The Medical Care System under National Health Insurance: Four Models

1976 ◽  
Vol 1 (1) ◽  
pp. 22-68 ◽  
Author(s):  
Walter McClure
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
National Health Insurance ◽  
National Health ◽  
Medical Care System ◽  
Care System

Liberal Default, Labor Support, and Conservative Neutrality: The Kaiser Permanente Medical Care Program After World War II

1989 ◽  
Vol 1 (2) ◽  
pp. 156-180 ◽  
Author(s):  
Rickey L. Hendricks
Keyword(s):  
World War Ii ◽  
Health Insurance ◽  
Private Sector ◽  
Medical Care ◽  
National Health Insurance ◽  
National Health ◽  
Care Program ◽  
The Political ◽  
World War ◽  
Kaiser Permanente

In the politically turbulent post–World War II period, proposed federal legislation to expand the welfare state pitted conservative Republicans against liberal Democrats in Congress. The conflict over national health insurance introduced between 1943 and 1947 in the Wagner-Murray- Dingell bill ended in a conservative victory with the bill stalled in committee. The primary constituents of the two sides were American Medical Association (AMA) spokesmen and corporate interests on the political right and labor leaders and public health advocates on the left. By 1946 the conservatives controlled Congress; thereafter liberal congressional reformers defaulted on the national health issue, as they had throughout the twentieth century, to corporate progressives and the tenets of “welfare capitalism.” Government continued as a regulator of “minimum standards” for business and industry. Provision of voluntary health insurance and direct medical services was left to the private sector. The Kaiser Permanente Medical Care Program emerged out of the political stalemate over health care in the middle 1940s as a highly efficient and popular prepaid group health plan, innovative in its large scale and total integration of service and facilities. Its survival and growth was due to its acceptability to both liberals and conservatives as a model private-sector alternative to national health insurance or any other form of state medicine.

Care, Costs, and Health: Reactions to and Reinterpretation of the Rand Findings

PEDIATRICS ◽  
1985 ◽  
Vol 76 (4) ◽  
pp. 614-621
Author(s):  
Barbara Starfield ◽  
Diana Dutton
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
National Health Insurance ◽  
National Health ◽  
Cost Sharing ◽  
Controlled Trial ◽  
Private Insurance ◽  
Services Research ◽  
The Impact ◽  
Care Costs

The reports of Valdez et al1 and Leibowitz et al2 mark the culmination of a landmark effort. Initiated over a decade ago, the Rand Health Insurance Experiment—the most ambitious and expensive randomized controlled trial ever conducted in health services research—was designed to produce estimates of the costs of various forms of national health insurance. Projected estimates of the costs of Medicaid and Medicare had been far too low and health policy experts hoped to obtain information that would prove closer to the mark in the (then) seemingly likely passage of some form of national health insurance. Although national health insurance has not materialized, the impact of medical care costs on utilization of services and health status is still of great interest. The amount of "cost-sharing" (medical costs paid by patients) has increased dramatically in public insurance programs, and many health policymakers favor increases in private insurance programs. The central question now, however, is how much of the cost burden can be borne by patients without inducing reductions in utilization that are harmful to health. The two papers1,2 in the May issue of Pediatrics reported on the impact of cost-sharing on children's utilization and health. The basic findings were similar to those for adults. In general, the higher the costs paid by families, the fewer the children receiving medical care and the fewer the services per user. The only exception was hospitalization of children aged 5 to 13, which was largely unaffected by cost-sharing; higher costs did appear to reduce hospitalization of younger children, as well as ambulatory care for children of all ages.

The Effect of Copayments and Income on the Utilization of Medical Care by Subscribers to Japan's National Health Insurance System

1995 ◽  
Vol 25 (2) ◽  
pp. 295-312 ◽  
Author(s):  
Scott A. Kupor ◽  
Yong-Chuan Liu ◽  
Jungwoo Lee ◽  
Aki Yoshikawa
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
National Health Insurance ◽  
National Health ◽  
Capita Income ◽  
Health Insurance System ◽  
Per Capita Income ◽  
National Health Insurance System ◽  
Insurance System ◽  
Per Capita

This study uses cross-sectional data from Japan's 47 prefectures covering subscribers to Japan's National Health Insurance system to analyze the effects of income and copayment levels on the utilization of medical care. Multivariate regression models were run for the years 1984 and 1989, with the utilization ratio (number of health insurance claims per 100 insurance subscribers) for total, inpatient, outpatient, and dental services as the dependent variable. Independent variables included copayment per patient day, deflated per capita income, population density, percentage of subscribers over age 65, number of beds and clinics per 1,000 persons, and number of doctors and dentists per 1,000 persons. The data were then stratified according to per capita income and percentage of insurance subscribers over the age of 65 in each prefecture. The copayment amount exhibited a small, but significant negative effect on the utilization of all medical services. Utilization of outpatient care was most sensitive to the copayment rate. The per capita income stratification models revealed the greatest copayment effect on inpatient care for the lowest income group. The results of the age stratification models support popular notions about the use of hospitals by the elderly as substitutes for elderly care facilities. The effects of copayments and income vary not only among the type of medical care (inpatient, outpatient, and dental) but also among the income and age stratifications of groups in the National Health Insurance system.

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