Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Health Insurance”

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 1,369 records · Page 76Linked to original sources
PubMed1990

The Rand Health Insurance Experiment and HMOs.

The Rand Health Insurance Experiment (HIE) provides the most persuasive evidence to date on the relative effects of health maintenance organization (HMO) and fee-for-service care on utilization, costs, client satisfaction, and health care outcomes. Publications from the HIE have suggested that HMO care was associated with lower costs because of reduced hospitalizations, lower client satisfaction, and poorer health status among the subgroup with limited incomes and initial health status. In our view, the evidence justifies the conclusions related to utilization, costs, and satisfaction, but not the suggestion that HMO care had adverse health effects on low-income, sick individuals.

Adult↗
PubMed2000

The new health insurance rebate: an inefficient way of assisting public hospitals.

Private health insurance subsidy is now estimated to cost $2.19 billion; government support for private health care includes a further $1.2 billion of Medicare benefits expenditure in hospitals. The subsidy cannot be justified on efficiency grounds, as, on the basis of available evidence and taking casemix into account, public hospitals are more efficient than private hospitals. The original stated objective of the subsidy was to "take pressure off public hospitals". If the insurance subsidy and the Medicare Benefit Schedule rebate expenditure were applied to purchasing public hospital treatment at full average cost, 58% of current private sector demand could be accommodated. If 10% of the demand were met at marginal cost, this would increase to 65%. The objective of "taking pressure off public hospitals" could be more efficiently achieved by direct funding of public hospitals rather than through subsidies for private health insurance.

Australia↗
PubMed2005

Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study.

STUDY OBJECTIVE: We determined whether having a usual source of care or health insurance is associated with the likelihood of an emergency department (ED) visit. METHODS: This was a multivariate analysis of the 2000 to 2001 nationally representative Community Tracking Study Household Survey to assess the independent association of usual source of care, health insurance, income, and health status with the likelihood of making 1 or more ED visits in the previous year. RESULTS: Based on a sample of 49,603 adults, an estimated 45.3 million adults reported 79.6 million ED visits in the previous year; 83.1% of these visitors identified a usual source of care other than an ED. Persons with poor physical health status made 48.4% of visits. Adults without a usual source of care were less likely to have had an ED visit than those whose usual source of care was a private physician (odds ratio [OR] 0.75). Uninsured individuals were no more likely to have an ED visit than insured individuals. Poor physical health (OR 2.41), poor mental health (OR 1.51), 5 or more outpatient visits during the year (OR 4.05), and changes in insurance coverage (OR 1.14) or usual source of care (OR 1.32) during the year were associated with an ED visit. Enrollment in a health maintenance organization and satisfaction with one's physician were not independently associated with ED use. CONCLUSION: ED users are similar to nonusers with regard to health insurance and usual source of care but are more likely to be in poor health and have experienced disruptions in regular care. The success of efforts to decrease ED use may depend on improving delivery of outpatient care.

Adult↗
PubMed2002

Eating disorders and health insurance understanding and overcoming obstacles to treatment.

Eating disorders are complex in cause and course, with biomedical, psychiatric, and psychosocial components. To maximize the likelihood of recovery, patients require skillful and coordinated care from various health care professionals, including medical professionals, mental health professionals, and nutritionists. All too often, at some point in treatment, clinicians discover that their patients' health insurance status has been compromised or that further treatment is denied because of maximization of mental health benefits. It is important for patients, families, and health care professionals to understand the health insurance issues that are involved in the treatment of eating disorders and learn strategies that may help to overcome the obstacles that these issues present.

Adolescent↗
PubMed2005

Accuracy of diabetes diagnosis in health insurance claims data in Taiwan.

BACKGROUND AND PURPOSE: There are limited data from Taiwan about the accuracy of National Health Insurance (NHI) claims data. This study assessed the accuracy of NHI claims data for diabetes and its associated factors. METHODS: Insurance claims data for patients with a diagnosis of diabetes were extracted from the records of the Bureau of National Health Insurance, including detailed files of the outpatient, emergency, inpatient and pharmacy treatment records from January 1, 2000 to December 31, 2000. A stratified, 2-staged, probability proportional to size and equal probability method was used to sample 9000 diabetes patients. The accuracy of the diabetes diagnosis was assessed based on patient responses to questionnaire items. Subjects with negative or uncertain questionnaire answers who had hypoglycemic agents in pharmacy claims data were also classified as diabetic. RESULTS: A total of 1350 questionnaires were returned and an accurate diagnosis was verified from data in 1007 (74.6%) of these subjects. Univariate analysis showed that level of accreditation of the hospital, age, gender, follow-up department, type of complication, number of outpatient visits, emergent visit, as well as hospitalization were significant factors associated with an accurate diagnosis of diabetes. Multivariate logistic regression analysis revealed that number of outpatient visits, hospitalization, age, and the level of accreditation of the hospital were significant independent factors. The odds ratio of an accurate diagnosis increased with the number of outpatient visits and hospitalization. The probability of accurate diagnosis of diabetes among patients with >/= 4 outpatient visits was 99.16 times greater than that of patients with </= 1 outpatient visit. The probability of accurate diagnosis in patients with >/= 1 hospitalization was 5.26 times that of patients who had not been hospitalized. CONCLUSIONS: This study found that the accuracy of diabetes diagnosis in NHI claims data in Taiwan was 74.6%. Further attention to the association of inaccurate claims in cases with infrequent outpatient visits, young age and those attending non-accredited hospitals is needed in order to address the efficiency of diagnosis and surveillance of diabetes in Taiwan.

Adult↗
PubMed2002

Mongolian experiences with health insurance: are success factors unique?

We describe the health insurance model implemented in Mongolia after the Soviet Bloc collapsed in 1990, and note some of its good features. We then discuss the structural weaknesses that became evident over the first ten years of use, and some current proposals for reform. Finally, we consider the factors that appear to have affected success. We argue that the main constraints are much the same as in other countries including Australia--and relate more to confusion and disagreement over broad policy issues than to detailed knowledge of technical aspects or the research evidence.

Capitalism↗
PubMedDate not supplied

Health insurance coverage after welfare.

This DataWatch examines the health insurance coverage of former welfare recipients who left welfare between January 1995 and mid-1997, using data from the 1997 National Survey of America's Families. Although the majority of women who left welfare were working, only 33 percent of these women obtained health coverage through their jobs. Rates of uninsurance increase with the number of months since leaving welfare and with declines in Medicaid coverage. A year or more after leaving welfare, 49 percent of women and 30 percent of children were uninsured.

Adult↗
PubMed1976

Strategies for financing national health insurance: who wins and who loses.

Two sources of funds are available to underwrite the costs of any national health-insurance plan: prepayments (premiums, payroll taxes and income taxes) and out-of-pocket payments (coinsurance and deductibles). The extent to which taxes rather than premiums are used to finance an insurance program will be the major determinant of how large a share of the costs of health care will be borne by higher-income groups. The extent to which coinsurance and deductible provisions are reduced or waived for low-income persons will have a less important, but still substantial, role in determining how the costs of a program are distributed. These financing principles, once understood, provide a basis for the design of health-insurance legislation that will achieve any pattern of income redistribution that may be desired.

Deductibles and Coinsurance↗
PubMed1988

Competition among health insurers, revisited.

This paper updates our 1977 study of health insurance competition. We find that insurers are now far more willing to compete by controlling costs. Large consumer copayments and insurer utilization controls, once deemed politically infeasible, have become commonplace. HMOs and especially PPOs are booming. Blue Shield and Blue Cross market share and market power are declining. We discuss why the insurance market has changed and conclude with thoughts on the future.

Attitude↗
PubMed2006

Health insurance system and payments provided to patients for the management of severe acute pancreatitis in Japan.

The health insurance system in Japan is based upon the Universal Medical Care Insurance System, which gives all citizens the right to join an insurance scheme of their own choice, as guaranteed by the provisions of Article 25 of the Constitution of Japan, which states: "All people shall have the right to maintain the minimum standards of wholesome and cultured living." The health care system in Japan includes national medical insurance, nursing care for the elderly, and government payments for the treatment of intractable diseases. Medical insurance provisions are handled by Employee's Health Insurance (Social Insurance), which mainly covers employees of private companies and their families, and by National Health Insurance, which provides for the needs of self-employed people. Both schemes have their own medical care service programs for retired persons and their families. The health care system for the elderly covers people 75 years of age and over and bedridden people 65 years of age and over. There is also a system under which the government pays all or part of medical expenses, and/or pays medical expenses not covered by insurance. This is referred to collectively as the "medical expenses payment system" and includes the provision of medical assistance for specified intractable diseases. Because severe acute pancreatitis has a high mortality rate, it is specified as an intractable disease. In order to lower the mortality rate of various diseases, including severe acute pancreatitis, the specification system has been adopted by the government. The cost of treatment for severe acute pancreatitis is paid in full by the government from the date the application is made for a certificate verifying that the patient has an intractable disease.

Acute Disease↗
PubMed2001

Stand-alone health insurance tax credits aren't enough.

Using health insurance tax credits to help reduce the ranks of the nearly 43 million uninsured Americans has attracted broad bipartisan support in Congress. But tax credits alone will not help many sick or older people obtain affordable coverage, according to an expert panel at an April 10, 2001, conference sponsored by the Center for Studying Health System Change (HSC). To make tax credits a viable option for eligible people, the individual insurance market would need significant reforms or a better way to spread risk-similar to large employers-over a large and varied population. This Issue Brief highlights critical issues policy makers should consider when crafting tax credit proposals, including the use of purchasing pools.

Age Factors↗
PubMed1980

Equality in medical care under national health insurance in Montreal.

In November 1974, four years after national health insurance in Canada had eliminated all out-of-pocket payment for physicians' services, we surveyed 1559 households in a socially heterogeneous area of Montreal to assess social-class differences in the use of physicians' services. When reported health status as well as age and sex were taken into account, the rates of physician visits during the two-week period preceding the survey were essentially the same in the low, middle, and high economic classes, thus confirming that disparity of access had been reduced. However, relative to other groups, the poor still made considerable use of hospital clinics and emergency rooms for primary care and more of their visits entailed prescriptions and physician-initiated requests to return. The latter observations may indicate that the poor, as compared with other groups consulted the doctor for more advanced conditions. Official statistics showed no increase in the workload of the average physician, although the number of physician visits per person per year had risen steadily. There was no evidence of abuse of "free" medical care by the poor.

Data Collection↗
PubMed2001

A regional survey of health insurance coverage for complementary and alternative medicine: current status and future ramifications.

OBJECTIVE: The purpose of this survey is to evaluate the extent of health insurance coverage for complementary and alternative medicine (CAM) within one region in the United States, a study prompted by the increased utilization of CAM. DESIGN: Prospective telephone interview of health insurance representatives. LOCATION: A contiguous three-state area (New York, New Jersey, and Connecticut) in the North-east. RESULTS: Almost all of the insurers surveyed cover chiropractic services. Less than half of the insurers reimburse acupuncture, usually for chronic pain management. Coverage for massage therapy is minimal and usually associated with physical therapy or chiropractic treatment. Other CAM services receive negligible coverage. CONCLUSIONS: Current health insurance coverage of CAM is limited essentially to chiropractic medicine, acupuncture and massage therapy. Coverage of CAM is made confusing by different policies, practitioner requirements, and health plans within each carrier.

Acupuncture↗
PubMedDate not supplied

Paying for national health insurance--and not getting it.

The threat of steep tax hikes has torpedoed the debate over national health insurance. Yet according to our calculations, the current tax-financed share of health spending is far higher than most people think: 59.8 percent. This figure (which is about fifteen percentage points higher than the official Centers for Medicare and Medicaid Services [CMS] estimate) includes health care-related tax subsidies and public employees' health benefits, neither of which are classified as public expenditures in the CMS accounting framework. U.S. tax-financed health spending is now the highest in the world. Indeed, our tax-financed costs exceed total costs in every nation except Switzerland. But the sub rosa character of much tax-financed health spending in the United States obscures its regressivity. Public spending for care of the poor, elderly, and disabled is hotly debated and intensely scrutinized. But tax subsidies that accrue mostly to the affluent and health benefits for middle-class government workers are mostly below the radar screen. National health insurance would require smaller tax increases than most people imagine and would make government's role in financing care more visible and explicit.

Accounting↗
PubMedDate not supplied

Impact of health insurance status on vaccination coverage in children 19-35 months old, United States, 1993-1996.

OBJECTIVES: To show how health insurance (privately and publicly insured, insured and uninsured) relates to vaccination coverage in children 19-35 months old, and how this can be used to better target public health interventions. METHODS: The National Health Interview Survey (NHIS) gathers information on the health and health care of the U.S. non-institutionalized population through household interviews. The authors combined immunization and health insurance supplements from the 1993 through 1996 NHIS, and classified children 19-35 months old by their immunization and insurance status. Results were compared using both bivariate and multivariate analyses, and the backwards stepwise selection method was used to build multivariate logistic regression models. RESULTS: Uninsured children tended to have lower vaccination coverage than those who had insurance, either private or public. Among those with insurance, publicly insured children had lower vaccination coverage than privately insured children. Backwards stepwise regression retained insurance status, metropolitan statistical area, and education of responsible adult family member as major predictors of immunization. Factors considered but not retained in the final model included child race/ethnicity, family poverty index, and region of country. CONCLUSIONS: Insurance status was a critical predictor of vaccination coverage for children ages 19-35 months. After controlling for confounders, the uninsured were about 24% less likely to receive all recommended shots than the insured and, among the insured, those with public insurance were about 24% less likely to receive all recommended vaccines than those with private insurance.

Black or African American↗
PubMed1997

Health insurance coverage among foreign-born US residents: the impact of race, ethnicity, and length of residence.

OBJECTIVES: This study examined the health insurance status of the US foreign-born population and the influence of race, ethnicity, and length of residence on health insurance status. METHODS: Data were obtained from the 1989 and 1990 National Health Interview Surveys, including the Insurance and Family Resource Supplements. RESULTS: In 1989 and 1990, the foreign-born population was twice as likely as the US-born population to be uninsured (26.2% vs 13.0%). The highest rate of uninsured status, 40.8%, was found among foreign-born Hispanics. Persons who had lived in the United States for less than 15 years were 1.5 to 4.7 times more likely to be uninsured than were US-born Whites. CONCLUSIONS: Foreign-born US residents-especially Hispanics and persons residing in the United States for less than 15 years-are vulnerable to not having health insurance, which may limit their access to medical services. The administrative criteria for public programs may explain the high rates of uninsured status among recent immigrants. Recently enacted federal legislation could substantially increase the number of uninsured among the US foreign-born population, with profound public health implications.

Adolescent↗
PubMed1975

Economics of institutional pharmacy services under national health insurance in Australia.

The development and effect of the National Health Scheme on institutional Health Scheme on institutional pharmaceutical services in Australia are discussed. Government control over drug costs and the provision of pharmacy services, with its effect on both community and institutional practice, is assessed. Methods of improving the present system of health insurance under the Pharmaceutical Benefits Scheme in Australia are suggested, including their relevance to health care in the United States.

Australia↗