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At least 19 recordsLinked to original sources
PubMed1986

State health insurance pools: current performance, future prospects.

State health insurance pools have been suggested to help cover the uninsured. Their attraction lies in the theoretical economies of pooling and the limited public role intended for their administration and funding. Almost all existing pools have targeted high health risks, otherwise uninsurable people who can still afford high premiums for conventional, major-medical-style coverage. Enrollments have been low, even relative to the small eligible population, and medical spending high. Little risk pooling or other savings seem to have occurred. Deficits have therefore mounted, necessitating increased assessments on all private health insurers in pool states and indirectly burdening state treasuries as well. Better pools would have to attract a broader mix of risks, actively manage medical spending, or both.

Adult↗
PubMed1992

Third-party reimbursement coverage for diabetes outpatient education programs.

The purpose of this study was to report on current third-party reimbursement coverage for diabetes outpatient education programs. In 1986, the Centers for Disease Control began to collect and analyze information about reimbursement of outpatient diabetes education programs. Data compiled in the Diabetes Outpatient Education Reimbursement Database represented various information sources, including contact people in 42 states, surveys, government publications, the American Diabetes Association, the American Association of Diabetes Educators, and Communicating for Agriculture. The purpose of the data base was twofold: 1) to track national reimbursement trends and 2) to support health-care professional efforts in obtaining third-party reimbursement for education services. This article analyzes the Diabetes Outpatient Education Reimbursement Database. This study is a descriptive analysis of the major carriers that reimburse, legislation for reimbursement of education programs, and state risk-sharing insurance pools. Currently, Medicaid (in 37 states), Medicare (in 49 states), Blue Cross/Blue Shield (in 43 states), and private carriers (in 48 states) reimburse diabetes outpatient education programs. Sixteen states have operational pooled risk health insurance plans. This represents an increase in the number of states that report reimbursement from 1986. Progress has been made in procuring reimbursement coverage for diabetes outpatient education programs. However, progress does not imply that third-party reimbursement is uniform nationwide or effortlessly achieved. Many challenges must be addressed before reimbursement is no longer an issue in the management of diabetes education programs and the provision of essential services for people with diabetes.

Blue Cross Blue Shield Insurance Plans↗
PubMed1986

Insuring the uninsured through private action: ideas and initiatives.

The growing issue of health coverage for the uninsured has no single solution, but private initiatives hold promise for some alleviation. The keys to increasing coverage are: more insurance pooling (to share risk and management); different insurance products, especially ones featuring better spending controls (to be attractive yet affordable at the low end of the market); and subsidy plus information (to encourage voluntary enrollment). Lack of insurance is not a problem for employees in large workplaces because relatively low prices and high incomes, as well as employer and tax code paternalism, assure coverage to almost 100% of workers in large groups. People on their own or in small groups, as well as increasing numbers of dependents of workers in large groups, are significantly disadvantaged in comparison. Considerable progress should be possible privately, but no one should expect large improvements without more cultural change or social intervention.

Blue Cross Blue Shield Insurance Plans↗
PubMed1990

The escalating health care cost of AIDS: who will pay?

AIDS is a crisis that has been imposed on an imperfect healthcare system. The flaws are easy to recognize but difficult to treat. Difficult choices about who pays for the medical care for AIDS patients will be made by upper-class and upper middle-class policymakers who are influenced by their own sense of vulnerability and by an aroused public. Social prejudice and moral judgment must be set aside. While the public ethic speaks the language of social justice, public activity often speaks the language of market justice. Beauchamp (1984) cites the philosophy of Anthony Downs when he states that solving social problems "requires painful losses, the restructuring of society and the acceptance of new burdens by the most powerful and the most numerous on behalf of the least powerful or the least numerous" (p. 306). It is characteristic of the public to attend to social problems until "it becomes clear that solving these problems requires painful costs that the dominant interests in society are unwilling to pay" (p. 306). The problem of AIDS care will require painful costs; but unlike many social problems, it will refuse to be hidden, refuse to be contained, refuse to be silenced, and refuse to be equitable in the marketplace and in the social system.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Genetics and the moral mission of health insurance.

Deciding whether genetic differences among individuals are morally relevant to health insurance requires us to ask, What kind of good is health care? and, What principles should govern its distribution? There are good reasons to doubt that "actuarial fairness" is an adequate description of genuine fairness in health insurance.

Actuarial Analysis↗
PubMedDate not supplied

Insurance for the insurers. The use of genetic tests.

Genetic testing raises concerns that individuals will be denied health insurance (and thus, effectively, access to health care), or that employers will screen to eliminate potentially costly workers. Although we as a society do not yet concur on the degree to which private businesses have a responsibility to promote social justice, several different policy alternatives might allow us to weigh the interests of insurers, as businesses, against the interests of citizens in a responsible manner.

Eligibility Determination↗
PubMed1991

Health access America--strengthening the US health care system.

Although Americans remain generally satisfied with the health care provided to them, sufficient access to high-quality, affordable health care for citizens without health care insurance has become an increasing problem in the last decade. Using the policy development process of the American Medical Association, Health Access America was conceived by the Association to improve access to affordable, high-quality health care. The proposal consists of six fundamental principles and 16 key points. This article specifically focuses on the five points that, if enacted into law, would improve access to health care for Americans who are, for various reasons, without health insurance.

Aged↗
PubMed1990

Insurability and the HIV epidemic: ethical issues in underwriting.

The HIV epidemic has focused criticism on standard underwriting practices that exclude people with AIDS or at high risk for it from insurance coverage. Insurers have denied the charge that these practices are unfair, claiming instead that whatever is actuarially fair is fair or just. This defense will not work unless we assume that individuals are entitled to gain advantages and deserve losses merely as a result of their health status. That assumption is highly controversial at the level of theory and is inconsistent with many of our moral beliefs and practices, including our insurance practices. We should reject the insurers' argument. Justice in health care requires that we protect equality of opportunity, and that implies sharing the burden of protecting people against health risks. In a just healthcare system, whether mixed or purely public, the insurance scheme is in systematic terms actuarially unfair, for its overall social function must be to guarantee access to appropriate care. This does not mean that in our system insurers are ignoring their obligation to provide access to coverage. The obligation to assure access is primarily a social one, and the failures of access in our system are the result of public failures to meet those obligations. In a just but mixed system, there would be an explicit division of responsibility among public and private insurance schemes. In our mixed but unjust system, both legislators and insurers cynically pretend that the uninsured are the responsibility of the other. The attempt to treat actuarial fairness as a moral notion thus disguises what is really at issue, namely, the risk to insurers of adverse selection and the economic advantages of standard underwriting practices. Standard underwriting practices will be fair only if they are part of a just system, not if they simply are actuarially fair. The failure of the argument from actuarial fairness means that we must face an issue private insurers had hoped to avoid if we are to defend standard underwriting practices at all. In view of the clear risk that a mixed system will fail to assure access to care, the burden falls on defenders of a mixed system. They must show us that its social benefits outweigh its social costs, and that it is possible to have a mixed system that is not only just, but also is superior to a compulsory, universal insurance scheme.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Universal health insurance and high-risk groups in West Germany: implications for U.S. health policy.

Access to West Germany's broad-based health-insurance system is geared to the country's occupational structure. People who qualify, however, may seek coverage from alternative sources, including local "sickness funds." The changing nature of the German job market is leading to concentration of high-risk groups in the local funds, some of which could in turn face serious financial problems. Proponents of a universal health-insurance program for the United States need to take account of the growing segmentation of risk groups in the current German experience, which may ultimately threaten the concept of solidarity on which the system is founded.

Economic Competition↗
PubMed1988

The erosion of purchased health insurance.

In this paper, we trace the decline of purchased health insurance and examine the reasons for the rapid growth of self-insurance between 1981 and 1985. Then, using nationally representative data on benefits in larger private sector firms, we examine the changing content of self-insured plans and compare them with fully insured conventional plans from commercial insurers and Blue Cross and Blue Shield Plans. Between 1981 and 1985, the percentage of employees in mid- to large-sized firms covered by self-insurance grew from 21% to 42%. Self-insured plans cost more than purchased plans in 1981, and continued to cost more in 1985. Their higher premiums were not due to richer benefit packages. Indeed, they less often covered "fringe" services and required greater cost sharing via higher deductibles and coinsurance. Upon considering both the efficiency and the equity issues of self-insurance, we sound a cautionary note on this growing trend.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

Making fair decisions about financing care for persons with AIDS.

An estimated 40 percent of the nation's 55,000 persons with acquired immunodeficiency syndrome (AIDS) have received care under the Medicaid Program, which is administered by the Health Care Financing Administration (HCFA) and funded jointly by the Federal Government and the States. In fiscal year 1988, Medicaid will spend between $700 and $750 million for AIDS care and treatment. Medicaid spending on AIDS is likely to reach $2.4 billion by fiscal year 1992, an estimate that does not include costs of treatment with zidovudine (AZT). Four policy principles are proposed for meeting this new cost burden in a way that is fair, responsive, efficient, and in harmony with our current joint public-private system of health care financing. The four guidelines are to (a) treat AIDS as any other serious disease, without the creation of a disease-specific entitlement program; (b) bring AIDS treatment financing into the mainstream of the health care financing system, making it a shared responsibility and promoting initiatives such as high-risk insurance pools: (c) give States the flexibility to meet local needs, including Medicaid home care and community-based care services waivers; (d) encourage health care professionals to meet their obligation to care for AIDS patients.

Acquired Immunodeficiency Syndrome↗