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PubMed1995

Gainers and losers under a tax-based health care reform plan.

Currently, it appears that health care for the nonpoor and nonelderly in the United States will continue to be financed primarily through a private insurance market rather than a public insurance program. Even if this market-based system achieves maximum efficiency, a premium subsidy for low-income, non-Medicaid-eligible individuals likely will be required to make health insurance affordable for all Americans. There are advantages to carrying out that redistribution at the federal, rather than state or local, level, possibly using credits or deductions within the federal personal income tax system. Which individuals decide to claim these tax credits or deductions, and how much the tax subsidies would have cost in 1993, are examined in this paper. A tax on employer-provided health benefits finances the subsidy, and the paper analyzes characteristics of gainers and losers under the reform. The study uses data from the 1987 National Medical Expenditure Survey (NMES) to develop a microsimulation model of the federal personal income tax system.

Employer Health Costs↗
PubMed1997

[Implications of the federal government's austerity package in the field of intramural medical rehabilitation].

The austerity legislation passed September 13, 1996 as well as the additional austerity measures pending for the field of rehabilitation in the framework of legislation aimed at refocusing self-government and self-responsibility in the statutory health insurance scheme (1. und 2. Gesetz zur Neuordnung der Selbstverwaltung und Eigenverantwortung in der gesetzlichen Krankenversicherung-1st and 2nd GKV-NOG) are going to jeopardize insurees' provision with medical rehabilitation generally. For 1997 alone, economies totalling some 3.2 billion DM have been legislated. By drastically increasing the additional payments to be made, the insured are to an intolerable extent being subjected to contributing towards the cost of their medical treatment. What is more, the 2nd GKV-NOG is to enable health insurance funds to totally exclude rehabilitation benefits from the standard catalog of benefits to be provided. Along with these spending limitations in the social insurance schemes, additional burdens have been imposed on the insured in gainful employment under regulations in the field of labour law effective as of October 1, 1996 applicable in case of participation in an in-patient rehabilitation measure. Thus, the employer is entitled to make deductions with regard to an employee's claim to continued remuneration during sick leave as well as part of his annual paid recreational leave for the duration of the inpatient rehabilitation measure. The population most adversely affected by this policy are those with chronic illness and disability.

Cost Control↗
PubMed1996

Long-term care insurance: a private sector challenge.

Powerful demographic and economic forces are fueling the looming crisis related to providing medical and social services for the elderly. However, the American public remains largely oblivious to the devastating implications of the need for institutional or home-based care among senior citizens. Employers have a key role to play in resolving the situation by evaluating competing long-term care policies, endorsing the program of a strong carrier, assisting in offering the policies through payroll deduction and educating employees on the importance of selecting policy riders that best meet their evolving needs.

Aged↗
PubMed1983

Does free care improve adults' health? Results from a randomized controlled trial.

Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost? In an effort to answer this question, we studied 3958 people between the ages of 14 and 61 who were free of disability that precluded work and had been randomly assigned to a set of insurance plans for three or five years. One plan provided free care; the others required enrollees to pay a share of their medical bills. As previously reported, patients in the latter group made approximately one-third fewer visits to a physician and were hospitalized about one-third less often. For persons with poor vision and for low-income persons with high blood pressure, free care brought an improvement (vision better by 0.2 Snellen lines, diastolic blood pressure lower by 3 mm Hg); better control of blood pressure reduced the calculated risk of early death among those at high risk. For the average participant, as well as for subgroups differing in income and initial health status, no significant effects were detected on eight other measures of health status and health habits. Confidence intervals for these eight measures were sufficiently narrow to rule out all but a minimal influence, favorable or adverse, of free care for the average participant. For some measures of health in subgroups of the population, however, the broader confidence intervals make this conclusion less certain.

Adolescent↗
PubMed1999

The economics of catastrophic health insurance.

Currently over 41 million Americans lack health insurance and would experience severe financial stress if faced with a major illness. Catastrophic health insurance has been proposed as a means of addressing this problem. This study utilizes the National Medical Expenditures Survey of 34,400 households to calculate the cost of catastrophic medical coverage under a number of different assumptions. Estimates of the annual cost range from $109.2 billion to $149 billion, depending upon the size of the deductible, and whether a means test is used to determine degree of coverage. Given the current antideficit climate in Washington, an expense of this magnitude cannot simply be added to the Federal budget. Instead, a simple funding proposal is suggested that provides more than adequate resources to finance the program. Specifically, universal catastrophic coverage would provide insurance companies with relief from approximately $175 billion in medical bills, more than enough to fund even the most ambitious of the proposals.

Catastrophic Illness↗
PubMed2004

Risk segmentation related to the offering of a consumer-directed health plan: a case study of Humana Inc.

OBJECTIVE: To determine whether the offering of a consumer-directed health plan (CDHP) is likely to cause risk segmentation in an employer group. STUDY SETTING AND DATA SOURCE: The study population comprises the approximately 10,000 people (employees and dependents) enrolled as members of the employee health benefit program of Humana Inc. at its headquarters in Louisville, Kentucky, during the benefit years starting July 1, 2000, and July 1, 2001. This analysis is based on primary collection of claims, enrollment, and employment data for those employees and dependents. STUDY DESIGN: This is a case study of the experience of a single employer in offering two consumer-directed health plan options ("Coverage First 1" and "Coverage First 2") to its employees. We assessed the risk profile of those choosing the Coverage First plans and those remaining in more traditional health maintenance organization (HMO) and preferred provider organization (PPO) coverage. Risk was measured using prior claims (in dollars per member per month), prior utilization (admissions/1,000; average length of stay; prescriptions/1,000; physician office visit services/1,000), a pharmacy-based risk assessment tool (developed by Ingenix), and demographics. DATA COLLECTION/EXTRACTION METHODS: Complete claims and administrative data were provided by Humana Inc. for the two-year study period. Unique identifiers enabled us to track subscribers' individual enrollment and utilization over this period. PRINCIPAL FINDINGS: Based on demographic data alone, there did not appear to be a difference in the risk profiles of those choosing versus not choosing Coverage First. However, based on prior claims and prior use data, it appeared that those who chose Coverage First were healthier than those electing to remain in more traditional coverage. For each of five services, prior-year usage by people who subsequently enrolled in Coverage First 1 (CF1) was below 60 percent of the average for the whole group. Hospital and maternity admissions per thousand were less than 30 percent of the overall average; length of stay per hospital admission, physician office services per thousand, and prescriptions per thousand were all between 50 and 60 percent of the overall average. Coverage First 2 (CF2) subscribers' prior use of services was somewhat higher than CF1 subscribers', but it was still below average in every category. As with prior use, prior claims data indicated that Coverage First subscribers were healthier than average, with prior total claims less than 50 percent of average. CONCLUSIONS: In this case, the offering of high-deductible or consumer-directed health plan options alongside more traditional options caused risk segmentation within an employer group. The extent to which these findings are applicable to other cases will depend on many factors, including the employer premium contribution policies and employees' perception of the value of the various plan options. Further research is needed to determine whether risk segmentation will worsen in future years for this employer and if so, whether it will cause premiums for more traditional health plans to increase.

Adult↗
PubMed2003

A review of dental plans: PPOs and referral plans to dominate future.

This important benefit has changed greatly in the last 20 years. Double-digit health care cost increases in the late 1980s caused indemnity plans to evolve into network plans, such as dental HMOs and PPOs. PPOs and referral or access plans now seem to be the plans of choice.

Cost Savings↗
PubMedDate not supplied

Essential health care: affordable for all?

Access to affordable health care has become a national crisis. The uninsured have many faces and many reasons for being uninsured. The nation cannot afford to sustain this broken system; not in terms of resources, nor in terms of the deteriorating health of the public. Universal coverage could offer a promising opportunity to begin to ameliorate the unsustainable use of expensive illness care now substituting for effective low-cost prevention and early detection. A proposal for essential health care coverage, a balance between cost and choice to maximize use of beneficial care, is presented.

Adult↗
PubMed1996

Valuation of a dental practice.

The valuations discussed in this article deal with the actual sale of a practice and presume that the selling dentist will not compete. Valuations for litigation purposes may vary considerably as many states have different definitions of value in litigation environments that may vary from fair market values. The earnings-based models should be looked at when the practice is earning in excess of what a dentist can make without being an owner. To insure that the practice is not being under-valued the value based upon a continuing practice should also be considered. Finally, terms are very important. The tax deductibility of the purchase and the capital gain considerations of the seller are items to consider when constructing an offer. The new Section 197 of the Internal Revenue Code has a significant impact on practice negotiations since it now provides for the deductible write-off of goodwill. Frequently terms can be constructed that benefit both parties from a cash and tax standpoint.

Capital Financing↗