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Background: The costs associated with healthcare are of critical importance to both decision-makers and users, given the limited resources allocated to the health sector. However, the available scientific evidence on healthcare costs in low- and middle-income countries, such as Peru, is scarce. In the Peruvian context, the health system is fragmented, and the private health insurance and its financing models have received less research attention. We aimed to analyse user cost-sharing and associated factors within the private healthcare system. Methods: Our study was cross-sectional, using open data from the Electronic Transaction Model of Standardized Billing Data—TEDEF-SUSALUD, between 2021–2022. Our unit of analysis is the user's medical bills. We considered the total amount of cost-sharing, proportion of total payments as cost-sharing, and cost-sharing as a proportion of minimum salaries. We use a multiple regression model to perform the analyses. Results: Our study included 5,286,556 health services provided to users of the private health insurance in Peru. We found a significant difference was observed in the cost-sharing for hospitalization-related services, with an average of 419.64 soles per day (95% CI: 413.44 to 425.85). Also, we identified that for hospitalization-related services per day is, on average, 0.41 (95% CI: 0.41 to 0.41) minimum salaries more expensive than outpatient care, although cost-sharing per day of hospitalization represent on average only 14% of the total amount submitted. Conclusions: Our study provides a detailed overview of cost-sharing in the private healthcare system in Peru and the factors associated with them. Policymakers can use the study's finding that higher cost-sharing for inpatient hospitalization compared to outpatient care in private insurance can create inequities in access to healthcare to design policies aimed at reducing these costs and promoting a more equitable and accessible healthcare system in Peru. [ABSTRACT FROM AUTHOR]

Catastrophic diseases are diseases that require high funding and, if accompanied by complications, will result in threats that can even endanger lives. One of the catastrophic diseases that is the focus of health insurance financing is kidney failure. Haemodialysis is a type of kidney replacement therapy for chronic kidney disease using special equipment. One method of financing haemodialysis procedures is the National Health Insurance Program. Hospitals, as health service providers for JKN participants, have an interest in the INACBG rates. Based on the Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2023 concerning Health Service Tariff Standards in the Implementation of the Health Insurance Program, there are changes to tariffs for haemodialysis services. With the current tariff changes, single-use and re-use services are divided into two different tariffs (the tariff for re-use haemodialysis services is 85% of the tariff for single-use haemodialysis services). The research was conducted at Siloam Hospital Bali. The data taken is secondary data originating from the Financial Division of Siloam Hospital Bali, the Medical Records Department of Siloam Hospital Bali, and the Haemodialysis Department of Siloam Hospital Bali during the period January–April 2023. The data collected and the hypothesis formulated in this research will be tested using the MANOVA (Multivariate Analysis of Variance) test method, using SPSS software. The research results show that there is a significant difference in total costs for re-use and single-use haemodialysis services; there is a significant difference in the total INACBG rates per patient for re-use and single-use haemodialysis services; and there is no significant difference in the difference between INACBG rates and total costs in re-use and single-use haemodialysis services. [ABSTRACT FROM AUTHOR]

Universal health coverage relies on providing essential medical services and shielding individuals from financial risks. Our study assesses the progressivity of out-of-pocket (OOP) payments, identifies factors contributing to healthcare expenditure inequality, and examines catastrophic health expenditures (CHE) prevalence in Kazakhstan from 2018 to 2021. Using retrospective analysis of National Statistics Bureau data, we employed STATA 13 version for calculations CHE incidence, progressivity, Lorenz and concentration curves. In 2020–2021, OOP expenditures in Kazakhstan decreased, reflecting a nearly twofold reduction in the CHE incidence to 1.32% and 1.24%, respectively. However, during these years, we observe a transition towards a positive trend in the Kakwani index to 0.003 and 0.005, respectively, which may be explained by household size and education level factors. Increased state financing and quarantine measures contributed to reduced OOP payments. Despite a low healthcare expenditure share in gross domestic product, Kazakhstan exhibits a relatively high private healthcare spending proportion. The low CHE incidence and proportional expenditure system suggest private payments do not significantly impact financial resilience, prompting considerations about the role of government funding and social health insurance in the financing structure. [ABSTRACT FROM AUTHOR]

Achieving universal health coverage (UHC) involves difficult policy choices, and fair processes are critical for building legitimacy and trust. In 2021, The Gambia passed its National Health Insurance (NHI) Act. We explored decision-making processes shaping the financing of the NHI scheme (NHIS) with respect to procedural fairness criteria. We reviewed policy and strategic documents on The Gambia's UHC reforms to identify key policy choices and interviewed policymakers, technocrats, lawmakers, hospital chief executive officers, private sector representatives and civil society organizations (CSOs) including key CSOs left out of the NHIS discussions. Ministerial budget discussions and virtual proceedings of the National Assembly's debate on the NHI Bill were observed. To enhance public scrutiny, Gambians were encouraged to submit views to the National Assembly's committee; however, the procedures for doing so were unclear, and it was not possible to ascertain how these inputs were used. Despite available funds to undertake countrywide public engagement, the public consultations were mostly limited to government institutions, few trade unions and a handful of urban-based CSOs. While this represented an improved approach to public policy-making, several CSOs representing key constituents and advocating for the expansion of exemption criteria for insurance premiums to include more vulnerable groups felt excluded from the process. Overload of the National Assembly's legislative schedule and lack of National Assembly committee quorum were cited as reasons for not engaging in countrywide consultations. In conclusion, although there was an intent from the Executive and National Assembly to ensure transparent, participatory and inclusive decision-making, the process fell short in these aspects. These observations should be seen in the context of The Gambia's ongoing democratic transition where institutions for procedural fairness are expected to progressively improve. Learning from this experience to enhance the procedural fairness of decision-making can promote inclusiveness, ownership and sustainability of the NHIS in The Gambia. [ABSTRACT FROM AUTHOR]

Introduction: Iran is host to one of the largest urban refugee populations worldwide, about two million of whom are undocumented immigrants (UIs). UIs are not eligible to enroll in the Iranian health insurance scheme and have to pay out-of-pocket to access most health services. This increases the likelihood that they will delay or defer seeking care, or incur substantial costs if they do seek care, resulting in worse health outcomes. This study aims to improve understanding of the financial barriers that UIs face in utilizing health services and provide policy options to ensure financial protection to enhance progress towards UHC in Iran. Methods: This qualitative study was conducted in 2022. A triangulation approach, including interviews with key informants and comparing them with other informative sources to find out the complementary findings, was applied to increase data confirmability. Both purposive and snowball sampling approaches were used to select seventeen participants. The data analysis process was done based on the thematic content analysis approach. Results: The findings were explained under two main themes: the financial challenges in accessing health services and the policy solutions to remove these financial barriers, with 12 subthemes. High out-of-pocket payments, high service prices for UIs, fragmented financial support, limited funding capacity, not freeing all PHC services, fear of deportation, and delayed referral are some of the barriers that UIs face in accessing health care. UIs can get insurance coverage by using innovative ways to get money, like peer financing and regional health insurance, and by using tools that make it easier, like monthly premiums without policies that cover the whole family. Conclusion: The formation of a health insurance program for UIs in the current Iranian health insurance mechanism can significantly reduce management costs and, at the same time, facilitate risk pooling. Strengthening the governance of health care financing for UIs in the form of network governance may accelerate the inclusion of UIs in the UHC agenda in Iran. Specifically, it is necessary to enhance the role of developed and rich regional and international countries in financing health services for UIs. [ABSTRACT FROM AUTHOR]

Health insurance as a health financing mechanism especially in developing countries like India has a significant role. Private health Insurance is significant where the middle-income people get lesser options from the government to cover them for medical emergencies. Despite this; a significant portion of India's middle-income population is without any health insurance coverage. With this objective, an attempt was taken to investigate the Socio-Economic Variables, Health Insurance Knowledge, and Households' Perceptions of Health Insurance regarding the purchase of Private Health Insurance Policies. Data was obtained from middle-income households in seven Municipal Corporations in West Bengal. To identify 'Perception' variables Principal Component Analysis (PCA) is used and Logistic Regression Analysis showed Household income, Educational Qualification, Family Type, Health Insurance knowledge, and Households' perception of Quality of Service, Benefits, and Self-beliefs proved significant factors to influence the purchase of Private Health Insurance Policy. [ABSTRACT FROM AUTHOR]

Over half of the US population receives health insurance through an employer with premium contributions creating a flat "head tax" per worker, independent of their earnings. This paper develops and calibrates a stylized model of the labor market to explore how this uniquely American approach to financing health insurance contributes to labor market inequality. We consider a partial-equilibrium counterfactual in which employer-provided health insurance is instead financed by a statutory payroll tax on firms. We find that, under this counterfactual financing, in 2019 the college wage premium would have been 11 percent lower, noncollege annual earnings would have been $1,700 (3 percent) higher, and noncollege employment would have been nearly 500,000 higher. These calibrated labor market effects of switching from head tax to payroll tax financing are in the same ballpark as estimates of the impact of other leading drivers of labor market inequality, including changes in outsourcing, robot adoption, rising trade, unionization, and the real minimum wage. We also consider a separate partial-equilibrium counterfactual in which the current head tax financing is maintained, but 2019 US health care spending as a share of GDP is reduced to the Canadian share; here, we estimate that the 2019 college wage premium would have been 5 percent lower and noncollege annual earnings would have been 5 percent higher. These findings suggest that health care costs and the financing of health insurance warrant greater attention in both public policy and research on US labor market inequality. [ABSTRACT FROM AUTHOR]

The article discusses economic and political issues concerning health insurance coverage and financing in the U.S. Topics explored include the health insurance problems faced by the American public during the coronavirus disease 2019 (COVID-19) pandemic, the estimated percentage of uninsured Americans even after the enactment of the U.S. Affordable Care Act (ACA) in 2010, and the health care access of workers with employer-sponsored insurance.

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This article examines the political and economic dynamics of welfare markets in the USA. These marketplaces differ from other public–private welfare arrangements in that the state crafts and sustains these markets with the aim of using competition to promote cost-effective welfare provision. However, welfare markets face fundamental tensions between competition and stability that we trace to the allocation of risk between the state and private providers. Faced with the prospect of bearing potential losses, private firms often deploy instruments to reduce risk, lobby for risk protections from policymakers, or threaten to exit the market. The result is markets that are either non-competitive but stable, or competitive but unstable. In short, when policymakers create welfare markets they are riding a tiger, making themselves vulnerable to the functioning of markets over which they have imperfect control. We theorize and illustrate these dynamics through analyses of mortgage securitization, Medicare Advantage markets and the Obamacare health exchanges. This article contributes to the study of the US welfare state, speaks to the perils of marketized welfare in rich democracies and shows how market reforms can lead to unexpected state expansion. [ABSTRACT FROM AUTHOR]

Background: Ethiopia has achieved impressive improvements in health outcomes and economic growth in the last decade but its total health spending is among the lowest in Africa. Ethiopia launched a Community-Based Health Insurance (CBHI) scheme in 2011 with a vision of reaching 80% of districts and 80% of its population by 2020. This study aimed to identify early achievements in scaling up CBHI and the challenges of such scale-up.Methods: We interviewed 18 stakeholders working on health financing and health insurance in Ethiopia, using a semi-structured interview guide. All interviews were conducted in English and transcribed for analysis. We performed direct content analysis of the interview transcripts to identify key informants' views on the achievements of, and challenges in, the scale-up of CBHI.Results: Implementation of CBHI in Ethiopia took advantage of two key "policy windows"-global efforts towards universal health coverage and domestic resource mobilization to prepare countries for their transition away from donor assistance for health. CBHI received strong political support and early pilots helped to inform the process of scaling up the scheme. CBHI has helped to mobilize community engagement and resources, improve access to and use of health services, provide financial protection, and empower women.Conclusion: Gradually increasing risk pooling would improve the financial sustainability of CBHI. Improving health service quality and the availability of medicines should be the priority to increase and sustain population coverage. Engaging different stakeholders, including healthcare providers, lower level policy makers, and the private sector, would mobilize more resources for the development of CBHI. Training for operational staff and a strong health information system would improve the implementation of CBHI and provide evidence to inform better decision-making. [ABSTRACT FROM AUTHOR]

The article discusses the constitutional responsibility of the state for financing statutory health insurance. In times of crisis such as the current COVID-19 pandemic, financing health insurance poses a financial burden. It is discussed whether and to what extent a constitutional justification for state financing responsibility can be established. Various approaches are considered, such as the trust of insured individuals in the willingness of the health insurance provider to provide services, and fundamental considerations such as the existence of a right to medical care. It is determined that state financing responsibility can be justified based on organizational and individual legal considerations. [Extracted from the article]

Copyright of Public Health Forum is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The purpose of this study is to find funding sources for social health insurance in Sudan to cover vulnerable families. Design/methodology/approach: The concept of this paper is to look into the causality relationship between insured and directly paid poor people and their incomes through using the autoregressive distributed lag model (ARDL) and using a survey raw data carried out in 2010 in Sudan. Findings: The findings show that insured vulnerable people and income-generating activities have a significant positive relationship. The results, on the other hand, show a marginally negative effect on income for those who have directly paid poor people. Originality/value: Previous research on the position of zakat has focused primarily on its role in poverty alleviation and has given little consideration to its role in social security. This study is characterized by improving the possibility of changing the mechanism of distributing zakat funds in favor of health financing to maximize the benefit. [ABSTRACT FROM AUTHOR]

OBJECTIVE To describe and explore the experiences of hospital employees with the causes of fraud in the health insurance program at the hospitals. DESIGN AND SETTING This research was carried out at government hospitals in the Southeast Sulawesi Province in collaboration with BPJS Health, namely the Bahteramas Regional General Hospital and the Kendari City Regional General Hospital. Triangulation was carried out at BPJS Health, the Center for Health Insurance Financing at the Ministry of Health and the Center for Health Policy and Management at Gadjah Mada University, Yogyakarta. This research was conducted for one year, namely January 2020 to February 2021qualitative method with a phenomenological approach. Data collection methods were carried out through in-depth interviews, focus group discussions, and document studies. The number of participants in this study was 44 people consisting of doctors in charge of services, nurses, midwives, and case-mix team including coders who met the inclusion criteria. Data analysis used the Moustakas method. RESULT The causes of health insurance fraud in hospitals financial motives (the desire to get money or material or economic or welfare benefits, get high service services and low employee salaries), behavioral motives (low integrity, lifestyle and employee habits of committing fraud0, and social motives (kinship, humanitarian factors, avoiding conflict, social position, and the existence of pressure), internal controls (a weak monitoring system, poorly enforced regulations, unclear regulations and limited hospitals providing services, no monitoring and evaluation, and there are no sanctions for fraud perpetrators), revenue targets (hospitals income and increasing the number of claims), leadership (leadership style or weak leadership in the hospitals and the absence of transparency), incentive systems (poor distribution of incentives and the absence of transparency of services from hospitals management), National Health Insurance (NHI) regulations (dynamic regulations and the availability of the National Guidelines for Medical Services has not been fulfilled and there is no standard for readmission and fragmentation), the NHI financing system (inconvenience of the financing system and the adequacy of the INA-CBGs tariff calculation), and the BPJS Health system (inconvenience of the BPJS Health system and the BPJS Health system which makes it difficult). CONCLUSIONS The causes of health insurance fraud in hospitals can be explained by the gear fraud theory that Internal factors are the main cause and external factors predispose to health insurance fraud in hospitals. These internal and external factors interact with each other like the working mechanism of a gear. Understanding the theory of gear fraud will help formulate fraud prevention efforts in health insurance programs in hospitals that are more comprehensive and focus on eliminating the causes of fraud. [ABSTRACT FROM AUTHOR]

The catastrophic health expenditure (CHE) indicator has been used to measure the medical cost burden of households. Many countries have institutionalized their health insurance systems to reduce out-of-pocket payments, the main contributor to the financial burden. However, there is no method to estimate how the insurance coverage reduces the CHE. This study proposes an approach to evaluate the effectiveness of insurance in reducing the CHE impacts in terms of incidence and gap, which are based on a modified calculation method of CHE. Additionally, we apply these methods to data from the Korea Health Panel Survey (2011–2016). The results are as follows. First, under the setting of a threshold of 10%, the CHE incidence rate was 19.26% when the Korean national health insurance benefits reduced the CHE's incidence for 15.17% of the population in 2017. Second, the results of the concentration index of CHE showed that the intensity approach of CHE is better than the incidence approach. Third, the new approach we applied revealed that health insurance reduces the burden of CHE to some degree, although it was not an efficient way to reduce CHE. In conclusion, this study provides new policy approaches to save the finances of national health insurance and reduce the intensity of CHE at the same time by raising the low-cost burden of medical services and lowering that of high cost. Moreover, we suggest that policymakers should focus on income level of the households rather than specific diseases. [ABSTRACT FROM AUTHOR]

Outpatient medical care in Bulgaria is entirely private and is financed by the health insurance fund through capitation and fees. Emergency medical care is organized, managed and controlled by the Ministry of Health. It is financed from the state budget. Defects in the organization of the emergency care system have a negative impact on the adequate provision of emergency medical care in the country. [ABSTRACT FROM AUTHOR]

Background: Half of the global population is at risk for catastrophic health expenditure (CHE) in the event that they require surgery. Universal health coverage fundamentally requires protection from CHE, particularly in low- and middle-income countries (LMICs). Financial risk protection reports in LMICs covering surgical care are limited. We explored the relationship between financial risk protection and hospital admission among injured patients in Cameroon to understand the role of health insurance in addressing unmet need for surgery in LMICs. Methods: The Cameroon National Trauma Registry, a database of all injured patients presenting to the emergency departments (ED) of three Cameroonian hospitals, was retrospectively reviewed between 2015 and 2017. Multivariate regression analysis identified predictors of hospital admission after injury and of patient report of cost inhibiting their care. Results: Of the 7603 injured patients, 95.7% paid out-of-pocket to finance ED care. Less than two percent (1.42%) utilized private insurance, and more than half (54.7%) reported that cost inhibited their care. In multivariate analysis, private insurance coverage was a predictor of hospital admission (OR 2.17, 95% CI: 1.26, 3.74) and decreased likelihood of cost inhibiting care (OR 0.34, 95% CI: 0.20, 0.60) when compared to individuals paying out-of-pocket. Conclusion: The prevalence of out-of-pocket spending among injured patients in Cameroon highlights the need for financial risk protection that encompasses surgical care. Patients with private insurance were more likely to be admitted to the hospital, and less likely to report that cost inhibited care, supporting private health insurance as a potential financing strategy. [ABSTRACT FROM AUTHOR]

Copyright of Taiwan Economic Forecast & Policy is the property of Institute of Economics, Academia Sinica, Taiwan Economic Forecast & Policy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Accessibility of health care to students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health care to students with disabilities. This study, therefore, aims to explore the accessibility of health care to students with disabilities, in the quest of achieving universal health coverage in Ghana.Methods: Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data.Results: The study identified three themes - accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health care. The barriers faced by students with disabilities were unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health care.Conclusion: The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the National Health Insurance Scheme should be revised to adequately address the needs of people with disabilities. [ABSTRACT FROM AUTHOR]

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.

According to European regulations on the coordination of social security systems, Bulgarian legislation, and the respective bilateral agreements, the National Health Insurance Fund should use its budget to guarantee the health care coverage of insured persons during their stay on the territory of other EU Member States, the European Economic Area, Switzerland, Macedonia, Serbia, and Montenegro. By making an analysis of the number and types of issued certificates, amounts paid and due, the cost structure, and the medical fiends in which medical care is most often used in other countries, the goal of the present work is to monitor trends based on the information available to date about the structure and scope of treatment sought in other countries, funded with public financing by the National Health Insurance Fund. The conclusions indicate that there are medical specialties and fields in which a significant share of people seeking scheduled treatment abroad receives treatment abroad. This points to the need to work toward the advancement of these diagnostic and treatment fields in Bulgaria by means of financing, scientific research, technologies, and staffing as to overcome the deficit and the need for Bulgarian citizens to seek scheduled treatment abroad. These parameters and trends should be an object of analysis of the institutions tasked with decision making and modification and of better resource management in the healthcare system by respecting citizens’ rights. [ABSTRACT FROM AUTHOR]

Copyright of Rehabilitation / Rehabilitacija is the property of University Rehabilitation Institute, Republic of Slovenia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This research paper seeks to answer the question: What tax or combination of taxes knowledgeable individuals think the South African government can use as a potential source of revenue to fund the proposed National Health Insurance? The research methodology adopted is of an exploratory interpretive nature as it deals with the opinions of respondents. This methodology is well suited to the research process as the goal is to obtain and explore knowledgeable individuals' opinions on what they perceive to be the best tax or combination of taxes which can be used as a potential source of revenue to finance the National Health Insurance fund. The method initially comprised a normative study, focusing on a literature review, the results of which were then used to create a self-developed questionnaire. This research aims to contribute to the body of knowledge which the South African government can consider when making a decision on a tax or combination of taxes as a possible method of financing. A sample of 91 people consisting of 40 tax practitioners (44%), 33 academics (36.2%) and 18 economists (19.8%) were asked to complete the questionnaire. The resultant data were subjected to various statistical analysis methods, including factor analysis, Kruskal-Wallis tests and Cluster analysis. The results reveal that (a) an increase in Value-Added tax is perceived as being justifiable, fair and efficient, while (b) an increase in taxes on individuals or an introduction of payroll taxes is not. The respondents suggest that funds be ring-fenced for National Health Insurance as this will increase accountability and prevent the funds from being expropriated during the budgetary process. [ABSTRACT FROM AUTHOR]

Huge differences between the territories that are divided into the city and district municipalities are found after examining theoretical and methodological literature, obtaining abundant statistical information on the status of health care institutions in Lithuania, disclosing the system of indicators describing that status, and taking into account the analysis of the data of all the statistic residents of the Territorial Health Insurance Funds (THIF) and those registered at the outpatient primary personal health care institutions (OPPHCI). The number of residents who have registered at the OPPHCI of city municipalities is different from the rates provided by the statistics. Therefore, in the calculation of health indicators, a meaningful selection of them will more accurately reflect the status of health care facilities. Of these indicators, it is important to select not only those that best describe the existing medical care level in the municipalities but those that are also informative. The system of indicators was selected on the basis of the Delphi method. This article analyzes the state of the health care institutions in Lithuania and the qualitative and quantitative indicators of health care and their evaluation at the municipal level. The authors of this article used multivariate statistical methods in evaluating the state of health care institutions. The reliability and the validity of the obtained results are verified by two models; thus, the stability and suitability of the models are tested in investigating the state of health care institutions in Lithuania. The final aim of the study is to evaluate the administrative units of different territories and, from the medical level perspective, identify the best performing and most lagging municipalities. [ABSTRACT FROM AUTHOR]

Abstract In this paper, we examine the impact of macroeconomic, as well public and private health insurance financing (PHI) factors on out of pocket (OOP) healthcare expenditures, by using fixed/random effects and dynamic panel data methodology to a dataset of 26 EU and OECD countries for a period lasting from 1995 to 2013. The existing empirical literature has focused on testing the hypothesis that several macroeconomic and health financing determinants have an effect on OOP healthcare expenditures. Nevertheless, the related articles have not well tested the hypothesis concerning the potential impact of PHI financing on OOP spending. We find that public and PHI financing have a significant countervailing effect on OOP spending. Moreover, we show that unemployment rate has a significant positive impact on OOP expenditures. Sensitivity tests with variation of specifications and samples show that our findings are robust. We argue that policy-makers should give serious consideration to PHI institution; our results indicate that there is an inverse effect on OOP spending. We suggest that our examined countries have to provide financial risk protection to their citizens against OOP payments, rather than only attending health budgetary retrenchments in order to adjust public finances. [ABSTRACT FROM AUTHOR]

The article discusses the use of a comprehensive incentive approach to employee health care cost containment. A comprehensive approach would involve system controls to shrink the system as well as incentives for both providers and health care consumers to reduce utilization, be more price conscious, and provide services more quickly. Such incentives could encourage efficiency, restrain the rate of inflation in health services, and provide consumers with an unprecedented number of options and services.

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Although many people view the Patient Protection and Affordable Care Act (ACA) as a radical change in the way we finance health care in the U.S., in fact it is a continuation of the multifaceted system we've had for some time. The ACA includes a mix of public and private financing, with most Americans receiving insurance through their places of employment, while others will purchase private insurance as individuals. Some of these employers and individuals will purchase insurance through health exchanges. The ACA also retains roles for both state and federal governments. States will continue to participate in the Medicaid program, some with expanded eligibility. And most states will either develop state-run exchanges or partner with the federal government to do so. The health insurance exchange concept is a crucial component of the new multifaceted approach to financing health care. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This article addresses the new paradigms in German health promotion, as there is a new law (German Prevention Act) since summer 2015, asking for (new) challenges for social work. THEORETICAL BASE: This so-called "law to empower health promotion and prevention" encourages actors in this field to collaborate and forces the health insurances to put more than 500 million euros per year into a national health fund. The national prevention committee described recommendations on how to invest the money, and defined core areas (for example childcare services, schools, communities and care facilities) and core topics (for example the reduction of health inequalities). METHODS: Theoretical discussion and reflection on the current opportunities and the challenge for social work in health promotion and prevention. OUTCOME and SOCIAL WORK IMPLICATIONS: Lifeworld orientation in social work is derived as a theoretical framework to reduce health inequalities. Therefore, we focus on "health in everyday life" and discuss to what extend environmental limitations shape health-related agency - people's real options for action to decide either for or against an action. From a professional perspective it is inevitable to mandate for social work clients and their living environments, to include their agency in all considerations and to consequently address social disadvantaged target groups. [ABSTRACT FROM AUTHOR]

Abstract: Aim of the study was to assess the incidence of statin‐associated myopathy (SAM) under real‐life conditions in Germany. Database: Administrative data (master data, diagnoses, prescriptions) for all individuals in Germany insured with the Statutory Health Insurance. Basic population: individuals 18 years and older who have been insured continually from 2009 to 2011 (52.9 million; 29.9 million men, 23.9 million women). Data access is provided by the German Institute of Medical Documentation and Information, DIMDI) according to the Data Transparency Regulation of 2012. Statins: identification with the ATC–Codes: C10AA, C10BA and C10BX. Study population: incident statin users in 2010 with a diagnosis of lipid disorders (ICD‐10‐GM E78, excluding patients with: E78.1, E78.3, E78.6 in eight quarters before index prescription. Definition of SAM: documentation of myopathy (ICD‐10‐GM G72.0, G72.8; G72.9, M60.8, M60.9, M79.1) in the first statin prescription quarter or in one of the three following quarters. The first event is considered for the incidence estimate. The daily doses included in a package were classified as “days under therapy” (by assuming one DDD) and taken as exposition time. SAM was found in 1.9% of 531 672 incident statin users. The percentage differs according to the patterns of statin use: the lowest incidence is observed in those with only one prescription (1.3%), the highest incidence with 5.0% is observed in those who not only stopped the treatment within 365 days, but who also had their statin changed. Administrative data including diagnoses from ambulatory care provide a realistic estimate of SAM frequency in every day practice. [ABSTRACT FROM AUTHOR]

Recent federal legislation has linked the price paid for health insurance benefits to current income. Under the Patient Protection and Affordable Care Act of 2010, individuals and families with income as high as 400% of the federal poverty level are eligible for premium tax credits that limit their health insurance premiums to under 10% of their income. Under the Medicare Modernization Act of 2003, higher-income beneficiaries face income-related premiums over three times the standard premium for Part B coverage. For workers at or near retirement age, means testing based on current income provides an incentive for early retirement, dissaving, and income manipulation, raising concerns about the efficiency of such means testing. Further, current income is subject to short-term fluctuations, making it a noisy predictor of ability to pay. Using the Health and Retirement Study and linked Social Security earnings histories, this paper introduces a measure of lifetime income that compares favorably to current income as a basis for means testing. It offers less short-term variation in premiums while improving incentives for preretirement work and saving. [ABSTRACT FROM AUTHOR]

A Dutch physician who performs euthanasia must evaluate whether a patient is suffering hopelessly and unbearably, is adequately informed, has no reasonable alternatives available, and is making a voluntary and well considered request. When the patient visits the physician, an additional €11.51 (AU$18.63) is paid.[3] However, as euthanasia is a time and effort consuming trajectory, the physician is entitled to additional compensation. [Extracted from the article]