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PubMed1980

Taxation and its effect upon public and private health insurance and medical demand.

Multiple tax subsidies are available to many buyers and sellers of health insurance. These subsidies have the potential of creating excess demand for health insurance, which in turn can create excess demand for health services. A review of the literature on the effects of the tax subsidies on the price of health care shows that these subsidies, by raising prices in the medical sector, constrain the Medicare and Medicaid programs' ability to provide access to care for their beneficiaries.

Health Benefit Plans, Employee↗
PubMedDate not supplied

The first private sector health insurance company in Ghana.

This article analyses the development of Ghana's first private sector health insurance company, the Nationwide Medical Insurance Company. Taking both policy and practical considerations into account (stakeholders' perspectives, economic viability, equity and efficiency), it is structured around key questions which help to define the position and roles of stakeholders--the insurance agency itself, contributors, beneficiaries, and providers--and how they relate to one another and the insurance scheme. These relationships will to a large extent determine Nationwide's long-term success or failure. By creating a unique alliance between physician providers and private sector companies, Nationwide has used employers' interest in cost containment and physicians' interest in expanding their client base as an entrée into the virgin territory of health insurance, and created a hybrid variety of private sector insurance with some of the attributes of a health maintenance organization or managed care. The case study is unusual in that, while public sector programs are often open to academic scrutiny, researchers have rarely had access to detailed data on the establishment of a single private sector insurance company in a developing country. Given that Ghana is planning to launch a national health insurance plan, the article concludes by considering what the experience of this private sector initiative might have to offer public sector planners.

Cost Control↗
PubMed1999

Children's health insurance coverage and family structure, 1977-1996.

Using data from a series of nationally representative medical expenditure surveys, the authors document changes in children's health insurance coverage in a period of two decades. Overall, it is found that the proportion of children with private coverage declined, while the proportions publicly insured and uninsured increased. However, when the authors account for differences in family structure, they find striking disparities in children's insurance experiences. Contrary to overall trends, children in single-parent households made significant gains in private health insurance coverage after 1997 and experienced reductions in public insurance. Coincident with Medicaid expansions in the late 1980s, children in two-parent households experienced significant increases in public health insurance. It is found that the rise in the proportion of children who were uninsured in this period was largely a single-parent family phenomenon, and that parents' marital status, employment status, and family income are crucial factors associated with children's insurance status.

Child↗
PubMedDate not supplied

[Expert assessment of unconventional treatment methods within the scope of legal health insurance--problems based on current court decisions].

Court decisions of the Federal Court for Problems of Social Welfare (Bundessozialgericht) make health insurance pay for unconventional methods under certain circumstances. Physicians of the Health Insurance Medical Service (MDK) have to examine whether these conditions are fulfilled in a special case. The specific problems they encounter there are being described in this paper. Hermeneutic differences can be noticed. To guarantee the quality of medical care, which is the duty of the statutory health insurances, seems to be difficult in the case of "unconventional" medical methods.

Complementary Therapies↗
PubMed1994

Forming the system of health insurance in the Russian Federation.

A radical reform is being prepared in the Russian Federation health care. Its major point is a transition from tax-financed national health system to social health insurance. The paper highlights the issues of forming the system of health insurance. First, the arguments for a transition to a new model of finance are discussed. Secondly, the concept of the new model and its implementation in the context of the regional experiment are addressed. A discussion of current and expected developments focuses on two major issues: monopsony or pluralistic model of third-party purchasing? What is important for forming the market of health care provision? The major argument is that a transition from a highly integrated to a contractual model may start with regional monopsony or some version of it. A pluralistic model of third-party purchasing needs a refined regulation and may not meet health policy objectives. It is also argued that on the first stage of reform implementation forming the market of health care provision is more dependent on its regulation and management than on the market structure of health care purchasing.

Economic Competition↗
PubMedDate not supplied

Health insurance for children: a new federal initiative and opportunity.

In 1997, Congress enacted the State Children's Health Insurance Program to extend health insurance coverage to low-income children who are ineligible for other insurance, including Medicaid. The program is reviewed and considered in terms of children's access to health care and their health status.

Adolescent↗
PubMed2006

[Tasks and function of the German Medical Review Board of the Statutory Health Insurance (MDK). Latest aspects in dermatology in view of social medicine].

The German Medical Review Board of the Statutory Health Insurance (MDK) is a sociomedical service for impartial medical opinion and consultation. Together with the statutory health insurance companies it takes part in shaping the public health care system. Many recent developments are changing the german health insurance system. This article illustrates the complex sociomedical framework of MDK's activities in relation to current issues in dermatology. The article focuses on: new diagnostic and therapeutic methods, drugs (off-label-use), out-patient and in-patient dermatological rehabilitation and hospital treatment.

Dermatology↗
PubMedDate not supplied

Management tools for Medicaid and State Children's Health Insurance Program (SCHIP).

Medicaid and the State Children's Health Insurance Program need analytic tools to manage their programs. Drawing upon extensive discussions with experts in states, this article describes the state of the art in tool use, making several observations: (1) Several states have linked Medicaid/State Children's Health Insurance Program administrative data to other data (eg, birth and death records) to measure access to care. (2) Several states use managed care encounter data to set payment rates. (3) The analysis of pharmacy claims data appears widespread. The article also describes "lessons learned" regarding building capacity and improving data to support the implementation of management tools.

Child Health Services↗
PubMed2005

Donated care programs: a stopgap measure or a long-run alternative to health insurance?

In the absence of broad federal health care reform, interest has grown in local solutions to the problem of providing health care to the uninsured. Community-based donated medical care models have emerged as one alternative. We examine the early experience of a donated care program in southern Maine called CarePartners. Although such programs are often viewed as a short-term solution for those temporarily without health insurance, we find that CarePartners served a different role for many individuals. While clearly a stopgap measure for some enrollees, CarePartners appears to be a longer-term means for getting access to care for most enrollees.

Adult↗
PubMed1980

Attitudes toward National Health Insurance: dentists, dental students, and dental hygiene students.

The attitudes toward National Health Insurance held by 126 second year dental students and 108 second year dental hygiene students enrolled in the state of Wisconsin, U.S.A., were measured and compared with the attitudes held by practicing dentists in the U.S.A. Although some similarities were noted, marked differences were revealed, with students, generally, preferring broader coverage and more government involvement than practicing dentists. There is virtually no published data in this area, and more research is needed, as the success or failure of any National Health Insurance plan depends critically on the attitudes of both health care providers and those studying to become health care providers.

Adult↗
PubMed2006

Diabetes--prevalence and cost of illness in Germany: a study evaluating data from the statutory health insurance in Germany.

OBJECTIVE: This population-based study assesses the prevalence and cost of illness as a result of diabetes mellitus in Germany by retrospectively analysing routine health insurance data. Prevalence and costs were analysed from statutory health insurance (GKV) and societal perspectives. RESEARCH DESIGN AND METHODS: The analysis comprises data of all insured persons of six large sickness funds. The insured with diabetes were identified via ICD-9 diagnosis and Anatomical Therapeutic Chemical Classification System (ATC) code for regular medication prescriptions. Costs for inpatient stay, medication and sickness benefits were taken from claims data. Costs for rehabilitation, premature death and early retirement were calculated using the human capital approach and data from national statistics. RESULTS: Overall diabetes prevalence in this age and sex standardized census of six large sickness funds was 6.45%. The cost of illness for sickness funds including hospital cost, medication and sickness benefits, and excluding ambulatory doctor care, were Euro 3.69bn . The total cost of diabetes from a societal perspective was calculated at Euro 5.71bn for the year 1999. CONCLUSION: In accordance with the results of recent studies using routinely collected health insurance data, our study suggests that the prevalence of diabetes mellitus has increased steadily in the past years. The prevalence in our population of 14.7 million insured was 6.45%. Total costs of diabetes mellitus amounted to Euro 5.71bn.

Adolescent↗
PubMed2005

Health insurance coverage in survivors of childhood cancer: the Childhood Cancer Survivor Study.

PURPOSE: To examine the prevalence and predictors of health insurance coverage and the difficulties obtaining coverage in a large cohort of childhood cancer survivors. PATIENTS AND METHODS: This study included 12,358 5-year survivors of childhood cancer and 3,553 sibling controls participating in the Childhood Cancer Survivor Study. Data were collected by surveys distributed in 1994 (baseline) and 2000 (follow-up). RESULTS: At baseline, 83.9% of adult survivors, compared with 88.3% of siblings, had health insurance coverage (P < .01); 6 years later, small but significant survivor-sibling differences remained (88% v 91%; P < .01). Twenty-nine percent of survivors reported having had difficulties obtaining coverage, compared with only 3% of siblings (P < .01). In multivariate analysis of survivors 18 years of age or older, factors associated with being uninsured included younger age at diagnosis (diagnosis age of 0 to 4 years; odds ratio [OR] = 1.7; 95% CI, 1.3 to 2.2), male sex (OR = 1.3; 95% CI, 1.2 to 1.5), age at baseline survey (age 22 to 24 years; OR = 1.6; 95% CI, 1.2 to 2.1), lower level of attained education (less than high school, OR = 2.6, 95% CI, 2.1 to 3.3; high school graduate, OR = 2.1, 95% CI, 1.8 to 2.5), income less than 20,000 dollars (OR = 5.6, 95% CI, 4.5 to 7.1), marital status (widowed/divorced/separated; OR = 1.3; 95% CI, 1.1 to 1.6), smoking status (current smoker, OR = 2.0, 95% CI, 1.7 to 2.3; former smoker, OR = 1.4, 95% CI, 1.2 to 1.8), and treatment that included cranial radiation (OR = 1.3, 95% CI, 1.0 to 1.6). CONCLUSION: Compared with siblings, adult survivors of childhood cancer had significantly lower rates of health insurance coverage and more difficulties obtaining coverage. Since lack of coverage likely has serious health and financial implications for this at-risk population, any disparity in availability and quality of coverage is of great concern.

Adolescent↗
PubMed1996

Regulating health insurance: the challenges of managed networks.

The role of the regulator in health insurance is examined in the context of the change in nature of regulatory oversight necessary to monitor the activities of the regulated parties. Health insurance to this point has been largely regulated by insurance departments that have historically focused on monitoring the solvency and meeting the contractually required reimbursements for indemnity carriers. Now as the indemnity carrier has either migrated to managed care or faced a declining book of business, the historic role of regulation must change to match the new environment. This article examines the role of the health insurance/managed care regulator department under this new paradigm and identifies where and how the regulator can exert influence in such a system.

Bankruptcy↗
PubMed2006

Consumer choice in Dutch health insurance after reform.

This article investigates the scope and effects of enhanced consumer choice in health insurance that is presented as a cornerstone of the new health insurance legislation in the Netherlands that will come into effect in 2006. The choice for choice marks the current libertarian trend in Dutch health care policymaking. One of our conclusions is that the scope of enhanced choice should not be overstated due to many legal and non-legal restrictions to it. The consumer choice advocates have great expectations of the impact of enhanced choice. A critical analysis of its impact demonstrates that these expectations may not become true and that enhanced consumer choice should not be perceived as the 'magic bullet' for many problems in health care.

Choice Behavior↗
PubMed1997

Notification procedures for states implementing "alternative mechanisms" in the individual health insurance market--HCFA. Notice.

This notice generally describes the statutory provisions under section 111 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that guarantee availability of individual health insurance coverage to certain individuals with prior group coverage. It also provides procedural guidance for States that intend to implement an alternative mechanism under section 111 of HIPAA. Finally, this notice describes the statutory provisions that will apply in a State that does not implement an acceptable alternative mechanism. This notice does not establish new policy or requirements.

Centers for Medicare and Medicaid Services, U.S.↗