School superintendents' perceptions of schools assisting students in obtaining public health insurance

Background: Superintendents' perceptions regarding the effect of health insurance status on academics, the role schools should play in the process of obtaining health insurance, and the benefits/barriers to assisting students in enrolling in health insurance were surveyed. Superintendents' basic knowledge of health insurance, the link between health and learning, and specific school system practices for assisting students were also examined. Methods: A 4‐page questionnaire was sent to a national random sample of public school superintendents using a 4‐wave postal mailing. Results: Only 19% of school districts assessed the health insurance status of students. School districts' assistance in helping enroll students in health insurance was assessed using Stages of Change theory; 36% of superintendents' school districts were in the action or maintenance stages. The schools most often made health insurance materials available to parents (53%). The perceived benefits identified by more than 80% of superintendents were to keep students healthier, reduce the number of students with untreated health problems, reduce school absenteeism, and improvement of students' attention/concentration during school. The 2 most common perceived barriers identified by at least 50% of superintendents were not having enough staff or financial resources. Conclusions: Most superintendents believed schools should play a role in helping students obtain health insurance, but the specific role was unclear. Three fourths of superintendents indicated overwhelmingly positive beliefs regarding the effects of health insurance status on students' health and academic outcomes. School personnel and public policy makers can use the results to support collaboration in getting students enrolled in health insurance.     

Health insurance enrolment in the Upper West Region of Ghana: Does food security matter?

Toward achieving universal health coverage, Ghana's national health insurance has been acclaimed as a pro‐poor scheme, yet been criticized for leaving the poor behind. Arising from this is how poverty has been operationalized and how poor people are targeted for enrolment into the scheme. We examine the role of food insecurity (not currently considered) as a multidimensional vulnerability concept on enrolment into Ghana's health insurance using binary logistics regression on cross‐sectional survey of household heads (n = 1438) in the Upper West Region of Ghana. Our analyses show that heads of severely food‐insecure households were significantly less likely to enroll in national health insurance scheme (NHIS) relative to households who reported being food‐secure (OR = 0.36, P < .05). We also found education, occupation, and religion as significant predictors of health insurance enrolment. Based on our findings, it is crucial to incorporate food security status in the identification of vulnerable people for free enrolment in Ghana's health insurance.     

School Nurses' Perceptions and Practices of Assisting Students in Obtaining Public Health Insurance

BACKGROUND: From January through June 2009, 6.1 million children were uninsured in the United States. On average, students with health insurance are healthier and as a result are more likely to be academically successful. Some schools help students obtain health insurance with the help of school nurses. METHODS: This study assessed public school nurses' knowledge and beliefs of the impact of health insurance on students' health and academic success. The study also determined whether public school nurses or their schools were involved in helping students obtain public health insurance, and if so, how they did so. Additionally, the study assessed the public school nurses' perceived benefits of and barriers to helping students obtain public health insurance. A paper-and-pencil survey was sent to a national random sample of 750 public school nurses. The response rate was 56%. RESULTS: Nearly 60% of respondents had helped students enroll in public health insurance. The majority perceived that helping students obtain public health insurance would reduce school absenteeism (90%), improve attention during school (84%), reduce the number of students held back (80%), reduce school dropouts (72%), and increase academic test scores (69%). Although the majority (53%) of nurses thought schools should assist students' parents with filling out public health insurance enrollment forms, some expressed reservations about the process. CONCLUSION: School nurses indicated health insurance is important for the health and academic success of students. These beliefs are congruent with state Child Health Insurance Program (CHIP) directors' perceptions, yet few schools have taken on the role of facilitating student enrollment in public health insurance programs.     

The Mandatory Health Insurance System in Chile: Explaining the Choice between Public and Private Insurance

In Chile, dependent workers and retirees are mandated by law to purchase health insurance, and can choose between private and public health insurance. This paper studies the determinants of the choice of health insurance. Earnings are generally considered the key factor in this choice, and we confirm this, but find that other factors are also important. It is particularly interesting to analyze how the individual's characteristics interact with the design of the system to influence choice. Worse health, as signaled by age or sex (e.g., older people or women in reproductive ages), results in adverse selection against the public health insurance system. This is due to the lack of risk adjustment of the public health insurance's premium. Hence, Chile's risk selection problem is, at least in part, due to the design of the Chilean public insurance system.     

台湾地区全民健康保险制度建立对内地医改的启示

在全民医保覆盖的"新医改"思路下,通过对台湾地区建立全民健康保险的经验的介绍和分析,作者建议内地医改当务之急是戮力开放医疗市场。此外,以台湾医改为借镜,建议进一步通过建立单一的医保制度和舆论监督体系,促进社会公平和提高医疗体制整体绩效。     

The impact of medical insurance programmes on the health of the insured: Evidence from China

The impact of medical insurance on the health of the insured has long been an issue of major concern within academia. From the beginning of the 21^st century, the Chinese government has invested a large amount of money in national medical insurance programmes. China's current national medical insurance system consists of three types of programmes: basic medical insurance for urban employees (BMIUE), basic medical insurance for urban and rural residents (BMIURR), and public medical insurance (PMI). These three types of medical insurance have significant differences in terms of premiums, policy deductibles, and levels of coinsurance, thus providing us with the opportunity to study the different impacts these programmes have on their covered members. Based on the 2016 China Family Panel Studies (CFPS) conducted by the China Social Science Research Centre in Peking University, this paper applies the ordered probit model to study the various impacts of these three programmes on the insured under each plan. The study found that compared with citizens who are not enrolled in any insurance programme, citizens who are covered by one of the three programmes report better health; compared with those covered by the BMIUE and BMIURR plans, members covered under the PMI programme report significantly better health; and after controlling for the adverse selection of participants in either the BMIUE or BMIURR plan, citizens who are enrolled in the BMIUE programme have a higher utilization rate of medical resources and report better health than those enrolled in the BMIURR plan.     

Do prevailing theories sufficiently explain perceptions and health‐seeking behavior of Ghanaians?

The challenges faced by African countries that have pioneered a national health insurance scheme (NHIS) and the lessons learned can be of great value to other countries, contemplating the introduction of such a health financing system. In 2003, Ghana initiated the NHIS to provide access to healthcare for people in both the formal and informal sectors. The paper assesses the applicability of four theoretical models to explain the perceptions and decisions of Ghanaians to participate in the NHIS. To contextualize these models, we used qualitative data from individual and group interviews of Ghanaians. These interviews form part of the study “towards a client‐oriented health insurance system in Ghana” to explain the uptake of the Ghanaian social health insurance. The paper argues for a new integrated model to provide a better understanding of clients' perceptions on illness, healthcare and health insurance. Such a model should highlight trust as a fundamental factor influencing the decision of Ghanaians to enroll in the NHIS. Copyright © 2013 John Wiley & Sons, Ltd.     

Universal Health Insurance in India: Ensuring Equity, Efficiency, and Quality

Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India''s workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete.     

非典危机对构建公共健康保障机制的启示

非典危机暴露出我国现行公共健康保障机制上的缺陷。对此，应以人为本，重构公共健康保障机制，提高全体人民的健康水平。另外，还提出了完善浙江省公共卫生体系的构想。     

Is having private health insurance associated with less support for public healthcare? Evidence from the Norwegian NHS

The purpose of this study was to investigate whether increased uptake of private health insurance (PHI) in a traditionally NHS type system is likely to affect support for the public healthcare system. Using the Norwegian healthcare system as our case, and building on a survey among 7500 citizens, with 2688 respondents, we employed multivariate analysis to uncover whether the preferences for public health services are associated with having PHI, controlling for key predictors such as socio-economic background, self-rated health and perceived health service quality, as well as age and gender. The basis for our analysis was the following two propositions related to the role of public healthcare, which the respondents were asked to score on a 5-point Likert scale (1 = “totally disagree”, 5 = “totally agree”): 1) “the responsibility of providing health services should mainly be public”, and 2) “the activity of private commercial actors should be limited”. The regression analyses showed that the willingness to increase the role of commercial private actors is positively associated with having a PHI. However, we found no relationship between holding a PHI and support for public provision of health services when other factors were controlled for.     

Complementary health insurance in France. Who pays? Why? Who will suffer from public disengagement?

The study is based on a rare database with information about health status, socioeconomic characteristics and the complementary health insurance choices of the French population. We intend to characterise a two-stage decision process: first, the decision to purchase complementary health insurance, and then the factors related to choice of policy quality. Our econometric study indicates that (i) income level has a strong and significant effect on the decision to purchase complementary insurance, whilst there is no evidence that health risk considerations affect this decision at all; (ii) the individual decision about quality is associated barely if at all with any rational explanatory variables. The population's concrete behaviour, revealed by the study, is consistent with an allocation of low-risk people to private insurance and high-risk people to public insurance. Complementary insurance is not especially relevant to patients with serious diseases, who depend much more on the public system. If the public insurance system were to disengage significantly from coverage of serious illness, a vacuum would be created that would leave people at high risk without full coverage. These results have broad implications for numerous national systems of social protection seeking a new mix between private and public insurance.     

国际全科医生制度发展历程:影响因素分析及政策启示

全科医生制度建设的国际经验可以为中国全科医生制度的建立和发展提供借鉴。本文首先梳理了国民健康服务体制、社会医疗保险体制、商业医疗保险体制等部分典型国家的全科医生制度发展历程,重点分析了全科医生制度建设的影响因素。结果发现,建立和发展全科医生制度的主要影响因素有:经济社会因素、卫生保健体制对卫生体系的控制力、医师对卫生体系的控制力、全科医学服务的激励机制、全科医学的发展程度等。最后,结合近年我国全科医生制度建设的实际提出几点政策启示,一要以满足我国公众健康需求为目标,构建中国特色全科医生制度;二要普及全科医学服务核心价值,为建立全科医生制度提供公众民意基础;三要建立健全促进全科医生制度发展的激励机制,提高全科医生地位;四要积极推动全科与专科医学的专业分工,促进全科医学发展。     

民营医院纳入医保的意义与政策建议

随着国家社会办医政策的出台,民营医院发展已成为公众关心的问题,如何有效支持民营医院发展,使更多符合医疗保险定点要求的民营医院纳入医保、新农合等医疗保障体系,更好地满足百姓不同的医疗健康服务需求,成为未来政府政策关心的问题。     

上海发展民营医疗机构的政策建议

"上海发展社会办医"课题研究认为:上海需要根据其特点明确民营医疗机构在卫生服务体系中的定位和功能,而后将其纳入医疗机构设置总体规划,并需加强和完善以质量为核心的适合民营机构特点的监管规范,提高市场准入标准,增强其与医保联系,并对提供短缺基本医疗服务的民营机构给予政策优惠。     

Current trends in Canadian health care: disease prevention and health promotion

The Canadian national health insurance plan has not extended to disease prevention in any comprehensive way, and to this extent is incomplete. The Task Force on the Periodic Health Examination has done outstanding work, but no provincial insurance plan has systematically adjusted the benefit schedule to reflect its recommendations. Thus, the place of disease prevention under the Canadian system of universal health insurance is remarkably similar to that in the United States. Health promotion has a somewhat different meaning in Canada from that in the United States, emphasizing intervention at the population level more than health education of individuals. The health promotion movement now enjoys considerable support in Canada, especially in the public health sector, in voluntary agencies, and in the policies of the federal and several provincial departments of health. The movement is almost completely separate from mainstream health services, and is unrelated to the insurance program. To date, there has been mostly talk, but several structures are in place which should lead to action.     

关于社区卫生服务的思考

本文对深圳市开展社区卫生服务的经验、出现的问题进行深入地分析研究，提出了完善社区卫生服务应争取政府和地方的支持，社康站地点应尽量与医院有一定距离，社康站自身积极开展有特色的服务，通过科学的成本核算合理补偿，加强双向转诊机制，把社区卫生服务纳入医疗保险或其它的筹资方式等建议，为更好地搞好社区卫生服务提供了理论依据。     

部分国家政府举办公立医院的经验与启示

世界各国不论经济发达与否,均举办一定数量的公立医院。公立医院的重要地位和作用是：弥补市场缺陷、体现政府保障居民健康权益的责任,并在控制医药费用、提高卫生服务公平可及性、有效利用资源等方面发挥重要作用。不同卫生保健体制国家的公立医院功能定位具有不同特点：国民卫生服务体系国家强调政府主导卫生筹资,公立医院为人群提供免费或廉价的基本卫生服务;社会健康保险体制国家以德国为例,公立医院除承担一般性功能外主要提供住院服务;商业健康保险体制国家以市场为主导,公立医院的作用在于调节市场失灵,在医疗服务体系中发挥基础性但非主体性作用,并履行一定的社会职责。各国政府通过探索公立医院改革,如实行“管办分离”,以明确政府举办公立医院的职责。国际经验对我国的启示是：政府应举办一定数量的公立医院,为其承担大部分筹资,完善监管政策,促使其落实社会职能和责任;公立医院要通过高效率运行,为群众提供高质量的服务,并要代表国家医疗服务体系的先进水平,起到示范作用;政府进行公立医院改革要以转变政府职能为前提,并保障公立医院的社会功能;公立医院的功能应适应国家医药卫生体制的制度环境。     

社会医疗保险制度下公立医院财政补助机制

我国医疗卫生体制已从公共融合向公共契约模式转变，社会医疗保险的迅速推进使基本医疗需方投入为主成为实际的政策选择。在社会医疗保险制度框架下，公立医院仍有部分支出不能由社会医疗保险支付，需要财政补助予以保障。政府财政补助应与公立医院绩效评估机制相联系，以对公立医院经营者形成有效的激励约束机制。     

Insurability and the HIV epidemic: ethical issues in underwriting

The HIV epidemic has focused criticism on standard underwriting practices that exclude people with AIDS or at high risk for it from insurance coverage. Insurers have denied the charge that these practices are unfair, claiming instead that whatever is actuarially fair is fair or just. This defense will not work unless we assume that individuals are entitled to gain advantages and deserve losses merely as a result of their health status. That assumption is highly controversial at the level of theory and is inconsistent with many of our moral beliefs and practices, including our insurance practices. We should reject the insurers' argument. Justice in health care requires that we protect equality of opportunity, and that implies sharing the burden of protecting people against health risks. In a just healthcare system, whether mixed or purely public, the insurance scheme is in systematic terms actuarially unfair, for its overall social function must be to guarantee access to appropriate care. This does not mean that in our system insurers are ignoring their obligation to provide access to coverage. The obligation to assure access is primarily a social one, and the failures of access in our system are the result of public failures to meet those obligations. In a just but mixed system, there would be an explicit division of responsibility among public and private insurance schemes. In our mixed but unjust system, both legislators and insurers cynically pretend that the uninsured are the responsibility of the other. The attempt to treat actuarial fairness as a moral notion thus disguises what is really at issue, namely, the risk to insurers of adverse selection and the economic advantages of standard underwriting practices. Standard underwriting practices will be fair only if they are part of a just system, not if they simply are actuarially fair. The failure of the argument from actuarial fairness means that we must face an issue private insurers had hoped to avoid if we are to defend standard underwriting practices at all. In view of the clear risk that a mixed system will fail to assure access to care, the burden falls on defenders of a mixed system. They must show us that its social benefits outweigh its social costs, and that it is possible to have a mixed system that is not only just, but also is superior to a compulsory, universal insurance scheme.     

美国公共医疗保险的影响效应分析

作为美国医疗保险市场的重要组成部分,公共医疗保险近年来在市场上占据了相当可观的份额,并显现出强劲增长的态势。文章通过相关文献厘清目前美国公共医疗保险所产生的一系列影响,进而关注美国公共医疗保险的影响情况和溢出效应,并提出在未来研究公共医疗保险时应当着重考虑的方向和突破的重点难点问题,以及由此对我国医疗保险改革的经验借鉴。