WorldWideScience

Sample records for group health insurance

  1. Health Insurance Competition : The Effect of Group Contracts

    NARCIS (Netherlands)

    Boone, J.; Douven, R.C.M.H.; Droge, C.; Mosca, I.

    2010-01-01

    In countries like the US and the Netherlands health insurance is provided by private firms. These private firms can offer both individual and group contracts. The strategic and welfare implications of such group contracts are not well understood. Using a Dutch data set of about 700 group health insu

  2. 76 FR 46677 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Coverage of...

    Science.gov (United States)

    2011-08-03

    ... Internal Revenue Service 26 CFR Part 54 RIN 1545-BJ58 Requirements for Group Health Plans and Health... Center for Consumer Information & Insurance Oversight of the U.S. Department of Health and Human Services... with respect to group health plans and health insurance coverage offered in connection with a group...

  3. 75 FR 34571 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

    Science.gov (United States)

    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 issuers...

  4. 76 FR 46621 - Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under...

    Science.gov (United States)

    2011-08-03

    ...-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 of... to group health plans and group health insurance issuers on August 1, 2011. ADDRESSES: Written...

  5. 75 FR 70114 - Amendment to the Interim Final Rules for Group Health Plans and Health Insurance Coverage...

    Science.gov (United States)

    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 and...

  6. 76 FR 44491 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

    Science.gov (United States)

    2011-07-26

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

  7. 75 FR 70159 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

    Science.gov (United States)

    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 similar...

  8. 75 FR 27141 - Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age...

    Science.gov (United States)

    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 the...

  9. Health Insurance

    Science.gov (United States)

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

  10. 5 CFR 352.309 - Retirement, health benefits, and group life insurance.

    Science.gov (United States)

    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...

  11. 75 FR 27121 - Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Dependent...

    Science.gov (United States)

    2010-05-13

    ... Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 Under the... and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 Under the Patient... implementing the requirements for group health plans and health insurance issuers in the group and individual...

  12. 75 FR 43329 - Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal...

    Science.gov (United States)

    2010-07-23

    ... Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External... CFR Part 147 RIN 0991-AB70 Interim Final Rules for Group Health Plans and Health Insurance Issuers... Administration, Department of Labor; Office of Consumer Information and Insurance Oversight, Department of Health...

  13. Health Benefits Mandates and Their Potential Impacts on Racial/Ethnic Group Disparities in Insurance Markets.

    Science.gov (United States)

    Charles, Shana Alex; Ponce, Ninez; Ritley, Dominique; Guendelman, Sylvia; Kempster, Jennifer; Lewis, John; Melnikow, Joy

    2017-08-01

    Addressing racial/ethnic group disparities in health insurance benefits through legislative mandates requires attention to the different proportions of racial/ethnic groups among insurance markets. This necessary baseline data, however, has proven difficult to measure. We applied racial/ethnic data from the 2009 California Health Interview Survey to the 2012 California Health Benefits Review Program Cost and Coverage Model to determine the racial/ethnic composition of ten health insurance market segments. We found disproportional representation of racial/ethnic groups by segment, thus affecting the health insurance impacts of benefit mandates. California's Medicaid program is disproportionately Latino (60 % in Medi-Cal, compared to 39 % for the entire population), and the individual insurance market is disproportionately non-Latino white. Gender differences also exist. Mandates could unintentionally increase insurance coverage racial/ethnic disparities. Policymakers should consider the distribution of existing racial/ethnic disparities as criteria for legislative action on benefit mandates across health insurance markets.

  14. 75 FR 34537 - Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a...

    Science.gov (United States)

    2010-06-17

    ... Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection...-AB68 Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a... Consumer Information and Insurance Oversight, Department of Health and Human Services. ACTION: Interim...

  15. Self-insurance and the potential effects of health reform on the small-group market.

    Science.gov (United States)

    Linehan, Kathryn

    2010-12-21

    The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers--most often those in very large firms--are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA provisions become effective, some have argued that smaller firms that offer insurance may opt to self-insure their health benefits because of new small-group market rules. Such a shift could affect risk pooling in the small-group market. This paper examines the definition and prevalence of self-insured health plans, the application of PPACA provisions to these plans, and the possible effects on the broader health insurance market, should many more employers decide to self-insure.

  16. 75 FR 37242 - Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and...

    Science.gov (United States)

    2010-06-28

    ... Revenue Service 26 CFR Part 54 RIN 1545-BJ57 Requirements for Group Health Plans and Health Insurance..., Health care, Health insurance, Pensions, Reporting and recordkeeping requirements. Proposed Amendments to... U.S. Department of Health and Human Services are issuing substantially similar interim final...

  17. Health Insurance Basics

    Science.gov (United States)

    ... Can I Help Someone Who's Being Bullied? Volunteering 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 ...

  18. [Health Care Insurance in France: its impact on income distribution between age and social groups].

    Science.gov (United States)

    Fourcade, N; Duval, J; Lardellier, R

    2013-08-01

    Our study, based on microsimulation models, evaluates the redistributive impact of health care insurance in France on income distribution between age and social groups. This work sheds light on the debate concerning the respective role of the public health care insurance (PHI) and the private supplemental health care insurance (SHI) in France. The analysis points out that the PHI enables the lowest-income households and the pensioners a better access to health care than they would have had under a complete private SHI. Due to the progressivity of taxes, low-income households contribute less to the PHI and get higher benefits because of a weaker health. Pensioners have low contributions to public health care finance but the highest health care expenditures.

  19. HEALTH INSURANCE

    CERN Multimedia

    2000-01-01

    The CERN-AUSTRIA Agreement, which implemented CERN's health insurance scheme, expired on 31 December 1999.In accordance with CERN's rules, a call for tenders for the management of the health insurance scheme was issued and the contract was once again awarded to AUSTRIA. In June 1999, the Finance Committee thus authorised the Management to conclude a new contract with AUSTRIA, which came into force on 1st January 2000.Continuity is thus assured on favourable conditions and the transition from one contract to the other will entail no substantial changes in the system for those insured at CERN except for a few minor and purely formal amendmentsWHAT REMAINS UNCHANGEDThe list of benefits, i.e. the 'cover' provided by the system, is not changed;Neither is the reimbursement procedure.AUSTRIA's office at CERN and its opening hours as well as its city headquarters remain the same. The envelopes containing requests for reimbursement have had to be sent (since the end of 1998) to :Rue des Eaux-Vives 94Case postale 64021...

  20. HEALTH INSURANCE

    CERN Multimedia

    Division HR

    2000-01-01

    Change of name for AUSTRIA As of October 1, the AUSTRIA Assurances S.A. company will change its name to: UNIQA Assurances S.A. It inherits the same name as its parent Austrian company, which adopted it towards the end of 1999. This change has no effect on the contract which binds it to CERN for the administration of our Health Insurance Scheme. New insurance cards will be sent to you by UNIQA and the printed forms and envelopes will gradually be updated with the new name. Postal and phone addresses remain unaffected by the change. You should address your postal mail to: UNIQA Assurances rue des Eaux Vives 94 case postale 6402 1211 Genève 6 You may telephone your usual contact persons at the same numbers as before and send e-mails to the UNIQA office at CERN at: UNIQA.Assurances@cern.ch

  1. Veterans' Group Life Insurance (VGLI) no-health period extension. Final rule.

    Science.gov (United States)

    2012-11-01

    The Department of Veterans Affairs (VA) is issuing this final rule that amends the regulations governing eligibility for Veterans' Group Life Insurance (VGLI) to extend to 240 days the current 120-day "no-health" period during which veterans can apply for VGLI without proving that they are in good health for insurance purposes. The purpose of this rule is to increase the opportunities for disabled veterans to enroll in VGLI, some of whom would not qualify for VGLI coverage under existing provisions. This document adopts as a final rule, without change, the proposed rule published in the Federal Register on June 25, 2012.

  2. Expanding health insurance coverage in vulnerable groups: a systematic review of options.

    Science.gov (United States)

    Meng, Qingyue; Yuan, Beibei; Jia, Liying; Wang, Jian; Yu, Baorong; Gao, Jun; Garner, Paul

    2011-03-01

    Vulnerable groups are often not covered by health insurance schemes. Strategies to extend coverage in these groups will help to address inequity. We used the existing literature to summarize the options for expanding health insurance coverage, describe which countries have tried these strategies, and identify and describe evaluation studies. We included any report of a policy or strategy to expand health insurance coverage and any evaluation and economic modelling studies. Vulnerable populations were defined as children, the elderly, women, low-income individuals, rural population, racial or ethnic minorities, immigrants, and those with disability or chronic diseases. Forty-five databases were searched for relevant documents. The authors applied inclusion criteria, and extracted data using pre-coded forms, on contents of health insurance schemes or programmes, and used the framework approach to establish categories. Of the 21,528 articles screened, 86 documents were finally included. Descriptions about the USA dominated (72), with only five from Africa, six from Asia and two from South America. We identified six main categories: (1) changing eligibility criteria of health insurance; (2) increasing public awareness; (3) making the premium more affordable; (4) innovative enrollment strategies; (5) improving health care delivery; and (6) improving management and organization of the insurance schemes. All six categories were found in the literature about schemes in the USA, and schemes often included components from each category. Strategies in developing countries were much more limited in their scope. Evaluation studies numbered 25, of which the majority were of time series design. All studies found that the expansion strategies were effective, as assessed by the author(s). In countries expanding coverage, the categories identified from the literature can help policy makers consider their options, implement strategies where it is common sense to do so and establish

  3. 77 FR 37839 - Veterans' Group Life Insurance (VGLI) No-Health Period Extension

    Science.gov (United States)

    2012-06-25

    ... removal of the words ``Servicemembers' Group Life Insurance or,'' which refers to Retired Reservist SGLI... 38 CFR Part 9 Life insurance, Military personnel, Veterans. Dated: June 20, 2012. Robert C....

  4. Women's Health Insurance Coverage

    Science.gov (United States)

    ... Women's Health Policy Women’s Health Insurance Coverage Women’s Health Insurance Coverage Oct 21, 2016 Facebook Twitter LinkedIn Email ... of the ACA on women’s coverage. Sources of Health Insurance Coverage Employer-Sponsored Insurance: Approximately 57.5 million ...

  5. Group life insurance

    CERN Multimedia

    2013-01-01

    The CERN Administration wishes to inform staff members and fellows having taken out optional life insurance under the group contract signed by CERN that the following changes to the rules and regulations entered into force on 1 January 2013:   The maximum age for an active member has been extended from 65 to 67 years. The beneficiary clause now allows insured persons to designate one or more persons of their choice to be their beneficiary(-ies), either at the time of taking out the insurance or at a later date, in which case the membership/modification form must be updated accordingly. Beneficiaries must be clearly identified (name, first name, date of birth, address).   The membership/modification form is available on the FP website: http://fp.web.cern.ch/helvetia-life-insurance For further information, please contact: Valentina Clavel (Tel. 73904) Peggy Pithioud (Tel. 72736)

  6. EMPLOYEE GROUP PROPERTY AND LIABILITY INSURANCE.

    Science.gov (United States)

    FIELD, IRVING M.

    AN ATTEMPT IS MADE TO ESTABLISH A THEORETICAL FOUNDATION FOR GROUP PROPERTY AND LIABILITY INSURANCE AND TO ADVANCE THE GENERAL HYPOTHESIS THAT THE PRINCIPLES USED IN INSTALLING AND ADMINISTERING GROUP LIFE AND HEALTH INSURANCE ARE APPLICABLE TO THE INSTALLATION AND ADMINISTRATION OF GROUP PROPERTY AND LIABILITY INSURANCE. A SURVEY WAS CONDUCTED TO…

  7. Understanding health insurance plans

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000879.htm Understanding health insurance plans To use the sharing features on this ... plan for you and your family. Types of Health Insurance Plans Depending on how you get your health ...

  8. Group Life Insurance

    CERN Multimedia

    2013-01-01

    The CERN Administration would like to remind you that staff members and fellows have the possibility to take out a life insurance contract on favourable terms through a Group Life Insurance.   This insurance is provided by the company Helvetia and is available to you on a voluntary basis. The premium, which varies depending on the age and gender of the person insured, is calculated on the basis of the amount of the death benefit chosen by the staff member/fellow and can be purchased in slices of 10,000 CHF.    The contract normally ends at the retirement age (65/67 years) or when the staff member/fellow leaves the Organization. The premium is deducted monthly from the payroll.   Upon retirement, the staff member can opt to maintain his membership under certain conditions.   More information about Group Life Insurance can be found at: Regulations (in French) Table of premiums The Pension Fund Benefit Service &...

  9. Alternative health insurance schemes

    DEFF Research Database (Denmark)

    Keiding, Hans; Hansen, Bodil O.

    2002-01-01

    In this paper, we present a simple model of health insurance with asymmetric information, where we compare two alternative ways of organizing the insurance market. Either as a competitive insurance market, where some risks remain uninsured, or as a compulsory scheme, where however, the level...... competitive insurance; this situation turns out to be at least as good as either of the alternatives...

  10. Portability of health insurance: COBRA expansions and small group market reform.

    Science.gov (United States)

    Fronstin, P

    1995-10-01

    Proposals are currently being put forth to change the health care system incrementally. One area of proposed legislation addresses portability, which allows an individual to change insurers without being subjected to a new waiting period for preexisting conditions. These proposals, discussed in this Issue Brief, contain provisions to limit preexisting condition exclusions, guarantee access to health insurance, guarantee renewal of health insurance, allow individuals to contribute to medical savings accounts on a pretax basis, and change the current law under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). The proposals would affect insurers, employers, and insured individuals by potentially increasing the cost of providing and purchasing health insurance. Concern about the portability of health insurance primarily arises in situations where an individual is leaving, or would like to leave, a job. If health insurance is not offered by a prospective employer, if the worker must satisfy a waiting period before becoming eligible for coverage, if the benefits package offered through the prospective employer is less generous, or if the employee (or a dependent) has a medical condition that is considered a preexisting condition and would not be covered by the new plan, the employee may opt to remain with his or her current employer--a situation known as job lock. Expansions of COBRA may not have any effect on portability. Employers can charge up to 102 percent of the premium for COBRA coverage, making it unaffordable for many workers. Because cost is a major factor, if there is no reduction in cost (or health care cost inflation) there could be little or no increase in coverage. According to one survey, in 1994 average COBRA costs were $5,301 per COBRA covered worker, compared with $3,420 for active employees. Any expansion of COBRA would almost certainly increase employer cost for health insurance.(ABSTRACT TRUNCATED AT 400 WORDS)

  11. Social health insurance

    CERN Document Server

    International Labour Office. Geneva

    1997-01-01

    This manual provides an overview of social health insurance schemes and looks at the development of health care policies and feasibility issues. It also examines the design of health insurance schemes, health care benefits, financing and costs and considers the operational and strategic information requirements.

  12. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia.

    Science.gov (United States)

    Vilcu, Ileana; Probst, Lilli; Dorjsuren, Bayarsaikhan; Mathauer, Inke

    2016-10-04

    Many low- and middle-income countries with a social health insurance system face challenges on their road towards universal health coverage (UHC), especially for people in the informal sector and vulnerable population groups or the informally employed. One way to address this is to subsidize their contributions through general government revenue transfers to the health insurance fund. This paper provides an overview of such health financing arrangements in Asian low- and middle-income countries. The purpose is to assess the institutional design features of government subsidized health insurance type arrangements for vulnerable and informally employed population groups and to explore how these features contribute to UHC progress. This regional study is based on a literature search to collect country information on the specific institutional design features of such subsidization arrangements and data related to UHC progress indicators, i.e. population coverage, financial protection and access to care. The institutional design analysis focuses on eligibility rules, targeting and enrolment procedures; financing arrangements; the pooling architecture; and benefit entitlements. Such financing arrangements currently exist in 8 countries with a total of 14 subsidization schemes. The most frequent groups covered are the poor, older persons and children. Membership in these arrangements is mostly mandatory as is full subsidization. An integrated pool for both the subsidized and the contributors exists in half of the countries, which is one of the most decisive features for equitable access and financial protection. Nonetheless, in most schemes, utilization rates of the subsidized are higher compared to the uninsured, but still lower compared to insured formal sector employees. Total population coverage rates, as well as a higher share of the subsidized in the total insured population are related with broader eligibility criteria. Overall, government subsidized health

  13. Health insurance for "frontaliers"

    CERN Multimedia

    2013-01-01

    The French government has decided that, with effect from 1 June 2014, persons resident in France but working in Switzerland (hereinafter referred to as “frontaliers”) will no longer be entitled to opt for private French health insurance provision as their sole and principal health insurance.   The right of choice, which was granted by the Bilateral Agreement on the Free Movement of Persons between Switzerland and the European Union and which came into force on 1 June 2002, exempts “frontaliers” from the obligation to become a member of Switzerland’s compulsory health insurance scheme (LAMal) if they can prove that they have equivalent coverage in France, provided by either the French social security system (CMU) or a private French insurance provider. As the latter option of private health insurance as an alternative to membership of LAMal will be revoked under the new French legislation that will come into force on 1 June 2014, current “...

  14. Social insurance for health service.

    Science.gov (United States)

    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.

  15. 让团体健康保险健康发展%The Healthy Development of Group Health Insurance

    Institute of Scientific and Technical Information of China (English)

    彭守一; 李青青

    2015-01-01

    2014年8月13日,被称为“保险新国十条”的《国务院关于加快发展现代保险服务业的若干意见》正式发布,8月27日,国务院常务会议专门安排部署发展商业健康保险事宜,同时审议通过《关于加快发展商业健康保险的若干意见》。这些政策不仅使商业健康保险的发展完成了顶层设计,而且为中国商业健康保险的深化改革和转型升级注入了持久的动力。中国保监会时隔9年再次发文促进团体保险健康发展,这将推进商业健康保险专业化经营和健康保险业态的变革。%“Several Opinions of the State Council on Accelerating the Development of Modern Insurance Services”, which was called“New 10 National Notices about Insurance”was published formally on Aug 13, 2014. The development about commercial health insurance was arranged dedicatedly at the State Council Executive Meeting, and then, “Some Opinions on Speeding up the Development of Commercial Health Insurance” was deliberated and approved on Aug 27. It not only pushes the top layer designs for commercial health insurance development, but also injects lasting motivation for its deepened reform, transformation and upgrading. After a gap of 9 years, CIRC (China Insurance Regulatory Commission) issued a document again to promote the healthy development of group health insurance. It will further promote the specialization of commercial health insurance and the change of health insurance industry.

  16. Health insurance basic actuarial models

    CERN Document Server

    Pitacco, Ermanno

    2014-01-01

    Health Insurance aims at filling a gap in actuarial literature, attempting to solve the frequent misunderstanding in regards to both the purpose and the contents of health insurance products (and ‘protection products’, more generally) on the one hand, and the relevant actuarial structures on the other. In order to cover the basic principles regarding health insurance techniques, the first few chapters in this book are mainly devoted to the need for health insurance and a description of insurance products in this area (sickness insurance, accident insurance, critical illness covers, income protection, long-term care insurance, health-related benefits as riders to life insurance policies). An introduction to general actuarial and risk-management issues follows. Basic actuarial models are presented for sickness insurance and income protection (i.e. disability annuities). Several numerical examples help the reader understand the main features of pricing and reserving in the health insurance area. A short int...

  17. The intention to switch health insurer and actual switching behaviour: are there differences between groups of people?

    NARCIS (Netherlands)

    Hendriks, M.; Jong, J.D. de; Brink-Muinen, A. van den; Groenewegen, P.P.

    2010-01-01

    Background: Several western countries have introduced managed competition in their health care system. In the Netherlands, a new health insurance law was introduced in January 2006 making it easier to switch health insurer each year. Objective: The objective was to measure people's intention to swi

  18. The intention to switch health insurer and actual switching behaviour : are there differences between groups of people?

    NARCIS (Netherlands)

    Hendriks, Michelle; Jong, Judith D. de; Brink-Muinen, Atie van den; Groenewegen, Peter P.

    2010-01-01

    Background Several western countries have introduced managed competition in their health care system. In the Netherlands, a new health insurance law was introduced in January 2006 making it easier to switch health insurer each year. Objective The objective was to measure peoples intention to switch

  19. Deductibles in health insurance

    Science.gov (United States)

    Dimitriyadis, I.; Öney, Ü. N.

    2009-11-01

    This study is an extension to a simulation study that has been developed to determine ruin probabilities in health insurance. The study concentrates on inpatient and outpatient benefits for customers of varying age bands. Loss distributions are modelled through the Allianz tool pack for different classes of insureds. Premiums at different levels of deductibles are derived in the simulation and ruin probabilities are computed assuming a linear loading on the premium. The increase in the probability of ruin at high levels of the deductible clearly shows the insufficiency of proportional loading in deductible premiums. The PH-transform pricing rule developed by Wang is analyzed as an alternative pricing rule. A simple case, where an insured is assumed to be an exponential utility decision maker while the insurer's pricing rule is a PH-transform is also treated.

  20. Insurance Incentives for Health Promotion.

    Science.gov (United States)

    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.…

  1. Need Health Insurance?

    Centers for Disease Control (CDC) Podcasts

    2013-12-23

    Sign up for affordable health insurance with free preventive services available beginning October 1, 2013 through March 31, 2014.  Created: 12/23/2013 by Office of the Associate Director for Policy (OADP), Office of the Associate Director for Communication (OADC).   Date Released: 12/23/2013.

  2. Private Health Insurance Exchanges

    Science.gov (United States)

    Buttorff, Christine; Nowak, Sarah; Syme, James; Eibner, Christine

    2017-01-01

    Abstract Private health insurance exchanges offer employer health insurance, combining online shopping, increased plan choice, benefit administration, and cost-containment strategies. This article examines how private exchanges function, how they may affect employers and employees, and the possible implications for the Affordable Care Act's (ACA's) Small Business Health Options Program (SHOP) Marketplaces. The authors found that private exchanges could encourage employees to select less-generous plans. This could expose employees to higher out-of-pocket costs, but premium contributions would drop substantially, so net spending would decrease. On the other hand, employee spending may increase if, in moving to private exchanges, employers decrease their health insurance contributions. Most employers can avoid the ACA's “Cadillac tax” by reducing the generosity of the plans they offer, regardless of whether they move to a private exchange. There is not yet enough evidence to determine whether the private exchanges will become prominent in the insurance market and how they will affect employers and their employees. PMID:28845340

  3. 77 FR 66069 - Veterans' Group Life Insurance (VGLI) No-Health Period Extension

    Science.gov (United States)

    2012-11-01

    ...,'' which refer to Retired Reservist SGLI, which was discontinued by Public Law 104-275 as an independent..., 2012, for publication. List of Subjects in 38 CFR Part 9 Life insurance, Military personnel,...

  4. 78 FR 58264 - Servicemembers' Group Life Insurance and Veterans' Group Life Insurance Information Access

    Science.gov (United States)

    2013-09-23

    ... AFFAIRS 38 CFR Part 9 RIN 2900-AO42 Servicemembers' Group Life Insurance and Veterans' Group Life... Insurance (SGLI), Family SGLI, SGLI Traumatic Injury Protection, and Veterans' Group Life Insurance (all...-AO42 Servicemembers' Group Life Insurance and Veterans' Group Life Insurance Information...

  5. 75 FR 41787 - Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive...

    Science.gov (United States)

    2010-07-19

    ... Internal Revenue Service 26 CFR Part 54 RIN 1545-BJ58 Requirement for Group Health Plans and Health... Care Act (the Affordable Care Act) regarding preventive health services. The IRS is issuing the... Health and Human Services are issuing substantially similar interim final regulations with respect to...

  6. Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

    Directory of Open Access Journals (Sweden)

    Shabir Moosa

    2016-03-01

    Full Text Available Background: The South African government intends to contract with ‘accredited provider groups’ for capitated primary care under National Health Insurance (NHI. South African solo general practitioners (GPs are unhappy with group practice. There is no clarity on the views of GPs in group practice on contracting to the NHI.Objectives: To describe the demographic and practice profile of GPs in group practice in South Africa, and evaluate their views on NHI, compared to solo GPs.Methods: This was a descriptive survey. The population of 8721 private GPs in South Africa with emails available were emailed an online questionnaire. Descriptive statistical analyses and thematic content analysis were conducted.Results: In all, 819 GPs responded (568 solo GPs and 251 GPs in groups. The results are focused on group GPs. GPs in groups have a different demographic practice profile compared to solo GPs. GPs in groups expected R4.86 million ($0.41 million for a hypothetical NHI proposal of comprehensive primary healthcare (excluding medicines and investigations to a practice population of 10 000 people. GPs planned a clinical team of 8 to 12 (including nurses and 4 to 6 administrative staff. GPs in group practices saw three major risks: patient, organisational and government, with three related risk management strategies.Conclusions: GPs can competitively contract with NHI, although there are concerns. NHI contracting should not be limited to groups. All GPs embraced strong teamwork, including using nurses more effectively. This aligns well with the emergence of family medicine in Africa.Keywords: Capitation, human resource, primary health care,  family medicine, South Africa, health systems

  7. Health Care Utilization Rates After Oregon's 2008 Medicaid Expansion: Within-Group and Between-Group Differences Over Time Among New, Returning, and Continuously Insured Enrollees.

    Science.gov (United States)

    O'Malley, Jean P; O'Keeffe-Rosetti, Maureen; Lowe, Robert A; Angier, Heather; Gold, Rachel; Marino, Miguel; Hatch, Brigit; Hoopes, Megan; Bailey, Steffani R; Heintzman, John; Gallia, Charles; DeVoe, Jennifer E

    2016-11-01

    Although past research demonstrated that Medicaid expansions were associated with increased emergency department (ED) and primary care (PC) utilization, little is known about how long this increased utilization persists or whether postcoverage utilization is affected by prior insurance status. (1) To assess changes in ED, PC, mental and behavioral health care, and specialist care visit rates among individuals gaining Medicaid over 24 months postinsurance gain; and (2) to evaluate the association of previous insurance with utilization. Using claims data, we conducted a retrospective cohort analysis of adults insured for 24 months following Oregon's 2008 Medicaid expansion. Utilization rates among 1124 new and 1587 returning enrollees were compared with those among 5126 enrollees with continuous Medicaid coverage (≥1 y preexpansion). Visit rates were adjusted for propensity score classes and geographic region. PC visit rates in both newly and returning insured individuals significantly exceeded those in the continuously insured in months 4 through 12, but were not significantly elevated in the second year. In contrast, ED utilization rates were significantly higher in returning insured compared with newly or continuously insured individuals and remained elevated over time. New visits to PC and specialist care were higher among those who gained Medicaid compared with the continuously insured throughout the study period. Predicting the effect of insurance expansion on health care utilization should account for the prior coverage history of new enrollees. In addition, utilization of outpatient services changes with time after insurance, so expansion evaluations should allow for rate stabilization.

  8. Bankruptcy as Implicit Health Insurance

    OpenAIRE

    Neale Mahoney

    2012-01-01

    This paper examines the interaction between health insurance and the implicit insurance that people have because they can file (or threaten to file) for bankruptcy. With a simple model that captures key institutional features, I demonstrate that the financial risk from medical shocks is capped by the assets that could be seized in bankruptcy. For households with modest seizable assets, this implicit “bankruptcy insurance” can crowd out conventional health insurance. I test these predictions u...

  9. Health Insurance without Single Crossing

    DEFF Research Database (Denmark)

    Boone, Jan; Schottmüller, Christoph

    2017-01-01

    Standard insurance models predict that people with high risks have high insurance coverage. It is empirically documented that people with high income have lower health risks and are better insured. We show that income differences between risk types lead to a violation of single crossing...... in an insurance model where people choose treatment intensity. We analyse different market structures and show the following: If insurers have market power, the violation of single crossing caused by income differences and endogenous treatment choice can explain the empirically observed outcome. Our results do...

  10. [Abortion using health insurance].

    Science.gov (United States)

    Gritschneder, O

    1984-09-01

    The author reports on current German court rulings on whether non-medically indicated abortions (although not prohibited by law and therefore not actionable) should be financed via the compulsory health insurance scheme or by the Federal Government. 1. The social welfare court at Dortmund ruled that current legislation governing the financing of welfare expenditure violates the Federal German constitution, and has, therefore, referred this matter to the Federal Constitutional Court. However, the Federal Constitutional Court turned down the referral and dismissed the case, since an application for declaring a Federal law null and void can be filed by the Federal Government or by a Federal Land Government or by at least one-third of the total number of members of the Federal German Parliament (Bundestag) only. This means that the current proceedings at the Dortmund social welfare court must continue. The plaintiff pleads to prohibit the compulsory health insurance scheme authorities from defraying the expenses for performing foeticide via legally permitted abortion without medical indication. 2. The Federal Land Government of Baden-Württemberg is the only Land Government of the Federal Republic of Germany that does not grant any financial aid towards performing non-medically indicated (albeit not legally actionable) abortions. Hence, the Baden-Württemberg Administrative Courts turned down the plea filed by a woman government servant towards paying such aid. The court decision was based on the judge's opinion that even the principle of equality before the law guaranteed by the Constitution would not compel the Land Government to emulate the example of the other Land Governments who are agreeable to bearing abortion costs.

  11. Health Insurance Rules of the CERN Health Insurance scheme

    CERN Document Server

    Division HR

    2000-01-01

    A new document which groups together the general principles, the contributions, benefits, reimbursement procedures and other information making up the Rules of the CERN Health Insurance Scheme has been established. It was approved by the Director-General on 7th July 2000 and is being distributed to all contributing members of the Scheme. It has been dispatched by internal mail to members of the personnel and by postal mail to pensioners. These Rules will enter into force on 1st September 2000. Please make sure that you have received your copy. Should this not be the case, an additional copy may be obtained by telephoning 78003.

  12. HEALTH INSURANCE RULES OF THE CERN HEALTH INSURANCE SCHEME

    CERN Document Server

    Division HR

    2000-01-01

    A new document which groups together the general principles, the contributions, benefits, reimbursement procedures and other information making up the Rules of the CERN Health Insurance Scheme has been established. It was approved by the Director-General on 7th July 2000 and is being distributed to all contributing members of the Scheme. It has been dispatched by internal mail to members of the personnel and by postal mail to pensioners. These Rules will enter into force on 1st September 2000. Please make sure that you have received your copy. Should this not be the case, an additional copy may be obtained by telephoning 78003

  13. The economics of health insurance.

    Science.gov (United States)

    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.

  14. HEALTH INSURANCE IN HEALTH REFORM IN UKRAINE

    Directory of Open Access Journals (Sweden)

    H. Tlusta

    2014-03-01

    Full Text Available The author of the article researched the teoretical and methodological approaches to the formation and development of the health insurance market conditions, also investigated the condition and features of the functioning of the health system in Ukraine and abroad, reasonable prospects of introducing mandatory and dissemination of voluntary health insurance, as well as ways of improving financial provide health insurance system in Ukraine.

  15. 76 FR 70510 - Federal Employees' Group Life Insurance Program: New Federal Employees' Group Life Insurance...

    Science.gov (United States)

    2011-11-14

    ... MANAGEMENT Federal Employees' Group Life Insurance Program: New Federal Employees' Group Life Insurance... Management (OPM) is announcing changes in premiums for certain Federal ] Employees' Group Life Insurance... coincided with the implementation of the Federal Employees' Life Insurance Improvement Act, Public Law...

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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. © 2015 Society for Public Health Education.

  18. Consumers' misunderstanding of health insurance.

    Science.gov (United States)

    Loewenstein, George; Friedman, Joelle Y; McGill, Barbara; Ahmad, Sarah; Linck, Suzanne; Sinkula, Stacey; Beshears, John; Choi, James J; Kolstad, Jonathan; Laibson, David; Madrian, Brigitte C; List, John A; Volpp, Kevin G

    2013-09-01

    We report results from two surveys of representative samples of Americans with private health insurance. The first examines how well Americans understand, and believe they understand, traditional health insurance coverage. The second examines whether those insured under a simplified all-copay insurance plan will be more likely to engage in cost-reducing behaviors relative to those insured under a traditional plan with deductibles and coinsurance, and measures consumer preferences between the two plans. The surveys provide strong evidence that consumers do not understand traditional plans and would better understand a simplified plan, but weaker evidence that a simplified plan would have strong appeal to consumers or change their healthcare choices. Copyright © 2013 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    ... NewsYour Health ResourcesHealthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, ... NewsYour Health ResourcesHealthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, ...

  20. Health-insurance products and plan options.

    Science.gov (United States)

    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. [Health care insurance for Africa].

    Science.gov (United States)

    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.

  2. Health Insurance Marketplace Public Use Files

    Data.gov (United States)

    U.S. Department of Health & Human Services — A set of seven (7) public use files containing information on health insurance issuers participating in the Health Insurance Marketplace and certified qualified...

  3. 78 FR 14034 - Health Insurance Providers Fee

    Science.gov (United States)

    2013-03-04

    ... Internal Revenue Service 26 CFR Part 57 RIN 1545-BL20 Health Insurance Providers Fee AGENCY: Internal... covered entities engaged in the business of providing health insurance for United States health risks... regulations affect persons engaged in the business of providing health insurance for United States health...

  4. 3 CFR - State Children's Health Insurance Program

    Science.gov (United States)

    2010-01-01

    ... 3 The President 1 2010-01-01 2010-01-01 false State Children's Health Insurance Program... Insurance Program Memorandum for the Secretary of Health and Human Services The State Children's Health Insurance Program (SCHIP) encourages States to provide health coverage for uninsured children in families...

  5. CERN HEALTH INSURANCE SUPERVISORY BOARD

    CERN Multimedia

    Sylvain Weisz

    2002-01-01

    All Members of the CERN Health Insurance Scheme (CHIS) are invited to a: CHIS Public Information Meeting Main Amphitheatre Tuesday 1 October 2002 (14:00-16:00) Topics will include the CHIS balance, trends in costs and the challenges facing our Scheme. Particular emphasis will be placed on hospitalisation in the Geneva area. Sylvain Weisz Chairman of the CHIS Board

  6. The Impact of Health Insurance Reform on Insurance Instability

    Science.gov (United States)

    Freund, KM; Isabelle, AP; Hanchate, A; Kalish, RL; Kapoor, A; Bak, S; Mishuris, RG; Shroff, S; Battaglia, TA

    2015-01-01

    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. PMID:24583490

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Arnold Ikedichi Okpani

    2015-01-01

    Full Text Available 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.

  10. Health Insurance and Children with Disabilities

    Science.gov (United States)

    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…

  11. Health insurance for the "uninsurable".

    Science.gov (United States)

    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. CERN Health Insurance Scheme

    CERN Multimedia

    HR Department

    2011-01-01

    Changes implemented on 1 January 2011 In addition to the information provided in the Official News section of the Bulletin concerning the CHIS, the following changes are in place since 1 January 2011. Benefits The list of benefits including the ceilings will remain initially unchanged while the CHIS Board prepares proposals to the Director-General, who has been authorized by the Council to take timely measures to limit the increase of the CHIS expenses, by encouraging the use of health care providers and treatments which provide the best quality-to-cost ratio. Termination of the agreement with “La Metairie” Attempts to find an agreement with the management of “La Metairie” on the conditions to continue to collaborate failed. The present agreement that CHIS, as well as the other international organisations (WHO, ILO/ITU, UNOG) had signed, therefore came to an end on 31 December 2010. As a result, the rules applicable to hospitals without an agreement will apply to &...

  13. Evidence of Adverse Selection in Iranian Supplementary Health Insurance Market

    Directory of Open Access Journals (Sweden)

    Gh Mahdavi

    2012-07-01

    Full Text Available Background: Existence or non-existence of adverse selection in insurance market is one of the important cases that have always been considered by insurers. Adverse selection is one of the consequences of asymmetric information. Theory of adverse selection states that high-risk individuals demand the insurance service more than low risk individuals do.Methods: The presence of adverse selection in Irans supplementary health insurance market is tested in this paper. The study group consists of 420 practitioner individuals aged 20 to 59. We estimate two logistic regression models in order to determine the effect of individual's characteristics on decision to purchase health insurance coverage and loss occurrence. Using the correlation between claim occurrence and decision to purchase health insurance, the adverse selection problem in Iranian supplementary health insurance market is examined.Results: Individuals with higher level of education and income level purchase less supplementary health insurance and make fewer claims than others make and there is positive correlation between claim occurrence and decision to purchase supplementary health insurance.Conclusion: Our findings prove the evidence of the presence of adverse selection in Iranian supplementary health insurance market.

  14. Demystifiying state health insurance marketplaces.

    Science.gov (United States)

    Hahn, Joyce A; Sheingold, Brenda Helen; Ott, Karen M

    2013-01-01

    The state health insurance exchanges, mandated under the Patient Protection and Affordable Care Act, will impact how health care is delivered and reimbursed, and will touch the lives of nurses in all professional roles. The dynamics of how each model will operate within each state is currently a work in progress. Nurses have a tradition of providing voice and leadership in the health care reform arena from the unique position as both consumers and health care professionals. The time is right to contact state legislators and advocate for nurses to sit on the governing boards of the state health care exchanges. Communication between nurses in all states should be an ongoing dialogue through specialty and state nursing organizations to ensure nursing is aware of both issues and best practices nationwide.

  15. Health insurance and the development of diabetic complications.

    Science.gov (United States)

    Flavin, Nina E; Mulla, Zuber D; Bonilla-Navarrete, Aracely; Chedebeau, Fernando; Lopez, Oscar; Tovar, Yara; Meza, Armando

    2009-08-01

    Lack of health insurance can adversely affect access to medical care which leads to poor disease outcome. Few studies examine the effects of no insurance on the development of diabetes complications. The objective of this study was to determine if there is an association between health insurance status and the outcome of complications among a group of diabetic patients admitted to a teaching hospital on the Texas-Mexico border. A retrospective case-control study was conducted over a one-year period. Multiple imputations were used to address missing values. We examined 82 diabetics who had one or more complications and 83 diabetic controls without complications. A complication was defined as a current skin or soft-tissue infection or a limb amputation. The main exposure was health insurance status, a three-level variable: no health insurance, Medicaid, and other insurance (referent). Logistic regression was used to calculate health insurance odds ratios (OR) adjusted for age, sex, and a history of recent trauma. Patients with no health insurance were twice as likely to have a diabetic complication as patients in the referent category: adjusted OR = 2.22, P = 0.03. An association between Medicaid status and complications was not detected (adjusted OR = 1.16, P = 0.78). Not having health insurance was a risk factor for developing diabetic complications in a group of predominantly Hispanic patients.

  16. Does Retiree Health Insurance Encourage Early Retirement?

    Science.gov (United States)

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

    2013-08-01

    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.

  17. Reductions for Entrepreneurs in Health Insurance Contributions

    Directory of Open Access Journals (Sweden)

    Paweł Lenio

    2014-09-01

    Full Text Available This paper describes the reductions for entrepreneurs in health insurance contributions. Only entrepreneurs from specific social groups can take advantage of said reductions. They apply only to people retired, on pensions or handicapped. The reductions are also dependent on the potential recipient's income and revenue of the company. Handicapped entrepreneurs can benefit from some additional privileges as well. Author analyzes the legal regulations behind these reductions and exposes their shortcomings which cause the benefits to be rarely used.

  18. Reductions for Entrepreneurs in Health Insurance Contributions

    OpenAIRE

    Paweł Lenio

    2014-01-01

    This paper describes the reductions for entrepreneurs in health insurance contributions. Only entrepreneurs from specific social groups can take advantage of said reductions. They apply only to people retired, on pensions or handicapped. The reductions are also dependent on the potential recipient's income and revenue of the company. Handicapped entrepreneurs can benefit from some additional privileges as well. Author analyzes the legal regulations behind these reductions and exposes their sh...

  19. Cancer survival disparities by health insurance status.

    Science.gov (United States)

    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.

  20. Consumer price sensitivity in Dutch health insurance

    NARCIS (Netherlands)

    M. van Dijk (Machiel); M. Pomp (Marc); R.C.H.M. Douven (Rudy); T. Laske-Aldershof (Trea); F.T. Schut (Erik); W. de Boer (Willem); A. Boo (Anne)

    2008-01-01

    textabstractAim: To estimate the price sensitivity of consumer choice of health insurance firm. Method: Using paneldata of the flows of insured betweenpairs of Dutch sickness funds during the period 1993-2002, we estimate the sensitivity of these flows to differences in insurance premium. Results:

  1. Consumer choice of social health insurance in managed competition.

    NARCIS (Netherlands)

    Kerssens, J.J.; Groenewegen, P.P.

    2003-01-01

    Objective: To promote managed competition in Dutch health insurance, the insured are now able to change health insurers. They can choose a health insurer with a low flat-rate premium, the best supplementary insurance and/or the best service. As we do not know why people prefer one health insurer to

  2. Consumer choice of social health insurance in managed competition.

    NARCIS (Netherlands)

    Kerssens, J.J.; Groenewegen, P.P.

    2003-01-01

    Objective: To promote managed competition in Dutch health insurance, the insured are now able to change health insurers. They can choose a health insurer with a low flat-rate premium, the best supplementary insurance and/or the best service. As we do not know why people prefer one health insurer to

  3. Risk segmentation in Chilean social health insurance.

    Science.gov (United States)

    Hidalgo, Hector; Chipulu, Maxwell; Ojiako, Udechukwu

    2013-01-01

    The objective of this study is to identify how risk and social variables are likely to be impacted by an increase in private sector participation in health insurance provision. The study focuses on the Chilean health insurance industry, traditionally dominated by the public sector. Predictive risk modelling is conducted using a database containing over 250,000 health insurance policy records provided by the Superintendence of Health of Chile. Although perceived with suspicion in some circles, risk segmentation serves as a rational approach to risk management from a resource perspective. The variables that have considerable impact on insurance claims include the number of dependents, gender, wages and the duration a claimant has been a customer. As shown in the case study, to ensure that social benefits are realised, increased private sector participation in health insurance must be augmented by regulatory oversight and vigilance. As it is clear that a "community-rated" health insurance provision philosophy impacts on insurance firm's ability to charge "market" prices for insurance provision, the authors explore whether risk segmentation is a feasible means of predicting insurance claim behaviour in Chile's private health insurance industry.

  4. 48 CFR 3028.307-1 - Group insurance plans.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Group insurance plans. 3028.307-1 Section 3028.307-1 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND SECURITY, HOMELAND SECURITY ACQUISITION REGULATION (HSAR) SOCIOECONOMIC PROGRAMS BONDS AND INSURANCE Insurance 3028.307-1 Group insurance plans. Plans shall be...

  5. Consumer choice of social health insurance in managed competition

    NARCIS (Netherlands)

    Kerssens, Jan J.; Groenewegen, Peter P.

    2003-01-01

    Objective To promote managed competition in Dutch health insurance, the insured are now able to change heaith insurers. They can choose a health insurer with a low flat-rate premium, the best supplementary insurance and/or the best service. As we do not know why people prefer one health insurer to

  6. Consumer choice of social health insurance in managed competition

    NARCIS (Netherlands)

    Kerssens, Jan J.; Groenewegen, Peter P.

    2003-01-01

    Objective To promote managed competition in Dutch health insurance, the insured are now able to change heaith insurers. They can choose a health insurer with a low flat-rate premium, the best supplementary insurance and/or the best service. As we do not know why people prefer one health insurer to a

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

    Science.gov (United States)

    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. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  8. The adequacy of college health insurance coverage.

    Science.gov (United States)

    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.

  9. Health Insurance: principles, models and the Nigerian National ...

    African Journals Online (AJOL)

    Open Access DOWNLOAD FULL TEXT ... In addition, they all have different modes of operation. ... Key words: Health insurance, Health insurance models, market failure, Nigerian Health Insurance Scheme, Community Based Health ...

  10. ECONOMIC AND MANAGERIAL APPROACH OF HEALTH INSURANCES

    Directory of Open Access Journals (Sweden)

    Georgeta Dragomir

    2007-05-01

    Full Text Available The paper represents an analysis in the domain of the social insurances for health care. It emphasizesthe necessity and the opportunity of creating in Romania a medical service market based on the competingsystem. In Romania, the social insurances for health care are at their very beginning. The development of thedomain of the private insurances for health care is prevented even by its legislation, due to the lack of anormative act that may regulate the management of the private insurances for health care. The establishment ofthe legislation related to the optional insurances for health care might lead to some activity norms for thecompanies which carry out optional insurances for health care. The change of the legislation is made in order tocreate normative and financial opportunities for the development of the optional medical insurances. Thischange, as part of the social protection of people, will positively influence the development of the medicalinsurance system. The extension of the segment of the optional insurances into the medical insurance segmentincreases the health protection budget with the value of the financial sources which do not belong to thebudgetary funds.

  11. MARKETING STRATEGY OF COMMERCIAL HEALTH INSURANCE COMPANY

    Directory of Open Access Journals (Sweden)

    Cut Zaraswati

    2017-01-01

    Full Text Available The objectives of this research are to: 1 compare the effect of premium earnings products of health insurances after the launching of national social health insurance (JKN-BPJS (Badan Penyelenggara Jaminan Sosial for health; 2 analyze the internal and external factors of private/commercial health insurance companies; 3 formulate a marketing strategyy for health insurance product after the operation of JKN-BPJS for health.  It is a challenge for commercial health insurance to survive and thrive with the existence of JKN-BPJS for health which is compulsory to Indonesia’s citizens to be a member. The research begins by analyzing premium earnings of the commercial health insurance company one year before and after the implementation of JKN-BPJS for health, the intensive interviews and questionnaires to the chosen resource person (purposive samplings, the analysis on Internal Factor Evaluation (IFE, External Factor Evaluation (EFE, Matrix IE and SWOT are used in the research. Then it is continued by arranging a strategic priority using Analytical Hierarchy Process (AHP.  The result from the research is there is totally no decreasing premium earnings for the commercial health insurance company although the growth trend shows a slight drop.  The appropriate strategy for the health insurance company in the commercial sector is the differentiation where the implication is involving customer service quality improvement, product innovation, and technology and infrastructure development.      Keywords:  commercial health insurance company, Marketing Strategy, AHP Analysis, national social health insurance

  12. INFORMATION FROM THE CERN HEALTH INSURANCE SCHEME

    CERN Multimedia

    Tel : 7-3635

    2002-01-01

    Please note that, from 1 July 2002, the tariff agreement between CERN and the Hôpital de la Tour will no longer be in force. As a result the members of the CERN Health Insurance Scheme will no longer obtain a 5% discount for quick payment of bills. More information on the termination of the agreement and the implications for our Health Insurance Scheme will be provided in the next issue of the CHIS Bull', due for publication in the first half of July. It will be sent to your home address, so, if you have moved recently, please check that your divisional secretariat has your current address. Tel.: 73635 The Organization's Health Insurance Scheme (CHIS) has launched its own Web pages, located on the Website of the Social & Statutory Conditions Group of HR Division (HR-SOC). The address is short and easy-to-remember www.cern.ch/chis The pages currently available concentrate on providing basic information. Over the coming months it is planned to fill out the details and introduce new topics. Please give us ...

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

    Science.gov (United States)

    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. Copyright © 2015 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    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.

  15. The Dutch health insurance reform: consumer mobility.

    NARCIS (Netherlands)

    Jong, J.D. de; Groenewegen, P.P.; Rijken, M.

    2006-01-01

    On 1 January 2006, a number of far-reaching changes in the Dutch health insurance system came into effect. There is now one type of health care insurance for all. The standard package is compulsory for everyone who lives in The Netherlands or pays wage tax in The Netherlands. In the new system of ma

  16. Probability numeracy and health insurance purchase

    NARCIS (Netherlands)

    Dillingh, Rik; Kooreman, Peter; Potters, Jan

    2016-01-01

    This paper provides new field evidence on the role of probability numeracy in health insurance purchase. Our regression results, based on rich survey panel data, indicate that the expenditure on two out of three measures of health insurance first rises with probability numeracy and then falls again.

  17. Probability numeracy and health insurance purchase

    NARCIS (Netherlands)

    Dillingh, Rik; Kooreman, Peter; Potters, Jan

    2016-01-01

    This paper provides new field evidence on the role of probability numeracy in health insurance purchase. Our regression results, based on rich survey panel data, indicate that the expenditure on two out of three measures of health insurance first rises with probability numeracy and then falls again.

  18. Health Insurance: Understanding What It Covers

    Science.gov (United States)

    ... NewsYour Health ResourcesHealthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, ... NewsYour Health ResourcesHealthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, ...

  19. Conceptualising the lack of health insurance coverage.

    Science.gov (United States)

    Davis, J B

    2000-01-01

    This paper examines the lack of health insurance coverage in the US as a public policy issue. It first compares the problem of health insurance coverage to the problem of unemployment to show that in terms of the numbers of individuals affected lack of health insurance is a problem comparable in importance to the problem of unemployment. Secondly, the paper discusses the methodology involved in measuring health insurance coverage, and argues that the current method of estimation of the uninsured underestimates the extent that individuals go without health insurance. Third, the paper briefly introduces Amartya Sen's functioning and capabilities framework to suggest a way of representing the extent to which individuals are uninsured. Fourth, the paper sketches a means of operationalizing the Sen representation of the uninsured in terms of the disability-adjusted life year (DALY) measure.

  20. Public health insurance under a nonbenevolent state.

    Science.gov (United States)

    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.

  1. Economic and Managerial Approach of Health Insurances

    Directory of Open Access Journals (Sweden)

    Marinela BOBOC

    2005-10-01

    Full Text Available The paper represents an analysis in the domain of the social insurances for health care. It emphasizes the necessity and the opportunity ofcreating in Romania a medical service market based on the competing system. In Romania, the social insurances for health care are at their verybeginning. The development of the domain of the private insurances for health care is prevented even by its legislation, due to the lack of a normativeact that may regulate the management of the private insurances for health care. The establishment of the legislation related to the optional insurancesfor health care might lead to some activity norms for the companies which carry out optional insurances for health care. The change of the legislationis made in order to create normative and financial opportunities for the development of the optional medical insurances. This change, as part of thesocial protection of people, will positively influence the development of the medical insurance system. The extension of the segment of the optionalinsurances into the medical insurance segment increases the health protection budget with the value of the financial sources which do not belong tothe budgetary funds.

  2. Health Insurance Rate Review Fact Sheet

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act is bringing an unprecedented level of scrutiny and transparency to health insurance rate increases. The Act ensures that, in any State, any...

  3. 41 CFR 60-741.25 - Health insurance, life insurance and other benefit plans.

    Science.gov (United States)

    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...

  4. The Right to Health Care and Health Insurance Law

    OpenAIRE

    井上, 英夫

    1997-01-01

    The purpose of this paper is to consider the legality of decision for medical treatment expenses under Health Insurance Law. The following issues are discussed: The right to health and Connstitution of Japan; The right to health and Medical Social Security Law; History and concept of Health Insurance Law; Health Insurance Law and the right to self-determination and freedom of medical treatment selection; Care of acupuncture and moxa cautery and medical teratment expenses under Health Insuranc...

  5. Life cycle responses to health insurance status.

    Science.gov (United States)

    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.

  6. Determinants of health insurance and hospitalization

    Directory of Open Access Journals (Sweden)

    Tadashi Yamada

    2014-12-01

    Full Text Available Our paper empirically examines how the decision to purchase private insurance and hospitalization are made based on household income, socio-demographic factors, and private health insurance factors in both Japan and the USA. Using these two data-sets, we found some similarities and dissimilarities between Japan and the United States. As income of households rises, households have a positive effect on purchasing health insurance as a normal good. Another similarity between the two countries is seen in the income effect on risk of hospitalization, which is negative for both Japanese and US cases. For dissimilarity, the insurance premium effect on risk of hospitalization is positive for the Japanese case, while negative for the US case. Since the Japanese insurance data had variables such as payments per day of hospitalization if household gets hospitalized, insurance payments upon death of an insured person, and annuity payments at maturity, we tested to see if these characteristics affect the risk of hospitalization for households; we do not eliminate a possibility of adverse selection. For the US pure health issuance characteristics, an increase in premium of health insurance policies cause individuals to substitute more health capital investment which causes lower risk of hospitalization.

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

    Science.gov (United States)

    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.

  8. The role of health insurance in improving health services use by Thais and ethnic minority migrants.

    Science.gov (United States)

    Hu, Jian

    2010-01-01

    In Thailand, a universal coverage health care scheme for Thai citizens and a foreign worker health insurance program for registered foreign workers have been implemented since 2001. This study uses the 2000-2004 panel data of the Kanchanaburi Demographic Surveillance System to explore the role of health insurance in influencing the use of health care for Thai, Thai ethnic minority, and ethnic minority migrants from 2000 to 2004. The results show that health insurance plays a major role in improving the use of health care for ethnic groups, especially for Thai ethnic minorities. However, a gap still existed in 2004 between health insurance and health care use by ethnic minority migrants and by Thais. The results suggest that improving health insurance status for ethnic minority migrants should be encouraged to reduce the ethnic gap in the use of health care.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2014-01-01

    paying the insurance premiums within 6-10% of their income and employment status, are entitled to use the services. Providing services to the insured are performed by indirect forms. Payments to the service providers for the fee of inpatient and outpatient services are conservative and the related diagnostic groups system. Paying attention to the importance of modification of the fragmented health insurance system and financing the country's healthcare can reduce much of the failure of the health system, including the access of the public to health services. The countries according to the degree of development, governmental, and private insurance companies and existing rules must use the appropriate structure, comprehensive approach to the structure, and financing of the health social insurance on the investigated basis and careful attention to the intersections and differentiation. Studied structures, using them in the proposed approach and taking advantages of the perspectives of different beneficiaries about discussed topics can be important and efficient in order to achieve the goals of the health social insurance.

  11. Health insurance and hospital technology adoption.

    Science.gov (United States)

    Freedman, Seth

    2012-01-01

    This chapter discusses the relationship between health insurance and hospitals' decisions to adopt medical technologies. I focus on both how the extent of insurance coverage can increase incentives to adopt new treatments, and how the parameters of the insurance contract can impact the types of treatments adopted. I provide a review of the previous theoretical and empirical literature and highlight evidence on this relationship from previous expansions of Medicaid eligibility to low-income pregnant women. While health insurance has important effects on individual-level choices of health care consumption, increases in the fraction of the population covered by insurance has also been found to have broader supply side effects as hospitals respond to changes in demand by changing the type of care offered. Furthermore, hospitals respond to the design of insurance contracts and adopt more or less cost-effective technologies depending on the incentive system. Understanding how insurance changes supply side incentives is important as we consider future changes in the insurance landscape. ORIGINALITY/VALUE OF PAPER: With these previous findings in mind, I conclude with a discussion of how the Affordable Care Act may alter hospital technology adoption incentives by both expanding coverage and changing payment schemes.

  12. 42 CFR 403.220 - Supplemental Health Insurance Panel.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Supplemental Health Insurance Panel. 403.220... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health Insurance... determines whether or not a State regulatory program for Medicare supplemental health insurance policies...

  13. Optimal non-linear health insurance.

    Science.gov (United States)

    Blomqvist, A

    1997-06-01

    Most theoretical and empirical work on efficient health insurance has been based on models with linear insurance schedules (a constant co-insurance parameter). In this paper, dynamic optimization techniques are used to analyse the properties of optimal non-linear insurance schedules in a model similar to one originally considered by Spence and Zeckhauser (American Economic Review, 1971, 61, 380-387) and reminiscent of those that have been used in the literature on optimal income taxation. The results of a preliminary numerical example suggest that the welfare losses from the implicit subsidy to employer-financed health insurance under US tax law may be a good deal smaller than previously estimated using linear models.

  14. How to Shop for Health Insurance

    Science.gov (United States)

    ... Plan Applying for an insurance plan through the health care marketplace can be done online through healthcare.gov or a state site, over the phone, or through regular mail by filling out a form that can be mailed to ...

  15. Health Insurance and Managed Care in Nigeria

    African Journals Online (AJOL)

    main categories, healthcare infrastructure and healthcare ... sum (benefit) on the occurrence of a specified event. The basis for ... Every Insurance scheme or HMO providing health cover ... The NHIS idea was resurrected again in. 1988 by ...

  16. Health Insurance: what is the current situation?

    CERN Document Server

    Association du personnel

    2007-01-01

    One month ago, at our public meetings (see ECHO no. 38 - 24 September), we gave you certain information concerning our CERN Health Insurance Scheme (CHIS). Since then, several discussions have taken place and, as promised, we come back to the subject to bring you the latest important news. Just to remind you: health insurance is the last point to be dealt with in the framework of the last five-yearly review.

  17. The Swedish national dental insurance and dental health care policy

    DEFF Research Database (Denmark)

    Moore, Rod

    1981-01-01

    Sweden initiated a dental health care insurance in 1973. The health insurance is outlined, current problems and political issues are described. The benefits and limitations are described.......Sweden initiated a dental health care insurance in 1973. The health insurance is outlined, current problems and political issues are described. The benefits and limitations are described....

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

    DEFF Research Database (Denmark)

    Fenny, Ama Pokuah; Enemark, Ulrika; Asante, Felix A

    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...

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

    Science.gov (United States)

    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.

  20. Consumer's preferences in social health insurance.

    NARCIS (Netherlands)

    Kerssens, J.J.; Groenewegen, P.P.

    2005-01-01

    Allowing consumers greater choice of health plans is believed to be the key to high quality and low costs in social health insurance. This study investigates consumer preferences (361 persons, response rate 43%) for hypothetical health plans with differed in 12 characteristics (premium, deductibles,

  1. Consumer's preferences in social health insurance.

    NARCIS (Netherlands)

    Kerssens, J.J.; Groenewegen, P.P.

    2005-01-01

    Allowing consumers greater choice of health plans is believed to be the key to high quality and low costs in social health insurance. This study investigates consumer preferences (361 persons, response rate 43%) for hypothetical health plans with differed in 12 characteristics (premium, deductibles,

  2. [Development of pharmaceutical expenses in German private health insurance].

    Science.gov (United States)

    Böcking, W; Tidelski, O; Skuras, B; Kitzmann, F; Zuehlke, L

    2012-06-01

    Health Insurance costs in Germany have grown by 3 % p. a. over the last ten years and amount to approx. 280 bn EUR in 2009. While costs for stationary treatment as the largest cost category have been intensely analyzed over the past years, pharmaceutical expenses have been analyzed in less detail, mostly focusing on the Statutory Health Insurance side, even though pharmaceutical expenses have grown almost twice as much as costs for ambulant treatments. This research article therefore focuses on the question how pharmaceutical expenses in a large German private health insurance company are allocated with respect to age and indication groups, and how those have developed during the past four years. Therefore, the data of a private health insurance company with more than 600.000 customers was split into price and volume effects per age group to understand if price or volume drives the cost development. Additionally, the two largest indication groups are analyzed in detail. As a result, both price and volume effects drive an overall cost increase of 7,3 %. These effects are even stronger in older age groups. This strong cost increase is not sustainable for the German health insurance system over a longer period of time and will even further increase due to the ageing of the German population. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Building awareness to health insurance among the target population of community-based health insurance schemes in rural India.

    Science.gov (United States)

    Panda, Pradeep; Chakraborty, Arpita; Dror, David M

    2015-08-01

    To evaluate an insurance awareness campaign carried out before the launch of three community-based health insurance (CBHI) schemes in rural India, answering the questions: Has the awareness campaign been successful in enhancing participants' understanding of health insurance? What awareness tools were most useful from the participants' point of view? Has enhanced awareness resulted in higher enrolment? Data for this analysis originates from a baseline survey (2010) and a follow-up survey (2011) of more than 800 households in the pre- and post-campaign periods. We used the difference-in-differences method to evaluate the impact of awareness activities on insurance understanding. Assessment of usefulness of various tools was carried out based on respondents' replies regarding the tool(s) they enjoyed and found most useful. An ordinary least square regression analysis was conducted to understand whether insurance knowledge and CBHI understanding are related with enrolment in CBHI. The intervention cohort demonstrated substantially higher understanding of insurance concepts than the control group, and CBHI understanding was a positive determinant for enrolment. Respondents considered the 'Treasure-Pot' tool (an interactive game) as most useful in enhancing awareness to the effects of insurance. We conclude that awareness-raising is an important prerequisite for voluntary uptake of CBHI schemes and that interactive, contextualised awareness tools are useful in enhancing insurance understanding. © 2015 John Wiley & Sons Ltd.

  4. Selection on Moral Hazard in Health Insurance

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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. Copyright © 2011 Elsevier B.V. All rights reserved.

  6. Improving health insurance coverage in Ghana : a case study

    NARCIS (Netherlands)

    Kotoh, A.M.

    2013-01-01

    Ghana is one of the first sub-Saharan African countries to introduce national health insurance to ensure more equity in access to health care. The response of the population has been disappointing, however. This study describes and examines an experiment with so called 'problem-solving groups' that

  7. Improving health insurance coverage in Ghana : a case study

    NARCIS (Netherlands)

    Kotoh, A.M.

    2013-01-01

    Ghana is one of the first sub-Saharan African countries to introduce national health insurance to ensure more equity in access to health care. The response of the population has been disappointing, however. This study describes and examines an experiment with so called 'problem-solving groups' that

  8. Implementing health insurance for migrants, Thailand

    Science.gov (United States)

    Thwin, Aye Aye; Patcharanarumol, Walaiporn

    2017-01-01

    Abstract Problem Undocumented migrant workers are generally ineligible for state social security schemes, and either forego needed health services or pay out of pocket. Approach In 2001, the Thai Ministry of Public Health introduced a policy on migrant health. Migrant health insurance is a voluntary scheme, funded by an annual premium paid by workers. It enables access to health care at public facilities and reduces catastrophic health expenditures for undocumented migrants and their dependants. A range of migrant-friendly services, including trained community health volunteers, was introduced in the community and workplace. In 2014, the government introduced a multisectoral policy on migrants, coordinated across the interior, labour, public health and immigration ministries. Local setting In 2011, around 0.3 million workers, less than 9% of the estimated migrant labour force of 3.5 million, were covered by Thailand’s social security scheme. Relevant changes A review of the latest data showed that from April to July 2016, 1 146 979 people (33.7% of the total estimated migrant labourers of 3 400 787) applied, were screened and were enrolled in the migrant health insurance scheme. Health volunteers, recruited from migrant communities and workplaces are appreciated by local communities and are effective in promoting health and increasing uptake of health services by migrants. Lessons learnt The capacity of the health ministry to innovate and manage migrant health insurance was a crucial factor enabling expanded health insurance coverage for undocumented migrants. Continued policy support will be needed to increase recruitment to the insurance scheme and to scale-up migrant-friendly services. PMID:28250516

  9. Demand for Health Insurance by Military Retirees

    Science.gov (United States)

    2015-05-01

    dollars, it lowers OOP expenses, and they are financially risk averse. Insurance choice can be viewed as a three-step process. First, determine the...Journal of Public Economics 3 (1974): 303–328. 30 William H. Greene, Econometric Analysis (New York: Macmillan, 1990), 696. 17 expect the...population weights from the HCBSs with STATA software. 26 Table 7. Logit Model of Health Insurance Choice for Military Retirees Variable

  10. Health insurance and switching behavior : Evidence from the Netherlands

    NARCIS (Netherlands)

    Beest, van F.; Lako, C.J.; Sent, E.-M.

    2012-01-01

    Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insur- ers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insurance. The new health in- surance system aimed to create a more com- petitive marke

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

    Science.gov (United States)

    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.

  12. 78 FR 42159 - Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative...

    Science.gov (United States)

    2013-07-15

    ... Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility...-AR04 Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative... to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and...

  13. Strategies for expanding health insurance coverage in vulnerable populations.

    Science.gov (United States)

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

    2014-11-26

    evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence).In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are

  14. A 10-year experience with universal health insurance in Taiwan: measuring changes in health and health disparity.

    Science.gov (United States)

    Wen, Chi Pang; Tsai, Shan Pou; Chung, Wen-Shen Isabella

    2008-02-19

    Universal national health insurance, financed jointly by payroll taxes, subsidies, and individual premiums, commenced in Taiwan in 1995. Coverage expanded from 57% of the population (before the introduction of national health insurance) to 98%. To assess the role of national health insurance in improving life expectancy and reducing health disparities in Taiwan. A before-and-after comparison of the decade before the introduction of national health insurance (1982-1984 to 1992-1994) with the decade after (1992-1994 to 2002-2004). Taiwan. All townships (n = 358) in Taiwan were ranked according to overall mortality rates before the introduction of national health insurance and then ranked into 10 health class groups in descending order of health (groups 1 [healthiest] to 10 [least healthy]). Health improvement (change in life expectancy after the introduction of national health insurance) and health disparity (reduction in the difference in life expectancy between the highest- and lowest-ranked health class groups). After the introduction of national health insurance, life expectancy increased more in health class groups that had higher mortality rates before the introduction of national health insurance and health disparity narrowed, reversing an earlier trend toward widening disparity. The major contributors to the reduction in disparity were relatively larger reductions in death from cardiovascular diseases, ill-defined conditions, infectious diseases, and accidents in the lower-ranked health class groups. However, death from cancer increased more in the lower-ranked health class groups. Utilization of medical services increased, whereas cost remained at 5% to 6% of the gross domestic product. The per capita average annual number of visits to the physician's office was 14. The interpretation of comparisons before and after the introduction of national health insurance assumes that the changes were entirely due to the effect of national health insurance rather than

  15. Health-based risk neutralization in private disability insurance

    Science.gov (United States)

    Buitenhuis, Jan; Brouwer, Sandra; van der Klink, Jac J.L.; de Boer, Michiel R.

    2016-01-01

    Background: Exclusions are used by insurers to neutralize higher than average risks of sickness absence (SA). However, differentiating risk groups according to one’s medical situation can be seen as discrimination against people with health problems in violation of a 2006 United Nations convention. The objective of this study is to investigate whether the risk of SA of insured persons with exclusions added to their insurance contract differs from the risk of persons without exclusions. Methods: A dynamic cohort of 15 632 applicants for private disability insurance at a company insuring only college and university educated self-employed in the Netherlands. Mean follow-up was 8.94 years. Duration and number of SA periods were derived from insurance data to calculate the hazard of SA periods and of recurrence of SA periods. Results: Self-employed with an exclusion added to their insurance policy experienced a higher hazard of one or more periods of SA and on average more SA days than self-employed without an exclusion. Conclusion: Persons with an exclusion had a higher risk of SA than persons without an exclusion. The question to what extent an individual should benefit from being less vulnerable to disease and SA must be addressed in a larger societal context, taking other aspects of health inequality and solidarity into account as well. PMID:27371668

  16. The Effects of Health Shocks on Employment and Health Insurance: The Role of Employer-Provided Health Insurance

    Science.gov (United States)

    Bradley, Cathy J.; Neumark, David; Motika, Meryl

    2012-01-01

    Background Employment-contingent health insurance (ECHI) has been criticized for tying insurance to continued employment. Our research sheds light on two central issues regarding employment-contingent health insurance: whether such insurance “locks” people who experience a health shock into remaining at work; and whether it puts people at risk for insurance loss upon the onset of illness, because health shocks pose challenges to continued employment. Objective To determine how men’s dependence on their own employer for health insurance affects labor supply responses and health insurance coverage following a health shock. Data Sources We use the Health and Retirement Study (HRS) surveys from 1996 through 2008 to observe employment and health insurance status at interviews two years apart, and whether a health shock occurred in the intervening period between the interviews. Study Selection All employed married men with health insurance either through their own employer or their spouse’s employer, interviewed in at least two consecutive HRS waves with non-missing data on employment, insurance, health, demographic, and other variables, and under age 64 at the second interview. We limited the sample to men who were initially healthy. Data Extraction Our analytical sample consisted of 1,582 men of whom 1,379 had ECHI at the first interview, while 203 were covered by their spouse’s employer. Hospitalization affected 209 men with ECHI and 36 men with spouse insurance. A new disease diagnosis was reported by 103 men with ECHI and 22 men with other insurance. There were 171 men with ECHI and 25 men with spouse employer insurance who had a self-reported health decline. Data Synthesis Labor supply response differences associated with ECHI – with men with health shocks and ECHI more likely to continue working – appear to be driven by specific types of health shocks associated with future higher health care costs but not with immediate increases in morbidity that

  17. Can Health Insurance Reduce School Absenteeism?

    Science.gov (United States)

    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…

  18. Policy processes underpinning universal health insurance in Vietnam.

    Science.gov (United States)

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

    2014-12-01

    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.

  19. Policy processes underpinning universal health insurance in Vietnam

    Directory of Open Access Journals (Sweden)

    Bui T. T. Ha

    2014-09-01

    Full Text Available 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.

  20. HEALTH INSURANCE: FIXED CONTRIBUTION AND REIMBURSEMENT MAXIMA

    CERN Multimedia

    Human Resources Division

    2001-01-01

    Affected by the salary adjustments on 1 January 2001 and the evolution of the staff members and fellows population, the average reference salary, which is used as an index for fixed contributions and reimbursement maxima, has changed significantly. An adjustment of the amounts of the reimbursement maxima and the fixed contributions is therefore necessary, as from 1 January 2001. Reimbursement maxima The revised reimbursement maxima will appear on the leaflet summarizing the benefits for the year 2001, which will be sent out with the forthcoming issue of the CHIS Bull'. This leaflet will also be available from the divisional secretariats and from the UNIQA office at CERN. Fixed contributions The fixed contributions, applicable to some categories of voluntarily insured persons, are set as follows (amounts in CHF for monthly contributions) : voluntarily insured member of the personnel, with normal health insurance cover : 910.- (was 815.- in 2000) voluntarily insured member of the personnel, with reduced heal...

  1. 41 CFR 60-300.25 - Health insurance, life insurance and other benefit plans.

    Science.gov (United States)

    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,...

  2. 41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

    Science.gov (United States)

    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,...

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

    Science.gov (United States)

    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.

  4. Contracts and Insurance Group Formation by Myopic Players

    NARCIS (Netherlands)

    Lazarova, E.A.; Borm, P.E.M.; van Velzen, S.

    2005-01-01

    This paper employs a cooperative approach to insurance group formation problems.The insurance group formation is analyzed in terms of stability with respect to one-person deviations.Depending on the exact contractual setting, three stability concepts are proposed: individual, contractual and compens

  5. Strategies for expanding health insurance coverage in vulnerable populations

    Science.gov (United States)

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

    2014-01-01

    ) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. Main results We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence). In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Authors' conclusions Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies

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

    Science.gov (United States)

    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.

  7. Health Insurance Marketplace Quality Initiatives

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act requires the U.S. Department of Health and Human Services (HHS) to develop quality data collection and reporting tools such as a Quality...

  8. Risk Selection under Public Health Insurance with Opt-Out.

    Science.gov (United States)

    Panthöfer, Sebastian

    2016-09-01

    This paper studies risk selection between public and private health insurance when some, but not all, individuals can opt out of otherwise mandatory public insurance. Using a theoretical model, I show that public insurance is adversely selected when insurers and insureds are symmetrically informed about health-related risks, and that there can be adverse or advantageous selection when insureds are privately informed. Using data from the German Socio-Economic Panel, I find that (i) public insurance is, on balance, adversely selected under the German public health insurance with opt out scheme, (ii) individuals advantageously select public insurance based on risk aversion and residential location, and (iii) there is suggestive evidence of asymmetric information in the market for private health insurance. Copyright © 2016 John Wiley & Sons, Ltd.

  9. Health insurance and the obesity externality.

    Science.gov (United States)

    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.

  10. Consolidation of the health insurance scheme

    CERN Multimedia

    Association du personnel

    2009-01-01

    In the last issue of Echo, we highlighted CERN’s obligation to guarantee a social security scheme for all employees, pensioners and their families. In that issue we talked about the first component: pensions. This time we shall discuss the other component: the CERN Health Insurance Scheme (CHIS).

  11. 77 FR 16453 - Student Health Insurance Coverage

    Science.gov (United States)

    2012-03-21

    ... is appropriately sold to students--for instance, foreign students studying for only one semester in... students' family income levels would disqualify them for subsidies. Several commenters requested that... HUMAN SERVICES 45 CFR Parts 144, 147, and 158 CMS-9981-F RIN 0938-AQ95 Student Health Insurance Coverage...

  12. 78 FR 71476 - Health Insurance Providers Fee

    Science.gov (United States)

    2013-11-29

    ... under subchapter L, an entity providing health insurance under Medicare Advantage, Medicare Part D, or... entities from the DOL reporting requirements under 29 CFR 2520.101-2 governing MEWAs. The reasons... entity's status as an ECE is only relevant for reporting during a limited period of time. For...

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  15. Dutch health insurance reform: the new role of collectives.

    NARCIS (Netherlands)

    Groenewegen, P.P.; Jong, J.D. de

    2007-01-01

    In the new Dutch health insurance system individuals have the option of joining a collective insurance contract. Insurers are allowed to offer premium reductions of up to 10% to members of collectives, based on the number of insurees. Collectives might exert more influence on insurers than individua

  16. Dutch health insurance reform: the new role of collectives.

    NARCIS (Netherlands)

    Groenewegen, P.P.; Jong, J.D. de

    2007-01-01

    In the new Dutch health insurance system individuals have the option of joining a collective insurance contract. Insurers are allowed to offer premium reductions of up to 10% to members of collectives, based on the number of insurees. Collectives might exert more influence on insurers than

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

    Science.gov (United States)

    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.

  18. The impact of race, income, drug abuse and dependence on health insurance coverage among US adults.

    Science.gov (United States)

    Wang, Nianyang; Xie, Xin

    2016-05-04

    Little is known about the impact of drug abuse/dependence on health insurance coverage, especially by race groups and income levels. In this study, we examine the disparities in health insurance predictors and investigate the impact of drug use (alcohol abuse/dependence, nicotine dependence, and illicit drug abuse/dependence) on lack of insurance across different race and income groups. To perform the analysis, we used insurance data (8057 uninsured and 28,590 insured individual adults) from the National Surveys on Drug Use and Health (NSDUH 2011). To analyze the likelihood of being uninsured we performed weighted binomial logistic regression analyses. The results show that the overall prevalence of lacking insurance was 19.6 %. However, race differences in lack of insurance exist, especially for Hispanics who observe the highest probability of being uninsured (38.5 %). Furthermore, we observe that the lowest income level bracket (annual income dependence and nicotine dependence tend to increase the risk of lack of insurance for African Americans and whites, respectively; illicit drug use increases such risk for whites; alcohol abuse/dependence increases the likelihood of lack of insurance for the group with incomes $20,000-$49,999, whereas nicotine dependence is associated with higher probability of lack of insurance for most income groups. These findings provide some useful insights for policy makers in making decisions regarding unmet health insurance coverage.

  19. Inequalities in health: the role of health insurance in Nigeria

    Directory of Open Access Journals (Sweden)

    Amanda Chukwudozie

    2016-08-01

    Full Text Available Health financing is a core necessity for sustainable healthcare delivery. Access inequalities due to financial restrictions in low-middle income countries, and in Africa especially, significantly affect disease rates and health statistics in these regions. This paper focuses on the role of a national health insurance cover as a funding medium in Nigeria, highlighting the theoretical premise of health insurance, its driving forces, key benefits and key limitations particular to the country under scrutiny. Emphasis is laid on its overall effect on the pressing public health issue of health inequality.

  20. Employer Cooperation in Group Insurance Coverage for Public-School Personnel, 1964-65.

    Science.gov (United States)

    National Education Association, Washington, DC.

    This study presents data on group insurance coverage for public school personnel during the 1964-65 academic year, collected from 646 school systems of all sizes throughout the United States. Areas covered include (1) group life insurance, (2) group hospitalization insurance, (3) group medical-surgical insurance, (4) group major medical insurance,…

  1. 76 FR 50931 - Health Insurance Premium Tax Credit

    Science.gov (United States)

    2011-08-17

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BJ82 Health Insurance Premium Tax Credit AGENCY: Internal.... SUMMARY: This document contains proposed regulations relating to the health insurance premium tax credit... individuals who enroll in qualified health plans through Affordable Insurance Exchanges and claim the premium...

  2. 78 FR 7264 - Health Insurance Premium Tax Credit

    Science.gov (United States)

    2013-02-01

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BL49 Health Insurance Premium Tax Credit AGENCY: Internal... regulations relating to the health insurance premium tax credit enacted by the Patient Protection and... coverage and who wish to enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges...

  3. The geographic distribution of private health insurance in Australia in 2001.

    Science.gov (United States)

    Glover, John; Tennant, Sarah; Duckett, Stephen

    2009-08-17

    Private health insurance has been a major focus of Commonwealth Government health policy for the last decade. Over this period, the Howard government introduced a number of policy changes which impacted on the take up of private health insurance. The most expensive of these was the introduction of the private health insurance rebate in 1997, which had an estimated cost of $3 billion per annum. This article uses information on the geographic distribution of the population with private health insurance cover to identify associations between rates of private health insurance cover and socioeconomic status. The geographic analysis is repeated with survey data on expenditure on private health insurance, to provide an estimate of the rebate flowing to different socioeconomic groups. The analysis highlights the strong association between high rates of private health insurance cover and high socioeconomic status and shows the substantial transfer of funds, under the private health insurance rebate, to those living in areas of highest socioeconomic status, compared with those in areas of lower socioeconomic status, and in particular those in the most disadvantaged areas. The article also provides estimates of private health insurance cover by federal electorate, emphasising the substantial gaps in cover between Liberal Party and Australian Labor Party seats. The article concludes by discussing implications of the uneven distribution of private health insurance cover across Australia for policy formation. In particular, the study shows that the prevalence of private health insurance is unevenly distributed across Australia, with marked differences in prevalence in rural and urban areas, and substantial differences by socioeconomic status. Policy formation needs to take this into account. Evaluating the potential impact of changes in private health insurance requires more nuanced consideration than has been implied in the rhetoric about private health insurance over the last

  4. [Occupational health services as the insurance product and insurance economic instruments].

    Science.gov (United States)

    Rydlewska-Liszkowska, Izabela

    2014-01-01

    One of the most controversial issues in restructuring the Polish health insurance system is the implementation of private voluntary insurance and creation within it a new insurance product known as occupational health services (OHS). In this article some opportunities and dilemmas likely to be faced by providers and employers/employees, when contracting with insurance institutions, are considered as a contribution to the discussion on private insurance in Poland. The basic question is how private insurance institutions could influence the promotion of different preventive activities at the company level by motivating both OHS providers and employers. The descriptive qualitative method has been applied in the analysis of legal acts, scientific publications selected according to keywords (Pubmed), documents and expert evaluations and research project results. Taking into account the experiences of European countries, described in publications, international experts' opinions and results of research projects the solution proposed in Poland could be possible under the following several prerequisites: inclusion of a full scope of occupational health services into the insurance product, constant supervision of occupational medicine professionals, monitoring of the health care quality and the relations between private insurers and OHS provider and implementation of the economic incentives scheme to ensure an adequate position of OHS providers on the market. The proposed reconstruction of the health insurance system, comprising undoubtedly positive elements, may entail some threats in the area of health, organization and economy. Private voluntary health insurance implementation requires precisely defined solutions concerning the scope of insurance product, motivation scheme and information system.

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

    Science.gov (United States)

    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.

  6. Regulated competition in health care: switching and barriers to switching in the Dutch health insurance system.

    NARCIS (Netherlands)

    Reitsma-van Rooijen, M.; Jong, J.D. de; Rijken, M.

    2011-01-01

    Background: In 2006, a number of changes in the Dutch health insurance system came into effect. In this new system mobility of insured is important. The idea is that insured switch insurers because they are not satisfied with quality of care and the premium of their insurance. As a result, insurers

  7. Health, Disability Insurance and Retirement in Denmark

    DEFF Research Database (Denmark)

    Bingley, Paul; Datta Gupta, Nabanita; Jørgensen, Michael

    2014-01-01

    There are large differences in labor force participation rates by health status. We examine to what extent these differences are determined by the provisions of Disability Insurance and other pension programs. Using administrative data for Denmark we find that those in worse health and with less...... schooling are more likely to receive DI. The gradient of DI participation across health quintiles is almost twice as steep as for schooling - moving from having no high school diploma to college completion. Using an option value model that accounts for different pathways to retirement, applied to a period...

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

    Science.gov (United States)

    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. 77 FR 20886 - Agency Information Collection (Conversion From Servicemembers' Group Life Insurance to Veterans...

    Science.gov (United States)

    2012-04-06

    ... AFFAIRS Agency Information Collection (Conversion From Servicemembers' Group Life Insurance to Veterans' Group Life Insurance); Activity Under OMB Review AGENCY: Veterans Benefits Administration, Department of... Evaluation of the Conversion Privilege from Servicemembers' Group Life Insurance (SGLI) to Veterans'...

  10. Health insurance exchanges bring potential opportunities.

    Science.gov (United States)

    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

  11. Private health insurance and the use of health care services - a review of the theoretical literature with application to voluntary private health insurance in universal health care systems

    OpenAIRE

    Kiil, Astrid

    2012-01-01

    This paper reviews the theoretical literature on the demand for private health insurance and its effect on the use of health care services and applies the theoretical framework to the type of private health insurance that exists alongside a universal health care system. The predominant share of the theoretical literature on private health insurance is developed to model private health insurance in settings where this provides the primary source of coverage and the choice is between purchasing...

  12. Determinants of the demand for health insurance coverage

    NARCIS (Netherlands)

    K.P.M. Winssen van (Kayleigh)

    2017-01-01

    markdownabstractThe health insurance density in the Netherlands is among the highest in the world. This is shown by the fact that, in 2016, only 12 per cent of the Dutch insured opted for a reduction of health insurance coverage in the form of a voluntary deductible, while, at the same time, 84 per

  13. Determinants of the demand for health insurance coverage

    NARCIS (Netherlands)

    K.P.M. Winssen van (Kayleigh)

    2017-01-01

    markdownabstractThe health insurance density in the Netherlands is among the highest in the world. This is shown by the fact that, in 2016, only 12 per cent of the Dutch insured opted for a reduction of health insurance coverage in the form of a voluntary deductible, while, at the same time, 84 per

  14. Risk distribution across multiple health insurance funds in rural Tanzania

    DEFF Research Database (Denmark)

    Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika

    2014-01-01

    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......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...... 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...

  15. The 2007-09 recession and health insurance coverage.

    Science.gov (United States)

    Holahan, John

    2011-01-01

    Loss of employment and declining incomes meant that five million Americans lost employment-based health insurance during the recent economic recession (2007-09). All groups of Americans were affected, but the growth in the number of uninsured people was particularly noticeable for whites, native-born citizens, and residents of the Midwest and South. Adults did not benefit nearly as much as children from public programs designed to offset the decline in employer-sponsored insurance and thus bore all of the burden of rising uninsurance. Throughout the past decade, even in good economic times, the number of Americans with employer-sponsored insurance has fallen, and the number of uninsured Americans has increased. This finding underscores the importance of planned coverage expansions under the Affordable Care Act.

  16. [Different Regions, Differently Insured Populations? Socio-demographic and Health-related Differences Between Insurance Funds].

    Science.gov (United States)

    Hoffmann, Falk; Koller, Daniela

    2017-01-01

    Objectives: Analyses of health insurance claims data are getting more important in public health and health services research. Since there are several different health insurance funds in Germany, the specific characteristics of regional and socio-demographic population covered by a single fund has to be considered. The aim of this study is to evaluate the differences in socio-demographic and health-related variables between health insurance funds. Methods: This study is based on the GEDA-Study 2009 and 2010, 2 representative cross-sectional telephone surveys (n=42 534). We included socio-economic factors as well as information on area of residence and health-related variables to health status, health behavior and cardiovascular diseases. Results: There are fewer privately insured persons in the eastern regions of Germany. Insurants of the public health insurances have a lower socio-economic status and many have a migration background. Similar results can be found for smoking, obesity and cardiovascular factors. These differences between funds were found in many regional analyses. Conclusions: Especially differences in socio-economic factors are constant between insurance funds and regions. Therefore, the results show that analyses of one single health insurance fund cannot be generalized to the whole population. To ensure precise estimates on health services, morbidity or quality monitoring, we need data sets that integrate more funds. © Georg Thieme Verlag KG Stuttgart · New York.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  19. 77 FR 72721 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    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 The...

  20. Health, Disability Insurance and Retirement in Denmark

    DEFF Research Database (Denmark)

    Bingley, Paul; Datta Gupta, Nabanita; Jørgensen, Michael

    2014-01-01

    There are large differences in labor force participation rates by health status. We examine to what extent these differences are determined by the provisions of Disability Insurance and other pension programs. Using administrative data for Denmark we find that those in worse health and with less...... schooling are more likely to receive DI. The gradient of DI participation across health quintiles is almost twice as steep as for schooling - moving from having no high school diploma to college completion. Using an option value model that accounts for different pathways to retirement, applied to a period...... gradients in outcomes and behavior by health and schooling partially reflects the less educated having poorer health on average, but also that the less educated have worse job prospects and higher replacement rates due to a progressive formula for DI and other pension benefits....

  1. Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status.

    Science.gov (United States)

    Villelli, Nicolas W; Das, Rohit; Yan, Hong; Huff, Wei; Zou, Jian; Barbaro, Nicholas M

    2017-01-01

    OBJECTIVE The Massachusetts health care insurance reform law passed in 2006 has many similarities to the federal Affordable Care Act (ACA). To address concerns that the ACA might negatively impact case volume and reimbursement for physicians, the authors analyzed trends in the number of neurosurgical procedures by type and patient insurance status in Massachusetts before and after the implementation of the state's health care insurance reform. The results can provide insight into the future of neurosurgery in the American health care system. METHODS The authors analyzed data from the Massachusetts State Inpatient Database on patients who underwent neurosurgical procedures in Massachusetts from 2001 through 2012. These data included patients' insurance status (insured or uninsured) and the numbers of procedures performed classified by neurosurgical procedural codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Each neurosurgical procedure was grouped into 1 of 4 categories based on ICD-9-CM codes: 1) tumor, 2) other cranial/vascular, 3) shunts, and 4) spine. Comparisons were performed of the numbers of procedures performed and uninsured patients, before and after the implementation of the reform law. Data from the state of New York were used as a control. All data were controlled for population differences. RESULTS After 2008, there were declines in the numbers of uninsured patients who underwent neurosurgical procedures in Massachusetts in all 4 categories. The number of procedures performed for tumor and spine were unchanged, whereas other cranial/vascular procedures increased. Shunt procedures decreased after implementation of the reform law but exhibited a similar trend to the control group. In New York, the number of spine surgeries increased, as did the percentage of procedures performed on uninsured patients. Other cranial/vascular procedures decreased. CONCLUSIONS After the Massachusetts health care

  2. 77 FR 3842 - Proposed Information Collection (Conversion from Servicemembers' Group Life Insurance to Veterans...

    Science.gov (United States)

    2012-01-25

    ... AFFAIRS Proposed Information Collection (Conversion from Servicemembers' Group Life Insurance to Veterans' Group Life Insurance); Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans... members, especially service members with disabilities are informed about their life insurance...

  3. Strategies for expanding health insurance coverage in vulnerable populations

    OpenAIRE

    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), pa...

  4. Universal health insurance through incentives reform.

    Science.gov (United States)

    Enthoven, A C; Kronick, R

    1991-05-15

    Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

  5. Supplemental health insurance and equality of access in Belgium

    NARCIS (Netherlands)

    E. Schokkaert (Schokkaert); T.G.M. van Ourti (Tom); D. de Graeve (Diana); A. Lecluyse (Ann); C. van de Voorde (Carine)

    2010-01-01

    textabstractThe effects of supplemental health insurance on health-care consumption crucially depend on specific institutional features of the health-care system. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental

  6. State of emergency preparedness for US health insurance plans.

    Science.gov (United States)

    Merchant, Raina M; Finne, Kristen; Lardy, Barbara; Veselovskiy, German; Korba, Caey; Margolis, Gregg S; Lurie, Nicole

    2015-01-01

    Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. A survey of health insurance plans. We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices. Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend claim filing time and 71% could temporarily suspend prior medical authorization rules. Regarding connectedness, many plans shared their contingency plans with health officials, but often cited challenges in identifying regulatory agency contacts. Some health insurance plans had specific policies for assisting individuals dependent on durable medical equipment or home healthcare. Many plans (60%) expressed interest in sharing best practices. Health insurance plans are prioritizing emergency preparedness. We identified 6 policy modifications that health insurance plans could undertake to potentially improve healthcare system preparedness: establishing metrics and benchmarks for emergency preparedness; identifying disaster-specific policy modifications, enhancing stakeholder connectedness, considering digital strategies to enhance communication, improving support and access for special-needs individuals, and developing regular forums for knowledge exchange about emergency preparedness.

  7. Supplementary insurance as a switching cost for basic health insurance: Empirical results from the Netherlands.

    Science.gov (United States)

    Willemse-Duijmelinck, Daniëlle M I D; van de Ven, Wynand P M M; Mosca, Ilaria

    2017-08-10

    Nearly everyone with a supplementary insurance (SI) in the Netherlands takes out the voluntary SI and the mandatory basic insurance (BI) from the same health insurer. Previous studies show that many high-risks perceive SI as a switching cost for BI. Because consumers' current insurer provides them with a guaranteed renewability, SI is a switching cost if insurers apply selective underwriting to new applicants. Several changes in the Dutch health insurance market increased insurers' incentives to counteract adverse selection for SI. Tools to do so are not only selective underwriting, but also risk rating and product differentiation. If all insurers use the latter tools without selective underwriting, SI is not a switching cost for BI. We investigated to what extent insurers used these tools in the periods 2006-2009 and 2014-2015. Only a few insurers applied selective underwriting: in 2015, 86% of insurers used open enrolment for all their SI products, and the other 14% did use open enrolment for their most common SI products. As measured by our indicators, the proportion of insurers applying risk rating or product differentiation did not increase in the periods considered. Due to the fear of reputation loss insurers may have used 'less visible' tools to counteract adverse selection that are indirect forms of risk rating and product differentiation and do not result in switching costs. So, although many high-risks perceive SI as a switching cost, most insurers apply open enrolment for SI. By providing information to high-risks about their switching opportunities, the government could increase consumer choice and thereby insurers' incentives to invest in high-quality care for high-risks. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?

    Science.gov (United States)

    Woolhandler, Steffie; Himmelstein, David U

    2017-09-19

    About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Patient Protection and Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

  9. Basic Versus Supplementary Health Insurance : Moral Hazard and Adverse Selection

    NARCIS (Netherlands)

    Boone, J.

    2014-01-01

    This paper introduces a tractable model of health insurance with both moral hazard and adverse selection. We show that government sponsored universal basic insurance should cover treatments with the biggest adverse selection problems. Treatments not covered by basic insurance can be covered on the

  10. Basic versus supplementary health insurance : Moral hazard and adverse selection

    NARCIS (Netherlands)

    Boone, J.

    This paper introduces a tractable model of health insurance with both moral hazard and adverse selection. We show that government sponsored universal basic insurance should cover treatments with the biggest adverse selection problems. Treatments not covered by basic insurance can be covered on the

  11. Basic Versus Supplementary Health Insurance : Moral Hazard and Adverse Selection

    NARCIS (Netherlands)

    Boone, J.

    2014-01-01

    This paper introduces a tractable model of health insurance with both moral hazard and adverse selection. We show that government sponsored universal basic insurance should cover treatments with the biggest adverse selection problems. Treatments not covered by basic insurance can be covered on the p

  12. Basic versus supplementary health insurance : Moral hazard and adverse selection

    NARCIS (Netherlands)

    Boone, J.

    2015-01-01

    This paper introduces a tractable model of health insurance with both moral hazard and adverse selection. We show that government sponsored universal basic insurance should cover treatments with the biggest adverse selection problems. Treatments not covered by basic insurance can be covered on the p

  13. Basic versus supplementary health insurance : Moral hazard and adverse selection

    NARCIS (Netherlands)

    Boone, J.

    2015-01-01

    This paper introduces a tractable model of health insurance with both moral hazard and adverse selection. We show that government sponsored universal basic insurance should cover treatments with the biggest adverse selection problems. Treatments not covered by basic insurance can be covered on the p

  14. Basic Versus Supplementary Health Insurance : Moral Hazard and Adverse Selection

    NARCIS (Netherlands)

    Boone, J.

    2014-01-01

    This paper introduces a tractable model of health insurance with both moral hazard and adverse selection. We show that government sponsored universal basic insurance should cover treatments with the biggest adverse selection problems. Treatments not covered by basic insurance can be covered on the p

  15. Effect of health insurance type on access to care.

    Science.gov (United States)

    Froelich, John M; Beck, Ryan; Novicoff, Wendy M; Saleh, K J

    2013-10-01

    Growing orthopedic and nonorthopedic literature illustrates the point that having health insurance does not equal having access to care. The goal of this study was to evaluate the burden placed on patients to gain access to outpatient orthopedic care. For this study, burden was quantified as the distance traveled by the patient to be seen in clinic. This study was a retrospective review of all new patient encounters at an adult orthopedic outpatient clinic in an academic tertiary referral center over 1 calendar year. All patients were stratified into 4 categories: commercial/private insurance, Medic-aid, Medicare, and uninsured/private pay. The average distance traveled by each patient to the center was then calculated based on the patient's billing zip code. Patient visits were further stratified based on whether the patients were seen by 1 of 3 different categories of providers: general orthopedics/adult reconstruction, spine, and sports/upper extremity. The study group comprised 774 (31.1%) Medicaid patients, 653 (26.2%) Medicare patients, 917 (36.8%) commercial/private insurance patients, and 146 (5.9%) uninsured/private pay patients. The average 1-way distance traveled was 36.2 miles for Medicaid patients, 21.3 miles for Medicare patients, 24.1 miles for commercial/private insurance patients, and 25.3 miles for uninsured/private pay patients (Paccess to outpatient orthopedic care at a single institution. The specific burdens that each group faces to gain access to care are unclear.

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

    Science.gov (United States)

    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.

  17. Boosting health insurance coverage in developing countries: do conditional cash transfer programmes matter in Mexico?

    Science.gov (United States)

    Biosca, Olga; Brown, Heather

    2015-03-01

    Achieving universal health insurance coverage is a goal for many developing countries. Even when universal health insurance programmes are in place, there are significant barriers to reaching the lowest socio-economic groups such as a lack of awareness of the programmes or knowledge of the benefits to participating in the insurance market. Conditional cash transfer (CCT) programmes can encourage participation through mandatory health education classes, increased contact with the health care system and cash payments to reduce costs of participating in the insurance market. To explore if participation in a CCT programme in Mexico, Oportunidades, is significantly associated with self-reported enrolment in a public health insurance programme. Cross-sectional data from 2007 collected on 29 595 Mexican households where the household head is aged between ages 15 and 60 were analysed. A logit model was used to estimate the association between Oportunidades participation and awareness of enrolment in a public health insurance programme. Participation in the Oportunidades programme is associated with a 25% higher likelihood of being actively aware of enrolment in Seguro Popular, a public health insurance scheme for the lowest socio-economic groups. Participation in the Oportunidades CCT programme is positively associated with awareness of enrolment in public health insurance. CCT programmes may be used to promote participation of the lowest socio-economic groups in universal public health insurance systems. This is crucial to achieving universal health insurance coverage in developing countries. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

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

    Science.gov (United States)

    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.

  19. 78 FR 17612 - Health Insurance Providers Fee; Correction

    Science.gov (United States)

    2013-03-22

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 57 RIN 1545-BL20 Health Insurance Providers Fee; Correction AGENCY... entities engaged in the business of providing health insurance for United States health risks. FOR FURTHER...

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

    Science.gov (United States)

    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…

  1. 77 FR 41048 - Health Insurance Premium Tax Credit; Correction

    Science.gov (United States)

    2012-07-12

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BJ82 Health Insurance Premium Tax Credit; Correction AGENCY..., 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...

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

    Science.gov (United States)

    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…

  3. 75 FR 24470 - Health Care Reform Insurance Web Portal Requirements

    Science.gov (United States)

    2010-05-05

    ... health insurance coverage options in that State. In implementing these requirements, we seek to develop a... 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...

  4. Health Insurance – Affiliation to LAMal insurance for families of CERN personnel

    CERN Multimedia

    Staff Association

    2017-01-01

    On May 16, the HR department published in the CERN Bulletin an article concerning cross-border workers (“frontaliers”) and the exercise of the right of choice in health insurance: « In view of the Agreement concluded on 7 July 2016 between Switzerland and France regarding the choice of health insurance system* for persons resident in France and working in Switzerland ("frontaliers"), the Swiss authorities have indicated that those persons who have not “formally exercised their right to choose a health insurance system before 30 September 2017 risk automatically becoming members of the Swiss LAMal system” and having to “pay penalties to their insurers that may amount to several years’ worth of contributions”. Among others, this applies to spouses of members of the CERN personnel who live in France and work in Switzerland. » But the CERN Health Insurance Scheme (CHIS), provides insuranc...

  5. Development of the Health Insurance Literacy Measure (HILM): Conceptualizing and Measuring Consumer Ability to Choose and Use Private Health Insurance

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

  7. 26 CFR 1.79-1 - Group-term life insurance-general rules.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Group-term life insurance-general rules. 1.79-1...-term life insurance—general rules. (a) What is group-term life insurance? Life insurance is not group-term life insurance for purposes of section 79 unless it meets the following conditions: (1)...

  8. 42 CFR 457.618 - Ten percent limit on certain Children's Health Insurance Program expenditures.

    Science.gov (United States)

    2010-10-01

    ... 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... Children's Health Insurance Program expenditures. (a) Expenditures. (1) Primary expenditures are...

  9. Insurer market structure and variation in commercial health care spending.

    Science.gov (United States)

    McKellar, Michael R; Naimer, Sivia; Landrum, Mary B; Gibson, Teresa B; Chandra, Amitabh; Chernew, Michael

    2014-06-01

    To examine the relationship between insurance market structure and health care prices, utilization, and spending. Claims for 37.6 million privately insured employees and their dependents from the Truven Health Market Scan Database in 2009. Measures of insurer market structure derived from Health Leaders Inter study data. Regression models are used to estimate the association between insurance market concentration and health care spending, utilization, and price, adjusting for differences in patient characteristics and other market-level traits. Insurance market concentration is inversely related to prices and spending, but positively related to utilization. Our results imply that, after adjusting for input price differences, a market with two equal size insurers is associated with 3.9 percent lower medical care spending per capita (p = .002) and 5.0 percent lower prices for health care services relative to one with three equal size insurers (p market might lead to higher prices and higher spending for care, suggesting some of the gains from insurer competition may be absorbed by higher prices for health care. Greater attention to prices and utilization in the provider market may need to accompany procompetitive insurance market strategies. © Health Research and Educational Trust.

  10. Unemployment insurance and deteriorating self-rated health in 23 European countries.

    Science.gov (United States)

    Ferrarini, Tommy; Nelson, Kenneth; Sjöberg, Ola

    2014-07-01

    The global financial crisis of 2008 is likely to have repercussions on public health in Europe, not least through escalating mass unemployment, fiscal austerity measures and inadequate social protection systems. The purpose of this study is to analyse the role of unemployment insurance for deteriorating self-rated health in the working age population at the onset of the fiscal crisis in Europe. Multilevel logistic conditional change models linking institutional-level data on coverage and income replacement in unemployment insurance to individual-level panel data on self-rated health in 23 European countries at two repeated occasions, 2006 and 2009. Unemployment insurance significantly reduces transitions into self-rated ill-health and, particularly, programme coverage is important in this respect. Unemployment insurance is also of relevance for the socioeconomic gradients of health at individual level, where programme coverage significantly reduces health risks attached to educational attainment. Unemployment insurance mitigated adverse health effects both at individual and country-level during the financial crisis. Due to the centrality of programme coverage, reforms to unemployment insurance should focus on extending the number of insured people in the labour force. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Ghana's National Health insurance scheme and maternal and child health: a mixed methods study.

    Science.gov (United States)

    Singh, Kavita; Osei-Akoto, Isaac; Otchere, Frank; Sodzi-Tettey, Sodzi; Barrington, Clare; Huang, Carolyn; Fordham, Corinne; Speizer, Ilene

    2015-03-17

    Ghana is attracting global attention for efforts to provide health insurance to all citizens through the National Health Insurance Scheme (NHIS). With the program's strong emphasis on maternal and child health, an expectation of the program is that members will have increased use of relevant services. This paper uses qualitative and quantitative data from a baseline assessment for the Maternal and Newborn errals Evaluation from the Northern and Central Regions to describe women's experiences with the NHIS and to study associations between insurance and skilled facility delivery, antenatal care and early care-seeking for sick children. The assessment included a quantitative household survey (n = 1267 women), a quantitative community leader survey (n = 62), qualitative birth narratives with mothers (n = 20) and fathers (n = 18), key informant interviews with health care workers (n = 5) and focus groups (n = 3) with community leaders and stakeholders. The key independent variables for the quantitative analyses were health insurance coverage during the past three years (categorized as all three years, 1-2 years or no coverage) and health insurance during the exact time of pregnancy. Quantitative findings indicate that insurance coverage during the past three years and insurance during pregnancy were associated with greater use of facility delivery but not ANC. Respondents with insurance were also significantly more likely to indicate that an illness need not be severe for them to take a sick child for care. The NHIS does appear to enable pregnant women to access services and allow caregivers to seek care early for sick children, but both the quantitative and qualitative assessments also indicated that the poor and least educated were less likely to have insurance than their wealthier and more educated counterparts. Findings from the qualitative interviews uncovered specific challenges women faced regarding registration for the NHIS and other

  12. Enrolment in community-based health insurance schemes in rural Bihar and Uttar Pradesh, India.

    Science.gov (United States)

    Panda, Pradeep; Chakraborty, Arpita; Dror, David M; Bedi, Arjun S

    2014-12-01

    This article assesses insurance uptake in three community-based health insurance (CBHI) schemes located in rural parts of two of India's poorest states and offered through women's self-help groups (SHGs). We examine what drives uptake, the degree of inclusive practices of the schemes and the influence of health status on enrolment. The most important finding is that a household's socio-economic status does not appear to substantially inhibit uptake. In some cases scheduled caste/scheduled tribe households are more likely to enrol. Second, households with greater financial liabilities find insurance more attractive. Third, access to the national hospital insurance scheme Rashtriya Swasthya Bima Yojana does not dampen CBHI uptake, suggesting that the potential for greater development of insurance markets and products beyond existing ones would respond to a need. Fourth, recent episodes of illness and self-assessed health status do not influence uptake. Fifth, insurance coverage is prioritized within households, with the household head, the spouse of the household head and both male and female children of the household head, more likely to be insured as compared with other relatives. Sixth, offering insurance through women's SHGs appears to mitigate concerns about the inclusiveness and sustainability of CBHI schemes. Given the pan-Indian spread of SHGs, offering insurance through such groups offers the potential to scale-up CBHI. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

  13. Household perceptions towards a redistributive policy across health insurance funds in Tanzania

    DEFF Research Database (Denmark)

    Chomi, Eunice; Mujinja, Phares; Hansen, Kristian Schultz

    2015-01-01

    Background The Tanzanian health insurance system comprises multiple health insurance funds targeting different population groups but which operate in parallel, with no mechanisms for redistribution across the funds. Establishing such redistributive mechanisms requires public support, which...... data collected from a survey of 695 households relating to perceptions of household heads towards cross-subsidisation of the poor to enable them to access health services. Kruskal-Wallis test is used to compare perceptions by membership status. Generalized ordinal logistic regression models are used...

  14. Exclusion from the Health Insurance Scheme

    CERN Multimedia

    2003-01-01

    A CERN pensioner, member of the Organization's Health Insurance Scheme (CHIS), recently provided fake documents in support of claims for medical expenses, in order to receive unjustified reimbursement from the CHIS. The Administrator of the CHIS, UNIQA, suspected a case of fraud: Accordingly, an investigation and interview of the person concerned was carried out and brought the Organization to the conclusion that fraud had actually taken place. Consequently and in accordance with Article VIII 3.12 of the CHIS Rules, it was decided to exclude this member permanently from the CHIS. The Organization takes the opportunity to remind Scheme members that any fraud or attempt to fraud established within the framework of the CHIS exposes them to: - disciplinary action, according to the Staff Rules and Regulations, for CERN members of the personnel; - definitive exclusion from the CHIS for members affiliated on a voluntary basis. Human Resources Division Tel. 73635

  15. New CERN Health Insurance Scheme (CHIS) forms

    CERN Multimedia

    HR Department

    2015-01-01

    New versions of the following forms for claims and requests to the CERN Health Insurance Scheme (CHIS) have been released:   form for claiming reimbursement of medical expenses,   form for requesting advance reimbursement, and   dental estimate form (for treatments foreseen to exceed 800 CHF).   The new forms are available in French and English. They can either be completed electronically before being printed and signed, or completed in paper form. New detailed instructions can be found at the back of the claim form; CHIS members are invited to read them carefully. The electronic versions (PDF) of all the forms are available on the CHIS website and on the UNIQA Member Portal. CHIS Members are requested to use these new forms forthwith and to discard any previous version. Questions regarding the above should be addressed directly to UNIQA (72730 or 022.718 63 00 or uniqa.assurances@cern.ch).

  16. HEALTH INSURANCE: our money in a capitalized fund now

    CERN Multimedia

    Association du personnel

    In ECHO no. 41 on 5 November “Health insurance: what is the current situation?” we explained to you the situation of our Health Insurance Scheme and the ideas currently being discussed to ensure its future balance. If you missed this episode, you should catch up on it now so that you understand what follows.

  17. Stakeholders' perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study.

    Science.gov (United States)

    Housten, A J; Furtado, K; Kaphingst, K A; Kebodeaux, C; McBride, T; Cusanno, B; Politi, M C

    2016-11-08

    Approximately 29 million individuals are expected to enroll in health insurance using the Patient Protection and Affordable Care Act (ACA) Marketplace by 2022. Those seeking health insurance struggle to understand insurance options and choose a plan that best suits their needs. We interviewed stakeholders to identify the challenges associated with the ACA Marketplace health insurance enrollment and elicited feedback about what to include in health insurance decision support tools. Interviews were transcribed and themes were identified using inductive thematic analysis. Stakeholders stated that consumers felt frustrated by unclear terminology, high plan costs, and complex calculations required to assess costs. Consumers felt anxious about making the wrong choice and being unable to change plans within a calendar year. Stakeholders recommended using plain language tables defining complex terms, grouping information, and using engaging graphics to communicate information about health insurance. Stakeholders thought that narratives of how others made decisions about insurance might be helpful to consumers, but recommended that they be tailored to the needs of specific consumers. Strategies that clarify health insurance terms using plain language and graphics, acknowledge concern associated with making the wrong choice, calculate and enable cost comparison, and tailor information to consumers' unique needs could benefit those enrolling in ACA Marketplace plans, Narratives developed should be simple and inclusive enough for diverse populations.

  18. California bonanza? Providers and insurers cheer mandatory health insurance law, but business interests look at legal challenge to newly signed bill.

    Science.gov (United States)

    Reilly, Patrick

    2003-10-13

    Consider it Gov. Gray Davis' going-away present to the state's hospitals, insurers and physician groups. The California Health Insurance Act of 2003 could mean increased revenue for hospitals. Doctors like Brian Johnston, left, say the bill has been a long time coming and are pleased with the legislation, but others are concerned about what effects the mandatory insurance law will have on small businesses.

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

    Science.gov (United States)

    Hadley, Jack; Reschovsky, James D

    2002-01-01

    This paper explores the decisions by small business establishments (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.

  20. Identification of ovarian cancer symptoms in health insurance claims data.

    Science.gov (United States)

    Devlin, Sean M; Diehr, Paula H; Andersen, M Robyn; Goff, Barbara A; Tyree, Patrick T; Lafferty, William E

    2010-03-01

    Women with ovarian cancer have reported abdominal/pelvic pain, bloating, difficulty eating or feeling full quickly, and urinary frequency/urgency prior to diagnosis. We explored these findings in a general population using a dataset of insured women aged 40-64 and investigated the potential effectiveness of a routine review of claims data as a prescreen to identify women at high risk for ovarian cancer. Data from a large Washington State health insurer were merged with the Seattle-Puget Sound Surveillance, Epidemiology and End Results (SEER) cancer registry for 2000-2004. We estimated the prevalence of symptoms in the 36 months prior to diagnosis for early and late-stage ovarian cancer cases and for two comparison groups. The potential performance of a passive screener that would flag women with two or more visits for any of the symptoms in the previous 2-month period was examined. Of the 223,903 insured women, 161 had incident cases of ovarian cancer. Both early and late-stage patients had a higher prevalence of abdominal/pelvic pain and bloating than the comparison groups, primarily in the 3 months before diagnosis. The passive screener had a sensitivity of 0.31 and specificity of 0.83 and usually identified women right before diagnosis. Assuming an average cost of $500 per false positive, the screener would be considered cost-effective if the true positives had an average increase of 8.5 years of life expectancy. These results support previous findings that ovarian cancer symptoms were reported in health insurance claims and were more prevalent before diagnosis, but the symptoms may occur too close to the diagnosis date to provide useful diagnostic information. The passive screening approach should be reevaluated in the future using electronic medical records; if found to be effective, the method may be potentially useful for other incident diseases.

  1. 78 FR 4593 - Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in...

    Science.gov (United States)

    2013-01-22

    ... 42 CFR Parts 430, 431, 433, et al. 45 CFR Part 155 Medicaid, Children's Health Insurance Programs... Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans... Affordable Care Act), and the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). This...

  2. Health insurance in India: need for managed care expertise.

    Science.gov (United States)

    Thomas, Thomas K

    2011-02-01

    Health insurers in India currently face many challenges, including poor consumer awareness, strict regulations, and inefficient business practices. They operate under a combination of stifling administrative costs and high medical expense ratios which have ensured that insurers operate under steep losses. External factors (eg, onerous regulations, lack of standards, high claims payouts) and internal factors (eg, high administrative costs, dependence on indemnity models that cover inpatient treatment costs only) have forced the health insurance industry into a regressive spiral. To overcome these challenges, health insurers need to innovate in their product offerings and tighten their existing processes and cost structures. But as a long-term strategy, it is imperative that health insurers deploy managed care concepts, which will go a long way toward addressing the systemic issues in the current operational models of health plans.

  3. Willingness To Pay for Social Health Insurance in Iran

    Science.gov (United States)

    Nosratnejad, Shirin; Rashidian, Arash; Mehrara, Mohsen; Sari, Ali Akbari; Mahdavi, Ghadir; Moeini, Maryam

    2014-01-01

    Objective: The substantial level of out-of-pocket expenditure for health care by the population causes policy makers to draw particular attention to the proposal of a social health insurance for uninsured members of the community. Hence, it is essential to gather reliable information about the amount of Willingness To Pay (WTP) for health insurance. We assessed the WTP for health insurance in Iran in order to suggest an affordable social health insurance. Method: The study sample included 300 household heads in all Iranian provinces. The double bounded dichotomous choice approach was used to elicit the WTP. Result: The average WTP for social health insurance per person per month was 137 000 Rial (5.5 $US). Household heads with higher levels of education, income and those who worked had more WTP for the health insurance. Besides, the WTP increased in direct proportion to the number of insured members of each household and in inverse proportion to the family size. Conclusions: From a policy point of view, the WTP value can be used as a premium in a society. An important finding of this study is that although households’ Willingness To Pay is not more than the total insurance premium, households are willing to pay more than the premium they ought to pay for health insurance coverage. That is, total insurance premium is 150 000 Rials and households ought to pay approximately half of this sum. This can afford policy makers the ideal opportunity to provide good insurance coverage for medical services according to the need of society. PMID:25168979

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

    Science.gov (United States)

    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.

  5. Insurance Coverage and Whither Thou Goest for Health Info

    Data.gov (United States)

    U.S. Department of Health & Human Services — Authors of Insurance Coverage and Whither Thou Goest for Health Information in 2012, recently published in Volume 4, Issue 4 of the Medicare and Medicaid Research...

  6. Awareness and Coverage of the National Health Insurance Scheme ...

    African Journals Online (AJOL)

    A self-administered questionnaire was used to collect data from respondents. ... the NHIS, however only 13.5 % paid for health care services through the NHIS. ... Key words: health insurance, awareness, enrolment status, tiers of governance ...

  7. Insurance Coverage and Whither Thou Goest for Health Info

    Data.gov (United States)

    U.S. Department of Health & Human Services — Authors of Insurance Coverage and Whither Thou Goest for Health Information in 2012, recently published in Volume 4, Issue 4 of the Medicare and Medicaid Research...

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

    Science.gov (United States)

    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

  9. Health insurance and child mortality in rural Burkina Faso.

    Science.gov (United States)

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

    2015-01-01

    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. 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. 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. 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. 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.

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

    Science.gov (United States)

    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.

  11. Health insurance and child mortality in rural Burkina Faso

    Directory of Open Access Journals (Sweden)

    Anja Schoeps

    2015-04-01

    Full Text Available 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.

  12. The effect of health insurance reform on the number of cataract surgeries in Chongqing, China

    Directory of Open Access Journals (Sweden)

    Yuan Rongdi

    2011-03-01

    Full Text Available Abstract Background Cataracts are the leading cause of blindness in China, and poverty is a major barrier to having cataract surgery. In 2003, the Chinese government began a series of new national health insurance reforms, including the New Cooperative Medical Scheme (NCMS and the Urban Resident Basic Health Insurance scheme (URBMI. These two programs, combined with the previously existing Urban Employee Basic Health Insurance (UEBMI program, aimed to make it easier for individuals to receive medical treatment. This study reports cataract surgery numbers in rural and urban populations and the proportion of these who had health insurance in Chongqing, China from 2003 to 2008. Methods The medical records of a consecutive case series, including 14,700 eyes of 13,262 patients who underwent age-related cataract surgery in eight hospitals in Chongqing from January 1, 2003, to December 31, 2008, were analysed retrospectively via multi-stage cluster sampling. Results In the past six years, the total number of cataract surgeries had increased each year as had the number of patients with insurance. Both the number of surgeries and the number of insured patients were much higher in the urban group than in the rural group. The rate of increase in the rural group however was much higher than in the urban group, especially in 2007 and 2008. The odds ratios of having health insurance for urban vs. rural individuals were relatively stable from 2003 to 2006, but it decreased in 2007 and was significantly lower in 2008. Conclusions Health insurance appears to be an important factor associated with increased cataract surgery in Chongqing, China. With the implementation of health insurance, the number of Chongqing's cataract surgeries was increased year by year.

  13. 75 FR 48815 - Medicaid Program and Children's Health Insurance Program (CHIP); Revisions to the Medicaid...

    Science.gov (United States)

    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... Children's Health Insurance Program (CHIP). DATES: Effective Date: These regulations are effective on...

  14. 76 FR 67743 - Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee...

    Science.gov (United States)

    2011-11-02

    ... Medicare or Medicaid programs or Children's Health Insurance Program (CHIP); revalidating their Medicare... Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment..., Medicaid, and Children's Health Insurance Program (CHIP) provider enrollment processes. Specifically, and...

  15. 76 FR 16422 - Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee...

    Science.gov (United States)

    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 424...

  16. 78 FR 9457 - Medicare, Medicaid, Children's Health Insurance Programs; Transparency Reports and Reporting of...

    Science.gov (United States)

    2013-02-08

    ... 42 CFR Parts 402 and 403 Medicare, Medicaid, Children's Health Insurance Programs; Transparency..., Medicaid, Children's Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership... medical supplies covered by Medicare, Medicaid or the Children's Health Insurance Program (CHIP) to report...

  17. Measuring customer preferences in the German statutory health insurance.

    Science.gov (United States)

    Pendzialek, Jonas B; Simic, Dusan; Stock, Stephanie

    2017-09-01

    This paper investigates consumer preferences in the German statutory health insurance market. It further aims to test whether preferences differ by age and health status. Evidence is provided by a discrete choice experiment conducted in 2014 using the six most important attributes in sickness fund competition and ten random generated choice sets per participant. Price is found to be the most important attribute followed by additional benefits, managed care programmes, and distance to nearest branch. Other positive attributes of sickness funds are found to balance out a higher price, which would allow a sickness fund to position itself as high quality. However, significant differences in preferences were found between age and health status group. In particular, compromised health is associated with higher preference for illness-related additional benefits and less distance to the lowest branch, but lower preference for a lower price. Based on these differences, a distinct sickness fund offer could be constructed that would allow passive risk selection.

  18. 77 FR 22691 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    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 (202...

  19. 77 FR 47573 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    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 Fund...

  20. The Dutch health insurance reform: switching between insurers, a comparison between the general population and the chronically ill and disabled

    Directory of Open Access Journals (Sweden)

    Groenewegen Peter P

    2008-03-01

    Full Text Available Abstract Background On 1 January 2006 a number of far-reaching changes in the Dutch health insurance system came into effect. In the new system of managed competition consumer mobility plays an important role. Consumers are free to change their insurer and insurance plan every year. The idea is that consumers who are not satisfied with the premium or quality of care provided will opt for a different insurer. This would force insurers to strive for good prices and quality of care. Internationally, the Dutch changes are under the attention of both policy makers and researchers. Questions answered in this article relate to switching behaviour, reasons for switching, and differences between population categories. Methods Postal questionnaires were sent to 1516 members of the Dutch Health Care Consumer Panel and to 3757 members of the National Panel of the Chronically ill and Disabled (NPCD in April 2006. The questionnaire was returned by 1198 members of the Consumer Panel (response 79% and by 3211 members of the NPCD (response 86%. Among other things, questions were asked about choices for a health insurer and insurance plan and the reasons for this choice. Results Young and healthy people switch insurer more often than elderly or people in bad health. The chronically ill and disabled do not switch less often than the general population when both populations are comparable on age, sex and education. For the general population, premium is more important than content, while the chronically ill and disabled value content of the insurance package as well. However, quality of care is not important for either group as a reason for switching. Conclusion There is increased mobility in the new system for both the general population and the chronically ill and disabled. This however is not based on quality of care. If reasons for switching are unrelated to the quality of care, it is hard to believe that switching influences the quality of care. As yet there

  1. Employee Likelihood of Purchasing Health Insurance using Fuzzy Inference System

    Directory of Open Access Journals (Sweden)

    Lazim Abdullah

    2012-01-01

    Full Text Available Many believe that employees health and economic factors plays an important role in their likelihood to purchase health insurance. However decision to purchase health insurance is not trivial matters as many risk factors that influence decision. This paper presents a decision model using fuzzy inference system to identify the likelihoods of purchasing health insurance based on the selected risk factors. To build the likelihoods, data from one hundred and twenty eight employees at five organizations under the purview of Kota Star Municipality Malaysia were collected to provide input data. Three risk factors were considered as the input of the system including age, salary and risk of having illness. The likelihoods of purchasing health insurance was the output of the system and defined in three linguistic terms of Low, Medium and High. Input and output data were governed by the Mamdani inference rules of the system to decide the best linguistic term. The linguistic terms that describe the likelihoods of purchasing health insurance were identified by the system based on the three risk factors. It is found that twenty seven employees were likely to purchase health insurance at Low level and fifty six employees show their likelihoods at High level. The usage of fuzzy inference system would offer possible justifications to set a new approach in identifying prospective health insurance purchasers.

  2. Perceived Relationships among Components of Insurance Service for Users of Complementary Health Insurance Service

    Directory of Open Access Journals (Sweden)

    Urban Sebjan

    2013-12-01

    Full Text Available This article explores the relationship between the components of the services provided by complementary voluntary health insurance (CVHI, to which users ascribe different levels of importance. Research model that consists of four constructs (importance of quality service, additional coverage, price discounts of CVHI and insurance company reputation and an indicator of the importance of insurance premium of CVHI was tested with structural equation modelling (SEM on the sample of 300 Slovenian users of CVHI. Our findings show that - according to the users - the importance of the component of CVHI service (insurance premium is reflected in the perceived importance of other components of CVHI (additional coverage, quality, price discounts and insurance company reputation.

  3. Awareness of Health Insurance and Its Related Issues in Rural Areas of Jamnagar District

    Directory of Open Access Journals (Sweden)

    Maheshkumar L choudhary, Kalpesh I Goswami, Sudha B Khambhati, Viral R Shah, Naresh R Makwana, Sudha B Yadav

    2013-01-01

    Conclusions: Awareness regarding health insurance is poor; therefore awareness creation is needed. Education, socio-economical status and occupation were favourable determinants for opting health insurance.

  4. Determinants of health insurance ownership among women in Kenya: evidence from the 2008–09 Kenya demographic and health survey

    Science.gov (United States)

    2014-01-01

    Background The Government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. The objective of this study was to examine the determinants associated with health insurance ownership among women in Kenya. Methods Data came from the 2008–09 Kenya Demographic and Health Survey, a nationally representative survey. The sample comprised 8,435 women aged 15–49 years. Descriptive statistics and multivariable logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with health insurance ownership. Results Being employed in the formal sector, being married, exposure to the mass media, having secondary education or higher, residing in households in the middle or rich wealth index categories and residing in a female-headed household were associated with having health insurance. However, region of residence was associated with a lower likelihood of having insurance coverage. Women residing in Central (OR = 0.4; p insured compared to their counterparts in Nairobi province. Conclusions As the Kenyan government transforms the NHIF into a universal health program, it is important to implement a program that will increase equity and access to health care services among the poor and vulnerable groups. PMID:24678655

  5. Preferences and choices for care and health insurance

    NARCIS (Netherlands)

    Berg, B. van den; Dommelen, P. van; Stam, P.; Laske-Aldershof, T.; Buchmueller, T.; Schut, F.T.

    2008-01-01

    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

  6. Does the Market Choose Optimal Health Insurance Coverage

    NARCIS (Netherlands)

    Boone, J.

    2013-01-01

    Abstract Consumers, when buying health insurance, do not know the exact value of each treatment that they buy coverage for. This leads them to overvalue some treatments and undervalue others. We show that the insurance market cannot correct these mistakes. This causes research labs to overinvest in

  7. Using Clinical Decision Support Software in Health Insurance Company

    Science.gov (United States)

    Konovalov, R.; Kumlander, Deniss

    This paper proposes the idea to use Clinical Decision Support software in Health Insurance Company as a tool to reduce the expenses related to Medication Errors. As a prove that this class of software will help insurance companies reducing the expenses, the research was conducted in eight hospitals in United Arab Emirates to analyze the amount of preventable common Medication Errors in drug prescription.

  8. Preferences and choices for care and health insurance

    NARCIS (Netherlands)

    Berg, B. van den; Dommelen, P. van; Stam, P.; Laske-Aldershof, T.; Buchmueller, T.; Schut, F.T.

    2008-01-01

    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 b

  9. Asymmetric Information in Iranian’s Health Insurance Market: Testing of Adverse Selection and Moral Hazard

    Science.gov (United States)

    Lotfi, Farhad; Gorji, Hassan Abolghasem; Mahdavi, Ghadir; Hadian, Mohammad

    2015-01-01

    Background: Asymmetric information is one of the most important issues in insurance market which occurred due to inherent characteristics of one of the agents involved in insurance contracts; hence its management requires designing appropriate policies. This phenomenon can lead to the failure of insurance market via its two consequences, namely, adverse selection and moral hazard. Objective: This study was aimed to evaluate the status of asymmetric information in Iran’s health insurance market with respect to the demand for outpatient services. Materials/sPatients and Methods: This research is a cross sectional study conducted on households living in Iran. The data of the research was extracted from the information on household’s budget survey collected by the Statistical Center of Iran in 2012. In this study, the Generalized Method of Moment model was used and the status of adverse selection and moral hazard was evaluated through calculating the latent health status of individuals in each insurance category. To analyze the data, Excel, Eviews and stata11 software were used. Results: The estimation of parameters of the utility function of the demand for outpatient services (visit, medicine, and Para-clinical services) showed that households were more risk averse in the use of outpatient care than other goods and services. After estimating the health status of households based on their health insurance categories, the results showed that rural-insured people had the best health status and people with supplementary insurance had the worst health status. In addition, the comparison of the conditional distribution of latent health status approved the phenomenon of adverse selection in all insurance groups, with the exception of rural insurance. Moreover, calculation of the elasticity of medical expenses to reimbursement rate confirmed the existence of moral hazard phenomenon. Conclusions: Due to the existence of the phenomena of adverse selection and moral hazard

  10. Asymmetric Information in Iranian's Health Insurance Market: Testing of Adverse Selection and Moral Hazard.

    Science.gov (United States)

    Lotfi, Farhad; Abolghasem Gorji, Hassan; Mahdavi, Ghadir; Hadian, Mohammad

    2015-04-19

    Asymmetric information is one of the most important issues in insurance market which occurred due to inherent characteristics of one of the agents involved in insurance contracts; hence its management requires designing appropriate policies. This phenomenon can lead to the failure of insurance market via its two consequences, namely, adverse selection and moral hazard. This study was aimed to evaluate the status of asymmetric information in Iran's health insurance market with respect to the demand for outpatient services. This research is a cross sectional study conducted on households living in Iran. The data of the research was extracted from the information on household's budget survey collected by the Statistical Center of Iran in 2012. In this study, the Generalized Method of Moment model was used and the status of adverse selection and moral hazard was evaluated through calculating the latent health status of individuals in each insurance category. To analyze the data, Excel, Eviews and stata11 software were used. The estimation of parameters of the utility function of the demand for outpatient services (visit, medicine, and Para-clinical services) showed that households were more risk averse in the use of outpatient care than other goods and services. After estimating the health status of households based on their health insurance categories, the results showed that rural-insured people had the best health status and people with supplementary insurance had the worst health status. In addition, the comparison of the conditional distribution of latent health status approved the phenomenon of adverse selection in all insurance groups, with the exception of rural insurance. Moreover, calculation of the elasticity of medical expenses to reimbursement rate confirmed the existence of moral hazard phenomenon. Due to the existence of the phenomena of adverse selection and moral hazard in most of health insurances categories, policymakers need to adjust contracts so

  11. THE ACTION AND DIFFUCULTY OF SUPPLEMENTAL HEALTH INSURANCE IN PRIVATE HOSPITALS

    OpenAIRE

    Orhan, Ece; Kiyak, Mithat

    2015-01-01

    Supplemental health insurance is an utilization policy of health care services, that is covered by insurance with private health insurance and not need any additional charge, which is not guaranteed by general health insurance or the guaranteed ones that requires additional payment. Supplemental health insurance is an optional insurance policy for people who pay the additional payment. The aim of this study is determining the process of the benefits, problems and the losses of supplemental he...

  12. Health Insurance for Government Employees in Bangladesh: A Concept Paper

    OpenAIRE

    Hamid, Syed Abdul

    2014-01-01

    Introducing compulsory health insurance for government employees bears immense importance for stepping towards universal healthcare coverage in Bangladesh. Lack of scientific study on designing such scheme, in the Bangladesh context, motivates this paper. The study aims at designing a comprehensive insurance package simultaneously covering health, life and accident related disability risks of the public employees, where the health component would extend to all dependent family members. ...

  13. Public versus Private: Evidence on Health Insurance Selection

    Science.gov (United States)

    Pardo, Cristian; Schott, Whitney

    2012-01-01

    This paper models health insurance choice in Chile (public versus private) as a dynamic, stochastic process, where individuals consider premiums, expected out-of pocket costs, personal characteristics and preferences. Insurance amenities and restrictions against pre-existing conditions among private insurers introduce asymmetry to the model. We confirm that the public system services a less healthy and wealthy population (adverse selection for public insurance). Simulation of choices over time predicts a slight crowding out of private insurance only for the most pessimistic scenario in terms of population aging and the evolution of education. Eliminating the restrictions on pre-existing conditions would slightly ameliorate the level (but not the trend) of the disproportionate accumulation of less healthy individuals in the public insurance program over time. PMID:22374192

  14. Coverage and utilization of the health insurance among migrant workers in Shanghai, China

    Institute of Scientific and Technical Information of China (English)

    ZHAO Da-hai; RAO Ke-qin; ZHANG Zhi-ruo

    2011-01-01

    Background According to the regulations of the Chinese and Shanghai governments, migrant workers employed in Shanghai should all be entitled to Shanghai Migrant Worker Hospitalization Insurance (SMWHI) without premium and the vast majority should also have the New Rural Cooperative Medical System (NRCMS). This study aimed to examine the status of the coverage and utilization of health insurance among migrant workers employed in Shanghai. Methods Quantitative and qualitative research methods were employed in the study. A survey of 1020 migrant workers employed in Shanghai was conducted in 2010 with a structured questionnaire. Focus group discussions were held with respondents who were unable to maintain health insurance coverage through NRCMS or SMWHI. In-depth interviews were held with village heads and employers of the migrant workers, migrant workers who were hospitalized within the last year, and various individuals employed by the insurance agencies. Results The study found that 72.9% and 36.5% of migrant workers were covered by NRCMS or SMWHI, respectively,while 16.7% of them had no health insurance. The coverage by NRCMS among migrant workers correlated significantly with education level and workplace, while the coverage by SMWHI correlated significantly with the length of employment in Shanghai and workplace. The qualitative results confirmed that migrant workers were the main group who were not covered by NRCMS, and the coverage by SMWHI was completely dependent upon the employers of the migrant worker.The results also showed that health insurance utilization among migrant workers was strongly limited by hospital location. Conclusions We observed that the status of health insurance among migrant workers was not accordant with theory,and that Chinese health insurance policy should be further reformed in order to realize full coverage and equal utilization of health insurance among migrant workers in China.

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

    Science.gov (United States)

    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.

  16. Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues.

    Science.gov (United States)

    Lim, Byungmook

    2013-09-01

    National Health Insurance (NHI) in Korea has covered Korean medicine (KM) services including acupuncture, moxibustion, cupping, and herbal preparations since 1987, which represents the first time that an entire traditional medicine system was insured by an NHI scheme anywhere in the world. This nationwide insurance coverage led to a rapid increase in the use of KM, and the KM community became one of the main interest groups in the Korean healthcare system. However, due to the public's safety concern of and the stagnancy in demand for KM services, KM has been facing new challenges. This paper presents a brief history and the current structure of KM health insurance, and describes the critical issues related to KM insurance for in-depth understanding of the present situation.

  17. Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues

    Directory of Open Access Journals (Sweden)

    Byungmook Lim

    2013-09-01

    Full Text Available National Health Insurance (NHI in Korea has covered Korean medicine (KM services including acupuncture, moxibustion, cupping, and herbal preparations since 1987, which represents the first time that an entire traditional medicine system was insured by an NHI scheme anywhere in the world. This nationwide insurance coverage led to a rapid increase in the use of KM, and the KM community became one of the main interest groups in the Korean healthcare system. However, due to the public's safety concern of and the stagnancy in demand for KM services, KM has been facing new challenges. This paper presents a brief history and the current structure of KM health insurance, and describes the critical issues related to KM insurance for in-depth understanding of the present situation.

  18. Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003

    Directory of Open Access Journals (Sweden)

    Collins Charles D

    2007-03-01

    Full Text Available Abstract Background In 1997 there was a major reform of the government run urban health insurance system in China. The principal aims of the reform were to widen coverage of health insurance for the urban employed and contain medical costs. Following this reform there has been a transition from the dual system of the Government Insurance Scheme (GIS and Labour Insurance Scheme (LIS to the new Urban Employee Basic Health Insurance Scheme (BHIS. Methods This paper uses data from the National Health Services Surveys of 1998 and 2003 to examine the impact of the reform on population coverage. Particular attention is paid to coverage in terms of gender, age, employment status, and income levels. Following a description of the data between the two years, the paper will discuss the relationship between the insurance reform and the growing inequities in population coverage. Results An examination of the data reveals a number of key points: a The overall coverage of the newly established scheme has decreased from 1998 to 2003. b The proportion of the urban population without any type of health insurance arrangement remained almost the same between 1998 and 2003 in spite of the aim of the 1997 reform to increase the population coverage. c Higher levels of participation in mainstream insurance schemes (i.e. GIS-LIS and BHIS were identified among older age groups, males and high income groups. In some cases, the inequities in the system are increasing. d There has been an increase in coverage of the urban population by non-mainstream health insurance schemes, including non-commercial and commercial ones. The paper discusses three important issues in relation to urban insurance coverage: institutional diversity in the forms of insurance, labour force policy and the non-mainstream forms of commercial and non-commercial forms of insurance. Conclusion The paper concludes that the huge economic development and expansion has not resulted in a reduced disparity in

  19. Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003.

    Science.gov (United States)

    Xu, Ling; Wang, Yan; Collins, Charles D; Tang, Shenglan

    2007-03-03

    In 1997 there was a major reform of the government run urban health insurance system in China. The principal aims of the reform were to widen coverage of health insurance for the urban employed and contain medical costs. Following this reform there has been a transition from the dual system of the Government Insurance Scheme (GIS) and Labour Insurance Scheme (LIS) to the new Urban Employee Basic Health Insurance Scheme (BHIS). This paper uses data from the National Health Services Surveys of 1998 and 2003 to examine the impact of the reform on population coverage. Particular attention is paid to coverage in terms of gender, age, employment status, and income levels. Following a description of the data between the two years, the paper will discuss the relationship between the insurance reform and the growing inequities in population coverage. An examination of the data reveals a number of key points: a) The overall coverage of the newly established scheme has decreased from 1998 to 2003. b) The proportion of the urban population without any type of health insurance arrangement remained almost the same between 1998 and 2003 in spite of the aim of the 1997 reform to increase the population coverage. c) Higher levels of participation in mainstream insurance schemes (i.e. GIS-LIS and BHIS) were identified among older age groups, males and high income groups. In some cases, the inequities in the system are increasing. d) There has been an increase in coverage of the urban population by non-mainstream health insurance schemes, including non-commercial and commercial ones. The paper discusses three important issues in relation to urban insurance coverage: institutional diversity in the forms of insurance, labour force policy and the non-mainstream forms of commercial and non-commercial forms of insurance. The paper concludes that the huge economic development and expansion has not resulted in a reduced disparity in health insurance coverage, and that limited cross-group

  20. 45 CFR 148.122 - Guaranteed renewability of individual health insurance coverage.

    Science.gov (United States)

    2010-10-01

    ... 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 in...

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

    Science.gov (United States)

    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…

  2. Federal health insurance reform and "exchanges": recent history.

    Science.gov (United States)

    Brandon, William P; Carnes, Keith

    2014-02-01

    The major national innovation of the Affordable Care Act (ACA) is the insurance exchange or health insurance marketplace (HIM). We begin by briefly reviewing the ACA's chief features and detailing its HIM provisions. Section two explores the policy history of exchanges, beginning with Clinton's proposals and Massachusetts' Connector and concluding by contrasting the House-passed bill with one national exchange and the Senate bill with state-based exchanges. The Senate bill became the ACA. The evolution of policy ideas about exchanges suggests three critical conditions for a successful exchange: commodification (of insurance products), competition (between insurers), and communication (to potential buyers and the public about insurance). The penultimate section compares the rollout of the state-run Kentucky exchange and the federally facilitated exchange in North Carolina in light of what we will call the 3 Cs. The conclusion reflects more widely upon the unique form that the pro-competition or deregulatory strategy has taken in health policy.

  3. 77 FR 32397 - Servicemembers' Group Life Insurance Traumatic Injury Protection Program-Genitourinary Losses

    Science.gov (United States)

    2012-06-01

    ... AFFAIRS 38 CFR Part 9 RIN 2900-AO20 Servicemembers' Group Life Insurance Traumatic Injury Protection... Servicemembers' Group Life Insurance Traumatic Injury Protection (TSGLI) program by adding certain genitourinary... Servicemembers' Group Life Insurance Traumatic Injury Protection (TSGLI) program to add certain genitourinary...

  4. 78 FR 47017 - Submission for Review: Designation of Beneficiary: Federal Employees' Group Life Insurance, SF 2823

    Science.gov (United States)

    2013-08-02

    ... MANAGEMENT Submission for Review: Designation of Beneficiary: Federal Employees' Group Life Insurance, SF..., Designation of Beneficiary: Federal Employees' Group Life Insurance, SF 2823. As required by the Paperwork... or retiree covered by the Federal Employees' Group Life Insurance (FEGLI) Program, or an assignee...

  5. Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference?

    Directory of Open Access Journals (Sweden)

    Jiang Hanping

    2009-11-01

    Full Text Available Abstract Background As one of the most populous metropolitan areas in the Pearl River Delta of South China, Shenzhen attracts millions of migrant workers annually. The objectives of this study were to compare health needs, self-reported health and healthcare utilisation of insured and uninsured migrant workers in Shenzhen, China, where a new health insurance scheme targeting at migrant workers was initiated. Methods A cross-sectional survey using multi-staged sampling was conducted to collect data from migrant factory workers. Statistical tests included logistic regression analysis were used. Results Among 4634 subjects (96.54% who responded to the survey, 55.11% were uninsured. Disease patterns were similar irrespective of insurance status. The uninsured were more likely to be female, single, younger and less educated unskilled labourers with a lower monthly income compared with the insured. Out of 1136 who reported illness in the previous two weeks, 62.15% did not visit a doctor. Of the 296 who were referred for inpatient care, 48.65% did not attend because of inability to pay. Amongst those who reported sickness, 548 were insured and 588 were uninsured. Those that were insured, and had easier access to care were more likely to make doctor visits than those who were uninsured. Conclusion Health care utilisation patterns differ between insured and uninsured workers and insurance status appears to be a significant factor. The health insurance system is inequitably distributed amongst migrant workers. Younger less educated women who are paid less are more likely to be uninsured and therefore to pay out of pocket for their care. For greater equity this group need to be included in the insurance schemes as they develop.

  6. Two Centuries of Solidarity : German, Belgian and Dutch social health insurance 1770-2008

    OpenAIRE

    K.P. Companje; Hendriks, R. H. M.; Veraghtert, K.F.E.; Widdershoven, B.E.M.

    2009-01-01

    Today, health insurance is a key component in the system of social security in most European Union countries. In many of these countries, modern health-insurance funds and healthcare insurers play an essential role in implementing the public health-insurance system. Many of these health-insurance funds have a long and fascinating history, of which clear traces can be seen today in the organisation and structure of health insurance, as well as health-insurance funds and insurers. In Two centur...

  7. HEALTH INSURANCE: CONTRIBUTIONS AND REIMBURSEMENT MAXIMAL

    CERN Multimedia

    HR Division

    2000-01-01

    Affected by both the salary adjustment index on 1.1.2000 and the evolution of the staff members and fellows population, the average reference salary, which is used as an index for fixed contributions and reimbursement maximal, has changed significantly. An adjustment of the amounts of the reimbursement maximal and the fixed contributions is therefore necessary, as from 1 January 2000.Reimbursement maximalThe revised reimbursement maximal will appear on the leaflet summarising the benefits for the year 2000, which will soon be available from the divisional secretariats and from the AUSTRIA office at CERN.Fixed contributionsThe fixed contributions, applicable to some categories of voluntarily insured persons, are set as follows (amounts in CHF for monthly contributions):voluntarily insured member of the personnel, with complete coverage:815,- (was 803,- in 1999)voluntarily insured member of the personnel, with reduced coverage:407,- (was 402,- in 1999)voluntarily insured no longer dependent child:326,- (was 321...

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

    Science.gov (United States)

    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…

  9. The Health Insurance Marketplace: What Women Need To Know

    Centers for Disease Control (CDC) Podcasts

    2014-04-02

    In this podcast women will learn how the Health Insurance Marketplace meets the needs of women. The Marketplace allows women to find quality health coverage and gives women more choice and control over their health coverage.  Created: 4/2/2014 by Office of Women's Health.   Date Released: 4/2/2014.

  10. Would national health insurance itnprove equity and efficiency ...

    African Journals Online (AJOL)

    In many Latin American and Asian countries the ... ence of social health insurance, and some Asian countries .... rates increased with increasing income, especially for hos- pitals. .... tors have shown a growing interest in managed care, and.

  11. The impact of the tax system on health insurance coverage.

    Science.gov (United States)

    Gruber, J

    2001-01-01

    A central question in health economics is the extent to which this tax subsidization matters for the health insurance coverage of the U.S. population. I assess the impact of taxes on health insurance by using the considerable existing variation in tax subsidies, both at a point in time and across time. I do so by putting together data from more than a decade of Current Population Survey (CPS) data sets, and matching to workers in those data sets their tax subsidies to health insurance coverage. I find that the elasticity of insurance eligibility of workers is at least -0.6, and that the elasticity of own insurance coverage is roughly similar; the results imply that most of the impact of taxes on insurance coverage arise through firm offering and eligibility decisions. I also find that higher tax rates induce more private coverage through other sources, but less public coverage, so that overall there is a reduction in the rate of uninsurance that is comparable to the change in own employer-provided insurance coverage.

  12. Spillover effects of supplementary on basic health insurance: Evidence from the Netherlands

    NARCIS (Netherlands)

    A-F. Roos (Anne-Fleur); F.T. Schut (Erik)

    2012-01-01

    textabstractLike many other countries, the Netherlands has a health insurance system that combines mandatory basic insurance with voluntary supplementary insurance. Both types of insurance are founded on different principles. Since basic and supplementary insurance are sold by the same health

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

    Science.gov (United States)

    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.

  14. Whence and whither health insurance? A revisionist history.

    Science.gov (United States)

    Moran, Donald W

    2005-01-01

    Throughout the postwar era in federal health policy, policymakers have sought to expand both public and private insurance coverage, while wrestling with the cost consequences of the demand generated by the insurance-financing mechanisms thus created. This essay advances the view that the limits to insurance expansion have been reached and that public and private plan sponsors will henceforth continually "thin out" the coverage they offer. In this environment, policymakers seeking to mitigate access concerns may need to consider strategies that promote direct service delivery. This emerging regime, it is argued, will have important implications for the future of innovation in health care.

  15. Determinants of health insurance ownership among South African women

    OpenAIRE

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

    2005-01-01

    Abstract 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-secti...

  16. Expansion of health insurance in Moldova and associated improvements in access and reductions in direct payments.

    Science.gov (United States)

    Hone, Thomas; Habicht, Jarno; Domente, Silviu; Atun, Rifat

    2016-12-01

    Moldova is the poorest country in Europe. Economic constraints mean that Moldova faces challenges in protecting individuals from excessive costs, improving population health and securing health system sustainability. The Moldovan government has introduced a state benefit package and expanded health insurance coverage to reduce the burden of health care costs for citizens. This study examines the effects of expanded health insurance by examining factors associated with health insurance coverage, likelihood of incurring out-of-pocket (OOP) payments for medicines or services, and the likelihood of forgoing health care when unwell. Using publically available databases and the annual Moldova Household Budgetary Survey, we examine trends in health system financing, health care utilization, health insurance coverage, and costs incurred by individuals for the years 2006-2012. We perform logistic regression to assess the likelihood of having health insurance, incurring a cost for health care, and forgoing health care when ill, controlling for socio-economic and demographic covariates. Private expenditure accounted for 55.5% of total health expenditures in 2012. 83.2% of private health expenditures is OOP payments-especially for medicines. Healthcare utilization is in line with EU averages of 6.93 outpatient visits per person. Being uninsured is associated with groups of those aged 25-49 years, the self-employed, unpaid family workers, and the unemployed, although we find lower likelihood of being uninsured for some of these groups over time. Over time, the likelihood of OOP for medicines increased (odds ratio OR = 1.422 in 2012 compared to 2006), but fell for health care services (OR = 0.873 in 2012 compared to 2006). No insurance and being older and male, was associated with increased likelihood of forgoing health care when sick, but we found the likelihood of forgoing health care to be increasing over time (OR = 1.295 in 2012 compared to 2009). Moldova has

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

    Science.gov (United States)

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

    2015-07-01

    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. 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. 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. 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. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. 76 FR 9233 - Children's Health Insurance Program (CHIP); Allotment Methodology and States' Fiscal Years 2009...

    Science.gov (United States)

    2011-02-17

    ... the Children's Health Insurance Program (CHIP), as amended by the Children's Health Insurance Program.... SUPPLEMENTARY INFORMATION: I. Background A. The Children's Health Insurance Program Title XXI of the Social... Commonwealths and Territories to initiate and expand health insurance coverage to uninsured, low-income children...

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

    Science.gov (United States)

    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…

  20. 76 FR 11782 - Medicare, Medicaid, and Children's Health Insurance Programs; Renewal, Expansion, and Renaming of...

    Science.gov (United States)

    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 the...

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

    Science.gov (United States)

    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.

  2. Premium variation in the individual health insurance market.

    Science.gov (United States)

    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.

  3. Impact of medical loss regulation on the financial performance of health insurers.

    Science.gov (United States)

    McCue, Michael; Hall, Mark; Liu, Xinliang

    2013-09-01

    The Affordable Care Act's regulation of medical loss ratios requires health insurers to use at least 80-85 percent of the premiums they collect for direct medical expenses (care delivery) or for efforts to improve the quality of care. To gauge this rule's effect on insurers' financial performance, we measured changes between 2010 and 2011 in key financial ratios reflecting insurers' operating profits, administrative costs, and medical claims. We found that the largest changes occurred in the individual market, where for-profit insurers reduced their median administrative cost ratio and operating margin by more than two percentage points each, resulting in a seven-percentage-point increase in their median medical loss ratio. Financial ratios changed much less for insurers in the small- and large-group markets.

  4. Unwinding the State subsidisation of private health insurance in Ireland.

    Science.gov (United States)

    Turner, Brian

    2015-10-01

    Ireland's private health insurance market provides primarily supplementary health insurance for hospital services, operating alongside a public hospital system to which residents have universal access entitlements, subject to some copayments for those without a medical card. The State subsidises the purchase of private health insurance through measures including tax relief on premiums and not charging the full economic cost for private beds in public hospitals. Furthermore, privately insured patients occupying public beds in public hospitals did not, until 2014, incur charges for such accommodation, apart from modest statutory charges. In the Budget in October 2013, a number of measures were announced that began to unwind these subsidies. Although it was initially feared that these measures would add to premium inflation, leading in turn to further discontinuation of health insurance, the evidence suggests that premium inflation has eased and take-up has stabilised, although some of this may have been due to the introduction of lifetime community rating in May 2015. Nevertheless, it would appear that the restriction on the subsidisation of private health insurance has not had a significant adverse effect on the market, while it has reduced an inequitable cross-subsidy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Treatment-seeking behaviour and social health insurance in Africa

    DEFF Research Database (Denmark)

    Fenny, Ama P; Asante, Felix A; Enemark, Ulrika

    2014-01-01

    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...

  6. 44 CFR 61.17 - Group Flood Insurance Policy.

    Science.gov (United States)

    2010-10-01

    ... U.S.C. 5174) of an Individuals and Households Program (IHP) award for flood damage as a result of... insurance agent or producer or a private insurance company selling NFIP policies under the Write Your...

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

    Science.gov (United States)

    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. Seeing Health Insurance and HealthCare.gov Through the Eyes of Young Adults.

    Science.gov (United States)

    Wong, Charlene A; Asch, David A; Vinoya, Cjloe M; Ford, Carol A; Baker, Tom; Town, Robert; Merchant, Raina M

    2015-08-01

    We describe young adults' perspectives on health insurance and HealthCare.gov, including their attitudes toward health insurance, health insurance literacy, and benefit and plan preferences. We observed young adults aged 19-30 years in Philadelphia from January to March 2014 as they shopped for health insurance on HealthCare.gov. Participants were then interviewed to elicit their perceived advantages and disadvantages of insurance and factors considered important for plan selection. A 1-month follow-up interview assessed participants' plan enrollment decisions and intended use of health insurance. Data were analyzed using qualitative methodology, and salience scores were calculated for free-listing responses. We enrolled 33 highly educated young adults; 27 completed the follow-up interview. The most salient advantages of health insurance for young adults were access to preventive or primary care (salience score .28) and peace of mind (.27). The most salient disadvantage was the financial strain of paying for health insurance (.72). Participants revealed poor health insurance literacy with 48% incorrectly defining deductible and 78% incorrectly defining coinsurance. The most salient factors reported to influence plan selection were deductible (.48) and premium (.45) amounts as well as preventive care (.21) coverage. The most common intended health insurance use was primary care. Eight participants enrolled in HealthCare.gov plans: six selected silver plans, and three qualified for tax credits. Young adults' perspective on health insurance and enrollment via HealthCare.gov can inform strategies to design health insurance plans and communication about these plans in a way that engages and meets the needs of young adult populations. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  9. Does Uninsurance Affect the Health Outcomes of the Insured?

    DEFF Research Database (Denmark)

    Daysal, N. Meltem

    2012-01-01

    In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome -- the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999-2006). My...... of care to insured heart attack patients in response to reduced revenues, the evidence I have suggests a modest increase in the quantity of cardiac services without a corresponding increase in hospital staff.......In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome -- the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999-2006). My...... results indicate that uninsured patients have an economically significant effect that increases the mortality rate of insured heart attack patients. I show that these results are not driven by alternative explanations, including reverse causality, patient composition effects, sample selection...

  10. The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda

    Science.gov (United States)

    Temsah, Gheda; Mallick, Lindsay

    2017-01-01

    Abstract While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage—Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care. PMID:28365754

  11. 75 FR 58203 - Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements...

    Science.gov (United States)

    2010-09-23

    .... Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements... Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment... requirement for participation as a provider of health care services under a Federal health care program that...

  12. 76 FR 5861 - Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements...

    Science.gov (United States)

    2011-02-02

    ..., and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees..., Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees... reauthorized Indian Health Care Improvement Act, `` ny requirement for participation as a provider of health...

  13. The Assessment of Mental Health within Health Personnel and Paramedical in "Tabriz Social Insurance Hospitals", Iran

    National Research Council Canada - National Science Library

    Firouzan Vahideh; Saghiri Maryam; Hemmatzadeh Shahla; Ghojazadeh Morteza

    2015-01-01

    .... As health personnel is major part of health services and their high job incentive is a necessity for their health insurance, this research was implemented to assess their mental health quality...

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

    Science.gov (United States)

    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. Does Uninsurance Affect the Health Outcomes of the Insured?

    DEFF Research Database (Denmark)

    Daysal, N. Meltem

    2012-01-01

    In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome -- the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999-2006). My...... results indicate that uninsured patients have an economically significant effect that increases the mortality rate of insured heart attack patients. I show that these results are not driven by alternative explanations, including reverse causality, patient composition effects, sample selection...... of care to insured heart attack patients in response to reduced revenues, the evidence I have suggests a modest increase in the quantity of cardiac services without a corresponding increase in hospital staff....

  16. Risk distribution across multiple health insurance funds in rural Tanzania.

    Science.gov (United States)

    Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika; Hansen, Kristian; Kiwara, Angwara Dennis

    2014-01-01

    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. 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. 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. 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.

  17. Switching health insurers: the role of price, quality and consumer information search.

    Science.gov (United States)

    Boonen, Lieke H H M; Laske-Aldershof, Trea; Schut, Frederik T

    2016-04-01

    We examine the impact of price, service quality and information search on people's propensity to switch health insurers in the competitive Dutch health insurance market. Using panel data from annual household surveys and data on health insurers' premiums and quality ratings over the period 2006-2012, we estimate a random effects logit model of people's switching decisions. We find that switching propensities depend on health plan price and quality, and on people's age, health, education and having supplementary or group insurance. Young people (18-35 years) are more sensitive to price, whereas older people are more sensitive to quality. Searching for health plan information has a much stronger impact on peoples' sensitivity to price than to service quality. In addition, searching for health plan information has a stronger impact on the switching propensity of higher than lower educated people, suggesting that higher educated people make better use of available health plan information. Finally, having supplementary insurance significantly reduces older people's switching propensity.

  18. [Health insurance in Tunisia, current context and future perspectives].

    Science.gov (United States)

    Blel, S

    2001-05-01

    The Tunisian health system, notably in its health insurance component, has allowed to record a satisfactory evolution of health indicators. Nevertheless, socio-economic, demographic and epidemiological transitions impose a global reform of the system, notably of its financing. The present article, leaving from the presentation of the current system of coverage of the social security insured, analyses observed insufficiencies that have brought public authorities to commit the health insurance reform. The main observed insufficiencies refer to the multiplicity of regimes and their heterogeneity, generating iniquities between insured and a strong growth of care expenses financed directly by households. In addition, relationships of social security bodies with public and private providers of health care are little transparent, marked by a preferential processing of public structures, despite an important development of the private sector. In a second part, the author analyzes successively objectives of the health insurance reform of the social security regimes, its founder principles, characteristics of the proposed regime (a mandatory basic regime and an optional complementary regime) and sketches of providers payment methods.

  19. Patient Protection and Affordable Care Act; health insurance market rules. Final rule.

    Science.gov (United States)

    2013-02-27

    This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

  20. Age and choice in health insurance: evidence from a discrete choice experiment.

    Science.gov (United States)

    Becker, Karolin; Zweifel, Peter

    2008-01-01

    experiment was developed using six attributes (deductibles, co-payment, access to alternative medicines, medication choice, access to innovation, and monthly premium) that are currently in debate within the context of Swiss health insurance. These attributes have been shown to be important in the choice of insurance contract. Using statistical design optimization procedures, the number of choice sets was reduced to 27 and randomly split into three groups. One choice was included twice to test for consistency. Two random effects probit models were developed: a simple model where marginal utilities and WTP values were not allowed to vary according to socioeconomic characteristics, and a more complex model where the values were permitted to depend on socioeconomic variables.A representative telephone survey of 1000 people aged >24 years living in the German- and French-speaking parts of Switzerland was conducted. Participants were asked to compare the status quo (i.e. their current insurance contract) with ten hypothetical alternatives. In addition, participants were asked questions concerning utilization of healthcare services; overall satisfaction with the healthcare system, insurer and insurance policy; and a general preference for new elements in the insurance package. Socioeconomic variables surveyed were age, sex, total household income, education (seven categories ranging from primary school to university degree), place of residence, occupation, and marital status. All chosen elements proved relevant for choice in the simple model. Accounting for socioeconomic characteristics in the comprehensive model reveals preference heterogeneity for contract attributes, but also for the propensity to consider deviating from the status quo and choosing an alternative health insurance contract. The findings suggest that while the elderly do exhibit a stronger status quo bias than younger age groups, they require less rather than more specific compensation for selected cutbacks

  1. Expanding Medicare and employer plans to achieve universal health insurance.

    Science.gov (United States)

    Davis, K

    1991-05-15

    This article presents a proposal for expanding Medicare and employer-based health insurance plans to achieve universal health insurance. Under this proposed health care financing system, employees would provide basic health insurance coverage to workers and dependents, or pay a payroll tax contribution toward the cost of their coverage under Medicare. States would have the option of buying all Medicaid beneficiaries and other poor individuals into Medicare by paying the Medicare premiums and cost sharing. Other uninsured individuals would be automatically covered by Medicare. Employer plans would incorporate Medicare's provider payment methods. This proposal would result in incremental federal governmental outlays on the order of $25 billion annually. These new federal budgetary costs would be met through a combination of premiums, employer payroll tax, income tax, and general tax revenues. The principal advantage of this plan is that it draws on the strengths of the current system while simplifying the benefit and provider payment structure and instituting innovations to promote efficiency.

  2. Awareness and perception regarding health insurance in Bangalore rural population

    Directory of Open Access Journals (Sweden)

    Suwarna Madhukumar

    2012-04-01

    Full Text Available Background: Awareness and perception regarding health insurance was still very preliminary. Although health insurance is not a new concept and people are also getting familiar with it, yet this awareness has not reached to the level of subscription of health insurance products. Insurance as not been able to make inroads in the rural areas because of key reasons such as high cost of delivery and low awareness among the rural population about insurance products. There is a felt need to provide financial protection to rural families for the treatment of major ailments, requiring hospitalization and surgery. The present study is an effort in the area of health insurance to assess the individuals’ awareness level and willingness to join and pay for it. The present study is an effort to examine what are the reasons behind those who have not in favour of subscription. Methods: Nandagudi a village in Bangalore rural district was selected because the Rural Health Training Centre of MVJ Medical College & RH is located. The houses were listed and by using systematic random sampling every 2nd house was included in the study. 331 houses were interviewed. The interview was taken either from the head of the family or the family member who takes financial decisions in the house. Data was collected and analysed. Findings were described in terms of proportions and percentages. Statistical analysis was performed by SPSS statistical package. Results: In our study population majority were males (94.9%, Hindus (60%, literate (85%,and manual workers (79.5%.Only one third of the houses were aware of health insurance but only 22% had health insurance coverage. The coverage was not for all family members. The subscription depended on education, socio–economic status, type of family. The willingness to pay a premium was Rs 500 per year in 31% of the families. It was observed that the main barriers for the subscription of health insurance were low income or uncertainty

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

    Science.gov (United States)

    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…

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

    Science.gov (United States)

    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.

  5. Financial Health of a Commercial Insurance Company and its Coherences

    Directory of Open Access Journals (Sweden)

    Svatopluk Nečas

    2016-05-01

    Full Text Available Purpose of the article The main purpose of the article is to define the term “financial health of a commercial insurance company” and identify the factors that influence management and its economic results of a commercial insurance company. The above mentioned term will be faced with other similar terms such as financial stability, financial strength, solvency, liquidity or profitability (always with emphasis on the insurance sector. Related to this purpose, this hypothesis is formulated: "Financial health of a commercial insurance company can be identified in the long perspective with the term financial stability and as its synonym the concept of solvency can be stated. Methodology/methods The methods of description, analysis, deduction and induction will be used in the article. The research part is based on a qualitative basis. It combines three methods of qualitative research: interviews with experts, a structured interview with open questions, a questionnaire with open questions. Its subject is a managed conversation with leading experts in the field of insurance and related branches, who answered questions related to the topic. Evaluation of interviews was done by method of interview analysis, respectively thematic analysis and subsequent synthesis based on respondents' answers. The synthesis is used as a method to gain new knowledge. The conclusions are the basis for discussion for the theory completion in the case of the term mentioned above and for statements to other contexts that are defined in the objectives of the article. Synthetic approach is applied in the formulation of conclusions of the research. Significant findings for the theory are obtained by abstraction, as derived from observations of the issues, i.e. financial health of a commercial insurance company. The evaluation also includes a summary of significant matters and it reflects the opinion of the author devised throughout literature and based on interviews

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

    Science.gov (United States)

    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…

  7. 78 FR 6275 - Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in...

    Science.gov (United States)

    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 AND...

  8. The effect of Ghana's National Health Insurance Scheme on health care utilisation.

    Science.gov (United States)

    Blanchet, N J; Fink, G; Osei-Akoto, I

    2012-06-01

    The study investigates the effect of Ghana's National Health Insurance Scheme (NHIS) on health care utilisation. We provide a short history of health insurance in Ghana, and briefly discuss general patterns of enrolment in Ghana as well as in Accra in a first step. In a second step, we use data from the Women's Health Study of Accra wave II to evaluate the effect of insurance on health seeking behaviour using propensity score matching. We find that on average individuals enrolled in the insurance scheme are significantly more likely to obtain prescriptions, visit clinics and seek formal health care when sick. These results suggest that the government's objective to increase access to the formal health care sector through health insurance has at least partially been achieved.

  9. Employer-provided health insurance and hospital mergers.

    Science.gov (United States)

    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.

  10. Hukou and Health Insurance Coverage for Migrant Workers

    Directory of Open Access Journals (Sweden)

    Armin Müller

    2016-01-01

    Full Text Available Most migrant workers in mainland China are officially covered by the New Rural Cooperative Medical System (NRCMS, a rural health insurance system that operates in their home communities. The NRCMS and the system of household registration (户口, hukou are tightly linked and systemically interdependent institutions. Migrant workers have difficulties benefitting from this social protection because it remains spatially separated from them. Only a minority have access to urban health insurance systems. This paper sheds light on the institutional origins of the coverage problem of migrant workers and examines crucial policy initiatives that attempt to solve it. In the context of the ongoing hukou reforms, these policies aim to partially dissolve the systemic interdependence of hukou and health insurance. While the policies provide feasible, yet conflict-prone, solutions in short-distance and concentrated bilateral migration systems, covering migrants who cross provincial boundaries remains a challenge.

  11. Household perceptions and their implications for enrollment in the National Health Insurance Scheme in Ghana.

    NARCIS (Netherlands)

    Jehu-Appiah, C.; Aryeetey, G.C.; Agyepong, I.; Spaan, E.J.A.M.; Baltussen, R.M.

    2012-01-01

    OBJECTIVE: This paper identifies, ranks and compares perceptions of insured and uninsured households in Ghana on health care providers (quality of care, service delivery adequacy, staff attitudes), health insurance schemes (price, benefits and convenience) and community attributes (health 'beliefs a

  12. 77 FR 71423 - Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee...

    Science.gov (United States)

    2012-11-30

    ... 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 AND...

  13. 75 FR 82277 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient...

    Science.gov (United States)

    2010-12-30

    ... ``Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient Protection... Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements accurately states our... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND...

  14. [How does type of health insurance affect receipt of Pap testing in Peru?].

    Science.gov (United States)

    Barrionuevo-Rosas, Leslie; Palència, Laia; Borrell, Carme

    2013-12-01

    Describe the association between receipt of cervical cytology and type of health insurance in Peruvian women, and determine the role of sociodemographic and sexual health variables in this relationship. A cross-sectional study using information on a sample of 12 272 women aged 30 to 49 years from the Demographic and Family Health Survey (ENDES), Peru, 2005-2008. The dependent variable was receipt of at least one Pap smear in the last five years. The primary independent variables were type of health insurance, educational level, household socioeconomic level, ethnicity, and place of residence. Prevalence ratio, obtained from Poisson regression with robust variance, was used to measure multivariate association. Among sexually active women, 62.7% had received at least one Pap test in the last five years. Percentage of women tested varied by type of health insurance. Women with public or private insurance had a greater probability of having received a Pap smear--1.27 (95% CI, 1.24-1.31) and 1.52 (95% CI, 1.46-1.58) times greater, respectively--than uninsured women. This association was primarily explained by socioeconomic status variables. In addition, women who participated the least in screening were characterized by illiteracy or only a primary education, low socioeconomic level, speaking an indigenous language, and living in a rural area. When they also lacked health insurance, the gap widened, rising to as much as one third compared to more advantaged social groups. Inequalities were found in receipt of Pap testing according to type of health insurance; women without insurance were least likely to be screened, implying existence of a barrier to cervical cancer screening in Peru.

  15. 42 CFR 457.80 - Current State child health insurance coverage and coordination.

    Science.gov (United States)

    2010-10-01

    ... 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 AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies...

  16. Regulating a health insurance exchange: implications for individuals with mental illness.

    Science.gov (United States)

    McGuire, Thomas G; Sinaiko, Anna D

    2010-11-01

    Under the newly enacted health reform law, millions of lower- and middle-income Americans will purchase individual or family health insurance through state-based markets for private health insurance called insurance "exchanges," which consolidate and regulate the market for individual and small-group health insurance. The authors consider options for structuring choice and pricing of health insurance in an exchange from the perspective of efficiently and fairly serving persons with mental illness. Exchanges are intended to foster choice and competition. However, certain features-open enrollment, individual choice, and imperfect risk adjusters-create incentives for "adverse selection," especially in providing coverage for persons with mental illness, who have higher overall health care costs. The authors review the experience of persons with mental illness in insurance markets similar to the exchanges, such as the Massachusetts Connector and the Federal Employees Health Benefit Program, and note that competition among health plans for enrollees who are "good risks" can undermine coverage and efficiency. They review the possible approaches for contending with selection-related incentives, such as carving out all or part of mental health benefits, providing reinsurance for some mental health care costs, or their preferred option, running the exchange in the same way that an employer runs its employee benefits and addressing selection and cost control issues by choice of contractor. The authors also consider approaches an exchange could use to promote effective consumer choice, such as passive and active roles for the exchange authority. Regulation will be necessary to establish a foundation for success of the exchanges.

  17. Community Rating in Health Insurance : Trade-Off Between Coverage and Selection

    NARCIS (Netherlands)

    Bijlsma, M.; Boone, Jan; Zwart, G.T.J.

    2015-01-01

    We analyze the role of community rating in the optimal design of a risk adjustment scheme in competitive health insurance markets when insurers have better information on their customers’ risk profiles than the sponsor of health insurance. The sponsor offers insurers a menu of risk adjustment

  18. Universal Health Insurance in India: Ensuring equity, efficiency, and quality

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    2012-01-01

    Full Text Available 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.

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

    Science.gov (United States)

    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.

  20. Message from the CERN Health Insurance Supervisory Board (CHISB)

    CERN Multimedia

    2007-01-01

    At the end of 2006, the Management of Clinique La Colline canceled its 2005 tariff agreement with the health insurance schemes of international organizations (CERN, ILO-ITU, WHO, UNOG). The proposed 2007 tariffs were unacceptable to these schemes as they included an average increase of 12%. No agreement was found and therefore this clinic is no longer approved by the CHIS, according to the definition given in the Rules of the CERN Health Insurance Scheme. Our Administrator, UNIQA, will no longer act as paying third party for any hospitalisation which has not already been planned and agreed. More information will appear in the next issue of the CHISBull'. Tel.74484

  1. 26 CFR 31.3401(a)(14)-1 - Group-term life insurance.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Group-term life insurance. 31.3401(a)(14)-1... SOURCE Collection of Income Tax at Source § 31.3401(a)(14)-1 Group-term life insurance. (a) The cost of group-term life insurance on the life of an employee is excepted from wages, and hence is not subject...

  2. Regulated competition in health care: Switching and barriers to switching in the Dutch health insurance system

    Directory of Open Access Journals (Sweden)

    Rijken Mieke

    2011-05-01

    Full Text Available Abstract Background In 2006, a number of changes in the Dutch health insurance system came into effect. In this new system mobility of insured is important. The idea is that insured switch insurers because they are not satisfied with quality of care and the premium of their insurance. As a result, insurers will in theory strive for a better balance between price and quality. The Dutch changes have caught the attention, internationally, of both policy makers and researchers. In our study we examined switching behaviour over three years (2007-2009. We tested if there are differences in the numbers of switchers between groups defined by socio-demographic and health characteristics and between the general population and people with chronic illness or disability. We also looked at reasons for (not-switching and at perceived barriers to switching. Methods Switching behaviour and reasons for (not-switching were measured over three years (2007-2009 by sending postal questionnaires to members of the Dutch Health Care Consumer Panel and of the National Panel of people with Chronic illness or Disability. Data were available for each year and for each panel for at least 1896 respondents - a response of between 71% and 88%. Results The percentages of switchers are low; 6% in 2007, 4% in 2008 and 3% in 2009. Younger and higher educated people switch more often than older and lower educated people and women switch more often than men. There is no difference in the percentage of switchers between the general population and people with chronic illness or disability. People with a bad self-perceived health, and chronically ill and disabled, perceive more barriers to switching than others. Conclusion The percentages of switchers are comparable to the old system. Switching is not based on quality of care and thus it can be questioned whether it will lead to a better balance between price and quality. Although there is no difference in the frequency of switching

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

    Science.gov (United States)

    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.

  4. Insurance Accounts: The Cultural Logics of Health Care Financing.

    Science.gov (United States)

    Mulligan, Jessica

    2016-03-01

    The financial exuberance that eventually culminated in the recent world economic crisis also ushered in dramatic shifts in how health care is financed, administered, and imagined. Drawing on research conducted in the mid-2000s at a health insurance company in Puerto Rico, this article shows how health care has been financialized in many ways that include: (1) privatizing public services; (2) engineering new insurance products like high deductible plans and health savings accounts; (3) applying financial techniques to premium payments to yield maximum profitability; (4) a managerial focus on shareholder value; and (5) prioritizing mergers and financial speculation. The article argues that financial techniques obfuscate how much health care costs, foster widespread gaming of reimbursement systems that drives up prices, and "unpool" risk by devolving financial and moral responsibility for health care onto individual consumers. © 2015 by the American Anthropological Association.

  5. Child health insurance coverage: a survey among temporary and permanent residents in Shanghai

    Directory of Open Access Journals (Sweden)

    Li Bing

    2008-11-01

    Full Text Available Abstract Background Under the current healthcare system in China, there is no government-sponsored health insurance program for children. Children from families who move from rural and interior regions to large urban centres without a valid residency permit might be at higher risk of being uninsured due to their low socioeconomic status. We conducted a survey in Shanghai to describe children's health insurance coverage according to their migration status. Method Between 2005 and 2006, we conducted an in-person health survey of the adult care-givers of children aged 7 and under, residing in five districts of Shanghai. We compared uninsurance rates between temporary and permanent child residents, and investigated factors associated with child health uninsurance. Results Even though cooperative insurance eligibility has been extended to temporary residents of Shanghai, the uninsurance rate was significantly higher among temporary (65.6% than permanent child residents (21.1%, adjusted odds ratio (OR: 5.85, 95% confidence interval (95% CI: 4.62–7.41. For both groups, family income was associated with having child health insurance; children in lower income families were more likely to be uninsured (OR: 1.96, 95% CI: 1.40–2.96. Conclusion Children must rely on their parents to make the insurance purchase decision, which is constrained by their income and the perceived benefits of the insurance program. Children from migrant families are at even higher risk for uninsurance due to their lower socioeconomic status. Government initiatives specifically targeting temporary residents and providing health insurance benefits for their children are urgently needed.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  8. A political history of federal mental health and addiction insurance parity.

    Science.gov (United States)

    Barry, Colleen L; Huskamp, Haiden A; Goldman, Howard H

    2010-09-01

    This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring "parity" for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increasing fairness in the insurance market, whereas employers and insurers have opposed it because of concerns about its cost. The passage of this law is viewed as a legislative success by both consumer and provider advocates and the employer and insurance groups that fought against it for decades. Twenty-nine structured interviews were conducted with key informants in the federal parity debate, including members of Congress and their staff; lobbyists for consumer, provider, employer, and insurance groups; and other key contacts. Historical documentation, academic research on the effects of parity regulations, and public comment letters submitted to the U.S. Departments of Labor, Health and Human Services, and Treasury before the release of federal guidance also were examined. Three factors were instrumental to the passage of this law: the emergence of new evidence regarding the costs of parity, personal experience with mental illness and addiction, and the political strategies adopted by congressional champions in the Senate and House of Representatives. Challenges to implementing the federal parity policy warrant further consideration. This law raises new questions about the future direction of federal policymaking on behavioral health. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

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

    Science.gov (United States)

    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 insured with financial concerns, and insured without financial concerns, respectively (P 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 interval [CI]: 1.05-1.41, P=.01; no insurance, adjusted OR 1.38, 95% CI: 1.17-1.63, P insurance and financial concerns

  10. The impact of universal National Health Insurance on population health: the experience of Taiwan

    Directory of Open Access Journals (Sweden)

    Kuo Ken N

    2010-08-01

    Full Text Available Abstract Background Taiwan established a system of universal National Health Insurance (NHI in March, 1995. Today, the NHI covers more than 98% of Taiwan's population and enrollees enjoy almost free access to healthcare with small co-payment by most clinics and hospitals. Yet while this expansion of coverage will almost inevitably have improved access to health care, however, it cannot be assumed that it will necessarily have improved the health of the population. The aim of this study was to determine whether the introduction of National Health Insurance (NHI in Taiwan in 1995 was associated with a change in deaths from causes amenable to health care. Methods Identification of discontinuities in trends in mortality considered amenable to health care and all other conditions (non-amenable mortality using joinpoint regression analysis from 1981 to 2005. Results Deaths from amenable causes declined between 1981 and 1993 but slowed between 1993 and 1996. Once NHI was implemented, the decline accelerated significantly, falling at 5.83% per year between 1996 and 1999. In contrast, there was little change in non-amenable causes (0.64% per year between 1981 and 1999. The effect of NHI was highest among the young and old, and lowest among those of working age, consistent with changes in the pattern of coverage. NHI was associated with substantial reductions in deaths from circulatory disorders and, for men, infections, whilst an earlier upward trend in female cancer deaths was reversed. Conclusions NHI was associated in a reduction in deaths considered amenable to health care; particularly among those age groups least likely to have been insured previously.

  11. 42 CFR 431.636 - Coordination of Medicaid with the Children's Health Insurance Program (CHIP).

    Science.gov (United States)

    2010-10-01

    ... Insurance Program (CHIP). 431.636 Section 431.636 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES...'s Health Insurance Program (CHIP). (a) Statutory basis. This section implements— (1) Section 2102(b... coordination between a State child health program and other public health insurance programs. (b) Obligations...

  12. 75 FR 63480 - Medicaid Program: Implementation of Section 614 of the Children's Health Insurance Program...

    Science.gov (United States)

    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 Program...

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

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Average cost of a health insurance policy. 100.2... VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of determining..., less certain deductions. One of the deductions is the average cost of a health insurance policy,...

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

    Science.gov (United States)

    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.

  15. Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003

    OpenAIRE

    Xu, L.; Wang, Yan; Collins, C. D.; Tang, Shenglan

    2007-01-01

    Abstract Background In 1997 there was a major reform of the government run urban health insurance system in China. The principal aims of the reform were to widen coverage of health insurance for the urban employed and contain medical costs. Following this reform there has been a transition from the dual system of the Government Insurance Scheme (GIS) and Labour Insurance Scheme (LIS) to the new Urban Employee Basic Health Insurance Scheme (BHIS). Methods This paper uses data from the National...

  16. Extending social health insurance to the informal sector in Kenya. An assessment of factors affecting demand.

    Science.gov (United States)

    Mathauer, Inke; Schmidt, Jean-Olivier; Wenyaa, Maurice

    2008-01-01

    This paper contributes to analysing and understanding the demand for (social) health insurance of informal sector workers in Kenya by assessing their perceptions and knowledge of and concerns regarding health insurance and the Kenyan National Hospital Insurance Fund (NHIF). It serves to explore how informal sector workers could be integrated into the NHIF. To collect data, focus group discussions were held with organized groups of informal sector workers of different types across the country, backed up by a self-administered questionnaire completed by heads of NHIF area branch offices. It was found that the most critical barrier to NHIF enrollment is the lack of knowledge of informal sector workers about the NHIF, its enrollment option and procedures for informal sector workers. Inability to pay is a critical factor for some, but people were, in principle, interested in health insurance, and thus willing to pay for it. In sum, the mix of demand-side determinants for enrolling in the NHIF is not as complex as expected. This is good news, as these demand-side determinants can be addressed with a well-designed strategy, focusing on awareness raising and information, improvement of insurance design features and setting differentiated and affordable contribution rates.

  17. Reassembling and Cutting the Social with Health Insurance

    DEFF Research Database (Denmark)

    Ossandón, José

    2014-01-01

    By rescuing an obscure and almost forgotten parliamentary controversy in Chile, this article shows how private property and solidarity cohabit in health insurance. To do so, it follows both pragmatist sociology, where controversies are seen as situations in which social formations are questioned...

  18. 77 FR 41270 - Health Insurance Premium Tax Credit

    Science.gov (United States)

    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, 2012...

  19. Development and status of health insurance systems in China.

    Science.gov (United States)

    Barber, Sarah L; Yao, Lan

    2011-01-01

    Health insurance programs have changed rapidly over time in China. Among rural populations, insurance coverage shifted from nearly universal levels in the 1970s to 7% in 1999; it stands at 94% of counties in 2009. This large increase is the result of a series of health reforms that aim to achieve universal access to healthcare and better risk protection, largely through the rollout of the health insurance programs and the gradual increase in subsidies and benefits over time. In this paper, we present the development of the rural and urban health insurance programs, their modes of financing and operation and the benefits and reimbursement schemes at the end of 2009. We discuss some of the problems with the rural and urban residents' schemes including reliance on local government capacity, reimbursement ceilings and rates, and incentives for unnecessary care and waste in the design of the programs. Recommendations include increasing financial support and deepening the benefits packages. Strategies to control cost and improve quality include developing mixed provider payment mechanisms, implementing essential medicines policies and strengthening the quality of primary-care provision. Copyright © 2011 John Wiley & Sons, Ltd.

  20. Exit and voice in dutch social health insurance.

    NARCIS (Netherlands)

    Gress, S.; Delnoij, D.; Groenewegen, P.P.

    2003-01-01

    According to Hirschmann's concept of exit and voice, people have two options to make sure that firms or organisations realise what they (their consumers or members) are interested in (Hirschmann 1970). In the Dutch public health insurance system voice existed for a long time, but exit was only intro

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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…

  3. willingness to pay for voluntary health insurance in tanzania

    African Journals Online (AJOL)

    2011-02-02

    Feb 2, 2011 ... INTROdUCTION increasingly ... the health insurance sector, has hampered expansion efforts in many ... revenue generated by each scheme. ... given a mandate to oversee the management of the ... Data analysis were done using stata version 11.0. ... using Pearson chi-square (for binary or categorical.

  4. Economic Cost of Malaria Treatment under the Health Insurance ...

    African Journals Online (AJOL)

    care by examining costs incurred by health insurance card holders in the ... to poor households as it exposes their vulnerabilities and takes a toll on their already low .... of sickness; 5 = other indirect costs due to illness; and = local wage rate.

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

    Directory of Open Access Journals (Sweden)

    Shiva Raj Mishra

    2015-08-01

    Full Text Available 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. Health insurance theory: the case of the missing welfare gain.

    Science.gov (United States)

    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.

  7. Willingness to pay for community health insurance in a semi-urban ...

    African Journals Online (AJOL)

    Willingness to pay for community health insurance in a semi-urban ... Background: Community health insurance is now seen as a very viable and sustainable ... This study was conducted to assess the willingness of household heads' to pay ...

  8. PROVIDER CHOICE FOR OUTPATIENT HEALTH CARE SERVICES IN INDONESIA: THE ROLE OF HEALTH INSURANCE

    Directory of Open Access Journals (Sweden)

    Budi Hidayat

    2012-11-01

    Full Text Available Background: Indonesian's health care system is characterized by underutilized of the health-care infrastructure. One of the ways to improve the demand for formal health care is through health insurance. Responding to this potentially effective policy leads the Government of Indonesia to expand health insurance coverage by enacting the National Social Security Act in 2004. In this particular issue, understanding provider choice is therefore a key to address the broader policy question as to how the current low uptake of health care services could be turned in to an optimal utilization. Objective:To estimate a model of provider choice for outpatient care in Indonesia with specific attention being paid to the role of health insurance. Methods: A total of 16485 individuals were obtained from the second wave of the Indonesian Family Life survey. A multinomial logit regression model was applied to a estimate provider choice for outpatient care in three provider alternative (public, private and self-treatment. A policy simulation is reported as to how expanding insurance benefits could change the patterns of provider choice for outpatient health care services. Results: Individuals who are covered by civil servant insurance (Askes are more likely to use public providers, while the beneficiaries of private employees insurance (Jamsostek are more likely to use private ones compared with the uninsured population. The results also reveal that less healthy, unmarried, wealthier and better educated individuals are more likely to choose private providers than public providers. Conclusions: Any efforts to improve access to health care through health insurance will fail if policy-makers do not accommodate peoples' preferences for choosing health care providers. The likely changes in demand from public providers to private ones need to be considered in the current social health insurance reform process, especially in devising premium policies and benefit packages

  9. Does private insurance adequately protect families of children with mental health disorders?

    Science.gov (United States)

    Busch, Susan H; Barry, Colleen L

    2009-12-01

    Although private insurance typically covers many health care costs, the challenges faced by families who care for a sick child are substantial. These challenges may be more severe for children with special health care needs (CSHCN) with mental illnesses than for other CSHCN. Our objective was to determine if families of privately insured children who need mental health care face different burdens than other families in caring for their children. We used the 2005-2006 National Survey of Children With Special Health Care Needs (NS-CSHCN) to study privately insured children aged 6 to 17 years. We compared CSHCN with mental health care needs (N = 4918) to 3 groups: children with no special health care needs (n = 2346); CSHCN with no mental health care needs (n = 16250); and CSHCN with no mental health care need but a need for other specialty services (n = 7902). The latter group was a subset of CSHCN with no mental health care need. We used weighted logistic regression and study outcomes across 4 domains: financial burden; health plan experiences; labor-market and time effects; and parent experience with services. We found that families of children with mental health care needs face significantly greater financial barriers, have more negative health plan experiences, and are more likely to reduce their labor-market participation to care for their child than other families. Families of privately insured CSHCN who need mental health care face a higher burden than other families in caring for their children. Policies are needed to help these families obtain affordable, high-quality care for their children.

  10. CERN Health Insurance Scheme (CHIS) Contributions – Changes for 2012

    CERN Document Server

    HR Department

    2012-01-01

    Following the 2010 five-yearly review of financial and social conditions, which included the CERN Health Insurance Scheme (CHIS), the CERN Council decided in December 2010 to progressively increase the level of contributions over the period 2011-2015.   For 2012, the contribution rate of active and retired CHIS members will be 4.41%. The amounts of the fixed premiums for voluntarily insured members (e.g. users and associates) as well as the supplementary contributions for spouses with income from a professional activity increase accordingly : Voluntary contributions The full contribution based on Reference Salary II is now 1094 CHF per month. This fixed amount contribution is applied to voluntarily affiliated users and associates with normal coverage. Half of this amount (547 CHF) is applied to apprentices as well as to voluntarily affiliated users and associates with reduced coverage. Finally, an amount of 438 CHF is applied to children maintaining their insurance cover on a voluntary and tempo...

  11. Employer health insurance and local labor market conditions.

    Science.gov (United States)

    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.

  12. 26 CFR 1.79-0 - Group-term life insurance-definitions of certain terms.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Group-term life insurance-definitions of certain....79-0 Group-term life insurance—definitions of certain terms. The following definitions apply for... policy of life insurance is “carried directly or indirectly” by an employer if— (a) The employer pays...

  13. 77 FR 71687 - Federal Employees' Group Life Insurance Program: Court Orders Prior to July 22, 1998

    Science.gov (United States)

    2012-12-04

    ... RIN 3206-AM67 Federal Employees' Group Life Insurance Program: Court Orders Prior to July 22, 1998... the court order expressly provides that an individual receive Federal Employee's Group Life Insurance... Administrative practice and procedure, Government employees, Hostages, Iraq, Kuwait, Lebanon, Life...

  14. Servicemembers' Group Life Insurance--Veterans' Group Life Insurance regulation update--ABO, VGLI application, SGLI 2-year disability extension. Final rule.

    Science.gov (United States)

    2014-07-31

    This document amends the Department of Veterans Affairs (VA) insurance regulations concerning Servicemembers' Group Life Insurance (SGLI) to reflect the statutory provisions of the Veterans' Benefits Act of 2010, which became law on October 13, 2010, and resulted in the need for amendments to change the SGLI Disability Extension period from 1 year to 2 years in duration; provide SGLI Traumatic Injury Protection (TSGLI) retroactive coverage effective from October 7, 2001, for all qualifying injuries regardless of the geographic location and military operation in which the injuries were incurred; and remove the SGLI and Veterans' Group Life Insurance (VGLI) Accelerated Benefits Option (ABO) discount rate. This rule also clarifies that ``initial premium'' refers to ``initial Veterans' Group Life Insurance premium,'' updates the current address of the Office of Servicemembers' Group Life Insurance (OSGLI), managed by Prudential Insurance Company of America, to reflect where the ABO application is mailed for processing, and corrects the OSGLI phone number. Finally, this rule removes the ABO application form from the regulation, and it corrects and clarifies language concerning the VGLI application period that was inadvertently incorrectly modified in a prior amendment of the regulations.

  15. Ghana's National Health Insurance Scheme: insights from members, administrators and health care providers.

    Science.gov (United States)

    Barimah, Kofi Bobi; Mensah, Joseph

    2013-08-01

    The Ghana National Health Insurance Scheme (NHIS) was established as part of a poverty reduction strategy to make health care more affordable to Ghanaians. It is envisaged that it will eventually replace the existing cash-and-carry system. This paper examines the views of NHIS administrators, members/enrollees, and health care providers on how the Scheme operates in practice. It is part of a larger evaluation project on Ghana's NHIS, sponsored by the Bill and Melinda Gates Foundation and the Global Development Network as part of a two-year global research. We rely primarily on qualitative data from focus group discussion in the Brong Ahafo and the Upper East regions respectively. Our findings suggest that the NHIS has improved access to affordable health care services and prescription drugs to many people in Ghana. However, there are concerns about fraud and corruption that must be addressed if the Scheme is to be financially viable.

  16. Consumers, health insurance and dominated choices.

    Science.gov (United States)

    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.

  17. 78 FR 45208 - Children's Health Insurance Program (CHIP); Final Allotments to States, the District of Columbia...

    Science.gov (United States)

    2013-07-26

    ... HUMAN SERVICES Centers for Medicare & Medicaid Services RIN 0938-AR79 Children's Health Insurance... Columbia, and the U.S. Territories and Commonwealths to initiate and expand health insurance coverage to uninsured, low-income children under the Children's Health Insurance Program (CHIP). The fiscal year...

  18. 75 FR 6673 - Expert Meeting on Measurement Criteria for Children's Health Insurance Program; Reauthorization...

    Science.gov (United States)

    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 Program...

  19. 75 FR 62684 - Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction...

    Science.gov (United States)

    2010-10-13

    ... HUMAN SERVICES Office of the Secretary 45 CFR Part 162 RIN 0938-AM50 Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction Standards Adopted Under the Health Insurance...: This document announces maintenance changes to some of the Health Insurance Portability and...

  20. 76 FR 46684 - Medicaid and Children's Health Insurance Programs; Disallowance of Claims for FFP and Technical...

    Science.gov (United States)

    2011-08-03

    ...-AQ32 Medicaid and Children's Health Insurance Programs; Disallowance of Claims for FFP and Technical... within that time period; make conforming changes to the Medicaid and Children's Health Insurance Program... the Children's Health Insurance Program (CHIP) to jointly fund State efforts to initiate and expand...

  1. 77 FR 43290 - Children's Health Insurance Program (CHIP); Final Allotments to States, the District of Columbia...

    Science.gov (United States)

    2012-07-24

    ... HUMAN SERVICES Centers for Medicare & Medicaid Services RIN 0938-AR45 Children's Health Insurance... Columbia, and the U.S. Territories and Commonwealths to initiate and expand health insurance coverage to uninsured, low-income children under the Children's Health Insurance Program (CHIP). The fiscal year...

  2. 78 FR 52719 - Tax Credit for Employee Health Insurance Expenses of Small Employers

    Science.gov (United States)

    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 case...

  3. 77 FR 28788 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Under the Patient Protection and...

    Science.gov (United States)

    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 Implementing...

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

    Science.gov (United States)

    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…

  5. Consumers' perspectives on national health insurance in South Africa: using a mobile health approach.

    Science.gov (United States)

    Weimann, Edda; Stuttaford, Maria C

    2014-10-28

    Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. This research is based on a survey using Mxit as a mobile phone-based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system's governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform.

  6. Trends in Disparities in Low-Income Children's Health Insurance Coverage and Access to Care by Family Immigration Status.

    Science.gov (United States)

    Jarlenski, Marian; Baller, Julia; Borrero, Sonya; Bennett, Wendy L

    2016-03-01

    To examine time trends in disparities in low-income children's health insurance coverage and access to care by family immigration status. We used data from the National Survey of Children's Health in 2003 to 2011-2012, including 83,612 children aged 0 to 17 years with family incomes status categories: citizen children with nonimmigrant parents; citizen children with immigrant parents; and immigrant children. We used multivariable regression analyses to obtain adjusted trends in health insurance coverage and access to care. All low-income children experienced gains in health insurance coverage and access to care from 2003 to 2011-2012, regardless of family immigration status. Relative to citizen children with nonimmigrant parents, citizen children with immigrant parents had a 5 percentage point greater increase in health insurance coverage (P = .06), a 9 percentage point greater increase in having a personal doctor or nurse (P health insurance coverage than other groups. However, the group had a 14 percentage point greater increase in having a personal doctor or nurse (P family immigration status have lessened over time among children in low-income families, although large disparities still exist. Policy efforts are needed to ensure that children of immigrant parents and immigrant children are able to access health insurance and health care. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  7. Impact of community-based health insurance in rural India on self-medication & financial protection of the insured

    NARCIS (Netherlands)

    D.M. Dror (David); A. Chakraborty (Arpita); M. Majumdar (Manabi); P. Panda (Pradeep); R. Koren (Ruth)

    2016-01-01

    textabstractBackground & objectives: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medicatio

  8. Evidence-based health policy-making, hospital funding and health insurance.

    Science.gov (United States)

    Palmer, G R

    2000-02-01

    An important goal of health services research is to improve the efficiency and effectiveness of health services through a quantitative and evidence-based approach. There are many limitations to the use of evidence in health policy-making, such as differences in what counts as evidence between the various disciplines involved, and a heavy reliance on theory in social science disciplines. Community and interest group values, ideological positions and political assessments inevitably intrude into government health policy-making. The importance of these factors is accentuated by the current absence of evidence on the impact of policy options for improving the health status of the community, and ensuring that efficiency and equity objectives for health services are also met. Analysis of recent hospital funding and private health insurance initiatives shows the limited role of evidence in the making of these decisions. Decision-making about health policy might be improved in the future by initiatives such as greater exposure of health professionals to educational inputs with a policy focus; increased contribution of doctors to health services research via special postgraduate programs; and establishing a national, multidisciplinary centre for health policy research and evaluation.

  9. Progressive or regressive? A second look at the tax exemption for employer-sponsored health insurance premiums.

    Science.gov (United States)

    Schoen, Cathy; Stremikis, Kristof; Collins, Sara; Davis, Karen

    2009-05-01

    The major argument for capping the exemption of health insurance benefits from income tax is that doing so will generate significant revenue that can be used to finance an expansion of health coverage. This analysis finds that given the state of insurance markets and current variations in premiums, limiting the current exemption could adversely affect individuals who are already at high risk of losing their health coverage. Evidence suggests that capping the exemption for employment-based health insurance could disproportionately affect workers in small firms, older workers, and wage-earners in industries with high expected claims costs. To avoid putting many families at increased health and financial risk, and to avoid undermining employer-sponsored group coverage, any consideration of a cap would have to be combined with coverage for all, changes in insurance market rules, and shared responsibility for financing.

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

    Directory of Open Access Journals (Sweden)

    Chang Hung-Hao

    2010-10-01

    Full Text Available Abstract 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

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

    Science.gov (United States)

    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.

  12. 76 FR 7767 - Student Health Insurance Coverage

    Science.gov (United States)

    2011-02-11

    ... physical and mental illnesses), claims experience, receipt of health care, medical history, genetic... might have this effect. For example, the PHS Act guaranteed availability and guaranteed renewability... to whether this is the case with respect to these latter requirements. 1. Guaranteed Availability...

  13. Health seeking behavior in karnataka: does micro-health insurance matter?

    Science.gov (United States)

    Savitha, S; Kiran, Kb

    2013-10-01

    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. 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. 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. 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. 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.

  14. Rating the Efficiency of Regional Health Systems and Compulsory Health Insurance

    Directory of Open Access Journals (Sweden)

    Tatyana Nikolayevna Russkikh

    2015-12-01

    Full Text Available In the face of increasing of the regional differentiation of the health systems and compulsory health insurance, the comparative analysis and efficiency assessment of their performance in the context of the subjects of the Russian Federation becomes particularly relevant. Therefore, the research is focused on the regional health systems and compulsory health insurance (CHI, and the subject matter of the study is the analysis of the system performance. In the article, the comparative analysis of the authors’ approaches to the formation of efficiency criteria of the performance of regional health systems and CHI, as well as to the development of a typology of the constituent entities of the Russian Federation based on these criteria is conducted. The authors propose a system of indicators to measure the economic, medical and social efficiency of the systems under consideration. Moreover, a set of indicators of economic efficiency forms two groups of indicators. The first group of indicators reflects the financial performance, and the second — the structural efficiency. A methodological approach to the formation of the rating for subjects of the Russian Federation according to the levels of efficiency, based on the procedures of cluster analysis and fuzzy mathematics are developed. A feature of the proposed approach to the construction of a typology of the subjects in terms of efficiency is the introduction of a reference subject with the national average performance indicators system that allows to qualitatively assess the effectiveness of regional health systems and CHI by comparing them with the «reference subject». The results of the empirical research have indicated a high differentiation of the subjects of the Russian Federation in terms of economic efficiency, have allowed to identify the subjects-outsiders. The theoretical and practical results can be used for the rational choice of priorities of the state policy in the field of the

  15. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January -- June 2013

    Science.gov (United States)

    ... 2013, among persons under age 65 with private health insurance, 21.7% were in a family that had an FSA for medical expenses ( Table 10 ). (See Technical Notes for definition of FSA.) Insurance coverage by state Medicaid expansion status Under provisions of the ACA, states have the ...

  16. Social Security Disability Insurance Enrollment and Health Care Employment.

    Science.gov (United States)

    Pellegrini, Lawrence C; Geissler, Kimberley H

    2017-09-21

    To examine the relationship between Social Security Disability Insurance (SSDI) enrollment and health care employment. State-year level data from government and other publicly available sources for all states (2000-2014). Population-weighted linear regression analyses model associations between each health care employment measure and each SSDI enrollment measure (i.e., SSDI overall, physical, or mental health enrollment rates), controlling for factors associated with health care employment, state fixed effects, and secular time trends. Data are gathered from publicly available sources. A one standard deviation increase in SSDI enrollment per 100,000 population is associated with a statistically significant 2.6 and 4.5 percent increase in the mean employment rate per 100,000 population for health care practitioner and technical occupations and health care support occupations, respectively. The size of this relationship varies by the type of disabling condition for SSDI enrollment (physical versus mental health). Social Security Disability Insurance enrollment is significantly associated with health care employment at the state level. Quantifying the magnitude of this relationship is important given high SSDI enrollment rates as well as evolving policy and demographic shifts related to the SSDI program. © Health Research and Educational Trust.

  17. Competing health policies: insurance against universal public systems

    Science.gov (United States)

    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

  18. Competing health policies: insurance against universal public systems

    Directory of Open Access Journals (Sweden)

    Asa Ebba Cristina Laurell

    2016-01-01

    Full Text Available 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.

  19. A survey on the attitudes of doctors towards health insurance payment in the medical consortium

    Institute of Scientific and Technical Information of China (English)

    SHI Ge; WU Tao; XU Wei-guo

    2011-01-01

    Background Medical consortium is a specific vertical integration model of regional medical resources.To improve medical resources utilization and control the health insurance costs by fee-for-service plans (FFS),capitation fee and diagnosis-related groups (DRGs),it is important to explore the attitudes of doctors towards the different health insurance payment in the medical consortium in Shanghai.Methods A questionnaire survey was carried out randomly on 50 doctors respectively in 3 different levels medical institutes.Results The statistical results showed that 90% of doctors in tertiary hospitals had the tendency towards FFS,whereas 78% in secondary hospitals towards DRGs and 84% in community health centers towards capitation fee.Conclusions There are some obvious differences on doctors' attitudes towards health insurance payment in 3 different levels hospitals.Thus,it is feasible that health insurance payment should be supposed to the doctors' attitudes using the bundled payments along with the third-party payment as a supervisor within consortium.

  20. Cancellation of Nongroup Health Insurance Policies

    Science.gov (United States)

    2013-11-19

    1302 Essential Health Benefits (X) √ §1302 Minimum Actuarial Value (X) √ §1302 Maximum Out-of-Pocket Limits (X) √ Source: CRS analysis of ACA...also not possible to develop reliable estimates on the number of individuals who renewed policies through “early renewal” or who will be offered...must provide at least 30 days’ prior notice to the individual before coverage may be rescinded. Source: CRS analysis of relevant federal law and

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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…

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

    Science.gov (United States)

    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…

  4. Social capital and active membership in the Ghana National Health Insurance Scheme - a mixed method study.

    Science.gov (United States)

    Fenenga, Christine J; Nketiah-Amponsah, Edward; Ogink, Alice; Arhinful, Daniel K; Poortinga, Wouter; Hutter, Inge

    2015-11-02

    People's decision to enroll in a health insurance scheme is determined by socio-cultural and socio-economic factors. On request of the National health Insurance Authority (NHIA) in Ghana, our study explores the influence of social relationships on people's perceptions, behavior and decision making to enroll in the National Health Insurance Scheme. This social scheme, initiated in 2003, aims to realize accessible quality healthcare services for the entire population of Ghana. We look at relationships of trust and reciprocity between individuals in the communities (so called horizontal social capital) and between individuals and formal health institutions (called vertical social capital) in order to determine whether these two forms of social capital inhibit or facilitate enrolment of clients in the scheme. Results can support the NHIA in exploiting social capital to reach their objective and strengthen their policy and practice. We conducted 20 individual- and seven key-informant interviews, 22 focus group discussions, two stakeholder meetings and a household survey, using a random sample of 1903 households from the catchment area of 64 primary healthcare facilities. The study took place in Greater Accra Region and Western Regions in Ghana between June 2011 and March 2012. While social developments and increased heterogeneity seem to reduce community solidarity in Ghana, social networks remain common in Ghana and are valued for their multiple benefits (i.e. reciprocal trust and support, information sharing, motivation, risk sharing). Trusting relations with healthcare and insurance providers are, according healthcare clients, based on providers' clear communication, attitude, devotion, encouragement and reliability of services. Active membership of the NHIS is positive associated with community trust, trust in healthcare providers and trust in the NHIS (p-values are .009, .000 and .000 respectively). Social capital can motivate clients to enroll in health insurance

  5. Retiree Health Insurance for Public School Employees: Does it Affect Retirement?

    Science.gov (United States)

    Fitzpatrick, Maria D.

    2014-01-01

    Despite the widespread provision of retiree health insurance for public sector workers, little attention has been paid to its effects on employee retirement. This is in contrast to the large literature on health-insurance-induced “job-lock” in the private sector. I use the introduction of retiree health insurance for public school employees in combination with administrative data on their retirement to identify the effects of retiree health insurance. As expected, the availability of retiree health insurance for older workers allows employees to retire earlier. These behavioral changes have budgetary implications, likely making the programs self-financing rather than costly to taxpayers. PMID:25479889

  6. The ABCs of HIPCs (health insurance purchasing cooperatives).

    Science.gov (United States)

    Wicks, E K; Curtis, R E; Haugh, K

    1993-01-01

    HIPCs, or health care purchasing cooperatives, are attracting widespread interest as a key element of the managed competition approach to health reform. HIPCs perform several useful roles for individuals and small employers unable to obtain health insurance coverage in the current system by spreading risk more evenly and purchasing coverage in a given region or market area. While HIPCs are generally associated with managed competition, they are also compatible with reform strategies that require employers to pay for coverage or those that provide incentives for expanded coverage.

  7. Does health insurance ensure equitable health outcomes? An analysis of hospital services usage in urban India.

    Science.gov (United States)

    Dutta, Mousumi; Husain, Zakir

    2013-01-01

    In this paper, we examine the relationship between socio-economic status (SES) and the usage of in-patient services, and analyze the impact of introducing health insurance in India - a major developing country with poor health outcomes. In contrast to results of similar works undertaken for developed countries, our results reveal that the positive relation between usage of in-patient services and SES persists even in the presence of health insurance. This implies that health insurance is unable to eliminate the inequities in accessing healthcare services that stem from disparities in SES. In fact, insurance aggravates inequity in the healthcare market. The study is based on unit-level data from the 2005-06 Morbidity and Health Care Survey undertaken by National Sample Survey Organization.

  8. Health insurance and access to care among welfare leavers.

    Science.gov (United States)

    Danziger, Sheldon; Davis, Matthew M; Orzol, Sean; Pollack, Harold A

    2008-01-01

    This analysis explores the effects of the 1996 welfare reform on health insurance coverage and access to care among former recipients of cash aid. Using panel data from the Women's Employment Study, which conducted five interviews between 1997 and 2003 in one Michigan county, we find that 25% of welfare leavers lacked health insurance coverage in fall 2003. Uninsured adults were significantly more likely than others to report that they could not afford a medical or dental visit during the year prior to the 2003 interview. Fixed-effect logistic regression analysis indicates that women who had been off the welfare rolls for at least 12 months (the duration of transitional Medicaid) were significantly more likely to be uninsured than women who had made more recent welfare exits, and were significantly more likely to report financial obstacles to the receipt of medical and dental care.

  9. 29 CFR 2520.103-2 - Contents of the annual report for a group insurance arrangement.

    Science.gov (United States)

    2010-07-01

    ... collective trust maintained by a bank, trust company or similar institution, a copy of the annual statement... pooled separate account maintained by an insurance company, or a common or collective trust maintained by a bank or similar institution, and see § 2520.104-43(b)(2) for when the terms “group insurance...

  10. A median voter model of health insurance with ex post moral hazard.

    Science.gov (United States)

    Jacob, Johanna; Lundin, Douglas

    2005-03-01

    One of the main features of health insurance is moral hazard, as defined by Pauly [Pauly, M.V., 1968. The economics of moral hazard: comment. American Economic Review 58, 531-537), people face incentives for excess utilization of medical care since they do not pay the full marginal cost for provision. To mitigate the moral hazard problem, a coinsurance can be included in the insurance contract. But health insurance is often publicly provided. Having a uniform coinsurance rate determined in a political process is quite different from having different rates varying in accordance with one's preferences, as is possible with private insurance. We construct a political economy model in order to characterize the political equilibrium and answer questions like: "Under what conditions is there a conflict in society on what coinsurance rate should be set?" and "Which groups of individuals will vote for a higher and lower than equilibrium coinsurance rate, respectively?". We also extend our basic model and allow people to supplement the coverage provided by the government with private insurance. Then, we answer two questions: "Who will buy the additional coverage?" and "How do the coinsurance rates people are now faced with compare with the rates chosen with pure private provision?".

  11. Health insurance and quality of care: Comparing perceptions of quality between insured and uninsured patients in Ghana's hospitals.

    Science.gov (United States)

    Abuosi, Aaron A; Domfeh, Kwame Ameyaw; Abor, Joshua Yindenaba; Nketiah-Amponsah, Edward

    2016-05-12

    The introduction of health insurance in Ghana in 2003 has resulted in a tremendous increase in utilization of health services. However, concerns are being raised about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, inadequate physical examination by doctors and discrimination of insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in selected hospitals in Ghana to determine whether there is any unequal treatment between insured and uninsured patients in terms of quality of care, as empirical and anecdotal evidence seem to suggest. A cross-sectional survey of 818 out-patients was conducted in 17 general hospitals from three regions of Ghana. These are the Upper East, Brong Ahafo and Central Regions. Convenience sampling was employed to select the patients in exit interviews. Descriptive statistics, including frequency distributions, means and standard deviations, were used to describe socio-economic and demographic characteristics of respondents. Factor analysis was used to determine distinct quality of care constructs; t-test statistic was used to test for differences in quality perceptions between the insured and uninsured patients; and regression analysis was used to test the association between health insurance and quality of care. Overall, there was no significant difference in perceptions of quality between insured and uninsured patients. However, there was a significant difference between insured and uninsured patients in respect of financial access to care. The major quality of care concern affecting all patients was the problem of inadequate resources, especially lack of doctors, lack of drugs and other basic supplies and equipment to work with. It was concluded that generally, insured and uninsured patients are not treated unequally, contrary to prevailing anecdotal and empirical evidence. On the contrary, quality of

  12. Something old or something new? Social health insurance in Ghana

    Directory of Open Access Journals (Sweden)

    Garshong Bertha

    2009-08-01

    Full Text Available Abstract Background There is considerable interest at present in exploring the potential of social health insurance to increase access to and affordability of health care in Africa. A number of countries are currently experimenting with different approaches. Ghana's National Health Insurance Scheme (NHIS was passed into law in 2003 but fully implemented from late 2005. It has already reached impressive coverage levels. This article aims to provide a preliminary assessment of the NHIS to date. This can inform the development of the NHIS itself but also other innovations in the region. Methods This article is based on analysis of routine data, on secondary literature and on key informant interviews conducted by the authors with stakeholders at national, regional and district levels over the period of 2005 to 2009. Results In relation to its financing sources, the NHIS is heavily reliant on tax funding for 70–75% of its revenue. This has permitted quick expansion of coverage, partly through the inclusion of large exempted population groups. Card holders increased from 7% of the population in 2005 to 45% in 2008. However, only around a third of these are contributing to the scheme financially. This presents a sustainability problem, in that revenue is de-coupled from the growing membership. In addition, the NHIS offers a broad benefits package, with no co-payments and limited gate-keeping, and also faces cost escalation related to its new payment system and the growing utilisation of members. These features contributed to a growth in distressed schemes and failure to pay outstanding facility claims in 2008. The NHIS has had a considerable impact on the health system as a whole, taking on a growing role in funding curative care. In 2009, it is expected to contribute 41% of the overall resource envelope. However there is evidence that this funding is not additional but has been switched from other funding channels. There are some equity concerns

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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. Copyright © 2015 Academic Pediatric Association. All rights reserved.

  15. Health Insurance without Single Crossing : Why Healthy People have High Coverage

    NARCIS (Netherlands)

    Boone, J.; Schottmuller, C.

    2011-01-01

    Standard insurance models predict that people with high (health) risks have high insurance coverage. It is empirically documented that people with high income have lower health risks and are better insured. We show that income differences between risk types lead to a violation of single crossing in

  16. 40 CFR 5.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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...

  17. 49 CFR 25.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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....

  18. 29 CFR 36.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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...

  19. 24 CFR 3.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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...

  20. 10 CFR 1042.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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....

  1. 45 CFR 86.39 - Health and insurance benefits and services.

    Science.gov (United States)

    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....

  2. 36 CFR 1211.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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...

  3. 45 CFR 2555.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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....

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

    Science.gov (United States)

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

    Science.gov (United States)

    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....

  6. 32 CFR 196.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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....

  7. 45 CFR 618.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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....

  8. 44 CFR 19.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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...

  9. 13 CFR 113.440 - Health and insurance benefits and services.

    Science.gov (United States)

    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...

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

    Science.gov (United States)

    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.

  11. Nonprofit Health Insurers: The Story Wall Street Doesn't Tell

    National Research Council Canada - National Science Library

    Susan R. Johnson

    2003-01-01

    For several years, Wall Street investment firms have campaigned for conversion of nonprofit health insurers to investor ownership, arguing that an infusion of equity capital is critical to insurers' survival...

  12. Health Insurance Exchanges: Health Insurance Navigators and In-Person Assistance

    Science.gov (United States)

    2013-09-25

    apply for coverage through the exchanges may be eligible for small business tax credits.5 Consumers may apply for coverage over the phone, online , via...more recent CMS announcements reference 20-30 hours of training. 47 The Medicare Learning Network online navigator training is estimated to take 20...presented with an array of possible insurance plans. Shoppers can search for plans in different ways such as company name, average monthly cost, premiums

  13. Impact of China's Urban Employee Basic Medical Insurance on Health Care Expenditure and Health Outcomes

    OpenAIRE

    Feng Huang; Li Gan

    2015-01-01

    At the end of 1998, China launched a government-run mandatory insurance program, the Urban Employee Basic Medical Insurance (UEBMI), to replace the previous medical insurance system. Using the UEBMI reform in China as a natural experiment, this study identify variations in patient cost sharing that were imposed by the UEBMI reform and examine their effects on the demand for health-care services. Using data from the 1991-2006 waves of the China Health and Nutrition Survey, we find that the inc...

  14. Insurance choice and tax-preferred health savings accounts.

    Science.gov (United States)

    Cardon, James H; Showalter, Mark H

    2007-03-01

    We develop an infinite horizon utility maximization model of the interaction between insurance choice and tax-preferred health savings accounts. The model can be used to examine a wide range of policy options, including flexible spending accounts, health savings accounts, and health reimbursement accounts. We also develop a 2-period model to simulate various implications of the model. Key results from the simulation analysis include the following: (1) with no adverse selection, use of unrestricted health savings accounts leads to modest welfare gains, after accounting for the tax revenue loss; (2) with adverse selection and an initial pooling equilibrium comprised of "sick" and "healthy" consumers, introducing HSAs can, but does not necessarily, lead to a new pooling equilibrium. The new equilibrium results in a higher coinsurance rate, an increase in expected utility for healthy consumers, and a decrease in expected utility for sick consumers; (3) with adverse selection and a separating equilibrium, both sick and healthy consumers are better off with a health savings account; (4) efficiency gains are possible when insurance contracts are explicitly linked to tax-preferred health savings accounts.

  15. The Reallocation of Compensation in Response to Health Insurance Premium Increases

    OpenAIRE

    Goldman, Dana P.; Neeraj Sood; Arleen Leibowitz

    2003-01-01

    This paper examines how compensation packages change when health insurance premiums rise. We use data on employee choices within a single large firm with a flexible benefits plan; an increasingly common arrangement among medium and large firms. In these companies, employees explicitly choose how to allocate compensation between cash and various benefits such as retirement, medical insurance, life insurance, and dental benefits. We find that a $1 increase in the price of health insurance leads...

  16. Supplementary contribution payable to the Health Insurance Scheme for spouses

    CERN Multimedia

    HR Department

    2008-01-01

    Staff members, fellows and pensioners are reminded that any change in their marital status, as well as any change in their spouse or registered partner’s income or health insurance cover, must be reported to CERN in writing within 30 calendar days, in accordance with Articles III 6.01 to 6.03 of the Rules of the CERN Health Insurance Scheme (CHIS). Such changes may affect the conditions of the spouse or registered partner’s membership of the CHIS or the payment of the supplementary contribution to it for the spouse or registered partner’s insurance cover. For more information see: http://cern.ch/chis/contribsupp.asp From 1.1.2008, the indexed amounts of the supplementary monthly contribution for the different monthly income brackets are as follows, expressed in Swiss francs: more than 2500 CHF and up to 4250 CHF: 134.- more than 4250 CHF and up to 7500 CHF: 234.- more than 7500 CHF and up to 10,000 CHF: 369.- more than 10,000 CHF: 470.- It is in the member of the ...

  17. Longitudinal Patterns of Health Insurance Coverage Among a National Sample of Children in the Child Welfare System

    Science.gov (United States)

    Raghavan, Ramesh; Aarons, Gregory A.; Roesch, Scott C.; Leslie, Laurel K.

    2008-01-01

    Objectives. We sought to describe health insurance coverage over time among a national sample of children who came into contact with child welfare or child protective services agencies. Methods. We used data from 4 waves of the National Survey of Child and Adolescent Well-Being to examine insurance coverage among 2501 youths. Longitudinal insurance trajectories were identified using latent class analyses, a technique used to classify individuals into groupings of observed variables, and survey-weighted logistic regression was used to identify variables associated with class membership. Results. We identified 2 latent insurance classes—1 contained children who gained health insurance, and the other contained children who stably maintained coverage over time. History of sexual abuse, and race/ethnicity other than White, Black, and Hispanic, were associated with membership in the “gainer” class. Foster care placement and poorer health status were associated with membership in the “maintainer” class. Caregiver characteristics were not associated with class membership. Conclusions. The majority of children in child welfare had stable health insurance coverage over time. Given this vulnerable population’s dependence upon Medicaid, protection of existing entitlements to Medicaid is essential to preserve their stable insurance coverage. PMID:18235059

  18. Longitudinal patterns of health insurance coverage among a national sample of children in the child welfare system.

    Science.gov (United States)

    Raghavan, Ramesh; Aarons, Gregory A; Roesch, Scott C; Leslie, Laurel K

    2008-03-01

    We sought to describe health insurance coverage over time among a national sample of children who came into contact with child welfare or child protective services agencies. We used data from 4 waves of the National Survey of Child and Adolescent Well-Being to examine insurance coverage among 2501 youths. Longitudinal insurance trajectories were identified using latent class analyses, a technique used to classify individuals into groupings of observed variables, and survey-weighted logistic regression was used to identify variables associated with class membership. We identified 2 latent insurance classes--1 contained children who gained health insurance, and the other contained children who stably maintained coverage over time. History of sexual abuse, and race/ethnicity other than White, Black, and Hispanic, were associated with membership in the "gainer" class. Foster care placement and poorer health status were associated with membership in the "maintainer" class. Caregiver characteristics were not associated with class membership. The majority of children in child welfare had stable health insurance coverage over time. Given this vulnerable population's dependence upon Medicaid, protection of existing entitlements to Medicaid is essential to preserve their stable insurance coverage.

  19. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review.

    Science.gov (United States)

    Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  20. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review

    Science.gov (United States)

    Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  1. Modifications to the Rules of the CERN Health Insurance Scheme

    CERN Document Server

    HR Department

    2010-01-01

    On the proposal of the CHIS Board, and following examination by the Standing Concertation Committee on 29 April 2010, the Director-General has approved the new Rules of the CERN Health Insurance Scheme, which will come into effect on 1 June 2010. The Rules will shortly be available on the CHIS web site. As the Rules had not been revised since 2003, it had become necessary to make certain changes in order to bring them into line with other texts (such as the Staff Rules and Regulations and Administrative Circulars) and to clarify some practices. The new Rules do not introduce any new benefits or remove any existing ones. The following changes will affect all insured members:   Description of change Articles in the new Rules Time limit for claiming reimbursement The time period is measured from the invoice date (instead of the date of treatment). ...

  2. Have health insurance reforms in Tunisia attained their intended objectives?

    Science.gov (United States)

    Makhloufi, Khaled; Ventelou, Bruno; Abu-Zaineh, Mohammad

    2015-03-01

    A growing number of developing countries are currently promoting health system reforms with the aim of attaining ' universal health coverage' (UHC). In Tunisia, several reforms have been undertaken over the last two decades to attain UHC with the goals of ensuring financial protection in health and enhancing access to healthcare. The first of these goals has recently been addressed in a companion paper by Abu-Zaineh et al. (Int J Health Care Financ Econ 13(1):73-93, 2013). The present paper seeks to assess whether these reforms have in fact enhanced access to healthcare. The average treatment effects of two insurance schemes, formal-mandatory (MHI) and state-subsidized (MAS) insurance, on the utilization of outpatient and inpatient healthcare are estimated using propensity score matching. Results support the hypothesis that both schemes (MHI and MAS) increase the utilization of healthcare. However, significant variations in the average effect of these schemes are observed across services and areas. For all the matching methods used and compared with those the excluded from cover, the increase in outpatient and inpatient services for the MHI enrollees was at least 19 and 26 %, respectively, in urban areas, while for MAS beneficiaries this increase was even more pronounced (28 and 75 % in the urban areas compared with 27 and 46 % in the rural areas for outpatient and inpatient services, respectively). One important conclusion that emerges is that the current health insurance schemes, despite improving accessibility to healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for all services. Attaining the latter goal requires a strategy that targets the "trees" not the "forest".

  3. Employer contribution and premium growth in health insurance.

    Science.gov (United States)

    Liu, Yiyan; Jin, Ginger Zhe

    2015-01-01

    We study whether employer premium contribution schemes could impact the pricing behavior of health plans and contribute to rising premiums. Using 1991-2011 data before and after a 1999 premium subsidy policy change in the Federal Employees Health Benefits Program (FEHBP), we find that the employer premium contribution scheme has a differential impact on health plan pricing based on two market incentives: 1) consumers are less price sensitive when they only need to pay part of the premium increase, and 2) each health plan has an incentive to increase the employer's premium contribution to that plan. Both incentives are found to contribute to premium growth. Counterfactual simulation shows that average premium would have been 10% less than observed and the federal government would have saved 15% per year on its premium contribution had the subsidy policy change not occurred in the FEHBP. We discuss the potential of similar incentives in other government-subsidized insurance systems such as the Medicare Part D and the Health Insurance Marketplace under the Affordable Care Act. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. 78 FR 28007 - Submission for Review: Federal Employees' Group Life Insurance (FEGLI) Implementation...

    Science.gov (United States)

    2013-05-13

    ... From the Federal Register Online via the Government Publishing Office OFFICE OF PERSONNEL MANAGEMENT Submission for Review: Federal Employees' Group Life Insurance (FEGLI) Implementation Questionnaire for Tribal Employers AGENCY: U.S. Office of Personnel Management. ACTION: 60-Day Notice...

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

    Science.gov (United States)

    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…

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

    Science.gov (United States)

    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…

  7. Does Health Insurance Premium Exemption Policy for Older People Increase Access to Health Care? Evidence from Ghana.

    Science.gov (United States)

    Duku, Stephen Kwasi Opuku; van Dullemen, Caroline Elisabeth; Fenenga, Christine

    2015-01-01

    Aging in Sub-Saharan Africa causes major challenges for policy makers in social protection. Our study focuses on Ghana, one of the few Sub-Saharan African countries that passed a National Policy on Aging in 2010. Ghana is also one of the first Sub-Saharan African countries that launched a National Health Insurance Scheme (NHIS; NHIS Act 650, 2003) with the aim to improve access to quality health care for all citizens, and as such can be considered as a means of poverty reduction. Our study assesses whether premium exemption policy under the NHIS that grants non-payments of annual health insurance premiums for older people increases access to health care. We assessed differences in enrollment coverage among four different age groups (18-49, 50-59, 60-69, and 70+). We found higher enrollment for the 70+ and 60-69 age groups. The likelihood of enrollment was 2.7 and 1.7 times higher for the 70+ and 60-69 age groups, respectively. Our results suggest the NHIS exemption policy increases insurance coverage of the aged and their utilization of health care services.

  8. Willingness to pay for health insurance: an analysis of the potential market for new low-cost health insurance products in Namibia.

    Science.gov (United States)

    Gustafsson-Wright, Emily; Asfaw, Abay; van der Gaag, Jacques

    2009-11-01

    This study analyzes the willingness to pay for health insurance and hence the potential market for new low-cost health insurance product in Namibia, using the double bounded contingent valuation (DBCV) method. The findings suggest that 87 percent of the uninsured respondents are willing to join the proposed health insurance scheme and on average are willing to insure 3.2 individuals (around 90 percent of the average family size). On average respondents are willing to pay NAD 48 per capita per month and respondents in the poorest income quintile are willing to pay up to 11.4 percent of their income. This implies that private voluntary health insurance schemes, in addition to the potential for protecting the poor against the negative financial shock of illness, may be able to serve as a reliable income flow for health care providers in this setting.

  9. [Extension of health coverage and community based health insurance schemes in Africa: Myths and realities].

    Science.gov (United States)

    Boidin, B

    2015-02-01

    This article tackles the perspectives and limits of the extension of health coverage based on community based health insurance schemes in Africa. Despite their strong potential contribution to the extension of health coverage, their weaknesses challenge their ability to play an important role in this extension. Three limits are distinguished: financial fragility; insufficient adaptation to characteristics and needs of poor people; organizational and institutional failures. Therefore lessons can be learnt from the limits of the institutionalization of community based health insurance schemes. At first, community based health insurance schemes are to be considered as a transitional but insufficient solution. There is also a stronger role to be played by public actors in improving financial support, strengthening health services and coordinating coverage programs.

  10. Including health insurance in poverty measurement: The impact of Massachusetts health reform on poverty.

    Science.gov (United States)

    Korenman, Sanders D; Remler, Dahlia K

    2016-12-01

    We develop and implement what we believe is the first conceptually valid health-inclusive poverty measure (HIPM) - a measure that includes health care or insurance in the poverty needs threshold and health insurance benefits in family resources - and we discuss its limitations. Building on the Census Bureau's Supplemental Poverty Measure, we construct a pilot HIPM for the under-65 population under ACA-like health reform in Massachusetts. This pilot demonstrates the practicality, face validity and value of a HIPM. Results suggest that public health insurance benefits and premium subsidies accounted for a substantial, one-third reduction in the health inclusive poverty rate. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage over the Life-Course.

    Science.gov (United States)

    Sohn, Heeju

    2017-04-01

    Health insurance coverage varies substantially between racial and ethnic groups in the United States. Compared to non-Hispanic whites, African Americans and people of Hispanic origin had persistently lower insurance coverage rates at all ages. This article describes age- and group-specific dynamics of insurance gain and loss that contribute to inequalities found in traditional cross-sectional studies. It uses the longitudinal 2008 Panel of the Survey of Income and Program Participation (N=114,345) to describe age-specific patterns of disparity prior to the Affordable Care Act (ACA). A formal decomposition on increment-decrement life-tables of insurance gain and loss shows that coverage disparities are predominately driven by minority groups' greater propensity to lose the insurance that they already have. Uninsured African Americans were faster to gain insurance than non-Hispanic whites but their high rates of insurance loss more than negated this advantage. Disparities from greater rates of loss among minority groups emerge rapidly at the end of childhood and persist throughout adulthood. This is especially true for African Americans and Hispanics and their relative disadvantages again heighten in their 40s and 50s.

  12. Health care seeking behaviour and utilisation in a multiple health insurance system

    DEFF Research Database (Denmark)

    Chomi, Eunice Nahyuha; Mujinja, Phares G M; Enemark, Ulrika

    2014-01-01

    to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members...

  13. [Strategic options for the relationship-management between hospital and statutory health insurance - an explorative study].

    Science.gov (United States)

    Pick, V; Rossbach, C

    2010-05-01

    This investigation examines the specific demands of statutory health insurance organisations on hospitals. The need for such an analysis is determined by the increasing competition in the German health care system in the past years. Hospitals are confronted with growing and perhaps conflictual demands on the hospital's stakeholders. An empirical investigation should provide first insight into the widely unexplored relationship between statutory health insurances and hospitals. For this reason, 23 explorative interviews with managers of hospitals and statutory health insurance organisations were conducted. The resulting demands are structured and assigned to identified areas of demand. Aspects which are important for statutory health insurance organisations and aspects that hospitals assume are important were compared. Thus, an existing gap was identified. Furthermore, options for statutory health insurance (dis-)satisfaction are shown. Such an analysis is essential for hospitals to develop and maintain a positive relationship to the statutory health insurances and to achieve competitive advantages. Georg Thieme Verlag KG Stuttgart, New York.

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

    Science.gov (United States)

    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.

  15. The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

    Directory of Open Access Journals (Sweden)

    Odeyemi IA

    2013-03-01

    Full Text Available Isaac AO Odeyemi,1 John Nixon21Senior Director and Head of Health Economics and Outcomes Research, Astellas Pharma UK Ltd, Chertsey, UK; 2Teaching Associate in Health Economics, Department of Economics and Related Studies, University of York, York, UKBackground: Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI. This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity.Methods: A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia that illustrates the principal forms and roles of PHI. Literature describing each country's health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity.Results: In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system.Conclusion: PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications

  16. 78 FR 77470 - Health Insurance Exchanges; Approval of an Application by the Accreditation Association for...

    Science.gov (United States)

    2013-12-23

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Health Insurance Exchanges; Approval of an...\\ Health Insurance Exchanges; Application by the Accreditation Association for Ambulatory Health Care To Be...

  17. Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Experiment in Vietnam.

    Science.gov (United States)

    Wagstaff, Adam; Nguyen, Ha Thi Hong; Dao, Huyen; Bales, Sarah

    2016-06-01

    Subsidized voluntary enrollment in government-run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. We report the results of a cluster randomized experiment, in which 3000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam's government-run scheme and the benefits of health insurance, a voucher entitling eligible household members to 25% off their annual premium, and both. At baseline, the four groups had similar enrollment rates (4%) and were balanced on plausible enrollment determinants. The interventions all had small and insignificant effects (around 1 percentage point or ppt). Among those reporting sickness in the 12 months prior to the baseline survey the subsidy-only intervention raised enrollment by 3.5 ppts (p = 0.08) while the combined intervention raised enrollment by 4.5 ppts (p = 0.02); however, the differences in the effect sizes between the sick and non-sick were just shy of being significant. Our results suggest that information campaigns and subsidies may have limited effects on voluntary health insurance enrollment in Vietnam and that such interventions might exacerbate adverse selection. Copyright © The World Bank Health Economics © 2015 John Wiley & Sons, Ltd.

  18. The Affordable Care Act and Health Insurance Exchanges: Advocacy Efforts for Children's Oral Health.

    Science.gov (United States)

    Orynich, C Ashley; Casamassimo, Paul S; Seale, N Sue; Litch, C Scott; Reggiardo, Paul

    2015-01-01

    To evaluate legislative differences in defining the Affordable Care Act's (ACA) pediatric dental benefit and the role of pediatric advocates across states with different health insurance Exchanges. Data were collected through public record investigation and confidential health policy expert interviews conducted at the state and federal level. Oral health policy change by the pediatric dental profession requires advocating for the mandatory purchase of coverage through the Exchange, tax subsidy contribution toward pediatric dental benefits, and consistent regulatory insurance standards for financial solvency, network adequacy and provider reimbursement. The pediatric dental profession is uniquely positioned to lead change in oral health policy amidst health care reform through strengthening state-level formalized networks with organized dentistry and commercial insurance carriers.

  19. Association Between Health Insurance Status and In-Hospital Outcomes After ST-Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Pancholy, Samir; Patel, Gaurav; Pancholy, Maitri; Nanavaty, Sukrut; Coppola, John; Kwan, Tak; Patel, Tejas

    2017-10-01

    Lack of health insurance is associated with adverse clinical outcomes; however, association between health insurance status and outcomes in patients presenting with ST-elevation myocardial infarction (STEMI) is unclear. Using the Nationwide Inpatient Sample data from 2003 to 2014, hospitalizations with STEMI in patients 18 years of age and older were extracted. Based on health insurance status, patients were categorized into insured and uninsured groups. The primary outcome measure was in-hospital mortality. Adjusted analysis using inverse probability weighting with multivariable regression was performed to identify independent predictors of in-hospital mortality. Of 2,710,375 patients included in the final analysis, 220,770 patients were uninsured. Unadjusted in-hospital mortality was lower in uninsured patients (5.1% vs 9.3%; p health insurance was associated with the worst in-hospital mortality (odds ratio [OR] = 1.77, 95% confidence interval [CI] 1.72 to 1.82; p health insurance is independently associated with increased in-hospital mortality in patients presenting with STEMI. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Statutory caps: an involuntary contribution to the medical malpractice insurance crisis or a reasonable mechanism for obtaining affordable health care?

    Science.gov (United States)

    Chupkovich, P J

    1993-01-01

    A medical malpractice insurance crisis occurred in the mid-1970s and mid-1980s evidenced by escalating malpractice insurance rates and increasing numbers of malpractice claims. Insurance companies maintained that the increase in insurance rates was necessary because of the sharp rise in the number of malpractice lawsuits, astronomical damage awards, and ineffective mechanisms to prevent and to eliminate nonmeritorious claims. Physicians responded by forming their own insurance companies, cancelling high-risk procedures, and orchestrating intensive legislative lobbying for tort reform. Insurance companies, physicians, and the legislature collaborated efforts to resolve this medical malpractice crisis. A national debate erupted regarding the proper way to address the medical malpractice insurance crisis. Insurance companies and physicians pressured state legislatures to reform liability laws that, in their opinion, permitted recovery of excessive damage awards by plaintiffs. Consumer groups and lawyers suggested tighter regulation of the insurance industry. State legislatures, in an attempt to remedy the perception that injured plaintiffs were overcompensated for their injuries, enacted "tort reform legislation," which included statutory caps on damages recoverable in medical malpractice actions. As a result of the extensive lobbying effort by physicians and insurance companies, twenty-seven states enacted statutes limiting recovery of damages in medical malpractice lawsuits. Lawyers responded by challenging state malpractice legislation on constitutional grounds, alleging violations of federal and state equal protection and due process clauses and the Seventh Amendment right to a jury trial. Opponents of the cap also asserted violations of state constitution provisions such as the "open courts" provision or the "special legislation" clause. To date, the state courts have held that statutory caps are unconstitutional. Statutory caps and other tort reform measures are

  1. A perverse 'net' effect? Health insurance and ex-ante moral hazard in Ghana

    NARCIS (Netherlands)

    Debebe, Z.Y.; Kempen, L.A.C.M. van; Hoop, T.J. de

    2012-01-01

    Incentive problems in insurance markets are well-established in economic theory. One of these incentive problems is related to reduced prevention efforts following insurance coverage (ex-ante moral hazard). This prediction is yet to be tested empirically with regard to health insurance, as the healt

  2. The role of retiree health insurance in the early retirement of public sector employees.

    Science.gov (United States)

    Shoven, John B; Slavov, Sita Nataraj

    2014-12-01

    Most government employees have access to retiree health coverage, which provides them with group health coverage even if they retire before Medicare eligibility. We study the impact of retiree health coverage on the labor supply of public sector workers between the ages of 55 and 64. We find that retiree health coverage raises the probability of stopping full time work by 4.3 percentage points (around 38 percent) over two years among public sector workers aged 55-59, and by 6.7 percentage points (around 26 percent) over two years among public sector workers aged 60-64. In the younger age group, retiree health insurance mostly seems to facilitate transitions to part-time work rather than full retirement. However, in the older age group, it increases the probability of stopping work entirely by 4.3 percentage points (around 22 percent).

  3. 26 CFR 1.79-3 - Determination of amount equal to cost of group-term life insurance.

    Science.gov (United States)

    2010-04-01

    ...-term life insurance. 1.79-3 Section 1.79-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Income § 1.79-3 Determination of amount equal to cost of group-term life insurance. (a) In general. This section prescribes the rules for determining the amount equal to the cost of group-term life insurance...

  4. Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China

    Institute of Scientific and Technical Information of China (English)

    Yao Pan; Shanquan Chen; Manli Chen; Pei Zhang; Qian Long; Li Xiang; Henry Lucas

    2016-01-01

    Background:Health inequity is an important issue all around the world.The Chinese basic medical security system comprises three major insurance schemes,namely the Urban Employee Basic Medical Insurance (UEBMI),the Urban Resident Basic Medical Insurance (URBMI),and the New Cooperative Medical Scheme (NCMS).Little research has been conducted to look into the disparity in payments among the health insurance schemes in China.In this study,we aimed to evaluate the disparity in reimbursements for tuberculosis (TB) care among the abovementioned health insurance schemes.Methods:This study uses a World Health Organization (WHO) framework to analyze the disparities and equity relating to the three dimensions of health insurance:population coverage,the range of services covered,and the extent to which costs are covered.Each of the health insurance scheme's policies were categorized and analyzed.An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city (YC),which included 1506 discharges,was conducted to identify the differences in reimbursement rates and out-of-pocket (OOP) expenses among the health insurance schemes.Results:Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by (TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI,who have less inpatient expenses than those covered by the UEBMI).We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups.In terms of financial inequity,TB patients who earned less paid more.The NCMS provides modest financial protection,based on income.Overall,TB patients from lower socioeconomic groups were the most vulnerable.Conclusion:There are large disparities in reimbursement for TB care among the three health insurance schemes and this,in turn,hampers TB control.Reducing the gap in health outcomes between the three health insurance

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

    Science.gov (United States)

    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.

  6. Premium subsidies for health insurance: excessive coverage vs. adverse selection.

    Science.gov (United States)

    Selden, T M

    1999-12-01

    The tax subsidy for employment-related health insurance can lead to excessive coverage and excessive spending on medical care. Yet, the potential also exists for adverse selection to result in the opposite problem-insufficient coverage and underconsumption of medical care. This paper uses the model of Rothschild and Stiglitz (R-S) to show that a simple linear premium subsidy can correct market failure due to adverse selection. The optimal linear subsidy balances welfare losses from excessive coverage against welfare gains from reduced adverse selection. Indeed, a capped premium subsidy may mitigate adverse selection without creating incentives for excessive coverage.

  7. Message from the CERN Health Insurance Supervisory Board (CHISB)

    CERN Document Server

    2004-01-01

    Following a long series of discussions with the Administration of the La Tour Hospital, a tariff agreement has been concluded between the Hospital and the CERN Health Insurance Scheme. In the case of hospitalisations, this new agreement will apply to admissions on or after 1st September 2004 and will result, in particular, in the reintroduction of the third-party payer system. In the case of out-patient treatment, billing will be according to the Swiss medical tariff system TARMED and Uniqa will act as third-party guarantor. Further details will be published in the next issue of the CHISBull'. Tel.74484

  8. THE VOLUNTARY HEALTH INSURANCE IN BULGARIA - HISTORY, DEVELOPMENT AND CHANGES

    OpenAIRE

    Natalia M. Shtereva-Nikolova; Nikolay A. Popov; Tsvetelina M. Petrova-Gotova

    2014-01-01

    The aim of this article is to show the history and development of the Voluntary Health Insurance (VHI) in Bulgaria and the recent regulatory changes. During the investigated period (2003–2012) the market increases over seven times, the number of working and licensed VHI funds grew over three times. The regulatory changes in 2013 require re-licensing and higher capital, which reduced the number of the VHI companies. We analyze the changes in the market and how VHI funds succeed to meet the inc...

  9. State politics and the creation of health insurance exchanges.

    Science.gov (United States)

    Jones, David K; Greer, Scott L

    2013-08-01

    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.

  10. Current trends in health insurance systems: OECD countries vs. Japan.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  12. Reconciling research and implementation in micro health insurance experiments in India: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Doyle Conor

    2011-10-01

    Full Text Available Abstract Background Microinsurance or Community-Based Health Insurance is a promising healthcare financing mechanism, which is increasingly applied to aid rural poor persons in low-income countries. Robust empirical evidence on the causal relations between Community-Based Health Insurance and healthcare utilisation, financial protection and other areas is scarce and necessary. This paper contains a discussion of the research design of three Cluster Randomised Controlled Trials in India to measure the impact of Community-Based Health Insurance on several outcomes. Methods/Design Each trial sets up a Community-Based Health Insurance scheme among a group of micro-finance affiliate families. Villages are grouped into clusters which are congruous with pre-existing social groupings. These clusters are randomly assigned to one of three waves of implementation, ensuring the entire population is offered Community-Based Health Insurance by the end of the experiment. Each wave of treatment is preceded by a round of mixed methods evaluation, with quantitative, qualitative and spatial evidence on impact collected. Improving upon practices in published Cluster Randomised Controlled Trial literature, we detail how research design decisions have ensured that both the households offered insurance and the implementers of the Community-Based Health Insurance scheme operate in an environment replicating a non-experimental implementation. Discussion When a Cluster Randomised Controlled Trial involves randomizing within a community, generating adequate and valid conclusions requires that the research design must be made congruous with social structures within the target population, to ensure that such trials are conducted in an implementing environment which is a suitable analogue to that of a non-experimental implementing environment.

  13. AWARENESS ON HEALTH INSURANCE AMONG AN URBAN COMMUNITY IN IMPHAL: A CROSSSECTIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Haobam Danny

    2016-04-01

    Full Text Available BACKGROUND More than 70% of health care expenditure in India today is met out of individuals’ pocket. In this scenario, health insurance is emerging as an alternative mechanism for financing of health care. Literature regarding awareness on health insurance in Manipur is lacking. OBJECTIVES 1. To determine the level of awareness as well as the perception and practice about health insurance among an urban community. 2. To determine the association between awareness on health insurance with select demographic variables. METHODS This was a cross-sectional study conducted among 201 families in Thangmeiband Sinam Leikai, Imphal West. Participants were either head of the family or any responsible family member above the age of 18 years who were present at the time of visit. Data were collected by interviewing the participants using a semi-structured questionnaire. Data entry were done using SPSS version 21 (IBM. Descriptive statistics like mean, median, percentages and proportion were used. Test of association were done using Chisquare and t-test. RESULTS 62.7% (126 of the respondents were aware of health insurance and the major sources of information about health insurance were provided by friends and relatives (33.8% followed by insurance agents (26.9%. Only 9.5% of those who were aware of health insurance had an existing health insurance scheme. Higher Educational level and higher Socio-economic status of the respondents were found to be significantly associated with more awareness on health insurance. CONCLUSION Awareness about health insurance was satisfactory, but it did not lead to increased enrolment. There is a need to reinforce information, education and communication campaign about health insurance among the general population.

  14. Students left behind: the limitations of university-based health insurance for students with mental illnesses.

    Science.gov (United States)

    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 health insurance coverage to school enrollment can leave students vulnerable when they are most in need of help. Students whose health insurance is contingent upon their enrollment face significant lapses in coverage when they are required to leave school. This is especially challenging for students with mental illnesses whose treatment needs often go unmet in the absence of that coverage. The limitations in this system must be addressed as an increasing number of universities and students opt for university-based health insurance plans.

  15. INNOVATIVE APPROACH IN THE COMPULSORY HEALTH INSURANCE TARIFF SETTING

    Directory of Open Access Journals (Sweden)

    M. Yu. Zasypkin

    2015-02-01

    Full Text Available Development of a single channel financing in the health system of the Russian Federation based on the standards of the compulsory health insurance (CHI requires a single channel financing of the health system through the CHI as one of the main direction using payment of the medical services in the form of so-called «full» tariff [1-12].It is not a secret that for many years the medical services tariff in the CHI system contained from only five items of expenditures (salary, charges on payroll, soft goods and clothing, medicines, bandages, other medical expenses, and food. On one hand, such defective tariff was based on the parallel government financing of the medical institutions (MIs, on the other hand, because of this tariff, the manager was hoppled in the control of the financial flows.

  16. Value-Based Insurance Design: More Health at Any Price

    Science.gov (United States)

    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

  17. Performance evaluation of the fraud management system in health insurance

    OpenAIRE

    2016-01-01

    Efficient insurance fraud management can have significant effect on insurance companies’ competitive market position. Potential savings accumulated in fraudulent activities can add up to 10% of all expenses insurance companies pay for damage claims, which globally add up to several 100 billion Euros. There are various available methods to detect insurance fraud. The simplest one, that is to manually review a small number of insurance claims, is highly inefficient and its success rate is large...

  18. Equity in Utilization of Inpatient forNational Health Insurance (JKN Program in Indonesia

    Directory of Open Access Journals (Sweden)

    Ahmad Nizar Shihab

    2017-01-01

    Full Text Available Indonesia is targeting to achieve Universal Health Coverage (UHC in 2019. Currently, the National Health Insurance program (JKN has been running since it was first started at January 1, 2014 and includes as many as 171 million participants from 254 million targeted population of Indonesia as efforts in achieving UHC. Objective: The aim of this study was to evaluate the effect of JKN against the equity in the utilization of inpatient care in thegovernment hospital (RS and private hospitals before the implementation of JKN in 2013 and one year after JKN implemented in 2015 into 4 main groups: health insurance, geographic (rural and urban, income per capita, and education groups. This study used mixed method data collection techniques by using quantitative data obtained from secondary data of the National Socioeconomic Survey (Susenas 2013 and 2015, and BPJS (Social Security Agency of Health 2014-2015. The qualitative data obtained from the study of literature (desk review. Data analysis was performed by considering the percentage, delta, ratio, and odds ratio of utilization of inpatient care in government and private hospitals. Based on the analysis of the fourgroups studied, showed that the JKN program improve equity and increase public access to the utilization of inpatient both at the Government and Private Hospital especially for the JKN participants, ruralpopulation, lowest income groups and less educated group. Health insurance membershipp group: more patients using health services use health insurance both in government and at private hospitals, but the number of JKN card owner is the highest in government hospital. Conversely, those with private insurance use more health services in private hospitals. Geographic groups (rural and urban: JKN increase greater equity for rural people than urban communities. The increase in the highest access especially in utilization of health services in private hospitals. The access for rural communities in

  19. Health Insurance Coverage and Its Impact on Medical Cost: Observations from the Floating Population in China

    Science.gov (United States)

    Zhao, Yinjun; Kang, Bowei; Liu, Yawen; Li, Yichong; Shi, Guoqing; Shen, Tao; Jiang, Yong; Zhang, Mei; Zhou, Maigeng; Wang, Limin

    2014-01-01

    Background China has the world's largest floating (migrant) population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population. Methods A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost. Results 82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost. Conclusion For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost. PMID:25386914

  20. How Has the Affordable Care Act Affected Health Insurers' Financial Performance?

    Science.gov (United States)

    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.

  1. Healthcare financing reform in Latvia: switching from social health insurance to NHS and back?

    Science.gov (United States)

    Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm

    2014-11-01

    In the 1990s, Latvia aimed at introducing Social Health Insurance (SHI) but later changed to a National Health Service (NHS) type system. The NHS is financed from general taxation, provides coverage to the entire population, and pays for a basic service package purchased from independent public and private providers. In November 2013, the Cabinet of Ministers passed a draft Healthcare Financing Law, aiming at increasing public expenditures on health by introducing Compulsory Health Insurance (CHI) and linking entitlement to health services to the payment of income tax. Opponents of the reform argue that linking entitlement to health services to the payment of income tax does not have the potential to increase public expenditures on health but that it can contribute to compromising universal coverage and access to health services of certain population groups. In view of strong opposition, it is unlikely that the law will be adopted before parliamentary elections in October 2014. Nevertheless, the discussion around the law is interesting because of three main reasons: (1) it can illustrate why the concept of SHI remains attractive - not only for Latvia but also for other countries, (2) it shows that a change from NHS to SHI does not imply major institutional reforms, and (3) it demonstrates the potential problems of introducing SHI, i.e. of linking entitlement to health services to the payment of contributions.

  2. Health Insurance Coverage and Hypertension Control in China: Results from the China Health and Nutrition Survey.

    Science.gov (United States)

    Liao, Yi; Gilmour, Stuart; Shibuya, Kenji

    2016-01-01

    China has rapidly expanded health insurance coverage over the past decade but its impact on hypertension control is not well known. We analyzed factors associated with hypertension and the impact of health insurance on the management of hypertension in China from 1991 to 2009. We used individual-level data from the China Health and Nutrition Survey (CHNS) for blood pressure, BMI, and other socio-economic variables. We employed multi-level logistic regression models to estimate the factors associated with prevalence and management of hypertension. We also estimated the effects of health insurance on management of hypertension using propensity score matching. We found that prevalence of hypertension increased from 23.8% (95% CI: 22.5-25.1%) in 1991 to 31.5% (28.5-34.7%) in 2009. The proportion of hypertensive patients aware of their condition increased from 31.7% (28.7-34.9%) to 51.1% (45.1-57.0%). The proportion of diagnosed hypertensive patients in treatment increased by 35.5% in the 19 years, while the proportion of those in treatment with controlled blood pressure remained low. Among diagnosed hypertensives, health insurance increased the probability of receiving treatment by 28.7% (95% CI: 10.6-46.7%) compared to propensity-matched individuals not covered by health insurance. Hypertension continues to be a major health threat in China and effective control has not improved over time despite large improvements in awareness and treatment access. This suggests problems in treatment quality, medication adherence and patient understanding of the condition. Improvements in hypertension management, quality of medical care for those at high risk, and better health insurance packages are needed.

  3. Trends in risk factors chronic diseases, according of health insurance, Brazil, 2008-2013.

    Science.gov (United States)

    Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Oliveira, Martha

    2015-04-01

    This article aims to compare the trends for risk and protective factors for NCD in the population with and without health insurance. Analysis of temporal trends of the Vigitel phone survey, collected annually in adult population. Were used analyzed the temporal series of variables referent to risk and protective factors for NCD, from 2008 to 2013. Variables were compared according to the possession or not of health insurance using simple linear regression model. There was a reduction in the prevalence of smoking in the population with and without health insurance, in 0.72% and 0,69% per year respectively. The consumption of fruits and vegetables grew 0,8% and 0.72% per year respectively among the population with and without health insurance. Physical activity in leisure time increased 1.17% and 1.01% per year among population with and without health insurance. Excess weight increased in 1.03% and obesity in 0.74% p.y in the population with health insurance and 1.53% and 0.95% p.y without health insurance. Mammography increased 2.4% in the population without health insurance. Vigitel monitoring showed improvement in the indicators in the population with and without health insurance.

  4. What is the difference? Evidence on the distribution of wealth, health, life expectancy, and health insurance coverage.

    Science.gov (United States)

    Kennickell, Arthur B

    2008-09-10

    There is a literature of long standing that considers the relationship between income and differentials in mortality and morbidity, but information on differentials over the distribution of accumulated wealth have been far more scarce and subject to measurement problems. This paper provides evidence from the Survey of Consumer Finances, which is designed as a survey of wealth, on the distribution of wealth and income and how those distributions have shifted in recent years. Particular attention is paid to the distribution of wealth across minority groups and across age groups. The paper also examines the relationship between wealth and health status, life expectancy, and health insurance coverage.

  5. Effects of employer-sponsored health insurance costs on Social Security taxable wages.

    Science.gov (United States)

    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.

  6. Domestic and International College Students: Health Insurance Information Seeking and Use

    Science.gov (United States)

    Mackert, Michael; Koh, Hyeseung E.; Mabry-Flynn, Amanda; Champlin, Sara; Beal, Anna

    2017-01-01

    This study aimed to explore perceived barriers to using health insurance and identify discriminant factors between health insurance information seekers and non-seekers. A total of 615 domestic and international college students from a large university in the Southwest completed a cross-sectional survey. Findings imply that campus health providers…

  7. Building for a Healthy Future: Sustaining School-Based Enrollment in Health Insurance Programs.

    Science.gov (United States)

    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…

  8. 75 FR 32182 - Medicaid Program: Proposed Implementation of Section 614 of the Children's Health Insurance...

    Science.gov (United States)

    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 AND...

  9. 77 FR 31499 - Medicaid and Children's Health Insurance Programs; Disallowance of Claims for FFP and Technical...

    Science.gov (United States)

    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 AND...

  10. Does the Availability of Parental Health Insurance Affect the College Enrollment Decision of Young Americans?

    Science.gov (United States)

    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…

  11. Switching health insurers: the role of price, quality and consumer information search

    NARCIS (Netherlands)

    L.H.H.M. Boonen (Lieke); T. Laske-Aldershof (Trea); F.T. Schut (Erik)

    2015-01-01

    markdownabstract__Abstract__ We examine the impact of price, service quality and information search on people’s propensity to switch health insurers in the competitive Dutch health insurance market. Using panel data from annual household surveys and data on health insurers’ premiums

  12. Switching health insurers: the role of price, quality and consumer information search

    NARCIS (Netherlands)

    L.H.H.M. Boonen (Lieke); T. Laske-Aldershof (Trea); F.T. Schut (Erik)

    2015-01-01

    markdownabstract__Abstract__ We examine the impact of price, service quality and information search on people’s propensity to switch health insurers in the competitive Dutch health insurance market. Using panel data from annual household surveys and data on health insurers’ premiums and quality rat

  13. The effects of Ghana's national health insurance scheme on maternal and infant health care utilization

    NARCIS (Netherlands)

    I.E.J. Bonfrer (Igna); Breebaart, L. (Lyn); De Poel, E.V. (Ellen Van)

    2016-01-01

    textabstractIncreasing equitable access to health care is a main challenge African policy makers are facing. The Ghanaian government implemented the National Health Insurance Scheme in 2004 and the aim of this study is to evaluate its early effects on maternal and infant healthcare use. We exploit d

  14. Evaluation of Telephone Health Coaching of German Health Insurants with Chronic Conditions

    Science.gov (United States)

    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…

  15. The effect of social health insurance on prenatal care: the case of Ghana.

    Science.gov (United States)

    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.

  16. Health insurance system and provider payment reform in the Republic of Macedonia

    Directory of Open Access Journals (Sweden)

    Doncho M. Donev

    2009-03-01

    Full Text Available This article gives an insight to the current health insurance system in the Republic of Macedonia. Special emphasis is given to the specificities and practice of both obligatory and voluntary health insurance, to the scope of the insured persons and their benefits and obligations, the way of calculating and payment of the contributions and the other sources of revenues for health insurance, user participation in health care expenses, payment to the health care providers and some other aspects of realization of health insurance in practice. According to the Health Insurance Law, which was adopted in March 2000, a person can become an insured to the Health Insurance Fund on various modalities. More than 90% of the citizens are eligible to the obligatory health insurance, which provides a broad scope of basic health care benefits. Till end of 2008 payroll contributions were equal to 9.2%, and from January 1st, 2009 are equal to 7.5% of gross earned wages and almost 60% of health sector revenues are derived from them. Within the autonomy and scope of activities of the Health Insurance Fund the structures of the revenues and expenditures are presented. Health financing and reform of the payment to health care providers are of high importance within the ongoing health care reform in Macedonia. It is expected that the newly introduced methods of payments at the primary health care level (capitation and at the hospital sector (global budgeting, DRGs will lead to increased equity, efficiency and quality of health care in hospitals and overall system

  17. 2015 Plan Selections by ZIP Code in the Health Insurance Marketplace

    Data.gov (United States)

    U.S. Department of Health & Human Services — The dataset here provides the total number of Qualified Health Plan selections by ZIP Code for 37 states for the second Health Insurance Marketplace open enrollment...

  18. Effects of immigration on the health insurance status of natives.

    Science.gov (United States)

    Pylypchuk, Yuriy

    2009-09-01

    The objective of the paper is to estimate the effects of immigration on natives' probability of having private coverage and being uninsured. To examine whether immigrants affected employers' decisions to offer health benefits the study estimates immigration effects on natives' probability of being offered, eligible for, and a policy-holder of health insurance. Although in many cases the effects are statistically significant, most effects are very small. The increase in immigrant labor supply from 1995 to 2005 increases natives' uninsurance rates by about 0.7 percentage points and reduces the natives' probability of being offered and a holder of coverage by 0.8 and 1.9 percentage points, respectively. Immigrants' weaker preferences for coverage relative to natives' may be the key factor in this result.

  19. Health, life and disability insurance and hereditary risk for breast or colorectal cancer.

    Science.gov (United States)

    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.

  20. Body Mass Index and Employment-Based Health Insurance

    Directory of Open Access Journals (Sweden)

    Franks Peter

    2008-05-01

    Full Text Available Abstract Background Obese workers incur greater health care costs than normal weight workers. Possibly viewed by employers as an increased financial risk, they may be at a disadvantage in procuring employment that provides health insurance. This study aims to evaluate the association between body mass index [BMI, weight in kilograms divided by the square of height in meters] of employees and their likelihood of holding jobs that include employment-based health insurance [EBHI]. Methods We used the 2004 Household Components of the nationally representative Medical Expenditure Panel Survey. We utilized logistic regression models with provision of EBHI as the dependent variable in this descriptive analysis. The key independent variable was BMI, with adjustments for the domains of demographics, social-economic status, workplace/job characteristics, and health behavior/status. BMI was classified as normal weight (18.5–24.9, overweight (25.0–29.9, or obese (≥ 30.0. There were 11,833 eligible respondents in the analysis. Results Among employed adults, obese workers [adjusted probability (AP = 0.62, (0.60, 0.65] (P = 0.005 were more likely to be employed in jobs with EBHI than their normal weight counterparts [AP = 0.57, (0.55, 0.60]. Overweight workers were also more likely to hold jobs with EBHI than normal weight workers, but the difference did not reach statistical significance [AP = 0.61 (0.58, 0.63] (P = 0.052. There were no interaction effects between BMI and gender or age. Conclusion In this nationally representative sample, we detected an association between workers' increasing BMI and their likelihood of being employed in positions that include EBHI. These findings suggest that obese workers are more likely to have EBHI than other workers.

  1. A Case Study on the Implementation of Local Health Insurance Benefit Packages

    Directory of Open Access Journals (Sweden)

    Supriyantoro Supriyantoro

    2015-06-01

    Full Text Available Background: The variation of benefit packages implemented by some local social health insurance schemes (Jamkesda become an important issue in the effort to integrating them into National Health Insurance (JKN. This study aims to describe implementation of Jamkesda’s benefit packages as a basic consideration in integration to JKN. Methods: Design of this study is case study with qualitative and quantitative aproaches, conducted 2013–2014 in all of districts/cities which already have Jamkesda. Primary and secondary data was collected. Primary data has been collected by focus group discussion, interview, observation, and self administered questioner. Secondary data collected from many sources such as articles, journal, official document, statistics data, and others. Results:Of this study show there is no significant relationship between fiscal capacity group and benefit packages (continuity correction, p value = 0.065. But, districts/cities with high fiscal capacity (high and very high seem likely to have probability 1,920 bigger than lower capacity districts/cities in giving equal or more benefit than existing national social health insurance (Jamkesmas (Mantel-Haenszel, Common Odds Ratio Estimates = 1.920; Confidence Interval 95% =1.008–3.658; asymp. Sig 2 sided = 0.047. There is variation of benefit packages between each Jamkesda. Qualitative results show there are many obstacles faced in giving benefit health services, such as limited community accessibility to health facilities, the absence of health workforce, and lack of health infrastructure and equipment. Recomendation: This study recommends to set a national minimum benefit packages and equalizing percetion of local decission maker.

  2. Impact of insurance precertification on neurosurgery practice and health care delivery.

    Science.gov (United States)

    Menger, Richard P; Thakur, Jai Deep; Jain, Gary; Nanda, Anil

    2017-08-01

    OBJECTIVE Insurance preauthorization is used as a third-party tool to reduce health care costs. Given the expansion of managed care, the impact of the insurance preauthorization process in delaying health care delivery warrants investigation through a diversified neurosurgery practice. METHODS Data for 1985 patients were prospectively gathered over a 12-month period from July 1, 2014, until June 30, 2015. Information regarding attending, procedure, procedure type, insurance type, need for insurance approval, number of days for authorization, or insurance denial was obtained. Delay in authorization was defined as any wait period greater than 7 days. Some of the parameters were added retrospectively to enhance this study; hence, the total number of subjects may vary for different variables. RESULTS The most common procedure was back surgery with instrumentation (28%). Most of the patients had commercial insurance (57%) while Medicaid was the least common (1%). Across all neurosurgery procedures, insurance authorization, on average, was delayed 9 days with commercial insurance, 10.7 days with Tricare insurance, 8.5 days with Medicare insurance, 11.5 days with Medicaid, and 14.4 days with workers' compensation. Two percent of all patients were denied insurance preauthorization without any statistical trend or association. Of the 1985 patients, 1045 (52.6%) patients had instrumentation procedures. Independent of insurance type, instrumentation procedures were more likely to have delays in authorization (p = 0.001). Independent of procedure type, patients with Tricare (military) insurance were more likely to have a delay in approval for surgery (p = 0.02). Predictably, Medicare insurance was protective against a delay in surgery (p = 0.001). CONCLUSIONS Choice of insurance provider and instrumentation procedures were independent risk factors for a delay in insurance preauthorization. Neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and

  3. Health insurance in India: what do we know and why is ethnographic research needed.

    Science.gov (United States)

    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.

  4. THE ROLE OF HEALTH INSURANCE COMPANIES IN THE FINANCIAL PROVISION OF FREE MEDICAL CARE

    Directory of Open Access Journals (Sweden)

    Lyudmila Valentinovna Tokun

    2016-01-01

    Full Text Available This article discusses the features of the mandatory health insurance, the financial resources of health care and the characteristics of the Russian health care system. The article defines the need to apply the SWOT-analysis to the activities of medical organizations, it analyses the interconnection between the criteria of quality, availability and payment for services and their accordance to the sector of economics, which produces or pays for the service. Goal / Objectives: The goal of this article is to study the compulsory health insurance system, its pros and cons in the health system. The objectives of this paper is to identify the sources of financing of compulsory health insurance, the definition of the stages of formation of financial flows, the designation of the role of insurance companies in the compulsory health insurance system, the study of the processes of formation of funds of health insurance companies, the definition of the role of the compulsory health insurance in the risk protection and study of the positive and negative aspects of the modern health care system. Methodology: Methods of comparison, analysis and synthesis are used in this article. Results: as a result of the conducted research authors have made conclusions about the need for the major changes in the financing of public health care. The scope of work of health insurance companies requires increase in number of staff , premises, additional hardware and software. Health insurance companies should be motivated to maintain the health of the population and its improvement. Conclusions: The results of this research can be used to build a system of motivation in the health insurance organizations.

  5. Government health insurance for people below poverty line in India: quasi-experimental evaluation of insurance and health outcomes.

    Science.gov (United States)

    Sood, Neeraj; Bendavid, Eran; Mukherji, Arnab; Wagner, Zachary; Nagpal, Somil; Mullen, Patrick

    2014-09-11

    To evaluate the effects of a government insurance program covering tertiary care for people below the poverty line in Karnataka, India, on out-of-pocket expenditures, hospital use, and mortality. Geographic regression discontinuity study. 572 villages in Karnataka, India. 31,476 households (22,796 below poverty line and 8680 above poverty line) in 300 villages where the scheme was implemented and 28,633 households (21,767 below poverty line and 6866 above poverty line) in 272 neighboring matched villages ineligible for the scheme. A government insurance program (Vajpayee Arogyashree scheme) that provided free tertiary care to households below the poverty line in about half of villages in Karnataka from February 2010 to August 2012. Out-of-pocket expenditures, hospital use, and mortality. Among households below the poverty line, the mortality rate from conditions potentially responsive to services covered by the scheme (mostly cardiac conditions and cancer) was 0.32% in households eligible for the scheme compared with 0.90% among ineligible households just south of the eligibility border (difference of 0.58 percentage points, 95% confidence interval 0.40 to 0.75; Phealth expenditures for admissions to hospitals with tertiary care facilities likely to be covered by the scheme (64% reduction, 35% to 97%; PInsuring poor households for efficacious but costly and underused health services significantly improves population health in India. © Sood et al 2014.

  6. Lending to Parents and Insuring Children: Is There a Role for Microcredit in Complementing Health Insurance in Rural China?

    Science.gov (United States)

    You, Jing

    2016-05-01

    This paper assesses the causal impact on child health of borrowing formal microcredit for Chinese rural households by exploiting a panel dataset (2000 and 2004) in a poor northwest province. Endogenous borrowing is controlled for in a dynamic regression-discontinuity design creating a quasi-experimental environment for causal inferences. There is causal relationship running from formal microcredit to improved child health in the short term, while past borrowing behaviour has no protracted impact on subsequent child health outcomes. Moreover, formal microcredit appears to be a complement to health insurance in improving child health through two mechanisms-it enhances affordability for out-of-pocket health care expenditure and helps buffer consumption against adverse health shocks and financial risk incurred by current health insurance arrangements. Government efforts in expanding health insurance for rural households would be more likely to achieve its optimal goals of improving child health outcomes if combined with sufficient access to formal microcredit. Copyright © 2015 John Wiley & Sons, Ltd.

  7. Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States.

    Science.gov (United States)

    Courtemanche, Charles; Marton, James; Ukert, Benjamin; Yelowitz, Aaron; Zapata, Daniela

    2017-01-01

    The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.

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

    Science.gov (United States)

    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…

  9. CERN Health Insurance Scheme - changes on 1 January 2011

    CERN Multimedia

    HR Department

    2011-01-01

    Changes decided by the Council on 16 December 2010 Following the five-yearly review of financial and social conditions, which included the CERN Health Insurance Scheme (CHIS), the CERN Council has taken certain decisions which affect both active and retired staff. In order to restore the financial equilibrium of the CHIS, the level of contributions will increase progressively over the next five years. In 2011, the contributions of both active and retired members increase from 4.02% to 4.27%. The amounts of the fixed premiums for voluntary insured members (e.g. users and associates) as well as the supplementary contributions for spouses with an income from a professional activity increase accordingly. The amounts of the daily allowance for Long-Term Care have been increased by 20% as of 1 January 2011. The CHIS Rules have been amended according to the above decisions. They entered into force on 1 January 2011 and are available on the CHIS site. Tel. 74125 Members of the personnel shall be deemed to ...

  10. Employer-sponsored health insurance: down but not out.

    Science.gov (United States)

    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.

  11. Real Decision Support for Health Insurance Policy Selection.

    Science.gov (United States)

    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.

  12. Willingness to pay to sustain and expand National Health Insurance services in Taiwan

    Directory of Open Access Journals (Sweden)

    Lai Mei-Shu

    2008-12-01

    Full Text Available Abstract Background The purpose of the present study was to investigate people's willingness to pay to sustain the current National Health Insurance (NHI program in Taiwan and to extend that program to cover long-term care services. Methods A survey was administered to 1800 inpatients and 1800 outpatients, selected from health care facilities across all accreditation levels that were operating under the supervision of six different regional branches of Taiwan's Bureau of National Health Insurance (BNHI. We used a contingent valuation method with closed-ended questions to elicit participants' willingness to pay for continued national heath insurance and additional institutional long-term care services. We divided participants into six subgroups and asked individuals in these groups referendum-like yes-no questions about whether they were willing to pay one of six price bids: New Taiwan Dollar (NT$ 50, NT$100, NT$200, NT$300, NT$400, or NT$500. Logistic regression was used to analyze willingness to pay. Results We found maximum willingness to pay for continued coverage by the NHI program and additional institutional long-term care services to be NT$66 and NT$137 dollars per month, respectively. Conclusion We found that people were willing to pay more for their insurance coverage. With regard to methodology, we also found that using a contingent valuation method to elicit peoples' willingness to pay for health policy issues is valid. The results of the present referendum-like study can serve as a reference for future policy decision making.

  13. Children's Access to Health Insurance and Health Status in Washington State: Influential Factors. Research Brief. Publication #2009-21

    Science.gov (United States)

    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…

  14. Health insurance selection in Chile: a cross-sectional and panel analysis.

    Science.gov (United States)

    Pardo, Cristian; Schott, Whitney

    2014-05-01

    In Chile, workers are mandated to choose either public or private health insurance coverage. Although private insurance premiums depend on health risk, public insurance premiums are solely linked to income. This structure implies that individuals with higher health risks may tend to avoid private insurance, leaving the public insurance system responsible for their care. This article attempts to explore the determinants of health insurance selection (private vs public) by individuals in Chile and to test empirically whether adverse selection indeed exists. We use panel data from Chile's 'Encuesta de Proteccion Social' survey, which allows us to control for a rich set of individual observed and unobserved characteristics using both a cross-sectional analysis and fixed-effect methods. Results suggest that age, sex, job type, income quintile and self-reported health are the most important factors in explaining the type of insurance selected by individuals. Asymmetry in insurance mobility caused by restrictions on pre-existing conditions may explain why specific illnesses have an unambiguous relationship with insurance selection. Empirical evidence tends to indicate that some sorting by health risk and income levels takes place in Chile. In addition, by covering a less healthy population with higher utilization of general health consultations, the public insurance system may be incurring disproportionate expenses. Results suggest that if decreasing segmentation and unequal access to health services are important policy objectives, special emphasis should be placed on asymmetries in the premium structure and inter-system mobility within the health care system. Preliminary analysis of the impact of the 'Garantias Explicitas de Salud' plan (explicit guarantees on health care plan) on insurance selection is also considered.

  15. Health insurance selection in Chile: a cross-sectional and panel analysis

    Science.gov (United States)

    Pardo, Cristian; Schott, Whitney

    2014-01-01

    In Chile, workers are mandated to choose either public or private health insurance coverage. Although private insurance premiums depend on health risk, public insurance premiums are solely linked to income. This structure implies that individuals with higher health risks may tend to avoid private insurance, leaving the public insurance system responsible for their care. This article attempts to explore the determinants of health insurance selection (private vs public) by individuals in Chile and to test empirically whether adverse selection indeed exists. We use panel data from Chile’s ‘Encuesta de Proteccion Social’ survey, which allows us to control for a rich set of individual observed and unobserved characteristics using both a cross-sectional analysis and fixed-effect methods. Results suggest that age, sex, job type, income quintile and self-reported health are the most important factors in explaining the type of insurance selected by individuals. Asymmetry in insurance mobility caused by restrictions on pre-existing conditions may explain why specific illnesses have an unambiguous relationship with insurance selection. Empirical evidence tends to indicate that some sorting by health risk and income levels takes place in Chile. In addition, by covering a less healthy population with higher utilization of general health consultations, the public insurance system may be incurring disproportionate expenses. Results suggest that if decreasing segmentation and unequal access to health services are important policy objectives, special emphasis should be placed on asymmetries in the premium structure and inter-system mobility within the health care system. Preliminary analysis of the impact of the ‘Garantias Explicitas de Salud’ plan (explicit guarantees on health care plan) on insurance selection is also considered. PMID:23558960

  16. Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana.

    Science.gov (United States)

    Williams, Gemma A; Parmar, Divya; Dkhimi, Fahdi; Asante, Felix; Arhinful, Daniel; Mladovsky, Philipa

    2017-08-01

    To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership. In this paper we therefore look beyond economic explanations of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In particular, we investigate whether social exclusion, as measured through a sociocultural, political and economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional survey of 4050 representative households conducted in Ghana in 2012. Household indices were created to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally, economically and politically excluded children are less likely to enrol in the NHIS. Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partially-enrolled (i.e. not all children enrolled within the household) than fully-enrolled. These results suggest that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to improve coverage by removing the remaining small, annually renewable registration fee, implementing and publicising the new clause that de-links premium waivers from parental membership, establishing additional scheme administrative offices in remote areas, holding regular registration sessions in schools and conducting outreach sessions and providing registration support to female guardians of children. Ensuring equitable access to NHIS will contribute substantially

  17. A Political History of Federal Mental Health and Addiction Insurance Parity

    OpenAIRE

    Barry, Colleen L.; Huskamp, Haiden A.; Goldman, Howard H

    2010-01-01

    Context: This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring “parity” for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increa...

  18. HEALTH INSURANCE SCHEME - announcement from the CHIS Board

    CERN Multimedia

    2005-01-01

    A number of members of our Health Insurance Scheme are currently experiencing difficulties getting reimbursement for consulting an acupuncture practitioner. The CHIS Board wishes to remind you that in order to be reimbursed, you must receive your acupuncture treatment from doctors recognised by the competent authorities of the country in which they have their medical practice. In Switzerland, these are people possessing the title of doctor of medicine recognised by the Swiss Medical Association (FMH). Treatment provided by medical auxiliaries must be prescribed beforehand by a recognised doctor. As the practitioner in question is currently not recognised as a doctor in Switzerland, his services are not reimbursed. In order to avoid any inconvenience, we advise you to contact uniqa before undergoing such treatment. You will find all details concerning reimbursement of complementary medicine (acupuncture, chiropractic, osteopathy and ethiopathy) in CHISbull' No. 18 dated November 2004, which can also be co...

  19. HEALTH INSURANCE SCHEME -- announcement from the CHIS Board

    CERN Multimedia

    2005-01-01

    A number of members of our Health Insurance Scheme are currently experiencing difficulties getting reimbursement for consulting an acupuncture practitioner. The CHIS Board wishes to remind you that in order to be reimbursed, you must receive your acupuncture treatment from doctors recognised by the competent authorities of the country in which they have their medical practice. In Switzerland, these are people possessing the title of doctor of medicine recognised by the Swiss Medical Association (FMH). Treatment provided by medical auxiliaries must be prescribed beforehand by a recognised doctor. As the practitioner in question is currently not recognised as a doctor in Switzerland, his services are not reimbursed. In order to avoid any inconvenience, we advise you to contact uniqa before undergoing such treatment. You will find all details concerning reimbursement of complementary medicine (acupuncture, chiropractic, osteopathy and ethiopathy) in CHISbull’ No. 18 dated November 2004, which can ...

  20. THE CERN HEALTH INSURANCE SCHEME AND THE EURO

    CERN Multimedia

    Human Resources Division

    2002-01-01

    Since 1 January 2002, the euro is the common currency of 12 European countries and some 300 million people. Of course, such a change has some consequences on our Health Insurance Scheme. As you know, when filling in the medical expenses claim form, you are required to indicate a currency code, i.e. the currency in which you have incurred medical expenses. You may have noticed that the euro is not yet on the list of currencies which appear on the bottom left of the existing form. This will be changed very soon, once the stock of existing forms has been used up. Until then, please note that the currency code for the euro is 002 (easy to remember since the code for the Swiss franc is 001). If you forget this code, don't worry! Just indicate «euro» next to the amount of your medical bill, or simply use the euro symbol!