scholarly journals Trends in the Aggressiveness of End-of-Life Cancer Care in the Universal Health Care System of Ontario, Canada

2011 ◽  
Vol 29 (12) ◽  
pp. 1587-1591 ◽  
Author(s):  
Thi H. Ho ◽  
Lisa Barbera ◽  
Refik Saskin ◽  
Hong Lu ◽  
Bridget A. Neville ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Emergency Department ◽  
Cancer Care ◽  
The United States ◽  
Universal Health Care ◽  
Universal Health Care System ◽  
Eol Care ◽  
Universal Health ◽  
Over Time

Purpose To describe trends in the aggressiveness of end-of-life (EOL) cancer care in a universal health care system in Ontario, Canada, between 1993 and 2004, and to compare with findings reported in the United States. Methods A population-based, retrospective, cohort study that used administrative data linked to registry data. Aggressiveness of EOL care was defined as the occurrence of at least one of the following indicators: last dose of chemotherapy received within 14 days of death; more than one emergency department (ED) visit within 30 days of death; more than one hospitalization within 30 days of death; or at least one intensive care unit (ICU) admission within 30 days of death. Results Among 227,161 patients, 22.4% experienced at least one incident of potentially aggressive EOL cancer care. Multivariable analyses showed that with each successive year, patients were significantly more likely to encounter some aggressive intervention (odds ratio, 1.01; 95% CI, 1.01 to 1.02). Multiple emergency department (ED) visits, ICU admissions, and chemotherapy use increased significantly over time, whereas multiple hospital admissions declined (P < .05). Patients were more likely to receive aggressive EOL care if they were men, were younger, lived in rural regions, had a higher level of comorbidity, or had breast, lung, or hematologic malignancies. Chemotherapy and ICU utilization were lower in Ontario than in the United States. Conclusion Aggressiveness of cancer care near the EOL is increasing over time in Ontario, Canada, although overall rates were lower than in the United States. Health system characteristics and patient or physician cultural factors may play a role in the observed differences.

Impact of Managed Health Care on the United States: Implications for Universal Health Care System

2009 ◽  
Vol 19 (7) ◽  
pp. 805-819 ◽  
Author(s):  
Rachel Lepolstat ◽  
Katie Golbeck ◽  
Dana Kostelnik ◽  
Shruthi Mandyam ◽  
Darrel Montero ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care System ◽  
The United States ◽  
Universal Health Care ◽  
Managed Health Care ◽  
Universal Health Care System ◽  
Universal Health ◽  
Care System

Material deprivation and access to cancer care in a universal health care system

Cancer ◽  
2020 ◽  
Vol 126 (20) ◽  
pp. 4545-4552
Author(s):  
Laura E. Davis ◽  
Natalie G. Coburn ◽  
Julie Hallet ◽  
Craig C. Earle ◽  
Ying Liu ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Cancer Care ◽  
Material Deprivation ◽  
Universal Health Care ◽  
Universal Health Care System ◽  
Universal Health ◽  
Care System

… And Health Care for All: Immigrants in the Shadow of the Promise of Universal Health Care

2009 ◽  
Vol 35 (1) ◽  
pp. 185-204 ◽  
Author(s):  
Adrianne Ortega
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Services ◽  
Insurance Coverage ◽  
The United States ◽  
Care Plan ◽  
Universal Health Care ◽  
Care Services ◽  
Eligibility Requirements ◽  
Universal Health

President Obama’s ambitious universal health care plan aims to provide affordable and accessible health care for all. The plan to cover the estimated 46.5 million uninsured, however, ignores the over thirty million non-citizens living in the United States. If the United States passes universal health care coverage, Congress should repeal the prohibitions of the Welfare Reform Act, extend Medicaid coverage to non-citizens, and allow non-citizens to purchase employer-based insurance coverage.President Obama’s plan follows the lead of state universal health care legislation by retaining private, employer-sponsored insurance coverage and expanding the eligibility requirements of the Medicaid program. This strategy will not aid uninsured immigrants or overburdened states and hospitals, though, because current law excludes most non-citizens from nonemergency health care services.

Catholic Church Advocacy and the Affordable Care Act

2019 ◽  
Author(s):  
Jeanine Kraybill
Keyword(s):  
United States ◽  
Health Care ◽  
Affordable Care Act ◽  
Catholic Church ◽  
Health Care Policy ◽  
Common Ground ◽  
The United States ◽  
Universal Health Care ◽  
The Government ◽  
Universal Health

The American Catholic Church has a long history in health care. At the turn of 19th century, Catholic nuns began developing the United States’ first hospital and health care systems, amassing a high level of professionalization and expertise in the field. The bishops also have a well-established record advocating for healthcare, stemming back to 1919 with the Bishops’ Program for Social Reconstruction, which called for affordable and comprehensive care, particularly for the poor and vulnerable. Moving into the latter part of the 20th century, the bishops continued to push for health care reform. However, in the aftermath of Roe v. Wade (1973), the American bishops insisted that any reform or form of universal health care be consistent with the Church’s teaching against abortion, contraception, and euthanasia. The bishops were also adamant that health care policy respect religious liberty and freedom of conscience. In 1993, these concerns caused the bishops to pull their support for the Clinton Administration’s Health Security Act, since the bill covered abortion as a medical and pregnancy-related service. The debate over health care in the 1990s served as a precursor for the United States Conference of Catholic Bishops’ (USCCB) opposition to the Obama Administration’s Affordable Care Act (ACA) and the Department of Health and Human Services’ (HHS) contraception mandate. The ACA also highlighted a divide within the Church on health care among religious leaders. For example, progressive female religious leadership organizations, such as the Leadership Conference of Women Religious (LCWR) and their affiliate NETWORK (a Catholic social justice lobby), took a different position than the bishops and supported the ACA, believing it had enough protections against federally funded abortion. Though some argue this divide lead to institutional scrutiny of the sisters affiliated with the LCWR and NETWORK, both the bishops and the nuns have held common ground on lobbying the government for affordable, comprehensive, and universal health care.

scholarly journals The United States: A system built on fragmentation

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
H. Jarman
Keyword(s):  
Public Health ◽  
United States ◽  
Health Care ◽  
Health Care System ◽  
The United States ◽  
Universal Health Care ◽  
Local Public Health ◽  
The Us ◽  
Universal Health ◽  
Care System

Abstract Background The United States is effectively a laboratory for ways to produce public goods, such as public health, on the cheap. Its c. 90,000 governments compete for residents, businesses, taxes, development, and jobs while also trying to compensate for the lack of universal health care coverage. They all have structural incentives to provide services as cheaply as possible. The effects are diverse and poorly mapped. They can mean innovation in organizational forms, a different and typically less expensive skill mix among the workers, poor quality, or simple under provision. The exact mix can often be hard to identify. It can also mean extreme responsiveness to funding from higher levels of government such as the states or federal government. Methods A comparative historical analysis (CHA) based on government documents, law, and secondary sources. Results The distinctively expansive scope of US public health actions is largely due to the country’s failure to establish a universal health care system, and the diversity of US public health tasks reflects local adaptation of tens of thousands of governments. This means that public health in the United States retains much of the activity it had in, for example, the UK before the establishment of the US. In particular, and even in states that accepted the Medicaid expansion in the Affordable Care Act (ACA), local public health departments provide a substantial amount of direct care and fill in for gaps in health care provision. Conclusions The US public health system is highly fragmented like the governments that run it, and therefore diverse. Reflecting the failures of the US health care system, it carries out many more tasks that in other countries are seen as health, especially primary, care.

Symbols, Rationality, and Justice: Rationing Health Care

1992 ◽  
Vol 18 (1-2) ◽  
pp. 1-13 ◽  
Author(s):  
Daniel Callahan
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Health Care System ◽  
The United States ◽  
Universal Health Care ◽  
Universal Health Insurance ◽  
Ration Health Care ◽  
Universal Health ◽  
Care System

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.

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