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Purpose: This chapter describes the main features of the financing of health care expenditure in the French health care system.

Methodology/Approach: This chapter presents key reforms that have been implemented to make the health care system more sustainable in the main dimensions of care: ambulatory, hospital, pharmaceuticals and insurance coverage.

Findings: Overall, French public authorities have followed three paths to improve the sustainability of the health care system: reducing public expenses, generalising access to complementary health insurance and streamlining care toward the most disadvantaged individuals. Looking in the future, the sustainability of the French health care system will mainly rely on two areas of recommendations. The first area is to respect the national annual target for health insurance spending, with a focus on responsible prescriptions, optimised care pathways and increased use of primary and ambulatory care where possible. The second area is to increase efficiency on the short to medium terms. This includes an increased quality of the care toward patients with a disability or special needs, a clearer engagement of patients within their care pathways to increase treatment compliance, and more generally a search for coordinated care that is fair and appropriate.

This paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.

The authors trace the funding of health from foreign aid to health funding and health outcomes in the public system, foreign direct investment to health funding in the private system, and personal remittances to health outcomes. This is followed by panel data, fixed effects models subjected to 2-, 3- and 4-stage least squares regressions.

Findings from the first model were that aid in the form of Technical Cooperation Grants funded Infrastructure. Infrastructure Spending due to aid funds Government Health Plans, which reduced the Incidence of Tuberculosis, which in turn reduced Undernourishment and increases Life Expectancy. Other positive health outcomes included reduced Birth Rate and reduced Maternal Mortality. In the second model, Foreign Direct Investment increased Female Employment and GDP per Person, funding Private Health Plans, which increase Life Expectancy, reduced Undernourishment, increased Skilled Care at Birth, increased the Number of Hospital Beds, reduced Maternal Mortality and increased the Birth Rate. In the third model, Remittances influenced both Out-of-Pocket Medical Expenses and Private Plans.

Publicly funded programs may be directed to nutrition, increasing life expectancy. Private funding may be directed to improving maternal conditions, with remittances removing the liquidity constraints.

This paper is the first attempt to trace health funding from its sources of foreign aid, foreign direct investment and personal remittances using three separate paths.

The purpose of this paper is to explore the socio-economic impacts of AIDS on families caring for AIDS-orphaned children in Mbeya rural district, Tanzania.

A qualitative inquiry employing one-on-one in-depth interviews was conducted in 2015. Purposive sampling technique was used to recruit participants (n=24) comprising 20 heads of families caring for AIDS-orphaned children, two local government staff and two staff from Isangati Agricultural Development Organisation – a non-government organisation. Qualitative data were analysed using thematic and framework approach.

Results demonstrated that families caring for AIDS-orphaned children experienced severe socio-economic impacts of the epidemic. Reduction in household savings, increase in living expenses on health care and increased education fees were the identified economic impacts on these families. Social impacts included labour shortage, withdrawal of children from school and increased demand for food.

There is a need for urgent responses and for scaling up programmes delivered by organisations, institutions and the government of Tanzania to help families cope with these impacts.

This study provides evidence on socio-economic impacts of AIDS on families caring for AIDS-orphaned children in Tanzania. An understanding of these impacts can help governmental and non-governmental institutions and programme planners to address the problem in their policies and develop evidence-based strategies and interventions in responding to the problem in Mbeya and Tanzania. Moreover, responses to reducing the impacts of AIDS on families require a holistic approach that encourages the involvement of all sectors and agents outside of the health sector.

The main objective of this paper is to analyze patterns of consumption expenditure and the effects of income, prices and socioeconomic and demographic factors on demand among elderly- and young-adult-headed households in Brazil.

The authors estimated a Quadratic Almost Ideal Demand System demand system using the main household consumption good groups – food, housing, clothing, transportation, health care and other expenses – with data from three Brazilian Household Budget surveys.

The study results showed that elderly- and young-adult-headed households have different consumption patterns. The consumption of food, transportation and health care was more price-sensitive for households headed by the elderly, while higher income increases health care expenses in elderly-headed households to a greater extent than it does in younger-headed households.

The limitations are due to the structure of the data used, such as the effects of seasonality and individualized demand analyses, and sample design in the estimates. However, due to the structure of the demand models, which when estimating by seemingly unrelated regressions do not allow to take into account the sample design.

As a consequence of population aging, the Brazilian economy will experience changes in the composition of household consumption, mainly for food, housing, transportation and health-care-related products.

This paper fulfills the lack of studies that analyze the consumption patterns and how demand varies across different types of elderly-headed households in a developing country, such as Brazil.

The purpose of this paper is to examine whether the timing associated with the implementation of the health insurance-related provisions of the Patient Protection and Affordable Care Act (ACA) altered the presence and distribution of medical/non-medical debts accumulated by different types of bankruptcy filers.

Data were drawn from the US Bankruptcy Court’s Eastern Washington District over the years 2009, 2011 and 2014 using interval random sampling. Binary probit and Tobit analyses were used to model the existence, and distribution, of medical debts and total debts, respectively, at the time of filing. The impact of the time frame associated with the ACA was operationalized via a Chow test for structural dynamic change.

Chapter 13 filers in 2014 (post-ACA-based health exchange implementation) were more likely to report medical debts than Chapter 7 filers in the pre-intervention period, and were also more likely to report a larger proportion of outstanding debts owed to a single creditor. Filers claiming health insurance premium expenses in 2011 were (at the 10 percent significance level) more likely to report a more skewed distribution of medical debts.

The time frame associated with the implementation of the ACA impacts the distribution of medical debts among filers who have sufficient net disposable income to fund a Chapter 13 plan. The polarization of outstanding medical debts may indicate coverage gaps in existing health insurance policies, whose costs would be disproportionately borne by patients operating on thin financial margins.

Analyses the features, strategies and characteristics of health‐care reforms in the People’s Republic of China. Since the fourteenth Central Committee of the Chinese Communist Party held in 1992, an emphasis has been placed on reform strategies such as cost recovery, profit making, diversification of services, and development of alternative financing strategies in respect of health‐care services provided in the public sector. Argues that the reform strategies employed have created new problems before solving the old ones. Inflation of medical cost has been elevated very rapidly. The de‐linkage of state finance bureau and health service providers has also contributed to the transfer of tension from the state to the enterprises. There is no sign that quasi‐public health‐care insurance is able to resolve these problems. Finally, co‐operative medicine in the rural areas has been largely dismantled, though this direction is going against the will of the state. Argues that a new balance of responsibility has to be developed as a top social priority between the state, enterprises and service users in China in order to meet the health‐care needs of the people.

This case study is designed to enable students to analyze the competitive landscape of a business impacted by technological disruption; evaluate the viability of an organic growth strategy using stakeholder analysis; evaluate the revenue and cost structure of Apollo 24/7 and decide on the future investment strategy; and analyze funding strategies of traditional hospitals versus pure digital players.

To extend its reach, Apollo Hospitals Enterprise (Apollo Hospitals), a leading private sector brick-and-mortar hospital chain in India known for using state-of-the-art technology, launched a unified virtual mobile platform Apollo 24/7 in February 2020, 45 days into the COVID-19 pandemic. The management believed that the digital platform had a unique ecosystem that could not be replicated. The analysts were optimistic about the impact of the decision on the future performance of Apollo Hospitals, as it was expected to lead to higher penetration and increased revenue. They also anticipated the unlocking of value, as and when the venture capitalist (VC) would invest in Apollo Hospitals. However, with increasing operating expenses on account of burgeoning technological and marketing expenses, things did not seem to go going as planned. Three years later, in February 2022 after the Q3 of financial year 2023 results. Suneeta Reddy, the company’s managing director found herself pondering whether the digital platform could boost Apollo Hospitals’ profitability in addition to expanding its reach and increasing affordability when the company missed the analyst estimates. In India, which was then the second most populous country, “incremental access” and “affordability” were what mattered to the patients, However, for the investors and analysts, it was quarter-on-quarter performance. The change in the macroeconomic environment stalled the company’s plan of raising money from VCs.

Furthermore, the financing dilemma also plagued Reddy. She knew there was a difference between financing for conventional businesses that for digital businesses. She also had to take decide between short-term profitability with which investors were obsessed versus long-term sustainability, which involved taking care of stakeholders’ interests.

This case study is basically aimed at postgraduate courses and executive management courses.

Teaching notes are available for educators only.

CSS11: Strategy.

This chapter provides an introduction to the volume and reviews some issues related to access, quality and satisfaction with care as three critical concepts in health services and health care delivery. In addition to this review of some of the material on access, quality and satisfaction with care, this chapter also serves as an introduction to the volume. As such, the chapter explains the organization of the volume and briefly comments on each of the chapters included in the volume.

Key State Blue Cross and Blue Shield Plan (a disguised case of an actual BCBS Plan) is the merged product of three state plans. Initially burdened with a reputation of poor customer service, Key State's executives decided to invest heavily in service improvement, eventually achieving superior levels. Key State's high-quality customer service emerged as a true competitive advantage for its customers, who were primarily businesses and health benefits consultants who influenced corporate purchasers of health insurance. The Key State brand came to be synonymous with personal service, security, choice, and dependability. But the health care insurance market was changing under Key State's feet. Spiraling costs meant that high-quality service became less of a competitive advantage as employers were lured by low-cost, low-service providers. Many employers cut or dropped health care benefits entirely, swelling the ranks of the under- and uninsured, who in turn were extremely price-sensitive when shopping for health insurance on their own. Finally, the health care insurance market was being revolutionized by financial institutions willing to hold health benefit accounts and pay providers directly, thereby eliminating the need for Key State as a mediator. Key State executives were aware of these changes but were challenged by the mindset, culture, and organizational design custom-fit to their business accounts. The case asks the reader to consider whether Key State has the right number of target markets, whether it should have one brand or several for its different target markets, what it should do for the uninsured, and how it should improve its brand experience in light of the industry's changing landscape. All of these decisions will have significant implications for the organizational design of Key State.

To better understand the challenges involved in a successful health insurance company to cope with a rapidly changing and unpredictable environment; to formulate a new strategy and a new organizational design to accomplish this adaptation.