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We review the history, current status, and potential future of state infertility mandates and focus on the business implications of mandates and on the inadequacies and reproductive injustice resulting from gaps between legislative intent and practical implementation. Nineteen states have passed laws that require insurers to either cover or offer coverage for infertility diagnoses and treatment. The qualifications for coverage, extent of coverage, and exemptions vary drastically from one state to another, resulting in deficiencies in access to care even within mandated states for certain groups, such as single individuals, patients in same-sex relationships, and patients pursuing fertility preservation. Although insurance coverage of fertility services in the United States has expanded as an increasing number of states have enacted infertility mandates, significant gaps in implementation and access remain even among states with existing mandates. Provider, patient, and legislative advocacy is warranted in the name of reproductive justice to expand insurance coverage and, in turn, maximize reproductive outcomes, which have been shown to improve as financial barriers are lifted., (Copyright © 2020 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Current interest in a single-payer approach to universal health care coverage in the United States has also triggered interest in alternative multipayer approaches to the same goal.An analysis of experiences in Germany, the Netherlands, Switzerland, and Israel shows how the founding of each system required a distinctive political settlement and how the subsequent timing, content, and course of the reforms were shaped by political circumstances and adjustments to the founding bargain in each nation.Although none of these systems is directly transferable to the United States, certain parallels with the American context suggest that a multipayer approach might offer a model for universal coverage that is more politically feasible than a single-payer scheme but also that issues associated with risk selection and other potential inequities would remain.

Objectives: This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view., Results: All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into three main themes and 11 subthemes. The main themes include three kinds of requirements at three level of third party insurer, health care provider and citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.

During the last century, California policy makers tried multiple approaches to achieve the goal of affordable health coverage for all: employer and individual requirements, single payer, and hybrids. All failed, primarily because of the amount of financing needed to cover the large numbers of uninsured Californians and the supermajority vote requirements for tax increases. These failures, however, provided important lessons for state and national reform efforts. More immediate success was achieved with incremental reforms, such as child health insurance, Medicaid section 1115 waivers, and the creation of purchasing pools. These reforms, as well as the experience derived from the broader coverage expansion efforts, contributed to the intellectual and policy frameworks that underlay major national reforms and created building blocks for the state's successful implementation of the Affordable Care Act. That act allowed California to meet its greatest need: the financing required to make a truly sizable dent in the numbers of uninsured Californians.

Background: The primary reason cited by many scholars for the defeat of the Clinton Administration's 1994 health care reform bill has long been identified as Health Insurance Association of America and National Federation of Independent Businesses opposition to the bill. Given this predominant consensus combined with sizeable proposed funding for the bill by a large tobacco product tax, this manuscript examined what the tobacco industry's role was in whole or part in defeating the Clinton health care bill., Methods: This research occurred through crosschecking internal tobacco industry documents and Clinton White House documents., Results: Prior to the passage of the bill, the tobacco industry accepted a compromise of 45 cents per pack increase phased in over five years. Due to this compromise, the industry or third party allies had no role in the ultimate defeat in the bill., Conclusions: The primary reason for the bill's ultimate defeat was general business (but not tobacco industry and third party ally) opposition, the bill running out of time, and conflicting bills. Secondary reasons for the bill's defeat included issues with: employer mandates, high taxes on insurance plans, impacts on medical research and education, Congressional attention to other issues, election year politics, and possible future excise tax possibilities.

The 40B Drug Discount Program (340B Program) is a federally facilitated program that requires drug manufacturers to provide steep discounts on outpatient prescription drugs to qualifying safety net health care providers. The federal program is intended as a safeguard to ensure access to affordable drugs to the indigeut. However, over the last two decades safety net health care providers have exploited financial incentives under the 340B Program at the expense of drug manufacturers and patients, including the most needy and vulnerable populations-they are committed to serve. Although the federal government has been applauded for increasing effortsto combat health care fraud and abuse including recovering $3.3 billion in 2014, federal officials and the general public have paid markedly less attention to pervasive abuse of the 340B Program. In 2014, drug purchases of 340B-designated drugs totaled $7 billion and are expected to increase to $12 billion: by 2016 as a result of the expansion of the program under the Affordable Care Act. The 340B Program has completely lost its way, and comprehensive legislation is necessary to realign the program with its intent.

This reprinted article originally appeared in American Journal of Orthopsychiatry, 1981, Vol. 51, No. 3, 391-402. (The following abstract of the original article appeared in record 2013-42918-004.) This article focuses on reflections on mental health in the United States. This accumulation of wisdom and knowledge from experts inside and outside government has for the most part been ignored or shelved over the years because of revisions, deferrals, impoundments, vetoes, threatened vetoes, reorganizations, budget cuts, inflation, and military demands. Programs such as Head Start, which have been proven successful, have been fighting for survival, and community mental health centers, which in many ways represented a bold, new approach with much creative promise, were threatened with the loss of federal funding in the early 1970s. The humanist tradition in mental health and social services is best exemplified by Pinel's unchaining of psychotic patients: Itards infinite patience in working with Victor, the wild child: and Jane Addams's extraordinary development of community programs. On an international level a recent report of the WHO European Regional Office also has called for a wide ranging, independent group that would cut across national governments and exercise influence at high political levels to insure that important mental health policies are implemented. Perhaps the day will even come when an American President will feel responsible and accountable to the nation in an annual report to Congress and the people on the progress made in health and social welfare areas in his or her administration., ((c) 2014 APA, all rights reserved.)

The Liberal government in 1911 was determined to improve the health care of the poor and working class in Britain. The Chancellor of the Exchequer, Lloyd George, introduced a National Insurance Bill before Parliament without consulting the medical profession. The doctors were furious but Horsley, a progressive liberal, was firmly in favour of a national health service and vociferously supported the bill. This led to a series of acrimonious meetings that did not enhance the reputation of the profession and alienated Horsley from his colleagues.

The historiography of Zagreb sanatorium Merkur, founded by Merkur Insurance Society in 1930 is presented. The research is based on archival sources kept in the State's archives as well as in the National library in Zagreb aiming to identify the opening, building and governing the hospital until 1945. The analysis of the hospital historiography allowed the insight into social insurance development on our territory as well as of Zagreb's population receptivity towards the health institution and the quality of health service in the first half of the 20th century. The paper is dedicated to the 140th anniversary of Merkur Insurance Society foundation.

Health insurance coverage and the means by which it is paid have been topics of intense interest in recent years, but in the United States, creation of a uniform system for provision of medical care has been debated for nearly a century. During the Great Depression, before large group insurance plans, workers who formerly had been able to adequately support their families found themselves without employment or in low income jobs that barely put food on the table and a roof over their heads. Medical care was a luxury they could not afford. Health professionals suffered the effects of the economy too. Published in Public Health Nursing in 1936, this paper reflects a time period when the ravages of the Great Depression were manifest. California had received an influx of poor, migrant workers from other states hoping to provide for their families as pickers, canners, and manual laborers. The author, Marion E. Russell, described a 1935 health insurance proposal to cover all state residents. Selected excerpts illustrate differences in philosophy still evident in current considerations of national health care reform, particularly as related to mandated coverage. Russell worked in the State Relief Administration in San Francisco., (© 2013 Wiley Periodicals, Inc.)

This article contributes to the debate about using insurance records to reconstruct historical experiences of sickness during the Western mortality transition. Critics regard these sources as problematic as they measure morbidity indirectly through absences from work; these might be determined not by timeless biological criteria but by more contingent factors, notably shifting norms surrounding the sick role and responses to economic incentives (for which we adopt the generic term 'cultural inflation of morbidity'). We review historical demographers' contributions to this literature and discuss the concepts of moral hazard and the principal/agent problem as developed by health economists. This leads us to frame three empirical tests for 'cultural inflation' which allow us to assess the validity of insurance records for deriving morbidity trends: was there an increasing frequency of claims for complaints of diminishing severity; were unduly prolonged claims noticeable, particularly by older people for whom sickness benefit may have compensated for income insecurity; and did the insurer satisfactorily manage the agency problem to ensure reliable physician gatekeeping? We analyse records of the Hampshire Friendly Society, an exceptionally well-documented fund operational in Southern England, 1825-1989. Findings are based on a dataset of individual sickness histories of a sample of 5552 men and on qualitative documentary analysis of administrative records. On each count our results fail to demonstrate a cultural inflation of morbidity, except perhaps for those aged over 65. However, occasional discussion in the administrative records of economic incentives encouraging unnecessary prolongation of claims means we cannot rule it out entirely., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

There is great focus within the military medical community regarding the ever growing cost of medical care overall and dependent care specifically. A great deal of discussion relates to the delivery of care through a growing military-civilian partnership, where an increased amount of health care will be referred to an ever growing network of civilian providers. The U.S. military establishment now stands at an important crossroad leading into the future of dependent care. However, the special concerns, which arise from the responsibility of caring for military dependents, are not a solely recent phenomenon. Ever since the establishment of a permanent standing U.S. Army in the late 1700s, there have been families in need of medical treatment. Although changes occurred continuously, the development and evolution of policies regulating the delivery of medical care to dependants can be divided into three periods. The first is the longest and ranges from the establishment of the Army until the year 1900. The second period spans from 1900 to the post-Korean War year of 1956. The third and final period is from 1956 to 1975. Special changes and advances in each of these periods have served to shape the face of dependent care in today's Army Medical Department.

Background: Unlike pain practitioners, health care insurers in the United States are not expected to function according to a system of medical ethics. Rather, they are permitted to function under the business "ethic" of cost-containment and profitability. Despite calls for balancing the disparate agendas of stakeholders in pain management in a pluralistic system, the health insurance industry has continued to fail to take the needs of suffering chronic pain patients into consideration in developing and enacting their policies that ultimately dictate the quality and quantity of pain management services available to enrollees. This essay examined these self-serving strategies, which include failure to reimburse services and certain medications irrespective of their evidence-bases for clinical efficacy and cost-efficiency; "carving out" specific services from interdisciplinary treatment programs; and delaying and/or interrupting the provision of medically necessary treatment. Blatant and more subtle strategies utilized by insurers to achieve these ethically questionable goals are examined. Additionally, this essay addressed some of the insurance industry's efforts to delegitimize chronic pain and its treatment as a whole., Conclusion: The author concludes that the outlook for chronic pain sufferers is not particularly bright, until such time that a not-for-profit single-payer system replaces the current treatment/reimbursement paradigm., (Wiley Periodicals, Inc.)

Objectives. One of the major policy concerns at the federal and state level is the rising number of individuals without health insurance. The purpose of this article is to investigate whether party control of government and various state reforms impact the percentage of the state population without health insurance.Methods. Using data from 1987–2007, I empirically examine whether party control and five state policy reforms reduce the uninsured population.Results. The results show that Republicans are more effective than Democrats at the state level at reducing insurance gaps and that three of five policy reforms explored appear to significantly expand insurance coverage.Conclusions. The results provide valuable insight into which components of health-care reform at the national level may help address the health insurance problem.

We use categorical and logistic regression models to investigate the extent that family structure affects children’s health outcomes at age five (i.e., child’s type of health insurance coverage, the use of a routine medical doctor, and report of being in excellent health) using a sample of 4,898 children from the "Fragile Families and Child Well-Being Study." We find that children with married biological parents are most likely to have private health insurance compared with each of three other relationship statuses. With each additional child in the home, a child is less likely to have private insurance compared with no insurance and Medicaid insurance. Children with cohabiting biological parents are less likely to have a routine doctor compared with children of married biological parents, yet having additional children in the household is not associated with having a routine doctor. Children with biological parents who are not romantically involved and those with additional children in the household are less likely to be in excellent health, all else being equal.

This article examines the preferences of the general public in Australia regarding health care resource allocation. While previous studies have revealed that the public is willing to give priority to particular groups of patients based on their personal characteristics, the present article goes beyond previous efforts in attempting to explain these results. In the present study, there was strong support among respondents for giving “equal priority” to people regardless of their personal characteristics. However, respondents did reveal a preference for married patients over single, for children over adults, for carers of children and the elderly, sole breadwinners, and good community contributors. Further, they would give a lower priority to those perceived as “self-harmers”—smokers, individuals with unhealthy diets, and those who rarely exercise. Variation in the answers according to broad economic and social beliefs across seven different categories (“factors”) influenced the pattern of the public's attitudes towards rationing. The Principal Components Analysis (PCA) indicated that most of the items in our survey are associated with seven factors that explain or capture much of the variation. These relate to a patient's avoidance of self-harm behaviors (Safe Living), their Life Style (diet, exercise, etc.), their contribution to the community through caring for others (Caring), their talents (Gifted), their sexual behavior (Sexuality), their age and marital status (Family), and whether they are an Australian citizen or employed (Citizen). The strength of social preferences—e.g., how strongly respondents would “discriminate” against a recreational drug user or preference a person with a healthy diet—is related to the particular class of preferences.

Hospital public bodies were instituted in Italy in 1968. Their creation represents a fundamental step forward in the evolution of the national healthcare system and has allowed improvements in social equity in hospitals. The lack of independent funding beyond the insurance-type healthcare system existing at the time, hindered its success. The hospital body has however left a trace in the modern national healthcare system with the introduction of the hospital corporation.

This article analyzes the reforms introduced over the last quarter century into the French health care system. A particular public-private combination, rooted in French history and institutionalized through a specific division of the policy field between private doctors and public hospitals, explains the system's core characteristics: universal access, free choice, high quality, and a weak capacity for regulation. The dual architecture of this unique system leads to different reform strategies and outcomes in its two main parts. While the state has leverage in the hospital sector, it has failed repeatedly in attempts to regulate the ambulatory care sector. The first section of this article sets out the main characteristics and historical landmarks that continue to affect policy framing and implementation. Section 2 focuses on the evolution in financing and access, section 3 on management and governance in the (private) ambulatory care sector, and section 4 on the (mainly public) hospital sector. The conclusion compares the French model with those developed in the comparative literature and sets out the terms of the dilemma: a state-run social health insurance that lacks both the legitimacy of Bismarckian systems and the leverages of state-run systems. The French system therefore pursues contradictory policy goals, simultaneously developing universalism and liberalism, which explains both the direct state intervention and its limits.

In this article, I examine all the attempts to reform Australia's health insurance system since Medibank was introduced in 1975; there have been seven, and the eighth (which goes beyond just health insurance) is now in progress. I argue that the Rudd Labor government should take heed of history's lessons and reduce the pressure for ongoing structural reform. The lessons of history suggest that tipping the balance too far in favour of public or private insurance is not sustainable, and nor is setting the two schemes up in competition with each other. The challenge that faces the Australian Government now is to design a health system that integrates the public and private insurance schemes in a way that is economically sustainable. If it does not, major structural reforms to the health system will be needed again in the near future.

In this article, we explore whether policy network theory can be applied in the People's Republic of China (PRC). We carried out a literature review of how this approach has already been dealt with in the Chinese policy sciences thus far. We then present the key concepts and research approach in policy networks theory in the Western literature and try these on a Chinese case to see the fit. We follow this with a description and analysis of the policy-making process regarding the health insurance reform in China from 1998 until the present. Based on this case study, we argue that this body of theory is useful to describe and explain policy-making processes in the Chinese context. However, limitations in the generic model appear in capturing the fundamentally different political and administrative systems, crucially different cultural values in the applicability of some research methods common in Western countries. Finally, we address which political and cultural aspects turn out to be different in the PRC and how they affect methodological and practical problems that PRC researchers will encounter when studying decision-making processes.

Compared to other developed countries, the United States ranks poorly in terms of life expectancy at age 50. We seek to shed light on the US's low life expectancy ranking by comparing the age-specific death rates of 18 developed countries at older ages. A striking pattern emerges: between ages 40 and 75, US all-cause mortality rates are among the poorest in the set of comparison countries. The US position improves dramatically after age 75 for both males and females. We consider four possible explanations of the age patterns revealed by this analysis: (1) access to health insurance; (2) international differences in patterns of smoking; (3) age patterns of health care system performance; and (4) selection processes. We find that health insurance and smoking are not plausible sources of this age pattern. While we cannot rule out selection, we present suggestive evidence that an unusually vigorous deployment of life-saving technologies by the US health care system at very old ages is contributing to the age-pattern of US mortality rankings. Differences in obesity distributions are likely to be making a moderate contribution to the pattern but uncertainty about the risks associated with obesity prevents a precise assessment.

The evolution of health care in America had its beginnings even before the founding of the nation. This article divides the evolution of American health care into six historical periods: (1) the charitable era, (2) the origins of medical education era, (3) the insurance era, (4) the government era, (5) the managed care era, and (6) the consumerism era.

When President Lyndon Johnson signed the Medicare and Medicaid bill into law in 1965, it ended the 46-year campaign to enact a healthcare program for senior citizens and started what is now a 42-year effort by the American Dietetic Association (ADA) and its members to expand its coverage to 'nutrition services' for all appropriate diseases, disorders and conditions. In December 2000, Congress passed a Medicare Part B Medical Nutrition Therapy (MNT) provision, limited to patients with diabetes and/or renal disease, effective January 2002. In December 2003, the Medicare Modernization Act expanded access to MNT benefit and ADA continues to focus on the role of the registered dietician in MNT. Successful expansion of MNT benefits will require that ADA continues to demonstrate the cost-effectiveness and efficacy of nutrition counseling, as performed by the registered dietitian., (Copyright (c) 2009 S. Karger AG, Basel.)

No other country has undergone health care reforms as dramatic as China's. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper adds to the literature by examining China's health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from China's reform process.