Suchergebnisse

State health insurance high-risk pools are a key component of the US health care system's safety net, because they provide health insurance to the "uninsurable."

There is little consensus on what constitutes adequate health insurance coverage. The concept of a lack of adequate coverage, or underinsurance, is a matter of ongoing debate. A measure of adequate coverage is of critical importance as the nature of health insurance products evolves. Changes to health coverage include more direct out-of-pocket spending by consumers and a reduction of covered benefits. This article updates and extends an earlier review of underinsurance measurement published in 1993. We present a conceptual approach to measuring underinsurance and provide a review of the empirical findings obtained from the application of these approaches. A discussion of the limitations in the selection of a measurement approach includes a review of the extant data sources used. We recommend a national effort to develop a consistent approach to monitor changes in the economic and structural dimensions of health insurance coverage with a concerted effort to define and measure underinsurance.

The privately insured are assuming a greater share of the costs of their health care, yet little is known about changes in out-of-pocket spending at the state level. The central problem is that national surveys with the relevant data are not designed to generate state-level estimates. The study addresses this shortcoming by using a two-sample modeling approach to estimate state-level measures of out-of-pocket spending relative to income for privately insured adults and children. National data from the Medical Expenditure Panel Survey—Household Component and state representative data from the from the Current Population Survey are used. Variation in out-of-pocket spending over time and across states is shown, highlighting concern about the adequacy of coverage for 2.9% of privately insured children and 7.8% of privately insured adults. Out-of-pocket spending relative to income is an important indicator of access to care and should be monitored at the state level.

Hospital provision of uncompensated care is partly a function of insurance coverage of state populations. As states expand insurance coverage options and reduce the number of uninsured, hospital provision of uncompensated care should also decrease. Controlling for hospital characteristics and market factors, the authors estimate that increases in MinnesotaCare (a state-subsidized health insurance program for the working poor) enrollment resulted in a 5-year cumulative savings of $58.6 million in hospital uncompensated care costs. Efforts to evaluate access expansions should take into account the costs of the program and the savings associated with reductions in hospital uncompensated care.

Two important changes made to the Current Population Survey & Demographic Supplement (CPS-DS) during 2000 & 2001 are examined. The first is the enlargement of sample size designed to sharpen state estimates of poor uninsured children required by the Balanced Budget Act of 1999. The second is the inclusion of a verification question to support responses to inquiries about health insurance coverage. A concise discussion of a CPS-DS data processing anomaly, related to the sample size expansion, is also offered to underscore the complexities involved in changing the CPS-DS methodology. The objective here is to emphasize the effects of changes in methodology on the estimates of health insurance coverage as well as their significance for analysts & policymakers. The conclusion addresses the centrality of establishing communication & dissemination strategies to foster the comprehension of these key technical changes. 4 Tables, 25 References. K. Coddon