The Jimmy Carter UFO incident was an incident in which Jimmy Carter (US President 1977-1981) reported seeing an unidentified flying object while at Leary, Georgia, in. The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States. Key People-President Barack Obama Obama for America, One Prudential Plaza, Chicago, IL 2008 campaign organization (page updated and corrected March 26, 2014). Assistant Professor and Associate Director for Research, National Security Studies Institute. Damien Van Puyvelde is an Assistant.Management Team - NATIONAL BUSINESS AND TECHNICAL EXAMINATIONS BOARDPROF. IFEOMA MERCY ISIUGO- ABANIHE. IBIDAPO, ILESANMI OLABODE. HOD, Research & Quality Assurance. ALH. HOD, Examinations Development. MR. ADEYEMI MICHAEL ADEMOLA. HOD, Finance & Accounts. PROF. IFEOMA MERCY ISIUGO- ABANIHEProfessor Ifeoma Mercy Isiugo- Abanihe is the new Registrar and Chief Executive of the National Business and Technical Examinations Board (NABTEB), Benin City. Prior to her appointment by the Federal Government on August 0. Director, Institute of Education, University of Ibadan, Ibadan, where she had served as an academic staff for over twenty- three years. Ifeoma Isiugo- Abanihe is a professor of Language Education and Educational Evaluation. She obtained her Bachelor’s degree in English Language/Communication and Master’s degree in Educational Administration from Temple University, Philadelphia, USA, and Ph. D in Educational Evaluation from the International Centre for Educational Evaluation, Institute of Education, University of Ibadan, Ibadan, Nigeria. Ifeoma Isiugo- Abanihe has several academic and professional awards, including the British Council Cheevening Scholarship; Research Fellowship on Gender and Women’s Studies, sponsored by CIDA, Canada, and research award as Principal Investigator for an in- school and out- of- school sexuality/reproductive health study among adolescents in oil- producing communities, sponsored by the Mac. Arthur Foundation. Arising from her research activities, Prof. National Headquarters, No. 1, Benin-Agbor Road Ikpoba Hill, P.M.B 1747, Benin-City, Edo State, Nigeria T: +2348078840770. Suggested Citation: '5 Potassium.' Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National. Isiugo- Abanihe has been a visiting scholar at the University of Manchester, United Kingdom, Mount Saint Vincent University, Halifax and Dalhousie University, Canada. In addition to her academic and professional teachers’ certificates, Prof. Ifeoma Isiugo- Abanihe possesses other qualifications, including certificates in Youth leadership, sexuality and reproductive health from CEDPA, Washington, USA; Gender and Women Studies from the Summer Institute for Gender and Development, Canada; Women, Literacy and Development from the University of Manchester, Certificate on Monitoring and Evaluation from Philber Associates, USA, etc. She is actively involved in research networks and study teams such as the Ibadan Social and Evaluation Research Team. As an educational Consultant, Professor Ifeoma Isiugo- Abanihe has served as National/Lead Research Consultant to several government and non- governmental organizations, including the British Council, UNFPA, UNAIDS, UNICEF, Federal Ministry of Education, Federal Ministry of Women Affairs, National Examinations Council (NECO), UBE, etc. In the area of public examination, she, as Deputy Director, coordinated the writing of the report on NECO’s study on National Assessment for Educational Performance; and is involved as a Lead Resource Person in UBEC’s National Assessment for Learning Achievements in Basic Education (NALABE). Ifeoma Isiugo- Abanihe has taught several courses in Educational Evaluation, including Observational Techniques, Principles of Test Construction, Programme Evaluation, Curriculum Evaluation, Public Examining and Qualitative Research; in Communication and Language Arts, she has taught courses with the following titles: Readability and Style, Psycholinguistics and Reading, and Technical Writing, Skills Acquisition in Arts and Languages, Language Arts Methods, etc. Professor Ifeoma Isiugo- Abanihe has supervised more than thirty Master and Ph. D projects and thesis. She is a prolific writer with fifty published books, chapters and articles in learned journals, and belongs to professional associations relevant to her discipline. At the University of Ibadan, she served two terms as Sub- Dean (Post graduate) for the Institute of Education, Coordinator, Women’s Research and Documentation Centre (WORDOC); a member of the University Senate and member of several committees, including the Committees on Lecture method in the university, Committee on Evaluation of the University of Ibadan Commercial Enterprises, among others. BOROKINNI, OLUBUNMI JOSEPH Mr. Borokinni, Olubunmi Joseph was born at Ijare in Ifedore L. G. A. Peter’s Pry School, Ijare between 1. Anglican Grammar School, Ijare between 1. Division one, University of Nigeria, Nsukka 1. BSc in Computer Science; Obafemi Awolowo University, Ile- Ife, 1. Master’s Degree with Distinction in Computer Science. Prior to joining NABTEB, he was an IT Trainer with Shell Petroleum Development Company (SPDC) 1. Financial Institutions Training Centre (FITC) as Senior Manager 1. University of Ilorin as a Computer Analyst I 1. Since he joined National Business & Technical Examinations Board in 1. Deputy Director in the Department of ICT, he has served in several committees as a member or chairman. In 2. 00. 9 he was appointed Acting Head of Department of ICT. In this capacity, he has brought in professionalism to ICT development by computerizing a number of functions using in- house programmers and introduced efficiency to the workplace. Borokinni became Director (ICT) on the 1st of January 2. In 2. 00. 6- 2. 00. Volunteer Expatriate Lecturer in the Department of Computer Science, University of Gondar, Ethiopia. He has travelled extensively in Nigeria, Ghana, Ethiopia, Kenya, Philippines, Kazakhstan and the UK and he has written several papers in ICT and Training in Local and International Journals. He is a Member of Computer Professional Registration Council of Nigeria and Nigeria Computer Society. MALLAM BELLO ADAMU Mallam Bello Adamu was born to the family of Late Mallam & Mrs Bello of Eneye Omeiza Compound, Okene in Okene Local government Area, Kogi State on November 2. He attended L. E. A Primary School Sabon- Gari, Kaduna (1. Lafiagi Teacher’s College, Ilorin, Kwara State (1. Teachers’ Grade II Certificate; Federal College of Education, Katsina, Katsina State (1. Nigeria Certificate in Education (NCE); Ahmadu Bello University, Zaria, Kaduna State (1. Bachelor of Science Degree in Physical/Health Education; Kogi State Polytechnic, Lokoja, Kogi State (1. Higher Diploma in Public Accounting & Auditing; before proceeding to University of Ado- Ekiti, Nigeria (2. Masters in Public Administration (MPA)Degree. After twenty- five (2. Kogi State Universal Basic Education Board, Mallam Bello assumed duty with the Board on 3. May, 2. 00. 6 as Deputy Director, Administration in the Administration Department before his transfer to the Registrar’s Office as Deputy Director (Special Duties) in 2. Mallam Bello is a member of several professional organizations. He is a fellow, Institute of Industrialist and Corporate Administrators (FIICA). Fellow, Institute of Corporate Administrators of Nigeria (FICA)Member, Nigeria Institute of Management (MNI)The Governing Board at its 4. Regular Meeting approved the appointment of Mallam Bello Adamu as Director. He was subsequently deployed to Head the Department of Administration. DR. OPARADeacon Obinna hails from Nguru, Aboh Mbaise in Imo State. He started his academic voyage at Community Primary School Obibi Nguru in Aboh Mbaise Local Government Area of Imo State and proceeded to acquire a secondary school education at Community secondary school Amuzi Ahiara. He obtained a Bachelor of Science in Economics from University of Calabar, a Post Graduate Diploma in Education from the University of Port Harcourt, a Masters degree in Education (Management and Planning), University of Science and Technology Portharcourt. A Masters degree in Public Administration (MPA) from the University of Calabar and a Doctorate degree in Educational Administration from the University of Port Harcourt. He is a member of some Professional Bodies including Nigerian Institute of Management (NIM) and the Chartered Institute of Personnel Management of Nigeria (CIPMN). MR. He also schooled in the University of Benin, Benin City where he obtained Masters of Education (M. Ed) in Measurement and Evaluation. He equally attended the prestigious Interlink College of Technology and Business Studies, South- East London, where he obtained eight (8) professional Certificates amongst which are: Certificate as Internal Quality Assurance Manager in leading Quality Assurance and Assessment Processes/Practice and Award in Assessing Competence in the Work Environment. He has had above 3. Corporate Management. IBI, as he is fondly called by his admirers, is a versatile, mentor, dynamic, pragmatic and visionary leader. No wonder he has been rewarded for his hard work and competency in all his endeavours. Moreover, NABTEB in her pioneering effort at institutionalization of the National Vocational Qualifications Framework (NVQF) in Nigeria while partnering with other relevant bodies seconded him for training in the United Kingdom (UK). He has attended many seminars/workshops both within and outside Nigeria and has above 3. He has contributed immensely to the popularization of Technical and Vocational Education and Training (TVET) at various fora and has served severally in many National committees. In recognition of Mr. JIMOH ADEWOLA KASALI(NCE; B. Ed; M. Ed; PGDCS; m. MAN; m. STAN; TRCN)Alh. KASALI is the Acting Head of Examinations Development Department, National Business and Technical Examinations Board (NABTEB) Benin City. He was born on 3rd February 1. Kisi in Irepo Local Government Area of Oyo State, Nigeria. He accomplished his Education at Irepo Grammar School Igboho (1. He is given letter of commendation for his outstanding academic performance at the defunct Oyo State College of Education Ila- Orangun, Osun State (1. University of Benin (1. Alh. Kasali graduated in 1. Bachelor of Education (Science) in Mathematics with Second Class Upper Division from University of Benin, he obtained M. Ed (Measurement and Evaluation) 1. Post Graduate Diploma in Computer Science 2. Alma mater. His professional career started in 1. Federal Ministry of Education where he taught in various Federal Government Unity Schools across the country till 1. Lessons for Health Reform in the United States. Am J Public Health. January; 9. 3(1): 3. Rodwin is with the Wagner School, New York University, New York, NY, and the World Cities Project, New York, a joint venture of NYU Wagner and the International Longevity Center- USA. Requests for reprints should be sent to Victor G. Rodwin, Ph. D, MPH, 4 Washington Sq North, New York, NY 1. Accepted September 1. Copyright . Although the system is far from perfect, its indicators of health status and consumer satisfaction are high; its expenditures, as a share of gross domestic product, are far lower than in the United States; and patients have an extraordinary degree of choice among providers. Lessons for the United States include the importance of government’s role in providing a statutory framework for universal health insurance; recognition that piecemeal reform can broaden a partial program (like Medicare) to cover, eventually, the entire population; and understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market. THE FRENCH HEALTH CARE system has achieved sudden notoriety since it was ranked No. World Health Organization in 2. Although the methodology used by this assessment has been criticized in the Journal and elsewhere,2–5 indicators of overall satisfaction and health status support the view that France’s health care system, while not the best according to these criteria, is impressive and deserves attention by anyone interested in rekindling health care reform in the United States (Table 1 . French politicians have defended their health system as an ideal synthesis of solidarity and liberalism (a term understood in much of Europe to mean market- based economic systems), lying between Britain’s “nationalized” health service, where there is too much rationing, and the United States’ “competitive” system, where too many people have no health insurance. This view, however, is tempered by more sober analysts who argue that excessive centralization of decisionmaking and chronic deficits incurred by French national health insurance (NHI) require significant reform. Health Status and Consumer Satisfaction Measures: France, United States, Germany, United Kingdom, Japan, and Italy. Over the past 3 decades, successive governments have tinkered with health care reform; the most comprehensive plan was Prime Minister Jupp. This strategy has exacerbated tensions among the state, the NHI system, and health care professionals (principally physicians), tensions that have long characterized the political evolution of French NHI. Although the French ideal is now subject to more critical scrutiny by politicians, the system functions well and remains an important model for the United States. After more than a half century of struggle, in January 2. France covered the remaining 1% of its population that was uninsured and offered supplementary coverage to 8% of its population below an income ceiling. This extension of health insurance makes France an interesting case of how to ensure universal coverage through incremental reform while maintaining a sustainable system that limits perceptions of health care rationing and restrictions on patient choice. Following an overview of the system, and an assessment of its achievements, problems, and reform, this article explores lessons for the United States of the French experience with NHI. THE FRENCH HEALTH CARE SYSTEMThe French health care system combines universal coverage with a public–private mix of hospital and ambulatory care, higher levels of resources (Table 2 . All residents are automatically enrolled with an insurance fund based on their occupational status. In addition, 9. 0% of the population subscribes to supplementary health insurance to cover other benefits not covered under NHI. Another distinguishing feature of the French health system is its proprietary hospital sector, the largest in Europe, which is accessible to all insured patients. Finally, there are no gatekeepers regulating access to specialists and hospitals. French NHI evolved from a 1. World War II system of local democratic management by “social partners”—trade unions and employer representatives—but it is increasingly controlled by the French state. Although NHI consists of different plans for different occupational groups, they all operate within a common statutory framework. Health insurance is compulsory; no one may opt out. Health insurance funds are not permitted to compete by lowering health insurance premiums or attempting to micromanage health care. For ambulatory care, all health insurance plans operate on the traditional indemnity model—reimbursement for services rendered. For inpatient hospital services, there are budgetary allocations as well as per diem reimbursements. The French indemnity model allows for direct payment by patients to physicians, coinsurance, and balance billing by roughly one third of physicians. Like Medicare in the United States, French NHI provides a great degree of patient choice. Unlike Medicare, however, French NHI coverage increases as individual costs rise, there are no deductibles, and pharmaceutical benefits are extensive. In contrast to Medicaid, French NHI carries no stigma and provides better access. In summary, French NHI is more generous than what a “Medicare for all” system would be like in the United States, and it shares a range of characteristics with which Americans are well acquainted—fee- for- service practice, a public–private mix in the financing and organization of health care services, cost sharing, and supplementary private insurance. NATIONAL HEALTH INSURANCENHI evolved, in stages, in response to demands for extension of coverage. Following its original passage in 1. NHI program covered salaried workers in industry and commerce whose wages were under a low ceiling. In 1. 94. 5, NHI was extended to all industrial and commercial workers and their families, irrespective of wage levels. The extension of coverage took the rest of the century to complete. In 1. 96. 1, farmers and agricultural workers were covered; in 1. NHI should be universal. Not until January 2. France. 4. 0NHI forms an integral part of France’s social security system, which is typically depicted—following an agrarian metaphor—as a set of 3 sprouting branches: (1) pensions, (2) family allowances, and (3) health insurance and workplace accident coverage. The first 2 are managed by a single national fund, while the third is run by 3 main NHI funds: those for salaried workers (Caisse Nationale d’Assurance Maladie des Travailleurs Salari. In addition, there are 1. The CNAMTS covers 8. France, which includes salaried workers, those who were recently brought into the system because they were uninsured, and the beneficiaries of 7 of the smaller funds that are administered by the CNAMTS. The CANAM and MSA cover, respectively, 7% and 5% of the population, with 4% covered by the remaining 4 funds. All NHI funds are legally private organizations responsible for the provision of a public service. In practice, they are quasi- public organizations supervised by the government ministry that oversees French social security. The main NHI funds have a network of local and regional funds that function somewhat like fiscal intermediaries in the management of Medicare. They cut reimbursement checks for health care providers, look out for fraud and abuse, and provide a range of customer services for their beneficiaries. French NHI covers services ranging from hospital care, outpatient services, prescription drugs (including homeopathic products), thermal cures in spas, nursing home care, cash benefits, and to a lesser extent, dental and vision care. Among the different NHI funds, there remain small differences in coverage. Smaller funds with older, higher- risk populations (e. CNAMTS, as well as by the state, on grounds of what is termed “demographic compensation.” Retirees and the unemployed are automatically covered by the funds corresponding to their occupational categories. In France, the commitment to universal coverage is accepted by the principal political parties and justified on grounds of solidarity—the notion that there should be mutual aid and cooperation between the sick and the well, the active and the inactive, and that health insurance should be financed on the basis of ability to pay, not actuarial risk. ORGANIZATION OF HEALTH CAREThe organization of health care in France is typically presented as being rooted in principles of liberalism and pluralism. Liberalism is correctly invoked as underpinning the medical profession’s attachment to cost sharing and selected elements of la m. It is wrongly invoked, however, in the case of fee- for- service payment with reimbursement under universal NHI, for such a system is more aptly characterized as a bilateral monopoly whereby physician associations accept the monopsony power of the NHI system in return for the state’s sanctioning of their monopoly power. In the hospital sector, liberalism provides the rationale for the coexistence of public and proprietary hospitals, the latter accounting for 2. France in contrast to 1. United States (Table 2 . Also, unit service chiefs in public hospitals have the right to use a small portion of their beds for private patients. The French tolerance for organizational diversity—whether it be complementary, competitive, or both—is typically justified on grounds of pluralism. Although ambulatory care is dominated by office- based solo practice, there are also private group practices, health centers, occupational health services in large enterprises, and a strong public sector program for maternal and child health care. Likewise, although hospital care is dominated by public hospitals, including teaching institutions with a quasi- monopoly on medical education and research, there are, nevertheless, opportunities for physicians in private practice who wish to have part- time hospital staff privileges in public hospitals.
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