Health insurance coverage among recently entitled disability insurance beneficiaries: findings from the new beneficiary survey.
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Adult↗
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The effect of employment status on private health insurance coverage: 1977 and 1987.
Analyzing cross-sectional data from the National Medical Expenditure Survey (NMES), we find that the predicted probability of private insurance coverage for low-income individuals as a group fell dramatically from 1977 to 1987. The results of a decompositional technique show that the relationship between full-time employment and private insurance has weakened over the period for low-income females, but has strengthened for males in this group. While it appears that low-income females benefit from part-time employment relative to their unemployed cohorts, no discernible difference is found in the likelihood of being covered by private insurance for part-time and unemployed males. Finally, evidence suggesting a weakening over time in the relationship between part-time employment and private insurance coverage is found among middle-income females and high-income males. From a policy perspective, passage of the Health Insurance Portability and Accountability Act of 1996 has taken an important first step in attempting to lower the number of uninsured, especially among full-time workers. Our findings, however, suggest that this legislation may be too limited in scope to effectively reach part-time workers presently uninsured.
Adolescent↗
Expanding health insurance coverage and the implications for dentistry.
Numerous proposals have been suggested for expanding health insurance coverage to the over 30 million Americans without health insurance. These proposals range from establishing a program of national health insurance modeled after the Canadian system to establishing statewide risk pools. Many of these proposals could have an impact on financial access to dental care for the approximately 120 million people without dental insurance. Dental insurance coverage has been shown to increase access to dental services and improve oral health status. Oral health professionals could facilitate discussions concerning health insurance expansion by informing policymakers about important preventive benefits to be gained by improving access to dental services. Dental public health professionals can serve as a bridge between organized dentistry and health policymakers by providing information to help formulate the priorities and characteristics of a dental health insurance program. This visibility and influence in the health policy arena would be beneficial to dentistry and could ultimately result in greater access to dental services and improved oral health for the uninsured.
Dental Health Services↗
Knowledge of their health insurance coverage by the elderly.
Current legislative proposals to increase competition among private insurers assume that people are or can be well-informed about their insurance coverage. Evidence from the National Medical Care Expenditure Survey shows that among the population 65 years of age and older knowledge about health insurance coverage is substantial but generally lower than in the population younger than 65 years of age. Multivariate analysis is used to identify factors associated with high and low levels of knowledge. Although correct knowledge of coverage of particular services is highly associated with current experience of health problems, with use of these health services, and with the cost for private insurance, overall knowledge is lowest among some groups at high risk of serious illness, in particular, the old, nonwhites, and persons enrolled in Medicare but without Medicaid or private insurance supplements.
Aged↗
The extent of private and public health insurance coverage among adult Hispanics.
Data from the Health and Retirement Survey reveal extremely low levels of health insurance coverage among Hispanics and, especially, among Mexican Americans. The data reveal that this lack of insurance is associated with lower rates of employer-based and privately purchased coverage. Even after controlling for a large number of insurance-related factors, Hispanics have rates of health insurance coverage that are lower than those of either non-Hispanic blacks or whites. This serious lack of health insurance coverage among preretirement-age Hispanics has serious implications both for health, because the lack of insurance represents a major barrier to health care, and for the adequacy of retirement coverage, because private insurance represents an important supplement to Medicare.
Adult↗
The marginal benefits of invasive treatments for acute myocardial infarction: does insurance coverage matter?
This paper applies instrumental variable (IV) techniques and estimates the average benefits of invasive surgical treatments for marginal acute myocardial infarction (AMI) patients by insurance coverage. The study uses data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases for the state of Washington, for years 1988-1993. We observed differences in average benefits for marginal patients across insurance subpopulations that cannot be explained by differences in measured clinical circumstances. Our empirical results show that the insurance subpopulations with the greatest estimated marginal benefits are those with the lowest expected payment generosity to providers. Because of the relatively weak explanatory power of our instruments for three insurance subpopulations, and because many of the parameter estimates across the insurance subpopulations are not statistically different from each other, policy recommendations should be approached cautiously. However, our application of IV techniques to AMI patients demonstrates the usefulness of this approach to estimate treatment effects across patient populations (e.g., across types of insurance coverage) for medical conditions of interest to policymakers. These estimates may help determine whether treatments are overutilized or underutilized.
Adult↗
[Insurance coverage in repetitive strain injury of the upper limbs as provided by the National Insurance Institute for Occupational Diseases].
A brief outline is given of the current status of the insurance "coverage" provided by INAIL for WMSDs. In breach of a specific European Union recommendation, in Italy various WMSDs can be recognised as occupational only based upon sentence No 179/88 of the Constitutional Court, since such disorders are not included in the list attached to DPR law 336/94. At present, during the period 1990-95, INAIL awarded indemnities in only a handful of cases. Details are provided concerning the evidence that must be submitted in the specific case of claims pertaining to suspected occupational diseases. The authors discuss the problems associated with quantifying injuries for the purposes of claiming indemnities for work-related musculo-skeletal disorders.
Causality↗
Transforming insurance coverage into quality health care: voltage drops from potential to delivered quality.
Although the US health care system is often touted as one of the best in the world, disparities exist in quality of care received by different populations, in different regions, and across different institutions and clinicians. Initiatives to provide access to health insurance have been a major policy tool to ensure that Americans receive high-quality health care. However, availability of insurance coverage does not automatically lead to high-quality care. This article explores points of vulnerability in the US health care system at which the potential to achieve high-quality care can be lost: (1) access to insurance coverage; (2) enrollment in available insurance plans; (3) access to covered services, clinicians, and health care institutions; (4) choice of plans, clinicians, and health care institutions; (5) access to a consistent source of primary care; (6) access to referral services; and (7) delivery of high-quality health care services. Ensuring high-quality health care requires that each of these "voltage drops" be recognized and addressed. JAMA. 2000;284:2100-2107.
Delivery of Health Care↗
Health insurance coverage of adolescents: a current profile and assessment of trends.
Data from the National Health Interview Survey reveal that 4.7 million or 15% of US adolescents aged 10 through 18 were uninsured in 1989. Among adolescents, 73% were privately insured, 10% were publicly insured, and 2% were both privately and publicly insured. Poor, near-poor, and minority adolescents were at the greatest risk for lack of health insurance coverage. Among adolescents without insurance, cost continued to be cited as the leading barrier to obtaining coverage. A comparison of 1989 National Health Interview Survey data with a previous analysis, in which 1984 data were used, revealed a 10% increase in the proportion of adolescents without insurance coverage. The increase in the proportion of uninsured adolescents was entirely attributable to an erosion of private health insurance coverage. No significant change occurred in the proportion of adolescents with coverage under public programs. Planned expansions of the federally and state-financed Medicaid programs will help to stem further increases in the size of the uninsured adolescent population. However, unless marked improvements occur in the private health insurance sector, progress will be limited.
Adolescent↗
A shifting picture of health insurance coverage.
Data from the Current Population Survey are used in this DataWatch to explore the changing composition of health insurance coverage of the U.S. nonelderly population. The authors analyze coverage trends across various subpopulations for 1988-1993. During this time significant declines in employer-sponsored coverage coincided with equally significant increases in Medicaid coverage. Thus, the increase in the proportion of nonelderly persons without health insurance appears relatively small. However, this analysis reveals that the relative stability of the uninsurance rate for the entire nonelderly population belies more significant changes in insurance coverage--and lack of coverage--among various groups. The authors also discuss the extent to which a growing level of public insurance "crowds out" (or substitutes for) private health insurance.
Adolescent↗
Explaining the decline in health insurance coverage among young men.
This article examines the experience of cohorts of young American men to see how and why their employer-provided health insurance coverage has changed over time. It explores changes in the structure of the labor market, changes in the cost of employer-provided health insurance, and changes in the composition of wages and benefits offered to employees. We find that increases in the cost of health insurance rather than changes in the structure of the labor market are the principal cause of the observed decline in employer-provided health insurance coverage across all cohorts.
Adult↗
Health insurance coverage of Minnesota farm families.
This study of 1,482 farm families assesses the extent and cost of health insurance coverage among Minnesota farm families and finds that these families are buying less insurance coverage than urban families, while paying a higher proportion of their income for these premiums. More than three-fourths of the farm families surveyed buy their health insurance plan themselves and pay for it out of pocket. Their plans, on average, are slightly less expensive than employer-provided plans in urban areas, but they provide much less coverage and have more copayments and deductibles. Unlike their urban counterparts, who often choose health plans for convenience of location or freedom to choose physicians, farmers generally choose plans on the basis of costs and services provided. About 7 percent of farm families are without insurance, and many others are underinsured because they cannot afford to purchase an adequate plan.
Cost Control↗
Strategies to improve insurance coverage for infertility services.
Various studies repeatedly have demonstrated that in the United States, only a minority of couples with infertility receive medical treatment and even fewer receive such treatment from specialists. Primarily couples of higher socioeconomic status receive such treatment. It is therefore obvious that a lack of insurance coverage greatly contributes to this country's disproportionately low utilization of fertility services compared with other developed nations. Such low utilization raises significant ethical and economic issues. For example, if the treatment of infertility is to be perceived as the treatment of a disease stage (a notion widely supported in our professional community), then how can we defend the fact that services are principally available only to the affluent? Moreover, by having access to only a fraction of the potential national market for infertility services, the national overhead for these services is distributed over only a fraction of potential buyers, greatly increasing unit costs. In short, obtaining a larger market for our services through better insurance coverage would solve ethical quandaries and, at the same time, reduce fertility costs on a unit level. How, then, can such improved insurance coverage be achieved? A number of possible strategies come to mind.
Ethics, Medical↗
Changes in health insurance coverage within rural and urban environments--1977 to 1987.
This study examines changes in the health insurance coverage of the nonelderly population in rural and urban areas between 1977 and 1987, using data from the National Medical Care Expenditure Survey (NMCES) and the National Medical Expenditure Survey (NMES). It was designed to test the hypothesis that differences in the rates of health insurance coverage in rural and urban areas have diminished over time, and to explore the composition of changes in coverage within rural and urban environments. The data suggest that the proportions of the populations that are without health insurance in rural and urban areas have converged since 1977. Although both rural and urban settings witnessed increases in the proportion of their populations without health insurance from any source, urban regions experienced a greater increase than did rural areas. These changes occurred among most subgroups within the population. In no subgroup did the percentage of the population without insurance in urban areas exceed that found in rural areas in either 1977 or 1987.
Adolescent↗
Use of outpatient mental health services by a general population with health insurance coverage.
Characteristics of use of mental health services by 4,254 persons enrolled in the Rand Health Insurance Study were analyzed in an attempt to predict patterns of use by a general population with assigned insurance coverage. Families in the study, whose members ranged in age from birth through 62 years, were randomly assigned to one of 14 insurance plans covering a wide variety of services by all licensed provider groups. During a one-year period less than 4 percent of the enrollees visited a mental health specialist, and only 7.1 percent saw any provider for mental health care. About half of those receiving outpatient mental health care visited general medical providers only. Annual outpatient mental health expenses per enrollee were about $25 (1983 dollars). The authors compare their findings with those of other studies and discuss their implications for insurance coverage of mental health services.
Ambulatory Care↗
Trends in health insurance coverage, 1989-1997.
The authors analyze trends in health insurance coverage in the United States from 1989 through 1997, using cross-sectional surveys by the U.S. Census Bureau (Current Population Survey) of 160,000 persons representative of the non-institutionalized population. Between 1989 and 1997, the number of people without health insurance increased by 10.1 million to 43.4 million. From 1989 to 1993, the proportion covered by Medicaid increased by 3.6 percentage points while the proportion covered by private insurance declined by 4.2 percentage points. Since then, private coverage rates have stabilized and Medicaid coverage has decreased. Consequently, the number and percent uninsured continues to rise. Young adults age 18-39 had the largest increase in the proportion uninsured, and rates among children have also risen steeply since 1992. While blacks had the largest increase in the percent uninsured, Hispanics accounted for 35.6 percent of the increase in the number uninsured. Low-income families constituted over half of the increase in the number uninsured, but since 1993 the middle income group had the largest increase in the percent uninsured. Northeastern states had the largest increase in the percent uninsured. Thus, despite economic prosperity, the numbers and rates of the uninsured continue to rise. Principally affected are children and young adults, poor and middle-income families, blacks, and Hispanics.
Adolescent↗
Does chronic illness affect the adequacy of health insurance coverage?
Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Preexisting condition exclusions were a major source of inadequate insurance, though not the only cause. Our results emphasize the impact of enforcing the Health Insurance Portability and Accountability Act (HIPAA) of 1997, which limits preexisting condition exclusions.
Adult↗
Health insurance coverage amongst families with school aged children.
The level of private medical insurance coverage was studied in a sample of 1106 seven year old children and their families who were participants in the Christchurch Child Development Study. In the last seven years, there has been a rapid increase in the number of families who were covered by private medical insurance: in 1977 an estimated 18% of families had coverage and by 1984, this figure had risen to 43%. Levels of coverage were correlated with a large number of factors associated with family social background including single parenthood, low income, poor parental education, Polynesian ethnicity, depressed living standards, family size and parental age. However, multivariate analysis suggested that the primary determinants of insurance coverage were family earning power and family structure. The social implications of these findings are discussed.
Child↗