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Medicare spending by beneficiaries with various types of supplemental insurance

MEDICAL CARE RESEARCH AND REVIEW 1999年第2期56卷 137-155页

作者： Khandker, RK McCormack, LA Res Triangle Inst Res Triangle Pk NC 27709 USA

The authors analyzed Medicare spending by elderly noninstitutionalized Medicare beneficiaries with and without supplemental insurance such as Medigap, employer-sponsored plans, and Medicaid. Use of a detailed survey of Medicare beneficiaries and their Medicare health insurance claims enabled the authors to control for health status, chronic additions,functional limitations, and other factors that explain spending variations across supplemental insurance categories. The authors found that supplemental insurance was associated with a higher probability and level of Medicare spending, particularly for Part B services. Beneficiaries with both Medigap and employer plans had the highest levels of spending ceteris paribus, suggesting a possible moral hazard effect of insurance. Findings from this study are discussed in the context of the overall financing of health care for the elderly.

关键词：卫生经费支出/统计学和数值数据健康状况收入保险赔偿费保险 Medigap/经济学保险 Medigap/统计学和数值数据保险 Medigap/利用似然函数 Logistic模型 Medicaid/经济学 Medicaid/统计学和数值数据 Medicaid/利用 Medicare/经济学 Medicare/统计学和数值数据 Medicare/利用统计学非参数美国人类男(雄)性

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What we say and what we do: County-level public spending for health care

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JOURNAL OF RURAL HEALTH 1999年第4期15卷 421-430页

作者： Zimmerman, MK McAdams, R Univ Kansas Dept Hlth Policy & Management Overland Pk KS 66213 USA

The purpose oft his study is to examine county-level public spending for health care services in Kansas and to explain variation in spending levels with a model composed of population density population age and per capita income. Data are abstracted from budget documents for all 105 counties in Kansas for the years 1994, 1995 and 1996. Health care expenditures are defined as county tax revenues spent for ambulance, hospitals, ambulatory care, home health services, nursing homes, and mental health and substance abuse services. Results show that Kansas counties spent between 12.1 percent and 13.6 percent of their budgets to fund local health care services between 1994 and 1996, spending more than $133 million in 1996 alone. In 10 counties, one-quarter to one-third of the budget went for health services. Low population density and relatively high per capita income explained nearly one-third of the variation in how much counties spent and an even greater proportion when analysis was limited to the most rural counties. Findings from this study suggest there may be a significant local commitment in the United States to publicly supported health care services, more support than typically recognized and perhaps more than is estimated in national health care spending data. Future research on the economic effects of the health sector on local communities should take account of local spending for health care, especially at the county level.

关键词：预算筹资政府/经济学卫生卫生经费支出/统计学和数值数据卫生服务/经济学收入堪萨斯模型经济计量学人口密度问卷调查居住特征/统计学和数值数据人类

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Medicare is fundamental to the health care of Australia

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999年第4期23卷 339-341页

作者： Brooks, P Univ Queensland Fac Hlth Sci St Lucia Qld 4067 Australia

This article emphasizes the importance of Medicare to the health care system of Australia. In civilised societies, governments have a responsibility to provide and control the vital services of health, education and the utilities. This is not to say that some elements of service provision in these areas might not be provided by the private sector, but the important thing is getting a balance and making sure that balance provides the best opportunities for society as a whole. No Government since 1975 has been able to resist the opportunity of linkering' in some way with the health system. Current concern is particularly focused on the level of private health insurance in Australia, which has dropped significantly since the introduction of Medicare. It would be fair to say that Medicare has been extraordinarily successful, given its resources. It has played a major role in controlling burgeoning healthcare costs and in particular, the blow out in costs of technology that have led the U.S. to spend around 14% of the GDP on health care.

关键词：澳大利亚卫生保健提供/组织和管理卫生经费支出/统计学和数值数据卫生工作重点预期寿命国家卫生规划/组织和管理需求估价公共卫生人类

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Public hospital resource allocations in El Salvador: accounting for the case mix of patients

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HEALTH POLICY AND PLANNING 1998年第3期13卷 296-310页

作者： Fiedler, JL Schmidt, RM Wight, JB Univ Richmond Richmond VA 23173 USA

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

关键词：病床利用率/统计学和数值数据预算诊断相关患者组/分类诊断相关患者组/统计学和数值数据效率组织萨尔瓦多/流行病学卫生经费支出/统计学和数值数据卫生资源/分类卫生资源/利用卫生服务研究医院公立/经济学医院公立/组织和管理医院公立/利用年患病率人员配备和时间安排/统计学和数值数据疾病严重程度指数人类

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Researching the public/private mix in health care in a Thai urban area: methodological approaches

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HEALTH POLICY AND PLANNING 1998年第3期13卷 234-248页

作者： Pannarunothai, S Mills, A Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Buddhachinaraj Hosp Phitsanulok Thailand

The private health sector has been growing rapidly in many low and middle income countries, yet not enough is known about its sources of finance or characteristics of its users. Moreover, health care reform measures are leading to alterations in the mix of public and private finance and provision, increasing further the need for information. This paper presents and evaluates some research methods which can be used to collect information relevant to considering policies on the public/private mix. They comprise a household survey, a health diary and interview survey, a bed census, and a health resource survey. Each method is described as it was used in a study in a large urban setting in Thailand, and strengths and weaknesses of the methods are identified. The use of data to estimate the shares of public and private finance and provision, and particularly private sources of finance of public hospitals and public sources of finance for private hospitals, is demonstrated. Policy issues highlighted by the data are identified.

关键词：卫生保健改革卫生保健调查/方法卫生经费支出/统计学和数值数据医院私立/经济学医院私立/统计学和数值数据医院私立/利用医院公立/经济学医院公立/统计学和数值数据医院公立/利用收入/统计学和数值数据模型经济计量学私营部门/经济学私营部门/统计学和数值数据公共卫生管理/经济学公共卫生管理/统计学和数值数据社会经济因素泰国

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Private health care provision in developing countries: a preliminary analysis of levels and composition

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HEALTH POLICY AND PLANNING 1998年第3期13卷 195-211页

作者： Hanson, K Berman, P Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Harvard Univ Sch Publ Hlth Dept Populat & Int Hlth Boston MA 02115 USA

While the importance of the private sector in providing health services in developing countries is now widely acknowledged, the paucity of data on numbers and types of providers has prevented systematic cross-country comparisons. Using available published and unpublished sources, we have assembled data on the number of public and private health care providers for approximately 40 countries. This paper presents some results of the analysis of this database, looking particularly at the determinants of the size and structure of the private health sector. We consider two different types of dependent variable: the absolute number of private providers (measured here as physicians and hospital beds), and the public-private composition of provision. We examine the relationship between these variables and income and other socioeconomic characteristics, at the national level. We find that while income level is related to the absolute size of the private sector, the public-private mix does not seem to be related to income. After controlling for income, certain socioeconomic characteristics, such as education, population density, and health status are associated with the size of the private sector, though no causal relationship is posited. Further analysis will require more complete data about the size of the private sector, including the extent of dual practice by government-employed physicians. A richer story of the determinants of private sector growth would incorporate more information about the institutional structure of health systems, including provider payment mechanisms, the level and quality of public services, the regulatory structure, and labour and capital market characteristics. Finally, a normative analysis of the size and growth of the private sector will require a better understanding of its impact on key social welfare outcomes.

关键词：发展中国家卫生保健调查卫生经费支出/统计学和数值数据卫生资源卫生服务研究收入/统计学和数值数据私人开业/统计学和数值数据私营部门/经济学私营部门/统计学和数值数据社会经济因素

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Household health expenditures in Nepal: implications for health care financing reform

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HEALTH POLICY AND PLANNING 1998年第4期13卷 371-383页

作者： Hotchkiss, DR Rous, JJ Karmacharya, K Sangraula, P Tulane Univ Sch Publ Hlth & Trop Med Dept Int Hlth & Dev New Orleans LA 70012 USA Univ N Texas Dept Econ Denton TX 76203 USA

His Majesty's Government of Nepal has embarked on an ambitious social welfare programme of increasing the accessibility of primary education and health care services in rural communities. The implications on the financing of health care services are substantial, as the number of health posts has increased twelve-fold from 1992 to 1996, from 200 to 2597. To strengthen health care financing, government policy-makers are considering a number of financing strategies that are likely to have a substantial impact on household health care expenditures. However, more needs to be known about the role of households in the current structure of the health economy before the government designs and implements policies that affect household welfare. This paper uses the Nepal Living Standards Survey, a rich, nationally-representative sample of households from 1996, to investigate the level and distribution of household out-of-pocket health expenditures. Utilization and expenditures for different types of providers are presented by urban/rural status and by socioeconomic status. In addition, the sources of health sector funds are analyzed by contrasting household out-of-pocket expenditures with expenditures by the government and donors. The results indicate that households spend about 5.5% of total household expenditures on health care and that households account for 74% of the total level of funds used to finance the health economy. In addition, rural households are found to spend more on health care than urban households, after controlling for income status. Distributing health care expenditures by type of care utilized indicates that the wealthy, as well as the poor, rely heavily on services provided by the public sector. The results of this analysis are used to discuss the feasibility of implementing alternative health care financing policies.

关键词：发展中国家/经济学筹资政府/方法筹资个人/统计学和数值数据卫生保健改革/经济学卫生经费支出/统计学和数值数据卫生服务易得程度卫生服务研究尼泊尔乡村卫生服务/经济学乡村卫生服务/组织和管理农村人口市区人口

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Micro-level analysis of distributional changes in health care financing in Finland

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Journal of Health Services Research and Policy 1998年第1期3卷 23-30页

作者： Klavus, J. Hakkinen, U. STAKES Nat. R and D Centre Welfare Health Health Services Research Unit FIN-00531 Helsinki PO Box 220 Finland

Objectives: In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered. Method: The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index). Results: In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more. Conclusions: It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.

关键词：费用分担/统计学和数值数据费用分担/发展趋势筹资政府/统计学和数值数据筹资政府/发展趋势芬兰卫生保健改革卫生经费支出/统计学和数值数据卫生经费支出/发展趋势卫生服务研究收入/统计学和数值数据收入/发展趋势所得税膨胀通货国家卫生规划/经济学国家卫生规划/统计学和数值数据贫困/统计学和数值数据公营部门人类

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Changing the public-private mix: An assessment of the health reforms in Greece

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HEALTH CARE ANALYSIS 1998年第4期6卷 277-285页

作者： Liaropoulos, LL Kaitelidou, D Univ Athens Ctr Hlth Serv Management & Evaluat GR-15126 Athens Greece

The 1983 health reform in Greece was a major political event in the social policy agenda. The main objective of the reform was the institution of a National Health System and the expansion of the health sector, improved equity, and the assumption of full responsibility for health services delivery by the state. An assessment of the results 10 years after full implementation of the reform shows that despite the expansion of the public sector, the public-private mix in financing and delivery has changed in favour of the private sector, making the Greek health system the most 'privatised' among the EU countries. The main reasons why the health reform failed to meet its objectives was the restrictive enforcement of full-time and exclusive hospital employment for doctors, the virtual ban on private hospital expansion, the much faster introduction and diffusion of new health technology by the private sector, and poor management, planning and control in the public sector. A new health reform voted into law in the summer of 1997 shows promise of redressing some of the shortcomings of the 1983 reform. (C) 1998 John Wiley & Sons, Ltd.

关键词：行政管理人员筹资政府筹资组织/统计学和数值数据筹资组织/发展趋势希腊卫生保健改革/组织和管理卫生保健部门卫生经费支出/统计学和数值数据卫生经费支出/发展趋势保险健康医务人员医院国家卫生规划/经济学政治私营部门/经济学公营部门/经济学

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Reform follows failure: I. Unregulated private care in Lebanon

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HEALTH POLICY AND PLANNING 1997年第4期12卷 296-311页

作者： Van Lerberghe, W Ammar, W El Rashidi, R Sales, A Mechbal, A Inst Trop Med Dept Publ Hlth B-2000 Antwerp Belgium World Bank Washington DC 20433 USA WHO Beirut Lebanon

This first of two papers on the health sector in Lebanon describes how unregulated development of private care quickly led to a crisis situation. Following the civil war the health care sector in Lebanon is characterized by (i) ambulatory care provided by private practitioners working as individual entrepreneurs, and, to a small extent, by NGO health centres;and (ii) by a fast increase in hi-tech private hospitals. The latter is fuelled by unregulated purchase of hospital care by the Ministry of Health and public insurance schemes. Health expenditure and financing patterns are described. The position of the public sector in this context is analyzed. In Lebanon unregulated private care has resulted in major inefficiencies, distortion of the health care system, the creation of a culture that is oriented to secondary care and technology, and a non-sustainable cost explosion. Between 1991 and 1995 this led to a financing and organizational crisis that is the background for growing pressure for reform.

关键词：门诊医疗/组织和管理门诊医疗/统计学和数值数据发展中国家效率组织设施的规章和管理卫生保健改革卫生保健部门卫生经费支出/统计学和数值数据医院私立/组织和管理黎巴嫩未参加医疗保险者国家卫生规划私营部门公营部门战争

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