High Out-Of-Pocket Medical Spending Among the Poor and Elderly in Nine Developed Countries

Objective: The design of health insurance, and the role out-of-pocket (OOP) payments play in it, is a key policy issue as rising health costs have encouraged greater cost-sharing measures. This paper compares the percentage of Americans spending large amounts OOP to meet their health needs with percentages in eight other developed countries. By disaggregating by age and income, the paper focuses on the poor and elderly populations within each. Data Source: The study uses nationally representative household survey data made available through the Luxembourg Income Study. It includes nations with high, medium, and low levels of OOP spending. Study Design: Households have high medical spending when their OOP expenditures exceed a threshold share of income. I calculate the share of each nation\u27s population, as well as subpopulations within it, with high OOP expenditures. Principal Findings: The United States is not alone in exposing large numbers of citizens to high OOP expenses. In six of the other eight countries, one-quarter or more of low-income citizens devoted at least 5 percent of their income to OOP expenses, and in all but two countries, more than 1 in 10 elderly citizens had high medical expenses. Conclusions: For some populations in the sample nations, health insurance does not provide adequate financial protection and likely contributes to inequities in health care delivery and outcomes. © Health Research and Educational Trus

The UK overseas territories: A decade of progress and prosperity?

This article analyses the relationship between the UK and its Overseas Territories since the publication of the 1999 White Paper Partnership for Progress and Prosperity. The article considers the efforts by the UK government to improve links with the territories via a new partnership based on mutual obligations and responsibilities. It focuses on the two most important aspects of the White Paper - governance and economic growth and sustainability. Much has been achieved, but fundamental structural problems in the relationship remain unattended. The article concludes by recommending how the relationship can be improved over the coming years. © 2011 Taylor & Francis

From social rights to the market: neo-liberalism and the knowledge economy

Public higher education has a long history, with its growth associated with mass higher education and the extension of a social right to education from secondary schooling to university education. Following the rise in student numbers since the 1970s, the aspiration to higher education has been universalized, although opportunities remain structured by social background. This paper looks at changing policies for higher education in the UK and the emergence of a neoliberal knowledge regime. This subordinates higher education to the market and shifts the burden of paying for degree courses onto students. It seeks to stratify institutions and extend the role of for-profit providers. From a role in the amelioration of social inequality, universities are now asked to participate actively in the widening inequalities associated with a neoliberal global market order

Participatory and incremental development in an African local government accounting reform

Despite significant donor funding, government accounting reforms seeking transparent and effective management of public resources often fail or have limited success, especially in Africa, prompting questions about donors? implementation approach and calls for studies of successful reforms. This paper investigates a local government accounting reform in Benin supported by a German development agency ? perceived as successful due to the participatory, pragmatic and incremental approach reinforced by conditionalities in the face of neo-patrimonial leadership

Politics at the Cutting Edge: Intergovernmental Policy Innovation in the Affordable Care Act

In the eight years since the passage of the Patient Protection and Affordable Care Act (ACA), state governments have remained critical sites of contention over the law. Intense partisan conflict over ACA implementation has raised questions about traditional theories of intergovernmental relations, which posit that federal–state cooperation depends largely on policy design. Yet, few studies have examined how partisanship, as well as other important factors, shape state policy innovations under the ACA. This article examines the ACA’s State Innovation Models (SIM) initiative. SIM is specifically geared towards incentivizing states to experiment with new models of payment and delivery that can improve health outcomes and/or reduce health-care costs. Drawing on a combination of quantitative and qualitative evidence, we find that states’ participation in SIM is shaped by partisanship, administrative capacity, and state policy legacies. Our findings have implications for future efforts at intergovernmental health reforms