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PubMed1997

[Morbidity estimates of beneficiaries of national health insurance for seven chronic conditions].

This work is aimed at providing improved coefficients applicable to the statistics of Health Insurance concerning the long-lasting conditions in order to assess morbidity of Health Insurance members concerning diseases invoked legislation on long-lasting conditions. To reach this objective, we have applied the consequences of successive equivalence (between diseases and their specific treatment, and between the use of special prescriptions for exempting diseases and the acknowledgment of long-lasting conditions by Health Insurance) to the results of a survey on medicines carried out by the Caisse Nationale d'Assurance Maladie des Travailleurs Salariés in 1993 on the basis of a representative sample. Improved coefficients were equal to the inverse of the proportion of special prescriptions within the whole of the prescriptions including specific treatment. Those coefficients and their confidence intervals have been calculated for seven affections: non-insulin dependent diabetes [1.56-1.67], coronary disease [1.51-1.61], Parkinson's disease [1.51-1.85], manic-depressive psychosis [1.49-1.89], haemorrhagic rectocolitis and Crohn's disease [1.49-2.04], insulin dependent diabetes [1.10-1.20] and tuberculosis [1.61-3.33]. The critical analysis of our work and its comparison with the rare literature on the same subject confirms the value of our results. The application of those improved coefficients to the figures of prevalence and incidence provided by Health Insurance makes it possible to set confidence bounds to the statistics of morbidity concerning the people who are affiliated to that system of Health Insurance and treated for these diseases however serious they are.

Adolescent↗
PubMed2004

[Public health research with statutory health insurance drug data].

Major well-organized data sources about medical services are accumulated by statutory health insurance companies. These data are sufficiently representative of drug prescriptions and constitute a potential basis for pharmacoepidemiologic research. Especially for pharmacovigilance tasks or when political decisions have to be prepared, fast and reliable answers are often necessary. These can be generated utilizing health insurances' databases. Legal requirements for the analysis of data from medical services in the framework of research projects are described in Article 287 of the SGB V (Code of Social Law Book V). An increasing number of such projects were conducted during the last few years. The Gesetz zur Modernisierung der gesetzlichen Krankenversicherung (Law on Modernization of Statutory Health Insurance Companies of 14 November 2003) will induce important progress for the development and quality of pharmacoepidemiologic research using health insurance data. Probably in the future the analysis of such data will become-in addition to analyses of other data sources such as survey data-a substantial field of pharmacoepidemiology in Germany. This article describes the background and development of using routine data from health insurance companies for scientific purposes and discusses potentials and limitations of such data for public health research.

Adverse Drug Reaction Reporting Systems↗
PubMed1996

Patient choice of physician: do health insurance and physician characteristics matter?

Generous health insurance coverage is widely believed to have contributed to both high and rising health care costs. This paper tests the hypothesis that better insured patients will demand higher "quality" by choosing more often to visit specialists rather than generalist physicians. We model the conditional decision to seek care from a specialist physician as a function of health insurance status, physician characteristics, and other socioeconomic factors. Analysis of data from the 1987 National Medical Expenditure Survey and the American Medical Association suggests that the presence of insurance coverage does not affect choice of physician. The results do show that people enrolled in health maintenance organizations (HMOs) see specialists less often than other patients.

Adolescent↗
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↗
PubMed2006

Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States.

BACKGROUND: There has been a gradual decrease in the proportion of children covered by private health insurance in Colorado and the United States with a commensurate increase in those with public insurance or having no insurance which may impact access to care and outcomes. OBJECTIVE: The purpose of this work was to determine whether children with public or no health insurance have differences in hospital admission rates, morbidity, mortality, and/or charges that might be improved if standards of primary care comparable to those of children with private insurance could be achieved. METHODS: We conducted a retrospective comparison of hospitalization-related outcomes for children < 18 years of age in Colorado from 1995-2003 and in the United States in 2000. Population-based rates for hospital admission were determined stratified by age, race/ethnicity, disease grouping, and health insurance status. RESULTS: Compared with those with private insurance, children in Colorado and the United States with public or no insurance have significantly higher rates of total hospital admission, as well as admission for chronic illness, asthma, diabetes, vaccine-preventable disease, psychiatric disease, and ruptured appendix. These children have higher mortality rates, higher severity of illness, are more likely to be admitted through the emergency department and have significantly higher hospital charges per insured child. Higher hospitalization rates occur in children who are nonwhite and/or Hispanic and those who are younger. If children with public or no health insurance in the United States in 2000 had the same hospitalization outcomes as children with private insurance, $5.3 billion in hospital charges could have been saved. CONCLUSIONS: There is an opportunity to achieve improved health outcomes and decreased hospitalization costs for children with public or no health insurance if private insurance standards of health care could be achieved for all US children.

Adolescent↗
PubMed1997

Optimal non-linear health insurance.

Most theoretical and empirical work on efficient health insurance has been based on models with linear insurance schedules (a constant co-insurance parameter). In this paper, dynamic optimization techniques are used to analyse the properties of optimal non-linear insurance schedules in a model similar to one originally considered by Spence and Zeckhauser (American Economic Review, 1971, 61, 380-387) and reminiscent of those that have been used in the literature on optimal income taxation. The results of a preliminary numerical example suggest that the welfare losses from the implicit subsidy to employer-financed health insurance under US tax law may be a good deal smaller than previously estimated using linear models.

Canada↗
PubMed1986

Interpreting the estimates from four national surveys of the number of people without health insurance.

Four national surveys conducted between 1977 and 1980 seem to yield four different estimates of the number of people under 65 years old who lack health insurance. In this paper four explanations for the different estimates are assessed. The sample framework designs and methods for ex post weighting of the surveys' respondents are very similar. Nonresponses to the health insurance questions on the surveys were handled differently, and this remains a possible explanation of some of the differences in the estimates. But the most likely explanation of the differences is the following. Three of the four surveys ask people about their health insurance at the time of the interview. The fourth, the Current Population Survey, asks people about their health insurance during the previous year. But the Current Population Survey estimate of the uninsured population is remarkably close to the point-in-time estimates from the other three surveys. The same holds true for the surveys' estimates of the Medicaid population and people covered by private health insurance. Hence, if we assume that the Current Population Survey respondents are answering the health insurance questions with respect to when they are interviewed, the four surveys' estimates of the uninsured population at a point in time are very similar.

Adolescent↗
PubMed1999

A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance funds in Switzerland.

OBJECTIVES: The present investigation focuses on the following questions: 1. Are complementary medical services paid for by a health insurer used in addition to orthodox medical services, or as substitute for them?; 2. If health insurers include complementary medical services in the basic cover, what will be the effect on costs?; 3. If complementary medical services as included in the basic cover, what will be the effect on the policyholders' subjective state of health? STUDY DESIGN: A randomized experiment was set up in which 7500 members of Switzerland's biggest health insurance fund, Helvetia, were offered free supplementary insurance for alternative medicine for 3 years. This simulated a situation in which the experimental group had access to the full range of complementary medical treatments under their health insurance policies. The remaining members in the scheme (670,000) people) formed the control group. To evaluate the effect on costs, we analysed the health insurer's cost and benefits data. In addition, a survey was carried out among random samples of subjects from the experimental group and from the control group using the 36-Item Short-Form Health Survey (SF-36) to examine the effects of including complementary medicine on subjective state of health. RESULTS: The analysis of the cost data shown that subjects used alternative in addition to orthodox medical services. It is also clear that alternative medical treatments are given in combination with orthodox medicine; less than 1% of the experimental group used exclusively alternative medical services. However, as only a very small percentage of experimental subjects (6.6%) took advantage of complementary medicine, no significant impact on overall health costs can be inferred. On the other hand, multiple regressions show that use of complementary medicine has a greater effect on treatment costs than sex, age or language region. Neither at the beginning nor the end of the experiment were any significant differences noted in the scales of the SF-36 between the experimental and the control group. Nor did multiple regressions reveal any effects on subjects' state of health due to the inclusion of complementary medicine in the basic insurance cover.

Adult↗
PubMedDate not supplied

Parental employment, family structure, and child's health insurance.

OBJECTIVE: To examine the impact of family structure on the relationship between parental employment characteristics and employer-sponsored health insurance coverage among children with employed parents in the United States. METHODS: National Health Interview Survey data for 1993-1995 was used to estimate proportions of children without employer-sponsored health insurance, by family structure, separately according to maternal and paternal employment characteristics. In addition, relative odds of being without employer-sponsored insurance were estimated, controlling for family structure and child's age, race, and poverty status. RESULTS: Children with 2 employed parents were more likely to have employer-sponsored health insurance coverage than children with 1 employed parent, even among children in 2-parent families. However, among children with employed parents, the percentage with employer-sponsored health insurance coverage varied widely, depending on the hours worked, employment sector, occupation, industry, and firm size. CONCLUSIONS: Employer-sponsored health insurance coverage for children is extremely variable, depending on employment characteristics and marital status of the parents.

Child↗
PubMed1987

Bonus systems in health insurance: a microeconomic analysis.

Faced with the cost explosion in the health care sector, policy-makers in most industrialized countries have been focusing on cost-sharing in health insurance as a possible solution. This is a sanction meted out to users of medical care; the alternative of creating positive incentives for non-users has not yet received nearly as much attention. This paper reports on the experiences made by German private health insurers with their plans offering rebates as well as experience-rated bonuses for no claims. It is argued that a rebate offer may be at least as attractive as conventional cost-sharing plans from the point of view of the consumer since these new options allow him to choose the time at which he is to bear the financial consequences of an illness. In the second part of the paper, predictions are derived concerning the incentives contained in the policies written by three particular insurers. Clear evidence of a decrease in demand for ambulatory medical care at the lower end of the billings distribution is found in rebate and bonus plans. The concluding section of the paper contains a discussion of the results with a view on the continuing debate about the reform of social health insurance.

Community Participation↗
PubMed2001

The enactment of national health insurance: a Boolean analysis of twenty advanced industrial countries.

The scholarly literature on health care politics has generated a series of hypotheses to explain U.S. exceptionalism in health policy and to explain the adoption of national health insurance (NHI) more generally. Various cultural, institutional, and political conditions are held to make the establishment of some form of national health insurance policy more (or less) likely to occur. The literature is dominated by national and comparative case studies that illustrate the theoretical logic of these hypotheses but do not provide a framework for examining the hypotheses cross-nationally. This article is an initial attempt to address that void by using Boolean analysis to examine systematically several of the major propositions that emerge from the case study literature on the larger universe of twenty advanced industrial democracies. This comparative analysis offers considerable support for the veto points hypothesis while still finding each of the factors examined to be relevant in certain scenarios. We conclude with a discussion of the implications of these findings for future research and for advocates of national health insurance in the United States.

Causality↗
PubMedDate not supplied

Uncovering the health challenges facing people with disabilities: the role of health insurance.

Americans with disabilities have wide-ranging health care needs and face serious challenges in the health care system. This 2003 survey of 1,505 nonelderly adults with disabilities finds relatively large shares of people with disabilities reporting cost-related barriers to care. The study also reveals marked differences in cost-related experiences both between those with and without health insurance and across sources of coverage. These findings suggest the need for additional research, along with policies to provide health insurance to people with disabilities who lack coverage, to fill gaps in coverage among those with Medicare and private insurance, and to maintain coverage for Medicaid enrollees amid rising costs and state budget shortfalls.

Adolescent↗
PubMed2006

The demand for private health care under national health insurance: the case of the self-employed.

This study explores the demand for private health care and supplemental health insurance in Israel, where universal national health insurance provides all inhabitants with a standard package of medical care. Our theoretical model and empirical study follow research previously conducted in four other countries. It was found that the self-employed in Israel demand more private health services and supplemental health insurance than wage-earners. Income, age, education, health status, marital status, origin, and profession were found to play a part in explaining these demands.

Employment↗
PubMed2003

Proposal of the Physicians' Working Group for Single-Payer National Health Insurance.

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care--the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least 200 billion dollars annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program is the only affordable option for universal, comprehensive coverage.

Cost Control↗
PubMed1999

The value of health insurance: the access motive.

Why do people purchase health insurance? Many economists would answer that it permits purchasers to avoid risk of financial loss. This note suggests that health insurance is also demanded because it represents a mechanism for gaining access to health care that would otherwise be unaffordable. For example, although a US$300,000 procedure is unaffordable to a person with US$50,000 in net worth, access is possible through insurance because the annual premium is only a fraction of the procedure's cost. The value of insurance for coverage of unaffordable care is derived from the value of the medical care that insurance makes accessible.

Community Participation↗
PubMed1997

Expanding health insurance for children: examining the alternatives.

This Issue Brief examines the issue of uninsured children. The budget reconciliation legislation currently under congressional consideration earmarks $16 billion for new initiatives to provide health insurance coverage to approximately 5 million of the 10 million uninsured children during the next five years. Proposals to expand coverage among children include the use of tax credits, subsidies, vouchers, Medicaid program expansion, and expansion of state programs. However, these proposals do not address the decline in employment-based health insurance coverage--the underlying cause of the lack of coverage, to the extent that a cause can be identified. What is worse, some proposals to expand health insurance among children may discourage employers from offering coverage. Between 1987 and 1995, the percentage of children with employment-based health insurance declined from 66.7 percent to 58.6 percent. Despite this trend, the percentage of children without any form of health insurance coverage barely increased. In 1987, 13.1 percent were uninsured, compared with 13.8 percent in 1995. Medicaid program expansions helped to alleviate the effects of the decline in employment-based health insurance coverage among children and the potential increase in the number of uninsured children. Between 1987 and 1995, the percentage of children enrolled in the Medicaid program increased from 15.5 percent to 23.2 percent. Some questions to consider in assessing approaches to improving children's health insurance coverage include the following: If the government intervenes, should it do so through a compulsory mechanism or a voluntary system? Is the employment-based system "worth saving" for children? In other words, are the market interventions necessary to keep this system functioning for children too regulatory, too intrusive, and too cumbersome to be practical? In addition to reforming the employment-based system, what reforms are necessary in order to reach those families who have no coverage through the work place? Which approaches are both efficient and politically acceptable? Employment-based coverage of children will likely continue. The challenge for lawmakers is to find a way to cover more uninsured children without eroding employment-based coverage. Several current legislative proposals attempt to avoid this problem by excluding children who have access to employment-based coverage. Without such a requirement, the opportunity to purchase coverage at a discount would create incentives for some low-income employees to drop dependent/family coverage, which in turn could lead some employers to drop their health plans.

Adolescent↗
PubMed1997

Expanding health insurance for children.

This issue of States of Health provides information that advocates, consumers, legislators, and other policymakers can use in crafting effective state health insurance programs for children. It looks at states' options under the rules and funding of the State Children's Health Insurance Program, the 10-year, $50-billion federal package enacted in 1997 as Title XXI, highlighting the critical program design issues that may mean the difference between healthy children and wasted opportunity.

Child↗