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National Health Insurance (national + health_insurance)
Selected AbstractsIs it possible to identify early predictors of the future cost of chronic arthritis?FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2009The VErA project Abstract This study was conducted to identify early predictors of the total cost of inflammatory arthritis (IA). One hundred and eighty patients affected by undifferentiated arthritis (UA) or rheumatoid arthritis (RA) were included in the French Very Early rheumatoid Arthritis (VErA) cohort between 1998 and 2001. Health economic data for 2003 were collected using a patient self-questionnaire. Results were analysed in terms of direct, indirect and total costs in 2003 euros (2003,) for the population as a whole and in diagnostic subgroups. A payor perspective (the French National Health Insurance, in this case) was adopted. Multiple linear regression models were used to identify predictors of total cost from among the criteria assessed on recruitment. Results of the study showed that for the study population as a whole, the mean total cost was ,4700 per patient. The costs attributable to the RA and UA sub-groups were ,5928 and ,2424 per patient, respectively. In a univariate analysis, certain parameters were significantly correlated with a higher cost of illness. In the multivariate analysis, some of these parameters were further identified as being predictive of higher cost. Two strong significant, early predictors of total cost were identified: higher pain (P = 0.002) and the presence of rheumatoid factor (P = 0.004). In the RA sub-group, lower grip strength of the dominant hand (P = 0.039) was another predictor of the illness's subsequent economic impact. In conclusion, our data show that simple clinical and laboratory parameters can be used early in the course of IA to predict the condition's impact on healthcare budgets. [source] The effects of Taiwan's National Health Insurance on access and health status of the elderlyHEALTH ECONOMICS, Issue 3 2007Likwang Chen Abstract The primary objective of this paper is to evaluate the impact of Taiwan's National Health Insurance program (NHI), established in 1995, on improving elderly access to care and health status. Further, we estimate the extent to which NHI reduces gaps in access and health across income groups. Using data from a longitudinal survey, we adopt a difference-in-difference methodology to estimate the causal effect of Taiwan's NHI. Our results show that Taiwan's NHI has significantly increased utilization of both outpatient and inpatient care among the elderly, and such effects were more salient for people in the low- or middle-income groups. Our findings also reveal that although Taiwan's NHI greatly increased the utilization of both outpatient and inpatient services, this increased utilization of health services did not reduce mortality or lead to better self-perceived general health status for Taiwanese elderly. Measures more sensitive than mortality and self-perceived general health may be necessary for discerning the health effects of NHI. Alternatively, the lack of NHI effects on health may reflect other quality and efficiency problems inherent in the system not yet addressed by NHI. Copyright © 2006 John Wiley & Sons, Ltd. [source] Welfare reform and future challenges in the Republic of Korea: Beyond the developmental welfare state?INTERNATIONAL SOCIAL SECURITY REVIEW, Issue 4 2002ju Kwon Since the economic crisis of 1997,98, the Republic of Korea has carried out vigorous social policy initiatives including the reform of the National Pension Programme and National Health Insurance. This paper seeks to answer whether the country's welfare state has moved beyond welfare developmentalism, by examining the cases of those two programmes. By the reform, the coverage of the National Pension Programme was extended to the whole population; and its financial sustainability and accountability were enhanced. Regarding National Health Insurance, efficiency reform was carried out on the management structure, while reform regarding financing was put on hold. These reforms were in clear contrast to the welfare developmentalism that used to place overwhelming emphasis on economic considerations. Despite these reforms, however, the Republic of Korea's welfare state faces the issues of ineffectual implementation and lack of financial sustainability of social policy. The National Pension Programme has failed to cover the majority of irregular workers, whose numbers are on the increase, and National Health Insurance needs to find a way to meet increasing health expenditure. [source] Interview with a Quality Leader,Karen Davis, Executive Director of The Commonwealth FundJOURNAL FOR HEALTHCARE QUALITY, Issue 2 2009Lecia A. Albright Dr. Davis is a nationally recognized economist, with a distinguished career in public policy and research. Before joining the Fund, she served as chairman of the Department of Health Policy and Management at The Johns Hopkins School of Public Health, where she also held an appointment as professor of economics. She served as deputy assistant secretary for health policy in the Department of Health and Human Services from 1977 to 1980, and was the first woman to head a U.S. Public Health Service agency. Before her government career, Ms. Davis was a senior fellow at the Brookings Institution in Washington, DC; a visiting lecturer at Harvard University; and an assistant professor of economics at Rice University. A native of Oklahoma, she received her PhD in economics from Rice University, which recognized her achievements with a Distinguished Alumna Award in 1991. Ms. Davis is the recipient of the 2000 Baxter-Allegiance Foundation Prize for Health Services Research. In the spring of 2001, Ms. Davis received an honorary doctorate in human letters from John Hopkins University. In 2006, she was selected for the Academy Health Distinguished Investigator Award for significant and lasting contributions to the field of health services research in addition to the Picker Award for Excellence in the Advancement of Patient Centered Care. Ms. Davis has published a number of significant books, monographs, and articles on health and social policy issues, including the landmark books HealthCare Cost Containment, Medicare Policy, National Health Insurance: Benefits, Costs, and Consequences, and Health and the War on Poverty. She serves on the Board of Visitors of Columbia University, School of Nursing, and is on the Board of Directors of the Geisinger Health System. She was elected to the Institute of Medicine (IOM) in 1975; has served two terms on the IOM governing Council (1986,90 and 1997,2000); was a member of the IOM Committee on Redesigning Health Insurance Benefits, Payment and Performance Improvement Programs; and was awarded the Adam Yarmolinsky medal in 2007 for her contributions to the mission of the Institute of Medicine. She is a past president of the Academy Health (formerly AHSRHP) and an Academy Health distinguished fellow, a member of the Kaiser Commission on Medicaid and the Uninsured, and a former member of the Agency for Healthcare Quality and Research National Advisory Committee. She also serves on the Panel of Health Advisors for the Congressional Budget Office. [source] Health insurance and savings over the life cycle,a semiparametric smooth coefficient estimationJOURNAL OF APPLIED ECONOMETRICS, Issue 3 2004Prof. Shin-Yi Chou Individuals save for future uncertain health care expenses. This is less efficient than pooling health risk through insurance. The provision of comprehensive health insurance may raise welfare by providing the missing market to smooth out consumption through the life cycle. We employ a semiparametric smooth coefficient model to examine the effects of the introduction of the National Health Insurance in Taiwan in 1995 on savings and consumption over the life cycle. The idea is to estimate the coefficients of health insurance which vary with age. Our results suggest that younger households are more sensitive to the risk reductions, and that they demonstrate a greater response in the reduction of their precautionary saving. Copyright © 2004 John Wiley & Sons, Ltd. [source] Social and medical impact, sleep quality and the pharmaceutical costs of heartburn in TaiwanALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2005C.-L. LU Summary Background :,Little is known about the social and medical burdens of heartburn in Asia. Aim :,To assess the impact of heartburn in Taiwan. Methods :,We applied a questionnaire to 2018 apparently healthy adult Chinese receiving a routine health maintenance programme. Costs of heartburn-related prescriptions were obtained from the Bureau of National Health Insurance of Taiwan. Results :,Heartburn prevalence (>1 episode/week) was 7%. Smoking and increased body mass index were associated with heartburn occurrence. Heartburn sufferers reported more atypical gastro-oesophageal reflux disease symptoms, e.g. chest pain, dysphagia and globus. They were more likely to consult physicians, and have an increased frequency and number of days of absenteeism, irrespective of upper gastrointestinal or nongastrointestinal-related illnesses. They experienced sleep disturbances more frequently. The 62 heartburn consulters (48%) were more likely to have co-existing globus, visited physicians more, had more absenteeism, suffered from more sleep disturbances and had higher costs for antacids, proton pump inhibitors, hypnotic/sedatives, tranquilizers and antidepressants than nonconsulters. Conclusions :,Heartburn prevalence in Taiwan is lower than in Western countries. Nevertheless, heartburn in Taiwanese creates a significant burden in terms of social impact, health resource utilization, sleep quality and pharmaceutical costs. The increased costs of psychoactive drugs in consulters suggest that anxiety/depression affects their health-seeking behaviour. [source] Analgesic use and the risk for progression of chronic kidney disease,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 7 2010Hsin-Wei Kuo Abstract Purpose The chronic effect of various analgesics on the progression of chronic kidney disease (CKD) is inconclusive. There is also lack of information on the renal safety of selective cyclooxygenase-2 (COX-2) inhibitors. This study aimed to clarify the renal risk of analgesic use in CKD patients. Methods A cohort study using a nationally representative database randomly sampled from National Health Insurance (NHI) enrollees was performed. The study population included a total of 19,163 newly diagnosed CKD patients. Clinical conditions were defined by diagnostic codes and exposure information on analgesics was derived from service claims. Cox proportional hazard model was used to assess the association between analgesic use and the risk of progression to end stage renal disease (ESRD). Results CKD patients using acetaminophen, aspirin, and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) had an increased risk for ESRD with multivariable-adjusted HRs (95%CIs) of 2.92 (2.47,3.45), 1.96 (1.62,2.36), and 1.56 (1.32,1.85), respectively. The trends toward higher risk with increasing exposure dose were significant for all classes of analgesics (all P for trend,<,0.001). Among COX-2 inhibitors, only rofecoxib, but not celecoxib, shows a significant risk association with ESRD (HR,=,1.98; 95%CI, 1.15,3.40). Conclusions Our data indicated exacerbating effects of acetaminophen, aspirin, and non-selective NSAIDs on CKD in a dose-dependent manner. For COX-2 inhibitors, only rofecoxib showed an increased risk for ESRD. Although the possibility of residual confounding cannot be completely ruled out, given the common use of analgesics, the possible relation suggested by this study warrants further investigation. Copyright © 2010 John Wiley & Sons, Ltd. [source] Political Feasibility Analysis of the New Financing Scheme for the National Health Insurance Reform in Taiwan: An Application of Stakeholder AnalysisASIAN SOCIAL WORK AND POLICY REVIEW, Issue 3 2010Chao-Yin Lin This study carries out in-depth political feasibility analysis of the prospective health financing reform currently taking place in Taiwan. The National Health Insurance (NHI) Program, which was established in Taiwan in 1995, covers virtually all of the island's citizens. Between the years 2001 and 2004, the Taiwanese Government organized a taskforce to carry out the wholesale reform of the NHI program into the so-called ,Second Generation NHI Program'. This study is part of the comprehensive review, focusing on the preferences and positions of key policy stakeholders with regard to the financial reform proposals, as well as their network relationships. The approach of stakeholder analysis was employed to conduct this empirical study. The results reveal that the new financing scheme has a certain degree of support from the policy stakeholders participating in this study, and that in particular, the measures concerning equity and sustainability were most welcome. However, controversy remains with regard to the issue of the equitable sharing of contributions. It is clear that there is much strong support for the new scheme amongst the administrative and legislative elite, although the same level of support is not evident amongst the social elite affiliated with employees' associations and welfare groups. [source] Taiwan's High Rate of Cesarean Births: Impacts of National Health Insurance and Fetal Gender PreferenceBIRTH, Issue 2 2007Tsai-Ching Liu PhD ABSTRACT: Background: Taiwan has a high rate of cesarean section, approximately 33 percent in the past decade. This study investigates and discusses 2 possible factors that may encourage the practice, one of which is fetal gender difference and the other is Taiwan's recently implemented National Health Insurance (NHI). Methods: A logistic regression model was used with the 1989 and 1996 National Maternal and Infant Health Survey and with the 2001 to 2003 NHI Research Databases. Results: Using survey data, we found a statistically significant 0.3 percent gender difference in parental choice for cesarean section. However, no statistically significant difference was found in the rate of cesarean section before and after NHI implementation. Conclusions: Taiwan's high cesarean section rate is not directly related to financial incentives under NHI, indicating that adjusting policy to lower financial incentives from NHI would have only limited effect. Likewise, focusing effort on the small gender difference is unlikely to have much impact. Effective campaigns by health authorities might be conducted to educate the general population about risks associated with cesarean section and the benefits of vaginal birth to the child, mother, and society. (BIRTH 34:2 June 2007) [source] Antihypertensive Drugs and New-Onset Diabetes: A Retrospective Longitudinal Cohort StudyCARDIOVASCULAR THERAPEUTICS, Issue 3 2009Gwo-Ping Jong Antihypertensive drugs have been linked to new-onset diabetes (NOD); however, data on the effect of these drugs on the development of NOD in hypertensive patients has not been well determined. We aimed to investigate the association between antihypertensive drugs and NOD. This was a retrospective cohort study performed using data from claim forms provided to the central region branch of the Bureau of National Health Insurance in Taiwan from January 2002 to December 2007. Prescriptions for antihypertensive drugs before the index date were retrieved from a prescription database. We estimated the odds ratios (ORs) of NOD associated with antihypertensive drug use; nondiabetic subjects served as the reference group. A total of 4233 NOD cases were identified in 24,688 hypertensive patients during the study period. The risk of NOD after adjusting for sex and age was higher among users of diuretics (OR = 1.10, 95% confidence interval [CI]= 1.01,1.20), beta-blockers (BBS; OR = 1.12, 95% CI = 1.04,1.21), and calcium channel blockers (CCBs; OR = 1.10, 95% CI = 1.02,1.18) than among nonusers. Patients who take angiotensin-converting enzyme (ACE) inhibitors (OR = 0.92, 95% CI = 0.84,1.00), angiotensin receptor blockers (ARB; OR = 0.90, 95% CI = 0.81,0.98), or alpha-blockers (OR = 0.88, 95% CI = 0.80,0.98) are at a lower risk of developing NOD than nonusers. Vasodilators were not associated with the risk of NOD. The results of this study suggest that hypertensive patients who take ACE inhibitors, ARBs, or alpha-blockers are at a lower risk of NOD. Diuretics, BBs, and CCBs were associated with a significant increase in the risk of NOD. [source] Applying DALY to assessing national health insurance performance: the relationship between the national health insurance expenditures and the burden of disease measures in IranINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2005Mehdi Russel Abstract The Iranian government has considered using DALYs as an indicator to prioritize health service expenditures to reduce the burden of disease for the public. A cross-sectional study was designed to compare several measures of the burden of disease with the actual amounts of national health insurance (NHI) expenditures, in one province of Iran (Semnan) for a period of 2 months (September 2000 and February 2001). Furthermore, on the basis of the research findings, a questionnaire was designed and distributed to stakeholders at local and national levels to explore their ideas about the gap between the expenditures of the diseases group and their burden. A semi-structured interview was conducted to elicit participants' views on the research findings. The results of this study have revealed that, currently, there is no strong relation between the NHI expenditures and DALY (r,=,0.41, p,=,0.09), but that there are stronger relationships between the amounts of NHI reimbursements with YLL (r,=,0.52, p,<,0.05), mortality (r,=,0.67, p,<,0.01) and hospital days (r,=,0.90, p,<,0.01). Comparing each group of disorders' DALY with the resources allocated to them (cost per DALY) it was shown that diabetes mellitus, musculoskeletal diseases, maternal conditions, sense organ disorders received considerably generous funding; and, perinatal conditions, congenital abnormalities, nutritional deficiencies were relatively under-funded. The qualitative research results showed that the majority of respondents agreed that the differences presently existing between disorders' burden and NHI expenditures cannot be justified; and, further, that reducing the overall burden of disease must be one of the most important objectives for the NHI. Copyright © 2005 John Wiley & Sons, Ltd. [source] How to use laparoscopic surgical instruments safelyINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2009Eiji Higashihara The development of laparoscopic surgery has been accompanied by a rapid increase in the number of laparoscopic surgical procedures carried out in the field of urology. In 2002 laparoscopic nephrectomy was approved for coverage under Japanese national health insurance, and in 2003 there were over 1000 registered cases in which this procedure was carried out. This suggests that laparoscopic nephrectomy, a procedure formerly conducted at only a few institutions, is now spreading to hospitals across Japan. Laparoscopic surgery involves the use of specialized instruments within a restricted field of vision, and risky surgical techniques can potentially result in visceral or vascular damage. In order to promote the use of safe laparoscopic surgery procedures, the Japanese Urological Association and the Japanese Society of Endourology and Extracorporeal Shock Wave Lithotripsy (ESWL) have inaugurated a certification program for urologic laparoscopy. This program not only encourages development in this field of surgery and provides technical certification to ensure appropriate levels of expertise, but also reviews methods for the correct use of instruments such as trocars and hemostats. The purpose of this video is to present correct methods for the use of a variety of laparoscopic instruments, in order to increase the safety of this procedure. The video has been designed to be useful not only for practitioners who are just beginning laparoscopy, but also for those who already have extensive laparoscopic experience. The video discusses five laparoscopic instruments (trocar, electric surgical devices, ultrasonic surgery devices, clips and clip appliers and endo-staplers), and demonstrates their correct use. In addition, animal models are used to illustrate the potential complications that can be associated with some methods of use. [source] Healthcare financing reform and the new single payer system in the Republic of Korea: Social solidarity or efficiency?INTERNATIONAL SOCIAL SECURITY REVIEW, Issue 1 2003Soonman Kwon In July 2000, national health insurance in the Republic of Korea was transformed into a single insurer system. This major reform in healthcare financing resulted from the merger of more than 350 health insurance societies. Inequity in healthcare financing and the chronic financial situation of the health insurance societies for self,employed workers in rural areas have been the driving forces leading to the unified health insurance system. The unique institutional context together with political change opened the window of policy change, and various stakeholders such as politicians, rural self,employed workers, trade unions and civic groups were involved in the healthcare reform process. Fair income assessment of the self,employed and the role of the single insurer as a prudent purchaser of medical care will be vital for the new system to achieve its intended goal and improve social solidarity and efficiency of healthcare. [source] Self-Interest, Symbolic Attitudes, and Support for Public Policy: A Multilevel AnalysisPOLITICAL PSYCHOLOGY, Issue 4 2009Richard R. Lau This paper examines the role of self-interest and symbolic attitudes as predictors of support for two domestic policy issues,guaranteed jobs and incomes and national health insurance,in the American National Election Survey (ANES) between 1972 and 2004. As was the case in 1976 when Sears, Lau, Tyler, and Allen (1980) first explored this topic, symbolic attitudes continue to be much more important predictors of policy attitudes than various indicators of self-interest over the 30 years we analyze. We explore this finding further to determine whether any individual/internal and external/contextual variables affect the magnitude of self-interest effects on policy support. Five possible internal moderators of self-interest effects are examined: (1) political knowledge, (2) issue publics, (3) political values, (4) social identifications, and (5) emotions, but none are found to boost the magnitude of the self-interest effect. However, we do find some evidence that contextual variables representing the social/information environment moderate the impact of self-interest on public opinion. [source] Mortality of White Americans, African Americans, and Canadians: The Causes and Consequences for Health of Welfare State Institutions and PoliciesTHE MILBANK QUARTERLY, Issue 1 2005STEPHEN J. KUNITZ The life expectancy of African Americans has been substantially lower than that of white Americans for as long as records are available. The life expectancy of all Americans has been lower than that of all Canadians since the beginning of the 20th century. Until the 1970s this disparity was the result of the low life expectancy of African Americans. Since then, the life expectancy of white Americans has not improved as much as that of all Canadians. This article discusses two issues: racial disparities in the United States, and the difference in life expectancy between all Canadians and white Americans. Each country's political culture and institutions have shaped these differences, especially national health insurance in Canada and its absence in the United States. The American welfare state has contributed to and explains these differences. [source] The Struggle over Employee Benefits: The Role of Labor in Influencing Modern Health PolicyTHE MILBANK QUARTERLY, Issue 1 2003David Rosner Health care policy has often been described as the work of political actors seeking to benefit the larger community or a particular group of individuals. In 20th-century America, those actors worked in a historical context shaped by demographic and political pressures created during a period of rapid industrial change. Whereas scholars have placed the emergence of European social welfare in such a larger frame, their analysis of movements for health insurance in the United States has largely ignored the need for a frame. If anything, their studies have focused on the lack of a radical political working-class movement in this country as an explanation for the absence of national or compulsory health insurance. Indeed, this absence has dominated analyses of the failure of health policy reform in this country, which generally ignore even these passing historical allusions to the role of class in shaping health policy. Explanations of why health care reform failed during the Clinton administration cited the lack of coverage for millions of Americans but rarely alluded to the active role of labor or other working-class groups in shaping the existing health care system. After organized labor failed to institute national health insurance in the mid-twentieth century, its influence on health care policy diminished even further. This article proposes an alternative interpretation of the development of health care policy in the United States, by examining the association of health policy with the relationships between employers and employees. The social welfare and health insurance systems that resulted were a direct outcome of the pressures brought by organized and unorganized labor movements. The greater dependency created by industrial and demographic changes, conflicts between labor and capital over the political meaning of disease and accidents, and attempts by the political system to mitigate the impending social crisis all helped determine new health policy options. [source] | |||||||||||||