The Current State of Employment-Based Health Coverage

2004 ◽  
Vol 32 (3) ◽  
pp. 404-409 ◽  
Author(s):  
Sherry A. Glied ◽  
Phyllis C. Borzi
Keyword(s):  
Health Insurance ◽  
Current System ◽  
Insurance Coverage ◽  
Universal Coverage ◽  
Health Insurance Coverage ◽  
State Agency ◽  
Health Coverage ◽  
Current State ◽  
Policy Analysts ◽  
Employer Mandate

American policymakers and health policy analysts have a love-hate relationship with job-based health insurance. The policy press routinely runs articles about the demise of the current system of voluntary employer-sponsored health insurance coverage. Conservatives argue that it ought to be replaced with individually-purchased insurance, such as tax-favored spending accounts (see Mark Pauly’s article this issue). Liberals assert that government insurance ought to supplant it.Meanwhile, as the debate rages on about the future of employer coverage, states and the federal government pass legislation buttressing and building on the existing employment-based system. Most recently, California has passed an employer mandate requiring employers to cover their workers (and many other states have contemplated similar legislation) and Maine has adopted a universal coverage initiative that includes a voluntary small employer insurance program offered through a state agency (Dirigo Health Care).

scholarly journals Identifying the determinants of health insurance coverage among Peruvian women of reproductive age: an assessment based on the national Peruvian demographic survey of 2017

2020 ◽  
Author(s):  
Eduardo Ramos Rosas ◽  
Volker Winkler ◽  
Stephan Brenner ◽  
Manuela De Allegri
Keyword(s):  
Health Insurance ◽  
Rural Areas ◽  
Multinomial Logistic Regression ◽  
Insurance Coverage ◽  
Universal Coverage ◽  
Health Insurance Coverage ◽  
Reproductive Age ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Coverage Rates

Abstract Background: Like many other Latin America- and Caribbean countries, Peru has introduced a tax-financed health insurance scheme called “Sistema Integral de Salud (SIS)” to foster progress towards Universal Health Coverage. The scheme explicitly targets the poorest sections of the population. Our study explores levels of health insurance coverage and their determinants among Peruvian women following the introduction of SIS. We wish to determine the extent to which the introduction of SIS has effectively closed gaps in insurance coverage and for whom. Methods: Relying on the 2017 round of ENDES (Encuesta Nacional Demográfica y de Salud Familiar) survey, we analyzed data for 33168 women aged 15-49. We used multinomial logistic regression to explore the association between health insurance coverage (defined as No Insurance, SIS, Standard Insurance) and women’s socio-demographic and economic characteristics. Results: Out of the 33168 women, 25.3% did not have any insurance coverage, 45.5% were covered by SIS and 29.2% were covered by a Standard Insurance scheme. Women in the SIS group were found to have lower educational levels, live in rural areas and more likely to be poorer. Women in the Standard insurance group were found to be more educated, more likely to be “Spanish”, and to be wealthier. Most uninsured women appeared to belong to a middle class, not poor enough to be eligible for SIS, but also not eligible for standard insurance. Conclusions: Our study confirms that SIS has been effective in increasing coverage among vulnerable women, with coverage rates comparable with those observed among men. Nevertheless, on its own, it has proven to be insufficient to ensure universal coverage among women. Further reforms are needed to ensure that coverage is extended to all population groups.

scholarly journals Identifying the determinants of health insurance coverage among Peruvian women of reproductive age: an assessment based on the national Peruvian demographic survey of 2017

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Eduardo Ramos Rosas ◽  
Volker Winkler ◽  
Stephan Brenner ◽  
Manuela De Allegri
Keyword(s):  
Health Insurance ◽  
Rural Areas ◽  
Multinomial Logistic Regression ◽  
Insurance Coverage ◽  
Universal Coverage ◽  
Health Insurance Coverage ◽  
Reproductive Age ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Coverage Rates

Abstract Background Like many other Latin America- and Caribbean countries, Peru has introduced a tax-financed health insurance scheme called “Sistema Integral de Salud (SIS)” to foster progress towards Universal Health Coverage. The scheme explicitly targets the poorest sections of the population. Our study explores levels of health insurance coverage and their determinants among Peruvian women following the introduction of SIS. We wish to determine the extent to which the introduction of SIS has effectively closed gaps in insurance coverage and for whom. Methods Relying on the 2017 round of ENDES (Encuesta Nacional Demográfica y de Salud Familiar) survey, we analyzed data for 33,168 women aged 15–49. We used multinomial logistic regression to explore the association between health insurance coverage (defined as No Insurance, SIS, Standard Insurance) and women’s socio-demographic and economic characteristics. Results Out of the 33,168 women, 25.3% did not have any insurance coverage, 45.5% were covered by SIS and 29.2% were covered by a Standard Insurance scheme. Women in the SIS group were found to have lower educational levels, live in rural areas and more likely to be poorer. Women in the Standard insurance group were found to be more educated, more likely to be “Spanish”, and to be wealthier. Most uninsured women appeared to belong to a middle class, not poor enough to be eligible for SIS, but also not eligible for standard insurance. Conclusions Our study confirms that SIS has been effective in increasing coverage among vulnerable women, with coverage rates comparable with those observed among men. Nevertheless, on its own, it has proven to be insufficient to ensure universal coverage among women. Further reforms are needed to ensure that coverage is extended to all population groups.

scholarly journals Identifying the determinants of health insurance coverage among Peruvian women of reproductive age: an assessment based on the national Peruvian demographic survey of 2017

2020 ◽  
Author(s):  
Eduardo Ramos Rosas ◽  
Volker Winkler ◽  
Stephan Brenner ◽  
Manuela De Allegri
Keyword(s):  
Health Insurance ◽  
Rural Areas ◽  
Multinomial Logistic Regression ◽  
Insurance Coverage ◽  
Universal Coverage ◽  
Health Insurance Coverage ◽  
Reproductive Age ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Coverage Rates

Abstract Background: Like many other Latin America- and Caribbean countries, Peru has introduced a tax-financed health insurance scheme called “Sistema Integral de Salud (SIS)” to foster progress towards Universal Health Coverage. The scheme explicitly targets the poorest sections of the population. Our study explores levels of health insurance coverage and their determinants among Peruvian women following the introduction of SIS. We wish to determine the extent to which the introduction of SIS has effectively closed gaps in insurance coverage and for whom. Methods: Relying on the 2017 round of ENDES (Encuesta Nacional Demográfica y de Salud Familiar) survey, we analyzed data for 33168 women aged 15-49. We used multinomial logistic regression to explore the association between health insurance coverage (defined as No Insurance, SIS, Standard Insurance) and women’s socio-demographic and economic characteristics. Results: Out of the 33168 women, 25.3% did not have any insurance coverage, 45.5% were covered by SIS and 29.2% were covered by a Standard Insurance scheme. Women in the SIS group were found to have lower educational levels, live in rural areas and more likely to be poorer. Women in the Standard insurance group were found to be more educated, more likely to be “Spanish”, and to be wealthier. Most uninsured women appeared to belong to a middle class, not poor enough to be eligible for SIS, but also not eligible for standard insurance. Conclusions: Our study confirms that SIS has been effective in increasing coverage among vulnerable women, with coverage rates comparable with those observed among men. Nevertheless, on its own, it has proven to be insufficient to ensure universal coverage among women. Further reforms are needed to ensure that coverage is extended to all population groups.

scholarly journals Protracted statelessness and nationalitylessness among the Lahu, Akha and Tai-Yai in northern Thailand: Problem areas and the vital role of health insurance status

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Chantal Herberholz
Keyword(s):  
Health Insurance ◽  
Ethnic Groups ◽  
Insurance Coverage ◽  
Universal Coverage ◽  
Health Insurance Coverage ◽  
Healthcare Services ◽  
Primary Data ◽  
Health Coverage ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs

Thailand has one of the largest stateless populations in the world. Stateless people are denied access to basic rights and services, driving inequality and discrimination and threatening peace and security. This article aims to explore the problems that stateless people are facing in their daily lives, with a focus on healthcare services, health insurance coverage, and mobility. Primary data were collected in 2020 from 108 stateless and nationalityless adults in Chiang Mai province, belonging to three ethnic minorities, and analyzed using a mixed methods approach. The respondents are exposed to daily environmental stressors, the most serious being exclusion from the Universal Coverage Scheme, mobility restrictions and the absence of land rights. While out-of-pocket health expenditures increase financial vulnerability, a lack of health insurance is also associated with perceived poor quality of care and unmet healthcare needs. However, observed differences among the three ethnic groups highlight that some problems are specific to individual ethnic groups and not necessarily a consequence of citizenship problems. Given the experience Thailand has gained in achieving universal health coverage for Thai citizens, there is an opportunity to address the healthcare plight of Thailand’s stateless and nationalityless population through prioritizing the expansion and improvement of the existing Health Insurance for People with Citizenship Problems policy.

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 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 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.

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.

PARENTAL MORBIDITY, CHILD WORK, AND HEALTH INSURANCE IN RWANDA

2016 ◽  
Vol 83 (1) ◽  
pp. 111-127 ◽  
Author(s):  
Maame Esi Woode ◽  
Marwân-al-Qays Bousmah ◽  
Raouf Boucekkine
Keyword(s):  
Health Insurance ◽  
System Development ◽  
Insurance Coverage ◽  
Substitution Effect ◽  
Health Insurance Coverage ◽  
Health Shocks ◽  
Health Coverage ◽  
Child Work ◽  
Parental Health ◽  
Hurdle Models

AbstractMeasuring direct and indirect effects of extending health insurance coverage in developing countries is a key issue for health system development and for attaining universal health coverage. This paper investigates the role played by health insurance in the relationship between parental morbidity and child work decisions. We use a propensity score matching technique combined with hurdle models, using data from Rwanda. The results show that parental health shocks have a substantial influence on child work when households do not have health insurance. Depending on the gender of the sick parent, there is a substitution effect not only between the parent and the child on the labor market, but also between the time the child spends on different work activities. Altogether, results reveal that health insurance protects children against child work in the presence of parental health shocks.

scholarly journals Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Leila Doshmangir ◽  
Mohammad Bazyar ◽  
Arash Rashidian ◽  
Vladimir Sergeevich Gordeev
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Equity ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Health Care Expenditures ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
The Impact ◽  
Universal Health

Abstract Background Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC. Methods This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis. Results Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable. Conclusion To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.

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