Health affairs
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Rising health costs and an aging population present critical policy challenges. This paper examines the financial burden of out-of-pocket health spending among Medicare beneficiaries between 1997 and 2003. ⋯ In 2003, the 25 percent of beneficiaries with the largest burden spent at least 29.9 percent of their income on health care, while 39.9 percent spent more than a fifth of their income on health care. Results suggest that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries.
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In 2004, U. S. health care spending per capita was 2.5 times greater than health spending in the median Organization for Economic Cooperation and Development (OECD) country and much higher than health spending in any other OECD country. ⋯ S. health spending. One possible explanation is higher prevalence of obesity-related chronic disease in the United States relative to other OECD countries.
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President Bush, the World Health Organization, and leading scholars have called for greater price transparency in health care. Prices are transparent when the buyer knows his or her price or knows prices paid by others, in advance. ⋯ Under some conditions, however, price transparency can increase prices paid by the poor, deter business entry in poor markets, reduce competition, lower investment, and mislead if inaccurately measured by a third party. We recommend alternative approaches to lowering prices for the poor and increasing efficiency.
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The Santa Barbara County Care Data Exchange recently decided to disband. Because I founded the Santa Barbara Project and went on to lead U. S. health information technology (IT) efforts, it has been suggested that federal health IT policy relied too heavily on the approach used in Santa Barbara. ⋯ S. health IT effort rests upon a weak foundation and may be unsustainable. Conversely, the lessons of Santa Barbara were evident to investigators, including myself, long before its termination. These lessons, not the original assumptions and methods used in Santa Barbara, were applied to federal policy.
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Thailand became one of a handful of lower-middle-income countries providing universal health care coverage when it introduced reforms in 2001. Following the 2006 military coup, the coverage reforms are being reappraised by Thai policymakers. In this paper we take the opportunity to assess the program's achievements and problems. We describe the characteristics of the universal insurance program--the 30 Baht Scheme--and the purchaser-provider system that Thailand adopted.