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PubMed2003

Private health insurance for adolescents: is it adequate?

PURPOSE: To examine the nature and extent of private insurance coverage available for health services needed by six hypothetical adolescents with physical and mental health conditions. METHODS: Health insurance information was obtained from the most commonly sold product of the largest health maintenance organization (HMO) and preferred provider organization (PPO) in each state and the District of Columbia. Contract documents were collected in 1999 and were in effect at the end of 1998. Our response rate was 97% and included 49 HMOs and 49 PPOs. The extent of coverage was analyzed according to benefit availability, structure, limits, and protections, as well as condition and treatment restrictions. RESULTS: The two hypothetical adolescents with asthma and depression had coverage for their recommended health services in most of the 98 plans. However, the four hypothetical adolescents whose conditions included pregnancy and sexually transmitted disease, anorexia nervosa, injury, and substance abuse and bipolar disorder would rarely have access to coverage for all of their recommended services. Ancillary and behavioral health therapies were least likely to be available in the amounts considered necessary by medical experts. All of the hypothetical adolescents would be more likely to obtain coverage for certain services in HMO than in PPO plans. CONCLUSIONS: Despite the obvious value of the private health insurance system, insurance benefits are not always matched to the needs of the adolescent. Employers and policymakers may want to consider financial or other incentives to create more uniformity in employer-based coverage, particularly for preventive care, prescription drugs, and reproductive services; greater availability of mental health and substance abuse benefits; and new mechanisms to support access to confidential care.

Accidents, Traffic↗
PubMed1999

Computerized system for the networking of health services (Proposed solution for the informational support of the health insurance law in Romania).

The integration of health services in the health insurance system can only be performed by using an advanced informational system, due to the large volume of documents needed for the payment of medical services by the health insurance firms. To better facilitate the access to the medical databases throughout the country is it necessary that the different application and their respective supports are able to communicate with each other. Every component of the health system (doctors' offices, clinics, hospitals, pharmacies, county health insurance offices) consist of a local LAN/WAN network according to the individual computer capabilities. These networks are connecting through the Internet which can be describe as a network of networks that permits long range communication.

Computer Communication Networks↗
PubMed1992

Insurer competition and protection from risk redefinition in the individual and small group health insurance market.

Analyses of problems in the health insurance market usually focus on the individual and small group market. Consumers in this market who experience an illness or diagnosis of illness in one time period are likely to have their future risk redefined by insurers. Despite the fact that risk-averse consumers should desire protection against redefinition of risk, policies featuring that protection currently are not common in the individual and small group market. Contracts offering that protection must either be offered by pools that can guarantee replenishment of good risks over time, or be multiperiod contracts. Risk replenishment is impossible for individuals and may be technically difficult for many small groups. Also, the terms of multiperiod contracts with a single insurer may be unattractive to individuals and small groups, given the current structure of the market. Multiperiod contracts with a pool, rather than an individual insurer, may make it possible for individuals and small groups to enjoy the same advantages as consumers who obtain employment-based health insurance through large firms.

Consumer Advocacy↗
PubMed1995

[Longitudinal analysis of utilization of inpatient treatment based on insurance data of mandatory health insurance].

AIM: To investigate which of the routinely collected claims data from the German "Legal sickness funds" on hospital utilisation may be used, in addition to that prescribed by the legislator. DESIGN: We used claims data to study a cohort of sickness fund beneficiaries who were insured during the complete year 1992 (n = 81,309). Six utilisation parameters, using the number of cases and in hospital days overall as well as diseases specific (i.e. readmission rates, in-hospital days per person with [at least] one hospital stay) were calculated. RESULTS: There are 88 persons with (at least) one hospital stay, 116 hospital cases and a total of 1306 in-hospital days per 1000 insured persons in the study cohort. The average hospital days per person (14.8 days) are ca. 30% higher than the average length of stay (11.2 days). Hospital utilisation increases with age. Hospital stays associated with ICD-239 (neoplasms of unknown origin) resulted in a higher than average number of hospital days in total although the mean length of stay is not above the average. This is due to a high readmission rate. Hospital stays associated with elective surgical procedures have a high prevalence rate but a low readmission ratio and short length of stay. CONCLUSION: The parameters related to insured persons, cases and specifically personal parameters of hospital utilisation allow a detailed analysis of hospital care; different utilisation and user patterns can be investigated and possible determinants of utilisation can be identified. After technical transformation, routine data of the sickness funds can be used to obtain information relevant for health care planners as well as for quality management.

Adolescent↗
PubMed2006

What happens to children who lose public health insurance coverage?

Little is known about what happens to children who disenroll from public health-insurance programs. A telephone survey was conducted of children who recently had disenrolled from either Oregon's State Children's Health Insurance Program (SCHIP) or FHIAP (premium assistance) programs, both of which have identical eligibility requirements. Access for these disenrolled children was driven largely by health insurance coverage. Insured children were more likely to have a usual source of care and to have seen a physician when they needed one. While FHIAP-disenrolled children were more likely to have private health-insurance coverage than those leaving SCHIP, absolute levels were low (53 percent and 33 percent, respectively). Thus, these programs generally did not provide a bridge to nonsubsidized private health insurance. Despite higher incomes (the main reason for losing coverage), many families did not purchase private health insurance, presumably because they still could not afford to do so.

Adolescent↗
PubMed1994

Health insurance coverage among the elderly.

The research reported in this paper examines the decision to have private health insurance by elderly Medicare enrollees. Models allowing both stimultaneity and a joint error structure between health insurance and use of medical care are considered. We find that common unobserved variables underlying the joint errors are important determinants in the decision to purchase private health insurance. Simultaneity is present only between the decision to have private health insurance and the probability of visiting a doctor. Health status and functional limitations are important determinants of the decision to have private health insurance in addition to Medicare coverage. Other personal characteristics (age, sex, race and education), as well as household income, Medicaid enrollment, and the employment of a family member are also found to be related to the decision to have private health insurance.

Activities of Daily Living↗
PubMed1998

The impact of lack of health insurance on children.

This paper examines the impact that the lack of health insurance has on children and their families. A random sample of families of children who were newly enrolled in a children's health insurance program were interviewed by telephone and asked about the children's health status, the amount of unmet need and delayed care for a number of services, consequences of unmet need and delayed care, usual activities, and the effect on the lack of health insurance. Data were analyzed by using both quantitative and qualitative methods. We found that uninsured children had experienced considerable unmet need and delayed care that increased as the time without insurance increased. The parents reported some adverse consequences. The children were also found to be limited in the extent to which they could participate in various activities specifically because they lacked health insurance. Finally, the parents reported considerable stress and worry associated with their children's lack of coverage. We conclude that being without health insurance has broad consequences for America's children.

Blue Cross Blue Shield Insurance Plans↗
PubMed2004

Towards advanced risk-sharing in health care financing: with a focus on the potential of social health insurance in developing countries.

In this paper, we analyse the major health financing methods and the contribution they can make to improving access to health care among all of a country's population groups. Risk-sharing in health financing is proposed as a powerful method to achieve this improvement. The larger the degree of risk-sharing in a health financing system, the less people will have to bear the financial consequences of their own health risks, and the more they are likely to have access to needed care. Ideally countries should attempt to introduce 'advanced' risk-sharing aiming at equal access among individuals to an adequate package of health services. There are two major ways to implement advanced risk-sharing: general tax revenue may be main source of financing health services, or else social health insurance may be established. An important finding is that about 60% of the world's countries still need to pursue efforts towards the introduction of advanced risk-sharing. We further focus on the potential of social health insurance as an advanced risk-sharing method. In fact, there is recent interest in developing countries such as Côte d'Ivoire, Indonesia, Iran and Kenya in this particular health financing mechanism. Compared to health financing via general tax revenue, social health insurance spreads the immediate burden of financing among various groups, including the workers, the self-employed, enterprises and Government. Time and tedious discussions between these groups may be needed, however, before a consensus is reached, not only on the relative burden of financing but also on ways to achieve overall population coverage. It is suggested that action-research be used to test the adequacy of initial social health insurance policies.

Delivery of Health Care↗
PubMed2000

What people really know about their health insurance: a comparison of information obtained from individuals and their insurers.

OBJECTIVES: This study determined the validity of self-reported data on selected health insurance characteristics. METHODS: We obtained telephone survey data on the presence of health insurance, source of insurance, length of time insured, and type of insurance (managed care or fee-for-service) from a random sample of 351 adults in 3 Wisconsin counties and compared findings with data from respondents' health insurers. RESULTS: More than 97% of the respondents correctly reported that they were currently insured. For source of insurance among persons aged 18 to 64 years, sensitivity was high for those covered through private health insurance (93.8%) but low for those covered through public insurance (6.7%). Only 33.1% of the respondents accurately categorized length of enrollment in their current plan. Overall estimates for managed care enrollment were similar for the 2 sources, but individual validity was low: 84.2% of those in fee-for-service believed that they were in managed care. CONCLUSIONS: Information obtained from the general population about whether they have health insurance is valid, but self-reported data on source of insurance, length of time insured, and type of insurance are suspect and should be used cautiously.

Adolescent↗