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PubMed1999

The HUSKY program: an opportunity to insure Connecticut's children.

Uninsured children in Connecticut represent a diverse group, and insuring them is a monumental task. In August 1997, President Clinton signed into law the Children's Health Insurance Program, which provides $47 billion in funds to states over the next 10 years to insure the nation's low-income children. Connecticut has been a leader in modeling the federal Children's Health Insurance Program into action. Connecticut's version of the program, Healthcare for UninSured Kids and Youth, (HUSKY), was enacted over the summer, and, to date, has enrolled over 4,000 children in the program. Connecticut's HUSKY program provides a timely opportunity for the state, as well as community health centers and other primary-care facilities, to reach those uninsured children in Connecticut's communities and move the children into the HUSKY program. In order to achieve this goal, innovative outreach strategies need to be designed that utilize cultural and community resources to locate and insure these children.

Child↗
PubMedDate not supplied

Effect of insurance coverage on the relationship between asthma hospitalizations and exposure to air pollution.

OBJECTIVE: Based on the assumption that people without health insurance have limited access to the primary care services needed to prevent unnecessary hospitalizations for asthma, the authors hypothesized that insurance is a factor in the strength of the association between hospital admissions for asthma and exposure to air pollution. They tested this hypothesis with 1991-1994 data from central Los Angeles. METHODS: The authors analyzed the effect of insurance status on the association between asthma-related hospital admissions and exposure to atmospheric particulates (PM10) and ozone (O3) using hospital discharge and air quality data for 1991-1994 for central Los Angeles. They used regression techniques with weighted moving averages (simulating distributed lag structures) to measure the effects of exposure on overall hospital admissions, admissions of uninsured patients, admissions for which MediCal (California Medicaid) was the primary payer, and admissions for which the primary payer was another government or private health insurance program. RESULTS: No associations were found between asthma admissions and O3 exposure. An estimated increase from 1991 to 1994 of 50 micrograms per cubic meter in PM10 concentrations averaged over eight days was associated with an increase of 21.0% in the number of asthma admissions. An even stronger increase--27.4%--was noted among MediCal asthma admissions. CONCLUSIONS: The authors conclude that low family income, as indicated by MediCal coverage, is a better predictor of asthma exacerbations associated with air pollution than lack of insurance and, by implication, a better predictor of insufficient access to primary care.

Air Pollutants↗
PubMed1999

Reflections on a painful transition: from socialized to insurance medicine in Russia.

After the collapse of the Soviet Union in 1991, Russia decided to replace its deeply flawed and under-funded system of socialized medicine by a scheme of health insurance that involved the decentralization of health services and of off-budget financing. Every enterprise would pay 3.6% of its salary fund into a Regional Health Insurance Fund, and the Fund would finance private insurance companies that would compete for clients. The non-working population would have its insurance premiums paid from the budgets of regions or municipalities. The transition from one system to another has been problematic and plagued with a variety of problems not the least of which is that the Russian economic structure is not geared to sustain an insurance system at the present time. The Russian case presents an instructive experiment with the premature introduction of a scheme touted as an "anti-model" to socialized medicine and geared to market and legal arrangements that are, as yet, largely non-existent. Under-funding of health services remains and leads to the polarization of the population into those few who can afford private care, and the vast majority for whom this care is difficult to obtain, or unobtainable. This has ominous political implications.

Health Care Reform↗
PubMed1981

Getting ready for the next malpractice insurance crisis.

In light of indications that another malpractice insurance crisis may be just around the corner, hospital managements should be analyzing the available insurance options. This article reviews the advantages and disadvantages of commercial insurance, self-insurance, and captive insurance and suggests when each is appropriate.

Hospitals↗
PubMed1981

The case for self-insurance.

Faced with escalating costs for primary professional liability insurance, many hospitals are considering self-insuring at least part of their professional liability risk. Self-insurance offers advantages over commercial insurance in several areas. The most important corollary of self-insurance from the perspective of the board is the need for more intimate involvement in the quality of medical practice in the institution.

Hospitals↗
PubMed1985

Malpractice insurance options: claims-made vs. occurrence coverage.

Professional liability insurance is not the trivial matter it was once. Premium costs are significant, the threat of malpractice litigation is tangible, sources of coverage are diverse, and there has been a proliferation of insurance carriers of different genres. Such changes have elevated the choice of malpractice insurance policy to the status of a major decision about which practitioners must be well informed. Differences between claims-made and occurrence coverage are clarified, and the advantages and disadvantages of each type of coverage are canvassed. The benefits of insuring with a commercial carrier versus a physician-owned company are also discussed in the light of trends in the structure of the liability insurance industry.

Insurance, Liability↗
PubMed1981

Medicare program; Medigap--certification of Medicare supplemental health insurance policies: Health Care Financing Administration. Proposed rule.

This proposal would establish a program of certification, by the Secretary, of Medicare supplemental health insurance policies (so-called Medigap policies) voluntarily submitted by insurers for review. It would implement, in part, section 507 of the Social Security Disability Amendments of 1980. HCFA will administer the certification program. The voluntary certification program would go into effect July 1, 1982, and would apply only to policies issued in those States that do not have in effect a program for regulating Medigap policies equal to or more stringent than the one to be described in these regulations. A Supplemental Health Insurance Panel, consisting of the Secretary or a designee and four State Commissioners of Superintendents of Insurance appointed by the President, will determine the adequacy of a State's program in relation to the standards contained in the regulations. These regulations would: (1) set standards for policies voluntarily submitted to HCFA for certification, (2) establish procedures for the certification program, and (3) promulgate the statutory requirements that the Supplemental Health Insurance Panel would use to approve State regulatory programs.

Certification↗
PubMed1983

Problems in private psychiatric insurance.

Insurance coverage for hospitalization in a freestanding psychiatric facility faces challenging, but not insurmountable, difficulties currently and in the immediate future. Relevant issues include: possible reductions in health insurance tax deductibility, so-called "consumer choice" and "pro-competition" options, prospective financing, and cost shifting from government insurance onto private patients. Some problems more specific to private psychiatric hospitals include: misuse of insurance coverage for dubious "therapies," the effects of declining coverage, the "dental versus mental" conflict, the effect of non-physicians entering the provider pool, poor coverage for liaison and consultation psychiatry, inappropriate usage, and confidentiality concerns. Positive future possibilities include: implementation of government insurance programs through private sector contracts, continuing improvement in psychiatric scientific technology, increased accountability efforts, public education, and improvements in psychiatry's relationships with labor and management.

Cost Allocation↗
PubMed1987

Medicare and Medicaid programs; payment for the cost of malpractice insurance--HCFA. Confirmation of final rule.

In this document, we are addressing public comments received in response to the interim final rule on payment for the cost of malpractice insurance, insurance, published on April 1, 1986. (51 FR 11142.) In that interim final rule, we established a specific methodology for apportionment of hospital malpractice insurance cost (that is, the cost of premiums or self-insurance) under Medicare that relied on, in part, a "scaling factor formula." We also provided for apportionment of skilled nursing facility malpractice insurance cost on the basis of Medicare patient utilization. With respect to the Medicaid program and the Maternal and Child Health program, we deferred to the States instead of establishing payment methodologies for these programs. As a result of our consideration of timely comments on the interim final rule and reevaluation of appropriate data, we plan to specify the values of the factors used in the scaling factor formula for the hospital methodology separately for short-term acute care hospitals and other hospitals. Accordingly, we have recomputed the values of the factors in the formula and, in this document, we are establishing values for short-term acute care hospitals. The values are the same as those announced in the interim final rule for all hospitals. We will issue another Federal Register document as soon as possible in which, as noted above, we intend to establish the values to be used in applying the formula to other hospitals. In the interim, for these other hospitals, we will continue to use the same formula values that were established in the interim final rule. We are not changing any of the other policies established in the interim final rule.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Reforming long-term care financing through insurance.

Until recently, insurance for long-term care was not viewed as feasible. This perception has changed dramatically in the past few years. Several models of long-term care insurance have begun to be tested. Although the application of insurance principles to long-term care is still new, the emergence of private market interest in developing long-term care insurance has been a catalyst to renewed public-policy support for reforming the way we pay for long-term care. States, in particular, have become interested in developing public-private partnerships to support the emergence of long-term care insurance that could help relieve the mounting pressure on Medicaid budgets.

Aged↗
PubMed1989

Developing public-private long term care insurance partnerships.

Recognition of long term care as an insurable risk has provided a framework for reexamining how we finance and deliver nursing home, home health, and community care to our elderly citizens. Insurance options are beginning to be marketed that provide consumers the opportunity to pay for their long term care needs in a more reasonable way than the situation in which individuals have to first self-insure and then rely on Medicaid when their resources are inadequate. The emergency of long term care insurance has stimulated public policy interest in supporting market development. Government payers will benefit if private insurance can reduce the role of Medicaid as a source of payment for middle-income elderly by delaying or avoiding the need to spend-down their resources. States, in particular, have taken the lead in seeking ways to help make the available products appealing and affordable so that the market can be broadened to include those at risk of needing Medicaid assistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Financing, Government↗
PubMed1978

National health insurance and the physician assistant.

Although American medicine has vastly improved the delivery of medical care during the last half-century, there are still many problems confronting our health care delivery system. The physician assistant concept is but one attempt of many to alleviate the problem of access to health care of an acceptable quality. Another concept is national health insurance as a measure to bridge the economic gaps in medical care not met by Medicare, Medicaid, and private health insurance; and to make better use of all health resources. Physician assistants can have a beneficial impact on health care under national health insurance by: improving access to care; keeping practice costs down; and improving the quality of care provided. A program of national health insurance will undoubtedly create increased public demand to provide more health services than currently offered by federal programs. National health insurance can succeed only if an appropriate financing mechanism is developed and valid attempts are made to utilize available manpower such as physician assistants. These issues are discussed.

Humans↗
PubMed2000

Health insurance may be improving--but not for individuals with mental illness.

OBJECTIVE: To explore the question of how insurance coverage has changed among individuals with mental problems compared to the general population in the last two years. DATA SOURCES: HealthCare for Communities, a national survey to track health system changes. PRINCIPAL FINDINGS: The percentage of uninsured persons in the general population has not changed very much, and more respondents believe that health insurance coverage has improved rather than deteriorated over the years 1996 to 1998. However, among individuals with probable mental health disorders, more have lost insurance in those two years than have gained it and more report decreases in health benefits. Individuals with worse mental health consistently report a deterioration of access to care compared to individuals with better mental health. CONCLUSIONS: Substantial activity has taken place in state and federal legislation to increase the mental health benefits offered by health insurance. Although this activity could have improved health insurance especially for individuals with mental illness, such persons continue to fare significantly worse than the general population.

Adult↗
PubMed2001

[Health insurance in Tunisia, current context and future perspectives].

The Tunisian health system, notably in its health insurance component, has allowed to record a satisfactory evolution of health indicators. Nevertheless, socio-economic, demographic and epidemiological transitions impose a global reform of the system, notably of its financing. The present article, leaving from the presentation of the current system of coverage of the social security insured, analyses observed insufficiencies that have brought public authorities to commit the health insurance reform. The main observed insufficiencies refer to the multiplicity of regimes and their heterogeneity, generating iniquities between insured and a strong growth of care expenses financed directly by households. In addition, relationships of social security bodies with public and private providers of health care are little transparent, marked by a preferential processing of public structures, despite an important development of the private sector. In a second part, the author analyzes successively objectives of the health insurance reform of the social security regimes, its founder principles, characteristics of the proposed regime (a mandatory basic regime and an optional complementary regime) and sketches of providers payment methods.

Financing, Government↗
PubMed2001

The Danish patient insurance system.

In all Nordic countries, patient insurance schemes have now been introduced that ensure injured patients of an extended right to damages for injuries caused by treatment. The schemes are based on what can best be characterised as "no fault" liability. The article describes the background for the introduction of the patient insurance system in Denmark and gives an outline of the structure of the insurance scheme. The article also gives an account of the scope of the Danish Patient Insurance Act and the conditions for damages and compensation in pursuance of the Act. Examples are given of injury types for which damages may be obtained in pursuance of the Act. Finally, the article gives statistical information about, for example, the costs that have been connected with the introduction of the patient insurance scheme in Denmark and an evaluation of the importance it has had in that a decision has been made to separate the question of damages from the complaints system legislatively.

Denmark↗
PubMed2001

A family member's legal experience with an insurer's refusal to recertify inpatient mental health treatment.

My son Nathaniel has bipolar disorder and was hospitalized for 6 months, during which time our insurance company was prepared to refuse certification more than once despite a policy that included 365 days of inpatient mental health treatment. A break in coverage by the insurance company would have meant that Nathaniel, still suicidal, would not receive the life-saving care he needed. Fortunately, I am a lawyer, which enabled me to act as a legal advocate for my son when our insurer threatened not to recertify. Because my son's experience with the insurance company is not unusual--many patients with mental illness struggle with insurance companies who refuse to certify treatment--I believe that the family or support people of seriously ill psychiatric patients should be prepared to act in circumstances similar to mine. Psychiatric inpatient units should, as a matter of course, provide information on legal remedies that can be obtained before irreparable harm occurs.

Bipolar Disorder↗
PubMed2001

Employer health insurance premium subsidies unlikely to enhance coverage significantly.

State and local efforts to reduce the number of uninsured workers include three major approaches: public insurance expansions, subsidies paid directly to low income workers to help pay their share of employer-sponsored insurance premiums or buy individual insurance and subsidies paid directly to small employers to reduce the cost of health insurance premiums. Based on a national study by the Center for Studying Health System Change (HSC), premium subsidies paid directly to small firms are unlikely to significantly reduce the number of uninsured. About 16 million people work in firms with fewer than 50 workers that do not offer health insurance. A hypothetical 30 percent premium subsidy targeted to the employers of these workers--slightly more generous than the average in existing small firm subsidy programs across the country--would extend coverage to only about half a million uninsured workers if implemented nationally.

Financing, Government↗
PubMed1999

Dental insurance and use of dental services.

OBJECTIVES: This article examines socioeconomic differences in insurance for dental services among Canadians aged 15 or older and factors associated with the use of dental services. DATA SOURCE: The data on dental insurance coverage and use of dental services are from the cross-sectional file of Statistics Canada's 1996/97 National Population Health Survey. The sample size of respondents aged 15 or older was 70,884. ANALYTICAL TECHNIQUES: Logistic regression analysis was used to model variables related to dental insurance coverage and to dental visits in the past year. A weighted bootstrap resampling procedure was used to derive variance estimates. MAIN RESULTS: In 1996/97, 53% of the population aged 15 or older reported having dental insurance, and 59% said they had visited a dentist in the past year. But even when they had insurance, individuals with low incomes and low educational attainment had much lower odds of visiting a dentist than those with higher incomes and more education.

Adolescent↗