Int J Health Serv
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Described as "universal prepayment," the national health insurance (or single-payer) model of universal health coverage is increasingly promoted by international actors as a means of raising revenue for health care and improving social risk protection in low- and middle-income countries. Likewise, in the United States, the recent failed efforts to repeal and replace the Affordable Care Act have renewed debate about where to go next with health reform and arguably opened the door for a single-payer, Medicare-for-All plan, an alternative once considered politically infeasible. ⋯ Using available cross-national data, we categorize countries with universal coverage into those best exemplifying national health insurance (single-payer), national health service, and social health insurance models and compare them to the United States in terms of cost, access, and quality. Through this comparison, we find that many critiques of single-payer are based on misconceptions or are factually incorrect, but also that single-payer is not the only option for achieving universal coverage in the United States and internationally.
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India's urbanization, though precipitous, is undirected, random, and opportunistic, shaped more by pressures than by policies. This has resulted in inequitable access to health services and adverse health outcomes for the urban poor. Late 2013 saw the launch of India's National Urban Health Mission, a broad scheme aimed at prioritizing urban health in the country with an emphasis on the poor. ⋯ Even as recommendations were accepted, given the meager allocation for health in the country, only piecemeal implementation is underway. Thus, policy processes are often a dialectic involving shifts that a range of stakeholders may variably resist or embrace. The most important lesson, however, is that it is both feasible and desirable to engage directly with the community, implementers, and researchers and to negotiate and connect their knowledge in the crafting of public policy.
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This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant "grey" literature and websites. ⋯ Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data.
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President Obama's signature health care reform, the Affordable Care Act (ACA), was passed in 2010 and fully implemented in 2014. Two years later, Republicans' attacks on the ACA as a failed reform helped fuel their recent electoral victory. ⋯ This obeisance to corporate interests precluded making coverage universal or care affordable. As a result, the reform failed to address the grave health care problems faced by most working- and middle-class Americans and left many of them feeling betrayed by Democrats who oversold the ACA's benefits.
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The health care system in Nigeria remains topical because of concerns over unremitting health outcomes, such as maternal and infant mortalities and frequent epidemic outbreaks, and more recently because of regular strikes by health workers. The strikes arise mostly from disputes between medical doctors and other health workers over a range of issues, including salary levels and emoluments, leadership of teaching hospitals, and appointment of the Minister of Health. Other health workers, who allege that doctors are favored in the system, have formed Joint Health Sector Unions to confront the doctors. ⋯ Two presidential commissions have been instituted, to no avail. With the allegations of favoritism, only government even-handedness in more carefully delineating the areas of inclusion and exclusion in accordance with available legislations may stem the rising tide. Until solutions agreeable to both parties are found, the health system and the Nigerian people will continue to suffer frustrations of avoidable disruption of services.