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PubMed1981

Health insurance and health policy in the Federal Republic of Germany.

This paper presents a structured survey of the West German health care and health insurance system. The West German health insurance system is very comprehensive and generous. The scheme provides full coverage for all medically necessary services, including ambulatory and inpatient care, prescription drugs, dental care, medical appliances and even prolonged rehabilitation in the so called Kurorten (localities with health spas). Typically, patients do not bear any copayment at the point of service, or only very modest ones. Physicians are paid on a fee-for-service basis (according to negotiated fee schedules), hospitals are reimbursed on the basis of prospectively negotiated per diems, and the suppliers of drugs and appliances are reimbursed at what is referred to as "market prices" (that is, at prices set by suppliers with only mild indirect control from the public sector or third-party payors). This extraordinarily liberal insurance system causes West Germany to devote no greater a proportion of their Gross National Product (GNP) to health care than does the United States. Using the American definition of "national health care expenditures," both nations currently devote about 9.4 percent of their GNP to health care.

Germany, West↗
PubMedDate not supplied

[Managed care--a possibility for German Health Insurance?].

Health services systems in nearly all developed countries face similar problems. This fact raises the question whether concepts used in different countries can be changed without affecting the historically grown foundations of national health services as have been accepted by majority. A group of experts of the German Medical Services of the Statutory Health Insurance were asked to analyse whether the managed care approach could play a substantial role in reforming the German "Bismarck model", given that the advisory responsibility of the social medical service for the sick funds is respected in such a consideration and that basic essentials of the system are maintained. The group concludes, in brief, that managed care and the "German model" are contradictory in respect of preconditions, aims and assumed results. Furthermore, the experts share the view that the "German model" incorporates sufficient to cope with its problems without changing the nature of health services, based on principles of solidarity in Germany. The system needs structural reforms rather than changes in monetary mechanisms.

Forecasting↗
PubMed1981

Proposal for national health insurance and health policy: social survey results.

Numerous proposals for national health insurance (NHI) are before the Congress. This study measures public preferences for three widely debated forms of NHI bases on national survey data from 1978. Analyses of the comprehensive, catastrophic and deductible forms of NHI are conducted separately using the multivariate probit technique. Findings suggest that, in general, public preference is greatest for the comprehensive plan and lowest for the catastrophic plan. Supporters of the comprehensive plan tend to be young, Democrats, members of lower socioeconomic groups, nonwhite, residents of the West, Northeast or urban areas, and without extended health insurance coverage. Support of NHI options is associated with political party preference as well as sociodemographic characteristics.

Deductibles and Coinsurance↗
PubMedDate not supplied

Nonprofit to for-profit conversions by hospitals, health insurers, and health plans.

Conversion of hospitals, health insurers, and health plans from nonprofit to for-profit ownership has become a focus of national debate. The author examines why nonprofit ownership has been dominant in the US health system and assesses the strength of the argument that nonprofits provide community benefits that would be threatened by for-profit conversion. The author concludes that many of the specific community benefits offered by nonprofits, such as care for the poor, could be maintained or replaced by adequate funding of public programs and that quality and fairness in treatment can be better assured through clear standards of care and adequate monitoring systems. As health care becomes increasingly commercialized, the most difficult parts of nonprofits' historic mission to preserve are the community orientation, leadership role, and innovation that nonprofit hospitals and health plans have provided out of their commitment to a community beyond those to whom they sell services.

Community-Institutional Relations↗
PubMed2001

Health insurance and health services utilization in Ireland.

The numbers buying private health insurance in Ireland have continued to grow, despite a broadening in entitlement to public care. About 40% of the population now have insurance, although everyone has entitlement to public hospital care. In this paper, we examine in detail the growth in insurance coverage and the factors underlying the demand for insurance. Attitudinal responses reveal the importance of perceptions about waiting times for public care, as well as some concerns about the quality of that care. Individual characteristics, such as education, age, gender, marital status, family composition and income all influence the probability of purchasing private insurance. We also examine the relationship between insurance and utilization of hospital in-patient services. The positive effect of private insurance appears less than that of entitlement to full free health care from the state, although the latter is means-tested, and may partly represent health status.

Attitude to Health↗
PubMed2001

State child health; implementing regulations for the State Children's Health Insurance Program. Health Care Financing Administration (HCFA), HHS. Final rule.

Section 4901 of the Balanced Budget Act of 1997 (BBA) amended the Social Security Act (the Act) by adding a new title XXI, the State Children's Health Insurance Program (SCHIP). Title XXI provides funds to States to enable them to initiate and expand the provision of child health assistance to uninsured, low-income children in an effective and efficient manner. To be eligible for funds under this program, States must submit a State plan, which must be approved by the Secretary. This final rule implements provisions related to SCHIP including State plan requirements and plan administration, coverage and benefits, eligibility and enrollment, enrollee financial responsibility, strategic planning, substitution of coverage, program integrity, certain allowable waivers, and applicant and enrollee protections. This final rule also implements the provisions of sections 4911 and 4912 of the BBA, which amended title XIX of the Act to expand State options for coverage of children under the Medicaid program. In addition, this final rule makes technical corrections to subparts B, and F of part 457.

Child↗
PubMed1999

[Medical confidentiality towards employers,health insurance medical services and health insurance companies from the point of view of a medical society].

In the Federal Republic of Germany, the medical discretion is protected by criminal law section 203, by section 9 of the medical professional law, and by the state law regarding data protection. Patient's secret may only be revealed if the patient agrees, if a law demands or allows the revelation, or if a legal good of higher value facilitates the revelation. The employer may be informed about the fact of sickness of an employed and about the results of an occupational medical screening but not about diagnosis and therapy. Under specific circumstances, the health insurance companies have the right to demand revelation from the physician if this is legally permitted or if the patient agrees. Certified hospitals have to reveal certain data to the insurance companies. Medical services of health insurances have the right to demand certain data from the physician if a health insurance company has ordered an expert witness opinion or examination and if the revelation is necessary for this examination. If it is suspected that there is a mismanagement about the numbers of beds occupied by patients in a hospital, the medical service of a health insurance may examine all patient's records related to the health insurance of interest. There exists no legal rights or duties to reveal information to private health insurance companies. The revelation of patient's data to such companies is most commonly not allowed.

Confidentiality↗
PubMed1997

Providers as health insurers?

Health care providers, insurers and state regulators are preparing themselves for the next major battle in the managed care revolution. The fight will center on whether provider-sponsored networks and health maintenance organizations should meet the same regulatory requirements. Hundreds of billions of dollars are at stake, particularly lucrative Medicare contracts.

Health Maintenance Organizations↗
PubMed2002

[Dental care for young people insured by health insurance fund 1. Prevalence and treatment of dental caries between 1987 and 1999].

In 1987, 1993 and 1999 an epidemiological study was performed on oral health in youngsters, aged 5, 11, 17 or 23 years, in whom oral health care was covered by a health insurance fund. The prevalence of caries in the deciduous teeth of the 5-year-olds (examined without radiographs) did not change significantly between 1987 and 1999. Only a small proportion of dmfs was filled. Caries prevalence in permanent teeth of the 11-, 17- and 23-year olds decreased significantly. The number of filled surfaces decreased also. Between 1993 and 1999 the number of clinically found DS increased. However, this rise in dentinal caries lesions was not confirmed by similar findings in a simultaneous performed study with bitewing radiographs.

Adolescent↗
PubMed2002

An analysis of private health insurance purchasing decisions with national health insurance in Taiwan.

The Taiwanese health insurance industry is just over 30 years old. Originally private and domestic, the industry underwent substantial institutional changes when it opened to foreign competition between 1987 and 1994 and when the Taiwanese government established national health insurance (NHI) coverage in 1995. Congruent with these changes, rapid growth occurred in the Taiwanese demand for private health insurance. In order to better understand the recent performance of the Taiwanese health insurance industry, the structure of the NHI system is described and then household decisions to purchase private health insurance are analyzed using a two-part (hurdle) model on 1998 Survey of Family Income and Expenditure data. Logistic and OLS regressions are used to examine the factors influencing the probability and amount of private health insurance purchased. Generally, factors affecting the probability of having insurance also influence the amount of insurance coverage purchased. Higher income and education levels are associated with increased probabilities and larger quantities of private insurance purchases. Married females, the employed, and household heads working in state-run enterprises are more likely to purchase private insurance than their counterparts. The probability of private insurance purchases varies by region, with northern Taiwanese households having higher odds of owning private insurance than non-northern households. Compared to those in rural villages, households in cities and towns are more likely to have private insurance. The likelihood of private insurance purchase also tends to rise with advancing age and larger family sizes. In addition, one important implication in the private health insurance market is highlighted. There is no complementarity between the public and private systems.

Adult↗
PubMed1998

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

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

Career Mobility↗
PubMed1993

Health insurance and subjective health status: data from the 1987 National Medical Expenditure survey.

OBJECTIVES: The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. METHODS: Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance and self-reported health status. The analysis controlled for sociodemographic and attitudinal variables and medical conditions. RESULTS: Persons without health insurance had significantly lower levels of subjective health status than did persons with insurance. This adverse effect persisted after adjustments were made for the effects of age, sex, race, income, attitude toward the value of medical care and health insurance, and medical conditions. The detrimental effect of lacking health insurance on subjective health status was present for persons at all income levels and was greater than the effect on subjective health status found for 2 of the 11 reported medical conditions. CONCLUSIONS: Lacking health insurance is associated with clinically significant lower levels of subjective health status in both poor and non-poor persons.

Adult↗
PubMed1998

Changes in benefit payments and health insurance premiums among firms switching health insurance carriers.

Employer-purchased group health insurance is a major source of funding in the US healthcare system, accounting for approximately one third of each healthcare dollar spent. Surprisingly, little is known about employers' behavior in purchasing health insurance or the circumstances leading employers to switch health insurance carriers. We descriptively analyzed data for a cohort of 95 insured groups between 1985 and 1991 to determine the frequency with which employers switch health insurance carriers and the growth pattern in premiums and benefit payments before the switch was made. Thirty-seven percent of groups switched carriers during the study period, with at least five groups switching each year from 1987 through 1991. The groups that switched insurance carriers experienced higher average annual rates of growth in benefit payments than those that did not switch (18% versus 11%). Groups that switched did not have significantly higher observed premium growth rates than those that did not switch, suggesting that employers decided to switch insurers before absorbing an increase in premiums. However, some firms that switched experienced below average increases in both benefit payments and premiums, indicating that premiums and anticipated premium increases are not solely responsible for the decision to switch health insurance carriers.

Cohort Studies↗