Transitions from private to public health coverage among children: estimating effects on out-of-pocket medical costs and health insurance premium costs

Objective. To assess the effects of transitions from private to public health insurance by children on out‐of‐pocket medical expenditures and health insurance premium costs. Data Sources. Data are drawn from the 1996 and 2001 panels of the Survey of Income and Program Participation. We construct a nationally representative, longitudinal sample of children, ages 0–18, and their families for the period 1998–2003, a period in which states raised public health insurance eligibility rates for children. Study Design. We exploit the Survey of Income and Program Participation's longitudinal design to identify children in our sample who transition from private to public health insurance. We then use a bootstrapped instrumental variable approach to estimate the effects of these transitions on out‐of‐pocket expenditures and health insurance premium costs. Principal Findings. Children who transition from private to public coverage are relatively low‐income, are disproportionately likely to live in single‐mother households, and are more likely to be Black or of Hispanic origin. Child health status is highly predictive of transitions. We estimate that these transitions provide a cash‐equivalent transfer of nearly U.S.$1,500 annually for families in the form of reduced out‐of‐pocket and health insurance premium costs. Conclusions. Transitions from private to public health coverage by children can bring important social benefits to vulnerable families. This suggests that instead of being a net societal cost, such transitions may provide an important social benefit.     

Private payers of health care in Brazil: characteristics, costs and coverage

The private sector is the predominant provider of health care in Brazil, particularly for inpatient services, and financing is a mix of public (through a prospective reimbursement system) and private. Roughly a quarter of the population has private insurance coverage, reflecting rapid growth in the past decade fuelled by the crisis in the public reimbursement system and the perceived deterioration of publicly provided care. Four major forms of insurance exist: (1) prepaid group practice; (2) medical cooperatives, physician owned and operated preferred provider organizations; (3) company health plans where employers ensure employee access to services under various types of arrangements from direct provision to purchasing of private services; and (4) health indemnity insurance. Each type of plan includes a wide variety of subplans from basic individual/family coverage to comprehensive executive coverage. The paper discusses the characteristics, costs and utilization patterns of all types of privately financed care, as well as the major problems associated with private financing: the limited package of benefits and low payout ceilings, inadequate consumer information and virtually no regulation.     

Increasing health insurance costs and the decline in insurance coverage

OBJECTIVE: To determine the impact of rising health insurance premiums on coverage rates. DATA SOURCES & STUDY SETTING: Our analysis is based on two cohorts of nonelderly Americans residing in 64 large metropolitan statistical areas (MSAs) surveyed in the Current Population Survey in 1989-1991 and 1998-2000. Measures of premiums are based on data from the Health Insurance Association of America and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer-Sponsored Health Benefits. STUDY DESIGN: Probit regression and instrumental variable techniques are used to estimate the association between rising local health insurance costs and the falling propensity for individuals to have any health insurance coverage, controlling for a rich array of economic, demographic, and policy covariates. PRINCIPAL FINDINGS: More than half of the decline in coverage rates experienced over the 1990s is attributable to the increase in health insurance premiums (2.0 percentage points of the 3.1 percentage point decline). Medicaid expansions led to a 1 percentage point increase in coverage. Changes in economic and demographic factors had little net effect. The number of people uninsured could increase by 1.9-6.3 million in the decade ending 2010 if real, per capita medical costs increase at a rate of 1-3 percentage points, holding all else constant. CONCLUSIONS: Initiatives aimed at reducing the number of uninsured must confront the growing pressure on coverage rates generated by rising costs.     

社区老年人健康状况及卫生服务调查

目的对社区老年人的健康状况以及卫生服务情况进行调查。方法 2010年6月随机抽查广州市社区所属居委中的南园东居委340户家庭个人档案,调查分析该居委60岁以上老年人健康状况。结果慢性病患者69.06%,慢性病患病率排在前五位的是高血压、白内障、冠心病、慢性支气管炎及慢性阻塞性肺疾病、糖尿病。吸烟、高盐饮食是高血压发病的危险因素,参加体育锻炼可以有效降低冠心病、糖尿病的发病率。结论以预防保健为基础,大力开展社区卫生服务,是解决老年人卫生问题的主要途径。     

Twelve-year trends in health insurance coverage among Latinos, by subgroup and immigration status

We examine twelve-year trends in the Latino uninsured population by ethnic subgroup and immigration status. From 1993 to 1999, most Latino subgroups, particularly Puerto Ricans, had large decreases in Medicaid coverage. For some subgroups these were offset by increases in employer coverage, but not for Mexicans, resulting in a four-percentage-point increase in their uninsured population. During 2000-2004, Medicaid/SCHIP expansions benefited most subgroups and mitigated smaller losses in employer coverage. However, during 1993-2004, the percentage of noncitizen Latinos lacking coverage increased by several percentage points. This was attributable to Medicaid losses during 1993-1999 and losses in employer coverage during 2000-2004.     

医保拒付医疗费用的原因及对策

医保拒付是一个普遍的问题,已成为困扰医保定点医院和医务人员的难题,其中既有医保管理部门的原因,也有医院内部的原因。解决的办法：一是医保管理部门及时修改补充医保条款,改变部分病种资金结算模式;二是医院内部强化管理,以信息技术将医嘱系统与医保政策进行融合,改＂事后惩罚＂为＂事前管理＂,同时推行临床路径电子化管理,减少医保拒付发生。     

Smoking behaviour and health care costs coverage: a European cross-country comparison

The empirical evidence about the effect of smoking on health care cost coverage is not consistent with the expectations based on the notion of adverse selection. This evidence is mostly based on correlational studies which cannot isolate the adverse selection effect from the moral hazard effect. Exploiting data from the Survey of Health, Aging, and Retirement in Europe, this study uses an instrumental variable strategy to identify the causal effect of daily smoking on perceived health care cost coverage of those at age 50 or above in 12 European countries. Daily smoking is instrumented by a variable indicating whether or not there is any other daily smoker in the household. A self-assessment of health care cost coverage is used as the outcome measure. Among those who live with a partner (72% of the sample), the result is not statistically significant which means we find no effect of smoking on perceived health care cost coverage. However, among those who live without a partner, the results show that daily smokers have lower self-assessed perceived health care cost coverage. This finding replicates the same counter-intuitive relationship between smoking and health insurance presented in previous studies, but in a language of causality. In addition to this, we contribute to previous studies by a cross-country comparison which brings in different institutional arrangements, and by using the self-assessed perceived health care cost coverage which is broader than health insurance coverage.     

以妇幼保健为重点推进社区卫生服务的发展

海珠区妇幼保健院在领导的重视下，积极成立社区卫生服务站，转变观念，利用自身优势，在原有的保健工作基础上，广泛开展健康促进活动，将保健保偿纳入社区卫生服务中，拓宽服务项目，开展以妇幼保健为重点的社区卫生服务，取得一定成效，实践证明，以妇幼保健为重点，做好社区妇幼保健工作，有利于推进社区卫生服务的全面发展。     

社区居民健康状况调查

为了解社区居民健康状况及对社区卫生服务的需求情况,实施社区卫生服务,对泉州市丰泽新村２ ２４８ 例居民进行健康调查。结果显示：社区人群中６０岁以上老年人行为能力需要别人帮助的占１３．５％,主要疾病顺位为心 血管病、骨关节病、糖尿病和慢支,需要各种不同程度服务的占７９．４９％。提示：开展社区健康服务及教育的必要性。     

The effects of question order and response-choice on self-rated health status in the English Longitudinal Study of Ageing (ELSA)

BACKGROUND: One of the most ubiquitous global health measures is a single self-rated health item. This item may be sensitive to its position in questionnaires and to response-choice wording. The aims of this paper were to investigate the effects of question order and response choice on self-reported health status. METHOD: A secondary analysis of wave 1 of the English Longitudinal Study of Ageing (ELSA). Participants were a nationally representative sample of people aged 50 years and over living at home. Over 11 000 respondents were interviewed face-to-face in their homes, and were randomly assigned to one of two versions of a self-rated health item. RESULTS: The health status item asked after, rather than before, a module of health questions, resulted in more optimal health assessments, although the effect size was small. The version of the health status item with "excellent", rather than "very good" as the first response category resulted in more optimal health assessments, although it had a smaller ceiling effect. CONCLUSIONS: There was support for the insertion of the health status question at the beginning of health questionnaires, as it may be influenced by questions about health and disease if placed at the end, although the effect size was small. Evidence for the version of the item with "excellent", rather than "very good", as the first response choice was more mixed as, although optimism bias appeared higher, the ceiling effects were lower. The smaller ceiling effects for the "excellent" version has important implications for the ability to detect improvements in follow-up studies.     

The likely effects of employer-mandated complementary health insurance on health coverage in France

In France, access to health care greatly depends on having a complementary health insurance coverage (CHI). Thus, the generalisation of CHI became a core factor in the national health strategy created by the government in 2013. The first measure has been to compulsorily extend employer-sponsored CHI to all private sector employees on January 1st, 2016 and improve its portability coverage for unemployed former employees for up to 12 months. Based on data from the 2012 Health, Health Care and Insurance survey, this article provides a simulation of the likely effects of this mandate on CHI coverage and related inequalities in the general population by age, health status, socio-economic characteristics and time and risk preferences. We show that the non-coverage rate that was estimated to be 5% in 2012 will drop to 4% following the generalisation of employer-sponsored CHI and to 3.7% after accounting for portability coverage. The most vulnerable populations are expected to remain more often without CHI whereas non coverage will significantly decrease among the less risk averse and the more present oriented. With its focus on private sector employees, the policy is thus likely to do little for populations that would benefit most from additional insurance coverage while expanding coverage for other populations that appear to place little value on CHI.     

Prolonged recruitment efforts in health surveys: effects on response, costs, and potential bias

BACKGROUND: In health surveys, considerable effort and expense are invested to achieve a high response proportion and thereby to reduce selection bias. We investigated the interrelation of recruitment efforts and expense with potential nonresponse bias based on data from a large health survey. METHODS: In a population-based health survey, a stratified sample of 6640 residents of the Augsburg (Germany) region was selected, of whom 4261 attended the main study between October 1999 and April 2001. A short telephone interview yielded additional information on nearly half of the nonparticipants. All recruitment contacts were documented, and expenses were estimated on the basis of unit costs. Different recruitment strategies were modeled retrospectively. We compared their cost savings as well as their influence on the response proportion and on prevalence estimates. RESULTS: The distribution of total contacting cost per individual was highly skewed with 50% of the total sum spent on 17% of the sample. Late responders showed many similarities with nonresponders; both included a higher percentage of people with impaired health and with greater behavioral health risks. We were able to identify recruitment strategies that may save up to 25% of the recruitment costs without significant shift in the parameter estimates. Data collected in the short nonresponder interview proved to be important to correct for possible nonresponse bias. CONCLUSIONS: In general, prolonged recruitment efforts lead to a larger and more representative sample but at increasing marginal costs. Specific cost-saving recruitment strategies that do not enhance response bias can be suggested. Interviews of nonresponders are also useful.     

舟山社区卫生服务中心健康教育现况调查及对策探讨

目的了解舟山社区卫生服务中心健康教育工作现状,提出工作改进对策。方法全面调查舟山市42家社区卫生服务中心,采用问卷、观察和自由访谈的方法,了解舟山市社区卫生服务中心健康教育工作现状。结果舟山市社区卫生服务中心基本能够完成公共卫生服务项目中的健康教育任务,但质量不容乐观;且配备的健康教育专兼职人员资历低、非公共卫生专业占了大部分,而且缺少必要的专业培训;社区医生都认为健康教育重要,并有培训需求;政府没有健康教育专项经费的投入;除普陀区外,其他县（区）都未能充分发挥健康教育专业机构的作用;只有64．29％的社区卫生服务中心能够进行电视影像播放;基层社区卫生服务中心的控烟工作很不理想。结论舟山市应落实基本公共卫生服务项目的投入,设立健康教育专项经费,加大对社区卫生服务中心健康教育工作人员的培训力度,加强社区卫生服务中心的控烟工作。     

Issues and problems in measuring children's health status in community health research

The measurement of children's health status in community surveys is hampered by both methodologic and substantive problems. These include relatively low prevalence of medical conditions among children, appropriate selection of sample questionnaire items, and difficulties in measuring health status change. There is potential value in including measures of health risk instead of, or in addition to, health status measures. This may overcome problems of low prevalence, and provide a broader base for testing the effects of program and policy changes.