Expanding Medicare and employer plans to achieve universal health insurance

This article presents a proposal for expanding Medicare and employer-based health insurance plans to achieve universal health insurance. Under this proposed health care financing system, employees would provide basic health insurance coverage to workers and dependents, or pay a payroll tax contribution toward the cost of their coverage under Medicare. States would have the option of buying all Medicaid beneficiaries and other poor individuals into Medicare by paying the Medicare premiums and cost sharing. Other uninsured individuals would be automatically covered by Medicare. Employer plans would incorporate Medicare's provider payment methods. This proposal would result in incremental federal governmental outlays on the order of $25 billion annually. These new federal budgetary costs would be met through a combination of premiums, employer payroll tax, income tax, and general tax revenues. The principal advantage of this plan is that it draws on the strengths of the current system while simplifying the benefit and provider payment structure and instituting innovations to promote efficiency.     

Health care charities being squeezed “as more doors get slammed in canvassers' faces”

Canada's health care charities are beginning to feel the pinch as Canadians tighten their financial belts. They are in a struggle to maintain donation levels because of the tough economy, increasing competition for dwindling dollars and changing social patterns that affect traditional fund-raising efforts. Yet as governments cut health care funding and hospitals eliminate services, charities are being asked to play a greater role in patient education, research funding and service delivery. Their response is to explore new ways to raise money and to continue to lobby for changes in the tax system.     

市场环境下医疗卫生体制改革政策的伦理学思考

政策的合理性、公正性、正当性和社会性等问题，是判断医疗卫生体制改革政策绩效的伦理学指标。我国医疗卫生体制改革政策，既促进了医疗卫生事业的发展，又存在着不容忽视的体制、机制性问题，诸如医疗服务供给中的利益化倾向、政策的协调性与配套措施不力、政府定位不够准确和干预效果不好等。重构医疗卫生体制改革政策的伦理学目标在于，创新医疗卫生体制与机制、合理配置医疗卫生资源、完善医疗保障体系和优化医疗服务供给模式。     

DeBaKey Ⅲ型主动脉夹层动脉瘤腔内修复术围手术期护理

目的总结对主动脉夹层动脉瘤患者行覆膜支架腔内隔绝术围手术期护理的方法和效果。方法对42例主动脉夹层动脉瘤行覆膜支架腔内修复术的患者术前实行心理护理、健康教育、细致的生活护理、严密监测生命体征、有效控制血压和疼痛,使其平稳度过急性期;术后严密观察病情变化,继续控制血压,预防并发症的发生;出院时给予详细的出院指导。结果 42例患者均痊愈出院,无围手术期死亡病例,其中1例患者并发心肌梗死,经积极治疗后症状消失。结论对实施主动脉夹层腔内修复术的患者,做好耐心细致的术前准备、健康教育,加强疼痛与血压的观察与护理,完善术后护理,严密观察病情变化对提高手术治愈率、减少术后并发症起着重要作用。     

新医改与我国医疗卫生体制的公平性

医疗体制的公平是每个人基本权利的保证条件之一,我国经济快速平稳增长,医疗体制的公平性却不断受到质疑。在宏观形势与医疗体制自身需要的契机下,2009年中国开始了被称为"新医改"的医疗卫生体制改革。从医疗体制公平性角度,分析了改革方案中对医疗筹资、医疗支付和医疗服务机构3个方面的公平性考虑,提出加强累进性最强的税收筹资的力度,以及将财政资金更多地用于医疗需求方,即社会医疗保险的支持,以提高医疗筹资和支付的公平程度。坚持公立医院为主导,充分体现医院服务机构的公益性,也是改革方案中对公平性地体现,反映了新医改对公平性问题的高度关注。最后提出有待进一步明确的关于政府主导与市场调节的兼顾问题,农村医疗保障的完善、医疗筹资中公共资金的适度比例以及中医药的重新定位和重点发展。     

面向农村的医疗卫生一体化服务移动终端设计

分析目前新型农村合作医疗信息系统的不足和困难,研究与设计面向农村的医疗卫生一体化服务移动终端,介绍设计原则、系统功能和设计思路。该项目有利于提高农民的医疗保障,有利于新农合制度的改革,对促进社会和谐发展具有非常重要的意义。     

Health economics and cost-effectiveness research with special reference to hemato-oncology

The cost of health care is increasing globally, especially in cancer. Health economics is an increasingly important field and medical professionals should have a working knowledge of the basis for health technology assessment such as cost-effectiveness analysis, cost utility analysis and cost benefit analysis. There are limited studies on health technology assessment regarding expensive therapies, primarily from high-income countries, but these cannot be applied to countries with different gross domestic product (GDP) and cost of health care delivery. There is a need to carry out health economics related research utilizing data from India. Whereas clinical trials establish the efficacy of new drugs in controlled environments, with strict inclusion and exclusion criteria, their transferability to the “real-world” situation is not always true. With the shifting of the global cancer burden to middle-income and lower middle-income countries, this field is going to assume greater importance in the future. Health economics research conducted in India may be of benefit to other countries with similar economies. The Armed Forces Medical Services of India, with a well-established system of assessing health outcomes, and robust system of accounting for expenses, can provide the lead for these studies.     

Health care, federalism and the new Social Union

The Social Union framework agreement and the Health Accord provide examples of the close relationship that exists between federalism and the delivery of health care. These recent agreements represent a move from a federal-unilateral style of federalism to a more collaborative model. This shift will potentially affect federal funding for health care, interpretation of the Canada Health Act and the development of new health care initiatives. The primary advantage of the new collaborative model is protection of jurisdictional autonomy. Its primary disadvantages are blurring of accountability and potential for exclusion of the public from decision-making.     

Health economics and cost-effectiveness research with special reference to hemato-oncology

The cost of health care is increasing globally, especially in cancer. Health economics is an increasingly important field and medical professionals should have a working knowledge of the basis for health technology assessment such as cost-effectiveness analysis, cost utility analysis and cost benefit analysis. There are limited studies on health technology assessment regarding expensive therapies, primarily from high-income countries, but these cannot be applied to countries with different gross domestic product (GDP) and cost of health care delivery. There is a need to carry out health economics related research utilizing data from India. Whereas clinical trials establish the efficacy of new drugs in controlled environments, with strict inclusion and exclusion criteria, their transferability to the “real-world” situation is not always true. With the shifting of the global cancer burden to middle-income and lower middle-income countries, this field is going to assume greater importance in the future. Health economics research conducted in India may be of benefit to other countries with similar economies. The Armed Forces Medical Services of India, with a well-established system of assessing health outcomes, and robust system of accounting for expenses, can provide the lead for these studies.     

Facing the challenges: general practice in 2020

A strong primary medical care system is essential to the equity, efficiency and effectiveness of the health system as a whole. General practice in Australia faces significant challenges to its capacity to fulfil its role and function: in its financing, recognition, capacity to provide comprehensive care, and integration with the rest of the health system. Addressing these challenges requires a better system of remuneration for quality in general practice care, strengthening of the role of the generalist within the health system, involvement of Divisions of General Practice in service development, and establishment of collaborative networks and integrated primary health care services.     

Care for Canada''s frail elderly population: Fragmentation or integration?

Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.     

Role of Hawaii State Hospital in the care of the seriously disabled mentally ill

The Hawaii State Hospital (HSH) is one element within the total Hawaii mental health system that defines its role and functions according to its relationship with other elements of the system. As the only public psychiatric inpatient facility, the State Hospital's unique role is to provide inpatient care and treatment to patients who are not eligible for hospitalization in the private sector.     

Applying brakes to the runaway American health care system. A proposed agenda

The American health care system, and especially its cost, is out of control, inhibiting access to care for many, lessening quality of care for some, and creating an almost palpable angst among physicians and others concerned with this enormous national problem. Increased health care rationing in the next decade is inevitable, yet it must not be done with quick fixes, short-term solutions, and patchwork reform of our present system. That would create worse problems for health care in the 21 st century and is clearly unacceptable. We recommend that President Bush appoint a blue-ribbon commission to study our present system in depth, then offer alternative solutions for its many problems. He should look closely at at least the following nine issues: controlling medical technology, instituting a resource-based relative value system for physician reimbursement, establishing an ongoing national medical ethics commission, instituting national malpractice reform, implementing universal medical coverage with Medicare/Medicaid reform, establishing a national health services research and planning institute, reducing the nation's health care facilities, reducing physician supply, and improving health promotion/disease prevention education.     

美国医疗保险制度演变及对我国的启示

美国的医疗保障体系医疗支出无论从人均还是占GDP比例均居世界首位,但其成效一直引起争议,多届政府试图对其进行改革。本届政府医改主要着力点是扩大医保覆盖范围,对目前没有医疗保险人群中的大部分给与医疗保障。这一政策改革主要涉及政府在医疗体系中的角色及其权利,其中的一些观点及分析涉及到美国医疗体系支出的构成,高成本的成因,以及作为主要当事者的医生对医疗改革的认同度及倾向,这些素材对我国的医改也有很好的借鉴意义。     

高邮等地农村人群卫生服务需求与利用分析

目的通过调查人群健康状况、卫生服务需要量、卫生服务资源利用效率、就医行为等,了解人群健康意识和卫生服务行为之间的关系,分析卫生服务需要的变化及其影响因素。方法采取定量调查的方法,通过发放调查问卷对扬州高邮等地560户农户进行调查。结果两周患病率为15.9%,患病未就诊率占29.93%,造成需求和利用之间的差距的主要是健康意识不强,经济困难。结论居民的卫生服务行为和健康意识、医疗保健制度、经济收入、就诊方便程度等密切相关,开展健康教育,搞好农村卫生保健制度,合理配置卫生资源是改善需求和利用的重要措施。     

Health spending,illicit financial flows and tax incentives in Malawi

This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps. It begins with an assessment of the disease burden and government health expenditure. Then it analyses the tax revenues foregone by the government of Malawi by two main routes

• Illicit financial flows (IFF) from the country
• Tax incentives.

We find that there are significant financing gaps in the health sector; for example, government expenditure is United States Dollars (USD) 177 million for 2013/2014 while projected donor contribution in 2013/2014 is USD 207 million and the total cost for the minimal health package is USD 535 million. Thus the funding gap between the government budget for health and the required spending to provide the minimal package for 2013/2014 is USD 358 million. On the other hand we estimate that almost USD 400million is lost through IFF and corporate utilization of tax incentives each year.The revenues foregone plus the current government health spending would be sufficient to cover the minimal public health package for all Malawians and would help tackle Malawi''s disease burden. Every effort must be made, including improving transparency and revising laws, to curtail IFF and moderate tax incentives.     

Kidney stones and lithotripters: critical analysis of the introduction of extracorporeal shock wave lithotripsy into Canada.

It is possible for a nonpharmaceutical medical innovation to enter the mainstream of the health care system without its efficacy and effectiveness having first been established by means of a randomized controlled trial (RCT). The result of this omission may be the discreditation and abandonment of the technology or procedure but not before precious resources that could have been better used elsewhere in the health care system are absorbed. A possible example of such a misallocation of resources is the introduction into Canada of extracorporeal shock wave lithotripsy (ESWL) for the treatment of urolithiasis. We review the development and diffusion of ESWL and recommend ways in which the deficiencies in regulating the introduction of new medical technologies can be corrected.     

The US health care system: On a road to nowhere?

THIS ARTICLE REVIEWS THE CURRENT STATE AND FUTURE PROSPECTS of the health care system in the United States. The 1990s were a decade of reform and change in US medical care, with the debate over the Clinton plan for universal insurance and, after its defeat, the spread of managed care. In particular, managed care had a profound impact on the delivery of medical services, transforming traditional insurance arrangements. However, after all of the changes, the United States appears to be no closer to solving the problems that have characterized its health care system for the past 3 decades. Over 40 million Americans lack health insurance, universal coverage is nowhere in sight, and medical care costs are rising again after a period of moderation. It is doubtful that incremental health reforms will significantly ameliorate these problems.     

What should be done about the uninsured poor?

The author proposes a program for the expansion of access to medical care which realistically reflects the public belief that everyone has a right to adequate health care and the assumption that the individual taxpayer should not have to pay more than $50 per year to see this happen: scrap Medicaid and create a new initiative, administered through state health departments, to subsidize private health insurance policies; require basic private health insurance coverage for all full-time (including temporary) employees; and tax the individual between $50 and $65 to insure those not in the workplace full-time. This plan offers the promise of achieving bipartisan support by relying on private health insurance linked to employment and the removal of disincentives for seeking work among the poor.     

Cloud Based Emergency Health Care Information Service in India

A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the past years. We have developed two services for health care. 1. Cloud based Palm vein recognition system 2. Distributed Medical image processing tools for medical practitioners.