A Principled Approach to Radical Health-Care Finance Reform

2017 ◽  
pp. 131-158
Author(s):  
Gunnar Almgren
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Health Care System ◽  
Social Insurance ◽  
Health Care Financing ◽  
Democratic Citizenship ◽  
Finance Reform ◽  
The Social ◽  
Progressive Policy ◽  
Care System

Building upon contextualization of the ACA as not a panacea, but instead a stage of progressive policy evolution, this chapter is the first of three chapters that sketches out a vision of health care reform that more completely satisfies the requirements of democratic citizenship and the possibility of social mobility that is essential to the preservation and advancement of political democracy. A basic premise of this chapter is that health care system finance reform logically (and in historical terms empirically) precedes health care system delivery reforms. The particular form of health care financing that is presented and then argued in this chapter is a hybridization of the social insurance approach to health care financing, subsidized by a vibrant voluntary insurance market. This approach takes into account both the principles of health care reform advanced in Chapter 4 and a pragmatic appreciation of the social and political context that has shaped the American liberal welfare state and continues to define its boundaries.

scholarly journals THE ROLE OF SOCIAL AND PERSONAL INSURANCE IN PROVIDING PUBLIC WELFARE IN UKRAINE

2020 ◽  
pp. 51-64
Author(s):  
Mykhailo KRUPKA ◽  
Iryna PRYIMAK ◽  
Bohdana VYSHYVANA
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Social Insurance ◽  
Social Protection ◽  
Public Welfare ◽  
Pension Insurance ◽  
The Social ◽  
Personal Insurance ◽  
Care System

Introduction. Achieving public welfare is impossible without an effective social protection system, which combines pension insurance, social insurance, health care, as well as material support in difficult life situations. Low budget funding for social protection of population necessitates the use of insurance instruments to neutralize major social risks. However, the role of social and personal insurance in the financial provision of social protection remains insufficient, and its potential in improving the welfare of Ukrainians is underestimated. However, the role of social and personal insurance in the financial provision of social protection remains insufficient, and its potential in improving the welfare of Ukrainians is underestimated. The purpose is to define the role and outline the prospects for the development of social and personal insurance in the context of ensuring public welfare in Ukraine. Results. The essence and main components of social welfare are revealed. It was found that the level of well-being of Ukrainians is ten times lower than in European countries. There are the main negative factors which influence the social protection system defined, in particular: low income and rising expenditures of the Pension Fund of Ukraine and the Social Insurance Fund of Ukraine, the widespread practice of minimizing SSPs by refusing to enter into classic employment contracts in favor of civil agreements with individual entrepreneurs, reduction of the number of insured persons working for hire, high level of labor emigration of Ukrainians. The health care system impact on the growth of public welfare in Ukraine is analyzed. The inefficiency of the current financial support model of the health care system is substantiated, which makes it necessary for households to pay for most of the cost of medical services. Tendencies in the development of the domestic health insurance market are highlighted. Perspectives. It is proposed to revise the principles of building accumulative pension insurance and introduce a budget-insurance model of financing the health care system, which will help to improve the welfare of the population of Ukraine.

scholarly journals The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age

2017 ◽  
Vol 27 (6) ◽  
pp. 694-699 ◽  
Author(s):  
Nicolas W. Villelli ◽  
Hong Yan ◽  
Jian Zou ◽  
Nicholas M. Barbaro
Keyword(s):  
Health Care ◽  
New York ◽  
Health Care Reform ◽  
Health Care System ◽  
Spine Surgery ◽  
Private Insurance ◽  
New York State ◽  
Before And After ◽  
The Impact ◽  
Care System

OBJECTIVESeveral similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US.METHODSUsing the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control.RESULTSThe authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups.CONCLUSIONSAfter the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

Micro-Level Analysis of Distributional Changes in Health Care Financing in Finland

1998 ◽  
Vol 3 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Jan Klavus ◽  
Unto Häkkinen
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Structural Changes ◽  
Health Care Expenditure ◽  
Health Care Financing ◽  
Simulated Data ◽  
Health Care Reforms ◽  
Income Data ◽  
Severe Recession ◽  
Care System

Objectives: In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered. Method: The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index). Results: In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more. Conclusions: It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.

scholarly journals The U.S. Health Care System on the Eve of the Covid-19 Epidemic: A Summary of Recent Evidence on Its Impaired Performance

2020 ◽  
Vol 50 (4) ◽  
pp. 408-414 ◽  
Author(s):  
David U. Himmelstein ◽  
Steffie Woolhandler
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Social Insurance ◽  
The United States ◽  
Financial Health ◽  
Impaired Performance ◽  
Elective Surgical Procedures ◽  
Insurance Model ◽  
Insured Patients ◽  
Care System

Four decades of neoliberal health policies have left the United States with a health care system that prioritizes the profits of large corporate actors, denies needed care to tens of millions, is extraordinarily fragmented and inefficient, and was ill prepared to address the COVID-19 pandemic. The payment system has long rewarded hospitals for providing elective surgical procedures to well-insured patients while penalizing those providing the most essential and urgent services, causing hospital revenues to plummet as elective procedures were cancelled during the pandemic. Before the recession caused by the pandemic, tens of millions of Americans were unable to afford care, compromising their physical and financial health; deep-pocketed corporate interests were increasingly dominating the hospital industry and taking over physicians’ practices; and insurers’ profits hit record levels. Meanwhile, yawning class-based and racial inequities in care and health outcomes remain and have even widened. Recent data highlight the failure of policy strategies based on market models and the need to shift to a nonprofit social insurance model.

THE MEASURE OF A HEALTH CARE SYSTEM

PEDIATRICS ◽  
1996 ◽  
Vol 98 (3) ◽  
pp. 444-444
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Social Order ◽  
The Poor ◽  
The Social ◽  
Better Than ◽  
Care System

A health care system which neglects the poor and disenfranchised impoverishes the social order of which we are constituted. In a real (and not just hortatory) sense, a health care system is no better than the least well-served of its members.

A Principled Critique of the ACA and the ACA in an Evolutionary Perspective

2017 ◽  
pp. 104-130
Author(s):  
Gunnar Almgren
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Health Care System ◽  
National Health ◽  
Health Care Policy ◽  
Democratic Governance ◽  
Democratic Citizenship ◽  
Evolutionary Perspective ◽  
Heritage Foundation ◽  
National Health Care

The chapter begins with an analysis of the ACA for what it is: the realization of an approach to health care reform that traces its origins to the conservative framework for health care reform once advanced by the moderate faction of the GOP and also the Heritage Foundation in its more moderate past. The policy aims, strategies, and specific provisions of the ACA are then critiqued in accordance to the principles of a national health care policy that would be consistent with the realization of democratic citizenship, as explicated in the first two chapters of the book. The chapter then concludes with arguments in support of a perspective of the ACA as a flawed but essential stage in an evolutionary policy progression that propels the nation’s health care system further toward the more radical and fundamental health care reform that is requisite to both the preservation of democratic governance, and the advancement of a more democratic society.

Administrative and legal aspects of the state policy of ensuring the national security of Ukraine in the field of health care at the present stage

2020 ◽  
Vol 4 (4) ◽  
pp. 167-173
Author(s):  
Oleksandr Komisarov ◽  
Yuriy Shvets
Keyword(s):  
Health Care ◽  
Medical Care ◽  
National Security ◽  
Health Care Reform ◽  
Health Care System ◽  
State Policy ◽  
Legal Aspects ◽  
The State ◽  
Medical Reform ◽  
Care System

The article considers the main administrative and legal aspects of the state policy of national security of Ukraine in the field of health care. On this theoretical basis, the current challenges of medical reform are identified and proposals are developed to find the best ways to prevent and optimize them. Under the administrative and legal support of health care, we understand a set of organizational and legal forms and mechanisms to ensure socio-economic, health, anti-epidemic measures carried out by specialized organizations, the purpose of which is to preserve, strengthen and maintain human health, provide professional, high-quality and high-tech medical care to all who need it, as well as ensuring the availability of such care. It is concluded that the state policy of national security of Ukraine in the field of health care is aimed at creating such conditions for the health care system that allow for health education, disease prevention, provide medical care to citizens, conduct scientific research in the field of health care and training of medical and pharmaceutical workers, to maintain and develop the material and technical base of the health care system. Today in Ukraine the directions of the state policy of national security of Ukraine in the field of health care are determined by the European integration directions of our state and the commitments made by Ukraine in connection with the signing in June 2014 of the Association Agreement between Ukraine, on the one hand, and The EU, the European Atomic Energy Community and their Member States, on the other hand. However, the concept of health care reform in terms of its implementation to meet the relevant obligations has significant differences with the constitutional principle of free medical care, and therefore needs further refinement and improvement. It is substantiated that the highlighted topical issues of administrative and legal provision of health care should be taken into account in the implementation of the second stage of medical reform, which started on April 1, 2020. In addition, the experience of preventing and counteracting the spread of COVID-19 coronavirus infection should be an important aspect of health care reform.

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