The Emergence of the New Era of Reform

2017 ◽  
pp. 36-59
Author(s):  
Gunnar Almgren
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Successful Implementation ◽  
Health Security ◽  
New Era ◽  
Low Income Children ◽  
Working Families

The chapter begins with a review of the efforts to reform health care in ways that would assure health care for all Americans, beginning with Progressive Era reforms in the early 1900’s through the William Clinton administration’s ill-fated Health Security Act in the early 1990’s. After delving into the less ambitious reforms of late 1900’s aimed at cost-containment and incremental expansions of health insurance coverage for low-income children, the chapter examines the devolution of the employment-based insurance for working families was pivotal to the economic and political context of the Affordable Care Act (ACA) of 2009 –the first federal legislation in U.S. history to advance universal health insurance for all American citizens as its central goal. The chapter concludes with a prognosis for the successful implementation of the ACA, as well as its long term prospects.

RSBY: delivering health insurance through public-private contracting

2020 ◽  
Vol 10 (4) ◽  
pp. 1-36
Author(s):  
Dayashankar Maurya ◽  
Amit Kumar Srivastava ◽  
Sulagna Mukherjee
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Care Expenditure ◽  
Health Insurance Coverage ◽  
Insurance Companies ◽  
Content Type ◽  
Academic Level ◽  
Public And Private Sector

Learning outcomes The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India. Case overview/synopsis Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program. Complexity academic level India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government. Supplementary materials Teaching Notes are available for educators only. Subject code CSS: 10 Public Sector Management.

scholarly journals Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives

2021 ◽  
Vol 6 (8) ◽  
pp. e005964
Author(s):  
Doris Osei Afriyie ◽  
Brady Hooley ◽  
Grace Mhalu ◽  
Fabrizio Tediosi ◽  
Sally M Mtenga
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Financing ◽  
Health Insurance Coverage ◽  
Normalisation Process Theory ◽  
Successful Implementation ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Financing Policies

The development of effective and inclusive health financing reforms is crucial for the progressive realisation of universal health coverage in low-income and middle-income countries. Tanzania has been reforming health financing policies to expand health insurance coverage and achieve better access to quality healthcare for all. Recent reforms have included improved community health funds (iCHFs), and others are underway to implement a mandatory national health insurance scheme in order to expand access to services and improve financial risk protection. Governance is a crucial structural determinant for the successful implementation of health financing reforms, however there is little understanding of the governance elements that hinder the implementation of health financing reforms such as the iCHF in Tanzania. Therefore, this study used the perspectives of health sector stakeholders to explore governance factors that influence the implementation of health financing reforms in Tanzania. We interviewed 36 stakeholders including implementers of health financing reforms, policymakers and health insurance beneficiaries in the regions of Dodoma, Dar es Salaam and Kilimanjaro. Normalisation process theory and governance elements guided the structure of the in-depth interviews and analysis. Governance factors that emerged from participants as facilitators included a shared strategic vision for a single mandatory health insurance, community engagement and collaboration with diverse stakeholders in the implementation of health financing policies and enhanced monitoring of iCHF enrolment due to digitisation of registration process. Governance factors that emerged as barriers to the implementation were a lack of transparency, limited involvement of the private sector in service delivery, weak accountability for revenues generated from community level and limited resources due to iCHF design. If stakeholders do not address the governance factors that hinder the implementation of health financing reforms, then current efforts to expand health insurance coverage are unlikely to succeed on their own.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

scholarly journals Correlates of health care access problems among reproductive age women in Ethiopia: In-depth analysis of 2016 Ethiopia demographic Health Survey

2019 ◽  
Author(s):  
koku Tamirat ◽  
Zemenu Tadesse Tessema ◽  
Fentahun Bikale Kebede
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Access ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Reproductive Age ◽  
Rural Residence ◽  
Factors Associated ◽  
Care Access ◽  
Reproductive Age Women

Abstract Background Health care access is timely use of personal health services to achieve best health outcomes. Difficulties to access health care among reproductive age women may led to different negative health outcomes to death and disability. Therefore, this study aimed to assess factors associated with problems of accessing health care among reproductive age women in Ethiopia.Method This study was based on 2016 Ethiopia Demography and Health Survey. Individual women record (IR) file was used to extract the dataset and 15, 683 women were included in the final analysis. A composite variable of problem of accessing health care were created from four questions used to rate problem of accessing health care among reproductive age women. Generalized estimating equation (GEE) model was fitted to identify factors associated with problem of accessing health care. Crude and Adjusted odds ratio with a 95%CI computed to assess the strength of association between independent and outcome variables.Result In this study the magnitude of problem in accessing health care among reproductive age women was 69.9% of with 95%CI (69.3 to 70.7). Rural residence (AOR= 2.13, 95%CI: 1.79 to 2.53), women age 35-49 years (AOR= 1.24, 95%CI: 1.09 to 1.40), married/live together (AOR= 0.72, 95%CI: 0.64 to 0.81), had health insurance coverage (AOR=0.83, 95%CI: 0.70 to 0.95), wealth index [middle (AOR=0.75,95%CI: 0.66 to 0.85) and rich (AOR=0.47,95%CI:0.42 to 0.53)], primary education(AOR= 0.80, 95%CI: 0.73 to 0.88), secondary education (AOR= 0.57, 95%CI:0.50 to 0.64) and diploma and higher education (AOR= 0.43, 95%CI: 0.37 to 0.50) were factors associated with problem of health care access among reproductive age women.Conclusion Despite better coverage of health system, problems of health care access among reproductive age women were considerably high. Health insurance coverage, middle and rich wealth, primary and above educational level were negatively associated with problems health care access. In contrast, older age and rural residence were positively associated with problems of health care access among reproductive age women. This suggests that further interventions are necessary to increase universal reproductive health care access for the achievement of sustainable development goals.

France

2021 ◽  
pp. 558-589
Author(s):  
Matthias Brunn ◽  
Patrick Hassenteufel
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Public Management ◽  
New Public Management ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
National Health Insurance System ◽  
Health Politics ◽  
New Public ◽  
Unusual Combination

This chapter offers an in-depth look at health politics and the national health insurance system in France. It traces the development of the French healthcare system through its series of political regimes, characterized by its unusual combination of statism and corporatism. Since the 1990s, a technocratic consensus emerged that has led to new public management reforms, tighter parliamentary control of social security budgets, and efforts to improve coverage by subsidizing supplementary voluntary health insurance coverage for low-income persons and increasing tax-financing. Other healthcare issues have been regional health inequalities, reimbursement of medical professionals, and individuals’ responsibility for their health.

Holes in the Health Insurance System-Who Lacks Coverage and Why

2004 ◽  
Vol 32 (3) ◽  
pp. 390-396 ◽  
Author(s):  
Catherine Hoffman ◽  
Diane Rowland ◽  
Alicia L. Carbaugh
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Insurance System ◽  
Major Health ◽  
Insurance System ◽  
Current Health ◽  
Private And Public ◽  
Care Costs

Lack of health insurance coverage is a large and growing problem for millions of American families. Rising health care costs and economic insecurity continue to threaten the bedrock of the health insurance system - employer-sponsored coverage - while states’ fiscal situations and the escalating federal deficit complicate any efforts at reform. Providing health insurance coverage to the millions of uninsured remains a major health care challenge for the nation and understanding the current health insurance environment, who the uninsured are, and why they are uninsured is critical when considering health care reform. This paper aims to define the problem of the uninsured, providing an overview of the uninsured in America and the roles and limits of private and public insurance. Following this discussion, the paper describes the current health insurance environment and examines the prospects for improving coverage.

Sign in / Sign up

Export Citation Format

Share Document