scholarly journals Evaluating Medicare Performance: Perceptions of Performance Pre- and Post- ACA

2020 ◽  
Vol 7 (2) ◽  
pp. 28
Author(s):  
Ashleigh Chinelo Oguagha ◽  
Nickesha Joan Lambert
Keyword(s):  
Low Income ◽  
Medicare Beneficiary ◽  
National Level ◽  
Life Time ◽  
The Elderly ◽  
The United States ◽  
Health Coverage ◽  
Single Payer ◽  
Before And After ◽  
Performance Perceptions

Medicare is a national single-payer system that provides health coverage for the elderly, disabled, and terminally ill in the United States. Rising enrollment, costs, and decreases in financing options may affect the way Medicare performs. This study aimed to investigate participants’ perceptions of Medicare performance before and after the Affordable Care Act. A 3-part questionnaire was created and validated for use in this study. Respondents affiliated with several social work agencies were invited via email to participate in this study. 287 out of 519 invited questionnaires were used in data analyses. 27.5% of respondents reported being currently enrolled in Medicare, while 33.2% reported lifetime enrollment. Overall, retired/disabled, elderly and low-income participants reported currently or ever using Medicare. One’s perception of Medicare performance was determined by their status as a Medicare beneficiary. Medicare service efficacy was rated more positively over-time by current and life-time enrollees; additionally, Medicare performance was determined to be better in 2013 than in 2009. Ultimately, this study showed that health service and financial fairness factors are indicative of Medicare performance. Additional research should explore possible implications for the healthcare field as well as formulate a broad range of possible management and/or improvement strategies. Lastly, differences in performance across years can inform decision-makers and bolster the fundamental foundation of health policies at the state and national level.

Health

Getting By ◽  
2019 ◽  
pp. 329-428
Author(s):  
Helen Hershkoff ◽  
Stephen Loffredo
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
The United States ◽  
Health Coverage ◽  
Eligibility Criteria ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Child Health Insurance

This chapter addresses the issue of health care for low-income people. The United States, virtually alone among developed nations, does not offer universal access to health care, leaving many millions of individuals without health insurance or other means of obtaining necessary medical services. In 2010, Congress enacted the landmark Patient Protection and Affordable Care Act (ACA)—popularly known as “Obamacare”—marking an important but incomplete response to the nation’s health care crisis. This chapter examines the ACA in detail, including its impact on Medicaid and Medicare, the major government health programs in the United States, its creation of Health Insurance Exchanges and tax credits to help low-income households obtain private health coverage, and the reform of private health insurance markets through a patient’s bill of rights, which, among other measures, prohibits insurance companies from refusing coverage for preexisting medical conditions. Perhaps the most critical aspect of the ACA was its expansion of Medicaid to cover virtually all low-income citizens (and certain immigrants) who do not qualify for other health coverage. Although several states opted out of the ACA’s Medicaid expansion, the Medicaid program nevertheless remains the largest single provider of health coverage in the United States. This chapter also provides a detailed description of Medicaid, its eligibility criteria and scope of coverage; the Child Health Insurance Program (CHIP), a government-funded health insurance program for children in households with too much income to qualify for Medicaid; and Medicare, the federal health insurance program for aged, blind, and disabled individuals.

How Single-payer Stacks Up: Evaluating Different Models of Universal Health Coverage on Cost, Access, and Quality

2018 ◽  
Vol 48 (3) ◽  
pp. 568-585 ◽  
Author(s):  
Ashley Fox ◽  
Roland Poirier
Keyword(s):  
United States ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Coverage ◽  
The United States ◽  
Health Coverage ◽  
Single Payer ◽  
Access And Quality ◽  
Universal Health

Described as “universal prepayment,” the national health insurance (or single-payer) model of universal health coverage is increasingly promoted by international actors as a means of raising revenue for health care and improving social risk protection in low- and middle-income countries. Likewise, in the United States, the recent failed efforts to repeal and replace the Affordable Care Act have renewed debate about where to go next with health reform and arguably opened the door for a single-payer, Medicare-for-All plan, an alternative once considered politically infeasible. Policy debates about single-payer or national health insurance in the United States and abroad have relied heavily on Canada’s system as an ideal-typical single-payer system but have not systematically examined health system performance indicators across different universal coverage models. Using available cross-national data, we categorize countries with universal coverage into those best exemplifying national health insurance (single-payer), national health service, and social health insurance models and compare them to the United States in terms of cost, access, and quality. Through this comparison, we find that many critiques of single-payer are based on misconceptions or are factually incorrect, but also that single-payer is not the only option for achieving universal coverage in the United States and internationally.

scholarly journals Mind the Gap: Why Closing the Doughnut Hole Is Insufficient for Increasing Medicare Beneficiary Access to Oral Chemotherapy

2016 ◽  
Vol 34 (4) ◽  
pp. 375-380 ◽  
Author(s):  
Stacie B. Dusetzina ◽  
Nancy L. Keating
Keyword(s):  
Prescription Drug ◽  
Low Income ◽  
Cost Sharing ◽  
Medicare Beneficiary ◽  
Interquartile Range ◽  
Medicare Beneficiaries ◽  
Before And After ◽  
Prescription Drug Plan ◽  
Typical Treatment ◽  
Out Of Pocket Costs

Purpose Orally administered anticancer medications are among the fastest growing components of cancer care. These medications are expensive, and cost-sharing requirements for patients can be a barrier to their use. For Medicare beneficiaries, the Affordable Care Act will close the Part D coverage gap (doughnut hole), which will reduce cost sharing from 100% in 2010 to 25% in 2020 for drug spending above $2,960 until the beneficiary reaches $4,700 in out-of-pocket spending. How much these changes will reduce out-of-pocket costs is unclear. Methods We used the Medicare July 2014 Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files from the Centers for Medicare & Medicaid Services for 1,114 stand-alone and 2,230 Medicare Advantage prescription drug formularies, which represent all formularies in 2014. We identified orally administered anticancer medications and summarized drug costs, cost-sharing designs used by available plans, and the estimated out-of-pocket costs for beneficiaries without low-income subsidies who take a single drug before and after the doughnut hole closes. Results Little variation existed in formulary design across plans and products. The average price per month for included products was $10,060 (range, $5,123 to $16,093). In 2010, median beneficiary annual out-of-pocket costs for a typical treatment duration ranged from $6,456 (interquartile range, $6,433 to $6,482) for dabrafenib to $12,160 (interquartile range, $12,102 to $12,262) for sunitinib. With the assumption that prices remain stable, after the doughnut hole closes, beneficiaries will spend approximately $2,550 less. Conclusion Out-of-pocket costs for Medicare beneficiaries taking orally administered anticancer medications are high and will remain so after the doughnut hole closes. Efforts are needed to improve affordability of high-cost cancer drugs for beneficiaries who need them.

Analogical Framing: How Policy Comparisons Alter Political Support for Health Care Reform

2020 ◽  
Vol 48 (5) ◽  
pp. 596-611
Author(s):  
Jason Barabas ◽  
Benjamin Carter ◽  
Kevin Shan
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
The United States ◽  
Political Support ◽  
Health Coverage ◽  
Individual Health ◽  
Single Payer ◽  
Public Debates ◽  
Democrats And Republicans ◽  
Political Persuasion

Analogies have captivated philosophers for millennia, yet their effects on modern public opinion preferences remain largely unexplored. Nevertheless, the lack of evidence as to whether analogies aid in political persuasion has not stopped politicians from using these rhetorical devices in public debates. To examine such strategic attempts to garner political support, we conducted survey experiments in the United States that featured the analogical arguments being used by Democrats and Republicans as well as some of the policy rationales that accompanied their appeals. The results revealed that analogies—especially those that also provided the underlying policy logic—increased support for individual health coverage mandates, the Affordable Care Act (ACA), and even single payer national health proposals. However, we demonstrated that rebutting flawed analogies was also possible. Thus, within the health care arena, framing proposals with analogies can alter policy preferences significantly, providing a way to deliver policy rationales persuasively.

Social Provision before the Twentieth Century

2013 ◽  
Author(s):  
Laura S. Jensen
Keyword(s):  
Native Americans ◽  
Policy Development ◽  
National Level ◽  
The Elderly ◽  
The United States ◽  
Colonial Era ◽  
Welfare Benefits ◽  
Social Provision ◽  
The Disabled ◽  
Federal Land

This chapter traces the evolution of social provision in the United States from the colonial era forward, chronicling the local, state, and national-level policy developments that constituted the foundation on which the American welfare state would be built. Specific social welfare benefits discussed include local poor relief; institutional approaches to social provision, such as the poorhouse and the workhouse; state and federal veterans’ pensions and land grants; and federal land entitlements for nonveterans. The essay also considers the legacy of the English Poor Law; the social construction of citizen deservingness; the establishment of programmatic entitlement as a policy practice; the influence of federalism and of illiberal hierarchies of gender, race, ethnicity, and class on early social policy development; and the special challenges faced by women, the elderly, the disabled, slaves, free blacks, and Native Americans in seventeenth-, eighteenth-, and nineteenth-century America.

scholarly journals Micronutrients - a Global Perspective on Intake, Health Benefits and Economics

2012 ◽  
Vol 82 (5) ◽  
pp. 316-320 ◽  
Author(s):  
Birgit Hoeft ◽  
Peter Weber ◽  
Manfred Eggersdorfer
Keyword(s):  
Low Income ◽  
Health Care Systems ◽  
The Elderly ◽  
The United States ◽  
Global Perspective ◽  
Low Income Countries ◽  
Micronutrient Deficiencies ◽  
Micronutrient Status ◽  
Care Systems ◽  
Development And Aging

The link between a sufficient intake of vitamins and long term health, cognition, healthy development and aging is increasingly supported by experimental animal, human and epidemiology studies. In low income countries billions of people still suffer from the burden of malnutrition and micronutrient deficiencies. However, inadequate micronutrient status might also be an issue in industrialized countries. Recent results from nutritional surveys in countries like the United States, Germany, and Great Britain indicate that the recommended intake of micronutrients is not reached. This notably concerns certain vulnerable population groups, such as pregnant women, young children and the elderly, but also greatly influences the general healthcare costs. An overview is provided on the gap that exists between current vitamin intakes and requirements, even in countries where diverse foods are plentiful. Folic acid and vitamin D intake and status are evaluated in more detail, providing insight on health and potential impact on health care systems.

scholarly journals COVID-19 a health reform catalyst? —Analyzing single-payer options in the U.S.: Considering economic values, recent proposals, and existing models from abroad

2020 ◽  
Vol 9 (4) ◽  
pp. 10 ◽  
Author(s):  
Alan Parnell ◽  
Krzysztof Goniewicz ◽  
Amir Khorram-Manesh ◽  
Fredrick M. Burkle ◽  
Ahmed Al-Wathinani ◽  
...  
Keyword(s):  
Free Market ◽  
Universal Coverage ◽  
The United States ◽  
Fee For Service ◽  
Health Coverage ◽  
Industrialized Countries ◽  
Economic Values ◽  
Market Values ◽  
Single Payer ◽  
The U.S

The United States has continued to face severe health coverage and spending challenges that have been attributed to a fragmented multi-payer and fee-for-service delivery system which has become even more exposed by the COVID-19 pandemic. Legislators and healthcare professionals have tried to answer the challenges faced by the U.S. health system through the introduction of several state and federal proposals for a “Medicare-for-all” like system, which have failed to be adopted likely due to the lack of consideration for free-market economic values. Looking to existing models abroad can provide the U.S. with different ways to understand how to achieve the benefits of single-payer models with universal coverage while maintaining the integrity of free-market values. The health systems in wealthy, industrialized countries are closely referenced in this article because of the variation of methods in which each achieves a single-payer/universal coverage model as well as the contrast in their health outcomes compared to that of the U.S. The biggest considerations for any reform effort to achieve an efficient single-payer system with universal coverage is the maintenance of private health insurers and the degree to which expanded government influence would be accepted. The future state of health care remains uncertain and unstable as a result of the COVID-19 pandemic, therefore a window of opportunity exists now for leveraging this uncertainty to achieve reform.

Protect the Sick: Health Insurance Reform in One Easy Lesson

2008 ◽  
Vol 36 (4) ◽  
pp. 652-659 ◽  
Author(s):  
Deborah Stone
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Low Income ◽  
The Elderly ◽  
The United States ◽  
Government Programs ◽  
Insurance Reform ◽  
Sick People ◽  
Health Insurance Reform ◽  
Inducing Factors

In most other nations, insurance for medical care is called sickness insurance, and it covers sick people. In the United States, we have “health insurance,” and its major carriers — commercial insurers, large employers, and increasingly government programs — strive to avoid sick people and cover only the healthy. This perverse logic at the heart of the American health insurance system is the key to reform debates.Focusing on sick people versus healthy people might seem a strange way to view the coverage issue. Most discussions of insurance categorize people into other groupings: the insured versus the uninsured; Caucasian whites versus other racial and ethnic groups; men versus women; poor and low-income people versus everybody else; children, adults, and the elderly; or citizens versus immigrants and undocumented aliens. More recently, health researchers have begun talking about “vulnerable populations,” using most of the same demographic groupings and adding other illness-inducing factors such as social isolation, stress, and impoverished neighborhoods. But as I will show, insurance plans now use premiums, cost-sharing, and other design features in ways that indirectly divide each of these groups into the sick and the healthy, to the detriment of the sick. By shifting the costs of illness onto people who use medical care — that is, sick people — market-oriented reforms of the last few decades have eroded insurance in the name of strengthening it.

scholarly journals Challenges to achieving universal health coverage through community-based health planning and services delivery approach: a qualitative study in Ghana

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024845 ◽  
Author(s):  
Abraham Assan ◽  
Amirhossein Takian ◽  
Moses Aikins ◽  
Ali Akbarisari
Keyword(s):  
Qualitative Study ◽  
Universal Health Coverage ◽  
Low Income ◽  
Health Planning ◽  
National Level ◽  
Health Coverage ◽  
Community Based ◽  
Services Delivery ◽  
Universal Health ◽  
Local Levels

ObjectiveCommunity-based initiatives have enormous potential to facilitate the attainment of universal health coverage (UHC) and health system development. Yet key gaps exist and threaten its sustainability in many low-income and middle-income countries. This study is first of its kind (following the launch of the Sustainable Developments Goal [SDG]) and aimed to holistically explore the challenges to achieving UHC through the community-based health planning and service (CHPS) initiative in Ghana.DesignA qualitative study design was adopted to explore the phenomenon. Face-to-face indepth interviews were conducted from April 2017 until February 2018 through purposive and snowball sampling techniques. Data were analysed using inductive and deductive thematic analysis approach.SettingData were gathered at the national level, in addition to the regional, district and subdistrict/local levels of four regions of Ghana. Sampled regions were Central Region, Greater Accra Region, Upper East Region and Volta Region.ParticipantsIn total, 67 participants were interviewed: national level (5), regional levels (11), district levels (9) and local levels (42). Interviewees were mainly stakeholders—people whose actions or inactions actively or passively influence the decision-making, management and implementation of CHPS, including policy makers, managers of CHPS compound and health centres, politicians, academics, health professionals, technocrats, and community health management committee members.ResultsBased on our findings, inadequate understanding of CHPS concept, major contextual changes with stalled policy change to meet growing health demands, and changes in political landscape and leadership with changed priorities threaten CHPS sustainability.ConclusionUHC is a political choice which can only be achieved through sustainable and coherent efforts. Along countries’ pathways to reach UHC, coordinated involvement of all stakeholders, from community members to international partners, is essential. To achieve UHC within the time frame of SDGs, Ghana has no choice but to improve its national health governance to strengthen the capacity of existing CHPS.

scholarly journals Mapping Research Trends of Universal Health Coverage From 1990 to 2019: Bibliometric Analysis (Preprint)

2020 ◽  
Author(s):  
Mahboubeh Khaton Ghanbari ◽  
Masoud Behzadifar ◽  
Leila Doshmangir ◽  
Mariano Martini ◽  
Ahad Bakhtiari ◽  
...  
Keyword(s):  
Bibliometric Analysis ◽  
Universal Health Coverage ◽  
Low Income ◽  
The United States ◽  
World Health ◽  
Health Coverage ◽  
Related Research ◽  
Funding Sources ◽  
Number Of Publications ◽  
Universal Health

BACKGROUND Universal health coverage (UHC) is one of many ambitious, health-related, sustainable development goals. Sharing various experiences of achieving UHC, in terms of challenges, pitfalls, and future prospects, can help policy and decision-makers reduce the likelihood of committing errors. As such, scholarly articles and technical reports are of paramount importance in shedding light on the determinants that make it possible to achieve UHC. OBJECTIVE The purpose of this study is to conduct a comprehensive analysis of UHC-related scientific literature from 1990 to 2019. METHODS We carried out a bibliometric analysis of papers related to UHC published from January 1990 to September 2019 and indexed in Scopus via VOSviewer (version 1.6.13; CWTS). Relevant information was extracted: the number of papers published, the 20 authors with the highest number of publications in the field of UHC, the 20 journals with the highest number of publications related to UHC, the 20 most active funding sources for UHC-related research, the 20 institutes and research centers that have produced the highest number of UHC-related research papers, the 20 countries that contributed the most to the research field of UHC, the 20 most cited papers, and the latest available impact factors of journals in 2018 that included the UHC-related items under investigation. RESULTS In our analysis, 7224 articles were included. The publication trend was increasing, showing high interest in the scientific community. Most researchers were from the United States, the United Kingdom, and Canada, with Thailand being a notable exception. The Lancet accounted for 3.95% of published UHC-related research. Among the top 20 funding sources, the World Health Organization (WHO), the Bill and Melinda Gates Foundation, and the National Institutes of Health (NIH) accounted for 1.41%, 1.34%, and 1.02% of published UHC-related research, respectively. The highest number of citations was found for articles published in The Lancet, the American Journal of Psychiatry, and the Journal of the American Medical Association (JAMA). The top keywords were “health insurance,” “insurance,” “healthcare policy,” “healthcare delivery,” “economics,” “priority,” “healthcare cost,” “organization and management,” “health services accessibility,” “reform,” “public health,” and “health policy.” CONCLUSIONS The findings of our study showed an increasing scholarly interest in UHC and related issues. However, most research concentrated in middle- and high-income regions and countries. Therefore, research in low-income countries should be promoted and supported, as this could enable a better understanding of the determinants of the barriers and obstacles to UHC achievement and improve global health.

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