Legal and policy requirements of basic health insurance package to achieve universal health coverage in a developing country

OBJECTIVES

This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view.

RESULTS

All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into three main themes and 11 subthemes. The main themes include three kinds of requirements at three level of third party insurer, health care provider and citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.

Comprehensive Legislative Reform to Protect the Integrity of the 340B Drug Discount Program

The 40B Drug Discount Program (340B Program) is a federally facilitated program that requires drug manufacturers to provide steep discounts on outpatient prescription drugs to qualifying safety net health care providers. The federal program is intended as a safeguard to ensure access to affordable drugs to the indigeut. However, over the last two decades safety net health care providers have exploited financial incentives under the 340B Program at the expense of drug manufacturers and patients, including the most needy and vulnerable populations-they are committed to serve. Although the federal government has been applauded for increasing effortsto combat health care fraud and abuse including recovering $3.3 billion in 2014, federal officials and the general public have paid markedly less attention to pervasive abuse of the 340B Program. In 2014, drug purchases of 340B-designated drugs totaled $7 billion and are expected to increase to $12 billion: by 2016 as a result of the expansion of the program under the Affordable Care Act. The 340B Program has completely lost its way, and comprehensive legislation is necessary to realign the program with its intent.

Marking time in the land of plenty: reflections on mental health in the United States

This reprinted article originally appeared in American Journal of Orthopsychiatry, 1981, Vol. 51, No. 3, 391-402. (The following abstract of the original article appeared in record 2013-42918-004.) This article focuses on reflections on mental health in the United States. This accumulation of wisdom and knowledge from experts inside and outside government has for the most part been ignored or shelved over the years because of revisions, deferrals, impoundments, vetoes, threatened vetoes, reorganizations, budget cuts, inflation, and military demands. Programs such as Head Start, which have been proven successful, have been fighting for survival, and community mental health centers, which in many ways represented a bold, new approach with much creative promise, were threatened with the loss of federal funding in the early 1970s. The humanist tradition in mental health and social services is best exemplified by Pinel's unchaining of psychotic patients: Itards infinite patience in working with Victor, the wild child: and Jane Addams's extraordinary development of community programs. On an international level a recent report of the WHO European Regional Office also has called for a wide ranging, independent group that would cut across national governments and exercise influence at high political levels to insure that important mental health policies are implemented. Perhaps the day will even come when an American President will feel responsible and accountable to the nation in an annual report to Congress and the people on the progress made in health and social welfare areas in his or her administration.

Victor Horsley (1857-1915) and National Insurance

The Liberal government in 1911 was determined to improve the health care of the poor and working class in Britain. The Chancellor of the Exchequer, Lloyd George, introduced a National Insurance Bill before Parliament without consulting the medical profession. The doctors were furious but Horsley, a progressive liberal, was firmly in favour of a national health service and vociferously supported the bill. This led to a series of acrimonious meetings that did not enhance the reputation of the profession and alienated Horsley from his colleagues.

[A refined institution was created: which serves to all of the members of insurance in the case of illness: foundation and development of Merkur's sanatorium in Zagreb until 1945]

The historiography of Zagreb sanatorium Merkur, founded by Merkur Insurance Society in 1930 is presented. The research is based on archival sources kept in the State's archives as well as in the National library in Zagreb aiming to identify the opening, building and governing the hospital until 1945. The analysis of the hospital historiography allowed the insight into social insurance development on our territory as well as of Zagreb's population receptivity towards the health institution and the quality of health service in the first half of the 20th century. The paper is dedicated to the 140th anniversary of Merkur Insurance Society foundation.

Party control, policy reforms, and the impact on health insurance coverage in the U.S. states

Objectives. One of the major policy concerns at the federal and state level is the rising number of individuals without health insurance. The purpose of this article is to investigate whether party control of government and various state reforms impact the percentage of the state population without health insurance.Methods. Using data from 1987–2007, I empirically examine whether party control and five state policy reforms reduce the uninsured population.Results. The results show that Republicans are more effective than Democrats at the state level at reducing insurance gaps and that three of five policy reforms explored appear to significantly expand insurance coverage.Conclusions. The results provide valuable insight into which components of health-care reform at the national level may help address the health insurance problem.

Family structure and child health outcomes in the United States

We use categorical and logistic regression models to investigate the extent that family structure affects children’s health outcomes at age five (i.e., child’s type of health insurance coverage, the use of a routine medical doctor, and report of being in excellent health) using a sample of 4,898 children from the "Fragile Families and Child Well-Being Study." We find that children with married biological parents are most likely to have private health insurance compared with each of three other relationship statuses. With each additional child in the home, a child is less likely to have private insurance compared with no insurance and Medicaid insurance. Children with cohabiting biological parents are less likely to have a routine doctor compared with children of married biological parents, yet having additional children in the household is not associated with having a routine doctor. Children with biological parents who are not romantically involved and those with additional children in the household are less likely to be in excellent health, all else being equal.

The relevance of personal characteristics in health care rationing: what the Australian public thinks and why

This article examines the preferences of the general public in Australia regarding health care resource allocation. While previous studies have revealed that the public is willing to give priority to particular groups of patients based on their personal characteristics, the present article goes beyond previous efforts in attempting to explain these results. In the present study, there was strong support among respondents for giving “equal priority” to people regardless of their personal characteristics. However, respondents did reveal a preference for married patients over single, for children over adults, for carers of children and the elderly, sole breadwinners, and good community contributors. Further, they would give a lower priority to those perceived as “self-harmers”—smokers, individuals with unhealthy diets, and those who rarely exercise. Variation in the answers according to broad economic and social beliefs across seven different categories (“factors”) influenced the pattern of the public's attitudes towards rationing. The Principal Components Analysis (PCA) indicated that most of the items in our survey are associated with seven factors that explain or capture much of the variation. These relate to a patient's avoidance of self-harm behaviors (Safe Living), their Life Style (diet, exercise, etc.), their contribution to the community through caring for others (Caring), their talents (Gifted), their sexual behavior (Sexuality), their age and marital status (Family), and whether they are an Australian citizen or employed (Citizen). The strength of social preferences—e.g., how strongly respondents would “discriminate” against a recreational drug user or preference a person with a healthy diet—is related to the particular class of preferences.

Hospital bodies: the genesis of Italian National Health Service

Hospital public bodies were instituted in Italy in 1968. Their creation represents a fundamental step forward in the evolution of the national healthcare system and has allowed improvements in social equity in hospitals. The lack of independent funding beyond the insurance-type healthcare system existing at the time, hindered its success. The hospital body has however left a trace in the modern national healthcare system with the introduction of the hospital corporation.

The French health care system: liberal universalism

This article analyzes the reforms introduced over the last quarter century into the French health care system. A particular public-private combination, rooted in French history and institutionalized through a specific division of the policy field between private doctors and public hospitals, explains the system's core characteristics: universal access, free choice, high quality, and a weak capacity for regulation. The dual architecture of this unique system leads to different reform strategies and outcomes in its two main parts. While the state has leverage in the hospital sector, it has failed repeatedly in attempts to regulate the ambulatory care sector. The first section of this article sets out the main characteristics and historical landmarks that continue to affect policy framing and implementation. Section 2 focuses on the evolution in financing and access, section 3 on management and governance in the (private) ambulatory care sector, and section 4 on the (mainly public) hospital sector. The conclusion compares the French model with those developed in the comparative literature and sets out the terms of the dilemma: a state-run social health insurance that lacks both the legitimacy of Bismarckian systems and the leverages of state-run systems. The French system therefore pursues contradictory policy goals, simultaneously developing universalism and liberalism, which explains both the direct state intervention and its limits.

Applying policy network theory to policy-making in China: the case of urban health insurance reform

In this article, we explore whether policy network theory can be applied in the People's Republic of China (PRC). We carried out a literature review of how this approach has already been dealt with in the Chinese policy sciences thus far. We then present the key concepts and research approach in policy networks theory in the Western literature and try these on a Chinese case to see the fit. We follow this with a description and analysis of the policy-making process regarding the health insurance reform in China from 1998 until the present. Based on this case study, we argue that this body of theory is useful to describe and explain policy-making processes in the Chinese context. However, limitations in the generic model appear in capturing the fundamentally different political and administrative systems, crucially different cultural values in the applicability of some research methods common in Western countries. Finally, we address which political and cultural aspects turn out to be different in the PRC and how they affect methodological and practical problems that PRC researchers will encounter when studying decision-making processes.

US mortality in an international context: age variations

Compared to other developed countries, the United States ranks poorly in terms of life expectancy at age 50. We seek to shed light on the US's low life expectancy ranking by comparing the age-specific death rates of 18 developed countries at older ages. A striking pattern emerges: between ages 40 and 75, US all-cause mortality rates are among the poorest in the set of comparison countries. The US position improves dramatically after age 75 for both males and females. We consider four possible explanations of the age patterns revealed by this analysis: (1) access to health insurance; (2) international differences in patterns of smoking; (3) age patterns of health care system performance; and (4) selection processes. We find that health insurance and smoking are not plausible sources of this age pattern. While we cannot rule out selection, we present suggestive evidence that an unusually vigorous deployment of life-saving technologies by the US health care system at very old ages is contributing to the age-pattern of US mortality rankings. Differences in obesity distributions are likely to be making a moderate contribution to the pattern but uncertainty about the risks associated with obesity prevents a precise assessment.

Twenty-five years of convoluted health reforms in Mexico

Núria Homedes and Antonio Ugalde discuss 25 years of reform to the Mexican health care system and argue that although costs and accessibility have increased, health inequities, efficiency, productivity, and quality of care have not improved.

Poverty & health: criticality of public financing

Countries with universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. This contributes to both equity in healthcare as well as to low levels of poverty in these countries. It is only in countries like India and a number of developing countries, which still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast, a large majority of the population, who suffers a hand-to-mouth existence, is forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non existent. Thus, the absence of adequate public health investment not only results in poor health outcomes but it also leads to escalation of poverty. This article critically reviews the linkages of poverty with healthcare financing using evidence from national surveys and concludes that public financing is critical to good access to healthcare for the poor and its inadequacy is closely associated with poverty levels in the country.

[Jean-Charles Sournia and Berry]

A previous Eloge has been pronounced on June 30, 2001 during the work session of the French and the International Societies of History of Medicine. It was devoted to the various aspects of the medical, historical and public career of Prof Jean-Charles Sournia (November 24, 1917-June 8, 2000). The present session of the French Society of History of Medicine hold in Bourges, on June, 18, 2005 is an accomplishment of the wish of this child of Bourges, the capital of Berry. In this intoductive paper, from family testimonies and photographies, details are given about the childhood of Jean-Charles Sournia in Berry, his scholarship and his family. Sournia was deeply attached to the family house, to the city where he was born and to its hospital, called hôtel-Dieu.

[Sickness absence incidence in Norway 1975-2002]

BACKGROUND

The aim of the present paper is to describe the sickness absence incidence in Norway after the introduction of the present sickness absence benefit scheme in 1978.

MATERIAL AND METHODS

Data on sickness absence from the National Insurance Administration), Statistics Norway and the Confederation of Norwegian Business and Industry (the employers' federation) are presented and discussed.

RESULTS AND INTERPRETATION

The incidence of short-term absence has changed very modestly since the present system with self-certification of absence of 1 to 3 days was introduced. Long-term sickness absence was at its lowest levels in 1983 and 1994, coinciding with peaks of unemployment in Norway. From 1995 there has been a rather steep increase in sickness absence; in 2002 the Insurance Administration recorded the highest figures for sickness absence ever. Mean number of sickness absence days among all employed persons compensated by the Insurance Administration (only spells > 16 days) was 10.6 days for men and 16.7 days for women in 2002. The data from the employers' federation, however, indicate that sickness absence levels for male workers in private sector were still below the levels recorded in the 1970s. Mental disorders are an increasing reason for sickness absence in Norway and have contributed to an increase in mean duration of sickness absence spells. More epidemiological research on sickness absence in Norway is needed.

[A lead seal of the "Germanos' Health Service" as an early forerunner of the health insurance card in ancient Byzantium]

The aim of this study is to present a Byzantine lead seal from the 6th century A. D. in the light of other comparable finds and to explain its function. According to the Greek inscription it was issued by the so-called "Germanos' Health Service". Its beneficiaries carried it probably around the neck or wrist. This charitable institution, settled in Constantinople, supported people in need. Feeding of the poor and free access to the baths certainly belonged to the standard services of the "Germanos' Health Service". Several reasons favour the assumption that medical help was also included in the range of benefits offered to people to whom it would have otherwise been out of reach. Contrary to the modern Health Insurance there was no legal claim to the medical care. It was rather a voluntary charitable supply that is to be seen in the context of Christian love and of personal striving for the salvation of the soul through good deeds. Therefore, the seal of the "Germanos' Health Service" belongs at least indirectly among the forerunners of the modern Health Insurance Card which ought to give access to participation in the blessing of good health.

Hospitalization: a contentious issue for patients and health funds in Baden, 1893-1914

Hospitals in Germany had traditionally provided care on a voluntary basis. Before the end of the nineteenth century, hospitalization was compulsory only during epidemics or in the case of infectious diseases such as syphilis or leprosy. Voluntary hospitalization normally occurred only when hospital beds were available, when payment was guaranteed, or during emergencies. Towards the end of the nineteenth century, however, there was a definite increase in hospitalization levels, primarily due to two important developments: the introduction of health insurance in 1883, and the growing number and size of hospitals. Health insurance covered its members' hospital expenses, and the hospitals provided facilities for more and more patients.