Article

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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Available from: ncbi.nlm.nih.gov
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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: 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.
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