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PubMed1992

Correlates of health insurance coverage: evidence from the Midwest.

The Midwest is often overlooked in national studies of health insurance status. We analyzed the economic and social characteristics of uninsured and underinsured individuals and households in a Midwestern state using both bivariate and multivariate techniques. As in much of the country, economic factors, particularly income and employment, were most significant in accounting for insurance coverage. Unexpectedly, rural and urban residents were equally likely to lack insurance. Results indicate that in rural areas, underinsurance may be a greater problem than uninsurance, and that income-based health insurance is more effective than employer-provided plans in reaching all Americans.

Adolescent↗
PubMed2002

One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low-income countries?

A number of low and middle income countries (LMICs) are considering social health insurance (SHI) for adoption into their social and economic environment or striving to sustain and improve already existing SHI schemes. SHI was first introduced in Germany in 1883. An analysis of the German system from its inception up to today may yield lessons relevant to other countries. Such an analysis, however, is largely lacking, especially with regard to LMICs. This paper attempts to fill this gap. For each of the following lessons, it considers if and under which conditions they may be of relevance to LMICs. First, small, informal, voluntary health insurance schemes may serve as learning models for fund administration and solidarity, but in order to achieve universal coverage government action is needed to formalise these schemes and to introduce a principle of compulsion. Once compulsory health insurance exists for some people, incremental expansion of coverage to other regions and social groups may be feasible to achieve universality. Second, in order to ensure sustainability of SHI, the mandated benefit package should be adapted incrementally in accordance with changing needs, values and economic circumstances. Third. in a pluralistic SHI system equity, as well as risk pooling and spreading, can be enhanced if funds merge. The optimal number of funds, however, will depend on the stage of development of the SHI system as well as on other objectives of the system, including choice and competition. A risk equalisation scheme may prevent the adverse effects of risk selection, if competition between insurance funds is introduced into the system. Fourth, as an alternative to both state and market regulation, self-governance may serve as a source of stability and sustainability as well as a means of decentralising and democratising a health care system. Finally, costs can be successfully contained in a fee-for-service system, if cost-escalating provider behaviour is constrained by either political pressure or technical means.

Developing Countries↗
PubMed2000

The impact of health insurance market reforms on market competition.

OBJECTIVES: To assess the impact of state and federal health insurance market reforms on the nature and extent of market competition. STUDY DESIGN: Qualitative, comparative case studies in 7 states. METHODS: Two rounds of in-depth interviews were conducted with over 100 key informants from the insurance industry. In each state, these sources included 2 to 4 regulators, 5 to 6 independent agents, and several sources at each of 4 to 5 of the top insurers. Extensive documentary data relating to market activity were also collected. These multiple sources of information and data were analyzed with both qualitative and quantitative techniques. RESULTS: (1) Small-group health insurance markets are highly competitive, both in price and in product innovation and diversity. (2) In some of the more heavily regulated states, there is very little competition in less-populated areas, especially for indemnity insurance. (3) The rapid growth of managed care in the small-group market may have been precipitated by these reforms. (4) Standardized benefit plans have not achieved their objectives. (5) Competitive forces still focus to a considerable extent on risk selection techniques. CONCLUSION: Small-group market reforms have not harmed market competition and may have improved competition in several respects. However, these reforms do not alter the fundamental orientation of competitive insurance markets, which is to focus on risk selection factors and techniques to the extent feasible.

Economic Competition↗
PubMed2004

Use of health care services and costs of psychiatric disorders among National Health Insurance enrollees in Taiwan.

The National Health Insurance (NHI) database in Taiwan was used to detect the use of health care services and the costs of psychiatric disorders among NHI enrollees. Data were analyzed for 126,146 enrollees. Four categories were used for enrollees: no psychiatric disorder, a minor psychiatric disorder, a major psychiatric disorder without catastrophic illness registration, and a major psychiatric disorder with catastrophic illness registration (which eliminates copayments). Compared with enrollees with a minor psychiatric disorder, those with a major psychiatric disorder, either with or without catastrophic illness registration, had higher use and costs of mental health care services. Compared with enrollees without a psychiatric disorder, those with a minor psychiatric disorder or a major psychiatric disorder without catastrophic illness registration had higher use and costs of non-mental health care services. Both the mental and general health care of persons with psychiatric disorders are important.

Databases, Factual↗
PubMed2002

Health insurance status of the adult, nonelderly foreign-born population.

The last two decades have been marked by substantial immigration to the United States. As a result of this movement, the foreign-born population is growing rapidly. Previous studies have shown that the foreign-born population is much more likely than the native-born one to be without health insurance. The present analysis focuses on factors that distinguish the insured from the uninsured, utilizing nativity status (foreign born versus native born) as one of the independent variables in a set of logistic regression models. Results show that even after controlling for income, employment status, and other variables known to be associated with health insurance status, the foreign born are twice as likely to be without health insurance than are their native-born counterparts. Among the foreign born, recency of arrival emerges as an important factor in distinguishing the insured from the uninsured. Public policies intended to address the problem of health insurance in the foreign-born population must go beyond being based only on economic considerations and take into account factors such as cultural background and health-related attitudes to be effective.

Journal Article↗
PubMedDate not supplied

Do enrollees in 'look-alike' Medicaid and SCHIP programs really look alike? State Children's Health Insurance Program.

The State Children's Health Insurance Program (SCHIP), passed by Congress in 1997, has been implemented by states in many different forms, thus creating many natural experiments about insurance coverage for low-income children. In Georgia, SCHIP children are enrolled in a Medicaid look-alike program, PeachCare for Kids, with nearly the same administrative rules and providers as in the Medicaid program. Comparing the experiences of PeachCare and Medicaid children thus allows us to examine the impact of population differences on utilization and satisfaction. We find that Medicaid children, controlling for many demographic characteristics, report both less use of services and lower satisfaction with services used. Evidence presented here supports three possible explanations for these differences: Medicaid families are less familiar with and supportive of systems requiring use of an assigned primary care physician, the families face more nonprogram barriers to using care, and physicians have different responses to the two programs.

Attitude of Health Personnel↗
PubMed1988

Physician knowledge and attitudes about health insurance after the introduction of capitated health care plans.

A two-part closed-end survey similar to a survey done in 1980 was given to 25 family physicians at an academic family medical center to assess physician knowledge about five insurance programs covering most of the patients seeking care in the center, and to assess physician attitudes about the capitated insurance plan with which the clinic was affiliated. Results did not differ significantly from those obtained in a similar survey four years earlier at the same center. Physicians correctly identified benefits offered by insurance programs only about one half of the time and many did not ascertain patient insurance coverage at all. Physicians considered the most important advantages of capitated health care to be the patient protection from fees for services obtained, the coverage for health care maintenance, and the potential for controlling health care costs. Physician-perceived disadvantages included difficulties controlling costs generated by other specialists, dealing with after-the-fact authorization requests, controlling access to services, and obtaining information about costs within the capitated system.

Attitude of Health Personnel↗
PubMedDate not supplied

The commercial health insurance industry in an era of eroding employer coverage.

This paper analyzes the commercial health insurance industry in an era of weakening employer commitment to providing coverage and strengthening interest by public programs to offer coverage through private plans. It documents the willingness of the industry to accept erosion of employment-based enrollment rather than to sacrifice earnings, the movement of Medicaid beneficiaries into managed care, and the distribution of market shares in the employment-based, Medicaid, and Medicare markets. The profitability of the commercial health insurance industry, exceptionally strong over the past five years, will henceforth be linked to the budgetary cycles and political fluctuations of state and federal governments.

Adolescent↗
PubMed2002

Managing the behavior of the medically insured in Germany: the acceptance of cost-sharing and risk premiums by members of the statutory health insurance.

In the course of the conflicts over the reform of statutory health insurance in Germany complaints about moral hazard-behavior on the part of the insured were repeatedly raised and linked to the demand for expanding managerial incentives aimed at reducing the consumption of health care benefits (copayments). However, critics and supporters of managerial incentives mostly neglect the perceptions and dispositions of the insured. In contrast, the article examines how members of the statutory health insurance scheme assess managerial intervention, namely cost-sharing and risk premiums.

Cost Sharing↗
PubMed2006

The uninsured and the affordability of health insurance coverage.

The 2005 Current Population Survey (CPS) is used to estimate what share of uninsured Americans are eligible for coverage through Medicaid or the State Children's Health Insurance Program (SCHIP), need financial assistance to purchase health insurance, and are likely able to afford insurance. Twenty-five percent are eligible for public coverage, 56 percent need assistance, and 20 percent can afford coverage. This varies across uninsured populations: 74 percent of children are eligible for public programs, and 57 percent and 69 percent of parents and childless adults, respectively, need assistance. A central conclusion is that a large percentage of uninsured adults need help purchasing health insurance.

Adolescent↗
PubMed2006

Self-medication and health insurance coverage in Mexico.

Self-medication is a common practice in many developing countries but little is known about its determinants. This study analyzes the factors that are associated with the use of self-medication in Mexico using the Mexican Health and Aging Study, a new nationally representative survey on adults aged 50 and over. We find that self-medication is related to socioeconomic status and the lack of access to professional healthcare. Our empirical results suggest that lack of government-sponsored health insurance coverage increases the propensity to self-medicate. A 10% increase in the proportion of adults with health insurance coverage could decrease the use of pharmacy consultations by .8% for public sector workers and by 1.7% for private sector workers. Increasing health insurance coverage could reduce the demand for self-medication by making healthcare more affordable and by changing the population perceptions about the benefits of modern medicine.

Aged↗
PubMed2002

Findings of anthropometric and laboratory data from adult health screening under the National Health Insurance plan in Taiwan.

BACKGROUND: From April of 1996, all adults over 40 years old insured by the National Health Insurance (NHI) plan of Taiwan are eligible for a physical check-up once a year by most NHI-contracted family physicians. This study provides a benchmark data of their current physical health. METHODS: In total, 9,016 adult health examination reports were systematically sampled from 692,311 claims from April to September 1996. A subject profile included basic personal information, a physical examination, and routine blood and urine laboratory tests. The reliability of the data was verified by comparing the results of anthropometrical measures to others obtained from a nationwide nutrition survey. RESULTS: The mean height was 165 +/- 6.3 cm for men and 154 +/- 5.6 cm for women. Totally 54.3% of the people sampled were overweight, especially younger adults. The average systolic/diastolic blood pressure was 129+/- 19.9/80.9+/- 11.7 mmHg for men and 127.2 +/ -21.2/78.9 +/- 12.0 mmHg for women. There were 17.6% with high blood sugar, while only 8.0% were self-reported as diabetes mellitus (DM) sufferers. Women over 65 had higher cholesterol levels (>6.24 mmol/L) than did their younger peers and men. Men's blood triglyceride levels decreased from 1.74 to 1.28 g/L with age, while women's increased from 1.04 to 1.55 g/L with age. CONCLUSIONS: Taiwanese adults over 40 are 2-3 kg heavier and 2 cm taller than their counterparts 10 years ago, but may not be healthier. Future study may need to focus upon cost-effectiveness of this nationwide adult health screening program.

Adult↗
PubMed1991

Structure, process, effectiveness and efficiency of the check and review system in Japan's health insurance.

Keeping medical costs at an adequate and affordable level cannot be realized by the efforts of medical facilities alone, nor by the revision of fee schedules and price schedules of drugs in Japan's health insurance systems. Rationalization and improvement in the efficiency of all of the systems, including the various insurance organizations and the organizations for review and payment, are imperative. This paper first examines the system of review and payment for insurance claims under Japan's health insurance systems with emphasis on three main points, namely (1) qualification checks, (2) check and review of insurance claims and (3) computerization of the screening process. Relevant issues facing the check and review system are then discussed.

Cost Control↗
PubMed1980

Health insurance records in the course of alcoholism. A two-year follow-up study.

The Health Insurance Records of 32 male alcoholics were related to outcome after 2 years, with regard to drinking habits, self-esteem, social stability and Temperance Board registrations. The numbers of sickness benefit days were found significantly related to drinking habits (p less than 0.05), self esteem (p less than 0.01), social stability (p less than 0.01) and Temperance Board registrations (p less than 0.001). These levels of significance were generally higher than those between the outcome variables themselves. The number of sickness benefit days was superior to the incidence of sickness in describing the clinical course. Categorization according to the diagnoses did not increase the strength of the relationships with outcome variables. The number of sickness benefit days during the 5-year period prior to the first examination was significantly related to Temperance Board registrations (p less than 0.01) and social stability (p less than 0.05) during the follow-up period but not to drinking habits or self-esteem. No relationship was found between the number of sickness benefit days during this 5-year period and the follow-up period. It is concluded that Health Insurance Records are of use in follow-up studies on alcoholics.

Absenteeism↗
PubMed2005

[Quality assurance of outpatient nursing services in Baden-Württemberg -- overall view of 6 years of a total survey by the Medical Services of the Statutory Health Insurance (MDK)].

During the years 1997 to 2003 the medical services of the statutory health insurance in the German Federal State of Baden-Württemberg carried out a total survey regarding structure, process and outcome with regard to the quality of care of outpatients in the German long-term care insurance system. This survey provides information on the development of the quality of care. All outpatient nursing services licensed by the statutory long-term care insurance funds in Baden-Württemberg (n (1997 - 2000) = 863; n (2000 - 2003) = 779) were subjected to a uniform assessment based on a consented concept applied in all German Federal States. Our results demonstrate a tendency to fewer but larger nursing services providing care for an increasing number of patients. Qualification of head nurses and of caregiving staff in general has significantly improved. Information for the patient/consumer on the conditions of contracts which have to be made between a nursing service and the patient is still deficient in more than 20 % of cases. Adherence to proper procedures in the process of nursing has improved, especially with respect to taking a complete medical/nursing history and defining the individual resources of a patient and aims for therapy/nursing. However, only in (1/3) of the cases could we find a documentation of continuous adaptation of the planning of therapy. Efforts of in-house quality management and internal quality assurance by the outpatient nursing services have improved. Regarding the outcome of nursing there has been a decrease in the provision of stimulating care from 87 % of cases to 75 %. The majority of patients of outpatient nursing services do not receive benefits of the long-term care insurance system but of the statutory health insurance. This fact underlines the importance of a general conceptual framework for internal and external quality assurance.

Ambulatory Care↗