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PubMed1985

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↗
PubMed1998

Health insurance coverage among Chinese Americans in Los Angeles County.

OBJECTIVES: This paper examines the factors associated with health insurance coverage among Chinese Americans in Los Angeles County. METHODS: Data were obtained through interviews conducted in 1993 and 1994 with Chinese Americans (aged 18 through 65 years) residing in Los Angeles County. A multistage probability sample was used to select respondents. RESULTS: The final sample consisted of 1747 respondents, which represented an 82% response rate. Thirty-nine percent of the respondents in the survey were without health insurance at the time of the survey. CONCLUSIONS: Logistic regression analysis showed that marital status, length of residence in the United States, education, employment, and household income were associated with health insurance coverage among Chinese Americans.

Adolescent↗
PubMed2000

Impact of insurance coverage type on laboratory test ordering behaviour of general practitioners.

BACKGROUND: There exists much variation between GP's in the use of laboratory tests. Although the requesting pattern of GPs has been extensively described in the literature, little is still known of the factors which influence the GP's test ordering behaviour. AIM: This study aimed to determine whether the payment scheme according to which general practitioners are reimbursed influences the laboratory test ordering behaviour. METHOD: The laboratory test ordering behaviour of the general practitioners of Tilburg, a town with 180,000 citizens in the south of The Netherlands, was studied during a four month period, in relation to the type of insurance coverage of the patients. Two types of insurance were considered: voluntary and compulsory. The data were collected from the laboratory administration and coupled with information obtained from two, interview rounds. RESULTS: Two findings support the hypothesis that the type of insurance coverage of the patient, has an impact on the test ordering behaviour of the physician: The ratio between laboratory requests for sickness fund patients and patients with a private health insurance was found to depend on the fraction of persons with a private health insurance within the family practice. This was tested with multiple linear regression analysis. General practices were divided into two subgroups, those with many > 29%) and few (< 29%), voluntarily insured patients. Where a patient was privately insured it was found that relatively more tests were ordered. In case of general practices with many voluntarily insured patients this distinction disappears. The relative proportion of voluntarily insured patients was found to be an important variable in explaining the test ordering behaviour of general practice physicians in Tilburg.

Aged↗
PubMed1991

Health insurance coverage among disabled Medicare enrollees.

In this article, we use the Survey of Income and Program Participation to identify patterns of non-Medicare insurance coverage among disabled Medicare enrollees. Compared with the aged, the disabled are less likely to have private insurance coverage and more likely to have Medicaid. Probit analysis of the determinants of private insurance for disabled Medicare enrollees shows that income, education, marital status, sex, and having an employed family member are positively related to the likelihood of having private health insurance, whereas age and the probability of Medicaid enrollment are negatively related to this likelihood.

Aged↗
PubMed1999

Effect of race on insurance coverage and health service use for HIV-infected gay men.

OBJECTIVE: To determine whether race is associated with health insurance coverage and health service use among gay and bisexual men in the Baltimore center of the Multicenter AIDS Cohort Study. METHODS: Data from eight semiannual study visits between 1991 and 1996 were used. Descriptive, stratified, and logistic regression analyses were conducted to determine whether race is associated with insurance coverage, medical, or dental service use, after controlling for socioeconomic variables. RESULTS: No difference was found between blacks' and whites' likelihood of having health insurance, private insurance, using inpatient, emergency department services, or antiretroviral medications. Whites were more likely to use outpatient services, particularly if CD4 cell counts were high, and were more likely to use dental services, although blacks were more likely to have dental insurance. CONCLUSIONS: Further research must be conducted to examine cultural, social, and psychological factors that help explain why white gay men use more outpatient and dental services, when other service use is unrelated to race. Investigators should be precise when using race as a variable in health services and epidemiologic research, emphasizing when racial differences truly exist versus when the variable race is a surrogate for another factor.

Adult↗
PubMed2000

Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery.

BACKGROUND: The efficacy of prophylactic mastectomy and oophorectomy in reducing breast and ovarian carcinoma has recently been reported in high-risk women. Because cost has become central to medical decision-making, this study was designed to evaluate currently existing coverage policies for these procedures. METHODS: A confidential detailed cross-sectional nationwide survey of 481 medical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted. RESULTS: Of the 150 respondents, 65% (n = 97) had 100,000 or more enrolled members and 35% (n = 53) had fewer than 100,000 enrolled members. Only 44% of private plans have specific policies for coverage of prophylactic mastectomy for a strong family history of breast cancer and 38% of plans for a BRCA mutation. Only 20% of total responding plans had a policy for coverage of prophylactic oophorectomy under any clinical circumstance. Governmental carriers were significantly less likely to have any policy for prophylactic surgery (range, 2%-12%) compared with nongovernmental plans (range, 24%-44%; P < .001). No significant regional differences for coverage policies were identified (P > .05). CONCLUSIONS: Significant variations currently exist for health insurance coverage of prophylactic mastectomy and oophorectomy. As genetic testing becomes widespread, more uniform policies should be established to enable appropriate high-risk candidates equal access and coverage for these procedures.

BRCA2 Protein↗
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↗
PubMed1998

Life transitions and health insurance coverage of the near elderly.

OBJECTIVES: This study addresses three issues. (1) What are demographic wealth, employment, and health characteristics of near-elderly persons losing or acquiring health insurance coverage? Specifically, (2) what are the effects of life transitions, including changes in employment status, health, and marital status? (3) To what extent do public policies protect such persons against coverage loss, including various state policies recently implemented to increase access to insurance? METHODS: The authors used the 1992 and 1994 waves of the Health and Retirement Study to analyze coverage among adults aged 51 to 64 years. RESULTS: One in five near-elderly persons experienced a change in insurance coverage from 1992 to 1994. Yet, there was no significant change in the mix of coverage as those losing one form of coverage were replaced by others acquiring similar coverage. CONCLUSIONS: Individuals whose health deteriorated significantly were not more likely than others to suffer a subsequent loss of coverage, due to substitution of retiree or individual coverage for those losing private coverage and acquisition of Medicaid and Medicare coverage for one in five uninsured. State policies to increase access to private health insurance generally did not prevent individuals from losing coverage or allow the uninsured to gain coverage. Major determinants of the probability of being insured were education, employment status of person and spouse, and work disability status. Other measures of health and functional status did not affect the probability of being insured, but had important impacts on the probability of having public coverage, conditional on being insured.

Death↗
PubMed2001

Changes in insurance coverage and extent of care during the two years after first hospitalization for a psychotic disorder.

OBJECTIVE: This study examined changes in insurance coverage during the 24 months after first admission for a psychotic disorder and the relationship of insurance type to the extent of care. METHODS: The sample consisted of 443 persons who were enrolled in the Suffolk County (New York) Mental Health Project. Information about coverage-private insurance, Medicaid-Medicare, or no insurance-was obtained from hospital records and interviews. The insurance status groups were compared to examine differences in the percentage of days they received inpatient, outpatient, and day hospital care. RESULTS AND CONCLUSIONS: The proportion of persons with no insurance decreased from baseline to 24 months, from 42 percent to 21 percent. The proportion of persons with private insurance remained similar, 42 and 37 percent. The proportion of those with Medicaid-Medicare increased from 15 percent to 42 percent. Of those with Medicaid-Medicare at baseline (67 persons), 88 percent had such coverage 24 months later. Of those with private insurance at baseline (188 persons), 73 percent had the same coverage 24 months later. Of those with no insurance at baseline (188 persons), 35 percent had no insurance at 24 months, 54 percent had Medicaid-Medicare, and 11 percent had private insurance. Over the 24 months, the Medicaid-Medicare group had the most days of care, the private insurance group had the least inpatient care, and those with no insurance were least likely to receive outpatient care. There was a linear relationship between receiving more outpatient care and spending less time in the hospital and the day hospital.

Adolescent↗
PubMed1998

State-specific prevalence of lapses in health-care-insurance coverage--United States, 1995.

Lack of health-care-insurance coverage has been associated with decreased use of preventive health services, delay in seeking medical care, and poor health status. In 1995, an estimated 30.5 million persons aged 18-64 years in the United States did not have health insurance. To determine state-specific estimates of the prevalence of persons aged 18-64 who reported either short-term (i.e., <12 months) or long-term (i.e., > or = 12 months) lapses in health-care coverage, CDC analyzed data from the 1995 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis and indicates that among adults who reported having no health insurance in 1995, most were without insurance for > or = 1 year and that long-term lapses were more prevalent among men than women.

Adult↗
PubMed1988

Variations in content of care in a family medicine residency relating to types of insurance coverage.

The content of care in a family practice residency program was analyzed using a microcomputer information system. The distribution of recorded diagnoses in the training program was found to be very similar to results of two national studies of family medicine. Despite this overall similarity, important differences were found when distributions for patients with six types of insurance coverages were analyzed separately. This study demonstrates the potential effect of insurance coverage on the clinical content of family medicine. As the health care system changes, residency programs will need to remain adaptable to maintain patient bases reflecting the broad content of family medicine.

Adolescent↗
PubMed1988

Employer-sponsored insurance coverage for alcoholism and drug-abuse treatments.

This article examines the growth in employer-sponsored health insurance coverage for alcoholism and drug-abuse treatments. Data are drawn from the Bureau of Labor Statistics' Employee Benefit Surveys of 1981, 1983 and 1985. The surveys provide information on approximately 20.5 million full-time permanent employees in 43,000 establishments each year. The data are nationally representative. In 1985, 68.5% of employees with medical insurance had coverage for alcoholism treatments and 61.6% had coverage for drug-abuse treatments. Alcoholism coverage increased 89% from 1981 to 1985. The increases were reflected across all regions, firm sizes and occupational groups. Self-insured firms, exempt from mandated coverage laws, had the greatest increase in coverage. HMOs appear to have reduced coverage since 1981. Finally, substance abuse coverages did not appear to be discretionary and, therefore, were unlikely to be eliminated if tax laws on fringe benefits were changed.

Alcoholism↗
PubMed1997

Dental service use and dental insurance coverage--United States, Behavioral Risk Factor Surveillance System, 1995.

In the United States, 94% of adults have evidence of past or current tooth decay, and only one third of adults aged 35-44 years have all of their permanent teeth. Dental insurance is associated with increased use of dental services and improved oral health status. This report summarizes state-specific and aggregated state data on both private and public sources of dental insurance coverage and the use of dental services among adults in 25 states who participated in the oral health module of the 1995 Behavioral Risk Factor Surveillance System (BRFSS). The findings indicate that nearly half (44.3%) of adults in this survey reported having no dental insurance coverage.

Adult↗
PubMed1993

Health insurance coverage in U.S. urban and rural areas.

This study examines the health insurance coverage of the nonelderly population in U.S. urban and rural areas in 1989, using data from the March 1990 Current Population Survey conducted by the Bureau of the Census. Access to coverage was assessed by classifying all persons by family employment status and income. Rural residents had less access to coverage than urban residents but were only slightly less likely to be insured. In comparison to urban residents, fewer rural residents obtained coverage through employment, and more purchased private coverage outside the work place. The differences in coverage by family employment status and income were generally much greater than the differences by place of residence.

Adult↗
PubMed1993

Insurance coverage and usage of preventive health services.

The 1991 Florida Behavioral Risk Factor Survey which included 2,246 respondents to a random-digit-dial telephone survey, showed that 19.2% of Florida residents aged 18 and older reported they had no health insurance, and 24.7% reported they had no insurance covering outpatient services. Lack of insurance coverage was reported more frequently by younger adults (70% under age 40 vs 93% over age 60), by those with less than a high-school education (69% vs 85% for those with some college), by members of racial-ethnic minority groups (Hispanics 67.5%, Blacks 71.5%, whites 85%), and by residents of southeastern Florida. Persons without insurance coverage were less likely to report having had a check-up by a physician in the last year, more likely to report they needed to see a physician but could not because of cost (37% vs 9%), and less likely to have received a mammogram (33% vs 56%) or Pap smear (51.6% vs 67.8%) in the last year. These findings support the need for health-care reform to include assurance that health insurance covers preventive services.

Adolescent↗
PubMed1994

Health insurance coverage and medical care utilization among working-age Americans with visual impairment.

As access and cost of medical care emerge as the fundamental issues in the discussion of reforming the nation's health care system, more attention needs to be devoted to the understanding of how visual impairment and functional disability in general affects an individual's access to health insurance as well as medical care utilization. Based on the 1984 Survey of Income and Program Participation (SIPP), we estimate that only 57.5% of 7.0 million working-age (15-64 years old) visually impaired Americans, compared with 79.0% of those not visually impaired, have private health insurance coverage. Moreover, an estimated 1.5 million visually impaired working-age Americans are not covered by any form of health insurance, public or private. This 20.7% uninsurance rate is significantly higher than the 14.1% reported among those who are not visually impaired (p < 0.001). Multivariate logistic regression also supports the inverse association between visual impairment and insurance coverage. On the other hand, multivariate logistic regression suggests a positive association between visual impairment and utilization of outpatient medical services. Although there is a trend toward higher utilization of inpatient services as well among the visually impaired, the finding is not statistically significant. These findings suggest that visual impairment poses a barrier to accessing health insurance, even when controlling for income, education, and employment status. On the other hand, regardless of the health insurance status, visually impaired Americans are likely to have utilized more physician services, but not the hospital services, than the non-visually impaired.

Adult↗
PubMed2000

Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin.

OBJECTIVES: This study examined health insurance coverage among immigrants who are not US citizens and among individuals from the 16 countries with the largest number of immigrants living in the United States. METHODS: We analyzed data from the 1998 Current Population Survey, using logistic regression to standardize rates of employer-sponsored coverage by country of origin. RESULTS: In 1997, 16.7 million immigrants were not US citizens. Among non-citizens, 43% of children and 12% of elders lacked health insurance, compared with 14% of non-immigrant children and 1% of non-immigrant elders. Approximately 50% of non-citizen full-time workers had employer-sponsored coverage, compared with 81% of non-immigrant full-time workers. Immigrants from Guatemala, Mexico, El Salvador, Haiti, Korea, and Vietnam were the most likely to be uninsured. Among immigrants who worked full-time, sociodemographic and employment characteristics accounted for most of the variation in employer health insurance. For Central American immigrants, legal status may play a role in high un-insurance rates. CONCLUSIONS: Immigrants who are not US citizens are much less likely to receive employer-sponsored health insurance or government coverage; 44% are uninsured. Ongoing debates on health insurance reform and efforts to improve coverage will need to focus attention on this group.

Adolescent↗
PubMed1983

Consumers' knowledge about their health insurance coverage.

This paper describes how much families know about their health insurance coverage and investigates whether consumer education and simplified benefit structures would improve knowledge. Families' perceptions about their insurance benefits were measured in two household surveys administered in six sites. Knowledge was assessed by comparing families' responses with policy data collected from the carrier. The vast majority of families understand insurance policies that specify one or two parameters in their benefit provisions. However, more complex payment structures are not well understood. Increased exposure to information in the plans leads to increased knowledge which suggests that education programs could improve the general level of knowledge. We conclude that if market strategies for allocating medical resources are pursued, simplifying insurance benefit structures and educating consumers about their insurance benefits would aid consumers in making more informed economic choices about medical care.

Awareness↗