Market failure? Individual insurance markets for older Americans.
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This study examines the viability of tax credits and nongroup markets for covering uninsured adults ages fifty to sixty-four. We find that adults in this age group covered by nongroup plans tend to be healthier and wealthier than the average for their peers, yet more of them go without care and experience high medical bills relative to their incomes. Individual-market premiums rise steeply with age in most states and are well above employer-group rates. Costs are likely to be unaffordable for most uninsured older adults, even with large tax credits or in states with community rating. These findings indicate a need to include risk and age pooling to reach the uninsured in this age group. (+info)
Is equity being sacrificed? Willingness and ability to pay for schistosomiasis control in China.
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Decentralization of the health care system in China has led to an increasing need for income generation at all operational levels, both for curative services and for public health programmes. In general, people have accepted the costs of curative services, although the impact of charges on health-seeking behaviour has yet to be assessed. Public health programmes present particular problems in terms of revenue generation, however, because of the less direct impact of these activities on individual health and well-being. In this paper, we report the results of a cross-sectional study of willingness and ability to pay for schistosomiasis control. Questionnaires were administered to household heads of six representative villages in the Dongting Lake Region of Hunan Province, China. A total of 628 valid questionnaires were analyzed. The yearly mean household expenditure on schistosomiasis diagnosis and treatment was RMB 59.50 +/- 146.04 Yuan (US$1 = 8 RMB Yuan), accounting for 0.94% of the total yearly household income. Most household heads (514, 82%) thought schistosomiasis was the greatest health threat in their communities, but only 30.9% of them were willing to pay for screening, diagnosis and treatment of the infection. On the other hand, 72.3% of the respondents were willing to undertake volunteer work for control. (+info)
Insurance and new technology: from hospital to drugstore.
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This paper traces the relationship between insurance coverage and the technology-induced shift of the locus of medical care and medical spending from the inpatient to the outpatient setting. This shift was accompanied by an increase in the extent of private insurance coverage for outpatient treatments; technological change both caused the increase in coverage (for more costly treatments) and was affected by it (as lower user prices increased the demand for new types of care). Changes in insurance administration technology also facilitated the transformation. Some aspects of the change may have been inefficient, because of the presence of tax subsidy and legal requirements to cover costly new technologies of low effectiveness, but the transformation appears thus far to have worked better for private insurance than for Medicare. (+info)
Household spending on health care.
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OBJECTIVES: This article examines changes in household spending on health care between 1978 and 1998. It also provides a detailed look at household spending on health care in 1998. DATA SOURCES: Data on household spending are from Statistics Canada's Family Expenditure Survey for survey years between 1978 and 1996, and from the annual Survey of Household Spending for 1997 and 1998. ANALYTICAL TECHNIQUES: Proportion of after-tax spending was calculated by subtracting average personal income taxes from average total expenditures and then dividing health care expenditures by this figure. Per capita spending was calculated by dividing average household spending by average household size. Constant dollar figures and adjustments for inflation were calculated using the Consumer Price Index (1998 = 100) to control for the effect of inflation over time. MAIN RESULTS: Almost every Canadian household (98.2%) reported health care expenditures in 1998, spending an average of close to $1,200, up from around $900 in 1978. In 1998, households dedicated a larger share of their average after-tax spending (2.9%) to health care than they did 20 years earlier (2.3%). Health insurance premiums claimed the largest share (29.8%) of average health care expenditures, followed by dental care, then prescription medications and pharmaceutical products. (+info)
Changes in finances, insurance, employment, and lifestyle among persons diagnosed with hairy cell leukemia.
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BACKGROUND: While being cured of cancer generally leads to a life expectancy similar to that of the general population, the extent to which other aspects of life are affected is unknown. To address these concerns, patients with hairy cell leukemia, a cancer with a very high cure rate, were queried about employment, insurance, finances, and lifestyle during and following their treatment. METHODS: Study participants (n = 31) ranging in age from 24 to 73 years at the time of diagnosis (median, 49 years) were surveyed regarding changes in health and life insurance, employment, out-of-pocket medical costs, exercise, diet, and use of mental and alternative health services that occurred during or following hairy cell leukemia treatment. RESULTS: Following a diagnosis of hairy cell leukemia, 61.3% of the respondents paid for some aspect of medical care in spite of having health insurance coverage at the time of diagnosis. Four respondents (12.9%) could not obtain health insurance following treatment, and the occupational choices of several individuals or their spouses were based in large part on a desire to obtain or maintain comprehensive health insurance. Of the 13 individuals who attempted to purchase life insurance, 10 had difficulty obtaining a policy or were denied coverage. Lifestyle changes were noted by 40% to 60% of respondents, and included reports of more frequent exercise, adoption of a healthier diet, and having a greater appreciation for life, loved ones, and physical health. CONCLUSIONS: While hairy cell leukemia is a highly curable malignancy, cancer survivors' lives and lifestyles are altered substantially after receiving treatment for the illness. (+info)
Determining the full costs of medical education in Thai Binh, Vietnam: a generalizable model.
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We summarize a model for determining the full cost of educating a medical student at Thai Binh Medical School in Vietnam. This is the first full-cost analysis of medical education in a low-income country in over 20 years. We emphasize policy implications and the importance of looking at the educational costs and service roles of the major health professions. In Vietnam fully subsidized medical education has given way to a system combining student-paid tuition and fees with decreased government subsidies. Full cost information facilitates resource management, setting tuition charges at a school and adjusting budget allocations between medical schools, teaching hospitals, and health centres. When linked to quality indicators, trends within and useful comparisons between schools are possible. Cost comparisons between different types of providers can assist policy-makers in judging the appropriateness of expenditures per graduate for nursing and allied health education versus physician education. If privatization of medical education is considered, cost analysis allows policy-makers to know the full costs of educating physicians including the subsidies required in clinical settings. Our approach is intuitively simple and provides useful, understandable new information to managers and policy-makers. The full cost per medical graduate in 1997 was 111 462 989 Vietnamese Dong (US$9527). The relative expenditure per Vietnamese physician educated was 2.8 times the expenditure in the United States when adjusted for GNP per capita. Preliminary findings suggest that, within Vietnam, the cost to educate a physician is 14 times the cost of educating a nurse. Given the direct costs of physician education, the lifetime earnings of physicians and the costs that physicians generate for the use of health services and supplies, it is remarkable that so little attention is paid to the costs of educating physicians. Studies of this type can provide the quantitative basis for vital human resource and health services policy considerations. (+info)
The effects of different kinds of user fee on prescribing costs in rural Nepal.
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OBJECTIVES: (1) To estimate the cost of irrational prescribing, and (2) to compare the effect of three different kinds of user fee on prescribing costs, in rural Nepal. METHODS: A controlled before-after study was conducted in 33 government primary health care facilities in rural eastern Nepal during 1992-95. A fee per prescription (covering all drugs in whatever amounts) was regarded as the control against which two types of fee per drug item (covering a full course of treatment for each item) were compared. The average total cost to the patient for two drug items was the same in all fee systems. Total cost, expected cost (according to standard treatment guidelines) and wastage costs (total minus expected cost) per prescription were calculated from an average of 400 prescribing episodes per facility per year. The proportion of prescriptions conforming to standard treatment guidelines was calculated from 30 prescriptions per facility per year. RESULTS: 20-52% of total drug costs were due to inappropriate drug prescription. A fee per drug item, as compared with a fee per prescription, was associated with (1) significantly fewer drug items prescribed per patient, (2) significantly lower drug costs per prescription, (3) significantly lower wastage due to inappropriate drug prescription, and (4) a significantly greater proportion of prescriptions conforming to standard treatment guidelines. Average drug cost per prescription (which was 24-33 Nepali rupees [NRs] across districts and time) was 5.7 NRs (95% confidence interval 1.0 to 10.4) and 9.3 NRs (95% confidence interval 4.8 to 13.8) less with the two different item fees, respectively, than with the fee per prescription. CONCLUSION: The economic consequences of irrational prescribing are severe, particularly in association with charging a fee per prescription. Item fees in the public sector reduce irrational prescribing and associated costs. (+info)
Consumer out-of-pocket spending for pharmaceuticals in Kazakhstan: implications for sectoral reform.
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What do consumers pay for pharmaceuticals in a transition economy, and who is hit hardest? Kazakhstan is in the midst of emerging from a Soviet Union state to a market economy. It has seen a significant dip in Gross Domestic Product and available revenues for health as a result. New sources of revenues, such as out-of-pocket payments, both formal and informal, have become widespread. In this paper we use the results of a 1996 Living Standards survey jointly sponsored by the World Bank and the Kazakhstan Government to examine patterns of prescribed pharmaceutical spending. We use a two-part regression model that is utilized to adjust for the skewness of non-spenders and heavy utilizers. Results suggest that upper-income groups spend more in absolute terms, but low-income groups pay a higher share of their income for pharmaceuticals. Pharmaceutical expenditure is positively related to poor health status, chronic illness and rural area residence. Our estimates suggest that on average people in rural areas spend 16% more than people in urban areas. The analysis shows that certain types of illnesses impose significant out-of-pocket burden for consumers - gynaecologic as well as intestinal and cardiac. The findings can be used for developing and designing a new 10-year World Bank-financed programme for restructuring the health sector. They also suggest the need for prioritizing rural care, as well as covering pharmaceuticals for specific types of care interventions and certain demographic groups. (+info)