Search results

1 – 10 of over 10000
Book part
Publication date: 9 August 2012

Colleen K. Vesely, Marriam Ewaida and Katina B. Kearney

In this chapter we examine how micro- and macro-level issues including access to child-only or family public health insurance shape low-income immigrant families’ health care

Abstract

In this chapter we examine how micro- and macro-level issues including access to child-only or family public health insurance shape low-income immigrant families’ health care experiences in two policy contexts in the Washington, DC metropolitan area.

This qualitative study includes 40 in-depth interviews with first-generation, low-income immigrant Latin American and African mothers in DC and Northern Virginia.

The majority of families living in Virginia had child-only health insurance, whereas most of the families living in Washington, DC, had family health insurance. Regardless of these insurance differences, all mothers had access to free health care for prenatal care. Pregnancy, for most, was their entry into the U.S. health care system. Families’ ongoing health care experiences differed in relation to insurance access, and culture, including parents’ previous experiences with health care in their countries of origin.

Future research should consider the experiences of other immigrant groups, mental health experiences of immigrants, and fathers’ experiences with health care.

Future initiatives to address health care should focus on providing family health care to low-income immigrant families across the country, improving access to mental health services for immigrant families, and creating more culturally and linguistically appropriate health care services.

This study points to the importance of family health care for immigrant families, as well as care that is culturally and linguistically competent.

This study illustrates the need for public family health insurance for low-income immigrant families, and the importance of culturally competent health care for immigrants.

Details

Issues in Health and Health Care Related to Race/Ethnicity, Immigration, SES and Gender
Type: Book
ISBN: 978-1-78190-125-0

Keywords

Article
Publication date: 20 June 2016

Roger Lee Mendoza

Moral hazard is a concept that is central to risk and insurance management. It refers to change in economic behavior when individuals are protected or insured against certain…

2348

Abstract

Purpose

Moral hazard is a concept that is central to risk and insurance management. It refers to change in economic behavior when individuals are protected or insured against certain risks and losses whose costs are borne by another party. It asserts that the presence of an insurance contract increases the probability of a claim and the size of a claim. Through the US Affordable Care Act (ACA) of 2010, this study seeks to examine the validity and relevance of moral hazard in health care reform and determine how welfare losses or inefficiencies could be mitigated.

Design/methodology/approach

This study is divided into three sections. The first contrasts conventional moral hazard from an emerging or alternative theory. The second analyzes moral hazard in terms of the evolution, organization, management, and marketing of health insurance in the USA. The third explains why and how salient reform measures under the ACA might induce health care consumption and production in ways that could either promote or restrict personal health and safety as well as social welfare maximization.

Findings

Insurance generally induces health care (over) consumption. However, not every additional consumption, with or without adverse selection, can be considered wasteful or risky, even if it might cost insurers more in the short run. Moral hazard can generate welfare and equity gains. These gains might vary depending on which ACA provisions, insured population, covered illnesses, treatments, and services, as well as health outcomes are taken into account, and because of the relative ambiguities surrounding definitions of “health.” Actuarial risk models can nonetheless benefit from incorporating welfare and equity gains into their basic assumptions and estimations.

Originality/value

This is the first study which examines the ACA in the context of the new or alternative theory of moral hazard. It suggests that containing inefficient moral hazard, and encouraging its desirable counterpart, are prime challenges in any health care reform initiative, especially as it adapts to the changing demographic and socio-economic characteristics of the insured population and regulatory landscape of health insurance in the USA.

Details

Journal of Health Organization and Management, vol. 30 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 18 May 2015

Genevieve Elizabeth O'Connor

The purpose of this paper is to identify how need for service, enabling factors and pre-disposing characteristics influences access to service. In addition, the authors seek to…

Abstract

Purpose

The purpose of this paper is to identify how need for service, enabling factors and pre-disposing characteristics influences access to service. In addition, the authors seek to examine the moderating influence of pre-disposing variables on the relationship between insurance and health services utilization.

Design/methodology/approach

The authors utilize data from a major metropolitan hospital in the USA to test and extend the behavioral model of health care.

Findings

Results indicate that insurance and pre-disposing variables have a direct impact on type of health service utilization. However, the insurance effect is found to vary by demographic factors.

Research limitations/implications

This paper is limited to secondary data. Future work can incorporate both attitudinal and behavioral measures to obtain a more comprehensive evaluation of services access.

Practical implications

The research offers a tactical framework for management to segment consumer markets more effectively.

Social implications

Through the framework, management will have the requisite knowledge to target segmented populations based on need, insurance, and pre-disposing variables which will help improve access to services and clinical outcome.

Originality/value

The findings of this paper will serve as a basis for future research exploring the influence of insurance on access to services.

Details

International Journal of Bank Marketing, vol. 33 no. 3
Type: Research Article
ISSN: 0265-2323

Keywords

Book part
Publication date: 3 November 2005

D. Clayton Smith, James W. Grimm and Zachary W. Brewster

A random sample of insured adults (n=134) tests the effects of insurance on respondents’ emotional and physical health. Results showed that being married and being widowed…

Abstract

A random sample of insured adults (n=134) tests the effects of insurance on respondents’ emotional and physical health. Results showed that being married and being widowed improved physical health while having no religious identification heralded less emotional distress. Preferred Provider Organization services satisfaction was related to better physical health. Respondents in households that restructured themselves to acquire or maintain health coverage also reported more emotional distress than those in households without such problems. Implications of our results regarding improving insurance programs and the effects of marital status and the lack of religious affiliation upon adults’ health are discussed.

Details

Health Care Services, Racial and Ethnic Minorities and Underserved Populations: Patient and Provider Perspectives
Type: Book
ISBN: 978-0-76231-249-8

Article
Publication date: 1 November 2002

Rowena Jacobs and Maria Goddard

This paper examines some of the key features of social health insurance systems by drawing on experiences in Germany, Switzerland, France and The Netherlands. These countries have…

2584

Abstract

This paper examines some of the key features of social health insurance systems by drawing on experiences in Germany, Switzerland, France and The Netherlands. These countries have all implemented a variety of reforms, including some competition between health insurers in order to meet some of their health care objectives. The paper highlights some of the strengths and weaknesses inherent in these systems and how they perform on a number of criteria and suggests a number of trade‐offs which policymakers will have to grapple with to attain some of their (often competing) health system goals of efficiency, choice, solidarity and equity. This paper should provide useful information for countries with health care systems in transition or those considering adopting aspects of social health insurance systems.

Details

International Journal of Social Economics, vol. 29 no. 11
Type: Research Article
ISSN: 0306-8293

Keywords

Case study
Publication date: 20 January 2017

Robert D. Dewar

Key State Blue Cross and Blue Shield Plan (a disguised case of an actual BCBS Plan) is the merged product of three state plans. Initially burdened with a reputation of poor…

Abstract

Key State Blue Cross and Blue Shield Plan (a disguised case of an actual BCBS Plan) is the merged product of three state plans. Initially burdened with a reputation of poor customer service, Key State's executives decided to invest heavily in service improvement, eventually achieving superior levels. Key State's high-quality customer service emerged as a true competitive advantage for its customers, who were primarily businesses and health benefits consultants who influenced corporate purchasers of health insurance. The Key State brand came to be synonymous with personal service, security, choice, and dependability. But the health care insurance market was changing under Key State's feet. Spiraling costs meant that high-quality service became less of a competitive advantage as employers were lured by low-cost, low-service providers. Many employers cut or dropped health care benefits entirely, swelling the ranks of the under- and uninsured, who in turn were extremely price-sensitive when shopping for health insurance on their own. Finally, the health care insurance market was being revolutionized by financial institutions willing to hold health benefit accounts and pay providers directly, thereby eliminating the need for Key State as a mediator. Key State executives were aware of these changes but were challenged by the mindset, culture, and organizational design custom-fit to their business accounts. The case asks the reader to consider whether Key State has the right number of target markets, whether it should have one brand or several for its different target markets, what it should do for the uninsured, and how it should improve its brand experience in light of the industry's changing landscape. All of these decisions will have significant implications for the organizational design of Key State.

To better understand the challenges involved in a successful health insurance company to cope with a rapidly changing and unpredictable environment; to formulate a new strategy and a new organizational design to accomplish this adaptation.

Details

Kellogg School of Management Cases, vol. no.
Type: Case Study
ISSN: 2474-6568
Published by: Kellogg School of Management

Keywords

Book part
Publication date: 20 March 2007

Alfonso R. Oddo

Health care spending in the U.S. continues to outpace inflation and wage growth, which is likely to keep the burden of rising health care costs in the spotlight. As health care

Abstract

Health care spending in the U.S. continues to outpace inflation and wage growth, which is likely to keep the burden of rising health care costs in the spotlight. As health care costs increase, health insurers face the challenges of providing quality health care at a reasonable cost. Some health care providers and insurers use economic measures such as return on investment to assess the effectiveness of health care. How does one measure the value of health? What are some of the advantages and disadvantages of using economic measures to evaluate health care?

This paper looks health care costs and who pays for them. What portion of health care costs is borne by employers? What portion by employees? Who does or should pay for health care of people who are uninsured? What is the role of insurance? If people do not have health care insurance, does it matter whether the reason they are uninsured is because they cannot afford it or because they choose not to be insured?

Selvam (2002) belives that the number one ethical dilemma in the U.S. is how to address the almost 40 million Americans who lack health care coverage. With rising hospital costs, even the hardest-working and most prudent persons are at risk. Many workers do not have health insurance and even if they are covered, they may not get what they need. What are some of the ethical issues facing patients, health care providers and insurers? What role should government have in assuring that all people receive quality health care?

Details

Insurance Ethics for a More Ethical World
Type: Book
ISBN: 978-1-84950-431-7

Article
Publication date: 1 April 1996

Alan Earl‐Slater

Health‐care reform is everywhere. Although different countries are moving at different speeds, using somewhat different means and different routes, they are all trying to arrive…

628

Abstract

Health‐care reform is everywhere. Although different countries are moving at different speeds, using somewhat different means and different routes, they are all trying to arrive at the same place. The place is called “better value for money in health care”. Presents details of the health‐care reforms taking place in the Czech Republic, identifying and discussing the main strands of Czech reforms: the dissolution of the regional health authorities; the reorientation of district health authorities; the move to a pluralistic semi‐competitive insurance‐based system; hospitals receiving funding by winning contracts with purchasers; contracts becoming more sophisticated and being based on cost, volume and quality factors; changes in the incentives and rewards for GPs; the drive towards a primary‐care‐led health‐care system; and privatization.

Details

Journal of Management in Medicine, vol. 10 no. 2
Type: Research Article
ISSN: 0268-9235

Keywords

Book part
Publication date: 9 August 2012

Kathryn Freeman Anderson and Andrew S. Fullerton

A developing body of research has demonstrated the impact of racial residential segregation on a variety of negative health outcomes. However, little is known about the effect of…

Abstract

A developing body of research has demonstrated the impact of racial residential segregation on a variety of negative health outcomes. However, little is known about the effect of residential segregation on access to health care.

This study utilizes multilevel binary logit models based on individual-level health data from the 2008 Behavioral Risk Factor Surveillance System linked to metropolitan-area level data to examine the association between Black-White segregation in 136 metropolitan statistical areas in the United States and health-care coverage.

Overall, an increase in Black-White segregation is related to a decrease in the likelihood of having health insurance for Black residents and an increase in the Black-White gap in health-care coverage. These effects are substantial even when controlling for the effects of educational, social, and economic factors.

This study is the first to examine the impact of segregation on an individual's ability to access health-care coverage, which is an essential starting point for accessing health care in the United States.

Details

Issues in Health and Health Care Related to Race/Ethnicity, Immigration, SES and Gender
Type: Book
ISBN: 978-1-78190-125-0

Keywords

Article
Publication date: 11 September 2007

Leo van der Reis, Qian Xiao and Grant Savage

The purpose of this paper is to provide a general review about the major programs and factors characteristic of major changes in the health care access, from both consumer and…

2025

Abstract

Purpose

The purpose of this paper is to provide a general review about the major programs and factors characteristic of major changes in the health care access, from both consumer and provider perspectives. Customers' perspective emphasizes the fiscal control, with particular focus on the agencies that function as fiscal intermediaries and enablers, such as insurance companies. Providers' perspective concentrates on providers of health care services, such as physicians, nurses, technicians as well as various types of medical care facilities.

Design/methodology/approach

Historical approach was adopted to address the health care access issue, a general concept that summarizes the specific dimensions describing the fit between the patient and the health care system.

Findings

It is self‐evident that reform is needed and that major efforts should be made to remedy shortcomings in order to safeguard the health and welfare of the nation.

Originality/value

To achieve the goal of a truly caring commonwealth, we must improve quality and safety in health care, increase access and utilization of technology, promote greater consumer involvement at all stages, restructure the medical malpractice system to reach all who may be injured by systemic errors, and develop sustainable financing less subject to the vagaries of state revenues. However, the access issue still remains a basic and important problem we have to confront.

Details

International Journal of Health Care Quality Assurance, vol. 20 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

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