Repercusiones de "ObamaCare" para la reforma sanitaria en Chile / "ObamaCare": effects for the health reform in Chile

Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.

Cooperation with evil, the theory of action and the contraception mandate / Cooperación con el mal, la teoría de la acción y el mandato de anticoncepción / Cooperação com o mal, a teoria de ação e o mandato de contracepção

Abstract The debate concerning the so-called U.S.Health and Human Services (HHS) Contraception Mandatehas been adequately framed, in the academic field, within the traditional ethical doctrine oncooperation with evil. This principle will allow us to conclude whether employers may ethically comply with the onerous existing law or not. The discussion has been quite heated, because the practical conclusions authors have reached vary widely, depending on which interpretation of the theory they rely on. In this paper, some of these explanations are addressed and analyzed from the standpoint of the Thomistic theory of action, which is now the most common point of view. This work concludes that, although theContraception Mandatewill most likely be repealed by the current U.S. administration, as things once stood, compliance with it may have been ethically licit in some cases.

Resumen El debate académico sobre el llamadoU.S. Health and Human Services (HHS) Contraception Mandatese ha enmarcado, adecuadamente, en el contexto de la doctrina clásica acerca de lacooperación al mal. Este principio ayuda a discernir si las empresas y los empleadores estadounidenses deberían o no, éticamente, obedecer a tal ley injustamente impuesta. La discusión ha sido muy acalorada, porque las conclusiones a las que han llegado los distintos autores son muy variadas, en función de cuál ha sido la interpretación de esta doctrina en cada caso. En el presente artículo hemos tratado de examinar y analizar alguno de estos intentos de explicación, desde la perspectiva de la teoría tomista de la acción -que hoy en día es el punto de vista más común-. El trabajo concluye que, aunque elMandateprobablemente vaya a ser derogado por el actual gobierno de los Estados Unidos, tal como estaban las cosas, la obediencia de esta ley podría haber sido éticamente lícita en algunos casos.

Resumo O debate acadêmico sobre o chamado Mandato de Contracepção, do U.S. Health and Human Services (HHS), foi enquadrado, adequadamente, no contexto da doutrina clássica sobre a cooperação com o mal. Esse princípio ajuda a discernir se as empresas e os empregadores norte-americanos deveriam ou não, eticamente, obedecer a tal lei imposta injustamente. A discussão tem sido muito acalorada porque as conclusões a que diferentes autores chegaram são muito variadas, em função da interpretação dessa doutrina em cada caso. No presente artigo, buscamos examinar e analisar algumas dessas tentativas de explicação, a partir da perspectiva da Teoria Tomista da Ação - que, atualmente, é o ponto de vista mais comum. O trabalho conclui que, ainda que o mandato seja provavelmente revogado pelo atual governo dos Estados Unidos, assim como estavam as coisas, a obediência a essa lei poderia ter sido eticamente lícita em alguns casos.

From Obamacare to Trumpcare: Implication of American Medical Reform for China / 中国卫生经济

It reviewed the main contents,changes and effects of the two rounds of U.S.health care reforms since the signing of Patient Protection and Affordable Care Act in 2010,pointed out that the reform process manifested a struggle between the socialist welfare and capitalist free market,including the collision between the public demand of health and vested-interest group's concerns,the combat between two political parties with different value systems and the reality of "a broken America".Based on these facts,the implications that might benefit China in its healthcare reform were also summarized.

The Affordable Care Act: Disparities in emergency department use for mental health diagnoses in young adults / 世界急诊医学杂志（英文）

@#BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department (ED) utilization for mental health purposes. We aimed to study the race specific association between the dependent coverage provision of the Affordable Care Act (ACA) and changes in young adults' usage of emergency department services for psychiatric diagnoses. METHODS:We utilized a Quasi-Experimental analysis of ED use in California from 2009–2011 for behavioral health diagnoses of individuals aged 19 to 31 years. Analysis used a difference-in-differences approach comparing those targeted by the ACA dependent provision (19–25 years) and those who were not (27 to 31 years), evaluating changes in ED visit rates per 1000 in California. Primary outcomes measured included the quarterly ED visit rates with any psychiatric diagnosis. Subgroups were analyzed for differences based on race and gender. RESULTS:The ACA dependent provision was associated with 0.05 per 1000 people fewer psychiatric ED visits among the treatment group (19–25 years) compared to the control group (27–31 years). Hispanics and Asian/Pacific Islanders were the only racial subgroups who did not see this significant reduction and were the only racial subgroups that did not see significant gains in the proportion of psychiatric ED visits covered by private insurance. CONCLUSION:The ACA dependent provision was associated with a modest reduction in the growth rate of ED use for psychiatric reasons, however, racial disparities in the effect of this provision exist for patients of Hispanic and Asian/Pacific Islander racial groups.

¿Cuál es el impacto de aplicar un valor mínimo al Medical Loss Ratio (MLR) de los seguros de salud en Chile?: síntesis rápida de evidencia / What is the impact of applying a minimum value to the Medical Loss Ratio (MLR) of health insurance in Chile?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO El Medical Loss Ratio (MLR) es la proporción de los ingresos que un asegurador de salud recibe por primas, que es gastado en servicios clínicos. Una de las intervenciones que se ha propuesto es establecer un porcentaje mínimo para este indicador, controlando las ganancias que las Isapres pudiesen percibir a costa de los usuarios. En este contexto el Departamento de Asesoría Ministerial solicita esta síntesis de evidencia con el objetivo de informar la toma de decisiones respecto del efecto de una política para controlar las ganancias del sistema ISAPRE, imponiendo un umbral al MLR. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en 5 bases de datos con el objetivo de identificar revisiones sistemáticas del tema. Al no encontrarse, se seleccionaron todos los estudios primarios que abordaran el tema. Se incluyeron únicamente los casos de seguros individuales, excluyendo todo tipo de seguros colectivos o de vida. RESULTADOS El resumen NO utiliza revisiones sistemáticas -Los cambios ocasionados por el establecimiento de un MLR se centran más bien en el aumento de gastos en bonos más que en una reducción de las primas. -Los aseguradores con un MLR menor a 70% aumentan significativamente sus gastos en bonos al implementar un umbral de MLR obligatorio de 80%. -La definición de un umbral en el MLR generaría un aumento en los gastos para mejorar la calidad de la atención, no obstante, no se observó una mejora de calidad efectiva en salud mental. -Mercados monopólicos muestran menores MLR. Sin embargo, al aumentar la participación del asegurador en el mercado, aumentaría el MLR y número de bonos por persona. -Aseguradores con presencia en otros mercados tendrían menores MLR. -Para aseguradores con bajo MLR, la aplicación de un umbral para MLR generaría un aumento significativo de más de 10% en su MLR al año siguiente de aplicada la medida. -La experiencia de EE.UU. muestra que se redujeron los gastos administrativos, aumentaron las devoluciones de dinero a asegurados, mientras que el valor de las primas y la inversión en calidad se ha mantenido relativamente constante. Aseguradores con fines de lucro tendrían menores MLR.

Prevention in the United States Affordable Care Act / 예방의학회지

The Affordable Care Act (ACA) was signed into law on March 23, 2010 and will fundamentally alter health care in the United States for years to come. The US is currently one of the only industrialized countries without universal health insurance. The new law expands existing public insurance for the poor. It also provides financial credits to low income individuals and some small businesses to purchase health insurance. By government estimates, the law will bring insurance to 30 million people. The law also provides for a significant new investment in prevention and wellness. It appropriates an unprecedented $15 billion in a prevention and public health fund, to be disbursed over 10 years, as well as creates a national prevention council to oversee the government's prevention efforts. This paper discusses 3 major prevention provisions in the legislation: 1) the waiving of cost-sharing for clinical preventive services, 2) new funding for community preventive services, and 3) new funding for workplace wellness programs. The paper examines the scientific evidence behind these provisions as well as provides examples of some model programs. Taken together, these provisions represent a significant advancement for prevention in the US health care system, including a shift towards healthier environments. However, in this turbulent economic and political environment, there is a real threat that much of the law, including the prevention provisions, will not receive adequate funding.