Health care services financing

Board of Health Care Services. 2004. Committee On the Evaluation of Vaccine Purchase Financing in the U.S. Financing Vaccines in the 2T Century Assuring Access and Availability. Report prepared by the Institute of the National Academies. 

All advanced industrialized nations except the U.S. have a system of universal health care coverage. The coverage is a form of social insurance that assures that all citizens have access to health care services and are protected from financial devastation as a result of illness or injury. Under these systems, the national government assures that its citizens have health care coverage. Beyond assuring that all citizens are covered, rmiversal health care takes a different form in each country. There is wide variation in the forms of financing, administering, and delivery of health care. 

It is quite fascinating how the organization, structure, and financing of health care services can be so very diverse in different countries around the world. 

A national health care system reflects the social, political, economic, and cultural character of a nation. A nation s historical roots and dominant values shape policies and directions for the organization, quality, financing, and access to health care services. These factors determine who gets what kind of care—at which locations, for what price, and paid by whom. 

This range of social values from libertarianism to egalitarianism holds differing beliefs about equality, justice, opportunity, rights, and the functional responsibilities of government. When this spectrum of social values is held over health, health care, and the administration and financing of health care services, it is not... 

Health care services in the United States are provided by a broad array of facilities, which are financed from a variety of payment sources. As of 1998, there were 6021 hospitals,1,012,582 hospital beds, 33,765,940 admissions, and 241,574,380 inpatient days. In 1998, the average length of stay in community hospitals was 6 days, whereas it was 7.7 days in 1975. ... 

It is quite fascinating how the organization, structure, and financing of health care services can be so very diverse in different countries around the world. One might think that leaders and policymakers would be aware of each other s national health systems and, by emulating the best features, that they would tend to move toward harmonization and greater similarity. 

The team greatly benefited from comments and advice from Abdo Yazbeck, as well as participants of the workshop Competitive Vouchers for Health Care Service Delivery held at the World Bank on April 22, 2004. The team is grateful to Ellis Juan, the manager of Infrastructure Advisory Services, and Hossain Razavi, the director of Infrastructure Economics and Finance, for their support and guidance. 

By law, Medicare does not cover any drugs administered outside of the hospital or a physician s office, and the program does not pay for clinical research (487). Furthermore, to be covered by Medicare, drugs must be reasonable and necessary, a criterion that the Health Care Financing Administration (HCFA) has interpreted. .. to exclude. .. those medical and health care services that are not demonstrated to be safe and effective by clinical evidence (487). HCFA has taken this to mean that experimental and investigational drugs are not covered. 

Three major themes have emerged from the epidemiologic patient safety research the frequency of adverse events, the types of medical accidents, and the cost of adverse events. As health services research continues to reveal when and under what conditions adverse events occur, leaders will have access to better information and tools to improve their organization. They will also be better prepared to address the powerful external influences, such as the reaction of purchasers to the cost of medical accidents, that will increasingly affect the contracting and financing of health care services. 

Managed care links the financing or insurance aspect of health care with the provision of health care goods and services, and organizations with this type of linkage have been in existence for a long time. In 1933, a physician and an insurance agent devised a health care plan where the physician was paid 0.05 per worker per day to provide work-related health care to workers... 

Department of Health and Hnman Services, Health Care Financing Administration (1992) Clinical Laboratory Improvement Amendments of 1988 Final Rule. Federal Register 57,7001-7288. 

There is not a bottomless pit of resources, says Phil Wadeson, finance director for the National Health Service unit that oversees hospitals and doctors offices in Liverpool. We reached the point a while ago where there is far more medical intervention than any health-care system can afford. ... 

Medicare is a federal health care program, and its recipients include people over the age of 65, the disabled, and those with end-stage renal disease. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration. The Medicare program consists of two parts (parts A and B), but is funded by four different sources (1) general tax revenues, (2) beneficiaries premiums, (3) mandatory contributions from employers and employees, and (4) deducf-ibles and copayments paid by patients. ... 

Shi L. Health services financing. In Shi Leiyu, Ed., Delivering Health Care in America, 1st ed. Gaithersburg, MD Dow Jones Company, 1996, pp. 171-211. 

Health Care Financing Administration. Medicare priorities. 10156 Baltimore, MD U.S. Department of Health and Human Services, pp. 22-29, 2000. 

The remaining are the National Institutes of Health, the Centers for Disease Control and Prevention, the Agency for Toxic Substances and Disease Registry, the Indian Health Service, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality, the Health Care Financing Administration, the Administration for Children and Families, and the Administration on Aging. 

The National Association of Home Care estimates that more than 20,000 providers deliver home care services to approximately 8 million individuals each year. According to the Health Care Financing Administration (HCFA), the average number of home health visits a year per Medicaid beneficiary was 80, compared to 27 visits in 1989. Additionally, the number of home health agencies participating in Medicare has increased from almost 5000 in 1988 to over 10,000 in 1997. Care of patients in home settings is likely to expand as data further suggest reduced cost for such... 

When thinking about pharmacy s involvement in HSR, it is helpful to use seven areas of HSR outlined in the lOM s 1995 report.These are 1) organization and financing of health services 2) access to health care 3) quality of care 4) clinical evaluation and outcomes research 5) informatics and clinical decision making ... 

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