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PubMed2001

The association between socioeconomic status, health insurance coverage, and quality of life in men with prostate cancer.

The objective of this study was to examine the effect of socioeconomic status and insurance status on health-related quality of life (HRQOL) outcomes in men with prostate cancer. The design was a retrospective cohort study using multiple sites, including both academic and private practice settings. A cohort of 860 men with newly diagnosed, biopsy-proven prostate cancer of any stage was identified within CaPSURE, a longitudinal disease registry of prostate cancer patients. HRQOL was assessed with validated instruments, including the RAND 36-item Health Survey (SF-36) and the UCLA Prostate Cancer Index. Covariates included insurance status, education level, annual income, age, stage, comorbidity, Gleason grade, baseline PSA, marital status, ethnicity and primary treatment. HRQOL measurements were taken at 3-6-month intervals. Analysis of covariance was used to determine the effect of SES and insurance status on the HRQOL domains at baseline and over time. Patients with lower annual income had significantly lower baseline HRQOL scores in the all of the domains of the SF-36 and four of eight disease-specific HRQOL domains. No relationship was seen between annual income and HRQOL outcomes over time. Conversely, health insurance status was associated with HRQOL over time, but not at baseline. Health insurance status appears to have a unique effect on general HRQOL outcomes in men after treatment for prostate cancer. This study confirms the commonly held belief that patients of lower SES tend to have worse quality of life at baseline and following treatment for their disease. These findings have important ramifications for clinicians, researchers and policy makers.

Activities of Daily Living↗
PubMed2000

Conceptualising the lack of health insurance coverage.

This paper examines the lack of health insurance coverage in the US as a public policy issue. It first compares the problem of health insurance coverage to the problem of unemployment to show that in terms of the numbers of individuals affected lack of health insurance is a problem comparable in importance to the problem of unemployment. Secondly, the paper discusses the methodology involved in measuring health insurance coverage, and argues that the current method of estimation of the uninsured underestimates the extent that individuals go without health insurance. Third, the paper briefly introduces Amartya Sen's functioning and capabilities framework to suggest a way of representing the extent to which individuals are uninsured. Fourth, the paper sketches a means of operationalizing the Sen representation of the uninsured in terms of the disability-adjusted life year (DALY) measure.

Insurance Coverage↗
PubMed2001

Premium variation in the individual health insurance market.

Recent proposals to decrease the number of uninsured in the U.S. indicate that the individual health insurance market's role may increase. Amid fears of possible risk-segmentation in individual insurance, there exists limited information of the functioning of such markets. This paper examines the relationship between expected medical expense and actual paid premiums for households with individual insurance in the 1996-1997 Community Tracking Study's Household Survey. We find that premiums vary less than proportionately with expected expense and vary only with certain risk characteristics. We also explore how the relationship between risk and premiums is affected by local regulations and market characteristics. We find that premiums vary significantly less strongly with risk for persons insured by HMOs and in markets dominated by managed care insurers.

Adolescent↗
PubMed2003

Genetic information and testing in insurance and employment: technical, social and ethical issues.

The present paper examines the professional and scientific views on the social, ethical and legal issues that impact on genetic information and testing in insurance and employment in Europe. For this purpose, many aspects have been considered, such as the concerns of medical geneticists, of the insurers and employers, of the public, as well as the regulatory frameworks and unresolved issues. The method used was primarily the review of the technical, social, economical and ethical aspects of advances in genetics and the concerns of parties who are involved, that is, the insurers, the employers and the public. The existing guidelines and legislation on this topic were also reported. Then, the method was to examine the issues debated by these parties in Europe, as well as by 47 experts from 14 European countries invited to an international workshop organized by the European Society of Human Genetics Public and Professional Policy Committee in Manchester, UK, 25-27 February 2000. The result of this was that the most important issues raised by genetic information and testing in insurance and employment in Europe include a need for clear definitions of terms used in genetics, declaring the grounds on which genetic information is or is not used, and promoting confidence between the public and the insurance industry. There is currently very little use of genetic information in relation to employment, but the situation should be kept under review.

Employment↗
PubMed2003

Insurance status and patient behavior with asthma medications.

Few studies have measured patients' asthma medication compliance, medication costs, and insurance status. We used a questionnaire assessing details of asthma, medications used, patient costs, and methods used to reduce medication costs to assess these factors. Patients in outpatient clinics, emergency rooms, and inpatient units of two urban Chicago hospitals who had a history of asthma and an age of 18 years or older were eligible for the study. Two hundred subjects completed the questionnaire of which 54 (27%) were self-pay/uninsured, 54 (27%) had public aid, and 92 (46%) had insurance. The public aid group had a significantly higher rate of emergency room services. Eighty-four (42% of all participants) had no costs, including no copayment to obtain their antiasthma medications. Self-pay/uninsured patients more commonly reported delaying filling a prescription, failure to fill a prescription, and taking less than recommended doses than the other two groups. Self-pay/uninsured patients also more commonly reported choosing their pharmacy on the basis of medication costs. Participants with public aid reported their physicians inquired about insurance status, estimated medication costs, advised measures to reduce costs, and gave them free medication samples less often than the other two groups. In conclusion, patients report different methods to reduce their medication costs that vary according to their insurance status. Advice on methods to reduce medication costs and being supplied with medication samples also varied by insurance status according to participants' report.

Adult↗
PubMed2001

A regional survey of health insurance coverage for complementary and alternative medicine: current status and future ramifications.

OBJECTIVE: The purpose of this survey is to evaluate the extent of health insurance coverage for complementary and alternative medicine (CAM) within one region in the United States, a study prompted by the increased utilization of CAM. DESIGN: Prospective telephone interview of health insurance representatives. LOCATION: A contiguous three-state area (New York, New Jersey, and Connecticut) in the North-east. RESULTS: Almost all of the insurers surveyed cover chiropractic services. Less than half of the insurers reimburse acupuncture, usually for chronic pain management. Coverage for massage therapy is minimal and usually associated with physical therapy or chiropractic treatment. Other CAM services receive negligible coverage. CONCLUSIONS: Current health insurance coverage of CAM is limited essentially to chiropractic medicine, acupuncture and massage therapy. Coverage of CAM is made confusing by different policies, practitioner requirements, and health plans within each carrier.

Acupuncture↗
PubMed2001

Patterns of informal and formal caregiving among elders with private long-term care insurance.

PURPOSE: The purpose of this report is to provide basic descriptive information on community-dwelling, disabled, private long-term care (LTC) insurance policyholders who have accessed policy benefits. We focus on how benefits are used, whether claimants feel they are getting appropriate value from their policies, and what the patterns are of formal and informal service use. DESIGN AND METHODS: Data were obtained from a nationally representative sample of 693 LTC insurance claimants who were receiving benefits while living in the community and 424 of their informal caregivers. Eight of the largest LTC insurance companies representing about 80% of the market participated in the study. RESULTS: LTC insurance benefits are well targeted; they serve those truly dependent on ongoing care. The vast majority of claimants are satisfied with their policies, understand their coverage, and find it easy to file claims. Because of their LTC benefits, substantial numbers of disabled elderly individuals report that they are able to remain at home instead of being forced to seek institutional care. The availability of LTC benefits reduces stress among informal caregivers. For most claimants, formal care did not replace informal caregiving. IMPLICATIONS: As the LTC insurance market continues to grow and mature, there will be changes in the profile of claimants, the service delivery system, and the design of policies. Expansions in the private market will be associated with a greater number of disabled elderly remaining in their homes with a maintenance of and enhanced resiliency of informal support networks.

Aged↗
PubMed1995

Introducing health insurance in Vietnam.

Like many other countries Vietnam is trying to reform its health care system through the introduction of social insurance. The small size of the formal sector means that the scope for compulsory payroll insurance is limited and provinces are beginning to experiment with ways of encouraging people to buy voluntary insurance. Methods of contracting between hospitals and insurance centres are being devised. These vary in complexity and there is a danger that those based on fee for service will encourage excessive treatment for those insured. It is important that the national and provincial government continue to maintain firm control over funding while also ensuring that a substantial and targeted general budget subsidy is provided for those unable to make contributions.

Developing Countries↗
PubMed1996

Analysis of health insurance cover for reproductive immunology.

The objective of this study was to document the current state of health insurance cover for reproductive immunology in the USA. A survey of couples who had given birth to a child within the last 2 years while they were being treated with lymphocyte immunotherapy at the Reproductive Medicine Clinic of the Finch University of Health Sciences/The Chicago Medical School (FUHS/CMS), North Chicago, IL, USA, produced 61 completed questionnaires from couples in 16 states, representing a response rate of 55%. The Reproductive Medicine Clinic at the FUHS/CMS is a major centre that treats couples with reproductive immunological problems. These couples had experienced repeated pregnancy losses that were diagnosed as immunological in nature. This prospective study documents the insurance reimbursement of couples receiving lymphocyte immunotherapy who subsequently became parents. The findings indicate that 80% of couples had insurance claims initially denied for reproductive immunotherapy-related services. The most common reason given for a denied claim was that the treatment was experimental. Couples took further action and almost all received cover. Cover for immunotherapy-related services averaged 65% of the cost. The percentage of expenses covered by the insurance was quite variable. The survey indicates that insurance cover is provided if patients are willing to take action.

Abortion, Spontaneous↗
PubMed1979

National Health Insurance. Physical therapists' attitudes.

APTA members living in New England were surveyed by a mail questionnaire to assess their attitudes toward National Health Insurance. Respondents' strata included educators, private practitioners, and clinicians. Generally, respondents believed that National Health Insurance was inevitable, would not cause unnecessary use of physical therapy services, and would not affect the individual therapist's professional freedom. The majority of the respondents judged themselves not well informed about the health plan. Respondents' perceptions of their peers' views of National Health Insurance were inaccurate. Options favored by the respondents under a hypothetical health plan are reported. Results indicate that the physical therapists surveyed generally favored National Health Insurance and thought the APTA should represent them in planning such a program. No significant differences in attitude toward National Health Insurance could be attributed to respondent strata or any of the personal data collected.

Attitude of Health Personnel↗
PubMedDate not supplied

The effect of medical insurance coverage on the obtainment of pressure garments.

Pressure garments are used to alter the appearance of immature burn scars. These garments are costly, and delays in obtaining them are frequent. The purpose of the study was to determine the nature of the delays in the obtainment of pressure garments and to examine the role that the payer plays in these delays. The billing and medical records of all patients with burns measured for pressure garments between January 1, 1998, and August 1, 1999, were reviewed. The distribution of payers was as follows: workers' compensation, 37%; state-funded insurance, 32%; health maintenance organizations, 12%; private insurance, 16%; and other, 3%. Payment authorization time for pressure garments was 37 days for state payers and less than 10 days for all other groups. Patients with state-funded insurance waited an average of 67 days to receive their garments as opposed to a wait of 20 to 30 days for other payers. The percentage of billed charges paid was least for patients with state-funded and HMO insurance (58% and 51%, respectively). The interval to payment of charges was longer than 60 days for all groups. Marked delays in authorization exist for state-funded reimbursement of pressure garments. Reimbursement for patients with state- and HMO-funded insurance was lower than for other payers. These differences may have an adverse effect on outcome.

Adult↗
PubMed2000

Screening trauma patients for alcohol problems: are insurance companies barriers?

BACKGROUND: Impairment caused by alcohol is the leading risk factor for trauma. However, many physicians do not screen for alcohol use because of concerns about confidentiality and denial of insurance coverage. The purpose of this study was to examine objectively the confidentiality issues and insurance statutes affecting alcohol screening in trauma centers. METHODS: We conducted a survey of insurance commissioners in all 50 states to determine the prevalence of statutes allowing denial of coverage for injuries sustained while impaired due to alcohol, reviewed state insurance laws, and reviewed federal regulations protecting the confidentiality of alcohol information in patients seeking alcohol treatment. RESULTS: Special federal regulations protecting confidentiality of alcohol screening data depend on how such information is acquired and do not routinely cover trauma patients. Concerns about screening on insurance coverage are valid in 38 states. CONCLUSION: Segregating information about alcohol use in the medical record and assigning designated chemical dependency counselors to screen all trauma patients would provide confidentiality of alcohol information under current federal regulations, allowing denial of release of such information, except under subpoena.

Alcoholism↗
PubMed1999

Health Insurance Portability and Accountability Act of 1996: lessons from the States.

OBJECTIVES: To assess the likely effects of the 1996 Health Insurance Portability and Accessibility Act (HIPAA), based on small firms' experiences under state small group insurance reforms that were similar in design to HIPAA. METHODS: Data on 17,818 small businesses (range, 2-50 employees) nationwide from the 1994 National Employer Health Insurance Survey were analyzed to examine the effects of state small group reforms on the following: (1) employers' provision of coverage; (2) the percentage of workers in insured firms who were covered by plans; and (3) insurer practices of "enrollee exclusion." Logistic regression models were estimated and used to quantify the marginal effects of state small-group reform. Reform effects were examined for all small firms, for small firms by size category, and for small firms in redlined industries. RESULTS: Under full reform for at least 3 years (full reform includes guaranteed issue and renewal, portability, limits on pre-existing condition waits, and rating restrictions), employers were slightly more likely to sponsor health plans; however, employee participation in employer plans was no higher and the prevalence of enrollee-exclusion provisions was unchanged. Businesses in redlined industries clearly benefitted from all types of small group reform. For other subgroups of businesses, however, there were advantages and disadvantages associated with reforms, which varied with the scope of the measures and time since their implementation. CONCLUSION: Widespread small group reform may eventually help raise the proportion of small firms that sponsor health benefits, but not by much.

Commerce↗
PubMed1999

Insurance coverage for prescription drugs: effects on use and expenditures in the Medicare population.

BACKGROUND: Although most of the elderly are covered by Medicare, they potentially face large out-of-pocket costs for their health care because of excluded services. Aside from nursing home care, the exclusion of prescription drugs is one of the most significant. Several earlier policy initiatives have proposed adding prescription drug coverage to the Medicare program. To determine the effects of such an expansion, one must account for the potential increase in the demand for prescription drugs from providing insurance coverage. METHODS: The study uses a new data source, the RAND Elderly Health Supplement to the 1990 Panel Study of Income Dynamics (PSID). The endogenity of insurance coverage is tested using instruments that exploit the longitudinal nature of the data. Equations are estimated on 910 persons (> or = 66 years) using a two-part model. RESULTS: Insurance coverage for prescription drugs significantly increases the probability of use, but not of total expenditures, among those who use prescription drugs. However, insurance coverage significantly lowers out-of-pocket expenditures, thereby decreasing the financial burden on elderly households associated with prescription drug use. Medicaid coverage has effects that are smaller than those for private insurance, but the magnitude is less precisely estimated. These findings imply that if prescription drug coverage were added to Medicare, expected expenditures on drugs would rise by on average $83 for each elderly Medicare beneficiary (in 1990 dollars), although this increase is significant only at the 90% level. If the benefit had been included under Medicare, expected spending on prescription drugs by the elderly would have risen by approximately 20%, or $2.6 billion in 1990.

Aged↗
PubMed2003

Insured versus uninsured patients in the emergency room: is there a difference?

OBJECTIVE: To define the differences in emergency room usage patterns between patients with and without medical insurance coverage. METHODS: A retrospective analysis of the database of 34 642 consecutive patient visits to an urban hospital emergency room over a period of 509 days. Arrival times and admission rates were compared for insured and uninsured patients. RESULTS: A total of 46.8% of insured patients arrived at night or during the weekend versus 51.7% of the uninsured. Slightly more insured patients were admitted (18.6 versus 15.4%), both after their visit during the daytime (20.6 versus 17.1%) and outside daytime hours (16.3 versus 13.8%). The uninsured population was younger. CONCLUSION: Uninsured patients arrived more frequently during weekends and at night than insured patients. They were on average less likely to be admitted to the hospital. Demographic differences between both groups seemed to play an important role in the admission rate. Despite differences in emergency room usage patterns, it cannot be concluded that either group used the emergency room in excess of the other.

Adolescent↗
PubMedDate not supplied

Insurance reimbursement for risk-reducing mastectomy and oophorectomy in women with BRCA1 or BRCA2 mutations.

PURPOSE: Risk-reducing surgery is an important option for women with BRCA1 and BRCA2 mutations. There are reports in the literature that insurance reimbursement for these procedures varies greatly. Because health insurance coverage significantly affects medical decision-making, current information regarding reimbursement practices of third-party payers is needed. METHODS: Retrospective study of hospital billing records of 38 women with documented BRCA1 or BRCA2 mutations who underwent either a risk-reducing mastectomy or a risk-reducing oophorectomy between March 1, 1997, and July 30, 2000. RESULTS: Complete billing and reimbursement information was available for 35 women undergoing a total of 39 risk-reducing surgeries. A total of 38 of 39 (97%) risk-reducing surgeries were covered in full, less applicable coinsurance and deductibles. The rate of insurance reimbursement did not vary with type of insurance, personal history of cancer, or type of procedure. CONCLUSION: Insurance carriers reimbursed the vast majority of BRCA mutation carriers undergoing risk-reducing surgery.

Adult↗
PubMed2003

The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care.

OBJECTIVE: To examine the extent to which health insurance coverage and available safety net resources reduced racial and ethnic disparities in access to care. DATA SOURCES: Nationally representative sample of 11,692 African American, 10,325 Hispanic, and 74,397 white persons. Nonelderly persons with public or private health insurance and those who were uninsured. STUDY DESIGN: Two cross-sectional surveys of households conducted during 1996-1997 and 1998-1999. DATA COLLECTION: Commonly used measures of access to and utilization of medical care were constructed for individuals. These measures include the following. (1) percent reporting unmet medical needs, (2) percent without a regular health care provider, and (3) no visit with a physician in the past year. FINDINGS: More than 6.5 percent of Hispanic and African Americans reported having unmet medical needs compared to less than 5.6 percent of white Americans. Hispanics were least likely to see the same doctor at their usual source of care (59 percent), compared to African Americans (66 percent) and whites (75 percent). Similarly, Hispanics were less likely than either African Americans or whites to have seen a doctor in the last year (65 percent compared to 76 percent or 79 percent). For Hispanics, more than 80 percent of the difference from whites was due to differences in measured characteristics (e.g., insurance coverage, income, and available safety net services). Differences in measured characteristics between African Americans and whites explained less than 80 percent of the access disparities. CONCLUSION: Lack of health insurance was the single most important factor in white-Hispanic differences for all three measures and for two of the white-African American differences. Income differences were the second most important factor, with one exception. Community characteristics generally were much less important, with one exception. The positive effects of insurance coverage in reducing disparities outweigh benefits of increasing physician charity care or access to emergency rooms.

Adult↗
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↗