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 1,387 records · Page 77Linked to original sources
PubMed2005

High rates of uninsured among HCV-positive individuals.

BACKGROUND AND GOALS: There are no published data on the health insurance status of Hepatitis C virus (HCV)-positive individuals. To address this issue, we analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III). STUDY: Individuals 18 years of age and older who participated in NHANES III were included in the study. We determined the rates of health insurance coverage according to HCV status. We also determined healthcare status and health service utilization according to health insurance status among HCV-positive persons. RESULTS: HCV-positive individuals were more likely to be uninsured compared with those who were HCV-negative (29.6% vs. 12.2%, P = 0.0002). Among those with health insurance, HCV-positive individuals were more likely to have government insurance compared with those who were HCV-negative (42.9% vs. 27.6%, P < 0.005). Among HCV-positive individuals, being uninsured was associated with younger age, being unmarried, living in the South, Mexican-American race/ethnicity, and not graduating from high school. Additionally, the uninsured were less likely than their insured counterparts to identify a healthcare facility for sick or routine care, and less likely to have regular contact with a healthcare professional. CONCLUSIONS: A high proportion of HCV-positive individuals are uninsured, and many HCV-positive individuals with health insurance have publicly funded insurance. This finding may have implications for access to health care and for liver-related disease outcomes in HCV-positive persons.

Adolescent↗
PubMed1994

Health reform: the good, the bad, and the bottom line.

The Health Security Act is a pragmatic plan for achieving universal health insurance coverage for a broad package of benefits at reasonable cost. It proposes necessary and reasonable changes in insurance market practices and administrative structure. It finances the reformed system with a credible combination of achievable cost savings, mandatory private-sector payments, and limited "sin" taxes. Political constraints-the inability to tax openly or redistribute tax subsidies-result in weak incentives for consumers to choose low-cost plans and an inefficient scheme for providing subsidies to the poor. The act also unnecessarily restricts and regulates fee-for-service plans and the training of health workers. We propose changes to correct the act's weaknesses without compromising its basic objectives.

Community Participation↗
PubMed1990

Universal health insurance: lessons of the 1970s, prospects for the 1990s.

In the 1970s, proposals for universal health insurance were not successful. Health care providers, insurers, and others negotiating in the political process foresaw a better future without such legislation. Today, the growth of health insurance coverage has unmistakably reversed. Moral discomfort and self-interest shape the new politics of universal health insurance for the 1990s. Hospitals, physicians, insurers, employers, and tens of millions of individuals would benefit from a universal health insurance plan that was mindful of their concerns and interests. Proposals that require employers to provide insurance for full-time employees and expand public programs to cover to cover other uninsured persons now have the greatest chances for enactment. As leaders, health services and health insurance executives should be in the vanguard of efforts to enact universal health insurance.

Employment↗
PubMed1993

Insurance status and access to health services among poor persons.

OBJECTIVE: We examine the relationship between health insurance status and access to care among low-income persons 65 years of age and under, taking into account their social demographic characteristics and health care needs. DATA SOURCES AND STUDY SETTING: Study groups consist of the subsamples of persons with incomes between 100 and 150 percent of the federal poverty level and those below the federal poverty level interviewed in the 1983, 1984, and 1986 Health Interview Surveys (HIS) of the National Center for Health Statistics. Sample sizes range from about 6,000 to 11,000 depending on the proportion of each study group administered the insurance supplement. STUDY DESIGN: Annual visits and whether hospitalized during a year are used as measures of access to medical care. The analysis consists of identifying predictors of use of services (i.e., health status and social characteristics) and, taking them into account, examining the relationship of insurance status to access to care. This was first undertaken on the 1983 survey; the models obtained then are replicated on the other two years of data. DATA COLLECTION/EXTRACTION METHODS: The HIS utilizes in-person interviews to gather health and medical history information from a stratified random sample of the U.S. population. Data were obtained through public use tapes distributed by the National Center for Health Statistics. PRINCIPAL FINDINGS: Results are consistent for all three years among persons in poverty. Being covered by Medicaid, in contrast to having private insurance or being without health insurance, is related to use of both ambulatory care and hospital care. The access differences for persons in poverty, regardless of their vulnerability or "risk" of requiring medical care, are marked and generally statistically significant. Among the near-poor the same findings occur, although the differences are less sharp and less often statistically significant. CONCLUSIONS: The most obvious explanation is that the poor, and to a considerable extent the near-poor, have limited access because of copayments and deductibles that are typically part of private insurance coverage. The findings raise policy questions regarding the utility of either "play or pay" employer-provided insurance or income tax deductions to increase access.

Data Collection↗
PubMed1997

Charges for obstetric liability insurance and discontinuation of obstetric practice in New York.

BACKGROUND: The study objective was to determine whether New York physicians facing higher charges for obstetric liability insurance coverage are more likely to discontinue obstetric practice than physicians experiencing lower levels of increases in liability insurance charges. METHODS: We performed a physician-level analysis of factors predicting discontinuation of hospital-based obstetric practice by 1989 for physicians active in obstetrics in 1980. We examined both physicians who became completely clinically inactive in New York between 1980 and 1989, and physicians who remained clinically active but restricted their hospital practice to areas other than obstetrics. Multiple logistic regression models were used to analyze predictors of discontinuation of obstetrics, including regional malpractice insurance charges, physician characteristics, and practice characteristics. RESULTS: Although increases in malpractice insurance charges differed considerably among regions within New York State, there was no association between level of increase of charges for liability insurance and discontinuation of obstetric practice. A greater number of years since medical licensure was associated both with complete discontinuation of hospital practice in New York and selective discontinuation of obstetrical practice. Compared with obstetrician-gynecologists, family physicians were less likely to become completely clinically inactive. Among physicians who remained clinically active in hospital care, however, family physicians were less likely than obstetrician-gynecologists to continue to include obstetrics in their practice. CONCLUSIONS: There is no relationship between the level of increase in liability insurance premiums and the likelihood of discontinuing obstetric practice in New York. Discontinuation of obstetric practice appears to mainly reflect trends in the physician's life cycle of practice activity and in the scope of family and general practice.

Costs and Cost Analysis↗
PubMed2000

Simulating the impact of medical savings accounts on small business.

OBJECTIVE: To simulate whether allowing small businesses to offer employer-funded medical savings accounts (MSAs) would change the amount or type of insurance coverage. STUDY SETTING: Economic policy evaluation using a national probability sample of nonelderly non-institutionalized Americans from the 1993 Current Population Survey (CPS). STUDY DESIGN: We used a behavioral simulation model to predict the effect of MSAs on the insurance choices of employees of small businesses (and their families). The model predicts spending by each family in a FFS plan, an HMO plan, an MSA, and no insurance. These predictions allow us to compute community-rated premiums for each plan, but with firm-specific load fees. Within each firm, employees then evaluate each option, and the firm decides whether to offer insurance-and what type-based on these evaluations. If firms offer insurance, we consider two scenarios: (1) all workers elect coverage; and (2) workers can decline the coverage in return for a wage increase. PRINCIPAL FINDINGS: In the long run, under simulated conditions, tax-advantaged MSAs could attract 56 percent of all employees offered a plan by small businesses. However, the fraction of small-business employees offered insurance increases only from 41 percent to 43 percent when MSAs become an option. Many employees now signing up for a FFS plan would switch to MSAs if they were universally available. CONCLUSIONS: Our simulations suggest that MSAs will provide a limited impetus to businesses that do not currently cover insurance. However, MSAs could be desirable to workers in firms that already offer HMOs or standard FFS plans. As a result, expanding MSA availability could make it a major form of insurance for covered workers in small businesses. Overall welfare would increase slightly.

Adolescent↗
PubMedDate not supplied

The Health Insurance Flexibility and Accountability (HIFA) Demonstration program. A new initiative to cover the uninsured.

Seeking to keep his promise to give states more flexibility while expanding health insurance coverage to low-income people, President George W. Bush released a proposal to reform Medicaid and The Children's Health Insurance Program. This initiative, the Health Insurance Flexibility and Accountability Act (HIFA), represents a significant change in Medicaid policy. Whether states will find this proposal a useful tool to expand coverage remains to be seen.

Adolescent↗
PubMed1994

Poison center funding--who should pay?

To illustrate costs associated with poison center closure a survey of lay callers to the poison center and emergency department costs was conducted. For 21 days all callers to a Regional Poison Information Center receiving home treatment were asked the type of health insurance coverage the patient had. This information was documented on the medical record and tabulated. Health care costs were determined by surveying local hospitals. Of the callers, 1,276 (43%) provided insurance information: 928 (73%) of the patients were covered by private insurers; 258 (20%) received state medical assistance and 90 (7%) had no medical coverage. The average emergency department cost of an ingestion exposure was $210.75, ocular $172.22, and inhalation $298.03. In the absence of a Regional Poison Information Center responding to 61,000 calls annually, the state would incur a debt ranging from 1.27 to 2.20 million dollars if 60% of those covered under state assistance went to the emergency department. Private insurers would forfeit 4.58 to 7.93 million dollars per year. These cost estimates consider only the emergency department charges, not unnecessary admissions. State government and private insurers clearly are the financial beneficiaries of poison center services which save several times their operating costs.

Cost-Benefit Analysis↗
PubMed1979

Impact of Medicare on the use of medical services by disabled beneficiaries, 1972-1974.

The extension of Medicare coverage in 1973 to disabled persons receiving cash benefits under the Social Security Act provided an opportunity to examine the impact of health insurance coverage on utilization and expenses for Part B services. Data on medical services used both before and after coverage, collected through the Current Medicare Survey, were analyzed. Results indicate that access to care (as measured by the number of persons using services) increased slightly, while the rate of use did not. The large increase in the number of persons eligible for Medicare reflected the large increase in the number of cash beneficiaries. Significant increases also were found in the amount charged for medical services. The absence of large increases in access and service use may be attributed, in part, to the already existing source of third party payment available to disabled cash beneficiaries in 1972, before Medicare coverage.

Persons with Disabilities↗
PubMed2003

Unmanaged care: towards moral fairness in health care coverage.

Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.

Actuarial Analysis↗
PubMed1987

Tax policy toward health insurance and the demand for medical services.

Researchers have argued that the tax subsidy to employer-provided health insurance has led to overinsurance, excess demand for medical care, and to rapid expenditure growth in the medical care sector. This paper determines the quantitative significance of this linkage, using existing estimates of the elasticities of demand for health insurance and medical services in a static microsimulation model. We find that incorrect assumptions about the elasticities of demand and pattern of health insurance coverage led earlier researchers to overestimate the likely impact of the elimination of the tax expenditures for health insurance. We estimate, using mid-range assumptions, that complete elimination of the favorable tax treatment of employer contributions to health insurance would reduce the demand for employer-sponsored health insurance by 16-27 percent and the overall demand for medical services by about 4-6 percent and not more than 10 percent.

Data Collection↗
PubMed2002

Is the Turkish health care system ready to be a part of the European Union?

Lately, Turkey is struggling to recover from the economic effects of the economic crisis so that the government officials are trying to impose budget cuts in health and education sectors. After the United States, the country's national defense expenditures are the highest among the NATO countries. Therefore, Turkey allocates only 3-4% of the gross domestic product for health care expenses. Overall, the health status in Turkey is the lowest among the European Union countries; infant mortality rate is about 45 per 1000 live births, which is the highest on the European continent, and per capita health care expenditure is $120. Although 75% of the people are covered by some type of public insurance, 25% of the Turkish people do not have any insurance coverage. The national system is funded by taxes (43%), out of pocket payments (32%), and social and private insurance premiums (25%). This study examines whether Turkey is ready to be a part of the European Union in terms of the health sector of its economy and health status of its people.

Birth Rate↗
PubMed2004

Development of the rural health insurance system in China.

Ever since the collapse of the once successful Rural Cooperative Medical System (RCMS) in the early 1980s, when China transformed its system of collective agricultural production to private production, many rural communities, especially the poorer residents, have faced several major problems. In 1993, insurance coverage for rural residents was already low, at 12.8%. By 1998, only 9.5% of the rural population was insured. User charges have effectively blocked access for many rural residents who lack adequate income to purchase basic health care when needed. Impoverishment due to medical expenses is also a serious problem, which begs the question: why has there been no vigorous development of the rural health insurance system in China despite the country's rapid economic growth? This paper analyzes the major underlying reasons for the lack of rural health insurance in China. We found that lack of demand for the voluntary community financing schemes and inadequate government policies are the two major hindrances. Recently, the Chinese government announced a new rural health financing policy that relies on 'matching-funds' by the central and local governments as well as household contributions. The potential for success of this new model might be inferred from China's past experiences, as well as from the pilot projects that are underway.

China↗
PubMed2003

Costs of poor birth outcomes among privately insured.

Despite expansions in the public insurance coverage of pregnant women, concerns over poor birth outcomes remain. Poor birth outcomes occur among publicly and privately insured women, however, thereby imposing excess costs on employers and their insurers. Data from a large sample of privately insured for 1996 are used to examine these outcomes and costs. Almost one-fourth (24.3 percent) of the infants in our matched sample of 12,020 deliveries was premature or had other problems at birth. Costs for these infants accounted for 82 percent of the total $56 million spent on sample infants. The incremental cost of infants with poor birth outcomes versus those with normal, full-terms was approximately $14,600. We found that these relative costs had increased over time due perhaps to the increased technology and intensity of services used to save infant lives. We also found that factors other than maternal and infant complications affected cost variations. For example, employers located in the Northeast, hiring older mothers, and in unionized sectors have higher prenatal, delivery, and infant costs.

Adult↗
PubMed2006

Physician communication about the cost and acquisition of newly prescribed medications.

OBJECTIVE: To describe the frequency and content of physician discussions about the cost and acquisition of new medications. STUDY DESIGN: Qualitative and quantitative study combining patient and physician surveys with transcribed audiotaped office visits from 185 outpatient encounters with 15 family physicians, 18 internists, and 11 cardiologists in 2 Sacramento healthcare systems between January and November 1999, in which 243 new medications were prescribed. METHODS: Transcripts were qualitatively analyzed to describe conversations concerning the cost and acquisition of new medication prescriptions, frequencies of discussions were described, and multivariate logistic regression was used to examine the predictors of cost discussions. RESULTS: For one third of newly prescribed medications, physicians discussed an aspect of acquisition, including cost and insurance coverage for 12%, logistics of obtaining medications for 18%, and medication supply for 9%. Patients initiated cost or insurance concerns for fewer than 2% of the new medications prescribed. There were 5 discussions about patient out-of-pocket costs and 7 discussions offering tips for cost savings. In multivariate analysis, cost discussions were more likely to occur with patients earning less than 20,000 dollars per year compared with those earning more than 60,000 dollars per year, were less likely to occur with medications prescribed by family physicians or internists compared with cardiologists, and were less likely with medications prescribed to older patients. CONCLUSIONS: Physician-patient discussions about new medication cost and other acquisition issues, especially medication affordability, occur infrequently. Because physicians may not recognize patients' financial impediments to acquiring medications, this issue should be raised when prescribing new medications.

Adult↗
PubMed1978

Hospital-sponsored groups offer viable malpractice insurance.

Hospital - sponsored insurance organizations can offer their members many advantages, especially reasonable and stable malpractice insurance coverage and premium rates. To do so, they must ensure their financial stability through the support of the insured and through adequate reinsurance, compete effectively with commercial insurance companies, comply with federal regulations regarding reimbursement to hospitals for premiums, and develop effective internal management.

Bermuda↗
PubMed2004

Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs.

BACKGROUND: Back pain accounts for more than $100 billion in annual US health care costs and is the second leading cause of physician visits and hospitalizations. This study ascertains the effect of systematic access to chiropractic care on the overall and neuromusculoskeletal-specific consumption of health care resources within a large managed-care system. METHODS: A 4-year retrospective claims data analysis comparing more than 700 000 health plan members with an additional chiropractic coverage benefit and 1 million members of the same health plan without the chiropractic benefit. RESULTS: Members with chiropractic insurance coverage, compared with those without coverage, had lower annual total health care expenditures ($1463 vs $1671 per member per year, P<.001). Having chiropractic coverage was associated with a 1.6% decrease (P = .001) in total annual health care costs at the health plan level. Back pain patients with chiropractic coverage, compared with those without coverage, had lower utilization (per 1000 episodes) of plain radiographs (17.5 vs 22.7, P<.001), low back surgery (3.3 vs 4.8, P<.001), hospitalizations (9.3 vs 15.6, P<.001), and magnetic resonance imaging (43.2 vs 68.9, P<.001). Patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399, P<.001). CONCLUSIONS: Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs.

Adolescent↗
PubMed1985

Liability and liability insurance for medical malpractice.

Physicians typically carry virtually complete malpractice insurance coverage. This contradicts standard theoretical predictions that under a negligence rule of liability there should be no demand for insurance, and insurance policies under moral hazard will contain co-payment provisions. It is argued that judicial 'errors' in defining negligence generate a demand for liability and legal defense insurance. Physician co-payment undermines the insurer's incentives for legal defense and thus induces a trade-off between loss reduction by injury prevention and by legal defense. Fee-for-service reimbursement further distorts the physician's choice between injury prevention and insurance. Implications for the deterrent function of the tort system are discussed.

Actuarial Analysis↗