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Healthcare reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects healthcare delivery in a given place. Healthcare reform typically attempts to:

  • Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies
  • Expand the array of health care providers consumers may choose among
  • Improve the access to health care specialists
  • Improve the quality of health care
  • Decrease the cost of health care

Contents

The Netherlands

The Netherlands has introduced a new system of health care insurance based on risk equalization through a risk equalization pool. In this way, a compulsory insurance package is available to all citizens at affordable cost without the need for the insured to be assessed for risk by the insurance company. Furthermore, health insurers are now willing to take on high risk individuals because they receive compensation for the higher risks [1].

A 2008 article in the journal Health Affairs suggested that the Dutch health system, which combines mandatory universal coverage with competing private health plans, could serve as a model for reform in the US.[2][3]

A video (in Dutch and English) is available which explains the reforms. Subtitles in English are available by clicking the 'T' control on the video control after clicking this link.

Russia

Following the collapse of the Soviet Union, Russia embarked on a series of reforms intending to deliver better health care by compulsory medical insurance with privately owned providers taking the role of the former state run institutions. According to the OECD [4] none of this worked out as planned and the reforms had in many respects made the system worse. Russia has more physicians, hospitals, and health care workers than almost any other country in the world on a per capita basis,[1][2] but since the collapse of the Soviet Union, the health of the Russian population has declined considerably as a result of social, economic, and lifestyle changes.

Taiwan

Taiwan changed its health care system in 1995 to a National Health Insurance model similar to the US Medicare system for seniors. As a result, the 40% of Taiwanese people who had previously been uninsured are now covered.[5] It is said to deliver universal coverage with free choice of doctors and hospitals and no waiting lists. Polls in 2005 are reported to have shown that 72.5% of Taiwanese are happy with the system, and when they are unhappy, it's with the cost of premiums (equivalent to less than US$20 a month).[6]

National Health Insurance or NHI premiums is similar to that of social security contributions in the US. Employers and the self-employed are legally bound to pay them. Unlike funds raised via US social security taxes, which can be borrowed in the interim to fund military and other spending, the NHI is a pay-as-you-go system. The aim is for the premium income to pay costs, but there is also a tobacco tax surcharge that goes to the NHI, and contributions from the national lottery.[citation needed]

United Kingdom

Health care was reformed in 1948 with the creation of the National Health Service or NHS. It was originally established as part of a wider reform of social services and funded by a system of National Insurance, though receipt of health care was never contingent upon making contributions towards the National Insurance Fund. Private health care was not abolished but had to compete with the NHS. About 15% of all spending on health in the UK is still privately funded but this includes the patient contributions towards NHS provided prescription drugs, so private sector health care in the UK is quite small. As part of a wider reform of social provision it was originally thought that the focus would be as much about the prevention of ill-health as it was about curing disease. The NHS for example would distribute baby formula milk fortified with vitamins and minerals in an effort to improve the health of children born in the post war years as well as other supplements such as cod liver oil and malt. Many of the common childhood diseases such as measles, mumps, and chicken pox were mostly eradicated with a national program of vaccinations.

The NHS has been through several reforms since 1948 although it is probably fairer to say that the system has been through phases of evolutionary change. The Conservative Thatcher administrations attempted to bring competition into the NHS by developing a supplier/buyer role between hospitals as suppliers and health authorities as buyers. This necessitated the detailed costing of activities, something which the NHS had never had to do in such detail, and some felt was unnecessary. The Labour Party generally opposed these changes, although after the party became New Labour, the Blair government retained elements of competition and even extended it, allowing private health care providers to bid for NHS work. Some treatment and diagnostic centres are now run by private enterprise and funded under contract. However, the extent of this privatisation of NHS work is still very very small, though remains controversial. The administration committed more money to the NHS raising it to almost the same level of funding as the European average and as a result, there has been a large expansion and mordernisation programme and waiting times are now much more acceptable than they once were.

The government of Gordon Brown has announced several new reforms for care in England. One is to take the NHS back more towards health prevention by tackling issues that are known to cause long term ill health. The biggest of these is obesity and related diseases such as diabetes and cardio-vascular disease. The second reform is to make the NHS a more personal service, and it is negotiating with doctors to provide more services at times more convenient to the patient, such as in the evenings and at weekends. This personal service idea would introduce regular health check-ups so that the population is screened more regularly. Doctors will give more advice on ill-health prevention (for example encouraging and assisting patients to control their weight, diet, exercise more, cease smoking etc.) and so tackle problems before they become more serious. Waiting times, which have already fallen considerably under Blair (median wait time is about 6 weeks for elective non-urgent surgery) are also in focus. The NHS will from December 2008, ensure that no person waits longer than 18 weeks from the date that a patient is referred to the hospital to the time of the operation or treatment. This 18 week period thus includes the time to arrange a first appointment, the time for any investigations or tests to determine the cause of the problem and how it should be treated. An NHS Constitution for England has recently been published which lays out the legal rights of patients as well as promises (not legally enforceable) the NHS strives to keep in England.

United States

Health care reform in the United States
General
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Specific bills
Lead Proposal(s)
Superseded Proposal(s)

Systems

Reform advocacy groups

Health care in the United States

The debate over healthcare reform in the United States centers around questions of a right to health care, access, fairness, sustainability, and quality purchased by the high sums spent. The mixed public-private health care system in the United States is the most expensive in the world, with health care costing more per person than in any other nation, and a greater portion of gross domestic product (GDP) is spent on it than in any other United Nations member state except for East Timor (Timor-Leste).[7] A study of international health care spending levels in the year 2000, published in the health policy journal Health Affairs, found that while the U.S. spends more on health care than other countries in the Organisation for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.[8]

The U.S. is the only wealthy, industrialized nation that does not have a universal health care system, according to the Institute of Medicine of the National Academy of Sciences and others.[9][10] The number of people in America without health insurance coverage at some time during 2006 totaled about 16% of the population, or 47 million people.[11] Of these 47 million uninsured people, nine million or roughly twenty percent, reside in households whose income totals greater than $75,000[12] In addition, many or most of those with insurance are not sufficiently insured[13][14], with high-deductible policies, policies that do have limits on what they will pay for or policies that cost a significant percentage of their income[15].

In spite of the amount spent on health care in the US, according to a 2008 Commonwealth Fund report, the United States ranks last in the quality of health care among developed countries.[16] The World Health Organization (WHO), in 2000, ranked the US health care system 37th in overall performance and 72nd by overall level of health (among 191 member nations included in the study).[17][18] International comparisons that could lead to conclusions about the quality of the health care received by Americans are subject to debate. The US pays twice as much yet lags other wealthy nations in such measures as infant mortality and life expectancy, which are among the most widely collected, hence useful, international comparative statistics.

Health Care Reform in U.S. States-Hawaii, Massachusetts

Both Hawaii and Massachusetts have implemented some incremental reforms in health care, but neither state has become completelely 100% covered. To date, The U.S. Uniform Law Commission, sponsored by the National Conference of Commissioners on Uniform State Laws has not submitted a uniform act or model legislation regarding health care insurance or health care reform

Whether a universally accessible health care system should be implemented in the U.S. remains a hotly debated political topic. However, even a former executive Wendell Potter of the CIGNA health industry switched sides when time came and now supports reform proposals. He was appalled by many things happening because of the health industry and could no longer stand it. His public testimony can be found here:[1] Reform proposals include the removal of the private health insurance market, the establishment of a "public option," premium subsidies to help individuals purchase health insurance, increased use of health information technology, research and incentives to improve medical decision making, reduced tobacco use and obesity, reforming the payment of providers to encourage efficiency, limiting the tax federal exemption for health insurance premiums, and reforming several market changes such as resetting the benchmark rates for Medicare Advantage plans and allowing the Department of Health and Human Services to negotiate drug prices.

A fundamental problem in evaluating reform proposals is the difficulty of estimating their cost and potential impact. In an effort to cut drug costs and potential drug-related toxicities, medical doctors have been instructed by the FDA only to prescribe those medications which are "absolutely indicated" in the management of patient's illnesses. The empirical data and theory underlying cost estimates in this area are limited and subject to debate, increasing the variation between estimates and limiting their accuracy.[19]

Another impediment to implementing any reform that does not benefit insurance companies or the private health care industry is the power of insurance company and health care industry lobbyists in the United States.[20][21] Possibly as a consequence of the power of lobbyists, key politicians such as Senator Max Baucus have taken the option of single payer health care off the table entirely.[22]

Public opinion on health care reform, sometimes called health system reform, suggests a high percentage desire reforms; however, do not want to see their taxes raised. According to The Patient Poll, a study of Pennsylvania adults age 21 and older conducted in July 2008 by The Institute for Good Medicine at the Pennsylvania Medical Society, 63.4 percent believed that the United States should enact some form of universal health care. But, when asked how this care should be funded, only 26.8 percent were willing to have their taxes increased. [23] On a national polling level, similar results were found in a USA TODAY/Gallup Poll that suggested high interest in overhauling the health care system, but less enthusiasm on the funding mechanisms.[24] Another survey of Pennsylvanians conducted in July 2009 through The Patient Poll from The Institute for Good Medicine at the Pennsylvania Medical Society suggests that the majority of Pennsylvania adults (68.2 percent) believe that health care is neither a right nor a privilege, and that both government and individuals bear some degree of responsibility.[25] In 2010, 82% of Obama voters who voted for Brown in Massachusetts support the public option.[26]

The House of Representatives passed a health care reform bill by a vote of 220-215 on November 7, 2009. [27] Currently the fate of the bill rests on the Senate. The legislation once included changes that would give the government the power to negotiate policy premiums and to provide a public option, but in an effort to acquire the necessary votes to prevent a Republican filibuster the public option was eliminated from the bill. This would have given citizens the option to buy into public programs like Medicare for which current members pay only $96.40 monthly.[28] Instead the bill now requires that all Americans purchase private health insurance or be subject to fines. [29] The insurance industry represents a significant lobbying group in the United States. The major health interests have spent an average of $1.4 million per day to lobby Congress so far this year and are on track to spend more than half a billion dollars by the end 2009. [30] This data may be indicative of why the current bill no longer offers a public option. Currently the bill now requires that all Americans purchase private health insurance or be subject to fines.[31]

After the Democrats lost their filibuster proof majority in the Senate, it seems that any reform is far away. Apparently, Anthem Blue Cross (a Health Business Corporation) saw it the same and is about to raise the prices for health insurance on California residents by as much as 39% in a single go. [2]

Elsewhere

As evidenced by the large variety of different health care systems seen across the world, there are several different pathways that a country could take when thinking about reform. Germany for instance, makes use of sickness funds, which citizens are obliged to join but are able to opt out if they have a very high income (Belien 87). The Netherlands used a similar system but the financial threshold for opting out was lower (Belien 89). The Swiss, on the other hand use more of a privately based health insurance system where citizens are risk-rated by age and sex, among other factors (Belien 90). The United States government provides health care to just over 25% of its citizens through various agencies, but otherwise does not employ a system. Health care is generally centered around regulated private insurance methods.

Also interesting to notice is the oldest health care system in the world and its advantages and disadvantages, see Health in Germany.

See also

References

  1. ^ http://www.minvws.nl/en/themes/health-insurance-system/ Ministry of Health, Welfare and Sport
  2. ^ Wynand P.M.M. van de Ven and Frederik T. Schut, "UniversalMandatory Health Insurance In The Netherlands: AModel For The United States?," Health Affairs, Volume 27, Number 3, May/June 2008
  3. ^ Helen Garey and Deborah Lorber "Universal Mandatory Health Insurance in The Netherlands: A Model for the United States?," In the Literature, the Commonwealth Fund, May 13, 2008
  4. ^ OECD: HEALTHCARE REFORM IN RUSSIA: PROBLEMS AND PROSPECTS (2006)
  5. ^ PBS Taiwan: A New System They Copied From Others
  6. ^ PBS: Sick Around the World
  7. ^ WHO (May 2009). "World Health Statistics 2009". World Health Organization. http://www.who.int/whosis/whostat/2009/en/index.html. Retrieved 2009-08-02. 
  8. ^ Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey and Varduhi Petrosyan, "It’s The Prices, Stupid: Why The United States Is So Different From Other Countries", Health Affairs, Volume 22, Number 3, May/June 2003. Accessed February 27, 2008.
  9. ^ Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, 2004-01-14, accessed 2007-10-22
  10. ^ The Case For Single Payer, Universal Health Care For The United States
  11. ^ "Income, Poverty, and Health Insurance Coverage in the United States: 2006." U.S. Census Bureau. Issued August 2007.
  12. ^ http://www.census.gov/prod/2008pubs/p60-235.pdf
  13. ^ Underinsurance in Primary Care: A Report from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP) concludes in part, "Of those with insurance for a full year, 36.3% were underinsured."
  14. ^ Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families—Findings from the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2007. From the report: "In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses)."
  15. ^ Report Finds Insurance Coverage Inadequate: Even Those Who Are Insured Struggle Making Medical Payments. From the statement, "Kathleen Stoll, health policy director at the Families USA consumer advocacy group, said 10.7 million insured Americans spend more than a quarter of their annual paychecks on health care."
  16. ^ Health care in US ranks lowest among developed countries
  17. ^ World Health Organization assess the world's health system. Press Release WHO/44 21 June 2000.
  18. ^ Health system attainment and performance in all Member States, ranked by eight measures, estimates for 1997
  19. ^ Sherry Glied, Dahlia K. Remler and Joshua Graff Zivin, "Inside the Sausage Factory: Improving Estimates of the Effects of Health Insurance Expansion Proposals," The Milbank Quarterly, Vol. 80, No. 4, 2002
  20. ^ Seabrook, Andrea & Overby, Peter (July 23, 2009). "Drug Firms Pour $40 Million Into Health Care Debate." NPR. Retrieved on July 23, 2009.
  21. ^ Lorber, Jennie (July 21, 2009). "Lobbying Increases as Health Care Debate Intensifies." New York Times. Retrieved on July 23, 2009.
  22. ^ Eggen, Dan (July 21, 2009). "Industry Cash Flowed To Drafters of Reform; Key Senator Baucus Is a Leading Recipient." Washington Post. Retrieved on July 22, 2009.
  23. ^ Nation must realize that health care reform isn't free, USA Today, July 17, 2009, p. 6A
  24. ^ Poll: Americans want health care bill, but not the cost, USA Today, July 14, 2009, http://www.usatoday.com/news/washington/2009-07-13-poll-health-care_N.htm
  25. ^ Patient Poll Research, Institute for Good Medicine at the Pennsylvania Medical Society, p. 5, July 2009
  26. ^ Suzy Khimm, "Grijalva: Use Reconciliation to Pass Reform" The New Republic January 20, 2010.
  27. ^ www.cnn.com/2009/POLITICS/11/07/health.care/index.html
  28. ^ http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2100
  29. ^ http://news.yahoo.com/s/ap/us_health_care_overhaul
  30. ^ http://www.healthreformwatch.com/2009/06/27/health-care-reform-lobbyists-and-the-importance-of-being-there/
  31. ^ http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2100

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