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Biomedical subjects

G A Jensen

Publications and source records attributed to G A Jensen.

At least 19 recordsLinked to original sources
PubMed2000

Medicaid and crowding out of private insurance: a re-examination using firm level data.

While previous research has identified a relationship between expanded Medicaid eligibility and falling private health insurance coverage, the exact mechanism by which this "crowding out" occurs is largely unexplained. We combine individual and firm-level data to investigate possible responses to the Medicaid expansions by firms and workers. We find no evidence that the expansions affected employer offers of insurance to workers. However, we find some evidence of an effect on the probability that a firm offers family coverage, and on the percentage of full-time workers accepting employer-sponsored coverage offered to them.

Child↗
PubMed2000

Medical malpractice among physicians: who will be sued and who will pay?

This paper examines whether a physician's future claims of medical malpractice are predictable from information on the physician's recent claims history, training credentials, practice characteristics, and demographics. Data on the medical malpractice experience of 8,733 Michigan physicians between 1980 and 1989 is analyzed. We find strong evidence of repetition over time regarding who was sued and who paid claims. The worse a physician's malpractice litigation record during 1980-1984, the worse was his record during 1985-1989. Training credentials were also highly predictive of future malpractice experience. Physicians trained at lower ranked medical schools or who went through lower-ranked residency programs faced higher odds of developing adverse malpractice records, even after controlling for their previous litigation record. Growing internet access to information on these characteristics will help inform prospective patients if they wish to avoid physicians likely to be sued and likely to make payments in the future for malpractice.

Adult↗
PubMed1999

Health Insurance Portability and Accountability Act of 1996: lessons from the States.

OBJECTIVES: To assess the likely effects of the 1996 Health Insurance Portability and Accessibility Act (HIPAA), based on small firms' experiences under state small group insurance reforms that were similar in design to HIPAA. METHODS: Data on 17,818 small businesses (range, 2-50 employees) nationwide from the 1994 National Employer Health Insurance Survey were analyzed to examine the effects of state small group reforms on the following: (1) employers' provision of coverage; (2) the percentage of workers in insured firms who were covered by plans; and (3) insurer practices of "enrollee exclusion." Logistic regression models were estimated and used to quantify the marginal effects of state small-group reform. Reform effects were examined for all small firms, for small firms by size category, and for small firms in redlined industries. RESULTS: Under full reform for at least 3 years (full reform includes guaranteed issue and renewal, portability, limits on pre-existing condition waits, and rating restrictions), employers were slightly more likely to sponsor health plans; however, employee participation in employer plans was no higher and the prevalence of enrollee-exclusion provisions was unchanged. Businesses in redlined industries clearly benefitted from all types of small group reform. For other subgroups of businesses, however, there were advantages and disadvantages associated with reforms, which varied with the scope of the measures and time since their implementation. CONCLUSION: Widespread small group reform may eventually help raise the proportion of small firms that sponsor health benefits, but not by much.

Commerce↗
PubMed1999

Employer-sponsored health insurance and mandated benefit laws.

Regulations for the content of private health plans, called mandated benefit laws, are widespread and growing in the United States, at both state and federal levels. Three aspects of these laws are examined: their current scope; some economic reasons for their existence; and the theory and empirical evidence for their effects in health insurance markets. A growing body of literature suggests that society is paying a high price for enhanced coverage via mandated benefits. These laws increase insurance premiums, cause declines in wages and other fringe benefits, and lead some employers and their workers to forgo health benefits altogether. The cost of mandated benefit laws falls disproportionately on workers in small firms.

Costs and Cost Analysis↗
PubMed1999

Small group reform and insurance provision by small firms, 1989-1995.

Since 1989, states have enacted legislation to dismantle barriers facing small businesses that wish to purchase health insurance. Using data on the insurance offerings of 2,472 small firms (one to 49 employees) observed from 1989 to 1995, we assess whether state reforms encouraged more small firms to sponsor health benefits. We find that small group reforms did not spur uninsured firms to offer insurance. Firms without health insurance say that the high price of coverage is still the major barrier they face to offering a plan. Our findings suggest that the small group reforms within the 1996 Health Insurance Portability and Accountability Act are not likely to have an effect on the small group market. Most states already had implemented measures similar to those found in the act, and not much changed.

Cross-Sectional Studies↗
PubMed1998

Employer-sponsored health insurance for chiropractic services.

The use of chiropractors has increased substantially in recent years, and there is growing scientific evidence on the effectiveness of chiropractic treatment for common low back ailments. Despite the increased acceptance of chiropractic care, little is known about the prevalence of chiropractic coverage in employer health plans and the nature of such benefits when they are provided. This article reports on the extent and composition of chiropractic insurance among workers with employer-sponsored health insurance in 1993. The prevalence of the benefits in employer plans was examined, as was the extent to which plans are in compliance with state mandated benefits in this area. The authors also examined what the actual benefits consist of and how they compare with those for physician office visits and physical therapy.

Chiropractic↗
PubMed1997

Switching to managed care in the small employer market.

In 1993, only 22% of small employers offered a managed care product; by 1995, nearly 70% did. This study uses nationally representative data on small firms in 1993 and 1995 to examine the factors underlying this dramatic shift. Two explanations emerge from the regression work. Adoption of managed care by large employers appears to have served as a signal, certifying the acceptance of managed care among workers. Second, lower prices for managed care products, relative to conventional insurance, increased the adoption of managed care, particularly in 1995. There is little evidence that state insurance reforms prompted the switch, although they may have helped set the stage for it.

Consumer Behavior↗
PubMed1997

Small group reform in a competitive managed care market: the case of California, 1993 to 1995.

State-level insurance reforms designed to make health insurance more accessible for small businesses and their employees have become common in the 1990s. This study examines the effects of small group reform legislation enacted in California in 1993. Using survey data on health benefits in small firms, we look at changes in health insurance coverage that occurred between spring 1993 (just before reform) and spring 1995. Our results indicate that insurance became slightly more affordable and, among businesses with three to nine employees, employer provision increased more than 10 percentage points. Provision was unchanged among larger-sized businesses, however. Managed care penetration increased considerably. We argue that California's competitive health insurance market, which already was dominated by managed care, represented a favorable environment for small group reform. In this context, the modest growth in insurance provision highlights the limited potential of incremental reforms for expanding insurance coverage.

California↗
PubMed1995

The heart of aging: special challenges of cardiac ischemic disease and failure in the elderly.

The elderly are the fastest-growing segment of society, and heart disease is the single-most common cause of death in this population. In this article, age-related structural and functional changes that occur in the heart are discussed, including changes in the heart muscle, valves, conduction system and major arteries. Coronary artery disease affects half of those older than 65, resulting in acute myocardial infarction, angina pectoris, dysrhythmias, congestive heart failure and sudden death. Each of these is discussed, including altered presentation in the elderly and implications for practice derived from national and international studies.

Age Factors↗
PubMed1994

Small employers and the health insurance market.

In 1993 half of all small businesses (fewer than fifty workers) sponsored a health plan for their employees, up from 41 percent in 1989. While not as deep, the benefits offered by small firms are nearly as broad as benefits offered by large firms, and they have expanded since 1989. Small businesses pay more for coverage, however. Although coverage restrictions based on health status and preexisting conditions are a significant concern of small firms, actual limits of this type in the small-group market are modest. Firms not offering insurance report that they have wide access to coverage, and many would sponsor a plan if only prices were lower.

Data Collection↗
PubMed1992

Employer-sponsored postretirement health benefits: not your mother's medigap plan.

Using nationally representative data, we report the prevalence of retiree health insurance as a fringe benefit in private and public settings, and take an in-depth look at its content. We examine how it coordinates with Medicare to characterize the "total insurance" of beneficiaries who hold these supplements. Retiree health coverage is now widespread and typical benefits are far more generous than those found in medigap policies, the other major type of Medicare supplement. When a typical retiree plan is overlaid on Medicare, the resulting total insurance benefits are more generous than those held by either the working nonelderly or beneficiaries with a medigap supplement.

Aged↗
PubMed1992

The dynamics of health insurance among the near elderly.

Data from the Longitudinal Survey of Income and Program Participation were used to examine the dynamics of health insurance among persons 55 to 64 years of age. Persons in this age range are especially vulnerable to incurring high health care costs. Between the summer of 1983 and early 1986, 21% of persons 55 to 64 years of age experienced some time without health insurance. Approximately one fifth were continuously uninsured (4%) while the rest spent only part of the time without coverage, typically 4 months or less. Women were particularly vulnerable to periods without insurance, accounting for approximately twice as many of them as did men. Unlike younger cohorts, the coverage lost among the near elderly tended not to be employer coverage. Instead, most uninsured spells were ones in which individually purchased coverage was lost. Most spell beginnings were unrelated to changes in household employment, yet most spells ended when employment within the household increased. Some currently proposed reforms to expand health insurance, such as an all-employer mandate, a "pay-or-play" mandate, and extending Medicaid to persons in poverty, are less effective in reaching this medically high-risk population than in reaching younger persons who are uninsured.

Employment↗
PubMed1992

Can a universal coverage system temper the underwriting cycle?

The health insurance industry has experienced a pronounced six-year cycle of earnings for nearly three decades--three years of profits followed by three years of losses. This profitability cycle triggers a turbulent pricing cycle. After reviewing three schools of thought about the causes of the cycle, in this article we examine new evidence to determine the probable impact on the cycle of a private-public, universal coverage, national health plan. We find no evidence of a cycle in the pricing and use of health care services. Since 1985, the relationship between the overall economy and health insurance trends has weakened. We conclude that the root causes of the cycle are essentially internal to the insurance industry, and, therefore, national health care reform will have little impact on the underwriting cycle.

Delivery of Health Care↗
PubMed1991

Employer-sponsored insurance coverage for alcohol and drug abuse treatment, 1988.

This paper uses 1988 Bureau of Labor Statistics data to analyze the content of insurance coverage for alcohol and drug abuse treatment offered by medium and large private sector firms. Ninety percent of workers had medical insurance. Of these, 81% had coverage for alcohol abuse treatment and 75.5% had coverage for drug abuse treatment. The coverages were almost always offered together, and the benefits were generally identical for both. Coverage for inpatient detoxification was most common, followed by outpatient care and inpatient rehabilitation. Self-insured plans, although exempt from state-mandated benefits, were as likely to include alcohol and drug abuse coverage as Blue Cross and Blue Shield and commercial plans, and their specific benefits were no less generous. Coverage limitations tended to be more restrictive for these illnesses than for others. The nature of the limitations varied greatly, although day and dollar limits were most common for inpatient treatment, and visit limits and higher copayments were most common for outpatient treatment.

Alcoholism↗