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At least 19 recordsLinked to original sources
PubMed1999

Health insurance, health reform, and outpatient mental health treatment: who benefits?

This research examines how extending health insurance coverage to the previously uninsured impacts outpatient mental health treatment use among adults with different needs. Using data from the Epidemiologic Catchment Area Study and the 1987 National Medical Expenditure Survey, I develop simulations based on estimates of treatment demand. I find that insurance substantially increases demand by the mentally ill, but increased coverage alone cannot meet their treatment needs. Those in better mental health account for significant proportions of additional demand when coverage is expanded. Policies intended to increase access to mental health treatment among targeted groups should carefully consider the costs of increased use by other people.

Adult↗
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↗
PubMed1992

The practice and ethics of risk-rated health insurance.

Health insurance in the United States is driven by competitive risk rating and is promoted as the best way to give policyholders optimal value for their money and to be fair to those with lower risks. In practice, however, competitive risk rating costs more than noncompetitive, universal systems of health insurance, and it erodes the basic function of insurance to spread infrequent large losses over a wide base. This article describes not only how risk rating covers least those with the greatest medical bills, but also how it has spawned a labyrinth of complex manipulations by insurance companies to charge more or pay less than actuarially fair risk rating would justify. The final section shows that even if risk rating were done fairly, it contradicts moral fairness. Many of the leading proposals for national health insurance do not address these practical and ethical issues. The medical profession and policymakers need to discuss them and take a stand on them.

Actuarial Analysis↗
PubMed1997

The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment.

CONTEXT: The government of Taiwan introduced universal health insurance to cover all citizens in 1995. This national health insurance program was proposed to assure the accessibility to health care at reasonable cost. Evaluation of the consequences, including health care utilization and expenditure, is crucial for policy adjustment. OBJECTIVES: To evaluate the effect of Taiwan's national health insurance on health care utilization. DESIGN: Cohort survey conducted before and after the implementation of the national health insurance program. PARTICIPANTS: A total of 1021 randomly selected Taiwanese adults. MAIN OUTCOME MEASURES: Physician visits in the 2 weeks prior to the survey and hospital admissions and emergency department visits in the immediate past year. RESULTS: After the introduction of universal health insurance, the newly insured consumed more than twice the amount of outpatient physician visits (0.21 vs 0.48, P<.05) and hospital admissions (0.04 vs 0.11, P<.05) than before universal health insurance was implemented, bringing them to the same amount of health care contacts as the previously insured group. The newly insured also experienced an insignificant increase in emergency department visits. In contrast, the previously insured group had a small but statistically significant increase in outpatient visits (0.48 vs 0.59, P<.05) and insignificant changes in hospital admissions and emergency department visits. CONCLUSION: The universal health insurance removed some barriers to health care for those newly insured. The copayment design in the insurance scheme seemed to have an insignificant effect on curbing medical care utilization. Taiwanese health policy analysts should seriously consider the growth of health care expenditures since the implementation of universal health insurance.

Adult↗
PubMed2001

Korean American health insurance and health services utilization.

The purpose of this ethnic group study was to describe the unique pattern of Korean Americans, as compared with the aggregate of Asian Americans, for: (a) the predisposing, enabling, and need factors for health service utilization, focusing specifically on the role of health insurance coverage; and (b) predictors of health insurance coverage. Using the behavioral model for health service utilization, data were selected from the 1992 National Health Insurance Survey (NHIS, 1994) for Korean Americans (n = 345) and Asian Americans (n = 3,059). Results differed between the Korean American group and the Asian American group. Health insurance coverage was the strongest predictor of Korean American utilization, and need factors lacked significance, suggesting that uninsured Korean Americans have less access regardless of need. For the aggregate Asian American group, need factors tempered the influence of health insurance on utilization. Results of this type of study may be helpful for designing and implementing health care services tailored for specific ethnic at-risk markets.

Adolescent↗
PubMed1991

Who cares for the care givers? Lack of health insurance among health and insurance personnel.

OBJECTIVE: --To analyze the health insurance status of physicians, other health personnel, and insurance industry personnel. DESIGN: --The study was based on data collected by the US Bureau of the Census in the March 1991 Current Population Survey for six groups of workers in health care occupations and three classifications of insurance employees. This survey included 6182 civilian health personnel and 1498 insurance workers under the age of 65 years. RESULTS: --Of civilian health personnel under the age of 65 years, 9% (90% confidence interval [CI], 8.2% to 9.8%) are uninsured, equivalent to 834,000 persons, including 15,000 (90% CI, 5000 to 25,000) physicians. Among insurance workers, 5.1% (90% CI, 3.9% to 6.2%) are uninsured. While 6% (90% CI, 4.2% to 7.9%) of those working in physicians' offices are uninsured, 52.2% (90% CI, 48.2% to 56.3%) receive no employer contribution toward their coverage. More than a fifth of nursing home employees lack insurance coverage, as do nearly a quarter of the 1.868 million health care workers with annual incomes less than $10,000. CONCLUSION: --Nearly a million health care and insurance workers are themselves uninsured and at high risk for being unable to obtain needed care.

Health Workforce↗
PubMed1997

Introducing cards into Slovenian health insurance and health care.

This paper presents an outline of the Slovenian project of introducing card systems into health insurance and health care: bases for its launching; scope, system design, development phases, benefits, and issues of interoperability with the other card systems. The card system will induce distinct simplifications of the procedures now performed in the health care system, improve the quality of medical administrative services to the patients. The introduction of the card technology is under way in several European countries. With the Health insurance card system project, Slovenia is joining the EU projects, and can either test in practice and implement the concepts, as well as contributes particular original solutions.

Cost-Benefit Analysis↗
PubMedDate not supplied

Differences in health insurance and health service utilization among Asian Americans: method for using the NHIS to identify unique patterns between ethnic groups.

The purpose of this study is to outline a method to identify the characteristics of socioeconomic variables in determining the differences in health insurance coverage and health services utilization patterns for different ethnic groups, using the behavioural model of health service utilization. A sample drawn from Asian American adult respondents to the 1992, 1993, and 1994 National Health Interview Surveys (NHIS) in the USA formed the data set. The results showed Asian Americans as not being homogeneous. There were distinctly different demographic and socioeconomic characteristics between six Asian American ethnic groups that affect health insurance coverage and health service utilization. The study method is useful for constructing health policy and services to address the general public need without adversely affecting smaller minority groups. Secondary analysis of well-constructed national data sets such as the specific Asian ethnic groups in NHIS, offers a rich method for predicting the differential impact of specific health policies on various ethnic groups.

Adolescent↗
PubMed1976

Issues in national health insurance.

Health insurance, by reducing net price to the consumer and increasing the opportunities for revenue to the provider, has profound effects, among other things, on the volume, content and distribution of services, their prices, and the capacity of providers to produce them. The magnitude and nature of these effects depend, partly, on the design of insurance benefits and, partly, on the nature of the health care system, particularly its current and potential capacity and the methods it uses to pay providers. Those who believe that the unique aim of insurance is to protect against unpredictable expenses attempt to suppress these effects, mainly by imposing financial disincentives to utilization which, in turn, reduce protection for those who need it most. Those who wish to reform the system have a broader range of objectives which include protective efficacy, cost control, quantitative adequacy, qualitative adequacy, efficiency of production, efficiency of allocation, equity, and redistribution of capacity. An analysis of the effects of insurance in the light of these objectives reveals favorable as well as unfavorable consequences. The provision of comprehensive benefits generates the necessity for a fundamental change in the organization of health services, if the advantages are to be fully realized and the disadvantages minimized.

Deductibles and Coinsurance↗
PubMedDate not supplied

Health insurance and health status: implications for financing health care reform.

Self-reported health status measures from the 1987 National Medical Expenditure Survey indicate significant differences among each of five population groups defined by current health insurance coverage. These differences in health status imply that the groups are likely to exhibit different patterns of expenditures, even if enrolled in the same health insurance after health care reform. The healthiest group along most dimensions is the population covered by employer-sponsored insurance, followed in order by the population with nongroup private insurance, the uninsured population, the population that qualifies for public coverage based on income, and the population that qualifies for public coverage based on medical need. While the general health and mental health of the uninsured are slightly worse in comparison to the privately insured, the uninsured have fewer chronic health problems. The uninsured who recently lost private insurance or who live in working families are significantly healthier than the long-term or low-income and nonworking uninsured.

Adolescent↗
PubMedDate not supplied

Does universal health insurance make health care unaffordable? Lessons from Taiwan.

This paper examines the performance of Taiwan's National Health Insurance (NHI), a universal health insurance program, implemented in 1995, that covers comprehensive services. The authors address two key questions: Did the NHI cause Taiwanese health spending to escalate to an "unaffordable" level? What are the benefits of the NHI? They find that Taiwan's single-payer NHI system enabled Taiwan to manage health spending inflation and that the resulting savings largely offset the incremental cost of covering the previously uninsured. Under the NHI, the Taiwanese have more equal access to health care, greater financial risk protection, and equity in health care financing. The NHI consistently receives a 70 percent public satisfaction rate.

Comprehensive Health Care↗
PubMed1981

Medicare program; Medigap--certification of Medicare supplemental health insurance policies: Health Care Financing Administration. Proposed rule.

This proposal would establish a program of certification, by the Secretary, of Medicare supplemental health insurance policies (so-called Medigap policies) voluntarily submitted by insurers for review. It would implement, in part, section 507 of the Social Security Disability Amendments of 1980. HCFA will administer the certification program. The voluntary certification program would go into effect July 1, 1982, and would apply only to policies issued in those States that do not have in effect a program for regulating Medigap policies equal to or more stringent than the one to be described in these regulations. A Supplemental Health Insurance Panel, consisting of the Secretary or a designee and four State Commissioners of Superintendents of Insurance appointed by the President, will determine the adequacy of a State's program in relation to the standards contained in the regulations. These regulations would: (1) set standards for policies voluntarily submitted to HCFA for certification, (2) establish procedures for the certification program, and (3) promulgate the statutory requirements that the Supplemental Health Insurance Panel would use to approve State regulatory programs.

Certification↗
PubMed1996

[Current models in health insurance and health care delivery].

Health care organizations similar to American HMOs have recently appeared in Switzerland. They elicit many reactions, both in the general public and among the medical profession. In contrast to traditional health insurance, HMOs organize and actively manage health care delivered to their members. This paper reviews the historical background of similar organizations in Europe and in the United States, and focuses in particular on the recent evolution and fragmentation of the concept of "managed care". Follows a discussion of the mechanisms and the side-effects of various tools used to manage care, both in managed care settings and by traditional health insurance plans. It appears that all of health care is managed, that all management tools have potential side effects, and that use of some management tools implies a redistribution of the respective roles of plan members, administrators, and physicians. The authors suggest that the complexity of health care management requires a more active implication of the health professions in that process.

Delivery of Health Care↗