The roads to managed competition for mixed public–private health systems:a conceptual framework

Health systems’ insurance/funding can be organised in several ways. Some countries have adopted systems with a mixture of public–private involvement (e.g. Australia, Chile, Ireland, South Africa, New Zealand) which creates two-tier health systems, allowing consumers (groups) to have preferential access to the basic standard of care (e.g. skipping waiting times). The degree to which efficiency and equity are achieved in these types of systems is questioned. In this paper, we consider integration of the two tiers by means of a managed competition model, which underpins Social Health Insurance (SHI) systems. We elaborate a two-part conceptual framework, where, first, we review and update the existing pre-requisites for the model of managed competition to fit a broader definition of health systems, and second, we typologise possible roadmaps to achieve that model in terms of the insurance function, and focus on the consequences on providers and governance/stewardship.</p

La fórmula «in dubio» en la jurisprudencia actual

En aquest article s'analitzen grups sintàctics, oracions i expressions llatines que, encara que no presenten un verb, expressen continguts modals semblants a les oracions. S'estudia específicament el grup preposicional integrant de l'expressió fixa in dubio pro reo des del punt de vista etimològic i gramatical, el seu paral·lelisme amb altres màximes del dret romà, els tecnicismes creats per designar conceptes jurídics nous i la seva freqüència d'aparició en la jurisprudència del Tribunal Suprem (TS) en el període 2011 a 2013. Es comenten divuit principis i màximes de juristes romans o formulades per autors de les compilacions canòniques medievals i en segles posteriors, amb ús real documentat en resolucions de la sales Civil, Penal, Contenciosa Administrativa (C-A) i Social.In this article, Latin syntactical groupings, sentences and expressions are analyzed. Even though these phrases are verbless, they express modal contents similar to those in full-fledged sentences. Specifically, this paper analyzes the prepositional group that makes up the set expression in dubio pro reo from an etymological and grammatical perspective.  It also examines the parallels of this prepositional group with other maxims from Roman law, as well as the technical terms that were created to designate new legal concepts.  In addition, the paper studies the frequency of these expressions in Spanish Supreme Court rulings from 2011-2013. Eighteen principles and maxims that were either proposed by Roman legislators, formulated by authors of compilations of medieval canon law, or coined in later centuries, are discussed.  Actual usage is documented through rulings from the Civil, Criminal, Administrative and Labor Divisions of the Spanish Supreme Court.  En este artículo se analizan grupos sintácticos, oraciones y expresiones latinas que, aunque no presentan un verbo, expresan contenidos modales semejantes a las oraciones. Se estudia específicamente el grupo preposicional integrante de la expresión fija in dubio pro reo desde el punto de vista etimológico y gramatical, su paralelismo con otras máximas del Derecho Romano, los tecnicismos creados para designar conceptos jurídicos nuevos y su frecuencia de aparición en la jurisprudencia del Tribunal Supremo (TS) en el periodo 2011 a 2013. Se comentan dieciocho principios y máximas de juristas romanos o formuladas por autores de las compilaciones canónicas medievales y en siglos posteriores, con uso real documentado en resoluciones de la Salas Civil, Penal, Contencioso-Administrativo (C-A) y  Social.

La fórmula «in dubio» en la jurisprudència actual

En aquest article s'analitzen grups sintàctics, oracions i expressions llatines que, encara que no presenten un verb, expressen continguts modals semblants a les oracions. S'estudia específicament el grup preposicional integrant de l'expressió fixa in dubio pro reo des del punt de vista etimològic i gramatical, el seu paral·lelisme amb altres màximes del dret romà, els tecnicismes creats per designar conceptes jurídics nous i la seva freqüència d'aparició en la jurisprudència del Tribunal Suprem (TS) en el període 2011 a 2013. Es comenten divuit principis i màximes de juristes romans o formulades per autors de les compilacions canòniques medievals i en segles posteriors, amb ús real documentat en resolucions de la sales Civil, Penal, Contenciosa Administrativa (C-A) i Social

Designing feasible and effective health plan payments in countries with data availability constraints

Risk equalization schemes, which transfer money to/from insurers that have above/below average risks, are a fundamental tool in regulated health insurance markets in many countries. Risk sharing (the transfer of some responsibility for costs from a plan to the regulator or the overall insurance market), are an additional method of insulating insurers who attract higher-than-average risks. This paper proposes, implements and quantifies incorporating risk sharing within a risk equalization scheme that can be applied in a data-poor context. Using Chile's private health insurance market as case study, we show that modest amount of risk sharing greatly improves fit even in simple demographic-based risk equalization. Expanding the model's formula to include morbidity-based adjustors and risk sharing redirects compensations at insurer level and reduces opportunity to engage in profitable risk selection at the group level. Our emphasis on feasibility may make alternatives proposed attractive to countries facing data-availability constraints

Interventions for improving clinical outcomes and health-related quality-of-life for people living with skeletal dysplasias: an evidence gap map.

PURPOSE: Skeletal dysplasias are rare genetic disorders that are characterized by abnormal development of bone and cartilage. There are multiple medical and non-medical treatments for specific symptoms of skeletal dysplasias e.g. pain, as well as corrective surgical procedures to improve physical functioning. The aim of this paper was to develop an evidence-gap map of treatment options for skeletal dysplasias, and their impact on patient outcomes. METHODS: We conducted an evidence-gap map to identify the available evidence on the impact of treatment options on people with skeletal dysplasias on clinical outcomes (such as increase in height), and dimensions of health-related quality of life. A structured search strategy was applied to five databases. Two reviewers independently assessed articles for inclusion in two stages: titles and abstracts (stage 1), and full text of studies retained at stage 2. RESULTS: 58 studies fulfilled our inclusion criteria. The included studies covered 12 types of skeletal dysplasia that are non-lethal with severe limb deformities that could result in significant pain and numerous orthopaedic interventions. Most studies reported on the effect of surgical interventions (n = 40, 69%), followed by the effect of treatments on dimensions of health quality-of-life (n = 4, 6.8%) and psychosocial functioning (n = 8, 13.8%). CONCLUSION: Most studies reported on clinical outcomes from surgery for people living with Achondroplasia. Consequently, there are gaps in the literature on the full range of treatment options (including no active treatment), outcomes and the lived experience of people living with other skeletal dysplasias. More research is warranted to examine the impact of treatments on health-related quality-of-life of people living with skeletal dysplasias, including their relatives to enable them to make preference- and valued based decisions about treatment