[Diagnosis related groups--a prescription for higher health care cost?].
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Cost Allocation↗
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Results for “Insurance deductions”
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.
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Insurance plan raises benefits, lowers costs.
The Direct Service Contract encourages hospital employees to use their own hospital for medical services. The plan benefits the hospital, cuts costs, and raises employee morale.
Deductibles and Coinsurance↗
Employer-sponsored health insurance: pressing problems, incremental changes.
Despite large premium increases, employers made only modest changes to health benefits in the past two years. By increasing copayments and deductibles and changing their pharmacy benefits, employers shifted costs to those who use services. Employers recognize these changes as short-term fixes, but most have not developed strategies for the future. Although interested in "defined-contribution" benefits, employers do not agree about what this entails and have no plans for moving to defined contributions in the near future. While dramatic changes in health benefits are unlikely in the short term, policymakers may want to watch for future erosions in health coverage.
Consumer Behavior↗
Acute health care costs for the aged Medicare population: overview and policy options.
Despite its seeming largesse, Medicare has always been a cost-sharing program. The potential costs borne by beneficiaries can be substantial, leading to more than 70 percent seeking protection through supplementary private insurance. Others risk payment out of pocket, and fewer rely on Medicaid. Actual costs incurred by each group of Medicare beneficiaries are examined and seen to have significant and inequitable impacts. Current Medicare policies are often poorly designed or irrelevant. Future responses will have to address both taxation and copayment while weighing concerns for individual financial hardship against possible overuse of services.
Acute Disease↗
Inappropriate use of hospitals in a randomized trial of health insurance plans.
We examined geographic variation in the rate of inappropriate hospitalization and the effect of cost sharing on that rate. The medical records of 1132 adults hospitalized in a randomized trial of health insurance plans were reviewed by two physicians who were blinded to the patients' insurance plan. They judged 23 percent of the admissions to be inappropriate and an additional 17 percent to have been avoidable by the use of ambulatory surgery. The percentage of inappropriate admissions varied among six sites (from 10 to 35 percent), but areas with low total admission rates did not necessarily have low proportions of inappropriate admissions. In plans with cost sharing for all services, 22 percent of admissions and 34 percent of hospital days were classified as inappropriate, as compared with 24 percent of admissions and 35 percent of hospital days in the plan under which care was free to the patient (these differences were not statistically significant). Our data show that a substantial fraction of hospitalization is potentially avoidable. Because cost sharing did not selectively reduce inappropriate hospitalization, it is important to develop other mechanisms to do so.
Adult↗
Analytic dimensions of a prescription-medication benefit in medicare.
BACKGROUND: Many analysts believe that the lack of coverage for outpatient prescription medications represents a conspicuous deficiency in the Medicare benefits package. OBJECTIVE: This paper uses insurance theory to design and estimate the costs of a Medicare catastrophic-medication outpatient benefit. RESULTS: For efficiency and equity purposes, and to accommodate the tradeoff between the cost to the federal government and the insurance value of such a benefit to Medicare enrollees, we favor a benefit that would be means-tested by employing deductibles, coinsurance rates, and catastrophic limits, all of which would be progressively graduated for 7 household income classes. For equity reasons, we propose that the government's share of the medication benefit be financed from the general tax fund, using the progressive income tax. Another source of potential savings within the Medicare program that could pay for a medication benefit would be elimination of fraud, waste, and abuse. CONCLUSIONS: Because our proposal addresses both the efficiency and equity dimensions of a Medicare outpatient medication benefit, we believe it is worthy of serious consideration by both policymakers and Congress.
Aged↗
Individual market health insurance reform: portability from group to individual coverage: federal rules for access in the individual market; state alternative mechanisms to federal rules--HHS. Interim final rule with comment period.
This interim final rule with comment period implements section 111 of the Health Insurance Portability and Accountability Act of 1996, which sets forth Federal requirements designed to improve access to the individual health insurance market. Certain "eligible individuals" who lose group health insurance coverage are assured availability of coverage in the individual market, on a guaranteed issues basis, without preexisting condition exclusions. In addition, all individual health insurance coverage must be guaranteed renewable. This rule also sets forth procedures that apply to States that choose to implement a mechanism under State law, as an alternative to the Federal requirements, with respect to guaranteed availability for eligible individuals. It also sets forth the rules that apply if a State does not substantially enforce the statutory requirements.
Career Mobility↗
Health insurance coverage of Minnesota farm families.
This study of 1,482 farm families assesses the extent and cost of health insurance coverage among Minnesota farm families and finds that these families are buying less insurance coverage than urban families, while paying a higher proportion of their income for these premiums. More than three-fourths of the farm families surveyed buy their health insurance plan themselves and pay for it out of pocket. Their plans, on average, are slightly less expensive than employer-provided plans in urban areas, but they provide much less coverage and have more copayments and deductibles. Unlike their urban counterparts, who often choose health plans for convenience of location or freedom to choose physicians, farmers generally choose plans on the basis of costs and services provided. About 7 percent of farm families are without insurance, and many others are underinsured because they cannot afford to purchase an adequate plan.
Cost Control↗
Job-based health benefits in 2002: some important trends.
Based on a national survey of 2,014 randomly selected public and private firms with three or more workers, this paper reports changes in employer-based health insurance from spring 2001 to spring 2002. The cost of health insurance rose 12.7 percent, the highest rate of growth since 1990. Employee contributions for health insurance rose in 2002, from $30 to $38 for single coverage and from $150 to $174 for family coverage. Deductibles and copayments rose also, and employers adopted formularies and three-tier cost-sharing formulas to control prescription drug expenses. PPO and HMO enrollment rose, while the percentage of small employers offering health benefits fell. Because increasing claims expenses rather than the underwriting cycle are the major driver of rising premiums, double-digit growth appears likely to continue.
Cost Sharing↗
Sources of health insurance and characteristics of the uninsured. Analysis of the March 1996 Current Population Survey.
This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the way health protection has changed for the insured, how the states rank in health insurance protection, and the characteristics most closely related to whether or not an individual is likely to have health insurance. The report is based on Employee Benefit Research Institute analysis of the March 1996 supplement to the Current Population Survey (CPS) and represents the most recent data available. In 1995, there were 231.9 million civilian, nonelderly Americans in the United States, 163.9 million (70.7 percent) of whom were covered by private health insurance. Almost 148 million individuals (63.8 percent) were covered by an employment-based plan. Over 38.4 million individuals (16.6 percent) were covered by publicly financed health insurance, and 29 million (12.5 percent) were covered by Medicaid. In 1995, 17.4 percent of the nonelderly population, or 40.3 million individuals, were not covered by health insurance. This is an increase from 39.4 million, or 17.1 percent, in 1994. In general, the percentage of the population without health insurance has been increasing. In 1988, 15.2 percent of the U.S. population was uninsured. The 104th Congress passed the Health Insurance Portability and Accountability Act of 1996 in the interest of making health care more portable and affordable. Additional legislation was passed addressing mental health benefits and maternity length of stay. These bills will do little to decrease the size of the uninsured population. They include provisions for group-to-group portability, group-to-individual portability, an increase in the self-employed health deduction, medical savings accounts, mental health parity, and minimum length-of-stay requirements for childbirth. These provisions in large part benefit individuals who already have health insurance. They do not directly address the larger problem of its affordability. Data from the Survey of Income and Program Participation indicate that 50.7 million individuals lacked health insurance coverage for at least one month during calendar year 1992. Approximately 43 percent were uninsured between one and four months. The median spell without health insurance was six months. These data would seem to indicate that even though many individuals may lose health insurance during any given month, the majority are uninsured for a short period of time.
Adolescent↗
Understanding and coping with the new HCFA physician incentives stop-loss insurance rules.
The imposition of physician incentive regulations by the Health Care Financing Administration for Medicare risk and Medicaid managed care contracts has created disclosure and stop-loss reinsurance issues for both physician groups and their contracting health maintenance organizations. This article summarizes the key points of the stop-loss requirements of the new rules, describes the current types of stop-loss reinsurance purchased prior to the effective date of the regulations, and the practical problems of conforming current physician group contracting practices to these rules. The article also provides several suggested steps that physician groups should take to manage the changes required.
Actuarial Analysis↗
The Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).
The purpose of this article is to provide a general overview and reference source for the Health Insurance Portability and Accountability Act, which was signed into law by President Clinton last August. The focus of the article is on Title I--Improved Availability and Portability of Health Insurance Coverage, and on Title III--Tax-Related Health Provisions. The author points out that due to the trend towards an incremental approach to health care legislation, this act must be viewed as one of a series of initiatives being taken by the federal government intended to impact the cost of the U.S. health care delivery system.
Career Mobility↗
Financial fitness test. 10 ways to get in shape for a new payment era.
The advent of pay-for-performance contracts and insurance policies that force consumers to make more of their health care choices are dramatically changing how hospitals get reimbursed for their services by both private and government payers. Here are 10 strategies to help you confront this new payment era right now.
Accounts Payable and Receivable↗
Patterns of outpatient mental health care over time: some implications for estimates of demand and for benefit design.
The article examines patterns of starting and continuing outpatient mental health care as a function of time, and the implications of these patterns for estimates of the response of demand to generosity of fee-for-service insurance coverage. The data are from the RAND Health Insurance Experiment (HIE), which acquired a random sample of the nonelderly general population in six U.S. sites. People rarely had more than one episode of use of outpatient mental health services in a year. Persons who used in the prior year had high rates of continuing in treatment, while those without prior use entered treatment at a low, steady rate. Similar patterns of use by former users and nonusers were observed across insurance plans that varied widely in generosity, but the absolute probabilities of use were significantly lower in less generous plans. The probability of use of mental health services expanded significantly over time in the HIE; thus, estimates of demand in a steady state would be higher than those based on the HIE study years.
Community Mental Health Services↗
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↗
The impact on utilization of a copayment increase for ambulatory psychiatric care.
The impact of a copayment increase on the utilization of psychiatric services in a prepaid group practice program is examined. Data are presented on utilization at the Columbia Medical Plan (Columbia, Maryland) two years before and two years after the copayment increase. There was a highly transient response to the increse in the copayment for psychiatric care. The year of the copayment increase was characterized by a small decline in the proportion of enrollees using psychiatric care, and a slight decrease in the utilization rate. These declines were short-lived, and utilization returned to previous levels one year after the copayment increase.
Deductibles and Coinsurance↗
Pharmaceutical benefits scheme policy: confused and tough on patients.
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Australia↗