Insurance Options Research Articles

How The "Great Resignation" and COVID Unemployment Have Eroded the Employer Sponsored Insurance Model and Access to Healthcare.

Pre-pandemic, employer-sponsored health insurance (ESI) covered 175 million workers and their dependents, the equivalent of 49% of the country's total population. ESI, a valuable tax preference to employer and employee alike, spurred worker job dependence on employers resulting in access to healthcare dependent upon continued employment. With the advent of the pandemic and the dramatic increase in unemployment, the number of uninsured increased by more than 2.7 million people. Then, unemployment proliferated further by an unprecedented exit from the workforce dubbed the "Great Resignation." Over 47 million Americans voluntarilyquit their jobs in a movement characterized as a general labor strike. The pandemic opened the floodgates to workers' concerns about COVID safety in the workplace, wage stagnationdespite increases in the cost of living, enduring job dissatisfaction, and increased demand for a remote-working environment. Data shows that the unemployed shifted to the Affordable Care Act marketplace or to the public payer option, Medicaid, for coverage. This shift signals a change, post-pandemic, away from the destabilizing system of access to care based on employment and unwanted job dependence and provides a policy argument favoring the more stabilizing influence of public insurance options in the health insurance market.

The Need for Transparency in Medicaid Managed Care: Section 1115 Waiver Requirements as a Blueprint.

Medicaid plays a significant role in the health care space, providing insurance coverage to nearly one quarter of the U.S. population. In recent years, managed care organizations have taken on an increasingly prominent role in the Medicaid space, and in many instances have become the sole insurance option for Medicaid recipients. The scale and method of implementation for managed care programs has varied widely from state to state. This Note discusses the many methods by which a state can enact managed care within its Medicaid program, and summarizes the challenges with assessing the success of such programs. It proposes a uniform approach to managed care reporting requirements designed to increase transparency and accountability across state lines, and in turn ensure quality care for Medicaid managed care beneficiaries.

Utilization of health insurance by patients admitted for dental surgical procedures at a tertiary care hospital in Coastal Karnataka: a retrospective study.

Background: There are various medical insurance options available in India. However, unlike many other countries, dental insurance plans are rare. The aim of this study was to assess the utilization of various government and private health insurance schemes by patients admitted for dental surgical procedures at a tertiary care hospital in coastal Karnataka, India. Methods: A study was conducted retrospectively to gather data on the socio-demographics, bill details, insurance, and benefits claimed by patients admitted to the Department of Oral and Maxillofacial Surgery at a tertiary care hospital from May 2016 to September 2022. Results: Out of 1750 patients, only 856 (48.9%) patients had availed of insurance, 395 patients (22.6%) utilized government health insurance policies, and 461 patients (26.3%) availed of private health insurance plans. Among Government schemes, primarily Ayushman Bharat-Arogya Karnataka was used by 262 (30.6%) patients, followed by Employees' State Insurance Scheme by 110 (12.9%) patients. Among private schemes, 212 (24.8%) patients used the policies purchased by them, 19 (2.2%) patients' medical expenses were paid by their employers, 105 (12.3%) patients utilized Manipal Arogya Suraksha and 124 (14.5%) patients used Medicare provided by the hospital. Bivariate linear regression confirmed that the total bill amount, out-of-pocket expenditure by the patient, and insurance amount reimbursed to the hospital were significantly associated with the type of insurance (government vs. private). The study noticed a gradual rise in insured patients every year. Conclusion: Greater utilization of health insurance should be encouraged because the cost of dental treatment has always hindered the use of oral health services worldwide. This study highlights that the benefit available to the patients were mainly through general health insurance schemes, not specifically dental health insurance. Insurance schemes covering dental must be promoted more aggressively in the media, highlighting their available benefits, merits, and demerits.

Experiences of low-income college students in selection of health insurance, access, and quality of care

Objective To understand the experiences and perspectives of low-income University of California undergraduates related to their health insurance options, access to and quality of care. Participants 14 undergraduate students across five UC campuses who identified as socioeconomically disadvantaged or low-income. Methods We conducted 4 focus groups organized by type of insurance coverage in April 2022. Results (1) the insurance selection process for low-income students is complicated by multiple, sometimes competing factors; (2) the lack of clear information confuses students’ selection of insurance and health care options; and (3) students experiences challenges in access and quality of care, irrespective of insurance type. Conclusions Ensuring access to high quality care, information and coverage is critical to the university mission to support a diverse, equitable and inclusive environment, for a student body that reflects the needs of the population of California.

Nationwide analysis of legal barriers impacting patients with cancer and caregivers.

300 Background: The extent of legal barriers requiring appropriate navigation in patients following cancer diagnosis is unknown. We performed a nationwide analysis of a patient navigation program to investigate prevalence of such barriers. Methods: This retrospective analysis used the Triage Cancer Legal & Financial Navigation Program’s de-identified electronic database. Triage Cancer is a national, nonprofit organization that provides free education on legal issues that impact individuals diagnosed with cancer. Sociodemographic, financial, disease-site, and medical-legal navigation information were obtained for descriptive analysis. The main study outcome was the primary legal issue prompting a call to Triage Cancer for assistance. Associations between variables and the primary legal issue were explored with multinomial logistic regression analysis. Results: We investigated 2613 callers (1679 patients, 463 caregivers, 373 providers) between 2021-2023 in reference to patients who were 61% female, 57% aged 40-64y, 48% White, 37% employed, 32% on employer-sponsored insurance, and 45% with income <$50k. Breast (27%), hematologic (18%), and GI (10%) cancers were most common, and 39% of all patients were on treatment at time of call. Majority called for assistance with 1 (51%) or 2 (32%) legal barriers. Most common primary issue was health insurance (29% - insurance options, navigation, and appeals), followed by financial (20% - financial assistance or life insurance), disability (18% - applications and appeals), employment (17% - taking time off, working through treatment, returning to work, laid off, new job search, and unemployment benefits), and other (16% - housing, estate planning). Compared to health insurance, navigation for disability-related barriers was significantly higher among Black (OR 2.1) patients, and those with GI (OR 3.1) and lung cancer (OR 2.9) (Table). Employment barriers were higher among Black (OR 2.5) and Hispanic (OR 2.5) patients, and financial barriers among Black (OR 2.9), Hispanic (OR 2.4), and those on Medicaid (OR 2.9). Conclusions: This study highlights the prevalence of legal barriers impacting patients with cancer and their caregivers. It underscores an urgent need for accessible legal navigation programs, and potential for federal policy-level efforts in building legal safeguards to improve care.[Table: see text]

A STUDY ON COMPARATIVE ANALYSIS OF TERM INSURANCE PRODUCTS OF ICICI PRUDENTIAL LIFE INSURANCE WITH OTHER MAJOR INSURANCE PLAYERS IN BENGALURU

The research explores the relevance of term insurance as a form of life coverage, highlighting its focus on providing financial protection for a specific duration. Unlike permanent life insurance options, term insurance offers simplicity and affordability, addressing temporary coverage needs. The research identifies a gap in understanding consumer perceptions of term insurance and its associations with negative emotions. It discusses the uniqueness of term insurance and its customizable nature, catering to various financial goals and obligations. The study's focus on a paired samples analysis within Diverse age categories indicate considerable variations in profit returns, emphasizing the impact of age on returns and offering strategic insights. While relying on secondary data sources presents limitations, the findings suggest varied premium rates among insurance providers based on factors like financial stability and reputation. The research proposes strategies for companies with different premium rates and recommends picking the right age ranges for term insurance. In summary, this research amplifies comprehension, of term insurance's significance and aids in informed decision- making for both insurance providers and consumers. Key words: Comparative analysis, Term Insurance, Premium rate, other Insurance Players, Affordability, Ages, Policyholders, Policy Time

Two‐Minute Drill

Research reveals balance is key to success for student‐athletes Sports betting prevalent among young adults, survey shows NCAA to provide post‐eligibility injury insurance option

Culture of vitrified bovine ovarian tissue on agarose gel inserts maintains follicle integrity.

Ovarian tissue cryopreservation and culture provide an option for fertility preservation without tissue grafting, but need optimization. This study reveals that vitrified bovine ovarian tissue can be cultured on agarose gel and maintain follicle morphology, low activation, and low apoptosis. Ovarian tissue preservation is hitherto a promising fertility insurance option for precious animals. Ovarian tissue vitrification and culture combined approach would eliminate the need of transplanting ovarian tissue to obtain mature oocytes. We aimed at optimizing vitrification and in vitro culture conditions for improved bovine ovarian tissue viability. Ovaries obtained from the slaughterhouse were punched into fragments and divided into three groups. Group 1 (fresh) was divided into two and immediately placed in two-culture systems (culture inserts and agarose inserts). Group 2 was vitrified, warmed, and placed in the two-culture systems, while group 3 was only equilibrated and then placed in the two-culture systems. All cultures were maintained for 6 days and spent media were collected on alternate days for cytokine (interleukin 1β and interleukin 6) evaluation. Fragments were fixed for morphology assessment and immunohistochemistry. Higher percentages (P < 0.05) of grade 1 (morphologically intact) follicles were observed in fragments on agarose compared to those on culture inserts on days 2 and 4 of the culture. Conversely, we found higher (P < 0.05) shifts of primordial follicles to transitional follicles in fragments on culture inserts vis-à-vis agarose inserts which was consistent with a higher proportion of Ki-67 and MCM-7 and activated caspase-3-positive follicles. In conclusion, in vitro culture of bovine ovarian tissue on agarose inserts maintained follicle morphology, low follicle activation, and low apoptosis compared to culture inserts.

Utilization of health insurance by patients admitted for dental surgical procedures at a tertiary care hospital in Coastal Karnataka: a retrospective study

Background: There are various medical insurance options available in India. However, unlike many other countries, dental insurance plans are rare. The aim of this study was to assess the utilization of various government and private health insurance schemes by patients admitted for dental surgical procedures at a tertiary care hospital in coastal Karnataka, India. Methods: A study was conducted retrospectively to gather data on the socio-demographics, bill details, insurance, and benefits claimed by patients admitted to the Department of Oral and Maxillofacial Surgery at a tertiary care hospital from May 2016 to September 2022. Results: Out of 1750 patients, only 856 (48.9%) patients have availed of insurance, 395 patients (22.6%) utilized government health insurance policies, and 461 patients (26.3%) availed of private health insurance plans. Among Government schemes, primarily Ayushman Bharat-Arogya Karnataka was used by 262 (30.6%) patients, followed by Employees' State Insurance Scheme by 110 (12.9%) patients. Among private schemes, 212 (24.8%) patients used the policies purchased by them, 19 (2.2%) patients’ medical expenses were paid by their employers, 105 (12.3%) patients utilized Manipal Arogya Suraksha and 124 (14.5%) patients used Medicare provided by the hospital. Bivariate linear regression confirmed that the total bill amount, out-of-pocket expenditure by the patient, and insurance amount reimbursed to the hospital were significantly associated with the type of insurance (government vs. private). The study noticed a gradual rise in insured patients every year. Conclusion: Greater utilization of health insurance should be encouraged because the cost of dental treatment has always hindered the use of oral health services worldwide. This study highlights that the benefit available to the patients were mainly through general health insurance schemes, not specifically dental health insurance. Insurance schemes covering dental must be promoted more aggressively in the media, highlighting their available benefits, merits, and demerits.

High-deductible Health Plans and Nonfatal Opioid Overdose.

Opioid-related overdose is a public health emergency in the United States. Meanwhile, high-deductible health plans (HDHPs) have become more prevalent in the United States over the last 2 decades, raising concern about their potential for discouraging high-need populations, like those with opioid use disorder (OUD), from engaging in care that may mitigate the probability of overdose. This study assesses the impact of an employer offering an HDHP on nonfatal opioid overdose among commercially insured individuals with OUD in the United States. We used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. We used an intent-to-treat, difference-in-differences regression framework to estimate the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. We also used an event-study model to account for dynamic time-varying treatment effects. Across both comparison and treatment groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. Our primary model and robustness checks revealed no impact of HDHP offer on the probability of a nonfatal overdose. Our study suggests that HDHP offer was not associated with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD. However, given the strong evidence that medications for OUD (MOUD) can reduce the risk of overdose, research should explore which facets of insurance design may impact MOUD use.

Adequacy of psychiatry networks lags in Medicare Advantage plans

Medicare Advantage plans have become an increasingly attractive insurance option for older Americans, but results of a new study suggest that in many cases the cost savings they bring could come at the expense of access to psychiatric services.

Drivers of Health Insurance Coverage in Low Income Settlements: A Case of Kibera Informal Settlement, Nairobi County, Kenya

Insurance is critical for any country's economic growth and development to be sustainable. In rural areas of Kenya, among the illiterate, unemployed, poor, and vulnerable in society, health insurance adoption is extremely low. This paper focuses on determining the drivers for health insurance uptake among low-income populations in Kibera, Nairobi County. Semi structured questionnaires were administered to households located in Kibera informal settlements to collect data. The Yamane (1967) formula was used to select the sample size. Simple random sampling was adopted in selecting 399 respondents. Both descriptive and inferential analysis were conducted. The binary probit regression model was employed. Health insurance ownership was used as the dependent variable while age, gender, marital status, household size, school attainment, occupation, income levels, religion, cultural beliefs, frequency of hospital visits, cost of premiums, and pre-existing illness were used as the independent variables. Findings revealed that only 27.6 percent of the respondents had health insurance coverage. The findings further revealed that occupation, income levels, and religion significantly influence health insurance ownership among low-income populations in Kibera, Nairobi. Public health insurance cover was the most owned type of health insurance scheme. Recommendations were highlighted for the ministry of health and other relevant stakeholders to raise knowledge on the various health insurance options available and improve flexibility of the products to drive insurance uptake. In addition, national and county governments need to develop programmes and policies that could empower households in the informal settlements. Further, it is necessary for the government to subsidise the cost of acquiring public health insurance covers since this would encourage uptake among low-income families. The ministry of health should also work in conjunction with various religious denominations to campaign for uptake of health insurance among the poor.

Impact of financial well-being on gender affirmation surgery access and hospital course

Although gender affirmation surgery (GAS) can effectively treat gender dysphoria, it remains one of the most expensive components of gender affirming care. This study aims to identify the impact of financial well-being on GAS access and hospital course in the United States. The National Inpatient Sample database was queried from 2012 to 2019. US transgender patients undergoing GAS were identified. Predictors included patient sociodemographic variables. Outcomes included hospitalization course variables. Regression modeling was used to assess the relationship between predictor and outcome variables. Significance was set at α=0.05. A total of 5620 weighted GAS encounters were identified (genital surgery 92.3%, chest surgery 16.6%). 1825 (32.5%) patients were in the highest income bracket, compared with 1120 (19.9%) patients in the lowest bracket. Higher income was associated with younger age at the time of GAS. Patients in the highest income quartile were also 3.7 times more likely to be funded by private insurance and self-pay options than those in the lowest income quartile (95% confidence interval [CI]: 3.1-4.4, p<0.0001). Additionally, patients in the lowest income quartile were 4.2 times more likely to require either home healthcare or transfer to a nursing facility post discharge than those in the highest income quartile (95% CI: 3.1-5.8, p<0.001). To promote equitable care to transgender patients, efforts to reduce financial barriers to healthcare access are much needed, particularly through broader insurance coverage of GAS procedures. Broadly, our results highlight the impact of socioeconomic variables on healthcare access and outcomes.

How do forests contribute to food security following a weather shock? Evidence from Malawi

Rural residents in developing countries are particularly vulnerable to shocks related to weather events. In this context, forests are frequently presented as safety nets, especially for households with limited risk-management options. This analysis aims to provide further evidence on the effectiveness of such safety nets. Specifically, the objective of this work is to analyze the extent to which forests serve as an effective safety net for food security when other potential risk-management options are available, or not, in rural areas. Focusing on agricultural households in Malawi, we combine several rounds of observations from the World Bank's Living Standards Measurement Study-Integrated Surveys on Agriculture (LSMS-ISA) with geospatial data on forest cover and a drought index based on both precipitation and temperature. Our results show that forests play an important role in protecting households’ diets in the aftermath of a weather shock, especially amongst those that appear to have limited insurance options, and/or that may need to further diversify their portfolio of potential insurance mechanisms to cope with a shock. By looking at food security, we highlight both the market and non-market benefits of forest resources in the aftermath of a shock. Moreover, we provide additional empirical evidence on the characteristics of households that depend on forest resources during challenging times. Overall, in light of the fundamental role forests play for human and planetary health, these findings shed light on the need to preserve forest access to forest-dependent communities and strengthen the sustainable management of forest resources.

مكانة أصول الفقه في التأمين الشرعي: دراسة التأمين الشرعي لمستقبل الأطفال من أكسا مانديري الشريعة

Amid the many choices of conventional insurance products that are echoed by the private sector and the government, such as health insurance, education, employment, and old age insurance. Besides conventional insurance options, there are also Sharia insurance options. One of the interesting sharia insurance products is sharia child future insurance by AXA Mandiri Syariah. The purpose of this study is to see Maslahah Mursalah in the use of this insurance. This paper will present the position of ushul fiqh in Islamic insurance, a study on the Islamic future insurance program for children by AXA Mandiri Syariah. The analysis used to see this is a literature study related to the literature of the ushul fiqh school. The results of this study indicate that the benefits of using Islamic future insurance are more than not using it. Using the sharia insurance system adds value to the program so that both insurance managers and insurance participants benefit from the program.

Association Between a Capitated, Low-cost, County-Based Public Health Insurance Option and Affordable Care Act Premium Growth in California

Empirical evidence is needed on how a capitated, risk-based county plan performs as a viable public option in the Affordable Care Act (ACA) Marketplace in California. To estimate whether LA Care-a capitated, county-based public option and California's largest public insurer-was associated with health insurance premium growth in the Los Angeles (LA) regions of Covered California (CC), the ACA exchange in California. This economic evaluation used ACA silver plan premium data within the 19 CC regions. Difference-in-differences and event study models used data on plan-level premiums from Health Insurance Exchange Compare for years 2014 to 2022 to estimate the association between LA Care and ACA premium growth in LA. The intervention was LA Care becoming the lowest-cost health plan on the ACA exchange in 2018. The treatment group included the East and West LA regions, and the control group included the remaining 17 CC regions. The main outcome variable was annual premium growth of plans on CC from 2014 to 2022. Using 504 plan-level observations for 2014 to 2022, ACA premium growth in LA declined by 4.8% after LA Care became the lowest-cost health plan on the exchange in 2018 (coefficient estimate, -0.048; SE, 0.022; 95% CI, -0.093 to -0.002). Savings due to lower premium growth from 2019 to 2022 were calculated to be $345 million, with approximately 70% of the savings ($242 million) going to the federal government. In this economic evaluation, LA Care was associated with lower premium growth of other health insurance plans in the LA regions of CC, with the majority of savings going to the federal government. California could have captured these savings if it had applied for and received a State Innovation Waiver under section 1332 of the ACA. LA Care may be a viable public option with the potential to be expanded across California through the state's 16 other county-based health plans.

The role of peer imitation in agricultural index insurance adoption: Findings from lab‐in‐the‐field experiments in Kyrgyzstan

AbstractFrequent climate shocks require farmers in developing countries to increase their resilience. Although index insurance is often discussed as a promising climate adaptation strategy, take‐up rates are still low. This study primarily explores the role of peer behavior as peer imitation in the demand for three marketable and unsubsidized crop index insurance options. Furthermore, the influence of trust and understanding is investigated. We collected data in lab‐in‐the‐field experiments among farmers in Kyrgyzstan, where index insurance is planned for imminent implementation. Applying ordered logit estimations, our results show significant and strong peer imitation effects. Imitation attitudes decrease with own insurance experience and received insurance payouts, but intensify with peer size, insurance trust and practical insurance understanding. While trust robustly increases index insurance adoption, understanding effects only gain significance in the dynamic perspective. These findings underline the importance of community‐based extension treatments and trust toward the uptake of innovative agricultural technologies in the first steps of dissemination.

204 Patients without health insurance and experiencing food insecurity are more likely to suffer from anxiety and depression–a cross-sectional study at a Milwaukee student-run free clinic

OBJECTIVES/GOALS: At the Saturday Clinic for the Uninsured (SCU), a Milwaukee student-run free clinic affiliated with the Medical College of Wisconsin, we screened patients for food insecurity and evaluated associations of food security status with nine separate social determinants of health (SDOH) needs and eight chronic medical conditions influenced by diet. METHODS/STUDY POPULATION: This cross-sectional study took place from October 2021-April 2022 at SCU, which only sees uninsured patients. We added the USDA six-item food insecurity form to the clinic’s larger SDOH survey, which screens for medication financing, housing stability, energy assistance, legal issues, educational/work opportunities, substance use, mental health, health insurance options, and dental care needs. We then completed chart review for demographic, diagnostic, lab, and medication information pertaining to obesity, hypertension, diabetes, dyslipidemia, chronic kidney disease (CKD), gastroesophageal reflux disease (GERD), anxiety, and depression. We conducted descriptive statistics on demographics and measured associations using both Kendall’s tau correlation and odds ratios from binomial regression. RESULTS/ANTICIPATED RESULTS: Of the 157 patients seen during this time, most were middle-aged (mean age = 49.4 years ± 14.5 years), female (n = 98, 62.4%), Black or African American (n = 66, 42%) and resided in Milwaukee County (n = 144, 92.9%). 22 (16%) screened as food insecure and had greater odds and positively correlated with needing resources for medication financing (OR = 7.28, I2 = 0.33), housing (OR = 129.99, I2 = 0.28), energy assistance (OR = 3.94,I2= 0.2), mental health (OR = 4.54, I2= 0.28), insurance (OR = 2.86, I2= 0.18), and dental care (OR=3.65,I2= 0.28), but not legal concerns, education/work opportunities, or substance use. Food insecure patients had higher odds and positively correlated with having anxiety (OR = 3.26,I2= 0.23) or depression (OR = 2.88,I2= 0.19), but not obesity, hypertension, diabetes, dyslipidemia, CKD, or GERD. DISCUSSION/SIGNIFICANCE: Patients without health insurance and experiencing food insecurity were more likely to have multiple SDOH needs and mental health diagnoses. Risk factors separate from food security status may explain associations with other chronic medical conditions, including uninsured status, socioeconomic status, eating behaviors, or food accessibility.

'We don't have the right to get sick': A qualitative study of gaps in public health insurance among Im/migrant women in British Columbia, Canada.

Globally, the exclusion of im/migrants from public health care systems remains a significant health and human rights issue, calling into question claims of 'universality' of public health systems where eligibility for coverage is determined by immigration status. We aimed to describe lived experiences of health insurance coverage and the health and social impacts of gaps in health insurance amongst im/migrant women in British Columbia (BC), Canada. This analysis draws on qualitative in-depth interviews (n = 78) with im/migrant women and im/migrant-focused service providers (n = 10) conducted between July 2018-March 2021 in Metro Vancouver, BC, as part of a larger community-based, mixed-methods study of im/migrants' health access (IRIS). In contrast to common perceptions of Canada's health system as 'universal', participants faced multifaceted barriers to health insurance and necessary healthcare for themselves and their families following arrival in BC. Narratives highlighted the ways in which ineligibility for public health insurance coverage resulted in unmet needs for essential sexual and reproductive health and preventive care among im/migrant women, children, and families. Participants also described ineligibility for public health insurance as resulting in a high economic burden, and that exclusion from public health insurance perpetuated experiences of discrimination, invisibility, and exclusion from systems of care amongst im/migrant participants. Despite these structural challenges, participant narratives highlighted the crucial role of community-based supports for minimizing harm and navigating oppressive immigration and health systems. Changes to immigration and health policies are required to remove barriers to public health care for im/migrant women and ensure that Canada's health system is accessible to all. Expanding health insurance options to cover all residents and decoupling health insurance eligibility from immigration status are recommended, alongside implementation of 'Sanctuary' policies at the local level.

Risk of Claims and Moral Hazard for House Insurance in Canada

We investigate the risk of claims using hazard models for house insurance for the three periods: prior to, during and after the financial crisis. The present study is based on the data provided by Property & Casualty Carrier for the Canadian Market. The semiparametric Cox proportional hazard model results suggest that Canada’s house insurance options (Bronze, Silver, Gold, and Platinum) influence the risk of claims. The smaller coverage option, Bronze, has much fewer claims than the complete coverage option, Gold. This may suggest the presence of a moral hazard problem. The financial crisis however impacted the role of the type of coverage had on the risks of claims reducing the moral hazard problem, after controlling for the characteristics of the houses.