Health Care Delivery & Financing eJournal最新文献

{"title":"Health Care and Insurance Schemes and Health Outcomes: A Global Comparative Analysis","authors":"Jessie Smith Nibley","doi":"10.2139/ssrn.1796342","DOIUrl":"https://doi.org/10.2139/ssrn.1796342","url":null,"abstract":"One of the largest and most urgent problems facing countries today - especially the United States - is health care. With an aging population and seemingly hard limits on resources such as doctors, organs, and medicine, each nation must attempt to distribute the available resources in a fair and efficient way without breaking the bank and, ideally, without selling out the health of its population. Nations’ attempts at creating workable health care systems result in regulatory and insurance schemes that vary widely across the globe, as countries form policies based on national values, institutions, and interests. Differing health outcomes among nations suggest that all health care delivery and insurance mechanisms are not equal. Some nations rely almost exclusively on the private sector for insurance and health care services, while others place health care and insurance squarely under government control, with wildly divergent results. This paper looks at the health systems in twenty-four countries, groups them according to common attributes in their health insurance and health care delivery regimes, and quantitatively compares the health outcomes achieved by those systems in order to answer the question: which health care delivery and insurance systems work best?","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129941051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Universal Health Coverage is Not the Same as Universal Health Care: An Evaluation of the Public Health Economics Behind the Obama-Plan – Or the Flawed Logic Behind a Flawed Goal","authors":"B. P. Billauer","doi":"10.2139/ssrn.1740509","DOIUrl":"https://doi.org/10.2139/ssrn.1740509","url":null,"abstract":"The political solution to the health crisis appears to be an expansion of the health coverage program, perhaps requiring universal and mandatory health insurance. Increased coverage is expected to result in affordable (and available) care, which will translate into earlier diagnoses and more effective treatment, which, in turn, is expected to lower national health costs. To sustain itself, any feasible insurance program must realize lower health costs, as even maximizing funds by including the young and well in the premium pot will not provide enough funds to cover the health care costs an aging population. However, the goal of universal coverage i.e., maximizing funding, is not the same as improving health or providing more health providers. Consequently, universal coverage per se will not result in lower health care costs, notwithstanding its promises to do so. The flaws of the current reasoning derive from some (unnamed, unspecified, and uncited) article of faith, - that once health insurance becomes mandatory, competitive and quality coverage will instantaneously materialize which would lower insurance costs. Driving this miraculous state of affairs would be the venerated concept of market-place competition. (What is considered quality care, of course, is not defined, but left to the market to determine.) Augmenting the planned panacea is the expectation of lowered health care costs due to costly wellness plans, prevention programs (much of which is now available for free on the internet), and early detection via increased screening programs. These responses are confused with, but different from, the costs of the insurance (which include administration and underwriting). Based on the fallacy that the root cause of ill health is late diagnosis, universal health insurance programs advocate early screening - a low cost device - falsely believing that screening prevents disease and that early diagnosis lowers health costs. The increased costs that will certainly result from increased screening - as we begin to detect more cases - is ignored in costing the program. In this article I demonstrate the fallacy of relying on early detection to lower health care costs, demonstrating instead that these programs will increase health costs in a manner that the insurance costs cannot handle, leading to either their ultimate failure and demise of the insurance product or a serious curtailment of benefits that emasculates the entire concept. Instead, I suggest that rather that showering everyone with generic care and screening - our initial focus should be identifying precise causes and the best cures for illnesses, determining whether past data are representative of the current population and hence reflect future disease mortality and morbidity costs. A comparative assessment of the cost of provider services by country is also suggested.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"211 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122877838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mutual Funds Industry in India: The Branches of Mutual Funds Investments","authors":"Naila Iqbal","doi":"10.2139/SSRN.1653632","DOIUrl":"https://doi.org/10.2139/SSRN.1653632","url":null,"abstract":"Mutual fund is a mechanism for pooling the resources by issuing units to the investors and investing funds in securities in accordance with objectives as disclosed in offer document. Investments in securities are spread across a wide cross-section of industries and sectors and thus the risk is reduced. Diversification reduces the risk because all stocks may not move in the same direction in the same proportion at the same time.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114883034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Transition and Health Care Reform: The Experience of Europe and Central Asia","authors":"Adam A. Leive","doi":"10.5089/9781451982183.001","DOIUrl":"https://doi.org/10.5089/9781451982183.001","url":null,"abstract":"This paper exploits the staggered adoption of major concurrent health reforms in countries in Europe and Central Asia after 1990 to estimate their impact on public health expenditure, utilization, and avoidable deaths. While the health systems all derived from the same paradigm under central planning, they have since introduced changes to policies regarding cost-sharing, provider payment, financing, and the rationalization of hospital infrastructure. Provider payment reforms produce the largest impact on spending, with fee-for-service increasing spending and patient-based payment reducing it. The impact on avoidable deaths is generally negligible, but there is some evidence of improvements due to fee-for-service.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115391841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Patients with Compulsory Health Insurance have to Wait Longer? The Influence of the Insurance Status on the Access to Medical Services in the In-Patient Care Sector in Germany","authors":"D. Sauerland, Bjoern A. Kuchinke, A. Wübker","doi":"10.2139/ssrn.1117846","DOIUrl":"https://doi.org/10.2139/ssrn.1117846","url":null,"abstract":"Background: International studies (e.g. Asplin et al. 2005) show that waiting time for inpatient treatment depends on how the claimed services are financed. In Germany there is an ongoing debate about the assumption that privately insured patients do not only receive more benefits than members of the statutory health insurance but that they also have better access to diagnosis and treatment services. This assumption is also supported by a current study (WIdO 2006) for the German outpatient sector. Problem: Existing analysis of the determinants for waiting times in Germany are essentially based on the questioning of patients and do not cover the inpatient sector. This paper aims to fill both gaps by (i) generating new primary data and (ii) analyzing waiting times in German hospitals. Methods: We selected 3 diagnoses for medical problems, where treatment has to be started at short notice. The diagnoses were taken from gynecology (cervical conization for PAP III D), cardiology (stenosis) and surgery (Weber B fracture). For these diagnoses, anonymous telephone calls were performed to make an appointment for inpatient treatment. Altogether, 687 hospitals were included in the study. The interviewers recorded, (i) whether or not the hospitals asked actively if the caller was privately insured and (ii) the time between the call and the appointed date for treatment. The data was then analyzed econometrically to find out if the kind of insurance had an impact on the waiting time. Methods applied were T-Test for paired samples and Mcnemars test respectively. Results: The results show that 25 percent of the hospitals actively ask for the kind of insurance coverage, that patients have. Within this group of hospitals, the average waiting time for a treatment appointment is significantly longer for members of the statutory health insurance funds. Whereas 41 percent of privately insured patients received a date for treatment within one week after the appointment call, only 28 percent of the statutory health insured patients got a date in that period of time. On average, they have to wait 1,6 days longer for an treatment than those privately insured. Conclusion: The results introduced here may be of interest for political decision makers. This not only applies before the background of basic discussions repeatedly held in Germany with regard to a two-class medical system, which also include the access to medical services.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"163 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122367615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There a Market for Voluntary Health Insurance in Developing Countries?","authors":"M. Pauly, Fredric E Blavin, S. Meghan","doi":"10.3386/W14095","DOIUrl":"https://doi.org/10.3386/W14095","url":null,"abstract":"In many developing countries the proportion of health care spending paid out of pocket is about half of all spending or more. This study examines the distribution of such spending by income and care type, and the variation in spending about its expected value, in order to see whether voluntary private health insurance that reduces variation in spending might be able to be supplied. Using data from the World Health Survey for 14 developing countries, we find that out of pocket spending varies by income but that most spending usually occurs in income quintiles below the topmost quintile. We use estimates of the variance of total spending, hospital spending, physician spending, and outpatient drug spending about their means to generate estimates of the risk premia risk averse consumers might pay for insurance coverage. For hospital spending and total spending, these risk premia as a percent of expenses are generally larger than reasonable estimates of private health insurer loading as a percent of expenses, suggesting that voluntary insurance might be feasible. However, the strong relationship between spending and income suggests that insurance markets may need to be segmented by income.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125984564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participant Perceptions and Decision-Making Concerning Retirement Benefits","authors":"C. Medill","doi":"10.2139/ssrn.1157480","DOIUrl":"https://doi.org/10.2139/ssrn.1157480","url":null,"abstract":"From 1964 until 2002, the State of Nebraska sponsored a defined contribution plan for its employees. During this period, the plan was unique among state pension plans because it was an individual account-type plan that offered participants the choice of a lump sum or annuity distribution upon retirement. Such a choice presents the opportunity to learn more about how individuals perceive financial risks and weigh various factors when deciding how to access their retirement benefits. This study reports the results of a new survey of Nebraska state workers who retired or terminated employment in 1997. The results offer a perspective on how individuals perceive their decisions 10 years later. The findings reveal three general themes. First, retirees tended to underestimate the financial risks associated with uninsured health care expenses. Sixty-five percent of retiree respondents said that they had initially underestimated such risk. Second, federal policies may influence the distribution decision. For example, many respondents cited tax penalties on lump sum distributions as a major factor in their decision, which is consistent with a high percentage choosing a nontaxable direct rollover distribution. Finally, the results provide a basis for cautious optimism that retirees will be able to successfully manage a present value sum distribution during retirement. Over 90 percent of retiree respondents reported that they were able to cover their living expenses 10 years after their retirement.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124069450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retiree Health Benefit Coverage and Retirement","authors":"J. Marton, Stephen A. Woodbury","doi":"10.2139/ssrn.924236","DOIUrl":"https://doi.org/10.2139/ssrn.924236","url":null,"abstract":"Employer-provided health benefits for workers who retire before age 65 has fallen over the last decade. We examine a cohort of male workers from the Health and Retirement Survey to explore the dynamics of retiree health benefits and the relationship between retiree health benefits and retirement behavior. A better understanding of this relationship is important to the policy debate over the best way to increase health coverage for older Americans without reducing work incentives. Concerning the dynamics at work, we find that, between 1992 and 1996, 24 percent of full-time workers who had retiree health benefits lost their coverage, while 15 percent of full-time workers who lacked coverage gained it. Also, of the full-time employed men who were covered by retiree health benefits in 1992 and had retired by 1996, 3 percent were uninsured, and 15 percent were covered by health insurance other than employer-provided insurance. On the relationship between retiree health benefits and retirement, we find that workers with retiree benefits were 29 to 55 percent more likely to retire than those without. We also find that workers who are eligible for retiree health benefits tend to take advantage of them when they are relatively young.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124511115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Welfare State Retrenchment: The Partisan Effect Revisited","authors":"B. Amable, Donatella Gatti, J. Schumacher","doi":"10.1093/OXREP/GRJ025","DOIUrl":"https://doi.org/10.1093/OXREP/GRJ025","url":null,"abstract":"This paper aims to shed light on the role of the 'ideology' of political parties in shaping the evolution of the welfare state in 18 developed democracies, by providing empirical findings on the determinants of social programs entitlements and social spending over the period 1981-1999. The paper shows that structural change is a major determinant of the extent of social protection. Our results suggest that overall spending is driven up by structural change. On the other hand, strong structural change has a negative influence on welfare entitlements measured by net replacement rates of sickness insurance or unemployment benefits. Partisan influence plays an important role in the dynamics of the welfare state. Left-wing governments strengthen the positive effect of shocks on aggregate social expenditure while right-wing governments undertake even stronger cutbacks in replacement rates as a reaction to structural change.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125661314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Did Medicare Do (and Was it Worth it)?","authors":"Amy N. Finkelstein, Robin McKnight","doi":"10.3386/W11609","DOIUrl":"https://doi.org/10.3386/W11609","url":null,"abstract":"We study the impact of the introduction of one of the major pillars of the social insurance system in the United States: the introduction of Medicare in 1965. Our results suggest that, in its first 10 years, the establishment of universal health insurance for the elderly had no discernible impact on their mortality. However, we find that the introduction of Medicare was associated with a substantial reduction in the elderly%u2019s exposure to out of pocket medical expenditure risk. Specifically, we estimate that Medicare%u2019s introduction is associated with a forty percent decline in out of pocket spending for the top quartile of the out of pocket spending distribution. A stylized expected utility framework suggests that the welfare gains from such reductions in risk exposure alone may be sufficient to cover between half and three-quarters of the costs of the Medicare program. These findings underscore the importance of considering the direct insurance benefits from public health insurance programs, in addition to any indirect benefits from an effect on health.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132996761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}