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PubMedDate not supplied

Individual insurance: how much financial protection does it provide?

This paper examines the comparative financial protection provided by individual and group health insurance. Data sources include two national surveys of employer-based health plans and e-health insurance listings for individual coverage on the World Wide Web. Data on the use and cost of services are from the National Medical Expenditure Survey (NMES), a national household survey of Americans. We estimate that individual insurance pays on average 63 percent of the health care bill, whereas group health insurance pays 75 percent. Deductibles are much higher in individual insurance, and covered benefits are more meager. At 200 percent of poverty, the top 25 percent of health care users with individual coverage would spend 11 percent of their income for out-of-pocket health care expenses, as opposed to 6 percent for persons with group coverage.

Actuarial Analysis↗
PubMed2005

Effects of the State Children's Health Insurance Program Expansions on children with chronic health conditions.

OBJECTIVE: To estimate the effects of the State Children's Health Insurance Program (SCHIP) expansions on insurance coverage, use of health care services, and access to care for children with chronic health conditions. METHODS: The primary source of data was the National Health Interview Survey. Children with chronic health conditions were identified primarily through reported diagnoses of common chronic conditions (eg, asthma, attention-deficit disorder, mental retardation, Down syndrome, cerebral palsy, muscular dystrophy, sickle cell disease, diabetes, arthritis, heart disease) and on the presence of activity limitations caused by a health problem lasting at least 12 months. We examined changes in a broad array of outcomes for children with chronic health conditions who gained eligibility under SCHIP or who were already eligible for coverage under Medicaid, comparing the periods before and after implementation of the program. Changes for these treatment groups were compared with children with slightly higher incomes, who should not have been affected by the eligibility expansions. Comparisons were made with adjustment for child, family, and other characteristics that might have independent effects on the outcomes of interest. Outcomes included health insurance coverage, use of general and specialty services, access to care, and out-of-pocket spending on health care. Selected analyses were conducted for children not identified as having chronic health conditions. RESULTS: The SCHIP expansions resulted in a 9.8 percentage point increase in the proportion of children with chronic conditions reporting public insurance and a 6.4 percentage point decline in the proportion uninsured. Unmet need for health care decreased by 8 percentage points, with most of the decline found for dental care. Increases in specialist, eye care, and dental visits and decreases in out-of-pocket spending and emergency-department and mental health visits were observed but did not meet standards of statistical significance. Estimated reductions in unmet need were greater for children with chronic conditions than for other children. CONCLUSIONS: Recent expansions in public insurance eligibility under SCHIP have improved coverage for children with chronic conditions, with selected improvements in access to care. However, some eligible children with chronic conditions remain uninsured, and the impact on access to care and service use were limited. Additional progress may require targeted outreach to children with chronic conditions and improvements in Medicaid and SCHIP service-delivery systems. Given the current fiscal environment and the fact that children with chronic conditions have not generally been protected from cutbacks, the recent progress documented in this study may be reversed.

Child↗
PubMed2003

Receipt of preventive care among adults: insurance status and usual source of care.

OBJECTIVES: This study ascertained the separate and combined effects of having insurance and a usual source of care on receiving preventive services. METHODS: Descriptive and multivariate analyses of 1996 Medical Expenditure Panel Survey data were conducted. RESULTS: Receipt of preventive services was strongly associated with insurance and a usual source of care. Significant differences were found between insured adults with a usual source of care, who were most likely to have received services, compared with uninsured adults without regular care, who were least likely to have received services. Those with either a usual source of care or insurance had intermediate levels of preventive services. CONCLUSIONS: Having a usual source of care and health insurance are both important to achieving national prevention goals.

Adolescent↗
PubMed2004

Does supplemental private insurance affect care of Medicare recipients hospitalized for myocardial infarction?

OBJECTIVES: We sought to determine whether supplemental private insurance coverage among Medicare recipients alters patterns of health care or outcomes associated with acute myocardial infarction. METHODS: Medicare patients hospitalized after a myocardial infarction were identified from New York City hospitalization records. Patients who had only Medicare coverage were compared with those who had supplemental private or public insurance coverage. RESULTS: Patients with supplemental private insurance exhibited increased rates of revascularization and decreased rates of in-hospital mortality relative to patients with either Medicare only or Medicare and public insurance. Moreover, Blacks and women were less likely to undergo revascularization and exhibited higher in-hospital mortality rates. CONCLUSIONS: Despite Medicare, private insurance coverage appears to influence the likelihood of coronary revascularization among older patients hospitalized for acute myocardial infarction.

Aged↗
PubMed2005

Supplemental private health insurance and depressive symptoms in older married couples.

Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarchical generalized linear modeling. Lack of supplemental insurance is operationalized at the household level in terms of neither spouse covered, one spouse covered, or both spouses covered. Controlling for covariates at both individual and couple levels, supplemental insurance has significant impact on depression, but the pattern differs by race. White couples report the highest depression when neither spouse is covered by private health insurance; African-American couples report the highest depression when only one spouse is covered. Results suggest lack of supplemental private health insurance coverage is a stressor that significantly affects depressive symptoms.

Aged↗
PubMed2002

Voluntary health insurance in the European Union: a critical assessment.

The authors examine the role and nature of the market for voluntary health insurance in the European Union and review the impact of public policy, at both the national and E.U. levels, on the development of this market in recent years. The conceptual framework, based on a model of industrial analysis, allows a wide range of policy questions regarding market structure, conduct, and performance. By analyzing these three aspects of the market for voluntary health insurance, the authors are also able to raise questions about the equity and efficiency of voluntary health insurance as a means of funding health care in the European Union. The analysis suggests that the market for voluntary health insurance in the European Union suffers from significant information failures that seriously limit its potential for competition or efficiency and also reduce equity. Substantial deregulation of the E.U. market for voluntary health insurance has stripped regulatory bodies of their power to protect consumers and poses interesting challenges for national regulators, particularly if the market is to expand in the future. In a deregulated environment, it is questionable whether this method of funding health care will encourage a more efficient and equitable allocation of resources.

Economic Competition↗
PubMedDate not supplied

Consumer-centered vs. job-centered health insurance.

Most employees and their dependents in the United States have health insurance provided by the employer or labor-management health and welfare fund. In this system, employees and their families lose their health insurance when the breadwinner loses his or her job while, at the same time, a Medicaid beneficiary can lose Medicaid eligibility by getting a job, even a poorly paid one. Most health insurance pays the doctor on the basis of fee-for-service and the hospital on the basis of cost-reimbursement, rewarding both with more revenue for providing more and more costly services. The insured employee has little or no incentive to seek out a less costly provider. There are no rewards for economy in this system. It should be little wonder, then, that health care costs are out of control. There are alternative financing and delivery systems with built-in incentives to use resources economically, but, the author of this article asserts, their ability to compete and attract patients with their superior economic efficiency is blocked by many laws and government programs. The author believes that the most effective and acceptable way to get costs under control, and at the same time achieve universal coverage, would be through a system of fair economic competition. He discusses his Consumer Choice Health Plan proposal and describes how one of the main barriers to competition is today's system of job-linked health insurance.

Commerce↗
PubMed1979

Private health insurance plans in 1977: coverage, enrollment, and financial experience.

The private health insurance industry collected $47.1 billion in premiums in 1977 and returned $41.6 billion in benefits to their subscribers. Premiums rose 16.3 percent as a direct consequence of rapid claims growth in 1976. After operating expenses were deducted, the industry showed a small, $.4 billion underwriting loss. About 78 percent of the population were insured for hospital care, and about 76 percent for surgical services. Smaller percentages had coverage for other types of care. An estimated 61.8 percent of the aged bought private hospital insurance, and 47.1 percent bought surgical insurance, mostly to supplement Medicare benefits. About 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid.

Data Collection↗
PubMed1983

Consumers' knowledge about their health insurance coverage.

This paper describes how much families know about their health insurance coverage and investigates whether consumer education and simplified benefit structures would improve knowledge. Families' perceptions about their insurance benefits were measured in two household surveys administered in six sites. Knowledge was assessed by comparing families' responses with policy data collected from the carrier. The vast majority of families understand insurance policies that specify one or two parameters in their benefit provisions. However, more complex payment structures are not well understood. Increased exposure to information in the plans leads to increased knowledge which suggests that education programs could improve the general level of knowledge. We conclude that if market strategies for allocating medical resources are pursued, simplifying insurance benefit structures and educating consumers about their insurance benefits would aid consumers in making more informed economic choices about medical care.

Awareness↗
PubMed2001

A critical review of the arguments for insurance coverage for smoking-cessation therapies.

This article elucidates the reasons most insurance companies do not cover smoking-cessation therapies despite their obvious benefits. It critically reviews the arguments for and against using a universal mandate as a strategy to increase use of smoking-cessation programs to realize the associated health benefits and cost-savings. While convincing arguments exist to mandate insurance coverage for self-destructive health behaviors, their merit is tempered by several valid counter arguments. For example, insurance coverage for small, routine, and predictable events, such as smoking-cessation treatment, violates the "first principles" of what ought to be covered when considered from the traditional insurance perspective. An insurance solution to risky behaviors may be to make undesirable behaviors more undesirable to individuals by raising premiums rather than to make them less undesirable with subsidies.

Cost Savings↗
PubMed2001

Preference diversity and the breadth of employee health insurance options.

OBJECTIVE: To examine the effect of worker heterogeneity, firm size, and establishment size on the breadth of employer health insurance offerings. DATA SOURCES: The data were drawn from the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey of 22,000 business establishments selected randomly from ten states. STUDY DESIGN: The analysis was cross-sectional, using ordered probit models to relate the breadth of plan offerings to firm characteristics. PRINCIPAL FINDINGS: Firms with more diverse workforces offered a more diverse set of health insurance options. Firm and establishment size independently influenced the breadth of plan offerings. CONCLUSIONS: Employers are responsive to worker heterogeneity when determining the breadth of their health insurance offerings. However, diseconomies of scale in the purchase and administration of health insurance appear to limit the extent to which small employers can accommodate diverse worker preferences.

Cross-Sectional Studies↗
PubMed1987

Kinzie v. Physician's Liability Insurance Co., 22 September 1987.

The plaintiff sought reimbursement for the costs of an in vitro fertilization procedure which resulted in her conceiving a child. When her insurance company refused reimbursement, she brought suit claiming that the procedure was covered by her insurance policy. The Court ruled in favor of the insurance company, holding that an vitro fertilization procedure was not "medically necessary" within the meaning of the insurance policy because the plaintiff's infertile medical condition was in no way reversed or cured. It reached this decision despite the fact that the insurance company had previously paid for out-patient and in-patient surgical treatment designed to repair the plaintiff's fallopian tubes.

Americas↗
PubMed2003

Prevalence of inflammatory bowel disease in an insured population in Puerto Rico during 1996.

OBJECTIVES: Limited data exists about Inflammatory Bowel Disease (IBD) in Hispanic populations. The aims of the present study were to estimate overall and specific prevalence of IBD (Crohn's disease and ulcerative colitis) and to describe the characteristics of a group of patients from the University of Puerto Rico's IBD Registry. METHODS: To estimate the prevalence of IBD, computerized records of all physician billing and hospital discharges from a major health insurer in Puerto Rico and classified with ICD-9-CM codes 555.0-555.9 (Crohn's disease) and 556.0-556.9 (ulcerative colitis) during 1996 were searched. Prevalence was estimated by age group, sex, and type of insurance. To describe demographic and selected clinical information from patients with IBD, data gathered in the University of Puerto Rico's IBD Registry from 1995 through 2000 was analyzed. RESULTS: Out of 802,726 insured individuals, 332 had a diagnosis of Crohn's disease, 499 of ulcerative colitis and 21 had both diagnoses. The estimated prevalence per 100,000 was 41.4 for Crohn's disease, 62.2 for ulcerative colitis, and 106.1 cases per 100,000 for IBD. Peak prevalence of Crohn's disease occurred among the age groups 50-59 years and > or = 60 years, and the overall female:male prevalence ratio of Crohn's disease was 1.13 (95% CI: 0.91-1.42). Ulcerative colitis was most prevalent among insured individuals aged 50-59 years and 40-49 years. The prevalence of ulcerative colitis was significantly higher among females than among males, with an overall prevalence ratio of 1.42 (95% CI: 1.18-1.71). Of 342 patients participating in the IBD Registry, 155 (45.3%) had Crohn's disease and 187 (54.7%) had ulcerative colitis. Among patients diagnosed with Crohn's disease, 51.6% were females, the mean age was 35.2 +/- 18.3 years, and 18.1% had a family history of IBD. More than half (57.8%) of patients with ulcerative colitis were females, the mean age was 42.6 +/- 17 years, and 17.1% had a family history of IBD. CONCLUSIONS: The estimated prevalence of IBD in this insured population in Puerto Rico places it among the middle-range of that reported for other countries. Additional studies must be conducted in Puerto Rico in order to confirm the observed findings. Population-based epidemiologic studies aimed at estimating the burden of IBD in Hispanic populations in the United States and Latin America are essential for health care planning.

Adolescent↗
PubMed2003

Contracting with limited commitment: evidence from employment-based health insurance contracts.

Impediments to worker mobility serve to mitigate the attrition of healthy individuals from employer-sponsored insurance pools, thereby creating a de facto commitment mechanism that allows for more complete insurance of health risks than would be possible in the absence of such frictions. Using data on health insurance contracts obtained from the 1987 National Medical Expenditure Survey, we find that the quantity of insurance provided is positively related to the degree of worker commitment. These results illustrate the importance of commitment in the design of long-term contracts, and provide an additional rationale for the bundling of health insurance with employment.

Career Mobility↗
PubMed2004

Trends in U.S. health insurance coverage, 2001-2003.

Against the backdrop of a sluggish economy and rapidly rising health insurance premiums, the proportion of Americans under age 65 covered by employer-sponsored insurance fell dramatically from 67 percent to 63 percent between 2001 and 2003. Although the decline in employer coverage could have spurred a large increase in the uninsured, the proportion of Americans without health insurance did not increase significantly, according to findings from the Center for Studying Health System Change's (HSC) Community Tracking Study Household Survey. Expansion of public health insurance--including Medicaid and the State Children's Health Insurance Program (SCHIP)--forestalled a significant increase in the uninsured, as the proportion of the under-65 population enrolled in public coverage increased from 9 percent to 12 percent.

Adolescent↗
PubMed2005

"Insuring" the continued solvency of pharmaceutical companies in the face of product liability class actions.

Costly product liability lawsuits continue to plague the pharmaceutical industry, and insurance to cover these losses is severely inadequate. Furthermore, questionable regulation of drugs exists once a pharmaceutical has passed FDA approval. This article describes a plan that uses a capitalistic, rather than a governmental, approach to solve both the insurance and the quality control problems. Although the proposed plan has never been used to insure pharmaceutical companies, different permutations of it have been used to insure other litigation-prone industries. Success from the proposed insurance entity results from the combined knowledge of scientists and actuaries to provide both protection from product liability lawsuits for the pharmaceutical industry and enhanced post-market surveillance of pharmaceuticals.

Compensation and Redress↗
PubMed1991

[Meaning of the "scientific validity clause" of private hospital insurance (section 5/1 f MB/KK 76). With reference to recent verdicts].

As per Section 5/1 f of the classic conditions 1976 of the "Association of private health insurance carriers" (Verband der privaten Krankenversicherung), benefits won't be paid for methods of examination or treatment and remedies which are from the scientific point of view generally not recognized. Basic reflections have led to the fact that today the term "scientifically recognized methods" and the term "traditional medicine" will be treated as equivalent. Contrary verdicts, according to which treatments on the basis of anthroposophic medicine or by means of electro-acupuncture by Voll would be considered as generally recognized medicine from the scientific point of view and would have to be paid by the private health insurance carriers, are consequently not comprehensible. Supposing that the trend continues that private health insurers have to pay more and more expenses incurred for all kind of outsider-methods, this would lead not only to a great drain on the purse of the private health insurance carriers, but have also unpleasant consequences for the whole medicine, because the uniformity of the medicine is endangered. To take steps against has not only to be the task of the private health insurance carriers, but it is also in the interest of the physicians and, at last, of the patients, too.

Complementary Therapies↗
PubMed1991

Loss of private health insurance among homosexual men with AIDS.

In this study we analyze information on self-reported health insurance coverage, HIV screening by insurers, and loss of health insurance. We distributed questionnaires to gay male participants in the Baltimore and Los Angeles sites of the Multicenter AIDS Cohort Study and to leukemia patients and gay AIDS patients seen at the Johns Hopkins Hospital. In this unusually well-educated and well-insured group, 90% of participants without AIDS had private health insurance coverage, compared with only 64% of participants with AIDS. Persons with AIDS (PWAs) were 33 times as likely to have Medicaid as persons without AIDS, and PWAs were 5 times as likely to have lost health coverage altogether as persons without AIDS.

AIDS Serodiagnosis↗