Health insurance purchasers

The approach is nothing other than the analogue of the more general concept of defined contribution now widely recommended by many economists for the purchase of health insurance (Pauly et al. 1991). Under that approach, government or employers make a defined contribution to an individual s purchase of private health insurance, leaving the individual to pay the full difference between that contribution and the insurance premium actually charged by the private insurer. 

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. ... 

The U.S. is unique among advanced nations in that it has resisted the implementation of a system of imiversal health care and instead has gradually built a system in which employers are the primary sponsors of health care coverage for the majority of the population. Medicare and Medicaid cover the elderly, disabled, and very poor. According to data from the U.S. Census Bureau, a small proportion of people, less than 7% of the population under 65 years of age, purchase health insurance on their own. In 2002, the remaining 41 million persons were uninsured. The uninsured represent 14.6% of the total population, 16.5% of the population under 65 years. Those with adequate resources pay out of their pockets for health care. The others go without care, delay care, or seek health services from a fragile and incomplete system of charity care and safety-net providers. 

Health insurance is financed by purchasers. In the U.S., purchasers are employers, government (federal, state, and local), and individuals. Figure 18.1 is a chart displaying the sources of health insurance for people in the U.S. in 2001. 

In the U.S., over 16 million people purchase their basic health coverage on their own. These purchasers include individuals who are self-employed, unemployed, and nof eligible for a public health insurance program. They also include persons who are not eligible for their employer s coverage or their employer does not offer health insurance. 

Nearly half of the individual purchasers have access to group coverage through professional organizations, nonprofit associations, or former employers. An estimated 8.6 million persons purchase this coverage in what is called the individual health insurance market. 

The individual provincial governments offer different supplemental benefits not covered by the national Medicare program, such as drugs, dental care, and vision care to the poor, elderly, and other specific groups. Supplemental benefits for the typical, employed, and non-elderly person come from the purchase of supplemental health insurance from private sources. ... 

Private employers, the federal government, and state and local governments invest significant financial resources in health care purchasing expenditures. In 1995, private employers contributed 183.8 billion to private health insurance premiums, whereas the federal government spent 11.3 billion on private health insurance premiums, and state and local government spent 47.1 billion. " In 1995, more than 83% of the insured population was covered by private insurance, whereas about 31% was enrolled in a public program, such as Medicare or Medicaid. 

The health care lexicon includes two new terms to reflect these problems underinsured and uninsured. The underinsured may include the working poor, those individuals who have jobs and may be covered by a very limited, if any, health insurance program by their employers. They are likely low wage earners and those receiving incomes at, or slightly above, the poverty level. Typically, they do not qualify for Medicaid entitlements, do not have employer-paid health insurance benefits, and cannot afford (or choose not to purchase) third-party coverage for payment of health care services. 

Many patients cannot afford to purchase needed prescription medication. Approximately 16% of the U.S. population docs not have any health insurance, and a greater percentage has health insurance without prescription medication benefits. Pharmaceutical company-sponsored medication assistance programs provide valuable options to both patients and healthcare providers by providing drugs to patients who have limited means of purchasing their medications. 

Qualifications for the VFC program are as stated here. Each state s children s health insurance qualifications are unique but can be found at their web site. ° Children through 18 years of age qualify to receive federally purchased vaccines under the VFC program if they are medicaid-enrolled, uninsured, or Native Amer-icans/Native Alaskans. Children who have insurance that does not cover immunizations also qualify to receive VFC vaccine at federally qualified health centers and rural health clinics. In addition, states may use their funds to purchase vaccines for additional groups of children. Contact the immunization program in your state for more information. 

In countries, such as some of the member states of the European Community, where social health insurance funds are the largest purchasers of drugs, national reference pricing can have a considerable effect on corporate strategies for R D and on marketing policies. 

The costs of medicines purchased from abroad have to be borne by the budget of the institution. In some Countries these imported medicines are not reimbursed from a social health insurance, unless the patient has an allowance or is covered by an extra private insurance, specifically for that medicinal product. 

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