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At least 1,621 records · Page 90Linked to original sources
PubMed2003

Are there disparities in emergency care for uninsured, medicaid, and privately insured patients?

OBJECTIVES: To determine if there are any differences in proportion of high-acuity care and low-acuity care provided to uninsured, Medicaid-insured, and privately insured emergency department (ED) patients. METHODS: This was a retrospective, observational study using physician level of service provided as a marker for acuity. The study used computerized billing data (2000-2001) from an urban, teaching, Level I trauma center with 75,000 visits per year. All uninsured and Medicaid patients (age groups: pediatric, <18 years; adult, 18-64 years) were compared by physician level of service billed to Blue Cross-Blue Shield (BCBS) patients and analyzed using chi-square. Low-acuity care was defined by CPT codes 99281 and 99282. High-acuity care was defined by CPT codes 99285 and 99291. RESULTS: There were 152,379 total ED visits, with 13.2% BCBS (5,273 pediatric, 14,951 adult), 29.6% Medicaid (20,578 pediatric, 24,511 adult), and 8.1% uninsured (1,879 pediatric, 10,405 adult) patients. The percent of pediatric BCBS, Medicaid, and uninsured patients receiving low-acuity care was 30%, 35.7%, and 35.8% (p < 0.001), respectively; and for high-acuity care, it was 7.8%, 6.1%, and 6.8% (p < 0.001), respectively. The proportion of adults within these groupings was 13.7%, 13.2%, and 17.9% (p < 0.001) for low-acuity care, and 28.5%, 22.9%, and 16.7% (p < 0.001) for high-acuity care, respectively. CONCLUSIONS: Whereas there were some statistically discerned differences between insurance groupings for proportionate receipt of low-acuity care and high-acuity care among both the pediatric and adult populations, the magnitude of most differences noted was not large, and may not reflect important differences in health care need or ED use based on insurance.

Adolescent↗
PubMed1996

The influence of insurance status and income on health care use among the nonmetropolitan elderly.

The objective of this research is to examine the influence of income and type of insurance coverage on the use of health services among the nonmetropolitan elderly. A model of health services utilization is used as the foundation for examining this issue with data from a telephone survey of a randomly selected sample of residents from four nonmetropolitan counties in Pennsylvania. Results indicated that those elders with Medicaid coverage were less likely to visit a doctor than respondents with private insurance or Medicare only, even after controlling for income and other relevant factors. Further, lower income respondents with Medicare were less likely to visit the dentist than those with private insurance (Medicare does not cover dental care). In contrast, neither income nor insurance predicted hospital use. As such, the health and dental care needs of many lower income nonmetropolitan elders may potentially be going unmet. In general, findings highlight the continued relevance of economic barriers to the use of such services among the nonmetropolitan elderly.

Aged↗
PubMed1999

Primary cesarean section rates in uninsured, Medicaid and insured populations of predominantly rural northern New England.

Many studies in the United States during the past two decades have reported consistently lower cesarean section rates in women of lower socioeconomic status as defined by census tract, insurance status, or maternal level of educational attainment. This study sought to determine whether cesarean section rates in predominantly rural northern New England are lower for lower, compared with higher socioeconomic groups, as they are reported nationally and in more urban areas. Age-adjusted, primary cesarean section rates for privately insured, Medicaid and uninsured women were calculated using 1990 to 1992 uniform hospital discharge data for Maine, New Hampshire and Vermont. Age-adjusted cesarean section rates for insured women (15.71 percent) were significantly higher than those for Medicaid (14.35 percent) and uninsured (12.85 percent) women. These differences in the cesarean section rate between the insured and poorer populations in northern New England are much less than those reported elsewhere in the country.

Age Distribution↗
PubMed2005

Rural-urban differences in employment-related health insurance.

CONTEXT: Rural residents are disproportionately represented among the uninsured in the United States. PURPOSE: We compared nonelderly adult residents in 3 types of nonmetropolitan areas with metropolitan workers to evaluate which characteristics contribute to lack of employment-related insurance. RESEARCH DESIGN AND ANALYSIS: Data were obtained from the Medical Expenditure Panel Survey, pooled across 3 panels (1996--1998) to enhance the rural sample size. Econometric decomposition was used to quantify the contribution of employment structure to differences in the probability of being offered employment-related health insurance. FINDINGS: The most rural workers are 10.4 percentage points less likely to be offered insurance compared with urban workers; the difference is smaller for residents of other rural areas. In rural counties not adjacent to urban areas, lower wages and smaller employers each account for about one-third of the total difference. CONCLUSIONS: Health insurance disparities associated with rural residence are related to the structure of employment. Major factors include smaller employers, lower wages, greater prevalence of self-employment, and sociodemographic characteristics.

Adult↗
PubMed1987

Injury litigation and liability insurance dynamics.

Prices for some lines of liability insurance have increased sharply in recent years, even while the real amount of coverage provided has declined. What accounts for these changes? The large financial inertia inherent in the insurance business, forecasting errors repeated across the industry, and herd-like reactions among many insurers have made the market adjustments exceptionally abrupt. But the most likely underlying cause for the current crisis in liability insurance is the inexorable expansion in liability law.

Forecasting↗
PubMed1978

Medical malpractice insurance. Part I: A consideration of some of the factors.

The "crisis" of medical malpractice insurance is a product of a number of factors, both social and economic. Physicians, patients, insurance companies, and lawyers have all made individual and collective contributions. Social forces, changing physicians' roles and reorientation of patient attitudes have made institution of litigation against doctors much more culturally acceptable. Contingency fees, the need for compensation, and aggressive legal attitudes have increased the number of lawsuits and the size of awards, inflation, recession, and other economic developments have caused the insurance industry to be concerned about their financial welfare. The responses of various groups to these factors are presented, and their effect upon the cost and availability of medical malpractice insurance are considered.

Economics, Medical↗
PubMed1986

Use of outpatient mental health services by a general population with health insurance coverage.

Characteristics of use of mental health services by 4,254 persons enrolled in the Rand Health Insurance Study were analyzed in an attempt to predict patterns of use by a general population with assigned insurance coverage. Families in the study, whose members ranged in age from birth through 62 years, were randomly assigned to one of 14 insurance plans covering a wide variety of services by all licensed provider groups. During a one-year period less than 4 percent of the enrollees visited a mental health specialist, and only 7.1 percent saw any provider for mental health care. About half of those receiving outpatient mental health care visited general medical providers only. Annual outpatient mental health expenses per enrollee were about $25 (1983 dollars). The authors compare their findings with those of other studies and discuss their implications for insurance coverage of mental health services.

Ambulatory Care↗
PubMed1989

Utilization management in the small group insurance market.

Small businesses are the most rapidly growing segment of the economy, providing one half of all jobs in the United States. The health insurance industry must address issues which are unique to this market. The health insurance product for small businesses must have simple administration for the owners and easy access to quality medical care for the employees. Small businesses have been adversely affected by the high cost of health care. Numerous studies have shown that a major factor contributing to the high cost of health care is inappropriate and unnecessary utilization of health care. Until recently, techniques of utilization management have been difficult to adapt to the small group market. The Celtic Life Insurance Company has been using a managed care fee for service arrangement for the past three years. Celtic has been able to tailor a program for small businesses and maintain complete administrative coordination, instead of contracting with a private utilization review company. Our program maintains freedom of choice of providers and easy access to health care, without limiting access to specialists. Cost containment features have assisted insureds in selecting appropriate health care, in the appropriate setting while not interfering with the doctor-patient relationship.

Economic Competition↗
PubMed2005

The impact of private and public health insurance on medication use for adults with chronic diseases.

This article examines the impact of public and private health insurance on the use of medications for California adults with any of four chronic diseases: heart disease, high blood pressure, diabetes, and asthma. The data set used is the 2001 California Health Interview Survey. Multivariate analyses were conducted on individuals who had been diagnosed with each of these diseases. Controlling for various demographic, health status, and employment characteristics, the authors find that the uninsured are far less likely to be taking medications for each of the conditions than those with private insurance. Interestingly, those with Medicaid coverage are even more likely than those with private insurance to be taking such medications. The results of this study underscore the importance of health insurance for all persons with chronic conditions and the benefits of Medicaid in particular for low-income adults with chronic conditions.

Adolescent↗
PubMed1989

Access to health insurance in the United States.

One of the most compelling issues in United States health policy in the 1980s has been the growing number and proportion of the population with no health care coverage--no private health insurance, no Medicare coverage, no Medicaid coverage, no coverage through any other public or private program. Those without any coverage for health care expenses have come to be known as "the uninsured." The uninsured have increased from 27 million, 13 percent of the total population, in 1977 (Kasper, Walden, and Wilensky n.d.) to 37 million, 16 percent of the population, in 1987 (Short, Monheit, and Beauregard 1988). This article examines the reasons why health insurance coverage is an important issue, those groups most likely to be uninsured, the major sources and types of coverage for the insured population, and public policy options being considered to address the problem of access to health insurance.

Data Collection↗
PubMed1999

Covering uninsured children and their parents: estimated costs and number of newly insured.

The Child Health Insurance Program (CHIP) supplies $20.4 billion over 5 years and nearly $50 billion over 10 years to extend health insurance to uninsured children with family incomes up to 200 percent of poverty. This article analyzes the March 1997 Current Population Survey, estimating the number of children likely to be eligible for CHIP or currently eligible for Medicaid. Of the 8.6 million parents of uninsured children, four out of five were uninsured at the time of the survey. Expanding coverage to parents as well as children could make program participation more attractive and simplify the enrollment process. If 75 percent of uninsured parents of CHIP eligible children participated, 1.7 million parents could be insured, costing federal and state governments $4 billion. Another 3.4 million parents would be insured by expanding Medicaid to cover uninsured parents of Medicaid-eligible children.

Adolescent↗
PubMed1976

The medical care system under national health insurance: four models.

This paper presents a critical evaluation of four national health insurance models in light of their ability to counteract incentives in the present system that are dysfunctional in terms of costs and quality of care. The feasible models are labelled as: major risk insurance, alternative delivery systems under universal coverage; the public utility allocation model (alias the British system); and the public utility hospital model. It is concluded that substantial changes in the existing structure of the medical care system will be very difficult to achieve politically. Further, those models most politically feasible, the present medical care system with universal third party financing, and public utility process controls with universal third party financing, are the ones most likely to aggravate present cost-quality difficulties. Therefore, the recommended procedure for implementing national health insurance is unabashedly incremental: i.e.; to experiment with cost-sharing, alternative delivery systems, other provider incentive mechanisms and public utility regulation-budget allocation approaches, before wholesale adoption of national health insurance is entertained.

Delivery of Health Care↗
PubMed1995

Nothing succeeds like the right kind of failure: postwar national health insurance initiatives in Canada and the United States.

Health insurance was one of the most influential social reforms on the immediate postwar agenda in Canada and the United States. In both cases, proposals for national health insurance were not implemented. This article traces the evolution of these legislative proposals of the 1940s and shows how the events of this pivotal decade set the stage for future health reform in the two countries. The analysis focuses on how political institutions condition the role of state actors and the articulation of societal groups, and particularly on the crucial differences in party systems and the role of parties in shaping health reform in the two countries. In the United States, a divided Democratic party and the imperatives of political compromise made forging a consensus around health insurance more difficult. In Canada, meanwhile, the presence of a social-democratic third party led to a very different type of debate about health reform and opened the door for national health insurance.

Canada↗
PubMed1998

Proposal for a mutual insurance pool for transplant organs.

Over the past decade there have been numerous proposals to use market system incentives to attenuate the persistent shortage of transplantable human organs. While shortages have grown, opposition to market-based solutions has remained adamant. Much of the opposition has focused on monetary incentives. This article explores an alternative--a mutual insurance pool to increase the supply of organs. In the process, criticisms of earlier proposals (specifically the future delivery scheme) are addressed, the operation of an insurance pool is described, and problems associated with insurance markets are identified and addressed. The article concludes that an insurance pool could overcome public and political resistance to more explicit market-based solutions.

Attitude to Health↗
PubMed1995

The role of health insurance in the use of health services among the non-elderly.

Ronald Andersen's behavioral model was used to develop and test predictive expectations about the role of health insurance in the use of hospital and physician services. Health insurance should be more predictive of the use of physician than hospital services and it should not be predictive of the use of health care for those in poorer health who are in greater need of care. As expected, health insurance status was a predictor of physician use and not of hospital use. However, contrary to expectation, health insurance was also a predictor of hospital and physician use for those in poorer health. The results underscore the national debate concerning the uninsured and their access to health care, particularly for those in poorer health.

Adult↗
PubMed1992

Correlates of health insurance coverage: evidence from the Midwest.

The Midwest is often overlooked in national studies of health insurance status. We analyzed the economic and social characteristics of uninsured and underinsured individuals and households in a Midwestern state using both bivariate and multivariate techniques. As in much of the country, economic factors, particularly income and employment, were most significant in accounting for insurance coverage. Unexpectedly, rural and urban residents were equally likely to lack insurance. Results indicate that in rural areas, underinsurance may be a greater problem than uninsurance, and that income-based health insurance is more effective than employer-provided plans in reaching all Americans.

Adolescent↗
PubMed2003

Variation in preventive service use among the insured and uninsured: does length of time without coverage matter?

Lacking health insurance has consequences for the ways in which individuals seek care. In this research, the authors use data from the first panel (1996) of the Medical Expenditure Panel Survey to assess the relationship between preventive services and the length of time with insurance during a 12-month period. Regression analyses show that individuals with continuous coverage during the entire period have dramatically higher rates of preventive service use than individuals who lack coverage for all 12 months. For most services, the authors also find modest differences in preventive service use between the continually insured and those individuals with coverage for 1 to 6 months. Rates of preventive service use for individuals with 7 to 11 months of coverage are statistically indistinguishable from the continually insured. The authors' findings highlight the importance of considering the length of time without coverage when evaluating preventive service use of the uninsured population.

Adolescent↗
PubMedDate not supplied

A national study of commercial health insurance and medicaid definitions of medical necessity: what do they mean for children?

OBJECTIVE: To analyze medical necessity standards used by state Medicaid agencies and the largest commercial insurers in the United States on the basis of criteria related to scope of health problems covered and requirements for effectiveness and cost. METHODS: Information was obtained from managed care contract documents used by the 45 state Medicaid agencies enrolling children into managed care organizations and from certificates of coverage used by the largest health maintenance and preferred provider organization insurers in each state. RESULTS: Commercial insurers are more likely than Medicaid agencies to articulate medical necessity standards that limit coverage to treatment for illnesses and injuries and to include stringent requirements for cost and evidence of effectiveness. CONCLUSION: To reduce the discretion retained by insurers in determining medical necessity, particularly around the scope of health problems covered, much greater clarity and uniformity in medical necessity language will be required in the future.

Child↗