scholarly journals Achieving Horizontal Equity: Must We Have a Single-Payer Health System?

2009 ◽  
Vol 34 (4) ◽  
pp. 617-633 ◽  
Author(s):  
Michael K. Gusmano ◽  
Daniel Weisz ◽  
Victor G. Rodwin
Keyword(s):  
Health System ◽  
Horizontal Equity ◽  
Single Payer

scholarly journals Identification of the Main Elements of Single Payer System; A Comparative Study

2019 ◽  
Author(s):  
Ali Aboutorabi ◽  
Saman Ghasempour ◽  
Behzad Najafi ◽  
Sirous Panahi
Keyword(s):  
Health Care ◽  
Comparative Study ◽  
Health System ◽  
Risk Sharing ◽  
Optimal Allocation ◽  
Insurance Coverage ◽  
Health Sector ◽  
Health Coverage ◽  
Simple Task ◽  
Single Payer

Background: Progress towards universal coverage requires adequate capital in health sector. Investing and optimal allocation of resources in this sector will contribute to the development and reduction of poverty in countries in order to achieve the goals of health system. Therefore, the more people contribute to risk sharing, we have lower financial risks in facing the issue. The single payer system as a public health coverage model seeks to expand the insurance coverage scope at community level. The present study aimed to identify the main elements of S-PS to conduct a comparative study. Methods: A comparative study was conducted to describe the fundamental of financing and the provision of services in selected countries - Germany, Thailand, Turkey, and Colombia, as well as to achieve the main elements of S-PS. In addition, the health system of Iran has been studied. The basis for selection of countries was health system Garden typology. The main criteria for selection or rejection of studies were the separation of health services provider from financial functions; has allowed a single department to purchasing process. Results: single payer system in two functions of health system, namely, financing and providing health care; consolidation resources (reducing fragmentation by creating a single pooled fund and achieve massive purchase of health care through the insurance agent as single purchaser) and ensuring community health (delivery of services by the network of providers represented by Health Promotion Organization) represents 12 main organizational elements. Conclusion: the multiple insurers and payers of health care in Iran are both inequity and ineffective. And its integration is not a simple task. Iranian financing policies should aimed to achieving universal health coverage by creating greater risk pooling and becoming aware of the important tasks of insurance system; take advantage of the strength in numbers, setting the principles of cross-subsidy and preventing adverse reaction. It is important not to put together a long-term, coherent plan to reach the S-PS.

Predictors of clinical trial enrollment and impact on outcome in children and adolescents with acute lymphoblastic leukemia: A population based study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 7031-7031
Author(s):  
Paul James Gibson ◽  
Uma H. Athale ◽  
Vicky Rowena Breakey ◽  
Nicole Mittmann ◽  
Mylene Bassal ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Acute Lymphoblastic Leukemia ◽  
Health System ◽  
Children And Adolescents ◽  
Lymphoblastic Leukemia ◽  
Income Quintile ◽  
Factors Associated ◽  
Income Status ◽  
Single Payer

7031 Background: Outcomes in pediatric acute lymphoblastic leukemia (ALL) have shown remarkable improvements in large part due to sequential clinical trials. Concerns however persist around whether access to clinical trials is equitable. It is also unclear whether patient outcomes are improved simply by enrolling on a clinical trial. Our objective was to therefore determine which patient and disease-related factors are associated with enrollment, and whether enrollment was associated with clinical outcomes among children and adolescents with ALL in a single-payer health system in Ontario, Canada. Methods: We included all Ontario patients diagnosed with ALL between 0-18 years of age from 2002-2012 treated at a pediatric center, identified through a provincial pediatric cancer registry. Clinical trial availability was determined by whether each patient’s primary institution had an open frontline trial for which the patient was eligible at the time of their diagnosis, considering individual disease characteristics such as lineage, central nervous system (CNS) status and risk group. Demographic, disease, trial enrolment, and outcome data were obtained through chart abstraction. Logistic regression models determined factors associated with trial enrolment, while Cox proportional hazard models determined factors associated with event-free and overall survival (EFS, OS). Results: Of 858 patients, 693 (81%) were eligible for an open clinical trial at their time of diagnosis. 476 (69%) enrolled on a trial. In adjusted analyses, age > 15 years (odds ratio 0.4 vs. age 5-9, 95th confidence interval (95CI) 0.2-0.8; p = 0.01) and CNS3 disease (OR 0.38 vs. CNS1, 95CI 0.17-0.83; p = 0.01) were significantly associated with decreased likelihood of enrolment, while sex and neighborhood income quintile were not associated with enrolment. Adjusted for disease and demographic factors, clinical trial enrolment was not significantly associated with either EFS (hazard ratio (HR) 1.1, 95CI 0.7-1.7; p = 0.83) or OS (HR 1.3, 95CI 0.7-2.5; p = 0.44). Conclusions: The majority of patients with ALL eligible for available clinical trials at their time of diagnosis were enrolled. While no disparities in enrolment by income status were noted, adolescents were substantially less likely to participate in trials even within pediatric centers. Studies of mechanisms underlying this disparity are warranted in order to design and implement effective interventions targeting increased enrolment rates in this patient population. Our results however also suggest that clinical trial enrolment on its own is not associated with improved outcomes in the context of a single payer health system.

Health system reform: the case for a single-payer approach

JAMA ◽  
1994 ◽  
Vol 272 (14) ◽  
pp. 1102b-1102
Author(s):  
D. R. Steele
Keyword(s):  
Health System ◽  
System Reform ◽  
Health System Reform ◽  
Single Payer

scholarly journals Population-Based Estimates of Health Care Utilization and Expenditures by Adults During the Last 2 Years of Life in Canada’s Single-Payer Health System

2020 ◽  
Vol 3 (4) ◽  
pp. e201917
Author(s):  
Laura C. Rosella ◽  
Kathy Kornas ◽  
Catherine Bornbaum ◽  
Anjie Huang ◽  
Tristan Watson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health System ◽  
Population Based ◽  
Care Utilization ◽  
Single Payer

Geographic variation in systemic therapy in men age 66 years and older with de novo metastatic castration-sensitive prostate cancer: A population-based study in a single payer health-system.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 50-50
Author(s):  
Christopher J.D. Wallis ◽  
Shawn Malone ◽  
Ilias Cagiannos ◽  
Scott Carlyle Morgan ◽  
Robert James Hamilton ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health System ◽  
Systemic Therapy ◽  
De Novo ◽  
Population Based ◽  
Treatment Intensification ◽  
Population Based Study ◽  
Disease Characteristics ◽  
Single Payer ◽  
Geographic Regions

50 Background: Significant developments in the standard of care for patients with de novo metastatic castration-sensitive prostate cancer (mCSPC) have been reported over the past decade. Treatment intensification with systemic therapies in addition to androgen deprivation therapy (ADT) alone is guideline recommended for most patients. We studied the geographic variation in the use of systemic therapy for de novo mCSPC in Ontario, Canada, a single-payer health system. Methods: We performed a population-based study of men aged 66 years and older diagnosed with de novo mCSPC between 2014-2019. We linked population-based healthcare databases, as administered at the level of Local Health Integration Networks (LHINs) in Ontario, to examine treatment patterns following diagnosis of de novo mCSPC. We categorized initial mCSPC treatments as those begun within 60 days preceding and 6 months following diagnosis and examined the proportion of patients receiving LHRH alone, first generation anti-androgen (AA) alone, combined androgen blockade (CAB; LHRH + 1st gen AA), ADT + abiraterone acetate + prednisone (AAP), and, ADT + docetaxel (D). In aggregate, we considered LHRH alone, AA alone and CAB as “standard ADT”, and ADT + AAP and ADT + D as “ADT-plus”. Multinomial logistic regression analyses were used to examine the association between receiving systemic treatment intensification (“ADT-plus”) or no prostate cancer pharmacotherapy relative to ADT across geographic regions, while adjusting for baseline patient and disease characteristics. Results: We identified 3,556 men over 66 with de novo mCSPC. Overall, 2794 (78.6%) received standard ADT, 311 (8.7%) did not receive prostate cancer-directed pharmacotherapy, and 451 patients (12.7%) of patients received “ADT-plus”. Utilization of AAP increased from 0.5% to 3% following the LATITUDE data release in 2017, while D decreased from 12% to 10%. There was significant variation in treatment strategies between geographic regions in use of “ADT-plus” ranging from 7 to 20% (p < 0.0001), a difference which persisted after accounting for patient demographics, comorbidity, rurality, and disease characteristics (p = 0.036). Conclusions: Despite proven survival benefits in randomized controlled trials, intensified treatment with docetaxel or abiraterone in addition to ADT was infrequently utilized in this population-based study of men age 66 years and over with mCSPC.

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