Journal of health politics, policy and law
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Of Russia's 142 million citizens, fewer than 20 million are enrolled in outpatient drug coverage plans. The current government aims to establish universal health insurance including outpatient medicines. Based on the current political and regulatory environment, this report explores pharmaceutical pricing options for Russia that balance greater access to medicines with achieving government plans of boosting local pharmaceutical production. ⋯ Although generic market shares are high, generic medicine prices are higher than they should be. We propose tenders at the manufacturer level for the pricing of high-selling generics, and free pricing for products with sufficient market competition. These policy recommendations are a jumping-off point for further discussion about how pharmaceutical policy could aid this major economy to achieve its population health and health service goals.
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J Health Polit Policy Law · Apr 2014
Maternity leave duration and postpartum mental and physical health: implications for leave policies.
This study examines the association of leave duration with depressive symptoms, mental health, physical health, and maternal symptoms in the first postpartum year, using a prospective cohort design. Eligible employed women, eighteen years or older, were interviewed in person at three Minnesota hospitals while hospitalized for childbirth in 2001. Telephone interviews were conducted at six weeks (N = 716), twelve weeks (N = 661), six months (N = 625), and twelve months (N = 575) after delivery. ⋯ Moreover, ordinary least squares analysis showed a marginally significant linear positive association between leave duration and physical health. Taking leave from work provides time for mothers to rest and recover from pregnancy and childbirth. Findings indicate that the current leave duration provided by the Family and Medical Leave Act, twelve weeks, may not be sufficient for mothers at risk for or experiencing postpartum depression.
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J Health Polit Policy Law · Feb 2014
Right-wing conspiracy? Socialist plot? The origins of the Patient Protection and Affordable Care Act.
On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). Did the ACA signify a government takeover of the health care system, a first step on the road to socialism, as conservative critics charged? Or was it, rather, a sellout to the right wing, as liberal single-payer advocates proclaimed? The ACA's key provisions, the employer mandate and the individual mandate, were Republican policy ideas, and its fundamental principles were nearly identical to the Health Equity and Access Reform Today Act of 1993 (HEART), a bill promoted by Republican senators to deflect support for President Bill Clinton's Health Security plan. Yet the ACA was also a policy legacy of the Clinton administration in important ways that rarely are acknowledged, notably Medicaid expansion and insurance company regulation. Although the ACA departed from the liberal vision of a single-payer plan and adhered closely to the objectives of those who believed that the health care system should encourage the free market, it included provisions that will make coverage more affordable, reliable, and accessible.
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J Health Polit Policy Law · Feb 2014
Consumer choice in health insurance exchanges: can we make it work?
Under the Patient Protection and Affordable Care Act (ACA), consumer choice plays a critical role: it drives the competitive market in health insurance plans that will operate through health insurance exchanges. As the 2014 deadline for establishing exchanges approaches, states face choices: they can either allow the federal government to manage an exchange on their behalf; take on a minimalist role by managing a state exchange or partnering with the federal exchange; or assume an activist role--by aiming to influence the price, design, and quality of the health insurance options available through exchanges and taking steps to support consumers' ability to choose among these options. This article discusses states' choices and the governance issues that they raise, first by describing the extent of discretion that states have in shaping the range of health plans on offer as well as the issues they will need to consider in choosing an exchange model. We then discuss the considerable body of evidence that addresses how people behave in individual insurance markets, concluding that it strongly supports the need for states to take an active role in shaping health insurance exchanges and ensuring that they support consumer choice.