The single-payer health insurance proposal known widely as Medicare for All (M4A) cannot be enacted without first answering certain questions. Foremost among these is whether the public would support shifting more than $32 trillion in M4A’s first 10 years from private health spending, over which consumers retain some discretion, to federal health spending, over which consumers do not. A related open question is whether the federal government can adequately finance this amount of spending without triggering significant adverse economic effects. Other unanswered questions include M4A’s effects on health providers, the prescription drug market, and private health insurance. M4A would add further to national health cost growth unless provider reimbursements are cut more sharply than lawmakers have been willing to do historically. Yet the consequences of enacting such payment cuts simultaneously with a substantial increase in health service demand are unpredictable.
Reliance on Medicare Providers by Veterans after Becoming Age‐Eligible for Medicare is Associated with the Use of More Outpatient ServicesDecember 20, 2018
To estimate the effect of Medicare use on the receipt of outpatient services from 2001 through 2015 for a cohort of Veterans Administration (VA) users who became age‐eligible for Medicare in 1998–2000.
Data Sources/Study Setting
VA administrative data linked with Medicare claims for veterans who participated in the 1999 Large Health Survey of Enrolled Veterans.
We coded each veteran as VA‐reliant or Medicare‐reliant based on the number of visits in each system and compared the health and social risk factors between VA‐reliant and Medicare‐reliant veterans. We used bivariate probit and instrumental variables models to estimate the association between a veteran’s reliance on Medicare and the receipt of outpatient procedures in Medicare and the VA.
Veterans who chose to rely on the VA (n = 4,317) had substantially worse social and health risk factors than Medicare‐reliant veterans (n = 2,567). Medicare reliance was associated with greater use of outpatient services for 24 of the 28 types of services considered. Instrumental variable estimates found significant effects of Medicare reliance on receipt of advanced imaging and cardiovascular testing.
Expanded access to fee‐for‐service care in the community may be expensive, while the VA will likely continue to care for the most vulnerable veterans.
via Reliance on Medicare Providers by Veterans after Becoming Age‐Eligible for Medicare is Associated with the Use of More Outpatient Services – Hebert – 2018 – Health Services Research – Wiley Online Library
Attitudes Towards Large Income Risk in Welfare States: An International Comparison by Fred Schroyen, Karl Ove Aarbu :: SSRNSeptember 18, 2018
Using survey data and the instrument developed by Barsky et al. ([Barsky, R. B., 1997]), we estimate the distribution of attitudes towards income risk in a country where many employment and health‐related risks are generously covered by a tax‐financed social insurance system (Norway in 2006). Under a constant relative risk aversion assumption, the sample average for the coefficient of relative risk aversion is 3.8 with standard deviation 2.3. This number is then contrasted to that for five other OECD countries where risk attitudes have been measured using the same instrument and also prior to the financial crisis: Chile, France, Italy, the Netherlands and the USA. When we relate this distribution for stated relative risk aversion to that for generosity of social insurance and the risks related to employment and health expenditure, a picture emerges suggesting that more extensive welfare states induce higher risk tolerance for foreground risks—a relationship that is in line with the theory on risk vulnerability.
The Canary in the Coal Mine: Continence Care for People with Dementia in Acute Hospital Wards as a Crisis of DehumanizationMay 5, 2018
Continence is a key moment of care that can tell us about the wider care of people living with dementia within acute hospital wards. The spotlight is currently on the quality of hospital care of older people across the UK, yet concerns persist about their poor treatment, neglect, abuse, and discrimination within this setting. Thus, within hospitals, the care of people living with dementia is both a welfare issue and a human rights issue. The challenge of continence care for people living with dementia can be seen as the ‘canary in the coal mine’ for the unravelling of dignity within the acute setting. This paper draws on an ethnographic study within five hospitals in England and Wales, selected to represent a range of hospital types, geographies and socio‐economic catchments. Observational fieldwork was carried out over 154 days in acute hospitals known to admit large numbers of people living with dementia. This paper starts to fill the gap between theory and data by providing an in‐depth ethnographic analysis examining the ways in which treatment as a person is negotiated, achieved or threatened. We examine how the twin assaults on agency of a diagnosis of dementia and of incontinence threaten personhood. The acute threats to this patient group may then act to magnify perils to treatment as a person. Our findings suggest that personal dignity and the social construction of moral personhood are both threatened and maintained in such a setting. We show how empirical ethnographic data can lend weight to, and add detail to, theoretical accounts of moral personhood and dignity.
Preliminary figures show faster growth in the amounts governments are budgeting for healthcare over the past three years, according to a new report from the C.D. Howe Institute. In “Healthcare Costs in Canada: Stopping Bad News Getting Worse,” author William B.P. Robson warns that the preliminary figures likely understate the acceleration, since later figures typically reveal that provinces and territories have overshot their budget targets.
Health care reform discourse in Canada and the United States would be vastly improved if more commentators, advocates, and lawmakers could overcome the cross-border obsessions and misperceptions that distort contemporary debates. Canada does offer important lessons for reform in the United States, not least in its relentless commitment to equitable access for some key services, its administrative efficiency, and its success in cost-containment. However, Canada’s health care arrangements are rooted in different values, facilitated by a different model of democratic governance, and reflect a different era, both in the conditions that fostered their creation and in an outmoded architecture that makes them a dubious exemplar for the United States. There is arguably much more for the United States to learn from the panoply of long-standing national experiments with universal coverage that can be found across the OECD. Reinhardt, for one, suggested that Germany, the Netherlands, and Switzerland merited particularly close examination.
The recent challenges to the Affordable Care Act (ACA), which has increased the number of individuals with health insurance in the United States but has had little effect on cost, has revived the debate about a single-payer health care system.1 Whether a single-payer system is the answer or not depends on what question is being asked and what form single payer will take. Single payer can take many forms, and many questions can be asked. This Viewpoint considers 3 problems of US health care: the uninsured, poor health outcomes (relative to other high-income countries), and high cost. In discussing cost, it will be critical to consider the form that a single-payer health care system might take.