Public insurance systems

This chapter focuses on the issue of co-payment, which occurs in insurance environments when insurer and insured share the payment of the price of the medicine. Using this as our central axis, we begin by addressing certain conceptual aspects, including the various forms, formulas and personal extension of co-payment, in the first section, and in the second section we go on to make a comparison between co-payment in insurance markets and in compulsory public insurance systems. 

CO-PAYMENT IN INSURANCE MARKETS AND COMPULSORY PUBLIC INSURANCE SYSTEMS... 

However, these results are not applicable to compulsory pubhc insurance, nor to National Health Systems. The most notable differences between drag co-payment in an insurance market and in a National Health System or compulsory public insurance environment lie in their voluntariness or otherwise (users ability to choose their coverage) and the ultimate financing of the services (risk-adjusted premiums as opposed to taxes or social insurance contributions adjusted according to economic capacity). Hence, in compulsory public insurance systems, co-payment regulation is used not only as a health policy instrument but also as one of redistribution of income. 

Estimates based on European data are more scarce, and present other problems. In universal public insurance systems, in which financing is not based on premiums, there is no interpersonal (intra-group) variability in the drag copayment rates, or if there is it is very small. Therefore, temporal data are used to quantify the reactions of demand to normative changes in co-payment rates. The problem here is that such changes have occurred on very few occasions, and concurrently with other sources of variation in demand. 

How one should think of a situation in which the private seller of a patented product is negotiating with a large public insurance system is less clear. Presumably the public insurance system has a demand or marginal benefit curve in mind (since that is the marginal effectiveness part of the... 

Although this measure was first introduced in Germany in 1989, constraints on public drag spending and the creation of incentives for cheaper alternatives are not new to cost containment policies, especially in public health systems. Several forms of public financing of pharmaceuticals based on comparison (yardstick competition) have been used in some countries by public and private insurers. Public financing mechanisms that pursue a similar strategy to that of RP include the maximum allowable cost (MAC) applied by the... 

It seems likely that in the future we will need to tackle health problems from an angle that has more in common with the idea of a social insurance system. System for a better interlocking of ultimate objectives and health care services between public and private actors, and between different public actors, all politically legitimated throughout the territory, and for their better coordination, crucial for the success of ary health policy. Insurance because of the inescapable nature of the idea of specifying levels of health care coverage and... 

In contrast to people in other advanced nations, people in the U.S. value choice, competition, individual and family accountability, and volxmteerism, and are skeptical of the government. As in other nations, political and economic forces have further shaped the U.S. health system, specifically the system of health insurance. As a result, people in the U.S. tolerate a three-tiered system of coverage those with private health insurance, those with public insurance, and those without any coverage. Any reforms are likely to reflect the core values of individual accountability, voluntary participation, and a level of confidence in market forces. 

Despite these wide variations from country to country, a common element is the concern of the payer -public, private or individual - with the need to live within a limited budget all budget holders increasingly demand value for money. Where funding is in the hands of an insurance system, whether it be public or private, one might in theory raise contributions or premiums to whatever level is necessary to meet expenditure, but in practice there is a serious risk that this will in its own way place an intolerable burden on the individual or the community. The end result may thus again be that the patient is deprived of necessary treatment. 

The model we used to study the interface between OSHA and WC differs from the model developed in Chapter 3 in two respects. First, to increase realism we assumed workers attempt to maximize lifetime expected utility and firms attempt to maximize the present value of long-run expected profits. Second, to study the impact of possible public policy changes we incorporated specific relationships representing OSHA activities and the WC insurance system. 

In the first part of the chapter, we intend to revise the traditional analysis of the choice of environmental policies. The following part deals with the comparison between tax and tradable permit systems. Then the role that can be played by the insurance sector is considered. The different policy instruments are considered in the framework of climate as an economic global public good. And, finally, some conclusive remarks are presented in relation to the COP 21 conference in Paris in terms of the future policies against GHG effects. 

This chapter aims to describe the traditional theory on the choice of environmental policies following an economic analysis of law (EAL) approach (Section 2) to analyze the comparison between tax and tradable permit systems (Section 3), to outline the role of the insurance sector (Section 4), and to consider the different policy instruments in a context of economic global public goods. The final objective is to take into account the future COP 21 conference in Paris in terms of the choice of policy instruments against GHG effects. 

While less protection may initially reduce the capital investment and the ongoing maintenance costs, the additional risk to company assets, employees, the environment, and the public could be substantial. The potential for escalation increases due to the lack of fire protection systems. Should a company choose less protection, potential adverse affects such as damage to reputation, increased insurance costs, loss of business and customers, as well as possible charges of criminal negligence could become a factor in the event of an incident. 

The quantity of flammable liquids or gases or heated combustibles can be indicative of the need for fixed water spray fire protection. Table 8-4, developed from FM Data Sheet 7-14, suggests quantities of flammables where fixed water spray fire protection should be considered based on one insurance provider s guidance. Some company internal guidelines and practices allow up to 5,000 gal (18,927 I) in the largest vessel before water spray protection is recommended. Additional guidance on fixed fire protection is available in API Publication 2030, Application of Water Spray Systems for Fire Protection in the Petroleum Industry, (API, 1998). 

Innovation drivers Alternative paint strippers have been developed as a consequence of the chlorine debate . However, neither the detailed requirements related to occupational health and safety (TRGS 612 and 212) nor the lower efficiency (cf (3)) clearly supported the penetration of the market with the alternative paint stripping systems. One barrier may be that the users have to change their work and purchasing procedures to apply the alternatives successfully. By end of the nineties the construction employers liability insurance started, based on the public media, an information campaign about the risks of DCM-containing paint strippers. 

---