Single Payers, Multiple Systems: The Scope and Limits of Subnational Variation Under a Federal Health Policy Framework

Tuohy, Carolyn Hughes

doi:10.1215/03616878-2009-011

Cited by 22 publications

(19 citation statements)

References 13 publications

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“…This is arguably easily offset by direct cost recovery for industry trials and improved survival on a macro level. 19 While some patients are resistant to trial participation because of perceived higher cost, 20 this factor is less important in Canadian trials because of universal health care coverage. A study by Castel and colleagues showed that patients themselves are rarely a critical impediment to trial recruitment, finding instead that physicians play the vital role in accrual.…”

Section: Discussionmentioning

confidence: 99%

Incremental costs of prostate cancer trials: Are clinical trials really a burden on a public payer system?

Jones¹,

Syme²,

Eliasziw³

et al. 2012

CUAJ

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Introduction: Clinical trials are a critical component of improving cancer prevention and treatment strategies. However, the perception that patients enrolled in trials consume more resources than those receiving the standard-of-care (SOC) has contributed to an increasingly research-averse environment. Current economic data pertaining to the per-patient costs of prostate cancer trials relative to SOC treatment are limited. Methods: A retrospective observational cohort study was conducted to compare costs incurred by 59 prostate cancer patients participating in a mix of industry and non-industry sponsored clinical trials with costs incurred by an equal number of eligible nonparticipants who received SOC over a year. Resource utilization was tracked and quantified to standardized price templates. Results: No difference in overall resource utilization was seen between trial and SOC patients (two-tailed t-test, n = 118, p = 0.99). Variability in the types of resources used by each group indicated that, while trial patients may take up significantly more clinic time (p = 0.001) and undergo more tests and procedures (p = 0.001), SOC patients are more likely to receive other costly interventions, such as radiation therapy (p < 0.001). Other variables (e.g., pathology, diagnostic imaging, prescribed therapies) were statistically indistinguishable between groups. Conclusion: This study revealed differences in the cost distribution of patients enrolled in clinical trials versus those receiving SOC, which could be used to improve resource allocation. The lack of evidence for a difference in overall cost provides an argument for payers to more fully support clinical research without fear of adverse financial consequences. Further analysis is required.

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Section: Discussionmentioning

confidence: 99%

Incremental costs of prostate cancer trials: Are clinical trials really a burden on a public payer system?

Jones¹,

Syme²,

Eliasziw³

et al. 2012

CUAJ

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show abstract

“…While these concepts have been increasingly used to describe interactions between states (Dolowitz and Marsh ; Legrand ), there has been insufficient study of how subnational governments have engaged in horizontal policy learning and transfer, in Canada or elsewhere. Canadian provinces are no strangers to learning from each other with respect to health care, as shown by the effects of Saskatchewan's pioneering adoption of government‐funded medical and hospital insurance from the 1940s to the 1960s (Tuohy , 492; see also Jordan : 178–181; Maioni : 167). Certainly the above provides some evidence for the same phenomenon for parentage, given similar language and provisions in Alberta's 2009 Family Law Act , British Columbia's 2011 Family Law Act , and Manitoba's proposed Family Law Reform Act .…”

Section: Resultsmentioning

confidence: 99%

Measuring parentage policy in the Canadian provinces: A comparative framework

Snow¹

2016

Can Public Adm

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This paper develops a framework to measure parentage policy based on the legal barriers faced by intended parents, taking into account eligibility requirements, rules for genetic relationships, and surrogacy contract enforceability. It then applies this framework to the Canadian provinces. While parentage policy in Canada is undoubtedly a patchwork, policy change has moved in an increasingly permissive direction, often as a result of litigation. Moreover, this study provides an opportunity to develop broader research project for comparative scholars of parentage policy. Future studies of parentage policy, building from the framework developed here, should qualitatively examine the role of policy implementers other than legislatures and determine how policy learning and transfer affect parentage policy change. Because parentage policy can provide legal certainty for parents and prevent legal disputes, understanding the factors behind policy change is an endeavour with both theoretical and practical significance.

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“…We excluded search results from earlier than 1990, because single-payer in its current usage appeared in the early 1990s. 9 The search for single-payer bills on Congress.gov, Scout, and WestlawNext yielded 262 results. We reviewed titles and bill summaries to determine inclusion.…”

Section: Methodsmentioning

confidence: 99%

“…9 It has since evolved to often describe financing by a single public entity irrespective of the type of delivery. Table 1 shows single-payer definitions listed from narrow to broad.…”

Section: Definitionsmentioning

confidence: 99%

“…12 Tuohy suggests using the population covered, service category, and jurisdiction to describe a single-payer system within a broader hybrid. 9 White describes citizens in a geographic area, who make mandatory contributions and receive coverage for medical and hospital care. 13 Going beyond population, services, and financing, Blewett includes the possibility of simplified administration and explicit cost controls.…”

Section: Definitionsmentioning

confidence: 99%

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What is Single-Payer Health Care? A Review of Definitions and Proposals in the U.S.

Liu

Brook

2017

J GEN INTERN MED

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BACKGROUND: Single-payer systems have been proposed as a health care reform alternative in the United States. However, there is no consensus on the definition of single-payer. Most definitions characterize single-payer as one entity that collects funds and pays for health care on behalf on an entire population. Increased flexibility for state health care reform may provide opportunities for state-based single-payer systems to be considered. OBJECTIVE: To explore the concept of single-payer and to describe the contents of single-payer health care proposals. DESIGN: We compared single-payer definitions and proposals. We coded the proposal text for provisions that would change how the health care system functions and could impact health care access, quality, and cost. MAIN MEASURES: The share of proposals that include changes to the financing, pooling, purchasing, and delivery of health care; and possible impact on access, quality, and costs. KEY RESULTS: We identified 25 proposals for national or state single-payer plans from journal and legislative databases. The proposals typically call for wide-ranging reform; nearly all include changes across the financing, pooling, purchasing, and delivery of health care services. Many provisions aiming to improve access, quality, and cost containment are also included, but the proposals vary in how they plan to achieve these improvements. Common provisions are related to comprehensive benefits, patient choice of providers, little or no cost sharing, the role of private insurance, provider guidelines and standards, periodic reviews of the benefits package, electronic medical records and billing, prescription drug formulary, global budgets, administrative cost thresholds, payment reform and studies, and the authority to implement cost-containment strategies. CONCLUSIONS: Single-payer systems are heterogeneous. Acknowledgment of what is considered as singlepayer and the characteristics that are variable is important for nuanced policy discussions on specific reform proposals.KEY WORDS: health care reform; single payer; health insurance.

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Single Payers, Multiple Systems: The Scope and Limits of Subnational Variation Under a Federal Health Policy Framework

Cited by 22 publications

References 13 publications

Incremental costs of prostate cancer trials: Are clinical trials really a burden on a public payer system?

Incremental costs of prostate cancer trials: Are clinical trials really a burden on a public payer system?

Measuring parentage policy in the Canadian provinces: A comparative framework

What is Single-Payer Health Care? A Review of Definitions and Proposals in the U.S.

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