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At least 109 records · Page 6Linked to original sources
PubMed2006

Public perceptions on national health insurance: moving towards universal health coverage in South Africa.

BACKGROUND: Since 1994, considerable progress has been made in transforming the South African health care system, implementing programmes that improve the health of the population, and improving access to health care services. However, amid escalating health care costs disparities continue to exist between the public and private health sectors. The implementation of a national or social health insurance remains elusive despite three government-appointed committees on the matter. METHOD AND OBJECTIVE: This paper reports on the findings of a national probability household sample of the South African population, drawn as part of the 2005 HIV/AIDS national survey, to gauge public opinion on universal health care coverage. The perceptions of South Africans were assessed on selected health care affordability and financing issues. RESULTS: The majority support efforts to contain medicine costs and one-third are of the opinion that the country can provide everyone with all the needed health care and medical services. A large percentage of participants thought it more important to provide improved health care coverage even if it meant raising taxes, while a small percentage said it is better to hold down taxes despite lack of access to health care for some South Africans. Almost a quarter of participants were unable to comment on questions posed to them, indicating the need for improved public education and communication. CONCLUSION: The study provides important insights into public opinion on key policy issues. However, greater public awareness is needed to ensure an informed debate, while the design of a universal national health insurance scheme must take into account both the current context and public opinion.

Adolescent↗
PubMed2006

Volume matters: physician practice characteristics and immunization coverage among young children insured through a universal health plan.

OBJECTIVES: We studied the association between immunization coverage for a cohort of 2-year-old children covered by a universal health insurance plan and pediatric provider and other health services characteristics. METHODS: We assembled a cohort of 101,570 infants born in urban areas in Ontario, Canada, between July 1, 1997, and June 31, 1998. Children were considered to have up-to-date (UTD) immunization coverage if they had > or =5 immunizations by 2 years of age, ie, the recommended 3 doses and 1 booster of diphtheria-polio-tetanus-pertussis/Haemophilus influenzae type b vaccine and 1 dose of measles-mumps-rubella vaccine. Provider practice characteristics were derived from outpatient billing records, and 1996 census data were used to derive neighborhood income quintiles. The association between UTD immunization status and provider characteristics was assessed with multilevel regression models, controlling for patient characteristics. RESULTS: Overall, the rate of complete UTD immunization coverage was low (66.3%) despite a large number of primary care visits (median: 19 visits). Children whose usual provider had a low volume of pediatric primary care were less than one half as likely to be UTD. Other factors associated with not being UTD included very low continuity of care, low continuity of care, and usual provider in practice for <5 years. With adjustment for patient and provider characteristics, there was no difference in immunization coverage for general practitioners versus pediatricians. Children from low-income neighborhoods were less likely to be UTD. CONCLUSIONS: Despite universal access to primary care services, rates of complete immunization coverage among 2-year-old children in Ontario are low. Because visit rates are high, primary care reform should include interventions directed at provider immunization practices to reduce missed opportunities.

Child, Preschool↗
PubMed2002

The US health care system: on a road to nowhere?

This article reviews the current state and future prospects of the health care system in the United States. The 1990s were a decade of reform and change in US medical care, with the debate over the Clinton plan for universal insurance and, after its defeat, the spread of managed care. In particular, managed care had a profound impact on the delivery of medical services, transforming traditional insurance arrangements. However, after all of the changes, the United States appears to be no closer to solving the problems that have characterized its health care system for the past 3 decades. Over 40 million Americans lack health insurance, universal coverage is nowhere in sight, and medical care costs are rising again after a period of moderation. It is doubtful that incremental health reforms will significantly ameliorate these problems.

Delivery of Health Care↗
PubMed1990

Universal access versus universal insurance.

Debate over the nature of the American healthcare system reemerged in 1989. Advocates of universal health insurance and "universal access" argued their positions in the New England Journal of Medicine, and a Harris poll indicated that 89 percent of Americans feel the United States needs to make a fundamental change in its healthcare system. An adequate assessment of these reform proposals requires a clear understanding of what we want from our healthcare system. In 1981 the U.S. bishops specified six principles for U.S. healthcare policy. The bishops asserted that U.S. policy should (1) assume that healthcare is a right, (2) promote pluralism of delivery systems, (3) promote good health in addition to treating disease, (4) give consumers a choice of providers, (5) make healthcare planning essential, and (6) include methods of controlling costs. The bishops' principles help clarify both proposals' strengths and weaknesses.

Catholicism↗
PubMed1992

Symbols, rationality, and justice: rationing health care.

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.

Health Care Rationing↗
PubMed1992

Government, private health insurance, and the goal of universal health care coverage.

The Health Insurance Association of America advocates joint efforts by federal and state governments and the private sector to achieve the goal of universal access to health care. It recommends several changes in the small employer market to provide greater predictability and protection to those insured, including establishment of private, not-for-profit reinsurance organizations authorized by the states. State risk pools for uninsurable individuals who are not part of an employer group are also proposed. The federal government role would include expanding Medicaid eligibility and exempting all insured plans from state mandated benefits. HIAA's proposal also stresses the continued growth and use of managed care programs.

Cost Control↗
PubMed1996

An overview of the role of government in the organisation and provision of health services in Japan.

This article is illustrated with reference to health services in the Tokyo Prefecture. It seeks to describe the role of government in the organisation and provision of health services in Japan. It is based on experiences gained from a three-month placement at the Tokyo Metropolitan Government Bureau of Public Health in late 1994. Wherever possible the article identifies similarities and differences between the Japanese and Australian health care systems. Part of the analysis has been to identify areas where opportunities exist for Australian health service providers to develop further cooperation with particular sectors of the Japanese health system and also where the potential for the export of health services may exist. The health systems of Australia and Japan have points of similarity and difference. Essentially both systems operate within the context of a compulsory universal health insurance system. However, unlike Australia, the bulk of service provision in Japan is left to the private sector, while government retains the primary role of regulator. It is interesting to observe that while the Australian health care system is currently exploring options to expand the service range and level of participation of private sector services in health care delivery (within the context of universal health insurance), the Japanese health care system appears to be examining options through which further government intervention can improve service access and service efficiency. Japan presents opportunities to observe the benefits and disadvantages of predominantly private sector provision within the context of universal health insurance coverage.

Aged↗
PubMed2004

Obstacles to dependent health care access in Oregon: health insurance or health care?

In the 1980s, Oregon was one of a handful of "states that could not wait" for national health care reform. Oregon's chosen approach to reform was predicated on two widely accepted assumptions. First, universal access to health care is best achieved by universal access to health insurance. Second, universal access to health care could best be achieved, at least politically, by incrementally building upon the existing health care delivery and insurance system. This article questions both of these assumptions in light of Oregon's decade-long experience in trying to expand access to health care among its dependent population.

Child↗
PubMed2006

Incoherent policies on universal coverage of health insurance and promotion of international trade in health services in Thailand.

The Thai government has implemented universal coverage of health insurance since October 2001. Universal access to antiretroviral (ARV) drugs has also been included since October 2003. These two policies have greatly increased the demand for health services and human resources for health, particularly among public health care providers. After the 1997 economic crisis, private health care providers, with the support of the government, embarked on new marketing strategies targeted at attracting foreign patients. Consequently, increasing numbers of foreign patients are visiting Thailand to seek medical care. In addition, the economic recovery since 2001 has greatly increased the demand for private health services among the Thai population. The increasing demand and much higher financial incentives from urban private providers have attracted health personnel, particularly medical doctors, from rural public health care facilities. Responding to this increasing demand and internal brain drain, in mid-2004 the Thai government approved the increased production of medical doctors by 10,678 in the following 15 years. Many additional financial incentives have also been applied. However, the immediate shortage of human resources needs to be addressed competently and urgently. Equity in health care access under this situation of competing demands from dual track policies is a challenge to policy makers and analysts. This paper summarizes the situation and trends as well as the responses by the Thai government. Both supply and demand side responses are described, and some solutions to restore equity in health care access are proposed.

Health Policy↗
PubMed2006

Determinants of hospital loss in Thailand: experience from the first year of a universal coverage health insurance program.

The objective of this study was to examine determinants of hospital loss in Thailand. Administration national data for 640 public hospitals of fiscal year 2002 from Ministry of Public Health were analyzed. Results showed that various managerial, service mix, and market variables were significantly associated with the likelihood of the hospital being unprofitable. Hospital characteristics were associated with the amount of loss. The results also suggested that managing the number of hospital employees, inventory, and patient hospitalization could control the amount of loss. In conclusion, most of identified factors associated with hospital loss were manageable. The ramification of this study was to help policy makers understand the hospital loss situation in Thailand after implementing the UC scheme and design policy to resolve the hospital loss problems.

Data Collection↗
PubMed2003

Health care reform in South Korea: success or failure?

South Korea is one of the world's most rapidly industrializing countries. Along with industrialization has come universal health insurance. Within the span of 12 years, South Korea went from private voluntary health insurance to government-mandated universal coverage. Since 1997, with the intervention of the International Monetary Fund, Korean national health insurance (NHI) has experienced deficits and disruption. However, there are lessons to be drawn for the United States from the Korean NHI experience.

Health Care Reform↗
PubMed2003

The health care system under French national health insurance: lessons for health reform in the United States.

The French health system combines universal coverage with a public-private mix of hospital and ambulatory care and a higher volume of service provision than in the United States. Although the system is far from perfect, its indicators of health status and consumer satisfaction are high; its expenditures, as a share of gross domestic product, are far lower than in the United States; and patients have an extraordinary degree of choice among providers. Lessons for the United States include the importance of government's role in providing a statutory framework for universal health insurance; recognition that piecemeal reform can broaden a partial program (like Medicare) to cover, eventually, the entire population; and understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market.

Consumer Behavior↗
PubMedDate not supplied

Is there hope for the uninsured?

In an anecdote popular on the conference circuit, an American health policy analyst who has ascended to heaven asks God, "Will there ever be universal health insurance coverage in the United States?" "Perhaps," sighs God, "but not in my lifetime." This paper argues that this tale accurately describes the prospect of covering the uninsured in this country. Neither moral sentiments among a majority of U.S. political leaders, economic self-interest among those who would have to pay for universal health insurance, nor political pressure from the uninsured and likely-to-be-uninsured will provide a sufficiently strong imperative to move this country toward universal coverage soon, if ever.

Humans↗