Providing Health Care Benefits Research Articles

NATIONAL HEALTH INSURANCE AND CATASTROPHIC HEALTH EXPENDITURE: A COMPLEMENTARY LOG-LOG APPROACH ON YOGYAKARTA’S INCIDENCE 2022

National Health Insurance (JKN) aims to provide health care benefits to meet people's basic health needs. However, despite the high JKN coverage in D.I.Yogyakarta Province, catastrophic health expenditure events remain high. The study examines the implementation of National Health Insurance (JKN) in D.I.Yogyakarta Province and its effectiveness in reducing devastating health expenditures in 2022. Using the Complementary Log-log approach on the 2022 National Social and Economic Survey data, the research findings reveal that the implementation of JKN has been successful, and the ownership of JKN positively affects the reduction of catastrophic health expenditure. The study also shows that the education level of household members and household size have positive effects on reducing the incidence of catastrophic health expenditures. However, the presence of babies or the elderly, household economic status, and inpatient status could increase the risk of having catastrophic health expenditures. The study highlights the need for attention to be given to implementing JKN in D.I.Yogyakarta Province and other variables to achieve universal health coverage and reduce catastrophic health expenditure.

EQUALITY AND SOLIDARITY IN UNIVERSAL HEALTH INSURANCE AGAINST THE BACKGROUND OF CHANGES IN FINANCING OF THE HEALTH CARE FROM JANUARY 1, 2022

Equality and solidarity are values which, in universal health insurance, take on the form of legal principles anchored both in the constitutional directive of equal access, irrespective of the materialsituation of the citizen, to health care benefits financed from public funds (Article 68, paragraph 2 of the Constitution of the Republic of Poland) and the statutory provision that health insurance isbased on the principle of equal treatment and social solidarity (Article 65, point 1 of the Act on health care benefits financed from public funds). The relationship between these two principles within the framework of universal health insurance is that many of the existing exceptions to equal treatment are justified by solidarity in bearing the costs of this insurance (the rule from the insured/regions richer to the insured/regions poorer) or in providing health care benefits (the rule from less severely ill to more severely ill). However, not all regulations in this area result from objective differences between the insured. Doubts are raised particularly by the differentiation of the health contribution interest rate among entrepreneurs, the financing of health insurance by farmers, or the accumulation of contribution burdens on persons who earning income from employment or non-agricultural activity.

A Pilot Study of the Psychological Impact of the Anti-Same Sex Marriage Campaigns in the Marriage Equality Referendum on Gay People Living with HIV/AIDS in Taiwan

<p>公投期間愛滋一直被反同婚方用來作為反對同性婚姻的理由，本文期待了解愛滋負面文宣對男同志愛滋 感染者產生的心理影響。本文先多方收集反同婚理由述及愛滋的文宣，並透過愛滋民間團體工作人員招 募受訪者，於2019年4月進行一次性焦點訪談團體，團體前先進行所收集的負面文宣簡報，再進行2.5小 時訪談，之後形成逐字稿進行質性分析。8位男受訪者平均年齡38.75歲，平均感染愛滋11年，均服用抗 愛滋病毒藥物中，都接收過愛滋的負面文宣。研究結果如下:第一、受訪者會取笑文宣內容，或是感到 煩悶、生氣，因應方式會避開、客觀冷靜或是主動教育身邊的人。第二、在愛滋負面文宣下，受訪者面 臨三個兩難的三角關係:(1)受訪者不會想和反同婚方對話，轉而期待官方及其他有力人士澄清; (2)受訪者想提出反證會擔心殃及其他無辜族群;(3)受訪者擔心影響社會大眾對男同性戀者社群的 觀感或被社群切割。第三、受訪者建議愛滋反歧視的宣導，應強調愛滋治療效果、修改官方公布的愛滋 統計分類、與其他團體形成友善聯盟等面向。第四、家人開始討論同性戀議題，讓受訪者有被接納的感 覺，但還是不容易現身愛滋感染者身分。綜上，男同志愛滋感染者對於婚姻平權公投時的歧視愛滋文 宣，陷於內化汙名與外在歧視的處境下，帶來兩難的影響。</p> <p> </p><p>Context and Objective: On May 24, 2019, Taiwan becomes the first country in Asia to legalize same sex marriage. However, many supporters felt disappointed by the referendum on marriage equality that took place on November 24, 2018. Marriage equality was discussed in Taiwan before the referendum, which entailed many public hearings and debates. There were alliances opposing same sex marriage (referred to as "anti-same sex marriage groups"), as well as alliance that supported same sex marriage. During these debates, anti-same-sex marriage groups highlighted HIV/AIDS issues as justification for opposing same-sex marriage with arguments that included, "most people infected with HIV are gay", "gay sex among men is the primary factor in HIV transmission", " legalizing same sex marriage will cause the spread of HIV/AIDS epidemic", "Taiwan will become an HIV/AIDS island", "The cost of HIV/AIDS treatment will consume medical resources," and "Taiwan should not provide health care benefits to those who got HIV/AIDS." Internet and social media outlets have promoted numerous negative messages about HIV/AIDS, and the anti-same-sex marriage group still uses "HIV/AIDS" as a reason to repeatedly attack the gay community. The present research aims to understand the psychological impact of negative HIV/AIDS propaganda on gay men living with HIV/AIDS in Taiwan and how they coped during the marriage equality referendum. Methods: We first collected articles, pictures, videos, and news about anti-same- sex marriage justification for discrimination against HIV/AIDS from websites, social media, and mobile APP. We then recruited focus group participants through AIDS service for non-governmental organizations. On the day of the focus group in April 2019, we made a brief presentation on relevant negative propaganda before conducting the 2.5 hours focus group. We then conducted a qualitative content analysis after the verbatim transcript was created. The average age of the eight interviewees was 38.75, and the average years of HIV infection was 11 years. All participants were taking HAART (highly active antiretroviral therapy). The interviewees all stated that they had received negative propaganda messages about AIDS on social media during the marriage equality referendum promotion period. Results: (1) Respondents will make fun of the content of the propaganda, or feel bored and angry. In response, they will avoid, be objective and calm, or take the initiative to educate those around them. (2) Ways to respond to negative propaganda messages: somebody would avoid, disregarded, and simply ignore it; somebody would aim and calm, or somebody would actively educate other people around them. (3) There are three dilemmas: (a) They do not want to have conversations with anti-same sex marriage group that distribute the AIDS- stigma messages and instead look forward to clarification by officials (Taiwan Centers for Disease Control) and other powerful non-government organization; (b) Interviewees do not want to hurt other vulnerable groups during the process that messages are clarified; (c) They are worried about affecting the public’s perception of the gay community or being separated from the gay community. (4) For HIV/AIDS anti-discrimination advocacy recommendations, the effectiveness of HAART treatment should be strengthened, the official classification of HIV/AIDS statistics should be revised, and vulnerable groups that are friendly to HIV/AIDS should be invited to form alliances. (5) In particular, some of their family members began to discuss homosexuality issues, making the interviewee feel accepted, but it was still not easy to show up as a PLWHA. Discussion and Conclusion: Based on the research results, this study suggests: (1) Self-stigma is deeply rooted in PLWHA; (2) Public anti- discrimination education for HIV/AIDS needs to be promoted as soon as possible, especially on HAART treatment effects. Gay men with HIV/AIDS are discriminated against HIV/AIDS in the marriage equality referendum, and they are caught in a situation that includes both self-stigma and external discrimination.</p> <p> </p>

Adventures in getting paid

Adventures in getting paid

Pharmacists' viewpoint towards their professional role in healthcare system: a survey of hospital settings of Pakistan

BackgroundPharmacy service is an essential part of a healthcare system. The profession of pharmacy is well recognized and is practiced to its full potential in developed countries however, it is underutilized in developing countries such as Pakistan. The recognition of pharmacist’s role as healthcare professional is limited. This study aimed to document pharmacists’ attitude towards their role in Pakistan’s healthcare system, their experience with doctors and their perceptions towards involvement in medicines management.MethodsA 4-month cross-sectional survey (Jan – Apr 18) was conducted targeting pharmacists practising in 26 tertiary care hospitals across Pakistan using a developed and validated questionnaire in both Urdu/English languages. Chi square (χ2) test was used to report any associations between independent variables, i.e., education, type of hospital and work experience and, dependent variables, i.e., pharmacists’ attitudes, experience, and perception. A p-value of ≤0.01 with value of Cramer’s V ≥ 0.3 was considered cut-off for establishing statistical significance. The study was approved by ethical committee and local hospital committees.ResultsThree hundred ninety-six questionnaires were returned out of 500, i.e., response rate = 87.9%. Most participants (92.2%) interacted with doctors at least once daily. Most interactions were related to drug availability inquiry (72.5%). Most pharmacists (91.4%) mentioned that pharmacy duties are mostly clinical in nature. 93.4% of the respondents indicated that pharmacists are reliable source of information regarding general medicines. Furthermore, 87.4% reasoned inadequate training for not being able to discuss issues of clinical nature with doctors.ConclusionPharmacists were willing to perform their duties and provide healthcare benefits to patients however, they seemed sceptical of advanced clinical pharmacy roles such as intervening in prescriptions and medication therapy, consultations and prescribing. There is a need to increase awareness regarding pharmacist’s role. Therefore, it would be helpful if trainings and seminars are conducted on the importance of clinical pharmacy to improve the pharmacy services in Pakistan’s healthcare system.

Medicare Meltdown: How Wall Street and Washington Are Ruining Medicare and How to Fix It

The future of Medicare is in the news almost every day. Increasingly, Medicare is viewed as a runaway train of unsustainable expense. With little investigation, we think of it as an entitlement program to provide health care benefits for America’s elderly. What it has become, according to the authors of this book, is a $600 billion entitlement for for-profit businesses that have the primary goal of providing returns to investors. The authors contend, convincingly, that the growing cost of Medicare is a direct result of ever-increasing demand for better, quicker returns by business investors. Short-term profiteering has displaced long-term investments. One example of for-profit avarice described in the book is that of a specific statewide hospice whose egregious policies were uncovered by a whistle-blowing nurse. In 2004, Hospice Care of Kansas was bought by Vanguard, which was in turn bought by a $35 billion private equity firm, Apax Partners. With Medicare reimbursement to a hospice at about $150 a day per patient, regardless of services provided, profits were maximized by high enrollment. To keep enrollment up, employees of the hospice had performance objectives of enrolling and keeping as many patients as possible. Top recruiting employees were rewarded with luxurious vacations, but others were threatened with termination if they did not meet established enrollment quotas. Employees were warned not to record any evidence of patient improvement. Patients who were not dying were told they were. If physicians and nurses deemed that a patient was no longer eligible for Medicare’s hospice benefit, hospice executives initiated a 30-day discharge process, followed by another eligibility review. Once this was discovered, the hospice had to pay a $6.1 million fine for fraudulent Medicare billing. Yet, Apax was able to sell this hospice for $80 million, four times the purchase price, because it continued to be a lucrative investment. Currently, 50% of all hospice care, 20% of all hospital care, and 80% of all dialysis care are provided by for-profit businesses.

Employee Health Benefit Redesign at the Academic Health Center

The rapidly escalating cost of health care, including the cost of providing health care benefits, is a significant concern for many employers. In this article, the authors examine a case study of an academic health center that undertook a complete redesign of its health benefit structure to control rising costs, encourage use of its own provider network, and support employee wellness. With the implementation in 2006 of a high-deductible health plan combined with health reimbursement arrangements and wellness incentives, the Penn State Hershey Medical Center (PSHMC) was able to realize significant cost savings and increase use of its own network while maintaining a high level of employee satisfaction. By contracting with a single third-party administrator for its self-insured plan, PSHMC reduced its administrative costs and simplified benefit choices for employees. In addition, indexing employee costs to salary ensured that this change was equitable for all employees, and the shift to a consumer-driven health plan led to greater employee awareness of health care costs. The new health benefit plan's strong focus on employee wellness and preventive health has led to significant increases in the use of preventive health services, including health risk assessments, cancer screenings, and flu shots. PSHMC's experience demonstrates the importance of clear and ongoing communication with employees throughout--before, during, and even after--the process of health benefit redesign.

The Effects of Health Care Benefits on Health Care Use and Health

Under current law, most Social Security Disability Insurance (SSDI) beneficiaries are not eligible for Medicare until 29 months after the Social Security Administration determines the onset of their disability. During this waiting period, >1 in 5 lacks health insurance. This study investigated the effects of providing health care benefits on the health, employment, and other services of uninsured beneficiaries. New SSDI beneficiaries without health insurance were randomly assigned to receive health care benefits, health care benefits plus additional supports, or a control group. Compared with a control group, those provided health care benefits used more health care, had fewer unmet medical needs, spent less out of pocket on health care, and reported improved health. In addition, those provided the additional supports were more likely to look for work, but the supports did not affect work or SSDI benefits at this very early period. The results provide rigorous evidence that health care benefits can increase health care use and health outcomes. Longer-term follow-up is needed to fully assess the program's effects on its ultimate benefits and costs, including its long-term effects on health, employment, and benefit receipt.

Low-Cost Remote Patient Monitoring System Based on Reduced Platform Computer Technology

Telemedicine is a well-accepted method providing healthcare benefits to people over long distances. However, in normal telemedicine practices, dedicated complex hardware and network backbones for data collection and communication make the system unintelligible to the common man. Centralization of telemedicine units also makes it accessible only to the immediate surrounding community. In an attempt to address these issues, a study aimed at developing a low-cost remote patient monitoring (RPM) system based on reduced platform computer technology has been carried out. The main focus of the work was to develop a real-time, universal serial bus plug-in module for a portable RPM system, specifically the XO Laptop. In addition, this system is also intended to serve as an educational tool especially for the One Laptop per Child target community. This article discusses data collection, preprocessing, and constraints such as network bandwidth and power availability prior to data transmission over a user datagram protocol (UDP)-based network.

Fighting for Equal Treatment

This article explores how the United Auto Workers (UAW) came to address the issues of lesbian, gay, bisexual, and transgender/sexual (LGBT) union members. The UAW demonstrated its commitment to LGBT concerns through its successful fight to provide health care benefits to same-sex domestic partners during the contract negotiations of 1999 with the “Big Three” U.S. automakers. The UAW, however, does not fit the structural or demographic profile of a union likely to be proactive on LGBT issues because the union represents predominantly blue-collar men in private sector manufacturing jobs. An intensive qualitative case study of the UAW’s response to sexual orientation concerns was conducted to explore the adequacies of the predominant theories regarding labor unions and sexual orientation. The case study found that the responsiveness of the UAW was associated with individual and collective agency, the support of outside allies, and ideological traditions of social movement unionism.

The ongoing legitimacy project: corporate philanthropy as protective strategy

AbstractCombining insights from institutional theory and resource dependence theory, this paper suggests that legitimacy is a scarce intangible resource that is always contested. Legitimacy, as a socially defined resource, represents relational power within a community. The various members of an organizational field, therefore, seek to gain, maintain, defend, and deny to others, access to the legitimacy resource. The author looks to the issue of healthcare‐related employment benefits, and notes that organizations deny such benefits in communities containing strong labor movements, substituting less expensive corporate philanthropic practices in order to demonstrate commitment to the social contract and norms of legitimacy while simultaneously denying the legitimacy of organized labor's agenda. In communities without strong labor movements, however, corporations are less encumbered in providing healthcare benefits because in such communities they do not need to work to deny the legitimacy of organized labor.

Managed health care plans in Southern United States municipalities: empirical evidence on choice of plan

This study examines factors that influence choice of Southern municipal government health care plans in the United States. Using survey data, this article specifically examines the managed care offerings of Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) and Point of Service (POS) plans. Some of the more interesting empirical results indicate that HMO plans are associated more with employee satisfaction; PPO plans are associated with cost containment; and POS plans are more likely to provide health care benefits to part-time employees. Empirical evidence also indicates that employee satisfaction is increased when there is a greater choice of managed care plans available to municipal governments.

Is bigger better? Re-exploring the relationship between hospital volume and surgical outcomes

Is bigger better? Re-exploring the relationship between hospital volume and surgical outcomes

By gum – a buccal delivery system: Private prescription: A thought-provoking tonic on the lighter side

Rayomd C. Rowe on the history of chewing gum and its potential as a current and future delivery system for active ingredients that provide healthcare benefits.

Images of Main Street: Disney World and the American Adventure

When Dean Koontz wishes to evoke an image of innocence to contrast with horror and dread in Watchers, he introduces a shared love for characters between intelligent and good dog, Einstein, and his equally intelligent but evil nemesis, Outsider. In fact, this shared love for Mickey and his friends saves Einstein from murderous Outsider, originally named Other, when sight of a home video box softens his heart and leads him to show mercy on his intended victim for sake of their common memories. These memories were their only happy ones when they were experimental animals in a National Security Agency facility. As schmaltzy and sentimental as this summary may be, use of characters works in book just as it does for millions of people who share dream of Disney's Main Street U.S.A. of a pure innocence where mischief of Huey, Dewey, and Louie are boyish fun in contrast with lurid headlines that greet us daily. The entire Main Street experience is designed to evoke nostalgia for an Age of Innocence. In fact, there are a number of Main Streets at properties, each tapping into a different era and range of emotions: colonial period, frontier, and the future, for example. It is pointless to murmur that these depictions are romantic fantasies, for that is indeed point. Moreover, this very fantasizing reveals a great deal about special relationship Americans have with and manner in which has managed to bring American cultural fantasies to life, externalizing almost inchoate romantic images of people. Indeed, at times this Disney-influenced version of reality has resulted in criticisms from right as well as left. The action of Southern Baptist Convention in 1997 resolving to boycott because Walt Co. was providing health care benefits to companions of gay employees and its hosting of homosexual theme nights is a case in point (Book of Year 199. owns those people who bought their image of America and then used that image against them. It is instructive to examine some of these various Main Streets in World and compare them with a British view of America's Main Street at American Adventure amusement park in Ilkeston, Derbyshire, England, near Robin Hood's Nottingham and Sherwood Forest. Main Street, U.S.A., World Disney occupies a special place in American landscape and culture, states Michael Pollan; Few companies are as skillful at making places, at shaping physical environment to affect our behavior. Disney's theme parks deserve credit for helping to keep alive not only a large part of America's vernacular architecture but, on Main Street, very experience of walkable streets and pleasing public spaces-this at precisely time when Americans were abandoning real Main Streets for their cars and suburban cul-de-sacs. (58) Getting to Main Street U.S.A. for most visitors is an adventure in itself. In addition to months or years of planning and dreaming to visit secular Mecca that World has become, there is trip from parking lot or ticket and transportation center to enter park itself. Others have written of park's controlled environment and Walt Disney's determination not to have area around World be spoiled by other commercial ventures. Part of that plan is Disney's desire to rouse sense of a journey from mundane to magic in their guests. For most guests, there are two choices in reaching park from ticket and transportation area: monorail or steamboat. Experienced guests, many of whom have gotten tired of time it takes to leave mundane and experience magic, look quickly at lines to monorail and then to steam boat's dock to note whether boat has just left or is arriving. …

The Assault on Specialty Medicine and the Modern Surgeon

I would like to talk wth you about specialty medicine and the contemporary thoracic surgeon. I shall briefly trace the development of specialty medicine, of which thoracic surgery is a leading example, describe the challenges to the authority of the specialist, and finally suggest some responses called for in this new, rapidly changing, and embattled era. I believe that an assault on the specialist is adding to the burdens of the modern surgeon and calls for a response affirming what we stand for.

Providing Health Care Benefits in Retirement.

This volume highlights many of the special health insurance problems facing the elderly and some of the solutions that the reform process must consider. The contributors to this book represent the diverse professions involved in providing health care security to older Americans: policymaking and academic economists, actuaries, statisticians, physicians, employee benefit plan sponsors, labor union representatives, attorneys, and health care policy specialists. Issues central to the debate are the elderly population's special risk of health problems and its precarious position as health reform proposals unfold. The evolving process of reforming our health care system must reflect the politics and economics of retiree health care coverage. No other book includes such a diverse cross-section of research and opinion about this extremely expensive and valuable benefit. Providing Health Care Benefits in Retirement will be of interest to students, scholars, and professionals in areas of human resources, economics, health insurance, and employee benefits.

Book Review: Income and Social Security and Substandard Working Conditions: Providing Health Care Benefits in Retirement

Book Review: Income and Social Security and Substandard Working Conditions: Providing Health Care Benefits in Retirement

REVIEWS

Book Reviewed in This Articles Ageing in East and Southeast Asia Edited. by David R. PhillipsBook Reviewed in This Articles Understanding Marriage: A Hong Kong Case Study. By Katherine P. H. YoungBook Reviewed in This Articles Working with Schizophrenia: A Needs Based Approach. By Gwen HoweBook Reviewed in This Articles Medicine and Nursing: Professions in a Changing Health Service. By Sylvia Walby & June Greenwell with Lesley Mackay & Keith SoothillBook Reviewed in This Articles Providing Health Care Benefits in Retirement. By Judith E. Mazo, Anna M. Rappaport & Sylvester J. Schieber (Eds)

Health Care for Children of Farmworker Families

Migrant and seasonal farmworkers constitute a major portion of the labor force in the American agricultural industry. By harvesting and processing farm crops, they contribute positively to farm communities and the American economy. In 1988, the Office of Migrant Health estimated that nationwide migrant and seasonal farmworkers and their dependents numbered between 3 and 5 million.1 The majority of farmworkers are married and/or have children. Only 10% to 25% of farmworkers are estimated to be unauthorized workers. The average annual income for migrant and seasonal farmworkers is well below the poverty level despite the prevalence of families with two wage earners. Although most farmworker families qualify for some type of public assistance, only 18% actually receive it.2 Because health care insurance is invariably beyond the reach of farmworker family budgets, and employers of farmworkers rarely provide health care benefits for their employees, these families are usually uninsured. In some cases, these families lack US citizenship or are in this country illegally, further limiting access to health care for their children. Medicaid eligibility is complicated by migration, because different eligibility requirements must be met in each state. Because of their income level, lack of insurance, and mobile lifestyle, families of farmworkers often find that comprehensive child health care (health maintenance, anticipatory guidance, and preventive medicine) is essentially unavailable. Additionally, recent changes in immigration policy and economic developments have resulted in a rapid growth of population that is not parallelled by the growth of health care facilities. Other problems that delay or prevent access to health care for the children of farmworker families include language barriers and differences in culture.