scholarly journals Quantifying Overinsurance Tied to the Tax Exclusion for Employment-Based Health Insurance and Its Variation by Health Status

2019 ◽  
Vol 56 ◽  
pp. 004695801989385
Author(s):  
Bradley Herring ◽  
Erin Trish
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Status ◽  
Expected Utility ◽  
Low Income ◽  
Health Care Services ◽  
Medical Expenditure Panel Survey ◽  
Insurance Coverage ◽  
Medical Expenditure ◽  
Health Care Spending

The exclusion of employment-based health insurance from income and payroll taxes is thought to increase the generosity of insurance coverage and, in turn, increase the overutilization of low-value health care services. We examine this inefficiency of overinsurance by quantifying the change in expected utility across 4 benchmark plans varying in actuarial value (AV) and focus on the distribution of each of these estimates across different groups of people varying in health status. Specifically, we quantify the changes in health care spending due to moral hazard and the changes in uncertainty tied to risk aversion using data from the nationally representative sample of adults with employment-based coverage from the 2007-2016 Medical Expenditure Panel Survey, and produce estimates of expected utility for 24 groups of people based on their age, gender, and preexisting conditions. Our model suggests an average preferred AV of 78% without the tax exclusion, with 29.0% of the population preferring a 60% AV, 6.5% preferring a 70% AV, 18.1% preferring an 80% AV, and 46.4% preferring a 90% AV. When incorporating the distortionary effect of the employment-based tax exclusion, the preferred plan increases to an 83% AV for low-income people (with 71.0% of the population preferring a 90% AV) and an 84% AV for high-income people (with 76.0% of the population preferring a 90% AV). We estimate that policy changes to make subsidies independent of a plan’s AV could result in increases in utility equal to about 2.7% of total health care spending, but with those net gains concentrated among the healthy.

scholarly journals How Much Can Really Be Saved by Rolling Back SCHIP? The Net Cost of Public Health Insurance for Children

2005 ◽  
Vol 42 (1) ◽  
pp. 16-28 ◽  
Author(s):  
Thomas M. Selden ◽  
Julie L. Hudson
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Medical Expenditure Panel Survey ◽  
Insurance Coverage ◽  
Medical Expenditure ◽  
Low Income Families ◽  
Using Data ◽  
Financial Burdens ◽  
The Many ◽  
The Cost

A growing body of research demonstrates the many benefits of expanded public coverage for children. Expansions in Medicaid and the State Children's Health Insurance Program (SCHIP) have helped to increase insurance coverage, increase access to care, and reduce the financial burdens facing low-income families. Less attention has been focused on the cost of expanding public coverage. We argue that budgetary data may exaggerate the net costs of these expansions because many of the highest-cost children would have received publicly funded care even if the expansions had not taken place. Using data from the 2000 Medical Expenditure Panel Survey, we simulate the net cost of SCHIP, finding that the true cost of this program–both to states and to the federal government–is substantially less than average spending per enrollee would suggest. Our results strengthen the benefit-cost argument against implementing rollbacks in SCHIP.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

Autism and Families' Financial Burden: The Association With Health Insurance Coverage

2015 ◽  
Vol 120 (2) ◽  
pp. 166-175 ◽  
Author(s):  
Susan L. Parish ◽  
Kathleen C. Thomas ◽  
Christianna S. Williams ◽  
Morgan K. Crossman
Keyword(s):  
Health Insurance ◽  
Medical Expenditure Panel Survey ◽  
Financial Burden ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Autism Spectrum ◽  
Medical Expenditure ◽  
Outpatient Services ◽  
Raising Children

Abstract We examined the relationship between family financial burden and children's health insurance coverage in families (n  =  316) raising children with autism spectrum disorders (ASD), using pooled 2000–2009 Medical Expenditure Panel Survey data. Measures of family financial burden included any out-of-pocket spending in the previous year, and spending as a percentage of families' income. Families spent an average of $9.70 per $1,000 of income on their child's health care costs. Families raising children with private insurance were more than 5 times as likely to have any out-of-pocket spending compared to publicly insured children. The most common out-of-pocket expenditure types were medications, outpatient services, and dental care. This study provides evidence of the relative inadequacy of private insurance in meeting the needs of children with ASD.

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.

scholarly journals Wealth Status, Health Insurance, and Maternal Health Care Utilization in Africa: Evidence from Gabon

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
N’doh Ashken Sanogo ◽  
Sanni Yaya
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Maternal Health ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Maternal Health Care ◽  
Care Utilization ◽  
Services Utilization ◽  
Maternal Health Care Utilization ◽  
Care Services

Background. To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low. The achievement of universal health care requires the provision and availability of an adequate financing system. This study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon. Methods. The study used the 6th round of Gabon Demographic and Health Surveys (GDHSs)—2012 data to explore three outcome measures of maternal health care utilization extracted on number of antenatal care (ANC) visits during pregnancy, place of birth delivery, and postnatal health care. The dependent variable was women with health insurance coverage against those without. Logistic regression and propensity scoring matching analysed associations of health insurance coverage on women’s utilization of health care. Results. Mean (+/− SD) age of women respondents of reproductive age was 29 years (9.9). The proportion of at least 4 antenatal care visits was 69.2%, facility-based delivery was 84.7%, and postnatal care utilization was 67.9%. The analysis of data showed disparities in maternal health care services utilization. The GDHS showed maternal age, and geographical region was significantly associated with maternal health care service utilization. A high proportion of urban dwellers and Christian women used maternal health care services. According to the wealth index, maternal health services utilization was higher in women from wealthy households compared to lower households wealth index (ANC (Conc. Index = 0.117; p≤0.001), facility-based delivery (Conc. Index = 0.069; p≤0.001), and postnatal care (Conc. Index = 0.075; p≤0.001), respectively). With regard to health care insurance coverage, women with health insurance were more likely to use ANC and facility-based delivery services than those without (concentration indices for ANC and facility-based delivery were statistically significant; ANC: z-stat = 2.69; p=0.007; Conc. Index: 0.125 vs. 0.096 and facility-based delivery: z-stat = 3.38; p=0.001; Conc. Index: 0.076 vs. 0.053, respectively). Conclusion. Women enrollment in health insurance and improved household’s financial status can improve key maternal health services utilization.

scholarly journals Determining Health Insurance attributes and Levels: A Qualitative Study

2020 ◽  
Author(s):  
Mohammad Ranjbar ◽  
Ali Kazemi Karyani ◽  
Milad Shafiei ◽  
Elham Tayefi
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Qualitative Study ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Health Sector ◽  
Public Hospitals ◽  
Discrete Choice Experiments ◽  
Outpatient Services ◽  
Final Design

Background: Health insurance is one of the financing mechanisms in the health sector that reduces expensive and unforeseen costs of health care for households and converts these costs into predictable premiums. The purpose of this study was to identify the appropriate attributes and levels, using the discrete choice experiments for health insurance, which can describe health care services appropriately. Methods: The present study was a qualitative study that involved several stages. First, the literature was reviewed through a search of valid sites and related features were identified. Then, through interviews with 8 health insurance and health policy makers sampled by snowball method, specific health insurance weighting characteristics were assessed. Eventually the research team decided to include traits and levels in the final design after several panel meetings with experts. Results: The findings of this study showed that the most important attributes of health insurance include Public hospitals, and private hospitals benefits, outpatient services, dental insurance coverage, Para clinical services, medication and medical equipment cost coverage, and finally monthly premium. Conclusion: Policymakers and health insurance organizations need to focus on health and premium benefit packages appropriate to people's ability to pay and community inflation to improve and improve insurance in this area. Emphasizing these attributes can help individuals' preferences and willingness to pay for health insurance and lead to changes in the insurance system of the country, planning to improve basic insurance and increasing the benefits of insurance packages.

Immigrants and Private Insurance

Pained ◽  
2020 ◽  
pp. 57-60
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
Health Care ◽  
Medical Expenditure Panel Survey ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Medical Expenditure ◽  
Undocumented Immigrant ◽  
Common Belief ◽  
The Us ◽  
The Common ◽  
Per Capita

This chapter assesses the accusation that immigrants, particularly undocumented immigrants, take advantage of societal resources at the expense of native-born citizens. Between 2002 and 2009, immigrants paid an estimated $115.2 billion more into Medicare than they used. Meanwhile, a 2018 Health Affairs study used data from the Medical Expenditure Panel Survey (MEPS) to measure both premiums and expenditures from private health insurance. Both documented and undocumented immigrant groups had positive net contributions, meaning they paid more toward their private insurance coverage than they spent in receiving health services. In contrast, US natives had a negative net contribution, meaning that, per capita, their expenditures on health care were greater than their premiums. Thus, these findings upend the common belief that immigrants are a drain on the US health care system. In reality, immigrants who contribute to Medicare and to private health insurers are subsidizing the health care of US citizens.

The Impacts of the COVID-19 Pandemic on the Medical Expenditure Panel Survey

2021 ◽  
Vol 111 (12) ◽  
pp. 2157-2166
Author(s):  
Samuel H. Zuvekas ◽  
David Kashihara
Keyword(s):  
Health Care ◽  
Medical Expenditure Panel Survey ◽  
Insurance Coverage ◽  
Response Rates ◽  
Medical Expenditure ◽  
Care Utilization ◽  
Panel Survey ◽  
Quality Of Data ◽  
Statistical Precision ◽  
The Impact

The COVID-19 pandemic caused substantial disruptions in the field operations of all 3 major components of the Medical Expenditure Panel Survey (MEPS). The MEPS is widely used to study how policy changes and major shocks, such as the COVID-19 pandemic, affect insurance coverage, access, and preventive and other health care utilization and how these relate to population health. We describe how the MEPS program successfully responded to these challenges by reengineering field operations, including survey modes, to complete data collection and maintain data release schedules. The impact of the pandemic on response rates varied considerably across the MEPS. Investigations to date show little effect on the quality of data collected. However, lower response rates may reduce the statistical precision of some estimates. We also describe several enhancements made to the MEPS that will allow researchers to better understand the impact of the pandemic on US residents, employers, and the US health care system. (Am J Public Health. 2021;111(12):2157–2166. https://doi.org/10.2105/AJPH.2021.306534 )

The Impact of Health Care Financing on Family Budgets

1994 ◽  
Vol 24 (4) ◽  
pp. 691-714 ◽  
Author(s):  
Edith Rasell ◽  
Jared Bernstein ◽  
Kainan Tang
Keyword(s):  
Health Care ◽  
Low Income ◽  
Private Insurance ◽  
The Elderly ◽  
High Income ◽  
Medical Expenditure ◽  
Health Care Spending ◽  
Expenditure Survey ◽  
Low Income Families ◽  
The Impact

Although businesses, federal and state governments, and insurance companies are major funding sources for health care, they are just intermediate sources. Ultimately, individuals and families pay all health care costs through out-of-pocket spending, insurance premiums, or federal, state, and local taxes. Using a microsimulation model with data from the 1987 National Medical Expenditure Survey, the Internal Revenue Service's Individual Tax Model, and the Consumer Expenditure Survey, the authors examine the distribution of health care spending, by decile, among families and individuals. They find that the distribution of health expenditures is very regressive, with low-income families paying twice the share of income paid by high-income families. The distribution of out-of-pocket expenditures, which comprise 24 percent of total spending, is the most regressive, with low-income families paying 8.5 times the share of income paid by high-income families. Spending on premiums is also regressive, and the regressivity would increase if everyone had private insurance. Expenditures through the public sector are progressive. Regressivity is greater among the elderly than the nonelderly. Out-of-pocket expenditures account for 41 percent of all health care spending by the elderly. A more equitably financed health care system would increase the share of funding raised through progressive taxes, and decrease reliance on expenditures made out of pocket and on premiums.

Racial Differences in Health Insurance Coverage and Medical Expenditures in the United States

2006 ◽  
Vol 30 (4) ◽  
pp. 529-550 ◽  
Author(s):  
Melissa A. Thomasson
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Racial Differences ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Medical Expenditures ◽  
Health Care Spending ◽  
Data Set ◽  
Racial Gap

This article uses a unique data set from 1957 to examine the racial gap in health insurance coverage and the extent to which that gap influenced racial differences in health care spending. Results indicate that black households in 1957 were statistically significantly less likely to purchase health insurance than white households, even after controlling for differences in income, years of schooling, age, family size, marital status, and other personal and job-related characteristics. Findings in the article also provide weak support for the hypothesis that a racial gap in health insurance coverage contributed to racial differences in health care spending between blacks and whites; even after controlling for differences in income, education, and other characteristics, racial differences in medical expenditures were smaller for insured than for uninsured families, although the result is not statistically significant.

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