Stanford University: a prudent buyer case study of cost efficiency and quality of care.
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California↗
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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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Health system reform: let's not miss our chance.
Support for reform is at its highest level, but criticism of President Bill Clinton's plan is widespread. Nevertheless, the core components of the Clinton plan should be supported. These include (1) building on existing employer-based health insurance with a mandate that employers offer coverage to all workers and pay a substantial portion of the premium; (2) requiring that coverage be universal and benefits comprehensive; and (3) controlling total health care spending via a national expenditure limit. This paper does, however, suggest three changes to strengthen the plan: developing a broader base than Medicare and Medicaid to pay for reform; setting the national health care spending limit at a higher level (gross domestic product plus 1 percent); and strengthening the powers of the regional health alliances.
Cost Control↗
Early turmoil for Massachusetts universal health care law. Disappointed hospitals want long-term reimbursement reforms.
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Insurance, Hospitalization↗
The medical care system under national health insurance: four models.
This paper presents a critical evaluation of four national health insurance models in light of their ability to counteract incentives in the present system that are dysfunctional in terms of costs and quality of care. The feasible models are labelled as: major risk insurance, alternative delivery systems under universal coverage; the public utility allocation model (alias the British system); and the public utility hospital model. It is concluded that substantial changes in the existing structure of the medical care system will be very difficult to achieve politically. Further, those models most politically feasible, the present medical care system with universal third party financing, and public utility process controls with universal third party financing, are the ones most likely to aggravate present cost-quality difficulties. Therefore, the recommended procedure for implementing national health insurance is unabashedly incremental: i.e.; to experiment with cost-sharing, alternative delivery systems, other provider incentive mechanisms and public utility regulation-budget allocation approaches, before wholesale adoption of national health insurance is entertained.
Delivery of Health Care↗
Development of State Health Insurance System in Georgia.
Since 1994, health resources in Georgia have became insufficient. The spending for the health care services per person in 1985 were US$95. 5, US$12.2 in 1989, and US$0.9 in 1994. Currently there are 58.5 physicians per 10,000 inhabitants. The birth rate decreased from 16. 7 in 1989 to 11 in 1997. The mortality rate of pregnant women due to extragenital pathologies, iron deficiency anemias (40% of the total pregnant women), iodine deficiency and complicated abortions are also on the increase. The State Parliament of Georgia decided to reorganize the health care system and, in August 1995, State Health Care Programs and the new system of reimbursement of providers were launched. The monthly contribution rate of medical insurance, which was 4% of the payroll (3% paid by the employer and 1% by the employee), is transferred from the Central Budget directly to the State Medical Insurance Company, which implements nine State Curative Programs. State medical insurance system co-exists with municipal and private health care. Municipal health coverage is closest to the universal coverage (over 80% of the population), and municipal health care services are the closest to a basic package of services satisfying most health care needs of the population. The exceptions are pregnant women and mothers and children under 1 year of age, who are covered by the Federal Programs under State Medical Insurance.
Georgia (Republic)↗
Insurance coverage and financial burden for families of children with special health care needs.
OBJECTIVE: To examine the role of insurance coverage in protecting families of children with special health care needs (CSHCN) from the financial burden associated with care. METHODS: Data from the 2001 National Survey of Children with Special Health Care Needs were analyzed. We built 2 multivariate regression models by using "work loss/cut back" and "experiencing financial problems" as the dependent variables, and insurance status as the primary independent variable of interest while adjusting for income, race/ethnicity, functional limitation/severity, and other sociodemographic predictors. RESULTS: Approximately 29.9% of CSHCN live in families where their condition led parents to report cutting back on work or stopping work completely. Families of 20.9% of CSHCN reported experiencing financial difficulties due to the child's condition. Insurance coverage significantly reduced the likelihood of financial problems for families at every income level. The proportion of families experiencing financial problems was reduced from 35.7% to 23.0% for the poor and 44.9% to 24.5% for low-income families with continuous insurance coverage (P < .01 for both comparisons). Similarly, the proportion of parents having to cut back or stop work was reduced from 42.8% to 35.9% for the poor (P < .05) and 43.5% to 33.9% for low-income families (P < .01). CONCLUSIONS: Continuous health insurance coverage provides protection from financial burden and hardship for families of CSHCN in all income groups. This evidence is supportive of policies designed to promote universal coverage for CSHCN. However, many poor and low-income families continue to experience work loss and financial problems despite insurance coverage. Hence, health insurance should not be viewed as a solution in itself, but instead as one element of a comprehensive strategy to provide financial safety for families with CSHCN.
Adolescent↗
[Impact of the public health reform law on research and education].
The statutory health insurance reform law of 1993 had a serious impact on the management of university hospitals. Firstly, the phase of strict budget caps, new in and out patient services could only be introduced when compensated with the elimination of other services. Most universities have mastered this challenge. In the second phase, an entirely new system of hospital fees will be introduced. This will lead to a high degree of uncertainty on the financial situation of the university hospitals. The new regulation on hospital fees only insufficiently takes into consideration tertiary care hospitals. A severe loss of income has to be reckoned with. The funding of current subsidies for medical research, training, construction projects and big-ticket equipment is threatened by the fiscal budget crisis due to the current recession and the heavy financial burdens of the German reunification. Therefore fundamental reforms with regard to the statutory form, the form of ownership, the responsibilities of the university hospital, the organization of management and decision processes, the public service law and investment financing are all unavoidable.
Cost Control↗
Health economic analysis of fluoropyrimidine-based therapies of colorectal cancer from the perspective of statutory sickness funds.
AIMS: 1) to identify the treatment costs of different standard fluoropyrimidine-based therapies, i. e., the Mayo-Clinic and AIO/Ardalan regimens, under real-life conditions in settings routinely used for chemotherapy administration in Germany (inpatient, day-clinic or office-based oncologists) and 2) to investigate the cost implications of the routine use of capecitabine, an oral alternative for the treatment of metastatic colorectal cancer. METHODS: We analysed the actual fee-listings of office based oncologists and projected the results to several hospital-based treatment settings and to oral treatment with capecitabine from the perspective of statutory sickness funds. RESULTS: Office-based setting: the highest quarterly treatment costs of 9.874 were found for the AIO/Ardalan-regimen, followed by the Mayo-Clinic regimen, which incurred costs of 2.497. The cheapest treatment option was capecitabine with quarterly costs of 1.610. Day-clinic setting: the costs of the Mayo-Clinic protocol amounted to 2.036 in a municipal hospital and 8.455 in a university hospital. The respective costs for the AIO/Ardalan regime were 1.294 and 5.374. In-patient setting: the Mayo-Clinic protocol costs were 3.143 in a municipal hospital and 10.5609 in a university hospital. The respective costs found for the AIO/Ardalan-regimen were 1.998 and 6.717. CONCLUSION: From a health economic perspective, substantial cost savings for health insurance may be realised if patients with colorectal carcinoma were treated in the office-based setting with capecitabine instead of a hospital-based treatment. Economic consequences would be positive for municipal hospitals (avoided losses) and negative for university hospitals. Further savings could be realised if drug prices in hospital and retail pharmacies were harmonized.
Administration, Oral↗
Strategic implications of healthcare reform for mental health providers.
While most of the recent national attention on healthcare reform has focused on physicians, acute-care hospitals, and the insurance industry, what about mental healthcare providers? Where do psychiatric hospitals, psychiatrists, psychologists, and other mental healthcare professionals fit into the healthcare payment system of the future? For example, if the United States ends up with what is called universal access--a payment source for all Americans--will it include mental health benefits? The stakes are high; one quarter of the American population either has no health insurance or is covered by Medicaid. Many current reform proposals include tort reform; but how would it affect mental healthcare providers? Will managed care--primarily health maintenance organizations (HMOs) and preferred provider organizations (PPOs)--be a part of the reshaping of the United States healthcare system? This article has three objectives: To summarize the various healthcare reform proposals and provide a description of the key elements anticipated in the most likely reform package. To consider the strategic implications of payment reform for the mental healthcare industry. To identify strategies for mental healthcare providers that are likely to be useful regardless of the shape of healthcare reform.
Cost Control↗
New Hampshire, health care, and the 1992 election.
A poll of New Hampshire voters who participated in the February 17 presidential primary shows that the recession and overall concern for the economy was the most important factor in determining the outcome of the election. Health care and national health insurance ranked second, significantly outranking concerns over all other issues. When presented with the leading policy options for health care reform, the majority of voters favored a plan that would guarantee universal coverage by law--either a "play or pay" plan or an all-government plan. However, even though a majority of voters favored universal coverage, they also preferred plans that would make insurance available through private insurers rather than through an all-government plan.
Adolescent↗
Prevalence of inflammatory bowel disease in an insured population in Puerto Rico during 1996.
OBJECTIVES: Limited data exists about Inflammatory Bowel Disease (IBD) in Hispanic populations. The aims of the present study were to estimate overall and specific prevalence of IBD (Crohn's disease and ulcerative colitis) and to describe the characteristics of a group of patients from the University of Puerto Rico's IBD Registry. METHODS: To estimate the prevalence of IBD, computerized records of all physician billing and hospital discharges from a major health insurer in Puerto Rico and classified with ICD-9-CM codes 555.0-555.9 (Crohn's disease) and 556.0-556.9 (ulcerative colitis) during 1996 were searched. Prevalence was estimated by age group, sex, and type of insurance. To describe demographic and selected clinical information from patients with IBD, data gathered in the University of Puerto Rico's IBD Registry from 1995 through 2000 was analyzed. RESULTS: Out of 802,726 insured individuals, 332 had a diagnosis of Crohn's disease, 499 of ulcerative colitis and 21 had both diagnoses. The estimated prevalence per 100,000 was 41.4 for Crohn's disease, 62.2 for ulcerative colitis, and 106.1 cases per 100,000 for IBD. Peak prevalence of Crohn's disease occurred among the age groups 50-59 years and > or = 60 years, and the overall female:male prevalence ratio of Crohn's disease was 1.13 (95% CI: 0.91-1.42). Ulcerative colitis was most prevalent among insured individuals aged 50-59 years and 40-49 years. The prevalence of ulcerative colitis was significantly higher among females than among males, with an overall prevalence ratio of 1.42 (95% CI: 1.18-1.71). Of 342 patients participating in the IBD Registry, 155 (45.3%) had Crohn's disease and 187 (54.7%) had ulcerative colitis. Among patients diagnosed with Crohn's disease, 51.6% were females, the mean age was 35.2 +/- 18.3 years, and 18.1% had a family history of IBD. More than half (57.8%) of patients with ulcerative colitis were females, the mean age was 42.6 +/- 17 years, and 17.1% had a family history of IBD. CONCLUSIONS: The estimated prevalence of IBD in this insured population in Puerto Rico places it among the middle-range of that reported for other countries. Additional studies must be conducted in Puerto Rico in order to confirm the observed findings. Population-based epidemiologic studies aimed at estimating the burden of IBD in Hispanic populations in the United States and Latin America are essential for health care planning.
Adolescent↗
Untangling universal coverage.
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Health Care Reform↗
Democrats drop universal coverage.
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Health Care Reform↗
Single-payer national health insurance. Physicians' views.
BACKGROUND: Forty-one million Americans have no health insurance and, despite the growth of managed care, medical costs are again increasing rapidly. One proposed solution is a single-payer health care financing system with universal coverage. Yet, physicians' views of such a system have not been well studied. METHODS: We surveyed a random sample of physicians (from the American Medical Association Masterfile) in Massachusetts, regarding their views on a single-payer health care financing system and other financing and physician work-life issues that such a system might affect. RESULTS: Of 1787 physicians, 904 (50.6%) responded to our survey. When asked which structure would provide the best care for the most people for a fixed amount of money, 63.5% of physicians chose a single-payer system; 10.7%, managed care; and 25.8%, a fee-for-service system. Only 51.9% believed that most physician colleagues would support a single-payer system. Most respondents would give up income to reduce paperwork, agree that it is government's responsibility to ensure the provision of medical care, believe that insurance firms should not play a major role in health care delivery, and would prefer to work under a salary system. CONCLUSIONS: Most physicians in Massachusetts, a state with a high managed care penetration, believe that single-payer financing of health care with universal coverage would provide the best care for the most people, compared with a managed care or fee-for-service system. Physicians' advocacy of single-payer national health insurance could catalyze a renewed push for its adoption.
Attitude of Health Personnel↗
Trends in rural and urban differentials in incidence rates for ruptured appendicitis under the National Health Insurance in Taiwan.
OBJECTIVES: Rural-urban disparities in health remain a major focus of concern. This population-based study examined the performance of Taiwan's universal healthcare system in reducing rural-urban disparities in health, through better accessibility. Changes in the rates of ruptured appendicitis were compared between residents of remote and non-remote areas in Taiwan, under the National Health Insurance (NHI) programme. METHODS: We identified all 128,930 patients undergoing appendectomy in Taiwan between 1996 and 2001. The NHI inpatient files, enrolment files, major disease files, hospital registry and the household registry were linked to provide comprehensive individual and hospital information. Probit regression analyses were used to obtain adjusted estimates. RESULTS: During the first 3 years, although the differences between the remote and non-remote areas were apparent, they were seen to be narrowing. This downward trend continued, and, since 1999, few discernible differences have been observed. After adjusting for individual and hospital characteristics, over time, the ruptured appendix rate among remote area residents was seen to be decreasing significantly faster (1.1%) than among non-remote area residents. More specifically, the children showed a substantially steeper narrowing trend (3.3%) in rural-urban disparities, than did adults. CONCLUSIONS: Our findings have shown a significant narrowing of health disparities between remote and non-remote populations, resulting from free access to care and more healthcare provision in remote areas under the NHI programme; particular success has been observed in rural children. Although certain disparities still exist, Taiwan's universal healthcare system has effectively reduced rural-urban disparities in access to care and in ultimate health outcomes.
Adolescent↗
A call for action. The Pepper Commission's blueprint for health care reform.
After a year of deliberation and investigation, the Pepper Commission recommended action to ensure that all Americans would have health insurance protection in an efficient, effective health care system. Because it believes that action is urgent, the commission would build universal coverage by securing, improving, and extending the combination of job-based and public coverage we now have. Reform would entail the following elements: a combination of incentives and requirements that would guarantee all workers (with their nonworking dependents) insurance coverage through their jobs; replacement of Medicaid with a new federal program that would cover all those not covered through the workplace and workers whose employers find public coverage more affordable; guaranteed affordable coverage for employers--through reform of private insurance, tax credits for small employers, and the opportunity to purchase public coverage; a minimum benefit standard for private and public plans that would cover preventive and primary services as well as catastrophic care and would include cost sharing, subject to ability to pay; and a combination of public and private sector initiatives to promote quality and contain costs.
Cost Control↗
Antidepressant drug use in general practice: inter-practice variation and association with practice characteristics.
OBJECTIVE: The use of antidepressants (ADs) has escalated and prompted considerable debate. Many depressed patients go unrecognised or under-treated and the area of indication of the new ADs is widening. The aim of this study was to analyse (i). the variation in general practitioners' prescribing of ADs by comparing with prescribing of other drug groups and (ii). whether the general prescribing behaviour, practice activity and demography are associated with the AD prescribing. METHODS: Analysis of AD prescribing patterns among 174 general practices (93.5%) in the County of Funen, Denmark. Age- and sex-standardised 1-year incidences and prevalences of AD prescribing for patients listed were calculated using individual prescription data from Odense University Pharmacoepidemiologic Database. Data about health services and practice demography were obtained from the Health Insurance Register. The variation in AD 1-year prevalence was compared with other drug groups by a variation index (90%/10% percentile). Univariate linear regression analysis was used to examine associations between practice characteristics and prescribing. RESULTS: The 1-year prevalence of AD prescribing varied sixfold, no more than the prevalence of five other drug groups. Practices with high yearly: general prescribing prevalence, mean number of drugs per medicated patient, number of surgery consultations/100 patients and counsellings/100 surgery consultations showed the highest yearly prevalence of AD prescribing. Single-handed practices had higher AD prescribing rates than partnerships. The relative use of selective serotonin re-uptake inhibitors and other new ADs showed only little variation (10% and 90% percentiles as close as 66-86%), but practices with high 1-year prevalence and incidence most often chose the new ADs. CONCLUSION: Analysis of inter-practice variation showed no extraordinary quality problems with regard to AD prescribing, but does not exclude that there might be problems. The general prescribing pattern of the general practitioners seems essential to their attitude to AD prescribing. The relationship between counselling and prescribing was a feature specific to ADs and deserves further investigation. Quality indicators are needed to understand differences in AD prescribing, and studies based on prescription data have to be supplemented with individual clinical data.
Adult↗
Reflections on national health care reform based on Hawaii's experience.
In 1974, Hawaii began addressing the problem of health care accessibility. As a result of legislative action, near universal health care coverage has been achieved. These include employer mandates to provide adequate health insurance, regulation of insurance products, control of costly health care facilities, and government assistance to those not provided health insurance through employment. By providing primary care, total health care costs are considerably below national average--even though actual cost of living is over 30% greater. Public health statistics suggest a healthier population than the national average. This cannot be attributed to a healthy or relaxed lifestyle or ethnic mix, but rather to the state health care system itself. Economically and culturally, Hawaii closely resembles the rest of the United States, and there has been no evidence of reduced employment due to the aforementioned employer mandate.
Hawaii↗