Pub Date : 2010-01-01DOI: 10.1108/s0731-2199(2010)0000022006
Lieke H H M Boonen, Stéphanie A van der Geest, Frederik T Schut, Marco Varkevisser
Purpose: To analyse the development of pharmaceutical policy in the Dutch market for outpatient prescription drugs since the early 1990s.
Methodology: A literature review and document analysis is performed to examine the effects of pharmaceutical policy on the performance of the Dutch market for outpatient prescription drugs since the early 1990s.
Findings: Government efforts to control prices of pharmaceuticals were effective in constraining prices of in-patent drugs, but had an opposite effect on the prices of generic drugs. The gradual transition towards managed competition--that particularly gained momentum after the introduction of the new universal health insurance scheme in 2006--appears to be more effective in constraining prices of generic drugs than earlier government efforts to control these prices.
Originality: Comparative analysis of the impact of price regulation and managed competition on generic drug prices in the Netherlands.
Implications: Implications of the changing role of health insurers are discussed for the future market for prescription drugs and role of pharmacies in the Netherlands.
{"title":"Pharmaceutical policy in the Netherlands: from price regulation towards managed competition.","authors":"Lieke H H M Boonen, Stéphanie A van der Geest, Frederik T Schut, Marco Varkevisser","doi":"10.1108/s0731-2199(2010)0000022006","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022006","url":null,"abstract":"<p><strong>Purpose: </strong>To analyse the development of pharmaceutical policy in the Dutch market for outpatient prescription drugs since the early 1990s.</p><p><strong>Methodology: </strong>A literature review and document analysis is performed to examine the effects of pharmaceutical policy on the performance of the Dutch market for outpatient prescription drugs since the early 1990s.</p><p><strong>Findings: </strong>Government efforts to control prices of pharmaceuticals were effective in constraining prices of in-patent drugs, but had an opposite effect on the prices of generic drugs. The gradual transition towards managed competition--that particularly gained momentum after the introduction of the new universal health insurance scheme in 2006--appears to be more effective in constraining prices of generic drugs than earlier government efforts to control these prices.</p><p><strong>Originality: </strong>Comparative analysis of the impact of price regulation and managed competition on generic drug prices in the Netherlands.</p><p><strong>Implications: </strong>Implications of the changing role of health insurers are discussed for the future market for prescription drugs and role of pharmacies in the Netherlands.</p>","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"53-76"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29078106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-01-01DOI: 10.1108/s0731-2199(2010)0000022012
Teresa Bernard Gibson, Catherine G McLaughlin, Dean G Smith
Purpose: The purpose of this study is to estimate the own- and cross-price elasticity of brand-name outpatient prescription drug cost-sharing for maintenance medications and to estimate the effects of changes in the price differential between generic and brand-name prescription drugs.
Methodology/approach: We first review the literature on the effects of an increase in brand-name drug patient cost-sharing. In addition, we analyze two examples of utilization patterns in filling behavior associated with an increase in brand-name cost-sharing for patients in employer-sponsored health plans with chronic illness.
Findings: We found that the own-price elasticity of demand for brand-name prescription drugs was inelastic. However, the cross-price elasticity was not consistent in sign, and utilization patterns for generic prescription fills did not always increase after a rise in brand-name cost-sharing.
Research limitations: The empirical examples are limited to the experience of patients with employer-sponsored health insurance.
Practical implications: The common practice of increasing brand-name prescription drug patient cost-sharing to increase consumption of generic drugs may not always result in higher generic medication use. Higher brand-name drug cost-sharing levels may result in discontinuation of chronic therapies, instead of therapeutic switching.
Originality/value of chapter: The value of this chapter is its singular focus on the effects of higher brand-name drug cost-sharing through a synthesis of the literature examining the own- and cross-price elasticity of demand for brand-name medications and two empirical examples of the effects of changes in brand-name cost-sharing.
{"title":"Generic utilization and cost-sharing for prescription drugs.","authors":"Teresa Bernard Gibson, Catherine G McLaughlin, Dean G Smith","doi":"10.1108/s0731-2199(2010)0000022012","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022012","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to estimate the own- and cross-price elasticity of brand-name outpatient prescription drug cost-sharing for maintenance medications and to estimate the effects of changes in the price differential between generic and brand-name prescription drugs.</p><p><strong>Methodology/approach: </strong>We first review the literature on the effects of an increase in brand-name drug patient cost-sharing. In addition, we analyze two examples of utilization patterns in filling behavior associated with an increase in brand-name cost-sharing for patients in employer-sponsored health plans with chronic illness.</p><p><strong>Findings: </strong>We found that the own-price elasticity of demand for brand-name prescription drugs was inelastic. However, the cross-price elasticity was not consistent in sign, and utilization patterns for generic prescription fills did not always increase after a rise in brand-name cost-sharing.</p><p><strong>Research limitations: </strong>The empirical examples are limited to the experience of patients with employer-sponsored health insurance.</p><p><strong>Practical implications: </strong>The common practice of increasing brand-name prescription drug patient cost-sharing to increase consumption of generic drugs may not always result in higher generic medication use. Higher brand-name drug cost-sharing levels may result in discontinuation of chronic therapies, instead of therapeutic switching.</p><p><strong>Originality/value of chapter: </strong>The value of this chapter is its singular focus on the effects of higher brand-name drug cost-sharing through a synthesis of the literature examining the own- and cross-price elasticity of demand for brand-name medications and two empirical examples of the effects of changes in brand-name cost-sharing.</p>","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"195-219"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29080200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-07-21DOI: 10.1108/S0731-2199(2009)0000021006
P. Prakongsai, S. Limwattananon, V. Tangcharoensathien
Objective: This paper assesses the health equity achievements of the Thai health system before and after the introduction of Universal Coverage (UC). It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payment for health, equity in health service use and the incidence of public subsidies for health. Methodology: The standard methods proposed by O’Donnell et al. (2008b) were used to measuring equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys. Findings: General tax was the most progressive source of finance. Because this source dominates total financing, the overall outcome was progressive, with the rich contributing a greater share of their income than the poor. The low incidence of catastrophic health expenditure and impoverishment prior to UC was further reduced after UC. Use of healthcare and the distribution of government subsidies were both pro-poor: in particular the functioning primary health care at the district level serves as a “pro-poor hub” in translating policy into practice and equity outcomes. Policy implications: The Thai health financing reforms have been accompanied by nationwide extension of primary health care coverage, mandatory rural health service by new graduates, and systems redesign, especially the introduction of a contracting model and closed-ended provider payment methods. Together, these changes have led to a more equitable and more efficient health system. Institutional capacity to generate evidence and to translate it into policy decisions, effective implementation, and comprehensive monitoring and evaluation are essential to successful system-level reforms.
{"title":"The equity impact of the universal coverage policy: Lessons from Thailand","authors":"P. Prakongsai, S. Limwattananon, V. Tangcharoensathien","doi":"10.1108/S0731-2199(2009)0000021006","DOIUrl":"https://doi.org/10.1108/S0731-2199(2009)0000021006","url":null,"abstract":"Objective: This paper assesses the health equity achievements of the Thai health system before and after the introduction of Universal Coverage (UC). It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payment for health, equity in health service use and the incidence of public subsidies for health. Methodology: The standard methods proposed by O’Donnell et al. (2008b) were used to measuring equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys. Findings: General tax was the most progressive source of finance. Because this source dominates total financing, the overall outcome was progressive, with the rich contributing a greater share of their income than the poor. The low incidence of catastrophic health expenditure and impoverishment prior to UC was further reduced after UC. Use of healthcare and the distribution of government subsidies were both pro-poor: in particular the functioning primary health care at the district level serves as a “pro-poor hub” in translating policy into practice and equity outcomes. Policy implications: The Thai health financing reforms have been accompanied by nationwide extension of primary health care coverage, mandatory rural health service by new graduates, and systems redesign, especially the introduction of a contracting model and closed-ended provider payment methods. Together, these changes have led to a more equitable and more efficient health system. Institutional capacity to generate evidence and to translate it into policy decisions, effective implementation, and comprehensive monitoring and evaluation are essential to successful system-level reforms.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"9 3 1","pages":"57-81"},"PeriodicalIF":0.0,"publicationDate":"2009-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81237481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-06-26DOI: 10.1108/s0731-2199(2009)21
D. Chernichovsky, K. Hanson
List of Contributors. Overview. The double burden of disease in developing countries: The Mexican experience. Protecting pro-poor health services during financial crises: Lessons from experience. The equity impact of the universal coverage policy: Lessons from Thailand. Social health insurance and labor market outcomes: Evidence from Central and Eastern Europe, and Central Asia. Trust in the context of community-based health insurance schemes in Cambodia: Villagers' trust in health insurers. Methodological challenges in evaluating health care financing equity in data-poor contexts: Lessons from Ghana, South Africa and Tanzania. The role of risk equalization in moving from voluntary private health insurance to mandatory coverage: the experience in South Africa. Purchasing health care in China: Experiences, Opportunities and challenges. The impact of Nepal's national incentive programme to promote safe delivery in the district of Makwanpur. Service- and population-based exemptions: Are these the way forward for equity and efficiency in health financing in low-income countries?. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. Reforming "developing" health systems: Tanzania, Mexico, and the United States. Advances in health economics and health services research. Innovations in health system finance in developing and transitional economies. Copyright page.
{"title":"Innovations in health system finance in developing and transitional economies.","authors":"D. Chernichovsky, K. Hanson","doi":"10.1108/s0731-2199(2009)21","DOIUrl":"https://doi.org/10.1108/s0731-2199(2009)21","url":null,"abstract":"List of Contributors. Overview. The double burden of disease in developing countries: The Mexican experience. Protecting pro-poor health services during financial crises: Lessons from experience. The equity impact of the universal coverage policy: Lessons from Thailand. Social health insurance and labor market outcomes: Evidence from Central and Eastern Europe, and Central Asia. Trust in the context of community-based health insurance schemes in Cambodia: Villagers' trust in health insurers. Methodological challenges in evaluating health care financing equity in data-poor contexts: Lessons from Ghana, South Africa and Tanzania. The role of risk equalization in moving from voluntary private health insurance to mandatory coverage: the experience in South Africa. Purchasing health care in China: Experiences, Opportunities and challenges. The impact of Nepal's national incentive programme to promote safe delivery in the district of Makwanpur. Service- and population-based exemptions: Are these the way forward for equity and efficiency in health financing in low-income countries?. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. Reforming \"developing\" health systems: Tanzania, Mexico, and the United States. Advances in health economics and health services research. Innovations in health system finance in developing and transitional economies. Copyright page.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"21 1","pages":"xiii-xxi"},"PeriodicalIF":0.0,"publicationDate":"2009-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2009)21","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62306375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-06-11DOI: 10.1108/S0731-2199(2009)0000021012
T. Powell-Jackson, B. Neupane, S. Tiwari, K. Tumbahangphe, D. Manandhar, A. Costello
OBJECTIVE Nepal's Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the aim of encouraging greater use of professional care at childbirth. It provided cash to women giving birth in a public health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We aimed to assess the impact of the programme on neonatal mortality and health care seeking behaviour at childbirth in one district of Nepal. METHODS Impacts were identified using an interrupted time series approach, applied to houSehold data. We estimated a model linking the level of each outcome at a point in time to the start of the programme, demographic controls, a vector of time variables and community-level fixed effects. FINDINGS The recipients of the cash transfer in the programme's first two years were disproportionately wealthier households, reflecting existing inequality in the use of government maternity services. In places with women's groups--where information about the policy was widely disseminated--the SDIP substantially increased skilled birth attendance, but failed to impact on either neonatal mortality or the caesarean section rate. In places with no women's groups, the SDIP had no impact on utilisation outcomes or neonatal mortality. IMPLICATIONS FOR POLICY The lack of any impact on neonatal mortality suggests that greater increases in utilisation or better quality of care are needed to improve health outcomes. The SDIP changed health care seeking behaviour only in those areas with women's groups highlighting the importance of effective communication of the policy to the wider public.
{"title":"The impact of Nepal's national incentive programme to promote safe delivery in the district of Makwanpur.","authors":"T. Powell-Jackson, B. Neupane, S. Tiwari, K. Tumbahangphe, D. Manandhar, A. Costello","doi":"10.1108/S0731-2199(2009)0000021012","DOIUrl":"https://doi.org/10.1108/S0731-2199(2009)0000021012","url":null,"abstract":"OBJECTIVE\u0000Nepal's Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the aim of encouraging greater use of professional care at childbirth. It provided cash to women giving birth in a public health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We aimed to assess the impact of the programme on neonatal mortality and health care seeking behaviour at childbirth in one district of Nepal.\u0000\u0000\u0000METHODS\u0000Impacts were identified using an interrupted time series approach, applied to houSehold data. We estimated a model linking the level of each outcome at a point in time to the start of the programme, demographic controls, a vector of time variables and community-level fixed effects.\u0000\u0000\u0000FINDINGS\u0000The recipients of the cash transfer in the programme's first two years were disproportionately wealthier households, reflecting existing inequality in the use of government maternity services. In places with women's groups--where information about the policy was widely disseminated--the SDIP substantially increased skilled birth attendance, but failed to impact on either neonatal mortality or the caesarean section rate. In places with no women's groups, the SDIP had no impact on utilisation outcomes or neonatal mortality.\u0000\u0000\u0000IMPLICATIONS FOR POLICY\u0000The lack of any impact on neonatal mortality suggests that greater increases in utilisation or better quality of care are needed to improve health outcomes. The SDIP changed health care seeking behaviour only in those areas with women's groups highlighting the importance of effective communication of the policy to the wider public.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"1 1","pages":"221-49"},"PeriodicalIF":0.0,"publicationDate":"2009-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/S0731-2199(2009)0000021012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62306593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-06-11DOI: 10.1108/S0731-2199(2009)0000021014
Joseph Kutzin, Melitta Jakab, S. Shishkin
OBJECTIVE The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in poor countries. In particular, we analyze the introduction of social health insurance (SHI) in Kyrgyzstan and Moldova. To some extent, the intent of SHI introduction in these countries was similar to that in LMIs elsewhere: increase prepaid revenues for health and incorporate the entire population into the new system. But the approach taken to universality was different. In particular, the SHI fund in each country was used as the key instrument in a comprehensive reform of the health financing system, with the new revenues from payroll taxation used in an explicitly complementary manner to general budget revenues. From a functional perspective, the reforms in these countries involved not only the introduction of a new source of funds, but also the centralization of pooling, a shift from input- to output-based provider payment methods, specification of a benefit package, and greater autonomy for public sector health care providers. Hence, their reforms were not simply the introduction of an SHI scheme, but rather the use of an SHI fund as an instrument to transform the entire system of health financing. METHODOLOGY/APPROACH The study uses administrative and household data to demonstrate the impact of the reforms on regional inequality and household financial burden. FINDINGS The approach used in these two countries led to improved equity in the geographic distribution of government health spending, improved financial protection, and reduced informal payments. IMPLICATIONS FOR POLICY The comprehensive approach taken to reform in these two countries, and particularly the redirection of general budget revenues to the new SHI funds, explain much of the success that was achieved. This experience offers potentially useful lessons for LMIs elsewhere in the world, and for shifting the global debate away from what we see as a false dichotomy between SHI and general revenue-funded systems. By demonstrating that sources are not systems, these cases illustrate how, in particular by careful design of pooling and coverage arrangements, the introduction of SHI in an LMI context can avoid the fragmentation problem often associated with this reform instrument.
{"title":"From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova.","authors":"Joseph Kutzin, Melitta Jakab, S. Shishkin","doi":"10.1108/S0731-2199(2009)0000021014","DOIUrl":"https://doi.org/10.1108/S0731-2199(2009)0000021014","url":null,"abstract":"OBJECTIVE\u0000The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in poor countries. In particular, we analyze the introduction of social health insurance (SHI) in Kyrgyzstan and Moldova. To some extent, the intent of SHI introduction in these countries was similar to that in LMIs elsewhere: increase prepaid revenues for health and incorporate the entire population into the new system. But the approach taken to universality was different. In particular, the SHI fund in each country was used as the key instrument in a comprehensive reform of the health financing system, with the new revenues from payroll taxation used in an explicitly complementary manner to general budget revenues. From a functional perspective, the reforms in these countries involved not only the introduction of a new source of funds, but also the centralization of pooling, a shift from input- to output-based provider payment methods, specification of a benefit package, and greater autonomy for public sector health care providers. Hence, their reforms were not simply the introduction of an SHI scheme, but rather the use of an SHI fund as an instrument to transform the entire system of health financing.\u0000\u0000\u0000METHODOLOGY/APPROACH\u0000The study uses administrative and household data to demonstrate the impact of the reforms on regional inequality and household financial burden.\u0000\u0000\u0000FINDINGS\u0000The approach used in these two countries led to improved equity in the geographic distribution of government health spending, improved financial protection, and reduced informal payments.\u0000\u0000\u0000IMPLICATIONS FOR POLICY\u0000The comprehensive approach taken to reform in these two countries, and particularly the redirection of general budget revenues to the new SHI funds, explain much of the success that was achieved. This experience offers potentially useful lessons for LMIs elsewhere in the world, and for shifting the global debate away from what we see as a false dichotomy between SHI and general revenue-funded systems. By demonstrating that sources are not systems, these cases illustrate how, in particular by careful design of pooling and coverage arrangements, the introduction of SHI in an LMI context can avoid the fragmentation problem often associated with this reform instrument.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"21 1","pages":"291-312"},"PeriodicalIF":0.0,"publicationDate":"2009-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/S0731-2199(2009)0000021014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62306244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-06-11DOI: 10.1108/S0731-2199(2009)0000021008
S. Ozawa, D. Walker
OBJECTIVE To understand the role and influence of villagers' trust for the health insurer on enrollment in a community-based health insurance (CBHI) scheme in Cambodia. METHODOLOGY/APPROACH This study was conducted in northwest Cambodia where a CBHI scheme operates with the highest enrollment rates in the country. A mixed method approach was employed to gauge how individuals in the community trust the health insurer, and whether this plays a role in their decisions to enroll in CBHI schemes. Focus groups and household surveys were carried out to identify and measure trust levels, and to explore the association between insurer trust and enrollment in CBHI schemes. FINDINGS Although villagers generally trusted the health insurance organization, villagers with poor experiences with other organizations in the past were less willing to trust the insurer. Insurer trust represented a combination of interpersonal and impersonal trust. After controlling for demographic factors, health care utilization, and household socioeconomic status, insurer trust levels for villagers who newly enrolled (RRR = 1.07, p < 0.001) and renewed insurance (RRR = 1.15, p < 0.001) were significantly higher than those who never enrolled in CBHI schemes. IMPLICATIONS FOR POLICY This study illustrates the relationship between CBHI enrollment and villagers' trust for the health insurer in a low-income, post-conflict country. It highlights the need for staff of health insurance organizations to place greater emphasis on building trusting interpersonal relationships with villagers. Understanding the nature of trust for the health insurer is essential to improve health insurance enrollment and protect people in poor rural communities against the impact of health-related shocks.
目的了解柬埔寨村民对健康保险公司的信任程度对社区健康保险(chi)参保的影响和作用。方法/方法本研究在柬埔寨西北部进行，该地区实施了一项CBHI计划，其入学率在该国最高。采用了一种混合方法来衡量社区中个人对健康保险公司的信任程度，以及这是否在他们决定参加社区健康保险计划中起作用。通过焦点小组调查和住户调查来确定和衡量信任水平，并探讨保险公司信任与加入cbi计划之间的关系。虽然村民普遍信任医疗保险机构，但过去与其他组织有不良经历的村民不太愿意信任保险公司。保险人信任是人际信任和非个人信任的结合。在控制人口统计学因素、医疗保健利用情况和家庭社会经济状况后，新参保村民(RRR = 1.07, p < 0.001)和续保村民(RRR = 1.15, p < 0.001)对保险公司的信任水平显著高于未参保村民。政策启示:本研究说明了在一个低收入、冲突后的国家，村民对医疗保险公司的信任与儿童健康保险公司注册之间的关系。它突出表明，医疗保险组织的工作人员需要更加重视与村民建立相互信任的人际关系。了解对健康保险公司的信任性质，对于提高健康保险登记率和保护贫困农村社区的人们免受健康相关冲击的影响至关重要。
{"title":"Trust in the context of community-based health insurance schemes in Cambodia: villagers' trust in health insurers.","authors":"S. Ozawa, D. Walker","doi":"10.1108/S0731-2199(2009)0000021008","DOIUrl":"https://doi.org/10.1108/S0731-2199(2009)0000021008","url":null,"abstract":"OBJECTIVE\u0000To understand the role and influence of villagers' trust for the health insurer on enrollment in a community-based health insurance (CBHI) scheme in Cambodia.\u0000\u0000\u0000METHODOLOGY/APPROACH\u0000This study was conducted in northwest Cambodia where a CBHI scheme operates with the highest enrollment rates in the country. A mixed method approach was employed to gauge how individuals in the community trust the health insurer, and whether this plays a role in their decisions to enroll in CBHI schemes. Focus groups and household surveys were carried out to identify and measure trust levels, and to explore the association between insurer trust and enrollment in CBHI schemes.\u0000\u0000\u0000FINDINGS\u0000Although villagers generally trusted the health insurance organization, villagers with poor experiences with other organizations in the past were less willing to trust the insurer. Insurer trust represented a combination of interpersonal and impersonal trust. After controlling for demographic factors, health care utilization, and household socioeconomic status, insurer trust levels for villagers who newly enrolled (RRR = 1.07, p < 0.001) and renewed insurance (RRR = 1.15, p < 0.001) were significantly higher than those who never enrolled in CBHI schemes.\u0000\u0000\u0000IMPLICATIONS FOR POLICY\u0000This study illustrates the relationship between CBHI enrollment and villagers' trust for the health insurer in a low-income, post-conflict country. It highlights the need for staff of health insurance organizations to place greater emphasis on building trusting interpersonal relationships with villagers. Understanding the nature of trust for the health insurer is essential to improve health insurance enrollment and protect people in poor rural communities against the impact of health-related shocks.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"21 1","pages":"107-32"},"PeriodicalIF":0.0,"publicationDate":"2009-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/S0731-2199(2009)0000021008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62305761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-06-11DOI: 10.1108/S0731-2199(2009)0000021007
A. Wagstaff, R. Moreno-Serra
OBJECTIVE The implications of social health insurance (SHI) for labor markets have featured prominently in recent debates over the merits of SHI and general revenue financing. It has been argued that by raising the nonwage component of labor costs, SHI reduces firms' demand for labor, lowers employment levels and net wages, and encourages self-employment and informal working arrangements. At the national level, SHI has been claimed to reduce a country's competitiveness in international markets and to discourage foreign direct investment (FDI). The transition from general revenue finance to SHI that occurred during the 1990s in many of the central and eastern European and central Asian countries provides a unique opportunity to investigate empirically these claims. METHODOLOGY/APPROACH We employ regression-based generalizations of difference-in-differences (DID) and instrumental variables (IV) on country-level panel data from 28 countries for the period 1990-2004. FINDINGS We find that, controlling for gross domestic product (GDP) per capita, SHI increases (gross) wages by 20%, reduces employment (as a share of the population) by 10%, and increases self-employment by 17%. However, we find no significant effects of SHI on unemployment (registered or self-reported), agricultural employment, a widely used measure of the size of the informal economy, or FDI. IMPLICATIONS FOR POLICY We do not claim that our results imply that SHI adoption everywhere must necessarily reduce employment and increase self-employment. Nonetheless, our results ought to serve as a warning to those contemplating shifting the financing of health care from general revenues to a SHI system.
{"title":"Social health insurance and labor market outcomes: evidence from central and eastern Europe, and central Asia.","authors":"A. Wagstaff, R. Moreno-Serra","doi":"10.1108/S0731-2199(2009)0000021007","DOIUrl":"https://doi.org/10.1108/S0731-2199(2009)0000021007","url":null,"abstract":"OBJECTIVE\u0000The implications of social health insurance (SHI) for labor markets have featured prominently in recent debates over the merits of SHI and general revenue financing. It has been argued that by raising the nonwage component of labor costs, SHI reduces firms' demand for labor, lowers employment levels and net wages, and encourages self-employment and informal working arrangements. At the national level, SHI has been claimed to reduce a country's competitiveness in international markets and to discourage foreign direct investment (FDI). The transition from general revenue finance to SHI that occurred during the 1990s in many of the central and eastern European and central Asian countries provides a unique opportunity to investigate empirically these claims.\u0000\u0000\u0000METHODOLOGY/APPROACH\u0000We employ regression-based generalizations of difference-in-differences (DID) and instrumental variables (IV) on country-level panel data from 28 countries for the period 1990-2004.\u0000\u0000\u0000FINDINGS\u0000We find that, controlling for gross domestic product (GDP) per capita, SHI increases (gross) wages by 20%, reduces employment (as a share of the population) by 10%, and increases self-employment by 17%. However, we find no significant effects of SHI on unemployment (registered or self-reported), agricultural employment, a widely used measure of the size of the informal economy, or FDI.\u0000\u0000\u0000IMPLICATIONS FOR POLICY\u0000We do not claim that our results imply that SHI adoption everywhere must necessarily reduce employment and increase self-employment. Nonetheless, our results ought to serve as a warning to those contemplating shifting the financing of health care from general revenues to a SHI system.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"21 1","pages":"83-106"},"PeriodicalIF":0.0,"publicationDate":"2009-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/S0731-2199(2009)0000021007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62306213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-01-01DOI: 10.1108/S0731-2199(2009)0000021004
C. Gutiérrez-Delgado, V. Guajardo-Barrón
OBJECTIVE To present the challenges arising from the double burden of disease in developing countries, focusing on the case of Mexico, and to propose a strategy for addressing these challenges. METHODOLOGY/APPROACH Mortality and morbidity data are presented for selected countries and groups of diseases. Specific examples of the pressures faced by the public health services in Mexico to provide and finance treatment for communicable and non-communicable diseases are used to illustrate the extent of the challenges in the context of a country with limited resources. FINDINGS Public health systems in developing countries face strong pressure to provide and finance treatment for both communicable and non-communicable diseases, inevitably producing competition among diseases and conditions and requiring trade-offs between equity and efficiency goals. IMPLICATIONS FOR POLICY In developing countries, addressing the challenges presented by the double burden of disease requires a multidisciplinary approach to develop and strengthen the policymaking process. This involves the use of analytical tools applied to each stage of the planning cycle, in particular the use of an explicit priority setting process together with monitoring and assessment to strengthen decision making under limited resources.
{"title":"The double burden of disease in developing countries: the Mexican experience.","authors":"C. Gutiérrez-Delgado, V. Guajardo-Barrón","doi":"10.1108/S0731-2199(2009)0000021004","DOIUrl":"https://doi.org/10.1108/S0731-2199(2009)0000021004","url":null,"abstract":"OBJECTIVE To present the challenges arising from the double burden of disease in developing countries, focusing on the case of Mexico, and to propose a strategy for addressing these challenges. METHODOLOGY/APPROACH Mortality and morbidity data are presented for selected countries and groups of diseases. Specific examples of the pressures faced by the public health services in Mexico to provide and finance treatment for communicable and non-communicable diseases are used to illustrate the extent of the challenges in the context of a country with limited resources. FINDINGS Public health systems in developing countries face strong pressure to provide and finance treatment for both communicable and non-communicable diseases, inevitably producing competition among diseases and conditions and requiring trade-offs between equity and efficiency goals. IMPLICATIONS FOR POLICY In developing countries, addressing the challenges presented by the double burden of disease requires a multidisciplinary approach to develop and strengthen the policymaking process. This involves the use of analytical tools applied to each stage of the planning cycle, in particular the use of an explicit priority setting process together with monitoring and assessment to strengthen decision making under limited resources.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"115 1","pages":"3-22"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/S0731-2199(2009)0000021004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62306162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To present the challenges arising from the double burden of disease in developing countries, focusing on the case of Mexico, and to propose a strategy for addressing these challenges.
Methodology/approach: Mortality and morbidity data are presented for selected countries and groups of diseases. Specific examples of the pressures faced by the public health services in Mexico to provide and finance treatment for communicable and non-communicable diseases are used to illustrate the extent of the challenges in the context of a country with limited resources.
Findings: Public health systems in developing countries face strong pressure to provide and finance treatment for both communicable and non-communicable diseases, inevitably producing competition among diseases and conditions and requiring trade-offs between equity and efficiency goals.
Implications for policy: In developing countries, addressing the challenges presented by the double burden of disease requires a multidisciplinary approach to develop and strengthen the policymaking process. This involves the use of analytical tools applied to each stage of the planning cycle, in particular the use of an explicit priority setting process together with monitoring and assessment to strengthen decision making under limited resources.
{"title":"The double burden of disease in developing countries: the Mexican experience.","authors":"Cristina Gutiérrez-Delgado, Veronica Guajardo-Barrón","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To present the challenges arising from the double burden of disease in developing countries, focusing on the case of Mexico, and to propose a strategy for addressing these challenges.</p><p><strong>Methodology/approach: </strong>Mortality and morbidity data are presented for selected countries and groups of diseases. Specific examples of the pressures faced by the public health services in Mexico to provide and finance treatment for communicable and non-communicable diseases are used to illustrate the extent of the challenges in the context of a country with limited resources.</p><p><strong>Findings: </strong>Public health systems in developing countries face strong pressure to provide and finance treatment for both communicable and non-communicable diseases, inevitably producing competition among diseases and conditions and requiring trade-offs between equity and efficiency goals.</p><p><strong>Implications for policy: </strong>In developing countries, addressing the challenges presented by the double burden of disease requires a multidisciplinary approach to develop and strengthen the policymaking process. This involves the use of analytical tools applied to each stage of the planning cycle, in particular the use of an explicit priority setting process together with monitoring and assessment to strengthen decision making under limited resources.</p>","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"21 ","pages":"3-22"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40044540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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