RESUMO
OBJECTIVE: The primary objectives of this study were to measure and compare health insurance coverage between nonelderly Puerto Rican adults in cohabiting same-sex relationships and their counterparts in cohabiting different-sex relationships. METHODS: This study used data from the 2008-2014 Puerto Rican Community Survey on nonelderly adults (18-64 years) in cohabiting same-sex (n=274) and different-sex (n=58,128) relationships. Multinomial logistic regression models estimated differences in primary source of health insurance while controlling for key demographic and socioeconomic characteristics. RESULTS: Compared with men in different-sex relationships, men in same-sex relationships were less likely to have employer-sponsored insurance (ESI). Women in same-sex relationships were less likely than others to have ESI, insurance purchased directly from an insurer, and public health insurance after controlling for socio-demographic factors. CONCLUSIONS: Employment-based discrimination and policy barriers may have prevented same-sex couples from enjoying the full benefits associated with marriage and cohabitation in Puerto Rico, including employer-sponsored health insurance.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Homossexualidade/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Casamento/estatística & dados numéricos , Adolescente , Adulto , Feminino , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Assistência Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Porto Rico/etnologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: The main purpose of this article was to assess the differences between Seguro Popular (SP) and employer-based health insurance in the use of preventive services, including screening tests for diabetes, cholesterol, hypertension, cervical cancer, and prostate cancer among older adults at more than a decade of health care reform in Mexico. METHOD: Logistic regression models were used with data from the Mexican Health and Nutrition Survey, 2012. RESULTS: After adjusting for other factors influencing preventive service utilization, SP enrollees were more likely to use screening tests for diabetes, cholesterol, hypertension, and cervical cancer than the uninsured; however, those in employment-based and private insurances had higher odds of using preventive care for most of these services, except Pap smears. DISCUSSION: Despite all the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in health care access and utilization still exist in Mexico.
Assuntos
Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Idoso , Estudos Transversais , Diabetes Mellitus/diagnóstico , Feminino , Reforma dos Serviços de Saúde , Pesquisas sobre Atenção à Saúde , Disparidades em Assistência à Saúde , Humanos , Hipercolesterolemia/diagnóstico , Hipertensão/diagnóstico , Modelos Logísticos , Masculino , México , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/diagnósticoRESUMO
OBJECTIVE: To identify factors associated with small group employer participation in New Mexico's State Coverage Insurance (SCI) program. DATA SOURCES: Telephone surveys of employers participating in SCI (N=269) and small employers who inquired about SCI (N=148) were fielded September 2008-January 2009. STUDY DESIGN: Descriptive and multivariate analyses investigated differences between employer samples, including employer characteristics, concerns that applied to the business when deciding whether to participate in SCI, prior offerings of insurance to workers, and perceived affordability of the program. DATA COLLECTION/EXTRACTION METHODS: Unweighted employer samples yielded 88 and 75 percent response rates for the participating and inquiring employers, respectively. PRINCIPAL FINDINGS: The administrative issue most commonly selected by inquiring employers as applying to their business was difficulty understanding how eligibility requirements applied to their business and its employees (53.5 percent). Inquiring businesses were significantly more likely to report concern about affording to pay the premiums in the first month (35.6 versus 18.7 percent) and the cost to the business over the long run (46.5 versus 26.6 percent) relative to participating employers. From the model results, businesses with the fewest full-time employees (zero to two) were 19 percentage points less likely to participate relative to businesses with six or more full-time employees. CONCLUSIONS: Administrative and cost barriers to participation in SCI reported by employers suggest that the tax credit offered to small businesses under new federal provisions, which merely offsets the employer portion of premium, could be more effective if accompanied by additional supports to businesses.
Assuntos
Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Reforma dos Serviços de Saúde , Política de Saúde , Empresa de Pequeno Porte/estatística & dados numéricos , Definição da Elegibilidade , Planos de Assistência de Saúde para Empregados/economia , Pesquisas sobre Atenção à Saúde , Humanos , New Mexico , Empresa de Pequeno Porte/economiaRESUMO
For decades, the Chilean health system has included a requirement for dependent workers to spend a certain percentage of their wages on health insurance. Since 1981, workers have been able to choose between public insurance and several private insurance providers. The reforms introduced more choice, moving away from reliance on an exclusive public provider. By 1999, about half of the country's active dependent workers had opted out of the public and into the private insurance system. The development of the private insurance system has been accompanied by controversy, however, regarding possible inequities in the utilization of medical services, the degree of risk segmentation, inefficiencies in the system's operation, and other factors. This paper discusses the issues of risk segmentation and equity. It starts by reviewing the system's design on a theoretical level, then deriving hypothesis and finally providing empirical evidence regarding these hypothesis. Particular attention is given to the issues of how individuals choose between the public and private system (to determine the reasons behind risk segmentation) and the differences in utilization among the various income groups (to clarify the issue of possible inequities).
Assuntos
Comportamento do Consumidor/economia , Planos de Assistência de Saúde para Empregados/economia , Reforma dos Serviços de Saúde/economia , Seleção Tendenciosa de Seguro , Programas Nacionais de Saúde/economia , Análise Atuarial , Chile , Financiamento Pessoal/estatística & dados numéricos , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Humanos , Fundos de Seguro/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Privatização/economia , Setor Público/economia , Medição de Risco , Justiça Social , Fatores SocioeconômicosRESUMO
We study the existence of self-selection and moral hazard in the Chilean health insurance industry. Dependent workers must purchase health insurance either from one public or several private insurance providers. For them, we analyze the relationship between health care services utilization and the choice of either private or public insurance. In the case of independent workers, where there is no mandate, we analyze the relationship between utilization and the decision to voluntarily purchase health insurance. The results show self-selection against insurance companies for independent workers, and against public insurance for dependent workers. Moral hazard is negligible in the case of hospitalization, but for medical visits, it is quantitatively important.
Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Seleção Tendenciosa de Seguro , Programas Nacionais de Saúde/economia , Setor Privado/economia , Setor Público/economia , Adolescente , Adulto , Comportamento do Consumidor/economia , Características da Família , Feminino , Planos de Assistência de Saúde para Empregados/classificação , Planos de Assistência de Saúde para Empregados/economia , Serviços de Saúde/economia , Nível de Saúde , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Medição de RiscoRESUMO
This paper studies the relationship between health status and insurance participation, and between insurance status and medical use in the context of a social health insurance with an equalization fund (SHIEF). Under this system, revenues from a mandatory payroll tax are collected into a single pool (equalization fund) that reimburses for-profit insurance companies according to a capitated formula. Although competition should induce insurers to control costs without reducing the quality of service necessary to attract consumers, limitations in the capitation formula might induce insurers to select against bad risks, and limitations in the contribution system might induce more healthy individuals to evade enrollment. A three-equation model having social health insurance, private health insurance, and using medical services is estimated using a 1997 Colombian household survey. Consistent with similar studies, participation in SHIEF increases medical care use. On the other hand, the evidence on selection is somewhat mixed: individuals who report good health status are more likely to participate in SHIEF, while those without a chronic condition are less likely to participate in SHIEF.
Assuntos
Capitação , Planos de Assistência de Saúde para Empregados/economia , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Nível de Saúde , Seleção Tendenciosa de Seguro , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Mecanismo de Reembolso , Comportamento de Escolha , Colômbia , Características da Família , Feminino , Reforma dos Serviços de Saúde , Pesquisas sobre Atenção à Saúde , Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Programas Obrigatórios/economia , Programas Obrigatórios/estatística & dados numéricos , Modelos Econométricos , Cobertura Universal do Seguro de SaúdeRESUMO
Lack of health insurance is a serious problem in the United States. Using data from the 1996 Medical Expenditure Panel Survey, this paper examines how insurance varies between black, white, and Latino adults. Because Latino subgroups are not homogeneous, the paper also compares the factors associated with health insurance status for Mexican and Puerto Rican adults. Results indicate that access to private health insurance for Latino adults was more closely associated with workplace characteristics than employment itself. Time lived in the United States was a major factor associated with being uninsured for Mexican adults, while language barriers were a major factor limiting Puerto Rican individuals' access to private health insurance. The paper suggests two approaches for decreasing uninsurance among Latino adults: (1) strengthening the link between employment and private health insurance and (2) addressing disparities in access to public coverage for racial and ethnic groups, including recent immigrants.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , Aculturação , Adulto , Feminino , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Hispânico ou Latino/classificação , Humanos , Modelos Logísticos , Masculino , Americanos Mexicanos/classificação , México/etnologia , Pessoa de Meia-Idade , Porto Rico/etnologia , Fatores de Tempo , Estados UnidosRESUMO
Healthcare executives should have a strong interest in the recently released Statement of Financial Accounting Standards No. 106, Employers' Accounting for Postretirement Benefits other than Pensions (SFAS 106). The requirements of SFAS 106 focus heavily on estimating the healthcare benefits of retirees and forces corporations to project the magnitude of expected increases in healthcare costs. Estimates for recording these retiree healthcare benefits for all U.S. companies range from $200 billion to $400 billion, imposing significant financial statement implications for all firms that provide healthcare benefits to retirees. The requirements of SFAS 106 will also have an impact on the way corporations design and implement healthcare cost controls, which may directly affect many healthcare entities. Understanding SFAS 106, and the reactions of firms to this standard, will allow healthcare executives to better manage their organizations to take advantage of new opportunities and meet new challenges that may arise.
Assuntos
Contabilidade/normas , Custos de Saúde para o Empregador/estatística & dados numéricos , Planos de Assistência de Saúde para Empregados/economia , Indústrias/economia , Aposentadoria/economia , Coleta de Dados , Interpretação Estatística de Dados , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Renda/estatística & dados numéricos , Aposentadoria/estatística & dados numéricos , Estados UnidosRESUMO
In order to define the scope of corporate occupational health services as they exist today, a questionnaire was designed and sent to members of the College's Society of Corporate Medical Services. Industries represented in the survey include manufacturing, utilities, transportation, communications, research and development, banking, insurance, and publishing. The emphasis in this report is on data indicating trends in the provision of services.