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The article analyzes the role that preventive health care can have in reducing the costs of health care for patients, insurance companies, and the broader economy. The increasing number of people with a chronic disease requiring continual medical attention is cited in the article as one of the primary reasons why coverage of preventive care by insurance companies should be publicly mandated. Attempts to promote preventive care in both the public and private sector are outlined, along with the economic incentives for both patients and health care providers.

The significance of health system expenses led politicians of different countries to search for optimal tools to regulate hospital expenses and support economy efficiency of health facilities for the last two decades. At present, countries reduce the beds' numbers and decrease an average length of stay in the hospital. Day surgery development is connected with a process of beds' reduction and increase of hospitalized healthcare efficiency. Slovak day surgery is supported by MOH SR government programme within a system of hospital bed reduction. It is declared as a highly-effective treatment that emphasizes patient's painless and easy treatment in a short time, while highlighting quality and the lowest costs. However, its rate within the total amount of surgical procedures is very low and there is no evident positive progress. The reasons are systemic, while related to a policy of procedures' financing and health insurance companies' strategies. The paper focuses on solving the partial issues of Slovak day surgery development. It also deals with analysing the rate of pediatric and adult patients' hospitalization regarding specific field, region and analysed years. The analysis results provide a valuable platform for the authors of a strategic health system framework, or other actors of health and social policy. [ABSTRACT FROM AUTHOR]

Background: High-deductible health plans (HDHPs) are an increasingly common strategy to contain health care costs. Individuals with chronic conditions are at particular risk for increased out-of-pocket costs in HDHPs and resulting cost-related underuse of essential health care. Objective: To evaluate whether families with chronic conditions in HDHPs have higher rates of delayed or forgone care due to cost, compared with those in traditional health insurance plans. Design: This mail and phone survey used multiple logistic regression to compare family-level rates of reporting delayed/forgone care in HDHPs vs. traditional plans. Participants: We selected families with children that had at least one member with a chronic condition. Families had employer-sponsored insurance in a Massachusetts health plan and >12 months of enrollment in an HDHP or a traditional plan. Main Measures: The primary outcome was report of any delayed or forgone care due to cost (acute care, emergency department visits, chronic care, checkups, or tests) for adults or children during the prior 12 months. Results: Respondents included 208 families in HDHPs and 370 in traditional plans. Membership in an HDHP and lower income were each independently associated with higher probability of delayed/forgone care due to cost. For adult family members, the predicted probability of delayed/forgone care due to cost was higher in HDHPs than in traditional plans [40.0% vs 15.1% among families with incomes <400% of the federal poverty level (FPL) and 16.0% vs 4.8% among those with incomes ≥400% FPL]. Similar associations were observed for children. Conclusions: Among families with chronic conditions, reporting of delayed/forgone care due to cost is higher for both adults and children in HDHPs than in traditional plans. Families with lower incomes are also at higher risk for delayed/forgone care. [ABSTRACT FROM AUTHOR]

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Policymakers face mounting pressures from consumer demand and the 1999 Olmstead Supreme Court decision to extend formal (paid) programs that deliver personal care to the elderly, chronically ill, and disabled. Despite this, very little is known about the largest program that delivers personal care: the Medicaid State Plan personal care services (PCS) optional benefit. This paper presents the latest available national program (participant and expenditure) trend data (1999-2002) on the Medicaid PCS benefit and findings from a national survey of eligibility and cost control policies in use on the program. The program trends show that, over the study period, the number of states providing the Medicaid PCS benefit grew by four (from 26 to 30), and national program participation, adjusted for population growth, increased by 27%. However, inflation-adjusted program expenditures per participant declined by 39; between 1999 and 2002. Findings from the policy survey reveal that between 1999 and 2002 there was a marked decline in the range of services provided, and by 2004, almost half the programs operated a cap on the hours of services provided. [ABSTRACT FROM AUTHOR]

We studied the potential of community-based health insurance (CHI) to contribute to the performance of health financing systems. The international empirical evidence is analysed on the basis of the three health financing subfunctions as outlined in the World Health Report 2000: revenue collection, pooling of resources and purchasing of services. The evidence indicates that achievements of CHI in each of these subfunctions so far have been modest, although many CHI schemes still are relatively young and would need more time to develop. We present an overview of the main factors influencing the performance of CHI on these financing subfunctions and discuss a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies. [ABSTRACT FROM AUTHOR]

Explores the alternative strategies for achieving universal insurance coverage and examines previous federal and state initiatives concerning the health care system of the U.S. Reason for the inability of the U.S. to achieve universal health insurance coverage; Role of state governments in the federalist strategy toward universal coverage; Advantages and limitations of the pincer strategy towards universal coverage which emphasizes the expansion of the Medicaid and State Children's Health Insurance Program.

Focuses on the policy initiatives of improving of access to health care for children by the nurses and health care providers. Reduction of the ranks of uninsured children; Accounts on the integral part of patient care for all health care providers; Assessments of the health insurance coverage for children. INSET: How Do I Apply This Information to Nursing Practice?.

This article discusses transparency concerning the financial aspects of national health insurance in West Germany. The author explains that the costs of medical services are increasing and the quality of service is declining. The financial aspects of the federal budget for social services are discussed. The author notes that the goals of social policy are to encourage public health and well being.

The article presents information about reforms in West Germany's medical policy, specifically with regards to the care offered by physicians. The purpose of the reforms is described as an improvement of care for the chronically ill, as well as better preventative efforts for combating disease in general. Further topics discussed in the article include the financing of health insurance, the geographical distribution of physicians in West Germany, and physicians' salaries.

The author reflects on health care reform which was enacted in Massachusetts and on proposed health care reform which has been discussed by U.S. presidential candidates. She suggests that achieving universal coverage is important as a means of improving the functioning of the health insurance market. She argues that universal coverage that relies on private health plans is hardly unprecedented.

A model was developed to assess the impact of possible moves towards universal coverage in Tanzania over a 15-year time frame. Three scenarios were considered: maintaining the current situation (‘the status quo’); expanded health insurance coverage (the estimated maximum achievable coverage in the absence of premium subsidies, coverage restricted to those who can pay); universal coverage to all (government revenues used to pay the premiums for the poor). The model estimated the costs of delivering public health services and all health services to the population as a proportion of Gross Domestic Product (GDP), and forecast revenue from user fees and insurance premiums. Under the status quo, financial protection is provided to 10% of the population through health insurance schemes, with the remaining population benefiting from subsidized user charges in public facilities. Seventy-six per cent of the population would benefit from financial protection through health insurance under the expanded coverage scenario, and 100% of the population would receive such protection through a mix of insurance cover and government funding under the universal coverage scenario. The expanded and universal coverage scenarios have a significant effect on utilization levels, especially for public outpatient care. Universal coverage would require an initial doubling in the proportion of GDP going to the public health system. Government health expenditure would increase to 18% of total government expenditure. The results are sensitive to the cost of health system strengthening, the level of real GDP growth, provider reimbursement rates and administrative costs. Promoting greater cross-subsidization between insurance schemes would provide sufficient resources to finance universal coverage. Alternately, greater tax funding for health could be generated through an increase in the rate of Value-Added Tax (VAT) or expanding the income tax base. The feasibility and sustainability of efforts to promote universal coverage will depend on the ability of the system to contain costs. [ABSTRACT FROM AUTHOR]

Little is known about health system equity in Tanzania, whether in terms of distribution of the health care financing burden or distribution of health care benefits. This study undertook a combined analysis of both financing and benefit incidence to explore the distribution of health care benefits and financing burden across socio-economic groups. A system-wide analysis of benefits was undertaken, including benefits from all providers irrespective of ownership. The analysis used the household budget survey (HBS) from 2001, the most recent nationally representative survey data publicly available at the time, to analyse the distribution of health care payments through user fees, health insurance contributions [from the National Health Insurance Fund (NHIF) for the formal sector and the Community Health Fund (CHF), for the rural informal sector] and taxation. Due to lack of information on NHIF and CHF contributions in the HBS, a primary survey was administered to estimate CHF enrolment and contributions; assumptions were used to estimate NHIF contributions within the HBS. Data from the same household survey, administered to 2224 households in seven districts/councils, was used to analyse the distribution of health care benefits across socio-economic groups. The health financing system was mildly progressive overall, with income taxes and NHIF contributions being the most progressive financing sources. Out-of-pocket payments and contributions to the CHF were regressive. The health benefit distribution was fairly even but the poorest received a lower share of benefits relative to their share of need for health care. Public primary care facility use was pro-poor, whereas higher level and higher cost facility use was generally pro-rich.We conclude that health financing reforms can improve equity, so long as integration of health insurance schemes is promoted along with cross-subsidization and greater reliance on general taxation to finance health care for the poorest. [ABSTRACT FROM AUTHOR]

The article presents information on the structure and management of the Medicaid program in the U.S. The program helps to finance health and long-term care at an annual cost of nearly $300b for about 55m low-income children, people with severe disabilities, and the elderly. The cost is borne by the federal and state governments. The government is thinking of reshaping the program due to its growing role, increasing costs, budgetary pressures, and federal deficits. Many U.S. states are looking for savings from more strict eligibility levels, leaner benefits, increased cost sharing, and reductions in provider payment levels. Many of the states are seeking waivers from the federal government that would allow them to enact more sweeping changes than are permitted under the current law.

This article discusses hospital physicians and billing to insurance companies in West Germany. The author explains that hospital physicians who perform services for privately insured patients do not keep track of these services in their invoices. The author discusses medical policies which apply to hospitals and accounting practices.