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At least 127 records · Page 7Linked to original sources
PubMed1992

Private insurance reform in the 1990s: can it solve the health care crisis?

A number of health insurance reform proposals have surfaced at the state governmental level in the United States. These include Medicaid expansion for the below-poverty or near-poverty uninsured, state subsidy to individuals and/or businesses for the purchases of health insurance, risk pools for the medically uninsurable, insurance industry-initiated reforms within the small group market, the promotion of "stripped down" insurance plans that reduce premium cost, and state mandating of employer-sponsored health insurance for the employed uninsured. All of these insurance reform proposals have serious limitations: (1) they fail to address the inequities of the underwriting principle by which older and sicker people pay more for health insurance than the young and healthy population; (2) they extend the illogical linkage of employment and health insurance; and (3) they do not slow the rate of health cost inflation nor do they contain a mechanism to finance broader health coverage through savings within the health sector. An alternative to insurance reform is the establishment of a social insurance program that brings the entire population into a single risk pool.

Adult↗
PubMed1995

Small businesses: the health insurance bind.

This paper discusses the structural and regulatory barriers that stymie small businesses' efforts to provide health insurance for employees. Specifically, small businesses face lower revenues and higher health insurance costs than large businesses. Furthermore, small businesses cannot gain the administrative, as well as cost, advantages of self-insurance. The two options for pooled insurance-Taft-Hartley groups and Multiple Employer Wellness Arrangements-are increasingly difficult to pursue. Even state-developed "basic insurance" packages have not proven a genuine solution for small businesses. However much we as a nation want to tie health insurance to employers, the small business sector cannot easily fill that function for its employees.

Commerce↗
PubMedDate not supplied

The health insurance jigsaw. How to line up an arrangement that will keep you covered.

Health insurance options for people who are HIV-positive, while limited, have improved. Experts suggest strategies for HIV-positive people looking for coverage, including using unions, fraternal organizations, high-risk pools, VA insurance, "green card" marriages, and large employer groups and group plans offered by professional associations. Advice is also given for keeping health insurance, particularly for people changing jobs, going on disability, or for those who cannot afford to keep up with the benefits.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Reinsurance of health insurance for the informal sector.

Deficient financing of health services in low-income countries and the absence of universal insurance coverage leaves most of the informal sector in medical indigence, because people cannot assume the financial consequences of illness. The role of communities in solving this problem has been recognized, and many initiatives are under way. However, community financing is rarely structured as health insurance. Communities that pool risks (or offer insurance) have been described as micro-insurance units. The sources of their financial instability and the options for stabilization are explained. Field data from Uganda and the Philippines, as well as simulated situations, are used to examine the arguments. The article focuses on risk transfer from micro-insurance units to reinsurance. The main insight of the study is that when the financial results of micro-insurance units can be estimated, they can enter reinsurance treaties and be stabilized from the first year. The second insight is that the reinsurance pool may require several years of operation before reaching cost neutrality.

Community Health Planning↗
PubMed1997

Everybody into the pool! Medicare in the twenty-first century.

Both the President and now Republicans have proposed to slow the growth of Medicare costs by allowing seniors to join private managed care health insurance plans. In this article, the author demonstrates that a private market in health insurance will not function like a "normal" commercial insurance market, will constantly be undermined by adverse selection, and therefore is unlikely to achieve the objectives for which it is being created. This result follows from established principles of commercial insurance and our modern understanding of the pathophysiology of disease.

Aged↗
PubMed1991

Growth in self-insurance puts squeeze on Minnesota risk pool.

HMOs and other health plans in many states are diversifying into self-insurance to protect market share, but in Minnesota such a shift is leading to a growing deficit in the state-sponsored risk pool for uninsurable residents. That's because health plans must pay an assessment based on revenues to help fund the state's plan, but the burgeoning self-insured plans aren't required to ante up.

Data Collection↗
PubMed1988

On taking chances with the law of large numbers.

An increasing number of major purchasers of health services now consider capitation to be the preferred method of payment for individual physicians and small group practices. This paper is a primer on capitation payment plans for small risk pools. It describes some of the basic economic issues that purchasers and providers face when negotiating small-panel capitation contracts, including sources of risk, techniques of risk reduction and risk sharing. An empirical section analyses the experience of a plan that took a chance with the law (law of large numbers) and lost.

Capitation Fee↗
PubMed1988

Uncompensated care pools and care to the uninsured: lessons from the New York Prospective Hospital Reimbursement Methodology.

One policy response to both the growing number of uninsured and the increased volume of uncompensated care is the development of revenue pools to explicitly finance uncompensated care. Despite the growing popularity of this response, few analyses have examined their success in financing uncompensated care and improving access to the uninsured. This study examines one such program developed as part of New York State's all-payer rate-setting system. The results indicate that the revenue pools improved the financial condition of New York hospitals but were less effective in improving access to care by the uninsured. The latter result was traced to the method selected by New York to measure "need" and distribute payments to hospitals. If the goal of such programs is to earmark payments to the uninsured, methods other than the New York system should be employed.

Data Collection↗