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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

 

Personal Health Insurance Issues

 
     

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One in five American families has at least one member who lacks medical coverage, putting the entire family at greater risk of poor health and financial ruin  Often-cited figures on the number of uninsured Americans -- roughly 39 million individuals in all -- mask the impact of the problem on their relatives. About 20 million more persons, 40% of them children, are in a family unit with an uninsured person, it states.

Researchers have known for years that individuals who lack insurance get less regular healthcare and often have poorer overall health than those with coverage. Members of the Institute of Medicine (IOM) panel releasing the report now say they have evidence that those negative health effects also spread to other family members who have coverage.

The IOM is part of the National Academy of Sciences, a privately run organization created by Congress that conducts studies and advises the federal government on policy issues.

While most insured US families are covered by employer-subsidized policies, the anemic economy and steadily rising insurance costs mean that fewer and fewer bosses are offering coverage. Those that do may pare down coverage, no longer covering spouses or children on a worker's policy.

Low-income families face the greatest risk, since the cost of food and housing tends to squeeze out the ability to pay for insurance premiums. Even wealthier families are unlikely to tap their family budgets to seek regular medical care for an uninsured member.

The nation's insurance system is really a "hodgepodge" of private and a government insurance program that leaves millions of families with gaps in coverage as members retire, change jobs, or enter the workforce.

Federal and state programs cover most children without health insurance but less than half of the 8 million children who are eligible are enrolled. Parents who lack coverage are less likely to enroll their kids in such programs, possibly because of a lack of trust in the healthcare system.

The scenario forces many families to pick and choose whom to cover out of limited funds. Most will choose to cover a working parent so that wages are less likely to be lost in the event of illness. That still leaves the budget vulnerable to ruin if someone else in the family falls ill or sustains an injury.

ADDITIONAL ARTICLES:

Document Name & Link to Document

Description

File Size /Type**

Appealing Health Insurance Denials Your state Department of Insurance (DOI) has a wealth of information, including your rights regarding health insurance, the appeals process, whom to contact regarding an appeal and a general timeline for an appeal.  
Before and After Welfare Reform: The Uncertain Progress for Poor Families and Children The sweeping reforms of the ‘Personal Responsibility and Work Opportunity Reconciliation Act of 1996,’ which ended the federal entitlement to cash assistance under the Aid to Families with Dependent Children program and created the Temporary Assistance for Needy Families program, brought about dramatic decreases in welfare caseloads at a time when the economy was booming…The long-term impact of welfare reforms on the health and well-being of poor children and their families is far from clear 165 kb pdf

Census Bureau-Health Insurance Coverage-2001

Reversing two years of falling uninsured rates, the share of the population without health insurance rose in 2001. An estimated14.6 percent of the population or 41.2 million people were without health insurance coverage during the entire year in 2001,up from 14.2 percent in 2000, an increase of 1.4 million people

 

Closing the inequality gap in access to primary healthcare for women living with Hepatitis C  One of the major challenges facing women diagnosed with hepatitis C is overcoming the stigma attached to this illness which frequently acts as a barrier to appropriate and timely primary health care.  
COMPARING FEDERAL GOVERNMENT SURVEYS THAT COUNT UNINSURED PEOPLE IN AMERICA The number of uninsured Americans is large and growing over time, but there is debate about exactly how many Americans are uninsured. Researchers use data from several different surveys to estimate the number of uninsured people in America and discrepancies frequently arise. Why is there so much variance in federal estimates of the number of uninsured Americans? What are the differences in how these surveys are conducted? This brief compares estimates from four national surveys conducted by the federal government used to estimate the size of the uninsured population, identifies the differences between them, and points out two common threads – all the surveys report very large numbers of Americans living without health insurance and all show that these numbers have risen. Pdf 289 kb

Containing Cost while Maintaining Quality

Articles about how insurance companies are trying to reduce costs and maintain profitability

 

Data to Analyze Children’s Health Insurance Coverage: An Assessment of Issues

Survey data will play an important role in the evaluations of the Children’s Health Insurance Program (CHIP) because program administrative data cannot tell us what is happening to the number of uninsured children. This report discusses key analytic issues in the use of national survey data to estimate and analyze children’s health insurance coverage.

 

disease management

Report from the health insurance industry-"Financial and risk considerations for successful Disease Management Programs"

PDF / 211 kb

Est. future Hepatitis C morbidity, mortality, and costs in the US

This study estimated future morbidity, morality, and cost resulting from hepatitis C virus (Hepatitis C Virus).

PDF / 133 KB

health care exposure

Exposure to toxins and infectious diseases in the work area

PDF / 471 KB

Health care for ALL, not just the rich Since the mid-eighties, however, problems and challenges began to emerge as a result of increasing privatisation and marketisation of health services. The provision of health services is to be shared with the private sector. Likewise, the burden of financing the total costs of health services through the co-payment of certain services by the general public has now been introduced - instead of the government financing it all through general taxation Without a doubt, such increasing reliance on the private sector in health care provision and financing has been very much influenced by the neo-liberal economic ideology advocated by the International Monetary Fund and the World Bank. As a result of this shift, hospital services such as cleaning, laundry, clinical waste management, facility engineering management and bio-medical engineering management have been outsourced to the private sector. Such privatisation has increased the cost of servicing the health system.  

health care fraud

mid-way thru article-Corporate Healthcare Fraud-costs and risks

PDF / 346 KB

health care workers with AIDS

Surveillance of Health Care Workers with AIDS and the positions that they hold

PDF / 42 KB

Healthcare Costs and U.S. Competitiveness Factoring in costs borne by government, the private sector, and individuals, the United States spends over $1.9 trillion annually on healthcare expenses, more than any other industrialized country. Researchers at Johns Hopkins Medical School estimate the United States spends 44 percent more per capita than Switzerland, the country with the second highest expenditures, and 134 percent more than the median for member states of the Organization for Economic Cooperation and Development (OECD). These costs prompt fears that an increasing number of U.S. businesses will outsource jobs overseas or offshore business operations completely. U.S. Representative John P. Sarbanes (D-MD), a member of the House Education and Labor Committee, told CFR.org that in light of these concerns a “consensus is emerging” on Capitol Hill to do something to ease pressures on U.S. employers. Many experts recommend some form of increased public-private partnership, though the specifics of competing plans vary wildly
Competitive Disadvantage
Employer-funded coverage is the structural mainstay of the U.S. health insurance system. According to 2005 data from the U.S. Census Bureau, the most recent official data available, employer-provided health benefits cover 175 million Americans, or about 60 percent of the population. Those numbers have fallen since 2001, when 65 percent of the country had some form of employer coverage, based on data from the Kaiser Family Foundation, a nonprofit focused on healthcare issues. Premiums have skyrocketed, rising 87 percent since 2000. In 2004, health coverage became the most expensive benefit paid by U.S. employers, according to a report by the Employment Policy Foundation.
 

 

Health Insurance Coverage of the Near Elderly On the whole, the near elderly actually have higher rates of health insurance coverage than other age groups…Many are decreasing the level of their workforce participation and their incomes in turn are declining.  For many others, health status begins to decline in their mid-fifties. 1484 kb pdf
Health Insurance, Treatment and Outcomes: Using Auto Accidents as Health Shocks* Previous studies find that the uninsured receive less health care than the insured, yet differences in health outcomes have rarely been studied. In addition, selection bias may partly explain the difference in care received. To examine health outcomes and deal with selection problems, this paper focuses on an unexpected health shock—severe automobile accidents where victims have little choice but to receive treatment. Another innovation is the use of a comparison group that is similar to the uninsured: those who have private health insurance but do not have automobile insurance. The medically uninsured are found to receive twenty percent less care and have a higher mortality rate compared to patients with health insurance. It appears that the ability-topay of patients has a significant effect on treatment decisions and the additional treatment yields large improvements in health outcomes. Pdf 296 kb

Health Insurer Benefits

Oxford Health Plans reports improved first-quarter earnings and raises its profits forecast for year, becoming latest health insurer to benefit from nationwide trend of moderating hospital and drug costs; says net income rose 2.1 percent

 

High and Rising Health Care Costs. Can Costs Be Controlled While Preserving Quality? Several interrelated strategies involving physician leadership and participation have been proposed to contain health care costs while preserving or improving quality. These include programs targeting the 10% of the population that incurs 70% of health care expenditures, disease management programs to prevent costly complications of chronic conditions, efforts to reduce medical errors, the strengthening of primary care practice, decision support tools to avoid inappropriate services, and improved diffusion of technology assessment.
 An example of a cost-reducing, quality-enhancing program is post-hospital nurse monitoring and intervention for patients at high risk for repeated hospitalization for congestive heart failure. Disease management programs that target groups with a chronic condition rather than focusing efforts on high-utilizing individuals may be effective in improving quality but may not reduce costs. Error reduction has great potential to improve quality while reducing costs, although the probable cost reduction is a small portion of national health care expenditures. Access to primary care has been shown to correlate with reduced hospital use while preserving quality. Inappropriate care and overuse of new technologies can be reduced through shared decision-making between well-informed physicians and patients. Physicians have a central role to play in fostering these quality-enhancing strategies that can help to slow the growth of health care expenditure
 

HIPPA-portability

Insurance report on HIPPA regulations

PDF / 50 KB

HIV Exposure Report Form

Report Form for the potential HIV exposure

PDF / 80 KB

How Private Insurance Works-A Primer This primer provides a basic overview of private coverage for health care.  It begins by describing what we mean by private health coverage, and continues with discussions of the types of organizations that provide it, its key attributes, and how it is regulated. 1044 kb pdf

insurance claims

1998 legislative outlook for the insurance industry

PDF / 151 KB

Insurance for the Poor? Uninsured risk has substantial welfare costs, not just in the short run, but also in terms of perpetuating poverty. This paper discusses the scope for extending insurance to the poor in LAC countries. It is argued that insurance provision to the poor could play an important role in a comprehensive system of protection against risk, including other ex-ante measures such as promoting credit and savings as insurance, as well as a credible overall ex-post safety net. Insurance provision is best promoted via a partner-agent model, in which a local finance institution with close links to relatively poor communities teams up with an established insurer to deliver low cost, tailored products, and possible products include life, health, property and weather insurance. An essential role of the government would be to promote insurance provision to the poor by a relevant regulatory framework favouring MFIs within a partner-agent setup, and to provide overall credibility to the overall system of social protection. The paper also argues for the involvement of local indigenous risk-sharing and finance institutions as intermediaries to maximise the ability to reach the poor and the overall welfare benefits. Pdf 197 kb
Insurance Personnel Within the private sector, the insurance industry has been at the forefront of the societal response to HIV/AIDS, often in the ‘firing-line’ from AIDS activists resulting from the industry’s HIV testing policies. Pdf 372 kb

Insurance privacy issues

Insurance report on the current issues in Employee Benefits

PDF / 336 KB

insurance

Insurance report on the capitation arrangements to protect against losses

PDF / 462 KB

Insurance-Actuarial aspects of Dread Disease

Actuarial aspects of dread Disease Products concerning infectious diseases

PDF / 526 KB

Insurance-Hepatitis C-health, law protection

Insurance report on Hepatitis C and the potential cost hospitals may face

PDF / 417 KB

Near-Elderly Americans Talk about Health Insurance-At the Edge While some are retiring early because they can afford to do so (19%), others are out of the workforce because of illness or disability (14%).  But the majority are still working and despite their years, many are not financially stable.  More than a fifth of the near elderly are in low-income families, with incomes less that 200% of the federal poverty level 583 kb pdf
One in Three: Non-Elderly Americans Without Health Insurance 2002-03 This report examines how many people under the age of 65 were without health insurance for all or part of 2002 and 2003.  The findings are based exclusively on data projections drawn from the most recent CPS as well as the Census Bureau’s Survey of Income and Program Participation. 213 kb pdf

Outcomes and Costs of Care in Hepatitis C.

Prospective, multicenter, pharmaceutical company-sponsored randomized clinical trials in the treatment of chronic hepatitis C have shown that clearance of hepatitis C virus (Hepatitis C Virus) is more likely in those treated with -interferons than in untreated patients

 

Patients Paying Larger Percentage for Insurance Faced with "rapidly rising" prescription drug spending, which is climbing at about 15% per year, employers and insurers have increasingly shifted the costs to patients, who "may soon pay even more,"  
Pediatric Milliman and Robertson Length-of-Stay Criteria: Are They Realistic? LOS guidelines may help clinicians optimize care, reduce costs, and potentially improve patient satisfaction. However, both the public and policymakers are increasingly concerned that the recent pressures for cost-savings have come to dominate the practice of medicine. As but 1 example, the issue of drive-by mastectomies generated considerable attention and some legislative changes. Nonetheless, few data are available to inform this discussion and even fewer are relevant to the large group of vulnerable pediatric patients. Although we enthusiastically endorse the notion of increasing the efficiency of inpatient care, we are concerned that any process of goal-setting be informed by available data, that it be as open as possible, and that any effects on patients and families be carefully examined.  

 

Prevalence and Costs of Chronic Disease in a Health Care System Structured for Treatment of Acute Illness Chronic illnesses account for 70% of deaths and for the expenditure of over 75% of direct health care costs in the United States, according to the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services. Direct costs are now estimated at over $1.5 trillion. Indirect costs of chronic diseases, in the form of lost productivity and nonreimbursed personal costs, add several more hundreds of billions of dollars each year. In a landmark study published in 1996, Hoffman et al reported that in 1990 90 million people in the United States lived with a chronic disease or condition and 39 million people had more than one such condition. Extrapolating from these and other data, the Centers for Disease Control and Prevention estimated that as many as 25 million Americans have a chronic condition that is disabling. Although the literature does not support a single uniform definition for chronic disease, recurrent themes include the non–self-limited nature, the association with persistent and recurring health problems, and a duration measured in months and years, not days and weeks  
Probability Tables for disability Mathematical descriptions and methods used for determining the probability of disability used by the Rand corporation 230 kb pdf

Problems of Lost Health Benefits

Census Bureau figures, 1.4 million Americans lost their health insurance last year, an increase largely attributed to the economic slowdown and resulting rise in unemployment. The largest group of the newly uninsured — some 800,000 people — had incomes in excess of $75,000.

 

Preventive Services: Helping Employers Expand Coverage

By purchasing health insurance for their employees, employers influence access to health care for more than 168 million insured Americans…Two out of every three Americans were covered by private health insurance sponsored by employers in 2001

  348 kb pdf

Preventive Services: Helping States Improve Mandates (Large file-please allow extra time for download) Mandating coverage of a range of recommended preventive services can improve health, prevent disease and disability, and potentially lower some health costs 1487 kb pdf

Re unaffordable meds

Winning affordable medications for ALL Americans-a report to subcommittee on Health

PDF / 27 KB

Risk & Management for Healthcare workers-bloodborne

Risk and Management of Blood-Borne Infections in Health Care Workers-an insurance report

PDF / 354 KB

Risk Pooling in Health Care Financing: The Implications for Health System Performance Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. Its main purpose is to share the financial risk associated with health interventions for which there is uncertain need. The arguments in favor of risk pooling in health care embody equity and efficiency considerations. The equity arguments reflect the view that society does not consider it to be fair that individuals should assume all the risk associated with their health care expenditure needs. The efficiency arguments arise because pooling can lead to major improvements in population health, can increase productivity, and reduces uncertainty associated with health care expenditure. Pdf 854 kb
Sicker and Poorer: The Consequences of Being Uninsured If being uninsured leads to poorer health, inefficient use of medical care resources, fewer hours worked and lower earnings, and lower educational attainment, then a large uninsured population creates costs in the form of foregone opportunities, which do not appear as explicit government payments or budgetary line items. 1602 kb pdf
Survey of People with Disabilities Report offers many graphs and charts concerning this study 216 kb pdf

The Business of Medicine

A kind of "generational switch," which Dr. Trujillo believes has ushered out the golden epoch of medicine – characterized by professional autonomy and high reimbursement. "Now, we are in an era where increasing financial control is exerted upon us.

 

The high cost of Health goes Higher

Kaiser Family Foundation and the Health Research and Educational Trust finds that premiums for employer-sponsored health insurance, which covers two of three Americans, increased an average of 11 percent in 2001, the largest increase since 1992

 

The Other Drug War-Public citizen

How the pharmaceutical industry fights to protect its interests

PDF / 318 KB

The Right to Equal Treatment: Student Toolkit to address Racial and Ethnic Disparities in US Health Care The problem of racial and ethnic disparities in health is one of the most serious human rights issues facing Americans today.  People in racial and ethnic minority groups in this country tend to live shorter lives and suffer higher rates of diseases than do whites. 263 kb pdf
The Social Impact of AIDS in the United States The U.S. health care system stands alone among advanced industrial countries in lacking a national program to ensure universal or nearly universal health insurance coverage. The various public and private insurance plans and delivery systems (such as the Veterans Administration health system) reflect what John Iglehart  characterizes as ''society's profound ambivalence about whether medical care for all is a social good, of which the costs should be borne by society, or a benefit that employers should purchase for employees and their dependents, with government insurance for people outside the work force." This ambivalence, and the resulting lack of any political consensus on how to finance and deliver health services, has resulted in an odd assortment of programs that does provide health insurance to about 85 percent of the population, but leaves some 36 million people uninsured. The uninsured are primarily full-time workers and their dependents who are employed in small firms at a low or the minimum wage.  

tip of iceberg

Insurance report on occupational exposure to an infectious disease and how companies can protect themselves

PDF / 445 KB

Triangular Clinics: The Way of The Future Hepatitis C is not just a blood-borne disease, but a global threat, socially and economically. Every year, thousands of articles are written on this subject emphasizing the importance of urgent global efforts in reducing its incidence. World Health Organization (WHO) estimations suggest that up to 3% of the world's population (170 million) have been infected with HCV. About 85 percent of people with acute hepatitis C develop a chronic infection, an insidious disease whose barely discernible symptoms can mask progressive injury to liver cells over 2 to 4 decades. It is now the leading cause of liver cancer and results in more liver transplants than any other disease Pdf 223 kb

What Happens When COBRA Ends

There are two federal laws that can be used to continue health insurance once your COBRA Continuation Coverage ends. Both provide access to health insurance without having to prove that you are "insurable."

 

What Is Driving Health Care Costs? In recent years, the cost of health care has been increasing. According to the Centers for Medicare and Medicaid Services (CMS), national health expenditures increased almost 33 percent from 1995 to 2000 ($990 billion to $1.3 trillion). CMS estimates spending to have increased another 19 percent through 2002 - to $1.55 trillion. The change in the consumer price index (CPI) for medical care has exceeded the change in the CPI for all products each year for the past 10 years. Let's look at some contributing factors to the increasing costs.  
Why do Americans have such poor Health?  In order to understand the current status of medical care in the U.S., Canada and Europe it is vital to understand that health care in these 3 regions is nearly completely under the control of the pharmaceutical industry. All major pharmaceutical firms have interlocking boards of directors so there is no real competition among these companies.  

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