PUBLIC RESPONSIBILITY AND INEQUALITY IN HEALTH INSURANCE COVERAGE: AN EXAMINATION OF AMERICAN STATE HEALTH CARE SYSTEMS

This article examines the effect of the three publicness dimensions on inequality in health insurance coverage across 50 American state‐level health care systems. The analysis validates a Gini‐coefficient measure of Americans' unequal distribution of health insurance coverage across nine income groups and compares public ownership, financing, and control of health care systems across all 50 states from 2002 to 2010. There is a significant and negative relationship between public ownership and inequality in health insurance coverage, although the substantive impact of ownership is relatively small. Both public financing and control substantially reduce inequality in health insurance coverage across income groups. However, both of these must be present in order to be effective at reducing inequality. This article expands our understanding of the link between different institutional arrangements and inequality in health insurance coverage in hybrid health care systems.     

Social Health Insurance and the Use of Formal and Informal Care in Developing Countries: Evidence from Ghana’s National Health Insurance Scheme

This paper studies the relationship between the use of formal and informal health care in a developing country setting by examining the introduction of a social health insurance scheme in Ghana. We estimate the effects of gaining coverage on changes in care seeking behaviour and show how these effects differ by age and wealth status. District-level differences in the implementation of the insurance scheme provide exogenous variation in access to insurance and allow us to address issues with selection into coverage. Results indicate that insurance access strongly increased use of formal care and reduced out-of-pocket expenditures on health services.     

Health care finance in the US: Past,present, and future

Presently the US is the only major industrialized nation that does not insure universal access to health care for all of its citizens. Although the US spends one out of every eight dollars on health care, over one-eighth of all Americans lack basic health insurance coverage. Another concern is health care cost inflation. The quest for comprehensive health care coverage for all Americans began shortly after the turn of the century and has received varying degrees of support since then. Since the historical course of health policy in the US has followed an evolutionary rather than revolutionary course, unless consistent policies are developed to rationalize the incentives facing consumers, providers, and insurers, alike, the future path of American health policy will continue to be characterized by disjointed incrementalism. National health insurance can provide decision makers with a tool to structure and focus the American health care system. In order for cost control measures to be effective they must be coordinated with measures to promote universal access, and vice versa. NHI can be a catalyst to focus attention on the dual goals of access to care and cost containment.     

Health care benefits in the public sector: An examination of availability,size, and managerial effects among north carolina municipalities

This study focuses on the extent to which health care benefits are used in North Carolina municipal governments. As such, it not only maps out the existence of these practices, but also the conditions and circumstances in which they occur. Health care practices (Basic dental and medical coverage, employee assistance programs, and child care provisions) are examined.

Since group health coverage is nearly universal (albeit the type and extent of coverage varies), it was not examined in this survey. With the exception of pre-paid dental insurance (41 percent) and unpaid maternity leave (31 percent), limited use is made of the various health care programs surveyed.

Population and workforce size effects are marginal.The presence of a city manager or town administrator, on the other hand, results in two or three fold the use as occurs in mayor-council cities.     

Developments in health care finance

Costs, quality, and access are the central themes in health care policy in the United States. In the 1980s the predominate issue is becoming access, and the likelihood for universal health coverage, or a national health insurance program, is growing. This paper explores how the America health care system got to this point and examines the present conditions, the trends, and the consequences of those trends.     

Child Income Appropriations as a Disease-Coping Mechanism: Consequences for the Health-Education Relationship

This paper analyses the relationships between HIV/AIDS and education taking into account the appropriative nature of child income. Using a theoretical model, we show that considering remittances from one’s child as an insurance asset can reverse the usual negative relationship between disease prevalence and educational investment. This prediction confirms the results of an empirical study conducted on data compiled from the Demographic and Health Survey (DHS) database for 12 sub-Sahara African countries for children aged between 7 and 22-years-old. Using regional HIV prevalence as a measure of health risk, we find that the ‘sign of the slope’ between health risk and the enrolment of children is not constant. Splitting the data based on expected remittance patterns (for example rural versus urban), we obtain that the effect is most likely driven by household characteristics related to child income appropriation.     

Bureaucratic Corruption and Income: Evidence from the Land Sector in Bangladesh

We examine, for the first time, the effects of corruption on income using household survey data from a developing country. Estimating the effects of corruption on income is challenging because of the simultaneous relationship between the two variables. We use a two-step instrumental variable approach to identify the effects of corruption on income. We find that after adjusting for simultaneity bias the act of bribery reduces income and that higher bribes have a negative effect on income. Taken together, our results provide a possible explanation why a vicious cycle between corruption and income inequality does not exist in the land sector in Bangladesh.     

The oregon plan: Toward a model for the future of health care financing

The State of Oregon has proposed a new method of financing health care services for its citizens. Oregon proposes to fund only the most cost-effective services. But in addition to narrowing the offering of health services funded by the State, Oregon proposes to fund all of the State's poor for services, no matter the family status. This broadened number of poor (everyone at the federal poverty level and below, single or married, children or not) will provide health care for more than 200,000 additional Oregonians. The supplementary legislation, SB 534 and SB 935, combined with broadened health care coverage for the poor (SB 27) will cover an additional 478,000 Oregonians. Nearly 95 % of its citizens will have some form of health insurance in Oregon.     

Consequences of increased third-party payments for health care services.

The growth of third-party programs to pay the costs of health care has occurred in an unplanned manner. As a result, the country presently is faced with a number of uncoordinated payment programs that sometimes work against each other. While the expansion of health insurance programs has provided the financing necessary to keep our health care system up-to-date, and while such programs doubtlessly have reduced the financial barriers to seeking health care for some population segments, health insurance also has produced some problems. Generally, the contribution of health insurance to these problems is subtle and cannot be quantified. Yet, policymakers increasingly are recognizing that there are factors at work in our health care system that, if continued unabated, will exacerbate the country's health care cost problem. Many of these factors owe their existence to the socially unacceptable incentives provided by most health insurance programs. This article focuses on some of the adverse consequences of health insurance programs and indicates that the future of private health insurance depends upon how these problems are addressed.     

Achieving Equity in Health through Community-based Health Insurance: India's Experience with a Large CBHI Programme

This article analyses equity in enrolment, renewal of enrolment, and utilisation of community-based health insurance with special reference to the Yeshasvini health care programme. The analysis employs a primary survey conducted in rural Karnataka using a random sample of 4109 households. The study identifies quantifiable variables covering various dimensions of vulnerability and assesses their relationship with enrolment, renewal of enrolment, and utilisation using logistic regression techniques. The results demonstrate that inequities do exist even though they are less pronounced in utilisation than in enrolments and renewals. While community-based health insurance (CBHI) may be used as a mechanism to reach the disadvantaged population, they can not be considered as substitute for government-created health infrastructure.     

Income Inequality and Redistributive Spending: Evidence from Panel Data of Texas Counties

Abstract

The relationship between redistributive spending and income inequality has been of interest to researchers for several decades. Existing literature has largely focused on country-level studies and may be broadly divided into two groups: studies that find a positive relationship between the two and studies that find a negative relationship. The positive association is usually explained through the median voter theory and the negative association through the social insurance theory.

This study offers a test of the median voter and social insurance hypotheses by examining the relationship between economic inequality, voter turnout and redistributive spending at the sub-national level among the 50 largest counties in Texas over years 2006 to 2012. One of the advantages of using a regional sample is that counties are relatively more homogeneous and allow for the collection of better records across time. Random effects models suggest that income inequality is positively associated with redistributive spending. The study improves our understanding of the patterns of redistribution at the sub-national level and highlights the importance of careful inter-temporal modelling of relationships between redistributive spending and inequality.     

Bureaucracy and bribery a conceptual framework

Public bureaucracies carry a potential for bribery. This paper tries to identify and examine the factors affecting the potential or the probability of bribery. It is argued that the specific nature and the probability of bribery depend on the persons involved, the corrupt act in question, the organization in which the event takes place and finally the socio cultural, economic and political environment with in which the organization operates.     

The Political Economy of Child Mortality Decline in Tanzania and Uganda, 1995–2007

This article identifies political economy factors that help explain dramatic differences in the pace of child mortality reduction between Tanzania and Uganda from 1995 to 2007. The existing literature largely explains divergence in basic health outcomes with reference to economic variables such as GDP per capita. However, these factors cannot explain recent divergence across African countries with similar levels of GDP per capita, rates of economic growth, and levels of health funding. I argue that institutional and governance divergences between Tanzania and Uganda can be linked directly to differing coverage levels of key child health interventions (especially related to malaria control), and thus to differing child health outcomes. These institutional differences can be explained in part by historical factors, but more relevant causes can be found in recent political events. In Tanzania, there was an unusually effective project of institution building in the health sector, while in Uganda, by contrast, there was a negative political shock to the health system. This was driven by the repatrimonialization of the Ugandan state after President Yoweri Museveni??s decision to eliminate term limits in the 2001?C2006 period. This repatrimonialization process reversed previous health sector institutional gains and had particularly negative effects on child health service delivery in Uganda over the period in question.     

Some economic costs of corruption in LDCs

It has often been argued that bribery creates auction‐like conditions and, hence, improves the allocative efficiency of bureaucratic decisions. This article shows that these auction‐like conditions are not likely to exist because officials will restrict access to bribery in order to reduce the risks of detection. Alternatively, officials may engage in supply‐stretching whose long‐term costs are likely to outweigh any gains in allocative efficiency. It is also shown that bribery may impose other costs resulting from the efforts of officials to create or augment the opportunities for receiving bribes.     

Curbing Corruption in Public Administration: A Case Study from Italy

The aim of this article is to verify whether the historic sentence, no. 500/1999 of the Italian Legitimacy Court (Corte di Cassazione) in Plenary Session, may have contributed to diminishing bribery in Italy, by increasing the area of liability for both civil servants and the public administration. The empirical analysis is based on a case study conducted in Sicily, in the province of Catania, using a unique data set. The main results of the article are: paying bureaucrats by means of an incentive wage regimes may not be effective in reducing corruption; an extension of the liability rule for the public administration and civil servants may discourage the phenomenon of bribery; and, the perfect specification of property rights helps to reduce corruption.     

Gender and Corruption in Business

Are firms with female owners or managers less corrupt than other firms? We test this question using firm-level data on corruption, ownership, and management. We find that women in positions of influence are associated with less corruption: female owners are associated with a lower incidence of bribery and report smaller levels of bribery. Moreover, corruption is seen as less of an obstacle in companies where women are represented in top management. By providing evidence that women are associated with lower levels of corruption in business our research contributes to the literature on development, gender equality, and corruption.     

Why Are the Poor More Vulnerable to Bribery in Africa? The Institutional Effects of Services

Whereas most studies find the poor in Africa to be more vulnerable to bribery because of their lower socio-economic status, this paper proposes institutional differences as an alternative explanation. Because poor people are unable to afford privately provided services, they must use public services. In relying on the state more often, the poor become more vulnerable to bribery. Analyses of Afrobarometer data show that the poor are not more likely to pay bribes for state monopolised services. The poor’s disproportionate vulnerability to bribery for choice services is a function of their greater likelihood to have contact with the state.     

Financing the health care of the aged.

The Medicare and Medicaid programs, which were enacted through the 1965 amendments to the Social Security Act, placed the federal government in the central role of assuring access of the aged and the poor to needed medical care. In this article the trends in the sources of financing medical care services for the aged are examined. The distinction in terms of insurance coverage between acute care services and long-term care services is highlighted. The effect of the programs in terms of reducing the aged's direct financial cost of medical care, increasing their access to medical services, and improving their health status is explored. The unanticipated increase in the cost of these programs has led to a change in emphasis in public policy, from assuring access to mainstream medical care to containing the cost of providing care. The direction of new federal policies is analyzed, and it is concluded that no longer will it follow the private sector's specifications of the conditions and arrangements under which health services are provided to program beneficiaries.