Can private markets provide professional liability insurance coverage?

To insure against the financial claims of patients injured while receiving medical treatment, physicians, hospitals, and nursing homes in the United States have traditionally purchased professional liability insurance coverage. The insurance has been sold mainly by commercial carriers operating in the private market seeking to match insurance buyers and sellers. However, the experience of the last 30 years would indicate that insurance provided by private markets may not be a satisfactorily efficient means to compensate victims of medical injury. Given the involvement of state-established insurance mechanisms which seek to support private market coverage, perhaps the private market should be abandoned altogether in favor of public programs which seek to provide funding for compensation of medical injury victims.     

Can Turkey's general health insurance system achieve universal coverage?

This study aims to evaluate the General Health Insurance System (GHIS) in Turkey implemented since 1 October 2008, in order to assess whether the GHIS will be able to achieve its objective of universal coverage. Both the breadth and depth of coverage will be taken into account. The study notes out that some socio-economic problems, such as a significant informal economy, high unemployment rate, inefficiency in the creation of adequate employment opportunities, inequitable income distribution, and widespread poverty, are the main problems preventing the GHIS from reaching breadth of coverage in Turkey. Contribution conditions for entitlement to health services prevent the GHIS from providing breadth of coverage too. Outof- pocket payments, which are higher than in European and OECD countries, narrow the depth of coverage, but the GHIS brings additional user fees. Statistics show that despite its objective, the GHIS struggles to provide universal coverage. It seems the GHIS will not be able to provide universal coverage in the near future because of the socio-economic conditions and conditions for entitlement to health services. In this case the government will either introduce radical arrangements to cope with the socio-economic problems and issues with the funding system or should consider switching from an insurance-based system towards a tax-based system.     

Can a health unit take action on the determinants of health?

There is growing interest in improving population health by multi-sectorial partnerships that address the determinants of health. The Leeds, Grenville and Lanark District Health Unit worked with some 80 other community agencies to form the Lanark, Leeds and Grenville Health Forum in the spring of 2000. The goals of this Health Forum were to evaluate the determinants of health of the population over a five-year period, identify activities within an overall Health Improvement Plan to address these determinants, pursue ongoing resources for interventions, assess their impact on health, and modify plans and activities accordingly. The Health Forum identified that their region had increased mortality rates from cardiovascular disease and cancers compared with the rest of Ontario. The local district health unit offered three possible determinants to explain this: socio-economic determinants (residents below provincial average for income and education), behavioural determinants (residents had higher rates of smoking, sedentary activity and high fat diets) and lack of access to health care. The Health Forum developed a Health Improvement Plan to work on each of these determinants. Throughout its lifetime, the Health Forum proved to be both active and productive, leading to many cooperative ventures. This paper provides a brief overview of the approach taken with its Health Improvement Plan, as well as the successes and limitations of this approach. The experience of the Leeds, Grenville and Lanark Health Forum offers a practical model for public health units to work with partner agencies to address the determinants of health, as well as some insights into the requirements to sustain such a model.     

Can coverage be rescinded when negative trial results threaten a popular procedure? The ongoing saga of vertebroplasty

To attain the anticipated benefits of increased investments in comparative effectiveness research, the results must translate into improved medical practice and policy. In this article we present an analysis of a case study of percutaneous vertebroplasty, a widely used invasive procedure to treat painful vertebral fractures by injecting bone cement into the spine. In August 2009, results from a pair of rigorous double-blind randomized controlled trials were published and reported that vertebroplasty provided no better pain relief than a sham procedure in which needles were introduced into the back without injecting cement. More than two years after publication of the two studies, insurers' coverage of the procedure continues unchanged. This raises serious questions about the policy mechanisms that exist in the United States to interpret and act upon "negative" research findings from studies of popular health care interventions.     

Expanded managed care liability: what impact on employer coverage?

Policymakers are considering legislative changes that would increase managed care organizations' exposure to civil liability for withholding coverage or failing to deliver needed care. Using a combination of empirical information and theoretical analysis, we assess the likely responses of health plans and Employee Retirement Income Security Act (ERISA) plan sponsors to an expansion of liability, and we evaluate the policy impact of those moves. We conclude that the direct costs of liability are uncertain but that the prospect of litigation may have other important effects on coverage decision making, information exchange, risk contracting, and the extent of employers' involvement in health coverage.     

Can your nurses stop a surgeon?

With an "audacious" attitude, leaders at Advocate Health Care have set out to create a culture of safety that permeates every level of the organization. The initiative, inspired by work at Sentara Healthcare, gives all employees the power to stop any action they think might harm a patient or co-worker. More importantly, it creates a work environment in which critical thinking is as routine as breathing.     

Hope for the uninsured? HHS proposes a series of initiatives to expand coverage,broaden access for the 41 million Americans without health insurance

It's no secret there's a deepening fear in the U.S. as more and more Americans go without health insurance. But the problem came into sharper focus last week as HHS proposed an array of initiatives to expand coverage and widen access. And in Utah, a Medicaid initiative offers ideas on covering the uninsured. Richard Kinnersley, left, president of the Utah Hospitals and Health Systems Association, praises that plan.