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At least 1,531 records · Page 85Linked to original sources
PubMed1978

No-fault malpractice insurance: Swedish plan shows us the way.

No-fault medical accident insurance could help solve some of the medical malpractice insurance problems that plague American physicians and hospitals. In Sweden, the Patient Injury Insurance Plan has been working for two years, and, with the statistics that are now available, the claims experiences under the new Swedish system can be compared with the claims experience in the United States under the traditional liability system. The author believes that an insurance system similar to the Swedish plan can work in the United States, but only if certain conditions are created.

Accidents↗
PubMed1995

[Expert assessment within the scope of legal social determination of the extent of economic responsibility of insurance for analytic psychotherapy].

Expert Opinions and Social Insurance Tribunal Rulings on the Scope of Medical Insurance Cover for Analytic Psychotherapy.--In Germany at present medical insurance cover is more or less automatic for a bone-marrow transplant costing anything up to 100,000 dollars--an operation where the death of the patients is by no means infrequent. In view of this state of affairs it is hard to comprehend the refusal on the part of insurance cover reviewers to approve ongoing cover for analytic psychotherapy beyond the 240-hour limit. In the case presented here, privately financed continuation by some 180 hours demonstrated that this prolongation and intensification of therapy was in fact essential to ensure the success of the treatment.

Expert Testimony↗
PubMed1994

Ethnic differences in use of inpatient mental health services by blacks, whites, and Hispanics in a national insured population.

OBJECTIVE: We examine whether ethnic differences in use of inpatient mental health services exist when the usually confounding effects of minority status and culture are minimized or controlled. DATA SOURCES AND STUDY SETTING: Secondary analyses were conducted using a national insurance claims database for 1.2 million federal employees and their dependents insured by the Blue Cross/Blue Shield (BC/BS) Federal Employees Plan (FEP). STUDY DESIGN: The Andersen-Newman model of health utilization was used to analyze predisposing, enabling, and need variables as predictors of inpatient mental health utilization during 1983. The study design was cross-sectional. DATA COLLECTION: The study database was made up of BC/BS insurance claims, Office of Personnel Management employee data, and Area Resource File data. PRINCIPAL FINDINGS: No significant differences were found among blacks, whites, and Hispanics in the probability of a psychiatric hospitalization or in the number of inpatient psychiatric days. Regression analyses revealed younger age and psychiatric treatment of other family members as significant predictors of a hospitalization; region of residence, younger age, hospital bed availability, and high option plan enrollment were significant predictors of the number of treatment days. CONCLUSIONS: Ethnic differences in use of inpatient mental health services were not significant in this generously insured population. Further research involving primary data collection among large and diverse samples of ethnic individuals is needed to fully examine the effects of cultural and socioeconomic differences on use of mental health services.

Adolescent↗
PubMed1996

Patient choice of physician: do health insurance and physician characteristics matter?

Generous health insurance coverage is widely believed to have contributed to both high and rising health care costs. This paper tests the hypothesis that better insured patients will demand higher "quality" by choosing more often to visit specialists rather than generalist physicians. We model the conditional decision to seek care from a specialist physician as a function of health insurance status, physician characteristics, and other socioeconomic factors. Analysis of data from the 1987 National Medical Expenditure Survey and the American Medical Association suggests that the presence of insurance coverage does not affect choice of physician. The results do show that people enrolled in health maintenance organizations (HMOs) see specialists less often than other patients.

Adolescent↗
PubMedDate not supplied

Marital status, spousal coverage, and the gender gap in employer-sponsored health insurance.

Not only do men who work full time earn more than women, but they are more likely to receive employer-sponsored health benefits. This paper provides evidence on the gender gap in employer-sponsored health insurance. The results indicate that the gap is driven largely by the tendency of married women to decline employer-sponsored insurance in favor of being covered through their husbands. Indeed, among single workers, women are more likely than men to be offered insurance. These findings call into question the conclusion made by previous researchers that employers discriminate against women in the provision of health insurance.

Adolescent↗
PubMed1998

Factors important in the purchase of partnership long-term care insurance.

OBJECTIVE: To understand the factors important in the purchase of long-term care insurance through the Robert Wood Johnson Foundation Partnership for Long-Term Care. DATA SOURCES: Information on the Partnership programs, telephone surveys, data on Partnership purchasers, and random sample frames. STUDY DESIGN: Logistic regression analysis is used to examine characteristics associated with the purchase of a Partnership insurance policy. Independent variables are health status, demographic and financial characteristics, knowledge, and attitudes. DATA COLLECTION: A telephone survey of Partnership purchasers and a random sample of the population in each Partnership state were conducted. Survey questions included health status, opinions about long-term care and long-term care insurance, financial planning, demographic characteristics, and income and assets. PRINCIPAL FINDINGS: Important in the purchase of a Partnership policy were variables associated with education and knowledge about long-term care. Other important factors include attitudes and health status. Partnership purchase is associated with higher income and asset levels up to a point, with the effect plateauing and decreasing at the highest income and asset levels. CONCLUSIONS: Improved education and knowledge are important in increasing long-term care insurance purchase. Attitudes about having a caregiver, and about the government's role in paying for long-term care as well as the potential purchaser's willingness to consider nursing home care affect policy purchase. Also associated with Partnership policy purchase are better health and middle income and asset levels.

Aged↗
PubMed1998

Effects of state reforms on health insurance coverage of adults.

States have tried a number of strategies to reduce the growing number of uninsured people. These include Medicaid expansions and various insurance reforms, such as low-cost plans, subsidized insurance products, risk pooling, open enrollment and continuity of coverage requirements, and community rating. Using data from 1989 to 1994, we examine the impact of such policies on health insurance coverage for adults. We find that few state policies have succeeded in increasing health insurance coverage. For those that work, impacts are very modest or are accompanied by adverse effects such as crowdout. Implementing effective state policies to reduce the number of uninsured remains a great challenge.

Adolescent↗
PubMed1978

The psychiatrist and health insurance claims review.

Expanded health insurance benefits for the treatment of mental illness have obliged psychiatrists to devote more time to justifying psychiatric treatment to claims reviewers. The author, drawing from experience in utilization review and peer review, summarizes factors contributing to the denial of payment for psychiatric services by health insurers, and gives practical advice on protecting against claims denials and on the process of appealing denials. Psychiatrists should make greater use of peer review committees to justify legitimate treatment services in the face of claims denials. Greater coverage for psychiatric treatment under national health insurance will increase the psychiatrist's responsibility for public accountability. This accountability will require better communication between psychiatrists and claims reviewers.

Insurance Benefits↗
PubMed1995

Differences in the frequency of cholesterol screening in patients with Medicaid compared with private insurance.

OBJECTIVE: To assess compliance with preventive screening for Medicaid recipients compared with individuals with equal access to preventive services. SETTING: A community-based family practice residency program. METHODS: Survey of a consecutive sample of English-reading individuals, aged 18 to 50 years, with Medicaid (n = 98) or private insurance (n = 75), who had scheduled appointments in the clinic. MAIN RESULTS: Patients with Medicaid were as likely as those with private insurance to be screened for hypertension and cervical cancer in the last 5 years but were less likely to have received cholesterol screening (39% vs 65%, P < .001). Even after adjusting for differences in gender composition, age, race, marital status, and education level attained, patients with Medicaid were still less likely to have received cholesterol screening (odds ratio, 0.43; 95% confidence interval, 0.21 to 0.57). Although patients with Medicaid were no more likely to identify a barrier and, when identifying barriers, did not identify significantly more barriers than patients with private insurance, Medicaid recipients were less likely to state that cholesterol testing had been recommended by their physician (30% vs 44%, P = .05). CONCLUSIONS: Because access to screening tests by patients with Medicaid is equal to or better than that of those with insurance, differences in the frequency of cholesterol screening should not reflect financial barriers. Differences in the attention paid to screening by physicians and differences in cultural beliefs about the importance of screening may play a role in the underuse of screening services by individuals in lower socioeconomic groups.

Adult↗
PubMedDate not supplied

The effects of insurance coverage on the quality of prenatal care.

OBJECTIVE: To compare the quality of prenatal care provided to patients with traditional fee-for-service, health maintenance organization, and Medicaid insurance using an evidence-based, community-derived prenatal care guideline. DESIGN: Retrospective cohort study. SETTING: Seven private and hospital-based prenatal care sites in a suburban county in southeast Michigan. PATIENTS: A stratified random sample of 267 patients (93 with Medicaid, 92 with health maintenance organization, and 82 with fee-for-service insurance) receiving prenatal care from community physicians (obstetricians-gynecologists and family practitioners) between January 1, 1991, and December 31, 1992. MAIN OUTCOME MEASURE: Adherence to explicit prenatal care criteria as measured by an evidence-based prenatal care guideline developed by a community panel. "Quality scores" were compared across groups in 4 areas: performance of prenatal screening procedures or tests, visit-based screening, substance use screening, and clinician management of abnormal clinical findings. RESULTS: Patients with Medicaid insurance presented for prenatal care significantly later in pregnancy (14.5 vs 10.5 weeks, P < .01). No significant differences were seen between groups in quality scores for screening tests, clinician management of abnormal clinical findings, visit-based screening, or substance use screening. The overall similarity in quality scores did obscure some significant differences in adherence to individual criteria, particularly in the area of screening tests. Significantly more patients with Medicaid were screened for genital infection (P < .001) and fewer for gestational diabetes (P < .001) or anemia (P < .001) than patients in the other 2 groups. CONCLUSIONS: Although patients with Medicaid presented for prenatal care later in pregnancy and received a different "package" of screening tests than the other 2 groups, there was no overall measurable difference in the quality of prenatal care provided to patients with Medicaid, health maintenance organization, and fee-for-service insurance. Clinicians may have altered screening protocols based on preexisting perceptions of patient risk. Although summary quality measures are a promising tool for comparative research, they provide an incomplete picture of the quality of the prenatal care process and must be interpreted with caution.

Fee-for-Service Plans↗
PubMed2002

Insurance coverage, medical conditions, and visits to alternative medicine providers: results of a national survey.

BACKGROUND: In 1997, patients made an estimated 629 million visits to complementary and alternative medicine (CAM) providers; however, little is known about factors associated with visits to CAM providers. OBJECTIVE: To examine the effect of insurance coverage on frequency of use of CAM providers. METHODS: We conducted a nationally representative, random household telephone survey of 2055 adults. MAIN OUTCOME MEASURE: The number of visits made to CAM providers. RESULTS: An estimated 44% of the US population used at least 1 CAM therapy in 1997. Of those using CAM, 52% had seen at least 1 CAM provider in the last year. Among those who used a CAM therapy, factors independently associated with seeing a provider were having been in the upper quartile of visits to conventional providers in the last year (adjusted odds ratio [AOR], 2.00; 95% confidence interval [CI], 1.33-3.01), female sex (AOR, 1.67; 95% CI, 1.17-2.38), and having used the therapy to treat diabetes (AOR, 5.20; 95% CI, 1.40-19.40), cancer (AOR, 2.99; 95% CI, 1.04-8.62), or back or neck problems (AOR, 1.51; 95% CI, 1.02-2.23). Factors independently associated with frequent use (. or = 8 visits per year) of a CAM provider were full insurance coverage of the CAM provider (AOR, 5.06; 95% CI, 2.45-10.47), partial insurance coverage (AOR, 3.26; 95% CI, 1.72-6.19), having used the therapy for wellness (AOR, 2.85; 95% CI, 1.63-4.98), and having seen the provider for back or neck problems (AOR, 2.26; 95% CI, 1.29-3.94). Conservative extrapolation to national estimates suggests that 8.9% of the population (17.5 million adults) accounted for more than 75% of the 629 million visits made to CAM providers in 1997. CONCLUSIONS: A small minority of persons accounted for more than 75% of visits to CAM providers. Extent of insurance coverage for CAM providers and use for wellness are strong correlates of frequent use of CAM providers.

Adult↗
PubMed1989

The effects of insurance generosity on the psychological distress and psychological well-being of a general population.

Reductions in the generosity of fee-for-service insurance lower the use of general medical and mental health services, but do they lead to lower mental health status for the covered population? We addressed this question using data from the RAND Corporation Health Insurance Experiment. Families in six sites in the United States were randomly assigned to one of 14 insurance plans for three- or five-year periods. On average, there were no significant adverse effects of cost-sharing plans, relative to a free-care plan, on either psychological well-being or psychological distress, when the cost-sharing plans included full catastrophic coverage. Those with high mental health status but low income at baseline had significantly more favorable mental health outcomes on the cost-sharing plans than on the free-care plan. We cannot definitively comment on the effects of insurance generosity for the sick poor. Our findings apply in the context of mandated comprehensive mental and general health coverage for a general nonelderly, nondisabled household population.

Adult↗
PubMed1999

Measuring the impact of health insurance with a correction for selection bias--a case study of Ecuador.

This article develops and uses methodologies to evaluate the impact of publicly-financed health insurance programmes on the use of health care. Using univariate and bivariate probit estimation techniques, the study tests and corrects for endogeneity resulting from selection bias. Potential endogeneity arises from the choice to be insured, eligibility for insurance, and differences in individuals' health status. The setting for the study is the country of Ecuador. The General Health Insurance (GHI) programme, which primarily covers workers in the formal sector of the economy, is found to have a strong positive association with the use of curative health care after correcting for selection bias, but no significant effect on the use of preventive care. Individuals with severe illnesses who are eligible for GHI have a preference for private health care, and self-select out of the GHI programme. The Seguro Campesino Social (SSC) programme, directed at farming populations, has positive but insignificant associations with both curative and preventive care.

Ecuador↗
PubMed2006

Differences in disease outcomes between medicaid and privately insured children: possible health disparities in juvenile rheumatoid arthritis.

OBJECTIVE: To determine the relationship between health insurance status and disease outcome in children with juvenile rheumatoid arthritis (JRA). METHODS: JRA patients followed at a tertiary pediatric rheumatology center were assessed for the number of active joints and number of joints with limited range of motion. Disease activity, patient well-being, and pain were measured. Disability was assessed by the Childhood Health Assessment Questionnaire, health-related quality of life by the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale, and the PedsQL Rheumatology Module. Health care resource utilization was estimated based on the number of billing events for health services coded in administrative databases; these databases also provided information on patient health insurance status. Children insured by Medicaid or similar state programs for low-income families were considered to have Medicaid status. Disease outcomes of children with Medicaid status was compared with that of children with private health insurance. RESULTS: Forty (14%) of the 295 children with JRA had Medicaid status. Patients with Medicaid status were more often of nonwhite race (P < or = 0.04) and more frequently had a polyarticular or systemic disease course (P = 0.04) compared with other patients (n = 255). After correction for differences in disease duration, race, JRA onset, and JRA course between groups, children with Medicaid status continued to have significantly higher disability (P < 0.0003), and lower mean PedsQL Generic Core Scale scores (P < 0.05), while health resource utilization appeared similar between groups. CONCLUSION: Despite apparently similar health resource utilization and joint involvement, Medicaid status is associated with significantly lower health-related quality of life and higher disability in JRA.

Adolescent↗
PubMed2003

Education, employment, insurance, and marital status among 694 survivors of pediatric lower extremity bone tumors: a report from the childhood cancer survivor study.

BACKGROUND: With increasing numbers of childhood cancer survivors, direct sequelae of cancer therapy and psychosocial outcomes are becoming more important. The authors described psychosocial outcomes (education, employment, health insurance, and marriage) for survivors of pediatric lower extremity bone tumors. METHODS: The long-term follow-up study of the Childhood Cancer Survivor Study is a multiinstitutional cohort study comprising 14,054 individuals who have survived for 5 or more years after treatment for cancer diagnosed during childhood or adolescence. Baseline demographic and medical information were obtained. Six hundred ninety-four survivors had osteosarcoma or Ewing sarcoma of the lower extremity or pelvis and were classified by amputation status and by age at diagnosis. The median age at diagnosis was 14 years old with a median of 16 years of follow up since diagnosis. Demographic characteristics were used to analyze the rates of psychosocial outcomes. RESULTS: Amputation status and age at diagnosis did not significantly influence any of the measured psychosocial outcomes. Education was a significant positive predictor of employment, having health insurance, and being currently in their first marriage. Male gender predicted ever being employed and female gender predicted having health insurance and marriage. When compared with siblings, amputees had significant deficits in education, employment, and health insurance. CONCLUSIONS: Overall, no differences between amputees and nonamputees were found. However, gender and education play a prominent role. When compared with siblings, amputees in this cohort may benefit from additional supports.

Adolescent↗
PubMed2007

Employment-contingent health insurance, illness, and labor supply of women: evidence from married women with breast cancer.

We examine the effects of employment-contingent health insurance (ECHI) on married women's labor supply following a health shock. First, we develop a theoretical framework that examines the effects of ECHI on the labor supply response to a health shock, which suggests that women with ECHI are less likely to reduce their labor supply in response to a health shock, relative to women with health insurance through their spouse's employer. Second, we empirically examine this relationship based on labor supply responses to breast cancer. We find that health shocks decrease labor supply to a greater extent among women insured by their spouse's policy than among women with health insurance through their own employer, suggesting that ECHI creates incentives to remain working when faced with a serious illness.

Breast Neoplasms↗
PubMedDate not supplied

The cost of rationing medical care by insurance coverage and by waiting.

This paper raises the question of the least-cost institutional mechanism to secure the value of certainty by reducing risk over the purchase of medical care. Two methods of reducing risk are evaluated: financing medical care with 'complete insurance', that is, ready access to medical care that is free at the point of purchase; and rationing by waiting time in a national health service that supplies a limited volume of medical care. The first system corresponds to the type of insurance held by most people in the United States, while the latter represents a stylized model of a national health service. The cost of over-utilization of services by insured consumers in the U.S. is substantial--larger on a per-family basis, and far larger for the nation, than the cost of under-utilization by those who lack insurance. The cost of rationing by waiting is estimated to be between $541 and $828 per family (in 1984 dollars). Thus, both systems involve costly mis-allocation of resources.

Actuarial Analysis↗
PubMed2003

Willingness-to-pay for community-based insurance in Burkina Faso.

PURPOSE: To study the willingness-to-pay (WTP) for a proposed community-based health insurance (CBI) scheme in order to provide information about the relationship between the premium that is required to cover the costs of the scheme and expected insurance enrollment levels. In addition, factors that influence WTP were to be identified. METHODS: Data were collected from a household survey using a two-stage cluster sampling approach, with each household having the same probability of being selected. Interviews were conducted with 2414 individuals and 705 household heads. The take-it-or-leave-it (TIOLI) and the bidding game were used to elicit WTP. RESULTS: The average individual was willing to pay 2384 (elicited by the TIOLI) or 3191 (elicited by the bidding game) CFA (3.17 US dollars or 4.25 US dollars) to join CBI for him/herself. The head of household agreed to pay from 6448 (elicited by the TIOLI) or 9769 (elicited by the bidding game) CFA (8.6 US dollars or 13.03 US dollars) to join the health insurance scheme for his/her household. These results were influenced by household and individual ability-to-pay, household and individual characteristics, such as age, sex and education. The two methods yielded similar patterns of estimated WTP, in that higher WTP was obtained for higher income level, higher previous medical expenditure, higher education, younger people and males. A starting point bias was found in the case of the bidding game. CONCLUSIONS: Both TIOLI and bidding game methods can elicit a value of WTP for CBI. The value elicited by the bidding game is higher than by the TIOLI, but the two approaches yielded similar patterns of estimated WTP. WTP information can be used for setting insurance premium. When setting the premiums, it is important to consider differences between the real market and the theoretical one, and between the WTP and the cost of benefits package. The beneficiaries of CBI should be enrolled at the level of households or villages in order to protect vulnerable groups such as women, elders and the poor.

Adult↗