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Sample records for longitudinal health insurance

  1. Impact of health insurance status changes on healthcare utilisation patterns: a longitudinal cohort study in South Korea

    PubMed Central

    Kim, Jae-Hyun; Lee, Sang Gyu; Lee, Kwang-Soo; Jang, Sung-In; Cho, Kyung-Hee; Park, Eun-Cheol

    2016-01-01

    Objectives The study examined medical care utilisation by health insurance status changes. Setting The Korean Welfare Panel Study (KoWePs) was used. Participants This study analysed 14 267 participants at baseline (2006). Interventions The individuals were categorised into four health insurance status groups: continuous health insurance, change from health insurance to Medical Aid, change from Medical Aid to health insurance, or continuous Medical Aid. Primary and secondary outcome measures Three dependent variables were also analysed: days spent in hospital; number of outpatient visits; and hospitalisations per year. Longitudinal data analysis was used to determine whether changes in health insurance status were associated with healthcare utilisation. Results The number of outpatient visits per year was 0.1.363 times higher (p<0.0001) in the continuous Medical Aid than in the continuous health insurance group. The number of hospitalisations per year was 1.560 times higher (p<0.001) in new Medical Aid and −0.636 times lower (p<0.001) in new health insurance than in continuous health insurance group. The number of days spent in hospital per year was −0.567 times lower (p=0.021) in the new health insurance than in the continuous health insurance group. Conclusions Health insurance beneficiaries with a coverage level lower than Medical Aid showed lower healthcare utilisation, as measured by the number of hospitalisations and days spent in hospital per year. PMID:27036140

  2. Health Insurance

    MedlinePlus

    Health insurance helps protect you from high medical care costs. It is a contract between you and ... Many people in the United States get a health insurance policy through their employers. In most cases, ...

  3. Longitudinal Changes in Access to Health Care by Immigrant Status among Older Adults: The Importance of Health Insurance as a Mediator

    ERIC Educational Resources Information Center

    Choi, Sunha

    2011-01-01

    Purpose: This longitudinal study examined the role of health insurance in access to health care among older immigrants. Design and Methods: Using data from the Second Longitudinal Study of Aging, the longitudinal trajectories of having a usual source of care were compared between 3 groups (all 70+ years): (a) late-life immigrants with less than 15…

  4. Making health insurers insure.

    PubMed

    Ortolon, Ken

    2010-12-01

    A section of the Patient Protection and Affordable Care Act requires health plans to maintain a minimum "medical loss ratio," or MLR, of between 80 percent and 85 percent. If they don't, they could be ordered to refund some premium dollars to their beneficiaries. Texas Medical Association officials say the new MLR provision could force health plans to spend more time providing insurance and less time meddling in patient care. But that is still unclear. PMID:21174243

  5. Does the Universal Health Insurance Program Affect Urban-Rural Differences in Health Service Utilization among the Elderly? Evidence from a Longitudinal Study in Taiwan

    ERIC Educational Resources Information Center

    Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An

    2012-01-01

    Purpose: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. Methods: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences…

  6. Health Insurance Basics

    MedlinePlus

    ... How Can I Help a Friend Who Cuts? Health Insurance Basics KidsHealth > For Teens > Health Insurance Basics Print ... thought advanced calculus was confusing. What Exactly Is Health Insurance? Health insurance is a plan that people buy ...

  7. CHIP Utilization in South Texas: A Prospective Longitudinal Study of the Children's Health Insurance Program. JSRI Research Report No. 33

    ERIC Educational Resources Information Center

    Millard, Ann V.; Mier, Nelda; Gabriel, Olga; Flores, Soledad

    2004-01-01

    The Children's Health Insurance Program (CHIP) began as a federal stopgap measure to assist families whose incomes were too high to qualify for Medicaid, but too low to make health insurance for their children affordable. In 2002, efforts were launched around the United States to recruit eligible children into the program. This pilot study…

  8. Stability and Change in Health Insurance Among Older Mexican Americans: Longitudinal Evidence From the Hispanic Established Populations for Epidemiologic Study of the Elderly

    PubMed Central

    Angel, Ronald J.; Angel, Jacqueline L.; Markides, Kyriakos S.

    2002-01-01

    Objectives. This study examined the association between health insurance coverage, medical care use, limitations in activities of daily living, and mortality among older Mexican-origin individuals. Methods. We analyzed longitudinal data from the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE). Results. The uninsured tend to be younger, female, poor, and foreign born. They report fewer health care visits, are less likely to have a usual source of care, and more often receive care in Mexico. Conversely, those with private health insurance are economically better off and use more health care services. Over time, the data reveal substantial changes in type of insurance coverage. Conclusions. The data reveal serious vulnerabilities among older Mexican Americans that result from a lack of private Medigap supplemental coverage. (Am J Public Health. 2002;92:1264–1271) PMID:12144982

  9. Insuring against health shocks: Health insurance and household choices.

    PubMed

    Liu, Kai

    2016-03-01

    This paper provides empirical evidence on the role of public health insurance in mitigating adverse outcomes associated with health shocks. Exploiting the rollout of a universal health insurance program in rural China, I find that total household income and consumption are fully insured against health shocks even without access to health insurance. Household labor supply is an important insurance mechanism against health shocks. Access to health insurance helps households to maintain investment in children's human capital during negative health shocks, which suggests that one benefit of health insurance could arise from reducing the use of costly smoothing mechanisms. PMID:26836108

  10. The impact of health insurance reform on insurance instability.

    PubMed

    Freund, Karen M; Isabelle, Alexis P; Hanchate, Amresh D; Kalish, Richard L; Kapoor, Alok; Bak, Sharon; Mishuris, Rebecca G; Shroff, Swati M; Battaglia, Tracy A

    2014-02-01

    We investigated the impact of the 2006 Massachusetts health care reform on insurance coverage and stability among minority and underserved women. We examined 36 months of insurance claims among 1,946 women who had abnormal cancer screening at six community health centers pre-(2004-2005) and post-(2007-2008) insurance reform. We examined frequency of switches in insurance coverage as measures of longitudinal insurance instability. On the date of their abnormal cancer screening test, 36% of subjects were publicly insured and 31% were uninsured. Post-reform, the percent ever uninsured declined from 39% to 29% (p .001) and those consistently uninsured declined from 23% to 16%. To assess if insurance instability changed between the pre- and post-reform periods, we conducted Poisson regression models, adjusted for patient demographics and length of time in care. These revealed no significant differences from the pre- to post-reform period in annual rates of insurance switches, incident rate ratio 0.98 (95%- CI 0.88-1.09). Our analysis is limited by changes in the populations in the pre- and post-reform period and inability to capture care outside of the health system network. Insurance reform increased stability as measured by decreasing uninsured rates without increasing insurance switches.

  11. Using the pharmacoepidemiology approach to evaluate the first-year posttransplantation ambulatory health care cost from the Longitudinal Health Insurance Database (2001 to 2006) in Taiwan.

    PubMed

    Lee, E K-L; Cham, T-M; Tseng, P-L

    2010-04-01

    This research evaluated the total first-year posttransplantation ambulatory health care cost using a countrywide health claims database. We searched all health reimbursement claims of posttransplantation patients from 2001 to 2006 using the ICD-9-CM codes (V42.0, V42.1, V42.6, V42.7, V42.8) for kidney, heart, lung, liver, and other specified organ transplantations. We excluded patients undergoing transplantation surgery>12 months before 2001 or with <1 year of or irregular follow-up visits. All of the studied ambulatory care expenditures by visit files were based on the Taiwan Longitudinal Health Insurance Database (2005), which contained the claims of 1,000,000 beneficiaries who were randomly sampled from the Registry for Beneficiaries of the National Health Insurance Research Database. During this 6-year period we identified 336 transplant patients with 145 new cases having consecutive and >12 months of follow-up ambulatory visits to calculate the first-year posttransplantation cost. Among them, the first-year posttransplantation drug costs and total health care costs of the kidney, heart, lung, liver, and other organ transplantations were (m NTs) 346,396.6+/-170,806.9 and 404,241.9+/-182,499.1, 242,878.5+/-128,772.7 and 302,325+/-129,609.9, 345,792+/-185,940.8 and 387,840.5+/-184,244.5, 404,441.8+/-299,311.7 and 471,631.5+/-306,936.3 and 40,718.2+/-50,740.2 and 67,469.8+/-70,765.7, respectively. Drug expenditures were approximately 80% of the total health care cost except for the other specified organ transplant, i.e., bone marrow, wherein they were 60%. The mean differences between drug expenditures and total costs of various organ transplants were significant (P<.01; ANOVA). Despite the first-year health care cost a the posttransplantation patient being less than dialysis costs in Taiwan, most end-stage renal disease patients are still a waiting organ donation; therefore, some candidates are seeking a transplants outside Taiwan.

  12. Insurance Incentives for Health Promotion.

    ERIC Educational Resources Information Center

    Hosokawa, Michael C.

    1984-01-01

    To reduce the cost of reimbursements, many insurance companies have begun to use insurance incentives as a way to motivate individuals to participate in health promotion activities. Traditional health education, research and demonstration, and policy-premium incentives are methods of health promotion used by life and health insurance companies.…

  13. Is It Really Worse to Have Public Health Insurance than to Have No Insurance at All? Health Insurance and Adult Health in the United States

    ERIC Educational Resources Information Center

    Quesnel-Vallee, Amelie

    2004-01-01

    Using prospective cohort data from the 1979 National Longitudinal Survey of Youth, this study examines the extent to which health insurance coverage and the source of that coverage affect adult health. While previous research has shown that privately insured nonelderly individuals enjoy better health outcomes than their uninsured counterparts, the…

  14. Self-insured health plans

    PubMed Central

    McDonnell, Patricia; Guttenberg, Abbie; Greenberg, Leonard; Arnett, Ross H.

    1986-01-01

    Nationwide, 8 percent of all employment-related health plans were self-insured in 1984, which translates into more than 175,000 self-insured plans according to our latest study of independent health plans. The propensity of an organization to self-insure differs primarily by its size, with large establishments more likely to self-insure. In the overwhelming majority of cases, the self-insured benefit was hospital and/or medical. Among employers who self-insure, 23 percent self-administer, and the remaining 77 percent hire a commercial insurance company, Blue Cross/Blue Shield plan, or an independent third-party administrator to administer the health plan. PMID:10312008

  15. Reforming health insurance in Argentina and Chile.

    PubMed

    Barrientos, A; Lloyd-Sherlock, P

    2000-12-01

    The paper examines the recent reforms of health insurance in Chile and Argentina. These partially replace social health insurance with individual insurance administered through the private sector. In Chile, reforms in the early 1980s allowed private health insurance funds to compete for affiliates with the social health insurance system. In Argentina, reforms in the 1990s aim to open up the union-administered social insurance system to competition both internally and from private insurers. The paper outlines the specific articulation of social and individual health insurance produced by these reforms, and discusses the implications for health insurance coverage, inequalities in access to healthcare, and health expenditures.

  16. Impact of Market Competition on Continuity of Care and Hospital Admissions for Asthmatic Children: A Longitudinal Analysis of Nationwide Health Insurance Data 2009-2013

    PubMed Central

    Cho, Kyoung Hee; Park, Eun-Cheol; Nam, Young Soon; Lee, Seon-Heui; Nam, Chung Mo; Lee, Sang Gyu

    2016-01-01

    Background Ambulatory care-sensitive conditions, including asthma, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization. Objective This study assessed the relationship between market competition, continuity of care (COC), and hospital admissions in asthmatic children according to their health care provider. Methods A longitudinal design was employed with a 5-year follow-up period, between 2009 and 2013, under a Korean universal health insurance program. A total of 253 geographical regions were included in the analysis, according to data from the Korean Statistical Office. Data from 9,997 patients, aged ≤ 12 years, were included. We measured the COC over a 5-year period using the Usual Provider Continuity (UPC) index. Random intercept models were calculated to assess the temporal and multilevel relationship between market competition, COC, and hospital admission rate. Results Of the 9,997 patients, 243 (2.4%) were admitted to the hospital in 2009. In the multilevel regression analysis, as the Herfindahl–Hirschman Index increased by 1,000 points (denoting decreased competitiveness), UPC scores also increased (ß = 0.001; p < 0.0001). In multilevel logistic regression analysis, the adjusted odds ratio (OR) for hospital admissions for individuals with lower COC scores (≥ 2 ambulatory visits and a UPC index score of < 1) was 3.61 (95% CI: 2.98–4.38) relative to the reference group (≥ 2 ambulatory visits and a UPC index score of 1). Conclusions Market competition appears to reduce COC; decreased COC was associated with a higher OR for hospital admissions. PMID:26958850

  17. The economics of health insurance.

    PubMed

    Jha, Saurabh; Baker, Tom

    2012-12-01

    Insurance plays an important role in the United States, most importantly in but not limited to medical care. The authors introduce basic economic concepts that make medical care and health insurance different from other goods and services traded in the market. They emphasize that competitive pricing in the marketplace for insurance leads, quite rationally, to risk classification, market segmentation, and market failure. The article serves as a springboard for understanding the basis of the reforms that regulate the health insurance market in the Patient Protection and Affordable Care Act.

  18. Social health insurance reexamined.

    PubMed

    Wagstaff, Adam

    2010-05-01

    Social health insurance (SHI) is enjoying something of a revival in parts of the developing world. Many countries that have in the past relied largely on tax finance (and out-of-pocket payments) have introduced SHI, or are thinking about doing so. And countries with SHI already in place are making vigorous efforts to extend coverage to the informal sector. Ironically, this revival is occurring at a time when the traditional SHI countries in Europe have either already reduced payroll financing in favor of general revenues, or are in the process of doing so. This paper examines how SHI fares in health-care delivery, revenue collection, covering the formal sector, and its impacts on the labor market. It argues that SHI does not necessarily deliver good quality care at a low cost, partly because of poor regulation of SHI purchasers. It suggests that the costs of collecting revenues can be substantial, even in the formal sector where non-enrollment and evasion are commonplace, and that while SHI can cover the formal sector and the poor relatively easily, it fares badly in terms of covering the non-poor informal sector workers until the economy has reached a high level of economic development. The paper also argues that SHI can have negative labor market effects. PMID:19399789

  19. Individual insurance: health insurers try to tap potential market growth.

    PubMed

    November, Elizabeth A; Cohen, Genna R; Ginsburg, Paul B; Quinn, Brian C

    2009-11-01

    Individual insurance is the only source of health coverage for people without access to employer-sponsored insurance or public insurance. Individual insurance traditionally has been sought by older, sicker individuals who perceive the need for insurance more than younger, healthier people. The attraction of a sicker population to the individual market creates adverse selection, leading insurers to employ medical underwriting--which most states allow--to either avoid those with the greatest health needs or set premiums more reflective of their expected medical use. Recently, however, several factors have prompted insurers to recognize the growth potential of the individual market: a declining proportion of people with employer-sponsored insurance, a sizeable population of younger, healthier people forgoing insurance, and the likelihood that many people receiving subsidies to buy insurance under proposed health insurance reforms would buy individual coverage. Insurers are pursuing several strategies to expand their presence in the individual insurance market, including entering less-regulated markets, developing lower-cost, less-comprehensive products targeting younger, healthy consumers, and attracting consumers through the Internet and other new distribution channels, according to a new study by the Center for Studying Health System Change (HSC). Insurers' strategies in the individual insurance market are unlikely to meet the needs of less-than-healthy people seeking affordable, comprehensive coverage. Congressional health reform proposals, which envision a larger role for the individual market under a sharply different regulatory framework, would likely supersede insurers' current individual market strategies. PMID:19899193

  20. Social insurance for health service.

    PubMed

    Roemer, M I

    1997-06-01

    Implementation of social insurance for financing health services has yielded different patterns depending on a country's economic level and its government's political ideology. By the late 19th century, thousands of small sickness funds operated in Europe, and in 1883 Germany's Chancellor Bismarck led the enactment of a law mandating enrollment by low-income workers. Other countries followed, with France completing Western European coverage in 1928. The Russian Revolution in 1917 led to a National Health Service covering everyone from general revenues by 1937. New Zealand legislated universal population coverage in 1939. After World War II, Scandinavian countries extended coverage to everyone and Britain introduced its National Health Service covering everyone with comprehensive care and financed by general revenues in 1948. Outside of Europe Japan adopted health insurance in 1922, covering everyone in 1946. Chile was the first developing country to enact statutory health insurance in 1924 for industrial workers, with extension to all low-income people with its "Servicio Nacional de Salud" in 1952. India covered 3.5 percent of its large population with the Employees' State Insurance Corporation in 1948, and China after its 1949 revolution developed four types of health insurance for designated groups of workers and dependents. Sub-Saharan African countries took limited health insurance actions in the late 1960s and 1970s. By 1980, some 85 countries had enacted social security programs to finance or deliver health services or both.

  1. Health Insurance Stability and Health Status: Do Family-Level Coverage Patterns Matter?

    ERIC Educational Resources Information Center

    Nielsen, Robert B.; Garasky, Steven

    2008-01-01

    Being uninsured affects one's ability to access medical services and maintain health. Using longitudinal data from the Survey of Income and Program Participation, the authors investigated how individual and family insurance coverage affects adult health. They found that health insurance coverage often varies across family members and changes…

  2. [Health care insurance for Africa].

    PubMed

    Schellekens, O P; Lindner, M E; van Esch, J P L; van Vugt, M; Rinke de Wit, T F

    2007-12-01

    Long-term substantial development aid has not prevented many African countries from being caught in a vicious circle in health care: the demand for care is high, but the overburdened public supply of low quality care is not aligned with this demand. The majority of Africans therefore pay for health care in cash, an expensive and least solidarity-based option. This article describes an innovative approach whereby supply and demand of health care can be better aligned, health care can be seen as a value chain and health insurance serves as the overarching mechanism. Providing premium subsidies for patients who seek health care through private, collective African health insurance schemes stimulates the demand side. The supply of care improves by investing in medical knowledge, administrative systems and health care infrastructure. This initiative comes from the Health Insurance Fund, a unique collaboration of public and private sectors. In 2006 the Fund received Euro 100 million from the Dutch Ministry of Foreign Affairs to implement insurance programmes in Africa. PharmAccess Foundation is the Fund's implementing partner and presents its first experiences in Africa. PMID:18179087

  3. How to Shop for Health Insurance

    MedlinePlus

    ... Know About Zika & Pregnancy How to Shop for Health Insurance KidsHealth > For Parents > How to Shop for Health Insurance Print A A A Text Size What's in ... seguro médico? In America today, we all need health insurance. You do. Your kids do. It's not a " ...

  4. Tensions in private health insurance regulation.

    PubMed

    Willcox, Sharon

    2003-02-01

    This article provides an analysis of the regulatory framework of Australian private health insurance linked to four major implicit regulatory objectives: promoting access to health insurance for consumers; promoting financial solvency and industry viability of registered health benefits organisations; promoting competition between registered health benefits organisations; and promoting accountability to consumers. Through an analysis of regulatory changes, case law and policy documents on the performance of the health insurance industry, it is argued that existing health insurance regulation exhibits inevitable tensions due to shifting and often conflicting government objectives about the role of private health insurance.

  5. Issues in national health insurance.

    PubMed Central

    Donabedian, A

    1976-01-01

    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. PMID:817614

  6. 78 FR 14034 - Health Insurance Providers Fee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-04

    ... applicable to student health insurance, see Student Health Insurance Coverage, 77 FR 16453, 16455-56 (March... definition of covered entity is also Sec. 2520.101-2(c)(2)(ii)(B) (RIN 1210-AB51). See 76 FR 76222. If and... Internal Revenue Service 26 CFR Part 57 RIN 1545-BL20 Health Insurance Providers Fee AGENCY:...

  7. The German Statutory Health Insurance Program.

    ERIC Educational Resources Information Center

    Stassen, Manfred

    1993-01-01

    Describes the German health insurance system which is mandatory for nearly all German citizens. Explains that, along with pension, accident, and unemployment insurance, health insurance is one of four pillars of the German national social security system. Asserts that controlling costs while maintaining high health care standards is a national…

  8. Health Insurance and Children with Disabilities

    ERIC Educational Resources Information Center

    Szilagyi, Peter G.

    2012-01-01

    Few people would disagree that children with disabilities need adequate health insurance. But what kind of health insurance coverage would be optimal for these children? Peter Szilagyi surveys the current state of insurance coverage for children with special health care needs and examines critical aspects of coverage with an eye to helping policy…

  9. Private health insurance: implications for developing countries.

    PubMed Central

    Sekhri, Neelam; Savedoff, William

    2005-01-01

    Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage. PMID:15744405

  10. Understanding health insurance plans

    MedlinePlus

    ... What is the difference between an HMO, PPO, POS, and EPO? Do they offer the same coverage? This guide to health plans can help you understand each type of plan. Then you can more easily choose the right plan for you and your family.

  11. Health insurance for the "uninsurable".

    PubMed

    Schneck, L H

    2000-01-01

    State-sponsored health insurance plans for people labeled "uninsurable" by commercial carriers provide financial lifelines for those who qualify. In 28 states, individuals suffering from cancer, AIDS, multiple sclerosis, emotional disorders, cystic fibrosis, para- or quadriplegia and other chronic or recurrent health problems receive benefits--for reasonable premiums--from innovative programs that can literally make the difference between life and death, solvency or indigence. Medical practices and other health care facilities can play a pivotal role in informing patients of these coverage options--and by doing so, increase their revenue, as well.

  12. Health Insurance and Risk of Divorce: Does Having Your Own Insurance Matter?

    PubMed Central

    Sohn, Heeju

    2016-01-01

    Most American adults under 65 obtain health insurance through their employers or their spouses’ employers. The absence of a universal healthcare system in the United States puts Americans at considerable risk for losing their coverage when transitioning out of jobs or marriages. Scholars have found evidence of reduced job mobility among individuals who are dependent on their employers for healthcare coverage. This paper finds similar relationships between insurance and divorce. I apply the hazard model to married individuals in the longitudinal Survey of Income Program Participation (N=17,388) and find lower divorce rates among people who are insured through their partners’ plans without alternative sources of their own. Furthermore, I find gender differences in the relationship between healthcare coverage and divorce rates: insurance dependent women have lower rates of divorce than men in similar situations. These findings draw attention to the importance of considering family processes when debating and evaluating health policies. PMID:26949269

  13. Health Insurance: Understanding Your Health Plan's Rules

    MedlinePlus

    ... have to pay more for it. Your insurance company can give you a list of drugs that are on the formulary. If necessary, show the list to your doctor when he or she writes you a ... for help. SourceInformation adapted from "Understanding Your Health ...

  14. Cancer survival disparities by health insurance status.

    PubMed

    Niu, Xiaoling; Roche, Lisa M; Pawlish, Karen S; Henry, Kevin A

    2013-06-01

    Previous studies found that uninsured and Medicaid insured cancer patients have poorer outcomes than cancer patients with private insurance. We examined the association between health insurance status and survival of New Jersey patients 18-64 diagnosed with seven common cancers during 1999-2004. Hazard ratios (HRs) with 95% confidence intervals for 5-year cause-specific survival were calculated from Cox proportional hazards regression models; health insurance status was the primary predictor with adjustment for other significant factors in univariate chi-square or Kaplan-Meier survival log-rank tests. Two diagnosis periods by health insurance status were compared using Kaplan-Meier survival log-rank tests. For breast, colorectal, lung, non-Hodgkin lymphoma (NHL), and prostate cancer, uninsured and Medicaid insured patients had significantly higher risks of death than privately insured patients. For bladder cancer, uninsured patients had a significantly higher risk of death than privately insured patients. Survival improved between the two diagnosis periods for privately insured patients with breast, colorectal, or lung cancer and NHL, for Medicaid insured patients with NHL, and not at all for uninsured patients. Survival from cancer appears to be related to a complex set of demographic and clinical factors of which insurance status is a part. While ensuring that everyone has adequate health insurance is an important step, additional measures must be taken to address cancer survival disparities.

  15. Private health insurance and access to healthcare.

    PubMed

    Duggal, Ravi

    2011-01-01

    The health insurance business in India has seen a growth of over 25% per annum in the last few years with the expansion of the private health insurance sector. The premium incomes of health insurance have crossed the Rs 8,000 crore mark with the share of private companies increasing to over 41%. This is despite the fact that from the perspective of patients, health insurance is not a good deal, especially when they need it most. This raises a number of ethical issues regarding how the health insurance business runs and how medical practice adjusts to it for profiteering. This article uses the personal experience of the author to argue that health insurance in an unregulated environment can only lead to unethical practices, further victimising the patient. Further, publicly financed healthcare which operates in an environment regulating both public and private healthcare provisioning is the only way to assure access to ethical and equitable healthcare to people. PMID:22106595

  16. Promoting private health insurance in Australia.

    PubMed

    Willcox, S

    2001-01-01

    Health insurance policy in Australia has been distinguished by considerable instability over the past five years. This paper reviews the rationale and emerging evidence on three major policy initiatives--a move to allow selective contracting, the introduction of a 30 percent government subsidy for private health insurance, and the abolition of pure community rating. Policy making on private health insurance has been characterized by insufficient attention to research that might provide a stronger evidence basis for policy reforms.

  17. Designing health insurance exchanges: key decisions.

    PubMed

    Starc, Amanda; Kolstad, Jonathan T

    2012-02-01

    A cornerstone of health care reform is the establishment of state-level insurance exchanges where individuals and small businesses can purchase health insurance in an online marketplace. States are required to develop an exchange by 2014, or participate in a federal one. The exchanges will help people without employer-sponsored insurance find and choose a health plan to meet their needs. This Issue Brief reviews the experience of Massachusetts in developing a health insurance exchange and offers policymakers guidance on key features and likely consumer responses. PMID:22451998

  18. Changing Awareness of the Health Insurance Marketplace

    PubMed Central

    Agarwal, Parul; Fitzgerald, Paula

    2015-01-01

    The Health Insurance Marketplace was designed to increase the affordability of health insurance. The success of the marketplace depends on people’s awareness and use of it. In a statewide mail survey of West Virginians, we found that respondents’ awareness of the West Virginia Health Insurance Marketplace increased from 2013 to 2014. However, large percentages of respondents continued to be unaware of the availability of federal subsidies and were unsure of their personal eligibility for these subsidies. It is essential that awareness and enrollment efforts continue and that they be expanded in novel ways to continue growth in access to health insurance through the marketplace. PMID:26447917

  19. 3 CFR - State Children's Health Insurance Program

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 3 The President 1 2010-01-01 2010-01-01 false State Children's Health Insurance Program Presidential Documents Other Presidential Documents Memorandum of February 4, 2009 State Children's Health Insurance Program Memorandum for the Secretary of Health and Human Services The State Children's...

  20. Increasing Health Insurance Costs and the Decline in Insurance Coverage

    PubMed Central

    Chernew, Michael; Cutler, David M; Keenan, Patricia Seliger

    2005-01-01

    Objective To determine the impact of rising health insurance premiums on coverage rates. Data Sources & Study Setting Our analysis is based on two cohorts of nonelderly Americans residing in 64 large metropolitan statistical areas (MSAs) surveyed in the Current Population Survey in 1989–1991 and 1998–2000. Measures of premiums are based on data from the Health Insurance Association of America and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer-Sponsored Health Benefits. Study Design Probit regression and instrumental variable techniques are used to estimate the association between rising local health insurance costs and the falling propensity for individuals to have any health insurance coverage, controlling for a rich array of economic, demographic, and policy covariates. Principal Findings More than half of the decline in coverage rates experienced over the 1990s is attributable to the increase in health insurance premiums (2.0 percentage points of the 3.1 percentage point decline). Medicaid expansions led to a 1 percentage point increase in coverage. Changes in economic and demographic factors had little net effect. The number of people uninsured could increase by 1.9–6.3 million in the decade ending 2010 if real, per capita medical costs increase at a rate of 1–3 percentage points, holding all else constant. Conclusions Initiatives aimed at reducing the number of uninsured must confront the growing pressure on coverage rates generated by rising costs. PMID:16033490

  1. Cancer Survivorship, Health Insurance, and Employment Transitions among Older Workers

    PubMed Central

    Tunceli, Kaan; Short, Pamela Farley; Moran, John R.; Tunceli, Ozgur

    2014-01-01

    This study examined the effect of job-related health insurance on employment transitions (labor force exits, reductions in hours, and job changes) of older working cancer survivors. Using multivariate models, we compared longitudinal data for the period 1997–2002 from the Penn State Cancer Survivor Study to similar data for workers with no cancer history in the Health and Retirement Study, who were also ages 55 to 64 at follow up. The interaction of cancer survivorship with health insurance at diagnosis was negative and significant in predicting labor force exits, job changes, and transitions to part-time employment for both genders. The differential effect of job-related health insurance on the labor market dynamics of cancer survivors represents an additional component of the economic and psychosocial burden of cancer on survivors. PMID:19489481

  2. BEHAVIORAL HAZARD IN HEALTH INSURANCE*

    PubMed Central

    Baicker, Katherine; Mullainathan, Sendhil; Schwartzstein, Joshua

    2015-01-01

    A fundamental implication of standard moral hazard models is overuse of low-value medical care because copays are lower than costs. In these models, the demand curve alone can be used to make welfare statements, a fact relied on by much empirical work. There is ample evidence, though, that people misuse care for a different reason: mistakes, or “behavioral hazard.” Much high-value care is underused even when patient costs are low, and some useless care is bought even when patients face the full cost. In the presence of behavioral hazard, welfare calculations using only the demand curve can be off by orders of magnitude or even be the wrong sign. We derive optimal copay formulas that incorporate both moral and behavioral hazard, providing a theoretical foundation for value-based insurance design and a way to interpret behavioral “nudges.” Once behavioral hazard is taken into account, health insurance can do more than just provide financial protection—it can also improve health care efficiency. PMID:23930294

  3. The adequacy of college health insurance coverage.

    PubMed

    McManus, M; Brauer, M; Weader, R; Newacheck, P

    1991-01-01

    This analysis of private health insurance plans offered in 100 four-year colleges and universities in 1988 indicates a tremendous diversity in plan options, benefits covered, cost-sharing requirements, and catastrophic protections. Consistent with relatively low premium prices, most student health insurance plans offer limited benefits and expose students to significant out-of-pocket medical cost liabilities. Only a minority of schools use financial incentives, such as preferred provider arrangements, to integrate their health insurance plans with their university health service system. We conclude that universities should carefully reexamine the adequacy of their health insurance plans and their relationship to student health centers. As more students rely on student health insurance as their only source of coverage, the quality of these plans assumes an even greater importance.

  4. Determinants of Health Insurance Coverage among People Aged 45 and over in China: Who Buys Public, Private and Multiple Insurance

    PubMed Central

    Jin, Yinzi; Hou, Zhiyuan; Zhang, Donglan

    2016-01-01

    Background China is reforming and restructuring its health insurance system to achieve the goal of universal coverage. This study aims to understand the determinants of public, private and multiple insurance coverage among people of retirement-age in China. Methods We used data from the China Health and Retirement Longitudinal Survey 2011 and 2013, a nationally representative survey of Chinese people aged 45 and over. Multinomial logit regression was performed to identify the determinants of public, private and multiple health insurance coverage. We also conducted logit regression to examine the association between public insurance coverage and demand for private insurance. Results In 2013, 94.5% of this population had at least one type of public insurance, and 12.2% purchased private insurance. In general, we found that rural residents were less likely to be uninsured (Relative Risk Ratio (RRR) = 0.40, 95% Confidence Interval (CI): 0.34–0.47) and were less likely to buy private insurance (RRR = 0.22, 95% CI: 0.16–0.31). But rural-to-urban migrants were more likely to be uninsured (RRR = 1.39, 95% CI: 1.24–1.57). Public health insurance coverage may crowd out private insurance market (Odds Ratio = 0.55, 95% CI: 0.48–0.63), particularly among enrollees of Urban Resident Basic Medical Insurance. There exists a huge socioeconomic disparity in both public and private insurance coverage. Conclusion The migrants, the poor and the vulnerable remained in the edge of the system. The growing private insurance market did not provide sufficient financial protection and did not cover the people with the greatest need. To achieve universal coverage and reduce socioeconomic disparity, China should integrate the urban and rural public insurance schemes across regions and remove the barriers for the middle-income and low-income to access private insurance. PMID:27564320

  5. Health insurance reform: labor versus health perspectives.

    PubMed

    Ammar, Walid; Awar, May

    2012-01-01

    The Ministry of Labor (MOL) has submitted to the Council of Ministers a social security reform plan. The Ministry of Public Health (MOPH) considers that health financing should be dealt with as part of a more comprehensive health reform plan that falls under its prerogatives. While a virulent political discussion is taking place, major stakeholders' inputs are very limited and civil society is totally put away from the whole policy making process. The role of the media is restricted to reproducing political disputes, without meaningful substantive debate. This paper discusses health insurance reform from labor market as well as public health perspectives, and aims at launching a serious public debate on this crucial issue that touches the life of every citizen.

  6. Competition between health maintenance organizations and nonintegrated health insurance companies in health insurance markets.

    PubMed

    Baranes, Edmond; Bardey, David

    2015-12-01

    This article examines a model of competition between two types of health insurer: Health Maintenance Organizations (HMOs) and nonintegrated insurers. HMOs vertically integrate health care providers and pay them at a competitive price, while nonintegrated health insurers work as indemnity plans and pay the health care providers freely chosen by policyholders at a wholesale price. Such difference is referred to as an input price effect which, at first glance, favors HMOs. Moreover, we assume that policyholders place a positive value on the provider diversity supplied by their health insurance plan and that this value increases with the probability of disease. Due to the restricted choice of health care providers in HMOs a risk segmentation occurs: policyholders who choose nonintegrated health insurers are characterized by higher risk, which also tends to favor HMOs. Our equilibrium analysis reveals that the equilibrium allocation only depends on the number of HMOs in the case of exclusivity contracts between HMOs and providers. Surprisingly, our model shows that the interplay between risk segmentation and input price effects may generate ambiguous results. More precisely, we reveal that vertical integration in health insurance markets may decrease health insurers' premiums.

  7. Acculturation and Health Insurance of Mexicans in the USA

    PubMed Central

    Kaushal, Neeraj; Kaestner, Robert

    2014-01-01

    We study how the health insurance coverage of Mexican immigrants changes with time in the U.S. Cross sectional estimates indicate that time since arrival is negatively correlated with the probability of being uninsured for both male and female Mexican immigrants, and about a third of the decline could be attributed to civic and labor market incorporation of Mexican immigrants. However, much of the relationship between time in the U.S. and health insurance coverage, after adjusting for demographic and labor market factors, is due to failure to control for age at arrival and period of arrival. Estimates from longitudinal analyses suggest that there is no systematic relationship between time in the U.S. and health insurance of Mexican immigrants, although imprecision in the fixed effects estimates makes it difficult to draw firm conclusions. PMID:27656051

  8. Acculturation and Health Insurance of Mexicans in the USA

    PubMed Central

    Kaushal, Neeraj; Kaestner, Robert

    2014-01-01

    We study how the health insurance coverage of Mexican immigrants changes with time in the U.S. Cross sectional estimates indicate that time since arrival is negatively correlated with the probability of being uninsured for both male and female Mexican immigrants, and about a third of the decline could be attributed to civic and labor market incorporation of Mexican immigrants. However, much of the relationship between time in the U.S. and health insurance coverage, after adjusting for demographic and labor market factors, is due to failure to control for age at arrival and period of arrival. Estimates from longitudinal analyses suggest that there is no systematic relationship between time in the U.S. and health insurance of Mexican immigrants, although imprecision in the fixed effects estimates makes it difficult to draw firm conclusions.

  9. How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

    PubMed

    Trish, Erin E; Herring, Bradley J

    2015-07-01

    The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans' transactions with employers and the other concentration measure representing insurers' bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. PMID:25910690

  10. HEALTH INSURANCE COVERAGE FOR WORKERS ON LAYOFF.

    ERIC Educational Resources Information Center

    KOLODRUBETZ, WALTER W.

    ESTIMATES OF GROUP HEALTH INSURANCE COVERAGE BY INDUSTRY INDICATE THAT EXTENDED PROTECTION DURING LAYOFF IS GUARANTEED TO NO MORE THAN A TENTH OF THE APPROXIMATELY 50 MILLION WORKERS COVERED BY GROUP HEALTH INSURANCE PLANS. THIS COVERAGE HAS LARGELY DEVELOPED DURING THE PAST 15 YEARS. FRAGMENTARY DATA SUGGEST THAT INCREASED COST ATTRIBUTABLE TO…

  11. Health Insurance Status May Affect Cancer Patients' Survival

    MedlinePlus

    ... or federal policy. More Health News on: Cancer Health Disparities Health Insurance Recent Health News Related MedlinePlus Health Topics Cancer Health Disparities Health Insurance About MedlinePlus Site Map FAQs Contact ...

  12. Public health insurance under a nonbenevolent state.

    PubMed

    Lemieux, Pierre

    2008-10-01

    This paper explores the consequences of the oft ignored fact that public health insurance must actually be supplied by the state. Depending how the state is modeled, different health insurance outcomes are expected. The benevolent model of the state does not account for many actual features of public health insurance systems. One alternative is to use a standard public choice model, where state action is determined by interaction between self-interested actors. Another alternative--related to a strand in public choice theory--is to model the state as Leviathan. Interestingly, some proponents of public health insurance use an implicit Leviathan model, but not consistently. The Leviathan model of the state explains many features of public health insurance: its uncontrolled growth, its tendency toward monopoly, its capacity to buy trust and loyalty from the common people, its surveillance ability, its controlling nature, and even the persistence of its inefficiencies and waiting lines.

  13. Life cycle responses to health insurance status.

    PubMed

    Pelgrin, Florian; St-Amour, Pascal

    2016-09-01

    This paper studies the lifetime effects of exogenous changes in health insurance coverage (e.g. Medicare, PPACA, termination of employer-provided plans) on the dynamic optimal allocation (consumption, leisure, health expenditures), status (health and wealth), and welfare. We solve, simulate, and structurally estimate a parsimonious life cycle model with endogenous exposure to morbidity and mortality risks, and exogenous health insurance. By varying coverage, we identify the marginal effects of insurance when young and/or when old on allocations, statuses, and welfare. Our results highlight positive effects of insurance on health, wealth and welfare, as well as mid-life substitution away from healthy leisure in favor of more health expenses, caused by peaking wages, and accelerating health issues.

  14. 41 CFR 60-741.25 - Health insurance, life insurance and other benefit plans.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life insurance and other benefit plans. 60-741.25 Section 60-741.25 Public Contracts and Property Management... Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical...

  15. Health insurance premium tax credit. Final regulations.

    PubMed

    2013-02-01

    This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.These final regulations provide guidance to individuals related to employees who may enroll in eligible employer-sponsored coverage and who wish to enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit. PMID:23476972

  16. Children and Health Insurance. Special Report.

    ERIC Educational Resources Information Center

    Rosenbaum, Sara; And Others

    This report examines the place of children in the employment-based health insurance system. The report, which uses data from three national studies conducted by the Federal Government between 1977 and 1990, estimates the number of children who are uninsured or underinsured and examines the decline of children's private insurance coverage between…

  17. Drug coverage insurance as a novel element of private health insurance in Poland.

    PubMed

    Czerw, Aleksandra; Religioni, Urszula

    2013-01-01

    In recent years, there have been observed increased costs of health care in Poland. The patient's out of pocket expenses on drug have grown too. To the above, the insurance companies have offered patients drug coverage insurance policies since recently. Drug insurance policy covers the cost of purchasing pharmaceutical products not reimbursed by the National Health Fund is a modern product on the Polish health insurance market. The aim of the article is to characterize drug coverage insurance policies on the health insurance market in Poland. The Polish insurance market and entities offered these types of insurance are also presented.

  18. Tax subsidies for private health insurance.

    PubMed

    Williams, Claudia; Burman, Len; Uccello, Cori; Wheaton, Laura; Kobes, Deborah; Khitatrakun, Surachai; Goodell, Sarah

    2003-05-01

    The exclusion from income and payroll taxes for employer-paid health insurance premiums amounted to more than $240 billion in 2010. As policy-makers search for ways to pay for health care reform and contain health care costs, this exclusion is coming under scrutiny, despite the fact that employee-sponsored insurance (ESI) is an integral part of the health insurance system. This update of a 2003 synthesis looks at the tax subsidy for private health insurance. Key findings include: The current tax subsidy benefits higher-income workers the most. The tax exclusion is worth more to those in higher tax brackets, higher-income workers are three times more likely to work for firms who offer ESI than lower-income workers, and they are more likely to purchase ESI when offered because they can afford it. Families earning $10,000 to $20,000 annually spend more than 25 percent of their income on health insurance but the value of their tax subsidy is only $1,500. By contrast, earners over $200,000 spend less than 5 percent on health insurance but their benefit is worth $4,500. Workers who cannot afford ESI or are ineligible, including the self-employed and many part-time workers, do not receive this subsidy when they purchase private, non-group coverage. PMID:22052181

  19. Who transitions from private to public health insurance?: Lessons from expansions of the State Children's Health Insurance Program.

    PubMed

    Shaefer, H Luke; Grogan, Colleen M; Pollack, Harold A

    2011-02-01

    This paper examines families of children who transition from private to public health insurance. These transitions include, but are not limited to, transitions that constitute crowd-out. We pool longitudinal panels from the Survey of Income and Program Participation (SIPP) covering 1990 to 2005. The annual rate of children who transition from private to public coverage more than doubled over this period, although it remains small. Transitioning children in recent years are typically in working families with median incomes of around 200% of poverty. Children who transition from private to public coverage are more likely to belong to minority groups, to have lower incomes, and to be in poorer health than children remaining privately insured. Public coverage now provides important protections for low-income working families, especially those with children in poor health. These findings underscore the need to implement post-health-reform policies with an eye towards possible adverse selection into public programs.

  20. Health-insurance products and plan options.

    PubMed

    Youkstetter, W D

    1990-10-01

    Trends in health insurance are discussed, with emphasis on insurers' efforts to offer an array of cost-effective plans tailored to the needs of employers and subscribers. Health-insurance companies, responding to employers' demands to curtail the rising costs of premiums, now offer a variety of insurance products. While indemnity plans, health maintenance organizations (HMOs), and preferred-provider organizations (PPOs) remain as the three basic types of plans, insurers are combining these elements in different ways, creating dual- and triple-option plans that consist of indemnity insurance and an HMO, a PPO and an HMO, or other variations. Insurers offering multiple options may effect internal cost savings through shared personnel and administrative expenses. Four factors influence the development and marketing of insurance products: cost and volume of healthcare services, adverse selection, competition, and the profit incentive. Many of the insurance products have been developed in response to requests for maximum freedom of choice of provider; as an example, the fastest-growing HMO product in 1989 was the point-of-service HMO, which allows the subscriber to seek care from a provider who is not part of the HMO network. PPOs and exclusive-provider organizations (EPOs) are growing; these are often organized by hospitals or physician networks. Among the new trends in product-line development are "riders" for specialty services such as vision care and prescription drugs. As competition intensifies, marketing efforts are focusing on previously overlooked groups such as the small employer and certain ethnic communities. Cost and freedom of choice will remain important criteria in the selection of insurance products.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Type of health insurance and the quality of primary care experience.

    PubMed Central

    Shi, L

    2000-01-01

    OBJECTIVES: This study examined the association between type of health insurance coverage and quality of primary care as measured by its distinguishing attributes--first contact, longitudinality, comprehensiveness, and coordination. METHODS: The household component of the 1996 Medical Expenditure Panel Survey was used for this study. The analysis primarily focused on subjects aged younger than 65 years who identified a usual source of care. Logistic regressions were used to examine the independent effects of insurance status on primary care attributes while individual sociodemographic characteristics were controlled for. RESULTS: The experience of primary care varies according to insurance status. The insured are able to obtain better primary care than the uninsured, and the privately insured are able to obtain better primary care than the publicly insured. Those insured through fee-for-service coverage experience better longitudinal care and less of a barrier to access than those insured through health maintenance organizations (HMOs). CONCLUSIONS: While expanding insurance coverage is important for establishing access to care, efforts are needed to enhance the quality of primary health care, particularly for the publicly insured. Policymakers should closely monitor the quality of primary care provided by HMOs. PMID:11111255

  2. Comparing Types of Health Insurance for Children

    PubMed Central

    DeVoe, Jennifer E.; Tillotson, Carrie J.; Wallace, Lorraine S.; Selph, Shelley; Graham, Alan; Angier, Heather

    2015-01-01

    Background Many states have expanded public health insurance programs for children, and further expansions were proposed in recent national reform initiatives; yet the expansion of public insurance plans and the inclusion of a public option in state insurance exchange programs sparked controversies and raised new questions with regard to the quality and adequacy of various insurance types. Objectives We aimed to examine the comparative effectiveness of public versus private coverage on parental-reported children’s access to health care in low-income and middle-income families. Methods/Participants/Measures We conducted secondary data analyses of the nationally representative Medical Expenditure Panel Survey, pooling years 2002 to 2006. We assessed univariate and multivariate associations between child’s full-year insurance type and parental-reported unmet health care and preventive counseling needs among children in low-income (n =28,338) and middle-income families (n = 13,160). Results Among children in families earning <200% of the federal poverty level, those with public insurance were significantly less likely to have no usual source of care compared with privately insured children (adjusted relative risk, 0.79; 95% confidence interval, 0.63–0.99). This was the only significant difference in 50 logistic regression models comparing unmet health care and preventive counseling needs among low-income and middle-income children with public versus private coverage. Conclusions The striking similarities in reported rates of unmet needs among children with public versus private coverage in both low-income and middle-income groups suggest that a public children’s insurance option may be equivalent to a private option in guaranteeing access to necessary health care services for all children. PMID:21478781

  3. Smart Choice Health Insurance©: A New, Interdisciplinary Program to Enhance Health Insurance Literacy.

    PubMed

    Brown, Virginia; Russell, Mia; Ginter, Amanda; Braun, Bonnie; Little, Lynn; Pippidis, Maria; McCoy, Teresa

    2016-03-01

    Smart Choice Health Insurance© is a consumer education program based on the definition and emerging measurement of health insurance literacy and a review of literature and appropriate theoretical frameworks. An interdisciplinary team of financial and health educators was formed to develop and pilot the program, with the goal of reducing confusion and increasing confidence in the consumer's ability to make a smart health insurance decision. Educators in seven states, certified to teach the program, conducted workshops for 994 consumers. Results show statistically significant evidence of increased health insurance literacy, confidence, and capacity to make a smart choice health insurance choice. Discussion centers on the impact the program had on specific groups, next steps to reach a larger audience, and implications for educators, consumers, and policymakers nationwide. PMID:26721502

  4. Selection on Moral Hazard in Health Insurance.

    PubMed

    Einav, Liran; Finkelstein, Amy; Ryan, Stephen; Schrimpf, Paul; Cullen, Mark R

    2013-02-01

    We use employee-level panel data from a single firm to explore the possibility that individuals may select insurance coverage in part based on their anticipated behavioral ("moral hazard") response to insurance, a phenomenon we label "selection on moral hazard." Using a model of plan choice and medical utilization, we present evidence of heterogeneous moral hazard as well as selection on it, and explore some of its implications. For example, we show that, at least in our context, abstracting from selection on moral hazard could lead to over-estimates of the spending reduction associated with introducing a high-deductible health insurance option.

  5. Selection on Moral Hazard in Health Insurance

    PubMed Central

    Einav, Liran; Finkelstein, Amy; Ryan, Stephen; Schrimpf, Paul

    2012-01-01

    We use employee-level panel data from a single firm to explore the possibility that individuals may select insurance coverage in part based on their anticipated behavioral (“moral hazard”) response to insurance, a phenomenon we label “selection on moral hazard.” Using a model of plan choice and medical utilization, we present evidence of heterogeneous moral hazard as well as selection on it, and explore some of its implications. For example, we show that, at least in our context, abstracting from selection on moral hazard could lead to over-estimates of the spending reduction associated with introducing a high-deductible health insurance option. PMID:24748682

  6. Pricing behaviour of nonprofit insurers in a weakly competitive social health insurance market.

    PubMed

    Douven, Rudy C H M; Schut, Frederik T

    2011-03-01

    In this paper we examine the pricing behaviour of nonprofit health insurers in the Dutch social health insurance market. Since for-profit insurers were not allowed in this market, potential spillover effects from the presence of for-profit insurers on the behaviour of nonprofit insurers were absent. Using a panel data set for all health insurers operating in the Dutch social health insurance market over the period 1996-2004, we estimate a premium model to determine which factors explain the price setting behaviour of nonprofit health insurers. We find that financial stability rather than profit maximisation offers the best explanation for health plan pricing behaviour. In the presence of weak price competition, health insurers did not set premiums to maximize profits. Nevertheless, our findings suggest that regulations on financial reserves are needed to restrict premiums.

  7. 77 FR 16453 - Student Health Insurance Coverage

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-21

    ... proposed rule (76 FR 7767) regarding section 1560(c) entitled ``Student Health Insurance Coverage.'' In the... Departments), published interim final rules (IFR) with request for comments (76 FR 46621) amending the Interim... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  8. Student Health Insurance: Problems and Solutions

    ERIC Educational Resources Information Center

    Wagner, Robin

    2006-01-01

    Student health insurance experiences the same inflationary trends as employee benefits, but is rarely viewed as a significant direct cost to an institution, nor is the bill as high as the costs associated with employee health plans. Several long-term solutions and strategies that could help colleges to contain the ever-escalating cost of providing…

  9. Can Health Insurance Reduce School Absenteeism?

    ERIC Educational Resources Information Center

    Yeung, Ryan; Gunton, Bradley; Kalbacher, Dylan; Seltzer, Jed; Wesolowski, Hannah

    2011-01-01

    Enacted in 1997, the State Children's Health Insurance Program (SCHIP) represented the largest expansion of U.S. public health care coverage since the passage of Medicare and Medicaid 32 years earlier. Although the program has recently been reauthorized, there remains a considerable lack of thorough and well-designed evaluations of the program. In…

  10. Many Hispanics, Poor Still Without Health Insurance: Report

    MedlinePlus

    ... fullstory_160507.html Many Hispanics, Poor Still Without Health Insurance: Report Majority live in states that haven't ... 2016 (HealthDay News) -- Despite an overall rise in health insurance coverage among all Americans, Hispanics, low-income earners ...

  11. 45 CFR 147.145 - Student health insurance coverage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Student health insurance coverage. 147.145 Section 147.145 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS §...

  12. 45 CFR 147.145 - Student health insurance coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Student health insurance coverage. 147.145 Section 147.145 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS §...

  13. 45 CFR 147.102 - Fair health insurance premiums.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Fair health insurance premiums. 147.102 Section 147.102 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS §...

  14. 45 CFR 147.102 - Fair health insurance premiums.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Fair health insurance premiums. 147.102 Section 147.102 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS §...

  15. 45 CFR 147.145 - Student health insurance coverage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Student health insurance coverage. 147.145 Section 147.145 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS §...

  16. Self-selection and moral hazard in Chilean health insurance.

    PubMed

    Sapelli, Claudio; Vial, Bernardita

    2003-05-01

    We study the existence of self-selection and moral hazard in the Chilean health insurance industry. Dependent workers must purchase health insurance either from one public or several private insurance providers. For them, we analyze the relationship between health care services utilization and the choice of either private or public insurance. In the case of independent workers, where there is no mandate, we analyze the relationship between utilization and the decision to voluntarily purchase health insurance. The results show self-selection against insurance companies for independent workers, and against public insurance for dependent workers. Moral hazard is negligible in the case of hospitalization, but for medical visits, it is quantitatively important.

  17. 41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management..., life insurance and other benefit plans. (a) An insurer, hospital, or medical service company,...

  18. 41 CFR 60-300.25 - Health insurance, life insurance and other benefit plans.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life insurance and other benefit plans. 60-300.25 Section 60-300.25 Public Contracts and Property Management..., life insurance and other benefit plans. (a) An insurer, hospital, or medical service company,...

  19. Operationalizing universal health coverage in Nigeria through social health insurance.

    PubMed

    Okpani, Arnold Ikedichi; Abimbola, Seye

    2015-01-01

    Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme. PMID:26778879

  20. Operationalizing universal health coverage in Nigeria through social health insurance.

    PubMed

    Okpani, Arnold Ikedichi; Abimbola, Seye

    2015-01-01

    Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme.

  1. Operationalizing universal health coverage in Nigeria through social health insurance

    PubMed Central

    Okpani, Arnold Ikedichi; Abimbola, Seye

    2015-01-01

    Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme. PMID:26778879

  2. Health insurance and the obesity externality.

    PubMed

    Bhattacharya, Jay; Sood, Neeraj

    2007-01-01

    If rational individuals pay the full costs of their decisions about food intake and exercise, economists, policy makers, and public health officials should treat the obesity epidemic as a matter of indifference. In this paper, we show that, as long as insurance premiums are not risk rated for obesity, health insurance coverage systematically shields those covered from the full costs of physical inactivity and overeating. Since the obese consume significantly more medical resources than the non-obese, but pay the same health insurance premiums, they impose a negative externality on normal weight individuals in their insurance pool. To estimate the size of this externality, we develop a model of weight loss and health insurance under two regimes--(1) underwriting on weight is allowed and (2) underwriting on weight is not allowed. We show that under regime (1), there is no obesity externality. Under regime (2), where there is an obesity externality, all plan participants face inefficient incentives to undertake unpleasant dieting and exercise. These reduced incentives lead to inefficient increases in bodyweight, and reduced social welfare. Using data on medical expenditures and bodyweight from the National Health and Interview Survey and the Medical Expenditure Panel Survey, we estimate that, in a health plan with a coinsurance rate of 17.5%, the obesity externality imposes a welfare cost of about $150 per capita. Our results also indicate that the welfare loss can be reduced by technological change that lowers the pecuniary and non-pecuniary costs of losing weight, and also by increasing the coinsurance rate.

  3. National Health Insurance and Health Education: Strategies for Change.

    ERIC Educational Resources Information Center

    Dwore, Richard B.

    1980-01-01

    The concept of National Health Insurance (NHI) as one of several strategies for resolving health problems in the U.S. is discussed. NHI goals include comprehensive health care, quality health care, efficient delivery systems, phased-in benefits, and consumer representation. (JD)

  4. Welfare Reform and Health Insurance of Immigrants

    PubMed Central

    Kaushal, Neeraj; Kaestner, Robert

    2005-01-01

    Objective To investigate the effect of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) on the health insurance coverage of foreign- and U.S.-born families headed by low-educated women. Data Source Secondary data from the March series of the Current Population Surveys for 1994–2001. Study Design Multivariate regression methods and a pre- and post-test with comparison group research design (difference-in-differences) are used to estimate the effect of welfare reform on the health insurance coverage of low-educated, foreign- and U.S.-born unmarried women and their children. Heterogenous responses by states to create substitute Temporary Aid to Needy Families or Medicaid programs for newly arrived immigrants are used to investigate whether the estimated effect of PRWORA on newly arrived immigrants is related to the actual provisions of the law, or the result of fears engendered by the law. Principal Findings PRWORA increased the proportion of uninsured among low-educated, foreign-born, unmarried women by 9.9–10.7 percentage points. In contrast, the effect of PRWORA on the health insurance coverage of similar U.S.-born women is negligible. PRWORA also increased the proportion of uninsured among foreign-born children living with low-educated, single mothers by 13.5 percentage points. Again, the policy had little effect on the health insurance coverage of the children of U.S.-born, low-educated single mothers. There is some evidence that the fear and uncertainty engendered by the law had an effect on immigrant health insurance coverage. Conclusions This research demonstrates that PRWORA adversely affected the health insurance of low-educated, unmarried, immigrant women and their children. In the case of unmarried women, it may be partly because the jobs that they obtained in response to PRWORA were less likely to provide health insurance. The research also suggests that PRWORA may have engendered fear among immigrants and dampened their

  5. Catastrophic health insurance and cost containment: restructuring the current health insurance system.

    PubMed

    Zucker, J L

    1980-01-01

    Catastrophic health insurance may be necessary to curb rising health care costs in the United States. A major factor in this rise has been the current structure of the nation's health insurance system, which inadequately protects individuals with expensive illnesses, but encourages over-insurance for less expensive illnesses. This Note examines the current health insurance system, and analyzes its impact on health care costs for individuals and society. It evaluates several proposals to modify the structure of the current health insurance system, and recommends the adoption of a catastrophic health insurance plan based on an economic definition of catastrophe. Such a plan would decrease shallow coverage, and would use coinsurance and deductible rates keyed to the individual's income as means of increasing consumer cost consciousness without making necessary care unreasonably expensive. This Note also recommends that a catastrophic plan only cover treatment that has been determined medically necessary by utilization review, and that this review encourage outpatient rather than costly inpatient treatment. PMID:7435508

  6. Does Retiree Health Insurance Encourage Early Retirement?*

    PubMed Central

    Nyce, Steven; Schieber, Sylvester J.; Shoven, John B.; Slavov, Sita Nataraj; Wise, David A.

    2013-01-01

    The strong link between health insurance and employment in the United States may cause workers to delay retirement until they become eligible for Medicare at age 65. However, some employers extend health insurance benefits to their retirees, and individuals who are eligible for such retiree health benefits need not wait until age 65 to retire with group health coverage. We investigate the impact of retiree health insurance on early retirement using employee-level data from 54 diverse firms that are clients of Towers Watson, a leading benefits consulting firm. We find that retiree health coverage has its strongest effects at ages 62 through 64. Coverage that includes an employer contribution is associated with a 6.3 percentage point (36.2 percent) increase in the probability of turnover at age 62, a 7.7 percentage point (48.8 percent) increase in the probability of turnover at age 63, and a 5.5 percentage point (38.0 percent) increase in the probability of turnover at age 64. Conditional on working at age 57, such coverage reduces the expected retirement age by almost three months and reduces the total number of person-years worked between ages 58 and 64 by 5.6 percent. PMID:24039312

  7. Life, health, and disability insurance: understanding the relationships.

    PubMed

    Jerry, Robert H

    2007-01-01

    Communitarian values are stronger in health insurance than in life or disability insurance. This correlates with increased tolerance for insurers' use of genetic information in disability insurance underwriting, which, in turn, is relevant to the scope and content of proposals to regulate such use.

  8. America's Children: Health Insurance and Access to Care.

    ERIC Educational Resources Information Center

    Edmunds, Margaret, Ed.; Coye, Molly Joel, Ed.

    The National Academy of Sciences Committee on Children, Health Insurance, and Access to Care was assembled to address questions about health insurance for children, evaluating the strengths and limitations of insurance as a means of improving children's health from a variety of approaches and policies. Meeting between March 1997 and January 1998,…

  9. Health Insurance Coverage: 2000. Consumer Income. Current Population Reports.

    ERIC Educational Resources Information Center

    Mills, Robert J.

    This report uses data from the U.S. Census Bureau's March 2001 Current Population Survey to examine health insurance coverage. The number and percentage of people covered by employment-based health insurance rose significantly in 2000, driving the overall increase in health insurance coverage. Among the entire population age 18-64 years, workers…

  10. Why Employed Latinos Lack Health Insurance: A Study in California

    ERIC Educational Resources Information Center

    Greenwald, Howard P.; O'Keefe, Suzanne; DiCamillo, Mark

    2005-01-01

    This article assesses the relative importance of several factors believed to reduce the likelihood of health insurance coverage among working Latinos in California, including cost, immigration history, availability of insurance, beliefs about insurance, and beliefs about health and health care. According to a survey of 1,000 randomly selected…

  11. Americans' health insurance coverage, 1980-91

    PubMed Central

    Levit, Katharine R.; Olin, Gary L.; Letsch, Suzanne W.

    1992-01-01

    The authors of this article have used Current Population Surveys to summarize public and private health insurance trends in the United States over the last 12 years. Key findings include the declining percentage of the non-elderly population with employer-sponsored coverage and increasing numbers of low- and middle-income uninsured. That is, in a period of fast-rising health care costs, the poor and the near-poor in working families have been losing coverage for health care and facing increasing risks of inadequate care and financial loss. These data highlight health care access and financing problems now facing the Nation. PMID:10124438

  12. Short-run effects of job loss on health conditions, health insurance, and health care utilization.

    PubMed

    Schaller, Jessamyn; Stevens, Ann Huff

    2015-09-01

    Job loss in the United States is associated with reductions in income and long-term increases in mortality rates. This paper examines the short-run changes in health, health care access, and health care utilization after job loss that lead to these long-term effects. Using a sample with more than 10,000 individual job losses and longitudinal data on a wide variety of health-related outcomes, we show that job loss results in worse self-reported health, activity limitations, and worse mental health, but is not associated with statistically significant increases in a variety of specific chronic conditions. Among the full sample of workers, we see reductions in insurance coverage, but little evidence of reductions in health care utilization after job loss. Among the subset of displaced workers with chronic conditions and those for whom the lost job was their primary source of insurance we do see reductions in doctor's visits and prescription drug usage. PMID:26250651

  13. [French national health insurance. The current situation].

    PubMed

    Huguier, Michel; Lagrave, Michel; Marcelli, Aline; Rossignol, Claude; Tillement, Jean-Paul

    2010-06-01

    An audit of the French national health insurance system would be justified by economic considerations alone, but this would risk overlooking the notions of solidarity and freedom to which the French are rightly attached. European comparisons suggest, however, that our system could be made more efficient without undermining public health. The national health insurance system allows each member of the population to receive high-quality medical care. Practitioners have near-total freedom of prescription and practice. Medical care contributes to the ongoing increase in life expectancy, which is currently 73 years and second only to Japan. Healthcare is also a source of a million jobs. Macro-economic spending controls have failed, owing to medical progress and population aging, and also to medical consumerism favored by an unprecedented range of examinations and treatments, the increasing reimbursement of medical care, and the extension of direct payment by the insurer. Many ineffective measures have been implemented, such as tarification according to activity, and hospital certification. Health spending is also increased unnecessarily by bureaucratisation of healthcare spending and the transfer of professionals to posts for which they are not qualified. Some controversial medical prescriptions are not adequately controlled by the health service. Many reforms are based on over-optimistic economic predictions that fail to take related overheads into account. Lobbying by special interests groups undermines reform and the public interest. Too many independent administrative bodies have been created, and many are less efficient than the public structures they replaced. In sum, the French national health insurance system has become less and less efficient over the years. PMID:21513139

  14. Recent developments in health insurance, life insurance, and disability insurance case law.

    PubMed

    Hasman, Joseph J; Chittenden, William A; Doolin, Elizabeth G; Wall, Julie F

    2008-01-01

    This survey reviews significant state and federal court decisions from 2006 and 2007 involving health, life, and disability insurance. Also reviewed is a June 2008 Supreme Court decision in the disability insurance realm, affirming that a conflict of interest exists when an ERISA plan sponsor or insurer fulfills the dual role of determining plan benefits and paying those benefits but noting that the conflict is merely one factor in considering the legality of benefit denials. In addition, this years' survey includes compelling decisions in the life and health arena, including cases addressing statutory penalties and mandated benefits, as well as some ERISA decisions of note. This year, the Texas Supreme Court held that Texas's most recent version of the prompt payment statute abolished the common law interpleader exception and allowed the prevailing adverse claimant in an interpleader action filed beyond the sixty-day statutory period to recover statutory interest and attorney fees from the insurer. Meanwhile, the Court of Appeals of New York upheld the constitutionality of a statute mandating coverage for contraceptives in those employer-sponsored health plans that offer prescription drug coverage, including those plans sponsored by faith-based social service organizations. In the ERISA context, litigants continue to fight over the standard of review with varying results. In a unique assault on the arbitrary and capricious standard of review, the Fourth Circuit found that an ERISA plan abused its discretion when it failed to apply the doctrine of contra proferentem to construe ambiguous plan terms against itself. In more hopeful news for plan insurers, the Tenth Circuit held that claimants are not entitled to review and rebut medical opinions generated during the administrative appeal of a claim denial before a final decision is reached unless such reports contain new factual information.

  15. The Disabled: Their Health Care and Health Insurance.

    ERIC Educational Resources Information Center

    Adler, Michele

    This paper examines issues concerning access to health care for persons with disabilities, specifically the health status of the disabled, utilization and cost of services, and a comparison of health insurance coverage of persons with and without disabilities. Three age groups (children, working-age adults, and the elderly) are considered. Data…

  16. Life and health insurance industry investments in fast food.

    PubMed

    Mohan, Arun V; McCormick, Danny; Woolhandler, Steffie; Himmelstein, David U; Boyd, J Wesley

    2010-06-01

    Previous research on health and life insurers' financial investments has highlighted the tension between profit maximization and the public good. We ascertained health and life insurance firms' holdings in the fast food industry, an industry that is increasingly understood to negatively impact public health. Insurers own $1.88 billion of stock in the 5 leading fast food companies. We argue that insurers ought to be held to a higher standard of corporate responsibility, and we offer potential solutions.

  17. 42 CFR 403.220 - Supplemental Health Insurance Panel.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health...

  18. 42 CFR 403.220 - Supplemental Health Insurance Panel.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health...

  19. 42 CFR 403.220 - Supplemental Health Insurance Panel.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health...

  20. 42 CFR 403.220 - Supplemental Health Insurance Panel.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health...

  1. 42 CFR 403.220 - Supplemental Health Insurance Panel.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health...

  2. Health Insurance Rate Review Act

    THOMAS, 112th Congress

    Sen. Feinstein, Dianne [D-CA

    2011-01-25

    01/25/2011 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S206) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  3. Health promotion financing with Mongolia's social health insurance.

    PubMed

    Bayarsaikhan, Dorjsuren; Nakamura, Keiko

    2015-03-01

    Health promotion is receiving more attention in Mongolia. A survey is undertaken to examine health promotion in terms of health-related information, education, counseling, screening, preventive and medical checkups. Almost all (97.5%) of the subjects feel that access to reliable and systematically organized health-related information is important. About 60% of the subjects expressed that the amount of currently available information is inadequate. There are several factors that limit the implementation of public health programs. These include inadequate focus on promoting health at individual level, lack of funds, and limited incentives to promote health. This article examined social health insurance as an option to address these issues. Three hypothetical benefits package options expanded to health promotion were developed and simulated by a computerized tool. The simulations show that all 3 options are financially sustainable at the existing level of contribution if Mongolia will gain near universal health insurance coverage and improve revenue collection practices. PMID:25834269

  4. Health promotion financing with Mongolia's social health insurance.

    PubMed

    Bayarsaikhan, Dorjsuren; Nakamura, Keiko

    2015-03-01

    Health promotion is receiving more attention in Mongolia. A survey is undertaken to examine health promotion in terms of health-related information, education, counseling, screening, preventive and medical checkups. Almost all (97.5%) of the subjects feel that access to reliable and systematically organized health-related information is important. About 60% of the subjects expressed that the amount of currently available information is inadequate. There are several factors that limit the implementation of public health programs. These include inadequate focus on promoting health at individual level, lack of funds, and limited incentives to promote health. This article examined social health insurance as an option to address these issues. Three hypothetical benefits package options expanded to health promotion were developed and simulated by a computerized tool. The simulations show that all 3 options are financially sustainable at the existing level of contribution if Mongolia will gain near universal health insurance coverage and improve revenue collection practices.

  5. 42 CFR 457.348 - Determinations of Children's Health Insurance Program eligibility by other insurance...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Determinations of Children's Health Insurance... CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Eligibility, Screening, Applications, and Enrollment § 457.348 Determinations of Children's Health...

  6. 42 CFR 457.348 - Determinations of Children's Health Insurance Program eligibility by other insurance...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Determinations of Children's Health Insurance... CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Eligibility, Screening, Applications, and Enrollment § 457.348 Determinations of Children's Health...

  7. 42 CFR 457.348 - Determinations of Children's Health Insurance Program eligibility by other insurance...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Determinations of Children's Health Insurance... CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Eligibility, Screening, Applications, and Enrollment § 457.348 Determinations of Children's Health...

  8. The cost conundrum: financing the business of health care insurance.

    PubMed

    Kelly, Annemarie

    2013-01-01

    Health care spending in both the governmental and private sectors skyrocketed over the last century. This article examines the rapid growth of health care expenditures by analyzing the extent of this financial boom as well some of the reasons why health care financing has become so expensive. It also explores how the market concentration of insurance companies has led to growing insurer profits, fewer insurance providers, and less market competition. Based on economic data primarily from the Government Accountability Office, the Kaiser Family Foundation, and the American Medical Associa tion, it has become clear that this country needs more competitive rates for the business of health insurance. Because of the unique dynamics of health insurance payments and financing, America needs to promote affordability and innovation in the health insurance market and lower the market's high concentration levels. In the face of booming insurance profits, soaring premiums, many believe that in our consolidated health insurance market, the "business of insurance" should not be exempt from antitrust laws. All in all, it is in our nation's best interest that Congress restore the application of antitrust laws to health sector insurers by passing the Health Insurance Industry Antitrust Enforcement Act as an amendment to the McCarran-Ferguson Act's "business of insurance" provision.

  9. Some demographic issues affecting private health insurance.

    PubMed

    Hanning, Brian

    2004-01-01

    There will be significant changes in the demography of persons with Private Health Insurance (PHI). Two methods of projecting PHI coverage are discussed in this paper. The first assumes the only factors affecting PHI coverage are demographic change and mortality and facilitates comparisons between actual and projected PHI coverage. The second projects the percentage of the population insured in each five year age cohort, and makes allowance for changes in PHI coverage due to all factors. Demographic change will increase Registered Health Benefit Organization (RHBO) premiums by 1.7% per annum. The role of these projections in analysing the effect of future premium increases on PHI retention rates is also discussed. PMID:15362293

  10. Health financing and insurance reform in Morocco.

    PubMed

    Ruger, Jennifer Prah; Kress, Daniel

    2007-01-01

    The government of Morocco approved two reforms in 2005 to expand health insurance coverage. The first is a payroll-based mandatory health insurance plan for public- and formal private-sector employees to extend coverage from the current 16 percent of the population to 30 percent. The second creates a publicly financed fund to cover services for the poor. Both reforms aim to improve access to high-quality care and reduce disparities in access and financing between income groups and between rural and urban dwellers. In this paper we analyze these reforms: the pre-reform debate, benefits covered, financing, administration, and oversight. We also examine prospects and future challenges for implementing the reforms. PMID:17630444

  11. Health insurance: an eye on American welfare.

    PubMed

    Draper, J

    1980-02-15

    One of the great myths about the United States is that it does not have a welfare state. The myth is largely founded on the fact that America is one of the few remaining western nations with no national health insurance scheme to protect its citizens against the crippling costs of medical and hospital care. However, that does not mean that the United States does not have an extensive welfare system, writes John Draper. PMID:10245813

  12. Health Insurance Claim Review Using Information Technologies

    PubMed Central

    Yoon, Jeong-Sik; Speedie, Stuart M.; Yoon, Hojung; Lee, Jiseon

    2012-01-01

    Objectives The objective of this paper is to describe the Health Insurance Review and Assessment Service (HIRA)'s payment request (PARE) system that plays the role of the gateway for all health insurance claims submitted to HIRA, and the claim review support (CRS) system that supports the work of claim review experts in South Korea. Methods This study describes the two systems' information technology (IT) infrastructures, their roles, and quantitative analysis of their work performance. It also reports the impact of these systems on claims processing by analyzing the health insurance claim data submitted to HIRA from April 1 to June 30, 2011. Results The PARE system returned to healthcare providers 2.7% of all inpatient claims (97,930) and 0.1% of all outpatient claims (317,007) as un-reviewable claims. The return rate was the highest for the hospital group as 0.49% and the lowest rate was found in clinic group. The CRS system's detection rate of the claims with multiple errors in inpatient and outpatient areas was 23.1% and 2.9%, respectively. The highest rate of error detection occurred at guideline check-up stages in both inpatient and outpatient groups. Conclusions The study found that HIRA's two IT systems had a critical role in reducing heavy administrative workloads through automatic data processing. Although the return rate of the problematic claims to providers and the error detection rate by two systems was low, the actual count of the returned claims was large. The role of IT will become increasingly important in reducing the workload of health insurance claims review. PMID:23115745

  13. Health insurance exchanges bring potential opportunities.

    PubMed

    Jacobs, M Orry; Eggbeer, Bill

    2012-11-01

    The introduction of the state health insurance exchanges, as provided for in the Affordable Care Act, has many strategic implications for healthcare providers: Unprecedented transparency; The "Walmart Effect", with patients playing a greater role as healthcare consumers; A rise in narrow networks spurred by low prices and narrow geographies; The potential end of the cross subsidy of Medicare and Medicaid by commercial plans; The possible end of not-for-profit status for hospitals

  14. Health Insurance as a Two-Part Pricing Contract *

    PubMed Central

    Lakdawalla, Darius; Sood, Neeraj

    2013-01-01

    Monopolies appear throughout health care. We show that health insurance operates like a conventional two-part pricing contract that allows monopolists to extract profits without inefficiently constraining quantity. When insurers are free to offer a range of insurance contracts to different consumer types, health insurance markets perfectly eliminate deadweight losses from upstream health care monopolies. Frictions limiting the sorting of different consumer types into different insurance contracts restore some of these upstream monopoly losses, which manifest as higher rates of uninsurance, rather than as restrictions in quantity utilized by insured consumers. Empirical analysis of pharmaceutical patent expiration supports the prediction that heavily insured markets experience little or no efficiency loss under monopoly, while less insured markets exhibit behavior more consistent with the standard theory of monopoly. PMID:23997354

  15. DIVORCE AND WOMEN'S RISK OF HEALTH INSURANCE LOSS*

    PubMed Central

    Lavelle, Bridget; Smock, Pamela J.

    2012-01-01

    This article bridges the literatures on the economic consequences of divorce for women with that on marital transitions and health by focusing on women's health insurance. Using a monthly calendar of marital status and health insurance coverage from 1,442 women in the Survey of Income and Program Participation, we examine how women's health insurance changes after divorce. Our estimates suggest that roughly 115,000 American women lose private health insurance annually in the months following divorce and that roughly 65,000 of these women become uninsured. The loss of insurance coverage we observe is not just a short-term disruption. Women's rates of insurance coverage remain depressed for more than two years after divorce. Insurance loss may compound the economic losses women experience after divorce, and contribute to as well as compound previously documented health declines following divorce. PMID:23147653

  16. Divorce and women's risk of health insurance loss.

    PubMed

    Lavelle, Bridget; Smock, Pamela J

    2012-01-01

    This article bridges the literatures on the economic consequences of divorce for women with that on marital transitions and health by focusing on women's health insurance. Using a monthly calendar of marital status and health insurance coverage from 1,442 women in the Survey of Income and Program Participation, we examine how women's health insurance changes after divorce. Our estimates suggest that roughly 115,000 American women lose private health insurance annually in the months following divorce and that roughly 65,000 of these women become uninsured. The loss of insurance coverage we observe is not just a short-term disruption. Women's rates of insurance coverage remain depressed for more than two years after divorce. Insurance loss may compound the economic losses women experience after divorce and contribute to as well as compound previously documented health declines following divorce.

  17. 77 FR 72721 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-06

    ... Internal Revenue Service 26 CFR Parts 40, 46, and 602 RIN 1545-BK59 Fees on Health Insurance Policies and... issuers of certain health insurance policies and plan sponsors of certain self-insured health plans to...-3970 (regarding health insurance policies). SUPPLEMENTARY INFORMATION: Paperwork Reduction Act...

  18. [Competition among health insurance funds: the position of the PKV].

    PubMed

    Leienbach, Volker

    2009-01-01

    Competition between private health insurers (PKV) and statutory health insurance funds (GKV) in Germany is far from being perfect, but the advantages resulting from the duality between PKV and GKV for the insured outweigh its disadvantages. Germany is the only country in the world where two systems compete for the best health insurance services and offer actual alternatives. They represent two different ways of funding leading into one common healthcare system. The dual structure stabilizes and enhances the medical infrastructure for all insured individuals alike. The rules of competition however can only take effect if the particularities of the two system are maintained and not mixed up. PMID:20120193

  19. The value of health insurance: the access motive.

    PubMed

    Nyman, J A

    1999-04-01

    Why do people purchase health insurance? Many economists would answer that it permits purchasers to avoid risk of financial loss. This note suggests that health insurance is also demanded because it represents a mechanism for gaining access to health care that would otherwise be unaffordable. For example, although a US$300,000 procedure is unaffordable to a person with US$50,000 in net worth, access is possible through insurance because the annual premium is only a fraction of the procedure's cost. The value of insurance for coverage of unaffordable care is derived from the value of the medical care that insurance makes accessible.

  20. Immigrants’ Access to Health Insurance: No Equality without Awareness

    PubMed Central

    Dzúrová, Dagmar; Winkler, Petr; Drbohlav, Dušan

    2014-01-01

    The Czech government has identified commercial health insurance as one of the major problems for migrants’ access to health care. Non-EU immigrants are eligible for public health insurance only if they have employee status or permanent residency. The present study examined migrants’ access to the public health insurance system in Czechia. A cross-sectional survey of 909 immigrants from Ukraine and Vietnam was conducted in March and May 2013, and binary logistic regression was applied in data analysis. Among immigrants entitled to Czech public health insurance due to permanent residency/asylum, 30% were out of the public health insurance system, and of those entitled by their employment status, 50% were out of the system. Migrants with a poor knowledge of the Czech language are more likely to remain excluded from the system of public health insurance. Instead, they either remain in the commercial health insurance system or they simultaneously pay for both commercial and public health insurance, which is highly disadvantageous. Since there are no reasonable grounds to stay outside the public health insurance, it is concluded that it is lack of awareness that keeps eligible immigrants from entering the system. It is suggested that no equal access to health care exists without sufficient awareness about health care system. PMID:25026082

  1. Health insurance tax credits, the earned income tax credit, and health insurance coverage of single mothers.

    PubMed

    Cebi, Merve; Woodbury, Stephen A

    2014-05-01

    The Omnibus Budget Reconciliation Act of 1990 enacted a refundable tax credit for low-income working families who purchased health insurance coverage for their children. This health insurance tax credit (HITC) existed during tax years 1991, 1992, and 1993, and was then rescinded. A difference-in-differences estimator applied to Current Population Survey data suggests that adoption of the HITC, along with accompanying increases in the Earned Income Tax Credit (EITC), was associated with a relative increase of about 4.7 percentage points in the private health insurance coverage of working single mothers with high school or less education. Also, a difference-in-difference-in-differences estimator, which attempts to net out the possible influence of the EITC increases but which requires strong assumptions, suggests that the HITC was responsible for about three-quarters (3.6 percentage points) of the total increase. The latter estimate implies a price elasticity of health insurance take-up of -0.42.

  2. Student Health Insurance: Important Considerations for Implementation and Carrying Out of a Student Health Insurance Program.

    ERIC Educational Resources Information Center

    O'Connell, John J.; Rue, Joseph

    1978-01-01

    The results of a recent study, which sought information pertaining to the current status of student health insurance programs in schools throughout the United States, is reviewed in this article. The availability and suitability of the programs are summarized, and recommendations for improvement are provided. (Author/DS)

  3. Health insurance tax credits, the earned income tax credit, and health insurance coverage of single mothers.

    PubMed

    Cebi, Merve; Woodbury, Stephen A

    2014-05-01

    The Omnibus Budget Reconciliation Act of 1990 enacted a refundable tax credit for low-income working families who purchased health insurance coverage for their children. This health insurance tax credit (HITC) existed during tax years 1991, 1992, and 1993, and was then rescinded. A difference-in-differences estimator applied to Current Population Survey data suggests that adoption of the HITC, along with accompanying increases in the Earned Income Tax Credit (EITC), was associated with a relative increase of about 4.7 percentage points in the private health insurance coverage of working single mothers with high school or less education. Also, a difference-in-difference-in-differences estimator, which attempts to net out the possible influence of the EITC increases but which requires strong assumptions, suggests that the HITC was responsible for about three-quarters (3.6 percentage points) of the total increase. The latter estimate implies a price elasticity of health insurance take-up of -0.42. PMID:23813687

  4. 77 FR 41048 - Health Insurance Premium Tax Credit; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-12

    ..., 2012 (77 FR 30377). The final regulations relate to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of... Internal Revenue Service 26 CFR Part 1 RIN 1545-BJ82 Health Insurance Premium Tax Credit; Correction...

  5. 77 FR 41048 - Health Insurance Premium Tax Credit; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-12

    ... Register on Wednesday, May 23, 2012 (77 FR 30377). The final regulations relate to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and... Internal Revenue Service 26 CFR Parts 1 and 602 RIN 1545-BJ82 Health Insurance Premium Tax...

  6. Divorce and Women's Risk of Health Insurance Loss

    ERIC Educational Resources Information Center

    Lavelle, Bridget; Smock, Pamela J.

    2012-01-01

    This article bridges the literatures on the economic consequences of divorce for women with that on marital transitions and health by focusing on women's health insurance. Using a monthly calendar of marital status and health insurance coverage from 1,442 women in the Survey of Income and Program Participation, we examine how women's health…

  7. Perceived health status and health insurance status: protective factors against health-related debt?

    PubMed

    Christy, Kameri; Hampton-Stover, Elena; Shobe, Marcia; Hammig, Bart

    2013-01-01

    Current health care debate has largely focused on the need for health insurance coverage rather than quality coverage. Yet the economic downturn has resulted in an increasing number of individuals who are uninsured or underinsured, and consequently face financial hardships. Multivariate analyses were used with 95 adults to examine relationships between health insurance, health status, and health debt. Controlling for demographics, and human and financial capital, findings suggest that health debt is not related to health insurance or health status. However, individuals with post-secondary education and non-homeowners appear to be more at risk for accumulating health debt.

  8. Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data.

    PubMed

    Dunn, Abe

    2016-07-01

    This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. PMID:27107371

  9. Development of the Health Insurance Literacy Measure (HILM): conceptualizing and measuring consumer ability to choose and use private health insurance.

    PubMed

    Paez, Kathryn A; Mallery, Coretta J; Noel, HarmoniJoie; Pugliese, Christopher; McSorley, Veronica E; Lucado, Jennifer L; Ganachari, Deepa

    2014-01-01

    Understanding health insurance is central to affording and accessing health care in the United States. Efforts to support consumers in making wise purchasing decisions and using health insurance to their advantage would benefit from the development of a valid and reliable measure to assess health insurance literacy. This article reports on the development of the Health Insurance Literacy Measure (HILM), a self-assessment measure of consumers' ability to select and use private health insurance. The authors developed a conceptual model of health insurance literacy based on formative research and stakeholder guidance. Survey items were drafted using the conceptual model as a guide then tested in two rounds of cognitive interviews. After a field test with 828 respondents, exploratory factor analysis revealed two HILM scales, choosing health insurance and using health insurance, each of which is divided into a confidence subscale and likelihood of behavior subscale. Correlations between the HILM scales and an objective measure of health insurance knowledge and skills were positive and statistically significant which supports the validity of the measure. PMID:25315595

  10. Health insurance, cost expectations, and adverse job turnover.

    PubMed

    Ellis, Randall P; Albert Ma, Ching-To

    2011-01-01

    Because less healthy employees value health insurance more than the healthy ones, when health insurance is newly offered job turnover rates for healthier employees decline less than turnover rates for the less healthy. We call this adverse job turnover, and it implies that a firm's expected health costs will increase when health insurance is first offered. Health insurance premiums may fail to adjust sufficiently fast because state regulations restrict annual premium changes, or insurers are reluctant to change premiums rapidly. Even with premiums set at the long run expected costs, some firms may be charged premiums higher than their current expected costs and choose not to offer insurance. High administrative costs at small firms exacerbate this dynamic selection problem. Using 1998-1999 MEDSTAT MarketScan and 1997 Employer Health Insurance Survey data, we find that expected employee health expenditures at firms that offer insurance have lower within-firm and higher between-firm variance than at firms that do not. Turnover rates are systematically higher in industries in which firms are less likely to offer insurance. Simulations of the offer decision capturing between-firm health-cost heterogeneity and expected turnover rates match the observed pattern across firm sizes well.

  11. Does health insurance continuity among low-income adults impact their children's insurance coverage?

    PubMed

    Yamauchi, Melissa; Carlson, Matthew J; Wright, Bill J; Angier, Heather; DeVoe, Jennifer E

    2013-02-01

    Parent's insurance coverage is associated with children's insurance status, but little is known about whether a parent's coverage continuity affects a child's coverage. This study assesses the association between an adult's insurance continuity and the coverage status of their children. We used data from a subgroup of participants in the Oregon Health Care Survey, a three-wave, 30-month prospective cohort study (n = 559). We examined the relationship between the length of time an adult had health insurance coverage and whether or not all children in the same household were insured at the end of the study. We used a series of univariate and multivariate logistic regression models to identify significant associations and the rho correlation coefficient to assess collinearity. A dose response relationship was observed between continuity of adult coverage and the odds that all children in the household were insured. Among adults with continuous coverage, 91.4% reported that all children were insured at the end of the study period, compared to 83.7% of adults insured for 19-27 months, 74.3% of adults insured for 10-18 months, and 70.8% of adults insured for fewer than 9 months. This stepwise pattern persisted in logistic regression models: adults with the fewest months of coverage, as compared to those continuously insured, reported the highest odds of having uninsured children (adjusted odds ratio 7.26, 95% confidence interval 2.75, 19.17). Parental health insurance continuity is integral to maintaining children's insurance coverage. Policies to promote continuous coverage for adults will indirectly benefit children.

  12. Putting Health Back Into Health Insurance Choice.

    PubMed

    Atanasov, Pavel; Baker, Tom

    2014-08-01

    What are the barriers to voluntary take-up of high-deductible plans? We address this question using a large-scale employer survey conducted after an open-enrollment period in which a new high-deductible plan was first introduced. Only 3% of the employees chose this plan, despite the respondents' recognition of its financial advantages. Employees who believed that the high-deductible plan provided access to top physicians in the area were three times more likely to choose it than employees who did not share this belief. A framed field experiment using a similar choice menu showed that displaying additional financial information did not increase high-deductible plan take-up. However, when plans were presented as identical except for the deductible, respondents were highly likely to choose the high-deductible plan, especially in a two-way choice. These results suggest that informing plan choosers about high-deductible plans' health access provisions may affect choice more strongly than focusing on their financial advantages. PMID:24811934

  13. Private health insurance and regional Australia.

    PubMed

    Lokuge, Buddhima; Denniss, Richard; Faunce, Thomas A

    2005-03-21

    Since 1996, an increasing proportion of federal government expenditure has been directed into Australia's healthcare system via private health insurance (PHI) subsidies, in preference to Medicare and the direct funding of public health services. A central rationale for this policy shift is to increase the use of private hospital services and thereby reduce pressure on public inpatient facilities. However, the impact of this reform process on regional Australia has not been addressed. An analysis of previously unpublished Australian Bureau of Statistics data shows that regional Australians have substantially lower levels of private health fund membership. As a result, regional areas appear to be receiving substantially less federal government health funding, compared with cities, than if these funds were allocated on a per-capita basis. We postulate that the lower level of membership in regional areas is mainly due to the limited availability of private inpatient facilities, making PHI less attractive to rural Australians. We conclude that PHI as a vehicle for mainstream federal health financing has potential structural failures that disadvantage regional Australians.

  14. The impact of health insurance on health services utilization and health outcomes in Vietnam.

    PubMed

    Guindon, G Emmanuel

    2014-10-01

    In recent years, a number of low- and middle-income country governments have introduced health insurance schemes. Yet not a great deal is known about the impact of such policy shifts. Vietnam's recent health insurance experience including a health insurance scheme for the poor in 2003 and a compulsory scheme that provides health insurance to all children under six years of age combined with Vietnam's commitment to universal coverage calls for research that examines the impact of health insurance. Taking advantage of Vietnam's unique policy environment, data from the 2002, 2004 and 2006 waves of the Vietnam Household Living Standard Survey and single-difference and difference-in-differences approaches are used to assess whether access to health insurance--for the poor, for children and for students--impacts on health services utilization and health outcomes in Vietnam. For the poor and for students, results suggest health insurance increased the use of inpatient services but not of outpatient services or health outcomes. For young children, results suggest health insurance increased the use of outpatient services (including the use of preventive health services such as vaccination and check-up) but not of inpatient services.

  15. [Health insurance benefits for dental and skeletal malocclusions].

    PubMed

    Galli, Andreas M; Rohrer, Felix A

    2010-01-01

    In view of the large quantity of additional insurance for dental and skeletal malocclusions offered in Switzerland the benefits of 24 Swiss health insurance companies have exemplary been compiled in a table for an insured party of Zurich. This should provide an opportunity for the dentist or orthodontist to better brief his or her patient and facilitate the parents' choice of a suitable additional insurance for their child. There are great varieties in the offered benefits of the different insurance versions. The table embodies all crucial issues in a clearly presented form. All parameters were analyzed und some of them are critically discussed.

  16. 77 FR 30377 - Health Insurance Premium Tax Credit

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-23

    ..., a notice of proposed rulemaking (REG-131491-10) was published in the Federal Register (76 FR 50931... Internal Revenue Service 26 CFR Parts 1 and 602 RIN 1545-BJ82 Health Insurance Premium Tax Credit AGENCY... regulations relating to the health insurance premium tax credit enacted by the Patient Protection...

  17. Health Insurance for Children. The Future for Children.

    ERIC Educational Resources Information Center

    Behrman, Richard E., Ed.

    2003-01-01

    This issue of "The Future of Children" focuses on efforts to provide publicly funded health insurance to low-income children in the United States through Medicaid and the State Children's Health Insurance Program (SCHIP). The articles summarize current knowledge and research about which children are uninsured and why, discuss ways to improve…

  18. 41 CFR 60-300.25 - Health insurance, life insurance and other benefit plans.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... insurance or subject a qualified disabled veteran to different terms or conditions of insurance based on... medical service company, health maintenance organization, or any agent or entity that administers benefit... based on or not inconsistent with state law. (b) The contractor may establish, sponsor, observe...

  19. 76 FR 16422 - Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... Health Insurance Programs; Provider Enrollment Application Fee Amount for 2011 AGENCY: Centers for... with comment period entitled: ``Medicare, Medicaid, and Children's Health Insurance Programs... Health Insurance Program (CHIP) provider enrollment processes. Specifically, and as stated in 42 CFR...

  20. The Role of Public Health Insurance in Reducing Child Poverty.

    PubMed

    Wherry, Laura R; Kenney, Genevieve M; Sommers, Benjamin D

    2016-04-01

    Over the past 30 years, there have been major expansions in public health insurance for low-income children in the United States through Medicaid, the Children's Health Insurance Program (CHIP), and other state-based efforts. In addition, many low-income parents have gained Medicaid coverage since 2014 under the Affordable Care Act. Most of the research to date on health insurance coverage among low-income populations has focused on its effect on health care utilization and health outcomes, with much less attention to the financial protection it offers families. We review a growing body of evidence that public health insurance provides important financial benefits to low-income families. Expansions in public health insurance for low-income children and adults are associated with reduced out of pocket medical spending, increased financial stability, and improved material well-being for families. We also review the potential poverty-reducing effects of public health insurance coverage. When out of pocket medical expenses are taken into account in defining the poverty rate, Medicaid plays a significant role in decreasing poverty for many children and families. In addition, public health insurance programs connect families to other social supports such as food assistance programs that also help reduce poverty. We conclude by reviewing emerging evidence that access to public health insurance in childhood has long-term effects for health and economic outcomes in adulthood. Exposure to Medicaid and CHIP during childhood has been linked to decreased mortality and fewer chronic health conditions, better educational attainment, and less reliance on government support later in life. In sum, the nation's public health insurance programs have many important short- and long-term poverty-reducing benefits for low-income families with children. PMID:27044710

  1. The Role of Public Health Insurance in Reducing Child Poverty.

    PubMed

    Wherry, Laura R; Kenney, Genevieve M; Sommers, Benjamin D

    2016-04-01

    Over the past 30 years, there have been major expansions in public health insurance for low-income children in the United States through Medicaid, the Children's Health Insurance Program (CHIP), and other state-based efforts. In addition, many low-income parents have gained Medicaid coverage since 2014 under the Affordable Care Act. Most of the research to date on health insurance coverage among low-income populations has focused on its effect on health care utilization and health outcomes, with much less attention to the financial protection it offers families. We review a growing body of evidence that public health insurance provides important financial benefits to low-income families. Expansions in public health insurance for low-income children and adults are associated with reduced out of pocket medical spending, increased financial stability, and improved material well-being for families. We also review the potential poverty-reducing effects of public health insurance coverage. When out of pocket medical expenses are taken into account in defining the poverty rate, Medicaid plays a significant role in decreasing poverty for many children and families. In addition, public health insurance programs connect families to other social supports such as food assistance programs that also help reduce poverty. We conclude by reviewing emerging evidence that access to public health insurance in childhood has long-term effects for health and economic outcomes in adulthood. Exposure to Medicaid and CHIP during childhood has been linked to decreased mortality and fewer chronic health conditions, better educational attainment, and less reliance on government support later in life. In sum, the nation's public health insurance programs have many important short- and long-term poverty-reducing benefits for low-income families with children.

  2. Health insurance and child mortality in rural Burkina Faso

    PubMed Central

    Schoeps, Anja; Lietz, Henrike; Sié, Ali; Savadogo, Germain; De Allegri, Manuela; Müller, Olaf; Sauerborn, Rainer; Becher, Heiko; Souares, Aurélia

    2015-01-01

    Background Micro health insurance schemes have been implemented across developing countries as a means of facilitating access to modern medical care, with the ultimate aim of improving health. This effect, however, has not been explored sufficiently. Objective We investigated the effect of enrolment into community-based health insurance on mortality in children under 5 years of age in a health and demographic surveillance system in Nouna, Burkina Faso. Design We analysed the effect of health insurance enrolment on child mortality with a Cox regression model. We adjusted for variables that we found to be related to the enrolment in health insurance in a preceding analysis. Results Based on the analysis of 33,500 children, the risk of mortality was 46% lower in children enrolled in health insurance as compared to the non-enrolled children (HR=0.54, 95% CI 0.43–0.68) after adjustment for possible confounders. We identified socioeconomic status, father's education, distance to the health facility, year of birth, and insurance status of the mother at time of birth as the major determinants of health insurance enrolment. Conclusions The strong effect of health insurance enrolment on child mortality may be explained by increased utilisation of health services by enrolled children; however, other non-observed factors cannot be excluded. Because malaria is a main cause of death in the study area, early consultation of health services in case of infection could prevent many deaths. Concerning the magnitude of the effect, implementation of health insurance could be a major driving factor of reduction in child mortality in the developing world. PMID:25925193

  3. Progressive segmented health insurance: Colombian health reform and access to health services.

    PubMed

    Ruiz, Fernando; Amaya, Liliana; Venegas, Stella

    2007-01-01

    Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-stage income segmented insurance to progress towards the universal insurance goal. PMID:16929487

  4. The Impact of School Enrollment-based Health Insurance on the State Children's Health Insurance Program (SCHIP).

    ERIC Educational Resources Information Center

    Romund, Camilla M.; Farmer, Frank L.

    2000-01-01

    Describes the current status of the State Children's Health Insurance Program (SCHIP), examining roles that school enrollment-based health insurance (SEBHI) programs play in three states and summarizing lessons SEBHI programs can offer SCHIP as states work toward full implementation. SEBHI programs are an important model leading to more…

  5. Small firms' demand for health insurance: the decision to offer insurance.

    PubMed

    Hadley, Jack; Reschovsky, James D

    2002-01-01

    This paper explores the decisions by small business establishments (< 100 workers) to offer health insurance. We estimate a theoretically derived model of establishments' demand for insurance using nationally representative data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey and other sources. Findings show that offer decisions reflect worker demand, labor market conditions, and establishments' costs of providing coverage. Premiums have a moderate effect on offer decisions (elasticity = -.54), though very small establishments and those employing low-wage workers are more responsive. This suggests that premium subsidies to employers would be an inefficient means of increasing insurance coverage. Greater availability of public insurance and safety net care has a small negative effect on offer decisions. PMID:12371567

  6. Main Determinants of Supplementary Health Insurance Demand: (Case of Iran)

    PubMed Central

    Motlagh, Soraya Nouraei; Gorji, Hassan Abolghasem; Mahdavi, Ghadir; Ghaderi, Hossein

    2015-01-01

    Introduction: In the majority of developing countries, the volume of medical insurance services, provided by social insurance organizations is inadequate. Thus, supplementary medical insurance is proposed as a means to address inadequacy of medical insurance. Accordingly, in this article, we attempted to provide the context for expansion of this important branch of insurance through identification of essential factors affecting demand for supplementary medical insurance. Method: In this study, two methods were used to identify essential factors affecting choice of supplementary medical insurance including Classification and Regression Trees (CART) and Bayesian logit. To this end, Excel® software was used to refine data and R® software for estimation. The present study was conducted during 2012, covering all provinces in Iran. Sample size included 18,541 urban households, selected by Statistical Center of Iran using 3-stage cluster sampling approach. In this study, all data required were collected from the Statistical Center of Iran. Results: In 2012, an overall 8.04% of the Iranian population benefited from supplementary medical insurance. Demand for supplementary insurance is a concave function of age of the household head, and peaks in middle-age when savings and income are highest. The present study results showed greater likelihood of demand for supplementary medical insurance in households with better economic status, higher educated heads, female heads, and smaller households with greater expected medical expenses, and household income is the most important factor affecting demand for supplementary medical insurance. Conclusion: Since demand for supplementary medical insurance is hugely influenced by households’ economic status, policy-makers in the health sector should devise measures to improve households’ economic or financial access to supplementary insurance services, by identifying households in the lower economic deciles, and increasing their

  7. The New Child Health Insurance Expansions: How Will School-Based Health Centers Fit In?

    ERIC Educational Resources Information Center

    Koppelman, Jane; Lear, Julia Graham

    Under the State Child Health Insurance Program, states receive funds to purchase health insurance for low-income, uninsured children. Noting that partnering with managed care will be essential if school-based health centers are to receive reimbursement for serving the publicly insured portion of their clientele, this paper examines the…

  8. Benefit distribution of social health insurance: evidence from china's urban resident basic medical insurance.

    PubMed

    Pan, Jay; Tian, Sen; Zhou, Qin; Han, Wei

    2016-09-01

    Equity is one of the essential objectives of the social health insurance. This article evaluates the benefit distribution of the China's Urban Residents' Basic Medical Insurance (URBMI), covering 300 million urban populations. Using the URBMI Household Survey data fielded between 2007 and 2011, we estimate the benefit distribution by the two-part model, and find that the URBMI beneficiaries from lower income groups benefited less than that of higher income groups. In other words, government subsidy that was supposed to promote the universal coverage of health care flew more to the rich. Our study provides new evidence on China's health insurance system reform, and it bears meaningful policy implication for other developing countries facing similar challenges on the way to universal coverage of health insurance. PMID:26936094

  9. Insurance Coverage & Whither Thou Goest for Health Information in 2012

    PubMed Central

    Saulsberry, Loren; Price, Mary; Hsu, John

    2014-01-01

    Objective Examine use of the Internet (eHealth) and mobile health (mHealth) technologies by privately insured, publicly insured (Medicare/Medicaid), or uninsured U.S. adults in 2012. Data Source Pew Charitable Trust telephone interviews of a nationally representative, random sample of 3,014 adult U.S. residents, age 18+. Methods Estimate health information seeking behavior overall and by segment (i.e., insurance type), then, adjust estimates for individual traits, clinical need, and technology access using logistic regression. Results Most respondents prefer offline to online (Internet) health information sources; over half across all segments use the Internet. More respondents communicate with providers offline compared with online. Most self-reported Internet users use online tools for health information, with privately insured respondents more likely to use new technologies. Unadjusted use rates differ across segments. Medicaid beneficiaries are more likely than the privately insured to share health information online, and Medicare beneficiaries are more likely than the privately insured to text with health professionals. After adjustment, these differences were minimal (e.g., Medicare beneficiaries had odds similar to the privately insured of online physician consultations), or the direction of the association reversed (e.g., Medicaid beneficiaries had greater odds than the privately insured of online physician consultations versus lower odds before adjustment). Discussion Few adults report eHealth or mHealth use in 2012. Use levels appear unevenly distributed across insurance types, which could be mostly attributed to differences in individual traits and/or need. As out-of-pocket costs of medical care increases, consumers may increasingly turn to these generally free electronic health tools. PMID:25383242

  10. [The pharmaceutical cost of elderly people in private health insurance].

    PubMed

    Wild, F

    2009-12-01

    In this paper the author analyses the prescription of pharmaceuticals for elderly private insured persons. Data from eight firms form the basis of the survey. The main focus lies in the analysis of the expenditure per capita and the distribution of the pharmaceuticals costs. It will illustrate that costs for elderly private insured persons will have a great impact on the expenditure for the private health insurance companies in the coming years. PMID:20052826

  11. The hidden cost of private health insurance in Australia.

    PubMed

    Seah, Davinia S E; Cheong, Timothy Z; Anstey, Matthew H R

    2013-02-01

    The provision of health services in Australia currently is primarily financed by a unique interaction of public and private insurers. This commentary looks at a loophole in this framework, namely that private insurers have to date been able to avoid funding healthcare for some of their policy holders, as it is not a requirement to use private insurance when treatment occurs in Australian public hospitals.

  12. 77 FR 47573 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-09

    ... Internal Revenue Service 26 CFR Parts 40 and 46 RIN 1545-BK59 Fees on Health Insurance Policies and Self... Patient Protection and Affordable Care Act on issuers of certain health insurance policies and plan sponsors of certain self-insured health plans to fund the Patient-Centered Outcomes Research Trust...

  13. 77 FR 22691 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-17

    ... Internal Revenue Service 26 CFR Parts 40 and 46 RIN 1545-BK59 Fees on Health Insurance Policies and Self... Protection and Affordable Care Act on issuers of certain health insurance policies and plan sponsors of..., Rebecca L. Baxter at (202) 622-3970 (regarding health insurance policies) or R. Lisa Mojiri-Azad at...

  14. Making health insurance cost-sharing clear to consumers: challenges in implementing health reform's insurance disclosure requirements.

    PubMed

    Quincy, Lynn

    2011-02-01

    The Affordable Care Act calls for a new health insurance disclosure form, called the Summary of Benefits and Coverage, which uses a fixed layout and standard terms and definitions to allow consumers to compare health insurance plans and understand terms of coverage. This brief reports on findings from a Consumers Union study that examined consumers' initial reactions to the form. Testing revealed that consumers were able to use the forms to make hypothetical choices among health plans. However, the study also found deep-seated confusion and lack of confidence with respect to health plan cost-sharing. These findings have significant implications for any venue providing comparative displays of health insurance information, like the future state exchanges, and for policies that rely on the ability of consumers to make informed health insurance purchasing decisions, such as "consumer-driven health care" policies. PMID:21348328

  15. Survey of social health insurance structure in selected countries; providing framework for basic health insurance in Iran

    PubMed Central

    Mohammadi, Effat; Raissi, Ahmad Reza; Barooni, Mohsen; Ferdoosi, Massoud; Nuhi, Mojtaba

    2014-01-01

    Introduction and Objectives: Health system reforms are the most strategic issue that has been seriously considered in healthcare systems in order to reduce costs and increase efficiency and effectiveness. The costs of health system finance in our country, lack of universal coverage in health insurance, and related issues necessitate reforms in our health system financing. The aim of this research was to prepare a structure of framework for social health insurance in Iran and conducting a comparative study in selected countries with social health insurance. Materials and Methods: This comparative descriptive study was conducted in three phases. The first phase of the study examined the structure of health social insurance in four countries – Germany, South Korea, Egypt, and Australia. The second phase was to develop an initial model, which was designed to determine the shared and distinguishing points of the investigated structures, for health insurance in Iran. The third phase was to validate the final research model. The developed model by the Delphi method was given to 20 professionals in financing of the health system, health economics and management of healthcare services. Their comments were collected in two stages and its validity was confirmed. Findings: The study of the structure of health insurance in the selected countries shows that health social insurance in different countries have different structures. Based on the findings of the present study, the current situation of the health system, and the conducted surveys, the following framework is suitable for the health social insurance system in Iran. The Health Social Insurance Organization has a unique service by having five funds of governmental employees, companies and NGOs, self-insured, villagers, and others, which serves as a nongovernmental organization under the supervision of public law and by decision- and policy-making of the Health Insurance Supreme Council. Membership in this organization

  16. Health insurance and use of alternative medicine in Mexico

    PubMed Central

    van Gameren, Edwin

    2014-01-01

    Objectives I analyze the effect of coverage by health insurance on the use of alternative medicine such as folk healers and homeopaths, in particular if it complements or substitutes conventional services. Methods Panel data from the Mexican Health and Aging Study (MHAS) is used to estimate bivariate probit models in order to explain the use of alternative medicine while allowing the determinant of interest, access to health insurance, to be an endogenous factor. Results The findings indicate that households with insurance coverage less often use alternative medicine, and that the effect is much stronger among poor than among rich households. Conclusions Poor households substitute away from traditional medicine towards conventional medicine. PMID:20546965

  17. "Crowd-out": what it means for children's health insurance.

    PubMed

    1998-06-01

    As states finalize proposals for the federal Title XXI Children's Health Insurance Program (CHIP), consumers, advocates, legislators, and policymakers across the country are facing the issue of "crowd-out." How can they prevent CHIP's new public funds from "crowding out"--or supplanting--private funds now used to insure children? This issue of States of Health looks at research on crowd-out and reviews what some states have learned as a result of previous Medicaid expansions. Their experiences shed light on the challenge of making sure that Title XXI health care dollars reach the intended consumers, children who lack adequate insurance.

  18. MORAL HAZARD IN HEALTH INSURANCE: DO DYNAMIC INCENTIVES MATTER?

    PubMed Central

    Aron-Dine, Aviva; Einav, Liran; Finkelstein, Amy; Cullen, Mark

    2016-01-01

    Using data from employer-provided health insurance and Medicare Part D, we investigate whether healthcare utilization responds to the dynamic incentives created by the nonlinear nature of health insurance contracts. We exploit the fact that, because annual coverage usually resets every January, individuals who join a plan later in the year face the same initial (“spot”) price of healthcare but a higher expected end-of-year (“future”) price. We find a statistically significant response of initial utilization to the future price, rejecting the null that individuals respond only to the spot price. We discuss implications for analysis of moral hazard in health insurance. PMID:26769985

  19. Supplemental health insurance: did Croatia miss an opportunity?

    PubMed

    Langenbrunner, John C

    2002-08-01

    Croatia continues to face a health-funding crisis. A recent supplemental health insurance law increases revenues through first increasing co-payments, then raising the payroll tax to cover those co-payments. This public finance "slight-of-hand" will not solve the system's structural issues and may worsen system performance both in terms of efficiency and equity. Should Croatia have considered private supplemental insurance as an alternative? There is a new single private supplemental health insurance market now evolving over the EU countries and into Eastern Europe. Croatians could take advantage of lowered costs due to larger risk pooling and the lower administrative overhead of mature insurance organizations. Private supplemental insurance, when designed well, can address several objectives, including a) increased revenues into the health sector; b) removal of the public burden of coverage of selected services for certain population groups; and c) encourage new management and organizational innovations into the sector. Private and multiple company insurance markets are thought to be superior in terms of consumer responsiveness; choice of benefits; adoption of new, more expensive technology; and use of private sector providers. Private sector insurers may also encourage "spillover" effects encouraging reforms with public sector insurance performance. There is already an emerging private insurance market in Croatia, but can it be expanded and properly regulated? The private insurance companies might capture as much as 30-70% of the market for certain services, such as high cost procedures, preferred providers, and hotel amenities. But the Government will need to strengthen the regulatory framework for private insurance and assure that there is adequate regulatory capacity.

  20. Supplemental health insurance: did Croatia miss an opportunity?

    PubMed

    Langenbrunner, John C

    2002-08-01

    Croatia continues to face a health-funding crisis. A recent supplemental health insurance law increases revenues through first increasing co-payments, then raising the payroll tax to cover those co-payments. This public finance "slight-of-hand" will not solve the system's structural issues and may worsen system performance both in terms of efficiency and equity. Should Croatia have considered private supplemental insurance as an alternative? There is a new single private supplemental health insurance market now evolving over the EU countries and into Eastern Europe. Croatians could take advantage of lowered costs due to larger risk pooling and the lower administrative overhead of mature insurance organizations. Private supplemental insurance, when designed well, can address several objectives, including a) increased revenues into the health sector; b) removal of the public burden of coverage of selected services for certain population groups; and c) encourage new management and organizational innovations into the sector. Private and multiple company insurance markets are thought to be superior in terms of consumer responsiveness; choice of benefits; adoption of new, more expensive technology; and use of private sector providers. Private sector insurers may also encourage "spillover" effects encouraging reforms with public sector insurance performance. There is already an emerging private insurance market in Croatia, but can it be expanded and properly regulated? The private insurance companies might capture as much as 30-70% of the market for certain services, such as high cost procedures, preferred providers, and hotel amenities. But the Government will need to strengthen the regulatory framework for private insurance and assure that there is adequate regulatory capacity. PMID:12187517

  1. Group Health Insurance Plans for Public-School Personnel, 1964-65.

    ERIC Educational Resources Information Center

    National Education Association, Washington, DC.

    This report explains the major considerations in developing group health insurance coverage for public school personnel. A general overview is given of (1) group health insurance coverage, (2) patterns of group health insurance, (3) group health insurance organizations, (4) eligibility and enrollment practices, and (5) continuous health insurance…

  2. SCHIP Directors' Perception of Schools Assisting Students in Obtaining Public Health Insurance

    ERIC Educational Resources Information Center

    Price, James H.; Rickard, Megan

    2009-01-01

    Background: Health insurance coverage increases access to health care. There has been an erosion of employer-based health insurance and a concomitant rise in children covered by public health insurance programs, yet more than 8 million children are still without health insurance coverage. Methods: This study was a national survey to assess the…

  3. 45 CFR 148.122 - Guaranteed renewability of individual health insurance coverage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... insurance coverage. 148.122 Section 148.122 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE INDIVIDUAL HEALTH INSURANCE MARKET... health insurance coverage. (a) Applicability. This section applies to all health insurance coverage...

  4. What Can Massachusetts Teach Us about National Health Insurance Reform?

    ERIC Educational Resources Information Center

    Couch, Kenneth A., Ed.; Joyce, Theodore J., Ed.

    2011-01-01

    The Patient Protection and Affordable Care Act (PPACA) is the most significant health policy legislation since Medicare in 1965. The need to address rising health care costs and the lack of health insurance coverage is widely accepted. Health care spending is approaching 17 percent of gross domestic product and yet 45 million Americans remain…

  5. [Persons insured with the German statutory sickness funds or privately insured: differences in health and health behaviour].

    PubMed

    Kriwy, P; Mielck, A

    2006-05-01

    This paper deals with differences in health and health behaviour between those who are insured in the German Statutory Sickness Funds (GKV) and those who are privately insured (PKV). This topic has been largely ignored in German Public Health research. The analyses are based on data from a large survey in Germany conducted in 1998 and including 6822 adults. The multivariate analyses have been performed with OLS and logistic regression, separately for men and women and controlling for age, educational level, income and region. The most important result is that PKV-insured men have fewer diseases and feel more healthy than GKV-insured men. For women, though, no significant association could be found between health and type of health insurance. The interpretation of these results is mainly based on the "selection hypothesis", stating that healthier persons are more likely to be insured in the PKV than in the GKV. This would imply that the "causation hypothesis" (stating that being privately insured has a positive effect on health) is less important. Taking into account the current discussion on the balance between GKV and PKV, it is believed that future research should focus more on these topics. PMID:16773548

  6. 75 FR 43109 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-23

    ... Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage offered in... health insurance issuers providing group health insurance coverage. The text of those...

  7. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system.

    PubMed

    Meng, Qingyue; Fang, Hai; Liu, Xiaoyun; Yuan, Beibei; Xu, Jin

    2015-10-10

    Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes.

  8. Wisconsin Blues' conversion: the privatization of a health insurer.

    PubMed

    Fetter, Bruce

    2007-12-01

    Wisconsin Blue Cross was chartered in 1939 as a "charitable and benevolent corporation" to cover hospitalization costs at a time when most Americans did not have health insurance. In order to promote the protection that insurance afforded, the Wisconsin legislature exempted the company from most state and local taxes. During World War II, the federal government created tax deductions for both employers and employees, which created new demand for health insurance. The company extended its coverage to physicians' services and, as Blue Cross Blue Shield United of Wisconsin (BCBSUW), became the state's largest health insurer. In 1965, when Medicare and Medicaid further extended health coverage to the elderly, disabled, and indigent, the company took on the additional activity of administering those benefits on behalf of the government. The surge in demand for health care led to inflation in health costs in the 1970s. Many in the insurance industry and government felt this inflation could be controlled through the extension of market competition among insurers. They therefore proposed abandoning their tax exemptions in exchange for the right to operate as for-profit corporations. As a condition of this transformation, the state government required that BCBSUW create charitable foundations to benefit medical education and public health. After privatization, however, the for-profit successors of BCBSUW failed to control both medical costs and company administrative expenses. A substantial share of the profits went to their executives. PMID:18237069

  9. Preferences and choices for care and health insurance.

    PubMed

    van den Berg, Bernard; Van Dommelen, Paula; Stam, Piet; Laske-Aldershof, Trea; Buchmueller, Tom; Schut, Frederik T

    2008-06-01

    Legislation that came into effect in 2006 has dramatically altered the health insurance system in the Netherlands, placing greater emphasis on consumer choice and competition among insurers. The potential for such competition depends largely on consumer preferences for price and quality of service by insurers and quality of affiliated providers. This study provides initial evidence on the preferences of Dutch consumers and how they view trade-offs between various aspects of health insurance product design. A key feature of the analysis is that we compare the responses of high and low risk individuals, where risk is defined by the presence of a costly chronic condition. This contrast is critically important for understanding incentives facing insurers and for identifying potential unanticipated consequences of market competition. The results from our conjoint analysis suggest that not only high risk but also low risk individuals are willing to pay substantially more for insurance products that can be shown to provide better health outcomes. This suggests that insurance products that are more expensive and provide better quality of care may also attract low risk individuals. Therefore, development and dissemination of good, reliable and understandable health plan performance indicators may effectively reduce the problem of adverse selection. PMID:18400349

  10. Children's Health Insurance Program (CHIP): accomplishments, challenges, and policy recommendations.

    PubMed

    Racine, Andrew D; Long, Thomas F; Helm, Mark E; Hudak, Mark; Racine, Andrew D; Shenkin, Budd N; Snider, Iris Grace; White, Patience Haydock; Droge, Molly; Harbaugh, Norman

    2014-03-01

    Sixteen years ago, the 105th Congress, responding to the needs of 10 million children in the United States who lacked health insurance, created the State Children's Health Insurance Program (SCHIP) as part of the Balanced Budget Act of 1997. Enacted as Title XXI of the Social Security Act, the Children's Health Insurance Program (CHIP; or SCHIP as it has been known at some points) provided states with federal assistance to create programs specifically designed for children from families with incomes that exceeded Medicaid thresholds but that were insufficient to enable them to afford private health insurance. Congress provided $40 billion in block grants over 10 years for states to expand their existing Medicaid programs to cover the intended populations, to erect new stand-alone SCHIP programs for these children, or to effect some combination of both options. Congress reauthorized CHIP once in 2009 under the Children's Health Insurance Program Reauthorization Act and extended its life further within provisions of the Patient Protection and Affordable Care Act of 2010. The purpose of this statement is to review the features of CHIP as it has evolved over the 16 years of its existence; to summarize what is known about the effects that the program has had on coverage, access, health status, and disparities among participants; to identify challenges that remain with respect to insuring this group of vulnerable children, including the impact that provisions of the new Affordable Care Act will have on the issue of health insurance coverage for near-poor children after 2015; and to offer recommendations on how to expand and strengthen the national commitment to provide health insurance to all children regardless of means.

  11. Employer-sponsored health insurance and the gender wage gap.

    PubMed

    Cowan, Benjamin; Schwab, Benjamin

    2016-01-01

    During prime working years, women have higher expected healthcare expenses than men. However, employees' insurance rates are not gender-rated in the employer-sponsored health insurance (ESI) market. Thus, women may experience lower wages in equilibrium from employers who offer health insurance to their employees. We show that female employees suffer a larger wage gap relative to men when they hold ESI: our results suggest this accounts for roughly 10% of the overall gender wage gap. For a full-time worker, this pay gap due to ESI is on the order of the expected difference in healthcare expenses between women and men. PMID:26614691

  12. Can an employer-based health insurance system be just?

    PubMed

    Jecker, Nancy S

    1993-01-01

    It is America's distinctive practice to tie private health insurance to employment, and recent proposals have tried to retain this link through mandating that all employers provide health insurance to their employees. My primary approach to these issues is neither economic, nor historical, nor political but ethical. After a brief historical overview, I outline a general approach to evaluating the ethical significance of linking the distributions of distinct goods. I examine whether an unjust distribution of jobs spoils justice in the distribution of health insurance, taking as a central example gender inequities in employment and exploring their impact on job-based health insurance. Second, I explore the possibility that justly awarding jobs guarantees justice in employment-sponsored insurance. However, linking the distributions of different goods remains problematic, because such links inevitably undermine equality by enabling the same individuals to enjoy advantages in many different distributive areas. Finally, I examine recent proposals to reform America's health care system by requiring all employers to provide health insurance to their employees. I argue that such proposals lend themselves to the same ethical problems that the current system does and urge greater attention to alternative reform options. PMID:11652666

  13. Can an employer-based health insurance system be just?

    PubMed

    Jecker, N S

    1993-01-01

    It is America's distinctive practice to tie private health insurance to employment, and recent proposals have tried to retain this link through mandating that all employers provide health insurance to their employees. My primary approach to these issues is neither economic, nor historical, nor political but ethical. After a brief historical overview, I outline a general approach to evaluating the ethical significance of linking the distributions of distinct goods. I examine whether an unjust distribution of jobs spoils justice in the distribution of health insurance, taking as a central example gender inequities in employment and exploring their impact on job-based health insurance. Second, I explore the possibility that justly awarding jobs guarantees justice in employment-sponsored insurance. However, linking the distributions of different goods remains problematic, because such links inevitably undermine equality by enabling the same individuals to enjoy advantages in many different distributive areas. Finally, I examine recent proposals to reform America's health care system by requiring all employers to provide health insurance to their employees. I argue that such proposals lend themselves to the same ethical problems that the current system does and urge greater attention to alternative reform options. PMID:8282993

  14. Can an employer-based health insurance system be just?

    PubMed

    Jecker, Nancy S

    1993-01-01

    It is America's distinctive practice to tie private health insurance to employment, and recent proposals have tried to retain this link through mandating that all employers provide health insurance to their employees. My primary approach to these issues is neither economic, nor historical, nor political but ethical. After a brief historical overview, I outline a general approach to evaluating the ethical significance of linking the distributions of distinct goods. I examine whether an unjust distribution of jobs spoils justice in the distribution of health insurance, taking as a central example gender inequities in employment and exploring their impact on job-based health insurance. Second, I explore the possibility that justly awarding jobs guarantees justice in employment-sponsored insurance. However, linking the distributions of different goods remains problematic, because such links inevitably undermine equality by enabling the same individuals to enjoy advantages in many different distributive areas. Finally, I examine recent proposals to reform America's health care system by requiring all employers to provide health insurance to their employees. I argue that such proposals lend themselves to the same ethical problems that the current system does and urge greater attention to alternative reform options.

  15. School Superintendents' Perceptions of Schools Assisting Students in Obtaining Public Health Insurance

    ERIC Educational Resources Information Center

    Rickard, Megan L.; Price, James H.; Telljohann, Susan K.; Dake, Joseph A.; Fink, Brian N.

    2011-01-01

    Background: Superintendents' perceptions regarding the effect of health insurance status on academics, the role schools should play in the process of obtaining health insurance, and the benefits/barriers to assisting students in enrolling in health insurance were surveyed. Superintendents' basic knowledge of health insurance, the link between…

  16. 76 FR 11782 - Medicare, Medicaid, and Children's Health Insurance Programs; Renewal, Expansion, and Renaming of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-03

    ... with or who are eligible for Medicare, Medicaid and the Children's Health Insurance Program (CHIP... Insurance Assistance Programs (SHIPs), health insurance plans, aging, Web health education, e-prescribing... insurance exchanges, and minority health education. We are requesting that all curricula vitae include...

  17. Strategies for expanding health insurance coverage in vulnerable populations

    PubMed Central

    Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

    2014-01-01

    Background Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. Objectives To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Selection criteria Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA

  18. Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?

    PubMed Central

    Marino, Miguel; Hoopes, Megan; Bailey, Steffani R; Gold, Rachel; O’Malley, Jean; Angier, Heather; Nelson, Christine; Cottrell, Erika; Devoe, Jennifer

    2015-01-01

    Objective To validate electronic health record (EHR) insurance information for low-income pediatric patients at Oregon community health centers (CHCs), compared to reimbursement data and Medicaid coverage data. Materials and Methods Subjects Children visiting any of 96 CHCs (N = 69 189) from 2011 to 2012. Analysis The authors measured correspondence (whether or not the visit was covered by Medicaid) between EHR coverage data and (i) reimbursement data and (ii) coverage data from Medicaid. Results Compared to reimbursement data and Medicaid coverage data, EHR coverage data had high agreement (87% and 95%, respectively), sensitivity (0.97 and 0.96), positive predictive value (0.88 and 0.98), but lower kappa statistics (0.32 and 0.49), specificity (0.27 and 0.60), and negative predictive value (0.66 and 0.45). These varied among clinics. Discussion/Conclusions EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients. Future work should attempt to replicate these analyses in other settings. PMID:25888586

  19. The effects of Taiwan's National Health Insurance on access and health status of the elderly.

    PubMed

    Chen, Likwang; Yip, Winnie; Chang, Ming-Cheng; Lin, Hui-Sheng; Lee, Shyh-Dye; Chiu, Ya-Ling; Lin, Yu-Hsuan

    2007-03-01

    The primary objective of this paper is to evaluate the impact of Taiwan's National Health Insurance program (NHI), established in 1995, on improving elderly access to care and health status. Further, we estimate the extent to which NHI reduces gaps in access and health across income groups. Using data from a longitudinal survey, we adopt a difference-in-difference methodology to estimate the causal effect of Taiwan's NHI. Our results show that Taiwan's NHI has significantly increased utilization of both outpatient and inpatient care among the elderly, and such effects were more salient for people in the low- or middle-income groups. Our findings also reveal that although Taiwan's NHI greatly increased the utilization of both outpatient and inpatient services, this increased utilization of health services did not reduce mortality or lead to better self-perceived general health status for Taiwanese elderly. Measures more sensitive than mortality and self-perceived general health may be necessary for discerning the health effects of NHI. Alternatively, the lack of NHI effects on health may reflect other quality and efficiency problems inherent in the system not yet addressed by NHI. PMID:16929478

  20. How Health Care Providers Can Help Link Children to Medicaid and Other Child Health Insurance Programs.

    ERIC Educational Resources Information Center

    Ross, Donna Cohen

    This reports that health care providers, including those based in schools, can be instrumental in efforts to enroll eligible children in Medicaid or low-cost health insurance. There are 10 ways in which health care providers can help: (1) inform families about the availability of free and low-cost health insurance for children; (2) enlist all…

  1. Premium variation in the individual health insurance market.

    PubMed

    Herring, B; Pauly, M V

    2001-03-01

    Recent proposals to decrease the number of uninsured in the U.S. indicate that the individual health insurance market's role may increase. Amid fears of possible risk-segmentation in individual insurance, there exists limited information of the functioning of such markets. This paper examines the relationship between expected medical expense and actual paid premiums for households with individual insurance in the 1996-1997 Community Tracking Study's Household Survey. We find that premiums vary less than proportionately with expected expense and vary only with certain risk characteristics. We also explore how the relationship between risk and premiums is affected by local regulations and market characteristics. We find that premiums vary significantly less strongly with risk for persons insured by HMOs and in markets dominated by managed care insurers.

  2. Multi-stage methodology to detect health insurance claim fraud.

    PubMed

    Johnson, Marina Evrim; Nagarur, Nagen

    2016-09-01

    Healthcare costs in the US, as well as in other countries, increase rapidly due to demographic, economic, social, and legal changes. This increase in healthcare costs impacts both government and private health insurance systems. Fraudulent behaviors of healthcare providers and patients have become a serious burden to insurance systems by bringing unnecessary costs. Insurance companies thus develop methods to identify fraud. This paper proposes a new multistage methodology for insurance companies to detect fraud committed by providers and patients. The first three stages aim at detecting abnormalities among providers, services, and claim amounts. Stage four then integrates the information obtained in the previous three stages into an overall risk measure. Subsequently, a decision tree based method in stage five computes risk threshold values. The final decision stating whether the claim is fraudulent is made by comparing the risk value obtained in stage four with the risk threshold value from stage five. The research methodology performs well on real-world insurance data.

  3. Health Insurance and the Elderly: Data from MCBS

    PubMed Central

    Chulis, George S.; Eppig, Franklin J.; Hogan, Mary O.; Waldo, Daniel R.; Arnett, Ross H.

    1993-01-01

    This article shows the supplemental insurance distribution and Medicare spending per capita by insurance status for elderly persons in 1991. The data are from the Medicare Current Beneficiary Survey (MCBS) and Medicare bill records. Persons with Medicare only are a fairly small share of the elderly (11.4 percent). About three-fourths of the Medicare elderly have some form of private insurance. The share with Medicaid is 11.9 percent, which has increased recently as qualified Medicare beneficiaries (QMBs) started to receive partial Medicaid benefits. In general, Medicare per capita spending levels increase as supplemental insurance comes closer to first dollar coverage. When the data were recalculated to control for differences in reported health status between the insurance groups, essentially the same spending differences were observed. PMID:10130575

  4. 75 FR 24470 - Health Care Reform Insurance Web Portal Requirements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-05

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Part 159 RIN 0991-AB63 Health Care Reform Insurance Web... that may be available to them in their State. The Department of Health and Human Services (HHS)...

  5. Crowd-out 10 years later: have recent public insurance expansions crowded out private health insurance?

    PubMed

    Gruber, Jonathan; Simon, Kosali

    2008-03-01

    Ten years ago, Cutler and Gruber [Cutler, D., Gruber, J., 1996. Does public health insurance crowdout private insurance? Quarterly Journal of Economics 111, 391-430] suggested that crowd-out might be quite large, but much subsequent research has questioned this conclusion. Our results using improved data and methods clearly show that crowd-out is still significant in the 1996-2002 period. This finding emerges most strongly when we consider family level measures of public insurance eligibility. We also find that recent anti-crowd-out provisions in public expansions may have had the opposite effect, lowering take-up by the uninsured faster than they lower crowd-out of private insurance.

  6. Racial Disparities in Children's Health: A Longitudinal Analysis of Mothers Based on the Multiple Disadvantage Model.

    PubMed

    Cheng, Tyrone C; Lo, Celia C

    2016-08-01

    This secondary data analysis of 4373 mothers and their children investigated racial disparities in children's health and its associations with social structural factors, social relationships/support, health/mental health, substance use, and access to health/mental health services. The study drew on longitudinal records for mother-child pairs created from data in the Fragile Families and Child Wellbeing Study. Generalized estimating equations yielded results showing children's good health to be associated positively with mother's health (current health and health during pregnancy), across three ethnic groups. For African-American children, good health was associated with mothers' education level, receipt of informal child care, receipt of public health insurance, uninsured status, and absence of depression. For Hispanic children, health was positively associated with mothers' education level, receipt of substance-use treatment, and non-receipt of public assistance. Implications for policy and intervention are discussed. PMID:26754044

  7. Treatment-seeking behaviour and social health insurance in Africa: the case of Ghana under the National Health Insurance Scheme.

    PubMed

    Fenny, Ama P; Asante, Felix A; Enemark, Ulrika; Hansen, Kristian S

    2014-10-27

    Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah.Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries.

  8. Myths And Misconceptions About U.S. Health Insurance

    PubMed Central

    Baicker, Katherine; Chandra, Amitabh

    2009-01-01

    Several myths about health insurance interfere with the diagnosis of problems in the current system and impede the development of productive reforms. Although many are built on a kernel of truth, complicated issues are often simplified to the point of being false or misleading. Several stem from the conflation of health, health care, and health insurance, while others attempt to use economic arguments to justify normative preferences. We apply a combination of economic principles and lessons from empirical research to examine the policy problems that underlie the myths and focus attention on addressing these fundamental challenges. PMID:18940834

  9. State Health Insurance Assistance Program (SHIP). Final rule.

    PubMed

    2016-06-01

    The Department of Health and Human Services is issuing a final regulation that adopts, without change, the interim final rule (IFR) entitled ``State Health Insurance Assistance Program (SHIP).'' This final rule implements a provision enacted by the Consolidated Appropriations Act of 2014 and reflects the transfer of the State Health Insurance Assistance Program (SHIP) from the Centers for Medicare & Medicaid Services (CMS), in the Department of Health and Human Services (HHS) to the Administration for Community Living (ACL) in HHS. Prior to the interim final rule, prior regulations were issued by CMS under the authority granted by the Omnibus Budget Reconciliation Act of 1990 (OBRA), Section 4360.

  10. State Health Insurance Assistance Program (SHIP). Final rule.

    PubMed

    2016-06-01

    The Department of Health and Human Services is issuing a final regulation that adopts, without change, the interim final rule (IFR) entitled ``State Health Insurance Assistance Program (SHIP).'' This final rule implements a provision enacted by the Consolidated Appropriations Act of 2014 and reflects the transfer of the State Health Insurance Assistance Program (SHIP) from the Centers for Medicare & Medicaid Services (CMS), in the Department of Health and Human Services (HHS) to the Administration for Community Living (ACL) in HHS. Prior to the interim final rule, prior regulations were issued by CMS under the authority granted by the Omnibus Budget Reconciliation Act of 1990 (OBRA), Section 4360. PMID:27295733

  11. Voluntary health insurance in the European Union: a critical assessment.

    PubMed

    Mossialos, Elias; Thomson, Sarah M S

    2002-01-01

    The authors examine the role and nature of the market for voluntary health insurance in the European Union and review the impact of public policy, at both the national and E.U. levels, on the development of this market in recent years. The conceptual framework, based on a model of industrial analysis, allows a wide range of policy questions regarding market structure, conduct, and performance. By analyzing these three aspects of the market for voluntary health insurance, the authors are also able to raise questions about the equity and efficiency of voluntary health insurance as a means of funding health care in the European Union. The analysis suggests that the market for voluntary health insurance in the European Union suffers from significant information failures that seriously limit its potential for competition or efficiency and also reduce equity. Substantial deregulation of the E.U. market for voluntary health insurance has stripped regulatory bodies of their power to protect consumers and poses interesting challenges for national regulators, particularly if the market is to expand in the future. In a deregulated environment, it is questionable whether this method of funding health care will encourage a more efficient and equitable allocation of resources.

  12. 75 FR 34571 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

    ... Revenue Service 26 CFR Part 54 RIN 1545-BJ50 Group Health Plans and Health Insurance Coverage Rules... respect to group health plans and health insurance coverage offered in connection with a group health plan... temporary regulations provide guidance to employers, group health plans, and health insurance...

  13. Assessing barriers to health insurance and threats to equity in comparative perspective: The Health Insurance Access Database

    PubMed Central

    2012-01-01

    Background Typologies traditionally used for international comparisons of health systems often conflate many system characteristics. To capture policy changes over time and by service in health systems regulation of public and private insurance, we propose a database containing explicit, standardized indicators of policy instruments. Methods The Health Insurance Access Database (HIAD) will collect policy information for ten OECD countries, over a range of eight health services, from 1990–2010. Policy indicators were selected through a comprehensive literature review which identified policy instruments most likely to constitute barriers to health insurance, thus potentially posing a threat to equity. As data collection is still underway, we present here the theoretical bases and methodology adopted, with a focus on the rationale underpinning the study instruments. Results These harmonized data will allow the capture of policy changes in health systems regulation of public and private insurance over time and by service. The standardization process will permit international comparisons of systems’ performance with regards to health insurance access and equity. Conclusion This research will inform and feed the current debate on the future of health care in developed countries and on the role of the private sector in these changes. PMID:22551599

  14. Risky business: how insurance companies gamble with your health coverage.

    PubMed

    Denny, J

    1993-01-01

    Under a patchwork of state laws and virtually no federal oversight, a decade of risky investments, questionable business dealings, lavish spending, and help-yourself ethics in the insurance industry is playing a hidden role in the crisis in affordable medical coverage. Skyrocketing medical costs are the main culprit, but financial losses have put pressure on insurers to raise premiums and cancel risky policyholders. The losses also are a major factor in the sharp increase in life/health insurance company failures, which can leave policyholders stranded.

  15. 77 FR 66069 - Veterans' Group Life Insurance (VGLI) No-Health Period Extension

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-01

    ... AFFAIRS 38 CFR Part 9 RIN 2900-AO24 Veterans' Group Life Insurance (VGLI) No-Health Period Extension... Life Insurance (VGLI) to extend to 240 days the current 120-day ``no-health'' period during which... insurability is needed, known as the Veterans' Group Life Insurance (VGLI) ``no- health'' period, from 120...

  16. The importance of health insurance and the safety net in rural communities.

    PubMed

    Irons, Thomas G; Moore, Kellan S

    2015-01-01

    Access to health insurance and health care are critical for people living in rural communities, where the safety net is fragile. However, rural communities face challenges as they enroll uninsured people in the health insurance marketplace, educate newly insured individuals on how to use insurance, and coordinate care for those who remain uninsured.

  17. Designing and regulating health insurance exchanges: lessons from Massachusetts.

    PubMed

    Ericson, Keith M Marzilli; Starc, Amanda

    The Massachusetts health care reform provides preliminary evidence on the function of health insurance exchanges and individual insurance markets. This paper describes the type of products consumers choose and the dynamics of consumer choice. Evidence shows that choice architecture, including product standardization and the use of heuristics (rules of thumb), affects choice. In addition, while consumers often choose less generous plans in the exchange than in traditional employer-sponsored insurance, there is considerable heterogeneity in consumer demand, as well as some evidence of adverse selection. We examine the role of imperfect competition between insurers, and document the impact of pricing and product regulation on the level and distribution of premiums. Given our extensive choice data, we synthesize the evidence of the Massachusetts exchange to inform the design and regulation on other exchanges. PMID:23469676

  18. Tax subsidies for private health insurance - july 2009 update.

    PubMed

    Burman, Len; Khitatrakun, Surachai; Goodell, Sarah

    2009-07-01

    Tax subsides for employer-sponsored health insurance are the largest subsidy for private health insurance and support key mechanisms of the U.S. insurance system, but they overwhelmingly benefit high-wage employees. When employers purchase or provide insurance for their employees, their contributions to the premium are excluded from income and payroll taxes. This tax exclusion provided more than $100 billion in income and payroll tax subsidies in 2002. High-income workers benefit more from these subsidies than those with lower incomes because of their higher marginal tax rate. Applying the tax exclusion in their respective tax brackets means high-income families (those earning more than $200,000) receive a subsidy worth one-third of the premium, while the lowest income families receive a subsidy worth just 10 percent. Despite these issues, ESI is a successful mechanism in many ways, covering a significant majority of Americans and providing a good pooling mechanism. PMID:22052151

  19. Strategies for expanding health insurance coverage in vulnerable populations

    PubMed Central

    Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

    2014-01-01

    Background Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. Objectives To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Selection criteria Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA

  20. Can decision biases improve insurance outcomes? An experiment on status quo bias in health insurance choice.

    PubMed

    Krieger, Miriam; Felder, Stefan

    2013-06-01

    Rather than conforming to the assumption of perfect rationality in neoclassical economic theory, decision behavior has been shown to display a host of systematic biases. Properly understood, these patterns can be instrumentalized to improve outcomes in the public realm. We conducted a laboratory experiment to study whether decisions over health insurance policies are subject to status quo bias and, if so, whether experience mitigates this framing effect. Choices in two treatment groups with status quo defaults are compared to choices in a neutrally framed control group. A two-step design features sorting of subjects into the groups, allowing us to control for selection effects due to risk preferences. The results confirm the presence of a status quo bias in consumer choices over health insurance policies. However, this effect of the default framing does not persist as subjects repeat this decision in later periods of the experiment. Our results have implications for health care policy, for example suggesting that the use of non-binding defaults in health insurance can facilitate the spread of co-insurance policies and thereby help contain health care expenditure. PMID:23783222

  1. Can decision biases improve insurance outcomes? An experiment on status quo bias in health insurance choice.

    PubMed

    Krieger, Miriam; Felder, Stefan

    2013-06-19

    Rather than conforming to the assumption of perfect rationality in neoclassical economic theory, decision behavior has been shown to display a host of systematic biases. Properly understood, these patterns can be instrumentalized to improve outcomes in the public realm. We conducted a laboratory experiment to study whether decisions over health insurance policies are subject to status quo bias and, if so, whether experience mitigates this framing effect. Choices in two treatment groups with status quo defaults are compared to choices in a neutrally framed control group. A two-step design features sorting of subjects into the groups, allowing us to control for selection effects due to risk preferences. The results confirm the presence of a status quo bias in consumer choices over health insurance policies. However, this effect of the default framing does not persist as subjects repeat this decision in later periods of the experiment. Our results have implications for health care policy, for example suggesting that the use of non-binding defaults in health insurance can facilitate the spread of co-insurance policies and thereby help contain health care expenditure.

  2. Can Decision Biases Improve Insurance Outcomes? An Experiment on Status Quo Bias in Health Insurance Choice

    PubMed Central

    Krieger, Miriam; Felder, Stefan

    2013-01-01

    Rather than conforming to the assumption of perfect rationality in neoclassical economic theory, decision behavior has been shown to display a host of systematic biases. Properly understood, these patterns can be instrumentalized to improve outcomes in the public realm. We conducted a laboratory experiment to study whether decisions over health insurance policies are subject to status quo bias and, if so, whether experience mitigates this framing effect. Choices in two treatment groups with status quo defaults are compared to choices in a neutrally framed control group. A two-step design features sorting of subjects into the groups, allowing us to control for selection effects due to risk preferences. The results confirm the presence of a status quo bias in consumer choices over health insurance policies. However, this effect of the default framing does not persist as subjects repeat this decision in later periods of the experiment. Our results have implications for health care policy, for example suggesting that the use of non-binding defaults in health insurance can facilitate the spread of co-insurance policies and thereby help contain health care expenditure. PMID:23783222

  3. 78 FR 6275 - Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-30

    ... 457 Office of the Secretary 45 CFR Part 155 RIN 0938-AR04 Medicaid, Children's Health Insurance... Federal Register entitled ``Medicaid, Children's Health Insurance Programs, and Exchanges: Essential... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  4. Mental Health and Substance Abuse Insurance Parity for Federal Employees: How Did Health Plans Respond?

    ERIC Educational Resources Information Center

    Barry, Colleen L.; Ridgely, M. Susan

    2008-01-01

    A fundamental concern with competitive health insurance markets is that they will not supply efficient levels of coverage for treatment of costly, chronic, and predictable illnesses, such as mental illness. Since the inception of employer-based health insurance, coverage for mental health services has been offered on a more limited basis than…

  5. Necessary health care and basic needs: health insurance plans and essential benefits.

    PubMed

    Ward, Andrew; Johnson, Pamela Jo

    2013-12-01

    According to HealthCare.gov, by improving access to quality health for all Americans, the Affordable Care Act (ACA) will reduce disparities in health insurance coverage. One way this will happen under the provisions of the ACA is by creating a new health insurance marketplace (a health insurance exchange) by 2014 in which "all people will have a choice for quality, affordable health insurance even if a job loss, job switch, move or illness occurs". This does not mean that everyone will have whatever insurance coverage he or she wants. The provisions of the ACA require that each of the four benefit categories of plans (known as bronze, silver, gold and platinum) provides no less than the benefits available in an "essential health benefits package". However, without a clear understanding of what criteria must be satisfied for health care to be essential, the ACA's requirement is much too vague and open to multiple, potentially conflicting interpretations. Indeed, without such understanding, in the rush to provide health insurance coverage to as many people as is economically feasible, we may replace one kind of disparity (lack of health insurance) with another kind of disparity (lack of adequate health insurance). Thus, this paper explores the concept of "essential benefits", arguing that the "essential health benefits package" in the ACA should be one that optimally satisfies the basic needs of the people covered.

  6. Patient satisfaction with primary health care - a comparison between the insured and non-insured under the National Health Insurance Policy in Ghana.

    PubMed

    Fenny, Ama Pokuaa; Enemark, Ulrika; Asante, Felix A; Hansen, Kristian S

    2014-04-01

    Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care. This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients' satisfaction and examines their links to their health insurance status. The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients' perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies.

  7. Patient Satisfaction with Primary Health Care – A Comparison between the Insured and Non-Insured under the National Health Insurance Policy in Ghana

    PubMed Central

    Fenny, Ama P.; Enemark, Ulrika; Asante, Felix A.; Hansen, Kristian S.

    2014-01-01

    Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care. This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients’ satisfaction and examines their links to their health insurance status. The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients’ perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies. PMID:24999137

  8. Health insurance coverage - United States, 2008 and 2010.

    PubMed

    Moonesinghe, Ramal; Chang, Man-huei; Truman, Benedict I

    2013-11-22

    One out of four adults aged 19-64 years reported not having health insurance at some time during 2011, with a majority remaining uninsured for ≥1 year. In the first quarter of 2010, an estimated 59.1 million persons had no health insurance for at least part of the year, an increase from 58.7 million in 2009 and 56.4 million in 2008. The unemployment rate increased from 5.8% to 9.3% from 2008 to 2009, the largest 1-year increase on record. Losing or changing jobs was the primary reason persons experienced a gap in health insurance. Employment-based coverage for persons aged <65 years continued to erode for the ninth year in a row, falling 3.0 percentage points from 61.9% in 2008 to 58.9% in 2009. Persons aged 18-64 years with no health insurance during the preceding year were seven times as likely as those continuously insured to forgo needed health care because of cost. PMID:24264491

  9. Policy processes underpinning universal health insurance in Vietnam

    PubMed Central

    Ha, Bui T. T.; Frizen, Scott; Thi, Le M.; Duong, Doan T. T.; Duc, Duong M.

    2014-01-01

    Background In almost 30 years since economic reforms or ‘renovation’ (Doimoi) were launched, Vietnam has achieved remarkably good health results, in many cases matching those in much higher income countries. This study explores the contribution made by Universal Health Insurance (UHI) policies, focusing on the past 15 years. We conducted a mixed method study to describe and assess the policy process relating to health insurance, from agenda setting through implementation and evaluation. Design The qualitative research methods implemented in this study were 30 in-depth interviews, 4 focus group discussions, expert consultancy, and 420 secondary data review. The data were analyzed by NVivo 7.0. Results Health insurance in Vietnam was introduced in 1992 and has been elaborated over a 20-year time frame. These processes relate to moving from a contingent to a gradually expanded target population, expanding the scope of the benefit package, and reducing the financial contribution from the insured. The target groups expanded to include 66.8% of the population by 2012. We characterized the policy process relating to UHI as incremental with a learning-by-doing approach, with an emphasis on increasing coverage rather than ensuring a basic service package and financial protection. There was limited involvement of civil society organizations and users in all policy processes. Intertwined political economy factors influenced the policy processes. Conclusions Incremental policy processes, characterized by a learning-by-doing approach, is appropriate for countries attempting to introduce new health institutions, such as health insurance in Vietnam. Vietnam should continue to mobilize resources in sustainable and viable ways to support the target groups. The country should also adopt a multi-pronged approach to achieving universal access to health services, beyond health insurance. PMID:25262793

  10. 75 FR 41787 - Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-19

    ... group health plans and health insurance coverage offered in connection with a group health plan under... regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The text of those temporary regulations also serves as the text of...

  11. 75 FR 27141 - Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-13

    ... Revenue Service 26 CFR Part 54 RIN 1545-BJ45 Group Health Plans and Health Insurance Issuers Providing... Labor and the Office of Consumer Information and Insurance Oversight of the U.S. Department of Health... health plans and health insurance coverage offered in connection with a group health plan under...

  12. 76 FR 44491 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-26

    ... amendment to the interim final rules (76 FR 37208) entitled, ``Group Health Plans and Health Insurance...-AQ66 Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and... rule with request for comments entitled, ``Group Health Plans and Health Insurance Issuers:...

  13. 75 FR 70159 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-17

    ... Internal Revenue Service 26 CFR Part 54 RIN 1545-BJ50 Group Health Plans and Health Insurance Coverage... provide guidance to employers, group health plans, and health insurance issuers providing group health... Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially...

  14. 75 FR 70114 - Amendment to the Interim Final Rules for Group Health Plans and Health Insurance Coverage...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-17

    ... Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under... and Insurance Oversight, Department of Health and Human Services. ACTION: Amendment to interim final... regulations implementing the rules for group health plans and health insurance coverage in the group...

  15. What Explains Divorced Women’s Poorer Health?: The Mediating Role of Health Insurance and Access to Health Care in a Rural Iowan Sample*

    PubMed Central

    Lavelle, Bridget; Lorenz, Frederick O.; Wickrama, K. A. S.

    2012-01-01

    The economic restructuring in rural areas in recent decades has been accompanied by rising marital instability. To examine the implications of the increase in divorce for the health of rural women, we examine how marital status predicts adequacy of health insurance coverage and health care access, and whether these factors help to account for the documented association between divorce and later illness. Analyzing longitudinal data from a cohort of over 400 married and recently divorced rural Iowan women, we decompose the total effect of divorce on physical illness a decade later using structural equation modeling. Divorced women are less likely to report adequate health insurance in the years following divorce, inhibiting their access to medical care and threatening their physical health. Full-time employment acts as a buffer against insurance loss for divorced women. The growth of marital instability in rural areas has had significant ramifications for women’s health; the decline of adequate health insurance coverage following divorce explains a component of the association between divorced status and poorer long-term health outcomes. PMID:23457418

  16. Private health insurance: an international overview and considerations for Canada.

    PubMed

    Dhalla, Irfan

    2007-01-01

    Since the passage of the Canada Health Act in 1984 and its prohibition of extra-billing, there has been an extremely limited role for private health insurance in Canada as a mechanism to pay for medically necessary physician or hospital services. In the aftermath of the landmark Supreme Court decision Chaoulli v. Québec, this may change.

  17. Adverse Selection in Health Insurance Markets: A Classroom Experiment

    ERIC Educational Resources Information Center

    Hodgson, Ashley

    2014-01-01

    Adverse selection as it relates to health care policy will be a key economic issue in many upcoming elections. In this article, the author lays out a 30-minute classroom experiment designed for students to experience the kind of elevated prices and market collapse that can result from adverse selection in health insurance markets. The students…

  18. Update: Health Insurance and Utilization of Care among Rural Adolescents

    ERIC Educational Resources Information Center

    Probst, Janice C.; Moore, Charity G.; Baxley, Elizabeth G.

    2005-01-01

    Context: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. Purpose: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. Methods:…

  19. Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

    PubMed Central

    2012-01-01

    Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance. PMID:22376290

  20. Management implications of the Health Insurance Portability and Accountability Act.

    PubMed

    Prince, L H; Carroll-Barefield, A

    2000-09-01

    Health care professionals are faced with ever-changing rules and regulations and technological advances. Add to this the 1996 Health Insurance Portability and Accountability Act (HIPAA) and the health care manager's list of challenges continues to expand. This article presents an overview of HIPAA requirements and tools for use by health care managers in ensuring their facility is in compliance with the latest rulings.

  1. Graduate students' health insurance status and preferences.

    PubMed

    Smith, D G

    1995-01-01

    A survey of graduate and professional students at the University of Michigan revealed that many (12.6%) do not have healthcare coverage. Minority students and students who are financing their education with loans and scholarships are at a particularly high risk of being uninsured. Students are divided in their preferences for changes in policies and systems of coverage. Most of the students' preference is for the university to offer a modestly improved plan and a requirement that students prove insurance coverage. In addition, some students indicated that they would like to have an inexpensive plan as well as the current system of voluntary insurance. After the survey, university officials opted to continue with current offerings and to add an improved policy under a voluntary system.

  2. 78 FR 53769 - Medicare, Medicaid, and Children's Health Insurance Programs; Meeting of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-30

    ... effectiveness of consumer education strategies concerning Medicare, Medicaid and the Children's Health Insurance... enrolled in, or eligible for, Medicare, Medicaid and the Children's Health Insurance Program (CHIP... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  3. 77 FR 17073 - Medicare, Medicaid, and Children's Health Insurance Programs; Meeting of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-23

    ... the Children's Health Insurance Program (CHIP). This meeting is open to the public. DATES: Meeting..., and the Children's Health Insurance Program (CHIP). Enhancing the Federal government's effectiveness... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  4. 78 FR 72089 - Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-02

    ... or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare... Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HEALTH...

  5. Health Insurance Hikes Ease but Workers Pay a Price, Survey Finds

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_161116.html Health Insurance Hikes Ease But Workers Pay a Price, Survey ... 22, 2016 (HealthDay News) -- Premiums for employer-sponsored health insurance rose modestly in 2016, but more workers must ...

  6. 77 FR 2983 - Medicare, Medicaid, and Children's Health Insurance Programs; Meeting of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-20

    ... the Children's Health Insurance Program (CHIP). This meeting is open to the public. DATES: Meeting..., and the Children's Health Insurance Program (CHIP). Enhancing the Federal government's effectiveness... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  7. Effects of Health Information Technology on Malpractice Insurance Premiums

    PubMed Central

    Kim, Hye Yeong

    2015-01-01

    Objectives The widespread adoption of health information technology (IT) will help contain health care costs by decreasing inefficiencies in healthcare delivery. Theoretically, health IT could lower hospitals' malpractice insurance premiums (MIPs) and improve the quality of care by reducing the number and size of malpractice. This study examines the relationship between health IT investment and MIP using California hospital data from 2006 to 2007. Methods To examine the effect of hospital IT on malpractice insurance expense, a generalized estimating equation (GEE) was employed. Results It was found that health IT investment was not negatively associated with MIP. Health IT was reported to reduce medical error and improve efficiency. Thus, it may reduce malpractice claims from patients, which will reduce malpractice insurance expenses for hospitals. However, health IT adoption could lead to increases in MIPs. For example, we expect increases in MIPs of about 1.2% and 1.5%, respectively, when health IT and labor increase by 10%. Conclusions This study examined the effect of health IT investment on MIPs controlling other hospital and market, and volume characteristics. Against our expectation, we found that health IT investment was not negatively associated with MIP. There may be some possible reasons that the real effect of health IT on MIPs was not observed; barriers including communication problems among health ITs, shorter sample period, lower IT investment, and lack of a quality of care measure as a moderating variable. PMID:25995964

  8. The impact of public voluntary health insurance on private health expenditures in Vietnam.

    PubMed

    Jowett, M; Contoyannis, P; Vinh, N D

    2003-01-01

    As a financing mechanism with the potential to raise additional funds for health services, whilst improving access to services amongst the poor, non-profit health insurance has become increasingly attractive to health policy-makers. Using data from a household survey in Vietnam, out of pocket health expenditure are compared between members and eligible non-members of the government-implemented voluntary health insurance scheme. Expenditures are analysed for individuals who sought care during their most recent illness. Using an endogenous dummy variable model to control for bias resulting from self-selection into the scheme, we find that health insurance reduces average out-of-pocket expenditures by approximately 200%. Whilst income inelastic, health expenditures are found to be significantly influenced by an individuals level of income, irrespective of insurance status. Despite this, insurance reduces expenditures significantly more for the poor than for the rich.

  9. The impact of voluntary health insurance on health care utilization and out-of-pocket payments: new evidence for Vietnam.

    PubMed

    Nguyen, Cuong Viet

    2012-08-01

    Vietnam aims to achieve full coverage of health insurance in 2015. An increasing type of health insurance in Vietnam is voluntary health insurance. Although there are many studies on the implementation of voluntary health insurance in Vietnam, little is known on the causal impact of voluntary health insurance. This paper measures the impact of voluntary health insurance on health care utilization and out-of-pocket payments using Vietnam Household Living Standard Surveys in 2004 and 2006. It was found out that voluntary health insurance helps the insured people increase the annual outpatient and inpatient visits by around 45% and 70%, respectively. However, the effect of voluntary health insurance on out-of-pocket expenses on health care services is not statistically significant.

  10. Children’s Receipt of Health Care Services and Family Health Insurance Patterns

    PubMed Central

    DeVoe, Jennifer E.; Tillotson, Carrie J.; Wallace, Lorraine S.

    2009-01-01

    PURPOSE Insured children in the United States have better access to health care services; less is known about how parental coverage affects children’s access to care. We examined the association between parent-child health insurance coverage patterns and children’s access to health care and preventive counseling services. METHODS We conducted secondary analyses of nationally representative, cross-sectional, pooled 2002–2006 data from children (n = 43,509), aged 2 to 17 years, in households responding to the Medical Expenditure Panel Survey (MEPS). We assessed 9 outcome measures pertaining to children’s unmet health care and preventive counseling needs. RESULTS Cross-sectionally, among US children (aged 2 to 17 years) living with at least 1 parent, 73.6% were insured with insured parents, 8.0% were uninsured with uninsured parents, and the remaining 18.4% had discordant family insurance coverage patterns. In multivariable analyses, insured children with uninsured parents had higher odds of an insurance coverage gap (odds ratio [OR] = 2.45; 95% confidence interval [CI], 2.02–2.97), no usual source of care (OR = 1.31; 95% CI, 1.10–1.56), unmet health care needs (OR = 1.11; 95% CI, 1.01–1.22), and having never received at least 1 preventive counseling service (OR = 1.20; 95% CI, 1.04–1.39) when compared with insured children with insured parents. Insured children with mixed parental insurance coverage had similar vulnerabilities. CONCLUSIONS Uninsured children had the highest rates of unmet needs overall, with fewer differences based on parental insurance status. For insured children, having uninsured parents was associated with higher odds of going without necessary services when compared with having insured parents. PMID:19752468

  11. 42 CFR 457.80 - Current State child health insurance coverage and coordination.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Current State child health insurance coverage and... HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach...

  12. 42 CFR 457.80 - Current State child health insurance coverage and coordination.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Current State child health insurance coverage and... HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach...

  13. 42 CFR 457.80 - Current State child health insurance coverage and coordination.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Current State child health insurance coverage and... HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach...

  14. 42 CFR 457.80 - Current State child health insurance coverage and coordination.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Current State child health insurance coverage and... HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach...

  15. Reinsurance of health insurance for the informal sector.

    PubMed Central

    Dror, D. M.

    2001-01-01

    Deficient financing of health services in low-income countries and the absence of universal insurance coverage leaves most of the informal sector in medical indigence, because people cannot assume the financial consequences of illness. The role of communities in solving this problem has been recognized, and many initiatives are under way. However, community financing is rarely structured as health insurance. Communities that pool risks (or offer insurance) have been described as micro-insurance units. The sources of their financial instability and the options for stabilization are explained. Field data from Uganda and the Philippines, as well as simulated situations, are used to examine the arguments. The article focuses on risk transfer from micro-insurance units to reinsurance. The main insight of the study is that when the financial results of micro-insurance units can be estimated, they can enter reinsurance treaties and be stabilized from the first year. The second insight is that the reinsurance pool may require several years of operation before reaching cost neutrality. PMID:11477971

  16. Medical Malpractice Reform and Employer-Sponsored Health Insurance Premiums

    PubMed Central

    Morrisey, Michael A; Kilgore, Meredith L; Nelson, Leonard (Jack)

    2008-01-01

    Objective Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Data Sources/Study Setting Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Study Design Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. Data Collection/Extraction Methods State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Principal Findings Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. Conclusions The findings suggest that tort reforms have not translated into insurance savings. PMID:18522666

  17. Community health insurance schemes & patient satisfaction - evidence from India

    PubMed Central

    Devadasan, N.; Criel, Bart; Damme, Wim Van; Lefevre, Pierre; Manoharan, S.; der Stuyft, Patrick Van

    2011-01-01

    Background & objectives: Quality of care is an important determinant for utilizing health services. In India, the quality of care in most health services is poor. The government recognizes this and has been working on both supply and demand aspects. In particular, it is promoting community health insurance (CHI) schemes, so that patients can access quality services. This observational study was undertaken to measure the level of satisfaction among insured and uninsured patients in two CHI schemes in India. Methods: Patient satisfaction was measured, which is an outcome of good quality care. Two CHI schemes, Action for Community Organisation, Rehabilitation and Development (ACCORD) and Kadamalai Kalanjiam Vattara Sangam (KKVS), were chosen. Randomly selected, insured and uninsured households were interviewed. The household where a patient was admitted to a hospital was interviewed in depth about the health seeking behaviour, the cost of treatment and the satisfaction levels. Results: It was found that at both ACCORD and KKVS, there was no significant difference in the levels of satisfaction between the insured and uninsured patients. The main reasons for satisfaction were the availability of doctors and medicines and the recovery by the patient. Interpretation & conclusions: Our study showed that insured hospitalized patients did not have significantly higher levels of satisfaction compared to uninsured hospitalized patients. If CHI schemes want to improve the quality of care for their clients, so that they adhere to the scheme, the scheme managers need to negotiate actively for better quality of care with empanelled providers. PMID:21321418

  18. Longitudinal health record: a pediatrician's viewpoint of the longitudinal health record.

    PubMed

    Oberst, B B

    1989-01-01

    This paper will discuss the Health Record in terms of content, value of a Longitudinal Record, need for a dynamic and interactive record versus the current archived chronological repository of information, areas of application in research, clinical benefits and population related research concerning present and future influences upon a person's health. It will contain the categories of information utilized in a model Health Record, what facts should be contained within a brief Synopsis or Record Abstract and the contents of a master Pediatric Database. Areas of uses, abuses, potential problems, security needs, privacy and confidentiality issues, legal aspects, transfer of information, technical considerations, computerization of the Record and other matters will be discussed.

  19. Employer-provided health insurance and hospital mergers.

    PubMed

    Garmon, Christopher

    2013-07-01

    This paper explores the impact of employer-provided health insurance on hospital competition and hospital mergers. Under employer-provided health insurance, employer executives act as agents for their employees in selecting health insurance options for their firm. The paper investigates whether a merger of hospitals favored by executives will result in a larger price increase than a merger of competing hospitals elsewhere. This is found to be the case even when the executive has the same opportunity cost of travel as her employees and even when the executive is the sole owner of the firm, retaining all profits. This is consistent with the Federal Trade Commission's findings in its challenge of Evanston Northwestern Healthcare's acquisition of Highland Park Hospital. Implications of the model are further tested with executive location data and hospital data from Florida and Texas.

  20. The RAND Health Insurance Experiment, Three Decades Later*

    PubMed Central

    Aron-Dine, Aviva; Einav, Liran; Finkelstein, Amy

    2013-01-01

    We re-present and re-examine the analysis from the famous RAND Health Insurance Experiment from the 1970s on the impact of consumer cost sharing in health insurance on medical spending. We begin by summarizing the experiment and its core findings in a manner that would be standard in the current age. We then examine potential threats to the validity of a causal interpretation of the experimental treatment effects stemming from different study participation and differential reporting of outcomes across treatment arms. Finally, we re-consider the famous RAND estimate that the elasticity of medical spending with respect to its out-of-pocket price is −0.2, emphasizing the challenges associated with summarizing the experimental treatment effects from non-linear health insurance contracts using a single price elasticity. PMID:24610973

  1. Universal health insurance in India: ensuring equity, efficiency, and quality.

    PubMed

    Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

    2012-07-01

    Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India's workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete. PMID:23112438

  2. Universal Health Insurance in India: Ensuring Equity, Efficiency, and Quality

    PubMed Central

    Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

    2012-01-01

    Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India's workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete. PMID:23112438

  3. Active and retired public employees' health insurance: potential data sources.

    PubMed

    Morrill, Melinda Sandler

    2014-12-01

    Employer-provided health insurance for public sector workers is a significant public policy issue. Underfunding and the growing costs of benefits may hinder the fiscal solvency of state and local governments. Findings from the private sector may not be applicable because many public sector workers are covered by union contracts or salary schedules and often benefit modifications require changes in legislation. Research has been limited by the difficulty in obtaining sufficiently large and representative data on public sector employees. This article highlights data sources researchers might utilize to investigate topics concerning health insurance for active and retired public sector employees. PMID:25479894

  4. The transfer of a health insurance/managed care business.

    PubMed

    Gavin, John N; Goodman, George; Goroff, David B

    2007-01-01

    The owners of a health insurance/managed care business may want to sell that business for a variety of reasons. Health care provider systems may want to exit that business due to operating losses, difficulty in complying with regulations, the inherent conflict in operating that business as part of a provider system, or the desire to focus on being a health care provider. Health insurers/HMOs may want to sell all or a portion of their business due to operating losses, difficulty in servicing a particular market, or a desire to focus on other markets. No matter what reason prompts a seller to undertake a sale, a sale of health insurance/managed care business can be a complicated transaction involving a multitude of issues. This article will focus first on the ways in which such a sale may be structured. The article will then discuss some transactional issues that may arise in the negotiations for the sale of a health insurance/managed care business. The article will then focus on some particular legal issues that arise in each sale-e.g., antitrust, HIPAA, regulatory approvals, and charitable issues. Finally, this article will provide an overview of tax structuring considerations.

  5. 76 FR 46621 - Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-03

    ... Services, Notice of Proposed Rulemaking on Student Health Insurance Coverage (76 FR 7767, February 22, 2011...-AQ07 Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under... group health plans and health insurance coverage in the group and individual markets under provisions...

  6. 75 FR 37242 - Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-28

    ... Revenue Service 26 CFR Part 54 RIN 1545-BJ57 Requirements for Group Health Plans and Health Insurance... temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The text of those temporary regulations also serves as the...

  7. Choosing your health insurance package: a method for measuring the public's preferences for changes in the national health insurance plan.

    PubMed

    Victoor, Aafke; Hansen, Johan; van den Akker-van Marle, M Elske; van den Berg, Bernard; van den Hout, Wilbert B; de Jong, Judith D

    2014-08-01

    With rising healthcare expenditure and limited budgets available, countries are having to make choices about the content of health insurance plans. The views of the general population can help determine such priorities. In this article, we investigate whether preferences of the general population regarding the content of health insurance plans could be measured with the help of a stated preference method: the Basket Method (BM). In this method, people use an online tool to include or exclude healthcare interventions from their hypothetical insurance package; this then affects their monthly premium. The study was conducted in the Netherlands. In total, 1007 members of two panels managed by the NIVEL filled out an online questionnaire that included the BM. The suitability of the BM was tested with the help of five criteria, e.g. the BM's ability to distinguish between healthcare interventions. Our results suggest that the BM is suitable for measuring preferences of the general population regarding the content of the health insurance plan, as it performs well on most criteria. Policy makers can use these preferences when deciding the content of the health insurance plan. Its contents will then be more aligned to the population's needs and preferences. PMID:24875333

  8. Choosing your health insurance package: a method for measuring the public's preferences for changes in the national health insurance plan.

    PubMed

    Victoor, Aafke; Hansen, Johan; van den Akker-van Marle, M Elske; van den Berg, Bernard; van den Hout, Wilbert B; de Jong, Judith D

    2014-08-01

    With rising healthcare expenditure and limited budgets available, countries are having to make choices about the content of health insurance plans. The views of the general population can help determine such priorities. In this article, we investigate whether preferences of the general population regarding the content of health insurance plans could be measured with the help of a stated preference method: the Basket Method (BM). In this method, people use an online tool to include or exclude healthcare interventions from their hypothetical insurance package; this then affects their monthly premium. The study was conducted in the Netherlands. In total, 1007 members of two panels managed by the NIVEL filled out an online questionnaire that included the BM. The suitability of the BM was tested with the help of five criteria, e.g. the BM's ability to distinguish between healthcare interventions. Our results suggest that the BM is suitable for measuring preferences of the general population regarding the content of the health insurance plan, as it performs well on most criteria. Policy makers can use these preferences when deciding the content of the health insurance plan. Its contents will then be more aligned to the population's needs and preferences.

  9. Mexican immigrants' attitudes and interest in health insurance: a qualitative descriptive study.

    PubMed

    Ziemer, Carolyn M; Becker-Dreps, Sylvia; Pathman, Donald E; Mihas, Paul; Frasier, Pamela; Colindres, Melida; Butterworth, Milton; Robinson, Scott S

    2014-08-01

    Mexican immigrants to the U.S. are nearly three times more likely to be without health insurance than non-Hispanic native citizens. To inform strategies to increase the number of insured within this population, we elicited immigrants' understanding of health insurance and preferences for coverage. Nine focus groups with Mexican immigrants were conducted across the State of North Carolina. Qualitative, descriptive methods were used to assess people's understanding of health insurance, identify their perceived need for health insurance, describe perceived barriers to obtaining coverage, and prioritize the components of insurance that immigrants value most. Individuals have a basic understanding of health insurance and perceive it as necessary. Participants most valued insurance that would cover emergencies, make care affordable, and protect family members. Barriers to obtaining insurance included cost, concerns about immigration status discovery, and communication issues. Strategies that address immigrants' preferences for and barriers to insurance should be considered.

  10. Healthy, wealthy and insured? The role of self-assessed health in the demand for private health insurance.

    PubMed

    Doiron, Denise; Jones, Glenn; Savage, Elizabeth

    2008-03-01

    Both adverse selection and moral hazard models predict a positive relationship between risk and insurance; yet the most common finding in empirical studies of insurance is that of a negative correlation. In this paper, we investigate the relationship between ex ante risk and private health insurance using Australian data. The institutional features of the Australian system make the effects of asymmetric information more readily identifiable than in most other countries. We find a strong positive association between self-assessed health and private health cover. By applying the Lokshin and Ravallion (J. Econ. Behav. Organ 2005; 56:141-172) technique we identify the factors responsible for this result and recover the conventional negative relationship predicted by adverse selection when using more objective indicators of health. Our results also provide support for the hypothesis that self-assessed health captures individual traits not necessarily related to risk of health expenditures, in particular, attitudes towards risk. Specifically, we find that those persons who engage in risk-taking behaviours are simultaneously less likely to be in good health and less likely to buy insurance. PMID:17623485

  11. Healthy, wealthy and insured? The role of self-assessed health in the demand for private health insurance.

    PubMed

    Doiron, Denise; Jones, Glenn; Savage, Elizabeth

    2008-03-01

    Both adverse selection and moral hazard models predict a positive relationship between risk and insurance; yet the most common finding in empirical studies of insurance is that of a negative correlation. In this paper, we investigate the relationship between ex ante risk and private health insurance using Australian data. The institutional features of the Australian system make the effects of asymmetric information more readily identifiable than in most other countries. We find a strong positive association between self-assessed health and private health cover. By applying the Lokshin and Ravallion (J. Econ. Behav. Organ 2005; 56:141-172) technique we identify the factors responsible for this result and recover the conventional negative relationship predicted by adverse selection when using more objective indicators of health. Our results also provide support for the hypothesis that self-assessed health captures individual traits not necessarily related to risk of health expenditures, in particular, attitudes towards risk. Specifically, we find that those persons who engage in risk-taking behaviours are simultaneously less likely to be in good health and less likely to buy insurance.

  12. Expanding insurance coverage through tax credits, consumer choice, and market enhancements: the American Medical Association proposal for health insurance reform.

    PubMed

    Palmisano, Donald J; Emmons, David W; Wozniak, Gregory D

    2004-05-12

    Recent reports showing an increase in the number of uninsured individuals in the United States have given heightened attention to increasing health insurance coverage. The American Medical Association (AMA) has proposed a system of tax credits for the purchase of individually owned health insurance and enhancements to individual and group health insurance markets as a means of expanding coverage. Individually owned insurance would enable people to maintain coverage without disruption to existing patient-physician relationships, regardless of changes in employers or in work status. The AMA's plan would empower individuals to choose their health plan and give patients and their physicians more control over health care choices. Employers could continue to offer employment-based coverage, but employees would not be limited to the health plans offered by their employer. With a tax credit large enough to make coverage affordable and the ability to choose their own coverage, consumers would dramatically transform the individual and group health insurance markets. Health insurers would respond to the demands of individual consumers and be more cautious about increasing premiums. Insurers would also tailor benefit packages and develop new forms of coverage to better match the preferences of individuals and families. The AMA supports the development of new health insurance markets through legislative and regulatory changes to foster a wider array of high-quality, affordable plans. PMID:15138246

  13. Health insurance reform: modifications to the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards. Proposed rule.

    PubMed

    2008-08-22

    This rule proposes to adopt updated versions of the standards for electronic transactions originally adopted in the regulations entitled, "Health Insurance Reform: Standards for Electronic Transactions," published in the Federal Register on August 17, 2000, which implemented some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These standards were modified in our rule entitled, "Health Insurance Reform: Modifications to Electronic Data Transaction Standards and Code Sets," published in the Federal Register on February 20, 2003. This rule also proposes the adoption of a transaction standard for Medicaid Pharmacy Subrogation. In addition, this rule proposes to adopt two standards for billing retail pharmacy supplies and professional services, and to clarify who the "senders" and "receivers" are in the descriptions of certain transactions. PMID:18958949

  14. Learning from Longitudinal Research in Criminology and the Health Sciences

    ERIC Educational Resources Information Center

    Vanderstaay, Steven L.

    2006-01-01

    This article reviews longitudinal research within criminology and the health sciences on the relationship between reading and criminal, delinquent, or antisocial behavior. Longitudinal research in criminology, medicine, and psychology examines the role of reading within a broad set of interactive processes, connecting literacy to public health via…

  15. How does retiree health insurance influence public sector employee saving?

    PubMed

    Clark, Robert L; Mitchell, Olivia S

    2014-12-01

    Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following: Most full-time public sector employees anticipate having employer-provided health insurance coverage in retirement, unlike most private sector workers.Public sector employees covered by RHI had substantially less wealth than similar private sector employees without RHI. In our data, Federal workers had about $82,000 (18%) less net wealth than private sector employees lacking RHI; state/local workers with RHI accumulated about $69,000 (or 15%) less net wealth than their uninsured private sector counterparts.After controlling on socioeconomic status and differences in pension coverage, net household wealth for Federal employees was $116,000 less than workers without RHI and the result is statistically significant; the state/local difference was not. PMID:25479891

  16. How does retiree health insurance influence public sector employee saving?

    PubMed

    Clark, Robert L; Mitchell, Olivia S

    2014-12-01

    Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following: Most full-time public sector employees anticipate having employer-provided health insurance coverage in retirement, unlike most private sector workers.Public sector employees covered by RHI had substantially less wealth than similar private sector employees without RHI. In our data, Federal workers had about $82,000 (18%) less net wealth than private sector employees lacking RHI; state/local workers with RHI accumulated about $69,000 (or 15%) less net wealth than their uninsured private sector counterparts.After controlling on socioeconomic status and differences in pension coverage, net household wealth for Federal employees was $116,000 less than workers without RHI and the result is statistically significant; the state/local difference was not.

  17. Biased selection within the social health insurance market in Colombia.

    PubMed

    Castano, Ramon; Zambrano, Andres

    2006-12-01

    Reducing the impact of insurance market failures with regulations such as community-rated premiums, standardized benefit packages and open enrolment, yield limited effect because they create room for selection bias. The Colombian social health insurance system started a market approach in 1993 expecting to improve performance of preexisting monopolistic insurance funds by exposing them to competition by new entrants. This paper tests the hypothesis that market failures would lead to biased selection favoring new entrants. Two household surveys are analyzed using Self-Reported Health Status and the presence of chronic conditions as prospective indicators of individual risk. Biased selection is found to take place, leading to adverse selection among incumbents, and favorable selection among new entrants. This pattern is absent in 1997 but is evident in 2003. Given that the two incumbents analyzed are public organizations, the fiscal implications of the findings in terms of government bailouts, are analyzed. PMID:16516333

  18. 75 FR 63480 - Medicaid Program: Implementation of Section 614 of the Children's Health Insurance Program...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-15

    ... HUMAN SERVICES Medicaid Program: Implementation of Section 614 of the Children's Health Insurance... Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3. Section 614... Security Act and for child health assistance expenditures under the Children's Health Insurance...

  19. THE OREGON HEALTH INSURANCE EXPERIMENT: EVIDENCE FROM THE FIRST YEAR*

    PubMed Central

    Finkelstein, Amy; Taubman, Sarah; Wright, Bill; Bernstein, Mira; Gruber, Jonathan; Newhouse, Joseph P.; Allen, Heidi; Baicker, Katherine

    2012-01-01

    In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides an opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group. PMID:23293397

  20. The demand for health with uncertainty and insurance.

    PubMed

    Liljas, B

    1998-04-01

    This paper develops Michael Grossman's demand-for-health model by letting the depreciation rate depend upon the level of health, by letting the incidence and size of illness be uncertain and by investigating how the individual's demand for health would be affected by the introduction of insurance. Beside the more theoretical results, there are also some results with important policy implications. When formulating the hypothetical scenario in willingness to pay (WTP) studies it is important whether the individual believes that the level of health is uncertain or not. The existence of insurance could also affect the stated WTP amount. Taking this into account could therefore explain some of the differences in the WTP for seemingly identical health care programs in different countries or different areas in the same country. PMID:10180913

  1. How and why the health insurance system will collapse.

    PubMed

    Taylor, Humphrey

    2002-01-01

    The advocates of defined-contribution health plans extol the virtues of consumer-driven health care, consumer choice, and empowered consumers as solutions to the problems--particularly the rapidly growing costs--of employer-sponsored health benefits. This paper argues that the widespread use of defined-contribution plans, with more consumer choice and more knowledgeable consumers, will lead to the erosion of the social contract on which health insurance must be based, with healthier employees subsidizing the care of older and sicker ones, and a death spiral of adverse selection. If unchecked by government intervention, these trends will lead to the collapse of employer-sponsored health insurance. PMID:12442855

  2. The demand for health with uncertainty and insurance.

    PubMed

    Liljas, B

    1998-04-01

    This paper develops Michael Grossman's demand-for-health model by letting the depreciation rate depend upon the level of health, by letting the incidence and size of illness be uncertain and by investigating how the individual's demand for health would be affected by the introduction of insurance. Beside the more theoretical results, there are also some results with important policy implications. When formulating the hypothetical scenario in willingness to pay (WTP) studies it is important whether the individual believes that the level of health is uncertain or not. The existence of insurance could also affect the stated WTP amount. Taking this into account could therefore explain some of the differences in the WTP for seemingly identical health care programs in different countries or different areas in the same country.

  3. Federal regulation comes to private health care financing: the group health insurance provisions of the Health Insurance Portability and Accountability Act of 1996.

    PubMed

    Rovner, J A

    1998-01-01

    Attorney Rovner presents a very detailed accounting of the impacts of the Health Insurance Portability and Accountability Act as it relates to group health insurance including provisions that concern pre-existing conditions, special enrollment rights, premium discrimination, maternity lengths of stay, parity for mental health benefits and small groups coverage. The article concludes with a discussion of the federalism question as it relates to regulation of private market health financing.

  4. National health insurance policy in Nepal: challenges for implementation.

    PubMed

    Mishra, Shiva Raj; Khanal, Pratik; Karki, Deepak Kumar; Kallestrup, Per; Enemark, Ulrika

    2015-01-01

    The health system in Nepal is characterized by a wide network of health facilities and community workers and volunteers. Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. But the reality is a far cry. Only 61.8% of the Nepalese households have access to health facilities within 30 min, with significant urban (85.9%) and rural (59%) discrepancy. Addressing barriers to health services needs urgent interventions at the population level. Recently (February 2015), the Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme (SHS) after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Mechanisms should be built for monitoring unfair pricing and unaffordable copayments, and an overall benefit package be crafted to include coverage of major health services including non-communicable diseases. Regulations should include such issues as accreditation mechanisms for private providers. Health system strengthening should move along with the roll-out of SHS. Improving the efficiency of hospital, motivating the health workers, and using appropriate technology can improve the quality of health services. Also, as currently a constitution drafting is being finalized, careful planning and deliberation is necessary about what insurance structure may suit the proposed future federal structure in Nepal. PMID:26300556

  5. National health insurance policy in Nepal: challenges for implementation.

    PubMed

    Mishra, Shiva Raj; Khanal, Pratik; Karki, Deepak Kumar; Kallestrup, Per; Enemark, Ulrika

    2015-01-01

    The health system in Nepal is characterized by a wide network of health facilities and community workers and volunteers. Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. But the reality is a far cry. Only 61.8% of the Nepalese households have access to health facilities within 30 min, with significant urban (85.9%) and rural (59%) discrepancy. Addressing barriers to health services needs urgent interventions at the population level. Recently (February 2015), the Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme (SHS) after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Mechanisms should be built for monitoring unfair pricing and unaffordable copayments, and an overall benefit package be crafted to include coverage of major health services including non-communicable diseases. Regulations should include such issues as accreditation mechanisms for private providers. Health system strengthening should move along with the roll-out of SHS. Improving the efficiency of hospital, motivating the health workers, and using appropriate technology can improve the quality of health services. Also, as currently a constitution drafting is being finalized, careful planning and deliberation is necessary about what insurance structure may suit the proposed future federal structure in Nepal.

  6. 76 FR 7767 - Student Health Insurance Coverage

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... protections) (75 FR 37188 (June 28, 2010)), and section 2713 (regarding preventive health services) (75 FR..., 2010, implemented rules for preventive health services (75 FR 41726). Concerns have been raised as to... health care professional (75 FR 37188). Concerns have been expressed by stakeholders...

  7. Determinants of health insurance ownership among South African women

    PubMed Central

    Kirigia, Joses M; Sambo, Luis G; Nganda, Benjamin; Mwabu, Germano M; Chatora, Rufaro; Mwase, Takondwa

    2005-01-01

    Background Studies conducted in developed countries using economic models show that individual- and household- level variables are important determinants of health insurance ownership. There is however a dearth of such studies in sub-Saharan Africa. The objective of this study was to examine the relationship between health insurance ownership and the demographic, economic and educational characteristics of South African women. Methods The analysis was based on data from a cross-sectional national household sample derived from the South African Health Inequalities Survey (SANHIS). The study subjects consisted of 3,489 women, aged between 16 and 64 years. It was a non-interventional, qualitative response econometric study. The outcome measure was the probability of a respondent's ownership of a health insurance policy. Results The χ2 test for goodness of fit indicated satisfactory prediction of the estimated logit model. The coefficients of the covariates for area of residence, income, education, environment rating, age, smoking and marital status were positive, and all statistically significant at p ≤ 0.05. Women who had standard 10 education and above (secondary), high incomes and lived in affluent provinces and permanent accommodations, had a higher likelihood of being insured. Conclusion Poverty reduction programmes aimed at increasing women's incomes in poor provinces; improving living environment (e.g. potable water supplies, sanitation, electricity and housing) for women in urban informal settlements; enhancing women's access to education; reducing unemployment among women; and increasing effective coverage of family planning services, will empower South African women to reach a higher standard of living and in doing so increase their economic access to health insurance policies and the associated health services. PMID:15733326

  8. Is employer-based health insurance a barrier to entrepreneurship?

    PubMed

    Fairlie, Robert W; Kapur, Kanika; Gates, Susan

    2011-01-01

    The focus on employer-provided health insurance in the United States may restrict business creation. We address the limited research on the topic of "entrepreneurship lock" by using recent panel data from matched Current Population Surveys. We use difference-in-difference models to estimate the interaction between having a spouse with employer-based health insurance and potential demand for health care. We find evidence of a larger negative effect of health insurance demand on business creation for those without spousal coverage than for those with spousal coverage. We also take a new approach in the literature to examine the question of whether employer-based health insurance discourages business creation by exploiting the discontinuity created at age 65 through the qualification for Medicare. Using a novel procedure of identifying age in months from matched monthly CPS data, we compare the probability of business ownership among male workers in the months just before turning age 65 and in the months just after turning age 65. We find that business ownership rates increase from just under age 65 to just over age 65, whereas we find no change in business ownership rates from just before to just after for other ages 55-75. We also do not find evidence from the previous literature and additional estimates that other confounding factors such as retirement, partial retirement, social security and pension eligibility are responsible for the increase in business ownership in the month individuals turn 65. Our estimates provide some evidence that "entrepreneurship lock" exists, which raises concerns that the bundling of health insurance and employment may create an inefficient level of business creation. PMID:20952079

  9. Is employer-based health insurance a barrier to entrepreneurship?

    PubMed

    Fairlie, Robert W; Kapur, Kanika; Gates, Susan

    2011-01-01

    The focus on employer-provided health insurance in the United States may restrict business creation. We address the limited research on the topic of "entrepreneurship lock" by using recent panel data from matched Current Population Surveys. We use difference-in-difference models to estimate the interaction between having a spouse with employer-based health insurance and potential demand for health care. We find evidence of a larger negative effect of health insurance demand on business creation for those without spousal coverage than for those with spousal coverage. We also take a new approach in the literature to examine the question of whether employer-based health insurance discourages business creation by exploiting the discontinuity created at age 65 through the qualification for Medicare. Using a novel procedure of identifying age in months from matched monthly CPS data, we compare the probability of business ownership among male workers in the months just before turning age 65 and in the months just after turning age 65. We find that business ownership rates increase from just under age 65 to just over age 65, whereas we find no change in business ownership rates from just before to just after for other ages 55-75. We also do not find evidence from the previous literature and additional estimates that other confounding factors such as retirement, partial retirement, social security and pension eligibility are responsible for the increase in business ownership in the month individuals turn 65. Our estimates provide some evidence that "entrepreneurship lock" exists, which raises concerns that the bundling of health insurance and employment may create an inefficient level of business creation.

  10. Risk equalisation and voluntary health insurance: The South Africa experience.

    PubMed

    McLeod, Heather; Grobler, Pieter

    2010-11-01

    South Africa intends implementing major reforms in the financing of healthcare. Free market reforms in private health insurance in the late 1980s have been reversed by the new democratic government since 1994 with the re-introduction of open enrolment, community rating and minimum benefits. A system of national health insurance with income cross-subsidies, risk-adjusted payments and mandatory membership has been envisaged in policy papers since 1994. Subsequent work has seen the design of a Risk Equalisation Fund intended to operate between competing private health insurance funds. The paper outlines the South African health system and describes the risk equalisation formula that has been developed. The risk factors are age, gender, maternity events, numbers with certain chronic diseases and numbers with multiple chronic diseases. The Risk Equalisation Fund has been operating in shadow mode since 2005 with data being collected but no money changing hands. The South African experience of risk equalisation is of wider interest as it demonstrates an attempt to introduce more solidarity into a small but highly competitive private insurance market. The measures taken to combat over-reporting of chronic disease should be useful for countries or funders considering adding chronic disease to their risk equalisation formulae. PMID:20619476

  11. 78 FR 7264 - Health Insurance Premium Tax Credit

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-01

    ...-131491-10) was published in the Federal Register (76 FR 50931). On May 23, 2012, final regulations (TD 9590) were published in the Federal Register (77 FR 30377). The final regulations reserved a rule (Sec... Internal Revenue Service 26 CFR Part 1 RIN 1545-BL49 Health Insurance Premium Tax Credit AGENCY:...

  12. 78 FR 17612 - Health Insurance Providers Fee; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-22

    ..., 2013 (78 FR 14034). The proposed regulations provide guidance on the annual fee imposed on covered...-118315-12), that was the subject of FR Doc. 2013-04836, is corrected as follows: Sec. 57.1 On page 14042... Internal Revenue Service 26 CFR Part 57 RIN 1545-BL20 Health Insurance Providers Fee; Correction...

  13. 77 FR 41270 - Health Insurance Premium Tax Credit

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 1 and 602 RIN 1545-BJ82 Health Insurance Premium Tax Credit Correction In rule document 2012-12421 appearing on pages 30377-30400 in the issue of Wednesday, May 23,...

  14. A Self-Insured Health Program: From Crisis to Opportunity

    ERIC Educational Resources Information Center

    Steffes, Gary D.

    2008-01-01

    Moberly Area Community College faced a crisis in healthcare coverage that eventually lead to enhanced benefits, greater control, plan stability, and increased flexibility through a self-insured program. Presented here is how Moberly Area Community College overcame the health care coverage crisis and how other institutions can benefit from the…

  15. 75 FR 48815 - Medicaid Program and Children's Health Insurance Program (CHIP); Revisions to the Medicaid...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-11

    ... Medicaid Program and Children's Health Insurance Program (CHIP); Revisions to the Medicaid Eligibility... Program and Children's Health Insurance Program (CHIP); Revisions to the Medicaid Eligibility Quality...), HHS. ACTION: Final rule. SUMMARY: This final rule implements provisions from the Children's...

  16. Buying best value health care: Evolution of purchasing among Australian private health insurers

    PubMed Central

    Willcox, Sharon

    2005-01-01

    Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers representing all Australian private health insurers. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow. Insurers cite multiple reasons including poor understanding of private hospital costs, unfamiliarity with DRGs, resistance from the medical profession and concerns about premature discharge. Innovation in payment models has been limited, although some insurers are considering introduction of volume-outcome purchasing and pay for performance incentives. Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing. PMID:15801982

  17. Buying best value health care: Evolution of purchasing among Australian private health insurers.

    PubMed

    Willcox, Sharon

    2005-03-31

    Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers representing all Australian private health insurers. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow. Insurers cite multiple reasons including poor understanding of private hospital costs, unfamiliarity with DRGs, resistance from the medical profession and concerns about premature discharge. Innovation in payment models has been limited, although some insurers are considering introduction of volume-outcome purchasing and pay for performance incentives. Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing.

  18. Consumer choice in Dutch health insurance after reform.

    PubMed

    Maarse, Hans; Meulen, Ruud Ter

    2006-03-01

    This article investigates the scope and effects of enhanced consumer choice in health insurance that is presented as a cornerstone of the new health insurance legislation in the Netherlands that will come into effect in 2006. The choice for choice marks the current libertarian trend in Dutch health care policymaking. One of our conclusions is that the scope of enhanced choice should not be overstated due to many legal and non-legal restrictions to it. The consumer choice advocates have great expectations of the impact of enhanced choice. A critical analysis of its impact demonstrates that these expectations may not become true and that enhanced consumer choice should not be perceived as the 'magic bullet' for many problems in health care. PMID:17137018

  19. Health insurance theory: the case of the missing welfare gain.

    PubMed

    Nyman, John A

    2008-11-01

    An important source of value is missing from the conventional welfare analysis of moral hazard, namely, the effect of income transfers (from those who purchase insurance and remain healthy to those who become ill) on purchases of medical care. Income transfers are contained within the price reduction that is associated with standard health insurance. However, in contrast to the income effects contained within an exogenous price decrease, these income transfers act to shift out the demand for medical care. As a result, the consumer's willingness to pay for medical care increases and the resulting additional consumption is welfare increasing.

  20. State Health Insurance Assistance Program (SHIP). Interim final rule.

    PubMed

    2016-02-01

    This rule implements a provision enacted by the Consolidated Appropriations Act of 2014 and reflects the transfer of the State Health Insurance Assistance Program (SHIP) from the Centers for Medicare & Medicaid Services (CMS), in the Department of Health and Human Services (HHS) to the Administration for Community Living (ACL) in HHS. The previous regulations were issued by CMS under the authority granted by the Omnibus Budget Reconciliation Act of 1990 (OBRA `90), Section 4360.

  1. Employer health insurance and local labor market conditions.

    PubMed

    Marquis, M S; Long, S H

    2001-01-01

    Theory suggests that an employer's decisions about the amount of health insurance included in the compensation package may be influenced by the practices of other employers in the market. We test the role of local market conditions on decisions of small employers to offer insurance and their dollar contribution to premiums using data from two large national surveys of employers. These employers are more likely to offer insurance and to make greater contributions in communities with tighter labor markets, less concentrated labor purchasers, greater union penetration, and a greater share of workers in big business and a small share in regulated industries. However, our data do not support the notion that marginal tax rates affect employers' offer decision or contributions.

  2. Voluntary private health insurance among the over fifties in Europe◊

    PubMed Central

    Paccagnella, Omar; Rebba, Vincenzo; Weber, Guglielmo

    2012-01-01

    Using data from SHARE (Survey of Health, Ageing and Retirement in Europe), we investigate the determinants of voluntary private health insurance (VPHI) among the over fifties in eleven European countries, and their effects on health care spending. Firstly, we find that the main determinants of VPHI are different in each country, reflecting differences in the underlying health care systems, but in most countries education levels and cognitive abilities have a strong positive effect on holding a VPHI policy. We also analyse the effect of holding a voluntary additional health insurance policy on out-of-pocket (OOP) health care spending. We adopt a simultaneous-equations approach to control for self-selection into VPHI policy holding and find that only in the Netherlands VPHI policyholders have lower OOP spending than the rest of the population while in some countries (Italy, Spain, Denmark and Austria) they spend significantly more. This could be due to increased utilisation but also to cost-sharing measures adopted by the insurers in order both to counter the effects of moral hazard and to keep adverse selection under control. PMID:22315160

  3. Healthy Ties: The Grandparent's and Other Relative Caregiver's Guide to Health Insurance for Children.

    ERIC Educational Resources Information Center

    Children's Defense Fund, Washington, DC.

    Noting that many grandparents and other family child caregivers are concerned because they lack health insurance or because their health insurance will not cover the children under their care, this brochure presents information on two national programs providing free and low-cost health insurance to eligible children: Medicaid and the Children's…

  4. 78 FR 52719 - Tax Credit for Employee Health Insurance Expenses of Small Employers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-26

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BL55 Tax Credit for Employee Health Insurance Expenses of... certain small employers that offer health insurance coverage to their employees under section 45R of the... ``Affordable Care Act''). I. Section 45R Section 45R(a) provides for a health insurance tax credit in the...

  5. 75 FR 6673 - Expert Meeting on Measurement Criteria for Children's Health Insurance Program; Reauthorization...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-10

    ... Children's Health Insurance Program; Reauthorization Act Pediatric Quality Measures AGENCY: Agency for... (PQMP) under Section 1139A(b) of the Social Security Act as enacted in the Children's Health Insurance... INFORMATION: I. Purpose In early 2009, CHIPRA (Pub. L. 111-3) reauthorized the Child Health Insurance...

  6. 78 FR 54996 - Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-09

    ... on Health Insurance Coverage Offered Under Employer-Sponsored Plans AGENCY: Internal Revenue Service... credit to help individuals and families afford health insurance coverage purchased through an Affordable... health insurance coverage offered by an employer to the employee that is (1) a governmental plan,...

  7. 77 FR 28788 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Under the Patient Protection and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-16

    ... HUMAN SERVICES 45 CFR Part 158 Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Under the... Federal Register on December 1, 2010, entitled ``Health Insurance Issuers Implementing Medical Loss Ratio... published in the Federal Register on December 30, 2010, entitled ``Health Insurance Issuers...

  8. Students Left behind: The Limitations of University-Based Health Insurance for Students with Mental Illnesses

    ERIC Educational Resources Information Center

    McIntosh, Belinda J.; Compton, Michael T.; Druss, Benjamin G.

    2012-01-01

    A growing trend in college and university health care is the requirement that students demonstrate proof of health insurance prior to enrollment. An increasing number of schools are contracting with insurance companies to provide students with school-based options for health insurance. Although this is advantageous to students in some ways, tying…

  9. 75 FR 82277 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-30

    ... HUMAN SERVICES 45 CFR Part 158 RIN 0950-AA06 Health Insurance Issuers Implementing Medical Loss Ratio... ``Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient Protection... Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements accurately states...

  10. 78 FR 46339 - Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of Temporary Moratoria...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-31

    ... Children's Health Insurance Program (CHIP). Section 6401(a) of the Affordable Care Act added a new section... titled, ``Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements... and the Children's Health Insurance Program (CHIP) The February 2, 2011 final rule also...

  11. 45 CFR 158.321 - Information regarding the State's individual health insurance market.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... individual health insurance market. (a) State MLR standard. The State must describe its current MLR standard... withdrawals from the State's individual health insurance market. Such requirements include, but are not... individual market health insurance products in the State; (ii) Reported MLR pursuant to State law......

  12. Multi-stage methodology to detect health insurance claim fraud.

    PubMed

    Johnson, Marina Evrim; Nagarur, Nagen

    2016-09-01

    Healthcare costs in the US, as well as in other countries, increase rapidly due to demographic, economic, social, and legal changes. This increase in healthcare costs impacts both government and private health insurance systems. Fraudulent behaviors of healthcare providers and patients have become a serious burden to insurance systems by bringing unnecessary costs. Insurance companies thus develop methods to identify fraud. This paper proposes a new multistage methodology for insurance companies to detect fraud committed by providers and patients. The first three stages aim at detecting abnormalities among providers, services, and claim amounts. Stage four then integrates the information obtained in the previous three stages into an overall risk measure. Subsequently, a decision tree based method in stage five computes risk threshold values. The final decision stating whether the claim is fraudulent is made by comparing the risk value obtained in stage four with the risk threshold value from stage five. The research methodology performs well on real-world insurance data. PMID:25600704

  13. Employer Health Insurance Offerings and Employee Enrollment Decisions

    PubMed Central

    Polsky, Daniel; Stein, Rebecca; Nicholson, Sean; Bundorf, M Kate

    2005-01-01

    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. PMID:16174133

  14. Optimal health insurance for multiple goods and time periods.

    PubMed

    Ellis, Randall P; Jiang, Shenyi; Manning, Willard G

    2015-05-01

    We examine the efficiency-based arguments for second-best optimal health insurance with multiple treatment goods and multiple time periods. Correlated shocks across health care goods and over time interact with complementarity and substitutability to affect optimal cost sharing. Health care goods that are substitutes or have positively correlated demand shocks should have lower optimal patient cost sharing. Positive serial correlations of demand shocks and uncompensated losses that are positively correlated with covered health services also reduce optimal cost sharing. Our results rationalize covering pharmaceuticals and outpatient spending more fully than is implied by static, one good, or one period models.

  15. Health Seeking Behavior in Karnataka: Does Micro-Health Insurance Matter?

    PubMed Central

    Savitha, S; Kiran, KB

    2013-01-01

    Background: Health seeking behaviour in the event of illness is influenced by the availability of good health care facilities and health care financing mechanisms. Micro health insurance not only promotes formal health care utilization at private providers but also reduces the cost of care by providing the insurance coverage. Objectives: This paper explores the impact of Sampoorna Suraksha Programme, a micro health insurance scheme on the health seeking behaviour of households during illness in Karnataka, India. Materials and Methods: The study was conducted in three randomly selected districts in Karnataka, India in the first half of the year 2011. The hypothesis was tested using binary logistic regression analysis on the data collected from randomly selected 1146 households consisting of 4961 individuals. Results: Insured individuals were seeking care at private hospitals than public hospitals due to the reduction in financial barrier. Moreover, equity in health seeking behaviour among insured individuals was observed. Conclusion: Our finding does represent a desirable result for health policy makers and micro finance institutions to advocate for the inclusion of health insurance in their portfolio, at least from the HSB perspective. PMID:24302822

  16. Consumers, health insurance and dominated choices.

    PubMed

    Sinaiko, Anna D; Hirth, Richard A

    2011-03-01

    We analyze employee health plan choices when the choice set offered by their employer includes a dominated plan. During our study period, one-third of workers were enrolled in the dominated plan. Some may have selected the plan before it was dominated and then failed to switch out of it. However, a substantial number actively chose the dominated plan when they had an unambiguously better choice. These results suggest limitations in the ability of health reform based solely on consumer choice to achieve efficient outcomes and that implementation of health reform should anticipate, monitor and account for this consumer behavior. PMID:21300414

  17. Health Insurance, Medical Care, and Health Outcomes: A Model of Elderly Health Dynamics

    ERIC Educational Resources Information Center

    Yang, Zhou; Gilleskie, Donna B.; Norton, Edward C.

    2009-01-01

    Prescription drug coverage creates a change in medical care consumption, beyond standard moral hazard, arising both from the differential cost-sharing and the relative effectiveness of different types of care. We model the dynamic supplemental health insurance decisions of Medicare beneficiaries, their medical care demand, and subsequent health…

  18. Health care and insurance loss of working AFDC recipients.

    PubMed

    Moscovice, I; Davidson, G

    1987-05-01

    The federal Omnibus Budget Reconciliation Act of 1981 (OBRA) produced substantial changes in the Aid to Families With Dependent Children (AFDC) program. The main effect of the changes has been the denial of assistance and hence Medicaid coverage to many AFDC recipients with jobs. Our analysis of the health care and insurance loss of working AFDC recipients in Hennepin County, Minnesota, found that the vast majority (87%) of families that were terminated from AFDC due to OBRA were able to remain off welfare and the majority (70% adults, 60% children) had private health insurance coverage 2 years later. These results highlight the dilemma facing state policymakers who want to develop successful programs to meet the health needs of the working poor, yet at the same time must cope with tight, short-term fiscal constraints. PMID:3121950

  19. The price of choice: private health insurance in Australia.

    PubMed

    Stoelwinder, Johannes U

    2002-01-01

    Private Health Insurance (PHI) is an integral part of the financing of the Australian health care system. PHI is popular and has strong political support because it is perceived to give choice of access and responsiveness. However, in the past increasing premiums have led to a progressive decline in membership. A package of reforms by the Commonwealth Government in support of the private health insurance has reinvigorated the industry over the last three years. Some strategies for achieving a sustainable PHI industry are described. The key challenge is to control claims cost to maintain affordable premiums. Many techniques to do this compromise choice and challenge the very rationale for purchasing the product. Funds and providers will have to establish a new level of relationship to meet this challenge.

  20. Impact of Health Insurance on Health Care Treatment and Cost in Vietnam: A Health Capability Approach to Financial Protection

    PubMed Central

    Nguyen, Kim Thuy; Khuat, Oanh Thi Hai; Pham, Duc Cuong; Khuat, Giang Thi Hong

    2012-01-01

    We applied an alternative conceptual framework for analyzing health insurance and financial protection grounded in the health capability paradigm. Through an original survey of 706 households in Dai Dong, Vietnam, we examined the impact of Vietnamese health insurance schemes on inpatient and outpatient health care access, costs, and health outcomes using bivariate and multivariable regression analyses. Insured respondents had lower outpatient and inpatient treatment costs and longer hospital stays but fewer days of missed work or school than the uninsured. Insurance reform reduced household vulnerability to high health care costs through direct reduction of medical costs and indirect reduction of income lost to illness. However, from a normative perspective, out-of-pocket costs are still too high, and accessibility issues persist; a comprehensive insurance package and additional health system reforms are needed. PMID:22698046

  1. Tax incentives and the demand for private health insurance.

    PubMed

    Stavrunova, Olena; Yerokhin, Oleg

    2014-03-01

    We analyze the effect of an individual insurance mandate (Medicare Levy Surcharge) on the demand for private health insurance (PHI) in Australia. With administrative income tax return data, we show that the mandate has several distinct effects on taxpayers' behavior. First, despite the large tax penalty for not having PHI coverage relative to the cost of the cheapest eligible insurance policy, compliance with mandate is relatively low: the proportion of the population with PHI coverage increases by 6.5 percentage points (15.6%) at the income threshold where the tax penalty starts to apply. This effect is most pronounced for young taxpayers, while the middle aged seem to be least responsive to this specific tax incentive. Second, the discontinuous increase in the average tax rate at the income threshold created by the policy generates a strong incentive for tax avoidance which manifests itself through bunching in the taxable income distribution below the threshold. Finally, after imposing some plausible assumptions, we extrapolate the effect of the policy to other income levels and show that this policy has not had a significant impact on the overall demand for private health insurance in Australia. PMID:24513860

  2. Tax incentives and the demand for private health insurance.

    PubMed

    Stavrunova, Olena; Yerokhin, Oleg

    2014-03-01

    We analyze the effect of an individual insurance mandate (Medicare Levy Surcharge) on the demand for private health insurance (PHI) in Australia. With administrative income tax return data, we show that the mandate has several distinct effects on taxpayers' behavior. First, despite the large tax penalty for not having PHI coverage relative to the cost of the cheapest eligible insurance policy, compliance with mandate is relatively low: the proportion of the population with PHI coverage increases by 6.5 percentage points (15.6%) at the income threshold where the tax penalty starts to apply. This effect is most pronounced for young taxpayers, while the middle aged seem to be least responsive to this specific tax incentive. Second, the discontinuous increase in the average tax rate at the income threshold created by the policy generates a strong incentive for tax avoidance which manifests itself through bunching in the taxable income distribution below the threshold. Finally, after imposing some plausible assumptions, we extrapolate the effect of the policy to other income levels and show that this policy has not had a significant impact on the overall demand for private health insurance in Australia.

  3. Disability, Health Insurance Coverage, and Utilization of Acute Health Services in the United States. Disability Statistics Report 4.

    ERIC Educational Resources Information Center

    LaPlante, Mitchell P.

    This report uses data from the 1989 National Health Interview Survey to estimate health insurance coverage of children and nonelderly adults with disabilities and their utilization of physician and hospital care as a function of health insurance status. In part 1, national statistics on disability and insurance status are provided for different…

  4. First-class health: amenity wards, health insurance, and normalizing health care inequalities in Tanzania.

    PubMed

    Ellison, James

    2014-06-01

    In 2008, a government hospital in southwest Tanzania added a "first-class ward," which, unlike existing inpatient wards defined by sex, age, and ailment, would treat patients according to their wealth. A generation ago, Tanzanians viewed health care as a right of citizenship. In the 1980s and 1990s, structural adjustment programs and user fees reduced people's access to biomedical attention. Tanzania currently promotes "amenity" wards and health insurance to increase health care availability, generate revenue from patients and potential patients, and better integrate for-profit care. In this article, I examine people's discussions of these changes, drawing on ethnographic fieldwork in the 2000s and 1990s. I argue that Tanzanians criticize unequal access to care and health insurance, although the systemic structuring of inequalities is becoming normalized. People transform the language of socialism to frame individualized market-based care as mutual interdependence and moral necessity, articulating a new biomedical citizenship.

  5. Affordability of the Health Expenditures of Insured Americans Before the Affordable Care Act.

    PubMed

    Nyman, John A; Trenz, Helen M

    2016-02-01

    Central to the Affordable Care Act is the notion of affordability and the role of health insurance in making otherwise unaffordable health care affordable. We used data from the 1996 to 2008 versions of the Medical Expenditure Panel Survey to estimate the portion of overall health care expenditures by insured respondents that would otherwise have been beyond their disposable incomes and assets. We found that about one third of insured expenditures would have been unaffordable, with a much higher percentage among publicly insured individuals. This result suggests that one of the main functions of insurance is to cover expenses that insured individuals would not otherwise be able to afford. PMID:26691116

  6. Affordability of the Health Expenditures of Insured Americans Before the Affordable Care Act.

    PubMed

    Nyman, John A; Trenz, Helen M

    2016-02-01

    Central to the Affordable Care Act is the notion of affordability and the role of health insurance in making otherwise unaffordable health care affordable. We used data from the 1996 to 2008 versions of the Medical Expenditure Panel Survey to estimate the portion of overall health care expenditures by insured respondents that would otherwise have been beyond their disposable incomes and assets. We found that about one third of insured expenditures would have been unaffordable, with a much higher percentage among publicly insured individuals. This result suggests that one of the main functions of insurance is to cover expenses that insured individuals would not otherwise be able to afford.

  7. Acceptance of selective contracting: the role of trust in the health insurer

    PubMed Central

    2013-01-01

    Background In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees’ trust in the health insurer on their acceptance of selective contracting. Methods An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Results Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. Conclusion This study provides insight into factors that influence people’s acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop. PMID:24083663

  8. THE MEXICAN POPULAR HEALTH INSURANCE: MYTHS AND REALITIES.

    PubMed

    Laurell, Asa Cristina

    2015-01-01

    Universal health coverage (UHC) is today a dominant issue in the global health policy debate. The hegemonic proposal is UHC that recommends universal health insurance with an explicit service package and a payer-provider split with public and private managers. The Mexican Popular Health Insurance (PHI) is widely presented as a UHC success case to be followed. This article reviews critically its achievements after a decade of implementation. It shows that universal coverage has not been reached and about 30 million Mexicans are uninsured. Access to needed services is quite limited for PHI affiliates given the restrictions of the service package, which excludes common high-cost diseases, and the lack of health facilities. Public health expenditure has increased 0.36 percent of Gross National Product, favoring the PHI at the expense of public social security. These funds are, however, lower than legal specifications and the service package under-priced. Private health expenditure as a percentage of total expenditure has not varied much and PHI affiliates' out-of-pocket payment is larger than the whole PHI budget. There is no evidence of health impact. The Mexican health reform corresponds to neoclassic-neoliberal reorganization of society on the market principle. Although some of the PHI problems are particular to Mexico, it illustrates some of the overall flaws of the UHC model. PMID:26460450

  9. Competing health policies: insurance against universal public systems

    PubMed Central

    Laurell, Asa Ebba Cristina

    2016-01-01

    Objectives: This article analyzes the content and outcome of ongoing health reforms in Latin America: Universal Health Coverage with Health Insurance, and the Universal and Public Health Systems. It aims to compare and contrast the conceptual framework and practice of each and verify their concrete results regarding the guarantee of the right to health and access to required services. It identifies a direct relationship between the development model and the type of reform. The neoclassical-neoliberal model has succeeded in converting health into a field of privatized profits, but has failed to guarantee the right to health and access to services, which has discredited the governments. The reform of the progressive governments has succeeded in expanding access to services and ensuring the right to health, but faces difficulties and tensions related to the permanence of a powerful, private, industrial-insurance medical complex and persistence of the ideologies about medicalized 'good medicine'. Based on these findings, some strategies to strengthen unique and supportive public health systems are proposed. PMID:26959328

  10. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  11. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  12. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  13. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  14. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  15. Community Mental Health Centers and Insurance Reimbursements.

    ERIC Educational Resources Information Center

    Nissim-Sabat, Denis; And Others

    The economic solvency of Community Mental Health Centers (CMHCs) is a problem that needs immediate attention. In order to study the shift in funding sources for the 40 Community Services Boards (CSBs) which administer the 114 CMHCs in Virginia, the funding sources of CMHCs, and the fee collections of the CSBs, were examined. Data revealed that…

  16. 78 FR 71476 - Health Insurance Providers Fee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-29

    .... See 77 FR 25788 (May 1, 2012). Because the scope of stop-loss coverage that may constitute health...- references to specified Code sections. A notice of proposed rulemaking (REG-118315-12, 78 FR 14034) was... governmental plan determinations, 76 FR 69172 (November 8, 2011). Applying principles similar to...

  17. Examining the types and payments of the disabilities of the insurants in the national farmers' health insurance program in Taiwan

    PubMed Central

    2010-01-01

    Background In contrast to the considerable body of literature concerning the disabilities of the general population, little information exists pertaining to the disabilities of the farm population. Focusing on the disability issue to the insurants in the Farmers' Health Insurance (FHI) program in Taiwan, this paper examines the associations among socio-demographic characteristics, insured factors, and the introduction of the national health insurance program, as well as the types and payments of disabilities among the insurants. Methods A unique dataset containing 1,594,439 insurants in 2008 was used in this research. A logistic regression model was estimated for the likelihood of received disability payments. By focusing on the recipients, a disability payment and a disability type equation were estimated using the ordinary least squares method and a multinomial logistic model, respectively, to investigate the effects of the exogenous factors on their received payments and the likelihood of having different types of disabilities. Results Age and different job categories are significantly associated with the likelihood of receiving disability payments. Compared to those under age 45, the likelihood is higher among recipients aged 85 and above (the odds ratio is 8.04). Compared to hired workers, the odds ratios for self-employed and spouses of farm operators who were not members of farmers' associations are 0.97 and 0.85, respectively. In addition, older insurants are more likely to have eye problems; few differences in disability types are related to insured job categories. Conclusions Results indicate that older farmers are more likely to receive disability payments, but the likelihood is not much different among insurants of various job categories. Among all of the selected types of disability, a highest likelihood is found for eye disability. In addition, the introduction of the national health insurance program decreases the likelihood of receiving disability

  18. Ethical assessment of national health insurance system of Korea.

    PubMed

    Lee, Yuri; Kim, Soyoon; Kim, Ganglip

    2012-09-01

    The current adverse effects of the health insurance system in Korea are considered to be problems that arise from an insufficient reflection of the notion of respecting human rights. The ethical principles most commonly suggested and used in public health are the 4 principles suggested by Beauchamp and Childress in 1994. From the perspective of the community, these 4 principles of medical ethics can be expanded to resolve problems surrounding existing social systems from a socialistic standpoint. This article describes a flexible, easy-to-use model for incorporating the 4 medical ethics principles into the National Health Insurance System (NHIS). First, the principle of respect for autonomy involves respecting the decision-making capacities of autonomous medical consumers and providers and enabling individuals to make reasoned and informed choices. Second is the principle of good practice. The government and medical institutions should act in a way that benefits the health care consumers. The principle of prohibiting bad practice involves avoiding causing health problems. The National Health Insurance Corporation and health care providers should not harm the health care consumers. Finally, the principle of justice is concerned with distributing benefits, risks, and costs fairly-that is, the notion that patients in similar positions should be treated in a similar manner. If these problems are solved, health system quality could be better and more accessible and sustainable. The ethical assessment of the NHIS could be a trial to match the 4 medical ethics principles and the NHIS. It can be applied internationally to relevant policy makers in different settings.

  19. Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis

    PubMed Central

    2012-01-01

    Background Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables. Methods A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index. Results The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant. Conclusions Despite the adverse contextual conditions and the limitations imposed by the Colombian health

  20. The ethics of the affordability of health insurance.

    PubMed

    Saloner, Brendan; Daniels, Norman

    2011-10-01

    In this essay we argue that the concept of affordable health insurance is rooted in a social obligation to protect fair equality of opportunity. Specifically, health insurance plays a limited but significant role in protecting opportunity in two ways: it helps keep people functioning normally and it protects their financial security. Together these benefits enable household members to exercise reasonable choices about their plans of life. To achieve truly affordable coverage, society must be able to contain the overall cost of health care, and health insurance must be progressively financed, meaning that those who are best able to pay for coverage should pay the largest share. While the recently passed Patient Protection and Affordable Care Act (ACA) falls short on both of these counts, we argue that it makes important contributions toward household affordability through the use of subsidies and regulations. The main shortcoming of the ACA is an insufficient protection against burdensome cost sharing, which we illustrate using several hypothetical scenarios. We conclude with recommendations about how to make opportunity-enhancing expansions to the current coverage subsidies.

  1. The ethics of the affordability of health insurance.

    PubMed

    Saloner, Brendan; Daniels, Norman

    2011-10-01

    In this essay we argue that the concept of affordable health insurance is rooted in a social obligation to protect fair equality of opportunity. Specifically, health insurance plays a limited but significant role in protecting opportunity in two ways: it helps keep people functioning normally and it protects their financial security. Together these benefits enable household members to exercise reasonable choices about their plans of life. To achieve truly affordable coverage, society must be able to contain the overall cost of health care, and health insurance must be progressively financed, meaning that those who are best able to pay for coverage should pay the largest share. While the recently passed Patient Protection and Affordable Care Act (ACA) falls short on both of these counts, we argue that it makes important contributions toward household affordability through the use of subsidies and regulations. The main shortcoming of the ACA is an insufficient protection against burdensome cost sharing, which we illustrate using several hypothetical scenarios. We conclude with recommendations about how to make opportunity-enhancing expansions to the current coverage subsidies. PMID:22065686

  2. Distributional impact of recent changes in private health insurance policies.

    PubMed

    Walker, Agnes; Percival, Richard; Thurecht, Linc; Pearse, James

    2005-05-01

    The impacts of changes to private health insurance (PHI) policies introduced since 1999 - in particular the 30% PHI rebate and the Lifetime Health Cover - have been much debated. We present historical analyses of the impacts in terms of the proportion of Australians having hospital insurance cover under different PHI policies, by age, gender and socioeconomic status, and project these to 2010 using a new Private Health Insurance coverage model. The combined effect of the 30% rebate and Lifetime Health Cover was to increase PHI membership from just over 30% in 1998 to just under 50% by the end of 2000, due mainly to more people taking out PHI cover from among the richest 20% of the population. Among the poorest 40% the impact was minimal. Model projections suggested that, had the new PHI policies not been introduced, then the proportion of Australians with PHI would have declined to around 20% by 2010, compared with 40% if the current arrangements remained in place. Also, analysis of 2001 survey data regarding choices to use a public or a private hospital indicated that higher income groups with or without PHI were the more likely to have used a private hospital than lower income groups. Among those with PHI, older people were more likely to have used a private hospital than younger ones.

  3. Optimal quality, waits and charges in health insurance.

    PubMed

    Gravelle, Hugh; Siciliani, Luigi

    2008-05-01

    We examine the role of quality and waiting time in health insurance when there is ex post moral hazard. Quality and waiting time provide additional instruments to control demand and potentially can improve the trade-off between optimal risk bearing and optimal consumption of health care. We show that optimal quality is lower than it would be in the absence of ex post moral hazard. But it is never optimal to have a positive waiting time if the marginal cost of waiting is higher for patients with greater benefits from health care.

  4. The Children's Health Insurance Program Reauthorization Act Evaluation Findings on Children's Health Insurance Coverage in an Evolving Health Care Landscape.

    PubMed

    Harrington, Mary E

    2015-01-01

    The Children's Health Insurance Program (CHIP) Reauthorization Act (CHIPRA) reauthorized CHIP through federal fiscal year 2019 and, together with provisions in the Affordable Care Act, federal funding for the program was extended through federal fiscal year 2015. Congressional action is required or federal funding for the program will end in September 2015. This supplement to Academic Pediatrics is intended to inform discussions about CHIP's future. Most of the new research presented comes from a large evaluation of CHIP mandated by Congress in the CHIPRA. Since CHIP started in 1997, millions of lower-income children have secured health insurance coverage and needed care, reducing the financial burdens and stress on their families. States made substantial progress in simplifying enrollment and retention. When implemented optimally, Express Lane Eligibility has the potential to help cover more of the millions of eligible children who remain uninsured. Children move frequently between Medicaid and CHIP, and many experienced a gap in coverage with this transition. CHIP enrollees had good access to care. For nearly every health care access, use, care, and cost measure examined, CHIP enrollees fared better than uninsured children. Access in CHIP was similar to private coverage for most measures, but financial burdens were substantially lower and access to weekend and nighttime care was not as good. The Affordable Care Act coverage options have the potential to reduce uninsured rates among children, but complex transition issues must first be resolved to ensure families have access to affordable coverage, leading many stakeholders to recommend funding for CHIP be continued. PMID:25906953

  5. Community-based health insurance and social capital: a review

    PubMed Central

    2012-01-01

    Community-Based Health Insurance (CBHI) is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for low-income rural households who are excluded from formal insurance. CBHI is currently being provided in some rural areas in developing countries and there is ongoing research about its impact on the well-being of the poor in these areas. However, the success of CBHI revolves around the existence of social capital in the community. This has led researchers to explore the impact of CBHI on the well-being of the poor in rural areas, especially as it relates to social capital. The overall objective of this paper is to review recent developments that address the link between CBHI and social capital. Policy implications are also discussed. JEL Classification C10, I15 PMID:22828204

  6. The future of employment-based health insurance.

    PubMed

    Battistella, R; Burchfield, D

    2000-01-01

    A transformation of employment-connected health insurance from a defined benefit to defined contribution arrangement is projected based on new economic realities affecting the competitiveness of the business environment. This article discusses those new realities along with the future of employment-based health insurance. The business of American business is profits, but, to the detriment of that goal, for the past half century business has also been in the business of providing health insurance for workers. However, in light of previously unencountered pressures on profits, employers are realizing they cannot afford to continue the practice of paying for and overseeing the provision of healthcare benefits to employees amid increasing premiums, state and federal mandates, the overbearing cost of managing healthcare benefits, and the threat of loss of protection under ERISA. Yet, the political and social pressures on businesses to continue to provide health insurance are formidable, perhaps impregnable, barriers to complete withdrawal of what has come to be thought of as a "right" of employees. Companies are anxious to find alternatives to the status quo, but any feasible alternative must cost less, require less administrative oversight, and ensure that employees still maintain a measure of choice. Two possible solutions for American businesses are adoption of (1) a "medical savings account" system, or (2) a "voucher" system. Either system would result in lower costs and greater fiscal stability for both employers and employees. They would also remove much of the responsibility for healthcare decisions from employers and place it in the hands of the employees. But, perhaps the greatest contribution of either system would be the reduction in moral hazard and its inflationary effect on medical costs. PMID:11066952

  7. Adverse selection: does it preclude a competitive health insurance market?

    PubMed

    Sloan, F A

    1992-10-01

    In sum, although fixed dollar subsidies have the great virtue of ferreting out cross subsidies, society may not be satisfied with the results. The scenario described by Marquis is only one of many. People seem to want lifetime insurance offering low premiums if things go bad rather than premiums that change annually as health outcomes are realized [see, e.g., Light (1992)]. But nondiversible risk may be too great for a market in life contracts to exist.

  8. Unconstrained invoice processing in the health insurance domain

    NASA Astrophysics Data System (ADS)

    Hurst, Matthew; Barney, Dave

    2003-01-01

    We present an overview of an information extraction application in the health insurance invoice processing domain. The system is novel in that it is not constrained by the document type - it has no explicit document model or document type classification phase. The system relies on constraints derived from a domain model, constraints derived from world state, and simple models of layout, including the use of labeled fields and the proximity of related information.

  9. Re-insurance in the Swiss health insurance market: Fit, power, and balance.

    PubMed

    Schmid, Christian P R; Beck, Konstantin

    2016-07-01

    Risk equalization mechanisms mitigate insurers' incentives to practice risk selection. On the other hand, incentives to limit healthcare spending can be distorted by risk equalization, particularly when risk equalization payments depend on realized costs instead of expected costs. In addition, cost based risk equalization mechanisms may incentivize health insurers to distort the allocation of resources among different services. The incentives to practice risk selection, to limit healthcare spending, and to distort the allocation of resources can be measured by fit, power, and balance, respectively. We apply these three measures to evaluate the risk adjustment mechanism in Switzerland. Our results suggest that it performs very well in terms of power but rather poorly in terms of fit. The latter indicates that risk selection might be a severe problem. We show that re-insurance can reduce this problem while power remains on a high level. In addition, we provide evidence that the Swiss risk equalization mechanism does not lead to imbalances across different services. PMID:27157115

  10. The impact of health insurance programs for children: evidence from Vietnam.

    PubMed

    Nguyen, Cuong

    2016-12-01

    This study assesses the impact of children's health insurance programs on health care utilization and health care expenditures of children from 6 to 14 years old in Vietnam using four rounds of the Vietnam Household Living Standard Surveys from 2006 to 2012. We find a positive effect of both student and free health insurance programs on the number of health care visits. This positive impact tends to increase over time, and the impact of the free health insurance program is larger than the impact of the student health insurance program. Regarding out-of-pocket health expenditures per visit, we find a reducing effect on this outcome of the free health insurance program but not the student health insurance program. PMID:27491776

  11. The impact of health insurance programs for children: evidence from Vietnam.

    PubMed

    Nguyen, Cuong

    2016-12-01

    This study assesses the impact of children's health insurance programs on health care utilization and health care expenditures of children from 6 to 14 years old in Vietnam using four rounds of the Vietnam Household Living Standard Surveys from 2006 to 2012. We find a positive effect of both student and free health insurance programs on the number of health care visits. This positive impact tends to increase over time, and the impact of the free health insurance program is larger than the impact of the student health insurance program. Regarding out-of-pocket health expenditures per visit, we find a reducing effect on this outcome of the free health insurance program but not the student health insurance program.

  12. Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran.

    PubMed

    Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

    2016-01-01

    There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. PMID:27239868

  13. The Importance of Family-Based Insurance Expansions: New Research Findings about State Health Reforms.

    ERIC Educational Resources Information Center

    Ku, Leighton; Broaddus, Matthew

    Although a national consensus has emerged regarding the importance of extending publicly-funded health insurance coverage to low-income children under the State Children's Health Insurance Program (SCHIP) and Medicaid, substantial numbers of eligible children remain uninsured. This study examined whether extending insurance coverage to low-income…

  14. Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran.

    PubMed

    Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

    2016-01-01

    There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper.

  15. Perspectives on National Health Insurance and Rehabilitation. Emerging Issues in Rehabilitation.

    ERIC Educational Resources Information Center

    Dorken, Herbert; LaRocca, Joseph

    Major research findings are synthesized and innovations of current concern to vocational rehabilitation professionals are reported in this paper on national health insurance (NHI) and rehabilitation. Discussion covers the following topics: the concept of insurance, forms of health insurance, issues arising from hearings on NHI, perspectives of…

  16. Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran

    PubMed Central

    Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

    2016-01-01

    There are fragmentations in Iran’s health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. PMID:27239868

  17. 5 CFR 352.309 - Retirement, health benefits, and group life insurance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... life insurance. 352.309 Section 352.309 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... Organizations § 352.309 Retirement, health benefits, and group life insurance. (a) Agency action. An employee... entitled to retain coverage for retirement, health benefits, and group life insurance purposes if he or...

  18. 5 CFR 352.309 - Retirement, health benefits, and group life insurance.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... life insurance. 352.309 Section 352.309 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... Organizations § 352.309 Retirement, health benefits, and group life insurance. (a) Agency action. An employee... entitled to retain coverage for retirement, health benefits, and group life insurance purposes if he or...

  19. 34 CFR 106.39 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Prohibited § 106.39 Health and insurance benefits and services. In providing a medical, hospital, accident, or life insurance benefit, service, policy, or plan to any of its students, a recipient shall not... 34 Education 1 2010-07-01 2010-07-01 false Health and insurance benefits and services....

  20. 32 CFR 196.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Activities Prohibited § 196.440 Health and insurance benefits and services. Subject to § 196.235(d), in providing a medical, hospital, accident, or life insurance benefit, service, policy, or plan to any of its... 32 National Defense 2 2010-07-01 2010-07-01 false Health and insurance benefits and services....

  1. 13 CFR 113.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ....440 Health and insurance benefits and services. Subject to § 113.235(d), in providing a medical, hospital, accident, or life insurance benefit, service, policy, or plan to any of its students, a recipient... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Health and insurance benefits...

  2. 45 CFR 618.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....440 Health and insurance benefits and services. Subject to § 618.235(d), in providing a medical, hospital, accident, or life insurance benefit, service, policy, or plan to any of its students, a recipient... 45 Public Welfare 3 2010-10-01 2010-10-01 false Health and insurance benefits and services....

  3. 24 CFR 3.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Activities Prohibited § 3.440 Health and insurance benefits and services. Subject to § 3.235(d), in providing a medical, hospital, accident, or life insurance benefit, service, policy, or plan to any of its... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Health and insurance benefits...

  4. 7 CFR 15a.39 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Programs and Activities Prohibited § 15a.39 Health and insurance benefits and services. In providing a medical, hospital, accident, or life insurance benefit, service, policy, or plan to any of its students, a... 7 Agriculture 1 2010-01-01 2010-01-01 false Health and insurance benefits and services....

  5. 10 CFR 1042.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... in Education Programs or Activities Prohibited § 1042.440 Health and insurance benefits and services. Subject to § 1042.235(d), in providing a medical, hospital, accident, or life insurance benefit, service... 10 Energy 4 2010-01-01 2010-01-01 false Health and insurance benefits and services....

  6. 29 CFR 36.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Education Programs or Activities Prohibited § 36.440 Health and insurance benefits and services. Subject to § 36.235(d), in providing a medical, hospital, accident, or life insurance benefit, service, policy, or... 29 Labor 1 2010-07-01 2010-07-01 true Health and insurance benefits and services. 36.440...

  7. 49 CFR 25.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Basis of Sex in Education Programs or Activities Prohibited § 25.440 Health and insurance benefits and services. Subject to § 25.235(d), in providing a medical, hospital, accident, or life insurance benefit... 49 Transportation 1 2010-10-01 2010-10-01 false Health and insurance benefits and services....

  8. 40 CFR 5.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 5.440 Health and insurance benefits and services. Subject to § 5.235(d), in providing a medical, hospital, accident, or life insurance... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Health and insurance benefits...

  9. 36 CFR 1211.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Activities Prohibited § 1211.440 Health and insurance benefits and services. Subject to § 1211.235(d), in providing a medical, hospital, accident, or life insurance benefit, service, policy, or plan to any of its... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Health and insurance...

  10. 45 CFR 2555.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Activities Prohibited § 2555.440 Health and insurance benefits and services. Subject to § 2555.235(d), in providing a medical, hospital, accident, or life insurance benefit, service, policy, or plan to any of its... 45 Public Welfare 4 2010-10-01 2010-10-01 false Health and insurance benefits and services....

  11. 45 CFR 86.39 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.39 Health and insurance benefits and services. In providing a medical, hospital, accident, or life insurance benefit, service... 45 Public Welfare 1 2010-10-01 2010-10-01 false Health and insurance benefits and services....

  12. 44 CFR 19.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Education Programs or Activities Prohibited § 19.440 Health and insurance benefits and services. Subject to § 19.235(d), in providing a medical, hospital, accident, or life insurance benefit, service, policy, or... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Health and insurance...

  13. 10 CFR 5.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Education Programs or Activities Prohibited § 5.440 Health and insurance benefits and services. Subject to § 5.235(d), in providing a medical, hospital, accident, or life insurance benefit, service, policy, or... 10 Energy 1 2010-01-01 2010-01-01 false Health and insurance benefits and services. 5.440...

  14. Employer-sponsored health insurance for early retirees: impacts on retirement, health, and health care.

    PubMed

    Strumpf, Erin

    2010-06-01

    The proportion of large employers offering retiree health insurance in the US has declined by half in the past 20 years. This paper examines the potential implications of this change by estimating the effects of a retiree health insurance (RHI) offer on a comprehensive set of labor, health and health care use outcomes in the near-elderly population. An RHI offer increases the probability of early retirement by 37% for both men and women. While the results suggest that an RHI offer has little, if any, effect on health, there is strong evidence that RHI provides significant protection from high out-of-pocket medical costs. In the top 40% of the out-of-pocket spending distribution, those with an offer of retiree coverage spend 22% less on average. Estimates of the value of RHI of over $4,000 per year suggest that increasing opportunities for the near-elderly to purchase coverage at actuarially-fair prices through the individual market or public programs could significantly increase insurance coverage and reduce financial risk for this age group. PMID:19705278

  15. Application of preventive medicine resources in the health insurance system

    PubMed Central

    de Oliveira, Karla Regina Dias; Liberal, Márcia Mello Costa De; Zucchi, Paola

    2015-01-01

    ABSTRACT Objective To identify the financial resources and investments provided for preventive medicine programs by health insurance companies of all kinds. Methods Data were collected from 30 large health insurance companies, with over 100 thousand individuals recorded, and registered at the Agência Nacional de Saúde Suplementar. Results It was possible to identify the percentage of participants of the programs in relation to the total number of beneficiaries of the health insurance companies, the prevention and promotion actions held in preventive medicine programs, the inclusion criteria for the programs, as well as the evaluation of human resources and organizational structure of the preventive medicine programs. Conclusion Most of the respondents (46.7%) invested more than US$ 50,000.00 in preventive medicine program, while 26.7% invested more than US$ 500,000.00. The remaining, about 20%, invested less than US$ 50,000.00, and 3.3% did not report the value applied. PMID:26761558

  16. The role of health insurance in the growth of the private health sector in Korea.

    PubMed

    Yang, B M

    1996-01-01

    The Korean health care system has been recognized by other countries for its rapid expansion of national health insurance. The government's policy of promoting the private sector, relying on market forces for various allocation decisions, and using the fee-for-service payment system has created a number of challenges for the Korean health system. Among these are rapid growth of health care expenditure, proliferation and duplication of medical technology, and lack of access for low-income groups due to high out-of-pocket payments for services covered by insurance. A number of recommendations are made concerning national health policy, modifying health insurance, and developing political consensus for bringing about health reform.

  17. 42 CFR 440.350 - Employer-sponsored insurance health plans.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Employer-sponsored insurance health plans. 440.350 Section 440.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Benchmark-Equivalent Coverage § 440.350 Employer-sponsored insurance health plans. (a) A State may...

  18. 42 CFR 440.350 - Employer-sponsored insurance health plans.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Employer-sponsored insurance health plans. 440.350 Section 440.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Benchmark-Equivalent Coverage § 440.350 Employer-sponsored insurance health plans. (a) A State may...

  19. 42 CFR 457.618 - Ten percent limit on certain Children's Health Insurance Program expenditures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Ten percent limit on certain Children's Health Insurance Program expenditures. 457.618 Section 457.618 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO...

  20. 42 CFR 457.618 - Ten percent limit on certain Children's Health Insurance Program expenditures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Ten percent limit on certain Children's Health... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS... Children's Health Insurance Program expenditures. (a) Expenditures—(1) Primary expenditures...

  1. 42 CFR 457.618 - Ten percent limit on certain Children's Health Insurance Program expenditures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Ten percent limit on certain Children's Health... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS... Children's Health Insurance Program expenditures. (a) Expenditures. (1) Primary expenditures...

  2. 42 CFR 457.618 - Ten percent limit on certain Children's Health Insurance Program expenditures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Ten percent limit on certain Children's Health... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS... Children's Health Insurance Program expenditures. (a) Expenditures—(1) Primary expenditures...

  3. 42 CFR 457.618 - Ten percent limit on certain Children's Health Insurance Program expenditures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Ten percent limit on certain Children's Health... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS... Children's Health Insurance Program expenditures. (a) Expenditures. (1) Primary expenditures...

  4. Health insurance reform; modifications to the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards. Final rule.

    PubMed

    2009-01-16

    This final rule adopts updated versions of the standards for electronic transactions originally adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This final rule also adopts a transaction standard for Medicaid pharmacy subrogation. In addition, this final rule adopts two standards for billing retail pharmacy supplies and professional services, and clarifies who the "senders" and "receivers" are in the descriptions of certain transactions. PMID:19385110

  5. Utilization of Comprehensive Health Insurance Scheme, Kerala: A Comparative Study of Insured and Uninsured Below-Poverty-Line Households.

    PubMed

    Philip, Neena Elezebeth; Kannan, Srinivasan; Sarma, Sankara P

    2016-01-01

    We aimed to compare the sociodemographics, health care utilization pattern, and out-of-pocket (OOP) expenses of 149 insured and 147 uninsured below-poverty-line households insured under the Comprehensive Health Insurance Scheme, Kerala, through a comparative cross-sectional study. Family size more than 4 (odds ratio [OR] = 2.34; 95% confidence interval [CI] = 1.13-4.82), family member with chronic disease (OR = 2.05; 95% CI = 1.18-3.57), high socioeconomic status (OR = 2.95; 95% CI = 1.74-5.03), and an employed household head (OR = 2.69; 95% CI = 1.44-5.02) were significantly associated with insured households. Insured households had higher inpatient service utilization (OR = 1.57; 95% CI = 1.05-2.34). Only 40% of inpatient service utilization among the insured was covered by insurance. The mean OOP expenses for inpatient services among insured (INR 448.95) was higher than among uninsured households (INR 159.93); P = .003. These findings show that urgent attention of the government is required to redesign and closely monitor the scheme. PMID:26316502

  6. Utilization of Comprehensive Health Insurance Scheme, Kerala: A Comparative Study of Insured and Uninsured Below-Poverty-Line Households.

    PubMed

    Philip, Neena Elezebeth; Kannan, Srinivasan; Sarma, Sankara P

    2016-01-01

    We aimed to compare the sociodemographics, health care utilization pattern, and out-of-pocket (OOP) expenses of 149 insured and 147 uninsured below-poverty-line households insured under the Comprehensive Health Insurance Scheme, Kerala, through a comparative cross-sectional study. Family size more than 4 (odds ratio [OR] = 2.34; 95% confidence interval [CI] = 1.13-4.82), family member with chronic disease (OR = 2.05; 95% CI = 1.18-3.57), high socioeconomic status (OR = 2.95; 95% CI = 1.74-5.03), and an employed household head (OR = 2.69; 95% CI = 1.44-5.02) were significantly associated with insured households. Insured households had higher inpatient service utilization (OR = 1.57; 95% CI = 1.05-2.34). Only 40% of inpatient service utilization among the insured was covered by insurance. The mean OOP expenses for inpatient services among insured (INR 448.95) was higher than among uninsured households (INR 159.93); P = .003. These findings show that urgent attention of the government is required to redesign and closely monitor the scheme.

  7. Health insurance providers fee. Final and temporary regulations.

    PubMed

    2015-02-26

    This document contains temporary regulations that provide rules for the definition of a covered entity for purposes of the fee imposed by section 9010 of the Patient Protection and Affordable Care Act, as amended. The temporary regulations are necessary to clarify certain terms in section 9010. The temporary regulations affect persons engaged in the business of providing health insurance for United States health risks. The text of the temporary regulations also serves as the text of the proposed regulations (REG-143416-14) published in the Proposed Rules section in this issue of the Federal Register.

  8. Early experience with 'new federalism' in health insurance regulation.

    PubMed

    Pollitz, K; Tapay, N; Hadley, E; Specht, J

    2000-01-01

    The authors monitored the implementation of the Health Insurance Portability and Accountability Act (HIPAA) from 1997 to 1999. Regulators in all states and relevant federal agencies were interviewed and applicable laws and regulations studied. The authors found that HIPAA changed legal protections for consumers' health coverage in several ways. They examine how the process of regulating such coverage was affected at the state and federal levels and under an emerging partnership of the two. Despite some early implementation challenges, HIPAA's successes have been significant, although limited by the law's incremental nature.

  9. Implementing insurance market reforms under the federal health reform law.

    PubMed

    Nichols, Len M

    2010-06-01

    Lost in the rhetoric about the supposed government takeover of health care is an appreciation of the inherently federalist approach of the Patient Protection and Affordable Care Act. This federalist tradition, particularly with regard to health insurance, has a history that dates back at least to the 1940s. The new legislation broadens federal power and oversight considerably, but it also vests considerable new powers and responsibilities in the states. The precedents and examples it follows will guide federal and state policy makers, stakeholders, and ordinary citizens as they breathe life into the new law. The challenges ahead are formidable, and the greatest ones are likely to be political.

  10. Assessing the Need for a New Household Panel Study: Health Insurance and Health Care

    PubMed Central

    Levy, Helen

    2016-01-01

    This paper considers the availability of data for addressing questions related to health insurance and health care and the potential contribution of a new household panel study. The paper begins by outlining some of the major questions related to policy and concludes that survey data on health insurance, access to care, health spending, and overall economic well-being will likely be needed to answer them. The paper considers the strengths and weaknesses of existing sources of survey data for answering these questions. The paper concludes that either a new national panel study, an expansion in the age range of subjects in existing panel studies, or a set of smaller changes to existing panel and cross-sectional surveys, would significantly enhance our understanding of the dynamics of health insurance, access to health care, and economic well-being. PMID:27279677

  11. Policy interventions to address child health disparities: moving beyond health insurance.

    PubMed

    Currie, Janet

    2009-11-01

    A full accounting of the excess burden of poor health in childhood must include any continuing loss of productivity over the life course. Including these costs results in a much higher estimate of the burden than focusing only on medical costs and other shorter-run costs to parents (such as lost work time). Policies designed to reduce this burden must go beyond increasing eligibility for health insurance, because disparities exist not only in access to health insurance but also in take-up of insurance, access to care, and the incidence of health conditions. We need to create a comprehensive safety net for young children that includes automatic eligibility for basic health coverage under Medicaid unless parents opt out by enrolling children in a private program; health and nutrition services for pregnant women and infants; quality preschool; and home visiting for infants and children at risk. Such a program is feasible and would be relatively inexpensive.

  12. 76 FR 37037 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-24

    ... the Center for Consumer Information & Insurance Oversight of the U.S. Department of Health and Human... with respect to group health plans and health insurance coverage offered in connection with a group.... The temporary regulations provide guidance to employers, group health plans, and health...

  13. Linkage Rate Between Data From Health Checks and Health Insurance Claims in the Japan National Database

    PubMed Central

    Okamoto, Etsuji

    2014-01-01

    Background Japan’s National Database (NDB) includes data on health checks and health insurance claims, is linkable using hash functions, and is available for research use. However, the linkage rate between health check and health insurance claims data has not been investigated. Methods Linkage rate was evaluated by comparing observed medical and pharmaceutical charges among health check recipients in fiscal year (FY) 2009 (N = 21 588 883) with expected charges from the same population when record linkage was complete. Using the NDB, observed charges were estimated from the first published result of linking health check recipients in FY2009 and their health insurance claims in FY2010. Expected charges were estimated by combining 3 publicly available datasets, including data from the Medical Care Benefit Survey and an ad-hoc report by the Japan Health Insurance Association. Results Only 14.9% of expected charges were linked by the NDB. The linkage rate was higher for women than for men (18.2% vs 12.4%) and for elderly adults as compared with younger adults (>25% vs <10%). Conclusions The linkage rate in the NDB was so low that any research linking health check and health insurance claims will not be reliable. Causes for the low linkage rate include differences between health check and health insurance claims data in name format (eg, insertion of a space between family and given names) and date of birth (Japanese vs Gregorian calendar). Investigation of the causes for the low linkage rate and measures for improvement are urgently needed. PMID:24317344

  14. Disability, Health Insurance and Psychological Distress among US Adults: An Application of the Stress Process

    PubMed Central

    Alang, Sirry M.; McAlpine, Donna D.; Henning-Smith, Carrie E.

    2014-01-01

    Structural resources, including access to health insurance, are understudied in relation to the stress process. Disability increases the likelihood of mental health problems, but health insurance may moderate this relationship. We explore health insurance coverage as a moderator of the relationship between disability and psychological distress. A pooled sample from 2008–2010 (N=57,958) was obtained from the Integrated Health Interview Series. Chow tests were performed to assess insurance group differences in the association between disability and distress. Results indicated higher levels of distress associated with disability among uninsured adults compared to their peers with public or private insurance. The strength of the relationship between disability and distress was weaker for persons with public compared to private insurance. As the Affordable Care Act is implemented, decision-makers should be aware of the potential for insurance coverage, especially public, to ameliorate secondary conditions such as psychological distress among persons who report a physical disability. PMID:25767740

  15. Extended applications with smart cards for integration of health care and health insurance services.

    PubMed

    Sucholotiuc, M; Stefan, L; Dobre, I; Teseleanu, M

    2000-01-01

    In 1999 in Romania has initiated the reformation of the national health care system based on health insurance. In 1998 we analyzed this system from the point of view of its IT support and we studied methods of optimisation with relational, distributed databases and new technologies such as Our objectives were to make a model of the information and services flow in a modern health insurance system, to study the smart card technology and to demonstrate how smart card can improve health care services. The paper presents only the smart cards implementations.

  16. HEALTH INSURANCE INFORMATION-SEEKING BEHAVIORS AMONG INTERNET USERS: AN EXPLORATORY ANALYSIS TO INFORM POLICIES.

    PubMed

    Erlyana, Erlyana; Acosta-Deprez, Veronica; O'Lawrence, Henry; Sinay, Tony; Ramirez, Jeremy; Jacot, Emmanuel C; Shim, Kyuyoung

    2015-01-01

    The purpose of this study was to explore characteristics of Internet users who seek health insurance information online, as well as factors affecting their behaviors in seeking health insurance information. Secondary data analysis was conducted using data from the 2012 Pew Internet Health Tracking Survey. Of 2,305 Internet user adults, only 29% were seeking health insurance information online. Bivariate analyses were conducted to test differences in characteristics of those who seek health insurance information online and those who do not. A logistic regression model was used to determine significant predictors of health insurance information-seeking behavior online. Findings suggested that factors such as being a single parent, having a high school education or less, and being uninsured were significant and those individuals were less likely to seek health insurance information online. Being a family caregiver of an adult and those who bought private health insurance or were entitled to Medicare were more likely to seek health insurance information online than non-caregivers and the uninsured. The findings suggested the need to provide quality health insurance information online is critical for both the insured and uninsured population.

  17. Clinton signs Kassebaum-Kennedy bill--reduces barriers to health insurance.

    PubMed

    Owens, M B

    1996-01-01

    In August, President Clinton signed the Health Insurance Reform Act of 1966. The bill, generally called the Kassebaum-Kennedy Bill, is an important first step in increasing access to health insurance coverage for 25 million people. The bill limits preexisting exclusion waiting periods, places mental health coverage on a par with physical health care insurance, and will establish a pilot program to study the benefits of Medical Savings Accounts.

  18. What's behind health insurance rate increases? an examination of what insurers reported to the federal government in 2013-2014.

    PubMed

    McCue, Michael J; Hall, Mark A

    2015-01-01

    The Affordable Care Act requires health insurers to justify rate increases that are 10 percent or more for nongrandfathered plans in the individual and small-group markets. Analyzing these filings for renewals taking effect from mid-2013 through mid-2014, this brief finds that the average rate increase submitted for review was 13 percent. Insurers attributed the great bulk of these larger rate increases to routine factors such as trends in medical costs. Most insurers did not attribute any portion of these medical cost trends to factors related to the Affordable Care Act. The ACA-related factors mentioned most often were nonmedical: the new federal taxes on insurers, and the fee for the transitional reinsurance program. On average, insurers that quantified any ACA impact attributed about a third of their larger rate increases to these new ACA assessments.

  19. The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions. NBER Working Paper No. 20178

    ERIC Educational Resources Information Center

    Cohodes, Sarah; Kleiner, Samuel; Lovenheim, Michael F.; Grossman, Daniel

    2014-01-01

    Public health insurance programs comprise a large share of federal and state government expenditure, and these programs are due to be expanded as part of the 2010 Affordable Care Act. Despite a large literature on the effects of these programs on health care utilization and health outcomes, little prior work has examined the long-term effects of…

  20. 78 FR 77470 - Health Insurance Exchanges; Approval of an Application by the Accreditation Association for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-23

    ... HUMAN SERVICES Centers for Medicare & Medicaid Services Health Insurance Exchanges; Approval of an... Essential Health Benefits, Actuarial Value, and Accreditation; Final Rule, 78 FR 12834, 12854-12855...\\ Health Insurance Exchanges; Application by the Accreditation Association for Ambulatory Health Care To...

  1. 76 FR 37120 - Medicare, Medicaid, and Children's Health Insurance Programs; Meeting of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-24

    ..., and Children's Health Insurance (CHIP) programs. This meeting is open to the public. DATES: Meeting..., Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Informing Medicare, Medicaid and... availability of other health coverage that may be available to them (for example, via health...

  2. 42 CFR 457.80 - Current State child health insurance coverage and coordination.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... services for low-income children. Such procedures include those designed to— (1) Increase the number of... 42 Public Health 4 2010-10-01 2010-10-01 false Current State child health insurance coverage and... HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS...

  3. France tries to save its ailing national health insurance system.

    PubMed

    Sorum, Paul Clay

    2005-07-01

    France has provided universal health care through employment-based health insurance funds. As its governments have increasingly used tax revenues to supplement payroll levies, they have assumed a larger role. Faced with widening deficits in the funds' accounts, the National Assembly adopted in August 2004 legislation designed to decrease health expenses, increase revenues to the funds, and improve quality of care. The apparent impacts of the so-called Douste-Blazy law are to reaffirm social solidarity and equality of access; to reinforce central control rather than relying more on decentralized and market forces; to give the now-unified funds a stronger director, shielded not only from labor and business but also, possibly, from the central government; to allow French private physicians to retain their unrivaled freedom of prescription; and to continue France's reliance on taxes as well as payroll levies to finance its health care. PMID:16022215

  4. Health Insurance Coverage at Midlife: Characteristics, Costs, and Dynamics

    PubMed Central

    Johnson, Richard W.; Crystal, Stephen

    1997-01-01

    Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and changes in coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of non-coverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists. PMID:10170345

  5. Toward an Anthropology of Insurance and Health Reform: An Introduction to the Special Issue.

    PubMed

    Dao, Amy; Mulligan, Jessica

    2016-03-01

    This article introduces a special issue of Medical Anthropology Quarterly on health insurance and health reform. We begin by reviewing anthropological contributions to the study of financial models for health care and then discuss the unique contributions offered by the articles of this collection. The contributors demonstrate how insurance accentuates--but does not resolve tensions between granting universal access to care and rationing limited resources, between social solidarity and individual responsibility, and between private markets and public goods. Insurance does not have a single meaning, logic, or effect but needs to be viewed in practice, in context, and from multiple vantage points. As the field of insurance studies in the social sciences grows and as health reforms across the globe continue to use insurance to restructure the organization of health care, it is incumbent on medical anthropologists to undertake a renewed and concerted study of health insurance and health systems. PMID:26698645

  6. Private health insurance: the problem child faces adulthood.

    PubMed

    Cormack, Mark

    2002-01-01

    Since its election to office in 1996, reform of Private Health Insurance (PHI) has been the most obvious health policy focus of the Howard Government. The reform process has focussed on price, product, promotion, legislation and regulation. It has resulted in one of the largest new Commonwealth health outlays in recent memory. Health insurance funds have emerged as active purchasers of care, not just passive reimbursers of costs. PHI fund reserves have moved from precarious liquidity to healthy surplus. Private hospitals are busier than ever before, but margins are slim. Anecdotally, public hospitals report little benefit to date. Waiting lists have not been reduced, and their budgets are unchanged as a result of the $2 Bn allocated under the 30% Rebate scheme. The paper begins by describing the origins of the PHI reform. Its objectives, policy initiatives, results to date and criticisms are analysed. Criticisms include the actual and opportunity costs. Specific concerns remain as to its effectiveness to date in reducing pressure on public hospitals, and perceived lack of equity for certain client groups. The most significant result is that much of the reform package is here to stay including the expensive and much criticised 30% rebate. Like Medicare before it, the PHI reforms have achieved bipartisan support. The paper concludes by describing future implications for Government, industry, consumers and the medical profession. PMID:12046153

  7. Private health insurance: the problem child faces adulthood.

    PubMed

    Cormack, Mark

    2002-01-01

    Since its election to office in 1996, reform of Private Health Insurance (PHI) has been the most obvious health policy focus of the Howard Government. The reform process has focussed on price, product, promotion, legislation and regulation. It has resulted in one of the largest new Commonwealth health outlays in recent memory. Health insurance funds have emerged as active purchasers of care, not just passive reimbursers of costs. PHI fund reserves have moved from precarious liquidity to healthy surplus. Private hospitals are busier than ever before, but margins are slim. Anecdotally, public hospitals report little benefit to date. Waiting lists have not been reduced, and their budgets are unchanged as a result of the $2 Bn allocated under the 30% Rebate scheme. The paper begins by describing the origins of the PHI reform. Its objectives, policy initiatives, results to date and criticisms are analysed. Criticisms include the actual and opportunity costs. Specific concerns remain as to its effectiveness to date in reducing pressure on public hospitals, and perceived lack of equity for certain client groups. The most significant result is that much of the reform package is here to stay including the expensive and much criticised 30% rebate. Like Medicare before it, the PHI reforms have achieved bipartisan support. The paper concludes by describing future implications for Government, industry, consumers and the medical profession.

  8. Health insurance coverage and health-related quality of life: analysis of 2000 Medical Expenditure Panel Survey data.

    PubMed

    Bharmal, Murtuza; Thomas, Joseph

    2005-11-01

    This study investigated relationships between health insurance status and health-related quality of life (HRQOL) using the 2000 Medical Expenditure Panel Survey data. Health-related quality of life was measured using the SF-12 Physical Component Summary (PCS) and SF-12 Mental Component Summary (MCS). The analysis controlled for sociodemographic and attitudinal variables and medical conditions. The analysis also investigated and controlled for possible reverse causality between HRQOL and health insurance in the models. After adjusting for covariates, individuals without health insurance had significantly lower mean PCS scores (beta=-5.8; SE=0.4) than those with health insurance. The adjusted association between no health insurance and MCS scores (beta=-1.1; SE=0.4) also was significant. The adjusted difference in HRQOL among people with health insurance and those without it exceeds or is comparable to adjusted differences in HRQOL between people with each of various medical conditions and people without them.

  9. Health Care Insurance, Financial Concerns, and Delays to Hospital Presentation in Acute Myocardial Infarction

    PubMed Central

    Smolderen, Kim G.; Spertus, John A.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Tang, Fengming; Ross, Joseph S.; Ting, Henry H.; Alexander, Karen P.; Rathore, Saif S.; Chan, Paul S.

    2011-01-01

    Context Little is known about how health insurance status affects decisions to seek care during emergency medical conditions like acute myocardial infarction (AMI). Objective To examine the association between lack of health insurance and financial concerns about accessing care among those with health insurance, and the time from symptom onset to hospital presentation (prehospital delays) during AMI. Design, Setting and Patients Multicenter, prospective registry of 3721 AMI patients enrolled between April, 2005 and December, 2008 from 24 U.S. hospitals. Health insurance status was categorized as uninsured, insured with financial concerns about accessing care, and insured without financial concerns. Insurance information was determined from medical records while financial concerns among those with health insurance were determined from structured interviews. Main Outcome Measure Prehospital delay times (≤2 hours, >2 to 6 hours, >6 hours), adjusted for demographic, clinical, social and psychological factors using hierarchical ordinal regression models. Results Of 3,721 patients, 738 (19.8%) were uninsured, and 689 (18.5%) were insured with financial concerns, and 2294 (61.7%) were insured without financial concerns. Uninsured and insured patients with financial concerns were more likely to delay seeking care during AMI, with prehospital delays >6 hours among 48.6% of uninsured patients, 44.6% of insured patients with financial concerns, and 39.3% of insured patients without financial concerns, as compared with prehospital delays of <2 hours among 27.5%, 33.5%, and 36.6% of those who were uninsured, insured with financial concerns, and insured without financial concerns, respectively (P <.001). After adjusting for potential confounders, both insurance with financial concerns and lack of insurance were associated with prehospital delays: insurance without financial concerns (reference); insurance with financial concerns, adjusted odds ratio [OR)], 1.21; 95% confidence

  10. [Labor market structure and access to private health insurance in Brazil].

    PubMed

    Machado, Ana Flavia; Andrade, Mônica Viegas; Maia, Ana Carolina

    2012-04-01

    This paper aims to describe health insurance coverage among different types of workers in Brazil. Health insurance coverage and labor market insertion are used to define homogeneous groups of workers. The Grade of Membership method is used to build a typology of workers. The database was the Brazilian National Household Survey (PNAD) for 1998 and 2003, including a health survey. Five worker profiles were defined. The key variables were: health insurance coverage, schooling, and work status. The main findings show a positive association between health insurance coverage, income from work, and trade union membership.

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

    PubMed Central

    Arnett, Ross H.; Trapnell, Gordon R.

    1984-01-01

    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. PMID:10310950

  12. Promoting Value for Consumers: Comparing Individual Health Insurance Markets Inside and Outside the ACA's Exchanges.

    PubMed

    McCue, Michael J; Hall, Mark A

    2016-06-01

    The new health insurance exchanges are the core of the Affordable Care Act's (ACA) insurance reforms, but insurance markets beyond the exchanges also are affected by the reforms. This issue brief compares the markets for individual coverage on and off of the exchanges, using insurers' most recent projections for ACA-compliant policies. In 2016, insurers expect that less than one-fifth of ACA-compliant coverage will be sold outside of the exchanges. Insurers that sell mostly through exchanges devote a greater portion of their premium dollars to medical care than do insurers selling only off of the exchanges, because exchange insurers project lower administrative costs and lower profit margins. Premium increases on exchange plans are less than those for off-exchange plans, in large part because exchange enrollment is projected to shift to closed-network plans. Finally, initial concerns that insurers might seek to segregate higher-risk subscribers on the exchanges have not been realized. PMID:27290751

  13. 77 FR 37839 - Veterans' Group Life Insurance (VGLI) No-Health Period Extension

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-25

    ... AFFAIRS 38 CFR Part 9 RIN 2900-AO24 Veterans' Group Life Insurance (VGLI) No-Health Period Extension... Affairs (VA) proposes to amend its regulations governing eligibility for Veterans' Group Life Insurance... indicate that they are submitted in response to ``RIN 2900-AO24--Veterans' Group Life Insurance (VGLI)...

  14. What's behind health insurance rate increases? an examination of what insurers reported to the federal government in 2012-2013.

    PubMed

    McCue, Michael J; Hall, Mark A

    2013-12-01

    The Affordable Care Act requires health insurers to justify rate increases of 10 percent or more for nongrandfathered plans in the individual and small-group markets. Analyzing these filings for rates taking effect from mid-2012 through mid-2013, insurers attributed the great bulk--three-quarters or more--of these larger rate increases to routine factors such as trends in medical costs. Insurers attributed only a very small portion of these medical cost trends to factors related to the Affordable Care Act. The ACA-related factor mentioned most often, but only in a third of the rate filings in this study, was the requirement to cover women's preventive and contraceptive services without patient cost-sharing. But, the insurers who point to this requirement or other ACA-related costs attributed only about 1 percentage point of their rate increases to the health reform law.

  15. Demand for Private Health Insurance Where Public Health Services are Free: The Case of Malawi

    NASA Astrophysics Data System (ADS)

    Makoka, Donald; Kaluwa, Ben; Kambewa, Patrick

    This study assesses the determinants of demand for private health insurance among formal sector employees in Malawi using a multinomial logit. We examine membership in the three different schemes of Medical Aid Society of Malawi`s (MASM), which was the only health insurance provider at the time of the study. The results indicate that formal sector employees prefer to receive medical treatment from private health facilities, but lack of access to information prevents many from becoming insured. Further, the probability of enrolling in any of MASM`s schemes increases with income and with age for the top and minimum schemes. More children and good health status reduce the probability of enrolling into the two lower schemes. Policies that improve access to information and income among the target group are likely to increase demand for MASM schemes.

  16. Small employers and self-insured health benefits: too small to succeed?

    PubMed

    Yee, Tracy; Christianson, Jon B; Ginsburg, Paul B

    2012-07-01

    Over the past decade, large employers increasingly have bypassed traditional health insurance for their workers, opting instead to assume the financial risk of enrollees' medical care through self-insurance. Because self-insurance arrangements may offer advantages--such as lower costs, exemption from most state insurance regulation and greater flexibility in benefit design--they are especially attractive to large firms with enough employees to spread risk adequately to avoid the financial fallout from potentially catastrophic medical costs of some employees. Recently, with rising health care costs and changing market dynamics, more small firms--100 or fewer workers--are interested in self-insuring health benefits, according to a new qualitative study from the Center for Studying Health System Change (HSC). Self-insured firms typically use a third-party administrator (TPA) to process medical claims and provide access to provider networks. Firms also often purchase stop-loss insurance to cover medical costs exceeding a predefined amount. Increasingly competitive markets for TPA services and stop-loss insurance are making self-insurance attractive to more employers. The 2010 national health reform law imposes new requirements and taxes on health insurance that may spur more small firms to consider self-insurance. In turn, if more small firms opt to self-insure, certain health reform goals, such as strengthening consumer protections and making the small-group health insurance market more viable, may be undermined. Specifically, adverse selection--attracting sicker-than-average people--is a potential issue for the insurance exchanges created by reform. PMID:22812029

  17. Mongolian experiences with health insurance: are success factors unique?

    PubMed

    Hindle, Don; Van Langendonck, Jef; Tsolmongerel, Tsilaajav

    2002-01-01

    We describe the health insurance model implemented in Mongolia after the Soviet Bloc collapsed in 1990, and note some of its good features. We then discuss the structural weaknesses that became evident over the first ten years of use, and some current proposals for reform. Finally, we consider the factors that appear to have affected success. We argue that the main constraints are much the same as in other countries including Australia--and relate more to confusion and disagreement over broad policy issues than to detailed knowledge of technical aspects or the research evidence.

  18. Health Insurance Marketplaces: Premium Trends in Rural Areas.

    PubMed

    Barker, Abigail R; Kemper, Leah M; McBride, Timothy D; Meuller, Keith J

    2016-05-01

    Since 2014, when the Health Insurance Marketplaces (HIMs) authorized by the Patient Protection and Affordable Care Act (ACA) were implemented, considerable premium changes have been observed in the marketplaces across the 50 states and the District of Columbia. This policy brief assesses the changes in average HIM plan premiums from 2014 to 2016, before accounting for subsidies, with an emphasis on the widening variation across rural and urban places. Since this brief focuses on premiums without accounting for subsidies, this is not intended to be an analysis of the "affordability" of ACA premiums, as that would require assessment of premiums, cost-sharing adjustments, and other factors. PMID:27416649

  19. Health Insurance Marketplaces: Premium Trends in Rural Areas.

    PubMed

    Barker, Abigail R; Kemper, Leah M; McBride, Timothy D; Meuller, Keith J

    2016-05-01

    Since 2014, when the Health Insurance Marketplaces (HIMs) authorized by the Patient Protection and Affordable Care Act (ACA) were implemented, considerable premium changes have been observed in the marketplaces across the 50 states and the District of Columbia. This policy brief assesses the changes in average HIM plan premiums from 2014 to 2016, before accounting for subsidies, with an emphasis on the widening variation across rural and urban places. Since this brief focuses on premiums without accounting for subsidies, this is not intended to be an analysis of the "affordability" of ACA premiums, as that would require assessment of premiums, cost-sharing adjustments, and other factors.

  20. State Politics and the Creation of Health Insurance Exchanges

    PubMed Central

    Greer, Scott L.

    2013-01-01

    Health insurance exchanges are a key component of the Affordable Care Act. Each exchange faces the challenge of minimizing friction with existing policies, coordinating churn between programs, and maximizing take-up. State-run exchanges would likely be better positioned to address these issues than a federally run exchange, yet only one third of states chose this path. Policymakers must ensure that their exchange—whether state or federally run—succeeds. Whether this happens will greatly depend on the political dynamics in each state. PMID:23763405

  1. Current Trends in Health Insurance Systems: OECD Countries vs. Japan

    PubMed Central

    SASAKI, Toshiyuki; IZAWA, Masahiro; OKADA, Yoshikazu

    2015-01-01

    Over the past few decades, the longest extension in life expectancy in the world has been observed in Japan. However, the sophistication of medical care and the expansion of the aging society, leads to continuous increase in health-care costs. Medical expenses as a part of gross domestic product (GDP) in Japan are exceeding the current Organization for Economic Co-operation and Development (OECD) average, challenging the universally, equally provided low cost health care existing in the past. A universal health insurance system is becoming a common system currently in developed countries, currently a similar system is being introduced in the United States. Medical care in Japan is under a social insurance system, but the injection of public funds for medical costs becomes very expensive for the Japanese society. In spite of some urgently decided measures to cover the high cost of advanced medical treatment, declining birthrate and aging population and the tendency to reduce hospital and outpatients’ visits numbers and shorten hospital stays, medical expenses of Japan continue to be increasing. PMID:25797778

  2. Longitudinal analysis of income-related health inequality.

    PubMed

    Allanson, Paul; Gerdtham, Ulf-G; Petrie, Dennis

    2010-01-01

    This paper considers the characterisation and measurement of income-related health inequality using longitudinal data. The paper elucidates the nature of the Jones and López Nicolás (2004) index of "health-related income mobility" and explains the negative values of the index that have been reported in all the empirical applications to date. The paper further presents an alternative approach to the analysis of longitudinal data that brings out complementary aspects of the evolution of income-related health inequalities over time. In particular, we propose a new index of "income-related health mobility" that measures whether the pattern of health changes is biased in favour of those with initially high or low incomes. We illustrate our work by investigating mobility in the General Health Questionnaire measure of psychological well-being over the first nine waves of the British Household Panel Survey from 1991 to 1999.

  3. Value-Based Insurance Design: More Health at Any Price

    PubMed Central

    Fendrick, A Mark; Martin, Jenifer J; Weiss, Alison E

    2012-01-01

    When everyone is required to pay the same out-of-pocket amount for health care services regardless of clinical indication, there is evidence of underuse of high-value services and overuse of interventions of no or marginal clinical benefit. Unlike most current health plan designs, value-based insurance design (V-BID) acknowledges heterogeneity of clinical interventions and patient characteristics. It encourages the use of services with strong evidence of clinical benefit and likewise discourages the use of low-value services. Implementing this concept into the national policy debate required a strategy that included conceptual framework development, program implementation, rigorous evaluation, media outreach, and an advocacy plan. Upon completion of this strategy involving several colleagues from multiple disciplines, Congress included language specifically authorizing V-BID in the Patient Protection and Affordable Care Act. A wide-ranging approach, planned as early as possible, can lead to the successful translation of health services research to policy. PMID:22150718

  4. Performance of universal health insurance: lessons from South Korea.

    PubMed

    Moon, Sangho; Shin, Jaeun

    2007-04-01

    The aim of this study was to assess the maturity of the South Korean healthcare system in comparison with those of the 30 countries of the Organization for Economic Co-operation and Development (OECD) and to provide a foundation to evaluate the performance of the South Korean healthcare system. Using OECD Health Data 2005, we evaluated the performance of the healthcare system of the 30 industrialized countries. The evaluation focused on three dimensions that have remained central to healthcare debates internationally for years: access, cost and outcomes. Although South Korea has successfully implemented its universal health insurance scheme in a very short period of time and possesses highly advanced medical technologies, we found that South Koreans incurred more out-of-pocket expenditures on healthcare. Health outcomes were of relatively low quality compared with those of other OECD countries, but compared relatively well with the four countries (Greece, New Zealand, Portugal and Spain) with similar per capita gross domestic product (GDP).

  5. Value-based insurance design: more health at any price.

    PubMed

    Fendrick, A Mark; Martin, Jenifer J; Weiss, Alison E

    2012-02-01

    When everyone is required to pay the same out-of-pocket amount for health care services regardless of clinical indication, there is evidence of underuse of high-value services and overuse of interventions of no or marginal clinical benefit. Unlike most current health plan designs, value-based insurance design (V-BID) acknowledges heterogeneity of clinical interventions and patient characteristics. It encourages the use of services with strong evidence of clinical benefit and likewise discourages the use of low-value services. Implementing this concept into the national policy debate required a strategy that included conceptual framework development, program implementation, rigorous evaluation, media outreach, and an advocacy plan. Upon completion of this strategy involving several colleagues from multiple disciplines, Congress included language specifically authorizing V-BID in the Patient Protection and Affordable Care Act. A wide-ranging approach, planned as early as possible, can lead to the successful translation of health services research to policy. PMID:22150718

  6. The Health Insurance Flexibility and Accountability (HIFA) Demonstration program. A new initiative to cover the uninsured.

    PubMed

    Benjamin, G C

    2001-01-01

    Seeking to keep his promise to give states more flexibility while expanding health insurance coverage to low-income people, President George W. Bush released a proposal to reform Medicaid and The Children's Health Insurance Program. This initiative, the Health Insurance Flexibility and Accountability Act (HIFA), represents a significant change in Medicaid policy. Whether states will find this proposal a useful tool to expand coverage remains to be seen.

  7. Mental health and substance abuse insurance parity for federal employees: how did health plans respond?

    PubMed

    Barry, Colleen L; Ridgely, M Susan

    2008-01-01

    A fundamental concern with competitive health insurance markets is that they will not supply efficient levels of coverage for treatment of costly, chronic, and predictable illnesses, such as mental illness. Since the inception of employer-based health insurance, coverage for mental health services has been offered on a more limited basis than coverage for general medical services. While mental health advocates view insurance limits as evidence of discrimination, adverse selection and moral hazard can also explain these differences in coverage. The intent of parity regulation is to equalize private insurance coverage for mental and physical illness (an equity concern) and to eliminate wasteful forms of competition due to adverse selection (an efficiency concern). In 2001, a presidential directive requiring comprehensive parity was implemented in the Federal Employees Health Benefits (FEHB) Program. In this study, we examine how health plans responded to the parity directive. Results show that in comparison with a set of unaffected health plans, federal employee plans were significantly more likely to augment managed care through contracts with managed behavioral health "carve-out" firms after parity. This finding helps to explain the absence of an effect of the FEHB Program directive on total spending, and is relevant to the policy debate in Congress over federal parity.

  8. Evaluation of Telephone Health Coaching of German Health Insurants with Chronic Conditions

    ERIC Educational Resources Information Center

    Härter, Martin; Dwinger, Sarah; Seebauer, Laura; Simon, Daniela; Herbarth, Lutz; Siegmund-Schultze, Elisabeth; Temmert, Daniel; Bermejo, Isaac; Dirmaier, Jörg

    2013-01-01

    Objective: This study aimed to investigate how patients with chronic conditions evaluate telephone health coaching provided by their health insurance company. Methods: A retrospective survey was conducted among coaching participants ("n" = 834). Outcomes included the general evaluation of the coaching, the evaluation of process and…

  9. How Has the Affordable Care Act Affected Health Insurers' Financial Performance?

    PubMed

    Hall, Mark A; McCue, Michael J

    2016-07-01

    Starting in 2014, the Affordable Care Act transformed the market for individual health insurance by changing how insurance is sold and by subsidizing coverage for millions of new purchasers. Insurers, who had no previous experience under these market conditions, competed actively but faced uncertainty in how to price their products. This issue brief uses newly available data to understand how health insurers fared financially during the ACA's first year of full reforms. Overall, health insurers' financial performance began to show some strain in 2014, but the ACA's reinsurance program substantially buffered the negative effects for most insurers. Although a quarter of insurers did substantially worse than others, experience under the new market rules could improve the accuracy of pricing decisions in subsequent years. PMID:27459740

  10. How Has the Affordable Care Act Affected Health Insurers' Financial Performance?

    PubMed

    Hall, Mark A; McCue, Michael J

    2016-07-01

    Starting in 2014, the Affordable Care Act transformed the market for individual health insurance by changing how insurance is sold and by subsidizing coverage for millions of new purchasers. Insurers, who had no previous experience under these market conditions, competed actively but faced uncertainty in how to price their products. This issue brief uses newly available data to understand how health insurers fared financially during the ACA's first year of full reforms. Overall, health insurers' financial performance began to show some strain in 2014, but the ACA's reinsurance program substantially buffered the negative effects for most insurers. Although a quarter of insurers did substantially worse than others, experience under the new market rules could improve the accuracy of pricing decisions in subsequent years.

  11. Private health insurance: a role model for European health systems.

    PubMed

    Arentz, Christine; Eekhoff, Johann; Kochskämper, Susanna

    2012-10-01

    European health care systems will face major challenges in the near future. Demographic change and technological progress induce rising costs. In order to deal with these developments and to preserve the current level of health care provision, health care systems need to be highly efficient. Yet existing health care systems show a lot of inefficiencies that result in waste of scarce resources. Therefore, improvements in performance are necessary. In this article, we argue that a change in financing health care accompanied by the liberalisation of the market for health care service providers offers a promising solution. We develop a market-based model for financing health care and show how it can be put into practice without generating additional costs for society while meeting social equity criteria.

  12. Ready, Set, Learn: Promoting Health Insurance for Children. A Guide for Schools.

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    Health problems impede the academic performance of 12 percent of students. Schools are in a unique position to help their state's Medicaid and children's health insurance programs connect with parents who lack health insurance for their children. This booklet provides suggestions to help school staff identify, inform, and help to enroll families…

  13. Promising Ideas in Children's Health Insurance: Coordination with School Lunch Programs.

    ERIC Educational Resources Information Center

    Pulos, Vicky; Lee, Lana

    Noting that sending information about children's health insurance through the school system is a very effective way to generate applications and enrollment for state health insurance programs, this issue brief is the first in a series to examine some of the innovative methods used to offer more children affordable health care. The brief presents a…

  14. 77 FR 21580 - Changes in Certain Multifamily Housing and Health Care Facility Mortgage Insurance Premiums for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-10

    ... URBAN DEVELOPMENT Changes in Certain Multifamily Housing and Health Care Facility Mortgage Insurance...) Multifamily Housing, Health Care Facilities, and Hospital Mortgage Insurance programs for commitments to be... multifamily housing, health care facility, and hospital loans. The increases will not apply to Low...

  15. 75 FR 32182 - Medicaid Program: Proposed Implementation of Section 614 of the Children's Health Insurance...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-07

    ... 614 of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3... under the Children's Health Insurance Program under title XXI of the Social Security Act. In other... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  16. 77 FR 70785 - Medicare, Medicaid, and Children's Health Insurance Programs; Meeting of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-27

    ... the Children's Health Insurance Program (CHIP). This meeting is open to the public. DATES: Meeting..., Medicare, Medicaid and the Children's Health Insurance Program (CHIP). Enhancing the federal government's... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  17. 75 FR 75469 - Priority Setting for the Children's Health Insurance Program Reauthorization Act (CHIPRA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-03

    ... Children's Health Insurance Program Reauthorization Act of 2009 (Pub. L. 111-3) amended title Xl of the... enacted the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111-3... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  18. Building for a Healthy Future: Sustaining School-Based Enrollment in Health Insurance Programs.

    ERIC Educational Resources Information Center

    Harper, Michelle

    Despite expansions in children's health insurance programs, rates of uninsurance in California continue to be high. Noting that absenteeism due to poor health is associated with school failure and asserting that schools offer an established framework on which to build a coordinated approach to enrolling children in health insurance programs, this…

  19. 77 FR 37681 - Medicare, Medicaid, and Children's Health Insurance Programs; Meeting of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-22

    ... Health Insurance Program (CHIP). This meeting is open to the public. ] DATES: Meeting Date: Thursday... enrolled in, or eligible for, Medicare, Medicaid and the Children's Health Insurance Program (CHIP... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  20. 78 FR 12327 - Medicare, Medicaid, and Children's Health Insurance Programs; Meeting of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-22

    ... the Children's Health Insurance Program (CHIP). This meeting is open to the public. DATES: Meeting..., Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Enhancing the federal governments... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  1. 76 FR 61365 - Medicare, Medicaid, and Children's Health Insurance Programs; Meeting of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-04

    ... the Children's Health Insurance Program (CHIP). This meeting is open to the public. DATES: Meeting..., Medicare, Medicaid and the Children's Health Insurance Program (CHIP). Enhancing the Federal government's... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  2. Does the Availability of Parental Health Insurance Affect the College Enrollment Decision of Young Americans?

    ERIC Educational Resources Information Center

    Jung, Juergen; Hall, Diane M. Harnek; Rhoads, Thomas

    2013-01-01

    The present study examines whether the college enrollment decision of young individuals (student full-time, student part-time, and non-student) depends on health insurance coverage via a parent's family health plan. Our findings indicate that the availability of parental health insurance can have significant effects on the probability that a young…

  3. 78 FR 32661 - Medicare, Medicaid, and Children's Health Insurance Programs; Renewal of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-31

    ... the Children's Health Insurance Program (CHIP), and also expanded the availability of other options... are eligible for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) about options... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  4. 75 FR 62684 - Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-13

    ... Register (65 FR 50312) entitled ``Health Insurance Reform: Standards for Electronic Transactions... the Federal Register (73 FR 49742) entitled ``Health Insurance Reform: Modifications to Electronic... January 16, 2009, we published a final rule in the Federal Register (74 FR 3296) entitled Health...

  5. 78 FR 32664 - Medicare, Medicaid, and Children's Health Insurance Programs; Meeting of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-31

    ... the Children's Health Insurance Program (CHIP). This meeting is open to the public. DATES: Meeting... enrolled in, or eligible for, Medicare, Medicaid and the Children's Health Insurance Program (CHIP... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  6. 77 FR 31499 - Medicaid and Children's Health Insurance Programs; Disallowance of Claims for FFP and Technical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-29

    ...-AQ32 Medicaid and Children's Health Insurance Programs; Disallowance of Claims for FFP and Technical...; make conforming changes to the Medicaid and Children's Health Insurance Program (CHIP) disallowance... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  7. 45 CFR 86.39 - Health and insurance benefits and services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.39 Health and insurance... 45 Public Welfare 1 2013-10-01 2013-10-01 false Health and insurance benefits and services. 86.39 Section 86.39 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  8. 45 CFR 86.39 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.39 Health and insurance... 45 Public Welfare 1 2011-10-01 2011-10-01 false Health and insurance benefits and services. 86.39 Section 86.39 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  9. Mandated Mental Health Insurance: A Complex Case of Pros and Cons. Human Resources Series.

    ERIC Educational Resources Information Center

    Paterson, Andrea

    1986-01-01

    The pros and cons of state laws mandating mental health insurance are discussed in this report. The history of a 1985 Supreme Court case which held that states could mandate mental health benefits introduces the report. In an overview of the issue, the long-standing argument between the insurance industry and the mental health establishment is…

  10. 78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ... Care Act; Health Insurance Market Rules; Rate Review'' (77 FR 70584). These standards apply to health... health insurance coverage in the group or individual market in a state to accept every employer and... small group markets, and in the large group market if a state, beginning in 2017, allows...

  11. Effects of employer-sponsored health insurance costs on Social Security taxable wages.

    PubMed

    Burtless, Gary; Milusheva, Sveta

    2013-01-01

    The increasing cost of employer contributions for employee health insurance reduces the share of compensation subject to the Social Security payroll tax. Rising insurance contributions can also have a more subtle effect on the Social Security tax base because they influence the distribution of money wages above and below the taxable maximum amount. This article uses the Medical Expenditure Panel Survey to analyze trends in employer health insurance contributions and the distribution of those costs up and down the wage distribution. Our analysis shows that employer health insurance contributions increased faster than overall compensation during 1996-2008, but such contributions grew only slightly faster among workers earning less than the taxable maximum than they did among those earning more. Because employer health insurance contributions represent a much higher percentage of compensation below the taxable maximum, health insurance cost trends exerted a disproportionate downward pressure on money wages below the taxable maximum.

  12. Effects of employer-sponsored health insurance costs on Social Security taxable wages.

    PubMed

    Burtless, Gary; Milusheva, Sveta

    2013-01-01

    The increasing cost of employer contributions for employee health insurance reduces the share of compensation subject to the Social Security payroll tax. Rising insurance contributions can also have a more subtle effect on the Social Security tax base because they influence the distribution of money wages above and below the taxable maximum amount. This article uses the Medical Expenditure Panel Survey to analyze trends in employer health insurance contributions and the distribution of those costs up and down the wage distribution. Our analysis shows that employer health insurance contributions increased faster than overall compensation during 1996-2008, but such contributions grew only slightly faster among workers earning less than the taxable maximum than they did among those earning more. Because employer health insurance contributions represent a much higher percentage of compensation below the taxable maximum, health insurance cost trends exerted a disproportionate downward pressure on money wages below the taxable maximum. PMID:23687744

  13. The effect of social health insurance on prenatal care: the case of Ghana.

    PubMed

    Abrokwah, Stephen O; Moser, Christine M; Norton, Edward C

    2014-12-01

    Many developing countries have introduced social health insurance programs to help address two of the United Nations' millennium development goals-reducing infant mortality and improving maternal health outcomes. By making modern health care more accessible and affordable, policymakers hope that more women will seek prenatal care and thereby improve health outcomes. This paper studies how Ghana's social health insurance program affects prenatal care use and out-of-pocket expenditures, using the two-part model to model prenatal care expenditures. We test whether Ghana's social health insurance improved prenatal care use, reduced out-of-pocket expenditures, and increased the number of prenatal care visits. District-level differences in the timing of implementation provide exogenous variation in access to health insurance, and therefore strong identification. Those with access to social health insurance have a higher probability of receiving care, a higher number of prenatal care visits, and lower out-of-pocket expenditures conditional on spending on care.

  14. The influence of supplementary health insurance on switching behaviour: evidence from Swiss data.

    PubMed

    Dormont, Brigitte; Geoffard, Pierre-Yves; Lamiraud, Karine

    2009-11-01

    This paper focuses on the switching behaviour of enrolees in the Swiss basic health insurance system. Even though the new Federal Law on Social Health Insurance (LAMal) was implemented in 1996 to promote competition among health insurers in basic insurance, there is limited evidence of premium convergence within cantons. This indicates that competition has not been effective so far, and reveals some inertia among consumers who seem reluctant to switch to less expensive funds. We investigate one possible barrier to switching behaviour, namely the influence of supplementary insurance. We use survey data on health plan choice (a sample of 1943 individuals whose switching behaviours were observed between 1997 and 2000) as well as administrative data relative to all insurance companies that operated in the 26 Swiss cantons between 1996 and 2005. The decision to switch and the decision to subscribe to a supplementary contract are jointly estimated.Our findings show that holding a supplementary insurance contract substantially decreases the propensity to switch. However, there is no negative impact of supplementary insurance on switching when the individual assesses his/her health as 'very good'. Our results give empirical support to one possible mechanism through which supplementary insurance might influence switching decisions: given that subscribing to basic and supplementary contracts with two different insurers may induce some administrative costs for the subscriber, holding supplementary insurance acts as a barrier to switch if customers who consider themselves 'bad risks' also believe that insurers reject applications for supplementary insurance on these grounds. In comparison with previous research, our main contribution is to offer a possible explanation for consumer inertia. Our analysis illustrates how consumer choice for one's basic health plan interacts with the decision to subscribe to supplementary insurance. PMID:19267356

  15. Health insurance reform; announcement of maintenance changes to electronic data transaction standards adopted under the Health Insurance Portability and Accountability Act of 1996. Notification.

    PubMed

    2010-10-13

    This document announces maintenance changes to some of the Health Insurance Portability and Accountability Act of 1996 standards made by the Designated Standard Maintenance Organizations. The maintenance changes are non-substantive changes to correct minor errors, such as typographical errors, or to provide clarifications of the standards adopted in our regulations entitled "Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards," published in the Federal Register on January 16, 2009. This document also instructs interested persons on how to obtain the corrections. PMID:20941887

  16. Health Care Costs and the Socioeconomic Consequences of Work Injuries in Brazil: A Longitudinal Study

    PubMed Central

    SANTANA, Vilma Sousa; FERNANDES DE SOUZA, Luis Eugênio Portela; PINTO, Isabela Cardoso de Matos

    2013-01-01

    Work injuries are a worldwide public health problem but little is known about their socioeconomic impact. This prospective longitudinal study estimates the direct health care costs and socioeconomic consequences of work injuries for 406 workers identified in the emergency departments of the two largest public hospitals in Salvador, Brazil, from June through September 2005. After hospital discharge workers were followed up monthly until their return to work. Most insured workers were unaware of their rights or of how to obtain insurance benefits (81.6%). Approximately half the cases suffered loss of earnings, and women were more frequently dismissed than men. The most frequently reported family consequences were: need for a family member to act as a caregiver and difficulties with daily expenses. Total costs were US$40,077.00 but individual costs varied widely, according to injury severity. Out-of-pocket costs accounted for the highest proportion of total costs (50.5%) and increased with severity (57.6%). Most out-of-pocket costs were related to transport and purchasing medicines and other wound care products. The second largest contribution (40.6%) came from the public National Health System − SUS. Employer participation was negligible. Health care funding must be discussed to alleviate the economic burden of work injuries on workers. PMID:23803496

  17. Insights in Public Health: All About the Insurance: The US health-Care System Through a Foreigner's Eyes.

    PubMed

    Pitt, Ruth

    2016-09-01

    Hawai'i had high insurance coverage rates even before the Affordable Health Care Act and continues to have a high percentage of the population with health insurance today. However, high insurance rates can disguise wide variation in what is covered and what it costs. In this essay, an Australian Masters in Public Health student from the University of Hawai'i considers the strengths and weaknesses of insurance coverage in the US health-care system when her friend "Peter" becomes seriously ill. PMID:27688955

  18. Improve medical malpractice law by letting health care insurers take charge.

    PubMed

    Reinker, Kenneth S; Rosenberg, David

    2011-01-01

    This essay discusses unlimited insurance subrogation (UIS) as a means of improving the deterrence and compensation results of medical malpractice law. Under UIS, health care insureds could assign their entire potential medical malpractice claims to their first-party commercial and government insurers. UIS should improve deterrence by establishing first-party insurers as plaintiffs to confront liability insurers on the defense side, leading to more effective prosecution of meritorious claims and reducing meritless and unnecessary litigation. UIS should improve compensation outcomes by converting litigation cost- and risk- laden "tort insurance" into cheaper and enhanced first-party insurance. UIS also promises dynamic benefits through further reforms by contract between the first-party and liability insurers that would take charge of system. No UIS-related costs are apparent that would outweigh these benefits.

  19. Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor.

    PubMed

    Miller, Grant; Pinto, Diana; Vera-Hernández, Marcos

    2013-10-01

    Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia's Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a "fuzzy" regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services - with measurable health gains.

  20. Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor.

    PubMed

    Miller, Grant; Pinto, Diana; Vera-Hernández, Marcos

    2013-10-01

    Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia's Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a "fuzzy" regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services - with measurable health gains. PMID:25346799

  1. Children's Access to Health Insurance and Health Status in Washington State: Influential Factors. Research Brief. Publication #2009-21

    ERIC Educational Resources Information Center

    Matthews, Gregory; Moore, Kristin Anderson; Terzian, Mary

    2009-01-01

    Health insurance, and especially coverage for children, has been a subject of recent political debate in Washington State, as well as on the national stage. Policy makers and health care providers can use high-quality state-level data to assess which children lack health insurance and devise possible solutions to address this need. Illustrating…

  2. About Insurance.

    ERIC Educational Resources Information Center

    Pieslak, Raymond F.

    The student manual for high school level special needs students was prepared to acquaint deaf students with the various types of insurance protection that will be available to them in their future life. Seven units covering the topics of what insurance is, automobile insurance, life insurance, health insurance, social security, homeowner's…

  3. Perceptions and uptake of health insurance for maternal care in rural Kenya: a cross sectional study

    PubMed Central

    Maina, Jackson Michuki; Kithuka, Peter; Tororei, Samuel

    2016-01-01

    Introduction In Kenya, maternal and child health accounts for a large proportion of the expenditures made towards healthcare. It is estimated that one in every five Kenyans has some form of health insurance. Availability of health insurance may protect families from catastrophic spending on health. The study intended to determine the factors affecting the uptake of health insurance among pregnant women in a rural Kenyan district. Methods This was cross-sectional study that sampled 139 pregnant women attending the antenatal clinic at a level 5 hospital in a Kenyan district. The information was collected through a pretested interview schedule. Results The median age of the study participants was 28 years. Out of the 139 respondents, 86(62%) planned to pay for their deliveries through insurance. There was a significant relationship between insurance uptake and marital status Adjusted odds ratio (AOR) 6.4(1.4-28.8). Those with tertiary education were more likely to take up insurance AOR 5.1 (1.3-19.2). Knowing the benefits of insurance and the limits the insurance would settle in claims was associated with an increase in the uptake of insurance AOR 7.6(2.3-25.1), AOR 6.4(1.5-28.3) respectively. Monthly income and number of children did not affect insurance uptake. Results Being married, tertiary education and having some knowledge on how insurance premiums are paid are associated with uptake of medical insurance. Information generated from this study if utilized will bring a better understanding as to why insurance coverage may be low and may provide a basis for policy changes among the insurance companies to increase the uptake. PMID:27279952

  4. Risk distribution across multiple health insurance funds in rural Tanzania

    PubMed Central

    Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika; Hansen, Kristian; Kiwara, Angwara Dennis

    2014-01-01

    Introduction Multiple insurance funds serving different population groups may compromise equity due to differential revenue raising capacity and an unequal distribution of high risk members among the funds. This occurs when the funds exist without mechanisms in place to promote income and risk cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania. Specifically we aim to 1) identify risk factors associated with increased utilisation of health services and 2) compare the distribution of identified risk factors among the CHF, NHIF and non-member households. Methods Data was collected from a survey of 695 households. A multivariate logisitic regression model was used to identify risk factors for increased health care utilisation. Chi-square tests were performed to test whether the distribution of identified risk factors varied across the CHF, NHIF and non-member households. Results There was a higher concentration of identified risk factors among CHF households compared to those of the NHIF. Non-member households have a similar wealth status to CHF households, but a lower concentration of identified risk factors. Conclusion Mechanisms for broader risk spreading and cross-subsidisation across the funds are necessary for the promotion of equity. These include risk equalisation to adjust for differential risk distribution and revenue raising capacity of the funds. Expansion of CHF coverage is equally important, by addressing non-financial barriers to CHF enrolment to encourage wealthy non-members to join, as well as subsidised membership for the poorest. PMID:25574326

  5. Health insurance in India: what do we know and why is ethnographic research needed.

    PubMed

    Ahlin, Tanja; Nichter, Mark; Pillai, Gopukrishnan

    2016-01-01

    The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses. PMID:26828125

  6. Health insurance in India: what do we know and why is ethnographic research needed.

    PubMed

    Ahlin, Tanja; Nichter, Mark; Pillai, Gopukrishnan

    2016-01-01

    The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.

  7. Health, life and disability insurance and hereditary risk for breast or colorectal cancer.

    PubMed

    Norum, J; Tranebjaerg, L

    2000-01-01

    Fear of insurance discrimination affecting the insurance-seeker and family has been reported as the singlemost important reason why individuals choose not to undergo genetic testing. The eleven health insurers operating on the Norwegian market were mailed a questionnaire asking them to list their insurance products and evaluate two individuals' requests for insurance. The requests were constructed in order to illustrate a high genetic risk for (a) colorectal (HNPCC) and (b) breast cancer (BRCAI/BRCA2), respectively. Nine out of 11 insurers responded. While no restriction was documented concerning risk of BRCA1/BRCA2 and life insurance or disability pension, the premium paid by persons with susceptibility to HNPCC varied between the different insurers from standard to raised premiums. The product 'critical disease' insurance was refused or obtained at normal or raised premiums in both cases, depending on the insurer in question. On examining personal indemnity insurance, we found that the BRCA1/BRCA2-risk individual was offered insurance at the standard premium, whereas HNPCC-risk individuals were offered a standard or raised premium. Only the major Norwegian insurer is in fact diverging in its policies.

  8. Covered today, sick tomorrow? Trends and correlates of children's health insurance instability.

    PubMed

    Hill, Heather D; Shaefer, H Luke

    2011-10-01

    Many children with health insurance will experience gaps in coverage over time, potentially reducing their access to and use of preventive health care services. This article uses the Survey of Income and Program Participation to examine how the stability of children's health insurance changed between 1990 and 2005 and to identify dynamic aspects of family life associated with transitions in coverage. Children's health insurance instability has increased since the early 1990s, due to greater movement between insured and uninsured states and between private and public insurance coverage. Changes in the employment and marital status of the family head are highly associated with an increased risk of a child losing and gaining public and private coverage, largely in hypothesized directions. The exception is that marital dissolution and job loss are associated with an increased probability of a child losing public insurance, despite there being no clear policy explanation for such a relationship.

  9. Health Benefits of Volunteering in the Wisconsin Longitudinal Study

    ERIC Educational Resources Information Center

    Piliavin, Jane Allyn; Siegl, Erica

    2007-01-01

    We investigate positive effects of volunteering on psychological well-being and self-reported health using all four waves of the Wisconsin Longitudinal Study. Confirming previous research, volunteering was positively related to both outcome variables. Both consistency of volunteering over time and diversity of participation are significantly…

  10. Evaluating the Impact of Health Insurance Industry Consolidation: Learning from Experience.

    PubMed

    Dafny, Leemore S

    2015-11-01

    Research shows consolidation in the private health insurance industry leads to premium increases, even though insurers with larger local market shares generally obtain lower prices from health care providers. Additional research is needed to understand how to protect against harms and unlock benefits from scale. Data on enrollment, premiums, and costs of commercial health insurance--by insurer, plan, customer segment, and local market--would help us understand whether, when, and for whom consolidation is harmful or beneficial. Such transparency is common where there is a strong public interest and substantial public regulation, both of which characterize this vital sector.

  11. Quality of life and changes in health insurance in long-term home care.

    PubMed

    Gaskamp, Carol D

    2004-01-01

    Changes in health insurance and concomitant changes in quality of life in patients receiving long-term home parenteral nutrition care were explored. A decrease in quality of life and increase in depression were significantly associated with a change of insurance providers. Knowing the importance of health insurance as a family economic resource, nurses working in these settings may be alert for potential socio-emotional problems when health insurance providers change or coverage is less. Policymakers also have an opportunity to ease the financial burden of long-term disease management by expanding coverage for prescription drugs in Medicare benefits.

  12. Closing the gaps in health insurance coverage. Council on Medical Service.

    PubMed

    1986-02-14

    Many persons in the United States are without adequate or any health insurance. Presented here are the details of the American Medical Association's proposal for the establishment of state private insurance pools to address the needs of the short-term unemployed and of state risk-pooling programs to help the medically uninsurable. Also discussed are possible solutions to the problems of a third group, those who cannot afford private health insurance policies or who cannot pay for adequate protection.

  13. The health insurance jigsaw. How to line up an arrangement that will keep you covered.

    PubMed

    Thomas, D

    1995-01-01

    Health insurance options for people who are HIV-positive, while limited, have improved. Experts suggest strategies for HIV-positive people looking for coverage, including using unions, fraternal organizations, high-risk pools, VA insurance, "green card" marriages, and large employer groups and group plans offered by professional associations. Advice is also given for keeping health insurance, particularly for people changing jobs, going on disability, or for those who cannot afford to keep up with the benefits.

  14. Employer-sponsored health insurance: down but not out.

    PubMed

    Christanson, Jon B; Tu, Ha T; Samuel, Divya R

    2011-10-01

    Rising costs and the lingering fallout from the great recession are altering the calculus of employer approaches to offering health benefits, according to findings from the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Employers responded to the economic downturn by continuing to shift health care costs to employees, with the trend more pronounced in small, mid-sized and low-wage firms. At the same time, employers and health plans are dissatisfied and frustrated with their inability to influence medical cost trends by controlling utilization or negotiating more-favorable provider contracts. In an alternative attempt to control costs, employers increasingly are turning to wellness programs, although the payoff remains unclear. Employer uncertainty about how national reform will affect their health benefits programs suggests they are likely to continue their current course in the near term. Looking toward 2014 when many reform provisions take effect, employer responses likely will vary across communities, reflecting differences in state approaches to reform implementation, such as insurance exchange design, and local labor market conditions.

  15. [Use of routine data from statutory health insurances for federal health monitoring purposes].

    PubMed

    Ohlmeier, C; Frick, J; Prütz, F; Lampert, T; Ziese, T; Mikolajczyk, R; Garbe, E

    2014-04-01

    Federal health monitoring deals with the state of health and the health-related behavior of populations and is used to inform politics. To date, the routine data from statutory health insurances (SHI) have rarely been used for federal health monitoring purposes. SHI routine data enable analyses of disease frequency, risk factors, the course of the disease, the utilization of medical services, and mortality rates. The advantages offered by SHI routine data regarding federal health monitoring are the intersectoral perspective and the nearly complete absence of recall and selection bias in the respective population. Further, the large sample sizes and the continuous collection of the data allow reliable descriptions of the state of health of the insurants, even in cases of multiple stratification. These advantages have to be weighed against disadvantages linked to the claims nature of the data and the high administrative hurdles when requesting the use of SHI routine data. Particularly in view of the improved availability of data from all SHI insurants for research institutions in the context of the "health-care structure law", SHI routine data are an interesting data source for federal health monitoring purposes.

  16. Understanding perception and factors influencing private voluntary health insurance policy subscription in the Lucknow region

    PubMed Central

    Mathur, Tanuj; Paul, Ujjwal Kanti; Prasad, Himanshu Narayan; Das, Subodh Chandra

    2015-01-01

    Background: Health insurance has been acknowledged by researchers as a valuable tool in health financing. In spite of its significance, a subscription paralysis has been observed in India for this product. People who can afford health insurance are also found to be either ignorant or aversive towards it. This study is designed to investigate into the socio-economic factors, individuals’ health insurance product perception and individuals’ personality traits for unbundling the paradox which inhibits people from subscribing to health insurance plans. Methods: This survey was conducted in the region of Lucknow. An online questionnaire was sent to sampled respondents. Response evinced by 263 respondents was formed as a part of study for the further data analysis. For assessing the relationships between variables T-test and F-test were applied as a part of quantitative measuring tool. Finally, logistic regression technique was used to estimate the factors that influence respondents’ decision to purchase health insurance. Results: Age, dependent family members, medical expenditure, health status and individual’s product perception were found to be significantly associated with health insurance subscription in the region. Personality traits have also showed a positive relationship with respondent’s insurance status. Conclusion: We found in our study that socio-economic factors, individuals’ product perception and personality traits induces health insurance policy subscription in the region. PMID:25674567

  17. Real Decision Support for Health Insurance Policy Selection.

    PubMed

    Stein, Roger M

    2016-03-01

    We report on an ongoing project to develop data-driven tools to help individuals make better choices about health insurance and to better understand the range of costs to which they are exposed under different health plans. We describe a simulation tool that we developed to evaluate the likely usage and costs for an individual and family under a wide range of health service usage outcomes, but that can be tailored to specific physicians and the needs of the user and to reflect the demographics and other special attributes of the family. The simulator can accommodate, for example, specific known physician visits or planned procedures, while also generating statistically reasonable "unexpected" events like ER visits or catastrophic diagnoses. On the other hand, if a user provides only a small amount of information (e.g., just information about the family members), the simulator makes a number of generic assumptions regarding physician usage, etc., based on the age, gender, and other features of the family. Data to parameterize all of these events is informed by a combination of the information provided by the user and a series of specialized databases that we have compiled based on publicly available government data and commercial data as well as our own analysis of this initially very coarse and rigid data. To demonstrate both the subtlety of choosing a healthcare plan and the degree to which the simulator can aid in such evaluations, we present sample results using real insurance plans and two example policy shoppers with different demographics and healthcare needs. PMID:27441582

  18. Concepts for NASA longitudinal health studies

    NASA Technical Reports Server (NTRS)

    Nicogossian, A. E.; Pool, S. L.; Leach, C. S.; Moseley, E.; Rambaut, P. C.

    1983-01-01

    Clinical data collected from a 15-year study of the homogenous group of pre-Shuttle astronauts have revealed no significant long-term effects from spaceflight. The current hypothesis suggests that repeated exposures to the space environment in the Shuttle era will similarly have no long-term health effects. However, a much more heterogenous group of astronauts and non-astronaut scientists will fly in Shuttle, and data on this group's adaptation to the space environment and readaptation to earth are currently sparse. In addition, very little information is available concerning the short- and long-term medical consequences of long duration exposure to space and subsequent readaptation to the earth environment. In this paper, retrospective clinical information on astronauts is reviewed and concepts for conducting epidemiological studies examining long-term health effects of spaceflight on humans, including associated occupational risks factors, are presented.

  19. Statutory health insurance competition in Europe: a four-country comparison.

    PubMed

    Thomson, Sarah; Busse, Reinhard; Crivelli, Luca; van de Ven, Wynand; Van de Voorde, Carine

    2013-03-01

    This paper explores the goals and implementation of reforms introducing choice of and competition among insurers providing statutory health coverage in Belgium, Germany, the Netherlands and Switzerland. In theory, health insurance competition can enhance efficiency in health care administration and delivery only if people have free choice of insurer (consumer mobility), if insurers do not have incentives to select risks, and if insurers are able to influence health service quality and costs. In practice, reforms in the four countries have not always prioritised efficiency and implementation has varied. Differences in policy goals explain some but not all of the differences in implementation. Despite significant investment in risk adjustment, incentives for risk selection remain and consumer mobility is not evenly distributed across the population. Better risk adjustment might make it easier for older and less healthy people to change insurer. Policy makers could also do more to prevent insurers from linking the sale of statutory and voluntary health insurance, particularly where take-up of voluntary coverage is widespread. Collective negotiation between insurers and providers in Belgium, Germany and Switzerland curbs insurers' ability to influence health care quality and costs. Nevertheless, while insurers in the Netherlands have good access to efficiency-enhancing tools, data and capacity constraints and resistance from stakeholders limit the extent to which tools are used. The experience of these countries offers an important lesson to other countries: it is not straightforward to put in place the conditions under which health insurance competition can enhance efficiency. Policy makers should not, therefore, underestimate the challenges involved. PMID:23395277

  20. Policy change and private health insurance: did the cheapest policy do the trick?

    PubMed

    Butler, James R G

    2002-01-01

    From the introduction of Australia's national health insurance scheme (Medicare) in 1984 until recently, the proportion of the population covered by private health insurance declined steadily. Following an Industry Commission inquiry into the private health insurance industry in 1997, a number of policy changes were effected in an attempt to reverse this trend. The main policy changes were of two types: "carrots and sticks" financial incentives that provided subsidies for purchasing, or tax penalties for not purchasing, private health insurance; and lifetime community rating, which aimed to revise the community rating regulations governing private health insurance in Australia. This paper argues that the membership uptake that has occurred recently is largely attributable to the introduction of lifetime community rating which goes some way towards addressing the adverse selection associated with the previous community rating regulations. This policy change had virtually no cost to government. However, it was introduced after subsidies for private health insurance were already in place. The chronological sequencing of these policies has resulted in substantial increases in government expenditure on private health insurance subsidies, with such increases not being a cause but rather an effect of increased demand for private health insurance. The paper also considers whether the decline in membership that has occurred since the implementation of lifetime community rating presages the re-emergence of an adverse selection problem in private health insurance. Much of the decline to date may be attributable to failure on the part of some members to honour premium payments when they first fell due. However, the changing age composition of the insured pool since September 2000, resulting in an increasing average age of those insured, suggests the possible reappearance of an adverse selection dynamic. Thus the 'trick' delivered by lifetime community ratings may not be

  1. Policy change and private health insurance: did the cheapest policy do the trick?

    PubMed

    Butler, James R G

    2002-01-01

    From the introduction of Australia's national health insurance scheme (Medicare) in 1984 until recently, the proportion of the population covered by private health insurance declined steadily. Following an Industry Commission inquiry into the private health insurance industry in 1997, a number of policy changes were effected in an attempt to reverse this trend. The main policy changes were of two types: "carrots and sticks" financial incentives that provided subsidies for purchasing, or tax penalties for not purchasing, private health insurance; and lifetime community rating, which aimed to revise the community rating regulations governing private health insurance in Australia. This paper argues that the membership uptake that has occurred recently is largely attributable to the introduction of lifetime community rating which goes some way towards addressing the adverse selection associated with the previous community rating regulations. This policy change had virtually no cost to government. However, it was introduced after subsidies for private health insurance were already in place. The chronological sequencing of these policies has resulted in substantial increases in government expenditure on private health insurance subsidies, with such increases not being a cause but rather an effect of increased demand for private health insurance. The paper also considers whether the decline in membership that has occurred since the implementation of lifetime community rating presages the re-emergence of an adverse selection problem in private health insurance. Much of the decline to date may be attributable to failure on the part of some members to honour premium payments when they first fell due. However, the changing age composition of the insured pool since September 2000, resulting in an increasing average age of those insured, suggests the possible reappearance of an adverse selection dynamic. Thus the 'trick' delivered by lifetime community ratings may not be

  2. Ten Ways Community Organizations Can Link Children to Medicaid (and Other Public Health Insurance Programs).

    ERIC Educational Resources Information Center

    Center on Budget and Policy Priorities, Washington, DC.

    Ten ways community organizations, which may include schools, can link children to Medicaid and other public health insurance programs are listed. They are: (1) disseminate information about the availability of health insurance for children in low-income families; (2) incorporate Medicaid income eligibility screening as part of the program's…

  3. AIDS and Health Insurance: An OTA Survey. AIDS-Related Issues Staff Paper 2.

    ERIC Educational Resources Information Center

    Eden, Jill

    The United States Office of Technology Assessment (OTA) conducted a study designed to provide a view of human immunodeficiency virus (HIV) testing in the context of other routine tests required by health insurers. The study was undertaken to collect basic information on underwriting practices and the use of medical screening by health insurers and…

  4. School Nurses' Perceptions and Practices of Assisting Students in Obtaining Public Health Insurance

    ERIC Educational Resources Information Center

    Rickard, Megan L.; Hendershot, Candace; Khubchandani, Jagdish; Price, James H.; Thompson, Amy

    2010-01-01

    Background: From January through June 2009, 6.1 million children were uninsured in the United States. On average, students with health insurance are healthier and as a result are more likely to be academically successful. Some schools help students obtain health insurance with the help of school nurses. Methods: This study assessed public school…

  5. 22 CFR 146.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 146.440 Health and insurance... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Health and insurance benefits and services....

  6. 43 CFR 41.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.440 Health and insurance... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Health and insurance benefits and...

  7. 7 CFR 15a.39 - Health and insurance benefits and services.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 1 2013-01-01 2013-01-01 false Health and insurance benefits and services. 15a.39... RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs and Activities Prohibited § 15a.39 Health and insurance benefits and services. In providing...

  8. 49 CFR 25.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 25.440 Health and insurance benefits and... 49 Transportation 1 2011-10-01 2011-10-01 false Health and insurance benefits and services....

  9. 22 CFR 229.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 229.440 Health and insurance... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Health and insurance benefits and services....

  10. 40 CFR 5.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 5.440 Health and insurance... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Health and insurance benefits...

  11. 43 CFR 41.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.440 Health and insurance... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Health and insurance benefits and...

  12. 28 CFR 54.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 54.440 Health and insurance... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Health and insurance benefits...

  13. 43 CFR 41.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.440 Health and insurance... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Health and insurance benefits and...

  14. 15 CFR 8a.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 8a.440 Health and insurance... 15 Commerce and Foreign Trade 1 2011-01-01 2011-01-01 false Health and insurance benefits...

  15. 6 CFR 17.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 17.440 Health and insurance... 6 Domestic Security 1 2012-01-01 2012-01-01 false Health and insurance benefits and services....

  16. 6 CFR 17.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 17.440 Health and insurance... 6 Domestic Security 1 2011-01-01 2011-01-01 false Health and insurance benefits and services....

  17. 31 CFR 28.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 28.440 Health and insurance... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Health and insurance benefits...

  18. 40 CFR 5.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 5.440 Health and insurance... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Health and insurance benefits...

  19. 43 CFR 41.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.440 Health and insurance... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Health and insurance benefits and...

  20. 7 CFR 15a.39 - Health and insurance benefits and services.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 1 2012-01-01 2012-01-01 false Health and insurance benefits and services. 15a.39... RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs and Activities Prohibited § 15a.39 Health and insurance benefits and services. In providing...

  1. 32 CFR 196.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 2 2014-07-01 2014-07-01 false Health and insurance benefits and services. 196... Activities Prohibited § 196.440 Health and insurance benefits and services. Subject to § 196.235(d), in... students, a recipient shall not discriminate on the basis of sex, or provide such benefit, service,...

  2. 22 CFR 146.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Health and insurance benefits and services. 146... the Basis of Sex in Education Programs or Activities Prohibited § 146.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would...

  3. 22 CFR 229.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Health and insurance benefits and services. 229... on the Basis of Sex in Education Programs or Activities Prohibited § 229.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would...

  4. 49 CFR 25.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Basis of Sex in Education Programs or Activities Prohibited § 25.440 Health and insurance benefits and... 49 Transportation 1 2012-10-01 2012-10-01 false Health and insurance benefits and services. 25.440... from providing any benefit or service that may be used by a different proportion of students of one...

  5. 10 CFR 5.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Health and insurance benefits and services. 5.440 Section... Education Programs or Activities Prohibited § 5.440 Health and insurance benefits and services. Subject to... benefit or service that may be used by a different proportion of students of one sex than of the...

  6. 28 CFR 54.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Health and insurance benefits and... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 54.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would...

  7. 6 CFR 17.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 6 Domestic Security 1 2014-01-01 2014-01-01 false Health and insurance benefits and services. 17... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 17.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would...

  8. 22 CFR 146.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Health and insurance benefits and services. 146... the Basis of Sex in Education Programs or Activities Prohibited § 146.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would...

  9. 44 CFR 19.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Health and insurance benefits... Education Programs or Activities Prohibited § 19.440 Health and insurance benefits and services. Subject to... benefit or service that may be used by a different proportion of students of one sex than of the...

  10. 36 CFR 1211.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Health and insurance benefits... Activities Prohibited § 1211.440 Health and insurance benefits and services. Subject to § 1211.235(d), in... students, a recipient shall not discriminate on the basis of sex, or provide such benefit, service,...

  11. 44 CFR 19.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Health and insurance benefits... Education Programs or Activities Prohibited § 19.440 Health and insurance benefits and services. Subject to... benefit or service that may be used by a different proportion of students of one sex than of the...

  12. 45 CFR 618.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false Health and insurance benefits and services. 618....440 Health and insurance benefits and services. Subject to § 618.235(d), in providing a medical... shall not discriminate on the basis of sex, or provide such benefit, service, policy, or plan in...

  13. 31 CFR 28.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Health and insurance benefits and... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 28.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would...

  14. 40 CFR 5.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Health and insurance benefits and... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 5.440 Health and insurance... of sex, or provide such benefit, service, policy, or plan in a manner that would violate §§...

  15. 34 CFR 106.39 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 1 2014-07-01 2014-07-01 false Health and insurance benefits and services. 106.39... Prohibited § 106.39 Health and insurance benefits and services. In providing a medical, hospital, accident... discriminate on the basis of sex, or provide such benefit, service, policy, or plan in a manner which...

  16. 34 CFR 106.39 - Health and insurance benefits and services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 1 2013-07-01 2013-07-01 false Health and insurance benefits and services. 106.39... Prohibited § 106.39 Health and insurance benefits and services. In providing a medical, hospital, accident... discriminate on the basis of sex, or provide such benefit, service, policy, or plan in a manner which...

  17. 28 CFR 54.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Health and insurance benefits and... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 54.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would...

  18. 13 CFR 113.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Health and insurance benefits and....440 Health and insurance benefits and services. Subject to § 113.235(d), in providing a medical... shall not discriminate on the basis of sex, or provide such benefit, service, policy, or plan in...

  19. 15 CFR 8a.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 15 Commerce and Foreign Trade 1 2013-01-01 2013-01-01 false Health and insurance benefits and... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 8a.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would...

  20. 15 CFR 8a.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 15 Commerce and Foreign Trade 1 2014-01-01 2014-01-01 false Health and insurance benefits and... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 8a.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would...