For Profit Enterprise in Health Care: Can it Contribute to Health Reform?

2010 ◽  
Vol 36 (2-3) ◽  
pp. 405-435 ◽  
Author(s):  
Eleanor D. Kinney
Keyword(s):  
Health Care ◽  
Health Reform ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
American People ◽  
Health Coverage ◽  
Public Programs ◽  
For Profit ◽  
New Treatments

Since the demise of the last major health reform initiative in 1994, health coverage for the American people has deteriorated. Private insurance costs have risen, and coverage under private insurance became less comprehensive, with higher deductibles and copayments. Many new treatments for serious diseases and associated provider compensation have become more and more unaffordable, even for those with health insurance coverage. Recent reports document the challenges for cancer patients faced with the soaring cost of cancer treatment. Public programs, such as Medicare and Medicaid, have picked up some slack and have grown in numbers. But gaps remain. Approximately 16 percent of the U.S. population is uninsured. Annual U.S. spending for health care was $2 trillion in 2005, and is estimated to reach $4 trillion by 2015.

scholarly journals Problems of health insurance coverage and health care in the United States: public and private solution strategies

1992 ◽  
Vol 8 (3) ◽  
pp. 270-286
Author(s):  
E. Richard Brown
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Care Financing ◽  
Health Insurance Coverage ◽  
The United States ◽  
Political Debate ◽  
Financing System

A nearly universal consensus has developed in the United States that the current health care financing system is a failure. The system has been unable to control the continuing rapid rise in health care costs (by far, the highest in the world), and it has been unable to stem the growing population that has no health insurance coverage (at least 36 million people). There is nearly universal political agreement that government must provide health insurance to a far greater share of the population than ever before. The political debate now focuses on whether this expanded government role should supplement the private insurance system with an enlarged public program covering those left out of private insurance coverage, or replace private insurance with a universal government health insurance program covering the entire population.

scholarly journals A Skeptic's View of Global Budget Caps

1994 ◽  
Vol 8 (3) ◽  
pp. 67-73 ◽  
Author(s):  
James M Poterba
Keyword(s):  
Health Care ◽  
Health Reform ◽  
Universal Access ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Care Spending ◽  
Global Budget ◽  
Medical Benefits ◽  
Spending Growth ◽  
Number Of Individuals

This brief paper explores the likely effects of government-imposed global budget caps, such as those in the Clinton administration proposal, on health care spending. It argues that health reform proposals that guarantee universal access to a basic package of medical benefits create a substantial new constituency for higher health care outlays. Political and potential legal pressures to expand rather than limit the set of guaranteed benefits, coupled with an expansion of the number of individuals with health insurance coverage, make it unlikely that global budget targets will succeed in reducing the rate of health care spending growth.

scholarly journals Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Leila Doshmangir ◽  
Mohammad Bazyar ◽  
Arash Rashidian ◽  
Vladimir Sergeevich Gordeev
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Equity ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Health Care Expenditures ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
The Impact ◽  
Universal Health

Abstract Background Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC. Methods This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis. Results Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable. Conclusion To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.

Revisiting equity in healthcare spending through capability-approach: assessing the effectiveness of health-insurance schemes in reducing OOPE and CHE in India

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rinshu Dwivedi ◽  
Jalandhar Pradhan
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Capability Approach ◽  
Financial Burden ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Sample Survey ◽  
Content Type ◽  
The Impact

Purpose This paper aims to draw theoretical insight from Sen’s capability-approach and attempts to examine the effectiveness of health-insurance-schemes in reducing out-of-pocket-expenditure (OOPE) and catastrophic-health-expenditure (CHE) in India. Design/methodology/approach Data were extracted from the National-Sample-Survey-Organization, 71st round on Health-2014. Generalized-linear-regression-model was used to investigate the impact of social-protection-schemes on OOPE and CHE. Findings A notable segment of the Indian population is still not covered under any health-insurance-schemes. The majority of the insured population was covered by publicly-financed-health-insurance-schemes (PFHIs), with a trivial-share of private-insurance. Households from 16–59 age-group, urban, literate, richest, southern-regions, using private-facilities and having ear and skin ailments have reported higher insurance coverage. Reimbursement was higher among elderly, literates, middle-class, central-regions, using private-facilities/insurance and for infections. Access to PFHIs significantly reduces the risk of OOPE and CHE. Unavailability of reimbursement exposes the population to a higher risk of CHE. Research limitations/implications Being a study based on secondary data sources, its applicability may vary as per the other social indicators. Practical implications Extending insurance-coverage alone cannot answer the widespread inequalities in health care. Rather, an efficiently managed reimbursement-mechanism could condense OOPE and CHE by enhancing the capability of the population to confront the undue financial burden. Social implications Extending the health-insurance-coverage to the entire population requires a better understanding of the underlying-dynamics and health-care needs and must make health-care affordable by enhancing the overall capability. Originality/value This research brings a theoretical and conceptual analysis for improving the health-insurance coverage among the community as a public health strategy.

scholarly journals Health insurance coverage and healthcare expenditure pattern in rural Mandya, Karnataka

2018 ◽  
Vol 5 (4) ◽  
pp. 1519
Author(s):  
Harish B. R. ◽  
Hugara Siddalingappa ◽  
Bharath J.
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Sampling Method ◽  
Insurance Coverage ◽  
Health Care Expenditure ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Medical Sciences ◽  
Field Practice ◽  
Expenditure Pattern

Background: Poverty and ill-health go hand in hand.In developing countries, high out of pocket payment, absence of risk pooling mechanism in health financing systems, and high level of poverty are said to result in catastrophic health expenditure.Health insurance (HI) is the need of the hour in the absence of Universal Health Coverage. Hence this study was undertaken to assess the health insurance coverage among people of rural field practice area of Mandya Institute of Medical Sciences, Mandya and to describe the health care expenditure pattern in the study population.Methods: Study design was based on community based cross sectional study. Study area was at rural field practice area of Mandya Institute of Medical Sciences, which comprises of 11 villages. Study population: Permanent residents of villages in the study area. Study period was on 4 months (August 2016–November 2016). Sample size: 264 households. Sampling method: Multistage sampling. Method of data collection: Personal interview of patients/head of the family of patients admitted to a hopital during study period using semi structured questionnaire.Results: 58.0% of the households in study area had some form of health insurance coverage. Among the covered households only 40.50% were having whole family coverage. Individual level HI coverage was 48.8%. Out of pocket (OOP) expenditure for inpatient care contributed to 83.81% of the health care expenditure.Conclusions: HI coverage is higher than national average. But health care expenditure is largely borne out of pocket.

The Changing Health Insurance Coverage Landscape in the United States

2020 ◽  
pp. e264-e274
Author(s):  
K. Robin Yabroff ◽  
Samuel Valdez ◽  
Mireille Jacobson ◽  
Xuesong Han ◽  
A. Mark Fendrick
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Cancer Care ◽  
Care Delivery ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Future Research ◽  
Health Coverage

Changes in the health insurance coverage landscape in the United States during the past decade have important implications for receipt and affordability of cancer care. In this paper, we summarize evidence for the association between health insurance coverage and cancer prevention and treatment. We then discuss ongoing changes in health care coverage, including implementation of provisions of the Affordable Care Act, increasing prevalence of high-deductible health insurance plans, and factors that affect health care delivery, with a focus on vertical integration of hospitals and providers. We summarize the evidence for the effects of the changes in health coverage on care and discuss areas for future research with the goal of informing efforts to improve cancer care delivery and outcomes in the United States.

A COMPARATIVE STUDY ON AWARENESS AND HEALTH INSURANCE COVERAGE IN RURALAND URBAN MEERUT

2021 ◽  
pp. 65-67
Author(s):  
Harivansh Chopra ◽  
Tanveer Bano ◽  
Niharika Verma ◽  
Gargi Pandey
Keyword(s):  
Health Insurance ◽  
Urban Area ◽  
Rural Area ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Rural And Urban ◽  
Economics Of Health ◽  
Poverty Status ◽  
Rural And Urban Area

Universal Health Coverage aims to provide essential health services to all while providing protection from catastrophic expenditure on health. To mitigate the economics of health expenditure, health insurance is one of the important tool. Hence, this study was conducted to nd out the awareness and practice of health insurance coverage in rural and urban Meerut.90 households were studied in both rural and urban area. Awareness was higher in urban area but coverage was higher in rural area. Awareness and coverage were found to be signicantly associated with poverty status in rural area of Meerut.

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