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Winnie C Yip, Yue-Chune Lee, Shu-Ling Tsai, Bradley Chen
As nations strive to achieve and sustain universal health coverage (UHC), they seek answers as to what health system structures are more effective in managing health expenditure inflation. A fundamental macro-level choice a nation has to make is whether to adopt a single- or a multiple-payer health system. Using Taiwan's National Health Insurance (NHI) as a case, this paper examines how a single-payer system manages its health expenditure growth and draws lessons for other countries whose socioeconomic development is similar to Taiwan's...
November 16, 2017: Social Science & Medicine
Carolyn H Tuohy
As the National Health Service (NHS) turns 70, it bears comparison with another universal system celebrating an anniversary this year: Canada's 50-year-old medicare model. Each system is iconically popular, and each revolves around a profession-state accommodation. Both the popularity and the central axis of each system have been tested by external shocks in the form of periodic fiscal cycles of investment and austerity, and internal stresses generating organizational cycles of centralization and decentralization...
March 16, 2018: Health Economics, Policy, and Law
Richard N Gottfried
No abstract text is available yet for this article.
April 2018: American Journal of Public Health
Feng-Jen Tsai, Valérie Junod
Taking advantage of its single-payer, universal insurance system, Taiwan has leveraged its exhaustive database of health claims data for research purposes. Researchers can apply to receive access to pseudonymized (coded) medical data about insured patients, notably their diagnoses, health status and treatments. In view of the strict safeguards implemented, the Taiwanese government considers that this research use does not require patients' consent (either in the form of an opt-in or in the form of an opt-out)...
March 1, 2018: Journal of Public Health
Szu-Jui Fan, Ning Lu, Hui-Chih Chang, Chao-Hsiun Tang, Kuo-Cherh Huang
The aim of the nationwide retrospective matched cohort study was to evaluate health service utilization and medical costs between patients with schizophrenia who received long-acting injectable (LAI) risperidone and those who took risperidone orally. Data were sourced from the 2008 to 2013 Psychiatric Inpatient Medical Claim Dataset in Taiwan. The sample selection process was performed by propensity score matching. Finally, there were 691 patients in the exposed cohort and 1382 patients in the unexposed cohort...
February 27, 2018: International Clinical Psychopharmacology
Louis P Garrison, Mark V Pauly, Richard J Willke, Peter J Neumann
The second section of our Special Task Force builds on the discussion of value and perspective in the previous article of the report by 1) defining a health economics approach to the concept of value in health care systems; 2) discussing the relationship of value to perspective and decision context, that is, how recently proposed value frameworks vary by the types of decisions being made and by the stakeholders involved; 3) describing the patient perspective on value because the patient is a key stakeholder, but one also wearing the hat of a health insurance purchaser; and 4) discussing how value is relevant in the market-based US system of mixed private and public insurance, and differs from its use in single-payer systems...
February 2018: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Paul Sorum
No abstract text is available yet for this article.
February 13, 2018: Annals of Internal Medicine
Isabelle Citron, Julia Amundson, Saurabh Saluja, Aline Guilloux, Hillary Jenny, Mario Scheffer, Mark Shrime, Nivaldo Alonso
BACKGROUND: The aim of this study was to describe the national epidemiology of burns in Brazil and evaluate regional access to care by defining the contribution of out-of-hospital mortality to total burn deaths. METHODS: We reviewed admissions data for Brazil's single-payer, free-at-point-of-care, public-sector provider and national death registry data abstracted from DATASUS for 2008-2014. Admissions, in-hospital mortality, hospital reimbursement, and total deaths from the death registry were assessed for records coded under ICD-10 codes corresponding to flame, scald, contact, and electrical burns...
February 8, 2018: Surgery
Stephen Jean, Malak Elshafei, Alison Buttenheim
OBJECTIVE: To assess social patterns in human papillomavirus (HPV) vaccine coverage in a school-based, government-funded vaccination programme located within a single-payer universal healthcare system. DESIGN: We conducted a cross-sectional analysis of HPV vaccine uptake data for the 2013-2014 school year for 131 local authorities in England, and then evaluated the association between vaccine uptake and socioeconomic status at the aggregate level. DATA SOURCES: HPV vaccination coverage data from Public Health England's vaccine uptake guidance and the UK's March 2011 Census...
January 12, 2018: Sexually Transmitted Infections
Scott Murray, Adrian Mendez, Alexander Hopkins, Hamdy El-Hakim, Caroline C Jeffery, David W J Côté
BACKGROUND: Epistaxis is the most common emergent consultation to otolaryngology-head & neck surgery (OHNS) and with 60% of the population having experienced an episode and 1.6 in 10,000 requiring hospitalization in their lifetime. In preliminary studies Floseal® (Baxter, USA) Hemostatic Matrix has shown efficacy in up to 80% of persistent anterior epistaxis. We sought to evaluate the clinical efficacy and cost-effectiveness of Floseal® (Baxter, USA) compared to traditional nasal packing for persistent epistaxis...
January 8, 2018: Journal of Otolaryngology—Head & Neck Surgery
Luc Dubois, Britney Allen, Krista Bray-Jenkyn, Adam H Power, Guy DeRose, Thomas L Forbes, Audra Duncan, Salimah Z Shariff
OBJECTIVE: Volume-outcome relationships for open abdominal aortic aneurysm (AAA) repair have received less attention in publicly funded health systems. Furthermore, the roles of surgeon seniority (years of experience) and composite volume (encompassing all major arterial cases) on outcomes after open AAA repair are less well known. We sought to determine the effects of surgeon volume, surgeon years of experience, and composite volume on outcomes after elective open AAA repairs performed in Ontario, Canada...
December 13, 2017: Journal of Vascular Surgery
Laura C Rosella, Kathy Kornas, Zhan Yao, Douglas G Manuel, Catherine Bornbaum, Randall Fransoo, Therese Stukel
BACKGROUND: A large proportion of health care spending is incurred by a small proportion of the population. Population-based health planning tools that consider both the clinical and upstream determinants of high resource users (HRU) of the health system are lacking. OBJECTIVE: To develop and validate the High Resource User Population Risk Tool (HRUPoRT), a predictive model of adults that will become the top 5% of health care users over a 5-year period, based on self-reported clinical, sociodemographic, and health behavioral predictors in population survey data...
November 17, 2017: Medical Care
S Karim, J Zhang-Salomans, J J Biagi, T Asmis, C M Booth
AIMS: Although FOLFIRINOX is a standard treatment option for advanced pancreas cancer, there are few data describing utilisation and effectiveness in routine clinical practice. Here we report practice patterns and outcomes in the general population of Ontario, Canada. MATERIALS AND METHODS: Using the Ontario Cancer Registry and New Drug Funding Program, we identified all patients with pancreas cancer treated with palliative intent gemcitabine or FOLFIRINOX in Ontario during 2006-2014...
January 2018: Clinical Oncology: a Journal of the Royal College of Radiologists
Muhammad Shahzeb Khan, Tariq Jamal Siddiqi, Kaneez Fatima, Haris Riaz, Faisal Khosa, Warren J Manning, Richard Krasuski
The categorization and characterization of pharmaceutical and device manufacturers or group purchasing organization payments to clinicians is an important step toward assessing conflicts of interest and the potential impact of these payments on practice patterns. Payments have not previously been compared among the subspecialties of cardiology. This is a retrospective analysis of the Open Payments database, including all installments and payments made to doctors in the calendar year 2015 by pharmaceutical and device manufacturers or group purchasing organization...
December 15, 2017: American Journal of Cardiology
Chapin White, Christine Eibner, Jodi L Liu, Carter C Price, Nora Leibowitz, Gretchen Morley, Jeanene Smith, Tina Edlund, Jack Meyer
This article describes four options for financing health care for residents of the state of Oregon and compares the projected impacts and feasibility of each option. The Single Payer option and the Health Care Ingenuity Plan would achieve universal coverage, while the Public Option would add a state-sponsored plan to the Affordable Care Act (ACA) Marketplace. Under the Status Quo option, Oregon would maintain its expansion of Medicaid and subsidies for nongroup coverage through the ACA Marketplace. The state could cover all residents under the Single Payer option with little change in overall health care costs, but doing so would require cuts to provider payment rates that could worsen access to care, and implementation hurdles may be insurmountable...
January 2017: Rand Health Quarterly
William C Hsiao, Shou-Hsia Cheng, Winnie Yip
The United Nations has incorporated the noble goal of Universal Health Coverage (UHC) in its 2030 Agenda for Sustainable Development. Most nations have already embraced UHC as their goal. However, an intense policy debate has risen about which health system structure can best achieve UHC. Is a single-payer system more efficient, equitable and effective than a multiple-payer system for middle income countries? We argue that empirical evidence and in-depth analysis of single-payer and multiple-payer systems should inform this debate...
December 7, 2016: Social Science & Medicine
Luc L Hagenaars, Niek S Klazinga, Michael Mueller, David J Morgan, Patrick P T Jeurissen
INTRODUCTION: Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. METHODS: We used OECD data, which include health system governance and financing-related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel)...
October 12, 2017: International Journal of Health Planning and Management
Akshay Bagai, Maria Eberg, Maria Koh, Asim N Cheema, Andrew T Yan, Arti Dhoot, Sanjeev P Bhavnani, Harindra C Wijeysundera, R Sacha Bhatia, Padma Kaul, Shaun G Goodman, Dennis T Ko
BACKGROUND: The appropriate use criteria considers cardiac stress testing within 2 years after percutaneous coronary intervention (PCI) to be rarely appropriate, unless prompted by symptoms or change in clinical status. Little is known about the patterns of cardiac stress testing after PCI in the single-payer Canadian healthcare system, where mechanisms for reimbursement are different from the United States. METHODS AND RESULTS: Frequency and timing of cardiac stress testing within 2 years of PCI performed between April 2004 and March 2013 in Ontario, Canada, was determined from linked provincial databases...
October 2017: Circulation. Cardiovascular Quality and Outcomes
Steffie Woolhandler, David U Himmelstein
No abstract text is available yet for this article.
October 3, 2017: Annals of Internal Medicine
David Silverman
No abstract text is available yet for this article.
October 3, 2017: Annals of Internal Medicine
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