In order to address fragmentation in the healthcarefinancing system, mandatory prepayment funding mechanisms in form of general tax revenues and mandatory health insurance would have to be probably considered to be efficiently implemented as principal healthcarefinancing mechanisms. Furthermore, budget allocations in the public health sector from nationally raised revenue sources would not need to be conducted largely based on the incremental budget approach, but rather based on differentials in healthcarefinancing needs of healthcare institutions and facilities on a realistically justifiable case-by-case criterion, as well as health expenditure needs of populations.
Significant changes have occurred in the commercial and government insurance marketplace after the passage of 2 federal legislation acts, the Patient Protection and Affordable Care Act of 2010 and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. Despite the potential these 2 acts held to improve the healthcare of adolescents and young adults (AYAs), including the financing of care, there are barriers to achieving this goal. In the first quarter of 2016, 13.7% of individuals 18 to 24 years of age still lacked health insurance. Limitations in the scope of benefits coverage and inadequate provider payment can curtail access to healthcare for AYAs, particularly care related to sexual and reproductive health and mental and behavioral health. Some health plans impose financial barriers to access because they require families to absorb high cost-sharing expenses (eg, deductibles, copayments, and coinsurance). Finally, challenges of confidentiality inherent in the billing and insurance claim practices of some health insurance plans can discourage access to healthcare in the absence of other obstacles and interfere with provision of confidential care. This policy statement summarizes the current state of impediments that AYA, including those with special healthcare needs, face in accessing timely and appropriate healthcare and that providers face in serving these patients. These impediments include limited scope of benefits, high cost sharing, inadequate provider payment, and insufficient confidentiality protections. With this statement, we aim to improve both access to healthcare by AYAs and providers ’ delivery of developmentally appropriate healthcare for these patients through the presentation of an overview of the issues, specific recommendations for reform of healthcarefinancing for AYAs, and practical actions that pediatricians and other providers can take to advocate for appropriate payments for providing healthcare to AYAs.
This research assessed equity of healthcarefinancing in Malaysia employing Kakwani's progressivity index. It rep- resents the first study to measure progressivity of each of the finance sources and the whole financing system in Malaysia in a comprehensive manner. An alternative methodology, fair financing was measured by the WHO in the World Health Report 2000. With a fairness of finan- cial contribution index of 0.917 (with an uncertainty interval of possible scores between 0.881 to 0.948), Malaysia was ranked at 122–123 from 191 member coun- tries. Subsequently, the MOH Malaysia measured the sim- ilar fairness of financial contribution index using the HES Malaysia 1998/99 with complementary data sources and found that the fairness of financial contribution index was 0.982 . It was very close to 1 of perfect equality, which indicates that the financial contribution in Malaysia is fairly and equally distributed. Clearly, the MOH's index was much higher than the 0.917 stated in the World Health Report 2000, which was presumably due to the different data sources used (1980's Malaysian HES versus 1998/99 HES). Additionally, given that the fairness of financial contribution index has been criticised as being unable to distinguish between healthfinancing system that are regressive from those that are progressive , it would be beneficial to use Kakwani's index as an alterna- tive index to assess the equity in healthcarefinancing in Malaysia. Furthermore, the progressive results from the Kakwani's index demonstrates equitable financing in the Malaysian healthfinancing system, whilst also confirming the applicability of Kakwani's index in another WHO member country.
A recent review of country-level financing mechanisms for maternal health found that direct out-of-pocket payments at the point of care reduced utilization of maternal health services in a number of countries and that pooled payments schemes (e.g. insurance) can help increase access (Ensor and Ronoh 2005). A number of sub-national studies indicate that private financing approaches reduce access to maternal, child and other essential health services (Wang 2003; Falkingham 2004; Jacobs and Price 2004; Palmer et al. 2004; Prata et al. 2004; Xu et al. 2006). Out-of-pocket payments for health services have also been found to be an important cause of impoverishment in several countries (Wagstaff 2002; Liu et al. 2003; Jacobs and Price 2004). However, these within-country studies are highly specific to local context and use different research methodol- ogies, making them difficult to generalize. Furthermore, they do not directly tackle the effectiveness of governments as primary payers of health services. Such information is essential to guide national policy as well as donor actions. This paper uses a cross- national analysis to examine whether greater government participation in healthcarefinancing is associated with utilization of essential maternal health services.
Funding of the healthcare sector in Nigeria is faced with enormous challenges that must be overcome if quality and effective healthcare service is to be made available to the people. While healthcare research has focused largely on the provision, access, and quality of the facilities, this study investigated the mechanism of public healthcarefinancing in Ondo State, Nigeria. The data used for the study were from both primary and secondary sources. A multi-stage sampling technique was adopted to select and elicit information from the respondents. The 18 local government areas (LGAs) in Ondo state were segregated into three senatorial districts; three LGAs were randomly selected from each senatorial district. With the aid of an interview guide, in-depth interview were held with the chairmen of the three LGAs. Information sought included the various sources of finance and healthcare financial challenges. Descriptive statistics as well as trend analysis were used for data analysis. The major challenges of healthcarefinancing were inadequate funding by government, high out-of pocket-payment, inadequate implementation of healthcarefinancing policy and corruption. This study concluded that healthcarefinancing was inadequate in the study area and recommended an increase in government budgetary allocation
ABSTRACT. Child healthcarefinancing must maxi- mize access to quality, comprehensive pediatric and pre- natal healthcare. This policy statement replaces the 1998 policy statement by the same title. Changes reflect recent state and federal legislation that affect child healthcarefinancing. The principles outlined in the statement will be used to evaluate the changing structure of child healthcarefinancing.
This paper presents the findings of the VAKKA study. The study builds on an extensive database comprising of longitudinal hospital utilization and discharge data from Hospital Discharge Registers. The study aims at estimat- ing municipal level predictions on the incidence of new illness cases, as well as their associated costs. The pre- dicted annual variation of illness cases and costs is indi- cated by the width of the respective confidence intervals. The objective is to analyze empirically whether there is greater uncertainty in anticipated specialized healthcare treatment episodes/costs in municipalities with smaller populations, and if so, is there a cut-off point in popula- tion size after which annual variation in costs levels off. The paper is organized as follows. The next section presents a short overview of two principal public health insurance models and outlines the main characteristics of Finnish tax-based healthcarefinancing in an Euro- pean context. Section 3 describes the data and estima- tion methods. Section 4 presents the predicted annual variation of illness cases and treatment costs for se- lected diagnosis groups. The final section concludes and discusses the main policy implications of the study.
These huge disproportions will take place, to different extents, in all industrialized countries, and are bound to produce distorting effects on labour markets, investments and production. Pay-as-you go financing schemes can no longer rely any more on the so-called Aaron’s theorem, which, given a young and growing population, states that yearly contributions paid by all working people were the best possible solution for both transferring resources across generations (pensions) and sustaining universalistic provisions (healthcare systems).
The number of uninsured demonstrates a partial failure of our medical system. Many recognize the necessity for compulsory catastrophic coverage for all residents. In addition, a more comprehensive ba- sic coverage is justified for children who cannot make economic choices for themselves. The problem is how to achieve this in a system that can maintain economic viability while meeting the basic health needs of both individuals and society. Among the basic flaws in the current system that reduce viability is limited individual freedom of choice of care with lack of perceived individual responsibility for the cost of that care. Neither the current market-driven nor the single-payer government systems have man- aged to solve these problems. Our proposed FHIRS is the linchpin necessary to correct these problems by reforming the current market-driven system and avoiding the difficulties of single-payer government programs.
In this subsection we present the estimated Gini coeﬃcients for income, health expenditure concentration indices and KIs household co-payments. The results are presented for rural areas of Iran, for the years 1997 to 2007. Table 2 presents the Gini coeﬃcient, concentration index of healthcare and Kakwani’s index (KI). Similar to the results in urban areas for rural areas, we’ve provided a similar table. In table (2) you can see that the mean of Kakwani’s index in total period in rural areas has been negative and equals with (-0.107), This indicates
All children must have coverage that ensures them access to af- fordable and comprehensive quality care. Appropriate and ade- quate payment is essential to ensure the viability of the pediatric workforce to provide such care. Coverage and payment must pro- vide access to pediatric primary care and comprehensive and co- ordinated medical subspecialty and surgical specialty services; de- velopmental, behavioral, and mental health services; inpatient and emergency department care; home healthcare; dental care; and other specialized pediatric services within a medical home model of care. The principles outlined in this statement should be used to evaluate national and state health insurance reform proposals and to make ongoing improvements to private and public ﬁnancing of healthcare for children and adolescents.
households with CYSHCN. Moreover, high deductible and consumer- driven plans appear less successful at reducing spending among privately insured children than plans that use network restrictions. Taken together, the articles in this Supplement indicate the considerable work to be done to make VBP strategies effective for the care of CYSHCN. Developed well and with the characteristics and needs of CYSHCN in mind, VBP may improve the system of care through strategies for care coordination and payment for high-value services among others. Issues to address include the low prevalence of many specific health conditions, the need for a life course perspective recognizing that investments in children’s health pay off over a long period of time, the risk of family financial hardship, and the recognition of inequities that span race, class, ethnicity, and other social determinants of health. VBP and related new financing models for CYSHCN must include pediatricians, families, policymakers, and others in their design and administration to develop strategies that address the issues outlined in the Supplement articles.
This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.
Against a background where Out-of-Pocket (OOP) pay- ments currently account for over 45 percent of healthcarefinancing in Ghana [3,21], under the NHI the government is seeking to provide quality, accessible, efficient and equit- able health services to about 60 percent of all Ghanaians by 2015 and subsequently to obtain universal coverage throughout the country . The current (2012) coverage rate by the scheme has enrolled about 33 percent popula- tion, with wide regional variation. Ghana’s ambitious, yet innovative, initiative has elements in common with the health insurance reforms introduced in Thailand . Despite these common features, however, there are wide- spread concerns about the sustainability of the compre- hensive and attractive benefit package covered by the NHI and concerns as well about how equity can be enhanced in ways that introduce a progressive payment regime. As the international community watches with interest Ghana’s giant step toward universal health insurance, there is a need for substantive research aimed at strengthening the design and implementation of the scheme to enhance its progress to universal access through equitable healthcarefinancing.