Health insurance coverage

Kuttner, R., "The American Health Care System—Health Insurance Coverage," N. 

D15. Do you currently have any type of health insurance coverage, including Medicare or Medicaid (DO NOT READ LIST) ... 

Some people may choose not to use their insurance to pay for testing because the results of a genetic test can affect a person s health insurance coverage. Instead, they may opt to pay out-of-pocket for the test. People considering genetic testing may want to find out more about their state s privacy protection laws before they ask their insurance company to cover the costs. 

Availability of vouchers may crowd out private health insurance coverage. If vouchers make being uninsured better than it would otherwise be, fewer persons may be expected to purchase insurance. But states have implemented policies to deter crowd-out for other government health insurance programs. ... 

Lo Sasso, A. T., and T. C. BuchmueUer. 2004. The Effect of the State Children s Health Insurance Program on Health Insurance Coverage. Journal of Health Economics 23(5) 1059-1082. 

Sloan, Frank A., and Chris J. Conover. 1998. Effects ofState Reforms on Health Insurance Coverage of Adults. Inquiry 35 280-293. 

Pharmacies have third-party patients and private-pay patients. Private-pay patients, sometimes referred to as cash patients, are people who do not have any health insurance coverage or people who have health insurance that does not cover prescription drugs. From the pharmacy s perspective, patients who pay the pharmacy directly for their prescriptions and later are reimbursed by their insurance company often are indistinguishable from private-pay patients. This type of prescription drug insurance, called indemnity insurance, used to be common, but it now has been replaced largely by service benefit plans. Under a service benefit plan, the patient may pay the pharmacy a predetermined portion of the prescription cost, but the pharmacy is reimbursed directly by the third party for most of the prescription cost. 

Care limited to diagnosable and covered mental health conditions, as per patient s mental health insurance coverage. 

Care of any covered health care condition, regardless of mental health insurance coverage. 

President John F. Kermedy made Medicare a major election issue in 1960, but it was not unhl Lyndon Johnson achieved a landslide victory, accompanied by Democrahc control of Congress, thaf another defining step was taken in the history of health insurance coverage. In 1965, Congress amended the Social Security Act to implement Medicare for the elderly and Medicaid to help states pay for health services for their very low-income parents and children. 

Many persons report more than one type of coverage. For example. Medicare beneficiaries often have supplemental retiree health benefits as well as Medicare, and a disabled child might be covered under both a parent s employer-sponsored coverage and Medicaid. The following sections discuss each of the major types of health insurance coverage. 

Figure 18.1 Health insurance coverage in the U.S., 2001. (From the U.S. Census Bureau, Health Insurance Coverage 2001, September 2002.)...

An estimated 30 million people in the U.S. are xmderinsured, i.e., having health insurance coverage less than adequate. As a consequence, these individuals and families experience high out-of-pocket costs (e.g., premium payments, deductibles, and copayments) and maximum benefit limits. Many policies exclude specific services, such as maternity services, mental health... 

Kaiser Commission on Medicaid and the Uninsured (2002b). Health Insurance Coverage in America 2000 Data Update. Washington, D.C. The Henry J. Kaiser Family Foundation. 

Those who are provided with basic health insurance coverage from their employers... 

The President s Commission outlines areas in which the American health care system could be improved in light of the reality that many individuals receive substandard care and 44.3 million individuals are without health insurance coverage. This commission outlines several types of quality problems including avoidable errors, underutilization of services, overuse of services, and variation in services. Based on the reality of these quality problems, the Commission recommended that the initial set of national aims should include ... 

Kronick, R. Todd, G. Explaining the dechne in health insurance coverage, 1979-1995. Health Aff. 1999, Mar/April, 30-47. 

An issue of great contrtwersy and consequence that is not likely to be resolved soon is the influence of health insurance coverage on wdicthcr a person gets treatment and, if so, what kind (Holder Blosc, 1991). A brief history of the role of finances and insurance will help you to appreciate the current controversy (Raw son, 1990-1991). 

Financial factors, especially health insurance coverage, have had and are having great influence on the type and accessibility of alcohol and drug treatment. Stepped care is one approach to professional treatment selection that integrates current knowledge about alcohol and drug treatment effectiveness and the conditions under which it is delivered. 

Companies have their own processes for patient enrollment that typically require the completion of an application and a reporting of the patient s health insurance coverage, assets, income, and liabilities. A prescription for the medication is usually required. Many programs allow enrollment over the phone, while others require written correspondence. In order to determine eligibility, many companies require verification of a patient s financial status by documents such as income tax returns, W-2 forms, social security and other benefit... 

Bureau of the Census. Current Population Reports. In Health Insurance Coverage, 1998, Government Printing Office Washington, DC, 1999. Available at http //www. census.gov/prod/99pubs/p60-208.pdf. 

Basic income can also be received in all cases of need where resources from work and other income are not sufficient to pass the threshold income set by law. Hence, basic income support does not only focus on registered unemployed without entitlements to unemployment insurance benefits, but also on people in school and training or in dependent employment if they pass the means test. The same holds for the self-employed. In contrast to former social assistance, UB II recipients are covered by both statutory health insurance and old-age pension insurance, which also means that the self-employed can receive health insurance coverage at a low premium under UB II. 

Although ethical pharmaceuticals include some nonprescriptions items, health insurance coverage is typically limited only 10 prescription drugs. Consequently, the remainder of this chapter refers to prescription drugs. 

In France, despite co-payment for drugs, prescription drugs are virtually free for the 80% of the population who enjoyed supplemental insurance in 1990. The supplemental private companies or co-operatives reimburse most or all of the co-payments. The recent law on universal health insurance coverage will extend this supplemental insurance to 100% of the population [5], Such exemptions, and reinsurance options for the population, offset the effect of co-payment in reducing the use of drugs that are not needed, or too expensive. Of OECD countries only Austria, Germany, Japan, Spain and Switzerland have officially excluded such a cost shifting by reinsurance in second-tier payment systems (Table 1). 

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