Numbers Matter: A Guide to Cost and Coverage Estimates in Health Reform Debates

2004 ◽  
Vol 32 (3) ◽  
pp. 446-453 ◽  
Author(s):  
Jeanne M. Lambrew
Keyword(s):  
Health System ◽  
Health Reform ◽  
Health Coverage ◽  
Reform Plan

Health reform proposals tend to be rich with details and dimensions. The primary goal of health reform is typically to extend health coverage to people who lack it. Yet even the most similar of plans differ in terms of exactly who is targeted for assistance, the means by which assistance is delivered, and the type of health coverage promoted. Moreover, the Byzantine nature of the existing U.S. health system means that any reform plan can appear complex. The plan that aims for a new, simple health system will require radical changes to achieve it, while the plan that strives to be the least disruptive will have extensive rules that target assistance while maintaining the existing sources of coverage. Indeed, some have argued that the complexity inherent in meaningful reform is an impediment to reform itself.

scholarly journals Measuring Equity in Iranian Healthcare System Financing: Experiences of Recent Health Reform Plan

2019 ◽  
Author(s):  
Abdolvahed Khodamoradi ◽  
Shahram Ghaffari ◽  
Amir Abbas Fazaeli ◽  
Reza Toyserkanmanesh ◽  
Vahid Rasi ◽  
...  
Keyword(s):  
Health System ◽  
Healthcare System ◽  
Urban Areas ◽  
Health Reform ◽  
Insurance Coverage ◽  
Financial Contribution ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Reform Plan ◽  
The Status

Background and objectives: One of the main goals of the health system is the fair contribution of people to healthcare financing. Therefore, the current study not only evaluated the status of fair financial contribution, but also investigated the impacts of the health reform plan on the financial pillars of the Iranian healthcare system. Method: To conduct this retrospective descriptive study, the data of Income and Expenditure Survey (2011-2015) commissioned by Statistical Center of Iran were used. To measure fairness of financing, four indices were used. Data were analyzed using the Excel and SPSS software. Findings: The results show that although the health reform plan has increased insurance coverage of both rural and urban households, out of pocket, and even its proportion to household capacity to pay continues to rise. Prevalence of catastrophic health expenditures in the baseline year in rural and urban areas was 2.19% and 1.04%, reaching 3.69% and 2.39% at the end of the study, respectively. Accordingly, fair financial contribution in rural and urban areas was obtained 0.830% and 0.850% in the baseline year, reaching 0.823% and 0.850% in the last year of the study, respectively. Conclusion: Although indices of fair financial contribution during the 5-year period varied, they ultimately showed a worse situation compared to the baseline year. Thus, it is assumed that the health reform plan has not yet been successful in meeting the goal of improving fair financial contribution to the health system.

scholarly journals Designing a Comprehensive Evaluation Model for Health Reform Plan in Iran

2021 ◽  
Author(s):  
Mohammadreza Rabiee Mandejin ◽  
Shahriar Janbazi
Keyword(s):  
Social Responsibility ◽  
Health System ◽  
Health Reform ◽  
Delphi Technique ◽  
Comprehensive Evaluation ◽  
System Reform ◽  
Statistical Population ◽  
Health System Reform ◽  
Internal Process ◽  
Reform Plan

Background: The present study aimed to design a comprehensive model to evaluate the health system reform plan so the indicators of this model can lead to the health reform plan's effectiveness. Hence, this plan's effective factors, including policymakers and managers, suppliers, and clients, were identified and explained. Methods:According to the practical purpose and nature of the research, the combined/mixed research method was used, in 2018-2019. For the qualitative phase, the Delphi technique was used in exploratory interviews, and quantitative methods were used to collect data through a questionnaire. In the quantitative phase, 400 employees of 10 hospitals were selected by stratified random sampling; and in the second section, 300 clients were randomly selected in two hospitals with the highest and lowest evaluation scores in the previous phase. Content analysis method and Delphi technique were used for classification and analysis of qualitative data, and SPSS Ver.22, AMOS Ver.24 and Expert Choicev24 were used for data description and dimensions and indices' weight extraction. Dimensions under consideration include the financial, social responsibility, growth and learning, citizens and client, and internal process fields. Results: The components with the highest and lowest weight and impact on the effectiveness of the plan were identified in the following dimensions: financial field, Social responsibility field, growth and learning field, citizens and client field, internal process field, including weights 0.266, 0.244, 0.202, 0.164, 0.124, respectively. Conclusion: Given the results, the components, indicators, dimensions, and levels of the model designed, the comprehensive evaluation of the Health System Reform Plan in Iran (CEHSRP-IR) with the normal mean was confirmed by the statistical population, and this model can be used in all organizations implementing this plan.

scholarly journals The Relationship between the Kind of Delivery and 5 Indexes of Mother and Baby's Health Before and After Implementing Health Reform Plan in Selected Hospitals of Azarbaijan Sharghi

2019 ◽  
Author(s):  
Hosin Jabari ◽  
Behyane Seyedamini ◽  
Elahe navvabi ◽  
Salah Salah
Keyword(s):  
Health System ◽  
Health Reform ◽  
Sampling Method ◽  
Simple Random Sampling ◽  
Private Hospitals ◽  
Reform Plan ◽  
Significant Difference ◽  
Before And After ◽  
The Relationship ◽  
Made In

Introduction and aim: To improve the individuals' health, reforms should be made in the health systems. As a result, assessing the impacts of reforms is a way to evaluate the effectiveness of the health system. The aim of this study was to study the relationship between the kind of delivery and the five indexes of mother and baby's health before and after implementing the health reform plan in selected hospitals of Azarbaijan Sharghi, Iran. Issues and methods: This descriptive-analytical study was conducted in 2017. The study was conducted among eight educational, medical, and private hospitals. Before and after the program, 800 files were selected using simple random sampling method. The researcher made a check list with confirmed validity to extract the data. The data were analyzed using descriptive statistics and T-tests by SPSS-22.  Results: The average age of mothers in the two intervals was 27 years. Most participants did not deliver before and their education was diploma or lower. The rate of natural delivery from 34.5% (before the plan) reached 44.2% (after the plan)(p<0.05). The rate of mothers and babies' mortality reduced from 0.3 and 0.8 to 0 and 0.5, respectively. Mothers and babies' mortality and stillbirth had no significant difference based on the kind of delivery (p>0.05). Conclusion: Findings indicated significant increase of natural delivery after the reform plan in health system. Moreover, the rate of mothers and babies' mortality decreased. These results can guide the policymakers for deciding about the course of plan and its review.

Health Reform Plan May Debut This Month

2009 ◽  
Vol 43 (6) ◽  
pp. 7 ◽  
Author(s):  
ALICIA AULT
Keyword(s):  
Health Reform ◽  
Reform Plan

scholarly journals Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion: a case-study from Ethiopia

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Amare Worku Tadesse ◽  
Kassu Ketema Gurmu ◽  
Selamawit Tesfaye Kebede ◽  
Mahlet Kifle Habtemariam
Keyword(s):  
Health Promotion ◽  
Global Health ◽  
Health System ◽  
Universal Health Coverage ◽  
World Health ◽  
Health Coverage ◽  
Health Security ◽  
Universal Health ◽  
Health Agenda

Abstract Background Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country’s health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. Methods We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the “hardware” (using the World Health Organization’s building blocks) and the “software” (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. Results Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. Conclusions Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country’s health indicators and may promote sustained functionality of the health system.

scholarly journals Exploring patient-provider interactions and the health system’s responsiveness to street-connected children and youth in Kenya: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Embleton Lonnie ◽  
Shah Pooja ◽  
Gayapersad Allison ◽  
Kiptui Reuben ◽  
Ayuku David ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Cultural Context ◽  
Healthcare Providers ◽  
Children And Youth ◽  
Economic Factors ◽  
Health Coverage ◽  
Socially Constructed ◽  
Prompt Attention

Abstract Background In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. Methods This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. Results Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. Conclusions This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions.

scholarly journals The Effect of Massachusetts' Health Reform on Employer-Sponsored Insurance Premiums

2010 ◽  
Vol 13 (2) ◽  
Author(s):  
John F Cogan ◽  
R. Glenn Hubbard ◽  
Daniel Kessler
Keyword(s):  
United States ◽  
Health Reform ◽  
Medical Expenditure Panel Survey ◽  
Private Insurance ◽  
The United States ◽  
Medical Expenditure ◽  
Insurance Premiums ◽  
Reform Plan ◽  
The Difference ◽  
The Cost

In this paper, we use publicly available data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) to investigate the effect of Massachusetts' health reform plan on employer-sponsored insurance premiums. We tabulate premium growth for private-sector employers in Massachusetts and the United States as a whole for 2004 - 2008. We estimate the effect of the plan as the difference in premium growth between Massachusetts and the United States between 2006 and 2008—that is, before versus after the plan—over and above the difference in premium growth for 2004 to 2006. We find that health reform in Massachusetts increased single-coverage employer-sponsored insurance premiums by about 6 percent, or $262. Although our research design has important limitations, it does suggest that policy makers should be concerned about the consequences of health reform for the cost of private insurance.

State Health System Performance And State Health Reform

2007 ◽  
Vol 26 (Suppl2) ◽  
pp. w664-w666 ◽  
Author(s):  
Karen Davis ◽  
Cathy Schoen
Keyword(s):  
Health System ◽  
System Performance ◽  
Health Reform ◽  
Health System Performance ◽  
State Health

scholarly journals Evaluation of Access on the perspective of adult users of Primary Health Care in Fortaleza, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Borges Costa ◽  
C Salles Gazeta Vieira Fernandes ◽  
T Custódio Mota ◽  
E Torquato Santos ◽  
M Moura de Almeida ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Assessment Tool ◽  
Health Coverage ◽  
Access To Health Services ◽  
Primary Health ◽  
Care Assessment ◽  
The City

Abstract The Alma-Ata Conference promoted Primary Health Care (PHC) worldwide as a form of universal and continuous access to quality and effective health services. In Brazil, PHC, through the Family Health Strategy (FHS), aims to be the gateway to the health system and its structuring axis. For this, it is necessary to promote access, an essential condition for the quality of health care services, following the attributes systematized by Barbara Starfield. The aim of this study was to evaluate the presence of the attribute “First Contact Access” on the perspective of adult users of public PHC services in the city of Fortaleza, Ceará, Brazil. A transversal study was carried out, in 19 PHC Units, from June to December 2019, using the Primary Care Assessment Tool (PCATool) Brazil version for adult users. Kruskal-Wallis test was used for statistical analysis. 233 users participated, mostly women (69.5%), aged 30 to 59 years old (55.3%), mixed-race (69.5%), with complete high school (38.2%), without private health coverage (89.3%), homeowners (68.7%) and belonging to families of up to 4 members (87.9%). The “Accessibility” component had the lowest score, 2.83, and the “Utilization” had the highest score, 8.06. Older age was associated with higher “Accessibility” scores (p = 0,018), while lower values of “Utilization” were associated with higher education (p = 0,004). The main problems observed were: low access for acute demand consultations, lack of access at nighttime and weekends, little access through non-personal ways, bureaucratic barriers and a long time for scheduling appointments. We conclude that, although there was an improvement in PHC coverage in the city over the years, mainly due to FHS, there is still a lot to improve to ensure timely access to health services. Key messages Users consider PHC as the usual source of care, demonstrated by the high score of 'Utilization', however, they are unable to use it when necessary, demonstrated by the low score of 'Accessibility'. Expanding forms of access is essential to contribute to the strengthening of PHC in Fortaleza, Brazil, facilitating the entry to its national Universal Health System.

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