Suchergebnisse

Few people would disagree that children with disabilities need adequate health insurance. But what kind of health insurance coverage would be optimal for these children? Peter Szilagyi surveys the current state of insurance coverage for children with special health care needs and examines critical aspects of coverage with an eye to helping policy makers and clinicians improve systems of care for them. He also reviews the extent to which insurance enhances their access to and use of health care, the quality of care received, and their health outcomes. Szilagyi begins by noting that nearly 9 percent of children with disabilities are uninsured for all or part of a year and that coverage even for many such children with insurance is inadequate—either not meeting their needs or not adequately covering the costs of care. By one estimate, nearly two of every five special needs children are either uninsured or inadequately insured. The author finds strong evidence that health insurance improves access to health care. Children with disabilities who are insured are more likely than those who are uninsured to have a primary care provider, to be able to reach a specialist, and to have access to supporting services. They also have fewer unmet needs for medical and oral health care and receive care more quickly. The bulk of the evidence shows that insurance improves quality of care for children in general and for children with disabilities. Parents of insured children with chronic conditions are more satisfied with their children's primary care, medications, specialty care, and overall health care than are parents of their uninsured peers. A handful of studies of specific diseases have found insurance to be related to improvements in quality measures, such as more doctor visits and greater continuity of care. In conclusion, Szilagyi stresses the need to provide adequate health insurance to all children with disabilities and to develop a set of best practices in health insurance to cover important services needed by this population. To that end, implementation of the federal health care reform act, including the mandate for insurance coverage, is important. He also urges support for medical home and other quality initiatives and better ways to monitor quality and health outcomes to ensure that children with disabilities receive cost-effective and equitable care.

A two-tiered approach to financial market development aimed at both bank and bond market reform would also be complementary to longer term economic development, provided services could be delivered through efficient financial and legal institutions (Chakraborty and Ray 2006) and there was strong protection for investors and sound fiscal and monetary policy management by government (Burger and Warnock 2006b). Historically, local issuers tend to issue in the major currencies (U.S. dollars, yen, and euro), and then either swap the proceeds into local currency (interest rate parity theory suggests this should deliver funds equivalent in yield to what is available in the domestic market) or, more often, sell the foreign currency proceeds in spot foreign exchange markets, leaving the repayment cash flows unhedged. Chakraborty and Ray (2006) recently established that although stronger bank monitoring helps to resolve information asymmetries and agency concerns, it is the efficiency of financial and legal institutions that influences growth outcomes, whether there is a bank- or a market-based financial system. Among them are the need for enabling regulation, including reform of withholding and other foreign investor taxes (Lejot, Arner, and Liu 2006); continuing reform of corporate governance, which includes better creditor rights, bankruptcy procedures, and contract enforcement (Beck, Levine, and Loayza 2000; Burger and Warnock 2006); and strong financial infrastructure for better information disclosure, the establishment of reliable credit ratings (Kisselev and Packer 2006) and robust benchmark yield curves The securities market is largely self-regulated through organizations such as the Korea Securities Dealers Association, the Korea Exchange, and the Korea Securities Depository, and four local agencies assign credit ratings: Korea Investor Service (a Moody's affiliate), Korea Ratings (a Fitch affiliate), National Information & Credit Evaluation, and Seoul Credit Rating & Information. This process began in 2004 with the introduction of the Korea Interbank Offered Rate (KORIBOR), which should become the benchmark interest rate for short-term financing for banks and may become a reference rate for bond or swap transactions. The first phase of the Foreign Exchange Liberalization Plan (2002 2005) increased won funding limits for nonresidents and raised the ceiling on the amount of residents' foreign borrowings requiring notification. The 2005 merger of the Korea Stock Exchange, the Korean Securities Dealers Automated Quotation stock market, and the Korea Futures Exchange into the Korea Exchange is expected to upgrade the competitiveness of the nation's trading system for a variety of financial products, including stocks, bonds, options, and other derivatives. There appears to be a natural ordering to the tasks involved: first, establish benchmark bonds and indices; second, develop a diverse derivatives market; third, systematically lengthen the bond market's maturity profile; and fourth, build and develop over-the-counter capability and price structures for derivatives and other complex financial instruments. In developed countries, as banks have become increasingly cautious about extending credit, a gradual process of disintermediation has been occurring in historically bank-oriented financial regimes, fed by considerable regulatory efforts directed at market liberalization.