Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Health Insurance”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 937 records · Page 52Linked to original sources
PubMed2004

Socioeconomic differences in health: how much do health behaviors and health insurance coverage account for?

As evidence accumulates that both unhealthy behaviors and inadequate access to health care are responsible in part for poor health, there is a tendency to attribute the differences in health status between the poor and the affluent to the higher prevalence of unhealthy behaviors and inadequate access to health care among people of low socioeconomic status (SES). The purpose of this study is to determine quantitatively how much health behaviors and health insurance coverage account for the SES disparity in health. The study employed secondary analysis of data collected through the Kentucky Behavioral Risk Factor Surveillance System for 2000. After adjusting for health behaviors and health insurance coverage, the differences in health among different levels of SES (measured by education and income) remained strong and significant. Health behaviors and health insurance coverage accounted for 10-16% of the socioeconomic differences in health.

Adolescent↗
PubMed2004

Innovation and risk selection in deregulated social health insurance.

One important motive for deregulating social health insurance is to encourage product innovation. For the first time, the cost savings achieved by non-US managed care plans that are attributable to product innovation are estimated, using a novel approach. Panel data from a major Swiss health insurer permits to infer health status, which can be used to predict health care expenditure. The econometric evidence suggests that the managed care plans benefit from risk selection effects. In the case of the health maintenance organization (HMO) plan, however, the pure innovation effect may account for as much as two-thirds of the cost advantage.

Actuarial Analysis↗
PubMed1995

Health insurance access to young adult survivors of childhood cancer in North Carolina.

Historically, there has been evidence to support the hypothesis that survivors of childhood cancer have been discriminated against in the private health insurance market in some areas of the United States. Results of previous studies have been inconsistent and have generally focused on a limited number of outcome variables. A retrospective cohort study of young adult survivors of childhood cancer and their siblings was performed to determine the risk of health insurance access problems of childhood cancer survivors in North Carolina. Mailed questionnaires were completed by 182 cancer survivors from three institutions who were diagnosed between 1976 and 1988, and by 101 of their siblings for a response of 62.1%. Using logistic regression in SAS, cancer survivors were found to be more likely to be denied health insurance than their siblings, with an adjusted odds ratio of 15.1. Childhood cancer survivors also had health insurance policies that excluded care for pre-existing medical conditions more often than their siblings (OR = 5.5). In addition, cancer survivors reported problems obtaining health insurance coverage more frequently than their siblings with an adjusted odds ratio of 22.8. In general, survivors of childhood cancer who were diagnosed in North Carolina have had decreased access to health insurance coverage when compared to their siblings of similar age. North Carolina health insurance regulations permit health insurance firms to discriminate against cancer survivors because of their history of illness, often decreasing their access to needed follow-up care.

Adult↗
PubMed2000

Laws restricting health insurers' use of genetic information: impact on genetic discrimination.

Since 1991, 28 states have enacted laws that prohibit insurers' use of genetic information in pricing, issuing, or structuring health insurance. This article evaluates whether these laws reduce the extent of genetic discrimination by health insurers. From the data collected at multiple sites, we find that there are almost no well-documented cases of health insurers either asking for or using presymptomatic genetic test results in their underwriting decisions, either (a) before or after these laws have been enacted or (b) in states with or without these laws. By using both in-person interviews with insurers and a direct market test, we found that a person with a serious genetic condition who is presymptomatic faces little or no difficulty in obtaining health insurance. Furthermore, there are few indications that the degree of difficulty varies according to whether a state regulates the use of genetic information. Nevertheless, these laws have made it less likely that insurers will use genetic information in the future. Although insurers and agents are only vaguely aware of these laws, the laws have shaped industry norms and attitudes about the legitimacy of using this information.

Genetic Counseling↗
PubMed1979

National Health Insurance. Physical therapists' attitudes.

APTA members living in New England were surveyed by a mail questionnaire to assess their attitudes toward National Health Insurance. Respondents' strata included educators, private practitioners, and clinicians. Generally, respondents believed that National Health Insurance was inevitable, would not cause unnecessary use of physical therapy services, and would not affect the individual therapist's professional freedom. The majority of the respondents judged themselves not well informed about the health plan. Respondents' perceptions of their peers' views of National Health Insurance were inaccurate. Options favored by the respondents under a hypothetical health plan are reported. Results indicate that the physical therapists surveyed generally favored National Health Insurance and thought the APTA should represent them in planning such a program. No significant differences in attitude toward National Health Insurance could be attributed to respondent strata or any of the personal data collected.

Attitude of Health Personnel↗
PubMed2000

Genetic discrimination in health insurance: an overview and analysis of the issues.

The problem of genetic discrimination in health insurance will increase as genetic knowledge expands and the number of genetic tests proliferates. Unless appropriate legislative protections are developed and enforced, a consequence of the genetic revolution may be that more people are put at risk for losing their health insurance. The current situation requires people to make difficult choices about taking tests that could save or prolong their lives. Unless these people believe that they and their families will be adequately protected from discrimination and from the possibility of losing or being denied health insurance, many will choose not to be tested for genetic conditions or predisposition to disease. Solutions to this problem require continuing research and debate and the creation of new policies and laws that protect the people while maintaining the economic viability of insurance companies. This article explores the problem of genetic discrimination as it relates to health insurance in the United States. The goal of this article is to assist nurses and other health care professionals to better understand the important and complex issues and concepts related to genetics, genetic testing, and genetic discrimination in health insurance.

Confidentiality↗
PubMed1992

Whither private health insurance? Self-destruction or rebirth?

The American public increasingly finds itself disenchanted with the system for health care financing in this country. Three forms of reform proposal are examined: those that place the locus of primary responsibility for health insurance coverage on the individual, those that would rely on employer mandates with patients and government bearing the residual responsibility, and those that lodge chief financial responsibility with the government, and act as primary agent for cost control. The second approach, government-mandated employer-provided health insurance, appears to be the most politically viable at this time. However, that option is likely to be acceptable to the business community only if the mandate is coupled with additional regulation of private health insurance. Specifically, private health insurance in such a system likely would be based on mandatory open enrollment, community-rated premiums, and all-payer reimbursement, under which every payer pays a given provider the same fee for the same service.

Consumer Behavior↗
PubMed1994

Health insurance status and ambulatory care for children.

BACKGROUND: Many children in the United States lack health insurance. We tested the hypothesis that these children are less likely than children with insurance to visit a physician when they have specific conditions for which care is considered to be indicated. METHODS: We examined the association between whether children were covered by health insurance and whether they received medical attention from a physician for pharyngitis, acute earache, recurrent ear infections, or asthma. Data were obtained on the subsample of 7578 children and adolescents 1 through 17 years of age who were included in the 1987 National Medical Expenditures Survey, a national probability sample of the civilian, noninstitutionalized population. RESULTS: Uninsured children were more likely than children with health insurance to receive no care from a physician for all four conditions (unadjusted odds ratios, 2.38 for pharyngitis; 2.04 for acute earache; 2.84 for recurrent ear infections; and 1.87 for asthma). Multiple logistic-regression analysis was subsequently used to control for age, sex, family size, race or ethnic group, region of the country, place of residence (rural vs. urban), and household income. After adjustment for these factors, uninsured children remained significantly more likely than insured children to go without a visit to a physician for pharyngitis (adjusted odds ratio, 1.72; 95 percent confidence interval, 1.11 to 2.68), acute earache (1.85; 95 percent confidence interval, 1.15 to 2.99), recurrent ear infections (2.12; 95 percent confidence interval, 1.28 to 3.51), and asthma (1.72; 95 percent confidence interval, 1.05 to 2.83). CONCLUSIONS: As compared with children with health insurance, children who lack health insurance are less likely to receive medical care from a physician when it seems reasonably indicated and are therefore at risk for substantial avoidable morbidity.

Adolescent↗
PubMed1998

Impact of a children's health insurance program on newly enrolled children.

CONTEXT: Although there is considerable interest in decreasing the number of US children who do not have health insurance, there is little information on the effect that health insurance has on children and their families. OBJECTIVE: To determine the impact of children's health insurance programs on access to health care and on other aspects of the lives of the children and their families. DESIGN: A before-after design with a control group. The families of newly enrolled children were interviewed by telephone using an identical survey instrument at baseline, at 6 months, and at 12 months after enrollment into the program. A second group of families of newly enrolled children were interviewed 12 months after the initial interviews to form a comparison sample. SETTING: The 29 counties of western Pennsylvania, an area with a population of 4.1 million people. SUBJECTS: A total of 887 families of newly enrolled children were randomly selected to be interviewed; 88.3% agreed to participate. Of these, 659 (84%) responded to all 3 interviews. The study population consists of 1031 newly enrolled children. The children were further classified into those who were continuously enrolled in the programs. The 330 comparison families had 460 newly enrolled children. MAIN OUTCOME MEASURES: The following access measures were examined: whether the child had a usual source of medical or dental care; the number of physician visits, emergency department visits, and dentist visits; and whether the child had experienced unmet need, delayed care, or both for 6 types of care. Other indicators were restrictions on the child's usual activities and the impact of being insured or uninsured on the families. RESULTS: Access to health care services after enrollment in the program improved: at 12 months after enrollment, 99% of the children had a regular source of medical care, and 85% had a regular dentist, up from 89% and 60%, respectively, at baseline. The proportion of children reporting any unmet need or delayed care in the past 6 months decreased from 57% at baseline to 16% at 12 months. The proportion of children seeing a physician increased from 59% to 64%, while the proportion visiting an emergency department decreased from 22% to 17%. Since the comparison children were similar to the newly enrolled children at enrollment into the insurance programs, these findings can be attributed to the program. Restrictions on childhood activities because of lack of health insurance were eliminated. Parents reported that having health insurance reduced the amount of family stress, enabled children to get the care they needed, and eased family burdens. CONCLUSIONS: Extending health insurance to uninsured children had a major positive impact on children and their families. In western Pennsylvania, health insurance did not lead to excessive utilization but to more appropriate utilization.

Adolescent↗
PubMed1989

[Health effects of volcanic air pollution--an analysis of the national health insurance].

Using the national health insurance bills covering the one-year period from January through December 1987, the morbidity figures for respiratory diseases, conjunctivitis and dermatitis were compared among four local districts; Ushine, Kaikata, Kunugibaru and Shinjo, in the city of Tarumizu. The former two districts are 10 km south-east of Mt. Sakurajima supposedly experience higher volcanic ash exposure compared to the latter two located 10 to 15 km from this volcano. Results obtained are as follows; 1) Age-adjusted rates of patients' consultations and existing patients were apparently higher in the Ushine and Kaikata districts than in the Kunugibaru and Shinjo districts for non-infectious or infectious respiratory diseases and the common cold. For the rates of other diagnostic categories of disease, i.e., rhinitis, other respiratory diseases, conjunctivitis and dermatitis, a difference between the district was not clearly noted. These figures are suggestive of an association of volcanic air pollution with an increased number of outpatient consultations for respiratory problems. 2) Variations of monthly clinical consultations for patients with diagnoses of non-infectious or infectious respiratory diseases and the common cold showed a seasonality, being highest in winter and lowest in summer, while another seasonality, highest in summer and lowest in winter, was proved in the variation of monthly clinical consultations for patients with dermatitis. Few or no stable seasonalities were shown in the variations of monthly clinical consultations for patients with the other diseases, studied, rhinitis, other respiratory diseases and conjunctivitis. In addition, the variations in the monthly averages of sulfur dioxide concentrations showed a stable seasonality with the highest peak in winter and the lowest in summer but there was no stable seasonality in the monthly variations of total suspended particles at the place in Arimura for which air pollution data were available. These facts suggest that in the area exposed to volcanic air pollution, the seasonal variation in the number of monthly clinical consultations for respiratory problems is partly modified by the exposure levels of sulfur dioxide rather than total suspended particles, although no adjustments were made for climatologic factors. 3) A few patients diagnosed as having "pneumoconiosis" were found in the Ushine and Kaikata districts. However, it is difficult to interpret these cases without information about occupational and other risk factors for the development of pneumoconiosis.

Adolescent↗
PubMed2000

Sources of health insurance and characteristics of the uninsured: analysis of the March 1999 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 1999 Current Population Survey (CPS), it represents 1998 data--the most recent data available. In 1998, 194.7 million nonelderly Americans--81.6 percent--had some form of health insurance. More than 64 percent had it through an employment-based health plan; 6.5 percent purchased it on their own; and 14.3 percent were covered by a public program, mostly through Medicaid (10.4 percent). In 1998, 18.4 percent of the nonelderly population was uninsured (43.9 million people), compared with 14.8 percent in 1987. The percentage of uninsured Americans has generally been increasing since at least 1987, although the percentage uninsured in 1998 was not statistically different from the percentage uninsured in 1997 (18.3 percent). The increase in the uninsured prior to 1993 can be attributed to the erosion of employment-based health insurance. However, since 1993, the percentage of nonelderly Americans covered by an employment-based health plan has increased from 63.5 percent to 64.9 percent. The decline in public sources of health insurance would mostly explain the recent increase in the uninsured. For example, between 1994 and 1998 the percentage of nonelderly Americans covered by CHAMPUS/CHAMPVA declined from 3.8 percent to 2.9 percent, in large part due to downsizing in the military. Similarly, between 1993 and 1998, the percentage of nonelderly Americans covered by Medicaid declined from 12.7 percent to 10.4 percent as people left welfare. The increase in employment-based coverage since 1994 was due mainly to a higher likelihood that children were covered by an employment-based health plan. Between 1994 and 1998, the percentage of children covered by an employment-based health plan increased from 58.1 percent to 60.2 percent. For adults, it increased less than one percentage point, from 66.1 percent to 66.9 percent. Adults started to realize gains in employment-based health insurance between 1997 and 1998. Between 1994 and 1997, the percentage of working adults with employment-based health insurance coverage held steady at roughly 72.3 percent. During this period, health care cost inflation was essentially nonexistent. However, between 1997 and 1998, the percentage of working adults with employment-based health insurance increased from 72.2 percent to 72.8 percent, despite the apparent return of health care cost inflation in 1998. It is likely that the changing composition of the labor force accounted for some of the increase in employment-based coverage.

Adolescent↗
PubMed2004

Trends in U.S. health insurance coverage, 2001-2003.

Against the backdrop of a sluggish economy and rapidly rising health insurance premiums, the proportion of Americans under age 65 covered by employer-sponsored insurance fell dramatically from 67 percent to 63 percent between 2001 and 2003. Although the decline in employer coverage could have spurred a large increase in the uninsured, the proportion of Americans without health insurance did not increase significantly, according to findings from the Center for Studying Health System Change's (HSC) Community Tracking Study Household Survey. Expansion of public health insurance--including Medicaid and the State Children's Health Insurance Program (SCHIP)--forestalled a significant increase in the uninsured, as the proportion of the under-65 population enrolled in public coverage increased from 9 percent to 12 percent.

Adolescent↗
PubMed1994

Retiree health insurance and pension coverage: variations by firm characteristics.

This study examined coverage by employer-sponsored retiree health insurance using the 1988 and 1989 Employee Benefits Surveys. The effects of firm characteristics on the probability of offering retiree health insurance and pension coverage are also estimated. We find that coverage by retiree health insurance varies across occupational groups, industries, and firm sizes. In addition, we find a strong relationship between a firm's decisions to offer retiree health insurance and pension coverage, with the retiree health insurance decision being more sensitive to specific firm characteristics.

Aged↗
PubMedDate not supplied

A different kind of 'new federalism'? The Health Insurance Portability and Accountability Act of 1996.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has been praised and criticized for asserting federal authority to regulate health insurance. We review the history of federalism and insurance regulation and find that HIPAA is less of a departure from traditional federal authority than it is an application of existing tools to meet evolving health policy goals. This interpretation could clarify future health policy debates about appropriate federal and state responsibilities. We also report on the insurance environments and the HIPAA implementation choices of thirteen states. We conclude with criteria for judging the success of HIPAA and the evolving federal/state partnership in health insurance regulation.

Career Mobility↗
PubMed1998

Sources of health insurance and characteristics of the uninsured: analysis of the March 1998 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 individuals' health insurance status. Based on EBRI analysis of the March 1998 Current Population Survey, it represents 1997 data--the most recent data available. In 1997, private or public health insurance, or both, covered 81.7 percent of Americans (193.1 million) at some point. Seventy-one percent of the nonelderly population had private insurance, 64.2 percent through an employment-based plan. Almost 15 percent of the nonelderly had public health insurance. In 1997, 18.3 percent of the nonelderly population was uninsured, compared with 14.8 percent a decade earlier, in 1987. The percentage of uninsured Americans has been increasing since at least 1987. While the increase in the uninsured between 1987 and 1993 can be attributed to the erosion of employment-based health benefits, the portion of Americans covered by employment-based health insurance increased between 1993 (63.5 percent) and 1997 (64.2 percent). The decline in public sources of health insurance would mostly explain the recent increase in the uninsured population. For example, between 1994 and 1996 the percentage of nonelderly Americans covered by CHAMPUS/CHAMPVA declined from 3.8 percent to 2.9 percent, in large part due to downsizing in the military. Similarly, between 1996 and 1997, the percentage of nonelderly Americans covered by Medicaid (the federal-state insurance program for the poor) declined from 12.1 percent to 11.0 percent as people left welfare for the private sector. This follows a decline in Medicaid participation between 1995 and 1996. Between 1996 and 1997 the percentage of nonelderly Americans without health insurance coverage increased from 17.7 percent to 18.3 percent. Further examination indicates that adults ages 18-64 accounted for almost all of this increase. In 1996, 14.8 percent of children and 18.9 percent of persons ages 18-64 were uninsured, compared with 15.0 percent of children and 19.7 percent of persons ages 18-64 in 1997. The decline in Medicaid coverage among nonworking and working adults appears to account for the overall increase in the uninsured. Employment and income play a dominant role in determining an individual's likelihood of having health insurance. In addition, age, gender, firm size, hours of work, and industry are all important determinants of an individual's likelihood of having coverage; however, these variables are also closely linked to employment status and income. Some of the widest variations involve factors that are not always examined in traditional demographic assessments, such as citizenship. However, variations by race, ethnicity, and citizenship are also closely linked to employment status and income.

Adolescent↗
PubMed2005

Risk selection in the German public health insurance system.

The German statutory health insurance market was exposed to competition in 1996. To limit direct risk selection the regulator required open enrollment. As the risk compensation scheme, introduced in 1994, is highly incomplete, substantial incentives for risk selection exist. Due to their low premiums, company-based sickness funds have been able to attract a lot of new members. We analyze, using data from the German Socio-Economic Panel, the determinants of switching behavior from 1995 to 2000. There is no evidence for selection by funds. The success of the company-based sickness funds originates in incomplete risk adjustment together with the negative correlation between health status and switching costs.

Adult↗
PubMed1999

Are market-oriented health insurance reforms possible in Latin America? The cases of Argentina, Chile and Colombia.

The process of health care reform benefits tremendously from comparing characteristics and performance across nations. This paper studies market-oriented health insurance reforms in three Latin American countries: Argentina, Chile and Colombia. Chile allowed private health insurers to compete for workers payroll contributions in the 1980s, permitting the modernization of the private health sector but relatively impoverishing the public health sector as a consequence of selection practices by private carriers. In the 1990s, Argentina and Colombia started liberalizing the health insurance sector but using policies to avoid the adverse effects encountered in the Chilean experience. These policies are scrutinized while challenges for these and future health insurance reform processes are discussed.

Argentina↗