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PubMed1995

[Legal aspects of health insurance claims and their potential use as a data source for epidemiological research].

Health insurance claims are legal documents for the purpose of billing health care cost and not intended for medical certification. They contain valuable public health data as well as sensitive personal information which must be kept confidential. Conflicts arise between the public interest and the privacy protection when public health researchers attempt to perform studies using health insurance claims. This article examines the legal aspects of health insurance claims and proposes legitimate procedures and forms for using claims data in public health research: researchers should act as "contractors" to perform survey under the auspices of insurers instead of requesting the "disclosure" of the personal information.

Confidentiality↗
PubMed2002

State Children's Health Insurance Program; eligibility for prenatal care and other health services for unborn children. Final rule.

In order to provide prenatal care and other health services, this final rule revises the definition of "child" under the State Children's Health Insurance Program (SCHIP) to clarify that an unborn child may be considered a "targeted low-income child" by the State and therefore eligible for SCHIP if other applicable State eligibility requirements are met. Under this definition, the State may elect to extend eligibility to unborn children for health benefits coverage, including prenatal care and delivery, consistent with SCHIP requirements.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1999

Adolescent health insurance coverage: recent changes and access to care.

OBJECTIVE: To assess the health insurance status of adolescents, the trends in adolescent health care coverage, the demographic and socioeconomic correlates of insurance coverage, and the role that insurance coverage plays in influencing access to and use of health care. Together, the results provide a current and comprehensive profile of adolescent health insurance coverage. METHODS: We analyzed data on 14 252 adolescents, ages 10 to 18 years, included in the 1995 National Health Interview Survey. The survey obtained information on insurance coverage and several measures of access and utilization, including usual source of care, site of the usual source of care, indications of missed or delayed care, and use of ambulatory physician services by adolescents. We conducted multivariate analyses to assess the independent association of age, sex, race, poverty status, family structure, family size, region of residence, metropolitan resident status, and health status on the likelihood of insurance coverage. We conducted bivariate and multivariate analyses to ascertain how insurance coverage was related to each of the access and utilization measures obtained in the survey. We also examined trends in health insurance coverage using the 1984, 1989, and 1995 editions of the National Health Interview Survey. RESULTS: An estimated 14.1% of adolescents were uninsured in 1995. Risk of being uninsured was higher for older adolescents, minorities, adolescents in low-income families, and adolescents in single parent households. Compared with their insured counterparts, uninsured adolescents were five times as likely to lack a usual source of care, four times as likely to have unmet health needs, and twice as likely to go without a physician contact during the course of a year. Between 1984 and 1995 the percentage of adolescents with some form of health insurance coverage remained essentially unchanged. During this period, the prevalence of private health insurance decreased, while the prevalence of public health insurance increased. CONCLUSIONS: This study demonstrates the critical importance of health insurance as a determinant of access to and use of health services among adolescents. It also shows that little progress has been made during the past 15 years in reducing the size of the uninsured adolescent population. The new State Children's Health Insurance Program could lead to substantial improvements in access to care for adolescents, but only if states implement effective outreach and enrollment strategies for uninsured adolescents.adolescents, health insurance, access, Medicaid, SCHIP.

Adolescent↗
PubMed1989

Access to health insurance in the United States.

One of the most compelling issues in United States health policy in the 1980s has been the growing number and proportion of the population with no health care coverage--no private health insurance, no Medicare coverage, no Medicaid coverage, no coverage through any other public or private program. Those without any coverage for health care expenses have come to be known as "the uninsured." The uninsured have increased from 27 million, 13 percent of the total population, in 1977 (Kasper, Walden, and Wilensky n.d.) to 37 million, 16 percent of the population, in 1987 (Short, Monheit, and Beauregard 1988). This article examines the reasons why health insurance coverage is an important issue, those groups most likely to be uninsured, the major sources and types of coverage for the insured population, and public policy options being considered to address the problem of access to health insurance.

Data Collection↗
PubMedDate not supplied

Health system reform under the Russian health insurance legislation.

The Russian (1993 amended) health insurance legislation initiated a far-reaching reform in the financing, organization and management of the Russian health system. However, the implementation of the legislation has been slow and unstructured due to a lack of appropriate administrative and financial mechanisms: these concern entitlement, private-public mix, financial responsibilities of government at all levels, investment instruments, reimbursement and compensation systems, and a well-defined role of government. These issues are discussed in this article in the context of the Russian economy, the state of the health system, and the reform effort in the system.

Financing, Government↗
PubMed1994

The medical care programs of the Farm Security Administration, 1932 through 1947: a rehearsal for national health insurance?

At a time of renewed interest in universal health insurance, an examination of earlier periods when society grappled with the link between socioeconomic status and health is fruitful. Between 1935 and 1947, the federal government sponsored a comprehensive medical care program for low-income farmers, sharecroppers, and migrant workers under the auspices of the Farm Security Administration (FSA). Despite the strong opposition of the American Medical Association, humanitarian and economic concerns at the local level often promoted physicians' participation in the program's group prepayment plans. Many FSA leaders clearly saw the program as a model upon which national health insurance might advance. However, in the wake of World War II, the FSA program declined as physicians' income improved, the rural population declined, and traditional ideological objections to federal intervention in medical care resurfaced. The FSA experience illuminates the complex ideological, economic, and humanitarian motivations of American physicians in the face of health care reform.

Agriculture↗
PubMed2001

A health insurance tax credit for uninsured workers.

This paper describes a new system of tax credits to help low-income workers pay for health insurance. The system would be designed to subsidize health insurance coverage for workers who are currently uninsured, or who pay high premiums for nongroup insurance. Anyone age 19 or older who is not covered by Medicaid, Medicare, or employer-sponsored health insurance would be eligible for a health insurance tax credit (HITC), administered through the Internal Revenue Service. The base amount of the proposed credit would be $2,000 per year for each covered individual, but this amount would be adjusted for the individual's age and sex, according to the effect of age and sex on the cost of insurance coverage. The base amount of the credit would be reduced by $150 for every $1,000 by which a person's income exceeded 200% of the federal poverty level, thus limiting HITC eligibility to lower-income workers. To encourage participation in the credit program, most of the credit would be available through an advance payment system, with final reconciliation after year's end.

Adult↗
PubMed2005

Supervision in social health insurance: a four country study.

This article presents the results of an international comparative study of a widely neglected element in social health insurance: supervision upon the sickness funds as implementing agents of social health insurance. The following countries were included: Belgium, Germany, Switzerland and the Netherlands. A comparative analysis of the institutional structure of supervision revealed many differences. The goals of supervision are more or less the same in each country: preserving the lawfulness of implementation; ensuring trust and stability; preserving efficiency and supporting policymaking. The analysis of the supervision process focused upon three sub-processes: the collection of information; the assessment of the performance of the sickness funds and interventions to correct deviant behaviour. Finally, the analysis deals with changes in supervision, in particularly the impact of market competition in social health insurance upon supervision. It is argued that market competition will substantially alter the role of supervisory agents in social health insurance.

Belgium↗
PubMed2007

National estimates of mental health insurance benefits.

This article presents estimates of the proportion of the U.S. population that had mental health benefits in 1999, of the extent of their coverage, and of the proportion that were enrolled in health plans subject to the Mental Health Parity Act of 1996 (MHPA). Findings indicate that over three-quarters (76%) of the U.S. population had mental health benefits as part of their health insurance. Approximately 18% of the population had no mental health benefits, and for the remaining 6%, mental health benefits could not be determined. Of the 18% with no mental health benefits, most (84%) had no health insurance whatsoever, while the remainder (16%) had health insurance that did not cover mental health benefits. Estimates of the generosity of coverage indicate that 44% of the population had benefits that included prescription drugs, and that provided at least 30 inpatient days and 20 outpatient visits for psychiatric care. For 12% of the population, benefit generosity could not be determined. Finally, study results suggest that the MHPA affected only 42% of the U.S. population.

Health Care Surveys↗
PubMed2006

How did welfare reform affect the health insurance coverage of women and children?

OBJECTIVE: To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996. DATA SOURCE: 1992-1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects. STUDY DESIGN: We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of time-invariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individual-level characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility. DATA COLLECTION/EXTRACTION METHODS: We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992-1996 panels of the SIPP covering the period 1992-1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP. PRINCIPAL FINDINGS: TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance. CONCLUSIONS: An unintended consequence of welfare reform was to adversely impact the health insurance coverage of economically vulnerable women and children, and that this impact was several times larger than the previous literature implies.

Adolescent↗
PubMed2004

Cigarette smoking and cancer incidence risk in adult men: National Health Insurance Corporation Study.

We analyzed risk while adjusting for age, body mass index, frequency of moderate physical activity, alcohol consumption, preference for vegetables versus meats, and frequency of meat consumption in a multivariate analysis and based our findings on not mortality data but incidence data. 733,134 Korean men who were 30 years old or older, insured by the National Health Insurance Corporation, and had a medical evaluation in 1996 were included in the study and followed up through 2000. During the 4-year follow-up period of 3,590,872 person-years, we identified 7204 new cases. We used the Cox proportional hazards model to estimate adjusted relative risks (aRRs), 95% confidence intervals (CIs). The association of current cigarette smoking was significantly stronger as compared with never smokers; aRR was 1.49 (95% CI=1.39-1.59) for all cancers, 4.46 (2.32-8.57) for esophageal, 3.83 (2.97-4.94) for lung, 3.01 (1.58-5.72) for laryngeal, 2.24 (1.48-3.39) for urinary bladder, 1.62 (1.42-1.84) for gastric, 1.75 (1.12-2.74) for oral and pharyngeal, 1.58 (0.97-2.27) for pancreatic, and 1.50 (1.29-1.74) for liver cancer. Our findings, based on incidence data, confirmed that differences in smoking habit were responsible for most of the differences observed in smoking-related cancers.

Adult↗
PubMed2004

The impact of urban health insurance reform on hospital charges: a case study from two cities in China.

During the transition from a centrally planned to a market economy, China's urban health insurance system is being reformed. The control of the rapidly increasing hospital expenses will be a major determinant of the success of the reform. This study aims to examine the impact of the reform on hospital charges by comparing changes between two cities with different insurance systems and identifying determinants for those changes. Data was collected from six hospitals in two cities, one city implemented an urban health insurance reform, the other did not. Acute appendicitis and normal childbirth were used as tracers for calculating hospital charges. Methods included the retrospective review of medical records, interviews with health policy makers and hospital staff, focus group discussions, and the review of hospital and health insurance documents. The results showed that hospital charges per case of acute appendicitis and childbirth increased 101 and 94%, respectively, in the city without reform, and 41 and 34% in the city with reform, between 1995 and 1999. Health insurance arrangements and average LOS were the major determinants for hospital charges. Drugs and non-pharmacological treatments were the major service categories for charge containment. The combined measures of a single insurer, selective contracts, a new payment system, and use of an essential drug list, is regarded as the key features for an effective hospital charge control, and would appear to be successful measures for hospital expenditure containment within health insurance reform.

Acute Disease↗
PubMed1989

National health insurance in America--can we practice with it? Can we continue to practice without it?

Health insurance in the United States is failing patients and physicians alike. In this country 37 million uninsured face economic barriers to care, and the health of many suffers as a result. The "corporatization" of medical care threatens professional values with an unprecedented administrative and commercial intrusion into the daily practice of medicine. Competitive strategies have also failed their most ostensible goal--cost control. In contrast, Canada offers a model of a national health insurance plan that provides universal and comprehensive coverage, succeeds at restraining health care inflation, and does little to abrogate the clinical autonomy of physicians in private practice. I propose that American physicians relent in their historical opposition to national health insurance and participate in the development of a universal, public insurance plan responsive to the needs of both patients and physicians.

Canada↗
PubMed1996

Use of health insurance in county-funded clinics: issues for health care reform.

This article determines to what extent people with and without health care insurance use public health care facilities and various health care services. A descriptive study analyzed the characteristics of 6,298 patients from four county-funded primary health care clinics. The patients were overwhelmingly poor regardless of insurance status. High cost-sharing requirements, coupled with larger families and low wages, may be causing some people with insurance to use public clinics. Implications for social work policy and practice are discussed.

Community Health Centers↗
PubMed1993

[Health care structure legislation--reform of health insurance].

On January 1st, 1993, the German Health Care Structure Reform Act has come into effect. It will fundamentally change the system of health insurance as well as the health care system. By the reform act, new structural and controlling elements have been installed in all central branches of health care, and, at the same time, a new order for the competition between the sickness funds has been established. Far-reaching structural alterations affect the hospital sector, the drug market and the system of ambulatory care. In the hospital sector, there will be a change-over to a price system consisting of special payments, payment according to diagnostic-related groups, and differentiated per-diem rates. On the drug market there will be introduced, besides a drug budget for doctors, a positive list for pharmaceuticals which will be worked out jointly by representatives of the medical profession and the sickness funds. In the ambulatory sector, licensing restrictions for doctors intending to set up practice will be introduced and the importance of the general practitioner or family doctor will be enhanced. The Health Care Structure Reform Act provides for self-government of the sickness funds and the medical profession with a wide range of controlling and shaping instruments. It also places the Ministry of Health in a better position to take influence. After the expire of the budgeting phase, competitive elements resp. extended controlling measures in the contracts sector will become more and more important features of the health care system. It remains to be seen whether the new controlling instruments will suffice to cause the intended limitation of expenditure.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗