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PubMed1993

Sources of health insurance and characteristics of the uninsured. Analysis of the March 1992 Current Population Survey.

Eighty-three percent of nonelderly Americans and 99 percent of elderly Americans (aged 65 and over) were covered by either public or private health insurance in 1991, according to EBRI tabulations of the March 1992 Current Population Survey (CPS). The March 1992 CPS is the most recent data available on the number and characteristics of uninsured Americans. In 1991, 16.6 percent of the nonelderly population--or 36.3 million people--were not covered by private health insurance and did not receive publicly financed health assistance. This number compares with 35.7 million in 1990 (16.6 percent), 34.4 million in 1989 (16.1 percent), and 33.6 million in 1988 (15.9 percent). The most important determinant of health insurance is employment. Nearly two-thirds (64 percent) of the nonelderly have employment-based coverage. Workers were much more likely to be covered by group health plans than nonworkers (71 percent versus 40 percent). Even though workers and members of their families were more likely to be covered by health insurance than nonworkers, 85 percent of the uninsured lived in families headed by workers in 1991, primarily because most people lived in families headed by workers. More than 60 percent of uninsured were in families headed by full-year workers with no unemployment. Nearly all persons who were covered by an employment based-plan received at least some contribution to that plan from their employer. The estimated average annual contribution among those receiving a contribution to employee or family plans was $2,129. Although many individuals in poor families are covered by public health plans, that coverage is far from universal. In 1991, only 52 percent of the nonelderly with income below the poverty line were covered by a public plan--49 percent by Medicaid. The number of children who were uninsured in 1991 was 9.5 million, or 14.7 percent of all children, compared with 9.8 million or 15.3 percent of all children in 1990. Twenty-three percent of children were covered by public health insurance, with 21 percent being covered by Medicaid. In 11 states and the District of Columbia, more than 20 percent of the population was uninsured in 1991. These states and their uninsured rates were the District of Columbia (30.3 percent), Texas (25.3 percent), New Mexico (24.5 percent), Louisiana (23.8 percent), Florida (23.5 percent), Mississippi (22.1 percent), Oklahoma (22.1 percent), Nevada (21.8 percent), California (21.7 percent),Arizona (21.1 percent), Alabama (20.6 percent), and Idaho (20.6 percent).

Adult↗
PubMed1984

Private health insurance: new measures of a complex and changing industry.

Private health insurance benefit payments are an integral component of estimates of national health expenditures. Recent analyses indicate that the insurance industry has undergone significant changes since the mid-1970's. As a result of these study findings and corresponding changes to estimating techniques, private health insurance estimates have been revised upward. This has had a major impact on national health expenditure estimates. This article describes the changes that have occurred in the industry, discusses some of the implications of those changes, presents a new methodology to measure private health insurance and the resulting estimate levels, and then examines concepts that underpin these estimates.

Evaluation Studies as Topic↗
PubMed2006

Possession of health insurance in Australia--how does it affect hospital use and outcomes?

OBJECTIVE: To assess the effect of possession of private health insurance on hospital use and outcomes in Western Australia. METHOD: Hospital morbidity records were extracted from the Western Australian (WA) Data Linkage System for all 22 major diagnostic categories (MDCs) for the period 1994-99, with follow-up to the end of 2000. Multivariate modelling techniques were used to estimate the effect of possession of private health insurance on hospital admission rates, average and total length of stay (LOS), cumulative incidence of admission at 30 days and one year, and case fatality at one year. RESULTS: Possession of private health insurance had significant effects on hospital use and outcomes, even after adjustments for age, sex, aboriginality, socioeconomic status, location and comorbidity. Non-insured patients tended to have a higher overall hospital admission rate but a lower admission rate for surgical episodes, and they generally had a longer LOS although this difference was only greater than a day in three MDCs. Case fatality was higher in non-insured patients, but there was no systematic trend with regard to readmission rates. CONCLUSIONS: The study found that for all MDCs, other than those where treatment was required on an emergency basis, patients with private health insurance had improved access to surgical procedures. Either non-insured patients were disadvantaged in their access to surgery or the higher intervention rate in privately insured patients represented supplier-/consumer-induced demand which may not always have been to the patient's advantage or both may have occurred.

Adolescent↗
PubMed2003

Expanding public health insurance to parents: effects on children's coverage under Medicaid.

OBJECTIVE: To assess whether expanding public health insurance coverage to parents leads to increases in Medicaid participation among children. DATA SOURCES/STUDY SETTING: Study uses data from the 1997 and 1999 National Survey of America's Families. Insurance coverage of children eligible for Medicaid under the poverty-related expansions is analyzed. STUDY DESIGN: We conduct two analyses. In the first, we examine the cross-sectional difference regarding whether Medicaid participation is higher for children eligible for Medicaid under the poverty-related expansions when states expand public health insurance programs to cover their parents. In the second, we use a difference-in-difference approach to assess whether the expansion of the Medicaid program to cover parents in Massachusetts led to an increase in Medicaid coverage among children between 1997 and 1999 relative to changes that occurred in the rest of the nation. DATA COLLECTION/EXTRACTION METHODS: The analysis relies on a detailed Medicaid and SCHIP eligibility simulation model that identifies children surveyed on the NSAF who are eligible for Medicaid under the poverty-related expansions. PRINCIPAL FINDINGS: Children who reside in states that expanded public health insurance programs to parents participate in Medicaid at a rate that is 20 percentage points higher than of those who live in states with no expansions. The Massachusetts expansion in coverage to parents led to a 14 percentage point increase in Medicaid coverage among children due principally to reductions in uninsurance among already eligible children. CONCLUSIONS: Expanding public health insurance coverage to parents has benefits to children in the form of increased participation in Medicaid.

Adult↗
PubMed1993

[Sports and public health insurance].

The range of payments by health insurance companies in case of accident and illness is presented and possible deficits of reimbursement are explained. The discussion of benefits and possible negative effects of physical activity leads--with a side-glance to professional sport--to the claim for a more reasonable use of our physical structure. Finally, abuses of our social network and financial consequences from our behavior are quoted as examples.

Adolescent↗
PubMed2004

Images of health insurance in popular film: the dissolving critique.

Several recent films have villainized the health-insurance industry as a central element of their plots. This Article examines three of those films: Critical Care, The Rainmaker, and John Q. It analyzes these films through the context of the consumer backlash against managed care that began in the 1990s and shows how these films reflect the consumer sentiment regarding health-insurance companies and the cost controlling strategies they employ. In addition, the Article identifies three key premises about health insurance in the films that, although exaggerated and incomplete, have significant factual support. Ultimately, the author argues that, despite their passionately critical and liberal tone, these films actually put forward solutions that are highly individualist and conservative, rather than inclusive and systemic.

Attitude to Health↗
PubMed2005

France tries to save its ailing national health insurance system.

France has provided universal health care through employment-based health insurance funds. As its governments have increasingly used tax revenues to supplement payroll levies, they have assumed a larger role. Faced with widening deficits in the funds' accounts, the National Assembly adopted in August 2004 legislation designed to decrease health expenses, increase revenues to the funds, and improve quality of care. The apparent impacts of the so-called Douste-Blazy law are to reaffirm social solidarity and equality of access; to reinforce central control rather than relying more on decentralized and market forces; to give the now-unified funds a stronger director, shielded not only from labor and business but also, possibly, from the central government; to allow French private physicians to retain their unrivaled freedom of prescription; and to continue France's reliance on taxes as well as payroll levies to finance its health care.

Delivery of Health Care↗
PubMed1976

The measurement of expenditures for outpatient physician and dental services: methodological findings from the health insurance study.

Survey data measuring outpatient health expenditure are evaluated for item nonresponse, measurement error, and bias. Item nonresponse is high for persons whose health care is financed through the public sector, but is otherwise manageable. Estimates of mean total and out-of-pocket physician and dental expenditure from two surveys using indirect methods (including the Health Insurance Study) are compared with nonsurvey estimates. Out-of-pocket physician expenditure is overestimated, but the other measures appear unbiased. Estimates using direct, self-administrated methods appear biased upward. We demonstrate that commonly used record check methods for evaluating survey data will make random error appear as bias, and a methodology we develop shows substantial random error in the measurement of dental expenditure: 44 per cent of the total variance in survey data and 39 per cent of the variance in records.

Ambulatory Care↗
PubMed1983

Private agencies for public purposes: some new perspectives on policy making in health insurance between the wars.

The approved societies, who were charged with the administration of health insurance in Britain, have long been blamed for the failure of the scheme to expand its coverage or scope in the interwar period. This paper takes a closer look at the administrative process and argues that societies were more vulnerable to central regulation than is commonly thought and were unable to resist cuts in public subsidies and extensions in liability introduced at their expense. They provided a convenient scapegoat for policies emanating primarily from the economic orthodoxy subscribed to by both government and the Treasury, modified to protect the unemployed during the slump. Health insurance policy was dominated to a large extent by the Government Actuary, who aimed to guarantee the cost effectiveness of the scheme. This paper also shows how administrative definitions and practices affected the classification of claimants to state social insurance at this time. It re-establishes the major weaknesses of the system, arguing that--in the light of recent discussions about reviving a system of national health insurance--we have much to learn from looking again at the experience of the interwar period.

Insurance, Health↗
PubMed1984

The cost of health care and health insurance in Australia: some problems associated with the fee-for-service system.

This paper reviews the health care system and the supporting health insurance framework in Australia. The importance of the health insurance mechanism is stressed in relation to the maintenance and growth of private fee-for-service medicine. The Medical Benefits Schedule, which is the negotiated basis for medical fees under insurance, is examined for the logic implicit in the fee structure. The high rewards for procedural medicine relative to consulting are suggested as part of the basis of the rapid growth in hospital admissions. It is also argued that the refund schedule has helped to determine the nature of the medical specialist manpower pool. Other problems associated with the complex nature of the refund schedule, such as fraud and wasteful over-servicing, are identified and discussed. It is asserted that the health insurance system and refund schedule are partly determining the nature of medical service provision and inducing inequities in the financing and delivery of medical care in Australia.

Australia↗
PubMedDate not supplied

Halfway there? Check to see if you are: six of 11 health insurance portability and accountability act rules are set.

The Health Insurance Portability and Accountability Act contains 11 rules, 6 of which have been released to date. Within each of the rules are numerous actions to be implemented. This article reviews those actions and provides health care managers with what exactly needs to be done to be in compliance with the Health Insurance Portability and Accountability Act effectively and efficiently.

Computer Security↗
PubMed2003

Navigating the road to implementation of the Health Insurance Portability and Accountability Act.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) has a profound impact on safety net providers. To help agencies afford expert consultation and provide the opportunity for collaboration, a regional health foundation has created the first model in the nation to bring together safety net providers to work toward implementation of the HIPAA.

Computer Communication Networks↗