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1.
Health Policy ; 125(3): 277-283, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33531170

RESUMO

The Sláintecare report developed by political consensus sets out a ten year plan for achieving Universal Health Care (UHC) in Ireland. This paper evaluates the design and progress of the report to mid 2020, but with some reflection on the new COVID 19 era, particularly as it relates to the expansion of entitlements to achieve UHC. The authors explore how close Sláintecare is to the UHC ideal. They also review the phased strategy of implementation in Sláintecare that utilises a systems-thinking approach with interlinkages between entitlements, funding, capacity and implementation. Finally the authors review the Sláintecare milestones against the reality of implementation since the publication of the report in 2017, cognisant of government policy and practice. Some of the initial assumptions around the context of Sláintecare were not realised and there has been limited progress made toward expanding entitlements, and certainly short of the original plan. Nevertheless there have been positive developments in that there is evidence that Government's Implementation Strategy and Action Plans are focussing on reforming a complex adaptive system rather than implementing a blueprint with such initiatives as integrated care pilots and citizen engagement. The authors find that this may help the system change but it risks losing some of the essential elements of entitlement expansion in favour of organisational change.


Assuntos
Reforma dos Serviços de Saúde/economia , Implementação de Plano de Saúde/economia , Política de Saúde , Assistência de Saúde Universal , Gastos em Saúde , Humanos , Irlanda , Formulação de Políticas
4.
N C Med J ; 81(6): 381-385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139470

RESUMO

The Affordable Care Act played a major role in transitioning American health care away from fee-for-service payment. We explore the spread of payment reforms since the implementation of the ACA, both nationally and in North Carolina; the corresponding effects on health care costs and quality; and further steps needed to achieve greater transformation.


Assuntos
Custos de Cuidados de Saúde/tendências , Reforma dos Serviços de Saúde/economia , Patient Protection and Affordable Care Act/economia , Betacoronavirus , Infecções por Coronavirus , Humanos , North Carolina , Pandemias , Pneumonia Viral , Estados Unidos
5.
Methodist Debakey Cardiovasc J ; 16(3): 232-240, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133360

RESUMO

In an effort to curb excessive health care spending and incentivize high-quality care, many payers have implemented value-based payment reforms designed to pay for the quality rather than the quantity of health care services. Medicare, the largest payer in the United States, has implemented numerous value-based payment policies over the past decade, many of which affect cardiovascular care. In this review, we discuss some of these major nationwide value-based payment reforms as they relate to cardiovascular care and what we may expect in the future from cardiovascular value-based policies.


Assuntos
Cardiologia/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Medicare/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Seguro de Saúde Baseado em Valor/economia , Aquisição Baseada em Valor/economia , Organizações de Assistência Responsáveis/economia , Cardiologia/legislação & jurisprudência , Doenças Cardiovasculares/diagnóstico , Custos de Cuidados de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Política de Saúde , Humanos , Medicare/legislação & jurisprudência , Pacotes de Assistência ao Paciente/economia , Formulação de Políticas , Resultado do Tratamento , Estados Unidos , Aquisição Baseada em Valor/legislação & jurisprudência
7.
Proc Natl Acad Sci U S A ; 117(32): 18939-18947, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32719129

RESUMO

Changes in the way health insurers pay healthcare providers may not only directly affect the insurer's patients but may also affect patients covered by other insurers. We provide evidence of such spillovers in the context of a nationwide Medicare bundled payment reform that was implemented in some areas of the country but not in others, via random assignment. We estimate that the payment reform-which targeted traditional Medicare patients-had effects of similar magnitude on the healthcare experience of nontargeted, privately insured Medicare Advantage patients. We discuss the implications of these findings for estimates of the impact of healthcare payment reforms and more generally for the design of healthcare policy.


Assuntos
Reforma dos Serviços de Saúde/economia , Política de Saúde/economia , Seguro Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Humanos , Cobertura do Seguro/economia , Estados Unidos
8.
Int J Equity Health ; 19(1): 89, 2020 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513283

RESUMO

BACKGROUND: Over the last decade, the expenditure on public medical and health has increased greatly in China, however, problems as low efficiency and unfairness still exist. How to accurately describe the effectiveness of existing medical and health resources in combination with regional heterogeneity is of great significance to China's medical and health reform. METHODS: Based on provincial panel data for the period of 2005 to 2017, combining expected output and unexpected output, this paper constructs a super-efficiency three-stage SBM-DEA model, to measure and analyze the spatial-temporal heterogeneity characteristics and influencing factors of public medical and health efficiency (PMHE). RESULTS: (1) After the impacts of random error and external environmental factors are removed, the mean value of overall PMHE is 0.9274, failing to reach DEA efficiency, and PMHE shows a fluctuated downward trend. (2) The adjusted PMHE level shows a prominent spatial imbalance at the stage 3. The average efficiency level is ranked by the East > the West > the Central > the Northeast. (3) The increases of GDP per capita and population density are beneficial to the improvement of PMHE, while income level and education level are disadvantageous to PMHE, and last, the urbanization level, an uncertain effect. (4) There is no σ convergence of the PMHE in the East, the Central and the West, that is, the internal differences may gradually expand in the future, while the Northeast shows a significant σ convergence trending of PMHE. (5) The state's allocation of medical and health resources has undergone major changes during "The Twelfth Five-Year Plan". CONCLUSION: This study innovatively incorporates undesired outputs of health care into the efficiency evaluation framework by constructing the main efficiency evaluation indicators. The results of the robust evaluation conclude that China's existing investment in medical and health resources is generally not effective. Therefore, although China's health care reform has made certain achievement, it is still necessary to expand the investment in health care resources.


Assuntos
Eficiência , Gastos em Saúde/tendências , Recursos em Saúde/economia , Modelos Estatísticos , Saúde Pública/economia , China , Reforma dos Serviços de Saúde/economia , Humanos , Alocação de Recursos , Análise Espaço-Temporal
9.
Artigo em Inglês | MEDLINE | ID: mdl-32110896

RESUMO

China's Serious Disease Insurance Scheme (SDIS) was set up to relieve the financial burdens on serious disease patients. It is a crucial part of the national basic medical insurance scheme, which is regarded as one of the largest government-funded social security programs in the world. The most significant institutional innovation of the SDIS is that the approach of a public-private partnership (PPP) is applied in an attempt to facilitate the efficiency of its implementation. The objective of this paper is to evaluate the implementation of the SDIS in China through PPPs, and to identify the problems to be tackled if the Chinese government intends to make such a plan work better for the majority of urban and rural residents. With the effective support from local officials and practitioners, the authors of this paper collected copies of SDIS contracts of multiple cities in Guangdong, one of the most developed provinces of China. Guided by a research framework drawn from the PPP literature, details of contract enforcement were also examined. The authors discovered that the role of local states is rather dominant; they have manipulated contract drafting and implementation. Additionally, current mechanisms for profit sharing, risk sharing, and information exchange have placed insurance companies in a rather disadvantageous situation. To achieve the sustainable development of the SDIS, the authors suggest that a further reform on implementation of a PPP must be pushed forward.


Assuntos
Reforma dos Serviços de Saúde , Seguro Saúde , Parcerias Público-Privadas , População Rural , China , Reforma dos Serviços de Saúde/economia , Humanos , Seguro Saúde/economia , Previdência Social
10.
J Am Soc Nephrol ; 31(3): 579-590, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32019784

RESUMO

BACKGROUND: In 2011, inclusion of injectable medications into an expanded ESKD payment bundle prompted concerns that dialysis facilities facing higher costs might close, disrupting care delivery and access to care. Whether this policy change influenced dialysis facility closures is unknown. METHODS: To examine whether facility closures increased after 2011 and whether factors influencing closures changed, we analyzed US Renal Data System registry data to identify all patients receiving in-center hemodialysis from 2006 through 2015 and to track dialysis facility closures. We used interrupted time series logistic regression models and estimated marginal effects to examine immediate and longer-term changes in the likelihood of being affected by facility closures following payment reform. We also examined whether associations between selected predictors of closures indicating populations at "high risk" of closure (patient characteristics, facility characteristics, and geography-related characteristics) and closures changed after payment reform. RESULTS: Dialysis facility closures were uncommon over the study period. In adjusted models, the relative odds of experiencing a closure declined by 37% (odds ratio [OR], 0.63; 95% confidence interval [95% CI], 0.59 to 0.67) immediately after payment reform and declined by an additional 6% (OR, 0.94; 95% CI, 0.91 to 0.97) annually thereafter, corresponding to a 0.3% lower absolute probability of closure in 2015 in association with payment reform. Patients who were black and who dialyzed at small, hospital-based facilities experienced slight increases in closures following payment reform, whereas Hispanic and Medicare/Medicaid dual-eligible patients experienced slight decreases in closures. CONCLUSIONS: Expansion of the ESKD payment bundle was not associated with increased closure of dialysis facilities, although the likelihood of closures changed slightly for some higher-risk populations.


Assuntos
Fechamento de Instituições de Saúde/estatística & dados numéricos , Unidades Hospitalares de Hemodiálise/economia , Falência Renal Crônica/terapia , Sistema de Pagamento Prospectivo/economia , Sistema de Registros , Diálise Renal/economia , Adulto , Idoso , Feminino , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Fechamento de Instituições de Saúde/economia , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Humanos , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Estudos Retrospectivos , Estados Unidos
11.
Ann Intern Med ; 172(2 Suppl): S33-S49, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31958802

RESUMO

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. Fundamental restructuring of payment policies and delivery systems is required to achieve a health care system that puts patients' interests first and supports physicians and their care teams to deliver high-value, patient- and family-centered care. The ACP calls for reform of U.S. payment, delivery, and information technology systems to achieve this vision. The ACP's recommendations include increased investment in primary care; alignment of financial incentives to achieve better patient outcomes, lower costs, reduce inequities in health care, and facilitate team-based care; freeing patients and physicians of inefficient administrative and billing tasks and documentation requirements; and development of health information technologies that enhance the patient-physician relationship.


Assuntos
Assistência à Saúde/economia , Reforma dos Serviços de Saúde/economia , Política de Saúde/economia , Acesso aos Serviços de Saúde/economia , Assistência Centrada no Paciente/economia , Controle de Custos , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/economia , Humanos , Informática Médica/economia , Relações Médico-Paciente , Qualidade da Assistência à Saúde/economia , Sociedades Médicas , Estados Unidos
12.
Ann Intern Med ; 172(2 Suppl): S7-S32, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31958805

RESUMO

This paper is part of the American College of Physicians' policy framework to achieve a vision for a better health care system, where everyone has coverage for and access to the care they need, at a cost they and the country can afford. Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage. The nation's existing health care system is inefficient, unaffordable, unsustainable, and inaccessible to many. Part 1 of this paper discusses why the United States needs to do better in addressing coverage and cost. Part 2 presents 2 potential approaches, a single-payer model and a public choice model, to achieve universal coverage. Part 3 describes how an emphasis on value-based care can reduce costs.


Assuntos
Assistência à Saúde/economia , Reforma dos Serviços de Saúde/economia , Política de Saúde/economia , Acesso aos Serviços de Saúde/economia , Seguro Saúde/economia , Cobertura Universal do Seguro de Saúde/economia , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Modelos Econômicos , Sociedades Médicas , Estados Unidos
16.
Int J Health Plann Manage ; 35(1): e210-e217, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31710130

RESUMO

Although Japan has implemented a universal health care system that is universal in terms of free access to health care services, it is managed by fragmented and financially insecure insurance societies that have cumulative deficits even with government subsidies. In terms of insurance premiums, the system is regressive to low-income and unstable workers, and the social benefit scheme only captures 1.6% of this population. The Japanese government is continuously instituting new health care policies to reduce growing health care expenditures. Recent health care reforms may improve economic efficiency, but the changes remain limited to controlling access to health services and pricing measures.


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/organização & administração , Administração Financeira/economia , Administração Financeira/organização & administração , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/organização & administração , Gastos em Saúde , Política de Saúde , Humanos , Seguro/economia , Japão , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/organização & administração
17.
J Aging Soc Policy ; 32(2): 108-124, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30642232

RESUMO

Reform of the U.S. long-term services and supports (LTSS) financing system has been historically difficult to achieve. This article outlines several recent reform proposals and offers a path forward on achieving LTSS reform. These proposals include the Commonwealth Fund's Medicare Help at Home proposal, the work of the Bipartisan Policy Center, as well as the State of Minnesota to develop an LTSS benefit. All three proposals focus on an expansion of Medicare to cover the LTSS needs of Americans. While Medicare increasingly pays for LTSS, these approaches ensure that the role of Medicare in LTSS financing is much more coordinated. Enhancing Medicare's role reduces the current reliance on Medicaid, the default payer of LTSS, while providing an opportunity for a more robust private insurance market to develop. This would help provide for the immediate LTSS needs of Americans while building a more sustainable and equitable financing system for future generations.


Assuntos
Reforma dos Serviços de Saúde , Seguro de Assistência de Longo Prazo , Assistência de Longa Duração , Medicare , Reforma dos Serviços de Saúde/economia , Política de Saúde , Humanos , Seguro de Assistência de Longo Prazo/economia , Assistência de Longa Duração/economia , Medicaid , Minnesota , Política , Cuidados Semi-Intensivos , Estados Unidos
18.
BMC Health Serv Res ; 19(1): 916, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783751

RESUMO

BACKGROUND: In September 2012, Beijing, the capital of China, selected five tertiary hospitals as pilots to remove the previously allowed 15% markup for drug sales. However, while most research demonstrated the significant decrease in drug sales, the core issue of high health expenditure was not well solved because of the unintended policy impact. This study aimed to empirically evaluate the short-term and long-term unintended impacts on controlling medical expenses of Beijing's zero markup drug policy from 2012 to 2015. METHODS: This study extracted 2012-2015 individual-level data from the Beijing Urban Employee Basic Medical Insurance (UEBMI) database and performed a propensity score-matched analysis to evaluate the short-term and long-term impacts on controlling medical expenses. All inpatients in the 5 pilot reform hospitals were selected as the intervention group, while inpatients in other tertiary hospitals were selected as the control group. RESULTS: A total of 520,996 inpatients were extracted in this study. For patients in the pilot hospitals, the total expenditures per admission decreased from 17,140.3 yuan in 2012 to 15,430.1 yuan in 2013 and then increased to 16,789.8 yuan in 2015. Expenditure on drugs reduced from 5811.7 yuan in 2012 to 3903.4 yuan in 2015. However, a significant substitution effect of medical consumables was first observed in the third quarter of 2014, which undermined the impact of the policy. In the long-term, the intervention group and control group demonstrated the same trend. CONCLUSIONS: After the zero markup drug policy, expenditure on drugs revealed a continuous decline. However, the decline in total expenditure was weakened by the substitution effect of medical consumables in the long term.


Assuntos
Controle de Custos/métodos , Custos de Medicamentos/tendências , Medicamentos Essenciais/economia , Reforma dos Serviços de Saúde/economia , Pequim , Custos de Medicamentos/normas , Humanos , Pontuação de Propensão
20.
Fam Syst Health ; 37(4): 328-335, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31815513

RESUMO

INTRODUCTION: Rhode Island has received national recognition as a leader in statewide, multipayer, multistakeholder initiatives that focus on investments in primary care as a strategy to build a strong delivery system foundation that delivers high-quality, affordable health care. METHOD: For this case study we summarize key structural, process and outcomes factors and lessons learned from internal and external evaluations and project based and stakeholder-engaged quality improvement efforts that helped Rhode Island become the most improved U.S. health system over the past 5 years. RESULTS: Rhode Island's Office of the Insurance Commissioner through a collaborative process contractually established per-member, per-month payments to practices that engaged in the statewide transformation program to the patient-centered medical home model of care and paid incentives for achieving quality, patient experience, and hospital utilization targets. DISCUSSION: Critical lessons learned include the importance of engaging stakeholders in systems change, measuring and monitoring primary care spending, and continuous learning and best-practice sharing. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Reforma dos Serviços de Saúde/normas , Atenção Primária à Saúde/normas , Estudos de Casos e Controles , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/normas , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/métodos , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Rhode Island
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