Private and public health insurance: competition incentives for the control of health care costs.
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Cost Control↗
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Colorectal cancer surgical care and survival: do private health insurance, socioeconomic and locational status make a difference?
BACKGROUND: The purpose of the present paper was to examine patterns of surgical care and the likelihood of death within 5 years after a diagnosis of colorectal cancer, including the effects of demographic, locational and socioeconomic disadvantage and the possession of private health insurance. METHODS: The Western Australian Data Linkage System was used to extract all hospital morbidity, cancer and death records for people with a diagnosis of colorectal cancer from 1982 to 2001. Demographic, hospital and private health insurance information was available for all years and measures of socioeconomic and locational disadvantage from 1991. A logistic regression model estimated the probability of receiving colorectal surgery. A Cox regression model estimated the likelihood of death from any cause within 5 years of diagnosis. RESULTS: People were more likely to undergo colorectal surgery if they were younger, had less comorbidity and were married/defacto or divorced. People with a first admission to a private hospital (odds ratio (OR) 1.31, 95% confidence interval (CI): 1.16-1.48) or with private health insurance (OR 1.27, 95% CI: 1.14-1.42) were more likely to undergo surgery. Living in a rural or remote area made little difference, but a first admission to a rural hospital reduced the likelihood of surgery (OR 0.76, 95% CI: 0.66-0.87). Residency in lower socioeconomic areas also made no difference to the likelihood of having surgical treatment. The likelihood of death from any cause was lower in those who were younger, had less comorbidity, were elective admissions and underwent surgery. Residency in lower socioeconomic status and rural areas, admission to a rural hospital or a private hospital and possession of private health insurance had no effect on the likelihood of death. CONCLUSIONS: The present study demonstrates that socioeconomic and locational status and access to private health care had no significant effects on surgical patterns of care in people with colorectal cancer. However, despite the higher rates of surgery in the private hospitals and among those with private health insurance, their survival was no better.
Age Factors↗
A new perspective on universal health insurance. Interview by Donald E.L. Johnson.
Stanford University professor Alain Enthoven and his associate Richard Kronick have developed a proposal for national, universal health insurance for Americans not covered by Medicare or Medicaid. The plan, published in the Jan. 5 and Jan. 12 editions of The New England Journal of Medicine, would mandate health insurance coverage for all workers. "Public sponsors," such as large employers and the Health Care Financing Administration, would be retained, to create agencies to buy group health insurance for the uninsured and for employees of firms too small to act as sponsors. In this interview with Donald E.L. Johnson, Health Care Strategic Management's editor and publisher, Enthoven discusses the plan.
Health Benefit Plans, Employee↗
Patterns of health insurance coverage among rural and urban children.
Despite the potential for the State Children's Health Insurance Program to improve the health care coverage of rural children, the expansion of public health insurance to children in rural areas may be hampered by a lack of understanding about the patterns of insurance coverage they experience. This study uses the Census Bureau's 1993-1996 panel of the Survey of Income and Program Participation to evaluate differences in the duration of, and in their entry into and exit from, uninsured spells. While the average duration of new spells was shorter for rural children and most regained coverage quickly, rural children were also more likely than urban children to experience protracted spells of uninsurance. Moreover, rural children were more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children.
Adolescent↗
[Diagnosis and therapy of erectile dysfunction: a function of legal health insurance?].
From the medical point of view erectile dysfunction (ED) is accepted as a disease. However, there is a difference between the medical definition and the definition used by the official health insurance companies. This means that these health insurance companies have sometimes refused payment to the urologists for work done in the diagnosis and treatment of ED, especially in elderly men. Studies on the sexual behavior of elderly men show that 53-80% of men older than 75 years are still interested in sex and that 26% of this group have intercourse several times a month. Therefore, no one can say that sexual interest and activity decrease in elderly men to the point of complete inactivity. For this reason, the basic principle of maintaining the health of the individual is just as applicable in this case as it is in elderly people who are hard-of-hearing or who have weak eyesight. Thus, the diagnosis and therapy of ED must, strictly speaking, be considered a medical service that is recognized and paid for by the official health insurance companies. The substances used have not been licensed for this indication by the German BGA (German equivalent of the FDA), but this does not influence the possibility of prescribing them. Generally speaking papaverine, papaverine/phentolamine and prostaglandin E1 can be prescribed. In our opinion, prostaglandin E1 is to be preferred.
Aged↗
Hawaii's near-universal health insurance--lessons learned.
To date, Hawaii is the only state to have implemented near-universal health insurance. The cornerstone of this program is the country's only requirement that employers provide health insurance for all employees who work at least 20 hours per week. Combined with low unemployment, voluntary modified community rating by health insurers, and expanded Medicaid and Medicare, this employer mandate has been part of a patchwork mechanism that insures upwards to 95 percent of the state's population. Indeed, by adding a state-sponsored gap group-insurance program, Hawaii may now insure in excess of 95 percent of its population. The program has generated good health outcomes, good consumer satisfaction, and relatively modest overall health care expenditures. But for all that near-universal insurance provides, there is still a great need for community-based preventive and primary care programs with outreach and family support services. In addition, traditionally underserved populations continue to be at increased risk. Both funding reform and continued infrastructure development must occur to achieve universal access to care.
Cost-Benefit Analysis↗
Crowd-in: the effect of private health insurance markets on the demand for Medicaid.
OBJECTIVE: To investigate the effects of local labor market conditions and the availability of employer-sponsored health insurance on exits from the Medicaid program. DATA SOURCE: Data for this project come from a unique administrative database containing a 2 percent sample of all cases on California's Medicaid program in 1987 and a 2 percent sample of all new cases starting each year between 1987 and 1995. STUDY DESIGN: The results are estimated using a discrete duration model where the monthly exit probability is a function of demographic characteristics, local labor market variables, the probability of having employer-sponsored insurance, and fixed year and county effects. PRINCIPAL FINDINGS: Improvements in labor market opportunities (i.e., employment growth, wage growth, and increases in the availability of employer-sponsored health insurance) promote exits off the Medicaid program. A 2.5 percentage point increase in the availability of employer-sponsored insurance leads to a 6 percent increase in the probability that a completed spell lasts no more than 2 years. It would take a 2 percentage point decrease in unemployment rates or a 10 percent increase in average quarterly earnings to yield an equivalent increase in the likelihood of exiting Medicaid within 2 years. These effects are robust to the inclusion of county-level fixed effects and time effects. CONCLUSIONS: Medicaid expenditures and caseloads are sensitive to local economic fluctuations and secular trends in the availability of health insurance. Continued decreases in employer-based health insurance coverage will greatly increase the demand for public insurance coverage and the financial pressures on state governments.
Adolescent↗
Direct reimbursement of nurse practitioners in health insurance plans of research universities.
The purpose of this study was to explore the nature of health insurance coverage research universities offer their employees and the extent to which these employers offer options providing for reimbursement of services of independent nurse practitioners. A request for health insurance documents mailed to 77 public research universities resulted in a response rate of 83 per cent. A total of 75 per cent sent usable descriptions of insurance coverage for analysis. Among the respondents, 69 per cent (n = 40) reported offering insurance through Blue Cross/Blue Shield companies. Nursing services reimbursed generally included traditional nursing care such as private duty nursing and home health care. Coverage of nursing services that overlap with traditional medical practice, such as prenatal care and labor and delivery services of nurse midwives, anesthesia services of nurse anesthetists, psychiatric services of nurse specialists, and primary care nursing services of nurse practitioners, was less evident. Findings generally indicated that in spite of the presence of enabling or mandatory state legislation for third-party reimbursement of nursing services, legislation is not being implemented in many states by employers in their purchase of group policies.
Data Collection↗
Disparity of medical care utilization among different health insurance schemes in Taiwan.
Potential excess use of health care services caused by insurance has been a major concern for almost every industrialized county. Moral hazard problems and fee-for-service payment methods are considered to be important factors for higher medical care utilization among those insured. Health care availability is another feature reportedly associated with health care use. Using the data from a National Health Interview Survey in Taiwan in 1990, this study examined differences in medical care utilization by beneficiaries under three major social insurance plans (i.e. Labor Insurance-LI, Government Employees' Insurance-GEI, and Farmers' Insurance-FI) which covered about half the population at that time. Logistic and Poisson regression models were applied to examine the effects of relevant factors on the probability and volume of physician visits. Results from the analyses revealed that (1) persons with different insurance plans had a similar higher probability of seeing a doctor than the uninsured, with the odds ratios ranged from 1.8 to 2.0. Also (2) the LI/FI participants consumed 60 73% more physician services than the uninsured, while the GEI enrollees utilized only 30% more physician services. Findings from our study concerning the access and use of physician services in different insurance plans provide some useful information for reforming a health care delivery system.
Health Benefit Plans, Employee↗
Small businesses: the health insurance bind.
This paper discusses the structural and regulatory barriers that stymie small businesses' efforts to provide health insurance for employees. Specifically, small businesses face lower revenues and higher health insurance costs than large businesses. Furthermore, small businesses cannot gain the administrative, as well as cost, advantages of self-insurance. The two options for pooled insurance-Taft-Hartley groups and Multiple Employer Wellness Arrangements-are increasingly difficult to pursue. Even state-developed "basic insurance" packages have not proven a genuine solution for small businesses. However much we as a nation want to tie health insurance to employers, the small business sector cannot easily fill that function for its employees.
Commerce↗
Health inequalities in different age groups: the case of type 2-diabetes: a study with health insurance and medication data.
OBJECTIVE: This study investigates social differentials in the prevalence of diabetes type 2 in women and men in a health insurance population. It is considered whether social gradients are present over different age strata. METHODS: Analyses were performed with records obtained from a German statutory health insurance comprising 77,294 women (31.8%) and men (68.2%) of at least 20 years. Occupational status was used as indicator of socio-economic position. Individuals with diabetes were identified using information about antidiabetic medication or by hospital diagnoses according to ICD9. The analyses were performed for the entire insurance population and for different age strata (<40 yrs /40-55 yrs/ >55 yrs). RESULTS: The analyses revealed considerable social differences in diabetes risks. Considering the whole insurance population with the highest socio-economic category as reference group, the odds ratio (OR) for skilled non-manuals was OR = 2.9, for skilled manuals it was OR = 4.7, and OR = 5.6 for unskilled and semi-skilled individuals. After stratifying the insurance population into three age groups the social gradients were reproduced for each stratum, but their magnitudes increased with age. CONCLUSIONS: In the health insurance population considered health inequalities with respect to diabetes are considerable, and they are persisting after stratification into age groups.
Adult↗
Effects of early health-insurance programs on European mortality and fertility trends.
In this study, we examined the mortality and fertility effects of the early health-insurance programs sponsored by several European governments in the course of the demographic transition. Three sets of effects were hypothesized, and tested with data for five countries, covering the 1875-1913 period. First, although initially small, the growing health-insurance coverage of national populations accelerated longer-term downtrends in mortality. It not only expanded access to health care, but also helped in disseminating health information and awareness. Second, widening coverage also had an opposite effect on fertility; by lowering the costs of bearing and rearing children, it acted to slow the ongoing downtrend in marital fertility. Third, there was a diverse set of interactions between the mortality and fertility effects. Improved prospects for the survival of infants and children weakened parents' motivation to produce "extra" offspring to offset losses to mortality and to insure against future losses. Child survival was further enhanced by longer intervals between births and fewer children per family. However, the reduced cost of children tended to dilute these antenatal effects. Our regression results supported the expected pattern of partial effects, but simulations were needed to gauge the total impacts of health-insurance. Two sets of simulations were conducted: first, historical simulations, which closely tracked the actual experience of each sample country; second, counterfactuals, in which health-insurance coverage was set at zero for the entire time period. Comparisons of the historical and counterfactual simulations clearly indicated that health-insurance accelerated the downtrend in mortality, but slightly retarded the secular decline in marital fertility. These effects varied in magnitude, but not in direction, among the sample countries.
Birth Rate↗
The health insurance plight of patients with sickle cell disease.
Despite chronic illness that requires routine medical follow-up as well as occasional acute care and hospitalizations, many persons with sickle cell disease (SCD) are not getting the care that they need. The primary reason for lack of proper care is due to the patients' lack of health insurance coverage. This paper will examine the problem of health insurance coverage among persons with chronic illnesses using SCD as a model. It is speculated by the author that persons who suffer from other chronic illnesses may also experience similar problems in obtaining health coverage. Supporting data for this report are derived from a survey on the health insurance status of a randomly selected group of SCD patients treated at the Howard University Center for Sickle Cell Disease. This survey revealed that 20 percent of 70 adult and pediatric patient respondents had no form of health insurance coverage.
Adolescent↗
Ideological goals of different health insurance plans.
Questionnaires sent to and interviews with managerial personnel in two types of health insurance organizations revealed substantial differences in their goals. Top policy makers, executive managers, and lower level management personnel (in all 165 people from four entities) were questioned. Although differences occurred among the various administrative levels, the commercial companies were more strongly oriented toward profit and growth and the prepaid group practice plans more strongly oriented toward service and community relations. These findings were confirmed by a study of the public statements of these organizations. The findings would seem to have relevance to the use of insurance companies by the government in implementation of any national health insurance program.
Administrative Personnel↗
The effectiveness of consumer choice in the Medicare supplemental health insurance market.
This article examines the factors that affect Medicare beneficiaries' choices in the supplemental health insurance market. Data include detailed survey information as well as copies of the health insurance policies owned by a sample of approximately 2,500 Medicare beneficiaries in six states during 1982. Logit analysis is employed to analyze the determinants of four dependent variables: whether a person owns (1) one or more private supplemental insurance policies, (2) two or more policies, (3) at least one policy that we define as "effective," and (4) a policy we define to be "less effective." Those who are better off from a socioeconomic standpoint appear to be making more effective choices in the supplemental health insurance market. However, there does not appear to be a relationship between consumer ignorance or vulnerability and the purchase of multiple supplemental insurance policies. Study results imply an important role for public policy in helping to provide the information necessary to ensure that the most vulnerable beneficiaries make insurance choices that are in their best interest.
Aged↗
Health insurance plan of greater New York; the first three years.
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Humans↗
Two plans for universal health insurance.
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National Health Insurance, United States↗
Panel on National Health Insurance.
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National Health Insurance, United States↗