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  1. Federalism and health system reform : Prospects for state action.

    Article - En anglais

    Objective

    - To assess the prospect that the states, acting independently, would undertake health insurance coverage expansions that together would result in meaningful reductions in the extent of uninsurance nationally.

    Design

    - We use microsimulation methods to contrast the federal income tax payments needed to finance a national program covering the uninsured with the state income tax payments needed to finance a state-specific program for the same purpose.

    The contrast reveals the effects on the tax burdens of differences among states in uninsured rates and tax capacity.

    Setting

    - Continental United States.

    Patients or Other Participants

    - Observations from the 1990 through 1993 Current Population Survey (N=305 477 families), weighted to represent the population of each state.

    Intervention

    - Illustrative public health insurance program for families with incomes below 250% of poverty, not covered by current public or employer-sponsored health insurance.

    Main Outcome Measures

    - Change in percent uninsured, change in per capita total tax payments.

    Results

    - The per capita cost of a state-specific program is directly related to current uninsured rates, $130 in states with low uninsured rates (10%) to $230 in states with high uninsured rates (21%). This would represent increases in state total tax effort of 10% to 19%, respectively. (...)

    Mots-clés Pascal : Système santé, Protection sociale, Financement, Evolution, Homme, Etats Unis, Amérique du Nord, Amérique, Economie santé

    Mots-clés Pascal anglais : Health system, Welfare aids, Financing, Evolution, Human, United States, North America, America, Health economy

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0433155

    Code Inist : 002B30A01B. Création : 19/12/1997.