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At least 1,027 records · Page 57Linked to original sources
PubMed1990

[Health promotion in the framework of the health reform legislation--current perspectives for health insurance and municipalities].

This paper describes the perspectives of health promotion within the framework of the basic laws promulgated as of January 1989 in the Federal Republic of Germany. The initial situation, the intentions of the legislator, the performance criteria and the types of organised health promotion on a regional or county (community) basis are described. The new legislation on health promotion opens up new perspectives for compulsory health insurance bodies and regional (community) bodies. The advantages offered thereby must be made use of. The health insurance bodies can revive the principles of self-administration by taking full advantage of all possibilities of creating health promotion facilities. Community bodies must not only bear costs, they are also centrally responsible for health promotion policies to be enforced in their respective regions by organising cooperation between the individual persons and institutions who can regionally act as health policy promoters, and they are expected to bring about a general consensus on health promotion procedures.

Germany, West↗
PubMed2004

Improving health insurance coverage for Latino children: a review of barriers, challenges and State strategies.

OBJECTIVES: To summarize key findings on disparities in health insurance coverage for latino children, to present selected socioeconomic and healthcare access indicators for the nine states with latino populations over 500,000, and to recommend state strategies to increase public health insurance coverage for latino children. METHODS: Literature review performed on latino children and health insurance coverage, key informant interviews with frontline service providers, review of outreach sections of eight state 1115 waiver requests approved by the Secretary of the U.S. Department of Health and Human Services, and national and state data compiled on sociodemographic and healthcare access indicators for nine states with the largest latino populations. RESULTS: Eligibility and enrollment into Medicaid and State Children's Health Insurance Program (SCHIP) are hindered by financial, nonfinancial, and social policy barriers. Disparities in insurance and access indicators show that lack of parental employment-linked benefits, procedural barriers to enrollment, and lack of clarification on eligibility for children of noncitizen parents are associated with low levels of insurance coverage among latino children. CONCLUSION: To state strategies consistent with the overarching goal of Healthy People 2010 to eliminate health disparities can increase health insurance coverage for children of low-wage latino workers.

Child↗
PubMed1986

Reasons for holding health insurance: a study of a group of Christchurch families.

The reasons for holding private medical insurance were studied in a sample of 495 insured Christchurch families having school aged children. In one-third of these families health insurance was provided by an employer. Two major reasons for holding insurance were cited by those whose insurance was not provided by an employer: three-quarters of these families stated that health insurance helped them meet medical bills and nearly two-thirds claimed that insurance provided them with access to immediate health care if this was needed. A minority (24%) of those holding health insurance believed that public sector services were inadequate to provide health care but only 9% of families were able to cite some specific shortcoming of public sector services which had impelled them to take out insurance cover. It is concluded that the rapid rise of private health insurance in New Zealand is likely to have arisen from the net effects of the promotional activities of insurance companies, the declining real contribution of State health care funding and the effects of growing public uncertainty about the ability of public sector services to deliver health care.

Child↗
PubMed1977

The effect of physician-controlled health insurance. U.S. v. Oregon State Medical Society.

The trial record in an antitrust case against the Oregon State Medical Society, finally decided in 1952, was examined to reconstruct the behavior of a competitive market for health insurance coverage. Health insurers, called "hospital associations," were found to have engaged individually in cost-control efforts similar to, but possibly more aggressive than, today's utilization review under professional sponsorship. The subsequent disappearance of these insurer-initiated cost controls in Oregon is traced to the medical society's organization of a competing Blue Shield plan as a model of insurer conduct and to a simultaneous boycott by physicians of the hospital associations as long as they persisted in questioning doctors' practices. Some modern parallels are noted, and the advantages of fostering privately sponsored cost-control efforts are suggested.

Hospitals↗
PubMedDate not supplied

[Prevention and health promotion as a responsibility of legal health insurance--exemplified by a local insurance bureau].

The German statutory health insurance bodies are legally obliged to support health promotion of the assured, as stipulated by German social legislation since 1988. An analysis was performed covering a period of 5 years (1986-1990) in respect of all health-promoting and preventive measures carried out by a local so-called "Allgemeine Ortskrankenkasse (= AOK)" looking after 170,000 insured persons, to find out the impact of the new legislation on the practice of that particular local insurance body. During the period under report no changes in activities were recorded that would be worth mentioning. Although expenditure for prevention rose by 50%, it was nevertheless impossible to administer preventive measures to all the insured persons throughout the area since the total amount reserved for this purpose was only 0.42% of the overall expenditure. A major portion of the documented measures such as consultation on foods, health-promoting sports, getting rid of the smoking habit, social counselling, anti-stress training courses and the like were not performed for primary prevention but on subjects who were already sick (diabetics, cardiovascular patients, patients suffering from diseases of the locomotor apparatus). Definite statements on the quality or success of the measures were possible in selected cases only. The results of the study prompted organisational improvements in that particular insurance body. Since their financial resources are limited, these bodies should shift the emphasis of their expert possibilities in prevention to on-target care of high-risk groups and to the training of multiplicators.

Adult↗
PubMed1997

Willingness to pay for health insurance in a developing economy. A pilot study of the informal sector of Ghana using contingent valuation.

In the midst of high cost of health care both at the macro and micro levels, health insurance becomes a viable alternative for financing health care in Ghana. It is also a way of mobilising private funds for improving health care delivery at the macro level. This study uses a contingent valuation method to assess the willingness of households in the informal sector of Ghana to join and pay premiums for a proposed National Health Insurance scheme. Focus group discussions, in-depth and structured interviews were used to collect data for the study. There was a high degree of acceptance of health insurance in all the communities surveyed. Over 90% of the respondents agreed to participate in the scheme and up to 63.6% of the respondents were willing to pay a premium of 5000 cents or $3.03 a month for a household of five persons. Using an ordered probit model, the level of premiums households were willing to pay were found to be influenced by dependency ratio, income or whether a household has difficulty in paying for health care or not, sex, health care expenditures and education. As income increases, or the proportion of unemployed household members drop, people are willing to pay higher premiums for health insurance.

Consumer Behavior↗
PubMed1996

Health care triage alternatives and the influence of health insurance, education and race.

The relationship between one of Andersen's enabling factors, health insurance status and the choice of a pharmacist as the initial contact in the health care system was examined via telephone surveys. Eighty-seven percent of the sample reported having some form of health insurance. Of all intended health care provider contacts, pharmacists were selected as the initial contact 21% of the time. Logistic regression identified insurance status, education and race as significant (alpha < 0.05) covariates in the model. The odds ratios generated from the logit model indicated that non-whites, persons with less education and no health insurance were more likely to select a pharmacist for triage. The study concluded that uninsured persons were nearly twice as likely to seek pharmacist triage than insured individuals. Pharmacists may be filling an important triage gap for individuals who have limited financial access to traditional sources of physician care.

Adolescent↗
PubMed2004

Community-based health insurance in low-income countries: a systematic review of the evidence.

Health policy makers are faced with competing alternatives, and for systems of health care financing. The choice of financing method should mobilize resources for health care and provide financial protection. This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge. Overall, the evidence base is limited in scope and questionable in quality. There is strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending. There is evidence of moderate strength that such schemes improve cost-recovery. There is weak or no evidence that schemes have an effect on the quality of care or the efficiency with which care is produced. In absolute terms, the effects are small and schemes serve only a limited section of the population. The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing. To improve reliability and validity of the evidence base, analysts should agree on a more coherent set of outcome indicators and a more consistent assessment of these indicators. Policy makers need to be better informed as to both the costs and the benefits of implementing various financing options. The current evidence base on community-based health insurance is mute on this point.

Community Networks↗
PubMed1978

The U.S. health insurance industry: an alternative view.

The health insurance industry in the U.S. can be characterized as a concentrated industry. It has evolved into its current structure as a result of certain historical conditions, particularly those following the Great Depression. The structure of the industry has had an effect on the manner in which the industry functions and the cost increases in the health care sector. Specifically, the pricing mechanism is that of a price leader setting a limit price; health premium prices are higher than would be expected under a competitive structure. Regulation has been ineffective, because it has been dominated historically by health care providers and insurers. The costs of health care in general, and hospital care in particular, have increased beyond what would be expected as a result of "cost-pass-through."

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

The Health Insurance Portability and Accountability Act of 1996: summary of provisions and anticipated effects.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA; PL 104-191), popularly known as the Kassebaum-Kennedy legislation, contains a broad array of provisions with collective implications for a large segment of the population. The legislation contains provisions affecting the private insurance markets, the federal tax code, and strategies for decreasing fraud and abuse and for increasing the simplification of administrative procedures. Two objectives hold together the disparate pieces of this legislation. The first objective is to improve the accessibility of insurance for individuals with preexisting medical conditions. The second objective is to make health insurance and health services more affordable. This article is designed to provide an overview of the multiple components of HIPAA, and to identify the parties that are likely to be affected by each component. It concludes with a discussion of how well HIPAA can be expected to fulfill its two goals.

Health Care Reform↗
PubMed1976

The medical care system under national health insurance: four models.

This paper presents a critical evaluation of four national health insurance models in light of their ability to counteract incentives in the present system that are dysfunctional in terms of costs and quality of care. The feasible models are labelled as: major risk insurance, alternative delivery systems under universal coverage; the public utility allocation model (alias the British system); and the public utility hospital model. It is concluded that substantial changes in the existing structure of the medical care system will be very difficult to achieve politically. Further, those models most politically feasible, the present medical care system with universal third party financing, and public utility process controls with universal third party financing, are the ones most likely to aggravate present cost-quality difficulties. Therefore, the recommended procedure for implementing national health insurance is unabashedly incremental: i.e.; to experiment with cost-sharing, alternative delivery systems, other provider incentive mechanisms and public utility regulation-budget allocation approaches, before wholesale adoption of national health insurance is entertained.

Delivery of Health Care↗
PubMed1999

[Estimation of the incidence of eight malignant tumours in France, on the basis of health insurance's statistics].

This work has for aim to suggest coefficients of adjustment applicable to the statistics of malignant tumours refunded through the health insurance as long-term diseases. Those coefficients would allow to evaluate the morbidity rate of cancer in the general population in France. To reach this target, we compared the figures of health insurance to those of the registers of cancers in six french departments, after we made the necessary adjustments to make the comparison possible. We showed that, for each cancer, the coefficient of adjustment is equal to the median of the relative differences that we noticed between the figures of the registers and those of the health insurance. We calculated the adjustment coefficients for bladder cancers (1.07), colon-rectum cancers (1.36), womb cancers (1), kidney cancers (0.83), lung cancers (1.33), oesophagus cancers (1.56) and prostate cancers (1.37). The comparison between the incidences adjusted on the basis of the figures of the health insurance, the incidences estimated by the Inserm and those released in the literature allowed us to confirm the validity of the coefficient we propose, except for the kidney cancer and the lung cancer by women, for whom we can't make any conclusions. Our work shows that the statistics of health insurance builds up a basis of information that can be used to study the morbidity rate of some malignant tumours in France.

Breast Neoplasms↗
PubMed1995

The impact of health insurance status on adolescents' utilization of school-based clinic services: implications for health care reform.

PURPOSE: 1) To examine variations among students with different health insurance coverage in their use of school-based clinics (SBCs), reasons for not receiving health care when needed, and reasons for using or not using SBCs, and 2) to determine if insurance status is a significant factor in predicting SBC use, after controlling for demographic variables and health status. METHODS: Confidential questionnaires were administered to 2,860 adolescents attending 3 urban high schools with on-site SBCs. Chi-square and multiple logistic regression analyses were used to assess differences among insurance groups in patterns of SBC use and reasons for clinic use/nonuse. RESULTS: Students with private insurance or HMO coverage had the highest rates of SBC utilization (67% & 66%) and students without health insurance and with Medicaid had the lowest (57% & 59%) (p < 0.01). While there was no difference among adolescents according to insurance group membership in their use of SBC medical services, a significantly higher proportion of students with Medicaid coverage used SBC mental health services. Students without health insurance were less likely to receive health care from any source when it was needed. After controlling for demographic variables and health status, no insurance factors remained significant. CONCLUSIONS: SBC users represent a variety of insurance groups. Health care reform efforts need to take into account the special needs of adolescents and the challenges they face in accessing care that go beyond financial barriers to care. SBC have been shown to provide a convenient and acceptable source of care, as well as offering the opportunity to provide preventive and primary care services to at-risk youth. As the country moves to a managed care environment potential partnerships with SBCs represent a unique opportunity to improve the delivery of care to adolescents, assuring increased access to a package of health services that they need.

Adolescent↗
PubMed1977

The political economy on national health insurance. Policy analysis and political evaluation.

National health insurance (NHI) is discussed as a redistributive issue (that is, conflict over it is characterized by stable coalitions with important ideological differences). Discussion of policy alternatives has been intensified, but obscured, by a rhetoric which insists that the medical care system is in crisis. Both rhetoric and discussion point to three problem areas: cost, quality, and distribution of care. Three kinds of NHI proposals exist--minimal intervention measurees (e.g., AMAs Medicredit proposal), major government action (e.g., Kennedy-Corman), and mixed strategies (e.g., CHIP). While these have different potentials for mitigating the problem areas discussed, none can provide complete solutions. Rather, the goal of NHI is to avert financial catastrophe for families and individuals. The emergence of Democratic majorities in Congress and a Democratic White House increases the chances that some NHI plan will be adopted. Political analysis suggests that, short of aggressive leadership committed to a comprehensive scheme, a "middle ground" solution will be outcome.

Economics, Medical↗
PubMedDate not supplied

Consumer-directed health plans and the RAND Health Insurance Experiment.

Today's consumer-directed health plans, with their high deductibles, bear a strong resemblance to the high-deductible plan of the RAND Health Insurance Experiment (HIE), although they come into a post-managed-care world. The high deductibles and the tools of managed care should complement each other, the former directed primarily at the initiation of care for an episode of illness and the latter at the costliness of episodes, especially ongoing chronic disease episodes. Although the RAND experiment established the effects of varying prices to patients, future experiments with how physicians respond to the various tools of managed care may be useful.

Community Participation↗
PubMedDate not supplied

The relationship between the stages of change for exercise and health insurance costs.

OBJECTIVE: To determine the relationship between the stages of exercise participation and health insurance costs. METHODS: A hurdle model was used to examine health survey and health insurance costs data by stage of exercise participation. RESULTS: Employees classified in the maintenance stage (regular exercisers) of exercise adoption had lower costs and a lower probability of being classified in the high-cost group than did employees classified in the other stages of change for exercise participation. CONCLUSION: This study offers evidence that the health insurance of individuals classified in the maintenance stage of exercise costs less than does that of individuals classified in other stages of exercise adoption.

Adult↗
PubMed2004

Why should the poor insure? Theories of decision-making in the context of health insurance.

Increasingly, low- and middle-income countries are looking to community-based health insurance (CBHI) as a means of ensuring access to health care for the poor. However, little evidence exists about the determining factors that affect poor individuals' insurance decisions. This article reviews the economic and social literature on theories of decision-making, and presents empirical findings from different socio-economic contexts to describe individuals' insurance enrolment decisions in a low-income environment. Evidence from these studies suggests that several factors may explain poor households' decision to insure or remain uninsured. Combining empirical evidence with theories may serve to develop health policies to address issues related to the insurance design, the socio-economic and the informational context; with the overall objective of improving access to care for the poor.

Community Health Planning↗