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We adopt a standard distributional impact methodology, based on Atkinson's cost of inequality approach, to estimate the degree of implicit redistribution created through…
We adopt a standard distributional impact methodology, based on Atkinson's cost of inequality approach, to estimate the degree of implicit redistribution created through public funding of health insurance in Canada. The first stage of the exercise is to determine the public health insurance benefits received by families of various age and composition and to add these to measured after-tax incomes. In our base case, which uses the Atkinson Mean Logarithmic Deviation as inequality index, we find that accounting for public health insurance benefits implies a reduction in inequality equivalent to 2.4% of per capita income. We then model the implications of moving to a hypothetical fully privatized system while proportionately refunding to individuals the tax revenues saved in doing so. This would give rise to a further 2.4% equivalent per capita income reduction resulting from increased inequality in the distribution of after-tax income. Thus, for this scenario, moving from public financing of health insurance in Canada to a fully privatized system implies an overall increase in inequality equivalent to a loss of 4.8% of per capita income. This corresponds to an increase of about 25% in existing inequality. Not surprisingly, the impact of publicly financed health insurance in reducing inequality is strongest for the elderly.
This study aims to explain the emergence and development of the concept of “Policy Networks” as a unit of analysis in the realm of public policies and their role in…
This study aims to explain the emergence and development of the concept of “Policy Networks” as a unit of analysis in the realm of public policies and their role in formulating a comprehensive policy for health insurance. The developments that took place over the past few decades had impacted a shift in the state’s role in shaping public policies, from a sole, key actor to one among other actors, both governmental and non-governmental, working interdependently through a set of networks.
The present study adopts the social network analysis as an approach and the social policy network as a tool to analyze public policymaking. The approach suggests the presence of a number of actors and interest groups that are actively involved in public policy and decision-making. These groups may vary from a cause to another and also from time to time. This research investigates and juxtaposes a selected sample of members of the health insurance policy network in Egypt.
In light of the study findings, one can see the existence of a policy network for the comprehensive health insurance system in Egypt. The study reveals the interrelations among a number of official and non-official key actors. The network has gone through several phases; the pre-establishment phase during the early stages of policymaking; the official establishment phase during the formative stage; and finally, the network operation phase during the implementation stage. The study also concludes that the policy network has influenced the different stages of policymaking through several tools and strategies. Moreover, the roles of different actors varied within the network; international organizations were the primary influencer in the early stages of policymaking; syndicates dominated the formative stage; and the public sector played the leading role in the implementation stage.
Serious attempts were made to benefit from policy networks with a particular focus on using the strengths of each actor while establishing an official institutional framework that consolidates coordination and cooperation among the involved parties. This framework should keep pace with global changes and developments. It should also have an official meeting venue. Above all, all parties should be listened to and their demands should be considered seriously as long as they are not actualized at the expense of the public interest nor do they undermine the sovereignty of the state. The study also enhances researchers to use policy networking as a unit for analyzing public policy and their effect on these policies.
Public policymaking in Egypt can become more responsive to people’s demands and more democratic once it was made through informative and interactive policy network. This pattern of policymaking will enhance both efficient and responsive.
Practical Implications: public policy making in Egypt can become more responsive to people demands and more democratic once it was made through informative and interactive policy network. This pattern of policymaking will enhance both efficient and responsive.
In addition to its practical contributions to the field of policymaking, this research fills a gap in the literature on the theoretical level.
This study evaluates whether sociodemographic characteristics, political affiliation, family-related circumstances, self-reported health status, and access to health…
This study evaluates whether sociodemographic characteristics, political affiliation, family-related circumstances, self-reported health status, and access to health insurance affect public opinion toward the current US health-care system. Opinions about the health-care system were measured in terms of consumer confidence and perceived need for health-care reform. Data come from the 2008 Cooperative Congressional Election Study (CCES), a nationwide survey of 1,000 respondents. All data were collected in November 2008, thus providing a useful alternative to volatile polling data because they were collected prior to and are thus immune to the polarized tone of the debates that have occurred over the past few years. Overall, we found that public confidence in medical technology and quality of care were consistently high, while confidence in the affordability of medical care was much lower among respondents. Younger adults, those with poor health, and those without health insurance had particularly low confidence in their ability to pay for health care. Although a strong majority of the population agreed that the US health-care system was in need of major reform, support for particular types of government-sponsored health insurance programs was primarily determined by political affiliation. In an era where a large proportion of the population has little access to health care (due to lack of insurance) and where the US government is facing tremendous opposition to the implementation of major reform efforts, it is useful to understand which subgroups of the population are most confident in the current health-care system and most likely to support reform efforts, as well as those who are most resistant to change given their precarious health needs, their inability to access health care (as a result of insurance or noninsurance), or their political affiliation.
In this chapter we examine how micro- and macro-level issues including access to child-only or family public health insurance shape low-income immigrant families’ health…
In this chapter we examine how micro- and macro-level issues including access to child-only or family public health insurance shape low-income immigrant families’ health care experiences in two policy contexts in the Washington, DC metropolitan area.
This qualitative study includes 40 in-depth interviews with first-generation, low-income immigrant Latin American and African mothers in DC and Northern Virginia.
The majority of families living in Virginia had child-only health insurance, whereas most of the families living in Washington, DC, had family health insurance. Regardless of these insurance differences, all mothers had access to free health care for prenatal care. Pregnancy, for most, was their entry into the U.S. health care system. Families’ ongoing health care experiences differed in relation to insurance access, and culture, including parents’ previous experiences with health care in their countries of origin.
Future research should consider the experiences of other immigrant groups, mental health experiences of immigrants, and fathers’ experiences with health care.
Future initiatives to address health care should focus on providing family health care to low-income immigrant families across the country, improving access to mental health services for immigrant families, and creating more culturally and linguistically appropriate health care services.
This study points to the importance of family health care for immigrant families, as well as care that is culturally and linguistically competent.
This study illustrates the need for public family health insurance for low-income immigrant families, and the importance of culturally competent health care for immigrants.
Health insurance in India has shown little development. It has not been able to evoke enthusiasm among Indian insurers. Consequently, several reports on Indian health care…
Health insurance in India has shown little development. It has not been able to evoke enthusiasm among Indian insurers. Consequently, several reports on Indian health care insurance have been produced. The purpose of this paper is to offer a review of this matter.
Critical review of related published and grey literature.
Almost 79 per cent of health expenditure is borne by private bodies and the rest by the public. Authors argue that to stimulate private health insurance growth, the Indian government should recognize health insurance as a separate line of business and distinguish it from other non‐life insurance. Particular emphasis is placed on the present health care scenario in India and international field generally. A global comparison of selected Asian countries, regarding their national incomes and health expenditure in public and private sectors, generates insights. Third party administrators (TPAs) facilitate a cashless health services for their customers and offer back‐up services to the insurance companies. Desired strategies and ways of furthering the role of the Insurance Regulatory and Development Authority in acting as a regulator for the purpose of ensuring the industry's smooth functioning is an issue for India's health services.
Information about the present complexities in the health insurance market has been gathered from various sources and summarized.
Since the implementation of the New Cooperative Medical Scheme (NCMS) in 2003, this program has experienced rapid growth. Even so, little is known about the association…
Since the implementation of the New Cooperative Medical Scheme (NCMS) in 2003, this program has experienced rapid growth. Even so, little is known about the association between NCMS expansion and labor force supply among rural residents in China. The purpose of this paper is to examine the effects of the NCMS on labor force supply for rural Chinese populations.
Using data from the China Health and Nutrition Survey (CHNS), a difference-in-differences (DD) approach is employed to estimate the impact of NCMS expansion on labor supply outcomes, including hours of worked in agriculture, off-farm labor force participation, not working, and weeks off due to illness. A number of falsification tests are conducted to identify whether the assumption of common trends of DD analyses is satisfied. The robustness of results is checked through additional estimation, including panel fixed effects and instrumental variable approach.
Results show that the NCMS expansion has a positive effect on the hours of worked in agriculture and off-farm labor force participation, and reduces the likelihood of not working and weeks off due to illness. The effect on hours of agricultural production is larger for male adults, those aged 50 or more, and individuals in low-income families. This study demonstrates the importance of potential health improvements from public health insurance in promoting rural residents’ labor productivity.
Studies concerning the effects of public health insurance on labor supply in developing countries remain limited. The findings of this study provide important insights into how public health insurance programs, like the NCMS, may affect patterns of labor supply among rural residents, and can help policymakers improve health policies aimed to reduce the number of uninsured farmers while maintaining high levels of labor supply, productivity, and health status among the most vulnerable of populations.
The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public…
The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.
Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.
Complexity academic level
India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.
Teaching Notes are available for educators only.
CSS: 10 Public Sector Management.
Access to health care, particularly for children, remains a topic of great importance to policy makers in the United States. Recent attention focuses primarily on the…
Access to health care, particularly for children, remains a topic of great importance to policy makers in the United States. Recent attention focuses primarily on the enactment and subsequent expansions of the Children’s Health Insurance Program (CHIP) (Kenney, Ullman & Weil, 2000). Though the legislation affects all qualifying low-income children, the unique service needs of children with disabilities justify a closer look at the relationship between health insurance, income, and needs amongst children with disabilities. This analysis seeks to answer the following questions. To what extent do children with disabilities need various supportive health services? Does this need vary across type of disability or income level? Do children with health insurance, either public or private, have fewer unmet needs than children without health insurance? Answers to these questions will assist policy makers when determining who should be targeted to receive additional assistance in the future as well as evaluate the effectiveness of current mechanisms in delivering supportive health services to children with disabilities.
If rational individuals pay the full costs of their decisions about food intake and exercise, economists, policy makers, and public health officials should treat the…
If rational individuals pay the full costs of their decisions about food intake and exercise, economists, policy makers, and public health officials should treat the obesity epidemic as a matter of indifference. In this paper, we show that, as long as insurance premiums are not risk rated for obesity, health insurance coverage systematically shields those covered from the full costs of physical inactivity and overeating. Since the obese consume significantly more medical resources than the non-obese, but pay the same health insurance premiums, they impose a negative externality on normal weight individuals in their insurance pool.
To estimate the size of this externality, we develop a model of weight loss and health insurance under two regimes – (1) underwriting on weight is allowed and (2) underwriting on weight is not allowed. We show that under regime (1), there is no obesity externality. Under regime (2), where there is an obesity externality, all plan participants face inefficient incentives to undertake unpleasant dieting and exercise. These reduced incentives lead to inefficient increases in bodyweight, and reduced social welfare.
Using data on medical expenditures and bodyweight from the National Health and Interview Survey and the Medical Expenditure Panel Survey, we estimate that, in a health plan with a coinsurance rate of 17.5%, the obesity externality imposes a welfare cost of about $150 per capita. Our results also indicate that the welfare loss can be reduced by technological change that lowers the pecuniary and non-pecuniary costs of losing weight, and also by increasing the coinsurance rate.
Exemption from hospital charges may appear as an essential policy in order to support the poor. Such policies can function for the fulfillment of governments’ social- and…
Exemption from hospital charges may appear as an essential policy in order to support the poor. Such policies can function for the fulfillment of governments’ social- and justice-based responsibilities in public hospitals. The purpose of this paper is to investigate the pattern of offering discounts to the poor and the effect of Iran’s recent Health Sector Evolution Plan on it.
The authors conducted analytical research longitudinally on the data related to cash discounts offered to the poor within a teaching hospital. Data were collected through the period of four months, September to December 2013, before the establishment of the Health Sector Evolution Plan, and in the similar months through 2014, after the establishment of the Health Sector Evolution Plan, in order to compare the amount of cash discounts. The type of insurance, length of stay, amount of discounts offered to patients, and total costs of hospital charges were studied and compared by referring to the social working department. Data were analyzed using the χ2-test, Mann-Whitney U test, ANOVA, and regression analysis aided by SPSS 20.
The number of patients offered discounts or exempted from payment in 2014 reduced compared to the number in 2013. The highest rate of demand for discounts was related to patients covered by Emdad Committee followed by those who had no insurance. The ratio of discount to cost in the oncology ward was higher than other groups.
The results of the present study can contribute to the plans of health system policy makers in organizing measures for supporting poor patients toward accessing healthcare services.