Rising health care costs : causes, implications, and strategies.

Includes bibliographical references.

Health benefits for retirees : employer-based plans /

"April 8, 1993."

H��lap��nz a magyar eg��szs��g��gyben = Gratitude money in the Hungarian health sector

A tanulm��ny szerz��i lakoss��gi ��s orvosi minta kik��rdez��se alapj��n arra keresik a v��laszt, hogy a val��s��gban mennyire elterjedt a h��lap��nz ad��sa ��s elfogad��sa a magyar eg��szs��g��gyben, mik��nt sz��r��dik az egyes orvosi szakm��k k��z��tt, ��s mekkora az egyes beavatkoz��si form��k h��lap��nz��ra. A kapott eredm��nyek szerint, a h��lap��nz��rak nyilv��noss�� t��tel��nek korl��tai ellen��re a piac szerepl��i t��bb��-kev��sb�� egy��ntet��en ��t��lik meg, mi mennyibe ker��l. A szerz��k megbecs��lik az egy ��v leforg��sa alatt kifizetett h��lap��nz ��sszeg��t. Ennek alapj��n arra a k��vetkeztet��sre jutnak, hogy az "��tlagorvos" h��lap��nzb��l sz��rmaz�� bev��tele b�� m��sf��lszerese h��lap��nz n��lk��l vett j��vedelm��nek. __________ The authors examine the incidence, in the Hungarian health sector, of gratitude payments from patients to doctors, based on a questionnaire administered to samples of the public and of the medical profession. They look at how the payments are distributed among the branches of medicine, and what payment is customary for various medical treatments. The survey findings show that although there are constraints on public knowledge of the size of gratitude payments, market actors more or less agree in their estimates of what provisions cost. Based on this, the authors conclude that the income the "average" doctor receives from gratitude payments is at least one-and-a-half times as much as his or her income apart from gratitude money.

Eg��szs��g��gyi reform Horv��torsz��gban (Health reform in Croatia)

A horv��torsz��gi eg��szs��g��gyi reform c��lja a decentraliz��ci�� elv��n alapul�� eg��szs��g��gyi rendszer l��trehoz��sa volt. Az eg��szs��g��gyi szolg��ltat��sok k��lts��gn��veked��se ��ltal okozott terheket a k��zponti k��lts��gvet��s helyett egyre nagyobb m��rt��kben a lakoss��g viseli, mik��zben kieg��sz��t�� biztos��t��s l��trehoz��s��val megk��s��relt��k cs��kkenteni a v��ltoz��sok nemk��v��natos k��vetkezm��nyeit. A gy��gyszer-finansz��roz��si rendszer ��talak��t��s��val a k��lts��gcs��kkent��s mellett el akart��k ��rni, hogy a betegek nagyobb ar��nyban jussanak hozz�� a modern, innovat��v gy��gyszerekhez. ________ The Croatian health care system faced great challenges during the1990s. The aim of the paper is to review some important aspects of the Croatian health care reform. Establishing a decentralized health care system was an important section of the reform. As a new element of the health insurance system, burdens generated by the increase of costs of health services have fallen on the society increasingly, while complementary health insurance tried to decrease the undesirable consequences of the changes. The objective of the drug-financing reform was to reduce the costs and improve access to innovative medicines as well. As regards the success of the reforms, besides increasing incomings, the method and result of the spending of the health insurance funds is crucial.

Comparing cost-sharing practices for pharmaceuticals and health care services among four central European countries

The paper reviews the existing cost-sharing practices in four Central European countries namely the Czech Republic, Hungary, Poland and Slovakia focusing on patient co-payments for pharmaceuticals and services covered by the social health insurance. The aim is to examine the role of cost-sharing arrangements and to evaluate them in terms of efficiency, equity and public acceptance to support policy making on patient payments in Central Europe. Our results suggest that the share of out-of-pocket payments in total health care expenditure is relatively high (24���27%) in the countries examined. The main driver of these payments is the expenditure on pharmaceuticals and medical devices, which share exceeds 70% of the household expenditure on health care. The four countries use similar cost-sharing techniques for pharmaceuticals, however there are differences concerning the measure of exemption mechanisms for vulnerable social groups. Patient payment policies for health care services covered by the social health insurance are also converging. All the four countries apply co-payments for dental care, some hotel services or in the case of free choice of physician. Also the countries (except for Poland) tried to extend co-payments for physician services and hospital care. However, their introduction met strong political opposition and unpopularity among public.

Preferences of Hungarian consumers for quality, access and price attributes of health care services ��� result of a discrete choice experiment

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients��� choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients��� preferences, and might support the development of an evidence-based and sustainable health policy on patient payments.

Formal professional relationships between general practitioners and specialists: possible associations with patient health and pharmacy costs

This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) affects either the health status of patients or their pharmacy costs. To this end, it measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. In strong GP���SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. To test these hypotheses and compare the characteristics of the strongest GP���SP connections with those of the weakest, this article concentrates on diabetes���a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest traffic of specialist medication prescriptions. This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health statuses. Key points for decision makers ��� The number of shared patients may be used to measure the strength of formal professional relationships between general practitioners and specialists. ��� A large number of shared patients indicates a strong, collaborative tie between general practitioners and specialists, whereas a low number indicates a weak, fragmented tie. ��� Tie strength does not affect patient health���strong, collaborative ties between general practitioners and specialists do not involve better patient health than weak, fragmented ties. ��� Tie strength does affect pharmacy costs���strong, collaborative ties between general practitioners and specialists involve significantly lower pharmacy costs than weak, fragmented ties. ��� Pharmacy costs may be reduced by lowering patient care fragmentation through channelling a general practitioner���s patients to a small number of specialists and increasing collaboration between general practitioner and specialists. ��� Limited patient choice is financially more beneficial than complete freedom of choice, and no more detrimental to patient health.

The impact of the recession on health care expenditure ��� How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008���2010 and 2000���2008. The classification of the OECD countries regarding ���development��� and ���relative growth��� resulted in four clusters. A large diversity of ���relative growth��� was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

The impact of the recession on health care expenditure ��� How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008���2010 and 2000���2008. The classification of the OECD countries regarding ���development��� and ���relative growth��� resulted in four clusters. A large diversity of ���relative growth��� was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

A gy��gyszerkiad��s ��s a betegek eg��szs��gi ��llapota a h��ziorvosi ��s szakorvosi kapcsolatok f��ggv��ny��ben = Formal professional relations between general practitioners and specialists. Possible links with patient health and pharmacy cost

Arra a k��rd��sre keress��k a v��laszt, hogy a szoros h��ziorvosi-szakorvosi szakmai kapcsolatoknak van-e hat��suk a betegek gy��gyszerkiad��s��ra, illetve eg��szs��gi ��llapot��ra. Az orvosok k��z��tti szakmai kapcsolatok szoross��g��t a k��z��sen gondozott betegek sz��ma alapj��n hat��roztuk meg, m��g a betegek eg��szs��g��gyi ��llapot��t a diagnosztiz��lt ��s kezelt t��rsbetegs��gek sz��m��val m��rt��k. Hipot��zis��nk egyr��szt az volt, hogy a hat��konyabb koordin��ci��nak k��sz��nhet��en a szoros kapcsolatban kezelt betegek jobb eg��szs��gi ��llapot��ak, m��sr��szt kezel��s��k az er��forr��sok hat��konyabb felhaszn��l��sa miatt kisebb gy��gyszerk��lts��ggel j��r. E k��t hipot��zist a cukorbetegekre tesztelt��k. Az��rt esett erre a kr��nikus betegs��gre a v��laszt��sunk, mert itt a h��ziorvosok ��s a szakorvosok egy��ttm��k��d��se els��dleges fontoss��g��. Magyarorsz��gon a cukorbetegek eset��ben a legnagyobb a k��z��sen kezelt betegek popul��ci��ja, valamint itt a legmagasabb a szakorvosi javaslatra fel��rt h��ziorvosi receptek sz��ma. Azt az eredm��nyt kaptuk, hogy a szoros kapcsolatban kezelt betegek nem rendelkeznek sem jobb, sem rosszabb eg��szs��gi ��llapottal, mik��zben a kapcsol��d�� gy��gyszerkiad��suk szignifik��nsan alacsonyabb. ____ The article considers whether strong formal professional relations between GPs and specialists in shared care affect either the health of patients or the pharmacy costs they incur. The strength of such relations is measured by the number of shared patients; patient health is proxied by number of co-morbidities diagnosed and treated. The first hypothesis is that patients treated amid strong GP-specialist relations have better health status than those treated amid weak ones, due to enhanced efficiency of care coordination. The second is that patients treated in such strong relations incur lower pharmacy costs high numbers of shared patients are assumed to promote appropriate, effective use of resources. The article tests these hypotheses and compares the outcomes of the strongest and weakest GP-specialist relations through the example of diabetes, a chronic condition where patient-care coordination is important. Diabetes generates the largest shared patient cohort in Hungary, with the highest number of specialist medication prescriptions. This article finds that stronger ties result in significantly lower pharmacy costs, but not a higher patient health status.

THE HEALTH OF YOUNG ADULTS WITH DISABILITIES IN THE UNITED STATES: THE COLLECTIVE ROLES OF RISK FACTORS IN SOCIAL ECOLOGIC FRAMEWORK

Background: Over the last few decades, the prevalence of young adults with disabilities (YAD) has steadily risen as a result of advances in medicine, clinical treatment, and biomedical technologythat enhanced their survival into adulthood. Despite investments in services, family supports, and insurance, they experience poor health status and barriers to successful transition into adulthood. Objectives: We investigated the collective roles of multi-faceted factors at intrapersonal, interpersonal and community levels within the social ecological framework on health related outcome including self-rated health (SRH) of YAD. The three specific aims are: 1) to examine sociodemographic differences and health insurance coverage in adolescence; 2) to investigate the role of social skills in relationships with family and peers developed in adolescence; and 3) to collectively explore the association of sociodemographic characteristics, social skills, and community participation in adolescence on SRH. Methods: Using longitudinal data (N=5,020) from the National Longitudinal Transition Study (NLTS2), we conducted multivariate logistic regression analyses to understand the association between insurance status as well as social skills in adolescence and YAD���s health related outcomes. Structural equation modeling (SEM) assessed the confluence of multi-faceted factors from the social ecological model that link to health in early adulthood. Results: Compared with YAD who had private insurance, YAD who had public health insurance in adolescence are at higher odds of experiencing poorer health related outcomes in self-rated health [adjusted odds ratio (aOR=2.89, 95% confidence interval (CI): 1.16, 7.23), problems with health (aOR=2.60, 95%CI: 1.26, 5.35), and missing social activities due to health problems (aOR=2.86, 95%CI: 1.39, 5.85). At the interpersonal level, overall social skills developed through relationship with family and peers in adolescence do not appear to have association with health related outcomes in early adulthood. Finally, at the community level, community participation in adolescence does not have an association with SRH in early adulthood. Conclusions: Having public health insurance coverage does not equate to good health. YAD need additional supports to achieve positive health outcomes. The findings in social skills and community participation suggest other potential factors may be at play for health related outcomes for YAD and the need for further investigation.