Assessing barriers to health insurance and threats to equity in comparative perspective: the Health Insurance Access Database

Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency?

This article evaluates the performance of 3 industrialized nations that have pursued market-based financing models, focusing on equity in access to care, care quality, health status, and efficiency. It then assesses the consistency of the findings with those of different research teams. Using secondary data obtained from a semi-structured review of articles from 2000 to 2017, we discuss the hypothesis that commercial health care insurance is detrimental to accessing professional health care and to population health status. The results show that in 2010 the unmet care needs of both poor and rich Americans exceeded those of the poor in several industrial countries. The number of Dutch adults experiencing financial obstacles to health care quadrupled between 2007 and 2013, and 22% of Swiss adults reported skipping needed care in a 2016 survey. The most negative impacts of "managed care" on care quality are its tight constraints on physicians' professional autonomy; a large reliance on the physicians' material motivation; health service fragmentation; and the tendency to apply evidence-based medicine too rigidly. Countries with a commercial insurance monopoly generally remained above the maternal, infant, and neonatal mortality rates versus the health-spending regression line. We conclude that the most inefficient system is where the insurance market has achieved its maximal development and that care industrialization contributes to the comparatively poor performance of the U.S., Dutch, and Swiss health systems.

The Institutional Foundations of Medicalization: A Cross-national Analysis of Mental Health and Unemployment

In this study, we question (1) whether the relationship between unemployment and mental healthcare use, controlling for mental health status, varies across European countries and (2) whether these differences are patterned by a combination of unemployment and healthcare generosity. We hypothesize that medicalization of unemployment is stronger in countries where a low level of unemployment generosity is combined with a high level of healthcare generosity. A subsample of 36,306 working-age respondents from rounds 64.4 (2005-2006) and 73.2 (2010) of the cross-national survey Eurobarometer was used. Country-specific logistic regression and multilevel analyses, controlling for public disability spending, changes in government spending, economic capacity, and unemployment rate, were performed. We find that unemployment is medicalized, at least to some degree, in the majority of the 24 nations surveyed. Moreover, the medicalization of unemployment varies substantially across countries, corresponding to the combination of the level of unemployment and of healthcare generosity.

Regulação dos serviços de radioterapia e quimioterapia pelas operadoras de planos de saúde no Brasil

Este artigo caracteriza a regulação das operadoras de planos de saúde sobre os seus prestadores ambulatoriais de radioterapia e quimioterapia, em especial a contratualização, e fornece a percepção dos prestadores em relação à regulação. O estudo baseou-se em dados primários, considerando 638 unidades de saúde hospitalares e ambulatoriais com os referidos serviços. Uma amostra aleatória estratificada foi selecionada, resultando na inclusão de 54 unidades representativas da população, excluindo hospitais somente com radioterapia. Serviços privados de quimioterapia são grandemente financiados por planos de saúde (75,0% da receita em média), e os de radioterapia, pelo sistema público de saúde (49,0% da receita em média). A contratualização não é utilizada em sua potencialidade como instrumento de regulação e coordenação do cuidado pelas operadoras. Os mecanismos de regulação estão centrados no controle da utilização e em aspectos administrativos. Reconhece-se a necessidade de focar mais a qualidade assistencial, e a contratualização pode contribuir neste sentido.