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PubMed1997

Interim rules for health insurance portability for group health plans--HCFA. Interim rules with request for comments.

This document contains interim rules governing access, portability and renewability requirements for group health plans and issuers of health insurance coverage offered in connection with a group health plan. The rules contained in this document implement changes made to certain provisions of the Internal Revenue Code of 1986 (Code), the Employee Retirement Income Security Act of 1974 (ERISA), and the Public Health Service Act (PHS Act) enacted as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Interested persons are invited to submit comments on the interim rules for consideration by the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (Departments) in developing final rules. The rules contained in this document are being adopted in an interim basis to accommodate statutorily established time frames intended to ensure that sponsors and administrators of group health plans, participants and beneficiaries, States, and issuers of group health insurance coverage have timely guidance concerning compliance with the recently enacted requirements of HIPAA.

Career Mobility↗
PubMedDate not supplied

Dental check-up of California's State Children's Health Insurance program.

PURPOSE: The purpose of this study was to compare dental utilization rates and related factors for children in California's State Children's Health Insurance dental program (SCHIP) to those for children with other types of dental insurance coverage or no coverage. METHODS: Data from the cross-sectional 2001 California Health Interview Survey for 10,454 children 2 to 11 years old were used. Data analyzed included: (1) the child's most recent dental visit; (2) dental insurance status; and (3) type of health insurance coverage. RESULTS: In 2001, 5% (+/-SE=0.3) of California children had SCHIP dental coverage, 19% had Medicaid dental insurance (Denti-CAL), and 52% had private dental insurance. Twenty-three percent (+/-0.5) of children, however, had no dental insurance. Dental utilization rates varied significantly according to type of dental insurance. Compared to uninsured children, SCHIP children were more likely to use dental services within the past year (58% vs 72%). Annual dental utilization rates were even higher for Denti-CAL and privately insured children (76% and 80%, respectively). Factors associated with disparities in dental utilization included lack of a usual source of health care and lack of continuous health insurance. CONCLUSIONS: Significant disparities occurred by dental insurance status and type. Annual dental utilization rates for SCHIP children lagged behind those of children with Denti-CAL or private dental insurance.

Analysis of Variance↗
PubMed2002

Lack of caregivers limits use of outpatient hematopoietic stem cell transplant program.

Our goal was to compare direct and indirect medical costs and quality of life associated with inpatient vs outpatient autologous hematopoietic stem cell transplantation (AuHSCT). Twenty-one sequential outpatients and 26 inpatients were enrolled on this prospective trial. All candidates for AuHSCT were screened for eligibility for outpatient transplantation. Patients with either breast cancer or hematologic malignancy, insurance coverage for the outpatient procedure, one to three caregivers available to provide 24 h coverage, and no significant comorbidities were eligible to participate. Patients without caregivers or insurance coverage for outpatient transplant were accrued to the study in a consecutive manner as inpatient controls, based on willingness to participate in the quality of life portion of the study and to permit review of their hospital and billing records. Approximately half of all 139 prospective outpatient candidates were ineligible because they lacked a caregiver. Most commonly, the patient without a caregiver was single or widowed or their family and friends were needed to provide childcare. Most caregivers were college educated from families with incomes greater than US dollars 80000. Indirect costs to the caregivers totaled a median of US dollars 2520 (range US dollars 684-US dollars 4508), with the majority attributed to lost 'opportunity costs'. Overall, there were significant differences in the total costs of treatment for inpatient vs outpatient AuHSCT (US dollars 40985 vs US dollars 29210, P < 0.01)). In general, no significant differences were detected between inpatient and outpatient scores on quality of life measures. Although significant cost savings were associated with outpatient transplantation, this approach was applicable to only half of our otherwise eligible candidates because of a lack of caregivers. The financial burden associated with the caretaking role may underlie this finding.

Adult↗
PubMed2005

Employment and health insurance in long-term liver transplant recipients.

This study was conducted to examine factors affecting health insurance and employment status in long-term liver transplant (OLT) recipients. All adult primary OLT recipients surviving at least 1 year were surveyed using existing questionnaires. Out of 217 eligible recipients, 186 (86%) responded. The median age of respondents was 55 years with a median survival after OLT of 3.4 years. The majority (98%) of respondents had health insurance coverage. Thirty-four (18%) reported having lost and/or having been denied health insurance since OLT, and 63 (34%) switched health insurance since OLT. Of the 179 that reported employment status, 98 (55%) were employed, including homemakers and students, while 39 (22%) were retired and 42 (24%) unemployed. The majority (76%) of those unemployed cited poor health as the reason for unemployment, followed by 5 (12%) who feared loss of disability or Medicaid benefits. Fourteen reported to have been denied or terminated from employment because of their transplant. In the regression analysis, employment prior to transplantation (odds ratio (OR)=5.1), age less than 57 (OR=5.1), physical function score>52.4 (OR=3.6) and general health score>33.3 (OR=7.6) were significantly associated with employment. These data may help identify high-risk pre-OLT patients for intervention measures such as work rehabilitation.

Adult↗
PubMedDate not supplied

Assessing the impact of health plan choice.

Many health policy researchers have argued that increased insurance plan choice will enhance the efficiency of the health care system. However, relatively little is known about plan choice and its association with insurance coverage and access to and satisfaction with health care. Using data from the 1996 Medical Expenditure Panel Survey, we find that 55 percent of workers had plan choice in that year. Approximately 26 percent of workers with choice obtained it through a family member. Controlling for other factors, plan choice is associated with higher levels of employment-based insurance coverage and a greater likelihood that workers are satisfied that their families' health care needs are being met.

Adult↗
PubMed2005

Factors associated with health care access for Mississippi children with special health care needs.

OBJECTIVES: This purpose of the study was to examine the factors associated with access to routine care and to specialty care for Mississippi children with special health care needs (CSHCN). METHODS: We analyzed data for Mississippi CSHCN from the 2001 National Survey of Children with Special Health Care Needs. Using a modified version of Andersen and Aday's Behavioral Model of Health Services Use, we explored the relationship of independent variables (e.g., demographics, insurance, severity of illness) to dependent variables (did not obtain routine care, did not obtain specialty care). We conducted bivariate and logistic regression analyses using SAS and SUDAAN. RESULTS: Based on self-reported data, with a 61% response rate, 66% of Mississippi CSHCN needed routine health care, and 52.8% needed specialty care. Of these children, 6.5% did not receive routine care and 9.3% did not receive specialty care. In a fully adjusted model, discontinuous insurance coverage was an important factor associated with not having obtained routine care (OR = 7.8; CI = 1.7-35.9) and specialty care (OR = 8.6; CI = 2.0-36.8). Children with a high illness severity rank were more likely to have not obtained routine care than children with a low rank (OR 1.4; CI = 1.1-1.9). CONCLUSIONS: It may be important to establish a health insurance safety net for families who lack insurance continuity since it appears that a lapse in insurance coverage impedes health care access. Further research is needed to understand the relationship between illness severity and lack of health care access, especially for children with special health care needs.

Adolescent↗
PubMed2003

Tribal benefits counseling program: expanding health care opportunities for tribal members.

American Indian tribal clinics hired benefits counselors to increase the number of patients with public and private insurance coverage, expand the range of health care options available to tribal members, and increase third-party revenues for tribal clinics. Benefits counselors received intensive training, technical assistance, and evaluation over a 2-year period. Six tribal clinics participated in the full training program, including follow-up, process evaluation, and outcomes reporting. Participating tribal sites experienced a 78% increase in Medicaid enrollment among pregnant women and children, compared with a 26% enrollment increase statewide during the same period. Trained benefits counselors on-site at tribal clinics can substantially increase third-party insurance coverage among patients.

Counseling↗
PubMed1997

Elderly veterans receiving care at a Veterans Affairs Medical Center while enrolled in Medicare-financed HMOs. Is the taxpayer paying twice?

Elderly veterans who visit our Veterans Affairs (VA) Medical Center primary care clinic often mention they are enrolled in HMOs. Approximately 20% of patients hospitalized at our facility report health insurance coverage. Of 1,000 hospitalizations during a 6-month period in which veterans reported insurance coverage, 337 involved elderly veterans. Of these 337 hospitalizations, 218 (65%) were for 174 veterans who stated they were enrolled in a Medicare-financed HMO. The VA's Medical Care Cost Recovery Program deemed only 46 (21%) of the hospitalizations billable and received reimbursement for 20 (9%). Thus, the VA is providing costly services already paid for by the Health Care Financing Administration under prepaid capitation contracts, and recovers minimal reimbursement from the HMOs.

Aged↗
PubMedDate not supplied

Counting the uninsured using state-level hospitalization data.

OBJECTIVE: To assess the appropriateness of using state-level data on uninsured hospitalizations to estimate the uninsured population. METHODS: The authors used 1992-1996 data on hospitalizations of newborns and of appendectomy and heart attack patients in Florida to estimate the number of people in the state without health insurance coverage. These conditions were selected because they usually require hospitalization and they are common across demographic categories. RESULTS: Adjusted for the gender and ethnic composition of the population, the percentages of uninsured hospitalizations for appendectomies and heart attacks produced estimates of the state's uninsured population 1.6 percentage points lower than those reported for 1996 in the US Census March Current Population Survey. CONCLUSION: Data reported by hospitals to state agencies can be used to monitor trends in health insurance coverage and provides an alternative data source for a state-level analysis of the uninsured population.

Adolescent↗
PubMed2006

The effect of poverty and caregiver education on perceived need and access to health services among children with special health care needs.

OBJECTIVES: We examined the association between several variables and the use of specialist physician services, developmental therapies, and prescription medications among children with special health care needs (N=38866). METHODS: We used a bivariate probit model to estimate whether a given child needed specialized services and whether that child accessed those services; we controlled for activity limitations and severity of special needs. Variables included family income, mother's (or other caregiver's) educational level, health insurance coverage, and perceived need for specialized services. We used data from the 2001 National Survey of Children with Special Health Care Needs. RESULTS: Lower-income and less-educated parents were less likely than higher-income and more-educated parents to say their special needs children needed specialized health services. The probability of accessing specialized health services-when needed-increased with both higher family income and insurance coverage. CONCLUSIONS: Children with special health care needs have less access to health services because their parents do not recognize the need for those services. An intervention in the form of information at the family level may be an appropriate policy response.

Adolescent↗
PubMed2003

The link between public and private insurance and HIV-related mortality.

As policymakers consider expanding insurance coverage for the human immunodeficiency virus (HIV+) population, it is useful to ask whether insurance has any effect on health outcomes, and, if so, whether public insurance is as efficacious as private insurance in preventing premature death. Using data from a nationally representative cohort of HIV-infected persons receiving regular medical care, we estimate the impact of different types of insurance on mortality in this population. Our main findings are that (1) ignoring observed and unobserved health status misleads one to conclude that insurance may not be protective for HIV patients, (2) after accounting for observed and unobserved heterogeneity, insurance does protect against premature death, and (3) private insurance is more effective than public insurance. The better performance of private insurance can be explained in part by more restrictive Medicaid prescription drug policies that limit access to highly efficacious treatment.

Adolescent↗
PubMed1992

[25 years rehabilitation. Questions--answers, unanswered questions--retrospective answers].

Starting out from the 10th World Congress of the International Society for Rehabilitation of the Disabled, held 1966 in Wiesbaden on the subject of "Industrial Society and Rehabilitation", social-legislational developments are out-lined, among them the 1971 accident insurance coverage for pupils, the 1974 rehabilitation harmonization act, and the 1975 extension of social insurance coverage to disabled persons working in workshops for the disabled; problems yet unsolved in the structured system of social protection are pointed out. The problem of "early rehabilitation", still to a very great extent unresolved, is dealt with in the context of the present distinction between "acute medicine" und "rehabilitation" facilities. In rehabilitation of persons with chronic mental illness, numerous models have been developed; a generally accepted, and available approach however has not emerged so far. For ensuring care quality and continuity, the urgent need for community-based availability of the "rehabilitation team" is underlined, and interdisciplinary further education efforts are demanded for all professions in the team, both in facility- and community-based service delivery.

Disability Evaluation↗
PubMed2006

How much health insurance is enough? Revisiting the concept of underinsurance.

There is little consensus on what constitutes adequate health insurance coverage. The concept of a lack of adequate coverage, or underinsurance, is a matter of ongoing debate. A measure of adequate coverage is of critical importance as the nature of health insurance products evolves. Changes to health coverage include more direct out-of-pocket spending by consumers and a reduction of covered benefits. This article updates and extends an earlier review of underinsurance measurement published in 1993. We present a conceptual approach to measuring underinsurance and provide a review of the empirical findings obtained from the application of these approaches. A discussion of the limitations in the selection of a measurement approach includes a review of the extant data sources used. We recommend a national effort to develop a consistent approach to monitor changes in the economic and structural dimensions of health insurance coverage with a concerted effort to define and measure underinsurance.

Health Care Surveys↗
PubMed2006

Health care disconnect: gaps in coverage and care for minority adults. Findings from the Commonwealth Fund Biennial Health Insurance Survey (2005).

Analysis of the Commonwealth Fund Biennial Health Insurance Survey (2005) finds that uninsured rates for Hispanic and African American adults are one and-a-half to three times greater than the rate for white adults. Nearly two-thirds (62%) of working-age Hispanics and one-third (33%) of African Americans were uninsured at some point during 2005, compared with 20 percent of working-age whites. Hispanics are particularly disconnected from the health care system, being substantially less likely than whites to have a regular doctor, to have visited a doctor in the past year, or to feel confident about their ability to manage their health problems. African Americans are significantly more likely than whites to visit the emergency room for non-urgent care and to experience serious problems with medical bills and medical debt. Along with expanded insurance coverage, policies promoting continuity in patients' relationships with health care providers also are needed to reduce disparities in access.

Adult↗
PubMed2005

Who can't pay for health care?

BACKGROUND: In an era of rising health care costs, many Americans experience difficulty paying for needed health care services. With costs expected to continue rising, changes to private insurance plans and public programs aimed at containing costs may have a negative impact on Americans' ability to afford care. OBJECTIVES: To provide estimates of the number of adults who avoid health care due to cost, and to assess the association of income, functional status, and type of insurance with the extent to which people with health insurance report financial barriers. RESEARCH DESIGN: Cross-sectional observational study using data from the Commonwealth Fund 2001 Health Care Quality Survey, a nationally representative telephone survey. PARTICIPANTS: U.S. adults age 18 and older (N=6,722). MEASURES: Six measures of avoiding health care due to cost, including delaying or not seeking care; not filling prescription medicines; and not following recommended treatment plan. RESULTS: The proportion of Americans with difficulty affording health care varies by income and health insurance coverage. Overall, 16.9% of Americans report at least 1 financial barrier. Among those with private insurance, the poor (28.4%), near poor (24.3%), and those with functional impairments (22.9%) were more likely to report avoiding care due to cost. In multivariate models, the uninsured are more likely (OR, 2.3; 95% CI, 1.7 to 3.0) to have trouble paying for care. Independent of insurance coverage and other demographic characteristics, the poor (OR, 3.6; 95% CI, 2.1 to 4.6), near poor (OR, 2.1; 95% CI, 1.9 to 3.7), and middle-income (OR, 1.8; 95% CI, 1.3 to 2.5) respondents as well as those with functional impairments (OR, 1.6; 95% CI, 1.3 to 2.0) are significantly more likely to avoid care due to cost. CONCLUSIONS: Privately and publicly insured individuals who have low incomes or functional impairments encounter significant financial barriers to care despite having health insurance. Proposals to expand health insurance will need to address these barriers in order to be effective.

Cross-Sectional Studies↗
PubMed2000

Sources of health insurance and characteristics of the uninsured: analysis of the March 2000 Current Population Survey.

This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the characteristics most closely related to an individual's health insurance status. Based on EBRI estimates from the March 2000 Current Population Survey (CPS), it represents 1999 data--the most recent available. In 1999, for the first time since at least 1987, the percentage of Americans with health insurance increased: 82.5 percent of nonelderly Americans (under age 65) were covered by some form of health insurance, up from 81.6 percent in 1998. The percentage of nonelderly Americans without health insurance coverage declined from 18.4 percent in 1998 to 17.5 percent in 1999. The main reason for the decline in the number of uninsured Americans is the strong economy and low unemployment. Between 1998 and 1999, the percentage of nonelderly Americans covered by employment-based health insurance increased from 64.9 percent to 65.8 percent, continuing a longer-term trend that started between 1993 and 1994. In 1999, 34.1 million Americans received health insurance from public programs, and an additional 15.8 million purchased it directly from an insurer. Twenty-five million Americans participated in the Medicaid program, and 6.5 million received their health insurance through the Tricare and CHAMPVA programs and other government programs designed to provide coverage for retired military members and their families. Despite expansions in the State Children's Health Insurance Program (S-CHIP), public health insurance coverage did not increase overall between 1998 and 1999. The percentage of nonelderly Americans covered by Medicaid and other government-sponsored health insurance coverage did not change between 1998 and 1999, though some children benefited from expansions in government-funded programs. The percentage of children in families just above the poverty level without health insurance coverage declined dramatically, from 27.2 percent uninsured in 1998 to 19.7 percent uninsured in 1999. Some of the decline can be attributed to expansions in Medicaid and S-CHIP, but it appears that expansions in employment-based health insurance and individually purchased coverage had an even larger effect than expansion of S-CHIP. Even though the number and percentage of uninsured declined substantially between 1998 and 1999, more than 42 million Americans remain uninsured. As long as the economy is strong and unemployment is low, employment-based health insurance coverage will expand and the uninsured will decline gradually. If the economy continues to soften or comes close to a recession, the number of uninsured would easily and quickly start to increase again as unemployment rises. Should a severe downturn in the economy occur, causing the uninsured to represent 25 percent of the nonelderly population, 63 million Americans would be uninsured.

Adolescent↗
PubMedDate not supplied

Health insurance and the homeless.

There is very little known about health care utilization among the homeless or about the role of health insurance on utilization patterns. Many health care reform proposals advocate expanding health insurance coverage for various segments of society, including the homeless. Although homeless people who lack health insurance face strong financial barriers to health services, providing them with health insurance may not appreciably increase their demand for health care if they also face important non-financial barriers. We investigate the relationship between insurance and utilization for this group based on estimates from an empirical model of medical care use and insurance coverage. Using our estimates, we simulate potential effects of policy changes on various types of utilization, including use of mental health services and treatment for alcohol or other drug abuse.

Adult↗