Health affairs
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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.
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State hospitals were once the most prominent components of U. S. public mental health systems. ⋯ However, more than 200 state hospitals remain open, serving a declining but challenging patient population. Using national and state-level data, this paper discusses the contemporary public mental hospital, the forces shaping its use, the challenges it faces, and its possible future role in the larger mental health system.
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Moving toward universal participation in health insurance using a "shared responsibility" approach requires new, more accessible, and more efficient ways for people who are not offered employer coverage to obtain coverage. California's recent health reform plan-which failed to pass-incorporated individual market reform and choice-pool constructs to achieve critically important risk spreading, assure solvency, and reduce cost shifts. These measures, as well as the considerations that led to their design, offer important insights for health reform at the federal level.
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Medicaid physician fees increased 15.1 percent, on average, between 2003 and 2008. This was below the general rate of inflation, resulting in a reduction in real fees. ⋯ However, because of slow growth in Medicare fees, Medicaid fees closed a small portion of their ongoing gap relative to Medicare-growing from 69 percent to 72 percent of Medicare. The increase in Medicaid fees relative to Medicare fees resulted from relative increases for primary care and obstetrical services, but not for other services.