Consumer-centered vs. job-centered health insurance

Most employees and their dependents in the United States have health insurance provided by the employer or labor-management health and welfare fund. In this system, employees and their families lose their health insurance when the breadwinner loses his or her job while, at the same time, a Medicaid beneficiary can lose Medicaid eligibility by getting a job, even a poorly paid one. Most health insurance pays the doctor on the basis of fee-for-service and the hospital on the basis of cost-reimbursement, rewarding both with more revenue for providing more and more costly services. The insured employee has little or no incentive to seek out a less costly provider. There are no rewards for economy in this system. It should be little wonder, then, that health care costs are out of control. There are alternative financing and delivery systems with built-in incentives to use resources economically, but, the author of this article asserts, their ability to compete and attract patients with their superior economic efficiency is blocked by many laws and government programs. The author believes that the most effective and acceptable way to get costs under control, and at the same time achieve universal coverage, would be through a system of fair economic competition. He discusses his Consumer Choice Health Plan proposal and describes how one of the main barriers to competition is today's system of job-linked health insurance.     

Health trend assessment in Indonesia Futures studies at the provincial level

Health trend assessment studies have been carried out in Indonesia at the national and provincial levels, to provide input into long-term national development plans and to build up the capacity for local health planning in anticipation of decentralization. Provincial health trend assessment studies have been done in five provinces by teams from local health and planning authorities and the local school of public health. These provincial teams have all used background documents and standard procedures developed by a national team and have gone through the same methodological training. Out of the experience have come specific ideas about how trend assessment and similar activities can be strengthened. Among the recommendations are the establishment of national research centres for trend analysis, efforts to improve availability and reliability of relevant data, the training of a cadre of health professionals familiar with futures methods, and continued promotion by WHO and other agencies of long-term health planning and health futures.     

Women in development: Kenya's experience

In Kenya, the government has promoted economic policies, development programs, and a legal system geared to increase incentives and productive capacity for women. Economic strength, family health and population growth can be greatly effected by programs in women's education, health care, family planning and agriculture extension. There are 10 million women in Kenya and 60% are below 20 years of age. Women's groups have been successful in improving health and family planning practice. Women manage most small farms: 75% of the labor on the farms is provided by women. Kenya has introduced an extension system nationally focusing on women farmers as well as men. Women's demand for credit is strong and the government is considering helping expand credit through women's groups. Water is obtained by women and 9 of 10 spend more than an hour getting water each day for the family. By providing better access to water, more time can be spent on farming, family and other more important pursuits. There are many projects to improve community water supplies sponsored by both governmental and non- governmental organizations. About 1/3 girls and 2/5 boys complete primary school. Women that have more than 5 years of education have less than 3 children. There have been difficulties getting girls into later primary and secondary education, because fewer spots are allocated for girls in government-aided schools. The government it trying to improve this, but many girls drop out because of pregnancy. A third of the deaths of women between 15-35 is caused by maternal mortality. This high rate can be reduced with better prenatal care, better family planning, and more effective care at child birth. There are now about 100,000 new family planning acceptors each year. The World Bank and many international organizations have given support to the women's needs in the development process.     

城镇职工退休人员缴纳医疗保险费的可行性及其相关问题探讨——社会保障学者专题讨论综述

2016年初有政府官员提出要建立合理分担、可持续的医保筹资机制,合理强化医保个人缴费责任,研究实行职工医保退休人员缴费政策。部分社会保障学者在微信平台上进行了"退休人员缴纳医疗保险费是否缓解医疗基金支付压力的良方"专题讨论。讨论从退休人员缴纳医保费问题的可行性开始,逐渐深入到医疗控费、公立医院改革、政府角色定位和长期护理保险等医疗领域重难点问题。     

Analyse der Abwicklung von gesetzlichen Krankenkassen per sozialrechtlicher Schließung oder per Insolvenzverfahren

Private as well as statutory health insurers have various ways of insolvency. Although the Insolvency Act has been applied for statutory health insurance since 2010, these new options were not used up to now. Anyway, the legislators laid the preference out of closure. This article investigates how the priority of closure could be in contradiction to the applicability of the Insolvency Act. It is asked, whether the introduction of the insolvency capability of health insurance funds was rather to assimilate the frame conditions relating to pension promises than creating a real alternative. One reason could be, that the Insolvency Act is not only generally applicable in the liquidation of a health insurance fund, but potentially even the best alternative. The insolvency proceedings for example are advantageous for health insurance funds within the same group because the maximum load is split and lower than it would be by a closure by social law and in addition to that the PSV is obligatory. The results show, that the generally-accepted, not limited standard preference of closure as laid out by the legislators in § 171b (3) S. 2 SGB V, seems inexplicable. The paper draws parallels to private health insurance companies under Solvency II and opens up new perspectives for legislative measures.     

The interplay between risk adjustment and risk rating in voluntary health insurance

Many regulated health insurance markets include risk adjustment (aka risk equalization) to mitigate selection incentives for insurers. Empirical studies on the design and evaluation of risk-adjustment algorithms typically focus on mandatory health insurance schemes. This paper considers risk adjustment in the context of voluntary health insurance, as found in Chile, Ireland, and Australia. In addition to the challenge of mitigating selection by insurers, regulators of these voluntary schemes have to deal with selection by consumers in and out of the market. A strategy for mitigating selection by consumers is to apply some form of risk rating. Our paper shows how risk adjustment and risk rating interact: (1) risk rating reduces the need for risk adjustment and (2) risk adjustment reduces premium variation across rating factors, thereby increasing incentives for consumers to select in and out of the market.     

Weak Links in the Chain II: A Prescription for Health Policy in Poor Countries

In an earlier article, the authors outline some reasons forthe disappointingly small effects of primary health care programsand identified two weak links standing between spending andincreased health care. The first was the inability to translatepublic expenditure on health care into real services due toinherent difficulties of monitoring and controlling the behaviorof public employees. The second was the "crowding out" of privatemarkets for health care, markets that exist predominantly atthe primary health care level. This article presents an approach to public policy in healththat comes directly from the literature on public economics.It identifies two characteristic market failures in health.The first is the existence of large externalities in the controlof many infectious diseases that are mostly addressed by standardpublic health interventions. The second is the widespread breakdownof insurance markets that leave people exposed to catastrophicfinancial losses. Other essential considerations in settingpriorities in health are the degree to which policies addresspoverty and inequality and the practicality of implementingpolicies given limited administrative capacities. Prioritiesbased on these criteria tend to differ substantially from thosecommonly prescribed by the international community.      

EVALUATING THE EFFICIENCY OF NONPROFIT ORGANIZATIONS: AN APPLICATION OF DATA ENVELOPMENT ANALYSIS TO THE PUBLIC HEALTH SERVICE

In this paper we have tried to evaluate the usefulness of the DEA model as a management tool when applied to the measurement of the efficiency of health centres. We have chosen the DEA model because it does not need prior specifications. This could be very useful when we lack data on costs. The overall evaluation of a number of health centres provides information on the distinctive features and comparative advantages of the most efficient ones. The information gathered could also be of great use in the selection of those centres in which operational audits should be carried out.     

Here it comes: defined contribution health care

The Patient Protection and Affordable Care Act includes provisions to make the individual health insurance marketplace one where all Americans, including those with preexisting health conditions, can obtain affordable coverage. At the same time, the act has failed to address, in any significant way, many of the underlying flaws in the current U.S. health care system that have caused costs to spiral out of control. The combination of persistent U.S. health care cost increases and a viable individual health insurance marketplace will cause a sea change in employer-sponsored health care offerings that is similar to that seen among employer-sponsored retirement benefit plans: movement away from defined benefit approaches and toward defined contribution designs. Although the authors show parallels between the evolution of employers' health care and retirement offerings, they explain why certain key developments will need to occur before defined contribution approaches become as prevalent in employer-sponsored health care plans as they are in today's employer-sponsored retirement plans.     

Developing Financial Accountability in British Acute Hospitals

This paper explains the process of defining, measuring and costing health service outputs (Health Resource Groups – HRGs). It identifies why the introduction of HRGs became necessary and how they were rolled out and became mandatory. The steps followed to achieve national uniformity are explained. Evidence is provided on the extent to which HRGs have been adopted and on the wider roles they may fulfil, such as benchmarking. The possible implications for resource allocation and the power of clinicians are discussed. Finally, attention is turned to the possible consequences of costed HRGs, as a means of achieving detailed financial accountability at operational level and to alternative means of control.     

Mental Health Patterns and Consequences: Results from Survey Data in Five Developing Countries

The social and economic consequences of poor mental health inthe developing world are presumed to be significant, yet remainunderresearched. This study uses data from nationally representativesurveys in Bosnia and Herzegovina, Indonesia, and Mexico andfrom special surveys in India and Tonga to show similar patternsof association between mental health and socioeconomic characteristics.Individuals who are older, female, widowed, and report poorphysical health are more likely to report worse mental health.Individuals living with others with poor mental health are alsosignificantly more likely to report worse mental health themselves.In contrast, there is little observed relation between mentalhealth and consumption poverty or education, two common measuresof socioeconomic status. Indeed, the results here suggest insteadthat economic and multidimensional shocks, such as illness orcrisis, can have a greater impact on mental health than poverty.This may have important implications for social protection policy.Also significant, the associations between poor mental healthand lower labor force participation (especially for women) andmore frequent visits to health centers suggest that poor mentalhealth can have economic consequences for households and thehealth system. Mental health modules could usefully be addedto multipurpose household surveys in developing countries. Finally,measures of mental health appear distinct from general subjectivemeasures of welfare such as happiness.     

Public/private health care: The British scenario

The issue of public versus private health care is too often treated as an ideological issue, with each side unwilling to discuss common problems of cost containment and quality control which have to be faced, no matter what the financial framework. Thus, cost containment will worry the administrators of insurance funds just as much, if not more, than health service administrators. Health care is not, in the economist's sense, a perfect market; it cannot and does not remain unregulated. So what is at issue is whether regulation is carried out by government, by insurance companies, or by the professions, and what the balance between them shall be.

These and other lessons are drawn from a series of studies describing the workings of insurance systems in a number of countries, in Europe, as well as the United States, Canada and Australia. The findings of the book ‐ The Public/Private Mix for Health, edited by Gordon McLachlan and Alan Maynard, and published this autumn by the Nuffield Provincial Hospitals Trust ‐ are too rich to be summarised here. What follows is an extract from the final chapter containing the editors’ own reflections on the material they have brought together.     

Vierfelder-Matrix der Markenpositionierung von gesetzlichen Krankenkassen

The branding in statutory health insurance is used for the delimitation of a legally regulated and quite homogeneous market. This paper presents a marketing concept as four-field matrix, which works out the essential determinants and severity factors. Health is here considered either emotional or rational concept. The health insurance company is regarded in this context as a saver versus supporter. The shaping factors are systematized in a four-field matrix for brand positioning (increasing the performance, motivation to comprehensive health, strengthen the capabilities, and preservation of the performance). Afterwards the concept is presented for the example of selected health insurance and critically discussed. In summary, the brands of individual health insurance can be useful classified and separated according to the present concept.     

Evolutionary theory in public health and the public health of evolutionary theory

Evolutionary theory is the most powerful explanatory system in the life sciences and is the only framework that can unify knowledge in otherwise disparate fields of research. Considerable advances have been made in the application of evolutionary biology to health issues in recent decades. Health researchers and practitioners could benefit considerably from an understanding of the basic principles of evolution and how humans have been shaped by natural and sexual selection, even if they are not explicitly testing evolutionary hypotheses. Life History Theory is a powerful framework that can be used for examining modern human environments and developing environments that maximize opportunities for positive health outcomes. Many of the recommendations derived from this framework converge with the visions of current public health advocates. Despite the benefits of an evolutionary framework, the challenges that face those attempting to integrate evolutionary theory into public health are perhaps greater than those in the social sciences. Although considerable advancements in the understanding of health issues have already been made, health researchers with an evolutionary perspective are very few in number and face constraining disciplinary attributes. Advances in medical technology will continue to extend the boundaries of saving lives in danger, however traditional public health efforts may be reaching their limits of effectiveness in encouraging health-promoting behaviors. This may partially account for the current interest in broad social and policy change to enhance health and reduce health disparities amongst sub-populations. Such substantial physical and social restructuring will face many challenges and gradual progress may be enhanced by a strong foundation of evolutionary human science. The slow but eventual integration of evolutionary principles will gradually enhance the effectiveness of health interventions and provide an ultimate explanation for patterns in health outcomes that are otherwise puzzling. The speed at which the field of public health adopts a Darwinian framework has yet to be determined, and several futures are possible. This pace will depend on several factors, including the visible utility of evolutionary theory for addressing the health promotion goals of the field.     

Health uninsurance premium and mortgage interest rates

I show that lenders charge higher interest rates on mortgage-financed houses in areas with a higher rate of health uninsurance to protect themselves against a potential future bankruptcy of the borrower caused by health uninsurance. The health uninsurance premium is higher for applicants who are more likely to file for bankruptcy and for mortgage-financed houses in areas where there are greater benefits to obtaining insurance or where there is a higher percentage of uninsured people who cannot afford insurance. The premium is lower following the implementation of the requirement to have qualifying health insurance coverage under the Affordable Care Act.     

Cost accounting comes to service industries

With rising prices and increased competition, service companies are finding that knowing the costs of their products and services is vital to their health, if not to their existence. However, many of these companies have found their cost accounting systems less than satisfactory. This author points out that many service companies use traditional product cost techniques, which are inappropriate for them. He explains why these techniques fail and describes a system of unique costs that should be successful.     

Effekte des Zusatzbeitrages auf das Management gesetzlicher Krankenkassen

Since introduction of the health fund in 2009 the health insurances which do not get by with the assignments from the health fund, other income or other measures must compensate corresponding deficits by an additional contribution after §242 SGB V. In 2010 a total of 16 health insurances have raised an additional contribution and in 2011 13 health insurances stated the elevation of an additional contribution. From 2012 is to be calculated on an exhaustive conversion. The elevation of the additional contribution puts the legal health insurances before numerous challenges. The present contribution deals with the essential effects of the introduction of the additional contribution on the single management areas of legal health insurances. The essential effects on the following management areas are shown: Company management, financial management, staff management, customer’s management, performance management and information management. Finally, the central challenges, recommendations and chances of the additional contribution are discussed for the health insurances.     

Recessions and Health: The Long-Term Health Consequences of Responses to the Coronavirus*

The lockdown measures that were implemented in the spring of 2020 to stop the spread of COVID-19 are having a huge impact on economies in the UK and around the world. In addition to the direct impact of COVID-19 on health, the following recession will have an impact on people's health outcomes. This paper reviews economic literature on the longer-run health impacts of business-cycle fluctuations and recessions. Previous studies show that an economic downturn, which affects people through increased unemployment, lower incomes and increased uncertainty, will have significant consequences on people's health outcomes both in the short and longer term. The health effects caused by these adverse macroeconomic conditions will be complex and will differ across generations, regions and socio-economic groups. Groups that are vulnerable to poor health are likely to be hit hardest even if the crisis hit all individuals equally, and we already see that some groups such as young workers and women are worse hit by the recession than others. Government policies during and after the pandemic will play an important role in determining the eventual health consequences.     

Some practical hints for newcomers to health futures

The three authors of this article are all relative newcomers to the health futures field. One is based within an academic Institute of Public Health, another at the regional tier of the UK National Health Service (NHS), and the third within the NHS Executive Headquarters. The common bond between them is a desire to contribute to the development of new ways of planning for health and a wish to see health futures actively engaged with health services to bring about effective change. With the aim of providing practical advice for others who are beginning to take an interest in health futures work, they look back on their own personal experiences and summarize the lessons they have learned.