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PubMedDate not supplied

Are subsidies enough to encourage the uninsured to purchase health insurance? An analysis of underlying behavior.

A growing concern over gaps in health insurance coverage has led to proposals for reform. Some proposals rely on incentives to encourage the purchase of private health insurance, while others rely on mandatory purchase. This paper explores families' demand for private health insurance, with an emphasis on lower income families, in order to understand the factors that affect purchasing decisions. The study uses data from the 1977 National Medical Care Expenditure Survey to show which factors are important in determining whether or not families purchase private health insurance as well as the quantity of insurance purchased. Results indicate that it is the combination of income, price, and substitutes for private health insurance that impact families' decision to purchase private health insurance. As long as a safety net of substitutes exists for low-income families, subsidies may not be enough to encourage more extensive private health insurance coverage.

Costs and Cost Analysis↗
PubMed2002

Policy change and private health insurance: did the cheapest policy do the trick?

From the introduction of Australia's national health insurance scheme (Medicare) in 1984 until recently, the proportion of the population covered by private health insurance declined steadily. Following an Industry Commission inquiry into the private health insurance industry in 1997, a number of policy changes were effected in an attempt to reverse this trend. The main policy changes were of two types: "carrots and sticks" financial incentives that provided subsidies for purchasing, or tax penalties for not purchasing, private health insurance; and lifetime community rating, which aimed to revise the community rating regulations governing private health insurance in Australia. This paper argues that the membership uptake that has occurred recently is largely attributable to the introduction of lifetime community rating which goes some way towards addressing the adverse selection associated with the previous community rating regulations. This policy change had virtually no cost to government. However, it was introduced after subsidies for private health insurance were already in place. The chronological sequencing of these policies has resulted in substantial increases in government expenditure on private health insurance subsidies, with such increases not being a cause but rather an effect of increased demand for private health insurance. The paper also considers whether the decline in membership that has occurred since the implementation of lifetime community rating presages the re-emergence of an adverse selection problem in private health insurance. Much of the decline to date may be attributable to failure on the part of some members to honour premium payments when they first fell due. However, the changing age composition of the insured pool since September 2000, resulting in an increasing average age of those insured, suggests the possible reappearance of an adverse selection dynamic. Thus the 'trick' delivered by lifetime community ratings may not be maintained in the longer term.

Australia↗
PubMed2002

Inner-city African American women who failed to receive cancer screening following a culturally-appropriate intervention: the role of health insurance.

Culturally-appropriate health promotion programs are thought to be more effective among minority groups than those designed for the population at large. We investigated factors associated with failure to obtain cervical and breast cancer screening among inner-city African American women who received a culturally-appropriate educational intervention. Women who completed the intervention, but did not obtain a Pap smear, a clinical breast examination, and/or a mammogram at follow-up were compared with those who did obtain these tests. Women with private health insurance were more likely to be screened following the intervention than those covered by Medicaid or Medicare or those who were not insured (P < 0.001). Post-intervention screening was not associated with age, education, income, employment, or marital status. The effectiveness of a culturally-appropriate intervention is likely to be reduced if women's ability to respond is limited by inadequate insurance coverage.

Adolescent↗
PubMedDate not supplied

The Philadelphia Health Insurance Organization: the results of managed health care for 96,000 medical assistance recipients.

On March 1, 1986, an innovative Medicaid program serving 96,000 recipients began operation in Philadelphia, Pennsylvania. Known as the HealthPASS program, it changed the previous fee for service Medicaid program into a capitated, managed care "gatekeeper" system. The plan was administered through a Health Insurance Organization (HIO) designed cooperatively by the Pennsylvania Department of Welfare and a for-profit health maintenance organization. In its first year, the program enrolled over 500 physician case managers, saved the Commonwealth of Pennsylvania $20 million, instituted a quality assurance program with on-site audit of primary care physician office facilities and medical records, provided a 24-hour hotline, made available central case management for mental health care, and began to compile a comprehensive database to support medical case management.

Cost Control↗
PubMed1995

Nothing succeeds like the right kind of failure: postwar national health insurance initiatives in Canada and the United States.

Health insurance was one of the most influential social reforms on the immediate postwar agenda in Canada and the United States. In both cases, proposals for national health insurance were not implemented. This article traces the evolution of these legislative proposals of the 1940s and shows how the events of this pivotal decade set the stage for future health reform in the two countries. The analysis focuses on how political institutions condition the role of state actors and the articulation of societal groups, and particularly on the crucial differences in party systems and the role of parties in shaping health reform in the two countries. In the United States, a divided Democratic party and the imperatives of political compromise made forging a consensus around health insurance more difficult. In Canada, meanwhile, the presence of a social-democratic third party led to a very different type of debate about health reform and opened the door for national health insurance.

Canada↗