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PubMedDate not supplied

How will changes in health insurance tax policy and employer health plan contributions affect access to health care and health care costs?

OBJECTIVE: To understand how changes in federal taxation of and employer contributions to health insurance benefits affect the decisions of firms to offer insurance, the willingness of households to purchase different health plans, and the resultant health expenditures. DESIGN: Economic policy simulation. SETTING: Secondary data analysis. PARTICIPANTS: A total of 18,343 sampled families (representing 77 million total families throughout the United States) with a working household head from the 1988 Current Population Survey who were not covered by either Medicare, Medicaid, or CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) insurance. INTERVENTIONS: One intervention limits the amounts of tax-free employer contributions to health insurance premiums to 80% of our estimate of the base plan in the market and assumes that employer contributions will also be limited to this maximum. A second intervention eliminates the favorable tax treatment of employer-paid premiums altogether and assumes that employees will pay the full price of insurance. MAIN OUTCOME MEASURES: Change in the number of working families offered employment-based insurance, change in insurance plan choice, and change in medical spending. RESULTS: Capping the favorable tax treatment and employer contributions decreases the number of families offered employment-based insurance by approximately 91,000, increases the number of families selecting the least generous insurance plan from 20% under the current situation to 33%, and reduces overall health spending by less than 2%. By eliminating the tax exemption altogether, the number of families offered employment-based insurance decreases by approximately half a million families, the number of families selecting the least generous plan goes from 20% to 40%, and overall spending falls by about $16 billion. CONCLUSIONS: Eliminating the tax subsidy and limiting employer-paid contributions to the low-cost plan substantially increases the number of low-income uninsured under a voluntary insurance system, decreases overall spending only modestly, but would raise tax revenues by $36 billion. These tax revenues could be used to assist low-income families to obtain insurance coverage.

Competitive Medical Plans↗
PubMedDate not supplied

Validity of self-reported health plan information in a population-based health survey.

OBJECTIVE: To validate information on private health insurance coverage in a population-based study. METHODS: Respondents to the Massachusetts Behavioral Risk Factor Surveillance System were asked the name of their health plan company (affiliation) and specific brand of insurance (product), the duration in which they belonged to the plan, and demographic and health-related data. Information on plan affiliation and product was used to classify individuals on type of coverage. At the end of the survey, respondents with health insurance were asked to retrieve their health plan cards, and to read detailed information from the cards. Self-reported data were compared with information from the cards. RESULTS: Self-reported information on health plan affiliation agreed with plan cards for 93 percent of individuals, while agreement was 79 percent for health plan product. Among health maintenance organization (HMO) participants, 93 percent correctly reported being in an HMO (sensitivity), whereas 76 percent of respondents in a non-HMO plan correctly self-reported (specificity). Individuals with higher levels of income, those with a primary care doctor, and those in a health plan for at least 1 year had higher agreement. Higher validity was associated with poor physical health and recent cancer screening. CONCLUSIONS: Self-reported data on health plan affiliation and product have good validity in a population-based sample of adults. While agreement differs according to specific respondent characteristics, these differences do not appear substantial.

Adolescent↗
PubMed1982

Medicare program; health care prepayment plans--Health Care Financing Administration. Final rule.

Prepaid health care organizations that furnish or arrange to furnish medical and other health services under Medicare Part B may elect to receive Medicare reimbursement on either a reasonable cost or a reasonable charge basis. These regulations amend the rules governing payment under both methods. The regulations provide that reasonable cost reimbursement to such plans will be based on reimbursement principles similar, to the extent possible, to those for Health maintenance Organizations (HMOs) reimbursed on a reasonable cost basis. Previously, the reimbursement rules for the two types of prepayment organizations were substantially different. The regulations require that prepayment organizations that elect to be paid on a reasonable charge basis be paid on the same basis as other suppliers, non-hospital clinics and physicians. Previously, prepayment plans were permitted a number of alternative methodologies for calculating reasonable charges (such as charges related to cost, reasonable charge payment on a non-bill basis, and so forth), which will be eliminated under these regulations. The purpose of these regulations is to clarify and simplify payment policy, and to assure consistent treatment of prepayment plans and other organizations and suppliers of services under Medicare.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Gender-planned health services.

Gender-planned health services are planned on the basis that women and men play different roles in society and have different medical needs. The feminist movement has provided a broad charter of rights for women, reflecting women's needs, but these have yet to be translated into operational programmes. National programmes for women would allow co-ordination of broad-based programmes to improve women's health and social position. To change social norms discriminating against women will require changing male attitudes. Health programmes for males have received little attention, except from family planning organizations, although in most countries, males have a high rate of accidents, infections and parasitic disease. Controlled studies are required to evaluate the benefits of gender-planned health services.

Developing Countries↗
PubMedDate not supplied

Health planning as social evolution.

Failure to actively plan the health care system has permitted many problems to develop and go uncorrected. However, the notion of a planned health system is out of fashion. In this essay, a rationale is offered that defends a return to development of a planned system. A view of an evolving health system is presented that might be characterized as organic or sociobiological. Drawing from the work of theorists who have applied evolution theory to social science, the author discusses the main elements of a more organized health system and the policy changes required to achieve it. This extension of the theory of evolution suggests that a planned system is more likely to survive environmental disruption. Finally, changes in the roles of planners are suggested.

Biological Evolution↗
PubMed1995

Assessing relative health plan risk with the RAND-36 health survey.

Unbiased risk assessment models base health plan payments on enrollee health care needs. We explored the risk structure of employed adult health maintenance organization (HMO) members using the RAND-36 health survey. We used multivariate techniques to estimate risk weights on demographic and health status factors. The dependent variable was annual real total health plan expense for covered services for the year following the survey. Repeated random-split-sample validation techniques minimized outlier influences. Five scales improved prediction over simple demographic factors, but demographic factors still were required to achieve unbiased forecasts. Self-reported health status is a useful and powerful risk measure for adults.

Actuarial Analysis↗
PubMed2000

Integrating mental health into the Oregon Health Plan.

Public mental health has long struggled to be accepted as a part of health care. Its interface with social services and its broad spectrum of professionals make a clear definition of public mental health's boundaries difficult, fueling policymakers' skepticism about such acceptance. The Oregon Health Plan was the result of a process that explicitly included mental health but recognized that the tools for doing so need to be carefully developed.

Health Plan Implementation↗
PubMed2001

To help or hinder: Which is more important in explaining a physician's willingness to recommend a health plan?

PURPOSE: To examine how specific health plan practices contribute to physicians' willingness to recommend a health plan to a patient, and whether the relative importance of plan practices is viewed differently when patients are seriously ill. METHODS: The Physician's Evaluation of Health Plans Project has surveyed 1,757 generalist physicians in 16 health plans in 5 areas nationwide. Each physician reported on one plan. Three multi-item scales assessed physicians' perceptions of health plan activities that facilitated or impeded high-quality care in the plans and the clinical capabilities of plan physicians. Regression analyses were used to explore relations between facilitators, barriers, and clinical capabilities, and two global physician judgments (the physician's willingness to recommend a plan and their judgment that a plan provided lower quality for sicker patients). RESULTS: A physician's willingness to recommend a health plan is more highly related to what plans do to facilitate care than to the barriers created by plans in managing care. However, barriers to care were substantially more important when evaluating health plan quality for sicker patients. CONCLUSIONS: From the physician's perspective, the relative importance of plan strategies to manage care is different for typical patients and patients who are more seriously ill. Efforts to collect information on health plan quality should separately evaluate care for sicker patients, in addition to evaluating the overall performance of the health plan.

Attitude of Health Personnel↗