Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Insurance Coverage”

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 1,297 records · Page 72Linked to original sources
PubMed2003

Nurse's role in promoting health transitions for adolescents and young adults with developmental disabilities.

This article examines the impact of cultural factors influencing the youth's transition process and includes recommendations for addressing these needs within the context of nursing practice. Youth-centered transition planning begins with a comprehensive, culturally competent assessment of adolescent and family needs in order to foster youth autonomy and family support during this important stage of development. Nurses who work with youth with developmental disabilities are faced with many questions from youth and families regarding the how, what, when, and where of transition planning, such as "Where do I find an adult health care provider who has the clinical expertise and sensitivity to my disability concerns?" and "Where can I get health insurance coverage when I "age out" of the health insurance program I am currently enrolled in?" The questions youth and families have not only reflect their needs for services and supports, but also represent the cultural context of their experiences. Who is this youth who is fast growing up, soon to become an adult? What has been this young person's experiences as a boy or a girl, a person with a developmental disability, a member of his or her family, and a member of the community? Each youth's experiences have an enormous impact shaping his or her progression through adolescence, and the impact continues with adult development. Nurses can serve as pivotal members of the team assisting these youths with developmental disabilities and their families in confronting the challenges and excitement of successfully transitioning to adulthood.

Adolescent↗
PubMed2002

Contribution of ED admissions to inpatient hospital revenue.

Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P <.001). Mean charges for individual discharged patients were $344.10 whereas for individual admitted patients mean charges were $14,692.28. (P <.001) Medicaid and self pay represented 55.4% of the insurance coverage for discharged ED patients whereas these same insurance classes accounted for only 16.3% of admitted patients. (P <.001) Medicare visits accounted for 12.7% of discharged ED patients but 60.7% of admitted patients (P <.001). Total hospital gross revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services.

Adult↗
PubMed1993

Segmentation in local hospital markets.

This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based on insurance coverage, particularly Medicaid, and race. Segmentation based on insurance and race is related to hospital characteristics, but not the characteristics of the hospital's community. Medicaid patients are more likely to go to hospitals with lower costs and fewer service offerings. Privately insured patients go to hospitals offering more services, although cost concerns are increasing. Hispanic patients also go to low-cost hospitals, ceteris paribus. Results indicate little evidence of segmentation based on medical condition in either 1983 or 1989, suggesting that "centers of excellence" have yet to play an important role in patient choice of hospital. The authors found that distance matters, and that patients prefer nearby hospitals, moreso for some medical conditions than others, in ways consistent with economic theories of consumer choice.

California↗
PubMed1990

Patterns of outpatient mental health care over time: some implications for estimates of demand and for benefit design.

The article examines patterns of starting and continuing outpatient mental health care as a function of time, and the implications of these patterns for estimates of the response of demand to generosity of fee-for-service insurance coverage. The data are from the RAND Health Insurance Experiment (HIE), which acquired a random sample of the nonelderly general population in six U.S. sites. People rarely had more than one episode of use of outpatient mental health services in a year. Persons who used in the prior year had high rates of continuing in treatment, while those without prior use entered treatment at a low, steady rate. Similar patterns of use by former users and nonusers were observed across insurance plans that varied widely in generosity, but the absolute probabilities of use were significantly lower in less generous plans. The probability of use of mental health services expanded significantly over time in the HIE; thus, estimates of demand in a steady state would be higher than those based on the HIE study years.

Community Mental Health Services↗
PubMed2001

Universal coverage in the United States: lessons from experience of the 20th century.

Both the rising numbers of uninsured Americans and the recent presidential election have put the issue of universal health insurance coverage back on the national agenda. Lack of health insurance is a major barrier to care for 44 million Americans, and lack of high-quality, comprehensive insurance is a barrier to millions more. Universal coverage is one of the best ways to ensure that all Americans have equitable access to quality care, and it also contributes to the financial stability of health care providers, especially those in the urban safety net. A wide variety of ideas to expand health care coverage were proposed, and in some cases enacted, during the last century. At the beginning of the 21st century, the American health care system is made up of varied elements, ranging from employer-sponsored health insurance for the majority of working-age adults to the public Medicare program for the elderly. While this patchwork system leaves many Americans without health insurance, it also creates many different ways to expand coverage, including various options in both the private and public sectors. By understanding how the current health care system developed, how the various proposals for universal health coverage gained and lost political and public support, and the pros and cons of the various alternatives available to expand coverage, we create a solid base from which to solve the problem of the uninsured in the 21st century.

Health Benefit Plans, Employee↗
PubMed1994

Insurance-related differences in the risk of ruptured appendix.

BACKGROUND: We studied differences in the incidence of appendiceal perforation in patients with acute appendicitis according to their insurance coverage. METHODS: In a retrospective analysis of hospital-discharge data, we examined the likelihood of ruptured appendix among adults 18 to 64 years old who were hospitalized for acute appendicitis in California from 1984 to 1989. RESULTS: After controlling for age, sex, psychiatric diagnoses, substance abuse, diabetes, poverty, race or ethnic group, and hospital characteristics, we found that ruptured appendix was more likely among both Medicaid-covered and uninsured patients with appendicitis than among patients with private capitated coverage (odds ratios, 1.49 [95 percent confidence interval, 1.41 to 1.59] and 1.46 [95 percent confidence interval, 1.39 to 1.54], respectively). After adjustment for the above factors, the risk of appendiceal rupture associated with a lack of private insurance was elevated at both county and other hospitals, but admission to a county hospital was an independent risk factor. In all income groups, appendiceal rupture was more likely with fee-for-service than capitated private coverage (overall odds ratio, 1.20 [95 percent confidence interval, 1.15 to 1.25]). CONCLUSIONS: Among patients with appendicitis an increased risk of ruptured appendix may be due to insurance-related delays in obtaining medical care. Both organizational and financial features of Medicaid and various types or levels of private third-party coverage may be involved. The significant association between ruptured appendix and insurance coverage after adjustment for socio-economic differences suggests barriers to receiving medically necessary acute care that should be considered in current deliberations on health policy.

Adolescent↗
PubMed2002

State Children's Health Insurance Program.

Despite a number of efforts by states and the federal government over several years, millions of low-income children still lack health insurance coverage and, therefore, have limited access to healthcare services. To address these problems, Congress has created, and states are now implementing, the new State Children's Health Insurance Program (SCHIP). Policymakers and agency officials who design, operate, and sponsor health coverage programs such as SCHIP must determine what constitutes an effective program. Efforts to maximize the number of children with coverage are important. The challenge for each state and its communities is to effectively identify and enroll eligible low-income children. They must create outreach strategies to find and enroll children in Medicaid and SCHIP. However, a truly effective program must go beyond simply enrolling children in health coverage programs. They must also assure that newly enrolled children receive quality comprehensive health care.

Child↗
PubMed2003

Health reform in Brazil: lessons to consider.

US analysts and decisionmakers interested in comparative health policy typically turn to European perspectives, but Brazil-notwithstanding its far smaller gross domestic product and lower per capita health expenditures and technological investments-offers an example with surprising relevance to the US health policy context. Not only is Brazil comparable to the United States in size, racial/ethnic and geographic diversity, federal system of government, and problems of social inequality. Within the health system the incremental nature of reforms, the large role of the private sector, the multitiered patchwork of coverage, and the historically large population excluded from health insurance coverage resonate with health policy challenges and developments in the United States.

Brazil↗
PubMed2003

Which children are still uninsured and why.

A strong economy and increased enrollment in employer-sponsored health insurance coverage, together with expansions in Medicaid and State Children's Health Insurance Program (SCHIP) led to reductions in uninsurance among low-income American children between 1998 and 2000 (from 15.6% to 13.3%). Nonetheless, 12% (about 9 million) of children remained uninsured. Identifying these children and understanding the factors that contribute to their continued lack of health coverage is key to providing them access to health care. Using 1994, 1998, and 2000 census data, this article analyzes recent trends in children's health coverage, as well as the groups that make up the population of uninsured children. The picture that emerges from these analyses is one of tremendous variation in coverage for different groups of children, with some groups having a higher risk for lacking health insurance. For example, poor children, Hispanics, adolescents, and children with foreign-born parents (particularly those whose parents are not U.S. citizens) are overrepresented among the uninsured. The authors conclude that the strong economy and concomitant increase in employer-based coverage played a bigger part in reducing uninsurance rates than did expansions in public programs. They also argue that lack of participation by eligible children rather than inadequate eligibility levels is the key policy issue, and conclude with several recommendations to increase program participation.

Child↗
PubMedDate not supplied

Are you insured against Medicare false claim audits?

The government's intensified efforts to identify fraud in Medicare have made it mandatory for practices to protect themselves from the results of billing audits. This article describes what practices should be considering for protective insurance coverage. It includes what is covered and not covered by standard insurance policies, describes specialized "errors and omissions" policies, and summarizes the issues to consider in shopping for and securing specialized coverage for Medicare and Medicaid audits.

Financial Audit↗
PubMed1996

Options for purchasing provider excess insurance.

Provider organizations accepting capitated payments often purchase provider excess insurance to protect themselves from catastrophic loss. These organizations have the option of purchasing such insurance coverage from the HMOs with which they contract or from commercial insurance companies. To determine which purchase strategy will be cost-effective, provider organizations must carefully analyze their risk, determine how much coverage they need, and exercise due diligence.

Capitation Fee↗
PubMed2004

Parents' beliefs and practices regarding childhood fever: a study of a multiethnic and socioeconomically diverse sample of parents.

OBJECTIVE: To examine childhood fever beliefs and practices in a multiethnic, multiracial, and socioeconomically diverse sample. DESIGN: Cross-sectional survey. PARTICIPANTS: Parents of children attending a hospital clinic, neighborhood health center, and a private practice. RESULTS: Two hundred seventy-four parents were interviewed; 45% were Latino; 15%, African-American; 25%, white; and 14%, other (excluded from further analysis, leaving a final sample size of 235). Latinos (11%) and African-Americans (7%) were more likely than whites (0%) to have no thermometers (P < 0.006). Only 42% of parents knew the correct temperature for fever. Greater proportions of Latinos (55%) and African-Americans (44%) take their child to the emergency department for fever than whites (21%; P < 0.001 and P = 0.02, respectively). Multivariate analyses revealed that parents who had not graduated from high school had 5 times the odds of not using a thermometer to check for fever and triple the odds of not asking a health care provider for fever advice, and parents of uninsured children were 5 times less likely to bring their febrile child to the emergency department. Low-income parents significantly more often used the emergency department and remedies other than antipyretics for their febrile children. Latino parents were more likely to believe that certain Latino folk illnesses cause fever, and African-American parents had triple the odds of not knowing the correct temperature for fever. CONCLUSIONS: Parents' beliefs and practices regarding childhood fever vary by race, ethnicity, sociodemographics, and the child's insurance coverage. Educating parents about fever, improving access to health insurance and primary care, and ensuring that families have thermometers may enhance appropriate use of health services and improve outcomes for febrile children.

Adolescent↗
PubMed2002

Employer-sponsored insurance: how much financial protection does it provide?

The authors examine the generosity of private employer health insurance coverage using data from two large national surveys of employers. Generosity is measured as the expected out-of-pocket share of medical expenditures for a standard population, given the provisions of the coverage. On average, those covered by employer-sponsored insurance can expect to pay 25 percent of expenditures out of pocket. There is little variability across plans in this share, though plans offered by smaller employers are somewhat less generous than those offered by larger employers. Individuals who incur high costs pay a smaller share of the bill than do those with lower levels of spending. The generosity of employer-sponsored plans increased slightly in the 1990s.

Adult↗
PubMed2006

Enrolling vulnerable, uninsured but eligible children in public health insurance: association with health status and primary care access.

OBJECTIVES: Given that more than two thirds of uninsured children in California are eligible for public health insurance coverage, this study examined differences in primary care access and health status between uninsured but eligible (UBE) children and those who were insured. METHODS: Using data on 19485 children from the 2001 California Health Interview Survey, this study examined differences in primary care access and health status for UBE children versus those who were enrolled in public coverage. Results are stratified by profiles of other risk factors (RF) for poor access: nonwhite, low income, low parent education, and non-English speaking. RESULTS: UBE children were less likely than publicly enrolled children to have a physician visit in the past year, dental visit in the past year, and a regular source of care. On the basis of differences between the UBE children and enrollees in the prevalence of each dependent measure, UBE children with multiple RFs experienced greater disparities than UBE children with fewer RFs. For example, enrollees were more likely than UBE children to have a regular source of care among children with 2, 3, or 4 RFs (differences of 26, 26, and 25 percentage points, respectively) compared with 1 RF (19 percentage points) and 0 RFs (12 percentage points). A similar pattern was found for dental visits but not physician visits. Although there was no difference in health status between UBE children and enrollees overall, enrollees were more likely than UBE children to have excellent/very good health status among children with 2 RFs (difference of 9 percentage points), 3 RFs (12 percentage points), and 4 RFs (11 percentage points). CONCLUSIONS: This study demonstrates that UBE children in California have poorer access to care compared with enrollees, and those with the highest levels of risk have poorer health status. This suggests that providing insurance to these children (and particularly those with multiple RFs) may lead to improved access and health for these vulnerable children.

Adolescent↗
PubMed2003

Private health insurance for adolescents: is it adequate?

PURPOSE: To examine the nature and extent of private insurance coverage available for health services needed by six hypothetical adolescents with physical and mental health conditions. METHODS: Health insurance information was obtained from the most commonly sold product of the largest health maintenance organization (HMO) and preferred provider organization (PPO) in each state and the District of Columbia. Contract documents were collected in 1999 and were in effect at the end of 1998. Our response rate was 97% and included 49 HMOs and 49 PPOs. The extent of coverage was analyzed according to benefit availability, structure, limits, and protections, as well as condition and treatment restrictions. RESULTS: The two hypothetical adolescents with asthma and depression had coverage for their recommended health services in most of the 98 plans. However, the four hypothetical adolescents whose conditions included pregnancy and sexually transmitted disease, anorexia nervosa, injury, and substance abuse and bipolar disorder would rarely have access to coverage for all of their recommended services. Ancillary and behavioral health therapies were least likely to be available in the amounts considered necessary by medical experts. All of the hypothetical adolescents would be more likely to obtain coverage for certain services in HMO than in PPO plans. CONCLUSIONS: Despite the obvious value of the private health insurance system, insurance benefits are not always matched to the needs of the adolescent. Employers and policymakers may want to consider financial or other incentives to create more uniformity in employer-based coverage, particularly for preventive care, prescription drugs, and reproductive services; greater availability of mental health and substance abuse benefits; and new mechanisms to support access to confidential care.

Accidents, Traffic↗
PubMed2005

Are employees informed about their health care coverage? Evidence from the buyers health care action group.

More than half of all Americans receive health insurance coverage through an employer. The rising costs and escalating complexity of health insurance has led many employers to embark on extensive employee education campaigns. In 2002, 1,365 randomly selected employees from 16 Buyers Health Care Action Group firms in the Minneapolis region were surveyed to evaluate their awareness of employer-provided health plan quality information and the extent to which this information influences their enrollment decisions. The study found mixed evidence with respect to the value of employer communication. On one hand, employer communication does not significantly increase the probability that an employee responded correctly to the pharmacy benefit question posed in the survey. However, employer communication has a large effect on the awareness of quality information. How well those campaigns work, and by extension how well employees are informed about the health benefits decisions they make, is a key issue in health care today.

Adolescent↗
PubMed1994

Legal liability of physicians in medical research.

The intent of this paper is to provide an overview, in layperson's language, of the concepts in law which may be applicable to a physician who undertakes research. The paper is divided into 2 parts. Part I deals with liability issues and standards of care. It is meant to enable the physician/researcher to recognize a potential liability situation. Part II examines insurance and related issues such as the role of the Canadian Medical Protective Association (CMPA). The paper begins with a review of 2 potential categories of liability: criminal and civil tort. Next, legal issues surrounding the consent process, which form the majority of negligence claims, are dealt with. The research process is then discussed with emphasis on the Medical Research Council of Canada Guidelines on Human Experimentation. Part II covers how research projects are funded and identifies the parties from whom insurance coverage may be sought. Information is provided from the various sources offering insurance and quasi-insurance protection with special attention on the CMPA. Each source details the circumstances necessary for its particular coverage to be triggered. Other issues addressed include those arising when research is conducted outside Canada and multiple coverage.

Behavioral Research↗