scholarly journals All-Payer Rate Setting: A Framework for a More Efficient Health Care System

2017 ◽  
Vol 24 ◽  
pp. 81
Author(s):  
Eric Flanagan
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Services ◽  
Health Care Systems ◽  
Private Insurance ◽  
The United States ◽  
Insurance Companies ◽  
Cost Shifting ◽  
The Us ◽  
Care System

The United States is unique among countries with health care systems that rely primarily on private insurance companies because there are generally no regulations that mandate a standard fee schedule for health care services. The prevalence of multiple private and public insurers is known as a multi-payer system. Other countries that have multiple payers set prices unilaterally, as is the case in Japan, or through negotiations between payers and providers, as is the case in Germany. The outcome is a uniform set of prices that applies to all payers within a single hospital. This framework is known as all-payer rate setting. This paper explains how all-payer rate setting regulation can mitigate several problems plaguing the US health care system. Examples include cost shifting, price discrimination, and provider market leverage. The paper then analyzes how these problems negatively affect the US health care system. Finally, the benefits of all-payer rate setting are explained, followed by the downsides (or tradeoffs) of such a system.

scholarly journals Disparities in Emergent Colectomy for Colorectal Cancer Contribute to Inequalities in Postoperative Morbidity and Mortality in The US Health Care System

2019 ◽  
Vol 109 (2) ◽  
pp. 102-107 ◽  
Author(s):  
F. Schlottmann ◽  
P. D. Strassle ◽  
A. L. Cairns ◽  
F. A. M. Herbella ◽  
A. Fichera ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care System ◽  
Private Insurance ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Wound Complications ◽  
Colorectal Cancer Surgery ◽  
The Us ◽  
Care System

Background and Aims: Colorectal cancer is the third most common cancer among both men and women in the United States. We aimed to determine racial and socioeconomic disparities in emergent colectomy rates for colorectal cancer in the US Health Care system. Material and Methods: We performed a retrospective analysis of the National Inpatient Sample including adult patients (⩾18 years) diagnosed with colorectal cancer, and who underwent colorectal resection while admitted between 2008 and 2015. Multivariable logistic and linear regression were used to assess the association between emergent admissions, compared to elective admissions, and postoperative outcomes. Results: A total of 141,641 hospitalizations were included: 93,775 (66%) were elective admissions and 47,866 (34%) were emergent admissions. Black patients were more likely to undergo emergent colectomy, compared to white patients (42% vs 32%, p < 0.0001). Medicaid and Medicare patients were also more likely to have an emergent colectomy, compared to private insurance (47% and 36% vs 25%, respectively, p < 0.0001), as were patients with low household income, compared to highest (38% vs 31%, p < 0.0001). Emergent procedures were less likely to be laparoscopic (19% vs 38%, p < 0.0001). Patients undergoing emergent colectomy were significantly more likely to have postoperative venous thromboembolism, wound complications, infection, bleeding, cardiac failure, renal failure, respiratory failure, shock, and inpatient mortality. Conclusion: There are significant racial and socioeconomic disparities in emergent colectomy rates for colorectal cancer. Efforts to reduce this disparity in colorectal cancer surgery patients should be prioritized to improve outcomes.

scholarly journals Expansion of Health Networks as a Building Block of a Functioning Health Landscape

2021 ◽  
Vol 12 (3) ◽  
pp. 24-29
Author(s):  
S. Wahl ◽  
A. Czirfusz
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Services ◽  
Service Providers ◽  
Health Care Systems ◽  
Insurance Companies ◽  
Patient Centered ◽  
Health Networks ◽  
Care Services ◽  
Care System

A health network is made up of institutions and organizations, resources, and people whose main purpose is to promote and improve health. The health care system in Germany is self-administering and is managed by multiple institutions and stakeholders which entails different organizations involved in the running of the health care as well as the structure of the health care system. The health care system is composed of three main areas: 1) outpatient care services, 2) inpatient care, 3) rehabilitation institutions. Some of the organizations and institutions that are mandated to run the health system include associations and representatives of different professions and service providers, regulatory bodies, health insurance companies, the Federal Ministry of Health, self-help groups, and patient-centered organizations. The German health care system is made up of four main principles: 1) compulsory insurance, 2) the principle of solidarity, 3) financing through insurance premiums, 4) selfgovernance. The goal of health care networks is to improve the overall performance of the health care systems concerning: 1) economic efficiency, 2) quality of health care services, 3) medical innovation, 4) as well as patient satisfaction.

Health System in Poland

2017 ◽  
Vol 53 (2) ◽  
pp. 107-112
Author(s):  
Daniel Ślęzak ◽  
Przemysław Żuratyński ◽  
Klaudiusz Nadolny ◽  
Marlena Robakowska ◽  
Alicja Kalis
Keyword(s):  
Health Care ◽  
Health Care System ◽  
National Health ◽  
Health Care Services ◽  
Health Care Systems ◽  
State Budget ◽  
Right To Health Care ◽  
Health Fund ◽  
National Health Fund ◽  
Care System

Health care systems face challenges related to the technological advances in medicine, demographic changes and limited opportunities for growth funding for health, necessitating greater involvement in the search for more efficient systems. The authors present the functioning of the Polish health care system based on social, historical outline of the healthcare system in Poland and the functioning of the National Health Fund (NFZ). Poland has undergone many reforms of the health care system, the Bismarck model, the model Siemaszko, and finally to a model of universal health insurance. So everyone has the same right to health care services financed by the NFZ or directly from the state budget (eg. The system of state emergency medical services). The National Health Fund allows anyone insured to free healthcare and reimbursement of medicines. Introduced information about information programs.

scholarly journals The nursing shortage: a worldwide problem

2002 ◽  
Vol 10 (3) ◽  
pp. 392-400 ◽  
Author(s):  
Rachel Z. Booth
Keyword(s):  
Health Care ◽  
Work Environment ◽  
Health Care System ◽  
Health Care Systems ◽  
Developed Countries ◽  
World Health ◽  
Insurance Companies ◽  
Advisory Group ◽  
Positive Effects ◽  
Care System

A worldwide shortage of nurses has been acknowledged by the multidisciplinary Global Advisory Group of the World Health Organization. The shortage is caused by an increased demand for nurses, while fewer people are choosing nursing as a profession and the current nurses worldwide are aging. The shortage applies to nurses in practice as well as the nurse faculty who teach students. The inter-country recruitment and migration of nurses from developing countries to developed countries exacerbates the problem. Although public opinion polls identifies the nurse as the person who makes the health care system work for them, the conditions of the work environment in which the nurse functions is unsatisfactory and must change. Numerous studies have shown the positive effects on the nurse of a healthy work environment and the positive relationships between nursing care and patient outcomes. It is important that government officials, insurance companies, and administrators and leaders of health care systems acknowledge and operationalize the value of nurses to the health care system in order to establish and maintain the integrity and viability of that system.

scholarly journals Rural Michigan Farmers’ Health Concerns and Experiences: A Focus Group Study

2021 ◽  
Vol 12 ◽  
pp. 215013272110535
Author(s):  
Nathan Wright ◽  
Marylee Scherdt ◽  
Michelle L. Aebersold ◽  
Marjorie C. McCullagh ◽  
Barbara R. Medvec ◽  
...  
Keyword(s):  
Health Care ◽  
Focus Groups ◽  
Health Care System ◽  
Health Care Services ◽  
Well Being ◽  
The United States ◽  
Full Time ◽  
Rural Residents ◽  
Care Services ◽  
Care System

Objectives: Rural residents comprise approximately 15% of the United States population. They face challenges in accessing and using a health care system that is not structured to meet their unique needs. It is important to understand rural residents’ perceptions of health and experiences interacting with the health care system to identify gaps in care. Methods: Our team conducted focus groups with members of the Michigan Farm Bureau during their 2019 Annual Meeting. Topics explored included resources to manage health, barriers to virtual health care services, and desired changes to localized healthcare delivery. Surveys were used to capture demographic and internet access information. Conclusion: Analysis included data from 2 focus groups (n = 14). Participants represented a wide age range and a variety of Michigan counties. The majority were full-time farm owners with most—93% (n = 13)—reporting they had access to the internet in their homes and 86% (n = 12) reporting that their cellphones had internet capabilities. Participants identified challenges and opportunities in 4 categories: formal health care; health and well-being supports; health insurance experiences; and virtual health care. Conclusion: The findings from this study provide a useful framework for developing interventions to address the specific needs of rural farming residents. Despite the expressed challenges in access and use of health care services and resources, participants remained hopeful that innovative approaches, such as virtual health platforms, can address existing gaps in care. The study findings should inform the design and evaluation of interventions to address rural health disparities.

Book Reviews: Coddington et al. - The Crisis in Health Care: Costs, Choices, and StrategiesDean C. Coddington, David J. Keen, Keith D. Moore, and Richard L. Clarke San Francisco: Jossey-Bass, 1991, 303 pp. US$30.95 cloth. ISBN 1-55542-273-X. Jossey-Bass Publishers, 350 Sansome St., San Francisco, CA 94104, USA.

1992 ◽  
Vol 11 (2) ◽  
pp. 274-275
Author(s):  
Andrea L. Bonnicksen
Keyword(s):  
Health Care ◽  
San Francisco ◽  
Health Care System ◽  
The United States ◽  
Economic Research ◽  
Present System ◽  
Cost Shifting ◽  
Hospital Administrators ◽  
The Impact ◽  
Care System

PrécisThe authors assume that costs can no longer be contained in the United States health care system and that the present system cannot be sustained beyond the near future. Three of the authors are affiliated with an applied economic research and consulting firm, and the fourth is president of the Healthcare Financial Management Association. They are trained in business and city planning. The bibliography lists articles from such journals as Hospitals, Business & Health, Business Insurance, and Medical Economics.The book is directed to members of hospital governing boards and other hospital administrators, but it will be of interest to students of health policy. Part I highlights tensions between what the authors call the worlds of doctors and hospital administrators struggling to survive, on the one hand, and health care planners worried about spiraling costs on the other. Part II contains five chapters that suggest reasons for growing costs and that criticize cost shifting as a remedy.In Part III the authors evaluate alternative health care systems by presenting four future scenarios: incremental change, universal access, consumer choice model, and single payer system. In these chapters they also approach the fundamental purpose of the book—to “help physicians, hospitals, and health plans take the next steps to position themselves for the future.” While not highly analytical, the book is a readable and thoughtful supplement to more abstract critiques of the impact of today's health care system on distributive justice.

Indicating Fields of Inequalities Regarding the Access to Health Benefits

2012 ◽  
Vol 1 (2) ◽  
pp. 41-54 ◽  
Author(s):  
Krzysztof Landa ◽  
Karolina Skóra
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care System ◽  
Health Care Services ◽  
Health Care Systems ◽  
Health Benefits ◽  
Access To Health Services ◽  
Web Portal ◽  
Access To Health ◽  
Care System

Restrictions to health services in Poland have been an inspiration to establish Watch Health Care Foundation (WHC). The fundamental disease of the system is namely the disproportion between the amount of the funds and the contents of the package. It causes everywhere the same ’symptoms’ and leads to the same pathological phenomena: queues and other forms of rationing (’guaranteed’) health benefits, corruption, making use of privileges. Foundation uses the potential of information society and available infrastructure (web portal http://www.watchealthcare.eu) and all activities are presented on the website with the aim of influencing the health care system. On the basis of reports of limited access to health services, a ranking is created at WHC web portal, which aims to show what the biggest gaps in access to health services are - this is the way of showing the patient and health care system needs and also one possible approach of continuous education of the health care services consumers targeted at health care systems improvement.

Blurring the boundaries between public and private health care services as an alternative explanation for the emergence of black medicine: the Israeli case

2014 ◽  
Vol 10 (3) ◽  
pp. 293-310 ◽  
Author(s):  
Dani Filc ◽  
Nissim Cohen
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Services ◽  
Qualitative Methodology ◽  
Health Care Systems ◽  
Public Health Care ◽  
Private Health Care ◽  
Public And Private ◽  
Care Services ◽  
Care System

AbstractBlack medicine represents the most problematic configuration of informal payments for health care. According to the accepted economic explanations, we would not expect to find black medicine in a system with a developed private service. Using Israel as a case study, we suggest an alternative yet a complimentary explanation for the emergence of black medicine in public health care systems – even though citizens do have the formal option to use private channels. We claim that when regulation is weak and political culture is based on ‘do it yourself’ strategies, which meant to solve immediate problems, blurring the boundaries between public and private health care services may only reduce public trust and in turn, contribute to the emergence of black medicine. We used a combined quantitative and qualitative methodology to support our claim. Statistical analysis of the results suggested that the only variable significantly associated with the use of black medicine was trust in the health care system. The higher the respondents’ level of trust in the health care system, the lower the rate of the use of black medicine. Qualitatively, interviewee emphasized the relation between the blurred boundaries between public and private health care and the use of black medicine.

Back to Europe: Back to Bismarck?

1996 ◽  
Vol 26 (4) ◽  
pp. 777-802 ◽  
Author(s):  
Hans-Ulrich Deppe ◽  
Stjepan Oreskovic
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Service Provision ◽  
Health Care Systems ◽  
Insurance Companies ◽  
Central State ◽  
German Health Care System ◽  
German Health ◽  
Care Systems ◽  
Care System

Since 1989 there have been enormous changes in all aspects of health policy, and the Former Socialist Economies (FSEs) are facing similar challenges. The general restructuring of politics and economies has resulted in two leading orientations in the transformation of health care systems: the separation of funding and service provision from the state, and the separation of funding and service provision from each other. Many FSEs have already passed legislation establishing a sickness insurance system under a single national funding institution, or a combination of compulsory and voluntary insurance, or a system involving private sector insurance companies in generating compulsory or voluntary health care funding. Due to the peculiarities and specific features of the German health care system, the uncritical intention to implement the “Bismarck model” in the FSEs faces several problems. These can be summarized in one main point: the relative stability of the German health care system, which may be attractive to the FSEs, is based on economic prosperity and on a strong ability to assert the will of the central state institutions; these preconditions are not present in the FSEs.

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.

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