Different Types Of Health Insurance Research Articles

Impact of Insurance on Readmission Rates, Healthcare Expenditures, and Length of Hospital Stay among Patients with Chronic Ambulatory Care Sensitive Conditions in China.

Background: The disparities in healthcare access due to varying insurance coverage significantly impact hospital outcomes, yet what is unclear is the role of insurance in providing care once the patient is in the hospital for a preventable admission, particularly in a weak gatekeeping environment. This study aimed to investigate the association between insurance types and readmission rates, healthcare expenditures, and length of hospital stay among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Methods: This retrospective observational study utilized hospitalization data collected from the Nanhai District, Foshan City, between 2016 and 2020. Generalized linear models (GLMs) were employed to analyze the relationship between medical insurance types and readmission rates, lengths of hospital stay, total medical expenses, out-of-pocket expenses, and insurance-covered expenses. Results: A total of 185,384 records were included. Among these, the participants covered by urban employee basic medical insurance (UEBMI) with 44,415 records and urban and rural resident basic medical insurance (URRBMI) with 80,752 records generally experienced more favorable outcomes compared to self-pay patients. Specifically, they had lower readmission rates (OR = 0.57, 95% CI: 0.36 to 0.90; OR = 0.59, 95% CI: 0.42 to 0.84) and reduced out-of-pocket expenses (β = -0.54, 95% CI: -0.94 to -0.14; β = -0.41, 95% CI: -0.78 to -0.05). However, they also experienced slightly longer lengths of hospital stay (IRR = 1.08, 95% CI: 1.03 to 1.14; IRR = 1.11, 95% CI: 1.04 to 1.18) and higher total medical expenses (β = 0.26, 95% CI: 0.09 to 0.44; β = 0.25, 95% CI: 0.10 to 0.40). Conclusions: This study found that different types of health insurance were associated with varying clinical outcomes among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Since the hospitalization of these patients was initially avoidable, disparities in readmission rates, lengths of hospital stay, and medical expenses among avoidable inpatient cases exacerbated the health gap between different insurance types. Addressing the disparities among different types of insurance can help reduce unplanned hospitalizations and promote health equity.

Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention.

Objectives: Small for gestational age (SGA) newborns have a higher risk of poor outcomes. French Guiana (FG) is a territory in South America with poor living conditions. The objectives of this study were to describe risk factors associated with SGA newborns in FG. Methods: We used the birth cohort that compiles data from all pregnancies that ended in FG from 2013 to 2021. We analysed data of newborns born after 22weeks of gestation and/or weighing more than 500g and their mothers. Results: 67,962 newborns were included. SGA newborns represented 11.7% of all newborns. Lack of health insurance was associated with SGA newborns (p < 0.001) whereas no difference was found between different types of health insurance and the proportion of SGA newborns (p = 0.86). Mothers aged less than 20years (aOR = 1.65 [1.55-1.77]), from Haiti (aOR = 1.24 [1.11-1.39]) or Guyana (aOR = 1.30 [1.01-1.68]) and lack of health insurance (aOR = 1.24 [1.10-1.40]) were associated with SGA newborns. Conclusion: Immigration and precariousness appear to be determinants of SGA newborns in FG. Other studies are needed to refine these results.

Demographic and media factors affecting women’s demand for different types of health insurance: Evidence from a developing country

Background: In the absence of a National Health Insurance Scheme, many Ugandans don’t have access to basic health care because of the high cost of attaining this health care. The problem is even worse among women who are faced with higher rates of morbidity and hospitalization. The objective of the study was to assess demographic and media factors affecting the demand for community, employer provided and private health insurance among women in Uganda. Methods: The study used secondary data from the 2016 Uganda Demographic Health Survey, a nationally representative survey. The sample comprised of 18,506 women aged 15-49 years from a population of 20,880 households. Data were analyzed using STATA version 15. Descriptive statistics, Chi square tests and the Firth logistic regression were used to understand the frequency distribution of different types of health insurance, demographic and media factors, associations between different types of health insurance, demographic and media factors and the demographic and media factors affecting the demand for community, employer provided and private health insurance. Results: The results indicated low demand for different types of health insurance among women. Education and wealth were the demographic factors that affected the demand for community and employer provided health insurance while marital status, age and education were demographic factors that affected the demand for community, employer provided and private health insurance respectively. Watching television, reading newspapers and listening to radio were the media factors that affected the demand for employer provided health insurance while listening to radio was the only media factor that affected the demand for community health insurance. Conclusions: There is a need to expedite the National Health Insurance policy to enhance the uptake of health insurance among women in Uganda.

Impact of a Statewide Multi-Payer Patient-Centered Medical Home Program on Antihypertensive Medication Adherence.

Evidence suggests that the patient-centered medical home (PCMH) model of primary care improves management of chronic disease, but there is limited research contrasting this model's effect when financed by a single payer versus multiple payers, and among patients with different types of health insurance. This study evaluates the impact of a statewide medical home demonstration, the Maryland Multi-Payer PCMH Program (MMPP), on adherence to antihypertensive medication therapy relative to non-PCMH primary care and to the PCMH model when financed by a single payer. The authors used a difference-in-differences analytic design to analyze changes in medication possession ratio for antihypertensive medications among Medicaid-insured and privately insured non-elderly adult patients attributed to primary care practices in the MMPP ("multi-payer PCMHs"), medical homes in Maryland that participated in a regional PCMH program funded by a single private payer ("single-payer PCMHs"), and non-PCMH practices in Maryland. Comparison sites were matched to multi-payer PCMHs using propensity scores based on practice characteristics, location, and aggregated provider characteristics. Multi-payer PCMHs performed better on antihypertensive medication adherence for both Medicaid-insured and privately insured patients relative to single-payer PCMHs. Statistically significant effects were not observed consistently until the second year of the demonstration. There were negligible differences in outcome trends between multi-payer medical homes and matched non-PCMH practices. Findings indicate that health care delivery innovations may yield superior population health outcomes under multi-payer financing compared to when such initiatives are financed by a single payer.

The Effect of China's Health Insurance on the Labor Supply of Middle-aged and Elderly Farmers.

Social security primarily improves residents’ welfare and ensures labor market sustainability. This study presents a new view of the association between health insurance and labor supply by using data from the China Health and Retirement Longitudinal Study. The results reveal that the health insurance system has a remarkable effect on labor supply. The health insurance coverage tends to encourage middle-aged and elderly farmers to increase their farm labor participation rate and working time, especially for their household agricultural labor participation rate and working time. However, it also reduces the non-farm labor participation rate and working time. Different types of health insurance have diverse effects on labor supply. The new cooperative medical insurance has a stronger pull-back effect. It encourages the middle-aged and elderly farmers to leave the urban non-farm sector and transfer to rural areas to engage in their household agricultural work. The urban employee medical insurance encourages farmers to reduce self-employed labor supply and increase employed work. The supplemental health insurance tends to reduce the labor supply of farm employed and non-farm labor supply, but improve the farm labor supply. Furthermore, urban resident medical insurance and government medical insurance encourage farmers to quit directly from the labor market. In conclusion, the health insurance system is facilitating change in the labor market. Policy-makers should pay full attention to such impacts while improving the health insurance system’s design and operation in China.

Abstract P162: Different Types of Health Insurance are Associated With Varying Levels of Glycemic Control and Insulin Resistance: The Multi-ethnic Study of Atherosclerosis (MESA)

Introduction: Health insurance may influence patient access and care, and thereby glycemic control. In this study, we assessed associations of insurance status with measures of glucose regulation and whether these associations varied by different insurance types, diabetes status, and/or diabetes medication use. Methods: We used baseline data (2000-2002) from the Multi-Ethnic Study of Atherosclerosis ( N = 6,627), a cohort study of adults from four racial/ethnic groups without clinically apparent cardiovascular disease. Using multivariable linear regression to adjust for confounders (age, race, sex, study site, usual site of medical care, alcohol and tobacco use, education, income, dyslipidemia, hypertension, BMI), we measured associations of insurance status and insurance type with fasting glucose and homeostasis model assessment of insulin resistance (HOMA-IR). Results: Approximately 50% of the cohort were female and the mean age and BMI were 62y and 28 kg/m 2 , respectively. Overall, 598 (9%) participants were uninsured, while 6,029 (3,343-Private, 830-Medicare, 104- Medicaid, 77-Military, 1,675-Multiple) had insurance. Fourteen percent of the total cohort had diabetes. The proportion of undiagnosed diabetes was higher in uninsured (5%) compared with insured (3%). Compared to the uninsured, insured participants had significantly lower fasting glucose (Table 1). This association persisted only among participants with diabetes. Private, Medicare, and Multiple insurance types were associated with lower fasting glucose, and only among participants with diabetes. Notably, Medicaid was associated with higher HOMA-IR. Conclusion: In this large multiethnic cohort, health insurance was associated with significantly lower fasting glucose. These findings demonstrate insurance coverage is relevant towards improving glycemic control in patients with diabetes. However, our study also highlights nuances and limitations to this relationship, suggesting that all types of insurance may not be equivalent.

Increased Rates of Allogeneic Hematopoietic Stem Cell Transplantation and Overall Survival in Philadelphia-Positive Acute Lymphoblastic Leukemia Patients with Broader Health Insurance Coverage

Introduction The Philadelphia chromosome is associated with a poor prognosis in patients with acute lymphoblastic leukemia (ALL). While modern day therapies including allogeneic hematopoietic stem cell transplantation (HSCT) have led to significant improvements in overall survival (OS) for this population, these treatments have variable accessibility in patients with limited to no health insurance. Methods We performed a single-center, retrospective study to investigate outcomes in Ph+ ALL adults with different types of health insurance. Health insurance options included Medicare, private insurance, Medicaid, or no insurance. Allogeneic HSCT was performed in patients who met transplant eligibility criteria of insurance coverage and caregiver availability at home. Patient OS was defined as the time from diagnosis of Ph+ ALL until patient death. Statistical analysis was performed using the Fisher's exact probability test with two-tailed p-values Results A total of 81 patients with Ph+ ALL were included in this study. Two groups of patients were compared: those with either Medicare or private insurance (M/P) versus those with Medicaid or no insurance (M/N). Thirty-three patients (40.7%) were included in the M/P group and 48 patients (59.2%) in the M/N group. Twenty patients (60.6%) in the M/P group were able to undergo allogeneic HSCT in contrast to 15 patients (31.3%) in the M/N group (p = 0.012). There were similar rates of caregiver availability to support HSCT between both groups; 24 M/P patients (72.7%) lived with a caregiver versus 33 M/N patients (68.8%) in comparison (p = 0.806). In analyzing rates of OS, the 1-year OS was 100% vs. 85.1% (p = 0.038), 2-year OS was 96.2% vs. 75.8% (p = 0.033), and 3-year OS was 88.2% vs. 59.2% (p = 0.049) for M/P patients compared to M/N patients, respectively. Conclusion With the emergence of allogeneic HSCT, the rates of OS in the Ph+ ALL population improved dramatically from the prior era. However, barriers still exist to undergoing transplant, one of the most formidable being appropriate insurance coverage. This study demonstrated that a significantly higher percentage of Ph+ ALL patients in the M/P group were able to undergo allogeneic HSCT compared to those in the M/N group. While eligibility for transplant depended on caregiver availability in addition to insurance status, there were similar rates of caregivers between the two groups, thus implying that this factor had no major impact on the differing rates of HSCT. Furthermore, M/P patients were found to have significantly higher rates of OS at the 1-year, 2-year, and 3-year marks compared to those in the M/N group. Given that broader health insurance coverage was correlated with increased rates of both allogeneic HSCT and OS, it remains a critical point of discussion in the treatment of Ph+ ALL patients from all socioeconomic backgrounds.

Health Insurance Status Impacts Rates of Overall Survival in Philadelphia-Positive Acute Lymphoblastic Leukemia

Introduction: The Philadelphia chromosome is associated with a poor prognosis in patients with acute lymphoblastic leukemia (ALL). Prior to the use of hematopoietic stem cell transplantation (HSCT) and tyrosine kinase inhibitors (TKIs), Philadelphia-positive (Ph+) ALL patients were found to have an overall survival (OS) rate of less than 20% over the course of 3 years (Thomas et al., Blood 2004). While modern day therapies including allogeneic HSCT and newer-generation TKIs such as dasatinib have led to significant improvements in OS for this population, these treatments have variable accessibility due to costs for patients with limited to no health insurance. Methods: We performed a retrospective study at the Norris Comprehensive Cancer Center and Los Angeles County Hospital, both associated with the University of Southern California, to investigate outcomes in Ph+ ALL adults with different types of health insurance. Individuals included in the study were diagnosed with Ph+ ALL between 2004-2019. Health insurance options included private insurance, Medicare, Medicaid, or no insurance. Treatment modalities included allogeneic HSCT followed by maintenance TKI therapy or combination chemotherapy plus a TKI. The former was preferred if patients met the key transplant eligibility criteria of insurance coverage and caregiver availability at home. Patient OS was defined as the time from diagnosis of Ph+ ALL until patient death. Statistical analysis was performed using the Fisher's exact probability test with two-tailed p-values &lt;0.05 deemed significant. Results: A total of 81 patients with Ph+ ALL were included in this study. Forty-seven patients (58%) were male and the median age at the time of diagnosis was 45 years (range 20-70). Two groups of patients were compared: those with either Medicare or private insurance (M/P) versus those with Medicaid or no insurance (M/N). Thirty-three patients (40.7%) were included in the M/P group and 48 patients (59.2%) in the M/N group. In comparing rates of OS, the 1-year OS was 100% vs. 85.1% (p = 0.038), 2-year OS was 96.2% vs. 75.8% (p = 0.033), and 3-year OS was 88.2% vs. 59.2% (p = 0.049) for M/P patients compared to M/N patients, respectively (Figure 1). In terms of treatment, there was a significant difference in the number of patients eligible to undergo allogeneic HSCT as 20 patients (60.6%) in the M/P group were able to be transplanted in contrast to 15 patients (31.3%) in the M/N group (p = 0.012). There were similar rates of caregiver availability to support HSCT between both groups; 24 M/P patients (72.7%) lived with a caregiver versus 33 M/N patients (68.8%) in comparison (p = 0.806). Furthermore, there were significantly more patients in the M/P group who were able to be treated with the newer-generation TKI dasatinib instead of the older agent imatinib compared to M/N patients (100% vs. 85.4%, p = 0.038). Conclusion: With the emergence of allogeneic HSCT and newer-generation TKIs, the rates of OS in the Ph+ ALL population improved dramatically from the prior era (Fielding et al., Blood 2009). However, barriers still exist to receiving these modern therapies, one of the most formidable being sufficient insurance coverage of costs. This study demonstrated that the Ph+ ALL population in the M/P group had significantly higher rates of OS at the 1-year, 2-year, and 3-year marks compared to those in the M/N group. Furthermore, there were also a greater percentage of patients in the former group who were able to undergo allogeneic HSCT during the study period. While eligibility for allogeneic HSCT depended on caregiver availability in addition to insurance status, there were similar rates of caregivers between the two groups, thus implying that this factor had no major impact on the differing rates of HSCT. Dasatinib was previously shown to have increased potency in inhibiting the in vitro growth of cells with wild-type BCR-ABL compared to imatinib, making it a preferred choice for TKI therapy (Li, Leukemia &amp; Lymphoma 2008). There were again significantly more M/P patients than M/N patients who were able to be treated with dasatinib rather than imatinib. Given that health insurance status was found to be correlated with rates of OS, allogeneic HSCT, and the availability of newer-generation TKIs, it remains a critical point of discussion in the treatment of Ph+ ALL patients from all socioeconomic backgrounds. Disclosures No relevant conflicts of interest to declare.

The impact of medical insurance on medical expenses for older Chinese: Evidence from the national baseline survey of CLHLS.

With the deepening population aging process in China, the medical expenses of older adults has become a widespread concerned. Medical insurance is a major source of Chinese medical financing and payment. The study aims to understand the current status of medical expenses for older adults and explore the effect of different types of health insurance on medical expenses in China.The data came from the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2014. The Kruskal–Wallis test and general multivariate linear regression model were applied to analyze the current situation and to explore how medical insurance as the main payment impacts medical expenses.A total of 4376 older participants were included in this study. The median of medical expenses of a total was 1500 Yuan per year. The proportions of participants who had the urban employee-based basic medical insurance (UE-BMI), the urban residents basic medical insurance (UR-BMI), the new rural cooperative medical insurance scheme (NCMS), and the commercial medical insurance were 10.8%, 8.4%, 72.7%, and 0.9%, respectively. 34.8% of older adults paid the health care service via the NCMS and 11.9% paid via the UE-BMI. Participating in the NCMS and UR-BMI are significantly related to the level of the medical fees of older adults. UE-BMI, UR-BMI, and NCMS as main payment eased the pressure of medical expenses.The influence of different types of medical insurances as main payments on the medical expenses of older adults is varied. Implementation of medical insurance should be taken to further relieve the medical expenses of older adults.

Facing the urban-rural gap in patients with chronic kidney disease: Evidence from inpatients with urban or rural medical insurance in central China.

BackgroundIn view of the irreversible pathology of progressive exacerbation, the societal burden of chronic kidney disease (CKD) is increasing along with the rise in total health expenditure. Meanwhile, disparities remain among urban and rural citizens with different types of health insurance. This study aimed to assess the socioeconomic disparities between hospitalized CKD patients in urban and rural areas.MethodA total of 501 CKD inpatients with urban or rural medical insurance (UMI or RMI, respectively) were selected from the top six tertiary hospitals in Wuhan. Demographic and socioeconomic data were collected as influencing factors. Data evaluation was performed using univariate and multivariate analyses.ResultSocioeconomic characteristics showed differences among hospitalized CKD patients with different health insurances. Patients with RMI were younger, and reported lower education levels, poor domestic economic conditions, shorter duration, and less frequent hospital stays than those with UMI (P<0.05). The predictors revealed varying associations between UMI and RMI. Among the hospitalized CKD patients with UMI, male and low-education individuals presented high hospitalization expenses (βgender = -0.406, βeducation level = 0.357, P<0.05). By contrast, no significant difference in this aspect was found among RMI inpatients.ConclusionsCare delivery and reimbursement models should be re-designed and implemented to improve equity among different CKD patients. The national health education should also be enhanced to prevent CKD and provide early treatment.

Trends in Cancer Survival by Health Insurance Status in California From 1997 to 2014

ImportanceThere have been substantial improvements in the early detection, treatment, and survival from cancer in the United States, but it is not clear to what extent patients with different types of health insurance have benefitted from these advancements.ObjectiveTo examine trends in cancer survival by health insurance status from January 1997 to December 2014.Design, Setting, and ParticipantsCalifornia Cancer Registry (a statewide cancer surveillance system) data were used to estimate population-based survival by health insurance status in 3 calendar periods: January 1997 to December 2002, January 2003 to December 2008, and January 2009 to December 2014 with follow-up through 2014. Overall, 1 149 891 patients diagnosed with breast, prostate, colorectal, or lung cancer, or melanoma in California were included in the study.Main Outcomes and MeasuresFive-year all-cause and cancer-specific survival probabilities by insurance category and calendar period for each cancer site and sex; hazard ratios (HRs) and 95% CIs for each insurance category (none, Medicare, other public) compared with private insurance in each calendar period.ResultsAccording to data from 1 149 891 patients diagnosed with breast, prostate, colorectal, or lung cancer, or melanoma gathered from the California Cancer Registry, improvements in survival were almost exclusively limited to patients with private or Medicare insurance. For patients with other public or no insurance, survival was largely unchanged or declined. Relative to privately insured patients, cancer-specific mortality was higher in uninsured patients for all cancers except prostate, and disparities were largest from 2009 to 2014 for breast (HR, 1.72; 95% CI, 1.45-2.03), lung (men: HR, 1.18; 95% CI, 1.06-1.31 and women: HR, 1.32; 95% CI, 1.15-1.50), and colorectal cancer (women: HR, 1.30; 95% CI, 1.05-1.62). Mortality was also higher for patients with other public insurance for all cancers except lung, and disparities were largest from 2009 to 2014 for breast (HR, 1.25; 95% CI, 1.17-1.34), prostate (HR, 1.17; 95% CI, 1.04-1.31), and colorectal cancer (men: HR, 1.16; 95% CI, 1.08-1.23 and women: HR, 1.11; 95% CI, 1.03-1.20).Conclusions and RelevanceAfter accounting for patient and clinical characteristics, survival disparities for men with prostate cancer and women with lung or colorectal cancer increased significantly over time, reflecting a lack of improvement in survival for patients with other public or no insurance. To mitigate these growing disparities, all patients with cancer need access to health insurance that covers all the necessary elements of health care, from prevention and early detection to timely treatment according to clinical guidelines.

Effect of health insurance on direct hospitalisation costs for in-patients with ischaemic stroke in China

Objectives The aim of the present study was to determine the direct medical costs of hospitalisations for ischaemic stroke (IS) in-patients with different types of health insurance in China and to analyse the demographic characteristics of hospitalised patients, based on data supplied by the China Health Insurance Research Association (CHIRA). Methods A nationwide and cross-sectional sample of IS in-patients with International Classifications of Diseases 10th Revision (ICD-10) Code I63 who were ensured under either the Basic Medical Insurance Scheme for Employees (BMISE) or the Basic Medical Insurance Scheme for Urban Residents (BMISUR) was extracted from the CHIRA claims database. A retrospective analysis was used with regard to patient demographics, total hospital charges and costs. Results Of the 49588 hospitalised patients who had been diagnosed with IS in the CHIRA claims database, 28850 (58.2%) were men (mean age 67.34 years) and 20738 (41.8%) were women (mean age 69.75 years). Of all patients, 40347 (81.4%) were insured by the BMISE, whereas 8724 (17.6%) were insured by the BMISUR; the mean age of these groups was 68.55 and 67.62 years respectively. For BMISE-insured in-patients, the cost per hospitalisation was RMB10131 (95% confidence interval (CI) 10014-10258), the cost per hospital day was RMB787 (95% CI 766-808), the out-of-pocket costs per patient were RMB2346 (95% CI 2303-2388) and the reimbursement rate was 74.61% (95% CI 74.48-74.73%). For BMISUR-insured in-patients the cost per hospitalisation was RMB7662 (95% CI 7473-7852), the cost per hospital day was RMB744 (95% CI 706-781), the out-of-pocket costs per patient were RMB3356 (95% CI 3258-3454) and the reimbursement rate was 56.46% (95% CI 56.08-56.84%). Conclusions Costs per hospitalisation, costs per hospital day and the reimbursement rate were higher for BMISE- than BMISUR-insured in-patients, but BMISE-insured patients had lower out-of-pocket costs. The financial burden was higher for BMISUR- than BMISE-insured in-patients. For BMISUR-insured in-patients, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursements to meet the health needs of in-patients with different income levels. What is known about the topic? Cardiovascular and cerebrovascular diseases are major non-communicable diseases affecting the health of the Chinese population. The China Health Statistics Yearbook (2013) reported that across all in-patients, 195million (5.82%) had been discharged with a diagnosis of cerebrovascular disease. Of these, 118million had IS, accounting for 60.51% of all in-patients with cerebrovascular disease and 54.97% of hospitalisation costs for all cerebrovascular disease in-patients. After the two basic insurance systems, namely the BMISE and BMISUR, had been established, the out-of-pocket expenses for patients were reduced. However, to date there have been no studies investigating how the different types of health insurance (i.e. the BMISE and the BMISUR) affected the costs of treatment of IS in-patients in China. What does this paper add? This paper reports the direct costs for patients diagnosed with IS based on data supplied by the CHIRA. Direct hospitalisation costs depending on the type of insurance cover, age and gender were also evaluated. What are the implications for practitioners? The present study found that the personal financial burden of disease treatment was higher for in-patients insured under the BMISUR than BMISE. For in-patients insured under the BMISUR, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursement rates to meet the health needs of patients with different incomes.

PCN186 - The Health Service Utilization of Liver Cancer Inpatients with Different types of Health Insurance in China

PCN186 - The Health Service Utilization of Liver Cancer Inpatients with Different types of Health Insurance in China

The Health Care Hand-book: A Clear and Concise Guide to the United States Health Care System

The Health Care Handbook has already garnered dozens of strongly favorable reviews, including a glowing one from the New York Times. So why another review? For starters, it may bring this book to the attention of more readers, which would be a very good thing. It is also an opportunity to provide information about additional content and supplemental resources that are available electronically. According to Merriam-Webster’s online dictionary, a handbook is “a small book that gives useful information about a particular subject” [1]. If that were the only benchmark, this book absolutely succeeds. Fortunately, it also succeeds admirably at achieving the authors’ stated goal: “to provide a baseline level of facts and analysis so that readers may go forth with the ability not only to understand and evaluate what they read but also to form their own opinions.” While still medical students, the authors sought unsuccessfully to find a book that would clearly and concisely explain the health care system in which they would soon be working. When they failed to find one, they decided to fill the gap themselves. The result is a thoroughly researched yet eminently readable book. Core concepts and key facts replace the jargon, acronyms, and bureaucratese that can thwart understanding. Written in a conversational and occasionally even humorous tone, this book is also a pleasure to read. Five well-organized chapters cover topics including inpatient and outpatient health care and delivery systems; the different types of health insurance and how they are structured; health policy and government health care programs; the Affordable Care Act, challenges to that law, and other reform options; and economic concepts and the factors that make health care so expensive. Excellent graphics help to illustrate key points. Each chapter concludes with a glossary, suggestions for additional reading, and a list of references. A comprehensive index makes it easy to find specific information. There is now a website hosted by Washington University, largely dedicated to promoting this book. There is no additional or updated content here, but a link leads to an educational resource, MedEdPORTAL , from the American Association of Medical Colleges. The authors are creating curricular materials to support use of this book in educational settings, which they are making freely available . MedEdPORTAL “promotes educational scholarship and collaboration by facilitating the open exchange of peer-reviewed health education teaching and assessment resources.” Although it is a work in progress with some pages still under construction, those of us who work with students will want to explore this resource further. Despite the 2012 publication date, it may be tempting to regard this book as already outdated—given the astonishingly rapid rate of change in health care—and no longer needed in a library’s collection. But that would be a disservice to our patrons. As Carl Sagan said, “You have to know the past to understand the present,” and the Health Care Handbook helps us do exactly that. Editor’s note: The second edition of this work will be reviewed in a future issue.

The effect of a severe health shock on work behavior: Evidence from different health care regimes

In this paper, we use the policy variation of two different types of health insurance in the US and in Denmark – employer-provided and universal insurance combined with substantial differences in expected and actual medical out-of-pocket expenditures – to explore the effect of new severe health shocks on the labor force participation of older workers. Our results not only provide insight into how relative disease risk affects labor force participation at older ages, but also into how different types of health care and health insurance systems affect individual decisions of labor force participation. Although employer-tied health insurance and greater out-of-pocket medical expenditures give US Americans greater incentives to continue to work, we find only small differences in the work response between the two countries. We provide compelling evidence that our somewhat counterintuitive finding is the result of differential mortality and baseline health differences coupled with distinct treatment regimes under the respective health care systems.

PCV120 - The Impact of Different Types of Health Insurance on The Hospitalization Services Utilization of Patients With Hemorrhagic Stroke In China

PCV120 - The Impact of Different Types of Health Insurance on The Hospitalization Services Utilization of Patients With Hemorrhagic Stroke In China

How well does the U.S. Government provide health insurance for infants?

The debate over universal health insurance (HI) in the U.S., as well as the proper role of the government in the HI market, has been quite heated. Fueling this debate is the uncertainty pertaining to the benefits of HI in general, and the relative benefits of private versus public HI in particular. This uncertainty stems from non-random selection into different types of HI (private, public, or none) in combination with the absence of experimental data. Moreover, the lack of typical exclusion restrictions complicates identification of the causal effects of different HI types. Here, the aim is to assess the causal impact of public HI, relative to private HI, on the insured infant’s health. To that end, this study employs the methodology proposed in Altonji et al. (J Polit Econ 113:151–184, 2005) which trades off what can be learned in exchange for not requiring an exclusion restriction. Nonetheless, the method remains quite informative in the present context. Specifically, using data from the Early Childhood Longitudinal Survey, Birth Cohort, along with several measures of infant health, the results suggest that while public HI is associated with worse infant health, this association disappears once selection on observables and unobservables is considered. In fact, the estimated effects of public HI are predominantly positive once both types of selection are admitted. Further analysis reveals that the likely beneficial effects of public HI are due to greater coverage for infants at a much lower cost.

Comparison study of inequality based on health expenses of households in provinces of Iran

Background & Objective: These days, in many societies, fair and equality are the most significant concepts among the governments and peoples. The concept of fairness in the health systems, describes equal expenses of households in this area. The aim of this paper is to investigate the health expense inequality of households in the Iran provinces, with Gini index of inequality measurement and statistical methods. Material & Methods: In this paper we use the 2008 health expense data from statistical center of Iran. The process of preparing data and estimating the statistical indexes, (like mean and coefficient of variation, Lorenz curve and evaluating the Gini index) and making plots have been done with the use of S-PLUS software. For making the index comparing maps we have used Arcgis 9.2 software. Results: By estimating the Gini index, plots and maps we found out that there is a remarkable inequality of health expenses in the provinces such as the Khorasan Razavi and Hormozgan by 0.71 and 0.92 who had the least and the most expenses between the provinces. On the other hand the mean of these expenses varies from 90000 to 630000 Rials and the poor provinces that are in the east borders of Iran have the least mean of this expense. Conclusions: The mean expenses of health in households decreases between states by going from east to the west of country. The household expenses of poor states have the least incomes and, the least facilities in health. On the other hand inequality in this expenses distribution is noticeable. Governments should decrease the inequality by increasing health facilities and financial aids in poor areas and in different ways such as different types of health insurance.

The role of different types of health insurance on access and utilization: comparative results on two chronic conditions (hypertension and diabetes type II without complication)

Managerial and Decision EconomicsVolume 28, Issue 4-5 p. 503-507 Research Article The role of different types of health insurance on access and utilization: comparative results on two chronic conditions (hypertension and diabetes type II without complication) How patient economics may influence physicians' prescribing decisions Christine Huttin, Corresponding Author Christine Huttin chris.huttin@comcast.net ENDEPUS Research, Inc., Cambridge, MA, USA, Visiting Berkeley Econometric Laboratory, and Professor, University Paul Cezanne, Aix-en-ProvenceENDEPUS Research, Inc., 1770 Massachusetts Avenue, Box 284, Cambridge, MA 02140, USASearch for more papers by this author Christine Huttin, Corresponding Author Christine Huttin chris.huttin@comcast.net ENDEPUS Research, Inc., Cambridge, MA, USA, Visiting Berkeley Econometric Laboratory, and Professor, University Paul Cezanne, Aix-en-ProvenceENDEPUS Research, Inc., 1770 Massachusetts Avenue, Box 284, Cambridge, MA 02140, USASearch for more papers by this author First published: 17 August 2007 https://doi.org/10.1002/mde.1358Citations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume28, Issue4-5Special Issue: Economic and Policy Issues in the Pharmaceutical IndustryJune ‐ August 2007Pages 503-507 RelatedInformation

Funding, Ethics, and Assistive Technology: Should Medical Necessity Be the Criterion by Which Wheeled Mobility Equipment Is Justified?

The article will explore the use of the term medical necessity as it relates to wheeled mobility. Health insurance will cover a wheelchair if it is determined that it is medically necessary for a particular client. There are many different types of health insurance, and no universal definition of medical necessity. This presents a problem for clients and for individuals who are making wheelchair recommendations for clients. Case studies describe how equipment is currently recommended based on the limitations of the client's insurance coverage. As more equipment becomes available to improve the quality of life for people with disabilities, it will become harder for therapists recommending equipment to determine the limits of medical necessity.