The public sector might seem to be an appealing growth opportunity to commercial insurers confronted by stalled private-sector coverage expansion, but whether these insurers have the means and motivation to deliver value to Medicare and Medicaid is unproven. State Medicaid purchasers in particular have found alternative sources for care management and have sound reasons to question whether industry-leading commercial insurers will be responsive to their needs. (+info)
Status report on Medicare Part D enrollment in 2006: analysis of plan-specific market share and coverage.
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The centerpiece of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was the Part D drug benefit, provided through new stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans. We examine 2006 Part D enrollment data to analyze organization- and plan-level market share and enrollment by plan type, benefit design, and gap coverage. Ten organizations captured 72 percent of Part D enrollment, primarily in low-premium plans and those with name recognition. More than twelve million Part D enrollees without low-income subsidies enrolled in plans with limited or no gap coverage in 2006, but the number with actual spending in the gap remains to be seen. (+info)
Transnational tobacco company influence on tax policy during privatization of a state monopoly: British American Tobacco and Uzbekistan.
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OBJECTIVES: The International Monetary Fund encourages privatization of state-owned tobacco industries. Privatization tends to lower cigarette prices, which encourages consumption. This could be countered with effective tax policies. We explored how investment by British American Tobacco (BAT) influenced tax policy in Uzbekistan during privatization there. METHODS: We obtained internal documents from BAT and analyzed them using a hermeneutic process to create a chronology of events. RESULTS: BAT thoroughly redesigned the tobacco taxation system in Uzbekistan. It secured (1) a reduction of approximately 50% in the excise tax on cigarettes, (2) an excise system to benefit its brands and disadvantage those of its competitors (particularly Philip Morris), and (3) a tax stamp system from which it hoped to be exempted, because this would likely facilitate its established practice of cigarette smuggling and further its competitive advantage.. CONCLUSIONS: Privatization can endanger effective tobacco excise policies. The International Monetary Fund should review its approach to privatization and differentiate the privatization of an industry whose product kills from privatization of other industries. (+info)
Different approaches to contracting in health systems.
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Contracting is one of the tools increasingly being used to enhance the performance of health systems in both developed and developing countries; it takes different forms and cannot be limited to the mere purchase of services. Actors adopt contracting to formalize all kinds of relations established between them. A typology for this approach will demonstrate its diversity and provide a better understanding of the various issues raised by contracting. In recent years the way health systems are organized has changed significantly. To remedy the under-performance of their health systems, most countries have undertaken reforms that have resulted in major institutional overhaul, including decentralization of health and administrative services, autonomy for public service providers, separation of funding bodies and service providers, expansion of health financing options and the development of the profit or nonprofit private sector. These institutional reshuffles lead not only to multiplication and diversification of the actors involved, but also to greater separation of the service provision and administrative functions. Health systems are becoming more complex and can no longer operate in isolation. Actors are gradually realizing that they need to forge relations. The simplest way to do that is through dialogue, although some prefer a more formal commitment. Interaction between actors may take various forms and be on different scales. There are several types of contractual relations: some are based on the nature of the contract (public or private), others on the parties involved and yet others on the scope of the contract. Here they are classified into three categories according to the object of the contract: delegation of responsibility, act of purchase of services, or cooperation. (+info)
Public-private partnerships for hospitals.
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While some forms of public-private partnerships are a feature of hospital construction and operation in all countries with mixed economies, there is increasing interest in a model in which a public authority contracts with a private company to design, build and operate an entire hospital. Drawing on the experience of countries such as Australia, Spain, and the United Kingdom, this paper reviews the experience with variants of this model. Although experience is still very limited and rigorous evaluations lacking, four issues have emerged: cost, quality, flexibility and complexity. New facilities have, in general, been more expensive than they would have been if procured using traditional methods. Compared with the traditional system, new facilities are more likely to be built on time and within budget, but this seems often to be at the expense of compromises on quality. The need to minimize the risk to the parties means that it is very difficult to "future-proof" facilities in a rapidly changing world. Finally, such projects are extremely, and in some cases prohibitively, complex. While it is premature to say whether the problems experienced relate to the underlying model or to their implementation, it does seem that a public-private partnership further complicates the already difficult task of building and operating a hospital. (+info)
The benefits of setting the ground rules and regulating contracting practices.
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In recent years, health systems have increasingly made use of contracting practices; despite results that are often promising, there have also been failures and occasionally harsh criticism of such practices. This has made it even more necessary to regulate contracting practices. As part of its stewardship function, in other words its responsibility to protect the public interest, the ministry of health has the responsibility of introducing the tools needed for such regulation. Several tools are available to help it do this. Some of them, such as standard contracts or framework contracts, useful as they may be, are nevertheless specific and ad hoc. Contracting policies, when carefully linked to overall health policies, are undoubtedly the most comprehensive of these tools, since they enable contracting to be accommodated within the management of the health system as a whole and thus take into account its potential contribution to improving health system performance. However, the requirements for success are not present automatically and it has to be ensured that there are mechanisms for vitalizing these regulatory mechanisms and that the key actors make proper use of the framework laid down by the ministry of health. The first three authors of this article have participated in the preparation and implementation of national policies on contracting in their own countries, viz. Chad, Madagascar and Senegal. (+info)
Is contracting a form of privatization?
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Contracting is often seen as a form of privatization, with contracts functioning as the tool that makes privatization possible. But contracting is also viewed by some as a means for the private sector to expand in a covert way its presence within the health sector. This article discusses the wider meaning of the term privatization in the health sector and the ways in which it is achieved. Privatization is seen here not simply as an action that leads to a new situation but also as one that leads to a change in behaviour. It is proposed that privatization may be assessed by looking at the ownership, management, and mission or objectives of the entity being privatized. Discussed also is the use of contracting by the state as a tool for state interventionism that is not based on authoritarian regulation. (+info)
Public road transport crashes in a low income country.
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OBJECTIVE: To assess the safety of government versus non-government public road transportation. DESIGN: Descriptive study. SETTING: Kandy Municipality Area, Sri Lanka. SUBJECTS: All road traffic crashes reported to the Kandy Police from 1 October 1998 to 30 September 1999. MAIN OUTCOME: Involvement in a road traffic crash reported to the Kandy Police in which a government bus, private bus, or a three-wheeler was involved. RESULTS: During the study period, 132 government buses, 243 private buses, and 115 three wheelers were involved in 437 police reported road crashes. Of these crashes, eight (1.8%) were fatal and 132 (30.2%) were crashes resulting in injury requiring hospitalization. The majority of road crashes involved vehicle-vehicle interaction (63.4%) and vehicle-pedestrian interaction (17.8%), while the remainder consisted of vehicle-passenger and vehicle-road structure crashes. The research highlights an increased risk associated with travel on privately owned buses (RR = 2.0, 95% CI 1.6 to 2.5) and three wheelers (RR = 2.2, 95% CI 1.7 to 2.8) compared to travel on government buses. The disparity in crash rates between government and privately owned transportation modes can be explained, in part, by fewer safety requirements being imposed on the deregulated public transportation system. CONCLUSIONS: Recommendations are made in order to address the differential in crash rates between public and private vehicle ownership used for public transportation in Sri Lanka. (+info)