scholarly journals The economic crisis, the Pharmaceutical Benefits Scheme, and the dilemmas of medicines policy

2009 ◽  
Vol 33 (2) ◽  
pp. 171
Author(s):  
Hans Löfgren
Keyword(s):  
Health Insurance ◽  
Middle Class ◽  
The United States ◽  
Insurance Companies ◽  
Real Economy ◽  
Access To Health Services ◽  
Australian Health ◽  
The Media ◽  
Social Disaster ◽  
The Cost

AS THIS SPECIAL ISSUE of Australian Health Review was finalised, the media reported daily on the global financial debacle and its deepening into a crisis in the real economy. The causes of the crisis are hazy ? but its impact, across the globe, on people?s lives is real and distressing. Many people are affected by worsening poverty and deteriorating access to health services and medicinal drugs. In the United States, unemployment often means the loss of health insurance, reinforcing risks of financial and social disaster for many families who would have previously considered themselves comfortable middle class. For those lucky enough to retain jobs, the cost of health insurance may rapidly become unaffordable; ?Healthcare a Budget-Buster for Families; Even County?s Middle Class Can?t Afford It?, ran a typical recent headline in a non-metropolitan newspaper.1 Even before the present crisis, tens of millions of Americans were excluded from health insurance. Those not excluded pay premiums to insurance companies that spend vast resources trying to insure the healthy, avoid the sick, and deny payment for claims wherever possible. Gaining power partly on a wave of resentment against the excesses of neo-liberalism, President Barak Obama has promised public health insurance for those not otherwise covered. Should this reform be successfully implemented, it will belatedly bring to US citizens a level of security approximating what Australians, and many Europeans, have had for decades.

A comprehensive assessment of the cost of multiple sclerosis in the United States

1998 ◽  
Vol 4 (5) ◽  
pp. 419-425 ◽  
Author(s):  
Kathryn Whetten-Goldstein ◽  
Frank A Sloan ◽  
Larry B Goldstein ◽  
Elizabeth D Kulas
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Insurance ◽  
Informal Care ◽  
Annual Cost ◽  
Lifetime Cost ◽  
The United States ◽  
Personal Health ◽  
Secondary Sources ◽  
The Cost

Comprehensive data on the costs of multiple sclerosis is sparse. We conducted a survey of 606 persons with MS who were members of the National Multiple Sclerosis Society to obtain data on their cost of personal health services, other services, equipment, and earnings. Compensation of such cost in the form of health insurance, income support, and other subsidies was measured. Survey data and data from several secondary sources was used to measure costs incurred by comparable persons without MS. Based on the 1994 data, the annual cost of MS was estimated at over $34 000 per person, translating into a conservative estimate of national annual cost of $6.8 billion, and a total lifetime cost per case of $2.2 million. Major components of cost were earnings loss and informal care. Virtually all persons with MS had health insurance, mostly Medicare/Medicaid. Health insurance covered 51 per cent of costs for services, excluding informal care. On average, compensation for earnings loss was 27 per cent. MS is very costly to the individual, health care system, and society. Much of the cost (57 per cent) is in the form of burdens other than personal health care, including earnings loss, equipment and alternations, and formal and informal care. These costs often are not calculated.

Comparative analysis of health system performance in Montreal and New York: the importance of context for interpreting indicators

2018 ◽  
Vol 14 (1) ◽  
pp. 101-118 ◽  
Author(s):  
Michael K. Gusmano ◽  
Erin Strumpf ◽  
Julie Fiset-Laniel ◽  
Daniel Weisz ◽  
Victor G. Rodwin
Keyword(s):  
New York ◽  
Health Insurance ◽  
Ambulatory Care ◽  
Health Systems ◽  
Empirical Studies ◽  
Insurance Coverage ◽  
The United States ◽  
Necessary Condition ◽  
Access To Health Services ◽  
Financial Barriers

AbstractAlthough eliminating financial barriers to care is a necessary condition for improving access to health services, it is not sufficient. Given the contrasting health systems with regard to financing and organization of health insurance in the United States and Canada, there is a long history of comparing these countries. We extend the empirical studies on the Canadian and US health systems by comparing access to ambulatory care as measured by hospitalization rates for ambulatory care sensitive conditions (ACSC) in Montreal and New York City. We find that, in New York, ACSC rates were more than twice as high (12.6 per 1000 population) as in Montreal (4.8 per 1000 population). After controlling for age, sex, and number of diagnoses, significant differences in ACSC rates are present in both cities, but are more pronounced in New York. Our findings are consistent with the hypothesis that universal, first-dollar health insurance coverage has contributed to lower ACSC rates in Montreal than New York. However, Montreal’s surprisingly low ACSC rate calls for further research.

Abstract 18272: The Increasing Proportion of Acute Myocardial Infarction Represented by the Uninsured: a Growing Financial Burden in the United States

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bethany Doran ◽  
Yu Guo ◽  
Jinfeng Xu ◽  
Sripal Bangalore
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Health Insurance ◽  
Financial Burden ◽  
Insurance Coverage ◽  
The United States ◽  
The Us ◽  
Hospital Stays ◽  
Nationally Representative ◽  
The Cost

Introduction: Under the provisions of the Affordable Care Act, insurance coverage will markedly increase with the Congressional Budgetary Office estimating the number of insured to increase by approximately 13 million in 2014 and 25 million in 2016. However, approximately 31 million non-elderly US citizens are expected to remain without health insurance in 2016. Acute myocardial infarction (AMI) remains a source of significant morbidity and mortality, as well as cost to society. No prior studies have examined temporal rates of uninsured among patients presenting with an AMI using a nationally representative database. Hypothesis: We tested the hypothesis that the proportion of uninsured individuals with AMI and cost of uninsured to society will vary by year. Methods: We used the Nationwide Inpatient Sample (NIS), which contains estimates from approximately 8 million hospital visits and information related to number of discharges, aggregate charges, and principal diagnoses of all patients discharged in the US. We calculated the percentage of acute myocardial infarction by insurance status, and the sum of all charges of hospital stays in the US adjusted for inflation. Results: The cost to society due to acute myocardial infarction in the uninsured increased substantially from 1997 to 2012, with total cost in 1997 of $852,596,272 and $3,446,893,954 in 2012 after adjustment for inflation. In addition, although rates of AMI decreased in the general population (from 268.6/100,000 individuals in 1997 to 193.8/100,000 individuals in 2012), the proportion of individuals with AMI who were uninsured increased (from 3.83% in 1997 to 7.37% in 2012). Conclusions: The proportion of those experiencing AMI who are uninsured is rising, as is cost to society. It remains to be seen what the effects of expanding health insurance will have on the rate of AMI as well as proportion of AMI represented by the uninsured.

Preemption and the MLR Provision of the Affordable Care Act

2014 ◽  
Vol 40 (2-3) ◽  
pp. 280-297
Author(s):  
Jeffrey Hoffmann
Keyword(s):  
United States ◽  
Health Insurance ◽  
Affordable Care Act ◽  
The United States ◽  
Insurance Companies ◽  
United States Department ◽  
Loss Ratio ◽  
Department Of Health ◽  
Outstanding Question ◽  
Medical Loss Ratio

This Note focuses on the medical loss ratio provision (“MLR Provision”) of the Patient Protection and Affordable Care Act (ACA). The MLR Provision states that health insurance companies must spend at least a certain percentage of their premium revenue on “activities that improve healthcare quality” (in other words, meet a minimum threshold medical loss ratio) and comply with reporting requirements determined by the Secretary of the United States Department of Health and Human Services (HHS). Because states have historically had authority over the regulation of health insurance, there is an outstanding question as to whether or not the MLR Provision has legal authority to preempt conflicting state MLR regulations.Part II of this Note outlines the major requirements in the MLR Provision and discusses the history of MLR regulation in the United States. Part III discusses the likelihood that the courts will soon resolve the question of preemption regarding the MLR Provision.

The Marriage Paradox

2017 ◽  
Author(s):  
Brian J. Willoughby ◽  
Spencer L. James
Keyword(s):  
United States ◽  
Middle Class ◽  
Emerging Adults ◽  
Young Adulthood ◽  
Mixed Method ◽  
The United States ◽  
Mixed Method Study ◽  
National Data ◽  
The Media ◽  
National Trends

This book explores one of the more puzzling findings in modern young adulthood. Most emerging adults report they value marriage highly, yet more and more of them are delaying and appear to be avoiding marriage. Using a mixture of national data and a mixed-method study of middle-class emerging adults from the Midwest, the book explores why this paradox might exist. Using interview data, the authors weave stories of real emerging adults into their narrative to provide illustrative examples of the concepts and themes being discussed. National data are provided to connect themes to national trends in the United States. Within the book, the authors explore how the context of emerging adulthood influences this paradox as well as the specific paradoxes being created around emerging adults’ beliefs regarding the timing of marriage, its importance, and how emerging adults seek potential spouses. Finally, the authors explore how factors such as parents, religion, and the media have all helped create many of these paradoxes before giving suggestions for how some of these paradoxes might be resolved.

scholarly journals A practical application of credibility to experience rating plans for hospitalization and medical-surgical insurance

1968 ◽  
Vol 5 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Mark Kormes
Keyword(s):  
Surgical Care ◽  
The United States ◽  
Insurance Companies ◽  
Simple Application ◽  
Practical Application ◽  
Experience Rating ◽  
Non Profit ◽  
Gradual Loss ◽  
The Cost ◽  
Blue Shield

This paper describes a rather simple application of credibility which was used to develop experience rating plans for Blue Cross and Blue Shield organizations in the United States. These are non-profit corporations which provide prepaid coverage for the cost of hospitalization and medical-surgical care. The benefits are in many instances full service benefits so that there is no additional cost to the subscribing member.While coverage is being granted to individual applicants, the bulk of the unterwriting is composed of groups, that is employees of a given commercial entity. Since the plans are voluntary and, in many instances, the employer either acts only as collecting agent for his employees or else pays only a fraction of the premium, certain minimum participation percentages have been established to prevent anti-selection.Because of the competion of Insurance Companies which have concentrated their efforts on larger and more profitable groups (especially those where the employer pays all of the premiums) it was early recognized that a uniform or “community” rate will result in a gradual loss of groups with good experience thereby requiring substantial increases in the average rates. The original program of experience rating which the author has developed for the Massachusetts Blue Cross in 1949 has been since adopted “mutatis mutandis” by a number of other Blue Cross and Blue Shield organizations.

The Use of Data Mining by Private Health Insurance Companies and Customers’ Privacy

2015 ◽  
Vol 24 (3) ◽  
pp. 281-292 ◽  
Author(s):  
YESLAM AL-SAGGAF
Keyword(s):  
Data Mining ◽  
Health Insurance ◽  
Private Health Insurance ◽  
Personal Information ◽  
Qualitative Interviews ◽  
Ethical Analysis ◽  
Insurance Companies ◽  
Australian Health ◽  
Use Of Data ◽  
Health Insurance Companies

Abstract:This article examines privacy threats arising from the use of data mining by private Australian health insurance companies. Qualitative interviews were conducted with key experts, and Australian governmental and nongovernmental websites relevant to private health insurance were searched. Using Rationale, a critical thinking tool, the themes and considerations elicited through this empirical approach were developed into an argument about the use of data mining by private health insurance companies. The argument is followed by an ethical analysis guided by classical philosophical theories—utilitarianism, Mill’s harm principle, Kant’s deontological theory, and Helen Nissenbaum’s contextual integrity framework. Both the argument and the ethical analysis find the use of data mining by private health insurance companies in Australia to be unethical. Although private health insurance companies in Australia cannot use data mining for risk rating to cherry-pick customers and cannot use customers’ personal information for unintended purposes, this article nonetheless concludes that the secondary use of customers’ personal information and the absence of customers’ consent still suggest that the use of data mining by private health insurance companies is wrong.

Capitalizing on Illness: The Health Insurance Industry

1974 ◽  
Vol 4 (4) ◽  
pp. 583-598 ◽  
Author(s):  
Thomas Bodenheimer ◽  
Steven Cummings ◽  
Elizabeth Harding
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
Access To Health Care ◽  
Insurance Industry ◽  
Private Insurance ◽  
The United States ◽  
Insurance Companies ◽  
Health Insurance Industry

The private health insurance industry in the United States began as a money-collection mechanism for hospitals and doctors, and has evolved into an important profit-making sector of the economy. Blue Cross is dominated by hospital representatives and serves to channel money into the nation's hospitals. Physicians control Blue Shield and are its principal beneficiaries. And commercial insurance companies are closely linked to banks and industrial corporations through the country's large financial empires. Some effects of this elite control over the health insurance industry have been inadequate and distorted insurance coverage, discrimination against the elderly, the sick, and the poor, and rapidly rising medical costs. In addition, the control of Medicare and Medicaid by private insurance institutions has contributed to the enormous inflation produced by these programs. Though governments, consumers, and even the insurance industry itself are beginning to apply controls to the unprecedented medical inflation of the late 1960s, these controls tend to limit access to health care, especially for low-income people. Unless insurance companies are barred from the health care field and a public financing mechanism based on progressive taxation is introduced, health care will never be an equal right for everyone in the United States.

scholarly journals The provision of chiropractic, physiotherapy and osteopathic services within the Australian private health-care system: a report of recent trends

2014 ◽  
Vol 22 (1) ◽  
Author(s):  
Roger M Engel ◽  
Benjamin T Brown ◽  
Michael S Swain ◽  
Reidar P Lystad
Keyword(s):  
Health Insurance ◽  
Private Sector ◽  
Private Health Insurance ◽  
Healthcare Services ◽  
Health Practitioner ◽  
Service Utilisation ◽  
Australian Health ◽  
Insurance Cover ◽  
Australian Bureau Of Statistics ◽  
The Cost

Abstract Background Chiropractors, physiotherapists, and osteopaths receive training in the diagnosis and management of musculoskeletal conditions. As a result there is considerable overlap in the types of conditions that are encountered clinically by these practitioners. In Australia, the majority of benefits paid for these services come from the private sector. The purpose of this article is to quantify and describe the development in service utilization and the cost of benefits paid to users of these healthcare services by private health insurers. An exploration of the factors that may have influenced the observed trends is also presented. Methods A review of data from the Australian Bureau of Statistics, Australian Health Practitioner Regulation Agency, and the Australian Government Private Health Insurance Administration Council was conducted. An analysis of chiropractic, physiotherapy and osteopathic service utilisation and cost of service utilisation trend was performed along with the level of benefits and services over time. Results In 2012, the number of physiotherapists working in the private sector was 2.9 times larger than that of chiropractic, and 7.8 times that of the osteopathic profession. The total number of services provided by chiropractors, physiotherapists, and osteopaths increased steadily over the past 15 years. For the majority of this period, chiropractors provided more services than the other two professions. The average number of services provided by chiropractors was approximately two and a half times that of physiotherapists and four and a half times that of osteopaths. Conclusions This study highlights a clear disparity in the average number of services provided by chiropractors, physiotherapists, and osteopaths in the private sector in Australia over the last 15 years. Further research is required to explain these observed differences and to determine whether a similar trend exists in patients who do not have private health insurance cover.

How Can the U.S. Government Control Physicians' Fees under National Health Insurance? A Lesson from the French System

1974 ◽  
Vol 4 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Laurence C. Thorsen
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Prescription Drugs ◽  
The United States ◽  
Care Hospital ◽  
Government Control ◽  
The Government ◽  
The Cost

The French national health insurance program covers most of the cost of medical and dental care, hospital care, and prescription drugs. The portion of health care costs borne by the patient varied widely prior to 1960 because of the failure of the government to control physicians' and dentists' fees adequately. In 1960, using expanded regulatory powers, the French government under DeGaulle applied controls on fees by imposing penalties on physicians and dentists who refused to be bound by annual contracts between their local associations and the social security system. The result is uniform fees and less rapid increases in the cost of health care. Control of costs is achieved at the expense of traditional professional independence, but it has made the system workable and is thus instructive for the United States as we consider moving toward national health insurance.

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