RESUMEN
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 single-payer and the characteristics that are variable is important for nuanced policy discussions on specific reform proposals.
Asunto(s)
Reforma de la Atención de Salud/clasificación , Patient Protection and Affordable Care Act/clasificación , Sistema de Pago Simple/clasificación , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/métodos , Humanos , Seguro de Salud , Patient Protection and Affordable Care Act/economía , Sistema de Pago Simple/economía , Estados UnidosAsunto(s)
Atención a la Salud , Reforma de la Atención de Salud , Atención a la Salud/clasificación , Atención a la Salud/economía , Atención a la Salud/legislación & jurisprudencia , Economía , Reforma de la Atención de Salud/clasificación , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/legislación & jurisprudencia , Humanos , Atención al Paciente , Política , Terminología como AsuntoRESUMEN
As mudanças contemporâneas produzidas pelas novas políticas de saúde mental colocam como desafio central a construção de serviços substitutivos ao hospital, desenvolvidos no contexto da atenção na comunidade. Tal desafio exige um complexo conjunto de condições que implicam, dentre outros fatores, no desenvolvimento de uma nova cultura ética e técnica capaz de criar respostas inovadoras para atenção às pessoas com transtornos mentais. É nesse cenário que se deve discutir a pertinência e a importância do projeto elaborado por Thornicroft e Tansella no "Modelo de Matriz" que é apresentado neste artigo. Nele os autores trazem contribuições fundamentais para alicerçar a nova cultura de serviços e formação profissional pretendidas pelo processo de reforma psiquiátrica. Este modelo pode ser utilizado no planejamento, avaliação e modelagem dos serviços além de trazer instrumentos úteis para a pesquisa em serviços de saúde mental.
The contemporary changes produced by the new mental health policies place as main challenge the construction of substitutive services to hospital, developed in the context of care in the community. This challenge requires a complex set of conditions involving, among other factors, the development of a new ethical and technical culture able to create innovative responses to care of people with mental disorders. It is in this scenario that we must discuss the relevance and importance of the project developed by Thornicroft and Tansella, "The Matrix Model", presented in this paper. There, the authors bring fundamental contributions to underpin the new culture of services and professional training sought by the process of psychiatric reform. This model can be used in planning, evaluation and modeling of services; in addition, it can bring useful tools to the research in mental health services.