Premium rebates and the quiet consensus on market reform for Medicare

Premium rebates allow beneficiaries who choose more efficient Medicare options to receive cash rebates, rather than extra benefits. That simple idea has been controversial. Without fanfare, however, premium rebates have become a key area of agreement in the debate on Medicare reform. Moreover, in legislation in late 2000, it became official policy: Medicare+Choice (M+C) plans will be allowed to offer rebates beginning in 2003. This article explores the economic rationale for premium rebates, provides a historical perspective on the rebate debate, discusses some of the implementation issues that need to be addressed before 2003, and reviews the implications of premium rebates for current legislative proposals for Medicare reform.     

Commoditization of the international teleradiology market

Telemedicine improves access to medical care. However, telemedicine will also increase market volatility because of its ability to stimulate price competition and the insidious way it shifts liability for providing medical services. To cope with increased volatility, other economic sectors have evolved commodities markets by making greater use of standardized forward/future contracts. In the past, the need for medical services to be produced and consumed locally and a lack of an objective definition for medical quality, prohibited the use of forward contracts for health-care services. However, telemedicine, and the increasing use of statistical definitions of medical quality now make standardized forward contracts for health-care services conceivable. Commoditization of teleradiology would offer several advantages including increasing market transparency, a mechanism for ensuring medical quality, and a means for bringing capital into the health-care sector. To reap the benefits of a commodities market in teleradiology, the key will be for market stakeholders to overcome their fear of the unknown in order to organize a central exchange.     

借鉴国际经验，加速履行《烟草控制框架公约》

《烟草控制框架公约》（以下简称《公约》）是世界卫生组织主持制定的多边国际公约，是联合国历史上最广泛受到热诚接受的条约之一。《公约》将通过减少烟草需求和烟草供应两方面宏观调控控制烟草跨境流行、减低和净化烟草消费，保护人类健康免受烟草的危害。本尝试与现实紧密结合，用综合、比较等方法来阐述国际经验与做法对我国烟草控制工作的意义和作用，并通过引介各缔约方做法，分析我国在履约准备工作基础上，如何处理好国家利益、缔约方权利和义务之间的关系。     

On reform of the international patent classification

In this work, the data on reformed IPC are presented. In IPC the core and advanced levels of classification system are used. It is shown that the goal of the IPC reform is to make possible complete search using a single classification edition for all documents, regardless of their publication date.     

世界各国卫生保健制度面临的挑战及改革动向研究

医疗费用的剧增和公平性差是卫生保健体系的一个全球性问题。医疗保障项目覆盖面小且没有系统化;国家财力薄弱,给付水平低;卫生保健管理落后、企业和机构承担了相当多的医疗保障义务,是绝大多数中低收入国家的主要问题。改革的主要方向是建立覆盖全民的基本医疗保障制度,采取费用分担、支付方式改革、引入竞争机制、管理体制改革、加强政府职责和监管、建立专门的老年社会照顾体系等。     

Good and bad models of market reform for managed care

The author argues that free market competition has not been given a fair chance in the health care industry and that the basic characteristics of a sound market can be met in the United States if the problem of asymmetric information is efficiently addressed. He proposes the "Buy-Right" system as an effective model for market reform.     

Back to the market: yet more reform of the National Health Service.

Yet more reform of the National Health Service in England has been announced by the Department of Health. In opposition, the Labour Party criticized the creation of an "internal market" for health care by the Conservative government, but five years into the Blair administration, market incentives are to be reinvigorated and the private sector is to be embraced in ways not seen hitherto. New guidance signals the introduction of competitive contracting using cost-per-case currencies, more choice for patients in where they will receive hospital treatment, and the freeing of NHS care providers from the direct political control of ministers. It is intended that the monopolistic features of the NHS in England should give way to greater pluralism, in particular through contracts with privately owned health care organizations. However, there is little evidence to suggest that these policies will be effective, and a number of practical problems may obstruct implementation.     

How to reform the health care system given the experience of past failures

There have been a number of attempts at a large-scale reform of the US health care system during the 20th century and all have failed. Problems continue to exist, however, in the organization, delivery, and financing of health care services. Under current economic conditions, the possibility for both reform and recovery is slim if at all. In this article, we discusses a realistic option to incremental reform that takes a more realistic view of the US social and economic situation of the 21st century and is more consistent with basic US values. Perhaps it is time for reformers to take such a pragmatic approach to this long-term problem.     

Removing user fees: learning from international experience to support the process

Removing user fees could improve service coverage and access, in particular among the poorest socio-economic groups, but quick action without prior preparation could lead to unintended effects, including quality deterioration and excessive demands on health workers. This paper illustrates the process needed to make a realistic forecast of the possible resource implications of a well-implemented user fee removal programme and proposes six steps for a successful policy change: (1) analysis of a country's initial position (including user fee level, effectiveness of exemption systems and impact of fee revenues at facility level); (2) estimation of the impact of user fee removal on service utilization; (3) estimation of the additional requirements for human resources, drugs and other inputs, and corresponding financial requirements; (4) mobilization of additional resources (both domestic and external) and development of locally-tailored strategies to compensate for the revenue gap and costs associated with increased utilization; (5) building political commitment for the policy reform; (6) communicating the policy change to all stakeholders. The authors conclude that countries that intend to remove user fees can maximize benefits and avoid potential pitfalls through the utilization of the approach and tools described.     

公私伙伴关系促进医疗服务供给侧改革的国际经验及其启示

基于公私伙伴关系(PPP)的相关理论与概念,本文从管理理念的变革,财政预算的压力,技术创新与服务模式的转变及健康服务业的发展等方面系统阐述了PPP模式在医疗服务领域的发展动力,并结合国际社会在医疗服务领域引入PPP模式的实践,总结了部分国家在改革实践中所取得的效果与存在的风险;研究发现,在医疗服务领域引入PPP模式对促进政府职能转变,缓解政府的筹资压力,特别是推进医疗服务供给侧的结构性改革,提升医疗服务系统对消费者需求的反应性,实现其"物有所值"的最大化等具有一定的促进作用与现实意义;但是,在实践中要处理好政府角色的定位,趋利行为与公益性,垄断与监管等方面的关系。相关的启示是,在深化医改的实践中要树立开放、包容、共享的创新发展理念,并进一步完善相关的政策法规,提升监督管理能力。     

国际排行榜对我国卫生体制改革的启动综述

为给我国卫生体制改革改革研究和决策提供国际卫生组织的有关信息，也为了与国际游戏规则接轨的需要，文章以WHO《2000年世界卫生报告》国际排行榜为主旋律，综合介绍有关排序情况和甸与部分国家排名比较，介绍了WHO为实现“2000年人人享有卫生保健”全球战略目标所做的一系列重要指标以及与我国合作进行的曾经很有声势的开创性活动，综合讨论了我国卫生体制改革有关的观念、问题及未来走向。     

Health reform for children: the Egyptian experience with school health insurance

In June 1992, the People's Assembly of Egypt passed Law 99 expanding health insurance to cover all school children. This was one of the most important initiatives undertaken in recent years by the Ministry of Health, and it effectively increased the number of beneficiaries covered by the Health Insurance Organization (HIO) from 3.75 million in 1988 to about 14 million in 1993. This paper first examines the policy processes for the introduction of this innovation in Egypt's health system. Next, the paper discusses the implementation and consequences of the new policy in terms of coverage, financing, benefits, and delivery of services, along with data on utilization and expenditures. Several important lessons derive from this analysis. First, major reform efforts are possible when there is a strong political commitment and the proposed program and solutions are acceptable to the key stakeholders. Second, compromises and trade-offs are essential to construct a politically feasible and ethically acceptable reform initiative. Third, while these trade-offs might yield short-term gains, the trade-offs in the long term may undermine the reform's capacity to achieve the anticipated equity enhancements and can potentially undermine the financial sustainability of the reform.     

Exposure to lead of the Belgian population

Summary According to the Council Directive of 29 March 1977 on biological screening of the population for lead, the blood-lead levels (PbB) were determined in samples of the Belgian population not occupationally exposed to this metal. Two campaigns of sampling were performed: the first one in 1979 (1678 samples analysed) and the second in 1981 (1000 samples analysed). Sampling was done in urban and industrial zones, as well as in areas where lead risk could be present. Concerning the urban and industrial areas, the results obtained seem to indicate that a particular lead risk does not exist for the adult population if we consider the reference levels of the CEE Directive. Moreover, the results of the second campaign of sampling showed a decreasing trend: the median PbB values dropped from 183 to 156 g/l in Brussels and from 192 to 139 g/l in Liège. This could be partly due to the limitation of the lead content of gazoline. On the other hand, the results of the surveys clearly demonstrated the existence of two areas where an obvious lead risk exists. In one of those, the lead risk is of industrial origin (lead smelter) and concerns mainly children: median PbB value 260 g/l, percentile 90 and 98 respectively 390 and 430 g/l. In the other one, the lead risk is from a hydric source and concerns adults and children: median PbB value 258 g/l, percentile 90 and 98 respectively 370 and 520 g/l.