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PubMed1990

Health-insurance products and plan options.

Trends in health insurance are discussed, with emphasis on insurers' efforts to offer an array of cost-effective plans tailored to the needs of employers and subscribers. Health-insurance companies, responding to employers' demands to curtail the rising costs of premiums, now offer a variety of insurance products. While indemnity plans, health maintenance organizations (HMOs), and preferred-provider organizations (PPOs) remain as the three basic types of plans, insurers are combining these elements in different ways, creating dual- and triple-option plans that consist of indemnity insurance and an HMO, a PPO and an HMO, or other variations. Insurers offering multiple options may effect internal cost savings through shared personnel and administrative expenses. Four factors influence the development and marketing of insurance products: cost and volume of healthcare services, adverse selection, competition, and the profit incentive. Many of the insurance products have been developed in response to requests for maximum freedom of choice of provider; as an example, the fastest-growing HMO product in 1989 was the point-of-service HMO, which allows the subscriber to seek care from a provider who is not part of the HMO network. PPOs and exclusive-provider organizations (EPOs) are growing; these are often organized by hospitals or physician networks. Among the new trends in product-line development are "riders" for specialty services such as vision care and prescription drugs. As competition intensifies, marketing efforts are focusing on previously overlooked groups such as the small employer and certain ethnic communities. Cost and freedom of choice will remain important criteria in the selection of insurance products.(ABSTRACT TRUNCATED AT 250 WORDS)

Economic Competition↗
PubMed1994

Health-insurance coverage for adults with diabetes in the U.S. population.

OBJECTIVE: To compare the extent and types of health insurance coverage for adults with diabetes to coverage for those without diabetes in the U.S. population. RESEARCH DESIGN AND METHODS: Nationally representative samples of 2,405 adults with diabetes and 20,131 adults who were not known to have diabetes in the U.S. completed a questionnaire on current health insurance, including coverage through Medicare, private insurance, the military, and Medicaid and other public programs. RESULTS: Among all adults with diabetes, 92.0% have some form of health insurance, including 86.5% of those 18-64 years of age and 98.8% of those > or = 65 years of age. Approximately 41% are covered by more than one health insurance mechanism, but almost 600,000 people with diabetes do not have any form of health-care coverage. Little difference was found by type of diabetes in the proportion who have health insurance. Only small differences exist between people with diabetes and those without diabetes in the percentages covered and the types of health-care coverage. Government-funded programs are responsible for health-care coverage of 57.4% of adults with diabetes, including 26.4% of those 18-64 years of age and 96.0% of those > or = 65 years of age. Private health insurance is held by 69.3% of diabetic people. Lack of private insurance appears to be attributable primarily to lower income. CONCLUSIONS: Almost all patients with diabetes who are > or = 65 years of age have health-care coverage, but 13.5% of those 18-64 years of age have no health insurance. Few differences exist in coverage between individuals with and without diabetes. However, the absence of insurance should have a substantially greater impact on the ability of patients with diabetes to obtain services necessary for care of their disease, compared with those without diabetes. Government-funded insurance mechanisms cover a large proportion of diabetic patients, which indicates a significant societal burden associated with diabetes. Any changes in government reimbursement and coverage policies could have a major impact on health care for patients with diabetes.

Adolescent↗
PubMed2001

Increasing health insurance coverage through an extended Federal Employees Health Benefits Program.

The Federal Employees Health Benefits Program (FEHBP) could be combined with health insurance tax credits to extend coverage to the uninsured. An extended FEHBP, or "E-FEHBP," would be open to all individuals who were not covered through work or public programs and who also were eligible for the tax credits on the basis of income. E-FEHBP also would be open to employees of very small firms, regardless of their eligibility for tax credits. Most plans available to FEHBP participants would be required to offer enrollment to E-FEHBP participants, although premiums would be rated separately. High-risk individuals would be diverted to a separate high-risk pool, the cost of which would be subsidized by the federal government. E-FEHBP would be administered by the states, or if a state declined, by an entity that contracted with the Office of Personnel Management. While E-FEHBP would provide group insurance to people who otherwise could not get it, premiums could exceed the tax-credit amount and some people still might find the coverage unaffordable.

Adult↗
PubMed2000

Parental employment and health insurance coverage among school-aged children with special health care needs.

OBJECTIVES: This study examined parental employment and health insurance coverage among children with and without special health care needs. Special needs were defined as conditions likely to require a high amount of parental care, potentially affecting parental employment. METHODS: Data from the 1994 National Health Interview Survey were analyzed for 21,415 children aged 5 to 17 years, including 1604 children with special needs. Logistic regression was used to estimate the effect of special needs on the odds of full-time parental employment and on the odds of a child's being uninsured, having Medicaid, or having employer-sponsored insurance. RESULTS: Parents of children with special needs had less full-time employment. Their children had lower odds of having employer-sponsored insurance (adjusted odds ratio [OR] = 0.7) than other children. Children with special needs had greater odds of Medicaid coverage (adjusted OR = 2.3-5.1, depending on family income). Children with and without special needs were equally likely to be uninsured. CONCLUSIONS: Lower full-time employment among parents of children with special needs contributes to the children's being less likely to have employer-sponsored health insurance. Medicaid covers many children with special needs, but many others remain uninsured.

Adolescent↗
PubMed2006

Thresholds for health insurance in Rwanda: who should pay how much?

Community-based health insurance schemes were introduced in Rwanda in 1999 and now cover 27% of the population. Due to widespread poverty, it remains unclear to what degree poorer population strata can be anticipated to pay into the system. This study investigates the extent to which the Rwandan population can financially contribute to obtain health insurance. More specifically, researchers explored the relationship between resource mobilization for the health system and the ability to provide community-based health insurance across socio-economic strata. Data from six household surveys are analysed revealing a consistent pattern: the goals of maximizing health revenue and maximizing participation in community-based health insurance are mutually exclusive. However, the upper three quartiles of the Rwandan population are able to contribute 1 US dollar per capita per year. In order to extend coverage to the poorest quartile, a corresponding subsidy for the coming years has to be considered.

Community Health Services↗
PubMed2000

Ovarian cancer. an institutional review of patterns of care, health insurance and prognosis.

The purpose of this study was to investigate the prognostic importance of the health insurance status in 145 consecutive patients with ovarian cancer diagnosed between 1984 and 1996. All patients had basic (Type III) insurance to cover outpatient treatment and hospital expenses for a per diem flat fee; some patients had one of two types of supplemental private insurance (Type I and Type II) to cover the treatment by physicians of their choice and fee-for-service hospital treatment. The prognostic impact of health insurance was evaluated by multivariate statistical methods. The median follow-up was 81.9 months (range: 21-181); the 5-year probability of survival was 72% (standard error of the mean (SEM) 9.8%) for stage I, 53% (SEM 16.2%) for stage II, 17% (SEM 5. 9%) for stage III and 11% (SEM 5.5%) for stage IV cancer. Age, stage, histological grade and debulking surgery were independent predictors of survival in multivariate proportional hazards regression analysis. Patients with private insurance were younger and received more chemotherapy than patients with basic insurance. In multivariate analysis, insurance was an independent predictor of survival: patients with Type II insurance had a hazard ratio of 2.31 (95% confidence interval (CI): 1.05-5.04), and patients with Type III insurance had a hazard ratio of 3.30 (95% CI 1.52-7.17) compared with the reference group of Type I insured patients. Health insurance status was an independent predictor of survival in ovarian cancer. Research is needed to devise strategies to improve the medical care of patients with basic insurance.

Adult↗
PubMed1976

The impact of national health insurance on the tasks and practice of psychiatry.

Psychiatry, like all professions, is strongly affected by changes in societal expectations and economic forces. Changes in professional priorities and patterns of patient care will undoubtedly be brought about by national health insurance. Two major types of national health insurance have been proposed: comprehensive health insurance and catastrophic insurance. We do not anticipate major impact on psychiatric tasks from some form of catastrophic insurance. Comprehensive health insurance would shape and change psychiatric practice. An examination of psychiatric tasks provides a framework for anticipating alterations in practice. We identify four major task areas in psychiatry: (1) medical tasks, (2) reparative tasks, (3) social control tasks, and (4) humanistic tasks. These tasks would be differentially influenced. Psychiatry's medical tasks will be stressed, while funding for many reparative tasks may be limited. The care of the severely ill patient may be fragmented because of problems in integrating medical and rehabilitative services.

Humans↗
PubMed1996

The health insurance status of US Latino women: A profile from the 1982-1984 HHANES.

OBJECTIVES: This research studied the correlates of health insurance status among three major subpopulations (Mexican, Puerto Rican, and Cuban) of adult (ages of 20 to 64) Latino women. METHODS: Data from the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-1984, were examined to determine the percentages of health insurance coverage among the sample populations and to assess the relationship between access to coverage and selected sociodemographic employment/income, ancestry, and acculturation variables. RESULTS: Variations in health insurance coverage existed by Latina subpopulation. While Puerto Rican women had the highest percentage of any health insurance coverage, Mexican-origin women (particularly those 50 to 64 years old) had the lowest. For all three Latina groups, health insurance coverage was greater among those who reported a family income above the poverty level than among those whose income fell below the poverty level; employment location, acculturation variables, and ancestry were also related to coverage. CONCLUSIONS: Eligibility requirements, particularly for Mexican-and Cuban-origin women, need to be streamlined, and innovative health insurance programs need to be developed to increase access of Latinas to health insurance.

Acculturation↗
PubMed2004

Trends in private and public health insurance for adolescents.

CONTEXT: Previous studies (1984-1995) of adolescent health insurance have shown little change in the proportion with coverage. Federally mandated expansions in Medicaid were offset by declines in private coverage. Further expansions of Medicaid and implementation of the State Children's Health Insurance Program (SCHIP) have opened new avenues for increasing coverage rates. OBJECTIVES: To assess the current health insurance status of adolescents, the demographic and socioeconomic correlates of insurance coverage, and document recent changes in public and private coverage rates. DESIGN, SETTING, AND PARTICIPANTS: We analyzed data on 12 995 adolescents aged 10 to 18 years, who had been included in the 2002 National Health Interview Survey. We conducted multivariate analyses to assess the independent association of age, sex, race, poverty status, family structure, family size, and region on the likelihood of having insurance coverage. Results are compared with previously published findings on adolescent health insurance coverage spanning 1984 to 1995. MAIN OUTCOME MEASURE: Insurance coverage for adolescents. RESULTS: An estimated 12.2% of adolescents were uninsured in 2002, which is a decrease from 14.1% in 1995 (P<.003). The decrease occurred entirely because of an expansion of public coverage and is concentrated among children in poor (<100% of the federal poverty level) and near-poor (100%-199% of the federal poverty level) families. A substantial decrease in the differences between poor and higher-income groups occurred between 1995 and 2002 due to gains in coverage for adolescents in poor and near-poor families and losses in coverage among those in middle- and upper-income families (> or =200% of the federal poverty level). Specifically, the proportion of adolescents in poor families without coverage declined from 27.4% in 1995 to 19.7% in 2002 (P<.001). The proportion of adolescents in near-poor families without coverage declined from 24.8% in 1995 to 19.2% in 2002 (P<.002). In contrast, the proportion of adolescents in middle- and higher-income families without insurance increased from 4.1% in 1995 to 6.3% in 2002 because availability of insurance through the private market declined (P<.001). CONCLUSIONS: A modest but significant reduction in the percentage of adolescents without insurance has occurred since 1995, largely as a result of expansions in public coverage. An even larger reduction in the proportion of adolescents without coverage would have occurred, if not for a reduction in private coverage for adolescents in middle- and higher-income families.

Adolescent↗
PubMed1999

Meeting information needs: lessons learned from New Jersey's Individual Health Insurance Reform Program.

At national and state levels, there have been significant changes in the regulations governing individual and small group health insurance markets. Reforms to the individual health insurance market in New Jersey exemplify the challenges of informing consumers about changes in the regulation of insurers, where the changes are intended to simplify and broaden access to health insurance. To best take advantage of expanded access to coverage under new regulations governing the individual health insurance market, individuals need to understand the changed rules under which carriers determine eligibility and premiums. Survey results from New Jersey indicate, however, that a significant proportion of people who purchased policies under the restructured individual health insurance market did not fully understand how the new market operates.

Adult↗
PubMed1986

State health insurance pools: current performance, future prospects.

State health insurance pools have been suggested to help cover the uninsured. Their attraction lies in the theoretical economies of pooling and the limited public role intended for their administration and funding. Almost all existing pools have targeted high health risks, otherwise uninsurable people who can still afford high premiums for conventional, major-medical-style coverage. Enrollments have been low, even relative to the small eligible population, and medical spending high. Little risk pooling or other savings seem to have occurred. Deficits have therefore mounted, necessitating increased assessments on all private health insurers in pool states and indirectly burdening state treasuries as well. Better pools would have to attract a broader mix of risks, actively manage medical spending, or both.

Adult↗
PubMedDate not supplied

The effect of change of health insurance on access to care.

This study examines how changes in health insurance status affect patients and their care. Results show that, controlling for socioeconomic factors, condition, age, and urgency, patients who lost insurance and patients who changed insurance were more likely to delay seeking care within the four months after visiting an emergency department than people whose health insurance status did not change. Patients who lost coverage were more likely to report no primary care provider and were less likely to have recommended follow-up care within the four-month period. Loss of insurance also was associated with lower likelihood of vaccine use and check-ups in the prior year. The study confirms that a loss or change in health insurance in the prior year has a measurable effect on access to health care. The greatest impact was among patients who lost insurance, though patients who changed health plans also were more likely to delay seeking care than patients whose health insurance status did not change.

Boston↗
PubMedDate not supplied

Does the incidence of group health insurance fall on individual workers?

Economic models predict that the cost of health insurance is borne by workers. In this paper we ask two questions. First, is cost shifting individual-specific: does a worker with higher expected medical expenses bear this cost? Second, how do explicit employee contributions affect cost shifting? We estimate wage change regressions that include as explanatory variables changes in health insurance coverage, changes in employee premium contributions, health status, and an interaction between health insurance changes and health status. We find no evidence of a significant wage offset at either the individual or group level and conclude that changes in health insurance status are not exogenous.

Cost Sharing↗
PubMed2005

The impact of filipino micro health-insurance units on income-related equality of access to healthcare.

BACKGROUND: This study aims to assess the impact of being insured by micro-health insurance units (MIUs) on equality of access to health care among groups with inequitable income distribution. We measure equality by relating income with access to healthcare. The analysis is based on a household survey conducted in five regions in the Philippines in 2002. METHODS: We generated concentration curves and indices (CI) for insured and uninsured households (150 for each cohort in each region). We also elaborated a method to retain the relative income rank of households when data were aggregated across regions, as the regions had quite different nominal income levels. RESULTS: We found a significant effect of household income on access to hospitalizations among the uninsured households (a positive CI), but no such effect among the insured households (CI close to zero). As regards professionally attended deliveries, an increased tendency of poorer households to deliver at home (CI slightly negative) and a lower rate of deliveries in hospital (CI slightly positive and statistically significant) were reported by both uninsured and insured households. Access to consultations was unrelated to income among the insured (CI close to 0), but negatively correlated with income among the uninsured (a positive and significant CI). CONCLUSION: We conclude that MIUs in Philippines improve income-related equality of access to hospitalization and medical consultation in cases of illness. The findings of this study strengthen a claim for government support for the operation of MIUs as successful (albeit micro) suppliers of health insurance.

Cross-Sectional Studies↗
PubMed2007

Demand for private health insurance in Chinese urban areas.

Between 1993 and 2003, the proportion of urban residents without health insurance rose from 27 to 50%. The probability of outpatient visits in the previous 2 weeks dropped from 19.9 to 11.8% in urban areas between 1993 and 2003, and from 16.0 to 13.9% in rural areas. To improve risk-pooling and risk-sharing, private health insurance should play an important role in China's health insurance system. This paper estimates the demand for private health insurance in urban areas using contingent valuation methods. Individuals were asked about their willingness-to-pay (WTP) for major catastrophic disease insurance (MCDI), inpatient expenses insurance (IEI), and outpatient expenses insurance (OEI). The study was based on a household survey conducted in four small cities in China in 2004 and included 2671 respondents. More people would like to buy IEI and MCDI (48.5 and 43.0%, respectively) than OEI (24.5%). In addition, individuals would pay a higher premium for MCDI and IEI than for OEI. The price elasticities of demand for MCDI, IEI, and OEI were -0.27, -0.34, and -0.42, respectively. The determinants of enrollment in the three private health insurance programs were similar with employment status, age, education, and income.

Adult↗
PubMed2001

Slovenian experience on health insurance (re)introduction.

A period of changes in what had previously been public health insurance began in Slovenia in 1992. A new legislation introduced a mixed public-private insurance, the share of GDP allocated for health care insurance in Slovenia equaled the EU average, and the financing of the public health insurance has been balanced up - until now. For the first time since Slovenia gained independence, the compulsory health insurance is planning a 6% reduction in its income. The way to the solution of the problem lies in a political consensus on the public health issues in Slovenia, but it is still unclear whether it can be reached. A successful political agreement on the adequate amount of health care, granted to the Slovenian citizens by the public health insurance, should secure its balanced financing, which is about to be disturbed.

Croatia↗