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PubMedDate not supplied

Guaranteed renewability and the problem of risk variation in individual health insurance markets.

Consumers should be protected against fluctuations in premiums for private individual health insurance associated with the onset of high-cost chronic conditions. The most commonly discussed way to do so is through community rating, which provides protection but can require a heavy regulatory burden and can create incentives for adverse selection and cream skimming. This paper describes an alternative method of providing the same type of protection: insurance contract provisions that guarantee renewability for the next coverage period at class-average rates. Drawing on recent work in insurance theory, the paper shows that such protection is feasible in competitive insurance markets. Guaranteed renewability, which is required of all individual health insurance by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, is incomplete because the law fails to require that premiums be the same for all insured persons in a rating class. However, the paper reports the results of a recent survey of state insurance regulation, which indicates that all but three state insurance departments report having such a requirement. The paper concludes with a discussion of possible threats to the protection guaranteed renewability provides against risk segmentation.

Actuarial Analysis↗
PubMed2001

[Implementation of health insurance reform].

Authors expose in the first part of this article practical modes to implement the health insurance reform under the angle of the mastery of care expenses, at the micro and the macroeconomic levels. Thus they pass in review the different possibilities to master expenses, at the supply and the demand sides, by identifying advantages and risks of each of they and by specifying orientations of the health insurance reform in this area: the moderating ticket, contractual payment methods of hospitals and health professionals, the path of care, the refund of care expenses, the rationalization of consumption of medicines and complementary examinations and the harmonious development of care supply by a better public and private mix. A particular accent is put on preliminaries and implementation conditions of the prospective payment of providers and organizational conditions of care provision, from general practitioner that would become the main entry of the care system. In a second part, authors pass in review organization and management conditions of social security bodies, needed for the health insurance reform implementation. On the basis of decentralization and a three levels organization (local, regional and central), social security bodies will put in place the most appropriate organization to insure a steady efficient implementation of the health insurance reform, in dialogue with stakeholders. Consultative committees at regional and central levels, regrouping all the intervening in the health insurance, will be instituted. The sought-after objective through this organization is to administer the health insurance, at the strategic, decisional and operational levels, with suppleness, as a changing and dynamic project, in function of flexibility imperatives necessary for the reform implementation.

Cost Control↗
PubMed1993

Predicting the receipt of employer-sponsored health insurance: the role of residence and other personal and workplace characteristics.

Americans without health insurance constitute a significant public policy concern. Previous research has demonstrated that rural Americans are more likely to be without coverage. Beyond documenting this comparative disadvantage, however, current research has two specific deficiencies: studies have not examined whether the factors that predict the receipt of employer-sponsored health insurance are equivalent across residence categories, and few studies have used a multivariate framework to examine the predictors of the receipt of health insurance. Using data from the 1987 National Medical Expenditure Survey, the influence of residence is examined along with other variables known to be associated with an increased likelihood of receiving health insurance from an employer (specifically, seven employee and six workplace characteristics). At a bivariate level, an individual's place of residence did affect the probability of receiving health insurance from an employer, with nonmetropolitan workers least likely to receive such benefits. The influence of the employee and workplace characteristics on receipt of insurance, however, did not vary significantly by place of residence. In a multivariate model, six employee and six workplace characteristics were identified as significant predictors. These findings do not refute the existence of important residential differences in health insurance coverage, rather, they suggest that the differences are due to identifiable population and workplace characteristics that vary in their distribution by residence.

Employment↗
PubMed2000

Gaining and losing health insurance: strengthening the evidence for effects on access to care and health outcomes.

This study uses longitudinal data to examine the consequences of losing and gaining health insurance coverage for access to care and health. For both Medicaid and privately insured persons, compared with those who remained insured, persons losing coverage over a 2-year period were more likely to lack a usual source of care, encounter difficulty in obtaining medical care, be very dissatisfied with ability to obtain needed care, and report no physician visits in the previous 12 months. Uninsured people who gained coverage showed improvement across all indicators of access, in contrast to those who remained without insurance. The effects of changes in coverage on health were in the same direction as those for access, but did not reach statistical significance. This study strengthens the evidence that health insurance coverage has a substantial impact on ability to gain access to medical care and may affect health status.

Health Services Accessibility↗
PubMed2002

Latino adults' health insurance coverage: an examination of Mexican and Puerto Rican subgroup differences.

Lack of health insurance is a serious problem in the United States. Using data from the 1996 Medical Expenditure Panel Survey, this paper examines how insurance varies between black, white, and Latino adults. Because Latino subgroups are not homogeneous, the paper also compares the factors associated with health insurance status for Mexican and Puerto Rican adults. Results indicate that access to private health insurance for Latino adults was more closely associated with workplace characteristics than employment itself. Time lived in the United States was a major factor associated with being uninsured for Mexican adults, while language barriers were a major factor limiting Puerto Rican individuals' access to private health insurance. The paper suggests two approaches for decreasing uninsurance among Latino adults: (1) strengthening the link between employment and private health insurance and (2) addressing disparities in access to public coverage for racial and ethnic groups, including recent immigrants.

Acculturation↗
PubMed1992

How will children and pregnant women fare under current national health insurance proposals?

OBJECTIVE: To compare the following five major national health insurance proposals and their implications for children and pregnant women: the MAtsui "play or pay" bill (HR 3393); the Russo Canadian-type bill (HR 1300); the Rockefeller "play or pay" bill (S 1177); the Stark Medicare-type bill (HR 650); and the president's market reform proposal. RESEARCH DESIGN: Using an analytic framework developed by the Association of Maternal and Child Health Programs, we examine the differences among the five proposals in basic approach, eligibility and enrollment, benefits, cost-sharing requirements, provider reimbursement, and cost-control measures. RESULTS: All of the plans, except for President Bush's, would provide coverage for virtually all children and pregnant women, using a combination of private and public approaches. President Bush's market approach provides financial incentives to purchase health insurance benefit plans that states can design within actuarial limits. The remaining four plans strive for uniformity in benefits, covering physician and hospital services in a manner similar to most plans today. Preventive care benefits extend beyond what has been offered in the past. The four plans differ sharply in their coverage of extended care services, with the Matsui and Russo bills covering the most generous package of benefits. The Rockefeller and Stark plans, on the other hand, require less cost-sharing for their basically preventive and primary care plans. CONCLUSIONS: Most of the health insurance proposals are aimed at extending preventive and primary care health insurance plans to more uninsured Americans. Only the Matsui bill devotes significant attention to developing a comprehensive benefit plan for children and pregnant women. Additional attention should be directed at extended care services for those with special health care needs, the future role of Medicaid, and the public health system infrastructure.

Child↗
PubMed1990

Universal health insurance: lessons of the 1970s, prospects for the 1990s.

In the 1970s, proposals for universal health insurance were not successful. Health care providers, insurers, and others negotiating in the political process foresaw a better future without such legislation. Today, the growth of health insurance coverage has unmistakably reversed. Moral discomfort and self-interest shape the new politics of universal health insurance for the 1990s. Hospitals, physicians, insurers, employers, and tens of millions of individuals would benefit from a universal health insurance plan that was mindful of their concerns and interests. Proposals that require employers to provide insurance for full-time employees and expand public programs to cover to cover other uninsured persons now have the greatest chances for enactment. As leaders, health services and health insurance executives should be in the vanguard of efforts to enact universal health insurance.

Employment↗
PubMed2000

Health insurance in South Africa: an empirical analysis of trends in risk-pooling and efficiency following deregulation.

This paper reports an empirical investigation into the pattern of private health insurance coverage in South Africa before and after deregulation of the health insurance industry. More specifically, we sought to measure trends in risk-pooling over the period 1985-95, and to assess the impact of risk pooling on the costs of health insurance cover over this period. South African mutual health insurers (Medical Schemes) have existed for over 100 years, and have been regulated under a specific Act since 1967. Up until 1989, health insurers were required by law to community rate their premiums, and were not allowed to exclude high-risk enrolees from cover. In 1989 these regulations were removed, effectively allowing health insurers to risk-rate the cover which they provided, and exclude 'medically uninsurables'. Data were obtained from the office of the health insurance regulator (the Registrar of Medical Schemes) for the period 1985-95, and consisted of the statutory returns from all registered medical schemes for each year during the study period. Multiple regression methods were used to assess the determinants of changes in the risk pools of insurers, and their costs. Both cross-sectional and longitudinal models were estimated. Unadjusted data suggest changes in risk-pooling since the deregulation period after 1985. Health insurers with open enrolment had worse than average risk profiles in the 1980s, but this reversed by the early 1990s, leaving them with significantly better risk profiles by 1995. Worsening risk profiles were associated with decreasing fund size, higher loss-ratios and past premium increases. Most models showed that risk rating of premiums was consistently associated with higher premiums, after adjustment for risk, quality, scale and other environmental differences between insurers. Likely explanations include the additional costs required for marketing and underwriting risk-rated policies, insufficient incentives to use cost-control techniques, and higher levels of moral hazard associated with diminished risk-pooling. Current re-regulation of risk-pooling within medical schemes may thus improve both equity and efficiency of private health care cover.

Actuarial Analysis↗
PubMed2002

Forces promoting health insurance coverage of homebirth: a case study in Washington State.

The movement of childbirth to the hospital in the early 1900s and the eventual establishments of health insurance reimbursement for hospital birth--but not for homebirth--solidified and reflected physician dominance in the area of obstetrics. Until recently, it was rare that a health insurer or a health maintenance organization (HMO) would cover a homebirth. However, in Washington State the majority of health insurance groups cover homebirths, which are generally attended by licensed midwives. In this context, our research is a case study focused on answering the question: What are the forces promoting the extensive coverage of homebirth by health insurers in Washington State? Data were gathered primarily through fourteen (14) in-depth, audiotaped interviews with key informants in relevant agencies and organizations in the state (i.e., state offices; midwife and other professional associations; and health insurance groups). Results suggest that consumer demand was an important precipitating factor without which changes to health insurance coverage would likely not have been made. Additionally, changes in state policies and professional mobilization on the part of licensed midwives were critical factors facilitating the widespread reimbursement for homebirth. Health care organizations' concerns for cost containment had little impact on this health insurance trend. Our study concludes that jurisdictional openings in the system of professions can be facilitated by a small number of strategically positioned individuals.

Adult↗
PubMed2004

Health insurance coverage and the macroeconomy.

This paper investigates the relationship between the macroeconomy and health insurance coverage for non-elderly Americans. We find that, for men, state unemployment rate is positively correlated with the probability of health insurance coverage in general and through an employer in particular, and that these correlations are only partly explained by changes in employment status. In contrast, the insurance coverage of women and children appears to be insulated from fluctuations in the unemployment rate by public health insurance programs like Medicaid and State Children's Health Insurance Program (SCHIP). We estimate that 984,000 Americans, nearly all of whom were adult men, lost health insurance due to macroeconomic conditions alone during the 2001 recession.

Adult↗
PubMed1989

[Determinants of income and expenditure development in the annual reports of the health insurance of the Federal Republic of Germany].

Contribution rates to the German statutory health insurance differ considerably between different sickness funds. While insurance benefits are largely standardized, these differences are widely regarded as a problem for the state's social policy. The health insurance bodies often offer hasty interpretations to justify the differences of contribution rates. These interpretations, however, cannot be checked on the basis of data from the annual reports of the health insurance. In reality, there is a number of determinants of the contribution rate which lie as well inside as outside the sphere of influence of the health insurance bodies. In order to estimate the respective impact of single determinants it is important to differentiate the health expenditures by age and sex of all insured persons (both the contribution paying members and their co-insured dependents). A further disentanglement of health expenditures into prices, quantities and structural components allows to identify the reasons of increases in health costs. This is also a necessary precondition for creating and implementing suitable measures that are directed to control health costs. At the same time, the improved information system of the statutory health insurance would contribute to a better understanding of the performance of the health system in general.

Age Factors↗
PubMed1980

Consumer-centered vs. job-centered health insurance.

Today's dominant health care financing system blocks economic competition and rewards doctors and hospitals for cost-increasing behavior. The author believes that the most effective and acceptable way to get health care costs under control, and at the same time achieve universal coverage, would be through a system of fair economic competition. He discusses his Consumer Choice Health Plan proposal and describes how one of the main barriers to competition is today's system of job-linked health insurance.

Community Participation↗
PubMed2001

Sources of health insurance and characteristics of the uninsured: analysis of the March 2001 Current Population Survey.

This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the characteristics most closely related to an individual's health insurance status. Based on EBRI estimates from the March 2001 Current Population Survey (CPS), it represents 2000 data--the most recent available. Between 1999 and 2000, the percentage of Americans with health insurance increased: 84.1 percent of nonelderly Americans were covered by some form of health insurance in 2000, up from 83.8 percent in 1999. The percentage of nonelderly Americans without health insurance coverage declined from 16.2 percent in 1999 to 15.9 percent in 2000, continuing a trend that started between 1998 and 1999. The main reason for the decline in the number of uninsured Americans was the strong economy and low unemployment. Between 1999 and 2000, the percentage of nonelderly Americans covered by employment-based health insurance increased from 66.6 percent to 67.3 percent, continuing a longer-term trend that started between 1993 and 1994. In 2000, 34.3 million Americans received health insurance from public programs, and an additional 16.1 million purchased it directly from an insurer. More than 25 million Americans participated in Medicaid or the State Children's Health Insurance Program, and 6.1 million received their health insurance through the Tricare and CHAMPVA programs and other government programs designed to provide coverage for retired military members and their families. Even though the number and percentage of uninsured declined substantially between 1998 and 2000, more than 38 million Americans remain uninsured. While an increasing percentage of Americans were being covered by employment-based health plans, this trend may not continue because of the combined re-emergence of health care cost inflation and the weak economy. As long as the economy is strong and unemployment is low, employment-based health insurance coverage will expand and the uninsured will decline gradually. However, the combination of the current weak economy and the rising cost of providing health benefits will likely result in more Americans without health insurance coverage. Should the uninsured remain unchanged and continue to represent 15.9 percent of the nonelderly population, 40 million would be uninsured by 2005. If the uninsured represented 25 percent of the population, 63 million would be uninsured in 2005 and 65 million nonelderly Americans would be uninsured by 2010.

Adolescent↗
PubMed1991

Expanding Medicare and employer plans to achieve universal health insurance.

This article presents a proposal for expanding Medicare and employer-based health insurance plans to achieve universal health insurance. Under this proposed health care financing system, employees would provide basic health insurance coverage to workers and dependents, or pay a payroll tax contribution toward the cost of their coverage under Medicare. States would have the option of buying all Medicaid beneficiaries and other poor individuals into Medicare by paying the Medicare premiums and cost sharing. Other uninsured individuals would be automatically covered by Medicare. Employer plans would incorporate Medicare's provider payment methods. This proposal would result in incremental federal governmental outlays on the order of $25 billion annually. These new federal budgetary costs would be met through a combination of premiums, employer payroll tax, income tax, and general tax revenues. The principal advantage of this plan is that it draws on the strengths of the current system while simplifying the benefit and provider payment structure and instituting innovations to promote efficiency.

Costs and Cost Analysis↗
PubMed2002

Racial and ethnic differences in health insurance for the near elderly.

Recent increases in the number of Americans without health insurance have spurred research designed to identify factors related to noncoverage. One age group receiving recent attention is the near elderly, persons 55 through 64 years of age. This paper brings together health insurance research on the near elderly with that focused on racial and ethnic differences in coverage. Logistic regression is used to study the factors that predict whether or not an individual has health insurance coverage. Results indicate that even after accounting for health insurance correlates such as education and income, non-Hispanic African Americans and Hispanics have a significantly higher probability of not having coverage than their non-Hispanic white counterparts. The results are discussed in terms of recent efforts to reshape public policy regarding health insurance, especially proposals that would affect the Medicare program.

Aged↗
PubMed2000

Management implications of the Health Insurance Portability and Accountability Act.

Health care professionals are faced with ever-changing rules and regulations and technological advances. Add to this the 1996 Health Insurance Portability and Accountability Act (HIPAA) and the health care manager's list of challenges continues to expand. This article presents an overview of HIPAA requirements and tools for use by health care managers in ensuring their facility is in compliance with the latest rulings.

Computer Communication Networks↗