Paying for family planning.
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Developing Countries↗
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Results for “Employment-based Services”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Nurses bring primary health care to industrial workers.
Progress in bringing health care to the workplace lags considerably behind progress in bringing health care to where people live. Experience in Botswana shows that the family nurse practitioner--a registered nurse midwife with one year of post-basic training--can provide useful preventive and curative services to people in their places of work.
Botswana↗
An up-to-date assessment of maternity care programme in the largest miners' colony in Asia.
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Female↗
Men's attitudes about family planning in Dakar, Senegal.
A survey of men's behaviour and opinions with respect to family planning, undertaken in Dakar in 1986, shows that contrary to popular belief, acceptance of contraception at least for the purpose of spacing births is substantial, even among men from the most conservative backgrounds. Actual use of contraceptives varied considerably across occupations. Among functionaries and students, it ranges between 25 and 49%. Among the working class, prevalence is low, especially within marriage. Uncertainty about the position of Islam regarding fertility control is apparent even among the highly educated and is given as a reason for rejecting use of contraceptives.
Adolescent↗
Child mortality differentials in Ghana: a preliminary report.
The relationship is examined of child mortality in Ghana with six socioeconomic factors: mother's type of place of residence, education, occupation and work status, and current husband's education and occupation. Using data from the 1979-80 Ghana Fertility Survey, Trussell's marriage duration model was employed to estimate probabilities of dying at exact ages 2 and 5 in different population subgroups. The two education variables (mother's and husband's education) have the largest effect on child mortality, followed by husband's occupation and mother's occupation, in that order. In order to reduce child mortality to tolerable levels, expansion is urgently required of the medical and health services, balanced by an equal development of education, particularly of girls, help being given especially to the rural areas where the majority of the population live.
Child↗
Universal Immunization Programme in Assam and West Bengal.
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Female↗
The domestic servant as family planning innovator: an Indian case study.
This paper reports on the relatively low fertility of female domestic servants in India. domestic servant have fewer numbers of ever-born and living children than women working in other occupations and women who are unemployed. This low fertility, which appears to be volitional, may have its roots in the incompatibility between the servant's reproductive and the productive roles, as well as in the changing values generated by continued exposure to a wealthier lifestyle. It is suggested that family planning messages aimed at and elicited by more "elite" classes may have a greater impact on fertility behavior than message from prompters with a socioeconomic background similar to the clients', which tend to concentrate on the harsher day-to-day realities of poverty.
Adolescent↗
Strategy for child immunization in Malaysian plantations.
An outline is given of a simple cost-effective strategy aimed at the immunization of all children and pregnant women residing in the plantation sector of Malaysia. It is based on a partnership between government, nongovernmental organizations and the private sector, and is supported by UNICEF.
Child, Preschool↗
Providing home care services in a for-profit environment.
It is no surprise that politics and ideology will determine the future of home health and long-term care. Those same forces will also dictate whether home care services will become more or less dependent upon federal support. At the moment the prospects are not promising. Over the last several years our national reimbursement policies have pointed toward more and more stringent use of Medicare home health care benefits, despite the assumptions (and the data) that prospective payment systems might legitimately increase their use. The implementation of tight cost limits, consolidation to ten regional fiscal intermediaries, and increased claim denials have signaled home care agencies that cost containment is the aim of the present conservative administration. Private insurance companies, however, have begun to examine the prospects for long-term care and home care policies. Presently, most home care benefits are available through employment-based policies, which, of course, are nearly useless to the elderly, the major users of home care services. But what if businesses provided more comprehensive health care policies so that their employees could have better protection in the case of long-term illnesses? What if the giant corporation such as IBM, Xerox, General Electric, General Motors, and so forth, established programs to underwrite the cost of long-term care? What if private insurance companies attempted to spread the risks among thousands of policy holders so that long-term care insurance premiums were affordable to most older Americans? Rather than new sources of funding, it is more reasonable to expect that the financing of home care services will be reshaped by innovative reimbursement strategies. The future will probably bring prospective, resource-sensitive, or capitated schemes. There are no easy remedies. We must secure the participation of all sectors of our country--both public and private--in a cooperative endeavor. And at the same time we are struggling to reshape the home care financing system, we must continue the effort to reshape the delivery system itself, because the two go hand-in-glove. It is only then that we can begin to allay one of the major deficiencies of our present health care system--the enormous gap in providing and paying for home health care.
Aged↗
Employment-based family planning programs.
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Cross-Cultural Comparison↗
Insurer competition and protection from risk redefinition in the individual and small group health insurance market.
Analyses of problems in the health insurance market usually focus on the individual and small group market. Consumers in this market who experience an illness or diagnosis of illness in one time period are likely to have their future risk redefined by insurers. Despite the fact that risk-averse consumers should desire protection against redefinition of risk, policies featuring that protection currently are not common in the individual and small group market. Contracts offering that protection must either be offered by pools that can guarantee replenishment of good risks over time, or be multiperiod contracts. Risk replenishment is impossible for individuals and may be technically difficult for many small groups. Also, the terms of multiperiod contracts with a single insurer may be unattractive to individuals and small groups, given the current structure of the market. Multiperiod contracts with a pool, rather than an individual insurer, may make it possible for individuals and small groups to enjoy the same advantages as consumers who obtain employment-based health insurance through large firms.
Consumer Advocacy↗
The fate of mental health services in health care reform: II. Realistic solutions.
In the second part of a two-part paper, the three major proposals for U.S. health care reform--the government-sponsored model, the employment-based model, and the market reform model--are reviewed. Barriers to their success include the current economic crisis, the lack of a clear consensus, and the high costs of the proposals. Most proposals limit the extent of psychiatric coverage; some exclude such coverage from minimum benefit packages, an area of concern for clinicians. The author concludes that any substantial health care reform is unlikely in the near future. A thoughtful, realistic, and yet vigorous strategic plan is needed now to forestall the possible exclusion of significant mental health coverage. The basic elements of such a plan are reviewed.
Cost Control↗
Financing long-term care. Health and Public Policy Committee. American College of Physicians.
The availability and delivery of long-term care services in the United States have been hindered by major organizational and financial problems. The American College of Physicians has previously identified and addressed some of the organizational problems that impede access to long-term care. In this issues paper, we provide background information on and analysis of the costs and the methods currently used to finance such care in the United States. The Canadian National Health Care System is also described for comparison. We then analyze such alternative financing mechanisms as private individual insurance (beyond Medigap), employment-based long-term care insurance, self-insurance, vouchers, financing through Medicare, home equity conversions, and prepaid capitated case management plans. The advantages and disadvantages of each of these methods are presented.
Aged↗
The 'Medicaidization' of AIDS. Trends in the financing of HIV-related medical care.
Among patients with the acquired immunodeficiency syndrome (AIDS) who were hospitalized in New York City, San Francisco, Calif, and Los Angeles, Calif, from 1983 through 1988, we observed a marked shift in the payer distribution toward Medicaid and away from private insurance. This trend, which we refer to as the "Medicaidization" of AIDS, occurred among whites as well as blacks and Hispanics and increased the burden on public hospitals and emergency rooms. "Medicaidization" jeopardizes access to office-based primary care because of very low reimbursement rates that are paid to physicians by Medicaid relative to private insurance. Policies designed to prevent the loss of employment-based private insurance would slow or reverse the trend to public financing. Increasing Medicaid reimbursement will improve access to care.
Acquired Immunodeficiency Syndrome↗
"Procompetition" and the continuing struggle to contain health-care costs.
Various proposals designed to increase competitive forces in the health-care services economy are discussed. Two concepts inherent in market-oriented strategies for containing health-care costs--cost sharing and fixed-dollar subsidies--are defined. Among the strategies for increasing market forces in health care are (1) increasing consumer choice, (2) increasing consumer cost sharing, (3) modifying tax treatment of insurance and medical care, (4) controlling the terms of employment-based insurance, and (5) application of antitrust law. Specific conceptual and legislative "procompetition" proposals are summarized. All of the "procompetition" proposals offer economic incentives for good management of hospitals as a whole as well as for individual departments such as the pharmacy.
Cost Control↗
Medicare coverage, supplemental insurance, and the use of mammography by older women.
BACKGROUND: On January 1, 1991, the Medicare program began offering reimbursement for screening mammography every two years. This study examined the use of mammography in women covered by Medicare during the first two years that the screening benefit was offered. METHODS: Medicare bills for 1991 and 1992 from a nationally representative sample of 4110 women 65 years of age or older were examined to determine the degree of compliance with recognized guidelines for screening mammography and the extent to which the use of mammography was associated with having supplemental insurance, which shields patients from the out-of-pocket costs associated with using Medicare benefits. RESULTS: A total of 36.9 percent of older U.S. women had mammography during the first two years of the Medicare benefit for screening mammography. Only 14.4 percent of the women lacking supplemental insurance had mammography, as compared with 44.7 percent of those with employer-sponsored supplemental insurance, 40.1 percent of those with self-purchased supplemental insurance, and 23.9 percent of those with Medicaid supplemental insurance. These differences persisted in the stratified and multivariate analyses. As compared with women lacking supplemental insurance, women with employment-based supplemental insurance were more likely to undergo mammography (adjusted odds ratio, 3.03; 95 percent confidence interval, 2.17 to 4.23), as were women with self-purchased supplemental insurance (adjusted odds ratio, 2.97; 95 percent confidence interval, 2.13 to 4.15) and women with Medicaid supplemental insurance (adjusted odds ratio, 1.99; 95 percent confidence interval, 1.30 to 3.07). CONCLUSIONS: The use of mammography was substantially below recommended levels during the first two years of Medicare coverage for screening mammography. Women lacking supplemental health insurance were at particularly high risk of failing to undergo mammography. Requiring copayments for preventive services is an obstacle to the effective mass screening of older women for breast cancer.
Aged↗
Defining geographic areas to adjust payments to physicians, hospitals, and HMOs.
Defining geographic areas for the purpose of paying health care providers has been difficult and is an issue that Congress continues to address. Employment-based insurance programs are starting to face this same issue in paying HMOs. Because input prices are related to population density, payment levels could be related to density. This paper offers a new measure of density that represents the population density for the average person. Using zip-code-level data, this measure calculates density of a county weighted by the population of the zip code. Payment areas can be devised by using the measure to categorize counties. This approach can be applied to paying physicians, hospitals, and HMOs.
Catchment Area, Health↗
Universal health care coverage--pitfalls and promise of an employment-based approach.
America's patchwork quilt of health care coverage is coming apart at the seams. The system, such as it is, is built upon an inherently problematic base: employment. By definition, an employment-based approach, by itself, will not assure universal coverage of the entire population. If an employment-based approach is to be the centerpiece of a system that provides universal coverage, special attention must be paid to all the categories of individuals who are not employees--children, unemployed spouses or singles, the unemployable ill and disabled, persons between jobs, students, retirees, the elderly. Moreover, in a purely voluntary employment-based arrangement, some employers will not provide insurance at all, and others will provide inadequate coverage, necessitating other special provisions for coverage. As a consequence, about one out of six people now has no health coverage whatsoever, and even more have inadequate coverage. All the while, the rapidly-increasing transaction costs of sustaining this grossly inadequate pluralistic system eat up sufficient funds to provide basic benefits to the entire population. The time for systematic reforms has come and gone; what is now needed is action to prevent disaster, followed by a complete rebuilding of this country's health coverage system. Although perhaps more likely to be tried than more radical, completely nationalized, ones, stepwise reforms may not go far enough to cure the significant ills of the current employment-based system. Passage of inadequate reforms, then, could well set the stage for nationalized health care in the not too distant future.
Employer Health Costs↗