Hospitals in Thailand operate in a multiple insurance payment environment. This paper examines 1) access to medicines and other medical technologies, 2) treatment outcomes, and 3) efficiency in resource use, among beneficiaries of the three government health insurance schemes in Thailand. Using 2003-2005 inpatient data for patients with three tracer diseases from three government hospitals, we find that utilization of more expensive items differs between patients whose insurers pay on a closed- or open-ended basis. Where new vs. conventional drugs are both available, patients whose insurer pays on a fee-for-service basis tend to have greater access to new drugs, compared to patients whose insurer pays on a capitated or case basis. Similar patterns were found where there are options between originator vs. generic drugs, drugs in different dosage forms, and more vs. less advanced diagnostic technologies. Effects of insurance payment are more pronounced where price gaps among the medical technologies are significant. Efficiency results are mixed, depending on nature of the disease conditions and type of resources required for treatment.

Published: Hirunrassamee, Sanita, and Sauwakon Ratanawijitrasin. "Does your health care depend on how your insurer pays providers? Variation in utilization and outcomes in Thailand." International journal of health care finance and economics 9.2 (2009): 153-168.

To analyze the impact of population aging on medical costs in South Korea, the authors use several approaches. Observation of the medical cost profile by age showed that, as the data was closer to the present, the medical costs for older people increased. The treatment quantity excluding price index was also increasing for older people. This implies that the medical resources that are allocated to older people are increasing, due to the increased resources applied to extend the expected life span that was enabled through higher income levels, rather than by aging itself.

In late 2006, the Chinese government appointed a high-level inter-ministerial commission—composed of fourteen government agencies, co-chaired by the National Development and Reform Commission and the Ministry of Health—to develop a blueprint for China’s healthcare system. One party to that process, China’s Insurance Regulatory Commission (CIRC), has developed a program of cooperation with its U.S. counterpart, the National Association of Insurance Commissioners (NAIC). To provide input to policymaking, representatives of CIRC, NAIC, private insurers in China and the United States, as well as Chinese and American scholars of health insurance gathered in Yichang, Hubei, PRC, on 18-19 June 2007, for a joint seminar on the role of commercial health insurance in the Chinese and U.S. healthcare systems.

The first section of this field report provides a brief description of China’s health care reforms in the past decades. The second section highlights the progress and challenges to date in developing commercial health insurance in China, and the final section summarizes the recommendations that the NAIC Commissioners provided to CIRC in 2007 at this critical juncture in China’s health policy reforms.

Since the mid-1980s, health maintenance organizations (HMOs) have grown rapidly in the United States.  Despite initial successes in constraining health care costs, HMOs have come under increasing criticism due to their restrictive practices.  To remain viable, this would seem to suggest that HMOs have to change at least some of these behaviors.  However, there is little empirical evidence on how restrictive aspects of HMOs may be changing.  The present study investigates one mechanism for constraining costs that is often associated with HMOs – the role of the primary care physician as a gatekeeper (e.g., monitoring patients’ use of specialist physicians).  In particular, we estimate the effect of primary care physician involvement with HMOs on the percentage of their patients for whom these physicians serve as gatekeepers.  We examine these relationships over two time periods: 2000-2001 and 2004-2005.  Because physicians can choose whether and to what extent they will participate in HMOs, we employ instrumental variables (IV) estimation to correct for endogeneity of the HMO measure.  Although the single-equation estimates suggest that the role of HMOs in terms of requiring primary care physicians to serve as gatekeepers diminished modestly over time, the endogeneity-corrected estimates show no changes between the two time periods.  Thus, one major tool used by HMOs to constrain health care costs – the physician as gatekeeper – has not declined even in the era of managed care backlash.

Published: Fang, Hai, Hong Liu, and John A. Rizzo. "Has the use of physician gatekeepers declined among HMOs? Evidence from the United States." International journal of health care finance and economics 9.2 (2009): 183-195.

This systematic review examines what factors explain the diversity of findings regarding hospital ownership and quality. We identified 31 observational studies written in English since 1990 that used multivariate analysis to examine quality of care at nonfederal general acute, short-stay US hospitals. We find that pooled estimates of ownership effects are sensitive to the subset of studies included and the extent of overlap among hospitals analyzed in the underlying studies. Ownership does appear to be systematically related to differences in quality among hospitals in several contexts. Whether studies find for-profit and government-controlled hospitals to have higher mortality rates or rates of adverse events than their nonprofit counterparts depends on data sources, time period, and region covered. Policymakers should be aware of the underlying reasons for conflicting evidence in this literature, and the strengths and weaknesses of meta-analytic synthesis. The "true" effect of ownership appears to depend on institutional context, including differences across regions, markets, and over time.

This issue of Value in Health presents selected articles from the ISPOR Second Asia Pacific Conference held in Shanghai, March 2006. Under the leadership of ISPOR and the ISPOR Asian Consortium, the ISPOR AsiaPacific Conference is held every two years in Asia with a twofold mission: to help develop knowledge and capacity for health economics and outcomes research (HE/OR) in Asia; and to promote the use of HE/OR in policymaking processes in Asia, with the goal of improving efficiency in the allocation of resources. With "Improving Evidence and Outcomes in Health Care Decision-Making" as the theme, the Second ISPOR Asia-Pacific Conference was well received, achieving an unprecedented level of participation from the Asian communities. All articles included in this issue underwent the usual anonymous process of peer review.