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Health Care Delivery & Financing最新文献

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Out-of-Pocket Health Spending between Low- and High-Income Populations: Who is at Risk of Having High Financial Burdens? 低收入和高收入人群的自费医疗支出:谁有高经济负担的风险?
Health Care Delivery & Financing Pub Date : 2005-03-01 DOI: 10.3386/W11179
Yu‐Chu Shen, Joshua McFeeters
{"title":"Out-of-Pocket Health Spending between Low- and High-Income Populations: Who is at Risk of Having High Financial Burdens?","authors":"Yu‐Chu Shen, Joshua McFeeters","doi":"10.3386/W11179","DOIUrl":"https://doi.org/10.3386/W11179","url":null,"abstract":"We examined characteristics of people with little, moderate, and high burden of out-of-pocket health spending separately for low-income (below 200% of Federal Poverty Line) and higher-income populations. We find that public insurance appears to offer the best financial protection against high out-of-pocket burden. People with private non-group coverage, regardless of their income levels, have the highest risk of being exposed to high out-of-pocket burden. Low-income adults with employer-sponsored insurance are also more likely to be in high burden group than the low-income uninsured adults. For higher-income families, having a family member in fair or poor health is another significant risk factor to increase the likelihood of high out-of-pocket burden. Increasing presence of HMO and Federally Qualified Health Centers appear to have lowered the odds of being in the high-burden category relative to low-burden category, especially for the low-income group.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127339799","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}
引用次数: 2
Will Competitive Bidding Decrease Medicare Expenditures? 竞争性投标会减少医疗保险支出吗?
Health Care Delivery & Financing Pub Date : 2004-12-01 DOI: 10.2139/ssrn.628721
K. McGeary, Brett Katzman
{"title":"Will Competitive Bidding Decrease Medicare Expenditures?","authors":"K. McGeary, Brett Katzman","doi":"10.2139/ssrn.628721","DOIUrl":"https://doi.org/10.2139/ssrn.628721","url":null,"abstract":"Recent measures to reduce Medicare spending include the use of competitive bidding in determining reimbursement prices. Several competitive bidding experiments have recently been conducted by The Centers for Medicare and Medicaid Services (CMS) to determine reimbursement prices. This paper investigates the use of competitive bidding to specifically set reimbursement prices for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). First, the competitive bidding process is examined on a theoretical level. It is shown that the CMS competitive bidding process (auction) is inefficient, may actually lead to price increases, and may cause decreases in the quality of services. Next, data supporting the theoretical predictions is analyzed. Finally, we suggest switching to a Vickrey style auction that does not suffer from the problems of the current design.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125740302","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}
引用次数: 2
Long Term Care: The State, the Market and the Family 长期护理:国家、市场和家庭
Health Care Delivery & Financing Pub Date : 2004-12-01 DOI: 10.2139/ssrn.688901
P. Pestieau, Motohiro Sato
{"title":"Long Term Care: The State, the Market and the Family","authors":"P. Pestieau, Motohiro Sato","doi":"10.2139/ssrn.688901","DOIUrl":"https://doi.org/10.2139/ssrn.688901","url":null,"abstract":"In this paper we study the optimal design of a long term care policy in a setting that includes three types of care to dependent parents: public nursing homes, financial assistance by children and assistance in time by children. The instruments are public nursing homes and subsidies to aiding children, both financed by a flat tax on earnings. The only source of heterogeneity is children's productivity. Parents can influence their children by leaving them gifts before they know whether or not they will need long term care, yet knowing the productivity of the children. We show that the quality of nursing homes and the level of tax-transfer depend on their effect on gifts, the distribution of wages and the various inequalities in consumption. We also consider the possibility of private insurance.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116292976","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}
引用次数: 1
Waiting Lists, Waiting Times and Admissions: An Empirical Analysis at Hospital and General Practice Level 等候名单，等候时间和入院:在医院和一般实践水平的实证分析
Health Care Delivery & Financing Pub Date : 2004-12-01 DOI: 10.2139/ssrn.717661
F. Windmeijer, H. Gravelle, P. Hoonhout
{"title":"Waiting Lists, Waiting Times and Admissions: An Empirical Analysis at Hospital and General Practice Level","authors":"F. Windmeijer, H. Gravelle, P. Hoonhout","doi":"10.2139/ssrn.717661","DOIUrl":"https://doi.org/10.2139/ssrn.717661","url":null,"abstract":"We report an empirical analysis of the responses of the supply and demand for secondary care to waiting list size and waiting times. Whereas previous empirical analyses have used data aggregated to area level, our analysis focuses on the supply responses of a single hospital and the demand responses of the GP practices it serves, and distinguishes between first outpatient visits, inpatient admissions, day-case treatment and emergency admissions. The results are plausible and in line with the theoretical model. For example: the demand from practices for first outpatient visits is negatively affected by waiting times and distance to the hospital. Increases in waiting times and waiting lists lead to increases in supply; the supply of elective inpatient admissions is affected negatively by current emergency admissions and positively by lagged waiting list and waiting time. We use the empirical results to investigate the dynamic responses to one off policy measures to reduce waiting times and lists by increasing supply.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128436746","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}
引用次数: 33
India's Public Health System: How Well Does it Function at the National Level? 印度的公共卫生系统:在国家层面上运行得如何?
Health Care Delivery & Financing Pub Date : 2004-11-04 DOI: 10.1596/1813-9450-3447
M. Das Gupta, M. Rani
{"title":"India's Public Health System: How Well Does it Function at the National Level?","authors":"M. Das Gupta, M. Rani","doi":"10.1596/1813-9450-3447","DOIUrl":"https://doi.org/10.1596/1813-9450-3447","url":null,"abstract":"India has relatively poor health outcomes, despite having a well-developed administrative system, good technical skills in many fields, and an extensive network of public health institutions for research, training, and diagnostics. This suggests that the health system may be misdirecting its efforts, or may be poorly designed. To explore this, the authors use instruments developed to assess the performance of public health systems in the United States and Latin America based on the framework of the Essential Public Health Functions, identified as the basic functions that an effective public health system must fulfill. The authors focus on the federal level in India, using data obtained from senior health officials in the central government. The data indicate that the reported strengths of the system lie in having the capacity to carry out most of the public health functions. Its reported weaknesses lie in three broad areas. First, it has overlooked some fundamental public health functions such as public health regulations and their enforcement. Second, deep management flaws hinder effective use of resources-including inadequate focus on evaluation, on assessing quality of services, on dissemination and use of information, and on openness to learning and innovation. Resources could also be much better used with small changes, such as the use of incentives and challenge funds, and greater flexibility to reassign resources as priorities and needs change. Third, the central government functions too much in isolation and needs to work more closely with other key actors, especially with sub-national governments, as well as with the private sector and with communities. The authors conclude that with some reassessment of priorities and better management practices, health outcomes could be substantially improved.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114065440","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}
引用次数: 44
The Evolution of Income-Related Health Inequalities in Switzerland Over Time 瑞士与收入有关的健康不平等的演变
Health Care Delivery & Financing Pub Date : 2004-10-01 DOI: 10.1093/CESIFO/IFL013
R. Leu, M. Schellhorn
{"title":"The Evolution of Income-Related Health Inequalities in Switzerland Over Time","authors":"R. Leu, M. Schellhorn","doi":"10.1093/CESIFO/IFL013","DOIUrl":"https://doi.org/10.1093/CESIFO/IFL013","url":null,"abstract":"This paper presents new evidence on income-related health inequality and its development over time in Switzerland. We employ the methods lined out in van Doorslaer and Jones (2003) and van Doorslaer and Koolman (2004) measuring health using an interval regression approach to compute concentration indices and decomposing inequality into its determining factors. Nationally representative survey data for 1982, 1992, 1997 and 2002 are used to carry out the analysis. Looking at each of the four years separately the results indicates the usual positive relationship between income and health, but the distribution is among the least unequal in Europe. No clear trend emerges in the evolution of the inequality indices over the two decades. Inequality is somewhat lower in 1982 and 1992 as compared to 1997 and 2002 but the differences are not significant. The most important contributors to health inequality are income, education and activity status, in particular retirement. Regional differences including the widely varying health care supply, by contrast, do not exert any systematic influence.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130115502","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}
引用次数: 29
Steeping of Health Expenditure Profiles
Health Care Delivery & Financing Pub Date : 2004-10-01 DOI: 10.2139/ssrn.798226
J. Wasem
{"title":"Steeping of Health Expenditure Profiles","authors":"J. Wasem","doi":"10.2139/ssrn.798226","DOIUrl":"https://doi.org/10.2139/ssrn.798226","url":null,"abstract":"If health care expenditure for the elderly grows faster than for younger people, the expenditure profiles become “steeper” – we call that “steeping”. Three instruments for measuring “steeping” are presented: (1) trend of the relation between per capita expenditure of the old and the young; (2) comparing the linear slopes of per capita expenditure in age groups; (3) trend in parameters of nonlinear modelling of expenditure profiles. Using data of the largest German private health insurer over a period of 18 years, “steeping” could be observed by all three methods in most examined insurance plans. There are some hints that steeping also occurs in Germany's social health insurance system. The impact of steeping on the sustainability of the health system is discussed. Consequences for the calculation methods in a capital-funded health insurance system and for the implicit inter-generational contract within a pay-as-you-go financed social health insurance system are analysed. The link between “steeping” and the topic of the “red herring” discussion is elaborated. The Geneva Papers (2006) 31, 581–599. doi:10.1057/palgrave.gpp.2510100","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121443426","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}
引用次数: 34
The Evolution of Income-Related Inequalities in Health Care Utilization in Switzerland Over Time 瑞士医疗保健利用中与收入相关的不平等的演变
Health Care Delivery & Financing Pub Date : 2004-09-01 DOI: 10.2139/ssrn.596941
R. Leu, M. Schellhorn
{"title":"The Evolution of Income-Related Inequalities in Health Care Utilization in Switzerland Over Time","authors":"R. Leu, M. Schellhorn","doi":"10.2139/ssrn.596941","DOIUrl":"https://doi.org/10.2139/ssrn.596941","url":null,"abstract":"This study investigates equity in access to health care in Switzerland over time, using nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple quintile distributions and concentration indices are used to assess horizontal equity, i.e. the extent to which adults in equal need for medical care appear to have equal rates of medical care utilization. Looking at each of the four survey years separately the results indicate that by and large, there is little or no inequity in use except with respect to specialist visits which are clearly pro rich distributed as in most other OECD countries. We neither find much significant variation over time despite the fact that the share of health care has grown from close to 8% to more than 11% over this period and that a major reform of the health care system has taken place in 1996.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"203 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125734423","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}
引用次数: 18
Diversity and Regional Inequalities: Assessing the Outcomes of the Spanish 'System of Health Care Services' 多样性和地区不平等:评估西班牙“卫生保健服务体系”的成果
Health Care Delivery & Financing Pub Date : 2004-04-01 DOI: 10.2139/ssrn.563343
G. López Casasnovas, I. Planas, Joan Costa-Font
{"title":"Diversity and Regional Inequalities: Assessing the Outcomes of the Spanish 'System of Health Care Services'","authors":"G. López Casasnovas, I. Planas, Joan Costa-Font","doi":"10.2139/ssrn.563343","DOIUrl":"https://doi.org/10.2139/ssrn.563343","url":null,"abstract":"The consolidation of a universal health system coupled with a process of regional devolution characterise the institutional reforms of the National Health System (NHS) in Spain in the last two decades. However, scarce empirical evidence has been reported on the effects of both changes in health inputs, outputs and outcomes, both at the country and at the regional level. This paper examines the empirical evidence on regional diversity, efficiency and inequality of these changes in the Spanish NHS using cross-correlation, panel data and expenditure decomposition analysis. Results suggest that besides significant heterogeneity, once we take into account region-specific needs there is evidence of efficiency improvements whilst inequalities in inputs and outcomes, although more ‘visible’, do not appear to have increased in the last decade. Therefore, the devolution process in the Spanish Health System offers an interesting case for the experimentation of health reforms related to regional diversity but compatible with the nature of a public NHS, with no sizeable regional inequalitiest.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"213 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124203117","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}
引用次数: 35
Market Structure, Commitment, and Treatment Incentives in Health Care 医疗保健的市场结构、承诺和治疗激励
Health Care Delivery & Financing Pub Date : 2004-02-18 DOI: 10.2139/ssrn.544902
Nolan Miller
{"title":"Market Structure, Commitment, and Treatment Incentives in Health Care","authors":"Nolan Miller","doi":"10.2139/ssrn.544902","DOIUrl":"https://doi.org/10.2139/ssrn.544902","url":null,"abstract":"People are more distrustful of managed care organizations (MCOs) than traditional health plans, a phenomenon that has become known as \"managed-care backlash.\" In a model of the relationship between a patient, insurer, and physician, this paper shows that when the roles of insurer and provider are combined into a single player (as in a staff-model HMO), the equilibrium insurance plan departs from the social optimum, due to the fact that the HMO cannot credibly commit to providing non-least-cost care. In contrast, when the insurer and provider roles are separate, as in fee-for-service insurance, the equilibrium reimbursements for the physician implement the first-best treatment regime at first-best cost. Thus, the relative inability of MCOs to commit to non-least-cost care may account for at least part of managed-care backlash.","PeriodicalId":238933,"journal":{"name":"Health Care Delivery & Financing","volume":"212 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122672876","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}
引用次数: 3
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