Simple fairness: ending discrimination in health insurance coverage of addiction treatment.
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This research uses a nationally representative sample of 1,425 low-income elders from the 1987 National Medical Expenditure Survey (NMES) to assess the independent and interaction effects of health insurance coverage and residence on the use of seven health care services: doctor visits, visits to other personnel, telephone contact, emergency room visits, overnight hospital stays, outpatient visits, and prescription medicines. It is hypothesized that (a) elders without insurance to supplement Medicare; (b) those who lived in nonmetropolitan areas use fewer health services; and (c) insurance status and residence interact to influence use of health services, with nonmetropolitan elders using fewer services than those living in metropolitan areas, regardless of insurance type. Using multivariate statistical analyses with both main effects and interaction term models, the data indicate that the type of insurance that low-income elders have is associated with their use of health services, and that residence has only modest effect. Individuals who have Medicaid, and to a lesser extent private supplements, use services more frequently than do those without supplements. Finally, despite the hypothesis, residence does not interact with insurance status in influencing use of services; the relationship between insurance and use of services does not vary across area of residence. The data suggest that the ability to pay, rather than supply constraints associated with nonmetropolitan areas, are of primary importance in determining health care use among low-income elders.
This analysis of private health insurance plans offered in 100 four-year colleges and universities in 1988 indicates a tremendous diversity in plan options, benefits covered, cost-sharing requirements, and catastrophic protections. Consistent with relatively low premium prices, most student health insurance plans offer limited benefits and expose students to significant out-of-pocket medical cost liabilities. Only a minority of schools use financial incentives, such as preferred provider arrangements, to integrate their health insurance plans with their university health service system. We conclude that universities should carefully reexamine the adequacy of their health insurance plans and their relationship to student health centers. As more students rely on student health insurance as their only source of coverage, the quality of these plans assumes an even greater importance.
There are practical proposals now on the public policy table to reduce the number of Americans without health coverage. While they won't make health care free or eliminate the forty million uninsured persons, they would help millions of Americans acquire or improve their health insurance. Practical strategies can also be taken to address access issues for unhealthy persons in the nongroup market through federal assistance to states to establish and improve state high-risk health insurance pools, as well as to make health insurance more affordable for low-income Americans.
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Despite a booming U.S. economy, falling unemployment and moderate health insurance premium growth, the percentage of working Americans and their families with employer-sponsored health insurance failed to increase substantially between 1997 and 2001, according to findings from the Center for Studying Health System Change (HSC) Community Tracking Study Household Survey. There were, however, dramatic changes in the insurance status of people who lacked access to or did not take up employer coverage: fewer uninsured, more public program enrollment and a decline in coverage by individual insurance and other sources. While the State Children's Health Insurance Program (SCHIP) clearly reduced uninsurance among low-income children, evidence also suggests a fair amount of substitution of public insurance for private coverage.
The effectiveness of treatment for depression is not in doubt, and common humanity would indicate that it should be provided to those that need it. However, in this paper I argue that the existence of effective treatment should not be regarded as a sufficient condition for the extension of insurance cover. This is because insurance coverage cannot guarantee that treatment is delivered effectively, nor that it is given to the right people; neither does it lend itself to the maximization of cost-effectiveness. Payment systems must take account of these considerations.
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As the number and cost of new technologies grow, it is increasingly important that we develop sound policies for payment for those technologies while their clinical impacts are being defined. Such policies need to balance social interests in promotion of innovation, early access to promising technology, patient safety, control of health care costs, and return on investment. We present a rationale, policy options, and a proposal for insurance coverage of experimental technology.
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