AbstractAs health care costs rise in Australia, the affordability of primary care and private health insurance (PHI) are critical concerns. Key questions include whether primary care should be free for all, and what role should PHI play alongside Medicare. The Government spends $6.7 billion on PHI rebates, yet these incentives have limited impact. The Government should reduce public support on PHI and improve primary and preventive care. Primary care should be free for all low‐income people and children regardless of where they live, and cheaper for other population. This can be achieved with the current budget and better policy design.
Penalty mandates are used in many countries to encourage people to purchase health insurance. But are they effective? We use a large administrative dataset for a 10% random sample of all Australian tax-filers to study how people respond to a step-wise age-based mandate, and whether this has changed over time. The mandate creates discontinuities in the incentive to insure by age, which we exploit to estimate causal effects. People who do not insure before the penalty dates face higher premiums in the future, which should encourage them to bring forward purchases. We find that people respond as expected to the initial age-penalty, but not to subsequent penalties. The 2% premium loading results in a 1-4% increase in take-up, with effects increasing after an annual government letter campaign that reminds people approaching the penalty deadline about the policy. We discuss the impact of the mandate on the overall efficiency of the market, and implications of potential reforms.
In response to the rapidly growing demand for elderly care service in China, rational allocation of limited resources and improvement of public satisfaction have become one of the urgent problems to be solved in government procurement of elderly care services. With the aid of quality function deployment, a programming model is established to allocate resource with maximizing customer satisfaction. Taking home care service as an example, on the basis of identifying the elderly's requirements, designing attributes, optimal allocation of limited resource is conducted based on the proposed approach. Results show that staff in the home care service center should pay more attention to improve their service attitude and service quality. Meanwhile, more resources should also be allocated to improve the specialization of the franchise center, and to increase the provision of professional medical personnel and purchase of common medicines for emergencies as well as facilities for rehabilitation. This study expands the field of elderly care service by introducing a more efficient resource-allocation approach, thus helping governments in decision-making.
This study contributes to our understanding of organizational identity through dichotomous motivations of altruism and egoism in non-profit organizations (NPO). By applying an empirical analysis of NPO members, organizational identity is found to be well explained by altruistic motivation and egoistic motivation. More importantly, this study finds that collectivism positively moderates the relationship between altruistic motivation and organizational identity, and negatively moderates the relationship between egoistic motivation and organizational identity. It is noticeable that altruistic motivations have a stronger impact on organizational identity when collectivism is high, while egoistic motivations have a stronger impact on organizational identity when collectivism is low. Finally, this study generates helpful management implications based on research findings. It is suggested that the managers of NPOs could enhance members' organizational identity by taking motivations and collectivism into consideration, that is to say, in order to build up organizational identity of NPO members, both righteousness and shared interests matter simultaneously.
BACKGROUND: Little information is available concerning the relationship between compliance with hypertensive care and poor quality of sleep among Chinese adults in rural areas. This study aimed to evaluate the association between the compliance with hypertensive care and sleep quality for hypertension of adults in a mountainous area in People's Republic of China. METHODS: A total of 551 hypertensive patients (30–96 years of age) living in a remote mountainous area were recruited. Poor sleep quality was assessed using the standard Pittsburgh Sleep Quality Index (PSQI), and compliance with care was measured based on the Compliance of Hypertensive Patients Scale (CHPS). Hypertension was defined as blood pressure ≥140/90 mmHg or treated with antihypertensive medication. The associations between sleep quality and compliance variables were examined using Pearson's correlation. Multiple linear regressions were established to verify significant variables associated with respondents' compliance with care and poor sleep quality. RESULTS: The average age of the sample was 67.15 years (SD=10.20), and 56.44% of the participants were female. The mean CHPS total score was 41.97 (SD=5.91), and the PSQI total score was 7.91 on average (SD=4.10). Correlation analysis revealed that patients with higher intention, healthier lifestyle, positive attitude and total compliance were more likely to have an increased risk of poor sleep quality. According to the results of multiple linear regression analyses, hypertension compliance was significantly associated with being female, married, non-rural residence and years of hypertension, while poor sleep quality had a significant association with living in rural areas, having concomitant disease and poor hypertension compliance. CONCLUSIONS: There is a significant association between hypertension compliance and poor sleep quality. Future intervention programs should focus on improving compliance behavior as a modifiable background factor for sleep quality.
Yuting Zhang, Xiaodong TanDepartment of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan 430071, People's Republic of ChinaBackground: Little information is available concerning the relationship between compliance with hypertensive care and poor quality of sleep among Chinese adults in rural areas. This study aimed to evaluate the association between the compliance with hypertensive care and sleep quality for hypertension of adults in a mountainous area in People'sRepublic of China.Methods: A total of 551 hypertensive patients (30–96 years of age) living in a remote mountainous area were recruited. Poor sleep quality was assessed using the standard Pittsburgh Sleep Quality Index (PSQI), and compliance with care was measured based on the Compliance of Hypertensive Patients Scale (CHPS). Hypertension was defined as blood pressure ≥140/90 mmHg or treated with antihypertensive medication. The associations between sleep quality and compliance variables were examined using Pearson's correlation. Multiple linear regressions were established to verify significant variables associated with respondents' compliance with care and poor sleep quality.Results: The average age of the sample was 67.15 years (SD=10.20), and 56.44% of the participants were female. The mean CHPS total score was 41.97 (SD=5.91), and the PSQI total score was 7.91 on average (SD=4.10). Correlation analysis revealed that patients with higher intention, healthier lifestyle, positive attitude and total compliance were more likely to have an increased risk of poor sleep quality. According to the results of multiple linear regression analyses, hypertension compliance was significantly associated with being female, married, non-rural residence and years of hypertension, while poor sleep quality had a significant association with living in rural areas, having concomitant disease and poor hypertension compliance.Conclusions: There is a significant association between hypertension compliance and poor sleep quality. Future intervention programs should focus on improving compliance behavior as a modifiable background factor for sleep quality.Keywords: People's Republic of China; rural area, hypertension, compliance, poor sleep quality
The Medicare Part D program allows beneficiaries to choose among Part D plans administered by different health plans in order to encourage market competition and give beneficiaries more flexibility. Currently around 40–50 Part D plans are available per region. When faced with so many options, do beneficiaries generally choose the least expensive plan? Using 2009 Part D data, we found that only 5.2% of beneficiaries chose the cheapest plan. Nationwide, beneficiaries on average spent $368 more annually than they would have spent under the cheapest plan available in their region, given their medication needs. Beneficiaries often overprotected themselves by paying higher premiums for plan features they did not need, such as generic drug coverage in the coverage gap. Our findings suggest that beneficiaries need more targeted assistance from the government to choose plans, for example, a customized letter indicating three top plans based on beneficiaries' medication needs.
AbstractThe 2014 Medicaid expansion excluded Americans who were 65 years old and older, but they could still be affected via spillover effects. Using Medicare administrative data, we test for spillovers in Medicare spending and Medicaid coverage among low‐income Medicare beneficiaries. We analyze two cohorts: those under 65 in 2014, who could have been induced by the expansion to take up Medicaid before joining Medicare; and those 65 or older in 2014, whose Medicaid eligibility was never affected by the expansion. We only find spillovers for the under‐65 cohort, where Medicare spending fell and Medicaid coverage increased, with no measurable adverse effect on mortality. Combined with a null effect for the over‐65 cohort, these facts suggest Medicare beneficiaries were not crowded out of health care by the expansion. Instead, those under‐65 cohort satisfied "pent‐up" demand via Medicaid, consuming care they would have otherwise obtained later under Medicare.
