Financial hardship,socio-economic position and depression: Results from the PATH Through Life Survey

There is a strong association between financial hardship and the experience of depression. Previous longitudinal research differs in whether this association is viewed as a contemporaneous relationship between depression and hardship or whether hardship has a role in the maintenance of existing depression. In this study we investigate the association between depression and hardship over time and seek to resolve these contradictory perspectives. We also investigate the consistency of the association across the lifecourse. This study reports analysis of two waves of data from a large community survey conducted in the city of Canberra and the surrounding region in south-east Australia. The PATH Through Life Study used a narrow-cohort design, with 6715 respondents representing three birth cohorts (1975–1979; 1956–1960; and 1937–1941) assessed on the two measurement occasions (4 years apart). Depression was measured using the Goldberg Depression Scale and hardship assessed by items measuring aspects of deprivation due to lack of resources. A range of measures of socio-economic circumstance and demographic characteristics were included in logistic regression models to predict wave 2 depression. The results showed that current financial hardship was strongly and independently associated with depression, above the effects of other measures of socio-economic position and demographic characteristics. In contrast, the effect of prior financial difficulty was explained by baseline depression symptoms. There were no reliable cohort differences in the association between hardship and depression having controlled for socio-demographic characteristics. There was some evidence that current hardship was more strongly associated with depression for those who were not classified as depressed at baseline than for those identified with depression at baseline. The evidence of the contemporaneous association between hardship and depression suggests that addressing deprivation may be an effective strategy to moderate socio-economic inequalities in mental health.     

Health sector reforms in Argentina and the performance of the health financing system

In Argentina, health sector reforms put particular emphasis on decentralization and self-management of the tax-funded health sector, and the restructuring of the social health insurance during the 1990s. Unlike other countries in the region, there was no comprehensive plan to reform and unify the sector. In order to assess the effects of the reforms on the performance of the health financing system, this study looks at impacts on the three inter-related functions of revenue collection, pooling, and purchasing/provision of health services. Data from various sources are used to illustrate the findings. It was found that the introduction of cost recovery by self-managed hospitals increased their budgets only marginally and competition among social health insurance funds did not reduce fragmentation as expected. Although reforming the Solidarity Redistribution Fund and implementing a single basic package for the insured was an important step towards equity and transparency, the extent of risk pooling is still very limited. This study also provides recommendations regarding strengthening reimbursement mechanisms for public hospitals, and regulating the private sector as approaches to improving the fairness of the health financing system and protecting people from financial hardship as a result of illness.     

Universal coverage reforms in the USA: From Obamacare through Trump

Since the election of Donald Trump as President, momentum towards universal health care coverage in the United States has stalled, although efforts to repeal the Affordable Care Act (ACA) in its entirety failed. The ACA resulted in almost a halving of the percentage of the population under age 65 who are uninsured. In lieu of total repeal, the Republican-led Congress repealed the individual mandate to purchase health insurance, beginning in 2019. Moreover, the Trump administration is using its administrative authority to undo many of the requirements in the health insurance exchanges. Partly as a result, premium increases for the most popular plans will rise an average of 34% in 2018 and are likely to rise further after the mandate repeal goes into effect. Moreover, the administration is proposing other changes that, in providing states with more flexibility, may lead to the sale of cheaper and less comprehensive policies. In this volatile environment it is difficult to anticipate what will occur next. In the short-term there is proposed compromise legislation, where Republicans agree to provide funding for the cost-sharing subsidies if the Democrats agree to increase state flexibility in some areas and provide relief to small employers. Much will depend on the 2018 and 2020 elections. In the meantime, the prospects are that the number of uninsured will grow.     

Health Insurance Coverage of the Children of Immigrants in the United States

Objectives: This study assesses the health insurance coverage of children of immigrants in the United States and variations among immigrant groups. Method: The study uses data from the March supplements of the 1994 and 1996 Current Population Survey to compare health insurance coverage of children who report foreign parentage. Separate logistic regressions are conducted to estimate the likelihood of being covered by any insurance, public insurance, and private insurance. Results: 27.3% of all children of immigrants are without health insurance, 34.1% are on public insurance, and 44.3% have private insurance. Foreign-born children who have not yet become U.S. citizens are the most likely to be without health insurance (38.0%). Many of these children are not covered because their parents are unable to find jobs that provide coverage and Medicaid fails to enroll as many of them as possible. Overall, the children's chances of being covered by any health insurance vary little according to when their parents came to this country. However, children of recent immigrants are more likely to rely on public health insurance (40.1% vs. 24.8%) and less likely to be covered through private sources (36.8% vs. 60.6%) than those of established immigrants. Among immigrant groups, children of Haitian (48.4%) and Korean (45.3%) immigrants are at the highest risks of being uninsured. Both children of the Dominican Republic (65.9%) and Laos (83.3%) report high rates of public insurance coverage. Conclusions: Greater disparity in health insurance coverage among children of immigrants is expected once the new welfare reform bills take effect. In particular, noncitizen children, children of recent immigrants, illegal immigrants, and Dominican Republican immigrants will be affected most. Efforts aimed at reducing the harm should target these vulnerable groups.     

强化卫生系统财务管理创新的意义

卫生部门通过创新现有的财务管理模式,应当能确保在根源上杜绝财务管理领域的潜在漏洞与风险,对于节约卫生系统资源以及提升系统运行效益都具有不可忽视的必要性。因此针对现阶段的卫生系统来讲,关键在于明确创新财务管理的重要意义,并且结合卫生系统现有的财务运行状态,确保体现最大化的财务管理创新效果。该文基于卫生系统财务管理现存的缺陷,提出健全卫生系统现有的财务管理体系,全面防控卫生系统的财务风险,培育专业化的卫生系统财务管理人才,引进全新的财务内控手段等创新管理的策略。     

Strengthening eHealth Systems to Support Universal Health Coverage in sub-Saharan Africa

The aim of universal health coverage (UHC) is to ensure that all individuals in a country have access to quality healthcare services and do not suffer financial hardship in using these services. However, progress toward attaining UHC has been slow, particularly in sub-Saharan Africa. The use of information and communication technologies for healthcare, known as eHealth, can facilitate access to quality healthcare at minimal cost. eHealth systems also provide the information needed to monitor progress toward UHC. However, in most countries, eHealth systems are sometimes non-functional and do not serve programmatic purposes. Therefore, it is crucial to implement strategies to strengthen eHealth systems to support UHC. This perspective piece proposes a conceptual framework for strengthening eHealth systems to attain UHC goals and to help guide UHC and eHealth strategy development.     

Early Impact of the Affordable Care Act on Health Insurance Coverage of Young Adults

Research Objective

To evaluate one of the first implemented provisions of the Patient Protection and Affordable Care Act (ACA), which permits young adults up to age 26 to enroll as dependents on a parent''s private health plan. Nearly one-in-three young adults lacked coverage before the ACA.

Study Design, Methods, and Data

Data from the Current Population Survey 2005–2011 are used to estimate linear probability models within a difference-in-differences framework to estimate how the ACA affected coverage of eligible young adults compared to slightly older adults. Multivariate models control for individual characteristics, economic trends, and prior state-dependent coverage laws.

Principal Findings

This ACA provision led to a rapid and substantial increase in the share of young adults with dependent coverage and a reduction in their uninsured rate in the early months of implementation. Models accounting for prior state dependent expansions suggest greater policy impact in 2010 among young adults who were also eligible under a state law.

Conclusions and Implications

ACA-dependent coverage expansion represents a rare public policy success in the effort to cover the uninsured. Still, this policy may have later unintended consequences for premiums for alternative forms of coverage and employer-offered rates for young adult workers.     

美国医疗改革及对我国的启示

医疗费用持续高涨、卫生可及性和卫生公平性等问题一直困扰着美国政府,2009年的金融危机更是使美国的医疗体制雪上加霜,这也进一步坚定了奥巴马政府实施医疗改革的决心。美国医疗改革的主要措施为:扩大医疗保险的覆盖面,制订有利于弱势群体的医疗保险政策;扩大筹资范围,缩减不必要的医疗费用开支;提高医疗服务质量等。然而,在经济环境的恶化以及来自利益集团的多重压力下,美国的医疗改革不可能解决医疗体制中存在的根本性问题。美国的经验告诉我们,一个国家的经济发展水平不是卫生公平的必要条件,构建一个医疗资源分配合理、医疗保险制度完善、医疗服务质量与效率高、医疗费用合理的公共医疗服务体系才是公民平等享有健康权利的关键。     

奥巴马政府的医改政策及评价

奥巴马的医改政策主要是通过减少政府干预和利用竞争机制,降低医疗服务成本和保险费用门槛,改善医疗服务质量,以及完善预防保健服务与信息技术,逐步建立全民医疗保障制度;同时,通过建立国家卫生服务与医疗保险监管机构,加强对医疗服务与保险费用的监督与管理,以建立一个高绩效的卫生保健服务与保障体系。     

古巴医疗体制发展历程及其启示

财富-健康的因果关系——这个曾经被人们普遍接受的观点现在受到了挑战。古巴作为中低收入国家,其国民健康状况却达到了发达国家的水平。介绍了古巴医疗体制建立与发展的不同阶段,从历史角度理解古巴医疗体制的概貌;同时勾勒了医疗配送和医疗融资体系,从医疗供给与需求的角度描述了古巴的公立医疗体制;最后从古巴的成功医疗体制经验中提出了医疗公平性对发展中国家的重要性、市场手段未必能够保证效率、基础医疗是成功医疗体制的基石,以及医疗供求市场的统一与分离的重新思考等4点对中国的有益启示。     

Recent issues of the Romanian health financing system

The aim of the paper is to examine the health financing reform in Romania in order to find out to what extent the expected results were achieved, what were the main factors that influenced the reform process and in what way the main unsolved problems are to be sorted out. The paper describes the main features of the health financing reform outlining the factors that determined or influenced it, presents some of the reform outcomes and discusses the current health policy agenda. The main findings of this examination are the following: the expected results of the health care reform were not fully achieved (one of the main causes was the too high expectations that did not take into account the country’s low starting point at the beginning of the transition); the reform process was slowed down mainly by political instability, the funds for health increased over time, but this was not enough to increase health system performance and patient satisfaction, the health system reform finally became one of the main priorities on the government agenda. The paper concludes that it took quite a long time until the Romanian government took over its stewardship role of the health system, with the understanding that health reform cannot be a separate process but rather is in need of intersectorial action, clear and coherent legislative support and strong political backing.     

继往开来 任重而道远——深化医药卫生体制改革的回顾与展望

回顾了中国五项重点改革取得的阶段性成果、经验和问题,并提出了政策建议：今后应探索建立一个统筹城乡居民的基本医保体制和经办机构;统一地方增补基本药物目录的遴选标准,健全政府补偿机制;健全基层医疗卫生服务体系,使基本医疗卫生服务更加公平可及,提高服务质量和效率;提高公共卫生服务均等化水平;通过补偿机制和支付制度的改革,探索公立医院改革的路径。     

Prevalence of Food Insecurity Among Cancer Survivors in the United States: A Scoping Review

BackgroundMedical financial hardship is an increasingly common consequence of cancer treatment and can lead to food insecurity. However, food security status is not routinely assessed in the health care setting, and the prevalence of food insecurity among cancer survivors is unknown.ObjectiveThis scoping review aimed to identify the prevalence of food insecurity among cancer survivors in the United States before the COVID-19 pandemic.MethodsFive databases (PubMed, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ProQuest Dissertations and Theses) were systematically searched for articles that reported on food security status among US patients receiving active cancer treatment or longer-term cancer survivors and were published between January 2015 and December 2020.ResultsAmong the 15 articles meeting the inclusion criteria, overall food insecurity prevalence ranged from 4.0% among women presenting to a gynecologic oncology clinic to 83.6% among patients at Federally Qualified Health Centers. Excluding studies focused specifically on Federally Qualified Health Center patients, prevalence of food insecurity ranged from 4.0% to 26.2%, which overlaps the food insecurity prevalence in the general US population during the same time period (range, 10.5% to 14.9%). Women were more likely than men to report being food insecure, and the prevalence of food insecurity was higher among Hispanic and Black patients compared with non-Hispanic White patients.ConclusionsGiven significant heterogeneity in study populations and sample sizes, it was not possible to estimate an overall food insecurity prevalence among cancer survivors in the United States. Routine surveillance of food security status and other social determinants of health is needed to better detect and address these issues.     

2004年中国卫生总费用测算结果与卫生筹资分析

概要描述2004年我国卫生总费用测算结果。2004年卫生总费用增速缓慢,政府卫生投入比例稳中有升,社会卫生支出比重持续回升,居民个人现金卫生支出所占比重保持近2年的下降趋势。还就卫生筹资面临的主要问题和挑战,从公平性角度对我国及部分地区卫生资金筹集和卫生服务利用进行分析评价,并讨论与借鉴世界卫生组织提出的卫生筹资政策目标和卫生筹资策略。     

对公立医院改革发展趋势的探讨

根据参加卫生部组织的“中英卫生创新伙伴计划-利康项目”医改国家试点城市管理培训班的院长们的座谈资料,从改革的目的、卫生体系、卫生筹资、支付机制与服务提供等方面进行整理,以供决策人员参考.院长们认为公立医院改革不仅仅涉及内部运行体制与机制的改革,而且涉及整个管理体制改革,仅卫生系统单独行动,成功希望小,必须是政府的大事.医院的管理要“管办分离”,政府必须真正承担起“主角”的责任.     

Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary

The Italian National Health Service (I-NHS) was established in 1978 to guarantee universal access to healthcare. Prominent in international reports, the I-NHS has reached a satisfactory level of efficiency and excellent standards of care in many regions, in forty years. Along the years, I-NHS has developed a structural public-private partnership in health services delivery that in some regions contributes to the achievement of very high standards of healthcare quality. However, the I-NHS is currently facing some major challenges: (a) Italy is experiencing a remarkable aging of its population with increasing health needs; (b) the recent and constant cuts to public expenditures are reducing the budget for welfare. It is of utmost importance to ensure that on-going efforts to contain health system costs do not subsume health care quality. In addition, monitoring of the essential levels of care (Livelli Essenziali di Assistenza, LEA) highlights significant differences in healthcare delivery among Italian regions that, in turns, contribute to the burdensome migration of patients to best-performing regions. Therefore, a more consolidated and ambitious approach to quality monitoring and healthcare improvement at a system level is needed to guarantee its sustainability in the future.     

Political analysis of the conception of the Polish National Health Fund

Background After the fall of communism, Poland implemented one of the widest reaching programmes of socio-economic reforms. However, in comparison health system reforms were less radical. At the end of the 1990s a change process had been started, but the political fight for power has heavily influenced the health reforms and led to two different reform concepts being implemented over a period of a few years. Aim The paper assesses the chances of implementation of the reform proposed in 2001 to recentralise health financing and organisation by replacing regional sickness funds by a National Health Fund. A hypothetical model is proposed which is placed at the start of the reforms and compares the model to the actual political course observed. Methods PolicyMaker software was used for a political mapping analysis. The policy content (goals and mechanisms) was based on official political documents as well as verbal declarations made by key policymakers in the media, newspapers and magazines. Results The analysis showed that the political situation was in favour of the government implementing a single National Health Fund. Nevertheless, this generated a strong resistance by the political opposition, experts and health care workers which could be a substantial obstacle for the realisation and effectiveness of the implemented model. The feasibility of the project could have been increased by implementing a number of strategies aimed at modifying the attitude of key stakeholders and by introducing the proposed reform as part of an overall improvement of the work environment for health professionals. Conclusions The concept of a National Health Fund generated important opposition against the proposed changes in the health care system. With its majority in Parliament, the government was nevertheless able to establish the new system. The actual course of the reforms however contained a large number of formal errors, which led the Constitutional Court to rule the reform as unconstitutional. Substantial imperfection of the reform caused a destabilization of the whole health care system. In addition, defeat of the reform caused a decrease of electoral support for the governing coalition.     

Health care reform in Russia: a survey of head doctors and insurance administrators

In keeping with the introduction of market-oriented reforms since the collapse of the Soviet Union, Russia's health care system has undergone a series of sweeping changes since 1992. These reforms, intended to overhaul socialized methods of health care financing and delivery and to replace them with a structure of competitive incentives to improve efficiency and quality of care, have met with mixed levels of implementation and results. This article probes some of the sources of support for and resistance to change in Russia's system of health care financing and delivery. It does so through a national survey of two key groups of participants in that system: head doctors in Russian clinics and hospitals, and the heads of the regional-level quasi-governmental medical insurance Funds. The survey results demonstrate that, on the whole, both head doctors and health insurance Fund directors claim to support the recent health care system reforms, although the latter's support is consistently statistically significantly stronger than that of the former. In addition, the insurance Fund directors' responses to the survey questions tend consistently to fall in the shape of a standard bell curve around the average responses, with a small number of respondents more in agreement with the survey statements than average, and a similarly small number of respondents less so. By contrast, the head doctors, along a wide variety of reform measures, split into two camps: one that strongly favors the marketization of health care, and one that would prefer a return to Soviet-style socialized medicine. The survey results show remarkable national consistency, with no variance according to the respondents' geographic location, regional population levels or other demographic or health characteristics, age of respondents, or size of health facility represented. These findings demonstrate the emergence of well-defined bureaucratic and political constituencies, their composition mixed depending on the particular element of reform under discussion, for and against specific avenues of continuity and change in Russia's health policy. As Russia struggles to devise policy strategies and tactics that balance access, equity, quality, and efficiency, it confronts not only policy choices but also political challenges that look not dissimilar to those faced by health reformers elsewhere in the world.     

中国全民统一健康保障发展程度定量分析

目的定量分析中国全民统一健康保障(简称全民统一健保)发展程度。方法构建加法模型,收集相关指标数据,定量分析中国自2003—2011年期间全民统一健保的发展程度。结果计量分析表明,在用0～5的取值范围表示全民统一健保发展程度的情况下,中国全民统一健保的得分在2003年为2.79,2008年为2.32,2011年为2.60,在全民统一健保的进程中行至一半。结论中国全民统一健保程度已处于发展中期。