SEARCH · PubMed Health

Results for “Employment-based Services”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources

PubMed1983

"Procompetition" and the continuing struggle to contain health-care costs.

Various proposals designed to increase competitive forces in the health-care services economy are discussed. Two concepts inherent in market-oriented strategies for containing health-care costs--cost sharing and fixed-dollar subsidies--are defined. Among the strategies for increasing market forces in health care are (1) increasing consumer choice, (2) increasing consumer cost sharing, (3) modifying tax treatment of insurance and medical care, (4) controlling the terms of employment-based insurance, and (5) application of antitrust law. Specific conceptual and legislative "procompetition" proposals are summarized. All of the "procompetition" proposals offer economic incentives for good management of hospitals as a whole as well as for individual departments such as the pharmacy.

Cost Control↗

PubMed1996

Trends in health insurance coverage in California, 1989-1993.

California's uninsurance rate of 22.7 percent is higher than the national average. The state's rate of employment-based insurance coverage--below the national average--is declining because of rising health insurance premiums, falling family incomes, and the changing structure of the economy and the labor market. Growing Medicaid coverage, fostered by expanded eligibility and falling incomes, has prevented rapid growth in the state's uninsured population. Anticipated cutbacks in federal Medicaid funding, however, would increase California's uninsurance rate. Continuing cutbacks in health services for the uninsured would reduce their access to health care and increase stress on many private health services.

Adolescent↗

PubMed2000

Uninsured status and out-of-pocket costs at midlife.

OBJECTIVE: To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period. DATA SOURCE: The first two waves of the Health and Retirement Study, a nationally representative survey of the noninstitutionalized population, ages 51 to 61 at baseline. Interviews were conducted in 1992 and 1994. Our sample consisted of 7,018 respondents who did not report public insurance as their sole source of coverage at baseline. STUDY DESIGN: We compared self-reports of physician visits, hospitalizations, and out-of-pocket health care costs, measured as payments to physicians, hospitals, and nursing homes, by type of insurance coverage at the beginning of the period. We estimated multivariate models of costs and service use to control for individual health, demographic, and economic characteristics and employed instrumental variable techniques to account for the endogeneity of insurance coverage. PRINCIPAL FINDINGS: Controlling for personal characteristics and accounting for the endogeneity of insurance coverage, persons at midlife with job-related health benefits went on to spend only about $50 per year less in out-of-pocket payments for health services than persons who lacked health insurance at the beginning of the period. However, they spent about $650 more per year in insurance premiums than the uninsured. The uninsured used relatively few health services, except when they were seriously ill, in which case they were likely to acquire public insurance. CONCLUSIONS: The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.

Age Factors↗

PubMed1995

Medicare coverage, supplemental insurance, and the use of mammography by older women.

BACKGROUND: On January 1, 1991, the Medicare program began offering reimbursement for screening mammography every two years. This study examined the use of mammography in women covered by Medicare during the first two years that the screening benefit was offered. METHODS: Medicare bills for 1991 and 1992 from a nationally representative sample of 4110 women 65 years of age or older were examined to determine the degree of compliance with recognized guidelines for screening mammography and the extent to which the use of mammography was associated with having supplemental insurance, which shields patients from the out-of-pocket costs associated with using Medicare benefits. RESULTS: A total of 36.9 percent of older U.S. women had mammography during the first two years of the Medicare benefit for screening mammography. Only 14.4 percent of the women lacking supplemental insurance had mammography, as compared with 44.7 percent of those with employer-sponsored supplemental insurance, 40.1 percent of those with self-purchased supplemental insurance, and 23.9 percent of those with Medicaid supplemental insurance. These differences persisted in the stratified and multivariate analyses. As compared with women lacking supplemental insurance, women with employment-based supplemental insurance were more likely to undergo mammography (adjusted odds ratio, 3.03; 95 percent confidence interval, 2.17 to 4.23), as were women with self-purchased supplemental insurance (adjusted odds ratio, 2.97; 95 percent confidence interval, 2.13 to 4.15) and women with Medicaid supplemental insurance (adjusted odds ratio, 1.99; 95 percent confidence interval, 1.30 to 3.07). CONCLUSIONS: The use of mammography was substantially below recommended levels during the first two years of Medicare coverage for screening mammography. Women lacking supplemental health insurance were at particularly high risk of failing to undergo mammography. Requiring copayments for preventive services is an obstacle to the effective mass screening of older women for breast cancer.

Aged↗

PubMed1998

Features of employment-based health plans.

This Issue Brief focuses on changes to the health care financing and delivery system as implemented by employers. It discusses health plan costs, cost sharing, plan funding, health care delivery systems, services covered under various health plan types, coverage limitations, and retiree health coverage. National health expenditures are estimated at $1.035 trillion, representing 13.6 percent of Gross Domestic Product in 1996, up from $699.5 billion and 12.2 percent in 1990. Rising health care spending is also evident at the employer level: In 1996, employer spending on private health insurance totaled $262.7 billion, up from $61.0 billion in 1980. Business health spending as a percentage of total compensation increased from 3.7 percent in 1980 to a high of 6.6 percent in 1993, and declined to 5.9 percent in 1996. Employment-based health plans are the most common source of health insurance coverage among the nonelderly population in the United States, providing coverage to nearly two-thirds of those under age 65. Despite the growth of many cost-sharing provisions, individuals are paying a smaller percentage of total health care costs. In 1960, 69 percent of private health care expenditures were paid out of pocket. Between 1993 and 1996, only 37 percent of private health expenditures were paid out of pocket. One of the most significant developments of the 1980s, which has continued throughout the 1990s, is the growth of managed care plans. As recently as 1994, traditional indemnity plans were the most commonly offered type of employment-based health plan. As fewer employers offered traditional indemnity plans, participation in these plans declined and participation in managed care plans increased. In 1997, 15 percent of employees participating in a health plan were enrolled in an indemnity plan, compared with 52 percent in 1992. Since 1993, employment-based health benefit cost inflation has been virtually nonexistent. Employers have kept cost increases low by using managed care and making other changes. Workers have been shifted to, have been induced to choose, or have voluntarily selected managed care health plans. Preferred provider organization (PPO) and point-of-service (POS) plans have experienced relatively strong gains in enrollment. Employers have also increased the use of utilization review for active workers, and cut back on health benefits for retirees. These changes are in stark contrast to the pre-1993 period, which saw even faster change, with rising health care costs and increasing deductibles and coinsurance for workers in non-HMOs.

Cost Sharing↗

PubMed1991

Defining geographic areas to adjust payments to physicians, hospitals, and HMOs.

Defining geographic areas for the purpose of paying health care providers has been difficult and is an issue that Congress continues to address. Employment-based insurance programs are starting to face this same issue in paying HMOs. Because input prices are related to population density, payment levels could be related to density. This paper offers a new measure of density that represents the population density for the average person. Using zip-code-level data, this measure calculates density of a county weighted by the population of the zip code. Payment areas can be devised by using the measure to categorize counties. This approach can be applied to paying physicians, hospitals, and HMOs.

Catchment Area, Health↗

PubMed2000

To buy, or not to buy: factors associated with the purchase of nongroup, private health insurance.

BACKGROUND: Employment-based health insurance coverage is declining in the United States. Many recent efforts to increase coverage have promoted the individual purchase of insurance, with or without subsidies. OBJECTIVES: To study the associations of factors including minority group membership, education, income, wealth, and health status with the voluntary purchase of nongroup, private health insurance. DESIGN: Analysis of the 1987 National Medical Expenditure Survey (NMES). SUBJECTS: Adult respondents to the NMES who were younger than 65 years of age in 2,574 health-insurance eligibility units (HIEUs) and who either were uninsured or who purchased nongroup, private health insurance for all of 1987. MEASURES: Adjusted odds ratios and marginal effects for the associations of minority group membership, educational attainment, income, and wealth with the purchase of nongroup insurance. RESULTS: Lower-income and less-wealthy HIEUs were much less likely to purchase insurance than higher-income and wealthier HIEUs, with income and wealth measures having relatively independent effects. With simultaneous adjustment for income, wealth, and other factors, members of minority groups had less than half the odds of non-Hispanic whites and persons with less than a high school education had less than half the odds of college graduates of purchasing nongroup insurance. CONCLUSIONS: Minorities and the less educated are much less likely to buy their own health insurance, even after adjustment for income and wealth. Programs encouraging the voluntary purchase of health insurance are likely to widen coverage gaps between historically disadvantaged groups and others.

Adult↗

PubMedDate not supplied

Japanese hospitals--culture and competition: a study of ten hospitals.

Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a non-profit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds. In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences--personal and formal skills required of the leadership in the hospital. There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective--'what kind of impact does the Japanese culture have on the health care organization?' and/or 'what kind of sub-culture is developed in the Japanese hospitals'. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies--specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialties--silent agreements between hospitals, etc.

Economic Competition↗

PubMed1995

Worker demand for health insurance in the non-group market.

This paper examines decisions to purchase individual insurance by workers who do not have employment-based insurance. Using data from the Current Population Survey and the Survey of Income and Program Participation, coupled with prices for a standard insurance product in different market areas, we estimate a price elasticity of -0.3 to -0.4 and an income elasticity of 0.15. Our estimate of the price response raises doubts that even substantial subsidies to the working uninsured would induce many of them to purchase coverage voluntarily.

Data Collection↗

PubMed2000

Health insurance and retirement behavior: evidence from the health and retirement survey.

This paper studies the role of health insurance in the retirement decisions of older workers. As policymakers consider mechanisms for how to increase access to affordable health insurance for the near elderly, considerations of the potential labor force implications of such policies will be important to consider--potentially inducing retirements just at a time when the labor force is shrinking. Using data from the 1992 and 1996 waves of the Health and Retirement Survey, this study demonstrates that access to post-retirement health insurance has a large effect on retirement. Among older male workers, those with retiree health benefit offers are 68% more likely to retire (and those with non-employment based insurance are 44% more likely to retire) than their counterparts who would lose employment-based health insurance upon retirement. In addition, the study demonstrated that in retirement models, when retiree health benefits are controlled for, the effects of pension coverage are reduced, suggesting that these effects may have been overestimated in the prior literature.

Aged↗

PubMed1997

Long-term determinants of patterns of health insurance coverage in the Medicare population.

Using data from the 1990 Health Supplement to the Panel Study of Income Dynamics, we examine the determinants of patterns of insurance coverage among the elderly. Among those with supplemental insurance through an employment-based source, the primary determinant of having insurance is work history, specifically job tenure and occupation of household heads and their spouses. Among those who do not have employer-provided insurance, wealth is the most important economic factor in the purchase of private insurance. Blacks, persons with less education and women household heads are less likely to purchase supplemental insurance. We find little evidence that persons in prior poor health are more likely to purchase supplemental insurance, and the most important determinant of dental or drug coverage is having employer-based insurance. The current trend toward decreased generosity of post-retirement benefits implies that fewer older Americans will have insurance for these services.

Black or African American↗

PubMed1992

Universal health care coverage--pitfalls and promise of an employment-based approach.

America's patchwork quilt of health care coverage is coming apart at the seams. The system, such as it is, is built upon an inherently problematic base: employment. By definition, an employment-based approach, by itself, will not assure universal coverage of the entire population. If an employment-based approach is to be the centerpiece of a system that provides universal coverage, special attention must be paid to all the categories of individuals who are not employees--children, unemployed spouses or singles, the unemployable ill and disabled, persons between jobs, students, retirees, the elderly. Moreover, in a purely voluntary employment-based arrangement, some employers will not provide insurance at all, and others will provide inadequate coverage, necessitating other special provisions for coverage. As a consequence, about one out of six people now has no health coverage whatsoever, and even more have inadequate coverage. All the while, the rapidly-increasing transaction costs of sustaining this grossly inadequate pluralistic system eat up sufficient funds to provide basic benefits to the entire population. The time for systematic reforms has come and gone; what is now needed is action to prevent disaster, followed by a complete rebuilding of this country's health coverage system. Although perhaps more likely to be tried than more radical, completely nationalized, ones, stepwise reforms may not go far enough to cure the significant ills of the current employment-based system. Passage of inadequate reforms, then, could well set the stage for nationalized health care in the not too distant future.

Employer Health Costs↗

PubMed1997

Issues in mental health care benefits: the costs of mental health parity.

This Issue Brief discusses issues in mental health care benefits. It describes the current state of employment-based mental health benefits and discusses studies and issues regarding full mental health parity. It also includes an analysis of the effect of full mental parity on the uninsured population and the effects of the limited mental health parity provision contained in the VA-HUD appropriations bill. The final section discusses the implications of mental health parity for health plans and health insurers. When employers began to provide health insurance benefits to their employees and their families, they extended coverage to include mental health benefits under the same terms as other health care services. Many employers continued to add mental health benefits through the 1970s and early 1980s until cost pressures required employers to re-examine all health care benefits that were offered. They quickly found that, while only a small proportion of the beneficiaries used mental health care services, the costs associated with this care were very high. As a result, employers placed limits on mental health benefits in an attempt to make the insurance risk more manageable. The general strategies employers have used to manage their health care costs are cost sharing, utilization review, managed care, and the packaging of provider services. Employers' cost management strategies may be restricted, however. Five states have mental health parity laws, but three of the states--Rhode Island, Maine, and New Hampshire--apply these laws only to the seriously mentally ill. In addition, 31 states mandate that mental health benefits be provided. However, state mandates apply only to insured plans, not to self-insured employer plans, which are exempt from state regulation of health plans under the Employee Retirement Income Security Act of 1974 (ERISA). A number of recent studies have examined the effect of mental health parity on health insurance premiums in a "typical" preferred provider organization and on the uninsured. In general, the studies concluded that mental health parity could increase health insurance premiums, decrease health insurance coverage for non-mental health related illnesses, and increase the number of uninsured individuals. All studies of mental health parity, and mandated benefits in general, assume that there is a strong likelihood that increased health benefit costs would be passed along to workers in the form of higher cost sharing for health insurance, lower wage growth, or lower growth in other employee benefits.

Cost Sharing↗

PubMed1995

Employment-based health insurance: implications of the sampling unit for policy analysis.

One of the least understood aspects of using employer data for the health reform debate concerns important differences between enterprise- and establishment-level surveys of employers. We demonstrate that the choice of sampling unit affects the size distribution of employees between large and small firms, as well as the estimated proportion of firms offering health insurance. Because health insurance decisions in multi-establishment enterprises generally are made for the entire enterprise rather than individual establishments, we conclude that enterprise surveys are most appropriate for collecting information on the factors affecting the decision to provide health insurance coverage. Nevertheless, an establishment-level survey may be preferred for evaluating decisions made at the state, regional, or industry level. But establishment-level surveys will underestimate the impact of an employer mandate on the unit that ultimately makes the decision to offer health insurance--the enterprise. Given the enormous human and financial stakes involved in health care reform, we urge policymakers and analysts to reflect on the strengths and limitations of alternative sampling units, and to consider the implications for interpreting survey data and formulating policy decisions.

Fee-for-Service Plans↗

PubMedDate not supplied

How will changes in health insurance tax policy and employer health plan contributions affect access to health care and health care costs?

OBJECTIVE: To understand how changes in federal taxation of and employer contributions to health insurance benefits affect the decisions of firms to offer insurance, the willingness of households to purchase different health plans, and the resultant health expenditures. DESIGN: Economic policy simulation. SETTING: Secondary data analysis. PARTICIPANTS: A total of 18,343 sampled families (representing 77 million total families throughout the United States) with a working household head from the 1988 Current Population Survey who were not covered by either Medicare, Medicaid, or CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) insurance. INTERVENTIONS: One intervention limits the amounts of tax-free employer contributions to health insurance premiums to 80% of our estimate of the base plan in the market and assumes that employer contributions will also be limited to this maximum. A second intervention eliminates the favorable tax treatment of employer-paid premiums altogether and assumes that employees will pay the full price of insurance. MAIN OUTCOME MEASURES: Change in the number of working families offered employment-based insurance, change in insurance plan choice, and change in medical spending. RESULTS: Capping the favorable tax treatment and employer contributions decreases the number of families offered employment-based insurance by approximately 91,000, increases the number of families selecting the least generous insurance plan from 20% under the current situation to 33%, and reduces overall health spending by less than 2%. By eliminating the tax exemption altogether, the number of families offered employment-based insurance decreases by approximately half a million families, the number of families selecting the least generous plan goes from 20% to 40%, and overall spending falls by about $16 billion. CONCLUSIONS: Eliminating the tax subsidy and limiting employer-paid contributions to the low-cost plan substantially increases the number of low-income uninsured under a voluntary insurance system, decreases overall spending only modestly, but would raise tax revenues by $36 billion. These tax revenues could be used to assist low-income families to obtain insurance coverage.

Competitive Medical Plans↗

PubMed1994

Health system reform in the Czech Republic. Policy lessons from the initial experience of the general health insurance company.

The Czech Republic is among the most aggressive of the former Warsaw Pact countries in encouraging competition and free-market reform. This aggressiveness was extended into the health care sector when, in 1992, a mandatory employment-based health insurance system was introduced. The move from a controlled socialist structure to an insurance-based, fee-for-service model occurred in a short time. Health care spending increased 50% in 2 years and now approaches that of many industrialized nations. Claims for reimbursements are increasing at a rate of 5% to 7% per quarter. Market incentives have changed behaviors within the medical community. Newly privatized physicians generate greater volume and consume more resources than those continuing as state employees. Policy issues requiring further evaluation include supply, distribution, and relative valuation of physician services; clinical resource allocation; and cost containment.

Czech Republic↗

PubMed1993

The effect of HMOs on premiums in employment-based health plans.

This study documents the effect of HMOs on premiums in employment-based health plans. We analyzed a survey of Minnesota employers conducted in 1986. Among 922 usable observations, 239 firms offered HMOs in addition to fee-for-service (FFS) health plans. We estimated an equation for the probability of offering an HMO, followed by equations for HMO enrollment share, and HMO and FFS premiums. The weighted average HMO and FFS premium in firms that offer HMOs was compared to the premium of FFS-only firms. We found that offering an HMO raises the average premium for family coverage health insurance by $25.14 per month and for single coverage by $3.68 per month. This effect was smaller for firms in the Twin Cities metropolitan area. HMOs may be viewed as a progressive and innovative health care benefit, but they are likely to increase firms' health insurance premiums.

Cost Sharing↗

PubMed1996

Family, work, and access to health insurance among mature women.

We use a life course approach to address much ignored variation in access to health insurance. Using data from the National Longitudinal Survey of Mature Women, we reinterpret the role of both family and employment characteristics in shaping coverage. Mature women are more likely to be insured as wives than as workers, but that safety net is only available to married women. As a result, unmarried women are two to three times as likely to be uninsured or to rely on public programs such as Medicaid. And because they are significantly less likely to be married to a covered worker, Black women are two to three times more likely to be uninsured or to rely on public programs. Given rising instability in employment and marital status across the life course, stable health insurance coverage can only be attained by universal rather than employment-based or family-based schemes.

Adult↗