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Copyright of Selcuk University Social Sciences Institute Journal is the property of Selcuk University Social Sciences Institute Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges. In this study, we test the impact of being insured on utilization and financial risk protection compared with no enrolment, using the 2012-13 Ghana Living Standards Survey (n = 72 372). Consistent with previous studies, we observed that participating in health insurance significantly decreased the probability of unmet medical needs by 15 percentage points (p.p.) and that of incurring catastrophic out-of-pocket (OOP) health payments by 7 p.p. relative to no enrolment in the NHIS. Households living outside a 1-h radius to the nearest hospital had lower reductions in financial risk from excess OOP medical spending relative to households living closer (-5 p.p. vs -9 p.p.). We also find evidence that in Ghana, the scheme was highly pro-poor. Once insured, the poorest 40% of households experienced significantly larger improvements in medical utilization (18 p.p. vs. 8 p.p.) and substantively larger reductions in catastrophic OOP health expenditure (-10 p.p. vs. -6 p.p.) compared with that of the richest households. However, health insurance did not benefit vulnerable persons equally from financial risk. Once insured, poor, low-educated and self-employed households living far from hospitals had significantly lower reductions in catastrophic OOP medical spending compared with their counterparts living closer. Taken together, we show that enrolment in the NHIS is associated with improved financial protection but less so among geographically remote vulnerable groups. Efforts to boost not just insurance uptake but also health service delivery may be needed as a supplement for insurance schemes to accelerate progress towards UHC. [ABSTRACT FROM AUTHOR]

Ghana implemented the National Health Insurance Scheme (NHIS) in 2005 with the intention of providing residents with quality affordable healthcare. Over the past few years, concerns have been raised about the quality of healthcare clients receive. This study assesses the experiences of NHIS subscribers with the quality of care they receive under the scheme by both private and public hospitals. The results from the 56 interviews show that the majority of the subscribers were dissatisfied with the overall quality of healthcare they received in both private and public hospital because of the long waiting hours, the poor attitude of nurses and the demand for payment of additional money. Even though clients who visited the private hospital paid for all services, excluding consultation, their level of satisfaction with the quality of healthcare was relatively higher than those who visited the public hospital. The paper concludes that NHIS clients do not receive the quality of healthcare the scheme promised, and this has implications for premium renewals and health-seeking behaviour. [ABSTRACT FROM AUTHOR]

Since 2014, average premiums for health plans available in the Affordable Care Act marketplaces have increased. We examine how premium price changes affected the amount consumers pay after subsidies for the lowest-cost bronze and silver plans available by age in the federally facilitated exchanges. Between 2015 and 2016, benchmark plan premiums increased in 83.3% of counties. Overall, rising benchmark premiums were associated with lower average after-subsidy premiums for the lowest-cost bronze and silver plans for older subsidy-eligible adults, but with higher after-subsidy premiums for younger adults purchasing the same plans, regardless of income. With recent discussions to replace or overhaul the Affordable Care Act, it is critical that we learn from the successes and failures of the current policy. Our findings suggest that the subsidy design, which makes rising premiums costlier for younger adults looking to purchase an entry-level plan, may be contributing to adverse selection and instability in the marketplace. [ABSTRACT FROM AUTHOR]

The article discusses the study on the cumulative expenses of the retirees on their health care expenses after reaching 70 years old until their demise. It mentions the use of self-reported expenses of the retirees involved in the studies while excluding their insurance premiums and Medicare. Findings of the study indicated that while the out-of-pocket health care expenses are catastrophic for some retirees, the expenses are not as high as perceived by others.

At the core of the stated preference method is choice of payment vehicle. Since payment vehicle is an intrinsic characteristic of a good, the choice of payment vehicle will naturally impact on the valuation of the good. Typical payment vehicles applied in the context of health are income tax levies, out-of-pocket payments at the point of consumption or private health insurance premiums. Where out-of-pocket payments will elicit use value only, private health insurance premiums will also disclose option value, i.e. the utility of knowing that one has access to a healthcare service should one need it. Income tax levies will disclose what in this paper is referred to as citizen's preferences, i.e. individual preferences that include use value, option value as well as (caring) externalities. This paper advocates that researchers design stated preference studies that encompass all relevant dimensions of value, and that serious thought is given to choice of payment vehicle. However, it is important to acknowledge that choice of payment vehicle has other potential implications for valuations. Payment vehicle and provider of services may be strongly linked in people's minds. If respondents implicitly associate a specific type of provider with a certain type of payment vehicle, it is important that any misperception is corrected by way of a precise description of the good being valued. Further, a pertinent issue is the extent to which respondents 'protest' to the stated preference question and how we should deal with these 'protesters'. No agreement currently exists about the procedure used to separate genuine zero values from protest values, nor about the treatment of protest responses in subsequent analyses. Beliefs are strongly associated with protesting, and exclusion of protest bids may therefore exclude individuals who have strong preferences for a payment vehicle. If it is acknowledged that payment vehicle is an intrinsic component of a good, exclusion of respondents who exhibit specific viewpoints may result in biased welfare estimates. Yet another issue is the presence of self-consciousness amongst respondents. If people derive utility from saying they are willing to pay for a public good (social desirability bias or warm glow), this potentially drives a wedge between people's stated value for a good in a survey and people's value for a good provided to them from the government. Tax payments are more binding than out-of-pocket payments. Payment towards public health programs via income tax may therefore generate lower consumer surplus than if the intervention was financed out-of-pocket with the option of opting out both in terms of participation as well as financially. Finally, only a few studies have looked at the impact of frequency of payments. The effect of temporal framing is clearly potentially important and at the same time an unavoidable component of the payment vehicle, yet it remains at present unexplored. [ABSTRACT FROM AUTHOR]

Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ), state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions. [ABSTRACT FROM AUTHOR]

Objectives Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance.Methods We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010.Results Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme.Conclusion CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic. [ABSTRACT FROM PUBLISHER]

Research Objective To evaluate the effect of the Health Insurance Flexibility and Accountability ( HIFA) demonstrations on the rate of uninsured. The policy purpose of the HIFA demonstrations is to encourage 'new comprehensive state approaches' that will increase the number of insured. HIFA interventions include changes in benefit packages, eligibility rules for public programs, and state subsidization of private health insurance premiums. Some states emphasized private insurance (premium assistance), whereas others placed greater emphasis on expanded eligibility for public insurance. Data Sources/Study Setting Data were drawn from the Current Population Survey from 2000 to 2007. The target populations for the HIFA waiver demonstrations consisted of individuals who were eligible for the HIFA waiver demonstrations in demonstration states. Study Design The estimation approach was a probit model using a difference-in-differences approach. Principal Findings In states that fully implemented their HIFA waiver, HIFA increased the rate of insurance coverage by 6.4 percentage points on average in the targeted adult population, suggesting that approximately 118,848 adults gained health insurance due to HIFA. Total HIFA adult enrollment in the six states studied was 280,739. The effect size varied by state, with Maine having the largest effect and Illinois the smallest. The results were robust to different specifications of the control group. Conclusions Our findings suggest that public insurance initiatives that provide states with flexibility regarding eligibility and plan design are a viable policy approach to reducing uninsurance rates. [ABSTRACT FROM AUTHOR]

The article presents information on the healthcare system of Japan and states that all Japanese citizens receive unlimited access to medicine through universal health insurance system controlled by the government. It discusses the streams of funding which include subsidies by the government of Japan, individual co-payment and health insurance premiums. It further focuses on several health care plans and the problems faced by the elder population of the country. It also discusses lifestyle and dietary counseling, funding mechanism of Metabo law and problems of obesity.

Consumer-directed health care is a potentially promising tool for moving toward more efficient use of health care resources. Tax policy has long been biased against health plans with significant patient cost sharing. Tax advantages created by health savings accounts (HSAs) began to change that, and proposed tax reforms could go even further. We assess various critiques of these plans, focusing on why they benefit not just the healthy and wealthy. Lower costs and more efficient health spending would help all patients and reduce uninsurance. Potential negative distributional effects are important but can be remedied more efficiently without distorting insurance design. [ABSTRACT FROM AUTHOR]

Continuing its historical role of bridging the worlds of health services research and health policy, the Commonwealth Fund recently established the Commission on a High Performance Health System to stimulate transformation at this critical juncture in U.S. health care. Double-digit increases in health insurance premiums, rising numbers of people without insurance, and unequal access to safe, effective care indicate the strong need for improved health system performance. Through coordinated program components focused on coverage, quality, and efficiency, the commission seeks to forge consensus on policy options and to spread innovation, making high-quality health care accessible and affordable for all Americans. [ABSTRACT FROM AUTHOR]

For many years, some business groups have advocated that the federal government should begin licensing health plans offered by trade associations that would be subject to less stringent regulation than state-licensed insurance products. In recent years, legislation that would make this concept a reality has gained momentum on Capitol Hill. Supporters argue that association health plans (AHPs) are one way to expand access to health insurance and address the rising costs of coverage. President Bush promoted the concept in his 2004 State of the Union address. In May of 2004, the U.S. House of Representatives passed a bill that would encourage the growth of AHPs nationally--legislation almost identical to what the House passed in 2003. In this article, we examine tire AHP legislation's key elements including consumer protection standards and oversight. We discuss arguments for and against tire legislation and conclude that it is unlikely that it would remedy the problems of rising health insurance costs and the growing number of people without health insurance coverage in the United States. [ABSTRACT FROM AUTHOR]

The article discusses the impossibility of creating "classless" medical care, given what wealth and private insurance can purchase and the opportunities the elites have to travel abroad for treatment. Those with regular German government insurance rarely have access to the top rank medical care enjoyed by the rich. The author discusses a sliding scale of health insurance premiums based on the insured's health risk and other alternative premium arrangements.

To better understand employer health benefit decision making, how employer health benefits strategies evolve over time, and the impact of employer decisions on local health care systems. Data were collected as part of the Community Tracking Study (CTS), a longitudinal analysis of health system change in 12 randomly selected communities. This is an observational study with data collection over a six-year period. The study used semistructured interviews with local respondents, combined with monitoring of local media, to track changes in health care systems over time and their impact on community residents. Interviewing began in 1996 and was carried out at two-year intervals, with a total of approximately 2,200 interviews. The interviews provided a variety of perspectives on employer decision making concerning health benefits; these perspectives were triangulated to reach conclusions. The tight labor market during the study period was the dominant consideration in employer decision making regarding health benefits. Employers, in managing employee compensation, made independent decisions in pursuit of individual goals, but these decisions were shaped by similar labor market conditions. As a result, within and across our study sites, employer decisions in aggregate had an important impact on local health care systems, although employers' more highly visible public efforts to bring about health system change often met with disappointing results. General economic conditions in the 1990s had an important impact on the configuration of local health systems through their effect on employer decision making regarding health benefits offered to employees, and the responses of health plans and providers to those decisions. [ABSTRACT FROM AUTHOR]

Health care spending per privately insured person increased 9.6 percent in 2002, a slight reduction from the 10 percent increase in 2001. This is the first time in five years that the spending trend did not accelerate. Nonetheless, health care spending grew nearly four times faster than the U.S. economy grew in 2002. Growth in hospital spending accounted for the largest portion of the overall increase (51 percent) for the second straight year. Moreover, hospital price inflation--which accelerated significantly in 2002-accounted for a larger share of hospital spending growth in 2002 than in 2001. Premium increases accelerated again in 2003, despite 2002's slight deceleration of the overall spending trend. [ABSTRACT FROM AUTHOR]

This paper uses a model of health insurance choice to show that market failure occurs when medical insurance premiums are not related to the insurer's expected medical care payments on behalf of individual consumers. Market failure is manifest by inefficient levels of health promotion spending, income production, and health insurance coverage. Causes of market failure are traced to insured individuals' incentive not to conserve on their use of medical care and insurers' practice of ignoring observable risk differences. Community rating may be a sales-maximizing strategy, or it may be a solution to the problem of adverse selection. The author suggests that subsidization of chronically ill individuals through their health insurance premiums is inefficient. It ought to be replaced by individual risk rating on the basis of exogenous variables, voluntary health-related behavior, and individual medical care use. The author suggests that such a rating system would be feasible for group health insurance policies. [ABSTRACT FROM AUTHOR]

This article shows that the impact of coinsurance varies across medical services in a systematic fashion depending upon the time price of the service. There is little firm information in the economics literature on demand elasticities for medical care. If anything, there is a consensus that demand elasticities are large. In 1967, a 25% coinsurance rate for out- patient physician services was introduced for a large group of individuals in Palo Alto. Before that, the coinsurance rate had been zero. Observations on 2567 individuals were obtained during the first full year before the coinsurance (1966) and the first full year after the coinsurance (1968). The data shows that home visit expenditures decreased much more than office visits; the computed arc elasticity for such expenditures was 0.37. Since time costs are essentially zero for home visits, the higher elasticity of demand for home visits is strong evidence supporting our theory of time-price and money-price responsiveness. There are also Canadian data available on utilization of physician services, but these cannot properly be used to derive an elasticity of demand. Unlike the Palo Alto case, where the insured constituted a small fraction (16%) of the medical group's practice, in Canada the insurance coverage of entire regions was changed.

This paper shows that social security, as the main health care system, is based on principles aimed at the compulsory coverage of all citizens, who are allowed accessibility to a certain package of services. The financial balance between the amount of contributions received and expenditures must be respected in order to perform the medical services. The independence of health insurance organisms in administration of funds, which are collected and used in the alternative, is ensured. The importance of private health insurance is emphasized, as well as the option for the private health care system that allows access to a wide variety of services within primary and secondary treatment, and makes many social groups to prefer private health care sector and to join complementary, additional or substitute private health insurance. [ABSTRACT FROM AUTHOR]

The article discusses several family law-related court cases in the U.S. They include Bingley v. Bingley on post-retirement health insurance premiums. Another is Owens v. Automotive Machinists Pension Trust on dividing unmarried couple's pension. Also included is Hannon v. Redler on the valuation of a medical practice.

The article discusses the effects of high health insurance premiums on employers and working families. The author notes that more people are finding it difficult to pay their medical bills. Discontinuation of insurance by employers is addressed. The consequences of personal medical debt are addressed including limiting access to health care. Efforts made by the trade association America's Health Insurance Plans (AHIP) to make health care more affordable and efficient are also discussed. The influence of health insurance on the treatment of patients is also discussed.

An editorial is presented which addresses what the authors refer to as the challenges that are associated with the process of measuring the affordability of health care in the U.S. as of 2017, and it mentions another article in the same issue of the journal which deals with a proposed Affordability Index and household expenditures for medical care in America. Employer-sponsored insurance plans and government subsidies for health insurance and health insurance premiums are assessed.