[Occupational accidents of the physician & their coverage by insurance].
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Accidents↗
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Results for “Insurance Coverage”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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Universal coverage health insurance in Saskatchewan.
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Humans↗
[Ambulatory psychotherapy coverage by insurance agencies, including primary medical psychosomatic care].
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Adolescent↗
Changes in liability coverage bring insurance crisis home.
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American Nurses' Association↗
Job-based coverage drops for adults and children but public programs boost children's coverage.
Based on data from the 2003 California Health Interview Survey (CHIS 2003), this policy brief provides a profile of nonelderly Californians' health insurance coverage and lack of coverage, as well as estimates of children and adults who are uninsured but eligible for coverage through public programs. It also describes how this profile has changed since 2001, based on data from CHIS 2001.
Adolescent↗
Racial differences in impact of coverage on diabetes self-monitoring in a health maintenance organization.
BACKGROUND: Insurance coverage of patient self-management devices like self-monitoring blood glucose (SMBG) equipment may help to reduce race-related barriers to effective care. OBJECTIVES: We examined whether providing free home glucose monitors had greater impacts on self-monitoring among black versus white patients with diabetes. RESEARCH DESIGN: Using electronic medical record data (1992-1996), we used longitudinal survival analysis to examine racial differences in rates of initiation of SMBG after coverage and rates of discontinuation of SMBG 18 months after initiation. We used piecewise Cox models to compare relative rates of SMBG initiation between black and white patients before and after the policy. SUBJECTS: The study cohort included 2275 continuously enrolled adult patients with diabetes in a large, staff model HMO. Multivariate models were restricted to patients using oral therapy. RESULTS: Controlling for time-dependent and fixed effects, black patients were as likely to initiate SMBG as white patients before the policy (hazard ratio 1.14; 95% confidence interval 0.86-1.50) but more likely after the policy (hazard ratio 1.33; 95% confidence interval 1.01-1.76). Among postpolicy SMBG initiators, black patients were consistently at higher risk of SMBG discontinuation than white patients over time (P < 0.05). By the end of follow-up, discontinuation rates were 78% among black patients and 64% among white patients. CONCLUSIONS: The policy is effective in triggering additional diabetes patients to self-manage, particularly black patients. However, persistence after initiation of monitoring is short-lived. Although our results show the potential of such policies to narrow racial gaps in self-management among racial minority groups, further interventions may be needed to promote long-term adherence.
Black or African American↗
Are adults benefiting from state coverage expansions?
This study provides a rigorous evaluation of state efforts to expand insurance coverage in California, Massachusetts, New Jersey, and Wisconsin. Overall, parents in Wisconsin and parents and childless adults in Massachusetts experienced the largest expansions in public coverage, with few, if any, offsetting reductions in private coverage. In contrast, the coverage expansions for parents in California and New Jersey led to increased enrollment, but often at the expense of private coverage. Because constraints on state resources are putting pressure on expansion efforts, we find evidence that cutbacks will place more adults at risk of being uninsured.
Adult↗
Barriers to health care access for Latino children: a review.
BACKGROUND AND OBJECTIVES: More than 9 million Latino children currently live in the United States. Latinos will soon be the largest minority group in the country, but little is known about access barriers to health care faced by Latino children. We reviewed the literature to define specific barriers to care for Latino children, identify methodologic problems, and highlight the clinical and research implications of the identified barriers. METHODS: We did a MEDLINE search, using combinations of the key words Hispanic, children, and access. Study exclusion criteria included "not an original research article," "enrolled only adult subjects," "no separate data analysis for children," and "dental care focus." RESULTS: The search yielded 497 citations, of which 27 met the inclusion criteria. Of the 32 potential barriers identified, 21 had good supportive evidence. Lack of health insurance was a consistent barrier; recent data revealed that 26% of Latino children are uninsured, compared with 10% of white children and 14% of African-American children. Latino children also are at greater risk for episodic insurance coverage, low rates of private insurance, and loss of employee-based coverage. Parent beliefs about the etiology and treatment of their child's illness, use of home remedies, choice of sources of advice, and folk medicine practices may also influence how health care is obtained. Few data are available on differences in access among major Latino subpopulations, and no studies focused primarily on barriers as perceived by Latino parents. Evidence is equivocal or lacking that the following are barriers for Latino children: immigration status, duration of parent residency in the United States, and acculturation. Several barriers were identified that originate with practices and behaviors of health care providers, including reduced screening, missed vaccination opportunities, decreased likelihood of receiving prescriptions, and poor communication. CONCLUSIONS: Lack of health insurance and lack of a regular source of care are major access barriers for Latino children, but many other barriers were identified that also can have a substantial effect on health care. In addition, the behaviors and practices of both health care providers and parents can affect access to care. Too little is known about what parents perceive to be the major barriers, access differences among Latino subpopulations, the roles of language and culture, and the causes of obstacles resulting from the actions of providers.
Acculturation↗
Health insurance and mammography: would a Medicare buy-in take us to universal screening?
OBJECTIVE: To determine whether health insurance expansions via a Medicare buy-in might plausibly increase mammography screening rates among women aged 50-64. DATA SOURCES: Two waves of the Health and Retirement Study (HRS) (1994, 1996). STUDY DESIGN: A longitudinal study with most explanatory variables measured at the second wave of HRS (1994); receipt of mammography, number of physician visits, and breast self exam (BSE) were measured at the third wave (1996). DATA EXTRACTION: Our sample included women aged 50-62 in 1994 who answered the second and third HRS interview (n = 4,583). PRINCIPAL FINDINGS: From 1994 to 1996, 72.7 percent of women received a mammogram. Being insured increased mammography in both unadjusted and adjusted analyses. A simulation of universal insurance coverage in this age group increased mammography rates only to 75-79 percent from the observed 72.7 percent. When we accounted for potential endogeneity of physician visits and BSE to mammography, physician visits remained a strong predictor of mammography but BSE did not. CONCLUSION: Even in the presence of universal coverage and very optimistic scenarios regarding the effect of insurance on mammography for newly insured women, mammography rates would only increase a small amount and gaps in screening would remain. Thus, a Medicare buy-in could be expected to have a small impact on mammography screening rates.
Breast Self-Examination↗
When insurance status is not static: insurance transitions of low-income children and implications for health and health care.
OBJECTIVES: Among low-income children, to characterize the frequency of transitions in health insurance coverage and examine associations of transitions with health status and health care access. METHODS: Data from the 1999 National Survey of America's Families were used in weighted analyses to identify sociodemographic characteristics associated with health insurance transitions for children living in households with income <200% of the federal poverty level over the preceding 12 months. In logistic regression models, we examined associations of insurance transitions with children's health status (fair/poor health), postponement of children's medical care or prescription medications, and lack of physician visits. RESULTS: Among 27.93 million low-income children in 1999, 5.7 million (20.4%) had experienced an insurance transition in the preceding year. Non-Hispanic black children (24.5%) and children whose parents did not have a partner or spouse (23.5%) were significantly more likely than other children to have experienced transitions. Hispanic children (16%) were least likely to have experienced transitions. Compared with children with continuous private coverage, children who had transitioned from public to private coverage were more likely to report fair or poor health, children who experienced transitions that included a period of no coverage were more likely to report postponed medical care and prescription drugs, and children who experienced a no-coverage-to-private-coverage transition were more likely to have foregone physician visits. CONCLUSION: Transitions in insurance coverage affect many low-income children and may represent barriers to their health care. Considering insurance transitions may provide a more complete picture of children's health and health care utilization.
Child↗
Health care in the upcoming 2000 election.
Health care will be one of the top issues in the year 2000 election, but voters' interest in health care is not as great as it was in 1992. There is no single unifying theme to the health care issue. Rather, there are multiple concerns: making Medicare financially sound, providing coverage for prescription medicines for seniors, covering the uninsured, and addressing patients' rights. Voters favor an incremental approach to expanding health insurance coverage rather than a major program. They express about equal levels of support for plans similar in concept to those proposed by presidential candidates Al Gore and George W. Bush.
Attitude to Health↗
Implications of the Health Security Act for mental health services for children and adolescents.
Lack of adequate insurance coverage is one reason that the percentage of children who currently utilize mental health services is significantly lower than the estimated percentage of children with serious mental disorders. Principles of a reformed health care system with particular relevance for children's mental health services include coverage of a broad array of home- and community-based services, provision of organized systems of care for children with serious and persistent mental illness, mechanisms to ensure appropriate utilization of services, and provision of mental health services on the same terms and conditions as other health services. The Clinton Administration's proposed Health Security Act embodied many of these principles. In addition, its call for universal coverage and for elimination of insurance exclusions for preexisting conditions would extend mental health coverage to children who are currently uninsured or underinsured; the plan would also expand the range of services covered to include state-of-the-art approaches such as intensive nonresidential services and other alternatives to hospitalization. Implementation of the proposed plan would require developing the service and workforce capacity to provide a full continuum of services, ensuring availability of existing services, integrating existing and new systems of care, guarding against underserving children with serious mental illness, and planning for the role of Medicaid funding in the reformed health care system.
Adolescent↗
A flexible benefits tax credit for health insurance and more.
This essay outlines a concept for a "flexible benefits" tax credit for expanding health insurance coverage and other purposes such as retirement savings plans (with potential withdrawals for higher education, first-home ownership, and catastrophic medical expenses). Two examples are presented. The advantages of a flexible benefits tax credit are considered in terms of efficient use of the budget surplus to help meet the varied (and changing) needs of American families, to eliminate major national gaps in health insurance and pension coverage, and to advance other objectives. If the budget surplus is used wisely, political decisionmakers could achieve health insurance coverage for most uninsured workers and children and assure a future with real economic security for American families.
Budgets↗
Predicting response to regulatory change in the small group health insurance market: the case of association health plans and HealthMarts.
Lack of health insurance continues to be a concern for many people, even among those who are employed, and employees of small firms are much less likely to be insured than employees of larger firms. For several years, the U.S. Congress has considered legislation that would establish two new vehicles for offering health insurance coverage to small employers: association health plans (AHPs) and HealthMarts. In this paper, we present a model for estimating the impact the new entities would have on coverage and premiums in the small group health insurance market. The model produces a range of estimates based on assumptions, among others, about demand for insurance among small firms and their willingness to switch to less expensive, less generous benefit plans. We estimate that approximately 4.6 million people would obtain coverage through AHPs and HealthMarts, but fewer than half a million of them would be newly insured (based on 1999 population figures). Premiums would increase slightly for firms that continued to purchase coverage in the traditional market.
Community Participation↗
Evaluating the State Children's Health Insurance Program: critical considerations.
The Balanced Budget Act of August 1997 was intended to improve the insurance coverage of low-income children. Although no specific mandates for evaluation accompanied the legislation, states are expected to assess its impact. Insurance improves access to and use of health services. The extent to which this is associated with better health depends on the kinds of services received. Access to a regular source of care is a critical characteristic. If this source of care provides good primary care, a variety of benefits would be expected to accrue. Thus, evaluation of the benefits of the State Children's Health Insurance Program should address not only improved coverage by health insurance for eligible children, but also the extent to which children receive high-quality primary care, including appropriate referrals when needed. Maternal access to and use of services is also a critical factor. Targets for evaluation include state activities to (a) enroll through outreach, inform through education, and develop information systems for tracking; (b) assess the degree of penetration of insurance among low-income children and their mothers, the availability of health care personnel, and the adequacy of benefits conferred by the insurance, primary-care services, and back-up specialty services; and (c) obtain evidence of improved health status. This article details approaches that can appropriately be used to address each of these aspects of concern.
Child↗
Entrances and exits: health insurance churning, 1998-2000.
Analysis of 1998-2000 health insurance data from the Medical Expenditure Panel Survey shows large numbers of people with unstable health insurance coverage. Young adults, Hispanics, people with low levels of education, those who transition into and out of poverty, and those with private non-group insurance are most likely to have unstable coverage. In addition, demographic factors and type of insurance interact to determine stability of coverage. Young adults and Hispanics with Medicaid or private insurance, for example, were relatively likely to lose their coverage. And less than half of people who transitioned into and out of low income and were initially uninsured were able to obtain coverage. Policies must target these high-risk groups in order to provide them with stable health insurance coverage.
Adult↗
Factors influencing health insurers' decisions to cover new genetic technologies.
OBJECTIVE: To examine the relative importance of factors influencing health insurers' coverage of new genetic technologies. METHODS: A national survey in which the decision makers for private health insurers were asked whether they would cover cystic fibrosis (CF) carrier screening, testing for genetic susceptibility to breast cancer (BRCA test), and medical costs of a clinical trial of gene therapy for CF under a variety of conditions. RESULTS: Respondents' coverage of the two tests and of medical costs of clinical trials was low at the time of the study (4%-15.5% of insurers). Their coverage of CF carrier screening and BRCA testing would be increased significantly if the group tested was restricted to those at high risk, if detection rates were higher and costs lower, and if testing was endorsed by a national professional group or consensus conference. Coverage of the medical costs of a trial of CF gene therapy would be significantly more likely if the trial was restricted to children or adults with severe CF, safety and effectiveness was proven, and therapy could be administered in a regional hospital or an outpatient setting rather than in a research hospital. CONCLUSIONS: Health insurers play a critical role in the diffusion of new genetic technologies. The validity of genetic tests and the safety and effectiveness of new therapies are primary factors influencing health insurers' coverage. Lower costs and approval of professional groups are other factors associated with increased coverage.
Adult↗
Playing by the rules and losing: health insurance and the working poor.
Using a sample of 7,734 employed adults from the National Medical Expenditure Survey, this research compares the sources of health insurance coverage and the antecedents of employer-sponsored insurance among the working poor to those at higher income thresholds. Concern with the working poor is warranted because they constitute the majority of the uninsured, they do not qualify for public health programs, and their health insurance benefits have eroded substantially. The data reveal that (1) the working poor are only one-third as likely to receive insurance from their employer as are the non-poor, and are over five times as likely to be without insurance from any source; (2) employment characteristics are critical antecedents of employer-sponsored insurance and, as a set, explain variation in coverage beyond that provided by human capital/socioeconomic factors; and (3) most employment characteristics have a similar effect on the odds of coverage across income categories, except for unionization and minimum wages. Implications for health care reform are addressed.
Adolescent↗