scholarly journals Combining Private Insurance with Public Programs to Achieve Universal Coverage

1992 ◽  
pp. 77-97 ◽  
Author(s):  
John H. Goddeeris
Keyword(s):  
Private Insurance ◽  
Universal Coverage ◽  
Public Programs

Switzerland

2021 ◽  
pp. 652-676
Author(s):  
Christian Rüefli
Keyword(s):  
Health Insurance ◽  
Direct Democracy ◽  
Private Insurance ◽  
Universal Coverage ◽  
Individual Responsibility ◽  
Managed Competition ◽  
State Control ◽  
Market Mechanisms ◽  
Healthcare Politics ◽  
Mandatory Health Insurance

This chapter offers an in-depth look at health politics and the mandatory health insurance system in Switzerland. It traces the development of the Swiss healthcare system, characterized by the strong role of the cantons and private stakeholder organizations in managing the system as well as the reliance on voluntary private insurance for most of the twentieth century. Since 1994, when a law on mandatory health insurance was adopted, the main issues in Swiss healthcare politics have been increasing costs, managed competition, the introduction of case-based payment, and healthcare governance. Switzerland’s consociational political system, with its instruments of direct democracy, federalism, and corporatist interest representation, impedes the development of consensus across the left–right divide about whether the health system should rely more on market mechanisms and individual responsibility or on state control and universal coverage.

The Vanishing Health Care Safety Net: New Data on Uninsured Americans

1992 ◽  
Vol 22 (3) ◽  
pp. 381-396 ◽  
Author(s):  
David U. Himmelstein ◽  
Steffie Woolhandler ◽  
Sidney M. Wolfe
Keyword(s):  
Private Insurance ◽  
Health Spending ◽  
Poverty Line ◽  
Safety Net ◽  
Census Bureau ◽  
Public Programs ◽  
Teachers College ◽  
Health Care Safety Net ◽  
Working Age ◽  
Uninsured Children

New data obtained from the Census Bureau shows that the number of Americans without any health insurance increased by 1.3 million between 1989 and 1990, bringing the total number of uninsured to 34.7 million, more than at any time since the passage of Medicare and Medicaid 25 years ago. This increase coincided with a 10.5 percent increase in health spending, the second largest in the past three decades. The number of people covered by Medicaid grew by 3.1 million, due to a one-time expansion of eligibility mandated by Congress, but this was more than counterbalanced by a population growth of 3 million and a decrease of 1.3 million in people covered by private insurance. Had Medicaid not been expanded, the number of uninsured would have increased by 4.4 million. The increase in the uninsured affected virtually all parts of the nation. Seven states had increases of more than 100,000 persons each. Only Texas experienced a decrease of that magnitude, but still had the second highest rate of uninsurance of any state. Of the 1.3 million additional uninsured in 1990, 77 percent were male, 32 percent had family incomes in excess of $50,000 per year, and 74 percent had annual family incomes above $25,000. Fewer than 9 percent had incomes below the poverty line. The numbers of uninsured children and senior citizens fell slightly (but not significantly), while the number of uninsured working-age adults rose by 1.4 million. The number of uninsured workers in each of four of 20 major industry groups increased by more than 100,000 in 1990. None of the industry groups showed a significant decline in the number of uninsured. Among professionals, there were substantial numbers of uninsured doctors, engineers, teachers, college professors, clergy, and others, but all legislators and judges were insured. The data presented here largely predate the recession and understate current problems. In 1991 the number of uninsured will likely reach nearly 40 million. Also, these estimates are based on the number of people uninsured at a single time during 1990; a far higher number were temporarily uninsured at some point during the year. Moreover the Census Bureau survey ignores the problem of the underinsurance of at least 50 million insured Americans. Patchwork public programs are grossly inadequate to plug the holes. A national health program covering all Americans could assure access to care and contain costs.

scholarly journals Pharmaceutical policy reform in Canada: lessons from history

2018 ◽  
Vol 13 (3-4) ◽  
pp. 299-322 ◽  
Author(s):  
Katherine Boothe
Keyword(s):  
Health System ◽  
Private Insurance ◽  
Universal Coverage ◽  
New Drugs ◽  
System Reform ◽  
The Social ◽  
Broad Public Health ◽  
Potential Methods ◽  
Integrated Health Services

AbstractCanada is the only country with a broad public health system that does not include universal, nationwide coverage for pharmaceuticals. This omission causes real hardship to those Canadians who are not well-served by the existing patchwork of limited provincial plans and private insurance. It also represents significant forgone benefits in terms of governments’ ability to negotiate drug prices, make expensive new drugs available to patients on an equitable basis, and provide integrated health services regardless of therapy type or location. This paper examines Canada’s historical failure to adopt universal pharmaceutical insurance on a national basis, with particular emphasis on the role of public and elite ideas about its supposed lack of affordability. This legacy provides novel lessons about the barriers to reform and potential methods for overcoming them. The paper argues that reform is most likely to be successful if it explicitly addresses entrenched ideas about pharmacare’s affordability and its place in the health system. Reform is also more likely to achieve universal coverage if it is radical, addressing various components of an effective pharmaceutical program simultaneously. In this case, an incremental approach is likely to fail because it will not allow governments to contain costs and realize the social benefits that come along with a universal program, and because it means forgoing the current promising conditions for achieving real change.

Crisis in U.S. Health Care: Corporate Power Still Blocks Reform

2017 ◽  
Vol 48 (1) ◽  
pp. 5-27 ◽  
Author(s):  
John Geyman
Keyword(s):  
Health Care ◽  
Insurance Industry ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Public Support ◽  
Universal Coverage ◽  
The United States ◽  
Industrial Complex ◽  
Current Crisis ◽  
The Government

The corporate, largely privatized market-based U.S. health care system is deteriorating in terms of increasing costs, decreasing access, unacceptable quality of care, inequities, and disparities. Reform efforts to establish universal insurance coverage have failed on six occasions over the last century, largely through opposition of corporate stakeholders in the medical-industrial complex. This article provides historical perspective to previous reform attempts, updates the current battle between Republicans and Democrats over repeal of the 2010 Affordable Care Act (ACA), and compares three financing alternatives—continuation of the ACA; its replacement by a Republican plan (the House’s American Health Care Act or its Senate counterpart, the Better Care Reconciliation Act); and single-payer national health insurance (NHI or Medicare for All). Markers are described that reveal the extent of the current crisis in U.S. health care. Evidence is presented that the private insurance industry, increasingly dependent on bailout by the government, is in a “death spiral.” NHI is gaining increasing public support as the only financing alternative to provide universal coverage. Nine lessons that are still unlearned in the United States concerning health care are discussed, together with future prospects to establish universal coverage in this embattled and changing political environment.

Participation in a Public Insurance Program: Subsidies, Crowd-Out, and Adverse Selection

2002 ◽  
Vol 39 (3) ◽  
pp. 243-257 ◽  
Author(s):  
Stephen H. Long ◽  
M. Susan Marquis
Keyword(s):  
Adverse Selection ◽  
Health Program ◽  
Private Insurance ◽  
Public Insurance ◽  
Public Programs ◽  
Basic Health ◽  
Insurance Program ◽  
Private Market ◽  
Crowd Out ◽  
Design Characteristics

This paper examines how varying the level of subsidies affects participation in a public insurance program, crowd-out of private insurance, and adverse selection. We study the experience in Washington's Basic Health program in 1997. Findings show that adverse selection is not a problem in voluntary public programs. Increasing subsidies have only modest effects on participation in subsidized programs, though the gains are not at the expense of the private market. Overall participation in the subsidized plan is also modest, even though participants benefit from it. The challenge to policymakers is to find program design characteristics, beyond subsidies, that attract the uninsured.

Slovenia

2021 ◽  
pp. 788-808
Author(s):  
Tamara Popic
Keyword(s):  
Health Insurance ◽  
Primary Care Physicians ◽  
Private Insurance ◽  
Social Health Insurance ◽  
Universal Coverage ◽  
Party Competition ◽  
Social Health ◽  
Large Hospital ◽  
Health Politics ◽  
Universal Health

This chapter offers an in-depth look at health politics and the universal health system in Slovenia based on compulsory social health insurance. It traces the development of the Slovenian healthcare system from the first health insurance schemes to the more established insurance system with universal coverage and focus on social medicine under communism. Since its independence in 1992, Slovenian politics has been marked by a pragmatic model of party competition with an important role in healthcare policymaking played by neo-corporatist structures. The major post-communist reform was the introduction of complementary private health insurance in 1993, which covers the majority of the population. Several unsuccessful reform proposals sought the abolition of complementary private insurance, the fairness of which remains the most controversial question regarding the system. Other healthcare issues outlined in the chapter include large hospital debt and uneven distribution of primary care physicians.

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 Long-Term Care over an Uncertain Future: What Can Current Retirees Expect?

2005 ◽  
Vol 42 (4) ◽  
pp. 335-350 ◽  
Author(s):  
Peter Kemper ◽  
Harriet L. Komisar ◽  
Lisa Alecxih
Keyword(s):  
Long Term Care ◽  
Baby Boom ◽  
Private Insurance ◽  
Family Care ◽  
Leading Edge ◽  
Policy Debate ◽  
Public Programs ◽  
Term Care ◽  
Uncertain Future

The leading edge of the baby boom generation is nearing retirement and facing uncertainty about its need for long-term care (LTC). Using a microsimulation model, this analysis projected that people currently turning age 65 will need LTC for three years on average. An important share of needed care will be covered by public programs and some private insurance, but much of the care will be an uninsured private responsibility of individuals and their families—a responsibility that will be distributed unequally. While over a third of those now turning 65 are projected to never receive family care, three out of 10 will rely on family care for more than two years. Similarly, half of people turning 65 will have no private out-of-pocket expenditures for LTC, while more than one in 20 are projected to spend $100,000 or more of their own money (in present discounted value). Policy debate that focuses only on income security and acute care—and the corresponding Social Security and Medicare programs—misses the third, largely private, risk that retirees face: that of needing LTC.

A Guide to Coding and Billing for the Audiological Management of Patients Receiving Ototoxic Medical Treatments

2019 ◽  
Vol 4 (5) ◽  
pp. 936-946
Author(s):  
Dawn Konrad-Martin ◽  
Neela Swanson ◽  
Angela Garinis
Keyword(s):  
Otoacoustic Emissions ◽  
Best Practice ◽  
Private Insurance ◽  
Monitoring Program ◽  
Current Method ◽  
International Classification Of Diseases ◽  
Ethical Practice ◽  
Party Payer ◽  
High Frequency Audiometry ◽  
Icd 10

Purpose Improved medical care leading to increased survivorship among patients with cancer and infectious diseases has created a need for ototoxicity monitoring programs nationwide. The goal of this report is to promote effective and standardized coding and 3rd-party payer billing practices for the audiological management of symptomatic ototoxicity. Method The approach was to compile the relevant International Classification of Diseases, 10th Revision (ICD-10-CM) codes and Current Procedural Terminology (CPT; American Medical Association) codes and explain their use for obtaining reimbursement from Medicare, Medicaid, and private insurance. Results Each claim submitted to a payer for reimbursement of ototoxicity monitoring must include both ICD-10-CM codes to report the patient's diagnosis and CPT codes to report the services provided by the audiologist. Results address the general 3rd-party payer guidelines for ototoxicity monitoring and ICD-10-CM and CPT coding principles and provide illustrative examples. There is no “stand-alone” CPT code for high-frequency audiometry, an important test for ototoxicity monitoring. The current method of adding a –22 modifier to a standard audiometry code and then submitting a letter rationalizing why the test was done has inconsistent outcomes and is time intensive for the clinician. Similarly, some clinicians report difficulty getting reimbursed for detailed otoacoustic emissions testing in the context of ototoxicity monitoring. Conclusions Ethical practice, not reimbursement, must guide clinical practice. However, appropriate billing and coding resulting in 3rd-party reimbursement for audiology services rendered is critical for maintaining an effective ototoxicity monitoring program. Many 3rd-party payers reimburse for these services. For any CPT code, payment patterns vary widely within and across 3rd-party payers. Standardizing coding and billing practices as well as advocacy including letters from audiology national organizations may be necessary to help resolve these issues of coding and coverage in order to support best practice recommendations for ototoxicity monitoring.

Bottom Line: Who Pays the Bill for Early Intervention Services?

ASHA Leader ◽  
2013 ◽  
Vol 18 (2) ◽  
pp. 26-27
Author(s):  
Janet McCarty ◽  
Laurie Havens
Keyword(s):  
Early Intervention ◽  
Private Insurance ◽  
Infants And Toddlers ◽  
Bottom Line ◽  
Early Intervention Services ◽  
Intervention Services

Medicaid, federal education funds and private insurance all cover the costs of speech-language and hearing services for infants and toddlers. Learn who pays for what.

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