Broadening the base of publicly funded health care

Department of Medicine and the Keenan Research Centre of the Li Ka Shing KnowledgeInstitute, St. Michael’s Hospital, Toronto, Ont.
Canadian Medical Association Journal (Impact Factor: 5.96). 11/2010; 183(5):E296-300. DOI: 10.1503/CMAJ.100999
Source: PubMed

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    • "Dhalla et al. recently considered options for broadening the funding base for health care in Canada [17]. They concluded that revenue could be raised through general taxation by eliminating the private health insurance subsidy available in all provinces except Quebec (which does not tax non-wage benefits) and/or by raising funds through social insurance or sin taxes (revenues garnered from the purchase of potentially harmful and indulgent resources) [18] Yet the question remains as to whether an expanded funding base would be used only to maintain current growth, or also to expand current service levels. "
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    ABSTRACT: This study considers three questions: 1. What are the Canadian public's prioritization preferences for new government spending on a range of public health-related goods outside the scope of the country's national system of health insurance? 2. How homogenous or heterogeneous is the Canadian public in terms of these preferences? 3. What factors are predictive of the Canadian public's preferences for new government spending? Data were collected in 2008 from a national random sample of Canadian adults through a telephone interview survey (n =1,005). Respondents were asked to rank five spending priorities in terms of their preference for new government spending. Bivariate and multivariable logistic regression analyses were conducted. As a first priority, Canadian adults prefer spending on child care (26.2%), followed by pharmacare (23.1%), dental care (20.8%), home care (17.2%), and vision care (12.7%). Sociodemographic characteristics predict spending preferences, based on the social position and needs of respondents. Policy leaders need to give fair consideration to public preferences in priority setting approaches in order to ensure that public health-related goods are distributed in a manner that best suits population needs.
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    ABSTRACT: Background Higher utilization of healthcare services has been observed among individuals who receive public aid compared to individuals who do not receive public aid in many countries. However, no systematic investigations have explored whether this pattern of higher utilization persists after correcting for a number of factors in Korea. In this study, we sought to examine whether the type of health insurance, wage-based contributory insurance (Health Insurance, HI) or government-subsidized public assistance (Medical Aid, MA), affects the utilization of inpatient services after controlling for baseline patient and institutional characteristics among patients with hypertension in Korea.Methods The Korean National Health Insurance claims database from 2006 and 2007 was used for analysis. To avoid biased estimates, we determined the most appropriate type of multivariate model for each outcome variable: a logistic regression model for the likelihood of hospitalization, a zero-inflated negative binomial model for the length of stay (LOS), and a generalized linear model with a log-link function for hospitalization costs.ResultsAdjusted odds ratio (OR) and factor changes showed that MA patients (n¿=¿21,539) had a significantly higher likelihood of hospitalization (OR: 1.41-1.71), average LOS per patient (factor change: 1.31-1.42), and hospitalization costs per patient (factor change: 1.10-1.41) compared to HI patients (n¿=¿304,027).Conclusions The pattern of higher healthcare utilization among MA patients persists even after controlling for baseline health conditions. This finding confirms that the type of health insurance affects the utilization of healthcare resources, and suggests that effective strategies are necessary to prevent the potential overutilization of inpatient care by MA patients with hypertension in Korea.
    Full-text · Article · Nov 2014 · BMC Health Services Research