James R. G. Butler

Moving towards universal health insurance in China: Performance, issues and lessons from Thailand

China is now in the course of implementing a new round of health system reforms. Universal health insurance coverage through the basic social medical insurance system is high on the reform agenda. This paper examines the performance of Chinas current social medical insurance system in terms of revenue collection, risk pooling, the benefit package, and provider payment mechanisms based on a literature review and publicly available data. On the basis of critical assessment, the paper attempts to address the issues challenging China as it moves towards universal coverage. Focusing in particular on the reform experience in Thailand as it implemented universal coverage, the following policy implications for further reform in China are articulated, taking into account Chinas particular circumstances: firstly, the gaps in the benefit package across different schemes should be further reduced; secondly, the prevailing fee-for-service payment system needs to be transformed; thirdly, the primary health care delivery and referral system needs to be strengthened in coordination with the reform of the health insurance system; and fourthly, raising the risk pooling level and integrating fragmented insurance schemes should be long-run objectives of reform.

Twenty-year trends in the incidence and prevalence of diagnosed anogenital warts in Canada.

Background: A vaccine has recently been licensed in many countries that protects against the human papillomavirus types 6, 11, 16, and 18. Types 6 and 11 account for approximately 90% of anogenital warts (AGWs). We describe the 20-year trends in the incidence and prevalence of AGWs in Manitoba, Canada. Methods: We used linked population-based hospital and physician databases for Manitoba for 1984 to 2004. Cases were identified using tariff (billing) and ICD codes. A case was considered to be incident if it was preceded by a 12-month interval free period of AGWs care. Otherwise, it was deemed to be prevalent. An episode was considered over once a 12-month interval had elapsed without an AGW claim. Results: Approximately 25,000 Manitobans were diagnosed with AGWs between 1985 and 2004. The annual age-standardized incidence rates peaked in 1992 (men, 149.9/100,000; women 170.8/100,000). In recent years, the rates have been increasing again, particularly for men. The male:female incidence rate ratio increased from 0.76 in 1985 to 1.25 in 2004. The highest incidence rate tended to be in those aged 20 to 24 years. Trends in prevalence were similar. Prevalence in 2004 was 165.2/100,000 for men and 128.4/100,000 for women. Conclusions: These population-based findings suggest that AGWs are a substantial burden to Manitobans and that their pattern has changed over time, with incidence and prevalence becoming higher in men than women. Monitoring the future trends in AGWs will provide an early marker of the effectiveness and duration of protection of human papillomavirus vaccination at a population level.

Attributes and weights in health care priority setting: A systematic review of what counts and to what extent

In most societies resources are insufficient to provide everyone with all the health care they want. In practice, this means that some people are given priority over others. On what basis should priority be given? In this paper we are interested in the general publics views on this question. We set out to synthesis what the literature has found as a whole regarding which attributes or factors the general public think should count in priority setting and what weight they should receive. A systematic review was undertaken (in August 2014) to address these questions based on empirical studies that elicited stated preferences from the general public. Sixty four studies, applying eight methods, spanning five continents met the inclusion criteria. Discrete Choice Experiment (DCE) and Person Trade-off (PTO) were the most popular standard methods for preference elicitation, but only 34% of all studies calculated distributional weights, mainly using PTO. While there is heterogeneity, results suggest the young are favoured over the old, the more severely ill are favoured over the less severely ill, and people with self-induced illness or high socioeconomic status tend to receive lower priority. In those studies that considered health gain, larger gain is universally preferred, but at a diminishing rate. Evidence from the small number of studies that explored preferences over different components of health gain suggests life extension is favoured over quality of life enhancement; however this may be reversed at the end of life. The majority of studies that investigated end of life care found weak/no support for providing a premium for such care. The review highlights considerable heterogeneity in both methods and results. Further methodological work is needed to achieve the goal of deriving robust distributional weights for use in health care priority setting.

Inequalities in bariatric surgery in Australia : findings from 49 364 obese participants in a prospective cohort study

Objectives: To investigate variation, and quantify socioeconomic inequalities, in the uptake of primary bariatric surgery in an obese population.

A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia

BackgroundType 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general practitioners (GPs) with diabetes management. This approach uses a centralized database of clinical data of an Australian Division of General Practice (a network of GPs) to co-ordinate care according to national guidelines.MethodsLong term outcomes for patients in the program were derived using clinical parameters after 5 years of program participation, and the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model, to project outcomes for 40 years from the time of diagnosis and from 5 years post-diagnosis. Cost information was obtained from a range of sources. While program costs are directly available, and costs of complications can be estimated from the UKPDS model, other costs are estimated by comparing costs in the Division with average costs across the state or the nation. The outcome and cost measures are used derive incremental cost-effectiveness ratios.ResultsThe clinical data show that the program is effective in the short term, with improvement or no statistical difference in most clinical measures over 5 years. Average HbA1c levels increased by less than expected over the 5 year period. While the program is estimated to generate treatment cost savings, overall net costs are positive. However, the program led to projected improvements in expected life years and Quality Adjusted Life Expectancy (QALE), with incremental cost effectiveness ratios of

Economic burden of malaria in rural Tanzania: variations by socioeconomic status and season.

A8,106 per life-year saved and

The direct cost of managing patients with chronic hepatitis B infection in Australia.

A9,730 per year of QALE gained.ConclusionsThe combination of an established model of diabetes progression and generally available data has provided an opportunity to establish robust methods of testing the cost effectiveness of a program for which a formal control group was not available. Based on this methodology, integrated health care delivery provided by a network of GPs improved health outcomes of type 2 diabetics with acceptable cost effectiveness, which suggests that similar outcomes may be obtained elsewhere.

Use of proxy measures in estimating socioeconomic inequalities in malaria prevalence

Objective  To determine the economic burden of malaria in a rural Tanzanian setting and identify any differences by socioeconomic status and season.

The relationship between body mass index and hospitalisation rates, days in hospital and costs : findings from a large prospective linked data study

Goals: To estimate the average annual cost of managing a patient with chronic hepatitis B (CHB) disease in Australia. Background: Little is known about the prevalence or economic burden of hepatitis B viral (HBV) infection in Australia, despite it being recognized as a significant cause of morbidity and mortality. Study: A retrospective analysis of 149 patients with CHB disease in six disease states (noncirrhotic CHB, compensated and decompensated cirrhosis, hepatocellular carcinoma, liver transplantation in year 1, and liver transplantation in subsequent posttransplantation years) was conducted. The cost of palliative care for 53 patients with chronic hepatitis and hepatocellular carcinoma was also estimated, based on data from a palliative care unit. Results: The average annual costs (year-2001 AUS

Risk equalisation and voluntary health insurance markets: the case of Australia

) for each disease state per patient were: noncirrhotic CHB,