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PubMed1995

The main challenges.

The last few decades have witnessed dramatic changes, not only in health, but also in all aspects of human life. From the social point of view, the individual and family are again becoming the focus of attention, and there is an increasing concern about socio-economic conditions and human rights. From the health point of view, morbidity and mortality patterns are changing and many people live longer and fewer people die. The reasons behind these changes are mainly the expansion in knowledge and technology and the concern about our lifestyles. These changes impact heavily on both medical education, the delivery of health services, and the cost of health care. Medical schools should respond by introducing changes in the medical education process and ensure the proper training of a new generation of doctors who are community- and socially oriented, capable of relating to the community and its needs. The health care system should also respond to these changes by restructuring its organization and finance to ensure quality in health care and that health services are not rationed according to an individual's ability to pay. There are apparent advantages in establishing close links between medical education and health care. Both systems and the community stand to gain from these links. Full integration of the two systems could be the final objective but should be preceded by careful study and experimentation.

Costs and Cost Analysis↗
PubMed1994

Bond ratings, debt insurance, and hospital operating performance.

In this study, the operating performances of not-for-profit community hospitals are compared among groups partitioned by bond ratings, level of debt insurance coverage, and number of bond rating services. The analysis indicates that the performances of hospitals with full debt insurance coverage resulting in AAA ratings are significantly lower than those of hospitals with partial debt insurance and with AA ratings or better. Indeed, the hospitals with full debt insurance resemble those with partial insurance that are rated BBB to A. These findings have implications for managerial action choices. Hospitals seeking external funding to improve their operating performance may consider the costs and benefits of full insurance coverage.

Analysis of Variance↗
PubMed1993

National health care reform and community and migrant health centers.

Community and migrant health centers (CHCs) have been shown to increase access to health care, improve health status, and reduce health care costs in communities that they serve. Thus CHCs can play an important role in providing for underserved communities under any program of national health care reform whose aim is universal, affordable access. To benefit the poor, such a plan should be federally administered and progressively financed, with comprehensible enrollment procedures, easy paperwork, and clearly delineated limits and benefits.

Community Health Centers↗
PubMed2005

Community-based health insurance in poor rural China: the distribution of net benefits.

The collapse of China's Cooperative Medical System (CMS) in 1978 resulted in the lack of an organized financing scheme for health care, adversely affecting rural farmers' access to health care, especially among the poor. The Chinese government recently announced a policy to re-establish some forms of community-based insurance (CBI). Many existing schemes involve low premiums but high co-payments. We hypothesized that such benefit design leads to unequal distribution of the "net benefits" (NB)--benefits net of payment--because even though low premiums are more affordable to poor farmers, high co-payments may have a significant deterrent effect on the poor in the use of services in CBI. To test this hypothesis empirically, we estimated the probability of farmers joining a re-established CBI using logistic regression, and the utilization of health care services for those who joined the scheme using the two-part model. Based on the estimations, we predicted the distribution of NB among those who joined the CBI and for the entire population in the community. Our data came from a household survey of 4160 members of 1173 households conducted in six villages in Fengshan Township, Guizhou Province, China. Three principal findings emerged from this study. First, income is an important factor influencing farmers' decision to join a CBI despite the premium representing a very small fraction of household income. Secondly, both income and health status influence enrollees' utilization of health services: richer/sicker participants obtain greater NB from the CBI than poorer/healthier members, meaning that the poorer/healthier participants subsidize the rich/sick. Thirdly, wealthy farmers benefit the most from the CBI with low premium and high co-payment features at every level of health status. In conclusion, policy recommendations related to the improvement of the benefit distribution of CBI schemes are made based on the results from this study.

Adolescent↗
PubMed1996

Rural maternity care: new models of access.

Despite huge health care expenditures, many rural areas of the United States are without adequate access to basic maternity services. Hospital closures and changes in reimbursement have created new threats, even in areas with functional systems of delivering maternity care. New models of care must be developed that take advantage of attributes of low-volume rural maternity units, increase the number of collaborative practices among various providers of maternity services, and judiciously apply new technologies to bring perinatal expertise into the rural hospital when appropriate. Local access to maternity care in rural communities is essential to improve birth outcomes and lower costs. Standardization of management of obstetric emergencies and advances in telecommunication technology may make these low-technology, isolated communities safer than they have been in the past. Changes in health care financing, particularly managed care with capitation, may further support these changes.

Female↗
PubMedDate not supplied

An overview of public sector financing for pediatric home care: Part 1.

This article is the first of a two-part series providing an overview of the public sector financing plans for children who require pediatric services at home and in the community. It is intended to assist families and health care professionals in accessing services that would alleviate some of the costs of long-term care.

Adolescent↗
PubMed1995

Compliance with the 24-hour, in-house attending coverage requirement. A survey.

Fifty-six residency training programs in Region I Council on Resident Education in Obstetrics and Gynecology/Association of Professors in Gynecology and Obstetrics were surveyed for compliance with the 24-hour, in-house attending coverage requirement, which took effect July 1991. Forty-six program directors responded to a questionnaire, for a response rate of 82.1%. Each had plans to implement this coverage in the 1991-1992 academic year. Two programs were unable to implement coverage because of inadequate financing or insufficient staffing. There were no differences in the types of programs (community, university, public or private university, or New York State program) in respondents as compared to non respondents. All the programs had overnight staff coverage for an average of 13 hours (range, 12-15) and had 24-hour, continuous coverage on the weekend. There was a wide variation in the attending/resident ratio. Twenty-eight programs (60.8%) reported that they compensated their attendings. Revenue for this compensation came from the hospitals (14), direct billing (8), faculty practice plans (6) or New York State (3). Of the 28 programs that offered compensation, 20 were private community hospitals, 6 were private university programs, 1 was a public university program and 1 was a public community hospital. Of the 28 programs compensating faculty, 17 were able to cite figures that had been approved by their respective institutions or practice plans. The annual cost ranged from $130,300 to $901,887 per program for institutions that compensated their attendings (mean, $340,402).

Gynecology↗
PubMed1995

Financing health care in Ghana.

Attempts to recover some government health care expenses through user charges have produced less revenue than hoped. National health insurance offers an attractive alternative, but needs to include features which check cost escalation. Community involvement and traditional medicine can also help to reduce costs.

Delivery of Health Care↗
PubMed1976

Health care financing in China.

Today's China, still a developing country with per capita health expenditure of 50 cents to one dollar (U.S.), has established a complex network of health facilities and well-distributed health personnel through the efforts of the existing political structure. The curative health services are decentralized and provide care through a variety of plans which combine capitation prepayment and modified fee-for service. Each plan is striving for the goal of making health care accessible to all at low cost, and hence, efforts of cost containment for self-sufficiency are widely practiced. The responsibility of the preventive health services (such as health education, screening, family planning, food distribution, etc.) are assumed by the central government and they are provided without charge to encourage maximal utilization. Other features of the Chinese system discussed include self-reliance, self-sufficiency, mass orientation, regionalization and innovative utilization of existing facilities, and personnel.

Allied Health Personnel↗
PubMedDate not supplied

Equity shortfalls & failure of the welfare state: community willingness to pay for health care at government facilities in Jehlum (Pakistan).

BACKGROUND: The question of willingness to pay is very crucial in planning for services. In Pakistan, the long-term issues of sustainability of health systems particularly, allocation of finances have routinely been addressed by planners with insufficient data and unclear goals. This study was conducted with the objectives to determine the demand for health care services in the community; at first level care facilities and community level and determine the willingness of the community (Willingness to pay) to participate in cost sharing mechanisms for provision of primary health care in fee for service and prepayment mechanisms. METHODS: A cross sectional stratified household interview survey of 600 households was carried out in urban and rural areas of district Jehlum, to address the financial sustainability of government health care interventions at the community level and to explore the question of willingness to pay for health care and their ability to participate in the cost sharing mechanisms. RESULTS: In response to willingness to pay at a Government facility to obtain health care 437 (72.7%) of the households expressed their willingness to pay for health care. In 72% of the cases, cost was not considered as a barrier in seeking care and only 19% of the cases considered cost as a partial barrier; the rest said that cost prohibited seeking care. A majority across all strata is willing to pay for consultation and medicines at public sector facilities, although the responses from the low income groups exhibit a slight decrease in the willingness to pay. The willingness to pay is marginally affected by income, place of residence and/or cost of the treatment incurred. CONCLUSION: The findings of this study suggest that the community is willing to pay for health care at the public sector facilities if payment can ensure provision of essential curative services and medications at improved quality levels.

Adolescent↗