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health insurance

The Academic Sting Operation

Adam Wagstaff's picture

Nobody likes to be stung. Doctors regard it as unethical. Publishers say it betrays the trust of their profession. But the fact is, as three recent studies have demonstrated, sting operations can be extremely effective at exposing questionable professional practices, and answering questions that other methods can't credibly answer.

Sting #1: Are open-access journals any good? 

Much of the world has gotten fed up with the old academic publishing business. Companies like the Anglo-Dutch giant Elsevier and the German giant Springer earn high profit margins from their academic journals (Elsevier earns 36% profit, according to The Economist), through a mix of ‘free’ inputs from academics (the article itself and the peer-review process) and high (and rapidly rising) subscription charges that impede access by academics working in universities whose libraries can’t afford the subscriptions. Of course, many of these universities paid for the authors’ time in the first place, and/or that of the peer-reviewers; tax-payers also contributed, by direct subsidizing universities and/or by the research grants that supported the research assistants, labs, etc. Unsurprisingly, libraries, universities, academics and tax-payers aren’t happy.

Scaling Up Affordable Health Insurance: Same Dish, Many Different Recipes

Jorge Coarasa's picture

             A baby in Ghana rests under a bed net to prevent malaria. (c) Arne Hoel/World Bank

The debate over how to ensure good health services for all while assuring affordability is nothing new.

However, it has recently acquired new impetus under the guise of Universal Health Coverage (UHC).  Discussions around UHC are contentious and as Tim Evans recently pointed out, “a lot of the discussion gets stuck on whether financing of the system will be through government revenue, through taxes, or through contributions to insurance.”

Public Health Insurance in India: The Real Story

Jesko Hentschel's picture

You might not think of health insurance as a suspenseful subject, but a recently released book on the subject proves different. As such, there is one missing entry on the back cover, describing the book "Government-Sponsored Health Insurance in India: Are You Covered?" by authors Gerard La Forgia and Somil Nagpal. Perhaps something like “The authors play with their readers’ nerves as they drill deeper and deeper into the mysterious workings of health insurance programs in India. Slowly a multi-faceted picture emerges, which the authors skillfully bring to bustling life, not least by adding fiscal and political economy spice throughout.”

Should you trust a medical journal?

Adam Wagstaff's picture

While we non-physicians may feel a bit peeved when we hear “Trust me, I’m a doctor”, our medical friends do seem to have evidence on their side. GfK, apparently one of the world’s leading market research companies, have developed a GfK Trust Index, and yes they found that doctors are one of the most trusted professions, behind postal workers, teachers and the fire service. World Bank managers might like to know that bankers and (top) managers come close to the bottom, just above advertising professionals and politicians.

Given the trust doctors enjoy, the recent brouhaha over allegations of low quality among some of the social science articles published in medical journals must be a trifle embarrassing to the profession. Here’s the tale so far, plus a cautionary note about a recent ‘systematic review’.

U.S. health reform – The cartoon version

Owen Smith's picture

Health Care Reform, by Jonathan GruberIn a landmark decision, the U.S. Supreme Court today upheld the main provisions of President Obama’s Affordable Care Act, including the individual mandate (i.e., everyone must buy health insurance). It represents a major step towards universal coverage for health care in the U.S., something that many countries around the world are striving to achieve.

For those interested in gaining a better understanding of this complex legislation, you can do no better than to start with a graphic novel about the law written by Jonathan Gruber, a professor at MIT and one of the main architects of the Affordable Care Act (and, for that matter, of the Massachusetts health reform that it closely resembles). It’s a great introduction to the policy issues surrounding market failure in health insurance, without having to wade through a dry textbook or World Bank report.

Health System Innovation in India Part II: Aarogyasri

Adam Wagstaff's picture

More than health insurance for the poor

In our last post, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In this post, we outline a novel government-sponsored health insurance program in the state of Andhra Pradesh (AP)—a program that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care.

a) “Actors”, and their rights and responsibilities

Initiated by the then chief minister of AP, the medical doctor YSR Reddy, the Rajiv Aarogyasri scheme started in 2007 and is targeted at the below-poverty line (BPL) population. The scheme focuses on life-saving procedures that aren’t covered elsewhere in India’s patchwork of health programs, for which treatment protocols are available, and for which specialist doctors and equipment are required. Currently 938 tertiary care procedures are covered. The scheme revolves around five key “actors”, one unique to Aarogyasri and all with interesting rights and responsibilities.