Healthcare reform

From Wikipedia, the free encyclopedia

Healthcare reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects healthcare delivery in a given place. Healthcare reform typically attempts to:

• Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies
• Expand the array of health care providers consumers may choose among
• Improve the access to health care specialists
• Improve the quality of health care
• Decrease the cost of health care

Contents 1 Netherlands 2 Russia 3 Taiwan 4 United Kingdom 5 United States 6 Elsewhere 7 See also 8 References 9 External links

[edit] Netherlands

See also Health care in the Netherlands

The Netherlands has introduced a new system of health care insurance based on risk equalization through a risk equalization pool. In this way, a compulsory insurance package is available to all citizens at affordable cost without the need for the insured to be assessed for risk by the insurance company. Indeed health insurers are now willing to take on high risk individuals because they receive compensation for the higher risks ^[1].

A 2008 article in the journal Health Affairs suggested that the Dutch health system, which combines mandatory universal coverage with competing private health plans, could serve as a model for reform in the US.^[2][3]

A video (in Dutch and English) is available which explains the reforms. Subtitles in English are available by clicking the 'T' control on the video control after clicking this link.

[edit] Russia

See Health care reform in Russia

Following the collapse of the Soviet Union, Russia embarked on a series of reforms intending to deliver better health care by compulsory medical insurance with privately owned providers taking the role of the former state run institutions. According to the OECD ^[4] none of this worked out as planned and the reforms had in many respects made the system worse.

[edit] Taiwan

Taiwan changed its health care system in 1995 to a National Health Insurance model similar to the US Medicare system for seniors. As a result, the 40% of Taiwanese people who had previously been uninsured are now covered.^[5] It is said to deliver universal coverage with free choice of doctors and hospitals and no waiting lists. Polls in 2005 are reported to have shown that 72.5% of Taiwanese are happy with the system, and when they are unhappy, it's with the cost of premiums (equivalent to less than US$20 a month).^[6]

National Health Insurance or NHI premiums is similar to that of social security contributions in the US. Employers and the self-employed are legally bound to pay them. Unlike funds raised via US social security taxes, which can be borrowed in the interim to fund military and other spending, the NHI is a pay-as-you-go system. The aim is for the premium income to pay costs, but there is also a tobacco tax surcharge that goes to the NHI, and contributions from the national lottery.^{[citation needed]}

[edit] United Kingdom

This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2009)

Health care was reformed in 1948 with the creation of the National Health Service or NHS. It was originally established as part of a wider reform of social services and funded by a system of National Insurance, though receipt of health care was never contingent upon making contributions towards the National Insurance Fund. Private health care was not abolished but had to compete with the NHS. About 15% of all spending on health in the UK is still privately funded but this includes the patient contributions towards NHS provided prescription drugs, so private sector health care in the UK is quite small. As part of a wider reform of social provision it was originally thought that the focus would be as much about the prevention of ill-health as it was about curing disease. The NHS for example would distribute baby formula milk fortified with vitamins and minerals in an effort to improve the health of children born in the post war years as well as other supplements such as cod liver oil and malt. Many of the common childhood diseases such as measles, mumps, and chicken pox were mostly eradicated with a national program of vaccinations.

The NHS has been through several reforms since 1948 although it is probably fairer to say that the system has been through phases of evolutionary change. The Conservative Thatcher administrations attempted to bring competition into the NHS by developing a supplier/buyer role between hospitals as suppliers and health authorities as buyers. This necessitated the detailed costing of activities, something which the NHS had never had to do in such detail, and some felt was unnecessary. The Labour Party generally opposed these changes, although after the party became New Labour, the Blair government retained elements of competition and even extended it, allowing private health care providers to bid for NHS work. Some treatment and diagnostic centres are now run by private enterprise and funded under contract. However, the extent of this privatisation of NHS work is still very very small, though remains controversial. The administration committed more money to the NHS raising it to almost the same level of funding as the European average and as a result, there has been a large expansion and mordernisation programme and waiting times are now much more acceptable than they once were.

The government of Gordon Brown has announced several new reforms for care in England. One is to take the NHS back more towards health prevention by tackling issues that are known to cause long term ill health. The biggest of these is obesity and related diseases such as diabetes and cardio-vascular disease. The second reform is to make the NHS a more personal service, and it is negotiating with doctors to provide more services at times more convenient to the patient, such as in the evenings and at weekends. This personal service idea would introduce regular health check-ups so that the population is screened more regularly. Doctors will give more advice on ill-health prevention (for example encouraging and assisting patients to control their weight, diet, exercise more, cease smoking etc.) and so tackle problems before they become more serious. Waiting times, which have already fallen considerably under Blair (median wait time is about 6 weeks for elective non-urgent surgery) are also in focus. The NHS will from December 2008, ensure that no person waits longer than 18 weeks from the date that a patient is referred to the hospital to the time of the operation or treatment. This 18 week period thus includes the time to arrange a first appointment, the time for any investigations or tests to determine the cause of the problem and how it should be treated.

[edit] United States

Health care reform in the United States
General
Debate for and against History Public opinion Drug prices Uninsured
Specific bills
America’s Affordable Health Choices Act Healthy Americans Act United States National Health Care Act
Systems
Canadian and American health care systems compared National health insurance Publicly-funded health care Single-payer health care Health insurance exchange Universal health care
Reform advocacy groups
American Medical Student Association California Nurses Association/National Nurses Organizing Committee Healthcare-NOW! Physicians for a National Health Program Progressive Democrats of America
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The debate over healthcare reform in the United States centers around questions of a right to health care, access, fairness, sustainability, and quality purchased by the high sums spent. The mixed public-private health care system in the United States is the most expensive in the world, with health care costing more per person than in any other nation, and a greater portion of gross domestic product (GDP) is spent on it than in any other United Nations member state except for the Marshall Islands.^[7] A study of international health care spending levels in the year 2000, published in the health policy journal Health Affairs, found that while the U.S. spends more on health care than other countries in the Organisation for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.^[8]

The U.S. is the only wealthy, industrialized nation that does not have a universal health care system, according to the Institute of Medicine of the National Academy of Sciences and others.^[9][10] Americans without health insurance coverage at some time during 2006 totaled about 16% of the population, or 47 million people.^[11] In addition, many of those with insurance are not sufficiently insured^[12][13], with high-deductible policies, policies that do have limits on what they will pay for or policies that cost a significant percentage of their income^[14].

In spite of the amount spent on health care in the US, according to a 2008 report, the United States ranks last in the quality of health care among developed countries.^[15] The World Health Organization (WHO), in 2000, ranked the US health care system 37th in overall performance and 72nd by overall level of health (among 191 member nations included in the study).^[16][17] International comparisons that could lead to conclusions about the quality of the health care received by Americans are subject to debate. The US lags other wealthy nations in such measures as infant mortality and life expectancy, but some argue that these differences have little to do with the structure of its health care system.^{[citation needed]}

Whether a government-mandated system of universal health care should be implemented in the U.S. remains a hotly debated political topic, with Americans divided along party lines in their views of the US health system and what should be done to improve it. Reform proposals include restructuring the private health insurance market, the establishment of a "public option" such as opening Medicare to all, employer "pay or play" requirements, premium subsidies to help individuals purchase health insurance, increased use of health information technology, research and incentives to improve medical decision making, reduced tobacco use and obesity, reforming the payment of providers to encourage efficiency, limiting the tax federal exemption for health insurance premiums, and reforming several market changes such as resetting the benchmark rates for Medicare Advantage plans and allowing the Department of Health and Human Services to negotiate drug prices.

A fundamental problem in evaluating reform proposals is the difficulty of estimating their cost and potential impact. Because proposals often differ in many important details, it is difficult to provide meaningful side-by-side cost comparisons. The empirical data and theory underlying cost estimates in this area are limited and subject to debate, increasing the variation between estimates and limiting their accuracy.^[18]

[edit] Elsewhere

This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2009)

As evidenced by the large variety of different health care systems seen across the world, there are several different pathways that a country could take when thinking about reform. Germany for instance, makes use of sickness funds, which citizens are obliged to join but are able to opt out if they have a very high income (Belien 87). The Netherlands used a similar system but the financial threshold for opting out was lower (Belien 89). The Swiss, on the other hand use more of a privately based health insurance system where citizens are risk-rated by age and sex, among other factors (Belien 90). The United States government provides health care to just over 25% of its citizens through various agencies, but otherwise does not employ a system. The free market provides the balance of health care services, generally centered around modestly regulated private insurance methods.

[edit] See also

• Health care in the United States
• Health care reform in the United States
• Healthcare-NOW!
• Healthcare system reform in the People's Republic of China
• Journal of Health Care for the Poor and Underserved
• Kaiser Family Foundation
• List of healthcare reform advocacy groups in the United States
• Massachusetts health care reform
• Medical cannabis
• Medicare Rights Center
• National health insurance
• National Physicians Alliance
• Progressive Democrats of America
• Puerto Rico Health Reform
• ShoutAmerica
• Single-payer health care
• United States National Health Care Act
• Universal health care
• Health care politics

[edit] References

[edit] External links

• Physicians support overhaul of U.S. healthcare system
• Health Revolution Petition