Supplementary Health Insurance Research Articles

Commentary: The Impact of Medicare Coverage Policies on Health Care Utilization

Traditional fee-for-service Medicare, by far the most popular choice of Medicare beneficiaries, lacks many of the tools that commercial health insurance and Medicare Advantage plans can use to control health care utilization. Prior authorization, selective contracting, utilization review, and capitation are generally absent from traditional Medicare. Furthermore, most beneficiaries are covered by supplemental health insurance. Supplemental plans cover many out-of-pocket payments, depriving Medicare of the ability to use cost-sharing to discourage overuse of medical services. Reimbursement can be an effective tool to control both utilization and expenditures. With Medicare's enormous market power, providers usually must accept the reimbursements it offers. As important as the ability to set reimbursement levels would seem to be, however, it is not a tool that the officials of the Centers for Medicare and Medicaid Services (CMS) can apply at will. CMS sets inpatient and outpatient reimbursement levels by formulas that it cannot easily modify or abandon (Medicare Payment Advisory Commission 2007). Congress, not CMS, sets basic parameters for provider reimbursement levels, and in recent years has chosen not to implement scheduled cuts in reimbursement. This experience has led to skepticism about the ability of reimbursement policy to control expenditures in the Medicare program.

A model to decompose the performance of supplementary private health insurance markets

For an individual insurance firm offering supplementary private health insurance, a model is developed to decompose market performance in terms of insurer profits. For the individual contract, the model specifies the conditions under which adverse selection, cream skimming, and moral hazard occur, shows the impact of information on contracting, and the profit contribution. Contracts are determined by comparing willingness to pay for insurance with the individual's risk position, and information on both sides of the market. Finally, performance is aggregated up to the total market. The model provides a framework to explain the attractiveness of supplementary markets to insurers.

AFLAC Inc.

AbstractInsurance (MIC: SIC: 6321 NAIC: 524114)AFLAC is a holding company that sells supplemental health and life insurance. At Dec 31 2007, Co.'s insurance operations were conducted via American Family Life Assurance Co. of Columbus, which operated in the U.S. (Aflac U.S.) and as a branch in Japan (Aflac Japan). Co.'s Aflac U.S. sells supplemental and life insurance products, including accident/disability, cancer expense, short‐term disability, sickness and hospital indemnity, hospital intensive care, fixed‐benefit dental, vision care and long‐term care plans.. Co.'s Aflac Japan sells cancer, care, living benefit life, ordinary life insurance and general medical indemnity plans as well as medical/sickness riders and annuities.

Financing the package of services during the first decade of the national health insurance law in Israel: Trends and issues

In 1995, a National Health Insurance Law (NHIL) was enacted in Israel. It specified a mandatory package of services to be provided by the four competing private non-profit sickness funds, and secured the financing of that provision. This review discusses the main issues associated with financing of--and the sickness funds' expenditure on--the package of services and analyzes the trends during the first decade of the implementation of the NHIL. The main findings indicate that between 1995 and 2005 the "real value" of the budget of the package of services has eroded by more than a third, most of it being due to the under-updating with regard to technological advances. The steep rise in the co-payment paid by users of health services and in voluntary supplementary health insurance ownership which is offered by the sickness funds partially financed that erosion. The growth of private spending on health, including on voluntary supplementary insurance, took place in all population groups and in the lowest income-quintile in particular. Indices of the progressivity of the financing of the package of services indicate that the burden of financing has been slightly regressive. In spite of the increase in the share of the regressive private expenditure between 1997 and 2003, overall, the finance became less regressive due to the health tax becoming less regressive. In conclusion, the introduction of the Israeli NHIL was a promising social achievement, but, during its first decade and facing tight national budgets and receiving lower national priority, subsequent regulation eroded the real value of its benefits, and its principles of solidarity and equity in finance. After 10 years of experience, the system might need refreshment and policy amendments that will correspond to its original aspirations.

AFLAC Inc.

AbstractInsurance (MIC: 8.2 SIC: 6321 NAIC: 524114)AFLAC is a holding company that sells supplemental health and life insurance. At Dec 31 2007, Co.'s insurance operations were conducted via American Family Life Assurance Co. of Columbus, which operated in the U.S. (Aflac U.S.) and as a branch in Japan (Aflac Japan). Co.'s Aflac U.S. sells supplemental and life insurance products, including accident/disability, cancer expense, short‐term disability, sickness and hospital indemnity, hospital intensive care, fixed‐benefit dental, vision care and long‐term care plans. Co.'s Aflac Japan sells cancer, care, living benefit life, ordinary life insurance and general medical indemnity plans as well as medical/sickness riders and annuities.

AFLAC Inc.

AbstractInsurance (MIC: 8.2 SIC: 6321 NAIC:524114)AFLAC is a holding company engaged in selling supplemental health and life insurance. At Dec 31 2006, Co.'s insurance operations were conducted via American Family Life Assurance Company of Columbus, which operated in the U.S. (Aflac U.S.) and operated as a branch in Japan (Aflac Japan). Co.'s Aflac U.S. sells cancer plans and health insurance, such as accident/disability, fixed‐benefit dental, sickness and hospital indemnity, hospital intensive care, long‐term care, ordinary life and short‐term disability plans. Co.'s Aflac Japan sells cancer plans, care plans, general medical indemnity plans, medical/sickness riders, living benefit life plans, ordinary life insurance plans and annuities.

A Dynamic Analysis of the Demand for Health Insurance and Health Care

We investigate the presence of moral hazard and advantageous or adverse selection in a market for supplementary health insurance. For this we specify and estimate dynamic models for health insurance decisions and health care utilization. Estimates of the health care utilization models indicate that moral hazard is not important. Furthermore, we find strong evidence for advantageous selection, largely driven by heterogeneity in education, income and health preferences. Finally, we show that ignoring dynamics and unobserved fixed effects changes the results dramatically.

A Dynamic Analysis of the Demand for Health Insurance and Health Care

We investigate the presence of moral hazard and advantageous or adverse selection in a market for supplementary health insurance. For this we specify and estimate dynamic models for health insurance decisions and health care utilization. Estimates of the health care utilization models indicate that moral hazard is not important. Furthermore, we find strong evidence for advantageous selection, largely driven by heterogeneity in education, income and health preferences. Finally, we show that ignoring dynamics and unobserved fixed effects changes the results dramatically.

Low Socioeconomic Status and Absence of Supplemental Health Insurance as Barriers to Diabetes Care Access and Utilization

ABSTRACT OBJECTIVE To identify patient-reported barriers that contribute to the gap between current and optimal diabetes care. METHODS Random-digit dialling was used to select 763 patients with diabetes representative of the Ontario population and 387 patients with diabetes sampled from low-income neighbourhoods. Data were obtained using a standardized telephone survey. RESULTS In multivariate analysis, annual household income CONCLUSIONS Low socioeconomic status and the absence of supplemental health insurance act as financial barriers to accessing optimal care. These barriers may be amenable to policy change.

Out‐of‐pocket payment for medical care under Taiwan's National Health Insurance system

The objective of this study is to estimate the amount of and factors associated with out-of-pocket (OOP) payment for medical care under Taiwan's National Health Insurance (NHI) program. This research used two methods to collect original data. The first method consisted of using a sample household survey and household diary records to collect data on OOP payment prospectively over a two-month period from a random sample of 600 households in central Taiwan. Using the individual as the unit of analysis, we obtained a total of 1062 sample subjects. To ascertain the quality and accuracy of survey data, the claim records of the bureau of NHI were merged with the survey data. These data were analyzed by a two-part model, with a probit model for use of health care and an ordinary least-squares model for OOP payments. Results of this research indicate that on average an individual's annual OOP payment for medical care was euro 247, which is substantial, compared with the average euro 144 for per capita NHI earmarked tax. Finally, results of model estimation indicate that supplemental health insurance and household income were positively associated with any use of health care, while household income was also positively associated with OOP payment for health care.

AFLAC Inc.

AbstractInsurance (MIC: 8.2 SIC: 6321 NAIC:524114)AFLAC is a general business holding company that mainly sells supplemental health and life insurance in the U.S. and Japan. At Dec 31 2006, Co.'s insurance operations were conducted via American Family Life Assurance Company of Columbus. Co.'s Aflac U.S. sells cancer plans and various types of health insurance, such as accident and disability, fixed‐benefit dental, personal sickness and hospital indemnity, hospital intensive care, long‐term care, ordinary life and short‐term disability plans. Co.'s Aflac Japan sells cancer plans, care plans, general medical expense plans, medical/sickness riders to its cancer plan, a living benefit life plan, ordinary life insurance plans and annuities.

Burden of Common Multiple-Morbidity Constellations on Out-of-Pocket Medical Expenditures Among Older Adults

On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults. We analyzed Health and Retirement Study data, determining out-of-pocket medical expenses from 1998 and 2002 separately and examining differences in the impact of multiple-morbidity constellations on these expenses. We paid particular attention to the most common disease constellations - hypertension, arthritis, and heart disease. An increasing prevalence of multiple morbidity (58% compared with 70% of adults had two or more chronic conditions in 1998 and 2002, respectively) was accompanied by escalating out-of-pocket expenditures (2,164 dollars in 1998, increasing by 104% to 3,748 dollars in 2002). Individuals with two, three, and four chronic conditions had health care expenditure increases of 41%, 85%, and 100%, respectively, over 4 years. Such patterns were particularly noticeable among the oldest old, those with higher educational attainment, and women, although having supplementary health insurance or Medicaid mitigated these expenses. Finally, there were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations. Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact out-of-pocket spending moves us closer to effective interventions to support vulnerable elders.

AFLAC Inc.

AbstractInsurance (MIC: 8.2 SIC: 6321 NAIC:524114)AFLAC primarily sells supplemental health and life insurance in the United States and Japan. Co.'s insurance operations are conducted through American Family Life Assurance Company of Columbus, which operates in the U.S. and as a branch in Japan. Aflac Japan sells cancer plans, care plans, general medical expense plans, medical/sickness riders to its cancer plan, a living benefit life plan, ordinary life insurance plans and annuities. Aflac U.S. sells cancer plans and various types of health insurance, including accident and disability, fixed‐benefit dental, personal sickness and hospital indemnity, hospital intensive care, long‐term care, ordinary life, and short‐term disability plans.

Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets

As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland. For each country, we review the available evidence of SI being used as selection device. We find that the probability that SI is and will be used for risk-selection substantially varies across countries. Finally, we discuss several strategies for policy makers to reduce the chance that SI will be used for risk-selection in BI markets.

AFLAC Inc.

AbstractInsurance (MIC: 8.2 SIC: 6321 NAIC:524114)AFLAC primarily sells supplemental health and life insurance in the United States and Japan. Co.'s insurance operations are conducted through American Family Life Assurance Company of Columbus, which operates in the U.S. and as a branch in Japan. Aflac Japan sells cancer plans, care plans, general medical expense plans, medical/sickness riders to its cancer plan, a living benefit life plan, ordinary life insurance plans and annuities. Aflac U.S. sells cancer plans and various types of health insurance, including accident and disability, fixed‐benefit dental, personal sickness and hospital indemnity, hospital intensive care, long‐term care, ordinary life, and short‐term disability plans.

Supplemental Health Insurance and Equality of Access in Belgium

It has been suggested that the unequal coverage of different socio-economic groups by supplemental insurance could be a partial explanation for the inequality in access to health care in many countries. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. We find that this institutional background is crucial for the explanation of the effects of supplemental insurance. We find no evidence of adverse selection in the coverage of supplemental health insurance, but strong effects of socio-economic background. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spells, but a negative effect on the number of nights. This is in line with patterns of socio-economic stratification that have been well documented for Belgium. It is also in line with the regulation on extra-billing protecting patients in common rooms. For ambulatory care, we find a positive effect of supplemental insurance on visits to a dentist and on number of spells at a day centre but no effect on visits to a GP, on drugs consumption and on visits to a specialist.

The Determinants of Purchasing Private Health Insurance in Korean Cancer Patients

The aim of this study is to identify factors determining the purchase of private health insurance under the mandatory National Health Insurance(NHI) system in Korea. The data were collected by the National Cancer Center in Korea. It includes cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer. Data were gathered from the hospital Order Communication System (OCS), medical records, and face-to-face interviews, using a structured questionnaire. Clinical, socio-demographic and private health insurance related factors were also gathered. Overall, 43.9% of patients had purchased one or more private health insurance schemes related to cancer, with an average monthly premium of won 65,311 and an average benefit amount of won 19 million. Females, younger aged, high income earners, national health insurers and metropolitan citizens were more likely to purchase private health insurance than their counterparts. About half of Korean people have supplementary private health insurance and their benefits are sufficient to cover the out-of-pocket fees required for cancer treatment, but inequality remains in the purchase of private health insurance. Further studies are needed to investigate the impacts of private health insurance on NHI, and the relationship between cancer patients' burden and benefits.

Effects of Private Health Insurance on Health Care Utilization and Expenditures in Korean Cancer Patients: Focused on 5 Major Cancers in One Cancer Center

To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.

AFLAC Inc.

AbstractInsurance (MIC: 8.2 SIC: 6321 NAIC: 524114)AFLAC primarily sells supplemental health and life insurance in the United States and Japan. Co.'s insurance operations are conducted through American Family Life Assurance Company of Columbus, which operates in the U.S. and as a branch in Japan. Aflac Japan sells cancer plans, care plans, general medical expense plans, medical/sickness riders to its cancer plan, a living benefit life plan, ordinary life insurance plans and annuities. Aflac U.S. sells cancer plans and various types of health insurance, including accident and disability, fixed‐benefit dental, personal sickness and hospital indemnity, hospital intensive care, long‐term care, ordinary life, and short‐term disability plans.

The demand for private health care under national health insurance

This study explores the demand for private health care and supplemental health insurance in Israel, where universal national health insurance provides all inhabitants with a standard package of medical care. Our theoretical model and empirical study follow research previously conducted in four other countries. It was found that the self-employed in Israel demand more private health services and supplemental health insurance than wage-earners. Income, age, education, health status, marital status, origin, and profession were found to play a part in explaining these demands.