Health insurance and the demand for medical care

With rare exceptions the provision of actuarially fair health insurance tends to substantially increase the demand for medical care by redistributing income from the healthy to the sick. This suggests that previous studies which attribute all the extra demand for medical care to moral hazard effects may overestimate the efficiency costs of health insurance.     

Health care service utilization under two types of insurance

Before public demand for health care services can be reduced in the effort to contain costs, policy makers must understand utilization patterns. Researchers report here on a study of enrollees covered by individual, employer-sponsored health insurance programs in Greater Philadelphia.     

Health transition in Africa: practical policy proposals for primary care

Sub-Saharan Africa is undergoing health transition as increased globalization and accompanying urbanization are causing a double burden of communicable and noncommunicable diseases. Rates of communicable diseases such as HIV/AIDS, tuberculosis and malaria in Africa are the highest in the world. The impact of noncommunicable diseases is also increasing. For example, age-standardized mortality from cardiovascular disease may be up to three times higher in some African than in some European countries. As the entry point into the health service for most people, primary care plays a key role in delivering communicable disease prevention and care interventions. This role could be extended to focus on noncommunicable diseases as well, within the context of efforts to strengthen health systems by improving primary-care delivery. We put forward practical policy proposals to improve the primary-care response to the problems posed by health transition: (i) improving data on communicable and noncommunicable diseases; (ii) implementing a structured approach to the improved delivery of primary care; (iii) putting the spotlight on quality of clinical care; (iv) aligning the response to health transition with health system strengthening; and (v) capitalizing on a favourable global policy environment. Although these proposals are aimed at primary care in sub-Saharan Africa, they may well be relevant to other regions also facing the challenges of health transition. Implementing these proposals requires action by national and international alliances in mobilizing the necessary investments for improved health of people in developing countries in Africa undergoing health transition.     

Health insurance and imperfect competition in the health care market

We show that when health care providers have market power and engage in Cournot competition, a competitive upstream health insurance market results in over-insurance and over-priced health care. Even though consumers and firms anticipate the price interactions between these two markets - the price set in one market affects the demand expressed in the other - Pareto improvements are possible. The results suggest a beneficial role for Government intervention, either in the insurance or the health care market.     

Health insurance coverage-enrollment and adequacy of prenatal care utilization.

Most studies have concluded that good prenatal care plays an essential role in improving birth outcomes, and numerous reports have documented barriers to adequate prenatal care. The relationship between health care insurance eligibility and enrollment procedures and adequacy of prenatal care, however, has not been suitably investigated. This study used data from a statewide representative sample of recently delivered women in South Carolina to assess (1) patterns of health care insurance source and (2) the independent effects of Medicaid enrollment and application procedures on receipt of prenatal care. Health insurance during pregnancy varied by sociodemographic characteristics. Black women's experiences with Medicaid enrollment and application procedures were associated with less than adequate prenatal care. Programmatic efforts and policies should emphasize further improvement in the systems of health care access and delivery to disadvantaged women.