Explore the vast range of titles available.

In 2006, Massachusetts passed health care reform legislation designed to achieve nearly universal coverage through a combination of insurance market reforms, mandates, and subsidies that later served as the model for national reform. Using data from the Behavioral Risk Factor Surveillance System, we provide evidence that health care reform in Massachusetts led to better overall self-assessed health. Various robustness checks and placebo tests support a causal interpretation of the results. We also document improvements in several determinants of overall health: physical health, mental health, functional limitations, joint disorders, and body mass index. Next, we show that the effects on overall health were strongest among those with low incomes, nonwhites, near-elderly adults, and women. Finally, we use the reform to instrument for health insurance and estimate a sizeable impact of coverage on health. © 2013 by the Association for Public Policy Analysis and Management.

According to Eurostat's At risk of poverty or social exclusion in the EU27, austerity measures could affect children in particular--they are disproportionately affected by the financial crisis with nearly 30% being at risk of poverty or social exclusion.

Commonwealth Fund reports have consistently rated the performance of the U.S. health care system last among high-income countries, though we spend far more on health care. An understanding of the reasons for that disparity may point the way to essential improvements.

Policy analysts consider the Netherlands health system a possible model for the United States. Since 2006 all Dutch citizens have to buy standardized individual health insurance coverage from a private insurer. Consumers have an annual choice among insurers, and insurers can selectively contract or integrate with health care providers. Subsidies make health insurance affordable for everyone. A Risk Equalization Fund compensates insurers for enrollees with predictably high medical expenses. The reform is a work in progress. So far the emphasis has been on the health insurance market. The challenge is now to successfully reform the market for the provision of health care. [PUBLICATION ABSTRACT]

This article examines why and how a national health insurance (NHI) proposal targeting universal health coverage (UHC) in Nigeria developed over time. The study involved document reviews, in-depth interviews, a further review of preliminary analysis by relevant actors and use of a stakeholder analysis approach. The need for strategies to improve healthcare funding during the economic recession of the 1980s stimulated the proposal. The inclusion of Health Maintenance Organizations (HMOs) as financing organizations for national health insurance at the expense of sub-national (state) government mechanisms increased credibility of policy implementation but resulted in loss of support from states. The most successful period of the policy process occurred when a new minister of health (strongly supported by the president that displayed interest in UHC) provided leadership through the Federal Ministry of Health (FMOH), and effectively managed stakeholders’interests and galvanized their support to advance the policy. Later, the National Health Insurance Scheme (the federal government’s implementing/regulatory agency) assumed this leadership role but has been unable to extend coverage in a significant way. Nigeria’s experience shows that where political leaders are interested in a UHC-related proposal, the strong political leadership they provide considerably enhances the pace of the policy process. However, public officials should carefully guide policymaking processes that involve private sector actors, to ensure that strategies that compromise the chance of achieving UHC are not introduced. In contexts where authority is shared between federal and state governments, securing federal level commitment does not guarantee that a national health insurance proposal has become a ‘national’proposal. States need to be provided with an active role in the process and governance structure. Finally, the article underscores the utility of retrospective stakeholder analysis in understanding the reasons for changes in stakeholder positions over time, which is useful to guide future policy processes. Nous examinons dans cet article pourquoi et comment la proposition de l’Assurance nationale de santé (ANS) d’arriver à la couverture de santé universelle (CSU) au Nigeria s’est développée au fil du temps. Cette étude implique des revues de documents, des interviews approfondies, une revue approfondie des analyses primaires par les acteurs concernés et l’utilisation d’une approche analytique. Le besoin de stratégies pour améliorer le financement de la santé pendant la récession économique des années 80 a motivé cette proposition. Le fait d’inclure la Health Maintenance Organizations (HMOs) comme des organisations de financement pour les assurances nationales de santé à la charge des Etats a augmenté la crédibilité de la mise en place de mesures mais a conduit à la perte du soutien des Etats. La meilleure période du processus d’application des mesures a eu lieu lorsqu’un nouveau ministre de la santé a été nommé (fortement soutenu par le président montrant des intérêts pour la CSU) apportant le leadership nécessaire au sein du Ministère Fédéral de la Santé et a permis de manager efficacement les intérêts des personnes concernées et de galvaniser le soutien pour faire avancer la mise en place des mesures. Plus tard, le programme d’assurance nationale de santé (l’agence fédérale de régulation et d’application du gouvernement) a pris ses responsabilités de leadership mais n’a pas été capable d’étendre la couverture de manière significative. L’expérience du Nigeria montre que lorsque les politiques s’intéressent à la proposition d’ANS, alors un fort leadership politique peut considérablement augmenter le rythme du processus politique. Quoiqu’il en soit, les représentants publics devraient prudemment guider le processus politique qui implique les acteurs du secteur privé, et devraient s’assurer que les stratégies qui peuvent compromettre les chances d’arriver à la CSU ne sont pas engagées. Dans un contexte où l’autorité est partagée entre le gouvernement fédéral et le gouvernement national, sécuriser l’engagement au niveau fédéral n’apporte pas la garantie que la proposition d’assurance santé au niveau national soit devenue une proposition nationale. Les Etats ont besoin d’avoir un rôle actif dans le processus et la structure de gouvernance. Finalement, cet article souligne l’utilité d’une analyse rétrospective des intervenants pour comprendre les raisons du changement de position des intervenants au fil du temps, ce qui pourra être utile pour guider les prochains processus politiques. 本文探讨在过去一段时间内，针对全民医疗保险（ (UHC) ）的 国家医疗保险（ (NHI) ）提议为什么以及如何在尼日利亚开展 的。该研究涉及文档调研，深入访谈，进一步调研相关参与 者的初步分析以及利益相关者分析方法的应用。 20 世纪 80 年代经济衰退过程中为改善医疗保险经费的策略上的需求促 进了这一提案。健康维护组织（ (HMOs) ）作为国家医疗保险 的融资机构在次国家级（州）政府机制支出中的涵义增加了 政策执行公信力，但却失去了各州的支持。推行政策最成功 的时期发生在新的卫生部长（获得对全民医疗保险表现出极 大兴趣的总统的强烈支持）通过联邦卫生部（ (FMOH) ）来领 导，同时有效管理利益相关者的利益和呼吁他们的支持的时 候。后来，国家医疗保险计划（联邦政府的执行/管理机构） 承担这一领导角色， 但并不能通过有效方法来扩大覆盖范 围。尼日利亚的经验表明，那里的政治领导人对全民医疗保 险相关的提议很感兴趣，他们提供的强有力的领导极大地促 进了政策实施的步伐。然而， 政府官员应该仔细指导涉及私 营部门参与者的决策过程，以确保没有引入可能会使完成全 民医疗保险所妥协的政策。在联邦政府和州政府共享权威这 一环境下，联邦一级的承诺并不能保证一个国家医疗保险提 议已经成为了一个“国家”的提案。各州需要在此过程和治理 结构中发挥积极作用。最后，文章强调了利用回溯性利益相 关者分析来理解在过去一段时间内利益相关者地位变化的原 因，这对将来指导政策实施是很有用的。 Este artículo examina porque y como un propuesta de seguro de salud nacional (SSN) con el objetivo de cobertura sanitaria universal (CSU) en Nigeria se desarrolló a través del tiempo. El estudio incluyó una revisión de documentos, entrevistas a profundidad, una revisión adicional del análisis preliminar por parte de los actores relevantes y el uso de análisis de partes interesadas. La necesidad de estrategias para mejorar los cuidados dela salud durante la recesión económica de los 1980s estimuló la propuesta. La inclusión de las Organizaciones del Mantenimiento de la Salud (OMS) como organizaciones financieras para el seguro de salud nacional a costa de los mecanismos de los gobiernos sub-nacionales (estados) incrementó la credibilidad en la implementación de las políticas pero resultó en la pérdida del apoyo de los estados. El periodo más exitoso del proceso de la política ocurrió cuando un nuevo ministro de salud (apoyado enfáticamente por el presidente, quien mostro interés en CSU) proveyó liderazgo a través del Ministerio Federal de Salud (MFDS), y gestiono efectivamente los intereses de las partes interesadas e incitó su apoyo para avanzar la política. Más adelante, el Programa de Seguro de Salud Nacional (la agencia implementadora/reguladora del gobierno federal) asumió este papel de liderazgo pero no ha sido capaz de extender la cobertura de manera significativa. La experiencia de Nigeria muestra que donde los líderes políticos están interesados en propuestas relacionadas con la CSU, el liderazgo político fuerte que ellos proveen mejora considerablemente el ritmo del proceso de las políticas. Sin embargo, los oficiales públicos deben guiar cuidadosamente los procesos de creación de políticas que involucran a los actores del sector privado para asegurarse que las estrategias que pongan en riesgo la obtención de la CSU no sean introducidas. En contextos donde la autoridad es compartida entre gobiernos federales y estatales, garantizar el compromiso a nivel federal no garantiza que una propuesta de seguro nacional de salud se haya convertido en una propuesta ‘nacional’. A los estados se les tiene que dar un papel activo en el proceso y estructura de la gobernanza. Finalmente, este artículo enfatiza la utilidad del análisis retrospectivo de partes interesadas para entender las razones detrás de los cambios en posiciones de las partes interesadas a través del tiempo, lo cual es útil para guiar procesos de políticas futuros.

The public social policy and programme decisions that are made in low-income countries have critical effects on human social and development outcomes. Unfortunately, it would appear that inadequate attention is paid to analysing, understanding and factoring into attempts to reshape or change policy, the complex historical, social, cultural, economic, political, organizational and institutional context; actor interests, experiences, positions and agendas; and policy development processes that influence policy and programme choices. Yet these can be just as critical as the availability of research or other evidence in influencing decision making on policies and their accompanying programmes and the resulting degree of success or failure in achieving the original objectives. Ghana, a low-income developing country in sub-Saharan Africa, embarked on a national policy process of replacing out-of-pocket fees at point of service use with national health insurance in 2001. This paper uses a case study approach to describe and reflect on the complex interactions of context with actors and processes including political power play; and the effects on agenda setting, decision making and policy and programme content. This case study supports observations from the literature that although availability of evidence is critical, major public social policy and programme content can be heavily influenced by factors other than the availability or non-availability of evidence to inform content decision making. In the low-income developing country context there can be imbalances of policy decision-making power related to strong and dominant political actors combined with weak civil society engagement, accountability systems and technical analyst power and position. Efforts at major reform need to consider and address these issues alongside efforts to provide evidence for content decision-making. Without an analysis and understanding of the politics of reform and how to work within it, researchers and other technical actors may find their information to support reform is not applied effectively. Similarly, without an appreciation of the need for critical technical analysis to support decision making rather than an indiscriminate use of political approaches, political actors may find that even with the best of intentions, desired policy objectives may not be attained.

[...]the Advanced Medical Care B system, which is similar to the Medicare Clinical Trial Policy system in the USA, under which unapproved or off-label drugs are used in a clinical trial setting with health insurance coverage for the routine medical care cost--the so-called mixed medical treatment system--a plausible measure that can provide patients with a chance to participate in clinical trials of unapproved or off-label oncology drugs.

U.S. “Medicare for All” is an idea for the long run. Its prospects of eventual enactment will be determined by our shifting views on a right to health care, likely cost savings, economic inequality, and the role of government in the lives of Americans.

In April 2006, Massachusetts passed legislation intended to move the state to near-universal coverage within three years and, in conjunction with that expansion, to improve access to affordable, high-quality health care. In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13 percent in fall 2006 to 7 percent in fall 2007. At the same time, access to care improved, and the share of adults with high out-of-pocket costs and problems paying medical bills dropped. Despite higher-than-anticipated costs, most residents of the state continued to support reform. [PUBLICATION ABSTRACT]

Context: An aging population leads to a growing demand for long-term services and supports (LTSS). In 2002, France introduced universal, income-adjusted, public long-term care coverage for adults 60 and older, whereas the United States funds means-tested benefits only. Both countries have private long-term care insurance (LTCI) markets: American policies create alternatives to out-of-pocket spending and protect purchasers from relying on Medicaid. Sales, however, have stagnated, and the market's viability is uncertain. In France, private LTCI supplements public coverage, and sales are growing, although its potential to alleviate the long-term care financing problem is unclear. We explore whether France's very different approach to structuring public and private financing for long-term care could inform the United States' long-term care financing reform efforts. Methods: We consulted insurance experts and conducted a detailed review of public reports, academic studies, and other documents to understand the public and private LTCI systems in France, their advantages and disadvantages, and the factors affecting their development. Findings: France provides universal public coverage for paid assistance with functional dependency for people 60 and older. Benefits are steeply income adjusted and amounts are low. Nevertheless, expenditures have exceeded projections, burdening local governments. Private supplemental insurance covers 11% of French, mostly middle-income adults (versus 3% of Americans 18 and older). Whether policyholders will maintain employer-sponsored coverage after retirement is not known. The government's interest in pursuing an explicit public/private partnership has waned under President François Hollande, a centrist socialist, in contrast to the previous center-right leader, President Nicolas Sarkozy, thereby reducing the prospects of a coordinated public/private strategy. Conclusions: American private insurers are showing increasing interest in long-term care financing approaches that combine public and private elements. The French example shows how a simple, cheap, cash-based product can gain traction among middle-income individuals when offered by employers and combined with a steeply income-adjusted universal public program. The adequacy of such coverage, however, is a concern.