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Introduction: Since non‐directed (altruistic) kidney donors do not stand to benefit from the lengthening and strengthening of a relationship that they intrinsically value, their donations are considered to constitute the most altruistic variety of living kidney donation. Methodology: This paper uses publicly‐available data to assess the expected value that accrues to the donor of altruistic kidney donation. Findings: Compared to healthy non‐donors, living kidney donors experience only marginally increased absolute risks of poor physical health outcomes, and no difference in important psychosocial health outcomes. Crucially, the chance of requiring a kidney donation is only marginally increased by becoming a living kidney donor. In the United Kingdom, previous living kidney donors that subsequently become in need of any organ donation (not only kidneys) themselves are considered priority patients for these donations. They consequently experience shorter waiting times for these organs and reduced exposure to the inherently harmful effects of dialysis therapy (if a kidney donation is required) compared to non‐donors in need of organ donation. As such, while key data points required to compute an accurate and complete expected value calculation are unavailable, it is likely that the additional risk incurred by becoming a living kidney donor is outweighed by the benefit of being considered a priority patient for the donation of any type of organ in the event that this is needed. Conclusion: Accordingly, the expected value of becoming a living kidney donor is likely to be positive, meaning the act of doing so may be considered akin to the taking out of an insurance policy. In the context of non‐directed (altruistic) kidney donation, this may diminish the extent to which such a donation is considered altruistic. [ABSTRACT FROM AUTHOR]

Despite a sizeable literature on the evolution of health insurance in Britain and Canada, there is virtually no research on the transnational migration of physicians between these countries in the immediate postwar period. This article hopes to address this neglected subject. Three inter-related topics will be examined. First, the paper will summarize the debate over physician emigration from the National Health Service (NHS) in postwar Britain. It will demonstrate how British social scientists and politicians began to come to grips with a major demographic exodus of British-trained doctors in the late 1950s and early 1960s. Second, it will analyze the changing health human resource situation in 1960s Canada, which focused, for practical and cultural reasons, on General Medical Council of Britain licensed practitioners. Third, through oral interviews of British-trained physicians who settled in Canada during the 1960s, it will examine the professional and personal reasons why physicians left Britain for Canada. It reveals that, among a myriad of personal issues that motivated a physician to leave the NHS, the inflexibility and hierarchical nature of British medicine loomed very large. The paper will conclude by reflecting on the contemporary significance of this fascinating historical phenomenon. [ABSTRACT FROM PUBLISHER]

The National Health Service (NHS) has always been compared to other things, to other organisations and systems both at home and abroad This paper explores those comparisons, beginning with the origins of national public health care in Lloyd George's study of German social insurance, and ending with Gordon Brown's claims for the NHS as 'the best insurance policy in the world'. It considers the comparisons and contrasts made for and with the NHS at the time of its foundation and the comparison of state and market around 1990, before reviewing the contemporary function of comparison as form and basis of health governance, The paper presents three related patterns of thought: one prompted by encounter with the other, one sustained by metaphor and one developed in more formal, analytic comparison. It concludes by discussing why comparison itself is such a dangerous and contested thing. [ABSTRACT FROM AUTHOR]

Countries differ markedly in their approach towards healthcare systems. There are variations in how much is spent, how funding is organised (taxation or mandatory insurance premiums), who delivers care (the mix of public and private providers), and where care is delivered (the mix of at home, community, primary and secondary care). Almost all developed countries aim to have universal access to high-quality healthcare, but in most cases systems are struggling with the financial burden of meeting these aspirations. The competing pressures are obvious - the drivers of healthcare demand (changes in medical technology, increases in unit costs and rising patient expectations) are outpacing healthcare funding. This paper explores whether it is possible to satisfy the objectives of keeping pace with healthcare demand and providing access to health services in line with conventional views of equity, within public spending constraints. The paper draws on examples from the UK's National Health Service in particular, but also from other countries. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 43-year-old patient who underwent bariatric surgery abroad. It mentions that, initially, the surgery was without complications, but upon returning to the United Kingdom, the patient faced severe wound healing problems and psychological distress. It highlights the risks and challenges associated with medical tourism for bariatric procedures.

The objective of this paper was to systematically review published studies to determine if disability limits access to health care and to attempt to identify what body functions, structures and activities and participation, as well as contextual factors (environmental and personal factors), interact with the health condition to limit this access. The AMED, CINAHL, EMBASE, Medline and psychINFO databases were searched for original study articles in English, dating from 1974 to 2008. Review articles and expert opinion were excluded. Each study had two independent reviews by either a general practitioner or specialist in rehabilitation medicine. Each study was critically appraised according to the National Service Framework for Long-term Conditions (Department of Health, 2005a) methodology and recorded on standardised data extraction sheets. Studies of poor quality were excluded. Sixty studies were included. No randomised controlled trials were identified. Studies broadly fell into the following three main groups: database studies (n=27), quantitative surveys (n=20) and qualitative interviews (n=13). Disabled people are restricted in accessing health care and report less satisfaction with their medical care. Many of the identified studies were from the United States (US) and based on subjective reporting. More objective evidence is needed, especially in the UK, to clarify the true level of access to health care in people with disabilities. The complex, interdependent factors in providing health care to disabled people require complex solutions. [ABSTRACT FROM AUTHOR]

The purchase of private health insurance (PHI) as a means to partially supplement the National Health System (NHS) coverage is often regarded as a potential signal for a declining support for the NHS. Exploiting the fact that PHI is typically purchased by the most affluent, in this paper we test the so called ‘secession of the wealthy’ hypothesis whereby the likelihood of expressing ‘lack of support for the NHS’ increases with having supplementary PHI. Using empirical data from Catalonia, we draw upon an empirical strategy that circumvents an obvious simultaneity problem by estimating both a recursive bivariate probit as well as an IV probit. After controlling for insurance premium, household income and other socio-demographic determinants, we find that the purchase of PHI reduces the propensity of individuals to support the NHS. We also find evidence that PHI is a luxury good and sensitive to fiscal incentives. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to investigate the determinants of private medical insurance (PMI) consumption in the UK. Design/methodology/approach - A unique combination of panel data estimators, reduced from equations and instrumental variables, applied to six waves of the British Household Panel Survey, 1996-2002. Findings - Results from previous studies are compromised by their failure to use appropriate estimation techniques. Furthermore, a clear distinction between being covered by PMI, having purchased PMI; and having an employer provide PMI is important. Research limitations/implications - Controlling for endogenous variables, such as income and the use of panel data estimators, should be a necessary research method in this area. Practical implications - This study provides a robust analysis of the determinants of PMI consumption in the UK, enabling product providers to identify and target potential customers in different segments of the PMI market Originality/value - This paper breaks new ground in concluding with confidence that age, experience of the NHS in the past years and the belief that the NHS is poor quality, are positive influences on PMI uptake. [ABSTRACT FROM AUTHOR]

This paper investigates empirically how different insurance plans affect individual behaviours in terms of prevention activities in the U.K. The data come from the British Household Panel Survey. We test if purchasing private health insurance modifies the probability of exercising, undergoing regular check-ups and smoking. Based on both simple probits and an IV strategy, our results suggest that, in the U.K., contracting private health insurance does not lead to less prevention. [ABSTRACT FROM AUTHOR]

With 29th March (Brexit day) fast approaching, UK citizens are looking to the Government for guidance on how a planned withdrawal—or no deal—will affect them. This is particularly the case for kidney patients, who have not been given reassurances from the Government on how their care will change in light of the UK's withdrawal from the EU. In this article, Fiona Loud from Kidney Care UK discusses why getting this right is so important for kidney patients [ABSTRACT FROM AUTHOR]

A changing socio-economic environment and competition have led trade unions to extend their role and become service providers. This paper examines some of the issues of service delivery which arise. Four central implications are discussed: the trade union's need (1) to adapt to the competitive service provider's market, (2) to enlarge its consumer body, (3) to become an employer of workers, and (4) to expand its interests with business establishments and authorities over non-union matters. The paper focuses on the General Federation of Labour in Israel (the Histadrut), and its comprehensive health insurance scheme (Kupat Holim). The scheme is provided to all union members and their families as part of union membership. Nonetheless, alternative service systems seem sufficiently attractive for many union members to consider `deserting' their union. The union depends on its members- consumers-to secure its broad base, universalistic image, source of income and legitimacy. Trying to attract consumers causes the union to bend some of its principles. Ultimately, service provision forces the union to adopt characteristics alien to, and even contradicting, its traditional, militant role as an organiser of labour. [ABSTRACT FROM AUTHOR]

A year after its launch, the results of the Department of Health & Social Care's (DHSC) consultation on 'appropriate clinical negligence cover' are still widely anticipated. In this article, we explore the benefits and disadvantages of regulated and discretionary indemnity cover as understood by the DHSC, the medical defence organisations (MDOs), insurance brokers and underwriters. We also turn to surgeons and clinicians with private practices to ask what they think about the current arrangements. Reforms to medical indemnity insurance forecast the passing of the UK's long-established medical defence and protection organisations. [ABSTRACT FROM AUTHOR]

The presence of undocumented migrants is increasing in many Western countries despite wide-ranging attempts by governments to increase border security. Measures taken to control the influx of immigrants include policies that restrict access to publicly funded health care for undocumented migrants. These restrictions to health care access are controversial, and evidence suggests they do not always have the intended effect. This study provides a comparative analysis of institutional, actor-related, and contextual factors that have influenced health care policy development on undocumented migrants in England and the Netherlands. For undocumented migrants, England restricts its access to care at the point of service, while the Netherlands restricts through the payment system for services. The study includes an analysis of policy papers and semistructured, in-depth interviews with various actors in both countries. Findings confirm the influence of such contextual factors as immigration considerations and cost concerns on health care policy making in this area. However, these factors cannot explain the differences between the two countries. Previously enacted policies, especially the organization of the health care system, affected the kind of restrictions for undocumented migrants. Concerns about the side effects of generous treatment of undocumented migrants on other groups played a substantial role in formulating restrictive policies in both countries. Evidently, policy development and implementation is critically affected by institutional rules, which govern the degree of influence that doctors and professional medical associations have on the policy process. [ABSTRACT FROM AUTHOR]

After reviewing the historical background and foundation of the British, Italian, German, Swiss and French, this paper discusses how – structural rather than policy – reforms have changed the organization of the delivery of primary care and how the role of private insurers differs across the selected countries.Journal of Medical Marketing (2009) 9, 96–103; doi:10.1057/jmm.2009.6; published online 5 June 2009 [ABSTRACT FROM AUTHOR]

Despite record increases in funding, the NHS still lags behind the rest of Europe for funding cancer care. This paper examines the growing incidence of cancer in the UK, the impact of a new generation of cancer medicines and the implications that this will have for funders — both NHS and private alike. Although the challenges for the NHS and private medical insurance (PMI) providers will be tough, they are by no means insurmountable. In an era of slower growth in public funding for healthcare, the NHS will need to find efficiency savings, freeing up existing resources to make available new treatments. The forthcoming Cancer Reform Strategy provides a chance to set the framework for delivering efficiency gains — this is an opportunity that the NHS can ill afford to miss. If the NHS faces tough choices in relation to cancer, then it is unclear that there is an easier private sector option. However, for PMI providers, cancer can be an opportunity as well as a challenge. In an age of short waiting times and greater choice for NHS patients, cancer could provide an opportunity for PMI providers to differentiate themselves from the NHS and their competitors on an issue that the public really cares about. [ABSTRACT FROM AUTHOR]

The aim of this paper is to identify the factors that determine the prevalence of private medical insurance (PMI) in England.Secondary data sources are the British Household Panel Survey (BHPS) 1997–2000, Laing's Healthcare Market Review 1999–2000, the United Kingdom (U.K.) Department of Health's National Health Service Waiting Times Team, and the Work Force Statistics Branch of the Department of Health.Logistic regression models for panel data were used to compare non-PMI subscribers with individual subscribers and those with employer-provided PMI.The BHPS data are collected by the Institute for Social and Economic Research at the University of Essex. Other data used were collected by Laing and Buisson and the U.K. Department of Health.Individual PMI is more prevalent among the well-educated and healthy. Income, age, sex, and political preference are key determinants of PMI prevalence for both individual and employer paid PMI. Individuals are also likely to reflect on information with regard to waiting times in deciding whether or not to purchase PMI cover. The withdrawal of the tax subsidy in 1997 to PMI subscribers over 60 years of age did not impact on their rate of withdrawal from PMI coverage relative to the rate among all PMI subscribers, but may have discouraged potential new subscribers.Current trends in the PMI market suggest that, over time, individually purchased PMI is likely to be partially displaced by PMI purchased as part of a company-based plan. However, having PMI is linked to economic factors in both groups, suggesting a similar segment of the population valuing the responsiveness that PMI provides. Geographic factors relating to waiting times and supply-side factors are associated with both individual and company-based PMI. The withdrawal of the tax subsidy to individual subscribers older than age of 60 resulted in a significant decline in the demand for PMI. In particular, the number of new subscribers in this group declined substantially. [ABSTRACT FROM AUTHOR]

Background Approximately 110 000 people in the United Kingdom are affected with familial hypercholesterolaemia (FH). At least 75 per cent are undiagnosed. Treatment with statins is effective but effective primary prevention requires early diagnosis. The best strategy to achieve this is unclear. This paper compares the costs and benefits over a 10 year period of two strategies found in our previous modelling: population screening of 16‐year‐olds or tracing family members of affected patients. [ABSTRACT FROM PUBLISHER]

This paper discusses the nature of demand for private health, insurance in a health care market in which the consumer can neither opt out of tax payments for nor lose his entitlement to public health care. A single equation econometric model of the demand for private health cover is estimated using the 1982 General Household Survey. The results indicate that income and employment status are significant determinants of the probability of health insurance purchase. [ABSTRACT FROM AUTHOR]

This paper examines the decision making process associated with the use of private health insurance. In particular, it focusses on the criteria respondents draw on to decide when to use the private health sector and when not to. This is an important issue as it gives insight into how the use of the private sector relates to use of the National Health Service. It also informs the theoretical debate about help-seeking behaviour, in particular, the usefulness of the notion of choice and 'shopping around' in the health care market. It is concluded that users of health care do exhibit a reasoned approach in deciding between different medical care settings, although due to lack of knowledge and passivity in the patient role, the final decision is usually made by their general practitioner. [ABSTRACT FROM AUTHOR]

Conscientious Objection or conscientious refusal (CO) in access to reproductive health care is at the center of current legal debates worldwide. In countries such as the US and the UK, constitutional dilemmas surrounding CO in the context of reproductive health services reveal inadequate policy frameworks for balancing CO rights with women's rights to access contraception and abortion. The Colombian Constitutional Court's holistic jurisprudence regarding CO standards has applied international human rights norms so as to not only protect women's reproductive rights as fundamental rights, but to also introduce clear limits for the exercise of CO in health care settings. This paper reviews Latin American lines of regulation in Argentina, Uruguay, and Mexico City to argue that the Colombian Court's jurisprudence offers a strong guidance for future comprehensive policy approaches that aim to effectively balance tensions between CO and women's reproductive rights. [ABSTRACT FROM AUTHOR]

Drawing on a mix-methods study comprised of an online questionnaire and semi-structured interviews, this article presents findings about the complexity and development in time of health service use by Polish migrants living in the United Kingdom. The article contributes to the analysis of transnational healthcare practices by operationalising a framework that considers service access within and beyond national borders, and between private and public sectors. By categorising engagements with healthcare providers based on their occurrence in time it argues for an understanding of transnational healthcare as a process. It finds that Polish migrants manage their health by accessing a variety of different providers. This complexity is also reflected in the multiple ways in which access to services with regards to specific health issues unfolds in time. By focusing the analysis on specific health issues rather than individuals the article finds that multiple ways to access healthcare services coexist for the same participant, who does not necessarily move towards particular healthcare providers unitarily, but adopts ad hoc solutions on the basis of their experiences within specific medical areas. Understanding migrants' patterns of accessing healthcare can contribute to more effective policy solutions supporting migrants in the UK today. [ABSTRACT FROM AUTHOR]

Advanced practice nursing (APN) roles have developed partly to address demand and workforce issues. In community care settings and general practice, an advanced nursing practitioner is generally understood to mean a nurse who has undertaken additional education and training in clinical assessment, including history-taking and physical examination, clinical reasoning and independent prescribing, so they can safely manage patients presenting with undifferentiated and undiagnosed conditions. Capabilities in the Skills for Health framework cover everything from communication and consultation skills, practising holistically and personalised care, to working with colleagues and in teams. The framework is intended to ensure advanced nursing practitioners work to an advanced level. It is also designed to support them to demonstrate and evidence their capabilities to service commissioners, employers, people accessing healthcare and the public. [ABSTRACT FROM AUTHOR]

The capacity to provide satisfactory nursing care is being increasingly compromised by current trajectories of healthcare funding and governance. The purpose of this paper is to examine how well Marxist theories of the state and its relationship with capital can explain these trajectories in this period of ever-increasing austerity. Following a brief history of the current crisis, it examines empirically the effects of the crisis, and of the current trajectory of capitalism in general, upon the funding and organization of the UK and US healthcare systems. The deleterious effect of growing income inequalities to the health of the population is also addressed. Marx's writings on the state and its relation to the capitalist class were fragmentary and historically and geographically specific. From them, we can extract three theoretical variants: the instrumentalist theory of the state, where the state has no autonomy from capital; the abdication theory, whereby capital abstains from direct political power and relies on the state to serve its interests; and the class-balance theory, whereby the struggle between two opposed classes allows the state to assert itself. Discussion of modern Marxist interpretations includes Poulantzas's abdication theory and Miliband's instrumentalist theory. It is concluded that, despite the pluralism of electoral democracies, the bourgeoisie do have an overweening influence upon the state. The bourgeoisie's ownership of the means of production provides the foundation for its influence because the state is obliged to rely on it to manage the supply of goods and services and the creation of wealth. That power is further reinforced by the infiltration of the bourgeoisie into the organs of state. The level of influence has accelerated rapidly over recent decades. One of the consequences of this has been that healthcare systems have become rich pickings for the evermore confident bourgeoisie. [ABSTRACT FROM AUTHOR]

Abstract: In Ireland, approximately 30% of the population (‘medical card patients’) are entitled to free general practitioner (GP) care while the remaining 70% (‘private patients’) must pay the full cost of each visit. Previous research has analysed the effect of this system on GP visiting patterns using regression methods, but to date, no attempt has been made to apply techniques from the treatment evaluation literature to this issue. Treatment evaluation techniques are commonly employed when observations are not randomly assigned to treatment and control groups; this is certainly the case here, as the primary criterion for medical card eligibility is an income below a specified income threshold (and individuals may also be granted medical cards for other reasons such as chronic ill-health). In this paper, previous Irish research, which has analysed the effect of medical card eligibility on GP visiting using regression methods, is extended to consider the use of difference-in-difference matching methods, which control for non-random selection into treatment and control groups, as well as differences in time-invariant unobserved characteristics between individuals in both groups. The results are largely consistent with earlier results using pooled cross-sectional and panel data, and confirm that medical card eligibility exerts a significant effect on GP visiting, even after controlling for observed and unobserved differences in characteristics between medical card and private patients. [Copyright &y& Elsevier]

This paper examines the determinants of the demand for private health insurance in the United Kingdom from 1978 to 1996 using a pseudo-cohort panel. The focus is on the impact of public and private sector quality, generational change, and past purchase on demand. The results indicate that there has been generational change in buying behaviour, that the number of senior doctors employed in the public sector impacts upon demand for the private alternative, and that there is limited impact of habit in purchase. Changes to the structure of labour contracts in the NHS may affect demand for the private alternative. [ABSTRACT FROM AUTHOR]

This paper uses the British Household Panel Survey for the years 1996-2000 to investigate the relationship between saving and private medical insurance in the UK. Because the National Health Service (NHS) gives comprehensive health coverage and is generally free at source, one would not expect private medical insurance to crowd-out saving. However, the NHS being characterised by long waiting lists and generally poor quality, many people prefer to use private health services. In such circumstances, those individuals who are not covered by private medical insurance, and who are therefore more exposed to facing unexpected out-of-pocket private health care expenditures or income losses while waiting for public treatment might save more for precautionary reasons than those who are covered. According to our findings, which are based on a wide range of econometric specifications, there is a positive association between insurance coverage and saving, suggesting that private medical insurance does not generally crowd-out private saving. However, we found some evidence of crowding-out in those areas where the quality of medical facilities is perceived as poor, and in rural areas, characterised by fewer NHS providers. [ABSTRACT FROM AUTHOR]

Focuses on a study which examined buyer and seller relationships in permanent health insurance sector in the United Kingdom. Background on the industry; Methodology of the study; Data and results; Implications for the importance of relationship marketing.

This paper examines the right to health care. Various expressions of this right may be distinguished. These include both individual rights and social rights which could be based upon international treaties and constitutional rights. They may be found in national health legislation and, in some cases, in jurisprudence. To analyze the consequences of limiting the right to health care, a framework for judicial review has been developed which encompasses these expressions of the right to health care. The framework was used to examine legal and health policy developments in three Western and two Eastern European countries. In Italy and the Netherlands the right to health care is protected constitutionally (but on differing legal bases) while the United Kingdom does not have a written constitution. In contrast, Hungary and Poland have for many years seen the state take responsible for the provision, administration and allocation of health care services and the right to health care was guaranteed theoretically but not in practice because of the lack of (financial) means. However, the Polish Constitution explicitly anticipates possible limitations of the right to health care. What all these countries have in common is a cost containment perspective where the future will bring even tighter limits on what resources patients may consume. Despite differences in legal structure between these countries, where they seem to converge is on the consequences of putting limitations on the right to health care. The courts in Italy, the Netherlands and the UK have formulated conditions drawn from the acceptance that this right has to be judged within the context of limited resources. It may be concluded that finding a compromise between the right to health care and cost containment policies could also be an issue, Eastern European countries will have to face in the future. [ABSTRACT FROM AUTHOR]

The main form of state insurance for long-term sickness in Britain is invalidity benefit. There has been a dramatic growth in the stock of claimants on this benefit since its introduction in 1971. A logit model is fitted to explain, at the individual level, the probability of entering invalidity benefit among over 50 000 women in 1977/8 and over 65 000 in 1983/4. Demographic characteristics played a powerful role in this model. Pay and benefit rates were also significant. Married women's entry probabilities were highly sensitive to local labor market conditions, and much more so than other population groups.
This paper investigates empirically the strength and significance of such relationships as they apply to one specific state sickness benefit, called Invalidity Benefit (IVB). IVB is a form of state benefit for long-term illness, and was first introduced in 1971. People can claim IVB after 28 weeks on a prior benefit (currently Statutory Sick Pay, although in the period under analysis here it was Sickness Benefit). Individuals must in general have sufficient National Insurance contributions or credits to claim the prior benefit, before they can go on to IVB (see Creedy and Disney (1985) for further discussion). [ABSTRACT FROM AUTHOR]

In the United Kingdom a range of services for elderly people in the community has developed that is delivered by a variety of professionals and administered within different organisations. This has resulted in a problem of co-ordinating services to meet the individual needs of the most frail elderly people. In the United States `case management' has been introduced as a way of improving the co-ordination of care. Despite structural differences in the provision of health and social services between the United States and the United Kingdom, the concept of case management has influenced the design of a number of innovatory schemes in the United Kingdom, including the Gloucester Care for Elderly People at Home project (CEPH). These innovatory schemes have demonstrated the need for a 'keyworker' and clarified the tasks that are involved in taking responsibility for co-ordinating services to meet the needs of elderly people at risk of failing to cope at home. There is, however, a danger of proliferating the complexity of service provision by creating a new breed of professional; an alternative might be to alter the responsibilities, attitudes and team orientation of existing professional workers so as to include taking on the keyworker role for some of their clients. [ABSTRACT FROM AUTHOR]

This article’s aim is to reintroduce the teleological approach formulated by professor Karel Engliš hundred years ago indicating it as a valuable analytical tool for social systems, including the health one. Engliš enriched the positive and normative approach of scientific analysis with teleological one, using postulates based on the principle of finality, and distinguished it both from positive causality and narrow normative measures or legal norms. Because health economics has been often struggling with managing the plurality of health systems, it is worth searching in theory for approaches that may improve this deficit and Engliš’s approach has shown as perfectly suitable for this purpose. We therefore subsequently explain its logic, which was thoroughly defended by Engliš in the literature in 1920s and 1930s. Then we look for specific attributes of four different health systems (the USA, the Netherlands, Germany, Great Britain) from teleological point of view and sum them up into a table which briefly combines social models, fiscal and tax policy measures, and ideals/postulates that those systems are based on. The result is better understanding of the health systems configuration and solid theoretical knowledge behind it, easing the need for finding the optimal or “most effective” health system by recognizing that more important is to know which properties and characteristics it ought to have and which principles it is built on. [ABSTRACT FROM AUTHOR]

Background Although juvenile idiopathic arthritis (JIA) occurs early in life, patients can require long-term treatment into adulthood due to active disease or flares. However, most available studies show that there are gaps in care during and after the transition to adult care. Transition has been associated with higher dropout rates, and there is limited evidence on treatment persistence in JIA patients. The current analysis evaluates etanercept bio-original (ETNBo) persistence up to 5 years and reports diagnostic patterns in early adolescence and young adults in Germany. Methods Patients with JIA (ICD10: M08) between 2-30 years of age with a first recorded ETNBo prescription between 1-January-2008 and 31-December-2012 were retrospectively identified in German health insurance claims data. Patients were followed until 31-December-2015 or end-of-record, whichever came first. Index date was set at the first ETNBo prescription after a 12-month etanercept-free look-back period. Patient characteristics, concomitant treatments and prior use of other biologic Disease-modifying antirheumatic Drugs (bDMARD) were evaluated in the 12-month look-back period. The 5-year etanercept treatment persistence, defined as median (95% confidence interval [CI]) months between the index date and a discontinuation (≥90-day treatment gap after last etanercept prescription), was estimated using Kaplan-Meier analysis, overall and for bio-naïve patients. Etanercept WHO defined daily dose (DDD) was adjusted by age; for patients 2-6, 7-10, 11-14 and >15 daily doses were defined as 1.4mg, 3.6mg, 5.4mg and 7.0mg, respectively. The proportion of patients receiving an adult rheumatic diagnosis after the age of 11 was described. Results We identified 125 patients diagnosed with JIA (median age: 15 years; 30% male). At index quarter 56% of patients were in the 11-20 age group. Most patients (94%) were bio-naïve and 46%, 34%, and 17% had concomitant use of NSAIDS, other DMARDS, and corticosteroids, respectively. Overall median persistence was 13 months (95%CI: 10-16; IQR: 5-27). Persistence for the bio-naïve patients was 50% (95%CI: 41-57), 27% (95%CI: 20-34), 16% (95%CI: 10-23), 10% (95%CI: 5-17) and 9% (95%CI: 4-15) at 12, 24, 36, 48, and 60 months respectively. The majority of patients (68%) received an additional diagnosis of rheumatoid arthritis after age 11, while 15% were given other adult rheumatic diagnoses. Only 9% of JIA patients had received no additional diagnosis to JIA. Conclusion This analysis provides important understanding of care in young JIA patients. We observed a decreasing persistence of etanercept therapy as patients progressed in time through the transition period into early adulthood. Importantly, we found that the majority of JIA patients received additional adult diagnoses, which suggests the transition could impact on the clinical management of this disease. Diagnostic patterns, clinical and patient circumstances during this critical period and their impact on persistence requires further analysis. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

The Affordable Care Act ("ACA") made health insurance accessible to many. Yet unaffordable insurance still abounds. This Article proposes a strategy for improving affordability that enables health insurance purchasers to choose, within reasonable limits, which treatments their insurance covers. After critiquing recently proposed strategies for improving affordability and reviewing past legal scholarship on content choice in health insurance, this Article introduces the "Affordable Choices" framework. This framework regulates choice in four ways. First, health plans should only exclude treatments whose merits are subject to reasonable disagreement among patients and physicians. Second, plans should appeal to purchasers' health-related values--values about the sort of life they want to live--rather than predictions about their health status. Third, plans should include interventions like vaccines that protect others from harm. Fourth, excluded interventions should be those costly enough that exclusion meaningfully shifts affordability. This Article will then discuss potential plan offerings, such as "international reference coverage" based on national plans in other developed countries like Canada or the United Kingdom, and discuss what legal reforms--if any--would be needed in order to offer Affordable Choices plans as part of ACA exchanges, employer-provided insurance, Medicare, or Medicaid. This Article then considers legal and ethical objections that ill people, plan purchasers, society, or providers might advance. It first addresses the objection that Affordable Choices plans will unfairly raise health insurance costs for less healthy people and argues that requiring plans to appeal to healthrelated values rather than health status expectations will help to avoid this problem. It then explains how the Affordable Choices framework can be structured to protect purchasers from misprediction or choice overload. Turning to objections from society, this Article explains how choice about the content of insurance is compatible with solidarity among insured patients, albeit liberal solidarity (focused on the framework that enables choice for all) rather than communitarian solidarity (focused on the substantive content of individuals' choices). It also explains how Affordable Choices plans can be compatible with state requirements regarding specific benefits and with anti-discrimination law. Last, it explains why participation in Affordable Choices plans accords, rather than conflicts, with providers' legal obligations and ethical duties, and argues that providers are not only permitted but ethically encouraged to protect patients from financial hardship. [ABSTRACT FROM AUTHOR]

For the last fifty years, the United States healthcare system has done an extremely poor job of delivering healthcare in a just and fair manner. The United States holds the dubious distinction of being the only industrialized nation in the world lacking provisions to ensure universal coverage. We attempt to provide some of the reasons this dysfunctional system has persisted and show that healthcare should not be a commodity. We begin with a brief historical overview of healthcare delivery in the United States since WWII. This is followed by a critical analysis of the for-profit model including reasons to support the view that healthcare should not be a free market commodity. We also demonstrate how special interest groups have been able to win support for their practices based on propaganda rather than fact. A brief analysis of the Affordable Care Act is offered along with critical comments regarding its ineffectiveness. We conclude with a brief overview of international approaches that have resulted in universal coverage and suggest the United States ought to adopt an approach similar to those outlined so that it no longer stands as the only industrialized nation to ignore the glaring problems that exist. [ABSTRACT FROM AUTHOR]

We study public policies designed to improve access and reduce costs for in vitro fertilization (IVF). High out-of-pocket prices can deter potential patients from IVF, while active patients have an incentive to risk costly high-order pregnancies to improve their odds of treatment success. We analyze IVF's rich choice structure by estimating a dynamic model of patients' choices within and across treatments. Policy simulations show that insurance mandates for treatment or hard limits on treatment aggressiveness can improve access or costs, but not both. Insurance plus price-based incentives against risky treatment, however, can together improve patient welfare and reduce medical costs. (JEL G22, I11, I13, I18, J13, J16) [ABSTRACT FROM AUTHOR]

The article presents the authors' response to the comment by Adam Gaffney on medical care and health insurance in the U.S. Topics discussed include the Medicare healthcare coverage policy in the U.S., the cost of Medicare as well as private health plans, and the impact on international health insurance market, including the insurance premium tax (IPT) rates in Great Britain.

Reports on the growth in the pet insurance market, according to the Sainsbury's Bank in Great Britain. Market value; Proportion of pet owners with pet insurance; Percentage of pet policies that cover the treatment of long-term conditions.

In Portugal, Civil Servants may have a differential utilization of health services due to their supplementary Health Subsystem (ADSE), which grants them access to health services in the private sector at lower price. We exploit the impact of this double coverage on the demand for Portuguese Public Emergency Departments (ED), following the recent increase in co-payments for public health care services in Portugal. Using detailed ED level data from three different EDs, one for each level of the Portuguese ED care, we rely on a difference-in-differences strategy, under the assumption that both civil servants and National Health Service (NHS) users were targeted by the public co-payment increase, but just the former have a low-cost alternative in the private sector that they can use when prices increase in the NHS. We found that the existence of a low-price alternative in the private sector caused ED demand to decrease among ADSE beneficiaries following a policy that increased co-payments in public NHS hospitals. Specifically, we show that this decrease was only significant for conditions which have arguably the closest substitutes in the private sector - the low and intermediate-severity conditions - and to patients who lived closer to the ED and to whom the co-payment was the largest share of the ED visit cost. These findings cast some concerns over the equity of the Portuguese Health System, since civil servants increasingly opt out from public health services but must co-fund both the ADSE and the NHS. [ABSTRACT FROM AUTHOR]

This article seeks to establish what lessons might be available to the English health care sector following enactment of the Health and Social Care Act 2012 from the Dutch experience of introducing market competition into health care via a mandatory health insurance scheme implemented by for-profit insurance companies. The existence of the Beveridge NHS model in England, and a Bismarckian insurance system in The Netherlands perhaps suggest that a comparison of the two countries is at best limited, and reinforced by the different Enthoven-inspired competitive models each has adopted. However, we contend that there are positive and negative issues arising from introducing competition into health care—, e.g. concerns about equity and benefits of efficiencies—which go beyond national boundaries and different systems and reflect the global paradigm shift towards the use of market forces in previously non-market areas such as health. The article examines the situation in England following the HSCA 2012 and The Netherlands following the 2006 reforms before analysing two areas of common ground: the focus in both countries on competition on quality (as opposed to price) and integrated care, which is assuming ever greater significance. We suggest that our combined insights (as a health lawyer and competition lawyer respectively) coupled with a comparative approach create a novel contribution to current calls for a wider public debate about the real role of markets in health care over and above simple characterisation as a force for good or bad. [ABSTRACT FROM PUBLISHER]

Margaret Thatcher (1925-2013) was the United Kingdom's prime minister from 1979 to 1990. Her informal transatlantic alliance with U.S. President Ronald Reagan from 1981 to 1989 played an important role in the promotion of an international neoliberal policy agenda that remains influential today. Her critique of UK social democracy during the 1970s and her adoption of key neoliberal strategies, such as financial deregulation, trade liberalization, and the privatization of public goods and services, were popularly labeled Thatcherism. In this article, we consider the nature of Thatcherism and its impact on health and well-being during her period as prime minister and, to a lesser extent, in the years that follow; we focus mainly on Great Britain (England, Scotland, and Wales). Thatcher's policies were associated with substantial increases in socioeconomic and health inequalities: these issues were actively marginalized and ignored by her governments. In addition, her public-sector reforms applied business principles to the welfare state and prepared the National Health Service for subsequent privatization. [ABSTRACT FROM AUTHOR]