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PubMedDate not supplied

How and why the health insurance system will collapse.

The advocates of defined-contribution health plans extol the virtues of consumer-driven health care, consumer choice, and empowered consumers as solutions to the problems--particularly the rapidly growing costs--of employer-sponsored health benefits. This paper argues that the widespread use of defined-contribution plans, with more consumer choice and more knowledgeable consumers, will lead to the erosion of the social contract on which health insurance must be based, with healthier employees subsidizing the care of older and sicker ones, and a death spiral of adverse selection. If unchecked by government intervention, these trends will lead to the collapse of employer-sponsored health insurance.

Catastrophic Illness↗
PubMed1993

Impact of employment-based health insurance on home attendants.

This study examines 253 newly hired home attendants to measure the degree to which employment-based health insurance can affect health status and utilization of health care services among a working poor population that has little experience with health insurance and may face other significant barriers to care. Physician contacts increased after benefits were received; attendants who had no coverage during the prior year experienced the greatest average increase. More attendants also reported using emergency rooms. Neither hospitalizations nor health status were affected. These findings indicate that insurance benefits may substantially improve access to care for many working poor persons, regardless of other barriers they may face.

Female↗
PubMedDate not supplied

Impact of family health insurance and other environmental factors on universal hearing screen program effectiveness.

OBJECTIVE: The study objective was to evaluate the relationship among health insurance type, other demographic factors, and newborn hearing screen compliance and outcomes. STUDY DESIGN: The cohort consisted of 39,153 infants screened in Rhode Island between July 1, 1995 and June 30, 1998. Multivariate analyses were completed to evaluate relationships between health insurance type and completion of the in-hospital hearing screen and the rescreen, if indicated. RESULTS: Successful newborn screen rates ranged from 98.1% to 99.8%. Infants with traditional Medicaid insurance were more likely to not be screened (p<0.0001) and to not return for a rescreen (p<0.0001). Infants in families with managed care Medicaid had screen compliance similar to infants with commercial health insurance. Multivariate analyses revealed that Medicaid insurance, no insurance, neonatal intensive care unit status, and out-of-state address predicted no initial screen (p<0.001) and no rescreen (p<0.0001). CONCLUSION: In population-based health services, it is important that the effects of socioeconomic and demographic variables on outcomes be evaluated.

Female↗
PubMed2003

The association of race, socioeconomic status, and health insurance status with the prevalence of overweight among children and adolescents.

OBJECTIVES: We examined the effect of race, socioeconomic status, and health insurance status on the prevalence of overweight among children and adolescents. METHODS: We studied an observational cohort from the 1996 Medical Expenditure Panel Survey Household Component. RESULTS: In the younger group, both Black and Latino children had a greater likelihood of being overweight compared with White children. Among the adolescent group, Latinos and Asian/Pacific Islanders were more likely to be overweight. Among adolescents, lacking health insurance and having public insurance were both positively associated with the prevalence of overweight. A relationship between insurance status and overweight was not observed for younger children. CONCLUSIONS: There are substantial racial differences in the prevalence of overweight for children and adolescents. Health insurance status is associated with the prevalence of overweight among adolescents.

Adolescent↗
PubMed1995

A shifting picture of health insurance coverage.

Data from the Current Population Survey are used in this DataWatch to explore the changing composition of health insurance coverage of the U.S. nonelderly population. The authors analyze coverage trends across various subpopulations for 1988-1993. During this time significant declines in employer-sponsored coverage coincided with equally significant increases in Medicaid coverage. Thus, the increase in the proportion of nonelderly persons without health insurance appears relatively small. However, this analysis reveals that the relative stability of the uninsurance rate for the entire nonelderly population belies more significant changes in insurance coverage--and lack of coverage--among various groups. The authors also discuss the extent to which a growing level of public insurance "crowds out" (or substitutes for) private health insurance.

Adolescent↗
PubMedDate not supplied

The health insurance jigsaw. How to line up an arrangement that will keep you covered.

Health insurance options for people who are HIV-positive, while limited, have improved. Experts suggest strategies for HIV-positive people looking for coverage, including using unions, fraternal organizations, high-risk pools, VA insurance, "green card" marriages, and large employer groups and group plans offered by professional associations. Advice is also given for keeping health insurance, particularly for people changing jobs, going on disability, or for those who cannot afford to keep up with the benefits.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Private health insurance: the problem child faces adulthood.

Since its election to office in 1996, reform of Private Health Insurance (PHI) has been the most obvious health policy focus of the Howard Government. The reform process has focussed on price, product, promotion, legislation and regulation. It has resulted in one of the largest new Commonwealth health outlays in recent memory. Health insurance funds have emerged as active purchasers of care, not just passive reimbursers of costs. PHI fund reserves have moved from precarious liquidity to healthy surplus. Private hospitals are busier than ever before, but margins are slim. Anecdotally, public hospitals report little benefit to date. Waiting lists have not been reduced, and their budgets are unchanged as a result of the $2 Bn allocated under the 30% Rebate scheme. The paper begins by describing the origins of the PHI reform. Its objectives, policy initiatives, results to date and criticisms are analysed. Criticisms include the actual and opportunity costs. Specific concerns remain as to its effectiveness to date in reducing pressure on public hospitals, and perceived lack of equity for certain client groups. The most significant result is that much of the reform package is here to stay including the expensive and much criticised 30% rebate. Like Medicare before it, the PHI reforms have achieved bipartisan support. The paper concludes by describing future implications for Government, industry, consumers and the medical profession.

Australia↗
PubMed1981

[Data analysis in health insurance].

In the last fifty years four to six mathematical research endeavours of general significance only have been designed in the field of health insurance. It is inconsequent to discuss the changes needed in the insurance system without having at one's disposal minimal mathematically-statistically firm basic figures. The present work first generally defines the mathematical bases in the health insurance field. The purpose of the project, within the first large scale data analysis, is above all the development of concepts for the institutionalized, systematic and periodical exploitation of the data available to health insurance carriers and their testing with econometric models. At the same time, thanks to methods to regularly collect data in the various health care sectors, the dependence of cost factors on medical care supply, on the structure of the insured population and on the cost causes will be studied at periodic intervals. Cheap sampling concepts shall be developed and tested in order to obtain the data which are not gathered directly. In a few fields data collection through surveys will be organized in order to allow for comprehensive interdisciplinary interpretation of the data.

Health Services↗
PubMed2003

National health insurance or incremental reform: aim high, or at our feet?

Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost. Moreover, even these projections are suspect; reforms of the past quarter century have not stemmed the erosion of coverage. Despite incrementalists' claims of pragmatism, they have proven unable to shepherd meaningful reform through the political system. While national health insurance is often dismissed as ultra left by the policy community, it is dead center in public opinion. Polls have consistently shown that at least 40%, and perhaps 60%, of Americans favor such reform.

Community Participation↗
PubMed1999

Effects of health insurance and race on early detection of cancer.

BACKGROUND: The presence and type of health insurance may be an important determinant of cancer stage at diagnosis. To determine whether previously observed racial differences in stage of cancer at diagnosis may be explained partly by differences in insurance coverage, we studied all patients with incident cases of melanoma or colorectal, breast, or prostate cancer in Florida in 1994 for whom the stage at diagnosis and insurance status were known. METHODS: The effects of insurance and race on the odds of a late stage (regional or distant) diagnosis were examined by adjusting for an individual's age, sex, marital status, education, income, and comorbidity. All P values are two-sided. RESULTS: Data from 28 237 patients were analyzed. Persons who were uninsured were more likely diagnosed at a late stage (colorectal cancer odds ratio [OR] = 1.67, P =.004; melanoma OR = 2.59, P =.004; breast cancer OR = 1.43, P =.001; prostate cancer OR = 1.47, P =.02) than were persons with commercial indemnity insurance. Patients insured by Medicaid were more likely diagnosed at a late stage of breast cancer (OR = 1.87, P<.001) and melanoma (OR = 4.69, P<.001). Non-Hispanic African-American patients were more likely diagnosed with late stage breast and prostate cancers than were non-Hispanic whites. Hispanic patients were more likely to be diagnosed with late stage breast cancer but less likely to be diagnosed with late stage prostate cancer. CONCLUSIONS: Persons lacking health insurance and persons insured by Medicaid are more likely diagnosed with late stage cancer at diverse sites, and efforts to improve access to cancer-screening services are warranted for these groups. Racial differences in stage at diagnosis are not explained by insurance coverage or socioeconomic status.

Aged↗
PubMed2004

Risk segmentation and equity in the Chilean mandatory health insurance system.

For decades, the Chilean health system has included a requirement for dependent workers to spend a certain percentage of their wages on health insurance. Since 1981, workers have been able to choose between public insurance and several private insurance providers. The reforms introduced more choice, moving away from reliance on an exclusive public provider. By 1999, about half of the country's active dependent workers had opted out of the public and into the private insurance system. The development of the private insurance system has been accompanied by controversy, however, regarding possible inequities in the utilization of medical services, the degree of risk segmentation, inefficiencies in the system's operation, and other factors. This paper discusses the issues of risk segmentation and equity. It starts by reviewing the system's design on a theoretical level, then deriving hypothesis and finally providing empirical evidence regarding these hypothesis. Particular attention is given to the issues of how individuals choose between the public and private system (to determine the reasons behind risk segmentation) and the differences in utilization among the various income groups (to clarify the issue of possible inequities).

Actuarial Analysis↗
PubMed2001

The effect of variable health insurance deductibles on the demand for physician visits.

In order to contain cost in the health care sector, the introduction of consumer incentives in health insurance has been suggested and realized in many countries. The Swiss health system reform of 1996 introduced a choice of deductible for health services in the mandatory basic health insurance. This paper estimates the effect of this choice on physician service utilization. A generalized method of moments (GMM) estimator is applied to take account of the endogeneity of the choice of the deductible in the estimation of the number of physician visits. This paper finds that most of the observed reduction in the number of physician visits among individuals who choose a higher deductible seems to be a result of self-selection of individuals into the respective insurance contracts, and not to induced changes in utilization behaviour.

Adolescent↗
PubMed1978

Private health insurance plans in 1976: an evaluation.

Private health insures collected a record $39.4 billion in premiums and returned $35 billion in benefits to their subscribers in 1976--a reflection of the steadily rising cost of health care, higher utilization, and the demand for expanded services. The industry experienced a net underwriting loss of $611 million, mainly because claims and operating expenses under insurance-company group business ran 3 percent above premium income. About 77 percent of the civilian population had some form of private hospital insurance, and about the same percentage had some form of surgical insurance. Lesser proportions were covered for other types of care. An estimated 12--13 percent of the population under age 65 had no economic protection against the costs of illness or health-related care--under either a private insurance plan or public program. Although virtually all of the aged were covered by Medicare, some 13--15 million bought private insurance, most of it under plans that covered some or all of the gaps in the Federal program.

Age Factors↗
PubMed2005

The effect of health insurance on medical care utilization and implications for insurance expansion: a review of the literature.

Both the costs and benefits associated with extending health insurance coverage depend on the extent and exact ways in which health insurance affects the utilization of medical care. We review the literature relating to such effects with the goal of informing researchers interested in simulating the impact of policy initiatives aimed at achieving universal coverage. Overall, this literature is quite consistent in finding significant effects of insurance on all types of utilization. Insurance coverage increases outpatient utilization by roughly 1 visit per year for children and between 1 and 2 visits for adults. For both children and adults, these visits are associated with an increased receipt of preventive care. Insurance coverage also increases inpatient utilization for children and adults; for children, there is some evidence that insurance coverage reduces ambulatory care sensitive hospital admissions.

Adolescent↗
PubMed1997

Individual market health insurance reform: portability from group to individual coverage; federal rules for access in the individual market; state alternative mechanism to federal rules; correction--HCFA. Interim final rule; correction.

This document corrects an interim rule and a previous correction to the interim rule published in the Federal Register of April 8, 1997 that implement the health insurance portability, availability, and renewability provisions of the Health Insurance Portability and Accountability Act of 1996 in the individual health insurance market.

Career Mobility↗
PubMed2002

The state Children's Health Insurance Program (CHIP).

PURPOSE: To provide an overview of the Children's Health Insurance Program (CHIP), along with implications for practice as it applies to nurse practitioners. DATA SOURCES: Extensive review of the on-line and published literature on CHIP. CONCLUSIONS: Congress established CHIP in an effort to reduce the high number of uninsured children in America. Each state administers its own program and children who are under age 19, 200% below federal poverty levels, and ineligible for Medicaid may qualify. Even though CHIP has made health care possible for over 3 million children, there are still many obstacles that need to be overcome to ensure that access to healthcare is a reality for America's children. IMPLICATIONS FOR PRACTICE: Although CHIP has made healthcare accessible for many low income children, there are still hundreds of children left without health insurance. Many children who could qualify for CHIP remain without access to healthcare. Nurse practitioners have the opportunity to make healthcare a reality for children by becoming knowledgeable about this plan in order to refer patients to the program who are eligible and by advocating for future legislation that will ensure its long term success.

Adolescent↗