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PubMed1991

Health insurance coverage of the immigrant elderly.

In this paper, I examine and contrast factors that contribute to whether individuals are covered by public health insurance (Medicare, Parts A and B, with and without Medicaid benefits) or private insurance. The study, based on data from a sample of foreign- and native-born elderly, employs descriptive analysis and a multivariate investigation involving logistic regression models. The results show that the immigrant population is less likely than native-born elderly to be covered by public insurance or to have private insurance. Medicare coverage for the immigrant elderly is strongly influenced by their length of stay in the United States, employment status, and country of origin, while their having private insurance coverage is affected by race, income, and employment status. For native-born elderly, race, income, and employment status are contributing factors to the type of insurance coverage retained. Policy implications are discussed.

Black or African American↗
PubMed1992

Correlates of health insurance coverage: evidence from the Midwest.

The Midwest is often overlooked in national studies of health insurance status. We analyzed the economic and social characteristics of uninsured and underinsured individuals and households in a Midwestern state using both bivariate and multivariate techniques. As in much of the country, economic factors, particularly income and employment, were most significant in accounting for insurance coverage. Unexpectedly, rural and urban residents were equally likely to lack insurance. Results indicate that in rural areas, underinsurance may be a greater problem than uninsurance, and that income-based health insurance is more effective than employer-provided plans in reaching all Americans.

Adolescent↗
PubMed2000

Parental employment and health insurance coverage among school-aged children with special health care needs.

OBJECTIVES: This study examined parental employment and health insurance coverage among children with and without special health care needs. Special needs were defined as conditions likely to require a high amount of parental care, potentially affecting parental employment. METHODS: Data from the 1994 National Health Interview Survey were analyzed for 21,415 children aged 5 to 17 years, including 1604 children with special needs. Logistic regression was used to estimate the effect of special needs on the odds of full-time parental employment and on the odds of a child's being uninsured, having Medicaid, or having employer-sponsored insurance. RESULTS: Parents of children with special needs had less full-time employment. Their children had lower odds of having employer-sponsored insurance (adjusted odds ratio [OR] = 0.7) than other children. Children with special needs had greater odds of Medicaid coverage (adjusted OR = 2.3-5.1, depending on family income). Children with and without special needs were equally likely to be uninsured. CONCLUSIONS: Lower full-time employment among parents of children with special needs contributes to the children's being less likely to have employer-sponsored health insurance. Medicaid covers many children with special needs, but many others remain uninsured.

Adolescent↗
PubMed1993

Health insurance coverage for smoking cessation services.

The health benefits from quitting smoking have been well documented; however, most health insurance plans in the United States, both public and private, have excluded coverage of smoking cessation services. Since 1988, numerous public health policy documents have called for health insurance coverage of smoking cessation services, although there is little agreement over what kinds of services or interventions are most appropriate for health insurance coverage. The purposes of this paper are to (1) describe current public policy for health insurance coverage of smoking cessation services; (2) review the current status of policy adoption by private health insurance carriers, health maintenance organizations, self-funded employers, as well as public insurance programs including Medicare and Medicaid; (3) analyze the major barriers faced by health insurers, health care providers and policy makers in offering coverage for smoking cessation services; and (4) outline the specific policy options that the federal government, state governments, employers and anti-smoking coalitions can take to increase insurance coverage for smoking cessation services. The paper concludes with recommendations for practitioners, researchers and policy makers.

Accounting↗
PubMed1997

Long-term determinants of patterns of health insurance coverage in the Medicare population.

Using data from the 1990 Health Supplement to the Panel Study of Income Dynamics, we examine the determinants of patterns of insurance coverage among the elderly. Among those with supplemental insurance through an employment-based source, the primary determinant of having insurance is work history, specifically job tenure and occupation of household heads and their spouses. Among those who do not have employer-provided insurance, wealth is the most important economic factor in the purchase of private insurance. Blacks, persons with less education and women household heads are less likely to purchase supplemental insurance. We find little evidence that persons in prior poor health are more likely to purchase supplemental insurance, and the most important determinant of dental or drug coverage is having employer-based insurance. The current trend toward decreased generosity of post-retirement benefits implies that fewer older Americans will have insurance for these services.

Black or African American↗
PubMed2001

Low-wage workers and health insurance coverage: can policymakers target them through their employers?

Many policy initiatives to increase health insurance coverage would subsidize employers to offer coverage or subsidize employees to participate in their employers' health plans. Using data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey, we contrast "low-wage employers" with all other employers. Employees in low-wage businesses have significantly worse access to employment-based insurance than other employees do; they are less likely to work for an employer that offers insurance, less likely to be eligible if working in a business that offers insurance, and less likely to be enrolled if eligible. Low-wage employers contribute lower shares of premiums and offer less generous benefits than other employers do. Policies that would target subsidies to selected employers to increase insurance offers to low-wage workers are difficult to design, however, because several commonly mentioned employer characteristics (including firm size) are found to be poor indicators of low-wage worker concentration. Programs that would set minimum standards for employer plans to be eligible for "buy-ins" need to base these standards on the less generous terms offered by low-wage employers in order to effectively reach low-wage workers and their dependents.

Eligibility Determination↗
PubMed1987

Health insurance coverage of the working poor.

This study examines the working poor, and their pattern of health insurance coverage. The data indicate that in 1977 almost 22% of the working poor lack health insurance throughout the year. Moreover, children of the working poor were almost twice as likely as children of the poor nonemployed to be without coverage. The implications of the Omnibus Budget Reconciliation Act of 1981 (OBRA) which restricted the working poor's eligibility for Medicaid are discussed. It is argued that being employed, in itself, does not guarantee poor people access to medical care and may, in fact, serve to restrict it.

Health Benefit Plans, Employee↗
PubMed1991

Employer-sponsored insurance coverage for alcohol and drug abuse treatment, 1988.

This paper uses 1988 Bureau of Labor Statistics data to analyze the content of insurance coverage for alcohol and drug abuse treatment offered by medium and large private sector firms. Ninety percent of workers had medical insurance. Of these, 81% had coverage for alcohol abuse treatment and 75.5% had coverage for drug abuse treatment. The coverages were almost always offered together, and the benefits were generally identical for both. Coverage for inpatient detoxification was most common, followed by outpatient care and inpatient rehabilitation. Self-insured plans, although exempt from state-mandated benefits, were as likely to include alcohol and drug abuse coverage as Blue Cross and Blue Shield and commercial plans, and their specific benefits were no less generous. Coverage limitations tended to be more restrictive for these illnesses than for others. The nature of the limitations varied greatly, although day and dollar limits were most common for inpatient treatment, and visit limits and higher copayments were most common for outpatient treatment.

Alcoholism↗
PubMed1985

The elderly's private insurance coverage of nursing home care.

About 40 per cent of Medicare beneficiaries had private insurance coverage of skilled nursing facilities (SNF) in 1977. Data from the 1977 National Medical Care Expenditure Survey show that among such persons, about 85 per cent had full coverage of Medicare's Part A copayments for days 21-100 but only 15.7 per cent had maximum coverage of at least 365 days of care or a benefit of $100,000 or more. The most comprehensive benefits are found among persons with middle or high incomes; more generous first-dollar coverage is found in the North Central and South regions, and more generous maximums in the West.

Aged↗
PubMed1995

Reduction mammaplasty: criteria for insurance coverage.

The guidelines by which insurers determine eligibility for coverage of reduction mammaplasty must rely largely on only subjective materials, yet they often apply strict criteria ranging from minimum resection weights to outright refusal to compensate. I have reviewed the data from 100 consecutive reduction mammaplasties performed by me over the last 2 years. Body weight, combined specimen weight, and height relationships were studied. Patient-identifiable questionnaires regarding the presence or absence of preoperative regional discomforts were sent to the same group. It was not possible to construct a useful formula that would verify either subject complaints of discomfort or the prospect for their relief based on body dimension or specimen weight. This study suggests that a graded, three-level minimum specimen weight standard for body weights less than 70 kg, 70 to 79 kg, and over 80 kg would be more equitable.

Body Height↗
PubMed1988

Insurance coverage and the demand for dental care. Results for non-aged white adults.

The fraction of the U.S. population with private dental insurance coverage increased considerably during the past two decades. Experimental data from the Rand Health Insurance Study have revealed that dental insurance is an important determinant of demand. In this analysis, detailed health insurance data from the National Medical Care Expenditure Survey are used to study the effects of insurance on demand by a standard population of white adults aged 16 to 64. Results from this national probability sample are generally comparable to those from the Rand experimental data. Estimates indicate that the primary effects of dental insurance are to facilitate access to care and to increase dental expenditures. Results are consistent with the notion that first-dollar coverage exerts a greater effect on demand than insurance which requires payment of a deductible. Findings also suggest that insurance affects the mix of dental services received. Loss of dental benefits because of cost containment efforts will result in significant reductions in demand for dental services.

Adolescent↗