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PubMed2000

Properties of actuarially fair and pay-as-you-go health insurance schemes for the elderly. An OLG model approach.

The aged dependency ratio or ADR is growing at a fast pace in many countries. This fact causes stress to the economy and might create conflicts of interest between young and old. In this paper the properties of different health insurance systems for the elderly are analysed within an overlapping generations (OLG) model. The properties of actuarial health insurance and different variations of pay-as-you-go (PAYG) health insurance are compared. It turns out that the welfare properties of these contracts are heavily dependent on the economy's dynamic properties. Of particular importance is the magnitude of the rate of population growth relative to the interest rate. In addition, it is shown that public health insurance is associated with an inherent externality resulting in a second-best solution.

Actuarial Analysis↗
PubMed1984

Corporate benefit policies and health insurance costs.

We tested the hypothesis that health insurance premium costs per employee are lower for employee groups where multiple health plans are offered and the employer pays a level dollar amount of the chosen premium than for employee groups where these two conditions are not met. Proposed national legislation relies on these conditions to create a competitive health care market. Data on 56 employee groups in 1981 and 66 employee groups in 1982 were collected from two surveys of large employers in Minnesota. Regression analysis of premium data from both surveys rejected the hypothesis. Indemnity plans in multiplan groups were cheaper if the employer paid a level dollar contribution versus a level percent (including 100) contribution. However, groups offered only an indemnity plan had lower premiums than groups meeting the two legislative conditions. These findings apply to both individual and family coverage premiums and are not caused by systematic differences in benefit provisions, employee demographics or factors influencing loading charges. Our findings cast doubt on attempts to achieve health care competition by legislative changes in insurance options and contribution methods.

Deductibles and Coinsurance↗
PubMed2001

A flexible benefits tax credit for health insurance and more.

This essay outlines a concept for a "flexible benefits" tax credit for expanding health insurance coverage and other purposes such as retirement savings plans (with potential withdrawals for higher education, first-home ownership, and catastrophic medical expenses). Two examples are presented. The advantages of a flexible benefits tax credit are considered in terms of efficient use of the budget surplus to help meet the varied (and changing) needs of American families, to eliminate major national gaps in health insurance and pension coverage, and to advance other objectives. If the budget surplus is used wisely, political decisionmakers could achieve health insurance coverage for most uninsured workers and children and assure a future with real economic security for American families.

Budgets↗
PubMed1990

Why requiring employers to provide health insurance is a bad idea.

There is mounting pressure at the federal (and state) level to require employers to provide health insurance to their employees. However, two quite different groups of workers could be affected by such a mandate. In addition, there are at least five major problems with requiring employers to provide health insurance. Chief among these is the further fracturing of the insurance market, so that the spreading of risk will be reduced, and only the young and healthy will be offered insurance at relatively low premiums. We should be designing a health insurance system that has both universal coverage and a cost-containment structure. Toward this end, we need to tackle issues that transcend alternative methods of financing health care in the U.S.

Evaluation Studies as Topic↗
PubMed1990

Estimating the cost of the most prevalent diseases of the retired beneficiaries of health insurance organizations in Alexandria.

A retrospective study was carried out in Alexandria Health Insurance Organization Polyclinics and pharmacies to determine the prevalence of diseases among the retired beneficiaries and their utilization of health insurance services, and to estimate the annual expenses by disease with comparison of the retired contributions and expenses. Arthritis (49.3%) and respiratory tract diseases (43.4%) were the for most prevalent disease groups. Ischaemic heart diseases ranked the first in term of total expenses. The outpatient medicaments constituted the largest burden of expenses and the expenditures were six to ten folds that of the retired contributions.

Aged↗
PubMed1984

National health insurance: a new imperative.

When viewed from the perspective of the policy analyst, observed inequities in the access to health services and the rising costs of physician and hospital care are among the most important issues confronting the American health delivery system. Recognizing that publicly financed health insurance programs result in a more equitable distribution of medical services, this paper focuses on the components of a national health insurance scheme that not only offers a comprehensive range of benefits but also employs prospective payment and a set of financial incentives to control the costs of care provided by physicians, hospitals, and other health facilities. The national health insurance program proposed in this paper is designed to eliminate or reduce unwarranted expenditures on plant and equipment; the responsibility for approving and funding capital acquisitions is also regarded as an integral component of the program.

Capital Expenditures↗
PubMed2005

Welfare reform and health insurance: consequences for parents.

OBJECTIVES: We assessed the relation between the work promotion, welfare reduction, and marriage goals of welfare reform and the stability of health insurance of parents in transition from welfare to work. METHODS: We analyzed a panel survey (1999-2002) of a stratified random sample of Illinois families receiving welfare in 1998 (n=1363). RESULTS: Medicaid remains the foremost source of health insurance despite a significant decline in the proportion of parents with Medicaid. Regardless of work/welfare status in year 1, transitioning to work only or no work/no welfare increased the likelihood of having unstable health insurance in years 2 and 3 compared with those who remained on welfare only. CONCLUSIONS: Parents who meet the welfare reform goals of work promotion and reduction of welfare dependence experience significant loss and instability of health insurance.

Aid to Families with Dependent Children↗
PubMed1987

Selecting health insurance: the importance of prescription drug coverage and pharmacy factors in consumer decision making.

This study determined how important prescription drug coverage was to consumers in selecting their health insurance plans, the specific pharmacy factors they considered, and the importance of factors considered. A mail survey questionnaire was sent to 800 state government and university employees residing in the Madison, Wisconsin area; 453 questionnaires were returned. The majority (59.0 percent) of respondents aware of health insurance prescription coverage placed at least moderate importance on that coverage when selecting their health insurance plan. The specific factors considered most often were cost, location, convenience, and flexibility to choose or change pharmacies. The importance ratings for cost, location, flexibility, and the pharmacist varied among respondents enrolled in different health insurance plans.

Community Participation↗
PubMed2004

Holding back the tide: policies to preserve and reconstruct health insurance coverage in Maryland.

Over the past decade, state officials have pursued a variety of strategies to protect and expand health insurance coverage for their residents. This article examines the course of action in Maryland, where new initiatives were shaped around the state's unique hospital payment system and its reimbursement of uncompensated care, an evolving Medicaid and children's health program, and regulation of the small group health insurance market. Several important patterns emerge from the Maryland experience. First, even the most incremental initiatives--programs intended to aid a few thousand beneficiaries--bring into play the very issues that hamper comprehensive reforms: who is deserving of mutual aid and what is the proper role of government versus private entities in administering that aid. In Maryland, these issues generate conflict not only between Democrats and Republicans but also urban and rural interests. Second, all of the important reforms of the past decade were undertaken primarily in reaction to federal policy initiatives. Contrary to rhetoric lauding states as the "laboratories of democracy," the political impetus for reform and basic policy options emerge from interaction between federal and state debates. Third, even with budget surpluses and Democrats in control of the governorship and legislature, Maryland did not move aggressively toward universal health insurance. Now, with a much weaker economy and a new, Republican governor, the primary challenge will be to prevent further erosion of insurance coverage. The Maryland experience reiterates that each step toward greater health security, no matter how small, is a major technical and political challenge and that it will be difficult if not impossible to rely on states to secure coverage for all Americans in the foreseeable future.

Child↗
PubMed1997

Individual market health insurance reform: portability from group to individual coverage: federal rules for access in the individual market; state alternative mechanisms to federal rules--HHS. Interim final rule with comment period.

This interim final rule with comment period implements section 111 of the Health Insurance Portability and Accountability Act of 1996, which sets forth Federal requirements designed to improve access to the individual health insurance market. Certain "eligible individuals" who lose group health insurance coverage are assured availability of coverage in the individual market, on a guaranteed issues basis, without preexisting condition exclusions. In addition, all individual health insurance coverage must be guaranteed renewable. This rule also sets forth procedures that apply to States that choose to implement a mechanism under State law, as an alternative to the Federal requirements, with respect to guaranteed availability for eligible individuals. It also sets forth the rules that apply if a State does not substantially enforce the statutory requirements.

Career Mobility↗
PubMed2005

The quality of mercy: social health insurance in the charitable liberal state.

This paper has two, mutually supportive purposes: (1) to show that the modern economic rationale for universal social health insurance is consistent with the classical liberal understanding of property rights; (2) to show that the writings of the leading liberal sages-Locke, Smith, Mill, and Hayek-are congenial to programs economically similar to universal social health insurance, and, in Hayek's cases, were specifically approving. It is hoped that these facts and reasonings, which are unlikely to be known in toto to those who do not normally study across the intersection of philosophy and economics, will encourage a dialogue that reasserts in a non-ideological way the neglected role of property rights in the health economic assessment of social health insurance alternatives.

Charities↗
PubMed1992

The dynamics of health insurance among the near elderly.

Data from the Longitudinal Survey of Income and Program Participation were used to examine the dynamics of health insurance among persons 55 to 64 years of age. Persons in this age range are especially vulnerable to incurring high health care costs. Between the summer of 1983 and early 1986, 21% of persons 55 to 64 years of age experienced some time without health insurance. Approximately one fifth were continuously uninsured (4%) while the rest spent only part of the time without coverage, typically 4 months or less. Women were particularly vulnerable to periods without insurance, accounting for approximately twice as many of them as did men. Unlike younger cohorts, the coverage lost among the near elderly tended not to be employer coverage. Instead, most uninsured spells were ones in which individually purchased coverage was lost. Most spell beginnings were unrelated to changes in household employment, yet most spells ended when employment within the household increased. Some currently proposed reforms to expand health insurance, such as an all-employer mandate, a "pay-or-play" mandate, and extending Medicaid to persons in poverty, are less effective in reaching this medically high-risk population than in reaching younger persons who are uninsured.

Employment↗
PubMed2004

The effects of increased private health insurance: a review of the evidence.

Private health insurance membership declined steadily between 1984 and 1997, after which major government interventions caused it to increase. We review some of the literature and conclude that the increases in membership were probably associated with a loss of equity and cost-effectiveness for the health care system as a whole. We attempt to explain why the government made the changes and conclude that the main factors were vested interests of those who have benefited and a confusion of objectives. The changes may have resulted in a more balanced use of available resources (such as the balance between government and private hospital utilisation) but these and other desirable objectives might have been better achieved in other ways. We advocate that a more serious effort be made in future to ensure that policy takes more account of evidence, logic, and system-wide design and coherence.

Delivery of Health Care↗
PubMed1992

[Willingness to share costs of health insurance].

The purpose of this investigation, undertaken in 1988, was to find out citizens' willingness to share the costs of health insurance in metropolitan Taipei. The individuals sampled were from three groups: government employee insurer GEI, Labor insurer LI, and others OT. A stratified random sampling method and a closed-format questionnaire were used in this study. A total of 300 samples were taken from GEI, 500 form LI and 300 from OT. The total number of effective questionnaires were 1065. The questionnaire had 8 parts including individual basic data, consciousness of self health conditions, knowledge of LI, knowledge of GEI, degree of satisfaction with medical services, medical care utilization, willingness of health insurance, and willingness to share costs. The results showed that most people pay, most respondents would only be willing to pay a limited amount. The different factors positively influencing a willingness to cost share were level of education, average income and knowledge of health insurance, while the degree of satisfaction towards medical services was a negative influence. Since the public is not yet willing to accept a cost-sharing system, this study was of limited value in trying to find out the explanatory or predicting factors. Nevertheless, because of the negative reactions of respondents, we are obliged to more carefully and circumspectly rethink the implementation of a cost-sharing system.

Consumer Behavior↗
PubMed2004

Final regulations for health coverage portability for group health plans and group health insurance issuers under HIPAA Titles I & IV. Final regulation.

This document contains final regulations governing portability requirements for group health plans and issuers of health insurance coverage offered in connection with a group health plan. The rules contained in this document implement changes made to the Internal Revenue Code, the Employee Retirement Income Security Act, and the Public Health Service Act enacted as part of the Health Insurance Portability and Accountability Act of 1996.

Eligibility Determination↗
PubMedDate not supplied

[Health insurance in the contributive and subsidized regimes and its impact on the service providers].

The performance of 18 private Health-promoting (EPS) and Family Compensation (CCF) entities, as well as their general balances for 1997, 1998 and 1999, were studied to determine the profit margins achieved by EPS's in their work of administering health insurance. The average behavior of each EPS balance sheet was analyzed to reduce the effect produced by extreme cases; each EPS's value was thus weighted by the number of its affiliated people. The expected behavior of the costs and expenses of companies whose main business is providing health insurance could thus become determined. The main source of operational income for a private EPS is the contributive regime's per capita unit of payment (UPC). Subsidized regime participation and that of other sources of income has decreased year by year. By contrast, public EPS's have shown decreasing participation in income obtained from UPC (contributive and subsidized) and growing dependence on other sources of income; this can be interpreted as being a symptom of weak commercial management. According to the balance sheets provided by the SNS, the EPS (public, private and Family Compensation entities), including the Social Security Institute (ISS), together obtained a total of 4.18 billion pesos operational income in 1999, an increase of 21.7% as compared to 1998. Income received from the ISS amounted to 1.93 billion dollars in 1999 (46% of the total). At 2000 prices, the total amount of operational income was 4.54 billion pesos in 1999 (15.6% real increase). Taking the behavior of 4 EPS's as our reference point (Sanitas, Humana Vivir, Coomeva and Famisanar), it can be concluded that an EPS whose main business is health insurance needs a 17.2% gross margin to cover its operational and non-operational costs and a 1.1% margin before tax.

Accounting↗
PubMed1999

Health insurance coverage of the unemployed: COBRA and the potential effects of Kassebaum-Kennedy.

We use the April 1993 Current Population Survey to examine the health insurance coverage decisions of the unemployed and to simulate the potential effects of the new Kassebaum-Kennedy legislation. After controlling for demographic characteristics, COBRA eligibility raises the probability of health insurance coverage by 0.095, while eligibility for spouse employer insurance increases the likelihood of coverage by 0.318, and eligibility for both increases the likelihood of coverage by 0.341. In our simulations, we find that had Kassebaum-Kennedy been in effect in April 1993, 9.0 percent of the unemployed would be eligible to take up coverage, and the coverage rate of the unemployed would have been increased by 0.85 percent to 1.5 percent from 41.6 percent. Our estimates of the effect of Kassebaum-Kennedy on health insurance coverage are much lower than those reported by the Government Accounting Office prior to the passage of the legislation.

Eligibility Determination↗
PubMed2005

CHIP shots: association between the State Children's Health Insurance Programs and immunization rates.

OBJECTIVE: The Balanced Budget Act of 1997 established the State Children's Health Insurance Program (SCHIP), which makes health insurance available to children in near-poor families who are ineligible for Medicaid. SCHIP mandates that all state plans cover the cost and administration of childhood vaccines. Whether SCHIP has narrowed immunization coverage rates between near-poor and nonpoor children is unknown. The objective of this study was to use data from the National Immunization Survey from 1995 to 2002 to analyze changes in immunization coverage rates among poor, near-poor, and nonpoor children before and after implementation of SCHIP. METHODS: A prepost analysis was made of changes in immunization rates among poor, near-poor, and nonpoor children before and after implementation of SCHIP in all 50 states and 28 Immunization Action Plan areas from 1995 to 2002. All children in the National Immunization Survey for whom information on vaccinations was available from the respondents' shot cards and/or from the children's immunization providers (N = 264214) were studied. Up-to-date status for the 4:3:1 (4 doses of diphtheria-tetanus toxoids-pertussis vaccine/3 doses of poliovirus vaccine/1 dose of measles-mumps-rubella vaccine) and the 4:3:1:3:3 (4 doses of diphtheria-tetanus toxoids-pertussis vaccine/3 doses of poliovirus vaccine/1 dose of measles-mumps-rubella vaccine/3 doses of Haemophilus influenzae type B vaccine/3 doses of hepatitis B vaccine) series as well at the hepatitis B and varicella vaccines was measured. RESULTS: The probability that a poor or near-poor child was up to date for the 4:3:1:3:3 vaccine series increased approximately 11 percentage points after implementation of SCHIP. However, we observed a similar increase for nonpoor children. The proportion of poor and near-poor children who were up to date for the varicella vaccine increased between 7 and 8 percentage points more than among nonpoor children after implementation of SCHIP. Relative increases among poor and near-poor children were greater in the 28 Immunization Action Plan areas, in states with high rates of uninsured children, and among Hispanics. CONCLUSION: SCHIP seems not to be associated with changes in the up-to-date status of poor and near-poor children for the 4:3:1 and the 4:3:1:3:3 vaccine series. Vaccine coverage rates increased broadly among all income groups between 1995 and 2002.

Chickenpox Vaccine↗