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PubMedDate not supplied

Health care cost containment strategies: the Jordanian experience.

Jordan's relative success in containing costs is the result of public financing of the health insurance system, the health care system reform strategy, and expanding the primary care network, which allows for cost containment and universal access based on the need for services rather than the ability to pay. The shift of costs from the public to the private sector must be curtailed. The determinants of health care (i.e. environment; human biology; life style; and health care system) are the main factors that determine future spending on health.

Cost Control↗
PubMed1994

Survey of health planning proposals.

It is important that physicians participate in the debate and planning process that will ultimately guide how we reform the way health care is financed and delivered in the United States. Herein is offered a perspective on the problem, one which is not necessarily appreciated by health planners. While we deliver the best quality of care in the world to most of our population, our system has been severely criticized because we fail to provide for access to a substantial minority of our population. Additionally, the cost of the product is considerably greater than that in comparable countries. Attempts to control costs without diminishing quality have introduced expensive complexities into our system without any real success in cutting costs. Several proposals have been advanced to address the issues of cost and access. One of these is a single payer system, common in Europe and Canada, whereby a single agent or group of agents finances all health care through universal rules and means. A system operating in Hawaii is a simple employer mandate to provide health insurance. A uniquely American plan is the Jackson Hole Plan or Managed Competition (now called "Managed Cooperation"). This system is currently popular among national health planners, and involves a defined minimum managed health plan offered by various groups of providers to employees and individuals through health plan purchasing cooperatives. This plan is interesting, but has not been implemented in any jurisdiction, and it is not certain it would accomplish its goals in practice since it is difficult to predict behavior of all parties to such a system.

Health Care Costs↗
PubMed1988

Scheduling mammograms for asymptomatic women.

A decision theoretic model was used to investigate the relative importance of risk level, radiation hazard, mammographic accuracy, and cost in mammographic screening decision. The model uses woman-specific medical and family history facts and clinic-specific information regarding mammographic accuracy and practice to profile both woman and clinic, and to formulate periodic screening recommendations. Model parameters were varied extensively to investigate the sensitivity of screening schedules to input values. Multivariate risk was estimated within the program using published data from the Breast Cancer Detection Demonstration Project 5-year follow-up study. Radiation hazard estimates were developed from published radiation physics and radioepidemiologic risk data. Benchmark values for mammographic sensitivity and specificity under screening conditions were calculated from Breast Cancer Detection Demonstration Project data. Procedural costs used in the analysis were varied around values reflecting conditions at the Washington University Medical Center. Mortality advantages of early versus late breast cancer detection were accounted for using Health Insurance Plan of New York case survival rates. Results are compared with published screening policies to provide insight into implicit assumptions behind those policies. This analysis emphasizes the importance of accounting for variations in clinical accuracy under screening circumstances, in costs, in radiation exposure, and in woman-specific risk when recommending mammographic screening.

Aged↗
PubMed2005

Prevalence of adequate control of increased serum low-density lipoprotein cholesterol in self-pay or Medicare patients versus Medicaid or private insurance patients followed in a University General Medicine Clinic.

In a study of 514 patients with increased serum low-density lipoprotein (LDL) cholesterol followed in a general medicine clinic at a university hospital, the serum LDL cholesterol in patients with coronary heart disease (CHD), other atherosclerotic vascular disease, or diabetes mellitus was <100 mg/dl in 219 of 276 patients (79%) with Medicaid or private insurance and in 28 of 67 self-pay or Medicare patients (42%) without pharmaceutical coverage (p <0.001). The serum LDL cholesterol was <130 mg/dl in patients with 2+ risk factor and a 10-year risk for CHD of < or =20% or <160 mg/dl in patients with a 0 to 1 risk factor, and a 10-year risk for CHD of <10% in 54 of 141 patients (38%) with Medicaid or private insurance and in 5 of 30 self-pay or Medicare patients (17%) (p <0.025).

Aged↗
PubMed2005

Descriptive epidemiology of affective disorders in multiple sclerosis.

BACKGROUND: Affective disorders present an important clinical challenge in multiple sclerosis (MS). Due to prohibitive sample size requirements, population-based studies have not yet provided an adequate description of the underlying epidemiology of this association. OBJECTIVE: To describe the epidemiology of affective disorders in MS in a general population sample. METHODS: The study presented here accessed administrative data from a universal healthcare insurance plan in the Canadian province of Alberta. Physician billing data recorded in the Alberta Health Care Insurance Plan was used to identify members of the population >15 years of age with and without MS. Crude and stratified estimates of the association between affective disorders and MS were made. Logistic regression analysis was used to evaluate statistical interactions and to provide adjusted estimates of the association. RESULTS: The estimated prevalence of MS in the population within the targeted age range (2.3 million individuals) was 386/100,000 and that of affective disorders was 7.7%. As expected, an association between MS and affective disorders was identified (crude relative prevalence: 2.2). The association varied in strength over age-sex categories. Although the prevalence of affective disorder was higher in women with MS than men with MS, the association of MS with affective disorders was stronger in men. The strength of association declined with age in both men and women. Affective disorder prevalence in people with MS becomes similar to that of the general population in older age groups. CONCLUSION: Affective disorders occur with an increased frequency in MS. This is true in men and women and across all relevant age groups, although the association gets weaker with advancing age. Higher frequencies of affective disorder occur in women with MS than in men with MS. The frequency of affective disorder in people with MS is highest in the 25-44 age group, and declines in older age categories.

Adolescent↗
PubMed2006

Caring for the new uninsured: Hospital charity care for older people without coverage.

Despite near-universal coverage through Medicare, a number of elderly residents in the United States do not have health insurance coverage. To the author's knowledge, this study is the first to document trends in the use of hospital charity care by uninsured older people. Data from the New Jersey Charity Care Program, which subsidizes hospitals for services provided to low-income uninsured people, were used to analyze trends in charity care utilization by older people from 1999 to 2004. Charity care charges are standardized to uniform Medicaid reimbursement rates and inflation adjusted using the Medical Care Consumer Price Index. From 1999 to 2004, use of charity care by older people grew much faster than it did for younger patients. As a result, older people now account for a greater share of hospital charity care in New Jersey than children. Elderly users of charity care generated higher costs per patient than their younger counterparts. Cost differences were especially salient at the upper end of the distribution, where high-cost elderly patients used significantly more resources than high-cost patients in other age groups. These results highlight an emerging source of strain on the healthcare safety net and point to a growing population of uninsured residents who have costly and complex medical needs. Similar experiences are likely to be found in other states, especially those that have growing populations of elderly immigrants who are likely to lack health insurance.

Adult↗
PubMed1996

The pleasures and perils of prophetic advocacy: Henry E. Sigerist and the politics of medical reform.

Henry E. Sigerist, an internationally renowned medical historian, played a surprisingly important and visible role in American medical politics in the 1930s and 1940s. Born in Paris of Swiss parents, he was professor in Leipzig, Germany, before coming to the United States in 1932 as professor of the history of medicine at Johns Hopkins University. Once in America. Sigerist became deeply involved in medical politics and the campaign for national health insurance. He argued that individualized medical practice was outdated and should gradually be superseded by state-run and state-financed health services. National health insurance was but one step in this historical progression. Sigerist thus lent the weight of history itself to the cause of medical care reform. The charming and erudite Sigerist was welcomed by the leaders of academic medicine in America. Soon, he emerged as a spokesman of the left wing of the medical profession, an effective and popular speaker and an impassioned advocate of socialized medicine. This paper traces Sigerist's political ideas and activities, and his contributions toward medical care reform in the United States.

Germany↗
PubMed1978

[Organization and tasks of occupational medicine in Switzerland].

Industrial health aims to harmonize man's relation to his work. In our country indusprial health is promulgated by the medical services of SUVA (Swiss Accident Insurance Institute) and BIGA (Federal Office for Industry and Labour) on one hand and by the lecturers of universities and at the ETH (Swiss Federal Institute of Technology) as well as by plant physicians on the other hand. Industrial health is a compulsory discipline with examination at medical faculties.

Occupational Medicine↗
PubMed1993

Combining a global health budget with a market-driven delivery system. Can it be done?

Two correlated problems, rampant escalation of health-care costs and the lack of access to health care for many Americans, challenge long-term solutions to our health-care crisis. Historically, free markets have provided the most effective method of controlling costs. Although the current health-care system is highly competitive, it falls far short of being a truly competitive marketplace emphasizing competition around cost and quality. A health-care system based on managed competition in which the marketplace is structured to create competition on cost and quality provides great promise for regulating health costs. Erosion of health-care benefits under our current system of employer-based health insurance threatens the effectiveness of any market-based solution. The 21st Century Health Care Act combines the cost-effectiveness and universal access derived through a single revenue spigot with the power of a market approach created by managed competition.

Delivery of Health Care↗
PubMed1991

Prudence in international comparisons: insights for the United States from the Canadian health insurance experience.

Canadian social insurance for medical care started in the province of Saskatchewan in 1946, when conditions were very different from those in the United States today. The Cooperative Commonwealth Federation political party has no counterpart in the United States today. Voluntary insurance was weak in the Canadian priaries, but currently strong in the United States. The U.S. Medicare and Medicaid programs help elderly and poor people, but Saskatchewan lacked such programs. Separation of executive and legislative powers in the United States differs from unified powers in Canada. However, there are several similarities between the U.S. federation of states, and the Canadian provinces. The U.S. Democratic Party has a progressive wing. Voluntary insurance in the United States grew weaker in the 1980s. The U.S. health care crisis on costs today is equivalent to post-Depression conditions in Canada. Both countries are dominated by private fee-for-service medical care, but access to that care has been promoted by compulsory insurance laws in several U.S. states. Therefore, the United States could well emulate Canada by action of the states, which would lead eventually to federal action. Coverage should be universal, with limited benefits initially; gradually, benefits would be broadened.

Canada↗
PubMed1992

Universal access in Canada. Questions of equity remain.

Health/PAC readers will remember Samuel Wolfe's previous Bulletin article about Canada's national health care system ("Importing Health Care Reform? Issues in Transposing Canada's Health Care System to the United States," Summer 1990), in which he described the uniqueness of our northern neighbor's experience. At that time, Wolfe expressed doubt that a Canadian-like model could find sufficient political and social momentum to be propelled south. In this latest article, Wolfe is joined by his long-time colleague, Robin Badgley, to discuss the inequity and inequality they believe still exists within the Canadian system. Wolfe and Badgley's insightful analysis of what they see as shortcomings of the Canadian model and suggestions for their remedy are especially welcome given the questionable validity of most criticism of the Canadian system that Americans hear. Their work helps us understand the real problems that remain in the still-evolving Canadian system. As Americans discuss the various possibilities for progressive single-payer reform, many envision of state-based system. Wolfe and Badgley point out that demographically rooted inequalities and the lingering health burdens of social class may interfere with truly national universal access. They also alert us to the dangers that federal retreat from adequate levels of support would pose to such a state strategy. Samuel Wolfe has a unique background as a country doctor, psychiatrist, and public health official who attended the difficult birth of Saskatchewan's provincial health plan--the prototype for Canada's national health insurance. A respected teacher, researcher, and community health activist, Wolfe has taught in the United States for more than 25 years. He will soon move back to Canada and the welcome security of its universal health care system.

Canada↗