PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Insurance Pools”

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 541 records · Page 30Linked to original sources
PubMed2002

Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges.

OBJECTIVE: To assess the Self Employed Women's Association's Medical Insurance Fund in Gujarat in terms of insurance coverage according to income groups, protection of claimants from costs of hospitalization, time between discharge and reimbursement, and frequency of use. METHODS: One thousand nine hundred and thirty claims submitted over six years were analysed. FINDINGS: Two hundred and fifteen (11%) of 1927 claims were rejected. The mean household income of claimants was significantly lower than that of the general population. The percentage of households below the poverty line was similar for claimants and the general population. One thousand seven hundred and twelve (1712) claims were reimbursed: 805 (47%) fully and 907 (53%) at a mean reimbursement rate of 55.6%. Reimbursement more than halved the percentage of catastrophic hospitalizations (>10% of annual household income) and hospitalizations resulting in impoverishment. The average time between discharge and reimbursement was four months. The frequency of submission of claims was low (18.0/1000 members per year: 22-37% of the estimated frequency of hospitalization). CONCLUSIONS: The findings have implications for community-based health insurance schemes in India and elsewhere. Such schemes can protect poor households against the uncertain risk of medical expenses. They can be implemented in areas where institutional capacity is too weak to organize nationwide risk-pooling. Such schemes can cover poor people, including people and households below the poverty line. A trade off exists between maintaining the scheme's financial viability and protecting members against catastrophic expenditures. To facilitate reimbursement, administration, particularly processing of claims, should happen near claimants. Fine-tuning the design of a scheme is an ongoing process - a system of monitoring and evaluation is vital.

Adult↗
PubMed2002

Employer offers, private coverage, and the tax subsidy for health insurance: 1987 and 1996.

Economists have long been interested in the effect of tax-based subsidies on private health insurance coverage. We examine this relationship using pooled data from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Our main tax price elasticity estimates for employer offers and for private coverage are near the mid-point of the existing literature. However, these estimates may mask substantial differences in tax-price responsiveness across subsets of workers. Our more disaggregated analysis reveals tax price responsiveness to be significantly above average for low-income workers, workers with low health risks, and workers in small firms--precisely those groups whose continued participation in employment-related risk pooling is of greatest policy concern. In addition, we present family-level elasticities that allow for joint decision-making in two-worker families.

Adult↗
PubMed2001

Increasing health insurance coverage through an extended Federal Employees Health Benefits Program.

The Federal Employees Health Benefits Program (FEHBP) could be combined with health insurance tax credits to extend coverage to the uninsured. An extended FEHBP, or "E-FEHBP," would be open to all individuals who were not covered through work or public programs and who also were eligible for the tax credits on the basis of income. E-FEHBP also would be open to employees of very small firms, regardless of their eligibility for tax credits. Most plans available to FEHBP participants would be required to offer enrollment to E-FEHBP participants, although premiums would be rated separately. High-risk individuals would be diverted to a separate high-risk pool, the cost of which would be subsidized by the federal government. E-FEHBP would be administered by the states, or if a state declined, by an entity that contracted with the Office of Personnel Management. While E-FEHBP would provide group insurance to people who otherwise could not get it, premiums could exceed the tax-credit amount and some people still might find the coverage unaffordable.

Adult↗
PubMed2005

Paying for health in two Rwandan provinces: financial flows and flaws.

The study intended to analyse the financial flows in two provinces within the Rwandan health system through the review of all available documentation and through interviews with key informants, to assess the scope for improved resource allocation. In Rwanda, there exists a large deficit of available financial resources in the health sector in general, and more specifically at health centre level. To improve this situation, it is considered to cover a large proportion of the entire population by mutual health insurance schemes. The schemes are able to pool certain risks, and they definitely improve financial access to health services. Nonetheless, they are inaccessible to the 'very poor', and--due to their limited financial base--they are unable to cover a complementary health care package. It is unlikely that they will mobilize substantial additional resources for health. External long-term commitments are required to cover this gap. A reassurance and readjustment system between the various insurance schemes should be established in order to increase financial protection provided. It might link up with insurance schemes in the formal employment sector. The combination of such a support for health insurance with performance-related incentives for health staff has the potential to increase both equity and quality of health services simultaneously and substantially.

Financing, Government↗
PubMedDate not supplied

Explaining the decline in health insurance coverage, 1979-1995.

The decline in health insurance coverage among workers from 1979 to 1995 can be accounted for almost entirely by the fact that per capita health care spending rose much more rapidly than personal income during this time period. We simulate health insurance coverage levels for 1996-2005 under alternative assumptions concerning the rate of growth of spending. We conclude that reduction in spending growth creates measurable increases in health insurance coverage for low-income workers and that the rapid increase in health care spending over the past fifteen years has created a large pool of low-income workers for whom health insurance is unaffordable.

Adult↗
PubMed1996

Pooling public and private funds in the patient's interest: the case for long-term care insurance.

Although the extent of medical care in France may be thought adequate, the same does not apply to the social medicine sector. The Assurance-maladie paid 87.7% of hospital health expenditure in 1994, whereas direct funding of home assistance amounted to only 9%. In contrast, a recent Legos study (Bungener M. et al. Le bilan économique et financier du secteur médico social, Université de Paris IX, Legos, Janvier 1994) [1] estimated that home assistance costs represent 41-50% of medical-social expenditure. When people are unable to manage because of the high costs of their invalidity, the social security system comes to their assistance, although only under Draconian conditions involving compulsory "family support commitments" and the state's claim on the inheritance of the beneficiary (total costs for hospital admission and boarding and the dual limits of 1000F liabilities and 250,000F net assets for home assistance). The elderly well appreciate the severity of this problem and are deeply distressed by the thought of dependency. Many, however, live under the illusion that the social security system or, to a lesser extent, the mutual funds will come to their assistance, although the problems involved lie partly outside their remits. We therefore need to design new systems to allow the elderly to finance their costs should they become dependant.

Aged↗
PubMed2002

Multistate analysis of factors associated with intimate partner violence.

BACKGROUND: Reports on prevalence estimates and risk factors of intimate partner violence (IPV) are limited in that they (1) focus on specific subgroup populations that are not representative of all women or (2) involve long questionnaires that are not useful as surveillance tools. OBJECTIVES: To report prevalence estimates and identify demographic and lifestyle factors associated with IPV in a large population-based sample of U.S. women using surveillance data. METHODS: Behavioral Risk Factor Surveillance System (BRFSS) data from eight U.S. states were analyzed individually and as a pooled sample (N=18,415). Multivariate logistic regression models were used to examine associations between IPV and the factors of interest. RESULTS: Factors consistently associated with IPV across the majority of states and in the pooled analysis included young age (pooled adjusted odds ratio [aOR], 3.07), single marital status (pooled aOR, 2.89), divorced/separated marital status (pooled aOR, 4.67), and annual household income <$25,000 (pooled aOR, 1.89). In addition, lack of health insurance, receipt of Medicaid, cigarette smoking, presence of children in the home, self-reported fair/poor health, and frequent mental distress were associated with IPV after adjustment for covariates. CONCLUSIONS: This study provides population-based estimates of IPV prevalence and factors associated with IPV using surveillance data. By pooling BRFSS data from individual states, the resulting large sample has adequate power to detect significant associations and has increased precision in the estimates of IPV risk. In addition, this study identifies high-risk populations to target for education and intervention programs and demonstrates the need for improved IPV surveillance.

Adolescent↗
PubMed1992

Expanding health insurance coverage and the implications for dentistry.

Numerous proposals have been suggested for expanding health insurance coverage to the over 30 million Americans without health insurance. These proposals range from establishing a program of national health insurance modeled after the Canadian system to establishing statewide risk pools. Many of these proposals could have an impact on financial access to dental care for the approximately 120 million people without dental insurance. Dental insurance coverage has been shown to increase access to dental services and improve oral health status. Oral health professionals could facilitate discussions concerning health insurance expansion by informing policymakers about important preventive benefits to be gained by improving access to dental services. Dental public health professionals can serve as a bridge between organized dentistry and health policymakers by providing information to help formulate the priorities and characteristics of a dental health insurance program. This visibility and influence in the health policy arena would be beneficial to dentistry and could ultimately result in greater access to dental services and improved oral health for the uninsured.

Dental Health Services↗
PubMed1997

Children at risk: their health insurance status by state.

OBJECTIVE: To inform policymakers and child health advocates about children's health insurance coverage in each state as Congress debates proposals to restructure the Medicaid program amidst declining employer-based dependent health insurance coverage. METHODS: Multiple years of data from the March supplement of the Current Population Surveys were pooled to yield more reliable estimates of changes in children's health insurance coverage in each state from 1987 to 1993. RESULTS: Overall, the number of uninsured children grew by nearly 1 million between 1987 and 1993. The proportion of infants and children <7 years old without health insurance declined; the proportion of uninsured children between the ages of 7 and 22 increased. Between 1987-1990 and 1991-1993, six states experienced a significant increase in the number of uninsured children, only two states experienced a significant decrease in the number of uninsured children, although no progress was found in reducing the number of uninsured children in 43 states. Between 1987-1990 and 1991-1993, the proportion of children covered by employer-based private insurance decreased significantly in three-fourths of the states and the proportion of children with Medicaid coverage increased significantly in four-fifths of the states. CONCLUSIONS: In a period of fast-declining employer-based health insurance coverage for dependents, Medicaid expansions have worked to moderate the surge in the number of children without health insurance. Of the 30 million children without private health insurance in 1993, nearly 18 million were insured by Medicaid. As policymakers debate the future of the Medicaid program, they must consider seriously its role as the country's largest insurer of children's health and its efficacy as a vital safety net for the nation's children.

Adolescent↗
PubMed2003

A tale of two visions: the changing fortunes of Social Health Insurance in South Africa.

Over the last two decades there has been growing interest in the potential of Social Health Insurance (SHI) as a health care financing mechanism in low- and middle-income countries. SHI schemes exist in many countries of Latin America and have also been introduced across Asia in recent years. However, few countries in Africa have implemented SHI. Despite the sustained interest in SHI, there are growing concerns about whether it will achieve equity and financial sustainability objectives. It is clear that the design of SHI is of critical importance in this regard. South Africa has debated whether or not to implement SHI for nearly a decade and a half, and the design of SHI proposals has changed dramatically over that period. This paper considers lessons that can be drawn from the South African experience of developing and adapting SHI design, in conjunction with recent evidence from other low- and middle-income countries. The paper illustrates how SHI design may be affected by the trade-offs that are made to accommodate key actors' views, an accommodation that may even undermine the achievement of key objectives. A critical design requirement to promote equity and sustainability is a common contribution and risk pool across the SHI and any existing private insurers. In addition, given the complexity of SHI reforms, and the fact that SHI is usually only one component of a broader package of health sector reforms, the appropriate sequencing of implementation of the SHI and associated, supporting organizational and financing reforms is essential. As SHI evolves within a country, it is important to benchmark the changing nature of its design against pre-determined objectives in order to protect the final integrity of the policy.

Health Care Reform↗
PubMed1990

[Effects of health reform law on the handicapped from the viewpoint of social assistance].

In the legislator's intention, the recent health reform legislation is aimed at strengthening solidarity and self-responsibility, so that our statutory insurance-based health care system may continue to be efficient and financially viable. The essential steering mechanism introduced is a system of fixed amount benefits in the various benefit areas, among them medicaments, technical aids such as wheelchairs, hearing aids, glasses, and various orthopaedic aids. Only part of the guidelines, tables and regulations needed for implementation have however been made available so far. It is therefore impossible as yet to undertake appropriate, objective evaluation of the advantages and disadvantages of the reform for patients and health funds. It may however already be said that, in respect of dentures, transport, as well as burial costs, health fund insurants have to raise considerable extra means, partly touching on the financial substance of many insurants. A hardship/overcharge clause is intended to keep the additional burdens socially compatible. This device however is absolutely insufficient in the case of chronically ill and very severely disabled people, paying no regard to the considerable additional expenses these populations have to incur for participating in general community life. The inclusion of benefits for domiciliary nursing and care is viewed as only a first step. The financial resources for protection against the risk of nursing and care dependency, however, should not come from the statutory health insurance scheme, but be based on a common pool of funds to be financed by the various social protection branches.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed1997

Recycling pool provides innovative financing for an integrated system.

Not-for-profit integrated delivery systems require innovative financing mechanisms to compete effectively with expanding for-profit systems. The Massachusetts Health and Educational Facilities Authority (Mass HEFA), in collaboration with Partners HealthCare Systems, Inc., Boston, Massachusetts, developed such a mechanism--a capital asset recycling pool funded through a $150 million bond issue. The recycling pool gives Partners flexible access to tax-exempt capital to fund routine capital expenses across the system and has enabled the system to centralize control of capital resources. Over the pool's 30-year life-span, Partners will be able to issue tax-exempt loans from the pool to any of its affiliates or, with Mass HEFA and insurer approval, transfer the funds to outside organizations. When the loans are repaid, the funds remain available and can be recycled at no additional cost to fund further capital projects. Creation of the pool was made possible by Partners' outstanding credit, strong market position, expanding primary care network, and substantial unrestricted net assets.

Boston↗
PubMed1994

Oregon Health Plan: ration or reason.

The Oregon Health Plan gained national attention by changing the focus of health care from who is covered to what is covered. This change was facilitated by insurance reforms in the areas of small market, employer mandates, high risk pooling and Medicaid. Most controversial of the reforms is the use by the legislature of a prioritized list of health services to determine benefit levels for the insurance programs. Significant debate has occurred over whether the use of such a list is rationing or reasoning. The Oregon Health Plan represents a thoughtful and deliberate blending of fact with public value for the purpose of responsible health policy. It is that unique blending of public values developed through community participation with fact that focused the attention of the world on Oregon.

Community Participation↗
PubMed1999

Genetics and the British insurance industry.

Genetics and genetic testing raise key issues for insurance and employment. Governmental and public concern galvanised the British insurance industry into developing a code of practice. The history of the development of the code, issues of genetic discrimination, access to medical information, consent and the dangers of withholding information and the impact on the equity of pooled risk are explored. Proactive steps by the Association of British Insurers suggest that moral reflection not legislation is the way forward.

Disclosure↗
PubMedDate not supplied

President Bush's comprehensive health reform program.

To deal with the shortcomings of the current U.S. health care system, President Bush has proposed a comprehensive reform package that would offer tax credits and deductions to low- and middle-income Americans to purchase private insurance, reform small market insurance to ensure availability and portability of insurance, allow creation of Health Insurance Networks to allow small businesses and nonprofit organizations to pool their purchasing power, reduce administrative costs, and control the growth of government health programs. Combined, the proposals would build on the strengths of the present private/public system and preserve consumer choice and free market discipline.

Cost Control↗
PubMed2002

Reforming China's urban health insurance system.

China's urban health insurance system is mainly consisted of labor insurance schemes (LIS) and government employee insurance scheme (GIS). LIS is a work unit-based self-insurance system that covers medical costs for the workers and often their dependents as well. GIS covers employees of the State institutions, is financed by general revenues. Since 1980s, China has implemented series of health insurance system reforms, culminating in the government's major policy decision in December of 1998 to establish a social insurance program for urban workers. Compared with the old insurance systems under LIS and GIS, the new system expands coverage to private sector employees and provides a more stable financing with its risk pool at the city level. Despite of these advantages, implementation of China's health insurance reform program is faced with several major challenges, including risk transfer from work units to municipal governments, diverse need and demand for health insurance benefits, incongruent roles of the central and regional governments. These challenges may reflect practical difficulties in policy implementation as well as some deficiencies in the original program design.

China↗
PubMed2006

Active immunization of broiler breeder cockerels against chicken inhibin accelerates puberty and prevents age-induced testicular involution.

Injection of quail and breeder hens with a recombinant protein antigen (MBP-cINA521)--a fusion of the bacterical maltose-binding protein (MBP) and a fragment of the alpha-subunit of chicken inhibin (cINA521)--accelerates puberty and enhances lay. Herein, the effects of this immunogen on reproductive responses in broiler breeder males were assessed. Cockerels were subcutaneously injected with 0 (vehicular controls), 1, 3, or 5 mg of MBP-cINA521 at 13 wk of age and with one-half of these dosages (boosters) at 18 wk. Bird subsamples were weighed, blood sampled, and killed at 24, 28, and 39 wk of age to assess age and vaccination effects on BW, testes weight (TWT), TWT relative to BW (RTWT), TWT > or = 20 g (TWT20; theoretical threshold TWT for maximum fertility), and plasma testosterone. Breeder males are sexually developing, reach peak sexual activity, and show age-related reproductive decline at these ages. Because vaccine gonadal effects at 24 wk appeared to be dramatic, the size of the left testis was also scored to see if size differences could be detected by mere visual inspection. Male fighting increasingly reduced sample sizes beyond 24 wk. Because mortality was unrelated to the treatments and to insure meaningful statistical comparisons, MBP-cINA521 data were pooled. Body weight (P < 0.04), testis score (P < 0.02), TWT (P < 0.03), RTWT (P = 0.06), and plasma testosterone (P = 0.08) were elevated in immunogen-treated males at 24 wk of age, and more (P < 0.05) MBP-cINA521-treated birds than controls achieved a TWT20 at this time. These variables did not differ by treatment at 28 wk. However, by 39 wk, treatment effects reemerged as follows: TWT (P < 0.04), RTWT (P = 0.06), and TWT20 (P < 0.01) were increased in vaccinated males who also showed nearly 3-fold higher levels of plasma testosterone. We conclude that immunoneutralization of inhibin accelerates puberty and retards age-related sexual senescence that typically occurs in broiler breeder males.

Aging↗