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At least 955 records · Page 53Linked to original sources
PubMed1998

Labor market responses to rising health insurance costs: evidence on hours worked.

Increases in the cost of providing health insurance must have some effect on labor markets, either in lower wages, changes in the composition of employment, or both. Despite a presumption that most of this effect will be in the form of lower wages, we document a significant effect on work hours as well. Using data from the Current Population Survey (CPS) and the Survey of Income and Program Participation (SIPP), we show that rising health insurance costs during the 1980s increased the hours worked by those with health insurance by up to 3%. We argue that this occurs because health insurance is a fixed cost, and as it becomes more expensive to provide, firms face an incentive to substitute hours per worker for the number of workers employed.

Adult↗
PubMed1999

Health insurance and productivity.

AIM: To provide a conceptual understanding of the basic relationship between health insurance and overall economic productivity, and to look at the human development index as a proxy for the quality of human capital. METHODS: Economic data and data related to human development in Central and Eastern European (CEE) countries, including Croatia, were compared to the European Union (EU) average. Data were selected out of databases provided by the International Monetary Fund, the Organization for Economic Cooperation and Development, and the United Nations. Income and growth rates were related to the EU averages. The human development index was used to compare the level of the average achievements in the longevity of life, knowledge, and quality of living in CEE countries. RESULTS: Relative to the EU-average, human development is lagging behind in CEE countries. Considering the world as a benchmark regarding human development, 8 out of 13 CEE countries exceed the world. However, all CEE countries have 3-28% lower human development than the industrialized countries. CONCLUSIONS: The specific challenge for transition countries is how to adopt strategies to translate economic progress into health and social gains through reliable institutions, among them social health insurance bodies. The institutions and the provision of social health insurance are particularly challenged at a turning point when transition in terms of macroeconomic stabilization, along with the consolidated organization and financing of social and health insurance schemes, is accommodated to a business cycle-driven market economy.

Economics↗
PubMed2006

Manufacturing firms' decisions regarding retiree health insurance.

The trend for employers to discontinue offering retiree health insurance has profound implications for a large and growing share of the U.S. older population. The authors explore factors related to the firm's decision to offer and contribute to retiree health insurance using data from manufacturing firms. Their findings indicate that while firm characteristics, such as size and age, affect the probability that a firm offers retiree health insurance, employer contributions to this benefit are significantly related to the firm's financial performance and the alternative insurance options available in the market. The article concludes with a brief discussion of policy-related measures with potentially important implications for the future of retiree health benefits.

Decision Making, Organizational↗
PubMedDate not supplied

Risk-rated health insurance programs: a review of designs and important issues.

PURPOSE OF THE REVIEW. The purpose of this review is to assist those who work in the field of health promotion when considering the implementation of an individually risk-rated health insurance plan. It does so by introducing the reader to the concept of individually risk-rating health insurance; uncritically reviewing selected risk-rated health insurance plans; and exploring several issues related to plan implementation, administration, and appropriateness. SEARCH METHODS USED. The review is based on the authors' awareness of the literature in the fields of preventive medicine, health promotion, and employee benefits. The six individually risk-rated health insurance programs that are reviewed were chosen because they demonstrate how aspects of the National Association of Insurance Commissioners' Model have been implemented using various combinations of administrative procedures, verification strategies, and types of economic incentives or disincentives. This review is not intended to be a comprehensive review of the literature. SUMMARY OF IMPORTANT FINDINGS. Individually risk-rated health insurance programs have been established using a variety of administrative procedures, verification strategies, and types of economic incentives or disincentives. The frequency with which these programs are being established is increasing. As the number of risk-rated programs grows, it will be increasingly important to address the many issues that implementing such plans generate: How should lifestyle behaviors be verified? Will healthy lifestyles save money? Can employees fully control their risk factors? Is risk-rating socially responsible? MAJOR CONCLUSIONS. As risk-rating becomes more widespread, there will be a continuing need to address the business, medical, ethical, and legal issues these programs create and to refine them accordingly. The health promotion community has both an opportunity and obligation to see to it that individually risk-rated health insurance programs are implemented in a socially acceptable manner and that the outcomes they generate are cost-beneficial.

Employee Incentive Plans↗
PubMed2004

Estimating rural households' willingness to pay for health insurance.

In many developing countries limited health budgets are a serious problem. Innovative ways to raise funds for the provision of health services, for example, through health care insurance, have a high priority. Health care insurance for rural households shields such patients from unexpected high costs of care. However, there are questions about whether, and how much, rural households are willing to pay to purchase such insurance, as well as the factors determining willingness to pay. In recent years the Iranian government has tried to improve health and medical services to rural areas through a health insurance program. This study was conducted to estimate rural households' demand and willingness to pay for health insurance. A contingent valuation method (CVM) was applied using an iterative bidding game technique. Data has been collected from a sample of 2,139 households across the country.

Adolescent↗
PubMed2001

Markets for individual health insurance: can we make them work with incentives to purchase insurance?

Simple income-based incentives to purchase health insurance (tax credits or deductions, or subsidies) are unlikely to succeed in significantly reducing the number of uninsured because income is not a good predictor of the extent to which individuals use medical service. Proposals to provide incentives to low-income people so they will purchase individual health insurance need to address the inherent tension between the interests of low-risk and high-risk people who rely on individual coverage. If carriers are forced to cover all applicants and to community rate premiums, low-risk people will drop coverage or not apply for it because premiums will exceed their expected need for insurance. Concern for people who currently have access to individual coverage calls for careful examination of options to permit incentive programs to succeed with the individual insurance markets. In particular, attention should focus on using alternatives to simple income-based subsidies to spread the burden of high-risk people's costs broadly, rather than impose the costs on low-risk people who purchase individual coverage. This paper describes three such alternatives. One uses risk adjustments and two rely on reinsurance so that carriers are compensated for the higher costs of covering high-risk people who use incentives to buy insurance. One alternative also permits risk selection by insurance carriers.

Economic Competition↗
PubMed1997

Differences in private health insurance coverage for working male Hispanics.

In 1993, 33.8% of all nonelderly adult Hispanics living in the United States lacked health insurance coverage (either private or public), compared to 8.1% of the entire nonelderly population. Because Hispanics are more likely to be uninsured than any other ethnic group and because they are the fastest growing minority group in the United States, the increase in the Hispanic population is likely to increase the proportion of the population without health insurance. Particularly striking are differences in private health insurance coverage among the three major Hispanic groups--Cuban-Americans, Mexican-Americans, and Puerto Ricans. In this paper, regression-based decomposition analysis is used to explain the sources of differences in private health insurance coverage among working males in these three group. The results indicate that among the study population, Cuban-Americans have higher rates of private health insurance coverage than Mexican-Americans and Puerto Ricans, and that wage rates, levels of education, age, occupation, and marital status explain most of the difference.

Adult↗
PubMed1997

Genetic discrimination and health insurance: a call for legislative action.

Fear of genetic discrimination in health insurance is a growing reality. Individuals who might otherwise choose genetic testing may decline it based on their fear that they or their family members will not be able to obtain or maintain health insurance coverage. This commentary notes the evolving legislative efforts to address genetic discrimination in health insurance and urges physicians to help move this legislative agenda forward.

Genetic Diseases, Inborn↗
PubMedDate not supplied

Psychosocial consequences of inadequate health insurance for patients with cancer.

The psychosocial aspects of health insurance in general, and inadequate coverage in particular, have received scant attention from psycho-oncology professionals. However, with the dehospitalization of cancer treatment, and the longer survival time for patients with cancer, the economic and social burden of cancer has shifted to the patient and family. This article explores several domains of the life of the patient with cancer that can be affected by insufficient health insurance. These include the physical, emotional, financial, social, and employment consequences of inadequate insurance coverage, which can be far-reaching. Health insurance can influence the patient's decision making regarding treatment, choice of physician, and hospital. The unmet needs that arise from deficient insurance coverage can cause strain and distress for the family and the patient. These areas of concern are discussed, and recommendations are made for clinical, educational, and research activities.

Adult↗
PubMed1999

Using social health insurance to meet policy goals.

Social health insurance, with contributions based on incomes and access to services on need is being considered as an option for health care finance in many countries. The argument in this paper starts from the premise that the choice of health care financing mechanisms should start with a clear focus on policy goals, with different options judged against the extent to which these are met. These are likely to include objectives of access to care for those in need, quality of care, incentives for efficient provision and cost control. Different systems will meet the objectives of mobilising resources, providing insurance against risk and redistribution resources to differing extents. It is argued that a particular problem in health care finance is shifting rights to resources over time. It is also important to be clear about the distinction between affordability of and payment mechanisms for health care. The choice of funding mechanisms may have little effect on other policy goals, such as economic development. However, they may differ in the degree to which they allow specific health policy goals to be met. Different mechanisms for collecting and managing funds, and for paying for services are discussed. The paper concludes with concerns that too much emphasis is placed on structures and not how they work, that a lack of cost control may be a serious risk in developing social health insurance and that it is important to have clear mechanisms for setting priorities if policy goals are to be met.

Cost Allocation↗
PubMed2002

Voluntary health insurance in the European Union: a critical assessment.

The authors examine the role and nature of the market for voluntary health insurance in the European Union and review the impact of public policy, at both the national and E.U. levels, on the development of this market in recent years. The conceptual framework, based on a model of industrial analysis, allows a wide range of policy questions regarding market structure, conduct, and performance. By analyzing these three aspects of the market for voluntary health insurance, the authors are also able to raise questions about the equity and efficiency of voluntary health insurance as a means of funding health care in the European Union. The analysis suggests that the market for voluntary health insurance in the European Union suffers from significant information failures that seriously limit its potential for competition or efficiency and also reduce equity. Substantial deregulation of the E.U. market for voluntary health insurance has stripped regulatory bodies of their power to protect consumers and poses interesting challenges for national regulators, particularly if the market is to expand in the future. In a deregulated environment, it is questionable whether this method of funding health care will encourage a more efficient and equitable allocation of resources.

Economic Competition↗
PubMed2004

The disparity in access to new medication by type of health insurance: lessons from Germany.

BACKGROUND: Drug provision within the German statutory health insurance system has undergone several reforms, including the introduction of drug macrobudgets in 1993. OBJECTIVE: The objective of this study was to investigate the extent to which statutorily (SHI) and fully privately (PHI) health-insured patients were provided with new medication recommended by professional bodies in an equitable fashion using the example of migraine patients. RESEARCH DESIGN: We conducted a retrospective cohort study. SETTING: A total of 367 primary-care practices (MediPlus, IMS Health) in Germany in the second year of the HealthCare Structural Reform Act were studied. SUBJECTS: Subjected consisted of 7703 SHI and 470 PHI migraineurs (International Classification of Diseases, 10th edition G43) aged 18 to 65 years at their first migraine prescription visit in 1994. OUTCOME MEASURE: We compared prescription of oral or subcutaneous serotonin 5HT1B/1D receptor agonist sumatriptan with nonserotoninergic migraine therapy. RESULTS: In multiplicative risk regression with variance estimation accounting for clustering of patients within practices, PHI patients were 2.3 times (95% confidence interval [CI], 1.6-3.3) more likely to receive sumatriptan than their SHI counterparts at the mean age of the cohorts (43 years) adjusted for incident versus prevalent migraine treatment, the gender of the patient, the age, gender, and primary care specialist group of the physician, and the type and the community size class of the practice. This disparity widened by 38% (95% CI, 1-88%) every 10 years of patient age. CONCLUSION: Even though virtually everyone in Germany has health insurance and drug coverage, use of new and recommended migraine medicines was less common among those with SHI compared with their privately insured counterparts. Systematic studies of access to health care recommended by professional bodies will be critically important to ensure delivery of high-quality health care for all patients.

Adolescent↗
PubMed2000

[Routine documentation based on disability data of the legal health insurance].

Data on sickness absence of employees are routinely used for health reporting and the analysis of work-related morbidity by institutions of the German health insurance. Since the insurance system comprises several different branches, these health reports differ in respect of objectives, data selection, methods of analysis, and presentation of results. A further lack of comparability is caused by the heterogeneous populations, since membership in a certain health insurance depends on social status and job requirements. Aim of this paper was to review the methods and characteristics of health reports as they are routinely published in Germany. By evaluating these reports recommendations should be derived to improve comparability. The review showed that at least four different kinds of health reports should be differentiated: company-based health reports, health reports for business branches, morbidity statistics, and reports from research projects. Such reports have different objectives and therefore require different methods of data analysis. However, group-specific and common standards could be set up and it is suggested that health insurance institutions should work out report guidelines based on the recommendations given in this review.

Absenteeism↗
PubMed1995

The health insurance system in Korea and its implications.

The national health insurance system was introduced in Korea in 1977 and achieved universal coverage in July 1989. This article briefly describes the general features of the insurance scheme: coverage, management, benefit package, financing provision of medical services and method of reimbursement. Generally speaking, the system mirrors that of the German and Japanese experiences. Although the Korean health insurance system achieved universal coverage during a remarkably short time-span, there is much room for improvement. In this regard, the article also highlights the problems related to Korea's health insurance system and the attempts to improve equity and efficiency in both financing and provision of services.

Cost-Benefit Analysis↗
PubMed1997

U.S. public school enrollment-based health insurance initiatives and America's uninsured.

This article reviews current literature on school enrollment-based health insurance programs underway or pending in the United States. This model of affordable family health insurance delivery was first proposed in a 1988 New England Journal of Medicine Sounding Board article, but only a few states--Arkansas, Florida, New Hampshire, and Texas--have begun public sector-driven programs in the 1990s that use school enrollment as a pooling mechanism to purchase group insurance policies from the private sector. Public support of this model is strong, interest is currently growing, and other states, including North Carolina and Iowa, are exploring or have enacted legislation that supports establishment of school enrollment-based health insurance programs. After summarizing these public-sector initiatives, additional information is presented on uninsuredness in America; risk factors for uninsuredness among children; and national public and private initiatives in child health insurance using eligibility criteria other than or including school enrollment that were examined by the GAO in 1994/95.

Adolescent↗
PubMed2006

Health insurance take-up by the near-elderly.

OBJECTIVE: To examine the effect of price on the demand for health insurance by early retirees between the ages of 55 and 64. DATA SOURCE: Administrative health plan enrollment data from a medium-sized U.S. employer. STUDY DESIGN: The analysis takes advantage of a natural experiment created by the firm's health insurance contribution policy. The amount the firm contributes toward retiree health insurance coverage depends on when a person retired and her years of service at that date. As a result of this policy, there is considerable variation in out-of-pocket premiums faced by individuals in the data. This variation is independent of the nonprice attributes of the health insurance plans offered and is plausibly exogenous to individual characteristics that are likely to affect the demand for insurance. A probit model is used to estimate the decision to take-up employer-sponsored health insurance by early retirees between the ages of 55 and 64. Demand for insurance is measured as a function of out-of-pocket premiums and a set of individual characteristics. PRINCIPAL FINDINGS: We find that price has a small but statistically significant effect on the decision to take up coverage. Estimated price elasticities range from -0.10 to -0.16, depending on the sample. CONCLUSIONS: The implied elasticities are comparable with results found in previous studies using very different data. Our estimates indicate that policy proposals for a Medicare buy-in or a nongroup tax credit will have a modest impact on take-up rates of near-elderly retirees.

Choice Behavior↗
PubMed1980

Private health insurance looks at HMOs.

The Kaiser/Prudential Health Plan, Inc., is a unique venture in HMO development, which may signal future capital involvement in HMOs by private health insurance companies.

Health Maintenance Organizations↗