Medical Insurance Scheme Research Articles

Rules & Regulations

First Private Hospital Covered by Reformed Medical Insurance Scheme. Jiangsu Lifts Restrictions on Sales of Class B OTC Drugs. India’s Drug Prices Revision. Japan Revises Parent-Child Legislation. GM Pet Fish Makes Splash in Japan.

Rules & Regulations

Guangdong Encourages Private Investment into Community Healthcare Centers. Hunan Expands Basic Medical Insurance Scheme. Copycats in India Likely to Benefit under US New Generics Law. Biotechnology Strategy Released by New Zealand Government.

Explaining Social Policy Adoption in South Korea: the Cases of the Medical Insurance Law and the Minimum Wage Law

Although policy priority has always been on economic management in East Asian countries, those countries also developed some notable social policies. However, explanations for the development of social policies in those countries have been relatively underdeveloped compared to those of their economic management policies. This study adds to our understanding of the social policy development in East Asia by examining two cases of social policy adoption in South Korea – the Medical Insurance Law and the Minimum Wage Law. This Korean case study shows a pattern of policy development primarily driven by particular ‘interests’ (state elites' perceived political survival needs and their reputation in international society), with ‘environmental’ factors and ‘policy legacies’ playing a supplementary role. In particular, these policies are interpreted as anticipatory concessions to moderate members of Korean society by the state elites who aimed to stabilise their regimes by separating radicals from moderates. In addition, the medical insurance scheme is understood as a by-product of the competition between the South and North Korean regimes. This study also draws our attention to such issues as the similarities and differences between the East Asian welfare regimes and the change and continuity in the development of social policies in East Asia.

Managed care systems in the people's republic of china

This article attempts to determine whether or not managed care is the way forward for health services systems reforms in urban China. It first highlights the problems of the present Chinese urban health care financing system, which is largely based on third party fee-for-service reimbursement. It then analyses the salient features of three existing managed care systems in China -private plans, plans under the existing public and labor medical insurance systems, and the newly introduced pilot Employees Medical Insurance Scheme. Available evidence tend to suggest that all of them have been quite effective in controlling cost escalation, and that there have been some improvement in terms of equity under the new Employees Medical Insurance Scheme.

The French health care system and its reform

The French health care system is characterized by its social insurance scheme with universal coverage, freedom of prescription and of location by the doctor, fee-for-service payment by patients, and free choice of doctor by patients, which essentially tends to inflate its health expenditures. Thus, the health expenditures of France has been increasing over the average expenditures of other European countries. Under the principle of autonomy of the social insurance fund, the increase in medical expenditures has been absorbed by a decrease in the reimbursement rate and an increase in the contribution rate of the insured. However, it is no longer possible to cope with this financial crisis by these traditional measures because of the worsening of the unemployment problem. Nowadays, the increase in the contribution rate is regarded as one of the important reasons for the economic stagnation of the French society. In order to cope with this difficult situation, the French government has changed its health policy from the demand side strategy to the supply side strategy. The concrete plan of this policy was presented by Prime Minister Alain Juppé (the Juppé plan). The plan consists of; 1) unification of the medical insurance scheme, 2) establishment of a ceiling on medical expenditures, 3) regionalization of health policy, 4) disclosure of medical information, 5) introduction of medical references, 6) creation of a social protection scheme for the dependent elderly, 7) introduction of an object tax for the social security fund, etc. These subjects have been materializing step by step after many twists and turn. The most important principles of the plan are the transparency of the medical information and the responsibility of each actor within the health system. The French government has conducted a lot of international comparable studies of health systems. According to the results of a series of active and profound discussions, the French government has conducted various social experiments. It is very meaningful for the Japanese government to analyze this process of health reform occurring in France in order to discuss the health system reforms in Japan.

Management of nontuberculous mycobacteriosis in health centers and tuberculosis surveillance system

Nontuberculous Mycobacteriosis (NTM) is a different disease from tuberculosis, but in Japan most of them are still obliged to be treated as tuberculosis under medical insurance scheme and included statistically in the number of tuberculosis. In this investigation, patients of NTM who were at first registered as tuberculosis and diagnosed later as NTM or found to be positive for nontuberculous mycobacteria were analysed from the standpoint of tuberculosis statistics and activities at health centers. Out of 1207 newly registered tuberculosis in 1993 at 23 health centers (HCs) or its branches in Hiroshima Prefecture, 482 cases were bacteriologically positive, and among them 40 cases were found to be NTM later. Under the current tuberculosis surveillance system, 4 cases from 1 HC were omitted from the tuberculosis registry, 10 cases from 4 HCs were kept on the tuberculosis registry as 'culture positive for nontuberculous mycobacterium', 15 cases from 7 HCs were registered as 'tuberculosis with nontuberculous mycobacteriosis as a complication' and in 11 cases no informations on NTM were entered into the registry. Only 6 smear positive cases which were registered as 'culture positive for nontuberculous mycobacteria' were excluded from the number of smear positive tuberculosis under the surveillance system. In other investigation made by hospitals in the same area on NTM, 59 patients with definite NTM were reported in 1993. At least 52 were registered first as tuberculosis, thus NTM occupies at least 4.3 percent of all newly reported tuberculosis and 10.8 percent of new smear positive cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Captive Medical Insurance Schemes using UK Trusts

Captive Medical Insurance Schemes using UK Trusts

THE SWEDISH MEDICAL INSURANCE SCHEMES: The Way Ahead for the United Kingdom?

THE SWEDISH MEDICAL INSURANCE SCHEMES: The Way Ahead for the United Kingdom?

Private Practice, Public Payment: Canadian Medicine and the Politics of Health Insurance, 1911-1966

Naylor's particular concern is with the nature and extent of the medical profession's opposition at both the provincial and federal levels. He details various developments in medical politics and policies, including the dispute over state health insurance plans in British Columbia during the depression, the national health insurance program drafted by the King government, the doctors' strike in Saskatchewan, and the development and eventual governmental rejections of prepayment plans sponsored by organized medicine. The author concludes that physicians regarded medical insurance schemes over which they had little administrative control, or where coverage was not limited to the indigent or to those earning below a modest wage, as threats to professional incomes and autonomy. His analysis of the evolution of the professional perspectives, policies, and pressure group activities suggests that physicians are as likely to act in their own economic and social interest as any other group, and that they oppose legislation that would threaten these interests while supporting laws that strengthen them. Since the Medical Care Act became law, Ottawa has moved to strengthen health care plans in the provinces, and once again the medical profession has resisted. The final chapter in Naylor's book puts these current conflicts in historical perspective by linking them to their political precedents.

Health Care for the Elderly in Canada

This article, written with American readers in mind, contains a number of comparisons of health data between the two countries—demographic and epidemiological, health care resources and expenditures. Although Canada sustains a much higher rate of institutional care (both acute and chronic) for the elderly than the United States, and has about the same level of availability of physicians, it expends considerably less per capita and as a percentage of the GNP or GDP. Part of the answer may be found in the much lower proportion of funding in the private sector in Canada. Federal funding for long term care has been provided not only through Canada's national hospital and medical insurance schemes but also in its Extended Health Care Services Program and Canada Assistance Plan. Provincial developments include a rapidly increasing variety of long term care services (both institutional and community) and much more readily available long term care insurance. This is occurring in all parts of the country though at different rates. A recently completed key informant survey emphasized the following issues: interprofessional rivalry and competition between the medical and social models; excessive institutionalization and medicalization; lack of interest in prevention of disease in the elderly; and cost constraints. The importance of housing, income and support for caregivers was also emphasized.

Ten years of national health service in Canada.

Ten years ago the medical profession in Canada was conscripted into a compulsory national health insurance scheme without any prior consultation. Predictions that an open-ended, so-called "free" medical insurance scheme would lead to cost overruns and deterioration of medical services as well as inflationary trends have come true. Federal and provincial governments now attempt to contain costs by closing active treatment beds or filling them up with chronic patients and by attrition of existing facilities. Compulsory national health insurance has not led to lower morbidity nor greater longevity. It has only provoked an insatiable demand from the public for more "free" services, with the result that the system has become a quagmire of cost overruns and unfulfilled and unrealizable promises.

The American Medical Association and the Supply of Physicians

Since the end of World War II there has been an .almost continuous debate concerning numerous aspects of the medical care industry in the United States. The profound public interest in the provision 'of adequate medical services is reflected in thousands of pages of congressional hearings, countless discussions in popular periodicals and the press, and millions of dollars voted for the construction of hospital facilities, medical research, and aid to the needy for medical care. Given the facts of rapidly growing private medical insurance schemes, the pressure for federally financed medical care insurance for the aged, and sharply rising medical costs-the fastest rising component in the consumer price index' -the issue of medical care is destined to be a major topic for public debate and legislative consideration throughout the current decade. Without minimising the significance of the large number of quantitative and qualitative factors that determine the level of medical care received by the American people, it is self-evident that a key variable in the provision of medical services is the number of physicians. No matter how the costs of medical care are financed, whether through expanded private insurance programmes, the extension of the social security system to include payments for medical care, or more drastically, through the adoption of a full-fledged national health insurance programme, the number of doctors available places a severe limitation on the amount and quality of medical services that can be provided. In recognition of this fact, three major governmental studies-the Magnuson report in I953,2 The Baynes-Jones report in I958,3 and the Bane report in I959,4-called for federal aid for both scholarships or loans to medical students and for the construction and expansion of medical school facilities. Following the recommendations of the Bane report, President Kennedy called on Congress to provide funds which would assist in the construction of twenty new medical schools by I970 and make substantial scholarship assistance available for medical students.5