Sickness Insurance System Research Articles

Back to Europe: back to Bismarck?

Since 1989 there have been enormous changes in all aspects of health policy, and the Former Socialist Economies (FSEs) are facing similar challenges. The general restructuring of politics and economies has resulted in two leading orientations in the transformation of health care systems: the separation of funding and service provision from the state, and the separation of funding and service provision from each other. Many FSEs have already passed legislation establishing a sickness insurance system under a single national funding institution, or a combination of compulsory and voluntary insurance, or a system involving private sector insurance companies in generating compulsory or voluntary health care funding. Due to the peculiarities and specific features of the German health care system, the uncritical intention to implement the "Bismarck model" in the FSEs faces several problems. These can be summarized in one main point: the relative stability of the German health care system, which may be attractive to the FSEs, is based on economic prosperity and on a strong ability to assert the will of the central state institutions: these preconditions are not present in the FSEs.

Dilemmas in sickness certification among Swedish physicians

Despite a growing concern for matters related to sick-leave and its economical and human consequences, little Is still known of the practice of sickness certification. To remedy this, a study based on the critical incident technique was designed to explore dilemmas experienced by physicians when issuing sickness certificates. A questionnaire was distributed to 170 general practitioners (GPs), private physicians and psychiatrists in the Swedish county of Ostergotland asking about sickness certification dilemmas, the consequences of the dilemma and how the situation was resolved. Through a semi-qualitative analysis, 2 main types of dilemma were identified. Insurance-associated dilemmas were the most frequent and concerned the grading of work incapacity, the duration of a sick-leave period and the difficulties in interpreting the sickness insurance legislation. The focus on biomedical diagnosis in the sickness certificate was found to complicate the certification routines, since working capacity may be reduced even though a diagnosis has not been confirmed. The primary medical dilemmas consisted of difficulties related to encountered obstacles In the clinical management, e.g. in subjective medical history, diagnosis or patient compliance. It is concluded that the physicians' role in the insurance system makes it necessary to give the medical diagnosis a social interpretation. The development of standards for grading of work incapacity is needed as well as routines for closer cooperation between the different actors in the sickness insurance system.

Drug reimbursement in four Nordic countries.

The purpose of the present study was to describe the reimbursement systems in use for the reimbursement of medicaments purchased within the state compulsory health (sickness) insurance systems in four Nordic countries, and to study whether and how reimbursement for drug consumption. During the study period drug reimbursement has been selective in Denmark and Norway, but in Finland and Sweden it had been a mixture of selective (free drugs) and unselective (partially reimbursed drugs). The use of drug reimbursement as a control measure to regulate the quality and quantity of drug consumption has not been explicit. With the exception of monetary costs, the objectives of the control have not been explicitly stated, and administrative practices have sometimes been arbitrary. Even though at first sight the Finnish, Norwegian and Swedish systems of free medications may appear alike, a more detailed analysis of diseases and drugs showed tht the comprehensiveness and contents of the schemes differed. The differences seemed largely of an administrative nature. The financial costs of drug reimbursement had risen rapidly and varied from one country to another, being highest in Sweden.

Compulsory Sickness Insurance: Comparative Analysis of National Laws and Statistics.Benefits of the German Sickness Insurance System from the Point of View of Social Hygiene. Franz Goldmann , Alfred Grotjahn

<i>Compulsory Sickness Insurance: Comparative Analysis of National Laws and Statistics</i>.<i>Benefits of the German Sickness Insurance System from the Point of View of Social Hygiene</i>. Franz Goldmann , Alfred Grotjahn

PRAGUE

<h3>Sickness Insurance and Venereal Disease Stations</h3> The question of consulting stations for venereal patients has been discussed lately on several occasions. The discussion was provoked by the growth of sickness insurance and the old age and invalidity insurance which were added to the insurance scheme of the country last year. The sickness insurance system does not fulfil its task in the handling of venereal patients. Venereal patients fear that, under the sickness insurance system, records might make their malady a matter of public knowledge. The insurance bodies themselves do not care to undertake the expense of treating venereal patients, especially patients with syphilis. The insurance societies maintain, furthermore, that it is not their task to treat a patient in order to prevent a manifestation of his sickness which may occur after long years when very likely he will belong to another society, if he is insured at all. With invalidity