Este estudo constrói um modelo microeconômico estático baseado nas teorias do consumidor e da firma para sintetizar o funcionamento do mercado de saúde. O modelo envolve os três principais agentes no setor privado: o consumidor, o provedor e o segurador. O seu objetivo é representar simultaneamente os três problemas tradicionais do mercado de saúde: a seleção adversa, o perigo moral e a demanda induzida. Desses três problemas, o perigo moral é o que recebe a atenção mais completa. Não obstante, ao invés da usual distorção do preço da assistência médica observado pelo consumidor segurado, a explicação do modelo para o problema do perigo moral está no custo da cooperação entre os consumidores segurados de um fundo de seguro-saúde. Por sua vez, a seleção adversa aparece no modelo como um viés entre a porcentagem observada de doentes na população e a porcentagem esperada de doentes no fundo, na medida em que a porcentagem no fundo permanece acima da porcentagem na população antes de igualá-la. Por último, a demanda induzida surge como uma discriminação do preço da assistência médica entre os pacientes segurados e não segurados de um provedor. A aplicação do modelo é demonstrada por meio da simulação de um mercado de saúde com dados relativamente parcimoniosos sobre uma população, uma doença e a cura para essa doença. Dentre os resultados, destaca-se o efeito de uma melhor distribuição de renda em reduzir o preço do seguro-saúde e diminuir a distância entre pacientes segurados e não segurados. / This study constructs a static microeconomic model based on consumer and firm theories in order to synthesize the functioning of the health market. The model deals with the three main agents in the private sector: the consumer, the provider and the insurer. Its objective is to simultaneously represent the three traditional problems of the health market: adverse selection, moral hazard and induced demand. Of these three problems, moral hazard is the one which has received the most complete attention. However, instead of the usual distortion of the price of health care observed by the insured consumer, the model?s explanation for the moral hazard problem is the cooperation cost among the insured consumers of a health insurance fund. In turn, the adverse selection appears in the model as a bias between the observed percentage of sick persons in the population and the expected percentage of sick persons in the health insurance fund, since the fund?s percentage stays above that of the population?s percentage rather than equal to it. Finally, the induced demand comes out as a discrimination of the health care price between insured and uninsured patients of a medical provider. The model?s application is demonstrated through a simulation of a health market with relatively parsimonious data on a population, an illness and the cure for this illness. One can detach among the results the effect of a better income distribution in reducing the health insurance price and diminishing the distance between insured and uninsured patients.

The agriculture industry has high rates of injury and illness. Furthermore, the average age of US farmers is 58 years old. Chronic conditions are more common among older populations and often require management by a health professional. Farmers face barriers when seeking healthcare. These barriers include limited free time, shortage of providers in rural areas, limited funds, and poor health insurance. In addition, lack of quality health insurance and concerns about paying for healthcare are identified as barriers to healthcare-seeking behavior among farmers. More research is needed to examine the impact of type of health insurance on utilization of specific types of healthcare services among this high-risk population. The goal of this study was to examine the association between a farmer’s type of health insurance and their healthcare-seeking behaviors. A brief, in-person, self-administered survey was used to identify the types of health insurance Midwest farmers were using and how this affected what type of healthcare services they utilized, specifically looking at preventive healthcare services. A second survey, administered online, was used to identify pre-existing conditions farmers had and the specific healthcare preventive healthcare services they utilized. The online survey found that type of health insurance was significantly associated with usage of preventive services. Other associations were found in the in-person survey between type of health insurance and stress over health insurance as well as stress over injury on the farm. These results can be used to inform future health and safety programs about the impact of health insurance on farmer’s healthcare-seeking behavior. However, additional research should be done with a larger sample.

Our study estimates the crowd-out of private health insurance following SCHIP expansions for children. We use panel data from the 2001 panel of the Survey of Income and Program Participation (SIPP). We use multivariate regression models to the crowd-out of private health insurance. This difference-in-differences approach controls for other factors that affect both the control group and treatment group, and measures the extent of crowd-out private coverage in the treatment group relative to the control group. We find that nearly 26 percent of the transitions from private coverage into SCHIP coverage were made by children who would have had private coverage in the absence of the expansions. This paper provides evidence that the SCHIP expansions have overall displacement effect of 52.9 percent for private coverage for those children who had private coverage or were uninsured from the first interview in 2001. This dissertation provides empirical evidence on the impact of SCHIP on single mothers¡¯ working decisions using recent CPS (Current Population Survey) data during 1999-2005. The empirical work requires a measure of the change in eligibility requirements; we compute a measure suggested by Yelowitz (1995). The major findings of this paper are: first, SCHIP expansions are found to have a significant positive impact on hours-worked decision; second, most models yielded results that indicated that SCHIP expansions have a generally insignificant impact on the decision to work.

This paper analyzes a 2009 U.S. policy which provided short term federal subsidies for COBRA health insurance premiums. COBRA allows the recently unemployed to continue purchasing health insurance through their employment-based insurance plan for a short time period after they become unemployed. Early analysis found low take-up rates for COBRA insurance due to the exceedingly high cost of full health insurance premiums, especially for those who have just lost a steady employment income. A short term 65 percent federal subsidy for COBRA insurance was implemented as a part of the American Recovery and Reinvestment Act in 2009. Subsidy policy proposed to increase take-up rates of COBRA and to keep national insurance rates from dropping during a time of rising unemployment. This paper finds a 3.09 percentage point increase in insurance rates for the unemployed when subsidies became available in 2009. It also finds that the gains made in 2009 were lost by 2010, suggesting that subsidies may have provided temporary relief but did not represent a long-term solution for many of the unemployed. Demographic analysis within the unemployed population determines that educated, middle to upper income earning men saw the greatest increases in insurance rates during this time. My analysis affirms previous research finding that COBRA eligibility requirements do not allow the majority of the low income, uninsured to receive federal assistance for health insurance through this policy. I also provide a positive analysis for the impact of direct-purchasing federal subsidies on insurance rates.

Abstract National Health Insurance (NHI) has been implemented in Taiwan for nearly eight years; since then, over 96% of 23 million residents of Taiwan have benefited from this program, and 70% of them are satisfied. Recently, the growth rate of healthcare expenditure, however, has been phenomenally rapid, owing to the ageing population, the economic development, the expansion of health insurance, the increased supply of healthcare resources, and the innovation of medical technology. Under the circumstance that the bill of raising the insurance premium rate could not be passed by the legislative congress, the Bureau of NHI (BNHI) was forced to economize on expense to achieve the financial balance. Currently, the BNHI implements ¡§total amount control¡¨ to control the total medical claimed payments of each medical healthcare provider. Facing the increasing volume of documentary auditing, the BNHI has to make its efforts on how to improve its auditing efficiency. This is also one of the purposes of this thesis. This study aimed to establish a reasonable and fair auditing procedure of medical claim payment, termed ¡§medical claim payments auditing (MCPA) procedure¡¨. At the stage of professional auditing, adopted the ¡§MIL-STD-105E sampling plan¡¨ to select data for professional audit and used the auditing results as a payment criterion. To verify the adaptability of the MCPA procedure, the researcher used the data provided by the institutes of Kaohsiung and Pintong as simulation objects. Further, the estimated cost model was adopted to increase the possibility of using this procedure. The MCPA procedure consists of the following characteristics: 1) The number of sampling is much lower than that of the current system used by the NHI, thus the audit labor-force and time can be reduced significantly. 2) The incentive mechanism design encourages the healthcare providers to honestly apply their medical claim payments and avoids inappropriate healthcare services. 3) Adopting international standards of sampling technology makes the MCPA procedure trustworthy and simultaneously can reduce the implementing obstructs. Keywords: National Health Insurance; Sampling plan; Incentive mechanism design

The National Health Insurance (NHI) program was officially launched in Taiwan on 1 March 1995. Three objectives are stressed in the program¡¦s implementation: (1) universal enrollment and equal-opportunity medical care; (2) balanced finances and long-term operational viability; (3) better quality medical care and better health for citizens. The initial balance of revenues and expenditures was stable, but there is a deficit during 1998. In order to prevent the financial status from keeping on worsening, the Bureau of NHI (BNHI) implement the global payment system, and expand the payroll-related premium base. What are the long-tem influences of these policies on the financial status and medical quality? Up to now, those researches of handling the financial problem of the NHI, focused mostly on those influences of the individual policies, rare studied the long-term whole influences of multiple policies. Moreover, those methods of the researches were mostly questionnaires, data analysis, regression, rare simulated methods. Hence, this dissertation applies system dynamics to explore the long-term influences of multiple policies on handling the financial problem of the NHI. There are two purposes in the research. One is that using those interacted relationships of decisions taken by the BNHI, beneficiaries, and contracted medical care institutions to understand those causes of the financial problem of the NHI, the other is that evaluating the long-term influences of multiple policies on handling the financial problem of the NHI. This research reaches two achievements. First, submitting casual loop diagrams focused on the financial problem of the NHI, can provide the BNHI, beneficiaries, and CMCI to have a further understanding on the financial problem of the NHI. Second, building the model of the financial problem and policies of the BNHI can simulate and evaluate he results of multiple policies on handling the financial problem of the NHI. In order to improve the financial imbalance of the NHI, the BNHI proposes three policies. Policy I, implement the global payment system. Policy II, implement the global payment system and expand the payroll-related premium base. Policy III, implement the global payment system, expand the payroll-related premium base and promote health communication. The simulation results are as follows: Policy III can solve the financial imbalance of the NHI and improve the health of citizens. This research has two reservations. First, only explore the financial status and medical quality. Second, different criteria using for judging the priority of policies under multilple objectives may have different results. Hence, the future research can deeply consider extending the model boundary and selecting the criteria using for judging the priority of policies under multilple objectives.

Abstract Due to the rapid rise in medical expenses and unanticipated accumulation of overdue premiums, Taiwan's National Health Insurance has impacted the management of all-size hospitals. For the purpose of survival and maintaining good performance, the hospitals need to adopt suitable strategic management. Medical centers take the responsibilities of service, teaching, and research, it should be some hard thinking as to how to manage the hospital continuously and make every effort to achieve the goal of ¡§health for all in the twenty-first century¡¨. This study was conducted in three stages: questionnaire development and testing, surveying, and data analysis. The 34-item questionnaire was self-made according to the definition and contents of community health nursing defined in United Kingdom Central Council (UKCC). Seven hundred and forty questionnaires were send to the community inhabitants with 679 were returned and valid, representing a response rate of 91.8%. Descriptive analysis, Chi-Square test, Pearson correlation analysis, factor analysis, and stepwise regression analysis were used for the statistical analysis. The information about community health nursing was obtained from bureau of public health in the majority of inhabitants (57%). As for the satisfaction of service of community health nursing to the inhabitants, people who were satisfied is less than those who weren't (21.4% vs 41.2%). Though fewer inhabitants who had a favorable impression on the medical center, more people prefer medical center to practice community health nursing. Community health nursing was classified into seven dimensions according to the factor analysis, "home health care" had a highest score (4.23), and "mental health care" got a lowest score (3.64). There was significant negative correlation between satisfaction and "supporting school health nursing", "home health care is of more humane care", "hospital gains profit from home health care", "willing to take home health care", and "hospital cooperates with community to care mental disabled". Significant positive correlation was noted between satisfaction and "accepting mental disabled in the community". In age 30-39 and 40-49, relating to the satisfaction of community health nursing, inhabitants who were unsatisfied are more than those who weren't, significant difference was noted. People who had higher educational background felt unsatisfied to the service of community health nursing, and the higher the less. Through stepwise regression analysis, "establish referral system" had the best predictability in using facilities efficiently to economies of scale to reduce operating cost; "ability to provide better service" had the best predictability in confidence of practicing community health nursing in medical center; "medical center is a good neighbor" had the best predictability in increasing benefits from practicing community health nursing; and "public health nursing helping disease prevention" had the best predictability in government health policy.

Thesis (Ph. D.)--University of Missouri-Columbia, 2003. / Typescript. Vita. Includes bibliographical references (leaves 54-57). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2003. / Typescript. Vita. Includes bibliographical references (leaves 54-57). Also available on the Internet.

published_or_final_version / Public Health / Master / Master of Public Health