Challenges and Solutions in Constructing a Microsimulation Model of the Use and Costs of Medical Services in Australia

This paper describes the development of a microsimulation model =HealthMod‘ which simulates the use and costs of medical and related services by Australian families. Australia has a universal social insurance scheme known as =Medicare‘ which provides all Australians with access to free or low-cost essential medical services. These services are provided primarily by general practitioners as well as specialist doctors but also include diagnostic and imaging services. Individuals may pay a direct out-of pocket contribution if fees charged for services are higher than the reimbursement schedule set by government. HealthMod is based on the Australian 2001 National Health Survey. This survey had a number of deficiencies in terms of modelling the national medical benefits scheme. The article outlines three major methodological steps that had to be taken in the model construction: the imputation of synthetic families, the imputation of short-term health conditions, and the annualisation of doctor visits and costs. Some preliminary results on the use of doctor services subsidised through Australia‘s Medicare are presented.Economic microsimulation modelling, medical services, use and costs, Australia

Constructing an Urban Population Model for Medical Insurance Scheme Using Microsimulation Techniques

China launched a pilot project of medical insurance reform in 79 cities in 2007 to cover urban nonworking residents. An urban population model was created in this paper for China's medical insurance scheme using microsimulation model techniques. The model made it clear for the policy makers the population distributions of different groups of people, the potential urban residents entering the medical insurance scheme. The income trends of units of individuals and families were also obtained. These factors are essential in making the challenging policy decisions when considering to balance the long-term financial sustainability of the medical insurance scheme

Forecasting China's Medical Insurance Policy for Urban Employees Using a Microsimulation Model

This paper uses microsimulation techniques to model individual's medical behavior and forecast the effects of different settings of medical insurance policies. The aim of the simulation is to measure the possible change and difference in policies in the process of implementation of the medical insurance policy settings for government policy makers. Based on predicting the medical expenses for urban employees in Zhenjiang, Jiangsu Province of China, the medical insurance policy was simulated over the five-year forecast period 2002 - 2006. The results estimated that the medical expenses of medical insurance participants in Zhenjiang will increase over this period. Retirees were found to be the main group of participants receiving the highest share of medical resource expenditure, with their medical expenses accounting for more than 45% of total medical expenses of all age groups. The proportion of medical expenses paid by the social pool funds for all groups of participants will increase annually. In addition to the base case forecasting the current policy setting, this paper also modeled two other policy settings to investigate what happens to key output variables if the policy settings are changed.Medical Insurance, Policy Research, Microsimulation, Model

Modelling an information management system for the National Health Insurance Scheme in Ghana

The National Health Insurance Scheme (NHIS) in Ghana was introduced to alleviate the problem of citizens having to pay for healthcare at the point of delivery, given that many did not have the financial resources needed to do so, and as such were unable to adequately access healthcare services. The scheme is managed from the national headquarters in the capital Accra, through satellite offices located in districts right across the length and breadth of the country. It is the job of these offices to oversee the operations of the scheme within that particular district. Current literature however shows us that there is a digital divide that exists between the rural and urban areas of the country which has led to differences in the management of information within urban-based and rural-based districts. This thesis reviews the variables affecting the management of information within the scheme, and proposes an information management model to eliminate identified bottlenecks in the current information management model. The thesis begins by reviewing the theory of health insurance, information management and then finally the rural-urban digital divide. In addition to semi-structured interviews with key personnel within the scheme and observation, a survey questionnaire was also handed out to staff in nine different district schemes to obtain the raw data for this study. In identifying any issues with the current information management system, a comparative analysis was made between the current information management model and the real-world system in place to determine the changes needed to improve the current information management system in the NHIS. The changes discovered formed an input into developing the proposed information management system with the assistance of Natural Conceptual Modelling Language (NCML). The use of a mixed methodology in conducting the study, in addition to the employment of NCML was an innovation, and is the first of its kind in studying the NHIS in Ghana. This study is also the first to look at the differences in information management within the NHIS given the rural-urban digital divide

Does culture matter at all in explaining why people still use traditional medicines?

Why do individuals still use traditional medicines when modern treatments are available? Economic explanations for an individual’s use of traditional instead of modern medicines are scarce and often fail to consider explanations beyond the conventional. This paper puts forward an economic explanation for the use of traditional medicine. First, traditional medicines were the default form of health care available in pre-colonial times where industry influence was yet to develop. Hence, both those individuals who exhibit lower incomes and are left out of health insurance coverage are more likely to use traditional medicines. Second, cultural attitudes and ethnic group controls explain variation in utilisation, even among those who have health insurance. Results are suggestive of the validity of cultural interpretations

Health Care Provider Choice

In order to achieve an ‘optimal health system’ health policies should not only be focused on the supply of health care, but also take cognisance of the demand for health care. Studies of health care demand in South Africa are scarce due to considerable data limitations. This analysis attempts to fill this gap by combining two data sets (specifically, the GHS 2004 and IES/LFS 2000) in order to be able to utilize the wealth of information regarding health care utilization in the General Household Survey. The aim is to inform and encourage debate on how to incorporate demand side considerations in order to arrive at improved public health care in South Africa.health care, demand for health, combining data sets, South Africa

Thesis on household poverty and wellbeing in China

My research is focused on estimating household vulnerability to poverty in China. Different from the traditional assessment of household economic status, which measures the static status of household poverty, I stress poverty as being a multifaceted and dynamic phenomenon and estimate the ex-ante probability of households being poor in the future. In the first chapter, I propose a subjective poverty line for each household to quantify the vulnerability to poverty in urban and rural households by considering residents’ expectations and their propensity to compare their perceived welfare level with those of other community members. The research question is whether the Chinese rural household are more likely to enter the poverty under the measurement of subjective poverty line. The findings show that the overall vulnerability incidence in urban households is lower than in rural households. The regional differential in terms of vulnerability to poverty continues to exist, but the western province in both urban and rural households has not shown a significantly higher vulnerability rate than in other regions. Educational qualification is a determinant of the vulnerability of rural residents, whereas it does not have remarkable positive effects on urban households. Meanwhile, the impacts of welfare systems upon both urban and rural households are larger than expected, while the coverage of them is incomplete and calls for government to implement more social reforms to mitigate the risk and buffer the vulnerability, and to adopt a more equalising approach (instead of unrestrained growth). In the second chapter, I apply the FGLS approach in order to explore the incidences and sources of poverty and vulnerability in urban China, the research question is whether the influence of covariate shocks upon household vulnerability to poverty is more than that of idiosyncratic shocks in urban Chinese household. Our results show that idiosyncratic shocks have a greater influence on household vulnerability, though both idiosyncratic and covariate shocks make contributions to household vulnerability to poverty. All the regions that we have discussed in this study follow this pattern except for Chongqing, a municipality in the western region that shows that idiosyncratic shocks have impacts that are equal to those of covariate shocks, which indicates that the insurance mechanism within the community makes a contribution to household income that is similar to that of the insurance mechanism across spatially separated communities. This implies that, in contrast to all other regions, which show a higher impact of idiosyncratic shocks upon household income than that of covariate shocks, Chongqing finds it easier to implement an ex-ante coping strategy to reduce household vulnerability to poverty, as idiosyncratic shocks are more difficult to anticipate than covariate shocks. In the third chapter, based on the 2013, 2015 and 2018 Chinese elder household surveys, I observe the changes in vulnerability of elder households to poverty during these years and the first research question is whether the different types of medical insurance are closely link with the incidence of vulnerability. And the second one is whether types of medical insurances have more significant effects on reduce the vulnerability to poverty in rural household than that in urban household. The results show that the vulnerability rate in rural areas is decreasing gradually, while the vulnerability rate in urban areas is increasing. Meanwhile, New Cooperative Rural Medical Insurance and Civil Servant Medical Insurance show a significant impact on reducing household vulnerability, while other medical insurance makes no significant contributions to the incidence of vulnerability, which is contrary to the empirical studies suggested. Overall, from the first chapter to the last chapter, different types of poverty line are used to test the characteristic Chinese household with vulnerability to poverty. The first chapter emphasizes the significant impact of children and youth on the household and the second one focus on the effect of adult and the last chapter concentrates on the influence of the elder on the household vulnerability to poverty. The whole paper covers all age groups in Chinese household and considers all the possible structures of Chinese household

The Progressivity Of Health Care Services In Ghana

経済学 / EconomicsThis paper examines the incidence of public health subsidies in Ghana using the Ghana Living Standards Survey. Using a combination of (uniform) benefit incidence analysis and a discrete choice model, our results give a clear evidence of progressivity with consistent ordering: postnatal and prenatal services are the most progressive, followed by clinic visits, and then hospital visits. Children health care services are more progressive than adults’. Own price and income elasticities are higher for public health care than private health care and for adults than children. Poorer households are substantially more price responsive than wealthy ones, implying that fee increases for public health care will impact negatively on equity in health care. Simulations based on an estimated nested logit model show the importance of opportunity costs in healthcare decisions and suggest that reforms that focus only on out-pocket expenses will have a limited ability to extend public healthcare to all potential users.JEL Classification Codes: H22, H51, H52, H53http://www.grips.ac.jp/list/jp/facultyinfo/munro_alistair