Private Insurance System Research Articles

Market forces in healthcare insurance: The impact of healthcare reform on regulated competition revisited

AbstractThe Dutch healthcare insurance reform in 2006 replaced the dual system of public and private insurance with a single compulsory health insurance scheme, in which insurance providers compete for customers in a free market. This paper investigates whether competition among healthcare insurers has indeed increased and their efficiency has improved. We measure competition directly from either shifts in market shares, or developments in profits, using Dutch regulatory data. We find that a structural break occurs after the reform: competition is significantly higher after 2006 than before. This holds both for the analysis based on shifts in market shares and that based on profits. Several robustness tests confirm this outcome. Hence, the reform has had a significant impact. Nevertheless, we find that the health insurance sector is still less competitive than financial sectors such as banking and life insurance.

Comparative Ethics of Modern Payment Models

Comparative Ethics of Modern Payment Models

Privatising, liberalising and dividing a welfare state without affecting universality? Debunking the myths surrounding the rapid rise of private health insurance in Sweden.

The privatisation of provision and the emerging privatisation of funding, manifested in the rapid rise of private health insurance, are the most obvious signs that the universal, Swedish health system is gradually weakened. Meanwhile, the private welfare industry creates a neoliberal Newspeak where the burdening effects of the private insurance system on public healthcare are said to be unburdening, and where every step away from the principles of a universal welfare model is said to be in line with the principles of a universal welfare model. The language spoken by the private welfare industry spills over into authorities, journalists and scholars. In this article, I discuss, problematise and partially reject two research questions - Does VHI unburden the public health care system? and Are VHI holders less supportive of funding public health care? - where the authors fail to place development in the context of increased inequality and declining tax ratio, and where they use the welfare industry's definitions invented to blur the consequences of a parallel health system.

Hospital admissions in Chile among patients with Parkinson's disease from 2001 to 2018

The progression of Parkinson's disease is associated with complications, most of them preventable. To analyze hospitalizations with a diagnosis of Parkinson's disease in Chile, comparing the different health subsystems. Analysis of hospital discharge database available at the website of the Chilean Ministry of Health. Discharges that incorporated the diagnosis of Parkinson's disease (ICD 10 code G20), between the years 2001 and 2018 were analyzed. The rate of discharges with the diagnosis of Parkinson's disease was 34.5 per 100,000 hospitalizations. The figures were 55.2 and 29.8 discharges per 100,000 in 2001 and 2018, respectively. Sixty seven percent of hospital admissions for Parkinson's occurred in the public sector and corresponded to beneficiaries of the public health insurance system (FONASA). Beneficiaries of private insurance systems accounted for 12% of hospital admissions. The mean hospital stay was 13.4 days. There is a decrease over time in the rate of hospitalizations with Parkinson's disease. This trend may be related with the incorporation of this disease in a special governmental program that guarantees a timely access to diagnosis and treatment.

Framing inclusion: The media treatment of irregular immigrants' right to health care in Spain

With the passing of Royal Decree-Law 16/2012, Spain's national health system switched from a model defined by universal and free health care principles, to a private insurance system that excluded large population groups. Based on a qualitative research design, this paper examines the media treatment of undocumented immigrants’ prerogatives to public health care in Spain (2012–2018). The analysis of 234 articles, drawn from three major Spanish newspapers, reveals three frames that underscore the media's "rhetorics of inclusion," which argue for the extension of free medical services to irregular immigrantsa topic traditionally underestimated by the literature. The moralist frame, supported by social justice arguments, is found in tandem with the cost-benefit frame that advocates for immigrants’ health care access as a means for containing medical expenses. The overall predominance of the legalist frame largely relies on arguments that reflect a Spanish political culture rooted in the universality of health rights.

Evolution of health social security expenditure in Chile: A review of financial aggregates from 2000 to 2018

In Chile, there is controversy regarding the magnitude of financing for the health system. Some experts state that more resources are needed, while others refer to the problems that may arise in managing a growing pool of resources. This article aims to offer evidence to encourage critical discussion through a time series analysis of the leading financial aggregates in constant 2018 Chilean pesos of the Chilean social security in the period from 2000 to 2018. We did an observational, descriptive, longitudinal, and time series trend analysis study. Financial aggregates are organized according to social security definitions and by financial administratorsthe public National Health Fund and the private health insurers. Social security health spending has increased almost four-fold in the study period. After enacting the Explicit Guarantees in Health, the National Health Fund expanded more than the private health insurance system due to government allocations to the National Health Fund. In contrast, individual contributions decreased steadily every year during the study period. Per capita expenditure was higher in the private health insurance system. However, the per capita expenditure of the private insurance system over the public health fund has gradually decreased over time. Firstly, Chile increased its health spending at a rate higher than observed in other Organization for Economic Co-operation and Development countries. Secondly, it transitioned from financing health mainly through workers contributions to growing prominence of the governments overall contribution. In the wake of the announced health reform, the discussion of health funding will include employers role in health financing.

Power as a Source of Risk

The problem of risk connected with the power administration requires a rethinking of traditional ideas about power. Its images of law and sovereignty, disciplinary domination within the framework of modern forms of government need to be rethought. The information theory of power developed by N. Luhmann and the concept of governmentality of M. Foucault are directed against the ideology of the subject, where the ruling subject is one of the effective means and images of power. For both Foucault and Luhmann, power is immanent in its own manifestations, it is synchronous with all transformations in the macrostructures of society and is not outside, but inside. For Luhmann, the risk of power is the risk of a decision. The topic of risk is not at all in the domain of the subject dimension; it must be sought in the state of the temporal and social dimension. However, modern society should present possible threats not in the risk mode, but in the danger mode. The problem is that it is impossible to identify false or correct decisions. Once the decision is made, the risk cannot be avoided. If there are no risk-free solutions, the multiplication of research and knowledge would not make it possible to move from risk to reliability. Luhmann's position is opposed by the followers of M. Foucault, who supplement the concept of government with the idea of reflexive control. Reflexive control abstracts from solution problems. For this direction, risk is a way of thinking about the world. Therefore, the task of management is to identify risky objects and accordingly coordinate management tasks and determine measures to eliminate or reduce the risk. The industrial society tried to protect itself by means of some kind of social contract against the dangers and damage generated by this society. A system of private and public insurance was established. Modern society questions the principle of insurance because it is unable to insure itself against the mega-hazards of nuclear energy or catastrophic climate change. The four pillars of "computable risks" are crumbling: compensation, constraint, security and computation. The risk has ceased to be calculable. Its incalculability characterizes the current state of society.

Market Forces in Healthcare Insurance: The Impact of Healthcare Reform on Regulated Competition Revisited

This paper investigates the impact of market forces on competitive behaviour and efficiency in healthcare by investigating the Dutch healthcare insurance reform in 2006. This reform replaced the dual system of public and private insurance with a single compulsory health insurance scheme, in which insurance providers compete for customers in a free market. We measure competition directly from either shifts in market shares, or developments in profits. Using formal tests we find that in each approach a structural break occurs after the reform: competition is significantly higher after 2006 than before. Several robustness tests confirm this outcome. Nevertheless, we find that the health insurance sector is still less competitive than the banking, manufacturing and service industries, and even less competitive than life insurance.

Farmers’ health and social insurance perceptions – A case study from a remote rural region in Greece

Abstract The agricultural sector, an important economic sector in Greece, is inextricably faced with health and safety risks, with farmers encountering various health and safety risks in their farming activities. A quantitative survey on a random sample of 263 farmers in a remote Greek region was conducted to achieve the threefold objectives of this work: First, to assess the health and safety hazards associated with the agricultural profession, along with exploring the distinct socio-demographic characteristics of farmers that express job satisfaction and prefer the public health and insurance system; second, to investigate the effectiveness of social policies on health and safety issues confronted by farmers; third, to assess any correlation between job satisfaction and perception of social policy practices. Results indicate that women, younger and highly educated farmers are more optimistic about the agricultural profession and take individual protective measures. Women in their 30s, highly educated and with lower incomes prefer the public health insurance system, whereas the private health and insurance system is the choice of male farmers with high family incomes and large farms. Most farmers have mainly experienced respiratory, ophthalmic and otalgia problems and had more working accidents in comparison to other economic activities.

Global Dialysis Perspective: Canada.

Canada is a federation of ten provinces and three territories, and health care is primarily a provincial responsibility. The provinces, therefore, have substantial autonomy in health care delivery but are required to follow the basic tenets of the 1967 Canada Health Act as a condition for receiving essential health care transfer payments from the federal government. These conditions include the key requirement that all essential medical services have a single public payer, and therefore, no private insurance systems are allowed to fund such services. Therefore, neither dialysis providers nor physicians can directly charge patients for dialysis care, and conversely, patients cannot pay extra to see a particular nephrologist or attend a particular dialysis unit. This is uniquely restrictive compared with other countries (1). Health care funds come from provincial tax revenues and from federal transfer payments. Exclusively public funding does not exclude private provision of health care, and indeed, most Canadian physicians are self-employed and reimbursed “fee for service” by provincial governments. Hospital care is delivered by “not for profit” hospitals that are nominally independent, but they are funded by the provincial ministries of health (1). The delivery of maintenance dialysis services described here will be primarily on the basis of the model used in Ontario, the most populous province with 40% of the entire population. Key points of difference from other provinces will be noted however. Maintenance dialysis is almost entirely provided by Renal Programs based in “not for profit” government-funded hospitals. These range from large academic centers associated with medical schools to modest-sized community hospitals. These Renal Programs typically provide in-center hemodialysis (HD), home peritoneal dialysis (PD), and often, home hemodialysis (HHD) as well as outpatient and inpatient nephrology. Most academic Renal Programs have an associated kidney transplant unit. Many of the Renal Programs operate in …

Natural disaster insurance: public-private sector partnership

The public sector should intervene in the natural disaster insurance market in order to increase economic efficiency and social welfare. However the governments should not put at risk the sustainability of public finance by undertaking excessive financial risks. Therefore, public-private sector partnership practices in natural disaster insurance are on the agenda. Public-private partnerships can incorporate some of the advantages of both public insurance systems and private insurance systems. In such insurance systems, government guarantees, fiscal incentives, regulations and private sector expertise come together. The insurance systems established in public-private partnership sectors should be designed appropriately to ensure sustainability. A sustainable public-private insurance system should include mandatory participation, risk-based premiums, encouraging risk-mitigation activities, risk transfer mechanisms. NFIP, CEA, CATNAT, TCIP, CCS, JER are successful examples of public-private sector partnership. However, these insurance systems do not have all the features that a good insurance system should have.

Precision Oncology in Clinical Practice in Japan

Abstract From June 1, 2019, 2 different cancer genomic panels (Oncoguide NCC Oncopanel, FoundationOneCDx) were decided to be covered by National Insurance System in Japan. The indication was the patient with solid cancer who have no standard treatment or who failed to all recommended treatment by guidelines. FoundationOneCDx was designed to be able to use as companion Dx, however, the medical fee for CDx was very low than analytic fee. Then, it is difficult to introduce these panels in clinical daily practice because reimbursement was not an paying basis. For the genomic profiling, so called expert-panel with sufficient required specialists (e.g. medical oncologist, pathologist, genomic counselor, bioinformatician, et al.) must be held and was conditioned for reimbursement. The expert panel was held by certified hospital for genomic medicine and their affiliated hospital should join it. One of the important problems is the availability for drug based on genomic panel. In Japan, the number of clinical trials were 1/10 compared to that of USA. In addition, off-label use in public insurance system was not accepted in Japan while it was accepted by private insurance system in USA. Number of certified genomic counselors is lack in Japan. To introduce cancer genomic panel test in clinical practice, we have to solve these issues ASAP.

The many roads to universal health care in the USA

Health-care systems in different countries have evolved along different paths, with some countries offering private insurance, some universal health care, and some a mixture between the two. In most high-income countries, health care is considered a human right and is provided universally, typically free at the point-of-care. The USA has developed a fractured for-profit system that is substantially more expensive than those of its European counterparts and delivers poorer outcomes than the health-care systems in other high-income countries, while leaving a substantial proportion of Americans without health coverage. This Personal View discusses the current health-care system in the USA and offers a roadmap towards the achievement of universal health care for the USA. Three key components of the roadmap are: support and improve the Affordable Care Act; maintain the existing private insurance system; offer in parallel a government-sponsored health-care insurance, or gradually expand Medicare to more people, and ultimately to all Americans not covered under existing health-care insurances.

Icon and taboo: single-payer politics in Canada and the US

AbstractIn 1965 and 1966, the United States and Canada adopted single-payer models of government insurance for physician and hospital services – universal in Canada, but restricted to certain population groups in the US. At the time, the American and Canadian political economies of health care and landscapes of public opinion were remarkably similar, and the different policy designs must be understood as products of the distinctive macro-level politics of the day. Subsequently, however, the different scopes of single-payer coverage would drive the two systems in different directions. In Canada, the single-payer system became entrenched in popular support and in the nexus of interest it created between the medical profession and the state. In the US, Medicare became similarly entrenched in popular support, but did so as part of the larger multi-payer private insurance system. In the process universal single-payer coverage became politically iconic in Canada and taboo in the US.

MEDICARE-FOR-ALL: PROPOSALS, POLITICS AND TRADEOFFS

Discussants: P. Neuman1, R. Frank2, K. Pollitz3, 1. Kaiser Family Foundation, Washington, District of Columbia, United States, 2. Harvard Medical School, Boston, Massachusetts, United States There is growing national interest in expanding Medicare as a strategy to stabilize and expand health insurance coverage and lower costs. Whether “Medicare for All,” or a “Medicare Buy-in” for people under 65, the proposals share the belief that Medicare is a system that we can build on for a broader population of beneficiaries. These ideas will become more prominent as elections pose the question of what’s next following the Affordable Care Act. This symposium offers several perspectives on these various proposals. John Rother, chair and moderator, reviews the history of the idea that Medicare should be the building block for a broader health-care insurance system. Tricia Neuman provides an overview of leading proposals, highlights key differences, and discusses the potential implications for the Medicare program and its beneficiaries. She reviews public opinion polling data on the various proposals, including positions held by the major political parties. Karen Pollitz discusses the implications of these proposals for the individual health insurance market, employer-based markets, and government programs such as Medicaid and the VA. Richard Frank addresses the broader economic implications of these proposals, including differences in administrative costs of Medicare vs. the private insurance system and the potential effects on health care organizations. The panel discussion that follows addresses trade-offs, including the likely opposition of acute-care providers and physicians’ organizations as well as current Medicare beneficiaries. There will be opportunity for questions and comments from the floor.

Public versus private insurance system with (and without) transaction costs: optimal segmentation policy of an informed monopolist

ABSTRACTComputer-mediated transactions allow insurance companies to customize their contracts, while transaction costs limit this tendency toward customization. To capture this phenomenon, we develop a complete-information framework in which it is costly to design a new market segment when the segmentation policy (number and design of segments) is endogenously chosen. Both the case of a private and a public insurer are considered. Without transaction costs, these two insurance systems are equivalent in terms of social welfare and participation. With transaction costs, this equivalence is no longer present, and the analysis of this difference is the subject of this article.

One Size Does Not Fit All: Programs Supporting Best Practices in Psychotropic Prescribing

The purpose of this Clinical Perspectives is to review the emerging literature on the effectiveness of these programs at different levels of the system of care (federal, state, and private insurance systems) and to evaluate for whom and under what conditions such programs are deemed effective.

PHP54 - DIRECTIVE 2004/18/EC: IMPLICATIONS FOR PUBLIC MEDICINE PROCUREMENT IN EUROPE

Directive 2004/18/EC provides a framework to any “public contract concluded in one of the EU Member State on behalf of the State, regional or local authorities […]”. This applies to medicines purchased by public hospitals. The research aim is to identify and compare the impact of the directive on procurement in European countries. The Directive 2004/18/EC, national European guidelines on public procurement were reviewed in addition to secondary research to identify any differences in the application of the directive. Procurement models and current level of implementation of the directive were then compared based on past vs future processes to assess any direct impact on the medicines purchase. The research findings were used to develop a typology of the various procurement models as well as to establish any modification in payers’ behaviour regarding medicines purchase. Although the EU directive applies to all European members, differences have been highlighted in countries based on a private vs public national insurance system. Fourteen years after its ratification, countries with less interest in the directive still do not use it, e.g. Italy where a more value-based contract model is used at the national level by AIFA. In countries where fully applied, e.g. Belgium, a shift between direct contracts with manufacturers towards a more transparent and clear tender process is happening. Countries governed by a more private health model, e.g. Netherlands and Germany are less impacted by the introduction of the Directive. Three different models of applications were identified across European countries. Each model impacts the procurement of medicines by influencing payers behaviour, influencing the flexibility for Managed Entry Agreements and modifying the procurement processes.

Brazil Needs Organized Breast Cancer Screening: Pilot Project in Rio De Janeiro

Background: In Rio de Janeiro there is only the opportunistic screening program for women with breast cancer who arrive at health facilities and with a 14% rate of mammography coverage. In countries that have implemented effective screening programs, with coverage of the target population, quality of screening, and adequate treatment, breast cancer mortality has declined. Evidence of the impact of screening on mortality by this neoplasm justifies its adoption as a public health policy, as recommended by WHO. 80% of the population use the public health system (Sistema Unico de Saude - SUS), provided by the government. This system mainly provides conventional mammography. The private insurance system covers the remaining 20%, who have access to modern technologies such as digital mammography or MRI. Aim: The breast cancer organized screening program in the community of the Andaraí, RJ is committed in assisting women asymptomatic 50-69 years from SUS. Methods: The program foresees the participation of these women for an indefinite period, free of charge, and the accomplishment of biennial digital mammography, going through the stages of early detection and diagnosis. In case of positivity for malignant disease, it will be treated properly. Results: Since April 2014 have been 350 women with an average age of 54 years. 100% of them were asymptomatic and 49% had never done before mammography. Only 1 woman presented clinical suspect aged 44 years. The screening program organized by breast cancer in the community of Andaraí, RJ presented a mammographic coverage rate of 70%. The program is contemplated in the healthcare plan of the SUS. Conclusion: Preliminary results of the study suggest that population based organized screening are feasible and age of onset mammography screening should be 50 years in Rio de Janeiro.

Meta-analysis based predictions of flood insurance and flood vulnerability patterns in Calgary, Alberta

Flood risk management requires an understanding of the role that the private insurance system can play in helping to manage future flood risk, and how insurance uptake may vary for different levels of social and physical vulnerability to floods. The objective of this research is to understand the patterns of flood risk, socio-economic characteristics and flood insurance uptake in the City of Calgary, Alberta, Canada, where a recent flood was followed by the introduction of private overland flood insurance. We use a meta-analysis approach to generate a pooled prediction of flood insurance uptake, and compare uptake across socioeconomic factors and flood hazard levels. Our results suggest that highest hazard areas have higher household income, higher average dwelling values and lower levels of home ownership compared to other areas in the city. Hazard levels vary less across measures of immigration status and identification as a visible minority. Predicted insurance coverage varies across the city, with households in high hazard areas most likely to purchase insurance, particularly for a pricing scheme in which low risk households cross-subsidize premiums for high risk households. Our findings provide an important starting point for understanding the role of private flood insurance on the future impacts of flooding in the study area, and may serve as a useful template for understanding the impact of insurance in other new markets.