Consumer Cost-Sharing in Marketplace vs. Employer Health Insurance Plans, 2015.

Using data from 49 states and Washington, D.C., we analyzed changes in cost-sharing under health plans offered to individuals and families through state and federal exchanges from 2014 to 2015. We examined eight vehicles for cost-sharing, including deductibles, copayments, coinsurance, and out-of-pocket limits, and compared findings with cost-sharing under employer-based insurance. We found cost-sharing under marketplace plans remained essentially unchanged from 2014 to 2015. Stable premiums during that period do not reflect greater costs borne by enrollees. Further, 56 percent of enrollees in marketplace plans attained cost-sharing reductions in 2015. However, for people without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits under catastrophic, bronze, and silver plans are considerably higher than under employer-based plans on average, while cost-sharing under gold plans is similar employer-based plans on average. Marketplace plans are far more likely than employer-based plans to require enrollees to meet deductibles before they receive coverage for prescription drugs.

Did the Great Recession influence retirement plans?

The recent recession constitutes one of the macro forces that may have influenced workers' retirement plans. We evaluate a multilevel model that addresses the influence of macro-, meso-, and micro-level factors on retirement plans, changes in these plans, and expected retirement age. Using data from Waves 8 and 9 of the Health and Retirement Study (N=2,618), we find that individuals with defined benefit plans are more prone to change toward plans to stop work before the stock market declined, whereas the opposite trend holds for those without pensions. Debts, ability to reduce work hours, and firm unionization also influenced retirement plans. Findings suggest retirement planning education may be particularly important for workers without defined pensions, especially in times of economic volatility.

Buying right: the consequences of glut.

This nation's health care system is poised for change, and the purchasers of health care services will call the shots. Their decisions can make the system much better, or much worse. If they make the right moves, this nation will make a marked move forward in the quality, efficiency, and availability of care and coverage received by all Americans. If they make the wrong moves, the quality, efficiency, and accessibility of medical care and coverage will be sharply reduced. There is thus great promise as well as great danger. This article explores who must do what to ensure a good outcome, and what will happen if they don't. Because providers have a greater stake in the outcome than any other party, they have a special incentive, and obligation, to ensure that purchasers have the information they need to make appropriate buying decisions.

Controle social no sistema único de saúde: subsídios para construção de competências dos conselheiros de saúde / Social control in the unified health system: subsidies to build health counselors' skills

Este artigo discute a experiência do curso de capacitação de conselheiros de saúde do município de Viçosa-MG, com base na perspectiva de sensibilização para o exercício consciente do controle social, possibilitando assim a construção de um sistema de saúde mais justo e igualitário, segundo o ideal pensado pelo movimento da reforma sanitária brasileira. Realiza uma abordagem qualitativa sobre as dinâmicas apresentadas no curso, sendo este baseado na metodologia ativa de ensino-aprendizagem. A metodologia participativa e a utilização de estratégias que privilegiaram a sistematização do conteúdo, assim como a reflexão sobre os referenciais teóricos, apresentados a partir da correlação dos temas com as experiências práticas, foram fundamentais para ampliar e aprofundar o processo de empoderamento dos conselheiros. Como resultado, foi possível identificar alguns desafios para o exercício do controle social, como a importância da participação ativa e da necessidade de buscar informações e trocar experiências. Destarte, destaca-se que a participação dos conselheiros de saúde em oficinas de capacitação aparece como uma possibilidade de superação das dificuldades de implementação das conquistas legais, ao sensibilizar estes atores sociais para transpor a posição de meros expectadores passivos em protagonistas na construção de um sistema de saúde universal e equitativo.

This paper discusses the experience of the training course for health counselors in the city of Viçosa, Minas Gerais State, from the perspective of awareness of the conscious exercise of social control, thus enabling the construction of a more fair and equitable health system, according to the ideal of the movement of the Brazilian health reform. We perform a qualitative approach on the dynamics presented in the course, which is based on the methodology of active teaching and learning. The participatory methodology and use of strategies that focused on the systematization of content, as well as the reflection on the theoretical frameworks presented from the correlation of topics with practical experiences were essential to broaden and deepen the process of empowerment of the counselors. As a result, it was possible to identify some challenges for the exercise of social control, such as the importance of active participation and the need to seek information and exchange experiences. Thus, it is emphasized that the participation of health counselors in training workshops appears as a possibility of overcoming the difficulties of implementing legal achievements, the awareness of these social actors to implement the position of mere passive spectators into protagonists in the construction of a universal and equitable health care system.

Are "choice plans" too good to be true?

Insurers and HMOs have created a new product to meet employers' demands for cost controls and employees' desire for a wider choice of providers. But will the system work?

Partnership for community health development.

A programme of community health development is reported from two villages in Haiti. It involves close cooperation between a district hospital, a local dispensary, and, most importantly, the inhabitants themselves. The programme is simple, financially realistic, adapted to local conditions, and linked to activities designed to meet basic requirements, such as those of food production and water supply.

PIP: The Albert Schweitzer Hospital in the Artibonite Valley of central Haiti was founded by William Larimer Mellon in 1956 to serve about 175,000 people. Early in 1977, the hospital decided to create a community health department and provide curative, preventive, and promotive health programs through 7 dispensaries. A mobile immunization team was established. In 1988, 2 villages with a total population of 1459, in the catchment area of the Plassac dispensary, were selected for a research and development project with a comprehensive baseline survey. Among children aged up to 5 years, 36% were of normal nutritional status, while 41%, 18%, and 4% suffered from first-, second- and third-degree malnutrition, respectively. Of these children, only 31% were completely immunized. 21% of the children had tuberculosis, malaria, and upper respiratory tract infections. The illiteracy rate was around 85%. A village development committee was elected by the community. Voluntary health workers, elected or selected among mothers, were trained in health promotional activities, and each was made responsible for 15-20 families. These workers, with the dispensary's health agents, delivered a minimum health care package, comprising maternal and child care, family planning, immunization, treatment of simple diseases, health and nutrition education, and environmental sanitation. In less than 2 years, there was a strong indication of declining mortality and malnutrition among children aged 1 to 3 years. No more cases of third-degree malnutrition were seen in the dispensary, and some 90% of children were fully immunized. Changes were evident in the health knowledge, attitudes, and practices of the population. It is expected that during 1993 the whole catchment area of the Plassac dispensary, with around 20,000 people, will be covered. The dispensary had to be upgraded to a community health center with 2 or 3 beds for emergency cases.

Patient cost-sharing innovations: promises and pitfalls.

Over the next decade, health plans and employers will refine patient cost sharing to encourage workers to seek more cost-effective care, according to a panel of market and health policy experts at a Center for Studying Health System Change (HSC) conference. Instead of using a single, large deductible, employers and health plans will likely vary patient cost sharing by choice of provider, site and type of service, so patients choosing less effective care options pay more. Employers also will try to limit financial hardships for low-income workers by, for example, varying cost sharing based on workers' income. However, significant obstacles could hinder the effectiveness of emerging cost-sharing strategies, including inadequate information on quality of care and provider resistance.

Promoción de la salud en Chile / Health promotion in Chile

Este artículo describe la racionalidad, organización y principales avances de la Promoción de Salud como política pública en Chile. De acuerdo con los cambios producidos en la transición epidemiológica y nutricional, el Ministerio de Salud readecuó las políticas basadas en lo materno-infantil a nuevas prioridades; enfermedades cardiovasculares, cáncer, accidentes y problemas de salud mental. Los principales factores condicionantes para estos problemas son la alimentación y nutrición, actividad física, tabaco, factores psico-sociales y ambientales. Para enfrentar estos factores se estableció un plan estratégico con metas para el período 2000-2010 y se creó el Consejo Nacional para la Promoción de Salud o Vida Chile constituido por 25 organizaciones gubernamentales, descentralizado a 12 regiones y 308 municipios. Se desarrollaron estrategias para cada uno de los factores condicionantes, las que están siendo implementadas en el nivel local en establecimientos educacionales pre-escolares y escolares, lugares de trabajo y municipios. Los principales logros han sido el contar con un modelo de promoción de salud descentralizado con programas y proyectos que se desarrollan en todo el país, con objetivos y metas precisas y una línea de base para evaluar los avances, que se efectuó en noviembre 2000. Los principales desafíos para el futuro son la incorporación plena de la promoción en todas las actividades del sector salud, el fortalecimiento de los vínculos entre las instituciones que componen Vida Chile y superar dilemas, como son los supuestos antagonismos entre promoción y prevención de salud, investigación científica y ciencias sociales y entre sector público y privado

Uma nova iniciativa no Sistema de Saúde do Distrito Federal / A new iniciative in the Health System of Federal District

Apresenta o Programa Saúde Brasília: Uniäo com a Comunidade (PROUNI BRASILIA). Trata-se de um Programa envolvendo a Comunidade, Serviço de Saúde e Universidade, com patrocínio da Fundaçäo W.K.Kellogg e tendo como princípios básicos: a reformulaçäo acadêmica no sentido de formar um profissional treinado na comunidade, para um trabalho multidisciplinar e multiprofissional; um novo modelo assistencial calcado no processo de distritalizaçäo; um desenvolvimento das lideranças e organizaçäo comunitária, bem como da própria comunidade

Sistema de vigilancia alimentaria y nutricional / System of feeding and nutritional surveillance

Contiene: Cómo saber la situación de salud y nutrición de nuestros niños (guía para el promotor); Directiva Interinstitucional N§001-90-SALUD-EDUCACION-PROCAN; guía de trabajo para la vigilancia nutricional; manual del SISUAN regional

Memoria del II Congreso Departamental de Responsables Populares de Salud / Memory of the II Departamental Congress of Responsible Popular of Health

Este documento es una memoria del congreso de responsables populares de salud realizado en Santa Cruz, los temas tratados fueron: Muerte materna: vigilancia epidemiológica, seguro básico de salud, lactancia materna y alimentación complementaria, medicamentos esenciales, información, educación, comunicación, capacitación y estrategia de la IEC