Double-edged sword of federalism: variation in essential health benefits for mental health and substance use disorder coverage in states

2020 ◽  
pp. 1-13 ◽  
Author(s):  
Charley E. Willison ◽  
Phillip M. Singer ◽  
Kyle L. Grazier
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Behavioral Health ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Health Benefits ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Behavioral Health Services ◽  
Essential Health Benefits

Abstract The Affordable Care Act requires all insurance plans sold on health insurance marketplaces and individual and small-group plans to cover 10 Essential Health Benefits (EHB), including behavioral health services. Instead of applying a uniform EHB plan design, the Department of Health and Human Services let states define their own EHB plan. This approach was seen as the best balance between flexibility and comprehensiveness, and assumed there would be little state-to-state variation. Limited federal oversight runs the risk of variation in EHB coverage definitions and requirements, as well as potential divergence from standardized medical guidelines. We analyzed 112 EHB documents from all states for behavioral health coverage in effect from 2012 to 2017. We find wide variation among states in their EHB plan required-coverage, and divergence between medical-practice guidelines and EHB plans. These results emphasize consideration of federated regulation over health insurance coverage standards. Federal flexibility in states benefit design nods to state-specific policymaking-processes and population needs. However, flexibility becomes problematic if it leads to inadequate coverage that reduces access to critical health care services. The EHBs demonstrate an incomplete effort to establish appropriate minimum standards of coverage for behavioral health services.

scholarly journals Union Effects on Health Insurance Provision and Coverage in the United States

ILR Review ◽  
2002 ◽  
Vol 55 (4) ◽  
pp. 610-627 ◽  
Author(s):  
Thomas C. Buchmueller ◽  
John Dinardo ◽  
Robert G. Valletta
Keyword(s):  
United States ◽  
Health Insurance ◽  
Survey Data ◽  
Insurance Coverage ◽  
Health Benefits ◽  
Union Density ◽  
Health Insurance Coverage ◽  
The United States ◽  
Health Coverage ◽  
Private Sector Union

During the past two decades, union density has declined in the United States and employer provision of health benefits has changed substantially in extent and form. Using individual survey data spanning the years 1983–97 combined with employer survey data for 1993, the authors update and extend previous analyses of private-sector union effects on employer-provided health benefits. They find that the union effect on health insurance coverage rates has fallen somewhat but remains large, due to an increase over time in the union effect on employee “take-up” of offered insurance, and that declining unionization explains 20–35% of the decline in employee health coverage. The increasing union take-up effect is linked to union effects on employees' direct costs for health insurance and the availability of retiree coverage.

scholarly journals Analysis of the Effect of Health Insurance on Health Care Utilization in Rwanda

2021 ◽  
Author(s):  
Roger Muremyi ◽  
Dominique Haughton ◽  
François Niragire ◽  
Ignace Kabano
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Health Care Utilization ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Secondary Data ◽  
Living Condition ◽  
Care Utilization ◽  
Health Coverage

In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

A COMPARATIVE STUDY ON AWARENESS AND HEALTH INSURANCE COVERAGE IN RURALAND URBAN MEERUT

2021 ◽  
pp. 65-67
Author(s):  
Harivansh Chopra ◽  
Tanveer Bano ◽  
Niharika Verma ◽  
Gargi Pandey
Keyword(s):  
Health Insurance ◽  
Urban Area ◽  
Rural Area ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Rural And Urban ◽  
Economics Of Health ◽  
Poverty Status ◽  
Rural And Urban Area

Universal Health Coverage aims to provide essential health services to all while providing protection from catastrophic expenditure on health. To mitigate the economics of health expenditure, health insurance is one of the important tool. Hence, this study was conducted to nd out the awareness and practice of health insurance coverage in rural and urban Meerut.90 households were studied in both rural and urban area. Awareness was higher in urban area but coverage was higher in rural area. Awareness and coverage were found to be signicantly associated with poverty status in rural area of Meerut.

scholarly journals Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance

2020 ◽  
Vol 17 (17) ◽  
pp. 6327
Author(s):  
Qiang Yao ◽  
Chaojie Liu ◽  
Ju Sun
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Health Insurance Coverage ◽  
Social Health ◽  
Local Health ◽  
Public Health Services ◽  
Internal Migrants ◽  
Use Of Health Services

On-the-spot settlements of medical bills for internal migrants enrolled with a social health insurance program outside of their residential location have been encouraged by the Chinese government, with the intention to improve equality in healthcare services. This study compared the use of health services between the internal migrants who had local health insurance coverage and those who did not. Data (n = 144,956) were obtained from the 2017 China Migrants Dynamic Survey. Use of health services was assessed by two indicators: visits to physicians when needed and registration (shown as health records) for essential public health services. Multi-level logistic regression models were established to estimate the effect size of fund location on the use of health services after controlling for variations in other variables. The respondents who enrolled with a social health insurance scheme locally were more likely to visit physicians when needed (adjusted odds ratio (AOR) = 1.18, 95% CI = 1.06–1.30) and to have a health record (AOR = 1.47, 95% CI = 1.30–1.65) compared with those who enrolled outside of their residential location: a gap of 3.5 percentage points (95% CI: 1.3%–5.8%) and 6.1 percentage point (95% CI: 4.3%–7.8%), respectively. The gaps were larger in the rural-to-urban migrants than those in the urban-to-urban migrants (AOR = 1.17, 95% CI = 0.93–1.48 for visiting physicians when needed; AOR = 0.71, 95% CI = 0.54–0.93 for having a health record). The on-the-spot medical bill settlement system has yet to fully achieve its proposed potential as inequalities in both medical and public health services remain between the internal migrants with and without local health insurance coverage. Further studies are needed to investigate how on-the-spot settlements of medical bills are implemented through coordination across multiple insurance funds.

scholarly journals Use of Inpatient Behavioral Health Services by Children and Adolescents With Private Insurance Coverage

2018 ◽  
Vol 69 (9) ◽  
pp. 1036-1039 ◽  
Author(s):  
Judith L. Teich ◽  
Ryan Mutter ◽  
Brent Gibbons ◽  
Kay Miller ◽  
Sean Lynch ◽  
...  
Keyword(s):  
Health Services ◽  
Children And Adolescents ◽  
Behavioral Health ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Behavioral Health Services

scholarly journals Prevalence and factors associated with health insurance coverage in resource-poor urban settings in Nairobi, Kenya: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031543 ◽  
Author(s):  
Peter O Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri F Mohamed ◽  
Hermann Pythagore Pierre Donfouet ◽  
Martin K Mutua
Keyword(s):  
Health Insurance ◽  
Primary Outcome ◽  
Insurance Coverage ◽  
Scale Up ◽  
Household Head ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Insurance Cover

ObjectiveTo determine the prevalence of health insurance and associated factors among households in urban slum settings in Nairobi, Kenya.DesignThe data for this study are from a cross-sectional survey of adults aged 18 years or older from randomly selected households in Viwandani slums (Nairobi, Kenya). Respondents participated in the Lown scholars’ study conducted between June and July 2018.SettingThe Lown scholars’ survey was nested in the Nairobi Urban Health and Demographic Surveillance System in Viwandani slums in Nairobi, Kenya.ParticipantsA total of 300 randomly sampled households participated in the survey. The study respondents comprised of either the household head, their spouses or credible adult household members.Primary outcome measureThe primary outcome of this study was enrolment in a health insurance programme. The households were classified into two groups: those having at least one member covered by health insurance and those without any health insurance cover.ResultsThe prevalence of health insurance in the sample was 43%. Being unemployed (adjusted OR (aOR) 0.17; p<0.05; 95% CI 0.06 to 0.47) and seeking care from a public health facility (aOR 0.50; p<0.05; 95% CI 0.28 to 0.89) was significantly associated with lower odds of having a health insurance cover. The odds of having a health insurance cover were significantly lower among respondents who perceived their health status as good (aOR 0.62; p<0.05; 95% CI 1.17 to 5.66) and those who were unsatisfied with the cost of seeking primary care (aOR 0.34; p<0.05; 95% CI 0.17 to 0.69).ConclusionsHealth insurance coverage in Viwandani slums in Nairobi, Kenya, is low. As universal health coverage becomes the growing focus of Kenya’s ‘Big Four Agenda’ for socioeconomic transformation, integrating enabling and need factors in the design of the national health insurance package may scale-up social health protection.

scholarly journals Increasing Health Insurance Coverage through an Extended Federal Employees Health Benefits Program

2001 ◽  
Vol 38 (2) ◽  
pp. 177-192 ◽  
Author(s):  
Beth C. Fuchs
Keyword(s):  
Health Insurance ◽  
High Risk ◽  
Small Firms ◽  
Insurance Coverage ◽  
Health Benefits ◽  
Health Insurance Coverage ◽  
Tax Credits ◽  
Federal Employees ◽  
Public Programs ◽  
The Cost

The Federal Employees Health Benefits Program (FEHBP) could be combined with health insurance tax credits to extend coverage to the uninsured. An extended FEHBP, or “E-FEHBP,” would be open to all individuals who were not covered through work or public programs and who also were eligible for the tax credits on the basis of income. E-FEHBP also would be open to employees of very small firms, regardless of their eligibility for tax credits. Most plans available to FEHBP participants would be required to offer enrollment to E-FEHBP participants, although premiums would be rated separately. High-risk individuals would be diverted to a separate high-risk pool, the cost of which would be subsidized by the federal government. E-FEHBP would be administered by the states, or if a state declined, by an entity that contracted with the Office of Personnel Management. While E-FEHBP would provide group insurance to people who otherwise could not get it, premiums could exceed the tax-credit amount and some people still might find the coverage unaffordable.

Serious Illness and Private Health Coverage: A Unique Problem Calling for Unique Solutions

1997 ◽  
Vol 25 (2-3) ◽  
pp. 180-191 ◽  
Author(s):  
Eleanor D. Kinney ◽  
Deborah A. Freund ◽  
Mary Elizabeth Camp ◽  
Karen A. Jordan ◽  
Marion Christopher Mayfield
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Unique Problem ◽  
Serious Illness ◽  
Access To Health ◽  
Catastrophic Disease ◽  
Seriously Ill

Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill.

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