The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals

Administrative costs account for 25 percent of health care spending, but little is known about the portion attributable to billing and insurance-related (BIR) functions. We estimated BIR for hospital and physician care in California. Data for physician practices came from a mail survey and interviews; for hospitals, from regulatory reporting; and for private insurers, from a consulting company. Private insurers spend 9.9 percent of revenue on administration and 8 percent on BIR. Physician offices spend 27 percent and 14 percent, and hospitals, 21 percent and 7-11 percent, respectively. Overall, BIR represents 20-22 percent of privately insured spending in California acute care settings.     

Access to insurance

George Washington University's Center for Health Policy Research has published results of a study that examines how access to private insurance for people with HIV may be expanding. The report discusses, among other things, individual market reforms and insurance risk pools that are in place across the nation. The authors are Jeffrey Levi, Kristina Sogocio, Alan E. Gambrell, and Paula M. Jones. Contact information is provided.     

Access to screening mammography: Patient concerns about insurance

Limitations in third-party payer coverage for screening mammograms and other insurance-related obstacles to care are examined to encourage providers to assist patients in insurance negotiations.     

Access to screening mammography: Patient concerns about insurance

Limitations in third-party payer coverage for screening mammograms and other insurance-related obstacles to care are examined to encourage providers to assist patients in insurance negotiations.     

Family physicians: supply and demand

The nation's supply of family physicians as estimated by the Graduate Medical Education National Advisory Committee appears fairly accurate. At the same time, the demands for family physicians appear to be strong, partially because case-management systems recognize the cost-effectiveness and appropriate training of family physicians for their needs. The largest factor inhibiting the supply of such physicians appears to be the relatively lower income of family practice compared to other specialty fields. This creates more difficulties in funding training positions and may limit the attractiveness of the field to medical school graduates.     

Patient attitudes, insurance, and other determinants of self-referral to medical and chiropractic physicians

OBJECTIVES: This study identified predictors of patient choice of a primary care medical doctor or chiropractor for treatment of low back pain. METHODS: Data from initial visits were derived from a prospective, longitudinal, nonrandomized, practice-based observational study of patients who self-referred to medical and chiropractic physicians (n = 1414). RESULTS: Logistic regression showed differences between patients who sought care from medical doctors vs chiropractors in terms of patient health status, sociodemographic characteristics, insurance, and attitudes. Disability, insurance, and trust in provider types were particularly important predictors. CONCLUSIONS: The study highlights the importance of patient attitudes, health status, and insurance in self-referral decisions. The significance of patient attitudes suggests that education might be used to shape attitudes and encourage cost-effective care choices.     

Mandatory reporting of intimate partner violence to police: views of physicians in California

OBJECTIVES: This study examined physicians' perspectives on mandatory reporting of intimate partner violence to police. METHODS: We surveyed a stratified random sample of California physicians practicing emergency, family, and internal medicine and obstetrics/gynecology. RESULTS: An estimated 59% of California primary care and emergency physicians (n = 508, 71% response rate) reported that they might not comply with the reporting law if a patient objects. Primary care physicians reported lower compliance. Most physicians agreed that the legislation has potential risks, raises ethical concerns, and may provide benefits. CONCLUSIONS: Physicians' stated noncompliance and perceived negative consequences raise the possibility that California's mandatory reporting law is problematic and ineffective.     

Transmission of financial incentives to physicians by intermediary organizations in California

Many U.S. physicians participate in provider-sponsored organizations that act as their intermediaries in contracting with managed care plans, particularly where capitation contracts are used. Examining a survey of 153 intermediary entities in California, we trace the cascade of financial incentives from health plans through physician organizations to primary care physicians. Although the physician organizations received the vast majority (84 percent) of their revenues through capitation contracts, most of the financial risk related to utilization and costs was retained at the group level. Capitation of primary care physicians was common in independent practice associations (IPAs), but payments typically were restricted to primary care services. Thirteen percent of medical groups and 19 percent of IPAs provided bonuses or withholds based on utilization or cost performance, which averaged 10 percent of base compensation.     

Factors affecting the supply of private hospital beds in the UK: private insurance, NHS pay beds, or NHS waiting list?

This study attempts to isolate the determinants of private hospital growth in the United Kingdom. Thirty-six variables, representing private medicine, the socio-economic environment, the political and government conditions, and the health care systems characteristics were selected for analysis. Multiple regression analysis shows that the number of independent hospital beds in the UK can be explained almost entirely by the number of persons with private health insurance, the number of NHS pay beds, and the overall bed level. Further analysis reveals that the number of persons with private health insurance can be explained to a large extent by the length of the NHS waiting list.     

Welfare reform, labor supply, and health insurance in the immigrant population

Although the 1996 welfare reform legislation limited the eligibility of immigrant households to receive assistance, many states chose to protect their immigrant populations by offering state-funded aid to these groups. I exploit these changes in eligibility rules to examine the link between the welfare cutbacks and health insurance coverage in the immigrant population. The data reveal that the cutbacks in the Medicaid program did not reduce health insurance coverage rates among targeted immigrants. The immigrants responded by increasing their labor supply, thereby raising the probability of being covered by employer-sponsored health insurance.