Health insurance of minorities in the United States.
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Biomedical subjects
Publications and source records attributed to P F Short.
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Determinants of health insurance choices are estimated from a logit model and data from the National Medical Care Expenditure Survey. Employees offered a choice between traditional health insurance plans chose the high option and the low option in roughly equal numbers. About a quarter of the employees who were offered enrollment in an HMO selected the HMO in preference to a traditional plan. Prices figured significantly in both types of decisions, with the choice between traditional plans about twice as sensitive to prices as the decision to enroll in an HMO. Comprehensive hospital benefits and superior catastrophic protection also appeared to be important factors in the choice of health insurance plans.
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This longitudinal study examines transitions on and off Medicaid in the 1984 Panel of the Survey of Income and Program Participation. A majority of those enrolled at the outset, but just 43% of those enrolled at any time during the 32-month survey, remained on Medicaid throughout. While slightly less than half of those departing the program subsequently enjoyed improved employment, private insurance, and higher incomes, nearly half were still poor and 55% became uninsured, indicating that persons who lost their Medicaid cards were in real danger of being without insurance and financial access to health care--a serious disincentive to get off welfare.
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Recent Medicare buy-in proposals agree on setting eligibility at age sixty-two but disagree on linking eligibility to loss of employer insurance or ability to pay. We examine arguments for targeting incremental coverage for older Americans in these ways. While access to retiree health insurance is declining, we question whether targeting loss of employer insurance can address many older Americans' insurance problems. Furthermore, focusing on persons ages sixty-two to sixty-four misses a large group of persons in poor health with limited resources. Efforts to improve coverage for older Americans should consider trade-offs between defining eligibility by age versus ability to pay.
Self-reported health status measures from the 1987 National Medical Expenditure Survey indicate significant differences among each of five population groups defined by current health insurance coverage. These differences in health status imply that the groups are likely to exhibit different patterns of expenditures, even if enrolled in the same health insurance after health care reform. The healthiest group along most dimensions is the population covered by employer-sponsored insurance, followed in order by the population with nongroup private insurance, the uninsured population, the population that qualifies for public coverage based on income, and the population that qualifies for public coverage based on medical need. While the general health and mental health of the uninsured are slightly worse in comparison to the privately insured, the uninsured have fewer chronic health problems. The uninsured who recently lost private insurance or who live in working families are significantly healthier than the long-term or low-income and nonworking uninsured.