Single-payer or a multipayer health system: a systematic ... · The payer type, whether single payer or multipayer, is a highly debatable issue for any country contemplating healthcare
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
ww.sciencedirect.com
p u b l i c h e a l t h 1 6 3 ( 2 0 1 8 ) 1 4 1e1 5 2
Available online at w
Public Health
journal homepage: www.elsevier .com/puhe
Review Paper
Single-payer or a multipayer health system: asystematic literature review
P. Petrou a,*, G. Samoutis b, C. Lionis c
a Pharmacy Program, Department of Life and Health Sciences, School of Science and Engineering, University of
Nicosia, Nicosia, Cyprusb St George's, University of London Medical Programme, Delivered in Cyprus by the University of Nicosia Medical
School, Cyprusc Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece
Wendt, Frisina and Heinz, 20094 Classification of health systems Conceptual comparison of health systems Financing, service provision and access to
health care
1,2,3,4,6,7,9,10
Van de Ven, Beck, Van de Voorde et al.,
200759Risk adjustment and risk selection Qualitative study across Belgium,
Germany, Israel, the Netherlands and
Switzerland
Comparison of risk equalisation schemes 1,2,3,4,5,6,7,8,9,10
Van de Ven, Beck, Buchner et al., 201343 Efficiency and affordability Belgium, Germany, Israel, the Netherlands
and Switzerland
Assessment of efficiency and affordability
in five European countries
1,2,3,4,5,6,7,8,9,10
1. Was there a clear statement of the aims of the research? (Consider � What was the goal of the research? � Why it was thought important? � Its relevance).
2. Is a qualitative methodology appropriate? (Consider � If the research seeks to interpret or illuminate the actions and/or subjective experiences of research participants � Is qualitative research the
right methodology for addressing the research goal? Is it worth continuing?).
3. Was the research design appropriate to address the aims of the research? (Consider � If the researcher has justified the research design [e.g. have they discussed how they decided whichmethod to
use?]).
4. Was the recruitment strategy appropriate to the aims of the research? (Consider � If the researcher has explained how the participants were selected � If they explained why the participants they
selected were the most appropriate to provide access to the type of knowledge sought by the study � If there are any discussions around recruitment [e.g. why some people chose not to take part]).
5. Was the data collected in a way that addressed the research issue? (Consider � If the setting for data collection was justified � If it is clear how data were collected [e.g. focus group, semi-structured
interview etc]. � If the researcher has justified the methods chosen � If the researcher has made the methods explicit [e.g. for interview method, is there an indication of how interviews were
conducted, or did they use a topic guide]? � If methods were modified during the study. If so, has the researcher explained how and why? � If the form of data is clear [e.g. tape recordings, video
material, notes etc] � If the researcher has discussed saturation of data).
p u b l i c h e a l t h 1 6 3 ( 2 0 1 8 ) 1 4 1e1 5 2150
Five-year outlook
The sustainability of health systems worldwide is going
under a stress test, which is expected to intensify as life ex-
pectancy increases, culminating to the proliferation of
healthcare needs. In the context of hovering financial
recession, health systems will be faced with the dubious
tasks of satisfying increasing needs with constrained re-
sources, a ‘do more with less’ approach. The constant
introduction of new medicines, with higher costs and un-
certainty apropos their clinical effectiveness, further aggra-
vates the feasibility of health systems to adequately provide
health care, especially in the current era, which is charac-
terised by easy dissemination of information to the public.
Moreover, an ageing population, will surge expenditure for
social care.
This implies that health agencies will scrutinise the payer
type of their health systems, with the ultimate task to further
enhance their efficiency. This becomes even more complex in
tandem with the current refugee crisis in Europe, the worse
since the end of World War II, which has seen millions of
people, the majority presenting with physiological and phys-
ical conditions, migrating to Europe. Because asylum seekers
and refugees are entitled to free medical care in almost all
European countries, this mounts the pressure for continuous
research and ensuing refinement of health system functions,
primarily the payer type.
Author statements
Ethical approval
This article does not contain any studies with human partici-
pants or animals and therefore does not require ethical
approval.
Funding
No funding was received.
Competing interests
The authors declare that they have no conflicts of interest.
Appendix A. Supplementary data
Supplementary data related to this article can be found at
https://doi.org/10.1016/j.puhe.2018.07.006.
r e f e r e n c e s
1. Chan M. Address to the 65th world health assembly. Geneva:World Health Organization; 2012.
2. Sanders J. Financing and organization of national healthsystems. In: Fried Bruce, Gaydos Laura, editors. World health
systems: challenges and perspectives. Chicago: HealthAdministration Press; 2002.
3. Wendt C, Frisina L, Rothgang H. Healthcare System Types: AConceptual Framework for Comparison. Soc Pol Adm February2009;43(1):70e90.
4. Chisholm D, Evans DB. Improving health system efficiency as ameans of moving towards universal coverage Dan World HealthReport. 2010. Background Paper, 28 available at: http://www.who.int/healthsystems/topics/financing/healthreport/28UCefficiency.pdf.
5. Mikkers M, Ryan P. “Managed competition” for Ireland? Thesingle versus multiple payer debate? BMC Health Serv Res2014;14:442.
6. Petrou P. Crisis as a serendipity for change in Cyprus'healthcare services. J Med Econ 2015;18(10):805e7. https://doi.org/10.3111/13696998.2015.1049179.
7. Kutzin J. A descriptive framework for country-level analysisof health care financing arrangements. Health Pol2001;56:171e204.
8. Abiiro GA, De Allegri M. Universal health coverage frommultiple perspectives: a synthesis of conceptual literatureand global debates. BMC Int Health Hum Right 2015;15:17.
9. Carrin G, Inke Mathauer, Xu K, Evans DB. Universal coverageof health services: tailoring its implementation. Bull WorldHealth Organ 2008;86:857e63.
10. Moher D, Liberati A, Tetzlaff J, Altman D. Preferred reportingitems for systematic reviews and meta-analyses: the PRISMAstatement. BMJ 2009;339:b2535.
11. Tandon A, Murray C, Lauer JA, Evans DB. Measuring overallhealth system performance for 191 countries GPE DiscussionPaper Series: No. 30 EIP/GPE/EQC. World HealthOrganization. Available at: http://www.who.int/healthinfo/paper30.pdf. last accessed August 2018
12. Schoen C, Doty MM, Collins SR, Holmgren AL. Insured but notprotected: how many adults are Underinsured? Health Aff2005. https://doi.org/10.1377/hlthaff.w5.289.
13. van Doorslaer E, Koolman X. Explaining the differences inincome-related health inequalities across Europeancountries. Health Econ 2004;13:609e28.
14. Ortiz-Ortiz KJ. Effects of type of health insurance coverage oncolorectal cancer survival in Puerto Rico: a population-basedstudy. PLoS One May 2014;9(5).
15. McDavid K, Tucker TC, Sloggett A, Coleman MP. Cancersurvival in Kentucky and health insurance coverage. ArchIntern Med 2003;163:2135e45.
16. Adepoju L, Wanjiku S, Brown M, et al. Effect of insurancepayer status on the surgical treatment of early stage breastcancer: data analysis from a single health system. JAMA Surg2013 Jun;148(6):570e2. https://doi.org/10.1001/jamasurg.2013.61.
17. Robbins AS, Pavluck AL, Fedewa SA, Chen AY, Ward EM.Insurance status, comorbidity level, and survival amongcolorectal cancer patients age 18 to 64 Years in the nationalcancer data base from 2003 to 2005. JCO August 1,2009;27(22):3627e33.
18. Niu X, Roche LM, Pawlish KS, Henry KA. Cancer survivaldisparities by health insurance status. Cancer Med2013;2(3):403e11.
19. Pulte D, Hermann B, Jansen L. Survival disparities byinsurance type for patients with non-hodgkin lymphoma.Blood November 15, 2013;122(21):17.
20. Farkas DT, Greenbaum A, Singhal V, Cosgrove JM. Effect ofinsurance status on the stage of breast and colorectal cancersin a safety-net hospital. Am J Manag Care 2012 May;18(5 SpecNo. 2):SP65.
21. Levinson KL, Bristow RE, Donohue PK, Kanarek NF, Trimble CL.Impact of payer status on treatment of cervical cancer at atertiary referral center. Gynecol Oncol 2011 Aug;122(2):324e7.
p u b l i c h e a l t h 1 6 3 ( 2 0 1 8 ) 1 4 1e1 5 2 151
22. Hinman A, Bozic K. Impact of payer type on resourceutilization, outcomes and access to care in total hiparthroplasty. J Arthroplasty 2008;23(6 Suppl. 1).
23. Rhee PM, Grossman D, Rivara F, et al. The effect of payerstatus on utilization of hospital resources in trauma care.Arch Surg 1997 Apr;132(4):399e404.
24. Martin CT, Callaghan JJ, Liu SS, Gao Y, Warth LC, Johnston RC.Disparity in total joint arthoplasty patient comorbidities,demographics and postoperative outcomes based on insurancetype. J Arthoplasty 2012 Dec;27(10):1761e5.
25. O'Brein J, Lu B, Ali NA, Levine DA, Aberegg SK, Lemeshow S.Insurance type and sepsis- associated hospitalizations andsepsis-associated mortality among US adults: a retrospectivecohort study. Crit Care 2011;15:R130.
26. Allen J, et al. International Society for Heart & LungTransplantation (ISHLT) 30th Anniversary Meeting: Abstract79. Presented April 21, 2010.
27. Piper CN, Elder K, Glover S, Baek JD, Murhp J. Disparitiesbetween asthma management and insurance type amongchildren. J Natl Med Assoc 2010 Jul;102(7):556e61.
28. Kucik JE, Cassell CH, Alverson CJ, Donohue P, Tanner JP,Minkovitz CS, et al. Role of health insurance on the survival ofinfants with congenital heart defects. Am J Public Health 2014Sep;104(9):e62e70. https://doi.org/10.2105/AJPH.2014.301969.
29. Lungen M, Stollenwerk, Messne P, Lauterbach KW, Gerber A.Waiting times for elective treatments according to insurancestatus: a randomized empirical study in Germany. Int J EquityHealth 2008;7:1.
30. Kuchinke BA, Sauerland D, Wubker A. The influence ofinsurance status on waiting times in German acute carehospitals: an empirical analysis of new data. Int J Equity Health2009 Dec 21;8:44.
31. Schwierz S, Wubker A, Wubker A, Kuchinke BA.Discrimination in waiting times by insurance type andfinancial soundness of German acute care hospitals. Eur JHealth Econ 05/2010;12(5):405e16.
32. Gaglia Jr MA, Torguson R, Xue Z, Gonzalez MA, Collins SD,Ben-Dor I, et al. Insurance type influences the use of drug-eluting stents. JACC Cardiovasc Interv 2010 Jul;3(7):773e9.https://doi.org/10.1016/j.jcin.2010.04.011.
33. Laux G, Szecsenyi J, Miksch A, Grun B, Gutscher A, Grun B,et al. Antihypertensive pharmacotherapy of patients inprimary care with either a statutory or private healthinsurance. Med Klin (Munich) 2009 Feb 15;104(2):108e13.https://doi.org/10.1007/s00063-009-1028-4. Epub.
34. Polanco A, Breglio AM, Itagaki S, Goldstone AB, Chikwe J. Doespayer status impact clinical outcomes after cardiac surgery?A propensity analysis. Heart Surg Forum 2012Oct;15(5):E262e7. https://doi.org/10.1532/HSF98.20111163.
35. LaPar DJ, Bhamidipati CM, Walters DM, Stukenborg GJ, Lau CL,Kron IL, et al. Primary payer status affects outcomes for cardiacvalve operations. J Am Coll Surg 2011 May;212(5):759e67.
36. Lu R, Hsiao W. Does universal health insurance make healthcare unaffordable? Lessons From Taiwan. Health Aff2003;22(3):77e88.
37. Freeman T. Using performance indicators to improve healthcare quality in the public sector: a review of the literature.Health Serv Manag Res 2002 May;15(2):126e37.
38. Geyman JP. The corporate transformation of medicine and itsimpact on costs and access to care. J Am Board Fam Pract2003;16(5):449.
39. Grembowski DF, et al. Measuring the “managedness” andcovered benefits of health plans. Health Serv Res2000;35(3):707e34.
40. Hussey P, Anderson GF. A comparison of single- and multi-payer health insurance systems and options for reform.Health Pol 2003;66(3):215e28.
41. Nichols LM, et al. Are market forces strong enough to deliverefficient health care systems? Confidence is waning. HealthAff (Millwood) 2004;23(2):8e21.
42. Emmert M, Meier F. An analysis of online evaluations on aphysician rating website: evidence from a German Publicreporting instrument. J Med Internet Res 2013 Aug6;15(8):e157.
43. Van de Ven A Wynard PMM, Beck Konstantin,Buchner Florian, Schokkaert Erik, (Erik) Schuta FT,Shmuelif Amir, et al. Preconditions for efficiency andaffordability in competitive healthcare markets: are theyfulfilled in Belgium, Germany, Israel, The Netherlands andSwitzerland? Health Pol 2013;109:226e45.
44. Besstremyannaya G. Managed competition in health insurancesystems in central and eastern Europe. CEFIR; Free Policy BriefSeries; October 2013.
45. Hussey P, Anderson GF, Osborn OR, Feek C, McLaughlin V,John Millar J, et al. How does the quality of care compare infive countries? Health Aff 2004;23(3):89e99.
46. Reinhardt U. Single-payer systems spark endless debate. Arethey a panacea or a form of “socialised medicine”? Americansjust cannot agree. BMJ 28 April 2007;334.
47. Dranove D. Demand inducement and the physician/patientrelationship. Econ Enq 1988;26:251e98.
48. Bloom Gerald, Standing Hilary, Lloyd Robert. Markets,information asymmetry and health care: towards new socialcontracts. Soc Sci Med 2008;66:2076e2087.
49. Freeman J. The contracting state. 28 Fla. St. U. L. Rev.; 2000.50. OECD. Health care systems: getting more value for money. OECD
Economics Department Policy Notes; 2010. No. 2.51. Feldman Roger. Quality of care in single-payer and multi-
payer health systems. J Health Polit Policy Law August,2009;34(3):649e70.
52. Blanchet N, Fox A. Prospective political analysis for policydesign: enhancing the political viability of single-payer health reform in Vermont. Health Pol 2013Jun;111(1):78e85.
53. Philipp Vetter, Boecker Klaus. Benefits of a single paymentsystem: case study of Abu Dhabi health system reforms.Health Pol 2012;108.
54. Anne-Fleur Roos, Schut Frederik T. Spillover effects ofsupplementary on basic health insurance: evidence from TheNetherlands. Eur J Health Econ 2012;13:51e62.
55. Dani€elle MID, Duijmelinck Ilaria Mosca, van de Ven WynandPMM. Switching benefits and costs in competitive healthinsurance markets: a conceptual framework and empiricalevidence from The Netherlands. Health Pol 2015May;119(5):664e71.
56. Thomson S, Busse R, Crivelli L, van de VenW, Van de Voorde C.Statutory health insurance competition in Europe: a four-country comparison. Health Pol 2013;109:209e25.
57. Thomson S, Mossialos E. Choice of public or private healthinsurance: learning from the experience of Germany and TheNetherlands. J Eur Soc Pol 16(4):315e327; 068271.
58. Frank Richard G, Choice Karine Lamiraud. Price competitionand complexity in markets for health insurance. J Econ BehavOrgan 2009;71:550e62.
59. van de Ven Wynand PMM, Beck Konstantin, Voorde CarineVan de, Wasem Jurgen, Zmora Irit. Risk adjustment and riskselection in Europe: 6 years later. Health Pol October2007;83(2e3):162e79.
60. Sheils JF, Haught RA. Analysis of the costs and impact ofuniversal health care models for the state of Maryland: thesingle-payer and multi-payer models. Fairfax, Va: LewinGroup; 2000.
61. Chollet D, Mays G, Angeles J. Feasibility of a single-payer healthcare model for the state of Maine. Mathematica Policy Research,Inc; 2002.
p u b l i c h e a l t h 1 6 3 ( 2 0 1 8 ) 1 4 1e1 5 2152
62. PrekerAS. The introduction of universal access tohealth care inthe OECD: lessons for developing countries. In:Nitagyarumphong ES, Mills A, editors. Achieving universalcoverage of health care. Bangkok: Ministry of Public Health; 1998.p. 103.
63. Woolhandler S, et al. Costs of health care administration inthe United States and Canada. N Engl J Med 2003;349:768e75.
64. Wallack AR. Single payer aheadd cost control and the evolvingVermontmodel.NEngl JMed2011;365. 7 nejm.584 org august 18.
65. Geyman J. Myths and memes about single-payer healthinsurance in the United States: a rebuttal to conservativeclaims John P. Int J Health Serv 2005;35(1):63e90.
66. Morra D, Nicholson S, Levinson W, et al. US physicianpractices versus Canadians: spending nearly four times asmuch money interacting with payers. Health Aff (Millwood)2011;30:1443e50.
67. Ven Van de WPMM. Risk adjustment and risk equalization:what needs to be done? Health Econ Pol Law2011;6(01):147e56.
68. Van de Ven WP MM, Ellis R. Risk adjustment in competitivehealth plan markets. In: Newhouse JP, Culyer AJ, editors.Handbook of health economics. Amsterdam: Elsevier; 2000.
69. Yates R. Universal health coverage: progressive taxes are key, vol.386; July 18, 2015. www.thelancet.com.