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PubMed1995

Long-term care and the private insurance market.

Increased life expectancy and the aging of the baby boom generation will bring rapid growth in the number of people at risk of needing long-term care (LTC). This Issue Brief provides an overview of the current LTC financing and delivery system in the United States, focusing on private-sector initiatives to meet the United States' LTC needs. It discusses private-sector plan design--particularly employment-based plan design--providing an in-depth look at the dramatic changes taking place in the private-sector LTC market since its inception in the early and mid 1980s. Aside from informal care provided in the community, the current system of financing LTC depends largely on the Medicaid program and individual financing. Issues confronting this system include spiraling costs associated with LTC services that may threaten beneficiaries' access to care. Other issues include the potential depletion of personal assets and a bias toward institutionalization (which may not always provide the most cost-effective or desired type of care available). Many leaders regard private long-term care insurance (LTCI) as a way to increase access to financing and as a potential alternative to Medicaid and out-of-pocket financing. By the end of 1993, a total of 3.4 million private-sector LTCI policies had been sold, up from approximately 815,000 in 1987. While the majority of these plans were sold to individuals or through group associations, employment-based plans accounted for a significant proportion of this growth. Premiums for LTCI vary substantially based on age and plan design. Insurers generally attempt to set premiums such that they will remain level over the insured's lifetime. However, because little LTC claims insurance experience yet exists, the actuarial basis for developing premiums and statutory reserves is limited. Several bills over the last three Congresses have been introduced to address the issue of LTC. However, due to cost implications and lack of consensus regarding the optimum overall structure required to finance and deliver care, broad legislation to expand coverage--particularly public coverage--is not likely in the near term.

Aged↗
PubMed1997

Individual market health insurance reform: portability from group to individual coverage: federal rules for access in the individual market; state alternative mechanisms to federal rules--HHS. Interim final rule with comment period.

This interim final rule with comment period implements section 111 of the Health Insurance Portability and Accountability Act of 1996, which sets forth Federal requirements designed to improve access to the individual health insurance market. Certain "eligible individuals" who lose group health insurance coverage are assured availability of coverage in the individual market, on a guaranteed issues basis, without preexisting condition exclusions. In addition, all individual health insurance coverage must be guaranteed renewable. This rule also sets forth procedures that apply to States that choose to implement a mechanism under State law, as an alternative to the Federal requirements, with respect to guaranteed availability for eligible individuals. It also sets forth the rules that apply if a State does not substantially enforce the statutory requirements.

Career Mobility↗
PubMed1991

Health insurance coverage among disabled Medicare enrollees.

In this article, we use the Survey of Income and Program Participation to identify patterns of non-Medicare insurance coverage among disabled Medicare enrollees. Compared with the aged, the disabled are less likely to have private insurance coverage and more likely to have Medicaid. Probit analysis of the determinants of private insurance for disabled Medicare enrollees shows that income, education, marital status, sex, and having an employed family member are positively related to the likelihood of having private health insurance, whereas age and the probability of Medicaid enrollment are negatively related to this likelihood.

Aged↗
PubMed1998

Marketing long-term care insurance. Public education ads to the proper target must precede sales efforts.

The ingredients for a financial calamity affecting both government and individual citizens and their families are in place. Federal legislators have made little progress in addressing the health care needs of an aging America, and the proposals that have been advanced offer little or nothing in the way of better help with long-term care. One potential scenario is that middle-income retirees placed in long-term care will exhaust their finances and then turn to Medicaid, creating an enormous expense for the government. Long-term care insurance could alleviate the situation, but current practices by the insurance industry in marketing products to the elderly complicate the sale of such insurance. Consumers approaching retirement age are receptive to this type of product, but first they must be made aware of the merits of long-term care insurance and the paucity of alternatives. Only then can marketers promote specific products successfully.

Advertising↗
PubMed1992

How much protection is enough? Debate over consumer safeguards in LTC insurance intensifies. Panel discussion.

The growing momentum behind a push for federal intervention in regulating long-term care insurance has sparked a tempestuous controversy with insurers, politicians, consumers and regulators in the eye of the storm. Some insurers are adamantly opposed to nationwide standards, while others have banded together to lobby for a combination of federal/state oversight. Consumer representatives generally favor uniform regulation, but regulators and politicians are split on the issue of whether the states or feds should control the requirements. A panel representing the assorted views of the special interest groups with a stake in this debate shared their perspectives during the Eighth Annual Private Long Term Care Insurance Conference that recently convened in San Francisco. The following comments are excerpts from their discussion on the role of regulation in consumer protection.

Consumer Advocacy↗
PubMed1997

Hepatitis C prevalence and the significance of liver enzyme elevations in the insurance population.

BACKGROUND: Liver enzyme elevation(s) are a common finding in the insurance applicant population. Hepatitis C infection results in histological and functional changes in the liver with both short and long term changes in serum liver enzyme levels. The prevalence of antibodies to HCV in the general population is estimated to be 4%. This paper reports on the prevalence of antibodies to HCV in the insurance applicant population and their relationship to the liver enzyme(s). RESULTS: Antibodies to HCV are present in 1.8% of a random sampling of insurance applicants. Alanine aminotransferase (ALT) elevations occur in 95.4% of all samples positive for antibodies to HCV. More than half of positive samples (56.7%) have ALT elevations of less than two time the upper range of normal. Antibody prevalence is lowest in samples with single enzyme elevation, 4.2%. In comparison, the prevalence is 16.4% in samples with all three enzymes, ALT, AST, and GGT, elevated. For maximal specificity two immunoassays, configured with different HCV antigens, should be performed sequentially on all positive applicant samples. CONCLUSION: HCV is the most prevalent, chronic viral infection in the insurance population. HCV prevalence is 40 times HIV prevalence. In an evaluation of enzyme reflex markers ALT was positive for antibodies to HCV 8.6% of the time while identifying 95.4% of HCV antibody positive applicants.

Adult↗
PubMed1999

Reform of health insurance in the Federation of Bosnia and Herzegovina.

The aim of this report is to provide an overview of the reform of health insurance in the Federation of Bosnia and Herzegovina (FBH). Health financing and resource allocation policies in the FBH are also summarized. Health financing should be ensured through three types of health insurance: compulsory, supplementary, and voluntary. The revenues for the compulsory health insurance will be ear-marked through payroll taxation. Facing the scarcity of resources, the Federation authorities have decided to raise the proportion of the payroll contribution as compared to the pre-war level and engage in various arrangements of cost-sharing and priority setting in health care. The resource allocation policy underlines two key parts of the health care reform: contracting mechanisms and payment systems. We also discuss the optimal correlation between solidarity and competition in the course of the ongoing reform of the health insurance in the Federation. The social function of a competent health system, where the well-being of the population is viewed as a sociological category of the overall society's concern, requires considerable subsidization. Incentive-based market mechanisms may be introduced into some of the segments of health care system but only under government-led control of the effects of such measures.

Bosnia and Herzegovina↗
PubMed1999

Health insurance and productivity.

AIM: To provide a conceptual understanding of the basic relationship between health insurance and overall economic productivity, and to look at the human development index as a proxy for the quality of human capital. METHODS: Economic data and data related to human development in Central and Eastern European (CEE) countries, including Croatia, were compared to the European Union (EU) average. Data were selected out of databases provided by the International Monetary Fund, the Organization for Economic Cooperation and Development, and the United Nations. Income and growth rates were related to the EU averages. The human development index was used to compare the level of the average achievements in the longevity of life, knowledge, and quality of living in CEE countries. RESULTS: Relative to the EU-average, human development is lagging behind in CEE countries. Considering the world as a benchmark regarding human development, 8 out of 13 CEE countries exceed the world. However, all CEE countries have 3-28% lower human development than the industrialized countries. CONCLUSIONS: The specific challenge for transition countries is how to adopt strategies to translate economic progress into health and social gains through reliable institutions, among them social health insurance bodies. The institutions and the provision of social health insurance are particularly challenged at a turning point when transition in terms of macroeconomic stabilization, along with the consolidated organization and financing of social and health insurance schemes, is accommodated to a business cycle-driven market economy.

Economics↗
PubMed1986

The legal system, insurance, and health care. What can be done about the liability problem? An ECRI technology management assessment.

Health care providers are currently experiencing a malpractice "crisis" that, in some regions and for some medical specialties, is as serious as the one that occurred a decade ago. Whether providers themselves, the insurance industry, or lawyers and the legal system are seen as responsible for today's crisis depends primarily on the observer. However, evidence indicates that, in health care, negligence by those who provide services (physicians and hospital personnel) is a more important factor in the health care liability crisis than is so for other sectors of society that also face liability-insurance problems (e.g., municipal governments, light aircraft manufacturers, ski-slope operators). While physicians and hospitals can participate in legislative efforts to achieve tort reform and more stringent regulation of liability insurers, this study suggests that they will have more success in reducing malpractice insurance premium rates by concentrating instead on improving the quality of patient care. Towards this end, a number of specific actions are outlined, ranging from greater use of patient-care protocols and algorithms to increased activity by state medical licensing and disciplinary boards.

Hospitals↗
PubMed1982

Medicare program; services covered under automobile, liability, and employer group health insurance--Health Care Financing Administration. Proposed rule.

The Health Care Financing Administration is proposing regulations dealing with services covered under automobile medical, no-fault, or liability insurance and services to end-stage renal disease beneficiaries who are also insured under employer group health plans. These rules are required by sections 953 of the Omnibus Reconciliation Act of 1980 which excludes from Medicare coverage any services for which payment has been made or can reasonably be expected to be made under an automobile or liability insurance policy or plan or under no-fault insurance, and section 2146 of the Omnibus Budget Reconciliation Act of 1981 which makes medicare benefits secondary to benefits payable under an employer group health plan for services furnished to end-stage renal disease beneficiaries during a specified period of up to 12 months. The intent is to conserve Medicare funds and prevent duplicate payments by Medicare.

Acute Kidney Injury↗
PubMed1985

Insurance coverage and ambulatory medical care of low-income children: United States, 1980.

In the household survey phase of the National Medical Care Utilization and Expenditure Survey of 1980, a survey was conducted of 17,123 persons who constituted a representative sample of the civilian population in the United States not residing in institutions. Through repeated interviews the survey obtained information on the health conditions of these people, the health care services they received in 1980, the costs of these services, and the sources of payment for services. This report, one of a series of reports on the survey findings, provides a profile of low-income children: Their health insurance coverage, health service use, and expenditures for physician visits. Children under 18 years of age in families below 150 percent of the 1980 Federal poverty level are considered low income. However, children who were ineligible to participate in the survey for part of the year are excluded, such as those who were born, who died, or who were institutionalized in 1980. A physician visit is defined as a face-to-face contact with a physician or a nonphysician working under the supervision of a physician. In addition, visits to nurse practitioners and physician assistants who were reported as "independent providers" are included. Otherwise, visits to independent providers (primarily chiropractors and optometrists), mental health visits, visits by physicians to hospital inpatients, and telephone contacts are excluded. Of the 63.9 million children under 18 years of age in the United States in 1980, about one-fourth (16.8 million) lived in low-income families, according to estimates from the National Medical Care Utilization and Expenditure Survey. Nearly one-half (46 percent) of the 16.8 million low-income children were covered by Medicaid for all or part of 1980: 31 percent were covered by Medicaid only for the full year, 3 percent were covered by Medicaid for part of 1980 and uninsured for the remainder of the year, and 12 percent were covered by both Medicaid and private insurance during the year. An additional 30 percent of the low-income children were privately insured for the full year, while 8 percent had private insurance coverage for part of the year and were uninsured otherwise. Sixteen percent of the children in low-income families, or 2.7 million children, were uninsured for all of 1980. When added to the 3 percent with part year Medicaid coverage and the 8 percent with private coverage part of the year, over one-fourth (28 percent) were uninsured for at least part of 1980.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

Private health insurance: new measures of a complex and changing industry.

Private health insurance benefit payments are an integral component of estimates of national health expenditures. Recent analyses indicate that the insurance industry has undergone significant changes since the mid-1970's. As a result of these study findings and corresponding changes to estimating techniques, private health insurance estimates have been revised upward. This has had a major impact on national health expenditure estimates. This article describes the changes that have occurred in the industry, discusses some of the implications of those changes, presents a new methodology to measure private health insurance and the resulting estimate levels, and then examines concepts that underpin these estimates.

Evaluation Studies as Topic↗
PubMed1999

Health insurance, the quantity and quality of prenatal care, and infant health.

This paper presents a comprehensive analysis of the relationship between Medicaid, infant health, and the quantity and quality of prenatal care using data from the 1988 National Maternal and Infant Health Survey (NMIHS). This integrated approach provides a more complete picture of the effect of Medicaid and its avenues of influence, and is less likely to lead to spurious findings. The results indicate that there was no statistically significant relationship between insurance status and birth weight holding constant other observed characteristics, although there was some evidence that uninsured women and Medicaid recipients received less prenatal care than did privately insured women. Differences in prenatal care utilization, however, were small. In addition, there was no evidence that uninsured women or Medicaid recipients received lower-quality prenatal care than privately insured women did even in a period prior to implementation of state programs aimed at ensuring high-quality care. The results of this paper raise questions about the efficacy of the current public health response to poor infant health that relies on expanding insurance coverage and enriched prenatal care programs.

Birth Weight↗
PubMed1999

The impact of insurance status on drug abuse treatment completion.

This article discusses the impact of insurance status on drug abuse treatment completion in a not-for-profit organization, presents demographic findings, mentions financial obstacles to paying for treatment, and describes the relationship between different variables: treatment modalities versus type of drug, treatment modality versus length of stay, reason for discharge versus type of drug, and reason of discharge versus treatment status (completed/not completed). Baseline data (n = 6,539) for the period 1990-1997 was analyzed. For the insurance status analysis we randomly selected and analyzed 1,153 client entries. A statistical software package (STATA) was used for a combination of bivariate and multivariate analysis. Our results indicated, consistent with expectations, that lack of health insurance is associated significantly with not completing treatment. Therefore, new strategies and mechanisms of payment should be created to overcome these obstacles and facilitate treatment completion for clients without insurance coverage.

Ambulatory Care↗
PubMed1999

[The quality perceived by the users of health centers and by private insurance companies].

OBJECTIVE: To find and analyse the views of both health centre users and users of private insurance companies on the quality of services offered. DESIGN: Descriptive, crossover study using qualitative methodology. The views of health centre and private insurance company users on the quality of services delivered were gathered through 8 focus groups. The variables of opinion analysed were defined according to the SERVQUAL model of Parasuraman on perceived quality. SETTING: Three health districts in a health area in Andalusia. PARTICIPANTS: 70 users took part. RESULTS: Accessibility (prior appointment, information and reception service, hours open), capacity for response (speed and efficiency of processing) and internal organisational coordination were considered by health centre users weak-points of the primary care services, which affected negatively their credibility. These variables were identified by private insurance users as the main advantages of the care model for which they had opted. Reliability was valued positively by health centre users, but received a higher valuation from private insurance users. However, the courtesy and friendliness of health centre professionals was seen as an outstanding point of the service, and no different from that of private professionals. The use of clinical records, the competence of the professionals and the tangible aspects of health centres were identified by their users as strong points of the primary care services and give the public care model an advantage over the private one.

Attitude to Health↗
PubMed1999

Donor and the health insurance card.

The health insurance card is a new electronic identification document of insured persons and facilitates smoother communication between the health insurance information system and the Slovene health care service provider information systems. The card stores the insured person's identification details as well as the information on the selected personal physician. Another procedure also to be hosted on the card, will be the card holder's personal decision about being voluntary donor of organs and tissues for transplant purposes. This data item will, supported by the enhancement of technological infrastructure, improve the control of the donorship information. In Slovenia, registering, recording and application of the organ and tissue donorship data is carried out, on a pilot basis, in the region of Posavje.

Humans↗
PubMed2000

Genetic testing, adverse selection, and the demand for life insurance.

The dramatic increase in genetic testing for adult-onset diseases has created a debate regarding whether or not insurance companies should be able to use genetic test results in underwriting. We use data from women who have been tested for the BRCA1 gene mutation along with data from otherwise comparable untested women to assess the potential for adverse selection in the life insurance market when tested individuals know their genetic test results but insurers do not. Our analyses show that women who test positive for the BRCA1 gene mutation do not capitalize on their informational advantage by purchasing more life insurance than those women who have not undergone genetic testing.

Adolescent↗
PubMed2000

Explaining the decline in health insurance coverage among young men.

This article examines the experience of cohorts of young American men to see how and why their employer-provided health insurance coverage has changed over time. It explores changes in the structure of the labor market, changes in the cost of employer-provided health insurance, and changes in the composition of wages and benefits offered to employees. We find that increases in the cost of health insurance rather than changes in the structure of the labor market are the principal cause of the observed decline in employer-provided health insurance coverage across all cohorts.

Adult↗