Provide Health Insurance Benefits Research Articles

Health‐Related Influences of Extending Marital Benefits to Same‐Sex Couples: Results From the California Health Interview Survey

ObjectiveTo explore how incremental California legal changes toward the implementation of same‐sex marriage influenced self‐reported mental and physical health among adult Californians in legal same‐sex marriages and partnerships.MethodsWe analyzed California Health Interview Survey data from 2005 to 2015 to assess the relationship between self‐reported mental and physical health and legal same‐sex marital/partnership status. Physical health was measured using a single self‐report question, mental health using the six‐item Kessler distress scale. Independent variables were sexual identity and legal marital/partner status. Bivariate analyses compared mental and physical health before and after the 2008 California Supreme Court decision affirming marriages as a basic civil or human right. Multivariate analyses tested relationships between marital/partnered status, sexual identity by year after adjusting for sociodemographics.ResultsReports of poor and fair health decreased, reports of very good health increased, and psychological distress scores decreased for legally coupled gay men and lesbians but increased slightly for single lesbians and gay men. Household income increased among espoused lesbians and gay men and decreased among unmarried counterparts.ConclusionsEspoused gay and lesbian respondents were more likely to be employed and to have college educations than unmarried counterparts, perhaps a continuing influence of 2005 California legislation requiring private employers to provide health insurance benefits to employees' same‐sex partners. Our findings suggest that physical and mental health improved for lesbians and gay men once same‐sex marriage became legal throughout California.ImplicationsThese findings demonstrate a need for survey questions to elicit information about marital status and the sex/gender of a respondent's spouse inclusive of sexual and gender identities.

The effect of non-employment-based health insurance program on firm's offering of health insurance: Evidence from the social health insurance system in China

To achieve universal health insurance coverage, many developing countries have established a segmented health insurance system, which contains separate programs for workers with formal employment and residents without formal employment. A potential concern with such a segmented system is that the establishment of a non-employment-based insurance program may generate a disincentive for firms to provide health insurance benefits to workers. In this study, we empirically examine this crowd-out effect of a non-employment-based insurance program, the Urban Residents Basic Medical Insurance (URBMI), in China. Exploiting city-by-year variations in the roll-out process of the program and utilizing a unique administrative dataset on Chinese firms, we find that the enactment of URBMI reduced a firm's offering of an employment-based health insurance program by a statistically significant 0.94-1.29 percentage point. This crowd-out effect was stronger among domestic private firms, new firms, and firms that are individual-owned.

Impact of employer-sponsored health insurance on firm capital structure: evidence from the Affordable Care Act

ABSTRACT This article investigates how employer-sponsored health insurance (ESHI) expenses affect firm capital structure. Since 2015, the Affordable Care Act employer mandate has required firms with more than 100 full-time employees to provide health insurance benefits to their employees. We exploit the exogenous increase in ESHI expenses for large firms after the mandate to identify the causal effect of ESHI on firm capital structure. Using COMPUSTAT merged with the Form 5500 data, we find that firms with higher ESHI expenses have higher long-term but lower short-term leverage. That is, accounting for ESHI expenses provides important explanatory power for firm capital structure.

Reaching the Missing Middle: Ensuring Health Coverage for India's Urban Poor

—India has seen impressive investments in government-funded health insurance but still severely underfunds the health sector. The government of India has a critical role in ensuring effective health coverage to the “missing middle”: the urban poor. The urban poor have been excluded from benefits targeting eligible populations below the poverty line. Lack of access to public facilities and qualified primary health care providers in urban areas often results in treatment delays or patients relying predominantly on out-of-pocket payments to informal providers. The urban poor are also excluded from affordable health insurance markets. Illiteracy and poverty in the slums result in limited access to goods and services and unequal participation in social life, as well as in overall social exclusion. The government of India, in its 2018 union budget, announced a flagship National Health Protection Scheme (NHPS) that will provide health insurance benefits of up to INR 500,000 (7,692 USD) per family per annum. This article explores current and future opportunities to fill an important gap in access to health services, specifically targeting the urban poor by providing health insurance schemes that include primary health services for this population. Current public health insurance schemes providing exclusively hospitalization benefits are unsustainable; part of the solution is keeping people healthy and out of the hospital. Primary care integrated into health insurance improves population health management and is associated with higher patient satisfaction, fewer hospitalizations and emergency department visits, lower claim costs, and overall reductions in morbidity and mortality. There is no single solution to finance health services for the urban poor. This population mostly belongs to the informal sector, which encompasses workers whose jobs are not recognized formally and from whom no taxes are collected. However, the new NHPS could play a major role in expanding safety nets for the urban poor by providing financial risk protection and improving social inclusion. The government could use the introduction of the new scheme to shape approaches aimed at increasing opportunities for the urban poor through investing in public health facilities, subsidizing and fostering public–private affordable health insurance, and enhancing access to information, voice, and respect for rights.

Health Insurance Trends in United States Living Kidney Donors (2004 to 2015).

Some transplant programs consider the lack of health insurance as a contraindication to living kidney donation. Still, prior studies have shown that many adults are uninsured at time of donation. We extend the study of donor health insurance status over a longer time period and examine associations between insurance status and relevant sociodemographic and health characteristics. We queried the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry for all living kidney donors (LKDs) between July 2004 and July 2015. Of the 53 724 LKDs with known health insurance status, 8306 (16%) were uninsured at the time of donation. Younger (18 to 34 years old), male, minority, unemployed, less educated, unmarried LKDs and those who were smokers and normotensive were more likely to not have health insurance at the time of donation. Compared to those with no health risk factors (i.e. obesity, smoking, hypertension, estimated glomerular filtration rate <60, proteinuria) (14%), LKDs with 1 (18%) or ≥2 (21%) health risk factors at the time of donation were more likely to be uninsured (p < 0.0001). Among those with ≥2 health risk factors, blacks (28%) and Hispanics (27%) had higher likelihood of being uninsured compared to whites (19%; p < 0.001). Study findings underscore the importance of providing health insurance benefits to all previous and future LKDs.

PS3-44: Can Health Insurance Improve Employee Health Outcome and Reduce Cost? An Evaluation of Geisinger's Value-Based Insurance Design

Background/Aims Employers have recently seen rapid increases in their cost of providing health insurance benefits for their employees, partly because the traditional health insurance benefit design does not reflect the value of healthcare consumed. Value-based insurance design (VBID) seeks to address this problem by incorporating value as well as cost in each beneficiary’s healthcare decisions. Since 2007, Geisinger Health System (GHS) has implemented its own version of VBID called MyHealth Rewards for its employee population. Key components of the program included zero-copay prescription drugs for patients with certain chronic conditions and a health management program designed to enhance employee self-management. In this study, we examine whether MyHealth Rewards has led to improvements in employee health outcomes in terms of reduced incidence of stroke and MI and also whether it has lowered the cost of care.

Child health insurance coverage: a survey among temporary and permanent residents in Shanghai

BackgroundUnder the current healthcare system in China, there is no government-sponsored health insurance program for children. Children from families who move from rural and interior regions to large urban centres without a valid residency permit might be at higher risk of being uninsured due to their low socioeconomic status. We conducted a survey in Shanghai to describe children's health insurance coverage according to their migration status.MethodBetween 2005 and 2006, we conducted an in-person health survey of the adult care-givers of children aged 7 and under, residing in five districts of Shanghai. We compared uninsurance rates between temporary and permanent child residents, and investigated factors associated with child health uninsurance.ResultsEven though cooperative insurance eligibility has been extended to temporary residents of Shanghai, the uninsurance rate was significantly higher among temporary (65.6%) than permanent child residents (21.1%, adjusted odds ratio (OR): 5.85, 95% confidence interval (95% CI): 4.62–7.41). For both groups, family income was associated with having child health insurance; children in lower income families were more likely to be uninsured (OR: 1.96, 95% CI: 1.40–2.96).ConclusionChildren must rely on their parents to make the insurance purchase decision, which is constrained by their income and the perceived benefits of the insurance program. Children from migrant families are at even higher risk for uninsurance due to their lower socioeconomic status. Government initiatives specifically targeting temporary residents and providing health insurance benefits for their children are urgently needed.

Corporate Smoking Cessation on Long Island

Tobacco addiction is a treatable health care problem. Employers are experiencing major annual increases in the cost of providing health insurance benefits. The expenditures due to smoking-related diseases are a major contributor to the escalating cost of employer-sponsored health and life benefit plans. An initiative that employers have adopted to help control increases in health care costs as well as improve the lifestyle of employees is the establishment of corporate wellness programs. Programs that promote healthy lifestyles and wellness are connected to the principle that a happy and healthy worker will be more effective and productive. Another dividend of corporate wellness programs is higher employee retention and better employee morale. An earlier study investigated the impact of wellness programs for Long Island employers. One of the major findings of that research was the confirmation of the prevalence of smoking cessation initiatives as components of the successful wellness programs. This article, through analysis of a follow-up survey, confirms that corporate smoking cessation programs have a significant return on investment. Further, the analysis identifies the components of the cessation programs and measures the relative impact of each element.

Prenatal care: revisions to SCHIP extend health care to "unborn children".

Effective November 1, 2002, the federal Department of Health and Human Services (DHHS) reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program (SCHIP). By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal policy has defined childhood as beginning at conception.”In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children.

Health Insurance Coverage

Unlike children in most other economically developed countries, children in the United States are not guaranteed health insurance coverage. Indeed, many U.S. children have no health insurance coverage at all. Their lack of coverage restricts their access to health care services: uninsured children have fewer physician visits per year than children with insurance and are less likely to have a usual source of routine health care. 1 In recognition of the importance of health insurance for children’s access to health care, a number of public programs, the largest of which is the federal-state Medicaid program, have been developed to provide health insurance benefits to poor children and others who would not otherwise have access to health care coverage. Indeed, health insurance coverage for all Americans was a key element of the recent effort to reform health care in the United States. 2 Because of the importance of health insurance coverage, many surveys and reports are devoted to gathering and disseminating statistics on the number and proportion of the U.S. population (including children) who have health insurance of various types. However, the statistics they present can appear contradictory. For example, for 1993, there were three major estimates of the number of uninsured children: the Employee Benefits Research Institute (EBRI) estimated that there were 11.1 million children without insurance; the Census Bureau, 9.5 million; and the Urban Institute, 8.7 million. 3 These different estimates were all based on a single data source, the 1994 Current Population Survey (CPS). This Child Indicators article examines the CPS as a source of data on health insurance coverage, the reasons for the different estimates of the numbers of uninsured children, recent trends in health insurance coverage for children, and the growing importance of the Medicaid program as both a current and a potential source of health insurance for children. This analysis suggests that, even though interpretations of CPS data may seem inconsistent, there are some clear trends in health insurance coverage for children. First, the proportion of children 0 to 10 years old who do not have health insurance has declined slightly over the past five years, while the

Health policy and craniofacial care: issues in resource allocation.

The distribution of health care services, including craniofacial services in the United States, is examined. The U.S. has a unique health care financing and organizational system in which persons are most commonly covered by health insurance as a benefit of their employment. Current estimates are that nearly 40 million Americans have no health insurance (Himmelstein et al., 1992). Approximately half of the uninsured persons are in low-wage employment that does not provide health insurance benefits nor allow them to qualify for Medicaid (Pepper Commission, 1990). Personal health care costs now exceed 11% of the U.S. gross domestic product, a significantly higher percentage than that found in other industrialized nations (Consumer Reports, 1990b). Within the current system, is health care distributed in a fair or moral manner? What are the effects of the allocation scheme? Possible changes in health care financing and delivery are examined and basic ethical and social issues associated with a changing U.S. health care delivery system are explored.

Health Policy and Craniofacial Care: Issues in Resource Alllocation

The distribution of health care services, including craniofacial services in the United States, is examined. The U.S. has a unique health care financing and organizational system in which persons are most commonly covered by health insurance as a benefit of their employment. Current estimates are that nearly 40 million Americans have no health insurance (Himmelstein et al., 1992). Approximately half of the uninsured persons are in low-wage employment that does not provide health insurance benefits nor allow them to qualify for Medicaid (Pepper Commission, 1990). Personal health care costs now exceed 11% of the U.S. gross domestic product, a significantly higher percentage than that found in other industrialized nations (Consumer Reports, 1990b). Within the current system, is health care distributed in a fair or moral manner? What are the effects of the allocation scheme? Possible changes in health care financing and delivery are examined and basic ethical and social issues associated with a changing U.S. health care delivery system are explored.