„Medical Savings Accounts“ — Eine internationale Bestandsaufnahme des Konzeptes der Gesundheitssparkonten und seine Implikationen für Deutschland

Medical Savings Accounts have gained rapid popularity in the international discussion as a means for financing health care over the last years. In Germany a similar idea has been discussed for the German Pension System known as the so called ?Riester Rente“. Countries like Singapore, South Africa, China and the USA have already introduced Medical Savings Accounts or are conducting pilot studies. This article summarizes the experience with Medical Savings Accounts in these countries and tries to evaluate first results, which are primarily positive so far. Finally it is suggested to introduce the concept of Medical Savings Accounts in the German Public Health Insurance in order to tackle its financing problems.     

Patient Power: The Free-Enterprise Approach to the U.S. Health Care Problem

Giving people choices in health care and instilling cost-consciousness is plain old common sense. In Medical Savings Accounts, authors Goodman and Musgrave have hit upon a bold concept that may revolutionize the way health care is delivered throughout America.     

An analysis of the Medical Savings Account as an alternative retirement savings Vehicle

Personal savings as a percentage of disposable income have dropped steadily since the early 1980s. Savings have continued to decline in 1999, as the savings rate—savings as a percentage of after-tax income—dropped to a record low of minus 0.7% in April 1999, according to the Department of Commerce. The study finds that MSA-type accounts are a viable supplement to retirement savings, but should not be used as a replacement for existing retirement alternatives given their current structure. Results show that future health care expenditures are an important factor in the success or failure of MSAs as supplemental retirement accounts. Medical Savings Accounts are currently eligible for long-term care expenses, and to the extent that such expenses occur during retirement, MSA balances could be used to pay for retirement expenses. In that respect the accounts already capture the characteristics of a retirement savings account. A comparison of the Roth IRA with the MSA as defined by the 1996 HIPAA legislation is also conducted.     

Designing a guideline-based utilization management program

Many public and private organizations are developing and publishing clinical guidelines to assist health care providers and patients in making appropriate medical decisions. Unless clinical guidelines are part of a well-designed managed care program, they have little effect on physician practice styles. This article explores integral components of an effective guideline-based utilization management program. Initial evaluation of this program suggests that, as part of a well-designed utilization management program, clinical guidelines can inform patients and physicians, and create appropriate incentives for effective health care delivery.     

Brain injury rehabilitation; the continuum of care

The continuum of care for individuals with traumatic brain injury has become quite complex. Medical technology has increased survival rates leaving many individuals with severe deficits. Quality treatment programs have been developed that are proving cost effective with good outcomes for many. To insure maximal recovery from traumatic brain injury, the patient should be provided the opportunity for treatment in the setting which is most conducive to maximal recovery. The acute hospital, the subacute program, the postacute program, the home program and the others should all be considered as part of the continuum of care for the brain injured individual. Timely movement to the appropriate setting will facilitate maximum recovery of a traumatic brain injured individual. Many patients have the potential to improve with quality treatment, appropriate setting and sufficient time to be treated. The article describes the levels of care that are available, with the goals and objectives of each level. It describes the patient that would best fit into each level. It further identifies assessment tools that are useful in measuring progress and outcomes.     

Medical foundations: one model for hospital-physician alignment

Some states that enforce a corporate practice of medicine prohibition have created medical foundation statutes allowing hospitals or health systems to own corporations providing physician services. Medical foundations may be useful in the coordination of care through employed or contracted physicians. Medical foundations that qualify as a tax-exempt entities have lower risks associated with tax-exempt rules as long as payments to physicians are reasonable and don't result in private inurement.     

印美医疗保障体系私有化比较

美国和印度都是医疗保障体系高度私有化的国家,对我国未来医疗保障适度私有化之路具有借鉴意义。通过梳理和比较,本文得出印美医疗保障体系私有化的3个异同点:(1)政府责任定位:印度政府的目标是建立初级保健水平的全民医疗,美国政府则给予弱势群体较好的医疗保障;(2)私营医疗保障体系结构:美国的非营利、营利和公立医疗机构三足鼎立,印度的营利机构占有重要地位,而非营利机构比重甚至低于公立医院;(3)公私合作意愿:印度医疗服务提供方面公私合作意愿强,美国意愿相对较弱。     

全民健保战略目标下的医疗救助理念研究——浙江省新型社会救助体系的启示

在全民健保的战略目标下,医疗救助的地位被弱化,只是对因病致贫人员和特殊群体实行的临时性救助。然而,以缴费型保险为主的医疗保障体系不能从根本上解决贫困人口的医疗费用问题。因此,从目前过渡到全民健保阶段,医疗救助的地位不应该被削弱。目前我国医疗救助的理念定位不清,没有充分化解贫困人口的疾病风险。本文以全民健保的战略目标和医改为背景,对基本风险、最低需求、政府责任这几个基本概念加以界定;并从医疗救助化解的社会风险出发,分析全民健保战略目标下仍需医疗救助处理的基本风险;再以浙江省分层分类的覆盖城乡的新型社会救助体系为例,阐述医疗救助理念定位需要重点解决的两个关键问题,反思医疗救助与社会医疗保险的关系和医疗救助水平,促进公平和效率。     

MEASUREMENT AND HEALTH CARE MANAGEMENT

Over recent decades many health care organisations have 'modernised' their management accounting systems by using the balanced scorecard (BSC). However, public health care involves multi-dimensional goals and resolving conflicts of interest. The question is whether a management control system based on measurements is suitable in a health care context. Light can be shed on this question using a study of the application of a BSC over a ten-year period at Högland Hospital. The study shows that the BSC and measurements of output and behaviour became a way of approaching unanswered questions about processes and quality development. Medical professionals with management responsibility, in co-operation with medical professionals responsible for different specialities, determined measures and targets and the measurements were integrated into activity processes and affected activities.     

How do low-income enrollees in the Affordable Care Act marketplaces respond to cost-sharing?

The Affordable Care Act requires insurers to offer cost-sharing reductions (CSRs) to low-income consumers on the marketplaces. We link 2013–2015 All-Payer Claims Data to 2004–2013 administrative hospital discharge data from Utah and exploit policy-driven differences in the actuarial value of CSR plans that are solely determined by income. This allows us to examine the effect of cost-sharing on medical spending among low-income individuals. We find that enrollees facing lower levels of cost-sharing have higher levels of healthcare spending, controlling for past healthcare use. We estimate demand elasticities of total health care spending among this low-income population of approximately −0.12, suggesting that demand-side price mechanisms in health insurance design work similarly for low-income and higher-income individuals. We also find that cost-sharing subsidies substantially lower out-of-pocket medical care spending, showing that the CSR program is a key mechanism for making health care affordable to low-income individuals.     

Medical Labour Supply and the Production of Healthcare

Medical labour markets are important because of their size and the importance of medical labour in the production of healthcare and in subsequent patient outcomes. We present a summary of important trends in the UK medical labour market, and we review the latest research on factors that determine medical labour supply and the impact of labour on patient outcomes. The topics examined include: the responsiveness of labour supply to changes in wages, regulation and other incentives; factors that determine the wide variation in physician practice and style; and the effect of teams and management quality on patient outcomes. This literature reveals that while labour supply is relatively unresponsive to changes in wages, medical personnel do react strongly to other incentives, even in the short run. This is likely to have consequences for the quality of care provided to patients. We set out a series of unanswered questions in the UK setting, including: the importance of non‐financial incentives in recruiting and retaining medical staff; how individuals can be incentivised to work in particular specialties and regions; and how medical teams can be best organised to improve care.     

The future financing of Medicare

Regardless of the timing and the type of federal action to reform the nation's health care system, the Medicare program's financial problems must be addressed soon. Serious concerns exist about both the Hospital Insurance and the Supplementary Medical Insurance portions of the program.     

Medical savings accounts: why do they work?

This article analyzes and reviews the cost and design characteristics of medical savings accounts (MSAs). By placing premium savings from high-deductible health insurance in medical savings accounts, individuals have an incentive to shop for medical services. A more market-oriented health insurance and delivery system results, as individuals are now both users and buyers of health care. Data show that most families would accumulate balances in their MSAs that may be used for future medical expenses or savings. Through program design, the potential problems of adverse selection and cost to risk can be greatly reduced.     

Did the Health Card Program Ensure Access to Medical Care for the Poor during Indonesia's Economic Crisis?

The Indonesian Social Safety Net health card program was implementedin response to the economic crisis that hit Indonesia in 1997,to preserve access to health care services for the poor. Healthcards were allocated to poor households, entitling them to subsidizedcare from public health care providers. The providers receivedbudgetary support to compensate for the extra demand. This articlefocuses on the effect of the program on primary outpatient healthcare use, disentangling the direct effect of allocating healthcards from the indirect effect of government transfers to healthcare facilities. For poor health card owners the program resultedin a net increase in use of outpatient care, while for nonpoorhealth card owners the program resulted mainly in a substitutionfrom private to public health care. The largest effect of theprogram seems to have come from a general increase in the supplyof public services resulting from the budgetary support to publicproviders. These benefits seem to have been captured mainlyby the nonpoor. As a result, most of the benefits of the healthcard program went to the nonpoor, even though distribution ofthe health cards was propoor. The results suggest that had theprogram, in addition to targeting the poor, established a closerlink between provision of services to the target groups andfunding, the overall results would have been more propoor.     

Medicare on the critical list. Understanding the etiology of the disease will help in the search for a cure.

Medicare, and its companion program Medicaid, came into being as part of Lyndon Johnson's Great Society. Their purpose was to provide the elderly with equal access to high-quality medical care. Though the goals were laudable, the magnitude of the costs and of the effects was unforeseen. As the two programs made medical care available to a large segment of the population, the demand grew. At the same time, private industry became more generous with its health insurance plans. Because of their emphasis on hospital care, the governmental and private industry plans helped push hospital prices up. Now that both sectors are finding the cost of medical care unacceptably high, Congress is proposing remedial legislation and corporations are trying alternative health care plans. These authors explore how well the maladies of Medicare may respond to the various cures that are being proposed.     

论人人享有基本卫生保健之改革

本文通过分析"看病贵、看病难"原因而导致的阻碍人人享有初级卫生保健的主要因素,提出必须深化卫生体制改革,发展基层社区卫生服务、建立覆盖全民的基本医疗保障制度以及实行均等化的公共卫生服务和基本药物制度,以实现人人享有初级卫生保健的目标。     

城乡居民医保逆选择的破解——一个基于不同人口年龄需求的设计

逆选择困扰了我国城乡居民医保事业的可持续发展.在原有的大病和重病保障之外,基于不同人口年龄需求设计一个有条件、有限度和有年龄差别的特殊医保待遇方案,让参保者在没有享受到大病重病医保待遇的情况下,也可获得一些与年龄相称的医保待遇.这一设计除了能增加参保的弹性,让各年龄群体都自愿积极参保,还可增强居民的健康意识,提高居民的健康水平,减少居民和医保的医药开支.此外,它还能促进基层医疗服务业的发展.     

广西城乡居民基本医疗保险一体化运行研究

广西新型农村合作医疗和城镇居民基本医疗保险在覆盖人群、筹资标准、待遇水平等方面都极其相似,可以将两种制度合并,实现城乡居民基本医疗保险一体化运行,统一制度设计,明确经办管理机构,提高统筹层次,扩大保障范围,增加政府对基层卫生服务的投入,逐步向全民医保迈进。     

构建目标管理体系的实践应用

医疗质量是医院生存和发展的基础,通过加大质量控制管理力度,构建目标管理体系,提高全院医务人员的质量意识和责任意识,从经济目标管理向全面质量管理转变,推进医院健康、有序、持续发展。     

Physicians and administrators can work together

This article describes the working relationship between the administration and medical staff of the Mid-Maine Medical Center which is comprised of two separate modern hospitals. The authors advocate the philosophy that "a hospital which harnesses the medical staff's considerable talent and expertise through sound organizational input will be a stronger institution." They explain that patient care is becoming increasingly complex and that management decisions impact heavily on the care provided. In 1973, the Medical Center changed from its traditional organizational form of having a full-time medical director and an administrator report to the board of directors, to a modified corporate model designed to increase physician involvement. In the new organization, the vice president of finance and a part-time chief of staff (acting as vice president for medical affairs) report to the president (former medical director) who, in turn, is responsible to the board of trustees. The authors attribute the success of the reorganization to the CEO's willingness to delegate and share authority, not to the CEO's physician background. Planning at the institution involves a committee of six physicians, four administrators, and one full-time planner. A budgeting committee of three physicians and three administrators is responsible for the review of the budget as well as for making recommendations for the executive board for the expected volume of services. It is concluded that there is no perfect way to run a hospital, but the involvement of doctors in hospital decisions is necessary.