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PubMedDate not supplied

The demand for Medicare supplemental insurance benefits: the role of attitudes toward medical care and risk.

This paper uses data from the 1987 National Medical Expenditure Survey to analyze the role that attitudes toward medical care and risk play in Medicare beneficiaries' demand for supplemental insurance. We investigate the factors affecting the demand for any supplemental insurance as well as specific Medigap benefits, such as coverage for Medicare's gaps in hospital and physician services, skilled nursing facility care, and prescription drug purchases. Our results indicate that attitudes significantly influence beneficiaries' decisions to purchase supplemental insurance and specific benefits with effects that are comparable in magnitude to those of self-reported health measures, education, and asset income.

Aged↗
PubMed1998

The association of insurance type with costs of dispensed drugs.

This study examines the association between types of prescription drug insurance coverage and the unit cost of dispensed drugs. Logistic regression and ordinary least squares regression were used to assess differences in the use of brand name and generic drugs and the unit cost of dispensed brand name or generic drugs across four insurance categories: Medicaid, private third party, indemnity, and uninsured. The results show that private third-party and indemnity prescriptions were more likely to be dispensed with brand name drugs. Also, indemnity patients and the uninsured were dispensed brand name and generic drugs with lower unit costs. The findings have ramifications for the design of prescription drug insurance benefits and suggest that physicians may respond to the economic situation of their patients when prescribing drugs.

Cross-Sectional Studies↗
PubMed2003

A structural econometric model of family valuation and choice of employer-sponsored health insurance in the United States.

This paper estimates a fully structural unitary household model of employment and health insurance decisions for dual wage-earner families with children in the United States, using data from the 1987 National Medical Expenditure Survey. Families choose hours of work and the breakdown of compensation between cash wages and health insurance benefits for each wage earner in order to maximize expected utility under uncertain need for medical care. Heterogeneous demand for the employer-sponsored health insurance is thus generated directly from variations in health status and earning potential. The paper concludes by discussing the benefits of using structural models for simulating welfare effects of insurance reform relative to the costly assumptions that must be imposed for identification.

Adolescent↗
PubMed2005

Health insurance disparities in traditional and contingent/alternative employment.

Relative to whites, Hispanics and blacks are less likely to have employer health insurance coverage. We examine whether ethnicity or race affects employment in traditional jobs or in contingent and alternative work arrangements, and whether ethnicity or race affects insurance offer, eligibility, and/or enrollment, conditional on employment sector. Health insurance disparities relative to whites are more pronounced for Hispanics, primarily due to disparities in employment by firms that offer coverage. Eliminating racial/ethnic disparities in offers, eligibility, and takeup would increase insurance coverage rates of Hispanics in traditional jobs and of both Hispanics and blacks in contingent and alternative jobs.

Adult↗
PubMed2006

Traditional risk-sharing arrangements and informal social insurance in Eritrea.

In Eritrea neither the state nor the market is effective in providing health insurance to low-income people (in rural and informal job sector). Schemes intended for the informal sector are confronted with low and irregular incomes of target populations and consequently negligible potential for profit making. Because of this there, are no formal health insurance systems in Eritrea that cover people in the traditional (or informal) sector of the economy. In the absence of formal safety nets traditional Eritrean societies use their local social capital to alleviate unexpected social costs. In Eritrea traditional risk-sharing arrangements are made within extended families and mutual aid community associations. This study reveals that in a situation where the state no longer provides free public health services any more and access to private insurance is denied, the extension of the voluntary mutual aid community associations to Mahber-based health insurance schemes at the local level is a viable way for providing modern health services.

Cross-Sectional Studies↗
PubMed2005

Experience from "double-insurance bypass." Surgical results and additional techniques to achieve complex aneurysm surgery in a safer manner.

BACKGROUND: "Double-insurance bypass" was recently advocated to avoid the risk of cerebral ischemia during prolonged temporary occlusion of the carotid artery. For large aneurysms needing temporary but prolonged obliteration of the internal carotid artery (ICA). We have attempted the double-insurance bypass in 15 patients and, herein, report the efficacies and limitations of the procedure, and surgical techniques to make this procedure safer. METHODS: We treated 15 patients with complex internal carotid aneurysms by clipping surgery with the aid of radial artery (RA) to proximal middle cerebral artery (MCA) bypass, so-called double-insurance bypass. We analyzed surgical results of the procedure. RESULTS: In 11 patients, the duration of temporary occlusion of the ICA could be prolonged for as long as 110 minutes (mean, 45 minutes) without any ischemic complications. One patient in the earlier period of our experience suffered extended cerebral infarction due to possible restricted blood flow through the RA, because the brachial artery was compressed by the firm shoulder joint and neighboring structures. Thereafter, we routinely monitored the blood pressure of MCA (MCABP) and never experienced such cortical infarctions. Another 3 patients, however, experienced ischemia in the territory of perforating arteries that originated from a segment that could not be perfused by the RA-MCA bypass. CONCLUSIONS: In combination with monitoring of MCABP, the double-insurance bypass can be a safer and more potent adjunctive procedure for the treatment of complex internal carotid aneurysms which require prolonged temporary occlusion of the ICA.

Aged↗
PubMed1999

Outpatient costs of osteoporosis in a national health insurance population.

There are few valid data on the outpatient diagnosis and treatment of osteoporosis in Germany, despite the high prevalence of this disease and the high costs associated with its complications. We therefore conducted a retrospective cohort study to investigate the prevalence of documented osteoporosis and the use of health care resources in its outpatient treatment in a representative random sample of 7490 patients from the Dresden area who were insured under the national health insurance program for a 1-year period from the 3rd quarter of 1993 to the 2nd quarter of 1994. Documented cases of osteoporosis were identified by International Statistical Classification of Diseases, 10th Revision diagnostic codes M80 to M82, and the costs of diagnostic services for osteoporosis were calculated using a uniform fee schedule. Specific and nonspecific osteoporosis medications were classified using a published anatomic-therapeutic-chemical code, and their costs were calculated on the basis of pharmacy sales prices. Three age- and sex-matched controls without documented osteoporosis (n = 705) were assigned for each case patient in estimating the net use of resources. Data for the region, as well as age-standardized information for the overall German national health insurance system, were calculated. The 1-year prevalence of documented osteoporosis in the region was 3.14% (5.20% in women, 0.89% in men), and the age-standardized prevalence in the German national health insurance system was 2.25%. During the study period, 51.1% of the cases and 2.1% of the controls were examined by osteodensitometry. Patients received 106 defined daily doses of osteoporosis medications during the year; 37.0% of the prescribed daily doses were for sodium fluorophosphate/calcium combinations, 4.3% were for sodium fluoride, and 7.7% were for calcium alone. Sex hormones and calcitonin each accounted for 7.7% of the prescribed daily doses. Only a fraction of epidemiologically expected cases of osteoporosis have been identified and documented in the outpatient sector. Only approximately 50% of these receive osteoporosis-specific therapy, and compliance with therapy is low. To reduce osteoporosis-associated fracture rates, which are extremely cost intensive and greatly impair patients' quality of life, more consistent treatment is needed.

Adolescent↗
PubMed2000

Appraising the financial reform in Bulgarian public health care sector: the Health Insurance Act of 1998.

The public health care services in Bulgaria were deteriorating, especially during the decade of transitional process. The method of health care finance was a major reason for the poor performance of the Bulgarian public health care sector. Bulgarian policy-makers decided that an insurance-based financial mechanism could help to rescue the failing public health care services. This paper explores the social benefits and the feasibility of the insurance-based finance in the Bulgarian public health care sector. The discussion in the paper implies that, in the current conditions of economic recession, the insurance-based health care finance can not be socially beneficial for Bulgaria. Moreover, the insurance implementation seams to be unfeasible due to a lack of sufficient financial resources.

Bulgaria↗
PubMed2001

The impact of national health insurance on the utilization of health care services by pregnant women: the case in Taiwan.

OBJECTIVES: Substantially increased funding for health care services occurred in Taiwan after the implementation of a national health insurance plan in 1995. This study attempts to examine the impact of this national health insurance plan on the utilization of prenatal and intrapartum care services. METHODS: Nationally representative surveys of all pregnant women in Taiwan in 1989 (1,662 participants) and in 1996 (3,626 participants) were included in the analysis. We first compared the distribution of birth characteristics between the two surveys. We then calculated the rate of utilization of various prenatal and intrapartum care services in the two surveys in the overall sample and in subsamples, stratified by maternal education, age, and parity. RESULTS: The utilization of most prenatal and intrapartum care services, especially the complicated laboratory tests, increased in 1996 compared to 1989. For example, the proportion of women who received amniocentesis increased from 1.62% in 1989 to 5.60% in 1996 and German measles testing increased from 5.96% to 27.11%. By contrast, the proportion of women who received consultation services was stable over time, or for family planning, consultation declined from 33.21% to 27.00%. These changes in utilization over time were consistently observed across different maternal education, age, and parity groups. CONCLUSIONS: The utilization of prenatal and intrapartum care services, especially for the more expensive services, has substantially increased in Taiwan since the implementation of the national health insurance. For countries considering similar national health insurance plan, it may be helpful to consider cost-containing measures before the implementation of such a plan.

Adolescent↗
PubMedDate not supplied

Does the incidence of group health insurance fall on individual workers?

Economic models predict that the cost of health insurance is borne by workers. In this paper we ask two questions. First, is cost shifting individual-specific: does a worker with higher expected medical expenses bear this cost? Second, how do explicit employee contributions affect cost shifting? We estimate wage change regressions that include as explanatory variables changes in health insurance coverage, changes in employee premium contributions, health status, and an interaction between health insurance changes and health status. We find no evidence of a significant wage offset at either the individual or group level and conclude that changes in health insurance status are not exogenous.

Cost Sharing↗
PubMed2004

Estimating the compensating differential for employer-provided health insurance.

The theory of wage differentials argues that workers must pay for employer-provided group health insurance coverage through lower wages or reductions in other fringe benefits. This paper uses data from the 1988-90 Consumer Expenditure Survey (CEX) to estimate the wage-health insurance trade-off for male workers between the ages of 25 and 55. A fixed-effects model, which takes advantage of the rotating panel design of the CEX, is used to control for unobservable worker characteristics that are positively related with all forms of compensation, including wage earnings and health insurance coverage. I find a compensating differential for health insurance equal to roughly 10 to 11 percent of wages. Some caution is advised here due to the fact that I was unable to control for other fringe benefits, the most important being paid vacation and sick leave.

Adult↗
PubMed2003

Utilization of hepatoprotectants within the National Health Insurance in Taiwan.

BACKGROUND: Although the hepatoprotectants of Western medicine have centuries of history, their utilization patterns have been seldom documented. Because the National Health Insurance program in Taiwan reimburses hepatoprotectant use, we could estimate the age- and sex-specific prevalence and utilization patterns of hepatoprotectants in Western medicine within the health insurance system in Taiwan. METHODS: We analyzed the outpatient prescription data of 50000 randomly sampled insured patients in 2000. Only patients using drugs indicated for liver diseases and diagnostic codes related to liver diseases on the same visit were considered to be receiving hepatoprotectants. Drugs involved in Chinese medicine were not included. RESULTS: Among the valid cohort of 46614 people, 783 (1.7%) were identified as patients with liver disease and receiving hepatoprotectants. Highest prevalence of hepatoprotectant use was 4.9% in the 60-69 years age group. Silymarin, multivitamins, methionine, ursodeoxycholic acid, and liver hydrolysate accounted for 88.8% of the 3215 prescribed items of hepatoprotectants. Patients receiving hepatoprotectants had, on average, visited the clinics more frequently than those not using hepatoprotectants (30 vs 14 times in a year, P < 0.001), and used more insurance benefits (US dollars 1352 vs US dollars 456, P < 0.001). CONCLUSIONS: The frequency of use of major hepatoprotectants in Taiwan corresponded to the current modalities of treatment under discussion worldwide.

Adolescent↗
PubMed2000

[Routine documentation based on disability data of the legal health insurance].

Data on sickness absence of employees are routinely used for health reporting and the analysis of work-related morbidity by institutions of the German health insurance. Since the insurance system comprises several different branches, these health reports differ in respect of objectives, data selection, methods of analysis, and presentation of results. A further lack of comparability is caused by the heterogeneous populations, since membership in a certain health insurance depends on social status and job requirements. Aim of this paper was to review the methods and characteristics of health reports as they are routinely published in Germany. By evaluating these reports recommendations should be derived to improve comparability. The review showed that at least four different kinds of health reports should be differentiated: company-based health reports, health reports for business branches, morbidity statistics, and reports from research projects. Such reports have different objectives and therefore require different methods of data analysis. However, group-specific and common standards could be set up and it is suggested that health insurance institutions should work out report guidelines based on the recommendations given in this review.

Absenteeism↗
PubMed2003

[Allocation decisions of health insurance rehabilitation managers--An explorative case study concerning stroke rehabilitation].

We investigated processes of and subjective reasons for resource allocation in three out of four rehabilitation specialists of a regional office of a major health insurance. Decisions of health insurance personnel include approval of and duration of rehabilitation treatment and choice of clinical provider. Insurance specialists are mainly involved in documentation and coordination, whereas decisions mainly follow expert recommendations, mainly of the medical service. Allocation is based primarily on somatic impairment and disability, psychosocial function, motivation and rehabilitation potential are regarded as secondary. Goals and expected results of rehabilitation are neither individually defined nor their achievement evaluated. Decision processes are dominated by routines and agreements. Only exceptionally, defined rules and procedures are applied. Active case management is hampered by a highly specialized internal structure of the investigated insurance fund. The optimal fulfillment of individual requirements for a limited-time rehabilitation treatment is the central criterion for decision making. However, the specialists lack detailed information concerning appropriateness, quality and efficacy of rehabilitation providers, especially when taking patient-related variables into account. Instead, they trust that only high-quality institutions are contracted. Systematic control and feedback of rehabilitation results is not available. The surveyed rehabilitation managers do not include cost aspects in their decision-making. They would regard this as alien to a member- and patient-oriented policy. Improvement potentials with respect to rehabilitation case management are being reviewed.

Adult↗
PubMed2005

[Ambulatory geriatric rehabilitation and its legal classification within the statutory health insurance system].

In Germany, the number and proportion of elderly people will continue to increase. Only few hospitals and rehabilitation units are currently providing inpatient geriatric services. Concepts for graded geriatric care see ambulatory geriatric rehabilitation (AGR) as an independent service und as a complement to pre-existing structures in geriatric care. In 2004, the national association of statutory health insurance funds established recommendations for AGR, which include criteria of structural and process quality of ambulant geriatric rehabilitation. This article describes various aspects of these framework recommendations (target groups, rehabilitation indicators, and equipment of services). In addition, the classification of AGR within the legislation of the statutory health insurance system is evaluated. The financing of AGR by the statutory health insurance system and the preconditions for accreditation of AGR-services within this system are discussed. The authors conclude that discrimination between existing partially-inpatient day clinics and AGR services is not appropriate. Furthermore, there is no legal basis for such a discrimination; on the contrary, the terms partially-inpatient and ambulatory rehabilitation services can be seen as a uniform benefit according to book 5 of the German social code, SGB V. Therefore there is no differentiation between AGR and partially-inpatient rehabilitation in the statutory health insurance system.

Aged↗
PubMed2003

Clients' perceptions of contact with professionals within healthcare and social insurance offices.

AIMS: An increasing number of people interact with professionals within healthcare and social insurance offices during periods of sick leave due to musculoskeletal disorders. Knowledge of clients' perceptions of such contact is scarce. This study analysed clients' perceptions of their contact with professionals within healthcare and social insurance offices. METHODS: A cohort study was conducted in the municipality of Linköping, Sweden. Participants were all citizens who in 1985 were aged 25-34 years and had at least one new sick-leave spell due to back, neck, or shoulder diagnoses exceeding 28 days (n = 213). In 1996, 11 years after inclusion, a questionnaire about perception of contact with professionals, self-perceived health, and mental health was administered. Register data on sickness absence and disability pension from 1985-96 were also obtained. RESULTS: Factor analysis indicated the existence of three dimensions of contact with professionals: supportive treatment, distant treatment, and empowering treatment. Women perceived their contact with both social insurance officers and healthcare professionals as more supportive than did the men. Respondents with disability pensions perceived their contact with social insurance officers as more supportive and empowering than persons without disability pensions. Respondents with mental health problems perceived their contact with both types of professionals as more distant. Respondents with neck/shoulder diagnoses perceived their contact with healthcare professionals as more empowering than respondents with low back diagnoses. CONCLUSION: There was a relationship between clients' perceptions of contact with professionals and the sex, disability pension, diagnosis, and mental health of clients.

Adult↗
PubMed2002

Effect of managed care insurance on the use of preventive care for specific ethnic groups in the United States.

BACKGROUND: Ethnic disparities in access to health care is a persistent problem in the US. Despite the broad implementation of managed care, there is little information that specifically addresses how this type of coverage may affect ethnic disparities. OBJECTIVES: To examine the effect of managed care insurance on the use of preventive care for different ethnic groups. RESEARCH DESIGN: Observational cohort using the 1996 Medical Expenditure Panel Survey. SUBJECTS: Adults with health insurance who report their ethnicity as white, black, Hispanic, or Asian/Pacific Islander. MAIN OUTCOME MEASURES: (1) Mammography within the past 2 years for women between 50 and 75 years of age; (2) clinical breast exam within the past 2 years for women between 40 and 75 years; (3) Papanicolaou smear within the past 2 years for women between 18 and 65 years; and (4) cholesterol screening within the past 5 years for men and women older than the age of 20 years. RESULTS: Hispanic people enrolled in a managed care plan report higher rates of mammography, breast exam, and Papanicolaou smear compared with Hispanic people with fee-for-service insurance. For example, the adjusted predicted probability of a mammogram for Hispanic women with managed care was 85.6% compared with 72.4% for Hispanic women with fee-for-service coverage (risk difference: 13.2%; 95% CI for the risk difference 0.7%-25.7%). White persons with managed care are also more likely than white persons with fee-for-service coverage to receive mammography and cholesterol screening. Managed care is not associated with less preventive care for any ethnic group. CONCLUSIONS: In this nationally representative household survey, it was found that managed care is associated with greater use of some preventive care for Hispanic persons and white persons than fee-for-service insurance. Despite a focus on prevention, the benefits of managed care are not apparent for black persons or Asian/Pacific Islanders.

Adult↗
PubMed2005

Employer health insurance offerings and employee enrollment decisions.

OBJECTIVE: To determine how the characteristics of the health benefits offered by employers affect worker insurance coverage decisions. DATA SOURCES: The 1996-1997 and the 1998-1999 rounds of the nationally representative Community Tracking Study Household Survey. STUDY DESIGN: We use multinomial logistic regression to analyze the choice between own-employer coverage, alternative source coverage, and no coverage among employees offered health insurance by their employer. The key explanatory variables are the types of health plans offered and the net premium offered. The models include controls for personal, health plan, and job characteristics. PRINCIPAL FINDINGS: When an employer offers only a health maintenance organization married employees are more likely to decline coverage from their employer and take-up another offer (odds ratio (OR)=1.27, p<.001), while singles are more likely to accept the coverage offered by their employer and less likely to be uninsured (OR=0.650, p<.001). Higher net premiums increase the odds of declining the coverage offered by an employer and remaining uninsured for both married (OR=1.023, p<.01) and single (OR=1.035, p<.001) workers. CONCLUSIONS: The type of health plan coverage an employer offers affects whether its employees take-up insurance, but has a smaller effect on overall coverage rates for workers and their families because of the availability of alternative sources of coverage. Relative to offering only a non-HMO plan, employers offering only an HMO may reduce take-up among those with alternative sources of coverage, but increase take-up among those who would otherwise go uninsured. By modeling the possibility of take-up through the health insurance offers from the employer of the spouse, the decline in coverage rates from higher net premiums is less than previous estimates.

Adolescent↗