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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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At least 649 records · Page 36Linked to original sources
PubMed2002

Prescription drug coverage for people with Medicare.

Medicare currently does not provide outpatient prescription drug coverage. People with Medicare who do not have continuous prescription drug coverage face higher out-of-pocket expenditures and may not comply with their prescriptions in order to save money. This brief explores some of the issues facing beneficiaries without drug coverage and describes some of the different options available to help offset the costs of prescription medications.

Aged↗
PubMed2002

Health plan responses to managed care regulation.

Little effort has been made to understand operational responses of health plans to the cascade of regulation imposed on them in the past decade. Using data from the Community Tracking Study, we cast some light on this area and illustrate how regulatory initiatives have produced both intended and unintended consequences. The findings both confirm speculation about regulatory effects and reveal some surprising and troubling developments.

Government Regulation↗
PubMed2003

Pitching plans to the uninsured. Insurers increasingly see viable market in growing pool of middle-class workers who don't have health insurance.

It's a bold new world in healthcare insurance. A few years ago, insurers would have been reluctant to use advertising dollars to reach the uninsured. But now, as the average income of the typical uninsured person is climbing and Congress is pondering initiatives to expand coverage, the market is gaining zealous suitors. "Things are really heating up," says Merrill Matthews Jr., left, director of the Council for Affordable Health Insurance.

Advertising↗
PubMed2003

Medicare program; improvement to the Medicare+Choice appeal and grievance procedures. Final rule with comment period.

This final rule with comment period responds to comments on the January 24, 2001, proposed rule regarding improvements to the Medicare+Choice (M+C) appeal and grievance procedures. It establishes new notice and appeal procedures for enrollees when an M+C organization decides to terminate coverage of provider services. The January 24, 2001 proposed rule was published as a required element of an agreement entered into between the parties in Grijalva v. Shalala, civ. 93-711 (U.S.D.C. Az.), to settle a class action lawsuit. This rule also specifies a Medicare-participating hospital's responsibility for issuing discharge or termination notices under both the original Medicare and M+C programs, amends the Medicare provider agreement regulations with regard to beneficiary notification requirements, and amends M+C enrollee grievance procedures.

Humans↗
PubMed2003

The impact of the recent Supreme Court rulings in Pegram and Rush Prudential on state regulation of managed care organizations.

Over the past two decades, the Employee Retirement Income Security Act of 1974 (ERISA) has shielded managed care organizations (MCOs) from liability for negligent treatment or coverage decisions. This Article examines the Supreme Court jurisprudence in the area of ERISA preemption, and assesses the impact of these recent decisions on state regulation of MCOs. The author concludes that recent decisions in Pegram v. Herdrich and Rush Prudential HMO, Inc. v. Moran have broadened the states' power to regulate MCOs and enhance the ability of injured plaintiffs to sue such organizations under state tort law.

Employee Retirement Income Security Act↗
PubMed1992

Health insurance coverage of adolescents: a current profile and assessment of trends.

Data from the National Health Interview Survey reveal that 4.7 million or 15% of US adolescents aged 10 through 18 were uninsured in 1989. Among adolescents, 73% were privately insured, 10% were publicly insured, and 2% were both privately and publicly insured. Poor, near-poor, and minority adolescents were at the greatest risk for lack of health insurance coverage. Among adolescents without insurance, cost continued to be cited as the leading barrier to obtaining coverage. A comparison of 1989 National Health Interview Survey data with a previous analysis, in which 1984 data were used, revealed a 10% increase in the proportion of adolescents without insurance coverage. The increase in the proportion of uninsured adolescents was entirely attributable to an erosion of private health insurance coverage. No significant change occurred in the proportion of adolescents with coverage under public programs. Planned expansions of the federally and state-financed Medicaid programs will help to stem further increases in the size of the uninsured adolescent population. However, unless marked improvements occur in the private health insurance sector, progress will be limited.

Adolescent↗