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PubMedDate not supplied

Renewed emphasis on consumer cost sharing in health insurance benefit design.

Purchasers and health plans are reemphasizing deductibles, coinsurance, and other consumer incentives in response to renewed inflation and the continuing backlash against managed care. This paper explores the partial convergence of cost sharing and benefit design for preferred provider and health maintenance products and highlights experiments that foster price-conscious choice among benefit configurations, provider networks, systems of care, drugs, medical devices, and clinicians. Health insurance is evolving from comprehensive coverage for a restricted set of choices to limited coverage for a broader set of choices. Diverse benefit designs and increased consumer cost sharing challenge conventional policy wisdom but may counteract some of the pernicious features of the health care status quo.

Community Participation↗
PubMed2003

The evolution of the State Children's Health Insurance Program (SCHIP) in New York: changing program features and enrollee characteristics.

BACKGROUND: The State Children's Health Insurance Program (SCHIP) has been operating for >5 years. Policy makers are interested in the characteristics of children who have enrolled and changes in the health care needs of enrolled children as programs mature. New York State's SCHIP evolved from a similar statewide health insurance program that was developed in 1991 (Child Health Plus [CHPlus]). Understanding how current SCHIP enrollees differ from early CHPlus enrollees together with how program features changed during the period may shed light on how best to serve the evolving SCHIP population. OBJECTIVE: To 1) describe changes in the characteristics of children enrolled in 1994 CHPlus and 2001 SCHIP; 2) determine if changes in the near-poor, age-eligible population during the time period could account for the evolution of enrollment; and 3) describe changes in the program during the period that could be responsible for the enrollment changes. SETTING: New York State, stratified into 4 regions: New York City, New York City environs, upstate urban counties, and upstate rural counties. DESIGN: Retrospective telephone interviews of parents of 2 cohorts of CHPlus enrollees: 1) children who enrolled in CHPlus in 1993 to 1994 and 2) children who enrolled in New York's SCHIP in 2000 to 2001. The Current Population Survey (CPS) 1992 to 1994 and 1999 to 2001 were used to identify secular trends that could explain differences in the CHPlus and SCHIP enrollees. PROGRAM CHARACTERISTICS: 1994 CHPlus and 2001 SCHIP were similar in design, both limiting eligibility by age, family income, and insurance status. SCHIP 2001 included 1) expansion of eligibility to adolescents 13 to 19 years old; 2) expansion of benefits to include hospitalizations, mental health, and dental benefits; 3) changes in premium contributions; 4) more participating insurance plans, limited to managed care; 5) expansions in marketing and outreach; and 6) a combined enrollment application for SCHIP and several low-income programs including Medicaid. SAMPLE: Cohort 1 included 2126 new CHPlus enrollees 0 to 13 years old who were enrolled for at least 9 months, stratified by geographic region. Cohort 2 included 1100 new SCHIP enrollees 0 to 13 years old who were enrolled for at least 9 months, stratified by geographic region, age, race, and ethnicity. Results were weighted to be representative of statewide CHPlus or SCHIP new enrollees who met the sampling criteria. Samples of age- and income-eligible children from New York State were drawn from the CPS and pooled and reweighted (1992-1994 and 1999-2001) to generate a comparison group of children targeted by CHPlus and SCHIP. MEASURES: Sociodemographic characteristics, race and ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic), prior health insurance, health care access, and first source of information about the program. ANALYSES: Weighted bivariate analyses (comparisons of means and rates) adjusted for the complex sampling design to compare measures between the 2 program cohorts and between the 2 CPS samples. We tested for equivalence by using chi2 statistics. RESULTS: As the program evolved from CHPlus to SCHIP, relatively more black and Hispanic children enrolled (9% to 30% black from 1994 to 2001, and 16% to 48% Hispanic), more New York City residents (46% to 69% from 1994 to 2001), more children with parents who had less than a high school education (10% to 25%), more children from lower income families (59% to 75% below 150% of the federal poverty level), and more children from families with parents not working (7% to 20%) enrolled. These socioeconomic and demographic changes were not reflected in the underlying age- and income-eligible population. A greater proportion of 2001 enrollees were uninsured for some time immediately before enrollment (57% to 76% had an uninsured gap), were insured by Medicaid during the year before enrollment (23% to 48%), and lacked a USC (5% to 14%). Although "word of mouth" was the most common means by which families heard about both programs, a greater proportion of 2001 enrollees learned about SCHIP from marketing or outreach sources. CONCLUSION: As New York programs for the uninsured evolved, more children from minority groups, with lower family incomes and education, and having less baseline access to health care were enrolled. Although changes in the underlying population were relatively small, progressively increased marketing and outreach, particularly in New York City, the introduction of a single application form for SCHIP and Medicaid, and expansions in the benefit package may have accounted, in part, for the large change in the characteristics of enrollees.

Adolescent↗
PubMedDate not supplied

Reproductive and sexual health benefits in private health insurance plans in Washington State.

CONTEXT: Although unintended pregnancy and sexually transmitted diseases (STDs) are considerable problems in the United States, private health insurance plans are inconsistent in their coverage of reproductive and sexual health services needed to address these problems. METHODS: A survey administered to a market-representative sample of 12 health insurance carriers in Washington State assessed benefit coverage for gynecologic services, maternity services, contraceptive services, pregnancy termination, infertility services, reproductive cancer screening, STD services, HIV and AIDS services, and sterilization, as well as for the existence of confidentiality policies. "Core" services in each category were defined based on U.S. Preventive Services Task Force and other recommendations. RESULTS: Of the 91 top-selling plans on which data were collected, 8% were indemnity plans, 14% were point-of-service plans, 21% were preferred-provider organization plans and 57% were health maintenance organization (HMO)-type products; they had a combined enrollment of 1.4 million individuals. Coverage of core services varied widely by type of plan. While a high proportion of plans covered core gynecologic, maternity, reproductive cancer screening, STD and HIV and AIDS services, nearly half of plans did not cover any kind of contraceptive method. Approximately 13% of female enrollees did not have core coverage for gyneco!ogic services, 19% for matemity services, 75% for contraception, 37% for sterilization and 53% for pregnancy termination; 98% of women and men were not covered for infertility treatment. Most carriers did not have specific policies for maintaining privacy of sensitive health information. Overall, benefit coverage was lower for indemnity, preferred-provider organization and HMO plans in Washington State than has previously been seen nationally. CONCLUSIONS: A sizable proportion of women and men in Washington State who rely on private-sector health insurance lack comprehensive coverage for key reproductive and sexual health services.

Family Planning Services↗
PubMed1978

A cash-equivalent option under "major-risk" national health insurance.

A central purpose of proposed "major-risk" ("catastrophic") national health insurance would be to provide an incentive to economize by requiring most households to pay, out of pocket, at least a fraction of the cost of all medical care they use. To help ensure the success of this cost-conscious strategy, the author asserts, a cash-equivalent option for workplace supplementary private health insurance should be legally required.

Deductibles and Coinsurance↗
PubMed2005

Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems.

We studied the potential of community-based health insurance (CHI) to contribute to the performance of health financing systems. The international empirical evidence is analysed on the basis of the three health financing subfunctions as outlined in the World Health Report 2000: revenue collection, pooling of resources and purchasing of services. The evidence indicates that achievements of CHI in each of these subfunctions so far have been modest, although many CHI schemes still are relatively young and would need more time to develop. We present an overview of the main factors influencing the performance of CHI on these financing subfunctions and discuss a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies.

Developing Countries↗
PubMed1982

Development of health insurance policy in Japan.

This article first reviews the history of Japanese social policy in the post-World War II period, and then focuses specifically on the policy and politics of national health insurance. It describes the roles and motivations of the primary participants in the formation and development of the Japanese health insurance system. It thereby demonstrates that the policy of "health insurance for the whole nation" was adopted in response to immediate social and political pressures, many of them not specifically related to matters of health; that the form this policy took was a product of incremental "muddling-through" rather than an orderly and rational process; and that the history of social insurance in Japan reflects primarily the preferences of the dominant political-economic elites, and only secondarily the needs and demands of ordinary Japanese citizens. Finally, the article examines possible lessons for the United States, and suggests that Americans take advantage of their position as "health insurance laggards" to study and reflect critically on the experience of Japan.

Government↗
PubMedDate not supplied

Health insurance trends are contributing to growing health care inequality.

A health plan chief medical officer comments on several trends underscoring the conclusion reached by Robert Hurley and colleagues that disparities in health care are widening. Growing use of new technology is driving up premiums, increasing the ranks of the uninsured and underinsured. Cost shifting by hospitals because of inadequate public program reimbursements drives premiums even higher. Although disparities in health care can never be eliminated, access to essential services can-and must-be made universal. That goal can be accomplished if insurance coverage is mandated and responsibility for its cost is spread broadly.

Health Services Accessibility↗
PubMed2002

Supplemental health insurance: did Croatia miss an opportunity?

Croatia continues to face a health-funding crisis. A recent supplemental health insurance law increases revenues through first increasing co-payments, then raising the payroll tax to cover those co-payments. This public finance "slight-of-hand" will not solve the system's structural issues and may worsen system performance both in terms of efficiency and equity. Should Croatia have considered private supplemental insurance as an alternative? There is a new single private supplemental health insurance market now evolving over the EU countries and into Eastern Europe. Croatians could take advantage of lowered costs due to larger risk pooling and the lower administrative overhead of mature insurance organizations. Private supplemental insurance, when designed well, can address several objectives, including a) increased revenues into the health sector; b) removal of the public burden of coverage of selected services for certain population groups; and c) encourage new management and organizational innovations into the sector. Private and multiple company insurance markets are thought to be superior in terms of consumer responsiveness; choice of benefits; adoption of new, more expensive technology; and use of private sector providers. Private sector insurers may also encourage "spillover" effects encouraging reforms with public sector insurance performance. There is already an emerging private insurance market in Croatia, but can it be expanded and properly regulated? The private insurance companies might capture as much as 30-70% of the market for certain services, such as high cost procedures, preferred providers, and hotel amenities. But the Government will need to strengthen the regulatory framework for private insurance and assure that there is adequate regulatory capacity.

Cost Sharing↗
PubMed1998

Keeping competition fair for health insurance: how the Irish beat back risk-rated policies.

OBJECTIVES: This paper describes how Ireland created a level playing field for competition in health insurance, the strategies of a major insurer to introduce risk-rated policies that would segment the market, the successful campaign to block these policies, and the policy implications of the European Union requirement of competition in health insurance. METHODS: Policy documents, interviews, and press reports were analyzed. RESULTS: The minister of health forced the commercial insurer to withdraw its policies and replace them with community-rated policies. CONCLUSIONS: Because it is easier and more profitable for insurers to engage in risk selection than to become more efficient, beneficial competition in health insurance markets is extremely difficult to create. Carefully drawn rules and monitoring are required to overcome inherent causes of market failure. The current enthusiasm for saving money through competitive schemes in health insurance seems likely to produce higher costs and greater inequality.

Adolescent↗
PubMed2006

A tale of two counties: expanding health insurance coverage for children in California.

During difficult economic times, many California counties have expanded health insurance coverage for low-income children. These Children's Health Initiatives (CHIs) enroll children in public programs and provide new health insurance, Healthy Kids, for those ineligible for existing programs. This article describes the policy issues in implementing the Santa Clara and San Mateo County CHIs, as well as the children's enrollment levels and utilization of services. These CHIs are among the first of the thirty California counties planning or implementing such initiatives. Their success depends on leadership from county agencies that have not traditionally worked closely together, as well as the development of a diverse public and private funding base. This effort to provide universal coverage for all children is important to national policymakers desiring similar goals.

Adolescent↗