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PubMed1999

Donor and the health insurance card.

The health insurance card is a new electronic identification document of insured persons and facilitates smoother communication between the health insurance information system and the Slovene health care service provider information systems. The card stores the insured person's identification details as well as the information on the selected personal physician. Another procedure also to be hosted on the card, will be the card holder's personal decision about being voluntary donor of organs and tissues for transplant purposes. This data item will, supported by the enhancement of technological infrastructure, improve the control of the donorship information. In Slovenia, registering, recording and application of the organ and tissue donorship data is carried out, on a pilot basis, in the region of Posavje.

Humans↗
PubMed2004

How much might universal health insurance reduce socioeconomic disparities in health? : A comparison of the US and Canada.

A strong association between lower socioeconomic status and worse health has been documented within many countries, but little work has been done to compare the strength of this relationship across countries. We compare the strength of the relationship between income and self-reported health in the US and Canada. We find that being below median income raises the likelihood that a middle-aged person is in poor or fair health by about 15 percentage points in the US, compared with less than 8 percentage points in Canada. We also find that this 7 percentage points stronger relationship between low income and poor health in the US compared with Canada is reduced by about 4 percentage points after age 65, the age at which virtually all US citizens receive basic health insurance through the Medicare programme. Income differences in the probability that an individual lacks a usual source of care are also significantly larger in the US than in Canada before the age of 65, but about the same after age 65. Our results are therefore consistent with the theory that the availability of universal health insurance in the US, or at least some other difference that occurs around the age of 65 in one country but not the other, decreases the difference in the strength of the income-health relationship in the US compared with Canada.

Adult↗
PubMed1997

Health insurance portability for group health plans--IRS. Notice of proposed rulemaking by cross-reference to temporary regulations.

Elsewhere in this issue of the Federal Register, the IRS is issuing temporary regulations relating to group health plan portability, access, and renewability requirements added to the Internal Revenue Code by section 401 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The IRS is issuing the temporary regulations at the same time that the Pension and Welfare Benefits Administration of the U.S. Department of Labor and the Health Care Financing Administration of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations relating to the group health plan portability, access, and renewability requirements added by HIPAA to the Employee Retirement Income Security Act of 1974 and the Public Health Service Act. The temporary regulations provide guidance to employers and group health plans relating to the obligation of plans to comply with new requirements relating to preexisting condition exclusions, discrimination based on health status, access to coverage, and other requirements. The text of those temporary regulations also serves as the text of these proposed regulations.

Career Mobility↗
PubMed2007

The effects of Taiwan's National Health Insurance on access and health status of the elderly.

The primary objective of this paper is to evaluate the impact of Taiwan's National Health Insurance program (NHI), established in 1995, on improving elderly access to care and health status. Further, we estimate the extent to which NHI reduces gaps in access and health across income groups. Using data from a longitudinal survey, we adopt a difference-in-difference methodology to estimate the causal effect of Taiwan's NHI. Our results show that Taiwan's NHI has significantly increased utilization of both outpatient and inpatient care among the elderly, and such effects were more salient for people in the low- or middle-income groups. Our findings also reveal that although Taiwan's NHI greatly increased the utilization of both outpatient and inpatient services, this increased utilization of health services did not reduce mortality or lead to better self-perceived general health status for Taiwanese elderly. Measures more sensitive than mortality and self-perceived general health may be necessary for discerning the health effects of NHI. Alternatively, the lack of NHI effects on health may reflect other quality and efficiency problems inherent in the system not yet addressed by NHI.

Aged↗
PubMed1994

Job loss due to health insurance mandates.

The proposed Health Security Act provides universal health insurance by extending the current employer-based health insurance financing system. It requires employers to pay approximately 80% of the health insurance premium for each of their workers. Experience with other legislation requiring employers to provide benefits to their employees indicates that most of the cost of a mandated benefit is shifted to employees in the form of lower wages. However, for workers without health insurance and with earnings close to the minimum wage, minimum-wage legislation prohibits employers from lowering wages in response to a health insurance mandate. These employers can be expected to respond by cutting employment. Recent evidence from employer reactions to increases in the minimum wage suggests that approximately 100,000 jobs would be lost due to the Health Security Act's employer mandate.

Employment↗
PubMed1997

Health insurance reform legislation.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), enacted on August 21, 1996 (Public Law 104-19), provides for improved access and renewability with respect to employment-related group health plans, to health insurance coverage sold in connection with group plans, and to the individual market (by amending the Public Health Service Act). The Act's provisions include improvements in portability and continuity of health insurance coverage; combatting waste, fraud, and abuse in health insurance and health care delivery; promoting the use of medical savings accounts; improving access to long-term care services and insurance coverage; administrative simplification; and addressing duplication and coordination of Medicare benefits.

Career Mobility↗
PubMed1983

Medicare program, services covered under automobile medical, no-fault, or liability insurance; services furnished to ESRD beneficiaries who are covered under employer group health insurance--Health Care Financing Administration. Final rule.

These regulations set forth policies and procedures on coverage of services that are reimbursable under automobile medical, no-fault, or liability insurance, and services to end-stage renal disease (ESRD) beneficiaries who are also covered under employee group health plans. The regulations are necessary to implement section 953 of the Omnibus Reconciliation Act of 1980 and section 2146 of the Omnibus Budget Reconciliation Act of 1981. The first of these sections excludes from Medicare coverage any services for which payment has been made or can reasonably be expected to be made under an automobile or liability insurance policy or plan or under no-fault insurance. The second section makes Medicare benefits secondary to benefits payable under an employer group health plan for services furnished to ESRD beneficiaries during a specified period of up to 12 months. The intent is to conserve Medicare funds and prevent duplicate payments by Medicare.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

[Strained relations between federal health insurance and the public health service].

A close cooperation between all partners according to section 20 IV SGB V is basically welcome. However, in times of financial straits in public budgets, attempts have to be avoided to shift tasks and financial burdens to statutory health insurance (SHI). A series of examples shows that because of the different responsibilities-related to the insured persons on the one hand, and the general population on the other-tendencies to shift burdens to SHI are observed. However, such measures are neither adequate nor without problems (e.g. protection by vaccination). Public health service is requested to improve its epidemiological capacities and the qualification of its doctors. Furthermore, the service should be re-orient to a modern citizen-oriented service organization. Communities and provincial ("Land") governments have to provide the financial prerequisites.

Budgets↗
PubMed2003

[Relationships between participation of national-health-insurance members in a health education program and exercise habits, medical expenses and other related parameters].

PURPOSE: This study was conducted with the aim of multi-faceted evaluation of a health education program, "Genki-jaya", run at Fukushima City Health and Welfare Center. METHODS: "Genki-jaya" is a health education program including individual health instructions combined with group education on exercises as well as diet. A total of 55 participants completed the program through December 1999 to March 2001. Twenty-six were under the medical care covered by national-health-insurance when the program started, and 19 of these, whose medical expenses for one month prior to the program were zero, were studied. The program was evaluated using the following: 1. Results of questionnaire surveys to examine self-care ability and perceived health conducted at the end of the program and three months after it finished. 2. Physical measurement items (blood pressure, weight, body fat rate, and BMI) and physical fitness items (maximum-oxygen-uptake, muscle-strength of legs, etc.) at the start of, and three months after the program. 3. Change in the total medical expenses between one year prior to and after the program, and its relationship with physical measurements and satisfaction with the program. Comparison of the mean three-month medical expenses before, during, and after the program. Comparison of medical expenses three months before, at the beginning and end of, and three months after the program. 4. Follow-up of continuous activities among graduates of the program. RESULTS: 1. Regarding self-care ability, dietary habits, and exercise habits, these continued to improve after the program and all participants were satisfied. Regarding perceived health, subjective symptoms improved. 2. Physical measurements improved through the program. Both mean diastolic pressure and body fat rate at the end of the program were significantly lower than at the beginning. Moreover, mean systolic and diastolic pressures significantly decreased from the end of the program through three months thereafter. 3. The medical expenses before and after the program did not change significantly, and differences did not correlate with physical measurements and satisfaction with the program. 4. Three self-supporting associations among the graduates had been organized to continue instructed exercises were active at the end of March 2001. CONCLUSION: Although Genki-jaya had no significant impact on medical expenses, improvement in self-care ability, perceived health, physical measurements and formation self-supporting associations was observed. Multi-faceted evaluation of the program will now be continued to examine larger numbers of newly enrolled trainees for a longer period of time.

Attitude to Health↗
PubMedDate not supplied

How will changes in health insurance tax policy and employer health plan contributions affect access to health care and health care costs?

OBJECTIVE: To understand how changes in federal taxation of and employer contributions to health insurance benefits affect the decisions of firms to offer insurance, the willingness of households to purchase different health plans, and the resultant health expenditures. DESIGN: Economic policy simulation. SETTING: Secondary data analysis. PARTICIPANTS: A total of 18,343 sampled families (representing 77 million total families throughout the United States) with a working household head from the 1988 Current Population Survey who were not covered by either Medicare, Medicaid, or CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) insurance. INTERVENTIONS: One intervention limits the amounts of tax-free employer contributions to health insurance premiums to 80% of our estimate of the base plan in the market and assumes that employer contributions will also be limited to this maximum. A second intervention eliminates the favorable tax treatment of employer-paid premiums altogether and assumes that employees will pay the full price of insurance. MAIN OUTCOME MEASURES: Change in the number of working families offered employment-based insurance, change in insurance plan choice, and change in medical spending. RESULTS: Capping the favorable tax treatment and employer contributions decreases the number of families offered employment-based insurance by approximately 91,000, increases the number of families selecting the least generous insurance plan from 20% under the current situation to 33%, and reduces overall health spending by less than 2%. By eliminating the tax exemption altogether, the number of families offered employment-based insurance decreases by approximately half a million families, the number of families selecting the least generous plan goes from 20% to 40%, and overall spending falls by about $16 billion. CONCLUSIONS: Eliminating the tax subsidy and limiting employer-paid contributions to the low-cost plan substantially increases the number of low-income uninsured under a voluntary insurance system, decreases overall spending only modestly, but would raise tax revenues by $36 billion. These tax revenues could be used to assist low-income families to obtain insurance coverage.

Competitive Medical Plans↗
PubMedDate not supplied

Predicting response to regulatory change in the small group health insurance market: the case of association health plans and HealthMarts.

Lack of health insurance continues to be a concern for many people, even among those who are employed, and employees of small firms are much less likely to be insured than employees of larger firms. For several years, the U.S. Congress has considered legislation that would establish two new vehicles for offering health insurance coverage to small employers: association health plans (AHPs) and HealthMarts. In this paper, we present a model for estimating the impact the new entities would have on coverage and premiums in the small group health insurance market. The model produces a range of estimates based on assumptions, among others, about demand for insurance among small firms and their willingness to switch to less expensive, less generous benefit plans. We estimate that approximately 4.6 million people would obtain coverage through AHPs and HealthMarts, but fewer than half a million of them would be newly insured (based on 1999 population figures). Premiums would increase slightly for firms that continued to purchase coverage in the traditional market.

Community Participation↗
PubMed2002

[The medical advisory services of social health insurance].

A social health insurance needs opinions on diagnostic and therapeutic procedures - for the single question regarding the individual patient and as general assessments (health technology assessments) as well. The Medical advisory services of social health insurance (their federal branches and their central board) have to do more than 9 Mio individual expert opinions and more than 100 general assessments or HTA-reports a year. Several examples are to be shown.

Consultants↗
PubMed1987

Public health insurance: the collective purchase of individual care.

Health insurance does not insure health. It reimburses the costs of health care, and enables potential users of care to pool their risks. But public health insurance is qualitatively different from private, in that risk pooling is not its only or even its primary function. Public systems also redistribute, deliberately, from low to high risk individuals. Perhaps even more important, public insurance is a mechanism for the collective purchase of care. It enables buyers, through their political representatives, to bargain with providers over both price and quantity of care, and thus to control overall system costs, in a way that individual patients cannot. This paper contrasts the experience of public insurance in Canada with private coverage in the U.S., to show how universal public coverage, used as a 'collective purchasing agency', has led to both better coverage and lower costs. Current policy changes in the U.S., described as 'competitive', are in fact efforts to create private collective purchasing agencies to bargain with providers on behalf of individuals. Yet economic analysis has been largely incapable of grasping this process, continuing to treat public and private insurance alike as simply reductions in the price of care faced by individual consumers, and thus generating erroneous predictions and analyses of the behaviour of public systems. It has encouraged a fruitless concern with the prices faced by patients, while ignoring the overwhelming significance of the structure and objectives of the insurer. This failure may be traceable to fundamental flaws in the concept of a transactor in economic theory.

Canada↗
PubMed1995

Health insurance coverage and receipt of preventive health services--United States, 1993.

In 1992, an estimated 38.5 million U.S. residents aged < 65 years did not have health insurance (1). Efforts by states to expand health-care coverage will require surveillance for and state-specific information about coverage for acute care and the receipt of preventive services. This report summarizes state-specific and aggregated data from the 1993 Behavioral Risk Factor Surveillance System (BRFSS) regarding the status of health insurance coverage and the receipt of preventive health services among adults aged 18-64 years. In addition, findings from the analysis of supplemental questions added to the BRFSS in Minnesota are included that address health-care utilization, source of health-care coverage, and coverage of children.

Adult↗