A review of data on the U.S. health sector spring 2006.

This report presents information on the state of the U.S. health system in the spring of 2006. It includes data on the uninsured and underinsured and their access to health care, on socioeconomic inequality in health care, and on the rising costs of the U.S. health system. It also presents information on the role of corporate money in health care, focusing on the pharmaceutical industry, Medicare HMOs, and corporate-government conflicts of interest. The author includes a survey of recent public opinion polls on health care and health system reform and an update on the U.S. national health insurance legislation. The article ends by reviewing recent data on international health systems and international system comparisons.     

A review of data on the health sector of the United States January 2002.

This report presents data on the state of U.S. health care at the end of 2001. It provides information on access to health care, inequalities in incomes and medical care, the increasing costs of health care and health insurance, and the role of corporate money in the provision of health care and the development, marketing, and patenting of pharmaceuticals. The author also looks at the state of health maintenance organizations, the results of some recent surveys on physicians' and public opinion on managed care, and news about the nursing professions. Also provided is an update on Congressional activity on health care legislation, the role of health care industry money in politics, and some developments in health care systems elsewhere in the world.     

A review of data on the U.S. health sector Fall 2002.

This report presents information on the state of U.S. health care in mid-2002. It provides data on the uninsured and underinsured and their difficulties in finding health care; the increasing costs of care; health, social, and economic inequalities; and the role of corporate money in health care. Information is also presented on mental health care, the hospital and pharmaceutical industries, Medicare HMOs, and the state of nursing. The author then provides updates on Congressional activity and the results of polls on matters of health, and some data on health care systems elsewhere in the world.     

A review of data on the health sector of the United States. May 2001.

This report presents data on the state of U.S. health care in early 2001. It provides information on the numbers of uninsured and underinsured and their difficulties in obtaining health care; the increasing costs of care; and medical, social, and economic inequalities. Data are presented on the state of the nations' health maintenance organizations (including Medicare HMOs), pharmaceutical industry, and hospital industry, and on the role of these industries' money in U.S. politics. The author also looks at some proposals on the Congressional agenda, and gives a summary of some reasons why tax credits won't work. Also provided is some recent information on the status of health care and health care systems elsewhere in the world.     

A review of data on the health sector of the United States.

This report provides data on the state of U.S. health care at the start of the new century. It reveals increasing numbers of uninsured and underinsured Americans; increasing costs for health insurance, health care services, and medicines; and increasing inequalities in health and in access to health care. The author also provides data on the current state of the pharmaceutical and health service industries, including Medicaid and Medicare HMOs. The results of some opinion polls on health care, conducted among physicians and the general public, are also summarized.     

Validity of insurance information on California birth certificates.

OBJECTIVES: This study assessed the validity of health insurance information on California birth certificates. METHODS: Insurance information from birth certificates and linked face-to-face interviews was compared for 7428 postpartum women in California. RESULTS: There was excellent agreement between insurance information in birth certificate and interview data, especially when capitated plans were grouped with all other private coverage. Analyses using both data sources produced similar estimates of the likelihood of untimely prenatal care according to type of insurance coverage. CONCLUSIONS: Birth certificate data including insurance information appear to be an appropriate resource for examining both the extent of coverage for maternity care and associations between prenatal care use and insurance status.     

A review of data on the health sector of the United States.

This report presents data on the state of U.S. health care in mid-2000. It provides information on the number of uninsured and underinsured (with special attention to health coverage among Hispanics and drug coverage among seniors); the increasing costs of health care; inequalities in the socioeconomic, health, and medical spheres; and the role of corporate money in health care. Recent data are presented on the pharmaceutical industry (with special notes on drug industry lobbying, drug safety, the use of publicly funded research to boost industry profits, and drug marketing to physicians) and the hospital and nursing home industries (including Medicare HMOs). The author also summarizes the health proposals of the presidential candidates, recent health care legislation, and some health system changes in Canada.     

Choosing and paying for care

This paper presents data from before and after implementation of the 1990 NHS and Community Care Act in 1993. It shows the low proportions of the population who are covered by private health insurance and draws attention to the fact that, although some older people have considered private health insurance, few are covered. Comparing data for people aged <65 with those aged >65, the paper explores the preferred sources of help in a range of situations. The findings show that in most instances, statutory services are preferred. Data for older people aged >80 are presented comparing findings from 1990/91 and 1995, which show that use of services for which charges have been introduced appear to have fallen. Low take-up of dental and optician services are identified. The implications of the findings for social policy are considered and it is suggested: that insurance cover for long-term care should be organized at a national level; that greater attention should be given to service preferences of users and potential users; and, that the effectiveness of various health and social care services should be evaluated.     

Designing health insurance information for the Medicare beneficiary: a policy synthesis.

Can Medicare beneficiaries make rational and informed decisions about their coverage under the Medicare program? Recent policy developments in the Medicare program have been based on the theory of competition in medical care. One of the key assumptions of the competitive model is the free flow of adequate information, enabling the consumer to make an informed choice from among the various sellers of a particular product. Options for Medicare beneficiaries in supplementing their basic Medicare coverage include the purchase of private supplementary insurance policies or enrollment in a Medicare HMO. These consumers, in a complex health insurance market, have only limited information available to them because many health plans do not make adequate comparable product information available. Moreover, since the introduction of the Medicare HMO option, the long-range plan for management of the Medicare budget has become based on the large-scale voluntary enrollment of beneficiaries into capitated health plans. The policy instrument that has been used to improve beneficiary decisions on how to supplement Medicare coverage is the informational or educational program. This synthesis presents findings regarding the relative effectiveness of different types of health insurance information programs for the Medicare beneficiary in an effort to promote practical use of the most effective types of information.     

Catastrophic health payments and health insurance: some counterintuitive evidence from one low-income country

OBJECTIVES: The purpose of the study is to quantitatively analyze the role of health insurance in the determinants of catastrophic health payments in a low-income country setting. METHODS: The study uses the most recent publicly available household level data from Zambia collected in 1998 containing detailed information on health care utilization and spending and on other key individual, household, and community factors. An econometric model is estimated by means of multivariate regression. RESULTS: The main results are counterintuitive in that health insurance is not found to provide financial protection against the risk of catastrophic payments; indeed, insurance is found to increase this risk. CONCLUSIONS: Reasons for the findings are discussed using additional available information focusing on the amount of care per illness episode and the type of care provided. The key conclusion is that the true impact of health insurance is an empirical issue depending on several key context factors, including quality assurance and service provision oversight.     

美国医疗保险改革演进及对中国的启示

美国在医疗保险方面独具特色,它以商业医疗保险为主体,以政府的医疗照顾和医疗救助为补充。美国曾因是唯一未能实现全民医疗保险的发达国家而饱受诟病。从1912年起,美国联邦政府就开始了全民医疗保险立法之路。但受到党派斗争、利益集团、价值理念等因素的影响,立法进程缓慢。直到2012年,在历经整整一个世纪之后才在奥巴马总统执政期间促成医保法案的最终通过,从而为美国迈向全民医保之路奠定了制度基础。考察美国医保演进之路对中国医保改革具有重要的启示,特别是其强调立法先行、民主参与和私营医疗保险的发展经验对当前中国医保覆盖面扩大后如何提升质量具有重要的借鉴意义。     

The effect of Health Savings Accounts on group health insurance coverage

This paper presents new empirical evidence on the impact of tax subsidies for Health Savings Accounts (HSAs) on group insurance coverage. HSAs are tax-free health care expenditure savings accounts. Coupled with high deductible health insurance plans (HDHPs), they together represent new health insurance options. The tax advantage of HSAs expands the group health insurance market by making health care more affordable. Using individual level data from the Current Population Survey and exploiting policy variation by state and year from 2004 to 2012, I find that HSA tax subsidies increase small-group coverage by a statistically significant 2.5 percentage points, although not coverage in larger firms. Moreover, if the tax price of HSA contribution decreases by 10 cents, small-group insurance coverage increases by almost 2 percentage points. I also find that for older workers or less-educated workers, HSA subsidies are associated with 2–3 percentage point increase in their group insurance coverage.     

The effect of the illness episode approach on Medicare beneficiaries'' health insurance decisions.

This article reports on a quasi-experimental test of the Illness Episode Approach (IEA), a new approach to providing Medicare beneficiaries with information about the financial consequences of alternative health care coverage decisions. Beneficiaries were randomly assigned to free, three-hour workshops, half using materials developed through application of the IEA, half using traditional comparative information on insurance options. Analysis of data collected before and after the workshops indicates that participants in the Illness Episode sessions were more likely to drop duplicative coverage, to spend less on premiums, and to report that their decisions to change coverage had met their expectations. The entire sample of workshop participants showed significant increases in knowledge of Medicare and their own insurance, as well as improved satisfaction with the cost of their health care coverage.     

Public perceptions of quality care and provider profiling in New York: implications for improving quality care and public health.

Despite a growing emphasis on providing health care consumers with more information about quality care, useful and valid provider-specific information often has not been available to the public or has been underutilized. To assess this issue in New York State, random telephone surveys were conducted in September 2002 and March 2003, respectively, of 1,001 and 500 English- or Spanish-speaking persons, 18 years or older. Results indicated that 33% of New Yorkers were very concerned about the quality of care, with African Americans being particularly concerned. Less than half of the respondents recalled hearing or seeing information about health care quality in the past year and less than 20% actually used this information in medical decision making. African Americans were the least likely to recall receiving or being exposed to quality-related information, whereas women and more educated adults were the most likely to report being exposed. Furthermore, New Yorkers received quality information from multiple sources, with about 20% saying that they obtained information about physician and hospital quality from media (eg, newspaper) and nonmedia (eg, recommendation by family member) sources. Evaluations of different kinds of information suggested that some types (eg, whether or not a doctor is board certified) carried more weight in health care decision making than other types (eg, government ratings). Unexpectedly, those who used information to make health care decisions were more likely to have reported experiencing a medical error in the household. Finally, in the 6-month follow-up survey, concerns about the quality of care in the state remained about the same, while fears of terrorism decreased and preparations for future terrorist attacks increased. In the survey, few major differences were found in results based on payer status (eg, private insurance versus Medicaid/no insurance). These findings have implications for both the private and public health care sectors. Specifically, they suggest that greater access to and use of provider-specific health care information by the public is a viable way to improve quality, particularly if health care professionals support the public use of these data.     

Validity of self-reported health plan information in a population-based health survey.

OBJECTIVE: To validate information on private health insurance coverage in a population-based study. METHODS: Respondents to the Massachusetts Behavioral Risk Factor Surveillance System were asked the name of their health plan company (affiliation) and specific brand of insurance (product), the duration in which they belonged to the plan, and demographic and health-related data. Information on plan affiliation and product was used to classify individuals on type of coverage. At the end of the survey, respondents with health insurance were asked to retrieve their health plan cards, and to read detailed information from the cards. Self-reported data were compared with information from the cards. RESULTS: Self-reported information on health plan affiliation agreed with plan cards for 93 percent of individuals, while agreement was 79 percent for health plan product. Among health maintenance organization (HMO) participants, 93 percent correctly reported being in an HMO (sensitivity), whereas 76 percent of respondents in a non-HMO plan correctly self-reported (specificity). Individuals with higher levels of income, those with a primary care doctor, and those in a health plan for at least 1 year had higher agreement. Higher validity was associated with poor physical health and recent cancer screening. CONCLUSIONS: Self-reported data on health plan affiliation and product have good validity in a population-based sample of adults. While agreement differs according to specific respondent characteristics, these differences do not appear substantial.     

Health care services utilization and access inequalities in the Sao Paulo Metropolitan Region

This paper presents case study findings in five municipalities in the S?o Paulo Metropolitan Region. Inequalities in access to health care services and their utilization were described through advanced tabulation data from the 1998 SEADE Life Conditions Survey. The variables analyzed were: owning or not owning private health care insurance, income and age brackets. The health care service attributes studied were: health care services coverage by a health insurance plan, health services demands and average waiting time to receive health care. Compared with other studies, using the 1998 IBGE PNAD, the results allowed us to confirm interregional imbalances which can only be detected in shorter special scale studies: the municipalities. Despite showing the high private health insurances coverage the S?o Paulo Metropolitan Region has a great inner heterogeneity. The inequalities in private health care insurance, access, waiting time, and type of insurance coverage were observed through income quintiles and age classes analyses. Findings suggest that an expansion of the State's regulation capacity is necessary in order to empower the Brazilian Health Care System principles of universality and equity to be qualified to offer Brazilians the right to access health care services.     

Affordability of the Health Expenditures of Insured Americans Before the Affordable Care Act

Central to the Affordable Care Act is the notion of affordability and the role of health insurance in making otherwise unaffordable health care affordable. We used data from the 1996 to 2008 versions of the Medical Expenditure Panel Survey to estimate the portion of overall health care expenditures by insured respondents that would otherwise have been beyond their disposable incomes and assets. We found that about one third of insured expenditures would have been unaffordable, with a much higher percentage among publicly insured individuals. This result suggests that one of the main functions of insurance is to cover expenses that insured individuals would not otherwise be able to afford.Central to the Affordable Care Act (ACA; Pub L No. 111–148) is the notion of affordability and the role of health insurance in making otherwise unaffordable health care affordable. Yet, to our knowledge, no reports in the health policy literature have estimated the extent to which insurance accomplishes this function. We used data from the 1996 to 2008 versions of the Medical Expenditure Panel Survey (MEPS) to estimate the portion of total health care expenditures by insured respondents that would have been beyond their disposable income and assets if they had been uninsured. We focused on the pre-ACA period because that period represents the political context in which the act was passed.The MEPS data include information on demographic characteristics, medical care expenditures, health insurance coverage, incomes, and assets among a representative sample of US households. The information used in our analysis was derived from the household component of the MEPS, which is limited to members of the civilian, noninstitutionalized population who were present in the household during the entire survey period. We employed the restricted-use version of the MEPS to gain access to information on respondents’ assets.     

美国医改实施的进展、前景与启示

美国医改实施三年来,在扩大医保可及性、改革医疗服务市场、降低医疗费用和改进服务质量方面取得较大进展,但许多触及既得利益集团的核心改革政策如建立保险交易所、改革支付方式、削减部分福利项目、提高富人税率等开源节流措施尚未正式启动,这将成为奥巴马连任后面临的主要挑战。美国医改鼓励服务的整合、改革支付制度、重视预防保健服务等做法值得中国医改借鉴,同时以商业医疗保险为主导的保险体系暴露出的弊端也启示中国政府以更加审慎的态度发展商业医疗保险。