Health Care, Health Insurance, and the Distribution of American Incomes

2010 ◽  
Vol 13 (1) ◽  
Author(s):  
Gary Burtless ◽  
Pavel Svaton
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Panel Study ◽  
The United States ◽  
Medical Expenditure ◽  
Cash Income ◽  
Health Coverage ◽  
Money Income ◽  
Health Care Consumption ◽  
The Impact

Cash income offers an incomplete picture of the resources available to finance household consumption. Most American families are covered by an insurance plan that pays for some or all of the health care they consume. Only a comparatively small percentage of families pays for the full cost of this insurance out of their cash incomes. As health care has claimed a growing share of consumption, the percentage of care that is financed out of household incomes has declined. Because health care consumption is more important for some groups in the population than others, the growth in spending and changes in the payment system for medical care have reduced the value of standard income measures for assessing relative incomes of the rich and poor and the young and old. More than a seventh of total personal consumption now consists of health care that is purchased with government insurance and employer contributions to employee health plans. This paper combines health care spending and insurance reimbursement data in the Medical Expenditure Panel Study and money income and health coverage data in the Current Population Survey to assess the impact of health insurance on the distribution of income. Our estimates imply that gross money income significantly understates the resources available to finance household purchases. The estimates imply that a more complete measure of resources would show less inequality than the income measures that are currently used. The addition of estimates of the value of health insurance to countable incomes reduces measured inequality in the population and the income gap between young and old. If the analysis were extended over a longer period, it would show a sizeable impact of insurance on inequality trends in the United States.

Impact of Health Plan Deductibles and Health Insurance Marketplace Enrollment on Health Care Experiences

2018 ◽  
Vol 77 (5) ◽  
pp. 483-497
Author(s):  
Weiwei Chen ◽  
Timothy F. Page
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
The United States ◽  
Health Plans ◽  
Medical Needs ◽  
Care Access ◽  
Health Care Experiences ◽  
Monitoring Survey ◽  
Using Data ◽  
The Impact

High-deductible health plans (HDHPs) have become increasingly prevalent among employer-sponsored health plans and plans offered through the Health Insurance Marketplace in the United States. This study examined the impact of deductible levels on health care experiences in terms of care access, affordability, routine checkup, out-of-pocket cost, and satisfaction using data from the Health Reform Monitoring Survey. The study also tested whether the experiences of Marketplace enrollees differed from off-Marketplace individuals, controlling for deductible levels. Results from multivariable and propensity score weighted regression models showed that many of the outcomes were adversely affected by deductible levels and Marketplace enrollment. These results highlight the importance of efforts to help individuals choose the plan that fits both their medical needs and their budgets. The study also calls for more attention to improving provider acceptance of HDHPs and Marketplace plans as these plans become increasingly common over time.

Health

Getting By ◽  
2019 ◽  
pp. 329-428
Author(s):  
Helen Hershkoff ◽  
Stephen Loffredo
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
The United States ◽  
Health Coverage ◽  
Eligibility Criteria ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Child Health Insurance

This chapter addresses the issue of health care for low-income people. The United States, virtually alone among developed nations, does not offer universal access to health care, leaving many millions of individuals without health insurance or other means of obtaining necessary medical services. In 2010, Congress enacted the landmark Patient Protection and Affordable Care Act (ACA)—popularly known as “Obamacare”—marking an important but incomplete response to the nation’s health care crisis. This chapter examines the ACA in detail, including its impact on Medicaid and Medicare, the major government health programs in the United States, its creation of Health Insurance Exchanges and tax credits to help low-income households obtain private health coverage, and the reform of private health insurance markets through a patient’s bill of rights, which, among other measures, prohibits insurance companies from refusing coverage for preexisting medical conditions. Perhaps the most critical aspect of the ACA was its expansion of Medicaid to cover virtually all low-income citizens (and certain immigrants) who do not qualify for other health coverage. Although several states opted out of the ACA’s Medicaid expansion, the Medicaid program nevertheless remains the largest single provider of health coverage in the United States. This chapter also provides a detailed description of Medicaid, its eligibility criteria and scope of coverage; the Child Health Insurance Program (CHIP), a government-funded health insurance program for children in households with too much income to qualify for Medicaid; and Medicare, the federal health insurance program for aged, blind, and disabled individuals.

The impact of Universal Health Coverage on health care consumption and risky behaviours: evidence from Thailand

2014 ◽  
Vol 10 (3) ◽  
pp. 251-266 ◽  
Author(s):  
Simone Ghislandi ◽  
Wanwiphang Manachotphong ◽  
Viviana M.E. Perego
Keyword(s):  
Health Care ◽  
Universal Health Coverage ◽  
Hospital Admissions ◽  
Health Coverage ◽  
Positive Health ◽  
Health Care Consumption ◽  
Thai Population ◽  
Risky Behaviours ◽  
The Impact ◽  
Universal Health

AbstractThailand is among the first non-OECD countries to have introduced a form of Universal Health Coverage (UHC). This policy represents a natural experiment to evaluate the effects of public health insurance on health behaviours. In this paper, we examine the impact of Thailand’s UHC programme on preventive activities, unhealthy or risky behaviours and health care consumption using data from the Thai Health and Welfare Survey. We use doubly robust estimators that combine propensity scores and linear regressions to estimate differences-in-differences (DD) and differences-in-DD models. Our results offer important insights. First, UHC increases individuals’ likelihood of having an annual check-up, especially among women. Regarding health care consumption, we observe that UHC increases hospital admissions by over 2% and increases outpatient visits by 13%. However, there is no evidence that UHC leads to an increase in unhealthy behaviours or a reduction of preventive efforts. In other words, we find no evidence ofex antemoral hazard. Overall, these findings suggest positive health impacts among the Thai population covered by UHC.

Restraining the Health Care Consumer

2006 ◽  
Vol 30 (4) ◽  
pp. 501-528
Author(s):  
Beatrix Hoffman
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Medical Insurance ◽  
The United States ◽  
Health Coverage ◽  
Health Savings Accounts ◽  
Savings Accounts ◽  
Deductible Insurance ◽  
Health Care Consumer ◽  
History Of

Health insurance with high deductibles is an important feature of the Bush administration's health savings accounts initiative. A similar type of insurance, known as major medical, was the most common type of health coverage in the United States from the 1950s through the 1970s. This article traces the history of cost sharing in health insurance from its origins in insurers' concerns about “moral hazard” to the heyday of major medical insurance to the temporary comeback of first-dollar coverage during the era of managed care. Proponents of deductibles and co-payments, today and in the past, have argued that they bring down costs by forcing consumers to make more careful health care choices. The history of major medical insurance, however, shows that high-deductible insurance failed to curb medical inflation and also hurt consumers who expected their coverage to protect their incomes from the costs of sickness and injury.

scholarly journals Does the take up of public insurance programs improves health care consumption of poor individuals?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
B Carré ◽  
M Thomas ◽  
F Jusot ◽  
J Wittwer ◽  
C Gastaldi-Ménager
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Access ◽  
Insurance Coverage ◽  
Individual Characteristics ◽  
Health Care Use ◽  
Health Coverage ◽  
Health Care Consumption ◽  
The Poor ◽  
Poor Population

Abstract Background The French health insurance system is universal but 95% of the population is also covered by a complementary private health insurance (CHI). The CHI take up is not uniform across the income distribution and health care access is partly conditioned by its coverage. The Complementary Universal Health Coverage (CMU-C) and the Health Insurance Vouchers Scheme (ACS) are mean tested programs providing CHI to the poor. The former is free while the latter takes the form of a voucher to buy private CHI. Our objective is to study and compare the evolution of health care use and consumption associated with the take up of the CMU-C or the ACS. Methods In a nationwide cohort of ACS and CMU-C beneficiaries we compute bi-annual expenditures, out of pockets expenditures and rates of use for different types of care: outpatient, inpatient, dental, optical and audiology. We use panel data regression methods to model the evolution of health care use and expenditures before, during and after the coverage periods of both programs. Results Our population is composed with about 10 million individuals benefiting at least once from either the ACS or the CMU-C on the 2012-2017 period. Preliminary results suggest that inpatient expenditures are increasing concomitantly with the take up of any program whereas outpatient expenditures tend to increase after. Results will be provided for the conference on the variations of the consumption according to the program (CMU-C or ACS), type of care, individual characteristics and health status. Conclusions Free or subsidized complementary health insurance may play an important role in the access to care for poor population, even in the presence of mandatory coverage. The take up of complementary health insurance for the poor population could be partly driven by the use of inpatient services but coverage may impact positively outpatient expenditures. Key messages Unlocking poor individuals financial constraint tends to increase their use of medical services. Generous insurance coverage targeting financially constrained individuals could be a tool to reduce health care use inequalities.

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.

scholarly journals Patients’ Perception of Morocco’s Medicine Pricing Reform and Determinants of Their Access to Health Care and Medicine

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Amine Cheikh ◽  
Meryem Moutahir ◽  
Ismail Bennani ◽  
Houda Attjioui ◽  
Wadie Zerhouni ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Access To Medicines ◽  
Third Party ◽  
Health Coverage ◽  
Access To Health ◽  
Medicine Prices ◽  
The Impact

Background. In 2014, the Ministry of Health of Morocco implemented a reform of medicine pricing that leads to lower prices. This reform has brought about a new method of pricing medicines and a reduction in the prices of more than 1,400 of the 5,000 medicines on the market. The objective of this study was to survey patients’ perceptions of the impact of the reform on medicine prices and affordability of health care, including medicine. Methods. Between September 2017 and September 2018, 360 patients that visited a community pharmacy in four selected areas of different socioeconomic levels were interviewed based on a questionnaire. Findings were studied through univariate and multivariate analyses. Results. Three hundred patients (83%) were included given their completed questionnaire. The majority (89%) of respondents considered medicine prices as a potential barrier to access to health care. Lower medicine prices following the reform were not perceived to have actually impacted respondents’ spending on health care. In some cases, care was delayed, in particular by lower-income respondents and people without insurance and health coverage. Conclusion. The majority of patients participating in the study did not perceive the decrease in medicine prices as sufficient. In addition, the study findings pointed to the relevance of further determinants of access to medicines, such as health insurance coverage. Patients think that the generalized third-party payment mode, which does not oblige patients to spend out of their pockets to have their treatment but rather their health insurance funds that will pay for them, provides optimal access to medicines.

scholarly journals Risk of Negative Health Outcomes and High Costs for People With Diabetes and Unmet Psychological Needs in the United States

2022 ◽  
Author(s):  
Aryana Sepassi ◽  
Mark Bounthavong ◽  
Renu F. Singh ◽  
Mark Heyman ◽  
Kristin Beizai ◽  
...  
Keyword(s):  
Health Care ◽  
Resource Utilization ◽  
Health Care Expenditure ◽  
Population Level ◽  
The United States ◽  
Psychological Needs ◽  
Medical Expenditure ◽  
Psychological Need ◽  
Total Health Care Expenditure ◽  
The Impact

Measuring the population-level relationship between compromised mental health and diabetes care remains an important goal for clinicians and health care decision-makers. We evaluated the impact of self-reported unmet psychological need on health care resource utilization and total health care expenditure in people with type 2 diabetes. Patients who reported unmet psychological needs were more likely than those who did not to incur a higher annual medical expenditure, have greater resource utilization, and have a higher risk of all-cause mortality.

scholarly journals The Facts About Applying: Health Care Coverage and the Affordable Care Act

EDIS ◽  
2013 ◽  
Vol 2013 (10) ◽  
Author(s):  
Meg McAlpine ◽  
Martie Gillen
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Affordable Care Act ◽  
The United States ◽  
Health Coverage ◽  
President Obama ◽  
Health Care Coverage ◽  
The Affordable Care Act ◽  
Health Care Law ◽  
Current Plan

President Obama signed the Affordable Care Act into law in March 2010, putting in place a set of reforms to health coverage in the United States. For Americans who have health insurance, they do not have to change their current plan under the health care law. However, those who do not have coverage will have the chance to shop for health insurance starting October 1 using the new Health Insurance Marketplace. This publication reviews some common questions about the new health care law and how it will affect citizens. This 3-page fact sheet was written by Meg McAlpine and Martie Gillen, and published by the UF Department of Family Youth and Community Sciences, October 2013. http://edis.ifas.ufl.edu/fy1394

Wealth and the health of older Black women in the United States

2018 ◽  
Vol 34 (5) ◽  
pp. 1055-1068
Author(s):  
Andy Sharma
Keyword(s):  
United States ◽  
Health Care ◽  
Black Women ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Panel Study ◽  
Well Being ◽  
The United States ◽  
Determinants Of Health ◽  
The Impact

Summary Public health scholars and policy-makers are concerned that the United States continues to experience unmanageable health care costs while struggling with issues surrounding access and equity. To addresses these and other key issues, the National Academy of Medicine held a public symposium, Vital Directions for Health and Health Care: A National Conversation during September 2016, with the goal of identifying clear priorities for high-value health care and improved well-being. One important area was addressing social determinants of health. This article contributes to this objective by investigating the impact of wealth on older Black women’s health. Employing the 2008/2010 waves of the RAND Health and Retirement Study on a sample of 906 older Black women, this panel study examined self-assessed health ratings of very good/good/fair/poor within a relaxed random effects framework, thereby controlling for both (i) observed and (ii) unobserved individual-level heterogeneity. This analysis did not find a statistically significant association with wealth despite a difference of approximately $75 000 in its valuation from very good to poor health. This also occurred after wealth was (i) readjusted for outliers and (ii) reformulated as negative, no change or positive change from 2008. This finding suggests that wealth may not play as integral a role. However, the outcome was significant for earnings and education, particularly higher levels of education. Scholars should further this inquiry to better understand how earnings/education/wealth operate as social determinants of health for minority populations.

Sign in / Sign up

Export Citation Format

Share Document