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Health Insurance Coverage (health + insurance_coverage)
Selected AbstractsYoung Adults Who Lack Continuous Health Insurance Coverage Have an Elevated Risk of Chlamydia InfectionPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 4 2006-D. Hollander No abstract is available for this article. [source] Assessing horizontal equity in medication treatment among elderly Mexicans: which socioeconomic determinants matter most?HEALTH ECONOMICS, Issue 10 2008Jürgen Maurer Abstract Many low- and middle-income countries are currently undergoing a dramatic epidemiological transition, with an increasing disease burden due to degenerative noncommunicable diseases. Inexpensive medication treatment often represents a cost-effective means to prevent, control or cure many of these health conditions. Using micro-data from the 2001 Mexican Health and Aging Study, we assess horizontal inequity in medication treatment among older Mexicans before the introduction of Popular Health Insurance in Mexico. In doing so, we investigate the role of various dimensions of socioeconomic status for obtaining indicated medication treatment within a comparatively fragmented health-care system that features relatively high out-of-pocket expenditures. Our empirical analysis suggests health insurance coverage as a key socioeconomic determinant of indicated medication use with large and statistically significant positive effects on take-up. The effects of insurance status thereby clearly dominate any other possible effects of socioeconomic status on medication treatment. Our results thus highlight the importance of access to reliable health care and comprehensive coverage for rational medication use in the management of degenerative diseases. In light of this evidence, we expect that recent Mexican health-care reforms, which expand health insurance coverage to the previously uninsured population, will alleviate socioeconomic gradients in medication treatment among older people in need. Copyright © 2007 John Wiley & Sons, Ltd. [source] The Impact of CHIP on Children's Insurance Coverage: An Analysis Using the National Survey of America's FamiliesHEALTH SERVICES RESEARCH, Issue 6 2009Lisa Dubay Objective. To assess the impact of the Children's Health Insurance Program (CHIP) on the distribution of health insurance coverage for low-income children. Data Source. The primary data for the study were from the 1997, 1999, and 2002 National Survey of America's Families (NSAF), which includes a total sample of 62,497 children across all 3 years, supplemented with data from other data sources. Study Design. The study uses quasi-experimental designs and tests the sensitivity of the results to using instrumental variable and difference-in-difference approaches. A detailed Medicaid and CHIP eligibility model was developed for this study. Balanced repeated replicate weights were used to account for the complex sample of the NSAF. Descriptive and multivariate analyses were conducted. Principle Findings. The results varied depending on the approach utilized but indicated that the CHIP program led to significant increases in public coverage (14,20 percentage points); and declines in employer-sponsored coverage (6,7 percentage points) and in uninsurance (7,12 percentage points). The estimated share of CHIP enrollment attributable to crowd-out ranged from 33 to 44 percent. Smaller crowd-out effects were found for Medicaid-eligible children. Conclusions. Implementation of the CHIP program resulted in large increases in public coverage with estimates of crowd-out consistent with initial projections made by the Congressional Budget Office. This paper demonstrates that public health insurance expansions can lead to substantial reductions in uninsurance without causing a large-scale erosion of employer coverage. [source] The American Community Survey and Health Insurance Coverage Estimates: Possibilities and Challenges for Health Policy ResearchersHEALTH SERVICES RESEARCH, Issue 2p1 2009Michael Davern Objective. To introduce the American Community Survey (ACS) and its measure of health insurance coverage to researchers and policy makers. Data Sources/Study Setting. We compare the survey designs for the ACS and Current Population Survey (CPS) that measure insurance coverage. Study Design. We describe the ACS and how it will be useful to health policy researchers. Principal Findings. Relative to the CPS, the ACS will provide more precise state and substate estimates of health insurance coverage at a point-in-time. Yet the ACS lacks the historical data and detailed state-specific coverage categories seen in the CPS. Conclusions. The ACS will be a critical new resource for researchers. To use the new data to the best advantage, careful research will be needed to understand its strengths and weaknesses. [source] Assessing the Value of the NHIS for Studying Changes in State Coverage Policies: The Case of New YorkHEALTH SERVICES RESEARCH, Issue 6p2 2007Sharon K. Long Research Objective. (1) To assess the effects of New York's Health Care Reform Act of 2000 on the insurance coverage of eligible adults and (2) to explore the feasibility of using the National Health Interview Survey (NHIS) as opposed to the Current Population Survey (CPS) to conduct evaluations of state health reform initiatives. Study Design. We take advantage of the natural experiment that occurred in New York to compare health insurance coverage for adults before and after the state implemented its coverage initiative using a difference-in-differences framework. We estimate the effects of New York's initiative on insurance coverage using the NHIS, comparing the results to estimates based on the CPS, the most widely used data source for studies of state coverage policy changes. Although the sample sizes are smaller in the NHIS, the NHIS addresses a key limitation of the CPS for such evaluations by providing a better measure of health insurance status. Given the complexity of the timing of the expansion efforts in New York (which encompassed the September 11, 2001 terrorist attacks), we allow for difference in the effects of the state's policy changes over time. In particular, we allow for differences between the period of Disaster Relief Medicaid (DRM), which was a temporary program implemented immediately after September 11th, and the original components of the state's reform efforts,Family Health Plus (FHP), an expansion of direct Medicaid coverage, and Healthy New York (HNY), an effort to make private coverage more affordable. Data Sources. 2000,2004 CPS; 1999,2004 NHIS. Principal Findings. We find evidence of a significant reduction in uninsurance for parents in New York, particularly in the period following DRM. For childless adults, for whom the coverage expansion was more circumscribed, the program effects are less promising, as we find no evidence of a significant decline in uninsurance. Conclusions. The success of New York at reducing uninsurance for parents through expansions of both public and private coverage offers hope for new strategies to expand coverage. The NHIS is a strong data source for evaluations of many state health reform initiatives, providing a better measure of insurance status and supporting a more comprehensive study of state innovations than is possible with the CPS. [source] Welfare Reform and Health Insurance of ImmigrantsHEALTH SERVICES RESEARCH, Issue 3 2005Neeraj Kaushal Objective. To investigate the effect of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) on the health insurance coverage of foreign- and U.S.-born families headed by low-educated women. Data Source. Secondary data from the March series of the Current Population Surveys for 1994,2001. Study Design. Multivariate regression methods and a pre- and post-test with comparison group research design (difference-in-differences) are used to estimate the effect of welfare reform on the health insurance coverage of low-educated, foreign- and U.S.-born unmarried women and their children. Heterogenous responses by states to create substitute Temporary Aid to Needy Families or Medicaid programs for newly arrived immigrants are used to investigate whether the estimated effect of PRWORA on newly arrived immigrants is related to the actual provisions of the law, or the result of fears engendered by the law. Principal Findings. PRWORA increased the proportion of uninsured among low-educated, foreign-born, unmarried women by 9.9,10.7 percentage points. In contrast, the effect of PRWORA on the health insurance coverage of similar U.S.-born women is negligible. PRWORA also increased the proportion of uninsured among foreign-born children living with low-educated, single mothers by 13.5 percentage points. Again, the policy had little effect on the health insurance coverage of the children of U.S.-born, low-educated single mothers. There is some evidence that the fear and uncertainty engendered by the law had an effect on immigrant health insurance coverage. Conclusions. This research demonstrates that PRWORA adversely affected the health insurance of low-educated, unmarried, immigrant women and their children. In the case of unmarried women, it may be partly because the jobs that they obtained in response to PRWORA were less likely to provide health insurance. The research also suggests that PRWORA may have engendered fear among immigrants and dampened their enrollment in safety net programs. [source] Older Married Workers and Nonstandard Jobs: The Effects of Health and Health InsuranceINDUSTRIAL RELATIONS, Issue 3 2009JEFFREY B. WENGER We examine the effects of health and health insurance coverage on older married workers' decisions to work in temporary, contract, part-time, self-employment, and regular full-time jobs. We model the behavior of older married workers as interdependent, showing that one spouse's health and insurance status affects the employment of the other. In general, we find that men and women are less likely to be employed in regular full-time jobs when they are in fair or poor health and are more likely to be in regular full-time employment when their spouses are in poor health. [source] Health, Healthcare Utilization, and Satisfaction with Service: Barriers and Facilitators for Older Korean AmericansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2005Yuri Jang PhD The present study assessed predictive models of subjective perception of health, healthcare utilization (hospital visits), and satisfaction with healthcare service using a sample of 230 older Korean Americans. Predisposing characteristics (age, sex, and education), health needs (chronic conditions, functional disability, and number of sick days), and a variety of enabling factors (health insurance, English speaking ability, transportation, living arrangement, trust in Western medicine, and reported experience of disrespect in medical settings) were considered. After controlling for predisposing and need factors, health insurance coverage was found to be a significant enabling factor for hospital visits. Subjective perception of health was found to be significant not only for healthcare utilization, but also for satisfaction with service. A greater likelihood of satisfaction was also observed in individuals with health insurance, better English-speaking ability, and greater trust in Western medical care. The reported experience of disrespect or discrimination in medical settings significantly reduced the odds of satisfaction with service. [source] Who Are the Uninsured Elderly in the United States?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2004James W. Mold MD Because of the Medicare program, a common assumption is made that virtually all older Americans have health insurance coverage. Data from the 2000 National Health Interview Survey were analyzed to estimate the number of people aged 65 and older without health insurance; their stated reasons for being uninsured; and the associations between lack of insurance and sociodemographic variables, health status, and access to and use of healthcare services. In 2000, there were approximately 350,000 older Americans with no health insurance. Those without insurance were more likely to be younger, Hispanic, nonwhite, unmarried (widowed, divorced, or never married), poor, and foreign-born. They were less likely to hold U.S. citizenship. Despite relatively high rates of chronic medical conditions, they were unlikely to receive outpatient or home healthcare services. The most common reason given for lack of insurance was its cost. This study reveals important gaps in the availability of health insurance for the elderly, gaps that are likely to affect an increasing number of older Americans in the coming decade. [source] An Exploratory Investigation of Heterosexual Licensed Domestic PartnersJOURNAL OF MARRIAGE AND FAMILY, Issue 4 2003Marion C. Willetts In-depth telephone interviews were conducted in four cities in an exploratory study of 23 licensed cohabitors to determine why they have chosen to legitimize their intimate unions through domestic partnership ordinances, rather than through legal marriage. The cohabitors in this sample are pursuing these licensed partnerships to obtain an economic benefit (e.g., health insurance coverage for a partner); as a substitute for legal remarriage; to legitimize their unions in a way other than through legal marriage; or as an ideological alternative to legal marriage. Regardless of motivations to pursue domestic partnership certificates, these respondents are divided over whether they should have the same rights and responsibilities as the married. [source] The devil may be in the details: How the characteristics of SCHIP programs affect take-upJOURNAL OF POLICY ANALYSIS AND MANAGEMENT, Issue 3 2005Barbara Wolfe In this paper, we explore whether the specific design of a state's program has contributed to its success in meeting two objectives of the Children's Health Insurance Program (SCHIP): increasing the health insurance coverage of children in lowerincome families and doing so with a minimum reduction in their private health insurance coverage (crowd-out). In our analysis, we use two years of Current Population Survey data, 2000 and 2001, matched with detailed data on state programs. We focus on two populations: the eligible population of children, broadly defined,those living in families with incomes below 300 percent of the federal poverty line (FPL),and a narrower group of children, those who we estimate are eligible for Medicaid or SCHIP. Unique state program characteristics in the analysis include whether the state plan covers families; whether the state uses presumptive eligibility; the number of months without private coverage that are required for eligibility; whether there is an asset test; whether a face-to-face interview is required; and specific outreach activities. Our results provide evidence that state program characteristics are significant determinants of program success. © 2005 by the Association for Public Policy Analysis and Management [source] Declining health insurance access among US hispanic workers: Not all jobs are created equalAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2010Kathryn E. McCollister PhD Abstract Introduction Approximately 18% of the U.S. population are uninsured, a proportion that may continue to rise, particularly among Hispanics, as the cost of medical care increases faster than the growth in wages. Methods Health insurance trends were analyzed by race,ethnic category, and among Hispanic workers by occupation type and industrial sector, using data on employed respondents ,18 years from 1997 to 2007 National Health Interview Survey (NHIS) (mean annual n,=,17,392, representing 123 million US workers on average over this 11 year period). Results From 1997 to 2007, the relative decline in health insurance coverage for US workers was greatest among Hispanics (7.0%). Hispanic workers in the Construction and Services industries had the greatest overall decline in coverage (24.9% and 14.7%), as well as Hispanic blue collar workers (14.0%). Conclusion Hispanic workers in general, and those employed in blue collar, construction, and services sectors in particular, are at greater risk for poor access to health care due to a lack of health insurance coverage. Am. J. Ind. Med. 53:163,170 2010. © 2009 Wiley-Liss, Inc. [source] Will Subsidising Private Health Insurance Help the Public Health System?THE ECONOMIC RECORD, Issue 242 2002Rhema Vaithianathan This paper challenges the argument that expanding private health insurance coverage in Australia will reduce the demand for public hospitals. We construct a simple model to illustrate that although a premium subsidy might expand insurance coverage, it may not reduce the demand for public health services. The reason is that, under certain conditions, government subsidies only increase insurance coverage among self,insured consumers; that is, consumers who are uninsured but purchase private health care if they fall ill. We argue that subsidising private health care rather than insurance is a more effective way of reducing the demand for public health services. [source] Do Children in Rural Areas Still Have Different Access to Health Care?THE JOURNAL OF RURAL HEALTH, Issue 1 2009Results from a Statewide Survey of Oregon's Food Stamp Population ABSTRACT:,Purpose: To determine if rural residence is independently associated with different access to health care services for children eligible for public health insurance. Methods: We conducted a mail-return survey of 10,175 families randomly selected from Oregon's food stamp population (46% rural and 54% urban). With a response rate of 31%, we used a raking ratio estimation process to weight results back to the overall food stamp population. We examined associations between rural residence and access to health care (adjusting for child's age, child's race/ethnicity, household income, parental employment, and parental and child's insurance type). A second logistic regression model controlled for child's special health care needs. Findings: Compared with urban children (reference = 1.00), rural children were more likely to have unmet medical care needs (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.07-2.04), problems getting dental care (OR 1.36, 95% CI 1.03-1.79), and at least one emergency department visit in the past year (OR 1.42, 95% CI 1.10-1.81). After adjusting for special health care needs (more prevalent among rural children), there was no rural-urban difference in unmet medical needs, but physician visits were more likely among rural children. There were no statistically significant differences in unmet prescription needs, delayed urgent care, or having a usual source of care. Conclusions: These findings suggest that access disparities between rural and urban low-income children persist, even after adjusting for health insurance. Coupled with continued expansions in children's health insurance coverage, targeted policy interventions are needed to ensure the availability of health care services for children in rural areas, especially those with special needs. [source] Update: Health Insurance and Utilization of Care Among Rural AdolescentsTHE JOURNAL OF RURAL HEALTH, Issue 4 2005Janice C. Probst PhD ABSTRACT: Context: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. Purpose: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. Methods: Cross-sectional design using data from the 1999,2000 National Health Interview Survey, a nationally representative sample of US households. Analysis was restricted to white, black, and Hispanic children aged 12 through 17 (8,503 observations). Outcome measures included health insurance, ambulatory visit within past year, usual source of care (USOC), and well visit within past year. Independent variables included race, residence, demographics, facilitating/enabling characteristics, and need. Results: Across races, rural adolescents were as likely to have insurance (86.8% vs 87.7%) but less likely to report a preventive visit (60.1% vs 65.5%) than urban children; residence did not affect the likelihood of a visit or a USOC. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a USOC. Most race-based differences were not significant in multivariate analysis holding constant living situation, caretaker education, income, and insurance. Low caretaker English fluency, limited almost exclusively to Hispanics, was an impediment to all outcomes. Conclusions: Most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents. [source] US Health Care Reform and Transplantation, Part II: Impact on the Public Sector and Novel Health Care Delivery SystemsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010D. A. Axelrod The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new ,models' of health care delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes. [source] Employers' Benefits from Workers' Health InsuranceTHE MILBANK QUARTERLY, Issue 1 2003Ellen O'Brien Most nonelderly americans receive their health insurance coverage through their workplace. Almost all large firms offer a health insurance plan, and even though they face greater barriers to providing coverage, so do the majority of very small firms. These employment-based plans cover two-thirds of nonelderly Americans and pay most of working families' expenses for health care and about one-quarter of national health spending. Despite employers' role in the health insurance market, however, very little attention has been paid to employers' motivations for providing health insurance to workers. Why do employers offer health insurance to workers? Is it because workers want it? Because their unions demand it? Or do employers offer health benefits to workers because their productivity and profitability depend on it? The standard economic theory of the availability of employer-provided health insurance focuses on worker demand (Cutler 1997; Pauly 1997; Summers 1989). Even though many employers believe that health insurance and health affect employees' productivity and firms' performance, health economists typically overlook and rarely measure firms' returns on health-related investments. Some research, however, suggests that firms may benefit economically by providing health insurance coverage for workers and their families. For example, health coverage may help employers recruit and retain high-quality workers. Health may contribute to productivity by reducing the costs of absenteeism and turnover and by increasing workers' productivity. This article reviews the evidence and proposes an agenda for future research. A better understanding of the benefits to employers of offering health coverage to workers may help clarify employers' behavior and help private employers and public officials make appropriate investments in health. [source] A black-white comparison of the quality of stage-specific colon cancer treatmentCANCER, Issue 3 2010Jamillah Berry MSW Abstract BACKGROUND: Several studies have attributed racial disparities in cancer incidence and mortality to variances in socioeconomic status and health insurance coverage. However, an Institute of Medicine report found that blacks received lower quality care than whites after controlling for health insurance, income, and disease severity. METHODS: To examine the effects of race on colorectal cancer outcomes within a single setting, the authors performed a retrospective cohort study that analyzed the cancer registry, billing, and medical records of 365 university hospital patients (175 blacks and 190 whites) diagnosed with stage II-IV colon cancer between 2000 and 2005. Racial differences in the quality (effectiveness and timeliness) of stage-specific colon cancer treatment (colectomy and chemotherapy) were examined after adjusting for socioeconomic status, health insurance coverage, sex, age, and marital status. RESULTS: Blacks and whites had similar sociodemographic characteristics, tumor stage and site, quality of care, and health outcomes. Age and diagnostic stage were predictors of quality of care and mortality. Although few patients (5.8%) were uninsured, they were more likely to present at advanced stages (61.9% at stage IV) and die (76.2%) than privately insured and publicly insured patients (p = .002). CONCLUSIONS: In a population without racial differences in socioeconomic status or insurance coverage, patients receive the same quality of care, regardless of racial distinction, and have similar health outcomes. Age, diagnostic stage, and health insurance coverage remained independently associated with mortality. Future studies of disparities in colon cancer treatment should examine sociocultural barriers to accessing appropriate care in various healthcare settings. Cancer 2010. © 2009 American Cancer Society. [source] Emergency Department Utilization in the United States and Ontario, CanadaACADEMIC EMERGENCY MEDICINE, Issue 6 2007DrPH, Guohua Li MD Objectives:The current crisis in the emergency care system is characterized by worsening emergency department (ED) overcrowding. Lack of health insurance is widely perceived to be a major contributing factor to ED overcrowding in the United States. This study aimed to compare ED visit rates in the United States and Ontario, Canada, according to demographic and clinical characteristics. Methods:This was a cross sectional study consisting of a nationally representative sample of 40,253 ED visits included in the 2003 National Hospital Ambulatory Medical Care Survey in the United States, and all ED visits recorded during 2003 by the National Ambulatory Care Reporting System in Ontario, Canada. The main outcome was the number of ED visits per 100 population per year. Results:The annual ED visit rate in the United States was 39.9 visits (95% confidence interval = 37.2 to 42.6) per 100 population, virtually identical to the rate in Ontario, Canada (39.7 visits per 100 population). In both the United States and Ontario, Canada, those aged 75 years and older had the highest ED visit rate and women had a slightly higher ED visit rate than men. The most common discharge diagnosis was injury/poisoning, accounting for 25.6% of all ED visits in the United States and 24.7% in Ontario, Canada. Overall, 13.9% of ED patients in the United States were admitted to hospitals, compared with 10.5% in Ontario, Canada. Conclusions:ED visit rates and patterns are similar in the United States and Ontario, Canada. Differences in health insurance coverage may not have a substantial impact on the overall utilization of emergency care. [source] | |||||||||||||