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PubMed1999

Reform of health insurance in the Federation of Bosnia and Herzegovina.

The aim of this report is to provide an overview of the reform of health insurance in the Federation of Bosnia and Herzegovina (FBH). Health financing and resource allocation policies in the FBH are also summarized. Health financing should be ensured through three types of health insurance: compulsory, supplementary, and voluntary. The revenues for the compulsory health insurance will be ear-marked through payroll taxation. Facing the scarcity of resources, the Federation authorities have decided to raise the proportion of the payroll contribution as compared to the pre-war level and engage in various arrangements of cost-sharing and priority setting in health care. The resource allocation policy underlines two key parts of the health care reform: contracting mechanisms and payment systems. We also discuss the optimal correlation between solidarity and competition in the course of the ongoing reform of the health insurance in the Federation. The social function of a competent health system, where the well-being of the population is viewed as a sociological category of the overall society's concern, requires considerable subsidization. Incentive-based market mechanisms may be introduced into some of the segments of health care system but only under government-led control of the effects of such measures.

Bosnia and Herzegovina↗
PubMed2002

[Use of a health insurance company database for study of theoretical exposure to hypolipidemic agents].

OBJECTIVE: The objective of the investigation was to analyze theoretical exposures to hypolipidaemics in patients treated chronically with these drugs, using the database of the health insurance company. INVESTIGATED GROUP: From the database (with information on age, sex of the insured person, the number of packages and the type of hypolipidemic and year of issue of the prescription) of subjects insured at the Employees Health Insurance Skoda Mladá Boleslav comprising some 100,000 insured subjects in 1994-2000. Patients with long-term (more than one year) hypolipidaemic treatment were selected in years from 1995 to 1999. The group increased every year. In 1995 it comprised 668 cases in 1999, 2396 subjects. METHOD: The consumption of hypolipidaemics was expressed in defined daily doses (DDD). The authors investigated the ratio of chronically treated patients and the proportion of the following groups of patients according to their annual consumption in 1995-1999: group of of drug "vacation" (0 DDD) and the group with a low (< 121.7 DDD), medium (< 243.3 & > 121.7 DDD) and optimal (> 243.3 DDD) consumption of hypolipidaemics and their relationship to sex and age. For statistical ealuation software SPSS 10.1 was used. RESULTS: In the course of the investigation among the insured subjects the statin consumption increased 76 times and the consumption of fibrates 5 times. The ratio of consumption of resin derivatives and of nicotinic acid was negligible. The size of the group of subjects treated with hypolipidaemics for longer than one year increased from 0.8% in 1995 to 2.2% of the database. The average age increased from 55 to 59 years. The ratio of seniors (> or = 65 years) increased in the course of the investigation and reached 33% in 1999 of all members of the investigated group. The mean annual consumption of hypolipidaemics increased significantly as compared with 1995 and the interannual increase as compared with the previous year was statistically significant in 1997 and 1999. In 1999 it was 237 DDD/per consumer. A lower consumption was recorded in women and in seniors. Drug "vacations" were recorded in 6% of the insured subjects of the group and the frequency did not change significantly in the course of the investigation and no relationship with age and sex was found. A low exposure according to DDD was found in 20%, medium exposure in about 40% and optimal exposure in only one third of the subjects of the investigated group. CONCLUSION: The authors developed a method which makes it possible, when individual data of the health insurance company are available, to investigate the theoretical exposure to hypolipidaemics in insured subjects treated on a long-term basis with these drugs. The authors provided evidence that analysis of the database of the health insurance company can provide certain signals for further pharmacoepidemiological research and for application in a defined medical discipline. Some of the insured subjects are exposed to smaller doses than theoretically assumed. It is necessary to extend the investigation so that the results will better reflect the population of patients and prescribing physicians. Complete evaluation of cases with a low exposure from the aspect of morbidity and drug compliance will be also essential.

Aged↗
PubMedDate not supplied

Expanding health insurance coverage for smoking cessation treatments: experience of the Pacific Business Group on Health.

The business case for health insurance coverage of smoking cessation treatments by employers is a strong one. Smoking is one of the nation's costliest health problems, in both human and financial terms. The science behind smoking cessation treatment and promotion of treatment is strong; the cost effectiveness of smoking cessation treatment is among the highest in all of medicine, the time required before a positive return on investment is reasonable for employers, and the short-term costs of treatments are well estimated and manageable for health plans and employers. Armed with this business case, the PBGH Negotiating Alliance has expanded health insurance to include pharmacotherapy, over the counter or by prescription, and behavioral interventions. Because PBGH has been a national leader, we hope that other employers, employer coalitions, and public purchasers will follow their lead. The potential health effect of even small reductions in smoking are striking, and unlike other chronic illnesses, nicotine addiction is curable, at both individual and societal levels. Thus, if employers make the investment in smoking cessation and other tobacco control today, they face the real possibility that the need for such outlays could decrease in the future.

California↗
PubMed2004

Why it is time to review the role of private health insurance in Australia.

The role of private health insurance (PHI) within the Australian health-care system is urgently in need of comprehensive review. Two decades of universal health cover under Medicare have meant a change in the function of PHI, which is not reflected in policies to support PHI nor in the public debate around PHI. There is increasing evidence that the series of policy adjustments introduced to support PHI have served to undermine rather than promote the efficiency and equity of Australia's health care system. While support for PHI has been justified to 'take pressure off the public hospital system' and to facilitate choice of insurer and private provider', and the incentives have indeed increased PHI membership, this increase comes at a high cost relative to benefits achieved. The redirection of hospital admissions from the public to private hospitals is small, with a value considerably less than 25% of the cost of the policies. The Commonwealth share of the health care budget has increased and the relative contribution from private health insurance is lower in 2001-02, despite an increase in PHI membership to nearly 45% of the population, compared with the 30% coverage in 1998. The policies have largely directed subsidies to those on higher incomes who are more likely to take out PHI, and to private insurance companies, private hospitals and medical specialists. Ad hoc policy adjustments need to be replaced by a coherent policy towards PHI, one that recognises the fundamental change in its role and significance in the context of universal health coverage.

Australia↗
PubMed2001

Preference diversity and the breadth of employee health insurance options.

OBJECTIVE: To examine the effect of worker heterogeneity, firm size, and establishment size on the breadth of employer health insurance offerings. DATA SOURCES: The data were drawn from the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey of 22,000 business establishments selected randomly from ten states. STUDY DESIGN: The analysis was cross-sectional, using ordered probit models to relate the breadth of plan offerings to firm characteristics. PRINCIPAL FINDINGS: Firms with more diverse workforces offered a more diverse set of health insurance options. Firm and establishment size independently influenced the breadth of plan offerings. CONCLUSIONS: Employers are responsive to worker heterogeneity when determining the breadth of their health insurance offerings. However, diseconomies of scale in the purchase and administration of health insurance appear to limit the extent to which small employers can accommodate diverse worker preferences.

Cross-Sectional Studies↗
PubMed2003

[Cost effectiveness evaluation of cataract patient care in respect of monofocal intraocular lenses from the perspective of German statutory health insurance].

BACKGROUND: Data on the cost effectiveness of cataract surgery with respect to the German statutory health insurance system are hardly available. Hence the increase in visual acuity as primary efficacy endpoint, order of posterior capsule opacification as primary complication endpoint and direct cost for supplementation with monofocal intraocular lenses have been assessed via meta-analyses to evaluate the procedure's cost effectiveness from the perspective of the German statutory health insurance system. MATERIAL AND METHODS: Using the medical internet database MEDLINE two meta-analyses on publications between 1995 and 2002 were carried out, one estimating the gained increase in visual acuity, the second to estimate the frequency of posterior capsule opacification 5 years after implantation of a monofocal lens. To estimate the direct cost of German health insurance current reimbursement rates were used. The primary objective of this investigation was the individual incremental cost effectiveness ratio (ICER) linking the direct cost with the cataract surgery-associated increase in visual acuity. RESULTS: 51 studies were included in the meta analysis regarding the increase in visual acuity after cataract surgery. The median increase in visual acuity was about 5 visual units (interquartile range 3.6 - 8.0 units) reaching a median postoperative visual acuity of 0.8. The median incidence rate of posterior capsule opacification during the observed period of 5 years was estimated 24 % (10 - 34 %). Computation of the current reimbursement rates of German health insurance resulted in a median incremental cost of 223.25 euro; per gained visual unit. CONCLUSION: Providing of cataract patients with monofocal intraocular lenses means median incremental costs of about 223 euro; to be refunded by the health insurance and is associated with a median visual acuity outcome of 0.8. Therefore the cost effectiveness of cataract surgery can be regarded quite encouraging compared to the outcome of other ophthalmological outpatient surgery.

Cataract↗
PubMed2007

An empirical analysis of US and Japanese health insurance using age-period-cohort decomposition.

Aggregate data on household health insurance expenditure in the US and Japan that are classified by period and age are decomposed into age, period, and cohort effects by using the Bayesian cohort models. These models are developed to overcome the identification problem involved in cohort analysis. Despite the differences between the health insurance systems of the two countries, three interesting empirical findings are obtained. First, in both the countries, the age effects are the most influential, and the cohort effects have negligible influence. The latter provides a striking policy implication since the generational imbalance in social security expenditures is widely recognized in developed countries. Second, in both the countries, the period effects show a roughly upward trend. Finally, the age effects exhibit a roughly upward movement for all age groups in the US; however, in Japan, these effects show a downward movement for the 55-59 age group due to the changes in the health insurance system on retirement.

Adult↗
PubMed1997

Absence of health insurance is associated with decreased life expectancy in patients with cystic fibrosis.

Life expectancy for individuals with cystic fibrosis (CF) has increased dramatically in the last 30 yr, but it is unclear whether the improved survival has applied equally to individuals with different health insurance status. We developed a retrospective inception cohort of all 189 patients with CF born 1/1/55 to 12/31/70 who had at least one hospitalization at a university referral center. The median survival for patients with CF who were without health insurance was 6.1 yr compared with 20.5 yr for those with Medicaid and 20.5 yr for those with private insurance. Using multivariate Cox regression, health insurance and increased socioeconomic status were independently associated with longer survival. The adjusted relative risk of death was greater for the absence of health insurance than for factors previously shown to predict mortality in individuals with CF (female sex and presentation with meconium ileus). In summary, the absence of health insurance was associated with increased mortality rate in children with CF and was a stronger predictor of mortality than variables previously shown to be associated with mortality for CF. If increasing numbers of children with CF lose health insurance coverage, our results suggest that their life expectancy will decrease dramatically.

Adult↗
PubMed1998

Child health benefits packages: lessons from Minnesota for State Children's Health Insurance Programs.

The State Children's Health Insurance Program (SCHIP) provides state maternal and child health (MCH) programs an opportunity to assure comprehensive health services are available to children through the selection of an appropriate benefits package. Minnesota had this chance in 1994 when the state was considering development of a universal standard benefits set. While the Minnesota MCH program was not at the policy table, they worked through a process that increased their influence on decisions by responding to a legislative call for a definition of "appropriate and necessary" care. This definition was ultimately adopted by policymakers in creating the recommended Universal Standard Benefits Set. This experience may provide an important incentive to other state MCH programs seeking opportunities to participate in the development of state SCHIP plans.

Child↗
PubMed1997

Health insurance and the financial impact of IDDM in families with a child with IDDM.

OBJECTIVE: To examine the health insurance experience and out-of-pocket health care costs of families with a child with IDDM. RESEARCH DESIGN AND METHODS: A case-control study of 197 families with a child with IDDM and 142 control families with no diabetic children was conducted. IDDM-affected families were identified from the Allegheny County IDDM Registry. Brothers and sisters of the parents in the IDDM-affected families were asked to participate as control subjects. Health insurance coverage and the money that families spent on health care services and supplies not reimbursed by insurance (out-of-pocket costs) were assessed by questionnaire. RESULTS: No difference was found between the IDDM-affected and control families in the percentages with or without insurance. Families with low household incomes ($10,000-$19,999) were at the greatest risk for having no insurance. While coverage provided by private plans was similar between the IDDM-affected and control families, many families had no reimbursement for insulin (10%), syringes (10%), or blood testing strips (30%). Out-of-pocket expenses were 56% higher in the IDDM-affected families than in the control families. Seventeen percent of the IDDM-affected families had expenses over 10% of their household income. This particularly affected families with low household incomes. Pre-existing illness clauses and insurance denial affected only a small proportion of the case families. CONCLUSIONS: These data illustrate that most families with a child with IDDM have health insurance, yet still incur larger out-of-pocket health care costs than do families without the presence of diabetes. IDDM-affected families likely face a number of economic decisions regarding health insurance and the use of health care.

Adolescent↗
PubMed1980

Group life & Health Insurance Co. v. Royal Drug Co.: the McCarran-Ferguson Act and Health Service Plans.

Until recently, contractual relationships between health care providers and health insurers appeared to be immune from antitrust scrutiny. The Supreme Court ended this apparent immunity in Group Life & Health Insurance Co. v. Royal Drug CO., 440 U.S. 205 (1979), holding that insurance plans offering goods and services to policyholders are not exempted by the McCarran-Ferguson Act from the federal antitrust laws. By denying a McCarran-Ferguson exemption, the Court did not decide the ultimate issue--whether the insurers in fact had violated federal antitrust law. This Note reviews Royal Drug in light of precedent and of the purpose of the McCarran-Ferguson Act. This Note contends that the result in Royal Drug follows logically and consistently from the Court's earlier readings of the Act, but that the Court's reasoning is unclear and, even under its strongest reading, unconvincing; hence, an alternative approach to interpreting and applying the McCarran-Ferguson Act is suggested. Finally, this Note analyzes the application of Royal Drug by lower federal courts and discusses its implications for the interface of health law and antitrust law.

Commerce↗
PubMed2005

The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System.

OBJECTIVE: To describe the association between type of health insurance coverage and the quality of care provided to individuals with diabetes in the United States. DATA SOURCE: The 2000 Behavioral Risk Factor Surveillance System. STUDY DESIGN: Our study cohort included individuals who reported a diagnosis of diabetes (n=11,647). We performed bivariate and multivariate logistic regression analyses by age greater or less than 65 years to examine the association of health insurance coverage with diabetes-specific quality of care measures, controlling for the effects of race/ethnicity, annual income, gender, education, and insulin use. PRINCIPAL FINDINGS: Most individuals with diabetes are covered by private insurance (39 percent) or Medicare (44 percent). Among persons under the age of 65 years, 11 percent were uninsured. The uninsured were more likely to be African American or Hispanic and report low incomes. The uninsured were less likely to report annual dilated eye exams, foot examinations, or hemoglobin A1c (HbA1c) tests and less likely to perform daily blood glucose monitoring than those with private health insurance. We found few differences in quality indicators between Medicare, Medicaid, or the Department of Veterans Affairs (VA) as compared with private insurance coverage. Persons who received care through the VA were more likely to report taking a diabetes education class and HbA1c testing than those covered by private insurance. CONCLUSIONS: Uninsured adults with diabetes are predominantly minority and low income and receive fewer preventive services than individuals with health insurance. Among the insured, different types of health insurance coverage appear to provide similar levels of care, except for higher rates of diabetes education and HbA1c testing at the VA.

Adult↗
PubMed1993

Genetic testing and the social responsibility of private health insurance companies.

In this paper, I have pressed the general question, "Are private health insurers responsible for preventing the problems of equity and access that genetic discrimination would pose?" I have argued that socially responsible insurance companies will avoid genetic discrimination, even if they conceive of their social responsibility in narrow terms. The significance of this point extends beyond the specific question of genetic testing, and bears relevance to broader debates about reforming the nation's health care system. Ultimately, society's attraction to retaining a private health insurance market depends upon private health insurers affirming and meeting responsibilities to the wider society. How society and the insurance industry respond in the face of new genetic testing capabilities will be a moral guidepost indicating how we as a society should devise and implement health care reform.

Delivery of Health Care↗
PubMed2002

Alternative health insurance schemes: a welfare comparison.

In this paper, we present a simple model of health insurance with asymmetric information, where we compare two alternative ways of organizing the insurance market. Either as a competitive insurance market, where some risks remain uninsured, or as a compulsory scheme, where however, the level of reimbursement of loss is to be determined by majority decision. In a simple welfare comparison, the compulsory scheme may in certain environments yield a solution which is inferior to that obtained in the market. We further consider the situation where the compulsory scheme may be supplemented by voluntary competitive insurance; this situation turns out to be at least as good as either of the alternatives.

Actuarial Analysis↗
PubMed1988

Socioeconomic determinants of health insurance status among Puerto Ricans.

The present study analyzed the socioeconomic determinants of health insurance status among Puerto Ricans. Given the fact that there are no mandated health benefits for private firms in Puerto Rico and that health services are provided almost free of charge in government facilities, Puerto Rico provides a unique case study to explore the determinants of health insurance status. The model, estimated using a household sample of 750 dwellings, was collected through the Master Sample Survey of Puerto Rico's Department of Health. Given the nature of the problem studied, logistic regression techniques are used for estimation purposes. The findings of this study point to the importance of age and socioeconomic status as the most important determinants of health insurance status.

Adult↗
PubMed2001

Communities play key role in extending public health insurance to children.

Nearly all low-income children are now eligible for public health insurance coverage through Medicaid or the State Children's Health Insurance Program (SCHIP), but millions of eligible children still lack coverage. Increasingly, states have turned to local communities to assist with SCHIP outreach. The Center for Studying Health System Change's (HSC) recent site visits to 12 nationally representative communities found many organizations not traditionally involved in public health insurance activities--such as schools, employers and religious and community groups--playing important outreach roles. Local social service agencies, health departments and providers also are helping children gain coverage. For policy makers seeking to increase enrollment, these community efforts offer a valuable road map. Local SCHIP outreach generally is considered successful but is costly. And, state budget shortfalls and reduced federal SCHIP funding could threaten outreach efforts.

Child↗
PubMed2004

[The well-informed patient from the statutory health insurance standpoint].

By introducing competition into the statutory health insurance system the model of the informed patient has obtained new importance. As corporations of public law,more than 350 statutory health insurance funds (SHI funds) fulfil original tasks of in-forming and counselling patients. Although the SHI funds lack incentives for more patient orientation due to an inadequate risk equalization scheme, the SHI funds are extending their competences to support health consumer protection. On the one hand, attractive offers for information and counselling are being regarded as an important competitive field in the framework of the respective corporate strategy. On the other hand, the SHI funds are highly interested in having well-informed patients assume personal responsibility and through their well-directed demands contribute to more quality and efficiency in the healthcare system. Which objective need for in-formation does the population still have?What are the effects of medical lay knowledge on the communication between doc-tor and patient? From the SHI funds' point of view, however, there are many relevant questions still unsolved. Therefore, they consider health care research desirable to help them make user-oriented information avail-able for different target groups.

Counseling↗
PubMedDate not supplied

The erosion of health insurance: the unintended consequences of tiered products by health plans.

When properly structured, consumer-driven health care may provide gains to both patients and the delivery system. However, the current approach by health plans could result in real harm to patients and to an already fragile health care delivery system. While health plans are presenting tiered products as a necessary mechanism to control rising hospital expenditures, this paper explores the real drivers of the rising cost of health care, including utilization, increased demand for advanced medication, and new technology. Left unchecked, such benefit designs could have dangerous public policy implications and consequences, including the further erosion of the basic tenets of health insurance.

Consumer Behavior↗