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Concept: Healthcare reform

173

With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc.

Concepts: Health care, Health economics, Medicine, Healthcare reform, Public health, Health insurance, Health, Health science

131

Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries.

Concepts: Health care, Health economics, Medicine, Healthcare reform, Healthcare, Evidence-based medicine, Performance

76

Since the Affordable Care Act (ACA) was passed in 2010, our health care system has changed for the better. The uninsured rate has fallen by 45%, and for the first time, more than 9 in 10 Americans have health insurance. Health care spending per beneficiary has grown more slowly in both the private and public sectors, and we’ve seen promising improvements in health care quality, including lower rates of hospital-acquired conditions and hospital readmissions - a sign that we are not just cutting costs but also delivering greater value. Nevertheless, work remains to be done to build a health care . . .

Concepts: Health care, Health economics, Medicine, Healthcare reform, Healthcare, Health insurance, Barack Obama, Massachusetts

74

Last December, Vermont Governor Peter Shumlin ended a 4-year initiative to create a single-payer health care system. The plan was abandoned because of legitimate political considerations, and any other state considering single payer will face similar obstacles.

Concepts: Health economics, Healthcare reform, Universal health care, Health care in the United States, Single-payer health care

62

About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine’s conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

Concepts: Health care, Health economics, Healthcare reform, Universal health care, Actuarial science, Investment, Insurance, Single-payer health care

45

The Affordable Care Act (ACA) has passed its fifth birthday and completed two enrollment periods for coverage in the state-based insurance exchanges and Medicaid. The U.S. uninsured rate is lower than ever, and coverage gains appear to be improving access to primary care and medications, affordability of care, and self-reported health.(1) But challenges for health care reform persist: millions of Americans are still uninsured, and even for those with coverage, substantial barriers remain to obtaining affordable, high-quality care. More than 30 million U.S. children and adults still lack insurance (see pie chart). Who are they, and what policy options exist for covering . . .

Concepts: Health care, Medicine, Healthcare reform, Health insurance, United States, Barack Obama, Massachusetts, Chart

39

Total nominal US health care spending increased 5.8 percent and reached $3.2 trillion in 2015. On a per person basis, spending on health care increased 5.0 percent, reaching $9,990. The share of gross domestic product devoted to health care spending was 17.8 percent in 2015, up from 17.4 percent in 2014. Coverage expansions that began in 2014 as a result of the Affordable Care Act continued to affect health spending growth in 2015. In that year, the faster growth in total health care spending was primarily due to accelerated growth in spending for private health insurance (growth of 7.2 percent), hospital care (5.6 percent), and physician and clinical services (6.3 percent). Continued strong growth in Medicaid (9.7 percent) and retail prescription drug spending (9.0 percent), albeit at a slower rate than in 2014, contributed to overall health care spending growth in 2015.

Concepts: Health care, Health economics, Medicine, Healthcare reform, Health insurance, Clinical trial, Hospital, Gross domestic product

39

OBJECTIVE To compare health insurance coverage and type of coverage for adults with and without diabetes. RESEARCH DESIGN AND METHODS The data used were from 2,704 adults who self-reported diabetes and 25,008 adults without reported diabetes in the 2009 National Health Interview Survey. Participants reported on their current type of health insurance coverage, demographic information, diabetes-related factors, and comorbidities. If uninsured, participants reported reasons for not having health insurance. RESULTS Among all adults with diabetes, 90% had some form of health insurance coverage, including 85% of people 18-64 years of age and ∼100% of people ≥65 years of age; 81% of people without diabetes had some type of coverage (vs. diabetes, P < 0.0001), including 78% of people 18-64 years of age and 99% of people ≥65 years of age. More adults 18-64 years of age with diabetes had Medicare coverage (14% vs. no diabetes, 3%; P < 0.0001); fewer people with diabetes had private insurance (58% vs. no diabetes, 66%; P < 0.0001). People 18-64 years of age with diabetes more often had two health insurance sources compared with people without diabetes (13 vs. 5%, P < 0.0001). The most common private plan was a preferred provider organization (PPO) followed by a health maintenance organization/independent practice organization (HMO/IPA) plan regardless of diabetes status. For participants 18-64 years of age, high health insurance cost was the most common reason for not having coverage. CONCLUSIONS Two million adults <65 years of age with diabetes had no health insurance coverage, which has considerable public health and economic impact. Health care reform should work toward ensuring that people with diabetes have coverage for routine care.

Concepts: Health care, Health economics, Healthcare reform, Health insurance, Health insurance in the United States, Preferred provider organization

38

With politicians and pundits clamoring in the background, the first open-enrollment period - created by the Affordable Care Act (ACA) for Americans seeking insurance coverage in the new individual marketplaces - came to a close on March 31. There were last-minute extensions by the Department of Health and Human Services and by certain states, but for most insurance seekers, March 31 was the last chance to enroll through the individual marketplaces until the next open-enrollment period launches in November. Americans who did not have qualified health insurance when open enrollment ended and who do not qualify for an exemption will . . .

Concepts: Health care, Health economics, Healthcare reform, Health insurance, Health, Barack Obama, Massachusetts, The Last Chance

37

The Affordable Care Act (ACA) will cause a major expansion of high-deductible health insurance, a fact that has received little attention but has substantial implications for patients, health care providers, and employers. High-deductible health plans (HDHPs), often considered “blunt instruments” that indiscriminately reduce utilization of both appropriate and discretionary care, require annual out-of-pocket payments of $1,000 to $10,000 for many services before more comprehensive coverage begins.(1) Unfortunately, large gaps remain in our understanding of HDHPs' effects on vulnerable populations, life-saving services, and health outcomes.(2),(3) In the ACA, Congress chose market-based cost controls over measures that are common internationally, such . . .

Concepts: Health care, Health care provider, Health economics, Healthcare reform, Healthcare, Health insurance, Illness, Economics