Hepatitis B virus vaccine: cost effects and insurance coverage.
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Adult↗
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Results for “Universal Health Insurance”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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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↗
[New features in the law respecting universal insurance].
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Age Factors↗
[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↗
[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↗
[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↗
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↗
Survey of Hawaii physicians' attitudes on health care reform.
Hawaii is more important in health care that its size suggests. It is the first state in the U.S. to have mandated employer-funded health insurance for all workers, and to realize near universal coverage for residents. Because of that, the U.S. can benefit from the experience of those who deliver health services to the people of Hawaii. To determine some of the problems in the current system and what physicians see as solutions, a study of the attitudes and experiences of local physicians was conducted.
Attitude of Health Personnel↗
The Medicare world from both sides: a conversation with Tom Scully. Interview by Uwe E. Reinhardt.
Tom Scully, administrator of the Centers for Medicare and Medicaid Services (CMS), the nation's largest health insurer, discusses the Medicare program with Princeton University economist Uwe Reinhardt. Scully's previous appointments in both the public and private sectors have given him a diverse set of experiences from which to draw in his current position. He praises the agency's staff for devising innovations to cope with a changing health care environment, praises the program for continuing to meet most seniors' needs, and staunchly defends the Bush administration's focus on the private sector as the way forward for Medicare.
Aged↗
[Cost analysis of peritrochanteric fractures according to types of surgical treatment and progressive care from the viewpoint of financial providers].
AIM: The aim of this study to calculate the health insurance cost of treatment of patients with pertrochanter fracture of femur from the first hospital admission for 18 months follow up period according to different surgical methods and progressivity levels. DATA AND METHODS: Recruitment criteria were: 1) all patients with a hip fracture in 2000 defined by the International Classification of Disease (ICD) as "S7210"; 2) working age between 18-60 and 3) first admission to surgical unit, and had an operation. The cost analyses include the cost of acute and chronic in-patient care, outpatient care and sick pay. RESULTS: The total costs were the highest in case of those types of operations with lower cost of prothesis device and lower load stability (Ender 588.000 Ft, fix angled plate 534.000 Ft) because of the higher sick-pay costs. The total costs were the lowest in case of those types of operations with higher cost of prothesis device and higher load stability (Gamma 512.000 Ft, DHS 465.000 Ft) because of the lower sick-pay costs. The gain in recovery time with the 3-4 months shorter disability period can be seen in case of operations with higher load stability. The average length of stay decreases from 15-17 days to 9-11 along progressivity levels. CONCLUSION: With the application of load stable prothesis device the total health insurance costs were the lowest at the universities and national institute while these costs proved to be higher.
Adult↗
Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey.
This paper assesses the extent to which Canada's universal health care system has eliminated socio-economic barriers in the use of physician services by examining the role of socio-economic status in the differential use of specific, publicly-insured, primary and specialist care services. Data from the 1994 National Population Health Survey, a nationally representative survey, were analysed using multiple logistic regression. In order to control for the association between primary and specialist utilisation, a two-staged least squares method was used for models explaining specialist utilisation. Health need, as measured by perceived health status and number of health problems, was found to be consistently associated with increased physician utilisation, for both primary and specialist visits. Whereas the likelihood of an individual making at least one visit to a primary care physician was found to be independent of income, those with lower incomes were more likely to be frequent users of primary care, that is, make at least six visits to a primary care physician. Even after adjusting for the greater utilisation of primary care services by those in lower socio-economic groups, and, therefore, their higher exposure to the risk of referral, the utilisation of specialist visits was greater for those in higher socio-economic groups. Canadians lacking a regular medical doctor were less likely to receive primary and specialist care, even after adjustments for socio-economic variables such as income and education. Although financial barriers may not directly impede access to health care services in Canada, differential use of physician services with respect to socio-economic status persists. After adjusting for differences in health need, Canadians with lower incomes and fewer years of schooling visit specialists at a lower rate than those with moderate or high incomes and higher levels of education attained despite the existence of universal health care.
Adolescent↗
Universal access to health care: a practical perspective.
Policy disconnected from economic reality is bad policy. Neither government financed health insurance nor an employer mandated health insurance approach are in the national interest. Higher national priorities compel a reallocation of resources from consumption to investment. This need not, however, cause an abandonment of efforts to deal with the problems of the uninsured and other health reforms. Successful health care reform is achievable provided it is responsive to higher priorities for economic growth. A strong economy and the production of wealth are indispensable to economic justice. Toward this end, a program of universal access is proposed whereby families and individuals are required to pay for their own health insurance up to a fixed percentage of disposable personal income before public payments kick in. Government's chief role is to establish a standard package of cost-effective benefits to be offered by all insurance carriers, the cost of which is approximately 40 percent less than conventional insurance coverage because of the elimination of reimbursement for clinically non-efficacious and cost-ineffective services. Public financing is relegated to a residual role in which subsidies are targeted on the needy. Much of the momentum for cost control is transferred to consumers and private insurers, both of whom acquire a vested interest in obtaining value for money. Uniform rules for underwriting, eligibility, and enrollment practices guard against socially harmful practices such as experience rating and exclusion of preexisting conditions. The household responsibility and equity plan described herein could free up as much as $90 billion or more for public investment in economic growth and national debt reduction while assuring access to health care regardless of ability to pay. Economic revitalization will be assisted by changes in household savings. With health care no longer a free good and government social programs concentrated on the truly needy, individual propensity to save will increase, thereby enlarging the pool of capital for financing investments in economic growth. Putting more responsibility for health care financing on households with an ability to pay also serves to reinforce and expand the work ethic. Privatizing responsibility by severing health insurance from the workplace connection improves the geographic and occupational mobility of labor, diminishes employer tendencies to discriminate against hiring the disabled and older employees, and eliminates a major source of labor unrest.(ABSTRACT TRUNCATED AT 400 WORDS)
Community Participation↗
Employment-based health insurance: a look at tax issues and public opinion.
This Issue Brief provides background information on the employment-based health insurance system and its alternatives. The report discusses the advantages and disadvantages of the current employment-based health insurance system, the current tax treatment of health insurance, and the strength and weaknesses of recent proposals to introduce tax credits. It presents findings from the public opinion survey conducted by the Employee Benefit Research Institute on public attitudes toward health insurance and summarizes recent research on the effects of tax changes on employment-based health benefits and the uninsured. Employment-based health plans are the most common source of health insurance among nonelderly individuals in the United States, providing coverage to nearly two-thirds of this population in 1997. Health insurance is probably the benefit most used and valued by workers and their families. Sixty-four percent of respondents to a recent survey rated employment-based health insurance benefits as the most important benefit. Despite essentially five years of very low health care cost increases and the recent increase in the percentage of Americans with employment-based health insurance coverage, the uninsured population has continued to rise. This has resulted in a new interest among policymakers in finding ways to reverse this trend. One question that continues to be asked is whether the employment-based health insurance system is the appropriate mechanism for expanding health insurance to the uninsured. Employment-based health plans are popular because they offer many advantages over other forms of health insurance and types of delivery systems. However, there are also potential drawbacks to the employment-based system. The advantages include reduced risk of adverse selection, group-purchasing efficiencies, employers acting as a workers' advocate, delivery innovation, and health care quality. The disadvantages include an unfair tax treatment, lack of portability and job lock, little choice of health plans, and lack of universal coverage. The tax credit proposals for health insurance, which come in all shapes and sizes, would either enhance the current employment-based health insurance system or put it at risk. This has potentially enormous public policy implications, since the vast majority of Americans get their health insurance coverage through employers. Such a change may also have political implications, as public opinion currently may not support such a fundamental change in the U.S. health insurance system. A recent public opinion survey conducted by the Employee Benefit Research Institute found that 68 percent of Americans with employment-based health insurance were satisfied with the current mix of benefits and wages. The EBRI survey found that under a changing tax code scenario, there is still strong support for the employment-based system. Strong support for the employment-based system may be the result of respondents' lack of confidence in their ability to choose the best health plan if their employer stopped offering health insurance.
Data Collection↗
A government sponsored clinic for the evaluation and treatment of chronic hepatitis C in an underinsured population in Puerto Rico.
BACKGROUND: Chronic hepatitis C (CHC) is a major health problem in Puerto Rico (PR). More than 50% of the population is insured by a government-sponsored managed care system that does not cover treatment for CHC. Lack of access to treatment will result in an increase in end-stage liver disease with its high socioeconomic impact in the future. In an attempt to identify strategies for the treatment of CHC in the publicly insured population, the PR Health Department and the University of Puerto Rico (UPR) Gastroenterology (GI) Division have developed a pilot clinic for the evaluation and treatment of CHC. METHODS: UPR and the PR Health Department negotiated a fee per patient to include all medical care and follow-up laboratories. Viral studies were covered by a grant to the Health Department. Medications were bought at a discount price by the government and dispensed at a government pharmacy. The Health Department allocated funds for 200 patients with government insurance. A dedicated clinic was established at the UPR, staffed by an internist under the supervision of the GI faculty. Patients with a positive HCVab were referred to this clinic. The public insurance covered the CBC, liver tests, metabolic panel, TSH, HBsAg, HIV, ultrasound and liver biopsy, which were required prior to evaluation for possible treatment. In the initial visit, patients underwent a medical evaluation, including assessment of suitability for therapy and counseling. Those deemed to be candidates who still needed a liver biopsy had it performed by the GI staff. Genotype and viral titers were ordered after the decision on treatment had been made. The clinic physician prescribed pegylated interferon and ribavirin, which were dispensed by the government pharmacy. Instruction on proper drug administration was given. Clinic visits were scheduled for 1, 3, 6 and 12 months but also allowed on demand. Laboratory tests were done at the clinic and reviewed by the physician expediently to monitor for toxicity. Any medical problems or treatment for complications of therapy were covered by the primary insurer. Viral load was repeated at 12 weeks to discontinue therapy in those unlikely to respond. The budget per patient for medical visits and laboratory tests was dollars 1,500.00, HCV RNA titers plus genotype costs dollars 200.00, and HCV qualitative RNA costs dollars 123.00 RESULTS: 405 patients have been referred between February 2002 and April 2003 (the number was increased at adjust for no-shows and those not treated). 30% are female, the major risk factor is IVDU, and 80% are unemployed. 101 have started treatment and 48 are awaiting biopsy. A support group has been established at the clinic. CONCLUSIONS: The treatment for CHC in practice is not only costly but also resource consuming. Most gastroenterologists in our community refer these patients for treatment. The establishment of a dedicated clinic with a primary physician supervised by the specialists reduces costs and facilitates caring for a larger number of patients. The volume of services allows for negotiation of medical, laboratory and drug costs. In allocating funds for this project, the PR Health Department recognized the importance in reducing the potential spread in the community by treating infected patients as well as reducing the future medical and socioeconomic burden of end-stage liver disease. Although the outcome of this project is still unseen, we believe that this model may serve to establish other clinics for the treatment of CHC at lower costs with the same effectiveness.
Adult↗
Pharmacy service for university health.
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Community Pharmacy Services↗
Taking care of Canada. Part I.
As America agonizes about soaring medical costs and the millions who lack health insurance, Canada's system illustrates the prospects and pitfalls of universal coverage.
Canada↗
Health insurance status and the use of emergency and other outpatient services by adults with sickle cell disease.
STUDY OBJECTIVE: To evaluate insurance status and frequency of use of emergency services in adults with sickle cell disease. DESIGN: Retrospective analysis of visits. SETTING: Emergency department and outpatient clinics of an urban university hospital. PARTICIPANTS: One hundred seventy-two subjects, who made 771 visits to the ED during 1990. RESULTS: Of the 172 subjects, 31 were covered by commercial insurance, 32 were covered by Medicare, and 109 were covered by Medicaid or were uninsured. Insurance status and frequency of use of emergency services were independent (P > .05). On discriminant analysis, Medicaid-covered and uninsured subjects were correctly classified, but commercially insured and Medicare subjects were not. Medicaid and uninsured subjects were more likely to be younger and to live closer to the hospital (P < .00005). High-frequency users of emergency services were discriminated from low-frequency users. High-frequency users were more likely to be younger, to be users of primary-care services, and to live closer to the hospital (P = .0004). CONCLUSION: Provision of primary-care services or stable insurance in the form of commercial insurance or Medicare did not decrease use of emergency services in subjects with sickle cell disease in a group of patients selected from one urban academic ED.
Adult↗
Stanford University's experience with managed competition.
Stanford University has a "managed competition" model of health insurance. Stanford contributes the cost of the low-cost plan, and employees are responsible for premium differences between this plan and other offerings. Each employee gets what he or she wants and is willing to pay for, and everyone has low-cost access to health insurance. Stanford risk-adjusts the premiums based on age and sex and plans soon to adjust including prescription drug data. In the past five years, premiums have risen rapidly, in line with the rest of the market. For competition to transform the delivery system, most employers in the region must adopt managed competition.
California↗