scholarly journals Private health insurance coverage-related lawsuits

2020 ◽  
Vol 73 (3) ◽  
Author(s):  
Ana Beatriz Perez Afonso ◽  
Mayra Gonçalves Menegueti ◽  
Thamiris Ricci de Araújo ◽  
Lucieli Dias Pedreschi Chaves ◽  
Ana Maria Laus
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Medical Procedures ◽  
Cross Sectional ◽  
Positron Emission ◽  
Percutaneous Rhizotomy ◽  
Using Data ◽  
National Regulatory Agency

ABSTRACT Objectives: to analyze lawsuits brought by beneficiaries of health insurance operators. Methods: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. Results: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. Conclusions: the lawsuits were filed because of the operators’ refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

PARTICIPATING IN HEALTH INSURANCE AND FACTORS AFFECTING AMONG PERSONS WHOSE ENROLMENT IS VOLUNTARY IN THUA THIEN HUE PROVINCE

2015 ◽  
pp. 89-95
Author(s):  
Thi Hoai Thuong Nguyen ◽  
Hoang Lan Nguyen ◽  
Mau Duyen Nguyen
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional ◽  
Factors Affecting ◽  
The People ◽  
Universal Health Insurance Coverage ◽  
The Social

Background:To provide information helps building policy that meets the practical situation and needs of the people with the aim at achieving the goal of universal health insurance coverage, we conducted this study with two objectives (1) To determine the rate of participating health insurance among persons whose enrolment is voluntary in some districts of ThuaThien Hue province; (2) To investigate factor affecting their participation in health insurance. Materials and Methodology:A cross-sectional descriptive study was conducted in three districts / towns / city of ThuaThien Hue in 2014. 480 subjects in the voluntary participation group who were randomly selected from the study settings were directly interviewed to collect information on the social, economic, health insurance participation and knowledge of health insurance. Test χ2 was used to identify factors related to the participation in health insurance of the study subjects. Results:42.5% of respondents were covered by health insurance scheme. Factors related to their participation were the resident location (p = 0.042); gender (p = 0.004), age (p <0.001), chronic disease (p <0.001), economic conditions (p<0.001) and knowledge about health insurance (p <0.001). Conclusion: The rate of participating health insurance among study subjects was low at 42,5%. There was "adverse selection" in health insurance scheme among voluntary participating persons. Providing knowledge about health insurance should be one of solutions to improve effectively these problems. Key words: Health insurance, voluntary, Thua Thien Hue

scholarly journals Private Health Insurance in Malaysia: Who Is Left Behind?

2021 ◽  
pp. 101053952110009
Author(s):  
Nur Zahirah Balqis-Ali ◽  
Jailani Anis-Syakira ◽  
Weng Hong Fun ◽  
Sondi Sararaks
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Home Ownership ◽  
Insurance Coverage ◽  
Binary Logistic Regression ◽  
Health Insurance Coverage ◽  
Rural Government ◽  
Lower Education Level ◽  
Current Drinker ◽  
Study Population

Despite various efforts introduced, private health insurance coverage is still low in Malaysia. The objective of this article is to find the factors associated with not having a private health insurance in Malaysia. We analyze data involving 19 959 respondents from the 2015 National Health Morbidity Survey. In this article, we describe the prevalence of not having health insurance and conducted binary logistic regression to identify determinants of uninsured status. A total of 56.6% of the study population was uninsured. After adjusting for other variables, the likelihood of being uninsured was higher among those aged 50 years and above, females, Malay/other Bumiputra ethnicities, rural, government/semigovernment, self-employed, unpaid workers and retirees, unemployed, lower education level, without home ownership and single/widowed/divorced, daily smoker, underweight body mass index, and current drinker. The likelihood of being uninsured also increased with increasing household size while the inversed trend was seen for household income. A substantial proportion of population in Malaysia did not have private health insurance, and these subgroups have limited preferential choices for provider, facility, and care.

Drivers of potentially avoidable emergency admissions in Ireland: an ecological analysis

2018 ◽  
Vol 28 (6) ◽  
pp. 438-448 ◽  
Author(s):  
Brenda Lynch ◽  
Anthony P Fitzgerald ◽  
Paul Corcoran ◽  
Claire Buckley ◽  
Orla Healy ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Emergency Admission ◽  
Health Insurance Coverage ◽  
County Level ◽  
Emergency Admissions ◽  
Admission Rates ◽  
System Factors

BackgroundMany emergency admissions are deemed to be potentially avoidable in a well-performing health system.ObjectiveTo measure the impact of population and health system factors on county-level variation in potentially avoidable emergency admissions in Ireland over the period 2014–2016.MethodsAdmissions data were used to calculate 2014–2016 age-adjusted emergency admission rates for selected conditions by county of residence. Negative binomial regression was used to identify which a priori factors were significantly associated with emergency admissions for these conditions and whether these factors were also associated with total/other emergency admissions. Standardised incidence rate ratios (IRRs) associated with a 1 SD change in risk factors were reported.ResultsNationally, potentially avoidable emergency admissions for the period 2014–2016 (266 395) accounted for 22% of all emergency admissions. Of the population factors, a 1 SD change in the county-level unemployment rate was associated with a 24% higher rate of potentially avoidable emergency admissions (IRR: 1.24; 95% CI 1.04 to 1.41). Significant health system factors included emergency admissions with length of stay equal to 1 day (IRR: 1.20; 95% CI 1.11 to 1.30) and private health insurance coverage (IRR: 0.92; 95% CI 0.89 to 0.96). The full model accounted for 50% of unexplained variation in potentially avoidable emergency admissions in each county. Similar results were found across total/other emergency admissions.ConclusionThe results suggest potentially avoidable emergency admissions and total/other emergency admissions are primarily driven by socioeconomic conditions, hospital admission policy and private health insurance coverage. The distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed when attempting to identify the causes of regional variation in emergency admission rates.

scholarly journals Determinants of self-rated private health insurance coverage in Jamaica

Health ◽  
2010 ◽  
Vol 02 (06) ◽  
pp. 541-550 ◽  
Author(s):  
Paul A. Bourne ◽  
Maureen D. Kerr-Campbell
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage

scholarly journals Risk selection into supplemental private health insurance in China

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yawen Jiang ◽  
Weiyi Ni
Keyword(s):  
Health Insurance ◽  
Instrumental Variable ◽  
Private Health Insurance ◽  
Developed Countries ◽  
Risk Selection ◽  
Alternative Analysis ◽  
Cross Sectional ◽  
Advantageous Selection ◽  
Using Data ◽  
Sectional Analysis

Abstract Background Information on risk selection is important for the regulation and development of supplemental private health insurance (PHI). The research on risk selection into supplemental PHI has been documented in several developed countries where the regulation of the PHI markets was relatively mature. However, evidence on this important aspect of the supplemental PHI market in China is still absent in the literature. The private insurers in China were not prohibited from discrimination against pre-existing conditions and did not guarantee ongoing enrolment. Therefore, the direction and degree of risk selection could not be inferred using the evidence from the other countries. To provide evidence on risk selection into supplemental PHI in China, we conducted a cross-sectional analysis using data from the 2015 wave of China Health and Retirement Longitudinal Study (CHARLS). Results Using probit models, we found that individuals having better self-reported general health were more likely to enrol in PHI in China, suggesting advantageous selection. This result was confirmed by an alternative analysis using an instrumental variable. We also adjusted the realized occurrence of hospitalization by excluding potential moral hazard effect and showed that the adjusted hospitalization risk was negatively associated with PHI enrolment, which also indicated advantageous selection. Conclusions The findings suggested potential over-insurance of healthier individuals or under-insurance of less healthy individuals. The regulation of the PHI market in China should aim to address the inefficiency. The current study could also contribute to the information base for policymakers in countries where the PHI markets similarly lack strong regulation.

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.

Sex, Lies, and Health Insurance: Employer-Provided Health Insurance Coverage of Abortion and Infertility Services and the ADA

1996 ◽  
Vol 22 (1) ◽  
pp. 51-84
Author(s):  
D'Andra Millsap
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Infertility Treatment ◽  
Insurance Contracts ◽  
Access To Health ◽  
Infertility Treatments ◽  
Infertile Couples

Employer-provided health insurance is the backbone of the American healthcare system. Approximately four of five workers in the United States rely on health insurance provided in the workplace. Many commentators view access to health insurance as the doorway to the entire health care system. Thus, the benefits covered in employer-provided health insurance plans significantly impact millions of Americans.While private health insurance usually covers abortion, it traditionally has not covered infertility services. Eventually, courts began interpreting insurance contracts to include infertility treatments, leading insurers to specifically exclude infertility treatments from coverage. In response, a few states have passed mandated benefit laws requiring coverage of some or all infertility services. Nonetheless, current insurance coverage of infertility services is “erratic” at best. These exclusions are significant because abortion and infertility services can be quite expensive for the millions of infertile couples seeking some sort of infertility treatment and the millions of women who have abortions each year.

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