Prepaid Program Research Articles

Analysis on the equity differential on household healthcare financing in developing countries: empirical evidence from Tanzania, East Africa

BackgroundAchieving equity in healthcare services has been a global priority. According to the literature, a slew of initiatives aimed at increasing household equity in healthcare financing have exacerbated the problem, making it hard for most developing countries to understand the real cause of the problem.MethodThe non-experimental research design has been used to explore the Tanzania Panel Survey (NPS) data 2019/2020, to investigate equity differential in household healthcare financing in Tanzania by the use of conventional instrumental variable methods of Two-stage and Three-stage least square methodsResultsDespite the global agenda of universal health coverage, this paper reveals that 86 percent of Tanzania lacks health insurance with a high degree of inequitable distribution of health facilities as 71.54 percent of the population is in rural areas, yet these areas have poor health systems compared to urban ones. These disparities increase pressure on household healthcare financing and widen the inequity and equality gaps simultaneously. Additionally, a household's income, education, health care waivers, out-of-pocket expenditure, and user fees have been found to have a significant impact on household equity in healthcare financing.ConclusionTo reverse the situation and increase equity in household healthcare financing in most developing countries, this paper suggests that an adequate pooling system should be used to allow more people to be covered by medical prepayment programs, and the donor-funded programs in developing countries should focus on health sector infrastructure development and not the capacity building.

Prepaid electricity and in-home displays: An alternative for the most vulnerable households in Colombia

Exploiting the implementation of a Prepaid Electricity Program in the region of Antioquia (Colombia), we estimate the impact that switching to a prepaid program has on users’ energy consumption behavior. In particular, we focus the analysis on those that are more vulnerable from a socio-economic perspective. The results show that the new metering scheme and the information provision is associated with a decline in electricity consumption.This scheme allow users to improve their consumption paths, while their access to public electricity services is guaranteed, minimizing disconnection risks and the associated costs.

Prepayment effect: Prepayment with clawback increases task participation

What constitutes effective means, other than increasing payment, to turn non-participants into participants in a task/program is an important concern in marketing and management. Although prepayment that leverages reciprocity was shown to increase mail response rates, it failed to apply to other contexts. The current study incorporated the element of commitment and clawing back in a prepayment program and successfully extended such program's effect on individuals' participation (vs. effort). By leveraging present bias and loss aversion, we were able to motivate individuals' willingness to accept the prepayment initially and then to show up for tasks subsequently. The proposed prepayment program has a wide range of potential applications.

PREPAID ELECTRICITY PLAN AND ELECTRICITY CONSUMPTION BEHAVIOR

By using customer‐level residential billing data from 2008 to 2010 of a major utility company in Phoenix metropolitan area, this study adopts a matching approach and a difference‐in‐differences method to estimate empirically the impact of a prepaid electricity plan on residential electricity consumption, after correcting for selection bias. Results show that the prepaid program is associated with a 12% reduction in electricity usage, customers with lower level of wealth or those with higher amount of arrearage prior to switching to the prepaid program tend to save more electricity after switching, and prepaid customers save more electricity in the summer than winter. (JEL L94, Q41)

Prepaid Cards and Overdraft

In the last few years, store gift certificates have matured into a diverse set of products including open loop prepaid cards capable of providing services traditionally reserved to banks. At the same time, tighter regulations on banks have raised the cost of bank accounts and driven many out of the banking market. Prepaid card providers including merchants like Walgreens are seeking to serve this new unbanked population with bank-like services including overdraft protection. Consumer groups have not given these new services a warm reception. In some cases, their concerns were warranted as prepaid programs made an end run around payday lending laws. However, recent actions have left companies in a quandary as to the precise limits of laws against deceptive and unfair practices. This paper seeks to survey regulatory actions, guidance, and current law to suggest a set of best practices that will allow companies to provide the innovative products that consumers are demanding while ensuring that they remain financially sound.

The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care by Tom Debley, Jon Stewart

THE STORY OF DR. SIDNEYR.GARFIELD: THEVISIONARY WHO TURNEDSICK CARE INTOHEALTH CARE byTomDebley in collaboration with Jon Stewart The Permanente Press, Oakland, California, and Portland, Oregon, 2009. Photographs, bibliography, index. 168pages. $19.95 paper. Everyone knows the Kaiser name, and spe cificallyHenry J. Kaiser. But how many know that Sidney R. Garfield was Kaiser's partner in the development of Kaiser Permanente, responsible forestablishing and expanding the principle ofprepayment health care combined with multispecialty group practice dedicated to prevention and maintenance of health? This short book, written by theDirector of theKaiser Permanente archives, tells Garfield's story,a narrative that isentwinedwith the rise of Kaiser Permanente. After completing his surgical residency in 1933at theLos Angeles County General Hospi tal, with thehelp of a loan fromhis father, Gar field constructed a twelve-bed hospital east of Los Angeles on the edge of the Mojave Desert. He named his small building theContractors General Hospital, aiming to provide medical care to the thousands ofworkers building the aqueduct to deliver Colorado River water to Los Angeles. Alonzo B. Ordway and Harold Hatch, both from the largest insurance company involved with theaqueduct project,became friendswith Garfield and viewed thehospital as essential in providing medical care to theworkers. Itwas Hatch who firstproposed a prepayment pro gram, amounting to a nickel a day per worker. Garfield immediately saw thathewould make more money by improving the health of the workers and preventing accidents; this insight was his unique contribution of combining pre payment with preventive health care. Finally, Garfield broadened theconcept ofprepayment by providing totalhealth care for theworkers and their families for another nickel per day paid by theworkers themselves. The concept worked, and Garfield prospered. Henry J. Kaiser's son Edgar was in charge of the consortium of contractors building theGrand Coulee Dam. When fatherand son wanted to provide medical care for thework ers on theGrand Coulee dam, they turned to Garfield. Edgar Kaiser supported the prepay ment and preventive care philosophy, and beginning in 1938, Garfield organized a group practice in the Mason CityHospital at thedam site.Garfield provided total familyhealth care for50 cents permonth foradults and 25 cents per child. When World War II made shipbuilding magnates of theKaiser family,Garfield, now thirty-five years old, was recruited to care for thousands ofworkers infour shipyards inCali fornia and Oregon, using his now-established program.With the end of thewar, many of the shipyardworkers remained in the West and, already familiarwith prepaid health care, eagerly signed up with the new non-profit Permanente Health Plan.When labor unions joined the program, the size and resources exploded. From near extinction in 1945, by 1950, there were about 250,000 members, and the Permanente Medical Group had 125 physicians. Eventually, Henry J.Kaiser and Garfield came to an impasse, culminating in a pivotal organization meeting in 1955. Kaiser aggres sively increased his involvement in the pro gram, and theKaiser physicians began to chafe under Garfield's direction. An agreement was reached in 1955, removing Garfield from his leadership position, and theorganization was named Kaiser Permanente. The name "Perma nente"was the suggestionofBess Kaiser,Henry J.'s first wife. On theKaiser private grounds on the San Francisco peninsula, awaterway that flowed year around bore the Spanish name Permanente Creek. Garfield turned his attention to designing and building new hospitals with innovations that earned critical praise. With enormous Reviews 643 foresight in the 1960s, he began to propose a reorganization ofmedicine with computers playing a central role ? thisat a timewhen the computer was amassive IBM machine using punch cards.He fine-tuned theKaiser model into something he called theTotal Health Care Project,described inScientific American in 1970, that laterbecame theKaiser blueprint, caring for about 9million members and employing more than 13,000 physicians. Garfield died inhis sleep at age seventy-six, on December 29,1984. He lefta history that contains lessons for the present. As America struggles to provide effective and efficient health care in thetwenty-first century, many of theconcepts and plans being articulated can be found inGarfield's story.It would be useful for present-day legislators to read theKaiser his tory, as recordedbyRickeyHendricks in 1993 in his book entitledAModel forNational Health Care: TheHistory of Kaiser Permanente (Health...

Tuition Inflation, Prepayment Programs, and the Mispricing of Tuition Prepayment Contracts

Twenty-two states and a consortium of more than 250 private colleges have designed tuition prepayment contracts to help families manage their tuition inflation risk exposure by prepaying the future cost of college. Nine of these states have either suspended enrollments (one temporarily) or terminated their plans, and at least 12 programs are balance-sheet insolvent. This paper analyzes college tuition inflation, describes tuition prepayment contracts, and develops a contingent-claims model to price them. The model allows for the adverse selection risk that program sponsors face, the moral hazard risk that contract purchasers bear, and the large discontinuous jumps that characterize tuition inflation especially in recent years. I find that the contracts in the largest, most popular public (Florida and Michigan) and private (Independent 529 Plan) programs are mispriced. The Florida and Independent 529 Plan contracts are underpriced, and Michigan's contracts are underpriced for the youngest beneficiaries and overpriced for the oldest beneficiaries even after allowing for adverse selection risk. Florida and Michigan have reduced their underpricing in the last three years, which coincide with public universities in many states announcing large jumps in tuition in response to cutbacks in state subsidies for higher education.

Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome

Study Objective: Cost concerns may inhibit emergency medical services (EMS) use. Novel tax-based and subscription prepayment programs indemnify patients against the cost of EMS treatment and transport. We determine whether the presence of (or enrollment in) prepayment plans increase EMS use among patients with acute chest discomfort, particularly those residing in low-income areas, those lacking private insurance, or both. Methods: This study uses a subset of baseline data from the REACT trial, a multicenter, randomized controlled community trial designed, in part, to increase EMS use. The sample includes 860 consecutive noninstitutionalized patients (>30 years old) presenting with nontraumatic chest discomfort to hospital emergency departments in 4 Oregon/Washington communities. The association between prepayment systems and EMS use was analyzed using multivariable logistic regression. Results: Overall EMS use was 52% (n=445). Among EMS users, 338 (75%) were subsequently admitted to the hospital and 110 (25%) were released from the ED. Prepayment was not associated with increased EMS use in the overall patient sample. However, patients residing in low-income census block groups (median annual income <$30,000) were 2.6 times (95% confidence interval [CI] 1.4 to 4.8) more likely to use EMS when a prepayment system was available than when no system was present. No association was noted among higher-income block group residents. Among low-income block group residents lacking private insurance, prepayment systems were associated with 3.8 times (95% CI 1.2 to 13.4) greater EMS usage. Conclusion: Economic considerations may affect EMS system utilization among underinsured and low-income patients experiencing a cardiac event. Prepayment systems may increase EMS utilization among these groups. [Seipmann DB, Mann NC, Hedges JR, Daya MR, for the Rapid Early Action for Coronary Treatment (REACT) Study. Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome. Ann Emerg Med. June 2000;35:573-578.]

Readiness for Medicaid managed care reform initiatives: a profile of rural family physicians.

Medicaid managed care is now an important factor in the financing of rural health care delivery. The participation of rural family physicians in Medicaid managed care is vital for the rural poor to access health services. This study examined 855 family physicians practicing in nonmetropolitan counties across the United States to determine their readiness to participate in Medicaid managed care. Physicians were asked about their experience with prepaid programs and the factors that would influence their participation in such a program. A shortage of health care providers and low reimbursement rates were most frequently cited as barriers to successful implementation. Physicians who had participated in prepaid programs in the past but were no longer participating had the most negative opinions about the potential for Medicaid managed care programs to enhance care for the poor in their communities. Overall, physicians reported potential for the program to improve access and quality of care, but they also expressed reservations about the financial and administrative effects on their practices. These results reveal that negative attitudes were associated with prepaid programs that failed to meet expectations, but physicians also expressed an optimism about the potential to serve the poor within a managed care model.

Can Physicians Manage the Quality and Costs of Health Care? The Story of The Permanente Medical Group

Many professionals in health and medicine who are concerned with mounting problems in the provision of medical care will find much of interest in this volume. It presents the response of Henry J. Kaiser, the great corporate contractor, to the challenges he confronted on the western industrial frontier that ushered in a lasting revolution in the provision of medical care. The author, John G. Smillie, MD, spent many years directing parts of the program he describes and has produced a book that will undoubtedly become the standard treatment of the Kaiser Permanente Medical Plan. Innovative methods in the delivery of medical care were nothing new when what became the foundation for the Kaiser Medical Program took shape in the 1930s. The federal government had introduced a prepayment program for merchant seamen in the late 18th century. Contract medical service reached back to the colonial era and gained a firm urban

Guaranteed Student Loan Prepayment: How Much of a Free Lunch Is There?

The Federal Government would enjoy reduced “special allowance" payments to lenders in the Guaranteed Student Loan program if borrowers prepaid their loans. This article investigates the extent to which borrowers might be induced to prepay by an offer from the Government to share a portion of its savings expected from prepayment. The analysis suggests that potential savings are not likely to be large enough to induce significant prepayment and that, accordingly, establishment of a prepayment program is not likely to be cost effective. A longer version of this paper, with full derivation of the model used, is available from the author on request.

Hospital Data on Duodenal Ulcers: A Base for the Cost-Benefit Assessment of Antiulcer Drugs

The late 1970s formed an opportune time to measure the effect of recent advances in the treatment of peptic ulcer (PU). Beginning in August 1977, the Food and Drug Administration had approved cimetidine to treat duodenal ulcers (DU). Combined with cimetidine's wide distribution and use, this step made it feasible to assess the effect of this innovation on the frequency of PU disease in populations; for some time before, this incidence had been diminishing in the United States and other developed countries.In that same era in the United States, hospital inpatient care had come to be viewed as costly, even extravagant for many conditions. Staff of prepayment programs and other health personnel often implied that charges for drugs were excessive. Related to antiulcer drugs, utilization data came promptly from the National Disease and Therapeutic Index. These data showed that DU patients attending the offices of private physicians were weaned swiftly from antacids to cimetidine as their main therapy. It thus ...

Health information needs of medicaid enrollees and medically underinsured

A convenience sample of 349 inner-city black patients attending a public health ambulatory clinic were interviewed with regard to their health information needs and level of understanding of Medicaid's fee-for-service and prepaid programs. The 264 Medicaid enrollees were most knowledgeable of benefits available under fee-for-service. The 85 persons classified as “medically underinsured” were most concerned with the costs of care and long waiting times. Both groups cited quality of care as the most important factor influencing their selection of provider. The implications of the survey findings for nurses serving medically indigent patients in ambulatory settings are discussed.

Hospital-physician relations under hospital prepayment.

Fundamental changes now occurring in the field of health services may make it increasingly difficult to develop or maintain satisfactory hospital-physician relations. This paper examines the nature of hospital-physician relations following the introduction of an experimental hospital prepayment program that capped budgets in nine hospitals for a 5-year period. Results from longitudinal analyses based on data from key physicians, hospital administrators, and board members indicate generally positive "effects" on hospital-physician relations, except for increased strain in the system. In most respects, there were no adverse effects on the work relations of physicians, in the perceived quality of medical care, or in the institutional performance of physicians at the nine participating hospitals after the introduction of prepayment. Moreover, to some extent, the prepayment program appears to have been effective in controlling hospital costs and is perceived by the principal participants to have been successful.

Choice of payment plan in the Medicare capitation demonstration.

This article identifies factors that influence the choice between joining an HMO and remaining with the traditional fee-for-service system among aged Medicare beneficiaries in three communities. Sources of marketing information were found to be strongly and positively related to the decision to join the HMO. Among beneficiaries who had to switch providers to join, persons who had a prior usual source of care and those who were satisfied with the amount of paperwork required to use that source of care were less likely to enroll in the HMO. Persons who did not have to switch providers to join the HMO were more likely to enroll in the prepaid program if they were satisfied with the amount of paperwork involved in using the HMO prior to the demonstration. Differences among the three communities suggest that the barrier to HMO enrollment presented by having a prior source of care who is not affiliated with the HMO may attenuate as the number of competing HMOs in the community increases, making the medical care environment more competitive. In the community with the most HMOs, persons who already had supplemental insurance were less likely to enroll than those who did not. None of the six HMOs studied experienced adverse selection, based on pre-enrollment health status.

The Prevalence of Hypovitaminosis C

<h3>To the Editor.—</h3> I wish to respond to the magnificent report by Reuler et al¹in which they point out the protean nature of adult scurvy and raise the question as to the real incidence and prevalence of hypovitaminosis C. I should like to provide two specific pieces of data. First, Schorah²reviewed the literature on this very subject (Table) and concluded that somewhere between 3% of young and healthy subjects and 100% of the institutionalized young suffer from hypovitaminosis C and 0% (healthy young subjects) to 50% (institutionalized elderly) may possibly demonstrate classic scurvy. In our clinic we have examined the epidemiology of vitamin C in four unique populations with over 4,000 subjects including the following: (1) a dental school patient population,³(2) patients in a dental prepayment program,⁴(3) orthodontic patients,^5,6and (4) a selected group of Floridian dentists and their staffs.^7,8Depending

The prevalence of hypovitaminosis C

<h3>To the Editor.—</h3> I wish to respond to the magnificent report by Reuler et al¹in which they point out the protean nature of adult scurvy and raise the question as to the real incidence and prevalence of hypovitaminosis C. I should like to provide two specific pieces of data. First, Schorah²reviewed the literature on this very subject (Table) and concluded that somewhere between 3% of young and healthy subjects and 100% of the institutionalized young suffer from hypovitaminosis C and 0% (healthy young subjects) to 50% (institutionalized elderly) may possibly demonstrate classic scurvy. In our clinic we have examined the epidemiology of vitamin C in four unique populations with over 4,000 subjects including the following: (1) a dental school patient population,³(2) patients in a dental prepayment program,⁴(3) orthodontic patients,^5,6and (4) a selected group of Floridian dentists and their staffs.^7,8Depending

Marketing ambulatory care centers: assessment, implementation, evaluation.

Associate Administrator Planning and Marketing Administrator Satellite and Prepayment Programs Henry Ford Hospital Detroit, Michigan

Quality Assurance and Prepaid Programs

This article presents the concepts of quality assurance and the various mechanisms that are employed in quality assurance systems. The implications for quality assurance are discussed in relation to the major types of prepaid programs. Capitation dental plans have certain opportunities to engage in quality assurance, whereas indemnity plans face a more complex set of constraints. Each type of plan faces different problems and requirements, and each needs to design quality assurance systems that address their concerns.

Cost-effectiveness of sealants in private practice and standards for use in prepaid dental care

Whether sealants are more cost-effective than restorative dentistry in reaching dental health goals for patients of private practitioners will depend on the relative excellence of materials and techniques, and on the values of prevention per se held by practitioner and patient. Given this heavy dose of subjectivity in the equation, it is doubtful if experimental cost-effectiveness studies of sealants in private practice will be fruitful. A more likely approach to answering questions on cost-effectiveness would be empirical testing of sealant reimbursement in prepayment programs under the standards suggested.