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At least 811 records · Page 45Linked to original sources
PubMed1991

Genetic discrimination: the use of genetically based diagnostic and prognostic tests by employers and insurers.

Genetic discrimination is detrimental to public health programs, as well as to society generally. Advances in genetic testing and screening, accelerated and prompted by the Human Genome Initiative, increase society's ability to detect and monitor chromosomal differences. These technologies and their resulting genomic data will enhance medical science, but may also encourage discrimination. Although few employers or insurers currently utilize genetic screening, testing or data, rising employee benefit costs and market forces create powerful incentives for usage. Current municipal, state and federal laws, including the Americans with Disabilities Act (ADA), may not sufficiently protect employees and insureds from genetic discrimination. While municipal and state protections should not be overlooked, the ADA's sweeping scope may currently provide the most comprehensive safeguard. Federal laws banning discrimination on the basis of race or sex might also successfully redress some forms of genetic discrimination. Genetic technologies' advent necessitates efforts to rectify state and federal statutory coverage gaps, strictly regulate employers and produce comprehensive guidelines regarding its use.

Persons with Disabilities↗
PubMed1991

Enrollee health status under Medicare risk contracts: an analysis of mortality rates.

Previous studies comparing the health status of Medicare beneficiaries enrolled under HMO risk contracts to that of Medicare beneficiaries in fee-for-service (FFS) have generally focused on demonstration projects conducted before 1985. This study examines mortality rates in 1987 for approximately 1 million aged Medicare beneficiaries enrolled in 108 HMOs. We estimated adjusted mortality ratios (AMR) for each HMO and across all HMOs, by dividing the actual number of deaths among HMO enrollees by the "expected" number of deaths. The expected number of deaths was based on death rates among local FFS populations, adjusting for age, sex, Medicaid buy-in status, and institutional status. The AMR for all HMO enrollees pooled together was 0.80. For persons newly enrolled in 1987, the AMR was 0.69; in general, AMRs were higher for beneficiaries who had been enrolled for longer periods of time. Among individual HMOs, none exhibited an AMR substantially above 1.00. Regression analysis indicated lower AMRs for staff model HMOs than for either IPA or group models. Low mortality among Medicare HMO enrollees is consistent with favorable selection or with improvements in the health status of enrollees due to better access or quality of care in HMOs. In either case, health status differences between HMO enrollees and FFS beneficiaries have implications for the appropriateness of Medicare's Adjusted Average Per Capita Cost (AAPCC) payment formula for HMOs.

Aged↗
PubMed1988

Hospital quality competition and the economics of imperfect information.

Competition in the health care industry has traditionally focused on indices of quality rather than price. Even in a period of vigorous price competition, the issue of quality remains central, given patient uncertainty. Quality in the future will be assessed, however, not only on the basis of structural characteristics--such as the acquisition of new clinical technologies--but also in terms of patient outcomes. Because outcome statistics are influenced by the severity of the patient's disease at the time of treatment, it is likely that health plans and medical care institutions may accelerate their preference for healthier patients. Pure price competition may have only a modest role to play.

Community Participation↗
PubMed1995

Protecting children with chronic illness in a competitive marketplace.

Health care for children with chronic illnesses is significantly more expensive than for the average child. Children with chronic illnesses are especially vulnerable in a competitive health care environment because of the higher ongoing cost associated with treating their illnesses and the inherent pressures to reduce services to manage within the capitated rate. To minimize the adverse impact a competitive market could have on these children, a "carve-out" for specific medical conditions is discussed. A capitation pricing system that reflects their higher costs is proposed, as well as a delivery system that is focused on their needs.

Capitation Fee↗
PubMed1995

Assessing relative health plan risk with the RAND-36 health survey.

Unbiased risk assessment models base health plan payments on enrollee health care needs. We explored the risk structure of employed adult health maintenance organization (HMO) members using the RAND-36 health survey. We used multivariate techniques to estimate risk weights on demographic and health status factors. The dependent variable was annual real total health plan expense for covered services for the year following the survey. Repeated random-split-sample validation techniques minimized outlier influences. Five scales improved prediction over simple demographic factors, but demographic factors still were required to achieve unbiased forecasts. Self-reported health status is a useful and powerful risk measure for adults.

Actuarial Analysis↗
PubMed1995

Health risk and access to employer-provided health insurance.

The attractiveness of a job offering health benefits increases with a worker's expected medical expenditures. At the same time, employers have an incentive to screen out high-risk workers. Evidence from the 1984 Survey of Income and Program Participation indicates that employer screening dominates high-risk workers' desire to select jobs that offer insurance. Workers who describe their health as fair or poor, report difficulty with physical tasks, or have a work-related disability are less likely to receive employer-provided health insurance than healthy workers. Part of this effect is explained by the negative impact of poor health on earnings and labor supply.

Actuarial Analysis↗
PubMed1994

Discrepancies in employer-sponsored health insurance among Hispanics, blacks, and whites: the effects of sociodemographic and employment factors.

Using a nationally representative sample of employed adults from the 1987 National Medical Expenditure Survey (NMES), this research explores differences in the incidence and predictors of employer-sponsored health insurance among Hispanics, blacks, and whites. The data suggest that: 1) whites are most likely, and Hispanics are least likely, to have employer-sponsored medical insurance in their own name, or in the name of another individual; 2) Hispanics are most likely, and whites are least likely, to be completely uninsured; and 3) the factors which increase the odds of receiving employer-sponsored coverage in one's own name are relatively similar across racial groups, though they differ substantially in magnitude.

Adult↗
PubMed1993

Does employment-related health insurance inhibit job mobility?

Most private health insurance in the United States is an employment-related, nonportable fringe benefit. As a result, severing an employment relationship can lead to a loss of such coverage. The risk of losing coverage has been identified as a primary reason for not changing jobs and has shaped the debate over health care reform. This paper examines the relationship between employment-related health insurance and job mobility. We model the likelihood that a worker voluntarily changes employment, based upon insurance status and wages at an initial job, expected insurance status and wages at alternative employment, other fringe benefits, and worker and dependent health status. Analyses of data from the 1987 National Medical Expenditure Survey support the "job lock" hypothesis.

Adult↗
PubMed1993

Medicare risk contracting: identifying factors associated with market exit.

Over the past few years, a number of HMOs have chosen to discontinue their Medicare risk contracts. Using logistic regression, this study sought to identify factors associated with Medicare risk contract market exit in 1988. Low AAPCC rates were found to systematically affect the market exit of only Medicare risk contractors that were regional components of a central HMO organization. The Medicare risk market exit of other HMOs was found to be principally related to two attributes suggestive of possible unfavorable risk selection: the dropping of a previously offered prescription drug benefit and higher proportions of categorically disabled Medicare enrollees.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1993

The effect of HMOs on premiums in employment-based health plans.

This study documents the effect of HMOs on premiums in employment-based health plans. We analyzed a survey of Minnesota employers conducted in 1986. Among 922 usable observations, 239 firms offered HMOs in addition to fee-for-service (FFS) health plans. We estimated an equation for the probability of offering an HMO, followed by equations for HMO enrollment share, and HMO and FFS premiums. The weighted average HMO and FFS premium in firms that offer HMOs was compared to the premium of FFS-only firms. We found that offering an HMO raises the average premium for family coverage health insurance by $25.14 per month and for single coverage by $3.68 per month. This effect was smaller for firms in the Twin Cities metropolitan area. HMOs may be viewed as a progressive and innovative health care benefit, but they are likely to increase firms' health insurance premiums.

Cost Sharing↗