Ryan White CARE Title II funding: Louisiana's potential cost savings in providing health insurance continuation coverage.
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Acquired Immunodeficiency Syndrome↗
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Health insurance problems among insured rheumatoid arthritis patients.
OBJECTIVE: To describe limitations in insurance coverage and their financial impact among a sample of rheumatoid arthritis (RA) patients. METHODS: A national sample of RA patients followed since 1988, completed a telephone interview about health insurance coverage, experiences with preexisting conditions clauses, and the financial impact of arthritis. Descriptive and multivariate logistic regression techniques were used to analyze the demographics and health status data. RESULTS: Trends in insurance coverage among people in this sample showed that participants were more likely to be in an HMO or PPO currently than 5 years previously. A majority of participants (67%) experienced financial impact from arthritis; 35% said that arthritis limited their ability to earn a living. Twenty-one percent had some insurance limitation because of arthritis as a preexisting condition. Eleven percent had been denied insurance. Those who had higher scores on the Stanford Health Assessment Questionnaire, were younger, were covered by Blue Cross/Blue Shield, and were more likely to be affected by a preexisting condition limitation. CONCLUSION: The data clearly indicate that even well-insured RA patients receiving care from rheumatologists experience limitations related to preexisting conditions and considerable financial impact.
Adult↗
Child support enforcement program, medical support enforcement--Office of Child Support Enforcement, HHS. Final rule.
OCSE is amending the Child Support Enforcement program regulations governing medical support enforcement. Prior regulations required State child support enforcement (IV-D) agencies to perform certain medical support enforcement activities. The regulation requires State IV-D agencies to extend these activities to certain IV-D cases no embraced by the prior regulations and eliminates a restriction which applies to cooperative agreements between State IV-D and State Medicaid agencies. The IV-D agency is required to develop criteria to identify existing child support cases which have a high potential for obtaining medical support, and to petition the court or administrative authority to modify support orders to include medical support for targeted cases even if no other modification is anticipated. In addition, the IV-D agency is required to provide the custodial parent with information pertaining to the health insurance coverage obtained by the absent parent for the dependent child(ren). Further, this regulation deletes the condition that IV-D agencies may only secure health insurance coverage under a cooperative agreement when it will not reduce the absent parent's ability to pay child support. Finally, this regulation deletes prior maintenance of effort requirements States must adhere to when entering into a cooperative agreement with the State Medicaid agency. No changes were made to the regulations as a result of comments received. These activities will expand the number of children for whom private health insurance coverage is obtained by increasing the availability of third party resources to pay for medical care and will result in Medicaid cost saving to State and Federal governments.(ABSTRACT TRUNCATED AT 250 WORDS)
Aid to Families with Dependent Children↗
Gender and uninsurance among young adults in the United States.
OBJECTIVE: Although one third of young adults in the United States are uninsured, lack of insurance in this age group has been the subject of few published studies. Because opportunities to obtain public and private insurance are likely to differ for men and women, the objective of this study was to describe the gender-specific relationship of sociodemographic variables and lack of insurance among young adults. METHODS: We examined data for 6884 young adults (aged 19-24 years) who completed the Sample Adult Questionnaire of the National Health Interview Survey for 1998, 1999, and 2000. Gender-stratified multiple logistic regression was used to estimate the odds of being uninsured associated with race/ethnicity, household income, major activity in the previous week, marital status, and pregnancy (women). RESULTS: Overall, 32% of male participants and 27% of female participants reported being uninsured at the time of the survey. Uninsured men outnumbered insured men in several sociodemographic categories, including Hispanic men (58% uninsured), men not attending high school (85%), and men employed in a workplace that did not offer health insurance (51%). High rates of uninsurance were reported by women not attending high school (65%), Hispanic women (46%), those who were keeping house (41%), and women with a household income between 10 000 dollars and 20 000 dollars (41%). In multiple logistic regression models, many of the sociodemographic variables studied were similarly correlated with health insurance for both men and women. Employment in a workplace where the young adult was not offered health insurance coverage, low household income, low educational attainment, and Hispanic ethnicity were associated with increased odds of being uninsured for both genders. Having attended college, higher household income, and being a student or employed in a workplace that offers health insurance coverage were associated with lower odds of being uninsured for both genders. CONCLUSION: This study suggests that additional opportunities for health insurance coverage are needed for young adults-particularly men, Hispanics, and those in low- and middle-income households. Increasing the availability of employment-based health insurance, discouraging attrition from primary and secondary education, and the creation of insurance opportunities for minorities and near-poor and middle-income households are potentially important target areas for programs that seek to reduce the number of uninsured young adults.
Adult↗
A historical analysis of medical spending growth, 1960-1993.
About half the growth in real per capita medical spending from 1960 to 1993 and two-thirds of its growth from 1983 to 1993 resulted from either the level or the growth of insurance coverage, chiefly the former. Dividing all factors determining the 1960-1993 growth in real per capita medical spending into two major categories, we find that 70 percent of this growth resulted from cost-increasing advances in medical services induced by insurance coverage levels and spending for noncommercial medical research. Only 30 percent was attributable to standard factors: growth in insurance coverage, changes in age/sex mix, and growth in real per capita disposable income.
Data Collection↗
Financial considerations insurance and coverage issues in intestinal transplantation.
OBJECTIVE: To increase healthcare workers' knowledge of reimbursement concerns. METHODS: Chronological survey of transplants reimbursed at the University of Nebraska Medical Center from December 1997 to October 2003, which include accounts of 30 patients who received intestine transplants. CONCLUSIONS: Gross billed hospital charges for the past 30 transplantations ranged from dollars 112094 to dollars 667597. Length of stay ranged from 18 to 119 days. Charges include organ procurement fees. All 30 intestine transplants were reimbursed by third-party healthcare coverage; combination of coverage; and/or patient and family payments, which resulted in adherence to financial guidelines prearranged by the hospital. Financial guidelines are usually cost plus a percentage. Thirteen transplantations occurred after April 2001, when Medicare made a national coverage decision to reimburse this form of transplantation. Since then, obtaining surgical authorization and reimbursement is easier. Most insurance companies and state public health agencies accept intestinal transplantations as a form of treatment. Researching transplant coverage before evaluation is essential to be compensated adequately. Financial guidelines will secure the fiscal success of the program. Educating patients to insurance and entitlements may reduce the out-of-pocket cost to patients. Transplant financial coordinators coordinate these efforts for the facility. The best coverage option for the patient and transplant programs is a combination of commercial healthcare coverage, secondary entitlement program, and fund-raising. With length of stay ranging up to 119 days and a lifetime of posttransplant outpatient follow-up care, it is beneficial for the facility to also have a fundraising program to assist patients.
Hospital Charges↗
Insurance and new technology: from hospital to drugstore.
This paper traces the relationship between insurance coverage and the technology-induced shift of the locus of medical care and medical spending from the inpatient to the outpatient setting. This shift was accompanied by an increase in the extent of private insurance coverage for outpatient treatments; technological change both caused the increase in coverage (for more costly treatments) and was affected by it (as lower user prices increased the demand for new types of care). Changes in insurance administration technology also facilitated the transformation. Some aspects of the change may have been inefficient, because of the presence of tax subsidy and legal requirements to cover costly new technologies of low effectiveness, but the transformation appears thus far to have worked better for private insurance than for Medicare.
Aged↗
Hospital provision of uncompensated care and public program enrollment.
Hospital provision of uncompensated care is partly a function of insurance coverage of state populations. As states expand insurance coverage options and reduce the number of uninsured, hospital provision of uncompensated care should also decrease. Controlling for hospital characteristics and market factors, the authors estimate that increases in MinnesotaCare (a state-subsidized health insurance program for the working poor) enrollment resulted in a 5-year cumulative savings of $58.6 million in hospital uncompensated care costs. Efforts to evaluate access expansions should take into account the costs of the program and the savings associated with reductions in hospital uncompensated care.
Adolescent↗
It's the premiums, stupid: projections of the uninsured through 2013.
Increases in the cost of health care from 1979 to 1999 accounted for the decline in health insurance coverage that occurred during that time period, as our earlier work demonstrated. Here we examine whether the model we presented adequately accounts for the observed changes in health insurance coverage from 1999 through 2002, and we show that the model accurately predicted the increase in uninsured people during that time period. Using the model and projections for national health spending, we project that the number of nonelderly uninsured Americans will grow from forty-five million in 2003 to fifty-six million by 2013.
Forecasting↗
Voluntary public health insurance for low-income families: the decision to enroll.
A dominant issue in the health reform debate is whether insurance coverage should be voluntary or mandatory. Clearly, the factors that determine who will seek voluntary coverage are relevant to this policy issue. This article uses experience from Washington State's Basic Health Plan to examine the enrollment choices of low-income families in a state-subsidized voluntary insurance plan offered through managed care organizations. We hypothesize that the decision to enroll, which encompasses the decisions to purchase insurance coverage and to select a particular plan, is influenced by four factors: the family's financial vulnerability, their risk perception, the price of coverage, and the transition costs of enrolling. Our enrollment model is supported by the data and has important implications for the design of voluntary programs. Families who choose to enroll are more likely to have a female head of household, young children, and a family member who has a part-time job and some college education. Higher premiums and availability of other insurance coverage decrease the probability of enrolling.
Adult↗
Improving childhood asthma outcomes in the United States: a blueprint for policy action.
BACKGROUND/OBJECTIVE: Asthma is increasingly being recognized as an important public health concern for children in the United States. Effective management of childhood asthma may require not only improving guideline-based therapeutic interventions, but also addressing social and physical environmental risk factors. The objective of this project was to create a blueprint for improvement of national policy in this area. DESIGN/METHODS: A nominal group process with nationally recognized experts and leaders (referred to as "the committee") in childhood asthma. RESULTS: The committee identified 11 policy recommendations (numbered in order below) in 2 broad categories: Improving Health Care Delivery and Financing, and Strengthening the Public Health Infrastructure. Recommendations regarding Improving Health Care Delivery and Financing include the development and implementation of quality-of-care standards in 1) primary care, 2) self-management education, and 3) case-management interventions, and the expansion of insurance coverage and benefit design by 4) extending continuous health insurance coverage for all children, 5) developing model insurance benefits packages for essential childhood asthma services, and 6) educating health care purchasers in how to use them. Recommendations for Strengthening the Public Health Infrastructure include public funding of asthma services that fall outside the insurance system through establishing 7) public health grants to foster asthma-friendly communities and 8) school-based asthma initiatives. 9) Launching a national asthma public education campaign, 10) developing a national asthma surveillance system, and 11) establishing a national agenda for asthma prevention research, with an emphasis on epidemiologic and behavioral sciences, are also recommended. CONCLUSIONS: Implementing these recommendations will require coordination of activities at the national, state, and local community level, and within and outside the health care delivery system. With a further commitment of national and local resources, implementation of these recommendations will likely lead to improved child and family asthma outcomes in the United States. childhood asthma, health care policy, health care services.
Advisory Committees↗
Dental insurance, managed care and traditional practice.
BACKGROUND AND OVERVIEW: The author examined the impact of trends in commercial insurance plans and their managed care products on the traditional fee-for-service solo or partnership model of dental practice. CONCLUSION: In response to rising dental expenditures, employers are passing on more costs of dental insurance to employees, dropping dental benefits altogether and moving from indemnity to managed care plans, mainly preferred provider organizations. These trends are likely to continue, resulting in fewer people with employer-based dental insurance coverage. PRACTICE IMPLICATIONS: These changes in dental insurance coverage are unlikely to challenge the traditional model of dental practice within the next five years, largely because of the growing decline in the supply of dental services and a lack of local market concentration of dental managed care companies.
Dentists↗
Many uninsured children qualify for Medi-Cal or Health Families.
Nearly 1.5 million California children ages 0-17 did not have health insurance coverage for all or part of the year in 2002. However, almost two-thirds of these uninsured children were eligible for one of the state's two public health insurance programs--Medi-Cal or Healthy Families. Uninsured children who were eligible but not enrolled in these programs were spread throughout the state, with wide variations between local areas. This policy brief presents data on children ages 0-17 in California who did not have health insurance coverage for some or all of the year and who were eligible for the Medi-Cal or Healthy Families programs. These data highlight the geographic variations in children's uninsured eligibility rates for state Assembly, Senate and Congressional districts, as well as for counties and the Los Angeles Service Planning Areas (SPAs). Uninsured-eligibility rates at local levels were estimated by applying a small-area methodology to multiple data sources, including the 2001 California Health Interview Survey (CHIS 2001), 2000-2002 Current Population Surveys, and the 2000 Census.
Adolescent↗
The influence of obesity and volume of resection on success in reduction mammaplasty: an outcomes study.
BACKGROUND: Indications for breast reduction surgery include neck pain, back pain, shoulder pain, and an intertriginous rash. Previous studies have established that bilateral breast reduction surgery is highly effective in relieving these symptoms. Third-party payers may refuse to cover breast reduction surgery for obese patients. In addition, some surgeons turn down obese breast reduction candidates, perhaps fearing that they will not achieve symptom relief or that the complication rate will be prohibitive. It is common for insurers to require an arbitrary minimum volume to be resected in order for them to reimburse for the procedure. This study was conducted to see whether patients with varying levels of obesity had any difference in surgical outcomes compared with nonobese patients with regard to symptom relief and complication rate. The authors also studied the relationship between volume of tissue resected and symptom relief and complication rate. METHODS: One hundred eighty-six consecutive patients underwent bilateral breast reduction surgery performed by a single surgeon using the inferior pedicle Wise pattern technique or the free nipple graft technique. Body mass index was calculated for each patient. RESULTS: Significant postoperative symptom relief occurred in 97 percent of patients. Statistical analysis demonstrated no difference among the various body mass index groups in terms of symptom relief or development of complications, nor was there any correlation between volume of tissue resected and relief of symptoms or complications. CONCLUSIONS: The authors conclude that there is no justification for discriminating against obese patients in either the performance of breast reduction surgery or the provision of insurance coverage for the same. The authors find no justification for denial of insurance coverage for patients in whom lesser tissue volumes are to be resected.
Adult↗
Out-of-pocket health expenses for Medicaid and other poor and near-poor persons in 1980.
The Medicaid program (Title XIX of the Social Security Act) was designed to provide access to health services at little or no out-of-pocket expense to low-income persons who might otherwise not be able to afford them. Information was collected through household interviews in the National Medical Care Utilization and Expenditure Survey (NMCUES) on total out-of-pocket expenditures for health care by noninstitutionalized persons in the United States in 1980. This report presents data to assess the degree to which Medicaid enrollees incur out-of-pocket expenses. These levels of expenditures are compared to those experienced by other persons not eligible for Medicaid who are below or near the official poverty level. Data contained in this report were derived from the National Household Survey (HHS), a panel survey of 6,600 households representative of the civilian, noninstitutionalized U.S. population, which is only one of the three surveys that were conducted as part of NMCUES. The other two surveys are a State Medicaid Household Survey (SMHS) of Medicaid households in four States and the Administrative Records Survey (ARS), a survey of existing Medicare and Medicaid administrative records for sample households. Since data were derived only from HHS, the findings in this report are national (or regional) in scope and cannot be tied directly to differences in individual State Medicaid programs. The data on eligibility and expenditures are all self-reported and have not been verified by administrative records. One definite limitation of these data is the exclusion from the NMCUES sample of all institutionalized persons. As a result, out-of-pocket expenses for one particularly high-cost group are excluded, and total out-of-pocket expenditures for each health insurance coverage group are understated. Another potential limitation of this analysis is that, as with many surveys, limited data on key items (such as out-of-pocket expenses and income) were at times missing from respondent reports. These missing data were imputed according to standard statistical techniques (see Appendix III). A variety of findings is presented, including data on the effect of health insurance coverage, demographic characteristics, health status, and continuity of Medicaid enrollment on out-of-pocket expenses. Within insurance coverage categories, Medicaid-covered persons had the lowest out-of-pocket expenses. This was true even though they had the highest mean per capita charges for care. Among the demographic characteristics that were analyzed, age and race had the most impact on the level of out-of-pocket health expenses.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Racial differences in the use of epidural analgesia for labor.
BACKGROUND: There is strong evidence that pain is undertreated in black and Hispanic patients. The association between race and ethnicity and the use of epidural analgesia for labor is not well described. METHODS: Using the New York State Perinatal Database, the authors examined whether race and ethnicity were associated with the likelihood of receiving epidural analgesia for labor after adjusting for clinical characteristics, demographics, insurance coverage, and provider effect. This retrospective cohort study was based on 81,883 women admitted for childbirth between 1998 and 2003. RESULTS: Overall, 38.3% of the patients received epidural analgesia for labor. After adjusting for clinical risk factors, socioeconomic status, and provider fixed effects, Hispanic and black patients were less likely than non-Hispanic white patients to receive epidural analgesia: The adjusted odds ratio was 0.85 (95% CI, 0.78-0.93) for white/Hispanic and 0.78 (0.74-0.83) for blacks compared with non-Hispanic whites. Compared with patients with private insurance, patients without insurance were least likely to receive epidural analgesia (adjusted odds ratio, 0.76; 95% CI, 0.64-0.89). Black patients with private insurance had similar rates of epidural use to white/non-Hispanic patients without insurance coverage: The adjusted odds ratio was 0.66 (95% CI, 0.53-0.82) for white/non-Hispanic patients without insurance versus 0.69 (0.57-0.85) for black patients with private insurance. CONCLUSION: Black and Hispanic women in labor are less likely than non-Hispanic white women to receive epidural analgesia. These differences remain after accounting for differences in insurance coverage, provider practice, and clinical characteristics.
Adult↗
Access to care and functional status change among aged Medicare beneficiaries.
OBJECTIVES: This study examined whether the extra-individual factors of better access to care and supplementary health insurance coverage can prevent, delay, or reverse transitions from functional independence to disability over time. METHODS: Six years of the Medicare Current Beneficiary Survey were pooled, yielding 40,793 transition periods for community residents aged 66 or older. Multinomial logit models of transitions among functional states were estimated, with functional improvement, functional decline, and mortality as outcomes. RESULTS: Insurance coverage and better access to care increased survival chances and reduced the odds of transitions from independence to disability by roughly 30%. Access and supplementary insurance did not appear to affect transitions from less disabled to more disabled states or affect functional improvement. DISCUSSION: The findings support the hypothesized role of extra-individual environmental factors in Verbrugge and Jette's conceptual scheme of the disablement process. Access to care is suggested to make the most difference in delaying or slowing down functional decline among functionally independent elderly persons. Transitions from less severe to more severe states of disability or to death appear to be influenced more by the natural course of chronic diseases, underlying health status, and medical instability.
Activities of Daily Living↗
Restricted access to care: the role of race, managed care, and type of insurance.
This article compares African American patients who entered the hospital with the same medical condition-acute myocardial infarction-to similar white patients to assess the relative contributions of insurance type and managed care to the race gap in access to three expensive invasive procedures for treating heart disease: cardiac catheterization, percutaneous transluminal coronary angioplasty (angioplasty or PTCA), and coronary artery bypass surgery (CABG). With data from the state of Maryland, we find that the races differ markedly in their insurance coverage and African Americans have significantly less access to the procedures. Type of insurance and HMO explained little of the difference in access to procedures. Medicare appears to offer as much access to African Americans as commercial providers. We conclude that equalizing access to types of insurance coverage would reduce only a small proportion of the race gap in access to the three procedures.
Adult↗