Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Health Insurance”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,225 records · Page 68Linked to original sources
PubMed1999

Response to health insurance by previously uninsured rural children.

OBJECTIVE: To examine the healthcare utilization and costs of previously uninsured rural children. DATA SOURCES/STUDY SETTING: Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. STUDY DESIGN: The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. PRINCIPAL FINDINGS: The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. CONCLUSIONS: An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.

Arkansas↗
PubMedDate not supplied

An examination of the decline in employment-based health insurance between 1988 and 1993.

This paper identifies factors associated with the decline in employment-based health insurance between 1988 and 1993. The contribution of these factors in explaining the decrease in employment-based health coverage over the period is explored using regression-based decomposition analysis. Our results indicate that decreased percentages of employers sponsoring health insurance plans, reductions in real wages, a trend toward using part-time workers, a decline in unionization, and the movement of workers across industry sectors account for 24% to 51% of the decline in employment-based health insurance coverage between 1988 and 1993.

Adolescent↗
PubMed1999

Trends in health insurance coverage, 1989-1997.

The authors analyze trends in health insurance coverage in the United States from 1989 through 1997, using cross-sectional surveys by the U.S. Census Bureau (Current Population Survey) of 160,000 persons representative of the non-institutionalized population. Between 1989 and 1997, the number of people without health insurance increased by 10.1 million to 43.4 million. From 1989 to 1993, the proportion covered by Medicaid increased by 3.6 percentage points while the proportion covered by private insurance declined by 4.2 percentage points. Since then, private coverage rates have stabilized and Medicaid coverage has decreased. Consequently, the number and percent uninsured continues to rise. Young adults age 18-39 had the largest increase in the proportion uninsured, and rates among children have also risen steeply since 1992. While blacks had the largest increase in the percent uninsured, Hispanics accounted for 35.6 percent of the increase in the number uninsured. Low-income families constituted over half of the increase in the number uninsured, but since 1993 the middle income group had the largest increase in the percent uninsured. Northeastern states had the largest increase in the percent uninsured. Thus, despite economic prosperity, the numbers and rates of the uninsured continue to rise. Principally affected are children and young adults, poor and middle-income families, blacks, and Hispanics.

Adolescent↗
PubMed2002

Effect of the North Carolina State Children's Health Insurance Program on Beneficiary Access to Care.

BACKGROUND: In the fall of 1998, North Carolina implemented its State Children Health Insurance Program, North Carolina Health Choice for Children (NCHC). This stand-alone, fee-for-service program quickly enrolled large numbers of children and has been considered one of the State Children Health Insurance Program success stories. OBJECTIVE: To explore the perceptions of parents of children enrolled in NCHC regarding their children's access to health care services before and after enrollment in the NCHC. DESIGN AND SETTING: Qualitative and quantitative data analyses are combined to assess program effectiveness. Two waves of surveys were fielded. A baseline survey asked parents of children newly enrolled in NCHC questions about their child's health experiences before enrollment in NCHC. Parents who responded with baseline data were resurveyed 1 year later to collect information on their child's experiences while insured by NCHC. PARTICIPANTS: Parents of 987 children newly enrolled in NCHC in the summer of 2000, randomly chosen within 3 age group strata. RESULTS: The NCHC has been successful in improving access to health care for low-income children. Parents reported that the program helped make health services financially accessible to their children, enabling them to get needed physician's care, eyeglasses, or prescription drugs. A significantly higher percentage of children received care in the private sector, increasing from 62% to 75% for well-child care visits and 67% to 78% for acute care. The percentage of children with unmet medical needs dropped significantly from 20% to just 2% after enrollment in NCHC. The improvement in access to care is much more striking for the older age groups and for children who were uninsured prior to NCHC enrollment (rather than those who graduated from Medicaid into the program). Despite these gains, there are still substantial numbers of children who are not receiving age-appropriate well-child care. CONCLUSION: The NCHC has successfully improved access to care for its enrollees.

Adolescent↗
PubMed1978

Consumer-choice health plan (first of two parts). Inflation and inequity in health care today: alternatives for cost control and an analysis of proposals for national health insurance.

The financing system for medical costs in this country suffers from severe inflation and inequity. The tax-supported system of fee for service for doctors, third-party intermediaries and cost reimbursement for hospitals produces inflation by rewarding cost-increasing behavior and failing to provide incentives for economy. The system is inequitable because the government pays more on behalf of those who choose more costly systems of care, because tax benefits subsidize the health insurance of the well-to-do, while not helping many low-income people, and because employment health insurance does not guarantee continuity of coverage and is regressive in its financing. Analysis of previous proposals for national health insurance shows none to be capable of solving most of these problems. Direct economic regulation by government will not improve the situation. Cost controls through incentives and regulated competition in the private sector are most likely to be effective.

Costs and Cost Analysis↗
PubMed1991

Associations of self-reported dental health and general health measures in the Rand Health Insurance Experiment.

Data from the Rand Health Insurance Experiment (HIE) are used in exploratory analyses to examine the associations of self-reported dental health with general health measures. Responses of 1658 dentulous participants 18-61 yr of age are examined. Patterns of association among and between items of the physical, mental, social, and general health indices and a three-item measure of self-reported dental health are tested using principal component analyses. Findings suggest that dental health represents a separate dimension of health that is not fully accounted for by other health measures. However, while dental health may be considered an independent health construct, the dental health index was weakly but statistically significantly associated with the general health perceptions index and, to a lesser extent, to the mental health index and the two physical health indices. Improved self-reported measures of dental health status, studied in association with other general health measures, will allow us to better define oral health, and patients' perceptions of oral health, particularly in relation to other general health perceptions. In addition, a valid and reliable multidimensional oral health measure would be valuable as a potential cost-effective method of epidemiologic data collection, as well as a tool for evaluating the effectiveness of oral health interventions, and for providing data for dental health policy making and planning.

Adolescent↗
PubMed2006

Improved asthma care after enrollment in the State Children's Health Insurance Program in New York.

BACKGROUND: Uninsured children with asthma are known to face barriers to asthma care, but little is known about the impact of health insurance on asthma care. OBJECTIVES: We sought to assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with asthma. DESIGN: Parents of a stratified random sample of new enrollees in New York's SCHIP were interviewed by telephone shortly after enrollment (baseline, n = 2644 [74% of eligible children]) and 1 year later (follow-up, n = 2310 [87%]). Asthma was defined by parent report using questions based on National Heart, Lung, and Blood Institute criteria. A comparison group (n = 401) who enrolled in SCHIP 1 year later was interviewed as a test for secular trends. MAIN OUTCOME MEASURES: Access (having a usual source of care [USC], unmet health needs, problems receiving acute asthma care), asthma-related medical visits, quality (continuity of care at the USC, problems receiving chronic asthma care, use of antiinflammatory medications), and asthma outcomes (change in asthma care or severity) were the main outcome measures used. Bivariate and multivariate analyses compared measures at baseline (year before SCHIP) versus follow-up (year during SCHIP). RESULTS: Three-hundred eighty-three children (14%) had asthma at baseline, and 364 had asthma at follow-up (16%). No secular trends were detected between the baseline study group and the comparison group. After enrollment in SCHIP, improvements were noted in access: lacking a USC (decrease from 5% to 1%), unmet health needs (48% to 21%), and problems getting to the USC for asthma (13 to 4%). Children had fewer asthma-related attacks and medical visits after SCHIP (mean number of attacks: 9.5 to 3.8: mean number of asthma visits: 3.0 to 1.5; hospitalizations: 11% to 3%). Quality of asthma care improved for general measures (most/all visits to USC: 53% to 94%; mean rating of provider: 7.9 to 8.8 of 10) and asthma-specific measures (problems getting to the USC for asthma care when child was well: 13% to 1%). More than two thirds of the parents at follow-up reported that both quality of asthma care and asthma severity were "better or much better" than at baseline, generally because of insurance coverage or lower costs of medications and medical care. CONCLUSIONS: Enrollment in New York's SCHIP was associated with improvements in access to asthma care, quality of asthma care, and asthma-specific outcomes. These findings suggest that health insurance improves the health of children with asthma.

Adolescent↗
PubMed2001

A national study of medical care expenditures for musculoskeletal conditions: the impact of health insurance and managed care.

OBJECTIVE: To provide estimates of all medical care expenditures on behalf of persons with musculoskeletal conditions in the United States in 1996, to estimate the increment in expenditures attributable to the musculoskeletal conditions among such persons, and to ascertain the impact of the presence or absence of health insurance and/or managed care on such expenditures. METHODS: The estimates were derived from the Medical Expenditure Panel Survey (MEPS), a national probability sample of 9,488 households, which includes responses from 21,571 persons. In the MEPS, respondents are surveyed every 6 months to report on medical care utilization and health care expenditures. Of the 21,571 persons surveyed, 4,161 reported having 1 or more musculoskeletal conditions. After weighting the data, these 4,161 individuals were inferred to represent 53.935 million persons in the nation as a whole. We tabulated all medical care expenditures of these individuals, stratified by comorbidity status, and then compared their expenditures with those among persons with chronic conditions other than musculoskeletal disease or with no chronic conditions. We then used regression techniques to estimate the increment of health care expenditures attributable to the musculoskeletal conditions. Finally, we used regression to estimate the impact of health insurance status and managed care status on the health care expenditures of the persons with musculoskeletal conditions. RESULTS: Per capita medical care expenditures in 1996 averaged $3,578 among persons with musculoskeletal conditions, for a national total of $193 billion, the equivalent of 2.5% of the Gross Domestic Product in that year. The largest components were hospital admissions (37%), physician visits (23%), and prescriptions (16%). Estimates of the per capita increment in total medical care expenditures attributable to musculoskeletal conditions ranged from a high of $723 when controlling for the other medical conditions present, to $364 when controlling for these variables and demographics. Persons with musculoskeletal conditions ages 16-64 who lacked health insurance reported total expenditures of $793, versus $3,249 among those with insurance (P < 0.0001). Among such persons with insurance, expenditures did not differ significantly between those in fee-for-service plans and those in managed care health plans. CONCLUSION: Persons with musculoskeletal conditions and health insurance experienced high total expenditures for medical care and high expenditures attributable to the musculoskeletal conditions. Insurance coverage under a managed care plan had no effect on the magnitude of these total expenditures, but lack of insurance coverage did have a significant effect among persons with musculoskeletal conditions.

Adolescent↗
PubMed2000

["Deficiencies in the mandatory health insurance system"--possibilities and limits of medical expert assessment].

In Germany, the Federal Committee of Physicians and Health Insurance Agencies is responsible for assessing which medical procedures are covered by the insurance agencies (therapeutic/economic value). The failure to evaluate certain medical procedures which promise therapeutic benefit may be considered a failure in the system of statutory health insurance as decreed by the German Federal Social Court. In cases of system failure the assessment of medical procedures is taken over by social courts. Evidence of therapeutic value will continue to be the decisive criterion of evaluation. In special cases, however, it may be replaced by the particular procedure's rate of incidence in everyday medical practice, as reflected by a widespread resonance in medical discussion and its use by a considerable number of physicians. Medical experts may face various difficulties in handling these alternative criteria. They usually lack reliable data on the frequency of the procedure, i.e. its distribution. Even if such data and data on secondary factors--such as disease incidence etc.--were available to them, they would still not be able to come up with a definite conclusion on the degree (widespread, considerable) of dissemination, as defined by the German Federal Social Court. Nevertheless, on request of statutory health insurances, social medical experts may investigate facts in order to establish basic knowledge for later decisions that are to be done by others. Factual investigation includes clarification of etiology, incidence, importance and natural history of the particular disease processes. Potential deficiencies in the medical services rendered for specific diseases as well as the characteristics of the procedure under scrutiny, and special requirements for evaluating the outcome have to be investigated as well. Additional attention needs to be paid to the quality of related publications (analysis of statistical data), possible recommendations for therapy (e.g. guidelines and their scientific basis), as well as to economic aspects. The result of such an investigation has to be stated without use of court criteria (widespread/considerable).

Evidence-Based Medicine↗
PubMed2006

Lower rates of emergency department injury visits among Latino children in the USA: no association with health insurance.

BACKGROUND AND OBJECTIVE: Latino children have lower rates of injury visits to emergency departments (EDs) than non-Latino white and African American children. This study tests the hypothesis that this difference reflects health insurance status. DESIGN: Secondary analysis. Patients/ SETTING: Children under 19 years of age visiting EDs in the USA, sampled in the National Hospital Ambulatory Medical Care Survey of EDs (NHAMCS-ED) from 1997 to 2001. MAIN OUTCOME MEASURES: Rates of ED injury visits; ED injury visit rates by race/ethnicity stratified by health insurance and adjusted for other covariates; subtypes of injury visits; and procedures and hospital admissions by race/ethnicity. RESULTS: Injuries accounted for >56 million, or 40.5%, of total ED visits among pediatric patients. Injury visits occurred at lower rates for Latino children (9.9 per 100 person years) than non-Latino white and African American children (16.2 and 18.3, respectively), although total ED visit rates were similar. Regardless of health insurance status, Latino children had lower rates of injury visits than non-Latino white and African American children. Latino children had lower rates of the three major subtypes of injury visits (sports, accidental falls, struck by/between objects). Latino children had similar rates of procedures and hospital admissions to non-Latino white children. CONCLUSIONS: Irrespective of their insurance status, Latino children have lower rates of ED injury visits in the USA than non-Latino white children. Possible reasons for this difference include different healthcare seeking behavior or different injury patterns by race/ethnicity, but not differences in health insurance status or barriers to accessing ED care.

Adolescent↗
PubMed1993

[The medical service of compulsory health insurance--quo vadis? The law, responsibility and interests of those involved].

In contrast to all predictions and expectations the Medical Advisor of Health Insurance (MDK) still has to cope with an enormous quantity of medical examinations and reports. As long as the capacities of the MDK are completely absorbed by this task it cannot fulfill its legal commission as a medical consultant of the health insurance in an economical and highly qualified way. The present economical crisis of the health insurance can also be regarded as a challenge to overcome this situation.

Cost Control↗
PubMed2000

Vulnerable populations and health insurance.

This study provided a national profile of health insurance of certain vulnerable populations including children, racial/ethnic minorities, low-income families, non-metropolitan statistical area (MSA) residents, and those with poor health status. The study shows an increase in the proportion of uninsured nonelderly population. While public insurance helped reduce the employment- and health-related disparities in private coverage, it has not overcome other disparities related to vulnerable characteristics including race/ethnicity, wages, education, and area of residence. Comparison between health maintenance organization (HMO) and fee-for-service insurance indicates that younger although not much healthier people, racial/ethnic minorities, MSA residents, and those residing in the West and Northeast regions were more likely to have HMO coverage. To reduce significant disparities in health insurance coverage, policy makers will have to consider expanding public insurance coverage, targeting vulnerable groups, particularly those with multiple vulnerable characteristics rather than merely the economically distressed. Expecting managed care to achieve cost containment for services provided to vulnerable populations may be unrealistic.

Adolescent↗
PubMed2003

A structural econometric model of family valuation and choice of employer-sponsored health insurance in the United States.

This paper estimates a fully structural unitary household model of employment and health insurance decisions for dual wage-earner families with children in the United States, using data from the 1987 National Medical Expenditure Survey. Families choose hours of work and the breakdown of compensation between cash wages and health insurance benefits for each wage earner in order to maximize expected utility under uncertain need for medical care. Heterogeneous demand for the employer-sponsored health insurance is thus generated directly from variations in health status and earning potential. The paper concludes by discussing the benefits of using structural models for simulating welfare effects of insurance reform relative to the costly assumptions that must be imposed for identification.

Adolescent↗
PubMed2000

Prevalence of employer self-insured health benefits: national and state variation.

Many large employers prefer to self-insure health plans offered to employees rather than purchase them from insurance companies to save costs and to avoid the burden of complying with varying state mandates. This concerns state governments because they cannot directly regulate self-insured plans. This article describes the prevalence of employer self-insurance for the nation and by state in 1993 and examines what factors, especially state policies, contribute to the national and state variation in the prevalence of self-insurance. Data from the National Employer Health Insurance Survey on 34,604 private sector establishments are analyzed. Variation in the prevalence of self-insurance was largely explained by the firm size of the establishments. After all other factors were examined, very little was added to predict the rate of self-insurance for each state. While state premium taxation and benefits mandates were not associated with self-insurance, small-group reforms were significantly and positively associated with the probability of self-insurance.

Data Collection↗
PubMed2000

Utilization under children's health insurance programs: children with vs. without chronic conditions.

States planning to expand health insurance for children need information on projected utilization. We examine these issues using data from children's health insurance programs in Pennsylvania. We estimate the average cost of a comprehensive benefit package for a continuously enrolled child during 1994-1995 was about $500 ($1,208 for a child with a chronic condition, and $454 for one without). There was wide variation by type of service. This underestimates the cost of new programs because some very sick children were excluded and because the average monthly cost of a continuously enrolled child is lower than that of a new enrollee.

Adolescent↗
PubMed1997

Incremental health insurance reform proposals to improve access.

This three-part series on health legislation describes the policy shift toward regulating the private healthcare system to ensure adequate consumer protection and access to health insurance. Still burning from the failed 1993-1994 healthcare reform effort, Congress and the White House are looking only for incremental policies necessary to reduce the federal deficit and protect the public while the private healthcare system continues to undergo major transformation. In previous articles, the author discussed Medicare, Medicaid, and other federal program revisions and consumer protection legislation aimed at unacceptable managed cure practices. This last article discusses incremental health insurance proposals aimed toward segments of the uninsured.

Child↗