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PubMed1997

The transplant trap: the impact of health policy on employment status following renal transplantation.

This study examined the relationship between concern for health insurance coverage and employment status following renal transplantation. The sample consisted of 293 individuals who underwent renal transplantation at The Ohio State University Medical Center. The study found fewer individuals reported employment during the past year (58%) than indicated they were able to work (72%). Although 72% of the sample indicated the physical ability to work 41% reported receiving a monthly disability check. Regression analysis revealed that receipt of a monthly disability check and employment status one day prior to transplant were the two most significant predictor variables for employment activity during the year prior to participation in this study. Intervention that is coordinated on a psychosocial level from the time of diagnosis of ESRD throughout the post-transplant period is critical to supporting individuals in pursuing their goals. Research findings should be utilized to advise policy-makers and advocate for system changes that support employment for individuals with ESRD.

Adolescent↗
PubMed2006

Universal health care: a regional perspective--why not a "Georgia SecureCare"?

Despite conventional wisdom that southern states have neither the money nor popular support for such a program, a Georgia group has outlined a universal, comprehensive, single-payer proposal called "Georgia SecureCare." The group's telephone survey in 2003 found that a majority of households was concerned about losing health insurance or access. Economic analyses demonstrated that SecureCare would reduce statewide health care spending by dollar 0.72 billion (approximately 2%) in the first year while providing all Georgia residents with a generous benefit package. Despite initial increased healthcare utilization costing about dollar 3.84 billion, notable savings were attributable to lower annual administrative costs (dollar 3.82 billion) and bulk purchasing (dollar 0.74 billion saved for prescription drugs and durable medical equipment). For most families and for large employers, annual expenditures for health would decline. Georgia respondents to the telephone survey initially expressed approximately 72% support for SecureCare. After furnishing them with common objections to the plan, their support dropped to approximately 62%. A universal, state-sponsored plan would likely save money for Georgia, and it could easily win broad-based popular support.

Financing, Government↗
PubMed2002

Managed competition using both market-driven and regulatory strategies.

The market-driven managed competition concept has been successful in reducing increases in healthcare costs by controlling utilization and price, but has failed to date to produce an effective and efficient delivery of health services. The proposed health reform plan calls for universal access (excluding illegal aliens), a relatively broad range of clinically effective basic benefits, an option to purchase supplementary benefits, a ceiling placed on the nation's total health expenditures, local decisionmakers allocating available resources, existing insurers administering the plan and providing consumers with additional quality of care comparisons.

Cost Control↗
PubMed2005

Private health insurance: implications for developing countries.

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

Developing Countries↗
PubMed1993

The competition vogue and its outcomes.

Social security and comprehensive health care financing were developed to protect all citizens and to redistribute money to cover costs. Their inspiration was social solidarity rather than pecuniary self-interest. The United States differed from other countries by continuing a private market in health, with many self-centred and competing providers and insurers; and its prevailing school of health economics deplored the national health insurance and national health services that were universal in other countries and recommended devices that would eliminate "market failure" in health. When health economics grew in Europe during the 1970s and 1980s, the reformers' first presumption was that the voluminous American market-oriented literature must offer answers; but much of it proved superfluous, since European health care systems still had much competition and consumer choice, and they worked better than the reality in the United States. The United States itself has paid a heavy price for turning over health financing policy to the devotees of microeconomics and free markets, and today its serious problems in health are unsolved. So powerful is the pro-competitive ideology that it has now been adopted by the Democratic Clinton Administration, contradicting the heritage of Roosevelt, Truman, and Johnson.

Economic Competition↗
PubMed2004

Prevalence of adequate blood pressure control in self-pay or Medicare patients versus Medicaid or private insurance patients with systemic hypertension followed in a university cardiology or general medicine clinic.

The prevalence of adequate blood pressure control was investigated in 614 patients (mean age 60 +/- 16 years) with systemic hypertension followed in a university cardiology or general medicine clinic. Systemic hypertension was adequately controlled in 46 of 122 patients (38%) who had to pay for their medications (self-pay or Medicare patients) versus 342 of 492 patients (70%) who received their medications at minimal or no cost because they were on Medicaid or had private insurance (p <0.001).

Aged↗
PubMed1996

Student health policies of U.S. medical schools.

BACKGROUND: Medical students are at risk of exposure to bloodborne pathogens, yet few data are available about U.S. medical schools' policies to protect students. METHOD: A cross-sectional survey of the student affairs deans at the 126 U.S. medical schools was conducted in May 1994. A confidential questionnaire inquired about policies regarding vaccination for hepatitis B virus (HBV), blood and body-fluid exposures, universal precautions training, and health and disability insurance for students. RESULTS: A total of 108 (86%) of the schools participated in the survey. Most (99, 92%) required either HBV vaccination, evidence of immunity, or a signed waiver refusing vaccination. Nearly all (94, 87%) required health insurance, and almost all (101, 94%) offered a plan (at a mean cost of $690 annually), but fewer schools (69, 64%) offered disability insurance. The schools frequently held students responsible for the costs of HBV vaccination (73, 68%), postexposure serologic testing (22, 20%), and treatment of training-related medical problems (43, 40%). CONCLUSION: Most medical schools comply with current recommendations for preventing training-related exposures to bloodborne pathogens, illness, and injury, but students face a substantial financial responsibility for these services at a time when many have large debts. Many schools do not have disability insurance readily available for students. Medical schools should review their student health policies to protect students adequately.

Blood-Borne Pathogens↗
PubMed1990

Burn DRGs: effects of recent changes and implications for the future.

With the institution of Diagnosis Related Groups (DRGs), the economic survival of tertiary care centers may be threatened. Even more worrisome to these institutions is the possibility of other third-party payors following Medicare's lead and converting to this reimbursement plan. This paper examines the present financial status of the Burn Center at the University of New Mexico Hospital, as well as the future impact if all third-party payments were based on the DRG system. For fiscal years 1985-1987, the Burn Center lost $246,512 over cost for Medicare patients. There was a profit of $724,762 for other third-party payors, and a loss of $692,354 for indigent patients. This resulted in a total loss of $214,101 for the Burn Center during the 3-year study period. With the hypothetical conversion++ of all third-party reimbursement to DRGs, the total 3-year loss would become $1,253,393. The effect of DRG 472, a recent change in burn DRG classification, is discussed, as well as specific recommendations to rectify current problems.

Adult↗
PubMed1990

From Medibank to Medicare: trends in Australian medical care costs and use from 1976 to 1986.

Private medical care costs and service use in Australia from 1976 to 1986 are compared. In each of these years Australia had a compulsory, universal, fee-for-service, national health insurance scheme - Medibank in 1976 and Medicare in 1986. Over the period of 1976 to 1986, the number of private medical services per capita, in the 6 month period 1 April to 30 September, increased from 2.79 to 3.95, an increase of 3.54 per cent per year. The cost of services per capita, adjusted for increases in schedule fees for each item-group of services (the 'fee-adjusted cost'), grew at a rate of 3.91 per cent per year. The results are reported by subsets of age, sex and item-group of service. It is found that very little of the large increases in use and cost of services can be attributed to demographic changes or population growth. Rather, they represent rapid increases in age and sex-specific rates of use, primarily among the very young, the very old and, for some types of service, women of child-bearing age. The most dramatic increases in service use are found in pathology, radiotherapy and miscellaneous procedures.

Adolescent↗
PubMed1992

Risk variation and fallback insurers in universal coverage insurance plans.

This paper argues that optimal treatment of health expenditure risk variation over one's lifetime requires partial offsetting of experience-related premium fluctuations. It argues that government should provide protection against the risk of serious chronic illness by offering risk-related tax credits that offset some (though not all) of the changes in premiums due to such illnesses. The performance of a fallback insurer, present in most market-based health reform proposals, is shown to depend on whether or not it is permitted to risk rate. Forbidding any risk rating is likely to cause adverse selection problems, whereas permitting the fallback insurer to risk rate should help it to perform its proper role and avoid being subject to dumping of high risks.

Choice Behavior↗
PubMedDate not supplied

[Analytic study of the hospital self inspection results with the medical insurance inpatient fee from the viewpoint of the hospital management--based on one university hospital pre-discharge inspection].

The purposes of this study were to evaluate the results of the hospital self inspection with the medical insurance and to offer basic materials to the medical insurance inspection and the education of medical insurance. The study was undertaken with 4,730 cases among the total 13,810 medical insurance in patients from Jan. 1990 to Dec. 1990 at one university hospital in Pusan. The major contents of the inspection were the omission of diagnosis and medical fee, curtailment, application mistake, the rates of inclusion, subtraction and total accumulation. The data were collected using patients charts and bills. The results of the paper analysis were as follows. 1. From the pre-discharge hospital self inspection, major omission were treatment and material fee but medication fee were moderately high and high curtailment was operation fee. 2. Decreasing order of operation fee adjustment were digestive (22.4%) muscular (22%) and neuro system operation (21.4%). Majority of the medication fee adjustments were injection form of medication (95.7%). 50% of the treatment fee adjustments were composed of injection fee (27.9%) and dressing or post-operative dressing fee (22.3%). 74.7% of material costs were composed of oxygen (30.6%), blood and the blood composed materials (44.1%). 3. Pre-discharge inspection showed 6% adjustment rate, 4.3% addition and 2.1% curtailment rate. Most of the adjustment were omission (66.1%). 4. Omission were divided by event omission (92.6%) and application mistake (7.4%). The decreasing order of omission fee were operation (21.84%), treatment (18.71%) diagnosis (18.68%), medication (14.53%) and material costs (10.84%). So operation and treatment part were the major part of the total omission fee (40.55%). 5. The average omission of diagnosis were 1,800 per month.

Fees, Medical↗
PubMed1993

[Comments on simulation and experts. A contribution from forensic practice].

The report deals with an insurant (private accident and health insurance), who succeeded in deceiving the university hospital of his mothertown for a long time and in a cost intensive way after he had an alleged concussion followed by an extreme, consecutive decline of his ability to see. The malingerer finally processed some documents, which forced the person inchange in case of a high percentage of disability to pay a sum insured of about one million DM or more. In the practice of an expert it was possible to find him guilty in a simple and cheap way.

Accidents, Occupational↗
PubMedDate not supplied

[Rationalization of health expenditures: the Séguin's plan in 1987].

Sickness insurance is universal and compulsory in France. It is financed mainly by contributions from employers and employees. Consequently its soaring costs may sharply reduce the competitive French products on the world market. Successive French administrations have attempted to curb the growing health costs by increasing co-payment. The program launched in 1987 was innovating since it was aimed at the group of insured people who were previously not submitted to co-payment (persons having presumably grave illness...). The program was a breakthrough in the French system which was built on a mixed concept of insurance and solidarity. The program was undoubtedly a great success. However, lack of an efficient information system, and reaction of the various actors (patients and doctors) who succeeded to adjust themselves to the new regulations, diminished its impact some years after it has been implemented.

France↗
PubMed2000

Health technology assessment in the United Kingdom.

The National Health Service (NHS) provides universal health coverage for all British citizens. Most services are free of charge, although modest copayments are sometimes applied. About 11% of the population also has private insurance. General practitioners, generally the first point of contact for accessing the system, are independent contractors who serve as gatekeepers for specialist and hospital services and enjoy substantial clinical autonomy. Hospitals are public and are regionalized, but the 1990 reforms made them self-governing trusts that contract with local purchasers (health authorities and general practitioner fundholders). Reforms beginning in 1990 moved the NHS away from a centralized administrative structure to more pluralistic arrangements in which competition, as well as management, influences how services develop. Health technology and health technology assessment (HTA) have gained increasing attention in the NHS during this period, as part of a wider NHS Research and Development (R&D) Strategy. The strategy promotes a knowledge-based health service with a strong research infrastructure and the capacity to critically review its own needs. HTA is the largest and most developed of the programs within the strategy. It has a formal system for setting assessment priorities involving widespread consultation within the NHS, and a National Co-ordinating Centre for Health Technology Assessment. The strategy supports related centers such as the U.K. Cochrane Centre and the NHS Centre for Reviews and Dissemination. A hallmark of the HTA program is strong public participation. The United Kingdom has made a major commitment to HTA and to seeking effective means of reviewing and disseminating evidence.

Delivery of Health Care↗