Health affairs
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India faces major challenges in sustaining the health gains achieved in the better-performing states and ensuring that the lagging states catch up with the rest of the country. In this paper we examine the current status of health financing in India, as well as alternatives for realizing maximal health gains for the incremental spending. A principal conclusion is that public expenditures of an additional US$6-US$7 per person per year (about 1 percent of gross domestic product) would, if focused on about sixteen key interventions, provide universal access to those interventions and have a favorable affect on population health.
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Historical Article
From a national, centrally planned health system to a system based on the market: lessons from China.
No other country has undergone health care reforms as dramatic as China's. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. ⋯ This paper adds to the literature by examining China's health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from China's reform process.
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This paper presents a framework for universal health insurance that builds on the current U. S. mixed private-public system by expanding group coverage through private markets and publicly sponsored insurance. ⋯ The paper estimates coverage and costs, and assesses the approach. Our findings indicate that the framework could reach near-universal coverage with little net increase in national health spending.
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Efforts to improve the quality and costs of U. S. health care have focused largely on fostering physician adherence to evidence-based guidelines, ignoring the role of clinical judgment in more discretionary settings. ⋯ Physicians in high-spending regions see patients back more frequently and are more likely to recommend screening tests of unproven benefit and discretionary interventions compared with physicians in low-spending regions; however, both appear equally likely to recommend guideline-supported interventions. Greater attention should be paid to the local factors that influence physicians' clinical judgment in discretionary settings.