uninsured Californians, emphasizing preventive and primary care, and we propose catastrophic coverage, at a minimum, for higher-income uninsured Californians. Proposed financing mechanisms include a health care sales tax and an "in-lieu" payroll tax.

California↗
PubMedDate not supplied

The Institute of Medicine committee's clarion call for universal coverage.

The Institute of Medicine (IOM) Committee on the Consequences of Being Uninsured is to be commended for its work, which recently culminated in the release of six volumes on the subject. The concluding volume presents a vision for universal coverage and describes four options for achieving it. The options include an incremental approach, employer and individual mandates, and a single-payer plan. We identify complications involving benefits and geographic variation in costs surrounding attempts to achieve universal coverage. The complications suggest that the committee's cost estimates may be too low and that there may be sizable political barriers to the proposals.

Geography↗
PubMed1995

Changes in asthma severity in Manitoba.

OBJECTIVE: To assess changes in the severity of physician-diagnosed asthma between 1983 and 1988. DESIGN: Cross-sectional studies examining the frequency of markers of asthma severity: hospitalizations, ICU admissions, hospital emergency department visits, multiple physician contacts, and referrals to specialists in patients aged 0 to 14 years, 14 to 34 years, and > or = 35 years separately. SETTING: Physicians' claims data from the universal Provincial Health Insurance Plan for fiscal years 1983 and 1988. PATIENTS: All patients with the diagnosis of asthma, bronchitis, and COPD identified from the Manitoba Health database. MEASUREMENTS: The markers of severity were related to the prevalence of patients seeing a physician and receiving a diagnostic label of asthma, COPD, or bronchitis. RESULTS: The number of patients with physician-diagnosed asthma increased by 36.4% over the 5 years. In 1983, 11% of asthmatics were hospitalized during the year and 8% were hospitalized in 1988 (-2.5%; 95% confidence interval [CI], -3.2 to -1.8%). During both years, about 75% of the patients hospitalized were in hospital once only. Mean and median duration of hospital stay declined. The percentage of asthmatics seen in the hospital emergency departments declined slightly in all age groups, the total being 21% in 1983 and 18% in 1988 (-3.5%; 95% CI, -4.5 to -2.5%). About one third of the patients with asthma were seen only once by a physician during both of the years examined, 43 to 45% of them being seen on three or more occasions during both years. Referrals to specialists for all asthmatics increased from 12 to 14% (1.9%; 95% CI, 1.0 to 2.8%) from 1983 to 1988. This was almost entirely due to an increase from 11 to 16% (5.1%; 95% CI, 4.0 to 6.2%) in the youngest age group, an increase not accompanied by an increase in any other marker of severity. Changes in asthma severity were similar to changes in the severity in patients with bronchitis and COPD. CONCLUSION: No increase in severity of asthma was seen between 1983 and 1988, but the prevalence of the diagnostic label of asthma increased substantially.

Adolescent↗
PubMed2003

Can universal access to health care eliminate health inequities between children of poor and nonpoor families?: A case study of childhood asthma in Alberta.

STUDY OBJECTIVE: Children from poor families are much more likely to have emergency visits for asthma than those from nonpoor families, which may be related to financial access barriers to good preventive care for the poor. We sought to determine whether in a health-care system that provides free access to outpatient and hospital services, the disparities in the rates of emergency visits for asthma would be less apparent across the income gradient. DESIGN: Longitudinal, population-based study. SETTING: Alberta, Canada. PARTICIPANTS: All children born in Alberta, Canada between 1985 and 1988 (n = 90,845) were classified into three mutually exclusive groups based on the reported annual income of their parents from the previous year: very poor, poor, and nonpoor groups. MEASUREMENTS AND RESULTS: We compared the relative risk (RR) of emergency visits for childhood asthma among children of very poor, poor, and nonpoor families using a Cox proportional hazard model during a 10-year follow-up. We found that the very poor children were 23% more likely to have had an emergency visit for asthma than those from nonpoor families (RR, 1.23; 95% confidence interval [CI], 1.14 to 1.33), adjusted for a variety of factors. The poor group, however, had a similar risk of asthma emergency visits as the nonpoor group (RR, 0.97; 95% CI, 0.91 to 1.04). The average number of office visits for asthma was similar between the very poor and nonpoor groups. CONCLUSIONS: In a setting of universal access to health care, children of poor and nonpoor families had similar rates of asthma emergency visits; the very poor children, however, continued to experience an excess risk. These findings suggest that a universal health-care system can reduce, but not fully eliminate, the disparities in emergency utilization of asthma across income categories.

Adult↗
PubMed2004

Risk of physician-diagnosed asthma in the first 6 years of life.

OBJECTIVE: The objective of this cohort study was to determine if complications of pregnancy and labor, characteristics at birth, and exposure to infections influence the incidence of asthma in the first 6 years of life. DESIGN: We identified all children born between 1980 and 1990 in the Province of Manitoba, Canada. We used records of physician contacts (inpatient and outpatient) and services of the universal provincial health insurance plan to follow up 170,960 children from birth to the age of 6 years to identify the first diagnosis of asthma. Information on mothers and siblings was also obtained to determine family history of disease and exposure to infections. RESULTS: During the study period, a diagnosis of asthma was made in 14.1% of children by the age of 6 years. The incidence was higher in boys than in girls, in those with family history of allergic diseases. It was higher in urban than in rural areas, and lowest in those born in winter. Asthma was more likely in those with low birth weight and premature birth. Certain congenital abnormalities and complications of pregnancy and labor also increased the risk of asthma. The risk of asthma increased with maternal age. Both upper and lower respiratory infections increased the risk of subsequent asthma, and this effect was more important than exposure to familial respiratory infections, which also tended to increase asthma risk. The risk of asthma decreased with the number of siblings when siblings had a history of allergic disorders. CONCLUSIONS: In addition to genetic influences, intrauterine and labor conditions are determinants of asthma. Exposure to both upper and lower respiratory tract infections increases the risk; these infections do not explain the protective effect associated with the increasing number of siblings.

Asthma↗
PubMed2004

Universal care.

Explore the source record for details and available documents.

Canada↗
PubMed2004

Universal care.

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Canada↗
PubMed2004

Universal care.

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Canada↗
PubMedDate not supplied

Towards an integrated adolescent health policy in Israel.

The principle health issues of Israeli adolescents are largely related to health risk behaviors, and are therefore preventable. Deciding which public health interventions are of highest priority ought to be determined according to the relative importance of these issues among Israeli youth. Violence in the schools and dieting to lose weight are highly prevalent in this population, with unintentional accidents, smoking and other substance abuse, and reproductive health being other important issues. Special health planning considerations that take into account Israel's unique population mix are necessary. Israel does not yet have a comprehensive, integrated health policy for youth. Nevertheless, legislation has been enacted that provides universal national health insurance, as well as preventive school health services to all school children from the 1st to 9th grade under the Ministry of Health's responsibility, setting the foundations for such a comprehensive youth health policy. In addition, policy makers and health care providers have recently recognized the need for a pro-active approach regarding health service development for adolescents. In this article, we give an overview of current Israeli health policies that impact upon the adolescent population, and propose seven priority areas that should be addressed in order to advance the health of youth in this country.

Adolescent↗
PubMedDate not supplied

[Recent health services reform in Quebec Province, Canada: on the frontier of preserving a public system].

This paper analyzes recent changes in the Canadian health system through a case study of Quebec. As the last Province to adopt federal principles of universal coverage, comprehensiveness, and public management, its reform, conducted in 1971, met these objectives by means of key innovations. In the 1980s and early 90s, a process of health services evaluation in this Province and in Canada as a whole launched a period of extensive changes. The relevant measures are described herein: decentralization and regional management, "clinical shift", selective reduction in the supply of services, and new mechanisms for resource allocation and social control. There is a tendency towards an environment of public competition, but the approach that was adopted for regulation does not correspond to the main models from central countries. Within a scenario of budget constraints, technocratically-defined measures allowed for the settlement of benefits, preserving the system's main guidelines. This evidence is one of the main contributions of comparative analysis to health system reform in peripheral countries. The study identifies the relationships between these measures and a worldwide trend towards cost control and macroeconomic adjustment policies, discussing the relevant implications for health services.

Canada↗
PubMedDate not supplied

[Towards a new social security in the 21st century: without financing solidarity there will be no universality].

In the countries of Latin America and the Caribbean, social security systems have traditionally been almost exclusively the responsibility of the public sector. These systems have had major shortcomings, such as low coverage rates, unbalanced budgets, inadequate funding, and poor management of resources. In order to solve these problems and face the increased demands associated with demographic and epidemiological transitions, in the 1990s a number of countries began to reform their social security systems. These reforms have been characterized by three fundamental features: a) a search for a closer link between contributions and benefits, in order to better balance income and expenses, b) changes in the public-private composition of the systems that allow a greater private role in the financing and delivery of services, and c) an emphasis on market mechanisms as a way to promote efficiency in applying resources, and leaving to the State a role as a regulator and as a guarantor of basic benefits to groups that, because of their socioeconomic conditions, cannot make certain minimum contributions. This article looks at some of the problems raised by the reforms carried out so far, and the lessons that can be learned from them. The piece also analyzes the relationship between universal coverage and societal unity. In addition, the article suggests that the main challenge with social security reforms is that of moving toward universal systems that significantly expand coverage. In order to achieve that, it is necessary to strengthen the mechanisms of cohesion in financing and to improve efficiency by introducing market instruments that do not negatively affect the unitarian character of the financing. The piece concludes that it is necessary to increase coverage; improve management; be concerned about the design of the public-private makeup; identify the responsibilities of the private sector and of the government in financing, provision, and regulation of social security systems; and introduce and strengthen unity mechanisms in financing.

Caribbean Region↗
PubMed2006

Impact of state vaccine financing policy on uptake of heptavalent pneumococcal conjugate vaccine.

OBJECTIVE: We examined heptavalent pneumococcal conjugate vaccine (PCV7) uptake among children aged 19 to 35 months in the United States and determined how uptake rates differed by state vaccine financing policy. METHODS: We analyzed data from the 2001-2003 National Immunization Survey. States that changed their vaccine financing policy between 2001 and 2003 (n=17) were excluded from analysis. Logistic regression was performed to identify the association between state vaccine financing policy and receipt of 3 or more doses of PCV7 after control for demographic characteristics. RESULTS: The proportion of children receiving 3 or more doses increased from 6.7% in 2001 to 69.0% in 2003. After controlling for demographic characteristics, children residing in states that provided all vaccines except PCV7 to all children had lower odds of receiving 3 or more doses compared to children residing in states that provided PCV7 only to children eligible for the Vaccines for Children program (odds ratio=0.58; 95% confidence interval=0.51, 0.66). CONCLUSION: It is essential that we continue to monitor the effect that state vaccine financing policy has on the delivery of PCV7 and future vaccines, which are likely to be increasingly expensive.

Child Health Services↗
PubMed2006

Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.

OBJECTIVES: We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status. METHODS: We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures. RESULTS: In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States. CONCLUSIONS: United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.

Adult↗