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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↗
PubMed1998

Insurance status among HIV+ Nebraskans.

OBJECTIVES: (1) To measure the rates of insurance in a population of HIV+ status. (2) To test an hypothesis that persons with AIDS are more likely to be uninsured than those who are HIV+ without AIDS. (3) To test the hypothesis that persons who are HIV+ experience difficulties maintaining their health insurance. METHODS: Clients of three service agencies were surveyed. Demographic information was used to eliminate duplicate responses. Of the potential 480 respondents, 238 returned the surveys, reflecting approximately 10% of the estimated number of HIV+ persons in Nebraska. Descriptive techniques were used to analyze the data, and chi-square techniques were used in group comparisons. RESULTS: Forty-three percent of the respondents were covered by private insurance, and 22% lacked any health insurance coverage. Persons with AIDS were less likely to have private insurance coverage and more likely to be receiving Medicaid coverage, but less likely to be uninsured. HIV+ test results contributed to a loss of insurance for 25 respondents, and HIV or AIDS positive was a reason for 29 respondents being denied insurance.

Chi-Square Distribution↗
PubMed2006

Six steps to fast-track insurance approval for bariatric surgery.

Most of the health-insurers approve bariatric surgery for patients according to the NIH standards, while others only approve the surgery if the patient has a BMI >50. Therefore, it is important for the physician to know and carefully follow the various criteria of different insurance companies. We suggest 6 steps to fast-track insurance approval: 1) a multidisciplinary team; 2) 6-month diet; 3) comprehensive medical evaluation; 4) flexibility and consistency; 5) analysis of each patient indication; 6) quality of cost-effectiveness and long-term monitoring and benefits. In the event that an insurance company rejects the request for surgery, a blueprint of an appeal letter is very important. The appeal letter should stress the indications and benefits of surgery for your patients. Insurance company criteria may differ from the NIH guidelines. Irrespective of this, the steps outlined will help speed the insurance approval process and reduce paperwork and confusion. Most often, rejections stem from letters that were not written clearly or that lacked one or more of the elements delineated above. If the surgeon follows the 6 steps described, he/she should meet less disappointment, as in our experience that went from 50% to 90% success because of better communication with insurance and more appropriate paperwork.

Bariatric Surgery↗
PubMed2001

Access to orthopedic care for children with medicaid versus private insurance in California.

OBJECTIVE: To compare the availability of timely orthopedic care to a child with a fractured arm insured by Medi-Cal (California state Medicaid) and by private insurance. STUDY DESIGN: Fifty randomly chosen offices of orthopedic surgeons were telephoned with the following scenario: "My 10-year-old son broke his arm last week during a vacation" followed by a request for an appointment that week. Each office was called twice with an identical script except for insurance status: once with Medi-Cal and once with private insurance. RESULTS: All 50 offices offered an appointment to see the child with private insurance within 7 days. Only 1 of the same 50 offices offered an appointment to see the child with Medi-Cal within 7 days. Of the offices that would not see a child with Medi-Cal, 87% were unable to recommend an orthopedic office that accepted Medi-Cal. CONCLUSIONS: Timely access to orthopedic care was available in 100% of offices polled to a child with private insurance versus in 2% of offices to a child with Medi-Cal. This is a significant difference. Lack of timely orthopedic care may result in poor outcome, ie, if a fracture is not properly aligned in the first few weeks, a permanent deformity may result. Although causation cannot be established from this study, we suspect that Medi-Cal reimbursement rates below the cost of office overhead may be of significance. Although federal guidelines require that payments must be sufficient to enlist enough providers so that services to Medi-Cal recipients are available to the same extent as those available to the general population, this study finds that that children with Medi-Cal insurance have significantly less access to timely orthopedic care.

Appointments and Schedules↗
PubMed2002

Family income and the impact of a children's health insurance program on reported need for health services and unmet health need.

OBJECTIVE: In an era when expanding publicly funded health insurance to children in higher income families has been the major strategy to increase access to health care for children, it is important to determine if the benefits to higher income children attributable to the receipt of health coverage are similar to those observed for lower income children. This study investigated how the likely impact of child health insurance expansions varies with family income. METHODS: We surveyed parents or guardians of children who were enrolled in a state-sponsored health insurance program (Massachusetts Children's Medical Security Plan [CMSP]) that, before the implementation of the State Children's Health Insurance Plan (SCHIP), was open to all children regardless of income. A stratified sample of children was drawn from administrative files. We grouped children by income category (low-income [LI]: < or =133% of the federal poverty limit [FPL], middle-income [MI]: 134%-200% of the FPL, high-income [HI]: >200% of the FPL) that corresponded to eligibility for public health insurance programs in the state (Medicaid-eligible, SCHIP-eligible, and income that exceeded SCHIP eligibility). The majority of telephone interviews were conducted between November 1998 and March 1999. The overall response rate was 61.8%, yielding a sample of 996 children. The CSMP benefit package included comprehensive coverage for preventive and specialty care and limited coverage for ancillary services. Children enrolled in CMSP were not covered for inpatient hospital stays but those whose family income was <400% of the FPL were eligible to receive full or partial coverage for inpatient care through the state's free care pool. Although the CMSP benefit package did not meet the standards for a SCHIP, it is an approximate equivalent for children with incomes <200% of the FPL, who have full coverage for hospitalization through the state's free care pool. We used survey responses to develop 2 sets of indicators: the first for reported need for services and the second for unmet need or delays in care among children whose parents reported a need for the service. Within each set, we created indicators for 5 types of service (medical care, dental care, prescription drugs, vision services, and mental health care) and an additional composite indicator. The composite indicator aggregated all categories of services covered under CMSP in a single measure; it included all services except dental services, which, at the time of the study, were not covered by the program. The composite indicator served as the dependent variable in regression models. We used weighted chi2 tests to identify statistically significant differences in reported need and unmet need for the 5 types of medical services and the aggregate measure of all services covered by CMSP. We examined differences across income groups at 2 points in time: during the period children were uninsured before enrollment and while enrolled. We used weighted logistic regression to assess the independent association of family income with our dependent variables: reported need for health services and the presence of unmet need, controlling for other covariates. To evaluate the impact of participation in a child health insurance program, we examined unmet need before and after program enrollment, testing for statistical significance using McNemar's test for within-subject changes. RESULTS: During the period of uninsurance before enrollment, prescription drugs (70%) was the health service needed most frequently, followed by medical (65%) and dental (57%) care. For the composite measure of services covered by CMSP, reported need for services was not significantly different by income. Need for medical care, dental care, and prescription drugs were significantly greater among children who had been uninsured for >6 months before enrollment. In addition, a significantly greater proportion of adolescent participants needed dental, vision, and mental health services than younger enrollees. While enrolled, among recently enrolled children, 77% need medical services, 68% prescription drugs, and 59% dental. In unadjusted models MI and HI children were more than 2 times as likely to report need for covered services as LI children. After adjusting for possible confounders, the effect of income was no longer significant. Instead, nonadolescents (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.25-4.76) and children with white ethnicity (OR: 3.03; 95% CI: 1.43-6.67) were significantly more likely to report need for services. Before enrollment, unmet need among those who reported need for services was 5% for medical, 4% prescription drugs, 31% dental, 30% vision, and 33% mental health. For the composite measure of services covered by CMSP, LI children were significantly more likely to have had unmet need before enrollment than MI and HI children (20%, 10%, 7% by income). As compared with younger children, adolescents also had significantly greater unmet need for the composite measure (19% vs 10%). In multivariate models, not having a usual site of care was a highly significant predictor of unmet need or delayed care (OR: 3.41; 95% CI: 1.28-9.11). Ninety-eight percent of parents cited cost as the reason they had difficulty obtaining needed care. After enrollment, the proportion of children who needed care and had difficulty obtaining it decreased for all categories of care. Less than 1% of enrollees reported unmet need or delays in care for medical services and 3% for prescription drugs. Children who needed vision and mental health services continued to experience difficulty obtaining these services (17% for each category of care), although they were covered as part of the benefit package. Unmet need or delays in care for dental services, which at the time of the study were not covered under CMSP, remained high (27%). We found a significant reduction in unmet need among children in all income groups and no significant differences in unmet need by income. Controlling for other covariates, adolescents (OR: 3.11; 95% CI: 1.58-6.12) and children with compromised health (OR: 3.20; 95% CI: 1.35-7.58) were more likely to have had difficulty obtaining needed services while enrolled in the program. Children in larger families (OR: 0.40; 95% CI: 0.17-0.96) and who were previously uninsured for >6 months (OR: 0.45; 95% CI: 0.22-7.58) were less likely to have difficulty obtaining care. CONCLUSION: Our findings demonstrate the positive impact of providing health insurance coverage to children regardless of income. The HI children who enrolled in the program looked similar to children with incomes that meet current SCHIP eligibility guidelines, suggesting that expansions of SCHIPs to HI children should not qualitatively change the program dynamics.

Child↗
PubMed2006

Insurance coverage and care of patients with non-ST-segment elevation acute coronary syndromes.

BACKGROUND: The impact of insurance coverage on the care of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) is unclear. OBJECTIVE: To compare NSTE ACS care patterns by insurance type. DESIGN: Comparison of Medicaid patients younger than 65 years of age and Medicare patients 65 years of age or older with patients of similar age who have health maintenance organization (HMO) or private insurance coverage. SETTING: 521 U.S. hospitals participating in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the ACC [American College of Cardiology]/AHA [American Heart Association] Guidelines) quality improvement initiative from January 2001 through March 2005. PATIENTS: 37,345 NSTE ACS patients younger than 65 years of age and 59,550 patients 65 years of age or older. MEASUREMENTS: Guideline-recommended treatments, and in-hospital outcomes. RESULTS: Medicaid was the primary payer for 18.7% (6999 of 37,345) of patients younger than age 65 years, whereas Medicare was the primary payer for 67.5% (40,199 of 59,550) of patients age 65 years or older. Medicaid patients were statistically significantly less likely to receive short-term (less than 24 hours) medications and to undergo invasive cardiac procedures than patients covered by HMO and private insurance. They also had higher mortality rates (2.9% vs. 1.2%; adjusted odds ratio, 1.33; 95% CI, 1.08 to 1.63). Medications and invasive procedures were used to a similar extent in patients with Medicare and HMO or private insurance, and respective mortality rates were not significantly different (6.2% vs. 5.6%; adjusted odds ratio, 1.08; 95% CI, 0.99 to 1.18). LIMITATIONS: Self-pay patients and patients without insurance were not assessed. CONCLUSIONS: NSTE ACS patients with Medicaid (but not Medicare) as the primary payer were less likely to receive evidence-based therapies and had worse outcomes than patients with HMO or private insurance as the primary payer. The causes of these treatment differences and solutions for narrowing the gaps in quality require further investigation.

Aged↗
PubMed1989

Putting a premium on medical staffs. A novel way to insure physician liability (and loyalty).

The physician malpractice insurance crisis is having an adverse financial impact on both hospitals and their medical staffs. Innovative hospitals are exploring ways to create insurance arrangements to cover the professional liability of their medical staffs. Hospital risk managers often have theorized that if the same insurer covered both hospitals and their staff physicians, providers and their patients would benefit. These programs--often referred to as "channeling" or "channeled programs"--use a common risk management program, common claims administration, and a common claims defense for insured hospitals and their medical staffs, reducing costs, unfavorable verdicts, and, thus, premiums. Unfortunately only a few commercial carriers now offer such a program. Some hospitals and systems have therefore turned to "captive" insurance companies to provide the benefits of a channeled program. Hospitals or systems and their medical staffs can establish a captive (i.e., a controlled insurance company designed to insure its owners and their affiliates) either offshore (typically in a tax-free jurisdiction such as the Cayman Islands, Barbados, or Bermuda) or onshore (typically in a state with facilitating legislation). The Tax Reform Act of 1986, together with the Liability Risk Retention Act of 1986, generally tips the regulatory balance in favor of onshore captives by allowing these entities to operate as risk retention groups (RRGs).

Financial Management↗
PubMed1999

An alternative approach to measuring the effects of insurance market reforms.

Reforms in the small group and individual insurance markets could make it easier for the currently insured to keep their coverage, and could expand coverage by making insurance more accessible to the currently uninsured. We use data from the 1989 through 1995 Current Population Survey to measure the impact of these reforms on state-level rates of uninsurance and private health insurance coverage. Instead of examining the effect of each of the various types of insurance marker reforms, we estimate the impact of packages of reforms on insurance coverage, reflecting how policies were implemented. We find that small group reforms have done little to affect insurance coverage. Individual market reforms, on the other hand, appear to increase uninsurance rates and reduce private coverage. Our findings suggest that small group reforms may have prevented erosion of private coverage, but have not reduced the numbers of uninsured people.

Employment↗
PubMed1999

Response to health insurance by previously uninsured rural children.

OBJECTIVE: To examine the healthcare utilization and costs of previously uninsured rural children. DATA SOURCES/STUDY SETTING: Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. STUDY DESIGN: The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. PRINCIPAL FINDINGS: The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. CONCLUSIONS: An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.

Arkansas↗
PubMed2000

Evolution of a children's health insurance program: lessons from New York State's Child Health Plus.

The State Children's Health Insurance Program (SCHIP) was passed by Congress in 1997. It provides almost $40 billion in federal block grant funding through the year 2007 for states to expand health insurance for children. States have the option of expanding their Medicaid programs, creating separate insurance programs, or developing combination plans using both Medicaid and the private insurance option. New York State's child health insurance plan, known by its marketing name Child Health Plus, was created by the New York Legislature in 1990. New York's program, along with similar ones from several other states, served as models for the federal legislation, especially for state health insurance plans offered through private insurers. New York's program provides useful data for successful implementation of SCHIP.

Child↗
PubMed1999

Healthcare transition managers make market exits easier for insurers.

Insurers have been struggling to meet and maintain their profit margins on the health insurance business they underwrite. As a result, many have exited or are contemplating exiting from the health insurance market. At the same time, managed care organizations are seeking ways to augment their enrollment base and satisfy investor expectations. Insurers that wish to transfer their health insurance business to other carriers and managed care organizations that are interested in accepting this business have turned to a new type of healthcare financing company--the healthcare transition manager--to facilitate the transaction. Part broker, part matchmaker, and part administrative coordinator, these companies make it possible for commercial insurers to exit the health insurance market without undue hardship to enrollees or the managed care plans that assume risk for their care.

Consultants↗
PubMed2004

Insurance status and vaccination coverage among US preschool children.

BACKGROUND: Insurance status has been shown to have an impact on children's use of preventive and acute health services. The objective of this study was to determine the relationship between insurance status and vaccination coverage among US preschool children aged 19 to 35 months. METHODS: We linked data from 2 national telephone surveys, the National Immunization Survey and the National Survey of Early Childhood Health, conducted during the first half of 2000. Children were considered up to date (UTD) when they had received at least 4 diphtheria-tetanus-acellular pertussis/diphtheria-tetanus-pertussis vaccines, 3 poliovirus vaccines, 1 MMR vaccine, 3 Haemophilus influenza vaccines, and 3 hepatitis B vaccines at the time the interview was conducted. RESULTS: Among the 735 children in our study sample, 72% were UTD. The vast majority (94%) reported some type of health insurance at the time of the survey. Children with private insurance were more likely to be UTD (80%) than those with public insurance (56%) or no insurance (64%). In a multivariate analysis that controlled for child's race/ethnicity; household income; maternal age/marital status/educational level; location of usual care; and Special Supplemental Nutrition Program for Women, Infants, and Children participation, insurance was no longer an independent predictor of vaccination. CONCLUSIONS: The disparity in vaccination coverage among publicly, privately, and uninsured children is dramatic, underscoring its importance as a marker for underimmunization, despite the multivariate findings. The Vaccines for Children Program, a partnership between public health and vaccination providers who serve uninsured children and those enrolled in Medicaid, is well suited to target and improve vaccination coverage among these vulnerable children.

Child, Preschool↗
PubMed2005

[Medical insurance coverage in Mexico].

OBJECTIVE: To present estimates of health insurance coverage in Mexico and discuss the differences among some sources of information. MATERIAL AND METHODS: Based on a national survey performed in 2002, the percentage of insurance coverage was estimated by state, rural condition, and expenditure level. RESULTS: The percentage of the population without medical insurance is 59.9%. The main insurance institution is the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social, IMSS), with a coverage of 29.5%. Private insurance agencies cover 1.5% of the total population. There are huge differences in insurance coverage by state, expenditure level and social exclusion level. CONCLUSIONS: Data on insurance coverage provided by Mexico's main social security institution differ from that obtained through population-based studies. Some of these differences may be due to probabilistic reasons and others to macroeconomic changes. However, these reasons had not been sufficiently explored. In depth studies are needed in order to explain the observed differences.

Data Collection↗
PubMed2005

[Fair health financing and catastrophic health expenditures: potential impact of the coverage extension of the popular health insurance in Mexico].

OBJECTIVE: To assess the impact on fair health financing and household catastrophic health expenditures of the implementation of the Popular Health Insurance (Seguro Popular de Salud). MATERIAL AND METHODS: Data analyzed in this study come from the National Income and Expenditure Household Survey (Encuesta Nacional de Ingresos y Gastos de los Hogares, ENIGH), 2000, and the National Health Insurance and Expenditure Survey, (Encuesta Nacional de Aseguramiento y Gasto en Salud, ENAGS), 2001. Estimations are based on projections of extension of the Popular Health Insurance under different conditions of coverage and out-of-pocket expenditure reductions in the uninsured population. The mathematic simulation model assumes applying the new Popular Health Insurance financial structure to the 2000 expenditure values reported by ENIGH, given the probability of affiliation by households. RESULTS: The model of determinants of affiliation to the Popular Health Insurance yielded three significant variables: being in income quintiles I and II, being a female head of household, and that a household member had a medical visit in the past year. Simulation results show that important impacts on the performance of the Mexican Health System will occur in terms of fair financing and catastrophic expenditures, even before achieving the universal coverage goal in 2010. A reduction of 40% in out-of-pocket expenditures and a Popular Health Insurance coverage of 100% will decrease catastrophic health expenditures from 3.4% to 1.6%. CONCLUSIONS: Our results show that the reduction of out-of-pocket expenditures generated by the new financing and health provision Popular Health Insurance model, will improve the financial fairness index and the financial contribution to the health system, and will decrease the percentage of households with catastrophic expenditures, even before reaching universal coverage. A greater impact may be expected due to coverage extension initiating in the poorest communities that have a very restricted and progressive financial contribution.

Adolescent↗
PubMed1990

[The covering physician system from the viewpoint of the insurance company].

The main question is: To whom and according to which regulations does the nonresident physician bill for reimbursement? The analysis brings to evidence, that different answers have to be given for each kind of treatment (outpatient medicine, care in ambulatory settings of hospitals, and inpatient medicine). Moreover, each kind has to be looked at differently with regard to three categories: (1) the patient who pays himself (self payers scheme), (2) the patient who is subject to the social illness insurance, and (3) the one is subject to the compulsory social accident insurance. The whole matter is extremely complex, and thus little understood as well by the nonresident physician as by the patients. Furthermore, economic disparities are apparent when looking at the various social insurance legislations, and when considering the medical tariff of each social insurance scheme. Obviously, the self payer schemes are simple, transparent and thus better understood: The nonresident physician bills to the patient directly, who in term owes payments, regardless whether he is insured or not. This system applies to all non-social insurance schemes, particularly to the private insurance scheme. Yet, the self payers schemes are successful only when State and local governments reduce their subsidies and grants to their own hospitals, and if all medical services are paid on an effective cost basis: in order to give equal chances to all medical services, private and public. Thus, the patients' position would be uprated. At the same token, the nonresident physicians would have firmer chances which in turn would mean an enormous advantage to their patients since they could be treated by one and the same physician before, during and after their hospital stays.

Fees, Medical↗
PubMed1978

Insurance coverage and access: implications for health policy.

Data are presented from a recent survey of the United States population comparing the characteristics and levels of access to medical care of persons under 65 years who have group or individual private health insurance, public health insurance, or no third-party coverage. The uninsured group appeared to fall between the privately insured and publicly insured groups on measures of social and economic status. Persons with publicly subsidized forms of insurance coverage utilized services at the highest rates, and uninsured persons used them at the lowest rates. Neither of these groups was as satisfied with the convenience or the quality of the care it obtained as the privately insured group. Implications of these findings for national health insurance and other health policy initiatives are discussed.

Adolescent↗
PubMed2006

How much risk pooling is there in the individual insurance market?

OBJECTIVE: To examine how much pooling of risks occurs among potential purchasers in the individual market, how much pooling occurs among those who purchase coverage, and whether there is greater pooling among longer-term enrollees. DATA SOURCES: The data are administrative records for enrollees in individual insurance plans in California in 2001, and from a survey of Californians enrolled in the individual insurance market and the uninsured. STUDY DESIGN: Logit models were estimated for 5 health outcome measures to compare the insured and uninsured after adjusting for other factors that affect insurance status and health. Multivariate models were also estimated to explore the relationship between health and three measures of pooling in the market: plan type, pricing tier, and the actuarially adjusted premium paid by the enrollee. PRINCIPAL FINDINGS: Those who purchase individual health insurance are in better health than those who remain uninsured. On the other hand, a large share of people with health problems does obtain individual insurance. The distribution of subscribers across plan type and pricing tier varies with their health status. Those in poor health are less likely to purchase low benefit plans. There is less separation of risks for those who become sick after enrollment based on the measure of pricing tier. The distribution of subscribers across plan type for those who have health problems at enrollment and those who become sick differs, but so does the distribution of those who become sick and those who remain healthy. CONCLUSIONS: Despite small differences among the healthy and sick, our results support the conclusion that there is considerable risk pooling in the individual market. To some extent, this pooling occurs because underwriting happens at the time people enroll and there is greater pooling among those who become sick than those who enroll sick. Our results however suggest that health savings accounts may further fragment the market.

California↗
PubMed1978

Private health insurance plans in 1976: an evaluation.

Private health insures collected a record $39.4 billion in premiums and returned $35 billion in benefits to their subscribers in 1976--a reflection of the steadily rising cost of health care, higher utilization, and the demand for expanded services. The industry experienced a net underwriting loss of $611 million, mainly because claims and operating expenses under insurance-company group business ran 3 percent above premium income. About 77 percent of the civilian population had some form of private hospital insurance, and about the same percentage had some form of surgical insurance. Lesser proportions were covered for other types of care. An estimated 12--13 percent of the population under age 65 had no economic protection against the costs of illness or health-related care--under either a private insurance plan or public program. Although virtually all of the aged were covered by Medicare, some 13--15 million bought private insurance, most of it under plans that covered some or all of the gaps in the Federal program.

Age Factors↗