Uninsured Citizens Research Articles

WAYS TO SOLVE PROBLEMS IN THE PENSION SYSTEM OF AZERBAIJAN

The purpose of the research is to analyze the reforms carried out in the system of the State Social Defence Fund, which are aimed at providing pensioners with a decent pension, attracting uninsured citizens to social insurance and replenishing the funds missing in the budget of the State Social Defence Fund. The methodology of the research consists of assessing the current state of the pension system based on the analysis of statistical data. The practical importance of the research - the article may serve as a theoretical basis for further research in the area under consideration, and the proposals put forward in this article may be implemented in the practical activities of the State Social Defence Fund. The results of the research consist of proposals for improving the mechanism for collecting social insurance contributions. The originality and scientific novelty of the research is that the work for the first time proposes to abandon the approach that interprets the balanced functioning of the labor market as achieving equality between the demand for labor and its supply. It is indicated that for the functioning of the national labor market with the degree of efficiency required by society, it is necessary to increase the state's attention to stabilizing the development of both the socio-economic system of society as a whole and its constituent elements.

Healthcare for individuals without health insurance in Germany – a mixed methods approach to assess the situation and current challenges

BackgroundHealth insurance is mandatory in Germany; nevertheless, many individuals there have no health insurance and depend on a parallel healthcare structure. Voluntary associations, such as MediNetz and healthcare vouchers (“Anonymer Krankenschein” - AKS), support uninsured citizens. This study aimed to provide insights into associations, such as MediNetz and AKS that provide healthcare for individuals without health insurance in North Rhine-Westphalia, the largest federal state in Germany.MethodsA mixed methods approach was chosen. A qualitative study using interviews with experts was performed to gain their knowledge and explore the various challenges that AKS and MediNetz associations faced and the possible improvements that could be made. A quantitative survey was conducted to analyse the demographic data of the patients who required AKS or MediNetz’s assistance and the characteristics of each association through a separate questionnaire. Data was received from the association in Aachen, Bielefeld, Bonn, Düsseldorf, and Essen.ResultsMore women than men sought medical care; most were between 25 and 49 years old. The proportion of individuals without residency status accounted for the largest share (53.6%). Common reasons for patients to make contact were acute illnesses (40.2%) and pregnancies (22.3%). Most patients were sent to gynaecologists and general practitioners. Asking the experts, it became apparent that the existing system could not reach the standard of the regular healthcare in Germany. Financial and human resources were insufficient. Therefore, prevention was limited, especially chronically ill patients or patients with a severe illness requiring hospitalisation could not be treated. AKS had advantages compared to MediNetz, as the care came closer to the expected German medical standards.ConclusionsThe results showed a demand for associations providing healthcare for individuals without health insurance. However, the healthcare provided by MediNetz and AKS did not reach the standard of healthcare in Germany and mainly depended on the organisations’ resources. Funded projects such as an AKS combined with clearing centres significantly improved healthcare. Until structural measures are implemented, they can be a transitional solution by spreading nationwide.

MP21-14 INCREASING HEALTH EQUITY THROUGH VOTER REGISTRATION IN OUTPATIENT CLINICS; THE ACTION PROJECT

You have accessJournal of UrologyCME1 Apr 2023MP21-14 INCREASING HEALTH EQUITY THROUGH VOTER REGISTRATION IN OUTPATIENT CLINICS; THE ACTION PROJECT Farah Rahman, Katherine Campbell, and Ranjith Ramasamy Farah RahmanFarah Rahman More articles by this author , Katherine CampbellKatherine Campbell More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While national organizations such as the AUA demonstrate the importance of advocacy on the federal and state level by lobbying government officials, advocacy can also take the face of patient empowerment. Voter registration in the US is an individually-driven responsibility. In turn, the group of registrants is not representative of community demographics. Voting disparities in marginalized communities are correlated with higher health disparities. Sicker or uninsured citizens are more supportive of expanding governmental healthcare, but are less likely to vote due to barriers such as registration. ACTION is built on the notion that outpatient clinics are uniquely positioned within minority communities to serve as non-partisan voter registration sites. The goal is to lessen disparities in civic engagement and increase downstream health equity through patient empowerment. METHODS: ACTION was based out of Loyola Outpatient Clinic in Maywood, Illinois. Volunteers were instructed to speak to patients about their registration and mail-in ballot status. All patient interactions were conducted in the clinic waiting room. The intervention was evaluated on the number of registrants, mail-in ballot applications, and survey results. RESULTS: Over 3 months, students volunteered for 43 shifts on 25 days. During this time, volunteers registered 52 patients, 29% of which identified as first-time voters. Volunteers submitted 78 mail-in ballot applications. 84.5% of survey respondents agreed that ACTION was a good idea and 78% agreed that they would like to see this service provided in more medical spaces, such as the main hospital, other specialty clinics, and the emergency room. Lastly, 88% of respondents claimed they had the correct identification at their doctor’s appointment for online voter registration, overcoming a major identified barrier in voter registration. CONCLUSIONS: The results of the study demonstrate the important role outpatient medical clinics can play in easing the civic engagement process for traditionally disenfranchised patients. Volunteers averaged 2.08 registered voters and 3.12 mail-in ballot applications per day. For reasons of efficiency, proper documentation to register, and the number of newly registered first-time voters—health clinics prove to be an efficacious location for voter registration. As the AUA commits itself to supporting diversity and equity, the option of mobile voter registration to increase patient empowerment and equitable health policies presents itself as a medium to achieve this success. Source of Funding: New York Academy of Medicine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e291 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Farah Rahman More articles by this author Katherine Campbell More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract PO-233: HPV+ and HPV- HNSCC show similar nrf2 nuclear and cytoplasmic staining patterns

Abstract This study set out to observe and better understand the differences, if any, in staining patterns for the oxidative stress response transcription factor Nrf2 in HNSCC patients who were HPV+ non- tobacco and alcohol users vs. HPV- tobacco and alcohol users. Increased Nrf2 activity is associated with resistance to therapy and poor outcomes. Tissues samples were obtained from the head and neck cancer repository of Nashville General Hospital at Meharry and Meharry Medical College. Nashville General Hospital at Meharry is a safety net hospital that serves the under- and uninsured citizens of Davidson County TN. FFPE sections were stained with anti- human Nrf2 antibody (Abcam 31163) and scored using a semi-quantitative evaluation gradient scale from 0-3 with 0 indicating no stain and 3 indicating strong positive Nrf2 staining. This study made use of 5 HPV+ and 2 HPV- patients. The results show that all HNSCC in the HPV+ and HPV- samples revealed positive staining for Nrf2 that ranged from weak to intense. We observed that the poorly differentiated HNSCC had a strong positive nuclear stain for Nrf2 when compared to lower tumor grades. Irrespective of whether the patient was in the HPV+ nonsmoker-nondrinker or HPV- smoker-drinker group, histological data indicates there was a positive correlation between increased Nrf2 staining and worsening tumor grade. These preliminary data suggest that potential use of Nrf2 as a prognostic biomarker for HNSCC will need to be evaluated differently for HPV+ and HPV- tumors, as HPV+ tumors are generally more responsive to therapy. Developing therapy that specifically targets Nrf2 could potentially play an immense role in managing HNSCC. Some of the limitations encountered in this study includes limited sample size. Citation Format: Oladipupo O. Anibire, Oyinloye Jose, Kenyada Williams, Billy R. Ballard, Michael G. Izban, Dana Marshall. HPV+ and HPV- HNSCC show similar nrf2 nuclear and cytoplasmic staining patterns [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-233.

Uninsured citizens in the period of the Greek economic crisis: Health, income, housing. The case of an Attica Region Municipality.

Introduction: In Greece, the implementation of the Fiscal Adjustment Programs was combined with policies of economic austerity resulting in high levels of unemployment and exclusion from health insurance for a large proportion of the population. Aim: This study explores the demographic and socio-economic characteristics and the health status of the uninsured citizens in one of the biggest Municipalities in Attica region. The study covers the period 2012-2016, during the economic crisis in Greece. Methods: Data stemming from official documents, from individual files of 1,738 uninsured citizens were processed. Possible associations between population characteristics and chronic disease categories were examined, using the chi-square test and univariable/multivariable analysis for chronic disease as an outcome. Results: Almost forty-two percent (41.7%) of the study population suffered from a chronic disease; with the 48% of those patients having zero real annual income and 60.4% being hosted by a relative or an acquaintance. Of the sample diagnosed with a mental illness 71% lived as guests to friends or relatives. Diagnosis with cancer appeared to be more related to zero income, compared to other chronic disease categories (72.7%, p <0.001). In the multivariable model, male gender (OR=1.70 95% CI: 1.35-2.13), age (OR=1.03 95% CI: 1.02-1.04) and guest status (OR=1.57 95% CI: 1.24-2.00) were associated with a chronic disease. Conclusions: In Greece, in the midst of the economic crisis, uninsured citizens with chronic illness are called upon to manage their health problem with zero income and housing problems. A key strategy to address such a prospect of further health degradation of the particular population group can only be the strengthening and reorganization of the provision of social protection and health services around a primary care model developed and functioning at community level, with as its basic principle, universal and equal access to it, for all citizens.

Increasing Health Care Access in Yemen Through Community-Based Health Insurance

This Note addresses the implementation of health insurance reform in Yemen. As a result of a system of user fees and a lack of health insurance, the current regime poses serious barriers to health care access for Yemen’s uninsured citizens. When the dust settles from the ongoing conflict with Houthi rebels, the time will be ripe for replacing Yemen’s health financing system. In order to rebuild trust and curb abuse in the public health system, legal reforms are required to implement health insurance through decentralized decision-making and accountability measures. The Welfare Regime Framework accommodates these general reforms through policies that reflect the particular circumstances of Yemen. The implementation of health insurance reform will require policy reforms that bring together local, national, and international stakeholders to finance and develop management capacity for community-based health insurance in Yemen.

Remedy and Reaction: The Peculiar American Struggle over Health Care Reform

Review of: Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform, by Paul Starr. New Haven: Yale University Press, 2013. 342 pp. $17.00 paper. ISBN: 978-­‐0-­‐300-­‐18915-­‐5 By: David N. Pellow. 2015. Contemporary Sociology 44(2): 256-­‐258 “Do we have an obligation to provide health care for our citizens?” Paul Starr opens this outstanding book with this question and follows up by asking another more vexing one: why is the U.S. health care system so stubbornly unique among capitalist democracies? It is a well-­‐known and embarrassing fact that the U.S. has the most expensive health care system in the world and yet has the highest number of uninsured citizens of any western democracy. But the solution to the problem has always eluded us. The answers to Starr’s questions vary widely across the political spectrum exposing deep divides between and within the major political parties and reveals how a combination of social forces prevents the U.S. from guaranteeing what people in many other democracies view as a fundamental right. Starr’s argument is that the U.S. missed a chance to set up a general system for financing health care in the first half of the 20 th century, and when the government finally sought to do so, the nation was caught in what he calls a policy trap, in which enough of the public and health care industry leaders were satisfied with the complicated and costly system that changing it became nearly impossible. He addresses the three factors usually indicted for producing the health care crisis in the U.S.: “special interests,” national values, and “the daunting complexity of the problems of health care and health policy.” And while Starr agrees that there is some truth within each of these explanations, he challenges the claim that any one of them alone is responsible for the quagmire that is our health care system. Of the three explanations, the argument that “special interests” have prevented major health care reform carries particular weight with many observers. After all, as Starr demonstrates throughout the book, the American Medical Association and other key stakeholders actively opposed anything resembling a national health care system virtually anytime the idea emerged in U.S. politics. But that explanation is too tidy because there have been moments when health care industry leaders have supported expanded coverage proposals that they viewed as better than less appealing alternatives such as single payer. The “special interest” explanation really falls short when we discover that the public itself is split over reform because unionized workers, veterans, disabled persons, and the elderly can access Medicare, while segments of low income populations can also qualify for Medicaid. These millions of Americans may not have the best health care, but they often see themselves as “reasonably well-­‐protected” and fear losing their coverage or benefits under any major reform, particularly since they feel they have earned their way into such programs while other groups are seen as less worthy. This, I believe, is the most disturbing and revealing aspect of the health care crisis in this country and— although Starr does not draw the link—has strong echoes of the kind of divisive

Funding, Coverage, and Access Under Thailand’s Universal Health Insurance Program: An Update After Ten Years

In 2001, Thailand implemented a universal coverage program by expanding government-funded health coverage to uninsured citizens and limited their out-of-pocket payments to 30 Baht per encounter and, in 2006, eliminated out-of-pocket payments entirely. Prior research covering the early years of the program showed that the program effectively expanded coverage while a more recent paper of the early effects of the program found that improved access from the program led to a reduction in infant mortality. We expand and update previous analyses of the effects of the 30 Baht program on access and out-of-pocket payments. We analyze national survey and governmental budgeting data through 2011 to examine trends in health care financing, coverage and access, including out-of-pocket payments. By 2011, only 1.64% of the population remained uninsured in Thailand (down from 2.61% in 2009). While government funding increased 75% between 2005 and 2010, budgetary requests by health care providers exceeded approved amounts in many years. The 30 Baht program beneficiaries paid zero out-of-pocket payments for both outpatient and inpatient care. Inpatient and outpatient contact rates across all insurance categories fell slightly over time. Overall, the statistical results suggest that the program is continuing to achieve its goals after 10years of operation. Insurance coverage is now virtually universal, access has been more or less maintained, government funding has continued to grow, though at rates below requested levels and 30 Baht patients are still guaranteed access to care with limited or no out-of-pocket costs. Important issues going forward are the ability of the government to sustain continued funding increases while minimizing cost sharing.

Availability of insurance linkage programs in U.S. Emergency departments.

IntroductionAs millions of uninsured citizens who use emergency department (ED) services are now eligible for health insurance under the Affordable Care Act, the ED is ideally situated to facilitate linkage to insurance. Forty percent of U.S. EDs report having an insurance linkage program. This is the first national study to examine the characteristics of EDs that offer or do not offer these programs.MethodsThis was a secondary analysis of data from the National Survey for Preventive Health Services in U.S. EDs conducted in 2008–09. We compared EDs with and without insurance programs across demographic and operational factors using univariate analysis. We then tested our hypotheses using multivariable logistic regression. We also further examined program capacity and priority among the sub-group of EDs with no insurance linkage program.ResultsAfter adjustment, ED-insurance linkage programs were more likely to be located in the West (RR= 2.06, 95% CI = 1.33 – 2.72). The proportion of uninsured patients in an ED, teaching hospital status, and public ownership status were not associated with insurance linkage availability. EDs with linkage programs also offer more preventive services (RR = 1.87, 95% CI = 1.37–2.35) and have greater social worker availability (RR = 1.71, 95% CI = 1.12–2.33) than those who do not. Four of five EDs with a patient mix of ≥25% uninsured and no insurance linkage program reported that they could not offer a program with existing staff and funding.ConclusionAvailability of insurance linkage programs in the ED is not associated with the proportion of uninsured patients served by an ED. Policy or hospital-based interventions to increase insurance linkage should first target the 27% of EDs with high rates of uninsured patients that lack adequate program capacity. Further research on barriers to implementation and cost effectiveness may help to facilitate increased adoption of insurance linkage programs.

Journal Digest

Journal Digest

Greek Economic Crisis and Health Care Reforms: Correcting the Wrong Prescription

In an era of economic crisis in Greece and with many uninsured citizens, the Troika (lenders of Greece) suggests reforms and promotes the internal market, resulting in a public-private system becoming more privatized. This article contradicts these proposals and attempts to suggest the necessary reforms to achieve equity of access for all and to promote efficiency, taking into account the existing needs of the population and the recession of the Greek economy.

It’s a small world after all

It’s a small world after all

The Costs and Adequacy of Safety Net Access for the Uninsured in Genesee County, Michigan

This commentary examines Genesee County (Flint) Michigan to explore whether a well-structured safety net system is able to provide low-income uninsured people adequate access to care at a reasonable cost. Genessee County is one of the more economically challenged communities in the country. This commentary explores the cost and adequacy of safety net care in Genessee County under the Genessee Health Plan (GHP). The analysis compares the cost of services under GHP to the cost of the same services offered by local private insurers and Medicaid. An analysis found that GHP, Flint-area physicians, hospitals, and foundations have succeeded in providing basic medical care access to a substantial majority of their low-income uninsured citizens. The costs of care, both paid by GHP and donated by local providers, are substantially less than the estimated costs if this population were covered by full Medicaid or private insurance.

Health technology assessment and its role in the future development of the Indian healthcare sector.

Public expenditure on healthcare in India is low by international comparison, and access to essential treatment pushes many uninsured citizens below the poverty line. In many countries, policymakers utilize health technology assessment (HTA) methodologies to direct investments in healthcare, to obtain the maximum benefit for the population as a whole. With rising incomes and a commitment from the Government of India to increase the proportion of gross domestic product spent on health, this is an opportune moment to consider how HTA might help to allocate healthcare spending in India, in an equitable and efficient manner. Despite the predominance of out-of-pocket payments in the Indian healthcare sector, payers of all types are increasingly demanding value for money from expenditure on healthcare. In this review we demonstrate how HTA can be used to inform several aspects of healthcare provision. Areas in which HTA could be applied in the Indian context include, drug pricing, development of clinical practice guidelines, and prioritizing interventions that represent the greatest value within a limited budget. To illustrate the potential benefits of using the HTA approach, we present an example from a mature HTA market (Canada) that demonstrates how a new treatment for patients with atrial fibrillation — although more expensive than the current standard of care — improves clinical outcomes and represents a cost-effective use of public health resources. If aligned with the prevailing cultural and ethical considerations, and with the necessary investment in expert staff and resources, HTA promises to be a valuable tool for development of the Indian healthcare sector.

Politika finansiranja zdravstvene zaštite u SAD

This paper accentuated the implementation of the policy of the United States whose primary goal is comprehensive health care for citizens and reduce the high medical expenses. Government in the public sector provides between 60 and 65% of funding for health care spending. Funds are directed to finance various programs of which the dominant Medikar (Medicare) and Medikaid (Medicade) programs, children’s health insurance program and the program of the health care of veterans. Health policy is still the most developed economy in the world, based on relevant indicators of government pressure and private sector, to conceptualize and adopt specific health care programs. Health policy is the policy of the future, addressed to the achievements of modern medical science, the rigorous control of financial flows and the timely implementation of pharmacological and technoeconomic procedures. Uninitiated may sound unbelievable, that in the United States to the end of 2009. year, over 50 million people (or 16.7% of the population) is not possessed any form of health insurance. Nevertheless, the total public health expenditure they occupy a very high third place in the world. The fact that causes disbelief and thereby does not change is that the United States for health care annually, spending more money per insured (US $ 7.960) than any other state in the world. In particular, the high cost of direct medical services, pharmaceutical procedures and administrative costs. They are causing a growing number of bankruptcies of insurance companies and health insurance funds and increased the number of uninsured citizens.

Healthcare Policy for the Nurse Practitioner

PhD, NP F or both individuals and government, healthcare accounts for one of the largest areas of their spending. As such, the mechanics of healthcare and how it is financed are surrounded by controversy. “Politics is always local” is a common phrase, and this is especially true when politics surrounds healthcare; we tend to generalize about the adequacy or inadequacy of the healthcare system based on our own experiences with it. Regardless of whether people agree or disagree with the recent healthcare reform legislation that was passed, there is growing acceptance that the United States could not continue the way it had been operating. Medical debt among uninsured and underinsured citizens is one of the leading causes of bankruptcy in the US. Expenses related to those unpaid medical debts and bankruptcies are eventually paid by all of us. It makes good political and economic sense to have an organized way to make sure individuals have healthcare. With the new reform legislation, nurse practitioners moved into the nationwide limelight and onto the national policy agenda in a way never before achieved. Whether NPs will continue to have a place as recognized healthcare providers through the anticipated modifications to this legislation remains to be seen. Ensuring the viability of the NP role in healthcare will require that NPs who have not previously been involved in policy become engaged. Health policy is not always thoroughly discussed in graduate NP programs. Policy itself may have a negative or mystifying connotation. But simply put, health policy refers to particular decisions, strategies, and actions that are undertaken to achieve specific healthcare goals within a society. Just as the state and national legislatures work to develop specific policies, the American College of Nurse Practitioners, whose central mission is policy development, works with its constituent members every year to tailor an explicit health policy for NPs based on the views of their members. This process achieves several things; most notably, it defines a vision for the future of healthcare in which NPs can work to the full measure of their potential. This vision, in turn, helps to establish goals and reference points for both the short and long term. Specific health policy decisions order priorities and describe the expected roles of different groups; ultimately these decisions will help build NP consensus and inform others. The future is likely to hold huge conceptual debates about healthcare. Policies will be crafted about who will have access to medical professionals from various fields and what medical technologies will be available, such as medication, surgical procedures, kidney dialysis machines, etc. NPs must be part of that debate. Every day NPs are implementing policy as they meet the needs of their patients. We have added “Policy in Practice” to our journal cover to emphasize this reality. To help inform NPs, JNP will also highlight information about relevant policy within each issue or article.

An evaluation of a chronic disease prevention program in the Republika Srpska (RS) of Bosnia and Herzegovina

In 2002 the Republika Srpska of Bosnia and Herzegovina adopted goals for reducing the burden of chronic disease through a new screening program in its publicly funded health centers ("Dom Zdravljas"). This study evaluated the first year of program implementation. The evaluation used in-depth interviews with 25 key stakeholders and in-person interviews with 1004 citizens. We found that many health care providers and citizens were unaware of the program. In addition, there was inadequate financing for the program, because the Health Insurance Fund does not collect revenue for uninsured citizens, more than 20 per cent of the population. We recommend improved co-ordination among public and private organizations involved in implementation; increased promotion of the program with health care providers and citizens; and increased financial resources for providing screening for uninsured citizens.

Universal private health insurance in the Netherlands: The first year

Rationale: After 30 years of discussions and failed attempts to integrate social (sickness funds) and private health insurance into a single mandatory scheme, a new scheme finally came into effect on 1 January 2006 under the Health Insurance Act. Adopted was a model with flat rate premiums under private law with public guarantees. Insureds can change insurer yearly, have to be accepted by the insurer (no risk selection allowed), and can opt to take out supplementary insurance (risk selection allowed). To compensate lower incomes for excessive premium burdens, a new tax-based compensation scheme, the Health Care Allowance Act, was installed. Objectives: To examine the short-term, mid-term and long-term impact of the new Health Insurance and Health Care Allowance Acts and give an overview of the history and developments after introduction. Methodology: A policy analysis, using a review based on literature, including 'grey' sources of information, official government documents and relevant journals. Results: The transition into the new system so far has been fairly smooth, and the chaos that some informed observers expected has not become reality. The premium levels for 2006 and 2007 are lower than the premium levels expected by the government and some critics. The willingness to swap insurer was higher than expected. Around 25% changed health insurer in 2006, which must also be ascribed to the catalysing effect of the collective contracts that can be offered against a 10% discount. Some expected a chaos in the administration and payments of compensation. However, the tax department has executed this task without too many problems. Huge financial problems for health care providers as a result of problems with declarations and remunerations failed to materialise, thanks to advance payments supplied by the insurers. Furthermore, the reform led to a realignment of the health insurance market. Patients and patient organisations have more influence and choice. Currently there are 24 collective contracts concluded by patient organisations. Health insurers received more responsibility and instruments in contracting care, but face even fiercer competition, resulting in a stronger consolidation trend and yielding clear winners and losers. Conclusions: The new system seems to empower patients and patient organisations. However, of key importance in the upcoming years is a working risk equalisation scheme, to keep 'higher risks' attractive customers for collective contracts, and a benefit catalogue that stays intact, so that higher risks do not become part of supplementary insurance for which risk selection is allowed. Furthermore some important questions remain: what happens to defaulters who can be cancelled under private law? Will it lead to an unacceptable increase of uninsured citizens? Will more competition truly bring about affordable health care of good quality? Is the system compatible with EU-law?

Health Care And Philosophy: Adding Justice To The Debate

Justice is frequently in the background of debates about health care access, financing, and delivery in the United States and elsewhere. Is it just to have as many uninsured citizens as we do? Are disparities in health care access between ethnic and social groups fair? Does an employer-based approach to health insurance qualify as just when not everyone works for an employer that provides it? These are just a few of the fundamental questions that can be, and are, asked of health care in the United States. Although often implicit, the idea of what a just approach to health care looks like isn’t often explicitly discussed. Perhaps this is because the focus tends to be upon single issues, such as the uninsured, rather than looking at U.S. health care in its entirety. Another impediment is that the concept of justice itself is open to debate. Conservative, liberal, libertarian, and utilitarian views of justice continue to be advanced and refined by philosophers and social thinkers. Even so, continuing increases in medical costs and the number of uninsured people, along with growing concerns about disparities in access to treatment, might bring justice to the fore in the health care debate. Waiting to be determined is whether health care is a fundamental right and what allocation of this presumably limited resource is socially just. A good starting point for this consideration is Social Justice, which argues for a liberal theory of social justice and applies it to public health and health policy. Madison Powers directs the Kennedy Institute of Ethics and is an associate professor of philosophy at Georgetown University. Ruth Faden is a professor of biomedical ethics and director of the Berman Bioethics Institute at the Johns Hopkins University. Influenced by the theory of the late John Rawls, they see social justice as foundational to the moral justification of public health. They argue that a just approach to health care must attend to certain basic human needs and that particular attention must be paid to meeting the needs of the least advantaged. Six essential dimensions must be considered when looking at social justice: health, personal security, reasoning, respect of others, attachment, and self-determination. Social justice in this context has the job of “securing a sufficient level of each dimension for each individual, insofar as possible” (p. 192). Concern for the least-advantaged members of society is closely tied to this view of social justice and its companion concept, well-being. These are the ones who have the hardest time securing a sufficient level within each of these dimensions. This “sufficiency theory” focuses less on the most appropriate distribution of goods in a particular society and more on “securing and preserving a level of sufficiency for each of the dimensions of well-being” (p. 59). Securing a level of sufficiency, they argue, points to problems of justice in U.S. health care. The employer-based system of health insurance exacerbates existing disadvantages B o o k R e v i e w s

Trends in healthcare payment.

1. Kathy Hansen 2. Don Lavanty ASCLS and other laboratory groups are alert to trends in Medicare payment, often the largest source of payment for a laboratory or a hospital. Developments in Medicare payment policy, such as competitive bidding, freezes to the Medicare Outpatient Laboratory fee schedule, threats of instituting a co-pay for Medicare beneficiaries, and others, have been the focus of advocacy efforts at the Legislative Symposium and in other campaigns. Legislators, businesses, and the public remain concerned about the rising cost of healthcare and the growing number of uninsured citizens in the United States. Many proposals have been made to control the rate of increase in healthcare costs. Laboratorians often feel that the laboratory is unfairly singled out for more than a fair or proportionate share of freezes or cuts in reimbursement. Concern from Congress about Medicare spending on Part B (outpatient) laboratory services stems from a significant increase in total dollars spent for laboratory services, despite the fact that the individual fees for tests have been frozen in 11 of the last 15 years. In the years 1991 and 1998, Medicare spending for laboratory services was $3.6 billion. There was a slight increase to $4.3 billion in 1993 and 1994, then a gradual decrease back to $3.6 billion in 1998. Since 1998, however, there has been an increasingly steep rise in total spending for laboratory services, averaging 8.8% annually, to $6.0 billion in 2004, the latest year for which data is available. (Data from the 2005 Medicare Trustees Report) Despite this growth, laboratory…