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PubMed2005

Employment and health insurance in long-term liver transplant recipients.

This study was conducted to examine factors affecting health insurance and employment status in long-term liver transplant (OLT) recipients. All adult primary OLT recipients surviving at least 1 year were surveyed using existing questionnaires. Out of 217 eligible recipients, 186 (86%) responded. The median age of respondents was 55 years with a median survival after OLT of 3.4 years. The majority (98%) of respondents had health insurance coverage. Thirty-four (18%) reported having lost and/or having been denied health insurance since OLT, and 63 (34%) switched health insurance since OLT. Of the 179 that reported employment status, 98 (55%) were employed, including homemakers and students, while 39 (22%) were retired and 42 (24%) unemployed. The majority (76%) of those unemployed cited poor health as the reason for unemployment, followed by 5 (12%) who feared loss of disability or Medicaid benefits. Fourteen reported to have been denied or terminated from employment because of their transplant. In the regression analysis, employment prior to transplantation (odds ratio (OR)=5.1), age less than 57 (OR=5.1), physical function score>52.4 (OR=3.6) and general health score>33.3 (OR=7.6) were significantly associated with employment. These data may help identify high-risk pre-OLT patients for intervention measures such as work rehabilitation.

Adult↗
PubMed1989

How informed is patients' consent to release of medical information to insurance companies?

A study was conducted to assess how informed the consent of patients is to the release of confidential information to insurance companies. Questionnaires were sent to 226 consecutive patients from four practices whose general practitioners had received requests to complete a personal medical attendant's report for an insurance company. In total 195 patients returned the questionnaire, whose six questions required only a yes or no answer. More than half of the patients (102 (52%] could not recall having given their consent and 79 (40%) had one or more objections to the questions commonly asked by insurance companies. Questions about sexually transmitted diseases and AIDS led to the greatest proportion of objections (85% (67/79) and 80% (63/79) respectively). Over half (111 (57%) of the 195 respondents expected their doctor to withhold sensitive information. Of the 93 patients who gave their informed consent, 63 (68%) did not expect that their doctor would be asked to answer one or more of the common questions. In most cases the consent of patients to the release of confidential information to insurance companies is neither knowingly given nor informed.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Morbidity of Swedish horses insured for veterinary care between 1997 and 2000: variations with age, sex, breed and location.

The aim of this study was to evaluate the potential usefulness of the database maintained by the Swedish insurance company Agria for providing disease statistics on Swedish horses. The demography of the horses insured for veterinary care during the period 1997 to 2000 was recorded and the incidence of morbidity, defined as horses that required veterinary care that cost more than the policy excess, was calculated. Yearly incidences were calculated for horses that required veterinary care at least once, first overall, and then for horses with complete insurance, by sex, age, breed group, breed, location and human population density. Poisson regression was applied to a multivariable model to produce estimates of relative risk adjusted for other factors in the model, such as age. The total number of horse-years at risk for those with complete insurance was over 72,000 each year. The annual incidence rate for horses that required veterinary care at least once varied from 1080 to 1190 events per 10,000 horse-years at risk; for geldings the averaged incidence rate was 1398 events, for mares it was 1042 events, and for stallions it was 780 events per 10,000 horse-years at risk. There were considerable variations in incidence rate between breeds.

Age Distribution↗
PubMed2004

Comparative prevalence of psychotropic medications among youths enrolled in the SCHIP and privately insured youths.

The one-year prevalence of use of psychotropic medications among youths enrolled in a Mid-Atlantic State Children's Insurance Program (SCHIP) in 1999 or 2000 was compared with the 1998-2000 prevalence findings for youths enrolled in four large multistate private medical insurance programs. Prevalence was significantly higher among youths enrolled in the SCHIP than among those with private insurance in all eight medication group comparisons. Unlike private insurance, the surveyed state SCHIP program did not require a copayment or have a restrictive formulary. These administrative differences may partly explain the comparatively higher rate of psychotropic use under the SCHIP.

Adolescent↗
PubMed2002

Patterns of health insurance coverage among rural and urban children.

Despite the potential for the State Children's Health Insurance Program to improve the health care coverage of rural children, the expansion of public health insurance to children in rural areas may be hampered by a lack of understanding about the patterns of insurance coverage they experience. This study uses the Census Bureau's 1993-1996 panel of the Survey of Income and Program Participation to evaluate differences in the duration of, and in their entry into and exit from, uninsured spells. While the average duration of new spells was shorter for rural children and most regained coverage quickly, rural children were also more likely than urban children to experience protracted spells of uninsurance. Moreover, rural children were more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children.

Adolescent↗
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↗
PubMed1993

The struggle for the soul of health insurance.

The politics of American health insurance is a struggle over which vision of distributive justice should govern: the solidarity principle or the logic of actuarial fairness. Actuarial fairness is central to American private health insurance. It is both an antiredistributive ideology and a method of organizing mutual aid by fragmenting communities into ever-smaller, more homogeneous groups, leading ultimately to the destruction of mutual aid. This fragmentation is accomplished by fostering in people a sense of their differences and their responsibility for themselves, rather than their commonalities and interdependence. Actuarial fairness developed as a business strategy for gaining market share. Medical underwriting, which is far more extensive than commonly known, is the information technology used for implementing actuarial fairness. Despite significant changes in the political context of health insurance which are leading toward restraints on underwriting, the logic of actuarial fairness is so deeply embedded in the structure of competitive markets in insurance and so deeply consonant with social divisions in American society that eradicating it will take more than any current reform proposals contemplate.

Actuarial Analysis↗
PubMed1995

Voluntary public health insurance for low-income families: the decision to enroll.

A dominant issue in the health reform debate is whether insurance coverage should be voluntary or mandatory. Clearly, the factors that determine who will seek voluntary coverage are relevant to this policy issue. This article uses experience from Washington State's Basic Health Plan to examine the enrollment choices of low-income families in a state-subsidized voluntary insurance plan offered through managed care organizations. We hypothesize that the decision to enroll, which encompasses the decisions to purchase insurance coverage and to select a particular plan, is influenced by four factors: the family's financial vulnerability, their risk perception, the price of coverage, and the transition costs of enrolling. Our enrollment model is supported by the data and has important implications for the design of voluntary programs. Families who choose to enroll are more likely to have a female head of household, young children, and a family member who has a part-time job and some college education. Higher premiums and availability of other insurance coverage decrease the probability of enrolling.

Adult↗
PubMed2004

Holding back the tide: policies to preserve and reconstruct health insurance coverage in Maryland.

Over the past decade, state officials have pursued a variety of strategies to protect and expand health insurance coverage for their residents. This article examines the course of action in Maryland, where new initiatives were shaped around the state's unique hospital payment system and its reimbursement of uncompensated care, an evolving Medicaid and children's health program, and regulation of the small group health insurance market. Several important patterns emerge from the Maryland experience. First, even the most incremental initiatives--programs intended to aid a few thousand beneficiaries--bring into play the very issues that hamper comprehensive reforms: who is deserving of mutual aid and what is the proper role of government versus private entities in administering that aid. In Maryland, these issues generate conflict not only between Democrats and Republicans but also urban and rural interests. Second, all of the important reforms of the past decade were undertaken primarily in reaction to federal policy initiatives. Contrary to rhetoric lauding states as the "laboratories of democracy," the political impetus for reform and basic policy options emerge from interaction between federal and state debates. Third, even with budget surpluses and Democrats in control of the governorship and legislature, Maryland did not move aggressively toward universal health insurance. Now, with a much weaker economy and a new, Republican governor, the primary challenge will be to prevent further erosion of insurance coverage. The Maryland experience reiterates that each step toward greater health security, no matter how small, is a major technical and political challenge and that it will be difficult if not impossible to rely on states to secure coverage for all Americans in the foreseeable future.

Child↗
PubMed1995

An investigation of the effects of lifestyle on care-seeking behavior using data from health insurance claims.

To clarify the effects of lifestyle on care-seeking behavior, we conducted a questionnaire survey using Morimoto's 8 lifestyle factors and tabulated the medical evaluations at annual medical checkup of 1212 male white-collar employees of a company (aged 21-60 years in 1991), and then extracted the health insurance data for these subjects for the first half of 1992 from the health insurance-carrier computer system. The percentage of employees who visited medical facilities, the number of days of medical care, and the medical fees reported on the health insurance claims were chosen as indices of care-seeking behavior, and the relationship of each index to lifestyle and medical checkup data was examined. The health practice index (HPI), which was obtained by summing the scores for the 8 lifestyle factors was associated with the medical evaluation as expected, but was inversely correlated with the indices of care-seeking behavior. The percentage of employees who visited medical facilities, the number of the days of medical care, and the total medical fees were all higher for the subjects with high HPI scores than for those with low HPIs. Our findings are consistent with those of other researchers who have found an inverse relationship between tobacco smoking and health insurance claims, which has been attributed to the degree of consciousness of health. Compared to smokers, non-smokers have high consciousness of health and tend to consult a doctor more frequently, with resulting increased frequency of medical facility consultation and days of medical care, as well as medical fees. Lifestyle is an important aspect of physical and mental health status.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Can regulation improve long-term care insurance? Lessons from the Medigap experience.

This article uses recent experiences from the Medigap market to draw conclusions about the advisability of alternative methods of regulating the market for long-term care insurance. The analysis is based in part on interviews of state insurance regulators, insurance companies, and interest-group representatives. The authors conclude that some regulation of the market is appropriate, but that the structure and extent of regulation found in the Medigap market would likely be inappropriate for the long-term care insurance market at this time.

Aged↗
PubMed2005

Mind the gap: parents' citizenship as predictor of Latino children's health insurance.

Parents' citizenship appears to be correlated with high rates of uninsurance and low rates of job-based insurance among Latino citizen children in families headed by citizens and non-citizens. Few studies have examined the direct relationship between parents' citizenship and children's insurance status. Data for U.S.-born Latino and non-Latino white children ages 0-18 years in working two-parent households obtained from the March 2001 Current Population Survey were analyzed. Results from logistic regressions were adjusted for a design effect to account for survey design. After controlling for other sociodemographic and employment characteristics, only Latino children in families headed by non-citizen couples are more likely to be uninsured and less likely to have employer-based insurance than others in the dataset. Even controlling for non-citizen parents' duration in the U.S., citizenship status of the head of household predicts children's coverage. Latino children are more likely to have health insurance if they have at least one citizen parent. Continued and varied efforts are needed to promote coverage among U.S.-born Latino children.

Adolescent↗
PubMed2006

Primary care and health insurance among women released from New York City jails.

Factors associated with primary care utilization and health insurance coverage were examined among 511 women leaving jail in New York City from 1997-2001. One year after release, roughly half of the sample reported primary care utilization (47%) and health insurance coverage (56%). Neither outcome was more likely among those reporting diabetes, asthma, or depression. Primary care utilization was more likely among those reporting receipt of public benefits, health insurance coverage, moderate social support, avoidance of illegal activity, and HIV seropositivity. Health insurance coverage was associated with receipt of public benefits, hospitalization, primary care, and avoiding re-arrest. This study demonstrated that a majority of women leaving jail, including those with chronic diseases, lack primary care. These data highlight the need to plan for continuity of care from corrections to the community and suggest further that this can be facilitated with provision of health benefits and social support.

Adolescent↗
PubMedDate not supplied

Explaining the decline in health insurance coverage, 1979-1995.

The decline in health insurance coverage among workers from 1979 to 1995 can be accounted for almost entirely by the fact that per capita health care spending rose much more rapidly than personal income during this time period. We simulate health insurance coverage levels for 1996-2005 under alternative assumptions concerning the rate of growth of spending. We conclude that reduction in spending growth creates measurable increases in health insurance coverage for low-income workers and that the rapid increase in health care spending over the past fifteen years has created a large pool of low-income workers for whom health insurance is unaffordable.

Adult↗
PubMedDate not supplied

Insurance and new technology: from hospital to drugstore.

This paper traces the relationship between insurance coverage and the technology-induced shift of the locus of medical care and medical spending from the inpatient to the outpatient setting. This shift was accompanied by an increase in the extent of private insurance coverage for outpatient treatments; technological change both caused the increase in coverage (for more costly treatments) and was affected by it (as lower user prices increased the demand for new types of care). Changes in insurance administration technology also facilitated the transformation. Some aspects of the change may have been inefficient, because of the presence of tax subsidy and legal requirements to cover costly new technologies of low effectiveness, but the transformation appears thus far to have worked better for private insurance than for Medicare.

Aged↗
PubMedDate not supplied

Commercial health insurance: smart or simply lucky?

Changes in the commercial health insurance industry are less a strategic shift than a defensive reaction to forces the industry cannot control and risky opportunities the industry cannot pass up. Diversification into the public sector presents short-term gains for the insurance industry but leaves unchanged the fundamental challenge it faces: rapid and apparently uncontrollable growth in health care costs. Commercial insurers have not proved to be any better than public payers at controlling costs. Unfortunately, unless the drivers of health care cost are tamed, the main benefits that people seek from insurance-stable coverage and financial protection--will erode further.

Adult↗
PubMedDate not supplied

The 'graying' of group health insurance.

We examine differential declines in private insurance by income and age. We show that older, higher-income people in working families are more likely to retain private coverage as premiums rise, and we project these effects on future coverage rates. The analysis suggests that trends are leading to the "graying" of the employment-based health insurance system, where older, higher-income people get private health insurance, and others increasingly have public coverage or go without. These changes raise questions about the private health care system's ability to pool health risks. Population aging could interact with rising premiums and place additional pressure on an already strained employment-based health insurance system.

Adolescent↗
PubMed2006

Improved asthma care after enrollment in the State Children's Health Insurance Program in New York.

BACKGROUND: Uninsured children with asthma are known to face barriers to asthma care, but little is known about the impact of health insurance on asthma care. OBJECTIVES: We sought to assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with asthma. DESIGN: Parents of a stratified random sample of new enrollees in New York's SCHIP were interviewed by telephone shortly after enrollment (baseline, n = 2644 [74% of eligible children]) and 1 year later (follow-up, n = 2310 [87%]). Asthma was defined by parent report using questions based on National Heart, Lung, and Blood Institute criteria. A comparison group (n = 401) who enrolled in SCHIP 1 year later was interviewed as a test for secular trends. MAIN OUTCOME MEASURES: Access (having a usual source of care [USC], unmet health needs, problems receiving acute asthma care), asthma-related medical visits, quality (continuity of care at the USC, problems receiving chronic asthma care, use of antiinflammatory medications), and asthma outcomes (change in asthma care or severity) were the main outcome measures used. Bivariate and multivariate analyses compared measures at baseline (year before SCHIP) versus follow-up (year during SCHIP). RESULTS: Three-hundred eighty-three children (14%) had asthma at baseline, and 364 had asthma at follow-up (16%). No secular trends were detected between the baseline study group and the comparison group. After enrollment in SCHIP, improvements were noted in access: lacking a USC (decrease from 5% to 1%), unmet health needs (48% to 21%), and problems getting to the USC for asthma (13 to 4%). Children had fewer asthma-related attacks and medical visits after SCHIP (mean number of attacks: 9.5 to 3.8: mean number of asthma visits: 3.0 to 1.5; hospitalizations: 11% to 3%). Quality of asthma care improved for general measures (most/all visits to USC: 53% to 94%; mean rating of provider: 7.9 to 8.8 of 10) and asthma-specific measures (problems getting to the USC for asthma care when child was well: 13% to 1%). More than two thirds of the parents at follow-up reported that both quality of asthma care and asthma severity were "better or much better" than at baseline, generally because of insurance coverage or lower costs of medications and medical care. CONCLUSIONS: Enrollment in New York's SCHIP was associated with improvements in access to asthma care, quality of asthma care, and asthma-specific outcomes. These findings suggest that health insurance improves the health of children with asthma.

Adolescent↗