Health affairs
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By insuring more than 80 percent of its population, Colombia provides a valuable opportunity to gather evidence on a hotly debated health policy issue. Results from three studies evaluating the impact of universal health insurance in Colombia show that it has greatly increased access to and use of health services, even those that are free for all, and has reduced the incidence of catastrophic health spending. The impact has been more dramatic among those most vulnerable to health shocks: those living in rural areas, the poorest, and the self-employed.
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Mental health spending attracts attention from payers and policymakers. Historically, the public sector paid directly for a good deal of care, and special institutions and rules governed private-sector spending. ⋯ In recent years, the delivery and financing of mental health care have come to look more like those for general health care. We show that in spite of this convergence, important differences remain between general health and mental health care in patterns of spending growth.
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Efforts by countries to attain universal coverage are often hampered by supply constraints that can reduce access to care for those already in the system and, in many Asian and developing countries, by the emergence of informal payment systems that extract under-the-table payments from patients. In 2001, Thailand extended government-financed coverage to all uninsured people with little or no cost sharing. We found that Thailand has added nearly fourteen million people to the system and achieved near-universal coverage without compromising access for those with prior coverage; we also found that, to date, no informal payment system has emerged.