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At least 577 records · Page 32Linked to original sources
PubMed1987

Long-term care policies: defusing a financial time bomb.

Most Americans have little or no private health insurance for chronic illness or disability, largely because of forces restricting the development of a market for long-term care insurance. Properly structured incentives could alter this situation and help defuse a financial time bomb confronting the nation. Spending for long-term care has grown dramatically in the last 20 years and is expected to continue escalating. The question is who will pay for it. Considerable room exists to increase private insurance's proportion of long-term care expenses, which are now largely paid by the patient out-of-pocket or by Medicaid. The current market, however, is under-developed because demand is thin and private third-party insurers are reluctant to write policies. But the potential demand is substantial because of the increasing elderly population. To develop a long-term care insurance market, tax incentives should be offered, the elderly need to be educated about the limited coverage provided by Medicare, and beneficiaries need to be made aware that relying on Medicaid's safety net could lead to impoverishment.

Aged↗
PubMed1999

Mental health carve-outs: effects and implications.

To control the rise in expenditures and to increase access to mental health and substance abuse (MH/SA) services, a growing number of employers and states are implementing a "carve-out." Under this arrangement, the sponsor separates insurance benefits by disease or condition, service category, or population and contracts separately for the management of care and/or associated risks. A carve-out allows a unique set of managed care techniques to be applied to a subset of particularly costly or complex benefits. This article describes various carve-out models, discusses the potential advantages and disadvantages of a full carve-out, and summarizes recent public and private sector research regarding the strategy's effects on access and use, cost savings and shifting, and quality of care. It concludes by discussing approaches to the assessment and monitoring of the processes and outcomes associated with a MH/SA carve-out.

Contract Services↗
PubMed1999

Preparing Medicare for the 21st century.

On July 1, 1966, the federal government offered assistance in paying for healthcare to almost all Americans aged 65 or older. The Medicare program has been an incredibly successful program ever since then, but is now facing severe financial and other challenges that require serious reforms. Healthcare delivery systems and technology have undergone tremendous change during the past three decades, and it is time to modernize the Medicare program to reflect these changes and prepare the program for the next century.

Delivery of Health Care↗
PubMed1999

Episodes of mental health and substance abuse treatment under a managed behavioral health care carve-out.

Little is known about the effect of a managed behavioral health care (MBHC) carve-out on treatment episodes for a mental health/substance abuse (MHSA) condition. This study found adoption of a carve-out for Massachusetts state employees associated with a dramatic drop in total MHSA costs per episode (particularly for individuals with certain severe MHSA conditions). The carve-out also was associated with a shift away from the use of facility care toward the use of outpatient care for enrollees with a diagnosis of unipolar depression.

Adult↗
PubMed1999

Eliciting consumer preferences for health plans.

OBJECTIVE: To examine (1) what people say is important to them in choosing a health plan; (2) the effect, if any, that giving health plan information has on what people say is important to them; and (3) the effect of preference elicitation methods on what people say is important. DATA SOURCES/STUDY SETTINGS: A random sample of 201 Wisconsin state employees who participated in a health plan choice experiment during the 1995 open enrollment period. STUDY DESIGN: We designed a computer system to guide subjects through the review of information about health plan options. The system began by eliciting the stated preferences of the subjects before they viewed the information, at time 0. Subjects were given an opportunity to revise their preference structures first after viewing summary information about four health plans (time 1) and then after viewing more extensive, detailed information about the same options (time 2). At time 2, these individuals were also asked to rate the relative importance of a predefined list of health plan features presented to them. DATA COLLECTION/EXTRACTION METHODS: Data were collected on the number of attributes listed at each point in time and the importance weightings assigned to each attribute. In addition, each item on the attribute list was content analyzed. PRINCIPAL FINDINGS: The provision of information changes the preference structures of individuals. Costs (price) and coverage dominated the attributes cited both before and after looking at health plan information. When presented with information on costs, quality, and how plans work, many of these relatively well educated consumers revised their preference structures; yet coverage and costs remained the primary cited attributes. CONCLUSIONS: Although efforts to provide health plan information should continue, decisions on the information to provide and on making it available are not enough. Individuals need help in understanding, processing, and using the information to construct their preferences and make better decisions.

Adult↗
PubMed1999

Lifetime redistribution under the Social Security program: a literature synopsis.

This article provides a brief overview of the more important studies of lifetime redistribution under the Old-Age and Survivors Insurance (OASI) and Disability Insurance (DI) programs. Studies are categorized into two types, those that focus on redistribution across successive cohorts of workers or typical members of those cohorts and those that focus on the distribution of results across characteristics of interest within particular cohorts of workers. A list of related studies is provided at the end of the article for those interested in additional reading.

Aged↗
PubMed1979

Canada's NHI: a physician's evaluation.

A physician in Manitoba reports that a national health care system has worked well in Canada, particularly for poor people and for governments concerned about the equitable and universal delivery of health care, as well as about rising health costs. Physicians, however, find the greatest problems are their own low salary and their lack of impact on government policy.

Attitude of Health Personnel↗
PubMed2000

Evolution of a children's health insurance program: lessons from New York State's Child Health Plus.

The State Children's Health Insurance Program (SCHIP) was passed by Congress in 1997. It provides almost $40 billion in federal block grant funding through the year 2007 for states to expand health insurance for children. States have the option of expanding their Medicaid programs, creating separate insurance programs, or developing combination plans using both Medicaid and the private insurance option. New York State's child health insurance plan, known by its marketing name Child Health Plus, was created by the New York Legislature in 1990. New York's program, along with similar ones from several other states, served as models for the federal legislation, especially for state health insurance plans offered through private insurers. New York's program provides useful data for successful implementation of SCHIP.

Child↗