RESUMO
South Korea is one of the few countries that has successfully consolidated its national risk pools into a single-payer health insurance system. This study analyzes national health insurance (NHI) consolidation in South Korea between 1980 and 2003, drawing lessons for countries seeking to consolidate their risk pools. The paper contextualizes the development of the South Korean national health insurance system and the consolidation of its risk pools in the changes in the political environment, particularly the processes of political democratization. It examines how these processes have affected the societal meanings and roles of the health insurance system. The paper focuses on two policy stages. During the agenda-setting stage, the government and employers emphasized the efficiency of the health insurance system. This emphasis contributed to the failure of a consolidation plan that emphasized equity over efficiency. However, as democratization expanded, the power of civil society movements and the popular demand for equity grew stronger. During the policy adoption phase, consolidation of health insurance trusts in South Korea was achieved through social and political processes that influenced public opinion, expanded civil society participation in decision-making, and worked with the government to integrate health insurance organizations and funds.
Assuntos
Programas Nacionais de Saúde , Política , República da Coreia , Humanos , Política de Saúde , Reforma dos Serviços de Saúde/métodos , Reforma dos Serviços de Saúde/tendências , Sistema de Fonte Pagadora ÚnicaRESUMO
While South Africa has some experience in various forms of health technology assessment (HTA), it is currently fragmented across numerous players. Additionally, there is a lack of systematic and consistently applied HTA processes that inform priority-setting and budget allocations. To address this, the country is journeying toward more institutionalized use of HTA. This will begin with the establishment of a Ministerial Advisory Committee on HTA for National Health Insurance (NHI) and will gradually embed HTA processes in decision-making. The goal is to create an independent HTA agency. Although these reforms will be intrinsically linked to the wider health financing reforms envisaged under NHI, such as formulating the benefits package, they will also assist in strengthening South Africa's health system. As a country facing a highly constrained fiscal environment, with limited space for additional funding for the health sector, evidence-based priority-setting will be critical to ensure that value for money is achieved in the government's investments in health care services in NHI.
Assuntos
Programas Nacionais de Saúde , Avaliação da Tecnologia Biomédica , África do Sul , Avaliação da Tecnologia Biomédica/métodos , Humanos , Reforma dos Serviços de Saúde/métodos , Reforma dos Serviços de Saúde/tendências , Comitês Consultivos , Prioridades em Saúde/tendênciasRESUMO
Mexico's health system is undergoing major restructuring by the administration of President Andrés Manuel López Obrador (known as AMLO) starting in December 2018. The government has eliminated the 2003 health reform (Seguro Popular) from national laws and government agencies and is returning Mexico to a centralized health system with integrated public financing and delivery and reduced private participation. This article looks at the political drivers of Mexico's restructuring reform. Three main ethical principles are identified as the foundation for the government's health system vision: universality, free services, and anti-corruption. The article then compares what existed under Seguro Popular with the new system under the Instituto de Salud para el Bienestar (INSABI), which began on 1 January 2020. The analysis uses the five policy levers that shape health system performance: financing, payment, organization, regulation, and persuasion. The article concludes with five lessons about the reform process in Mexico. First, undoing past reforms is much easier than implementing a new system. Second, the AMLO government's restructuring emerged more from broad ethical principles than detailed technical analyses, with limited plans for evaluation. Third, the overarching values of the AMLO government reflect a pro-statist and anti-market bias, swimming against the global flow of health policy trends to include the private sector in reforming health systems. Fourth, the experiences in Mexico show that path dependence does not always work as expected in policy reform. Finally, the debate of Seguro Popular versus INSABI shows the influence of personality politics and polarization.
Assuntos
Reforma dos Serviços de Saúde/métodos , Reforma dos Serviços de Saúde/normas , Reforma dos Serviços de Saúde/tendências , Humanos , México , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , PolíticaRESUMO
The American College of Physicians (ACP) has long advocated for universal access to high-quality health care in the United States. Yet, it is essential that the U.S. health system goes beyond ensuring coverage, efficient delivery systems, and affordability. Reductions in nonfinancial barriers to care and improvements in social determinants of health are also necessary. This ACP position paper calls for ending discrimination based on personal characteristics; correcting workforce shortages, including the undersupply of primary care physicians; and understanding and ameliorating social determinants of health. The ACP calls for increased efforts to address urgent public health threats, including injuries and deaths from firearms; environmental hazards; climate change; maternal mortality; substance use disorders; and the health risks associated with nicotine, tobacco use, and electronic nicotine delivery systems in order to achieve ACP's vision for a better U.S. health care system.
Assuntos
Atenção à Saúde/tendências , Reforma dos Serviços de Saúde/tendências , Política de Saúde/tendências , Acessibilidade aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde , Determinantes Sociais da Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Médicos/provisão & distribuição , Preconceito , Prática de Saúde Pública , Sociedades Médicas , Estados UnidosAssuntos
Reforma dos Serviços de Saúde , Programas Nacionais de Saúde , China , Financiamento Governamental , Reforma dos Serviços de Saúde/organização & administração , Reforma dos Serviços de Saúde/normas , Reforma dos Serviços de Saúde/tendências , Gastos em Saúde , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/tendências , Qualidade da Assistência à SaúdeRESUMO
The Affordable Care Act (ACA) reformed and expanded healthcare coverage with an exchange-based health insurance program. While millions of Americans have benefited from enrollment in ACA marketplace insurance plans, many individuals are likely to be affected by potential future policy changes. Since few studies on the features of marketplace enrollees exist, we adopted a retrospective, cross-sectional study design using 2016 National Health Interview data to identify sociodemographic and health characteristics of enrollees, comparing them to those without insurance. Chi-square tests and logistic regression examined factors associated with enrollees. Adults with multiple chronic diseases (AOR = 1.90, 95% CI = 1.44, 2.50), a history of smoking (AOR = 2.44, 95% CI = 1.82, 3.26), females, married, age 50-64 years, higher educational attainment, and retirees (AOR = 1.86, 95% CI = 1.06, 3.27) were more likely to be enrollees. Since enrollees are largely higher risk individuals with greater healthcare needs, policies that modify the ACA should take these factors into account to reduce potential adverse impacts on enrollees.
Assuntos
Trocas de Seguro de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Adulto , Distribuição por Idade , Estudos Transversais , Reforma dos Serviços de Saúde/tendências , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Fatores Socioeconômicos , Estados UnidosRESUMO
Objective: The study's purpose has been to analyze the auditing practices in the Sistema Único de Saúde (SUS) [Brazilian Unified Health System]. Methods: It is an integrative literature review that was carried out in the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) [Latin American and Caribbean Literature in Health Sciences], Virtual Health Library (VHL), and Web of Science databases. By using the inclusion and exclusion criteria, 12 scientific articles were selected for in-depth analysis. Results: The findings demonstrate the political and institutional advances regarding to the auditing practices in the SUS. There have been also identified many challenges that must be overcome in order to support such practices, such as the need to qualify the tools of the National Audit Department from the SUS and to improve the communication between State, Municipal, and Federal auditing. Conclusion: Auditing practices in the SUS are still under development, then requiring more studies and dissemination, aiming to bring contributions to both practice and the academic milieu
Objetivo: Analisar as práticas de auditoria no Sistema Único de Saúde (SUS). Métodos: Trata-se de uma revisão integrativa de literatura realizada na Biblioteca Virtual em Saúde (BVS), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), e Web of Science. Ao total, utilizando-se os critérios de inclusão e exclusão selecionou-se 12 artigos científicos para análise. Resultados: Os resultados apontam avanços políticos e nas instituições com relação as práticas de auditoria no SUS. Identificam-se também muitos desafios para fortalecer tais práticas, como a necessidade de qualificar as ferramentas do Departamento Nacional de Auditoria do SUS e melhorar a comunicação entre o componente, estadual, municipal e federal de auditoria. Conclusão: As práticas de auditoria no SUS estão em construção, necessitando de mais estudos e divulgação, afim de que traga contribuições para a prática e o meio acadêmico
Objetivo: Analizar las prácticas de auditoría en el Sistema Único de Salud (SUS). Método: Se trata de una revisión integrativa de literatura realizada en la Biblioteca Virtual en Salud (BVS), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs), y Web of Science. Al total, utilizando los criterios de inclusión y exclusión se seleccionaron 12 artículos científicos para análisis. Resultados: Los resultados apuntan avances políticos y en las instituciones con relación a las prácticas de auditoría en el SUS. Se identifican también, muchos desafíos para fortalecer tales prácticas, como la necesidad de calificar las herramientas del Departamento Nacional de Auditoría del SUS y mejorar la comunicación entre el componente, estatal, municipal y municipal, federal de auditoría. Conclusión: Las prácticas de auditoría en el SUS están en construcción, necesitando más estudios y divulgación, a fin de que traiga contribuciones para la práctica y el medio académico
Assuntos
Humanos , Masculino , Feminino , Sistema Único de Saúde/organização & administração , Reforma dos Serviços de Saúde/tendências , Auditoria Administrativa/normas , Auditoria Administrativa/estatística & dados numéricosRESUMO
A tese versa sobre a constituição e trajetória do movimento antimanicomial na América Latina. Ao longo do século XX, esse movimento social se constituiu como sujeito coletivo que encampa a denúncia da violência e repressão que o manicômio representa. Estabeleceu formas de luta pela defesa, valorização e garantia dos direitos humanos e, de maneira mais ampla, a luta pela democracia. O movimento antimanicomial latino-americano representa também a loucura em sua forma criativa e política, pois integra o conjunto de movimentos sociais que se articulam em torno da construção de espaços de liberdade, cidadania e cuidado às pessoas em sofrimento mental. O objetivo da pesquisa que originou esta tese era analisar a relação entre as reformas psiquiátricas, políticas de saúde mental e os movimentos sociais no âmbito dos países da América Latina. A pesquisa, de cunho exploratório e ativista, foi realizada através de participação e observação nos protestos, marchas, reuniões e encontros, assim como em eventos nacionais e internacionais onde estiveram reunidos líderes e representantes do movimento político. Também foram realizadas entrevistas, além de conversas, com participantes do movimento no Brasil, Argentina, Uruguai e México. Foi realizada pesquisa no acervo histórico "Memórias da Reforma Psiquiátrica", assim como a leitura e análise de bibliografia e documentos que contribuíram para organização e reconstrução da trajetória do movimento antimanicomial latino-maericano. Como resultados, apresenta-se essa trajetória mostrando que os participantes e representantes desse movimento social conseguiram se organizar e se integrar por meio de eventos e encontros marcados pela diversidade e multiplicidade de manifestações em dois momentos históricos: pela Rede Latino-Americana de Alternativas à Psiquiatria na década de 1980; e pelos congressos internacionais de saúde mental e direitos humanos, realizados pela Universidade Popular das Madres de la Plaza de Mayo, de 2002 a 2013. Desde 2017, uma nova integração do movimento antimanicomial latino-americano vem sendo construída por meio da Rede Latino-Americana e Caribe de Direitos Humanos e Saúde Mental. Como crítica desse processo, discute-se a importância da multiplicidade e ancestralidade do movimento antimanicomial retomando seu caráter revolucionário, na medida em que integra à luta de classes. Apontam-se suas ambiguidades na forma da acomodação em torno dos processos de reforma que se faz por meio de uma visão reducionista e voluntarista da luta política. Finalmente, discutem-se seus limites mostrando como a reestruturação do Estado e das políticas públicas tem provido um deslocamento da acumulação do capital do manicômio para as drogas psiquiátricas, moldando um intenso processo de medicalização social que exige do movimento antimanicomial reflexão e estratégias de luta política. Para além desse primeiro e maior limite, o risco da fragmentação é apontado como um segundo limite a superar. A luta política em torno da loucura e seu destino social é uma dos embates sociais que se travam na América Latina constantemente e que se integra à luta internacional que se dirige à transformação e à superação do sistema capitalista. Analisar e participar do movimento antimanicomial é uma maneira de se integrar a luta por uma América Latina sem manicômios
The thesis deals with the constitution and trajectory of the anti-asylum movement in Latin America. Throughout the twentieth century, this social movement was constituted as a collective subject that provides the denunciation of the violence and repression that the asylum represents. It established forms of struggle for the defense, valorization and guarantee of human rights and, more broadly, the struggle for democracy. The Latin American anti-asylum movement also represents madness in its creative and political form, because it integrates the set of social movements that are articulated around the construction of spaces of freedom, citizenship and care for people in mental suffering. The objective of the research that originated this thesis was to analyze the relationship between psychiatric reforms, mental health policies and social movements within the countries of Latin America. The research, exploratory and activist, was carried out through participation and observation in protests, marches, meetings and meetings, as well as in national and international events where leaders and representatives of the political movement were gathered. Interviews and conversations were also held with participants from the movement in Brazil, Argentina, Uruguay and Mexico. A research was carried out in the historical collection "Memories of the Psychiatric Reform", as well as the reading and analysis of bibliography and documents that contributed to the organization and reconstruction of the trajectory of the Latin-American movement. As a result, this trajectory shows how the participants and representatives of this social movement managed to organize and integrate themselves through events and meetings marked by the diversity and multiplicity of manifestations in two historical moments: by the Latin American Network of Alternatives to Psychiatry in the 1980s; and the international congresses of mental health and human rights held by the Popular University of the Mothers of the Plaza de Mayo from 2002 to 2013. Since 2017, a new integration of the Latin American anti-manicomial movement has been built through the Latin American Network and the Caribbean on Human Rights and Mental Health. As a critique of this process, the importance of the multiplicity and ancestry of the anti-asylum movement is discussed, resuming its revolutionary character, insofar as it is part of the class struggle. They point out their ambiguities in the form of accommodation around the reform processes that is done through a reductionist and voluntarist vision of the political struggle. Finally, its limits are discussed, showing how the restructuring of the State and public policies has provided a shift from the accumulation of the capital of the asylum to psychiatric drugs, shaping an intense process of social medicalization that demands of the antimanicomial movement reflection and strategies of political struggle . Beyond this first and largest limit, the risk of fragmentation is set as a second limit to be overcome. The political struggle over madness and its social destiny is one of the social struggles that are constantly being tackled in Latin America, and which is part of the international struggle for transformation and overcoming of the capitalist system, its crises and contradictions. Analyzing, integrating and participating in the anti-asylum movement is a way to integrate into this struggle for a Latin America without asylums
Assuntos
Humanos , Psiquiatria/tendências , Saúde Mental/tendências , Reforma dos Serviços de Saúde/tendências , Ativismo Político , Hospitais Psiquiátricos/tendências , América LatinaRESUMO
Resumo: Com o intuito de reformar a atenção primária à saúde (APS), o Ministério da Saúde planejou uma mudança que teve o seu avanço no período entre 2005 e 2006, e que se desenvolve até aos nossos dias. O objetivo deste artigo é enquadrar a reforma da APS em Portugal por diferentes fases de desenvolvimento, utilizando o modelo de fluxos múltiplos de Kingdon para refletir sobre a evolução do processo reformador e o seu futuro, na perspetiva do processo que busca alcançar o acesso universal à saúde. Como metodologia de trabalho, utiliza-se o estudo documental e de caso, de orientação qualitativa e com dimensões avaliativas. O estudo baseou-se em material publicado, nacional e internacionalmente, sobre a APS em Portugal. O modelo de fluxos múltiplos de Kingdon é utilizado para explicar o desenvolvimento concreto e contextual das políticas iniciadas durante a reforma da APS. Foram identificadas três fases da reforma, cada uma com duração de cerca de 5 anos: na primeira, a partir de 2005, surgiram as unidades de saúde familiar de constituição voluntária. Na segunda fase, iniciada em 2010, houve a consolidação do modelo. Em uma terceira fase, desde 2015 e que ainda acontece, há o amadurecimento do modelo, aproveitando o final da crise financeira, mas ainda suportando as suas sequelas. Os três ciclos de reforma representam três períodos distintos de coerência da coalizão que o empreendedor político foi capaz de estabelecer, cujas janelas de oportunidade para a mudança, internamente construídas, foram sobejamente influenciadas por fatores externos. Assinala-se a contribuição que a reforma da APS deu para a melhoria do estado de saúde da população portuguesa.
Abstract: In order to reform Portugal's primary health care (PHC), the Ministry of Health planned a change that was launched in 2005 and 2006, and which is still under way today. This article aims to analyze PHC reform in Portugal according to different phases in its development, using Kingdon's multiple streams model to reflect on the evolution in the reform process and its future, from the perspective of a process that seeks to achieve universal access to health. The working methodology was a document and case study with a qualitative approach and evaluative dimensions. The study was based on material on PHC in Portugal, published both in Portugal and elsewhere. Kingdon's multiple streams model was used to explain the actual and contextual development of policies implemented during the PHC reform. Three phases were identified in the reform, each lasting about five years. The first phase, starting in 2005, featured family health units with a voluntary basis. The second phase began in 2010, with the model's consolidation. In the third phase, since 2015 and still under way, the model came of age, benefiting from the end of the financial crisis but still suffering from its effects. The three reform cycles represent three distinct periods with consistency in the coalition that the policymaker was able to establish, in which the windows of opportunity for internally built change were heavily influenced by external factors. The article identifies the contribution by PHC reform to improvement of the Portuguese population's health status.
Resumen: Con el fin de reformar la atención primaria de salud (APS), el Ministerio de Salud planificó una transformación que tuvo su arranque durante el período entre 2005 y 2006, y que se desarrolla hasta nuestros días. El objetivo de este artículo es enmarcar la reforma de la APS en Portugal dentro de diferentes fases de desarrollo, utilizando el modelo de flujos múltiples de Kingdon, con el fin de reflexionar sobre la evolución del proceso reformador y su futuro, desde la perspectiva del proceso que pretende alcanzar el acceso universal a la salud. Como metodología de trabajo, se utiliza el estudio documental y de caso, de orientación cualitativa y con dimensiones evaluativas. El estudio se basó en el material publicado, nacional e internacionalmente, sobre la APS en Portugal. El modelo de flujos múltiples de Kingdon se utiliza para explicar el desarrollo concreto y contextual de las políticas puestas en marcha durante la reforma de la APS. Se identificaron tres fases de la reforma, cada una con una duración de cerca de 5 años: en la primera fase, a partir de 2005, surgieron las unidades de salud familiar de constitución voluntaria. En la segunda fase, iniciada en 2010, se produce la consolidación del modelo. En una tercera fase, desde 2015 y que todavía transcurre, se produce la madurez del modelo, aprovechando el final de la crisis financiera, pero todavía soportando sus secuelas. Los tres ciclos de reforma representan tres períodos distintos de coherencia de la asociación que el emprendedor político fue capaz de establecer, cuyas ventanas de oportunidad para el cambio, internamente construido, fueron influenciadas sobradamente por factores externos. Asimismo, se señala la contribución que la reforma de la APS significó para la mejora del estado de salud de la población portuguesa.
Assuntos
Humanos , Masculino , Feminino , Atenção Primária à Saúde/organização & administração , Reforma dos Serviços de Saúde/organização & administração , Política de Saúde , Portugal , Atenção Primária à Saúde/tendências , Saúde da Família , Reforma dos Serviços de Saúde/tendências , Carga Global da Doença , Acessibilidade aos Serviços de SaúdeRESUMO
Calls to repeal the Affordable Care Act (ACA) have become increasingly frequent. Most attempts to repeal the ACA have targeted specific policies rather than the ACA as a whole. This article describes the specific policies under debate and the ramifications of repealing each of them. Specific attention is given to insurance coverage, individual premiums, and budgetary impact. Based on the literature regarding the ACA's impact to date, the impact of ACA repeal on Surgical oncology care is predicted.
Assuntos
Reforma dos Serviços de Saúde/tendências , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Neoplasias/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Oncologia Cirúrgica/economia , Humanos , Neoplasias/cirurgia , Estados UnidosRESUMO
BACKGROUND: A central objective of recent U.S. healthcare policy reform, most notably the Affordable Care Act's (ACA) Health Insurance Marketplace, has been to increase access to stable, affordable health insurance. However, changing market dynamics (rising premiums, changes in issuer participation and plan availability) raise significant concerns about the marketplaces' ability to provide a stable source of healthcare for Americans that rely on them. By looking at the effect of instability on changes in the consumer choice set, we can analyze potential incentives to switch plans among price-sensitive enrollees, which can then be used to inform policy going forward. METHODS: Data on health plan features for non-tobacco users in 2512 counties in 34 states participating in federally-facilitated exchanges from 2014 to 2016 was obtained from the Centers for Medicaid & Medicare Services. We examined how changes in individual plan features, including premiums, deductibles, issuers, and plan types, impact consumers who had purchased the lowest-cost silver or bronze plan in their county the previous year. We calculated the cost of staying in the same plan versus switching to another plan the following year, and analyzed how costs vary across geographic regions. RESULTS: In most counties in 2015 and 2016 (53.7 and 68.2%, respectively), the lowest-cost silver plan from the previous year was still available, but was no longer the cheapest plan. In these counties, consumers who switched to the new lowest-cost plan would pay less in monthly premiums on average, by $51.48 and $55.01, respectively, compared to staying in the same plan. Despite potential premium savings from switching, however, the majority would still pay higher average premiums compared to the previous year, and most would face higher deductibles and an increased probability of having to change provider networks. CONCLUSION: While the ACA has shown promise in expanding healthcare access, continued changes in the availability and affordability of health plans are likely to result in churning and switching among enrollees, which may have negative ramifications for their health going forward. Future healthcare policy reform should aim to stabilize marketplace dynamics in order to encourage greater care continuity and limit churning.
Assuntos
Reforma dos Serviços de Saúde/economia , Trocas de Seguro de Saúde , Seguro Saúde/tendências , Patient Protection and Affordable Care Act , Custos e Análise de Custo , Reforma dos Serviços de Saúde/tendências , Trocas de Seguro de Saúde/economia , Acessibilidade aos Serviços de Saúde/economia , Humanos , Cobertura do Seguro/economia , Seguro Saúde/economia , Estados UnidosRESUMO
BACKGROUND: Access to medical care, by adequate insurance coverage, has a direct impact on outcomes for patients undergoing vascular procedures. We evaluated in-hospital mortality for patients undergoing index vascular procedures before and after the Massachusetts Healthcare Reform Law (MHRL) in 2006, which mandated insurance for all Massachusetts residents, both in Massachusetts and throughout the United States. METHODS: The National Inpatient Sample was queried to identify patients undergoing interventions for peripheral arterial disease, carotid artery stenosis, and abdominal aortic aneurysms based on International Classification of Diseases, Ninth Revision, Clinical Modification procedural and diagnostic codes. The cohort was then divided into patients treated within Massachusetts (MA) and non-Massachusetts (NMA) hospitals. Two time intervals were examined: before (2003-2006, P1) and after the MHRL (2007-2011, P2). The primary outcome of interest included in-hospital mortality. Patients in MA and NMA hospitals were described in terms of demographics and presentation by time interval (P2 vs P1) compared using χ2 and t-tests. Weighted logistic regression with term modeling change in the odds ratio (OR) for P2 was performed to test and to estimate trends in mortality. Time (year of procedure) and region interactions were investigated by inclusion of time-region interactions in our analyses. Subgroup analysis was performed for P2 vs P1 among nonwhite, nonelderly, and low-income patients. RESULTS: We identified 306,438 patients who underwent repair of abdominal aortic aneurysm, lower extremity bypass, or carotid endarterectomy in MA and NMA hospitals. MA hospital patients had an increase in both Medicaid and private insurance status after the MHRL (P1 = 2.6% and 21% vs P2 = 3.3% and 21.7%, respectively; P = .034). In-hospital mortality trended down for all groups across the entire study. In comparing P2 vs P1 trends, MA hospital odds of mortality per year was lowered by 26% (OR, 0.74; 95% confidence interval [CI], 0.56-0.99; P = .042) not seen in NMA hospitals (OR, 1.03; 95% CI, 0.97-1.09; P = .405). Time and region interaction terms indicated significant time trend difference in both unadjusted (P = .031) and adjusted (P = .033) analysis in MA hospitals not observed in NMA hospitals. This pattern continued when the samples were stratified by procedure. Patients undergoing vascular procedures in MA hospitals had a significantly lowered OR of mortality, with fewer patients presenting at late disease stages in P2 vs P1. Nonelderly patients in Massachusetts, who benefit from the Medicaid expansion provided by the MHRL, had a profound 92% drop in odds of mortality in P2 vs P1 (OR, 0.08; 95% CI, 0.010-0.641; P = .017) compared with the 14% drop in NMA (OR, 0.86; 95% CI, 0.709-1.032; P = .103). CONCLUSIONS: The 2006 MHRL is associated with a decrease in mortality for patients undergoing index vascular surgery procedures in MA compared with NMA hospitals. This study suggests that governmental policy may play a key role in positively affecting the outcomes for patients.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Melhoria de Qualidade/legislação & jurisprudência , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/legislação & jurisprudência , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Feminino , Reforma dos Serviços de Saúde/tendências , Acessibilidade aos Serviços de Saúde/tendências , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Patient Protection and Affordable Care Act/tendências , Melhoria de Qualidade/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/diagnóstico , Doenças Vasculares/mortalidade , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Procedimentos Cirúrgicos Vasculares/tendênciasRESUMO
Health care in the United States is in the midst of a significant transformation from a "fee for service" to a "fee for value" based model. The Medicare Access and CHIP Reauthorization Act of 2015 has only accelerated this transition. Anticipating these reforms, the Society of Gynecologic Oncology developed the Future of Physician Payment Reform Task Force (PPRTF) in 2015 to develop strategies to ensure fair value based reimbursement policies for gynecologic cancer care. The PPRTF elected as a first task to develop an Alternative Payment Model for thesurgical management of low risk endometrial cancer. The history, rationale, and conceptual framework for the development of an Endometrial Cancer Alternative Payment Model are described in this white paper, as well as directions forfuture efforts.
Assuntos
Neoplasias do Endométrio/economia , Reforma dos Serviços de Saúde/economia , Modelos Econômicos , Mecanismo de Reembolso/economia , Neoplasias do Endométrio/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/economia , Reforma dos Serviços de Saúde/tendências , Humanos , Médicos/economia , Mecanismo de Reembolso/tendências , Sociedades Médicas , Estados UnidosAssuntos
Antineoplásicos/economia , Pesquisa Biomédica , Ética Médica , Reforma dos Serviços de Saúde/tendências , Neoplasias/tratamento farmacológico , Responsabilidade Social , Redução de Custos , Medicina Baseada em Evidências , Alocação de Recursos para a Atenção à Saúde , Mau Uso de Serviços de Saúde/prevenção & controle , Humanos , Padrões de Prática Médica/ética , Padrões de Prática Médica/normas , Estados UnidosRESUMO
Objective: Taiwan has launched a Family Practice Integrated Care Project (FPICP) to develop an accountable family doctor system since March 2003. We aim to report the effectiveness of this nationwide demonstration programme over a 10-year period. Methods: Papers and reports related to the FPICP published both in English and in Chinese from 2003 to 2015 were collected systematically based on keywords including 'family doctor', 'primary care', 'integrated care' and 'Taiwan'. Also collected and reviewed were national health insurance administration annual reports and related publications from Taiwan Association of Family Medicine. Quality care indicators including structure, process and outcome for programme monitoring were reported. Results: Up to June 2015, the project had enrolled a total of 10.5% of Taiwan's population. Approximately 24.9% of primary care physicians and 29.7% of community clinics joined the project to serve the members of 426 community health care groups (CHCGs). Compared to non-members, CHCG members received more preventive care services, especially in adult health examination (49% versus 19%), Pap smear (29% versus 22%), elderly influenza vaccination (42% versus 28%) and immunochemical faecal occult blood test (43% versus 31%) (P < 0.01). Members showed a markedly high level of satisfaction (>95%), especially in overall satisfaction, provision of health consultation and information, and improvement in understanding personal health condition. Conclusions: In the future, through the support of family physicians and CHCGs, a person-centred integrated health care delivery system can be an effective solution to the current barriers in the medical care system.
Assuntos
Prestação Integrada de Cuidados de Saúde , Medicina de Família e Comunidade/tendências , Reforma dos Serviços de Saúde/tendências , Atenção Primária à Saúde/métodos , Adulto , Humanos , Serviços Preventivos de Saúde , Indicadores de Qualidade em Assistência à Saúde , TaiwanRESUMO
ISSUE: Prior to the Affordable Care Act (ACA), one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium because of their health, or had specific health problems excluded from their plans. Beginning in 2010, ACA consumer protections, particularly coverage for preventive care screenings with no cost-sharing and a ban on plan benefit limits, improved the quality of health insurance for women. In 2014, the law's major insurance reforms helped millions of women who did not have employer insurance to gain coverage through the ACA's marketplaces or through Medicaid. GOALS: To examine the effects of ACA health reforms on women's coverage and access to care. METHOD: Analysis of the Commonwealth Fund Biennial Health Insurance Surveys, 20012016. FINDINGS AND CONCLUSIONS: Women ages 19 to 64 who shopped for new coverage on their own found it significantly easier to find affordable plans in 2016 compared to 2010. The percentage of women who reported delaying or skipping needed care because of costs fell to an all-time low. Insured women were more likely than uninsured women to receive preventive screenings, including Pap tests and mammograms.