Health insurance claim form. Discussion of the uniform claim form for accident and health insurance as prepared by the American Medical Association.
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American Medical Association↗
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Insuring America's health. American Association of Health Plans and Health Insurance Association of America unify.
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Administrative Personnel↗
New directions for health insurance design: implications for public health policy and practice.
National attention on issues of public health preparedness necessarily brings into sharp focus the question of how to assure adequate, community-wide health care financing for preventive, acute care, and long-term medical care responses to public health threats. In the U.S., public and private health insurance represents the principal means by which medical care is financed. Beyond the threshold challenge of the many persons without any, or a stable form of, coverage lie challenges related to the structure and characteristics of health insurance itself, particularly the commercial industry and its newly emerging market of consumer-driven health plans. States vary significantly in how they approach the regulation of insurance and in their willingness to support various types of insurance markets. This variation is attributable to the size and robustness of the insurance market, the political environment, and regulatory tradition and custom. Reconciling health insurance markets with public health-related health care financing needs arising from public health threats should be viewed as a major dimension of national health reform.
Disaster Planning↗
How health insurance inhibits trade in health care.
A range of health care services are tradable, in that consumers can travel abroad for treatment. In this paper we first estimate the gains from trade. An international price comparison of fifteen procedures reveals that there could be savings of around 1.4 billion dollars annually even if only one in ten U.S. patients choose to undergo treatment abroad. We then identify a key impediment to realizing these gains: the nature of existing health insurance plans, which discriminate explicitly or implicitly against treatment abroad. We propose that coverage should be neutral to provider location and that reimbursement should include travel costs.
Commerce↗
Associations between childhood vaccination coverage, insurance type, and breaks in health insurance coverage.
OBJECTIVES: This study explored how vaccination coverage is associated with not being insured and with insurance type among children who are insured and to show how these associations are modified by race/ethnicity. METHODS: We determined whether 8324 children sampled in the National Immunization Survey in 2001 and 2002 were covered by private insurance only, Medicaid/State Children's Health Insurance Program, or another insurance type or were uninsured at the time of the National Immunization Survey interview or were uninsured at some time before the interview. Children were up to date if, by the date of the interview, their vaccination providers had administered > or =4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, > or =3 doses of polio vaccine, > or =1 dose of measles-mumps-rubella vaccine, > or =3 doses of Haemophilus influenzae type b vaccine, and > or =3 doses of hepatitis B vaccine. To evaluate the association between insurance type and breaks in insurance with timely completion of the recommended vaccination schedule soon after 19 months of age, we restricted our analyses to children 19 to 24 months of age. RESULTS: Nationally, 12.6 +/- 1.6% of all children 19 to 24 months of age were uninsured at some time. Children who were uninsured at the time of the National Immunization Survey interview had significantly lower vaccination coverage than did children with Medicaid/State Children's Health Insurance Program coverage or children with private insurance only (52.6% vs 70.0% and 75.6%). Children who had never been insured and children who were insured but had a break in insurance coverage in the 12 months immediately preceding the National Immunization Survey interview had significantly lower vaccination coverage than did children who had been insured continuously (47.4% and 64.8% vs 73.5%). CONCLUSIONS: Approximately 1 of 8 children were uninsured at some time, and those children were at greater risk of not being vaccinated on time as recommended.
Black or African American↗
Promoting private health insurance in Australia.
Health insurance policy in Australia has been distinguished by considerable instability over the past five years. This paper reviews the rationale and emerging evidence on three major policy initiatives--a move to allow selective contracting, the introduction of a 30 percent government subsidy for private health insurance, and the abolition of pure community rating. Policy making on private health insurance has been characterized by insufficient attention to research that might provide a stronger evidence basis for policy reforms.
Adolescent↗
Losing and acquiring health insurance: consequences for health care.
Data from a sample of 5530 Nebraska adults under age 65 are used to analyze the independent correlates of four different insurance statuses: insured 12 consecutive months, uninsured 12 consecutive months, insured at the end of a 12 month period, but not throughout, and uninsured at the end of a 12 month period, but not throughout. The effects of insurance status on utilization of health care services when perceived to be needed are assessed, controlling for demographic explanations. The results show that uninsurance status, whether long-lasting or recent, indicates lower utilization than being insured. Policies designed to expand the number of persons with insurance, especially those linked to practices of insurers, are predicted to have little impact since the underlying causes of uninsurance are related to household income. Lower use of health care services among the uninsured is thought to present financial problems to providers, since the uninsured who do seek care are more likely to need more services (without paying). Problems of higher cost to treat these individuals also present problems for public policies that in effect create subsidies to expand the number of insured. Finally, this study indicates that incremental policy approaches may not deal adequately with the fundamental problems that result in increases in the number of uninsured Americans and caring for their health care needs.
Adolescent↗
[Cooperation between the public health office and federal health insurance in the area of health promotion].
During the last few years several health projects were realised in cooperation with health insurance societies. One of the projects concerned the sports possibilities for people suffering from chronic diseases. Another one supplied information on symptoms of cardiac infarction. Cholesterol levels were analysed, height an body weight were determined and blood pressure was measured. Additionally, several data on anamnesis were stored anonymously as data files. One of the projects was performed with a normal part of the population in the office of a bank. During this arrangement many young people were also examined. Another event was a "doctor-patient-seminar" on the subject of cardiac infarction. We wanted to demonstrate a few interesting differences between the two groups that were examined. We found a circadian difference in the means of blood samples taken at 1-hour intervals, in respect of the cholesterol levels, the time difference being approximately two hours after the last ingestion. The cooperation with health insurance societies is a good possibility in view of the difficult situation of local or communal finances, to realise health education projects with financial support by health insurance societies. The statistical difference between the two examined populations for special risks shows that population groups with coronary insults in their anamnesis and hence treated "on target", yield statistically significantly better results in respect of cholesterol, systolic and diastolic blood pressure, than the group defined as a normal population.
Adult↗
Why some countries have national health insurance, others have national health services, and the U.S. has neither.
This article presents a discussion of why some capitalist developed countries have national health insurance schemes, others have national health services, and the U.S. has neither. The first section provides a critical analysis of some of the major answers given to these questions by authors belonging to the schools of thought defined as 'public choice', 'power group pluralism' and 'post-industrial convergence'. The second section puts forward an alternative explanation rooted in an historical analysis of the correlation of class forces in each country. The different forms of funding and organization of health services, structured according to the corporate model or to the liberal-welfare market capitalism model, have appeared historically in societies with different correlations of class forces. In all these societies the major social force behind the establishment of a national health program has been the labor movement (and its political instruments--the socialist parties) in its pursuit of the welfare state. In the final section the developments in the health sector after World War II are explained. It is postulated that the growth of public expenditures in the health sector and the growth of universalism and coverage of health benefits that have occurred during this period are related to the strength of the labor movement in these countries.
Capitalism↗
The functions and structure of a national health insurance system evaluation component. APA Task Force on Continuing Evaluation in National Health Insurance.
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Consumer Behavior↗
Contracting with limited commitment: evidence from employment-based health insurance contracts.
Impediments to worker mobility serve to mitigate the attrition of healthy individuals from employer-sponsored insurance pools, thereby creating a de facto commitment mechanism that allows for more complete insurance of health risks than would be possible in the absence of such frictions. Using data on health insurance contracts obtained from the 1987 National Medical Expenditure Survey, we find that the quantity of insurance provided is positively related to the degree of worker commitment. These results illustrate the importance of commitment in the design of long-term contracts, and provide an additional rationale for the bundling of health insurance with employment.
Career Mobility↗
Psychotherapy and health insurance.
The Australian health insurance industry has been critical of psychiatry. The data on patterns of claims which have been the focus for some of their concerns are reviewed. The evidence on the efficacy of psychotherapy is also reviewed. Psychotherapy has been shown to be an effective treatment for persons with incapacitating neurotic and personality disorders, a treatment too important to be endangered by dissent over health insurance payments. Proposals for a peer review process for long term psychotherapy are mooted in the expectation that agreement between the health insurance industry and psychiatry would benefit those patients in need of psychotherapy.
Australia↗
The economics of health insurance plan design.
In developing insurance products, health insurers have often failed to incorporate member-level economic decision making into the underlying plan design. Instead, health insurers have either completely isolated members from economic choices within a restricted network or simply shifted costs without providing members with an opportunity to more efficiently purchase health care services. In either approach, the plan designs do not provide members with a rational economic framework to make efficient health care purchases. In order to analyze the economic framework in traditional plan designs, this article first outlines the characteristics of an efficient economic transaction and then compares these characteristics with traditional insurance plans. The article concludes by suggesting new plan designs that achieve more economically efficient outcomes through the application of episode of care technology.
Decision Making↗
Integration of economic appraisal and health care policy in a health insurance system; the Dutch case.
This article discusses the role of economic appraisal in insurance based health care systems, taking the case of the Netherlands as an example. The public health insurance system in this country is governed by the Health Insurance Executive Board, which policies are firmly based on the results of economic appraisal. Furthermore, reimbursement policies regarding pharmaceutical products are described, emphasizing again the position of information from economic appraisal in these policies. The article concludes with the identification of some trends in health policy and in the way it is supported by economic appraisal studies.
Cost-Benefit Analysis↗
Wide CEO support for universal health insurance.
How do health care CEOs feel about universal health insurance? The time is ripe for universal health insurance funded by both government and business, according to 70 percent of responding hospital CEOs. But the majority are against a Canadian-type program that would be funded exclusively by government.
Attitude of Health Personnel↗
Future prospects of voluntary health insurance in Thailand.
Voluntary health insurance schemes in Thailand are still under development and have yet to seriously address the questions of equity and efficiency, while private health insurance is limited to people who can afford the premium. One form of insurance, commonly known as the health insurance card scheme, was first introduced as the Health Card Program in 1983. This program is based on risk sharing of health expenditures, with no cost sharing, in a voluntary health insurance prepayment scheme. With the uncertain performance of the Thai economy, program sustainability and the efficient use of resources are major concerns. The Health Card Program needs enough enrollees to ensure a sufficient pool of risks. This study looks at health card purchase and utilization patterns, using data from Khon Kaen Province, and finds that employment, education levels and the presence of illness are significant factors influencing card purchase. The last factor is related to the problem of adverse selection of the program; families with symptoms of sickness are more likely to buy cards, resulting in greater use of health services. The results also show an improvement in accessibility to health care and a high level of satisfaction among card holders, both key objectives of the program. It is suggested that changes in the health card system could enable it to evolve into a community-based compulsory health insurance scheme for rural areas.
Adolescent↗
Mandated mental health benefits in private health insurance.
Eleven states mandate coverage of inpatient and outpatient mental health care in private health insurance. Health insurers have objected to these laws on the grounds that they interfere with consumer choice of health insurance benefits and are too costly. This paper analyzes the benefits and costs of mandates for psychotherapy. The potential benefits considered have to do with adverse selection in insurance markets and the offset effects of psychotherapy. Arguments based on economic efficiency are presented to justify the possible appropriateness of overriding individuals' choice of health insurance benefits. Mandates are estimated econometrically to increase the cost of psychotherapy in a state by about 10-20 percent. We conclude that mandates for mental health benefits in private health insurance may be reasonable state policy.
Actuarial Analysis↗
Making health insurance work for the poor: learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India.
How best to provide effective protection for the poorest against the financial risks of ill health remains an unanswered policy question. Community-based health insurance (CBHI) schemes, by pooling risks and resources, can in principal offer protection against the risk of medical expenses, and make accessible health care services that would otherwise be unaffordable. The purpose of this paper is to measure the distributional impact of a large CBHI scheme in Gujarat, India, which reimburses hospitalization costs, and to identify barriers to optimal distributional impact. The study found that the Vimo Self-employed Women's Association (SEWA) scheme is inclusive of the poorest, with 32% of rural members, and 40% of urban members, drawn from households below the 30th percentile of socio-economic status. Submission of claims for inpatient care is equitable in Ahmedabad City, but inequitable in rural areas. The financially better off in rural areas are significantly more likely to submit claims than are the poorest, and men are significantly more likely to submit claims than women. Members living in areas that have better access to health care submit more claims than those living in remote areas. A variety of factors prevent the poorest in rural and remote areas from accessing inpatient care or from submitting a claim. The study concludes that even a well-intentioned scheme may have an undesirable distributional impact, particularly if: (1) the scheme does not address the major barriers to accessing (inpatient) health care; and (2) the process of seeking reimbursement under the scheme is burdensome for the poor. Design and implementation of an equitable scheme must involve: a careful assessment of barriers to health care seeking; interventions to address the main barriers; and reimbursement requiring minimum paperwork and at the time/place of service utilization.
Community Health Planning↗