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At least 307 records · Page 17Linked to original sources
PubMed1995

Hybridizing the health care plans of Hawaii, Oregon, and Singapore.

Universal coverage requires costcontainment. Working models of health care coverage from Hawaii, Oregon, and Singapore address different aspects of cost-containment. Hybridizing the three produces the following system: A percentage of an individual's salary is mandatorily set aside in an individual medical account. Using these savings, the individual purchases catastrophic medical insurance with a managed care organization. Residual funds are used as a deductible or co-payment and to purchase additional medical services as desired. Enough funds should accumulate during an individual's working life to enable continued coverage after retirement. The basic health care package needs to be limited and is defined by a systematic and rational process based on cost-benefit analysis and democratic consensus regarding priorities and coverage. Medicaid recipients get the same basic package from managed care organizations as that available to the rest of the population; low wage earners receive sliding-scale subsidies from the government. Co-payments and deductibles remain in place except for beneficial preventive services.

Bioethics↗
PubMed2004

Predictors of satisfaction of health plan members with prescription drug benefits.

PURPOSE: Relationships between sociodemographic and health plan characteristics and health plan member satisfaction with prescription drug benefits were studied. METHODS: A survey was mailed in November 2002 to a stratified random sample of 14,141 people covered by a pharmacy benefit management company (PBM) who had made at least one prescription drug claim during the second quarter of 2002. Survey recipients had commercial health insurance and were 19-64 years of age. Participants were stratified by drug benefit plan design (two-tier copayment system, three-tier copayment system, coinsurance, or closed formulary). The survey contained 39 questions covering satisfaction with the prescription drug benefit, health-related attitudes and knowledge, and experience with the benefit. Predictors of satisfaction were examined by using logistic regression with probability weights. RESULTS: A total of 3819 surveys were returned (response rate, 27%). Respondents were more likely to be mail-order pharmacy users and less likely to be enrolled in a plan with a closed formulary. Out-of-pocket costs were viewed as the most important feature of the pharmacy benefit. In the logistic regression, higher copayments, coinsurance, closed formularies, intensive managed care, large health care premiums, a recent increase in copayments, and a recent denial of coverage were associated with lower satisfaction with the prescription drug benefit. Excellent health and use of mail-order pharmacy were associated with greater satisfaction. CONCLUSION: The extent to which health plan members served by a PBM had to share drug costs was the strongest determinant of satisfaction with the prescription drug benefit.

Adult↗
PubMed1980

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

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

Cost Control↗
PubMed1983

Stability in the Federal Employees Health Benefits Program.

Recently the Federal Employees Health Benefits Program has been the subject of much discussion in Washington as a result of the rather large premium increases in 1982 and 1983, the delayed open season of 1981, and the benefit reductions. Enrollees responded in May 1982 to the changes; a record number switched plans. It appears that enrollees were simply responding to the new premiums and benefits. In this paper we describe the economic incentives faced by enrollees in the FEHBP. We find that, due to the strong incentives for enrollees to leave certain high-cost plans, continued instability should be expected. In fact, the disparity between expected benefits and premium is so great for some plans (e.g. the Blue Cross high-option) that their survival is questionable. This lack of stability raises important questions about the viability of some pro-competition proposals involving multiple-insurer systems.

Actuarial Analysis↗
PubMed1991

Trends in hospital deductions from revenue. Increases in uncompensated care and payment adjustments.

The 1980s produced tighter restrictions on Medicaid eligibility, greater reluctance among insurers to cover small groups, and increased price competition, resulting in a larger percentage of unreimbursed charges. Here the authors use financial data from a cross-section of California hospitals to explore the extent and variation of such deductions from revenue.

Accounts Payable and Receivable↗
PubMed1998

Medicare program; inpatient hospital deductible and hospital and extended care services coinsurance amounts for 1999--HCFA. Notice.

This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year 1999 under Medicare's hospital insurance program (Medicare Part A). The Medicare statute specifies the formulae used to determine these amounts. The inpatient hospital deductible will be $768. The daily coinsurance amounts will be: (a) $192 for the 61st through 90th day of hospitalization in a benefit period; (b) $384 for lifetime reserve days; and (c) $96 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Raising awareness of consumers' options in the individual health insurance market.

Lack of consumer awareness of where to get health insurance, what it costs, and what options exist is a critical barrier that prevents many people from obtaining coverage in the individual market (coverage that can include family members). However, a recent study suggests that that three-fourths of the uninsured could find a policy for less than 2,000 dollars per year and that one-third could find a policy for less than 1,000 dollars per year. More widespread dissemination of accurate and transparent information on prices, options, and benefits could play a role in expanding insurance coverage.

Adolescent↗
PubMed1995

Medical savings accounts make waves.

MSAs: the theory. Medical savings account legislation would allow consumers to set aside pre-tax dollars to pay for day-to-day healthcare costs. The accounts are to be backed up by a catastropic policy with a deductible roughly equal to the maximum amount allowed in the MSA. The aim is to reduce healthcare cost inflation by making consumers more aware of the costs of healthcare than they are under comprehensive policies and enabling them to shop for the lowest-cost, highest-quality care.

American Medical Association↗