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At least 19 recordsLinked to original sources
PubMed1977

State laws mandating mental health insurance coverage.

Insurance companies and administrators of group insurance plans have accepted the premise that coverage for mental illness must be different from coverage for other health problems, and thus insurers continue to limit their liability through various exclusions and restrictions. For several years providers and consumers of services have worked for the enactment of state laws that mandate or regulate certain kinds of coverage for mental illness; as of January 1, 1977, a total of 22 states had such statutes. The author presents a state-by-state summary of the provisions. He also classifies many of the provisions into six categories and discusses the probable basis for their enactment.

Ambulatory Care↗
PubMed1992

Risk variation and fallback insurers in universal coverage insurance plans.

This paper argues that optimal treatment of health expenditure risk variation over one's lifetime requires partial offsetting of experience-related premium fluctuations. It argues that government should provide protection against the risk of serious chronic illness by offering risk-related tax credits that offset some (though not all) of the changes in premiums due to such illnesses. The performance of a fallback insurer, present in most market-based health reform proposals, is shown to depend on whether or not it is permitted to risk rate. Forbidding any risk rating is likely to cause adverse selection problems, whereas permitting the fallback insurer to risk rate should help it to perform its proper role and avoid being subject to dumping of high risks.

Choice Behavior↗
PubMed1998

Private health insurance coverage and disability among older Americans.

OBJECTIVES: This study examines the relationship between the lack of private supplemental health insurance coverage and the development of disability among adults aged 65 and older. METHODS: Data are from the baseline and six follow-up waves of the Duke Established Populations for Epidemiologic Studies of the Elderly survey (N = 4,000). Discrete-time hazard models were used to estimate the impact of insurance coverage and other risk factors on the incidence of disability among those unimpaired at baseline. RESULTS: Controlling for education, income, and other potential confounders, the odds of developing disability were 35-49% higher among those without private coverage. Insurance coverage also statistically explained part of the increased risk of disability among low-income persons. DISCUSSION: The results indicate that changes in health insurance coverage as well as in individual behaviors may be needed to reduce disability generally and disability among the socioeconomically disadvantaged, in particular.

Aged↗
PubMedDate not supplied

Explaining the decline in health insurance coverage, 1979-1995.

The decline in health insurance coverage among workers from 1979 to 1995 can be accounted for almost entirely by the fact that per capita health care spending rose much more rapidly than personal income during this time period. We simulate health insurance coverage levels for 1996-2005 under alternative assumptions concerning the rate of growth of spending. We conclude that reduction in spending growth creates measurable increases in health insurance coverage for low-income workers and that the rapid increase in health care spending over the past fifteen years has created a large pool of low-income workers for whom health insurance is unaffordable.

Adult↗
PubMed1997

Trends in health insurance coverage.

This Issue Brief presents data on trends in health insurance coverage between 1987-1995. In 1995, 70.7 percent of the nonelderly population had private health insurance coverage, compared with 75.9 percent in 1987. During this period, the percentage of the nonelderly population with employment-based health insurance declined from 69.2 percent to 63.8 percent, while the percentage covered by Medicaid program increased from 8.6 percent to 12.5 percent. The percentage of the nonelderly population without any form of health insurance increased from 14.8 percent in 1987 to 17.4 percent, or 40.3 million individuals, in 1995. The percentage of nonelderly Americans with employment-based coverage fell for both individuals with coverage in their own name and those with coverage as dependents. In 1995, 32.7 percent of the nonelderly population had coverage in their own name, compared with 33.8 percent in 1987. Similarly, 31.1 percent of the nonelderly population had employment-based health insurance as dependents in 1995, compared with 35.4 percent in 1987. One of the most important determinants of health insurance coverage is work status and hours of work. While employment-based health insurance received directly from worker's employer decreased between 1987 and 1995 from 66.2 percent of 63.2 percent among full-time workers, the percentage of part-time workers with employment-based health insurance coverage in their own name increased from 17.2 percent to 20.1 percent. The percentage of workers with dependent coverage fell for both full-time and part-time workers, as did the percentage of nonworkers with dependent coverage. Workers in the manufacturing industry are most likely to have employment-based health insurance; they are also the workers most likely to have experienced a decrease in employment-based coverage between 1987 and 1995. In contrast, workers employed in most of the service sectors, experienced an increase in employment-based health insurance, self-employed workers experienced a decrease, and government workers experienced a slight increase. Cost is one of the primary factors contributing to the decline in employment-based health insurance coverage. While health insurance premium cost increases have slowed during the past three years, many health care analysts are predicting an increase in health insurance premiums during the next few years. Inflationary pressure may come from health care providers, health insurers, consumers, and/or policymakers. If inflationary pressure increases health insurance premiums, we are likely to see a continued decline in employment-based health insurance and a subsequent increase in both Medicaid and uninsured populations.

Adolescent↗
PubMedDate not supplied

The effect of health insurance coverage on the appropriate use of recommended clinical preventive services.

INTRODUCTION: Lack of health insurance coverage has been shown to reduce use of some preventive services. However, even when care is free or fully covered by insurance, clinical preventive services are not used at recommended levels. This study investigates the impact of different levels of health insurance coverage (ranging from none, some, most, and all preventive services covered) on the use of recommended clinical preventive services for adult men and women. METHODS: Logistic regression was used to estimate the effect of different levels of health insurance coverage for preventive care on the probability of receiving six different clinical preventive services including periodic health exam, blood pressure screening, cholesterol screening, Pap smear, clinical breast exam, and screening mammography, as well as all recommended services for a given age and gender group. The study sample of adults ages 18 to 64 is from the Centers for Disease Control's 1991 Behavioral Risk Factor Surveillance System (BRFSS) (n = 53,981). RESULTS: The results demonstrate a positive and statistically significant dose-response relationship between level of health insurance coverage for preventive care and receipt of recommended preventive services in adult men and women. The odds ratios (ORs) of men who had full coverage for preventive care receiving recommended preventive services compared to men with no coverage for preventive care ranged from 1.8 to 2.8. For women the ORs were 1.2 to 2.0. The ORs for men with "most" preventive services covered compared to none covered ranged from 1.3 to 2.1, and for women from 1.2 to 2.0. CONCLUSIONS: The level of health insurance coverage for preventive care is one of the most important determinants of receipt of recommended preventive services for adult men and women 18-64 years of age. These results suggest that comprehensive health insurance coverage for clinical preventive care may significantly increase receipt of recommended preventive services for this population.

Adolescent↗
PubMed1994

The relationship between insurance coverage and psychiatric disorder in predicting use of mental health services.

OBJECTIVE: This study investigated how insurance coverage for mental health services affects outpatient mental health service utilization among those with and among those without a DSM-III psychiatric diagnosis. The authors used a representative community sample to compare the regression effects of insurance coverage on utilization of mental health services among these subjects. METHOD: Data are from the second wave of the Piedmont, North Carolina, site of the Epidemiologic Catchment Area project. These data contain DSM-III diagnostic measures derived from the National Institute of Mental Health Diagnostic Interview Schedule as well as measures of insurance coverage and utilization. Responses from 2,889 community residents were analyzed using both ordinary least squares and logistic regression. RESULTS: In both models, insurance coverage was strongly associated with care among those with as well as among those without a psychiatric disorder. The association between coverage and the probability of care was strongest among those with a disorder. CONCLUSIONS: The findings are not consistent with the claim that failing to provide insurance coverage will reduce discretionary but not necessary mental health care utilization. They provide evidence that failing to provide insurance coverage will reduce utilization as much or more among those with a psychiatric disorder as among those without. This result has important implications for health care reform.

Adult↗
PubMed1998

Adolescents' knowledge of their health insurance coverage.

PURPOSE: To determine the accuracy of adolescents' self-report of health insurance coverage, using parents' report as a comparison standard. METHODS: Two separate samples of urban, school-based adolescents and their parents completed self-administered questionnaires about type of health insurance coverage. Sample 1 included 123 and Sample 2 included 93 adolescent-parent pairs. Percent agreement and the kappa statistic were determined for each of the sample groups, and for males versus females and older (> 14 years) versus younger (< or = 14 years) adolescents. RESULTS: In Sample 1, 33% of adolescent respondents responded "don't know" to the question about type of insurance coverage, and 4% left the question blank; in Sample 2, 3% answered "don't know," with none leaving the question blank. For Sample 1, we found a 57% rate of agreement of adolescents with their parents, and a corresponding kappa of .21. Females and older subjects demonstrated greater accuracy, with kappa's all in the range .13-.29. In Sample 2, 73% of subjects agreed with parents' report, with a kappa of .48. Females and older subjects also demonstrated greater accuracy, with the highest kappa of .59 demonstrated by older females. Excluding those responding with "don't know," we found overall percent agreement with parents of 87% in Sample 1 and 73% in Sample 2; the corresponding kappas were .47 and .51. Females demonstrated higher agreement with parents in both samples. The results stratifying by age were inconsistent. In Sample 1, privately insured subjects were more accurate reporters than those either on medical assistance or uninsured. In Sample 2, no differences were seen by type of insurance. CONCLUSIONS: Many adolescents do not know their health insurance coverage status. However, for those who did claim to know, acceptable rates of accuracy using both percent agreement and the kappa statistic were demonstrated. Further research is needed to determine how information about insurance is communicated to adolescents and how this knowledge affects access to and use of health services.

Adolescent↗
PubMed1999

Disparities in prescription drug insurance coverage.

OBJECTIVES: This article examines socioeconomic differences in supplementary insurance for prescription drugs among Canadians aged 15 or older and how the availability of such insurance affects prescription drug use. DATA SOURCE: The data on prescription drug insurance coverage and drug use are from the cross-sectional Health file of the 1996/97 National Population Health Survey (NPHS) conducted by Statistics Canada. The sample size of the population aged 15 or older was 70,884. ANALYTICAL TECHNIQUES: Rates of insurance coverage for prescription drug services were calculated. All summary estimates were age-adjusted using the 1996/97 population of Canada (both sexes). MAIN RESULTS: Among people aged 15 or older, 61% were covered for prescription medications in 1996/97. Sixty-five percent of workers reported coverage, while those who were not working were less likely to have benefits (52%). Only 38% of lower income groups had insurance compared with 74% of the highest income group. Regardless of the number of chronic diseases individuals had, those with drug insurance were more likely to report taking medication.

Adolescent↗
PubMed1993

Insurance coverage and residents' experience in a pediatric teaching clinic.

To examine the relationship between insurance coverage and the diagnostic content of residents' experience in a hospital-based pediatric teaching clinic, we analyzed outpatient problem lists for 6543 patients seen in our clinic over a 15-month period. Problem-list contents were categorized using diagnostic clusters. The frequency distribution of clustered problems was compared for patients with four types of insurance coverage: indemnity insurance, health maintenance organization, Medicaid, and no insurance. The four insurance categories differed in the overall distribution of problems, but the differences could not be attributed to a disparity in the frequency of any single diagnosis or diagnostic cluster. We conclude that there was no important effect of insurance coverage on the diagnostic content of residents' experience in a teaching clinic.

Child↗
PubMed1997

Changes in the 1995 Current Population Survey and estimates of health insurance coverage.

This analysis compares the March 1994 and March 1995 Current Population Survey (CPS) counts of the numbers of people with different types of health insurance and without any health insurance coverage. The findings contain some surprises: there were no changes in the numbers of nonelderly people with Medicaid coverage and without any health insurance, and there were increases in the numbers of nonelderly people with employer-sponsored health insurance and with CHAMPUS/VA/military health care. Four changes were introduced in the CPS in 1995 and were likely, by themselves, to both raise and lower the estimates of the numbers of people with specific types of health insurance coverage. Three of the changes relate to questions about health insurance coverage; they coincide with the traditional mid-decade shift in the sample framework for the CPS.

Adult↗
PubMed1986

Health services utilization in the U.S. population by health insurance coverage.

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) is to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning several aspects of insurance coverage were collected from household respondents in NMCUES. These data included the kind of insurance in effect for each person (Medicare, Medicaid, private, or other) and the use of inpatient and ambulatory health services. The purpose of this report is to provide descriptive information about the distribution of insurance coverage among the U.S. population and the use of inpatient and ambulatory services by people with different kinds of insurance. The results presented are based on data collected about the civilian noninstitutionalized persons in the NMCUES national household sample. In this report, "person-year" estimates for health insurance coverage are used; that is, individuals are assigned to different categories of insurance coverage according to the proportion of the year that they were covered by each kind of insurance. Although estimates are calculated as person-years of coverage, they are expressed as persons covered for convenience. Two important subpopulations--persons under 65 years of age and persons 65 years of age or over--are addressed separately because they have different patterns of insurance coverage and because utilization is so heavily influenced by age. Persons 65 years of age or over used significantly more inpatient and ambulatory services than persons under 65 years of age did. Only those in the younger group with Medicare, who were disabled, had utilization rates very similar to those of the aged. Persons under 65 years of age are classified by six mutually exclusive insurance categories: All Medicare. Medicaid, no private health insurance. Private health insurance, no Medicaid. Medicaid and private health insurance. Other coverage only. No insurance. Persons 65 years of age or over are classified by four mutually exclusive categories: Medicare only. Medicare and Medicaid. Medicare and private or other coverage. No Medicare. These categories of insurance coverage describe the kind of organization or program that supplies the coverage. With the exception of Medicare, which is a national program, these classifications provide little information about the scope of benefits and level of payment available to people who are covered. Considerable variation exists by State within the Medicaid category and by plan or program within the private insurance and other coverage categories.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗
PubMed1997

Differences in private health insurance coverage for working male Hispanics.

In 1993, 33.8% of all nonelderly adult Hispanics living in the United States lacked health insurance coverage (either private or public), compared to 8.1% of the entire nonelderly population. Because Hispanics are more likely to be uninsured than any other ethnic group and because they are the fastest growing minority group in the United States, the increase in the Hispanic population is likely to increase the proportion of the population without health insurance. Particularly striking are differences in private health insurance coverage among the three major Hispanic groups--Cuban-Americans, Mexican-Americans, and Puerto Ricans. In this paper, regression-based decomposition analysis is used to explain the sources of differences in private health insurance coverage among working males in these three group. The results indicate that among the study population, Cuban-Americans have higher rates of private health insurance coverage than Mexican-Americans and Puerto Ricans, and that wage rates, levels of education, age, occupation, and marital status explain most of the difference.

Adult↗
PubMed1995

Explaining trends in health insurance coverage between 1988 and 1991.

This paper uses regression-based decompositions to examine the downward trend in insurance coverage between 1988 and 1991. I find that falling family incomes account for much of the decline in overall insurance coverage, while a secular decline in insurance coverage across all industries, firm sizes, employment statuses, income levels, and demographic groups accounts for most of the decline in employer-sponsored insurance among workers. Rising unemployment and changing patterns of industrial employment explain little of the decline in coverage across the entire population. Taken together, these results suggest that fewer employers are offering health coverage, workers are finding it difficult to pay their share of the premiums, and those without access to employer-sponsored plans are finding it harder to purchase nongroup insurance. Thus, it appears that the rising cost of health insurance coupled with falling incomes and profits during the recession account for the fall in health insurance coverage between 1988 and 1991.

Family↗
PubMedDate not supplied

The influence of outpatient insurance coverage on the microvascular complications of non-insulin-dependent diabetes in Mexican Americans.

Does poor health insurance coverage contribute to increased microvascular complications (nephropathy and retinopathy) in Mexican Americans with non-insulin-dependent diabetes? Mexican-American subjects with diabetes were identified in a population-based cardiovascular risk factor survey, the San Antonio Heart Study. Retinopathy, nephropathy, source of health care, and type and extent of health insurance coverage were assessed in a special diabetes complications exam. Among Mexican-American subjects with non-insulin-dependent diabetes diagnosed prior to their participation in the survey (n = 255), 26% (n = 67) lacked any type of health insurance, and 28% relied on county- or federal-funded clinics rather than private doctors as their primary source of care. Among those with health insurance (188 of 255), only 68% (127 of 188) or 24% of the total sample had private health insurance, and, of those with private insurance, 48% (35 of 73) received reimbursement for outpatient doctor visits and 57% for outpatient medications. Microvascular complications were more common among those who received their health care from a clinic versus a private doctor, and among those who lacked health insurance coverage for outpatient doctor visits and medications. Thus, poor health insurance coverage in the outpatient setting correlates with higher rates of microvascular complications among Mexican Americans with non-insulin-dependent diabetes mellitus.

Albuminuria↗
PubMed1985

Supplemental health insurance coverage among aged Medicare beneficiaries.

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) of 1980 was to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning insurance coverage were collected from household respondents in NMCUES. These data included the kind of insurance in effect for each person, the services covered, and the amounts paid by each source. In addition, the administration of private insurance plans and the kinds of charges covered were identified. The purpose of this report is to provide descriptive information about supplemental insurance coverage among the aged Medicare population with special emphasis on private supplemental health insurance coverage. For this report, supplemental insurance is defined as coverage (i.e., Medicaid, private, or other) in addition to Medicare and is to be distinguished from the Supplementary Medical Insurance part of Medicare that is known as SMI or Part B of Medicare. The results presented are based on data collected about the civilian, noninstitutionalized persons in the NMCUES national household sample who at any time during the survey year of 1980: (1) were 65 years of age or over, and (2) reported having been covered by Medicare Hospital Insurance (HI), or Medicare Supplementary Medical Insurance (SMI), or both. This report uses time-adjusted estimates that assign a single individual to different categories of insurance coverage according to the proportion of the year that he or she was covered by each kind of insurance. Consequently, estimates are made for person-years of coverage although they are expressed as persons for convenience. Approximately 4 out of 5 aged Medicare beneficiaries reported having some kind of insurance coverage in addition to Medicare during 1980. Approximately 67 percent of the aged Medicare population are estimated to have had private insurance in addition to Medicare; an estimated 13 percent had Medicaid. (Both of these estimates include 2.5 percent who reported Medicaid and private insurance simultaneously.) About 21 percent of the aged Medicare beneficiaries reported that Medicare was their only source of third-party coverage. The percentage of the aged Medicare beneficiaries who reported Medicare as their only source of third-party coverage was consistently 20 percent regardless of health status. However, the distribution among insurance categories of the remaining 80 percent who reported supplemental coverage of some type varied by health status. Medicare beneficiaries who were in poor health were much more likely to have Medicaid than Medicare beneficiaries who reported being in excellent health.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗