Health Insurance Is The Focus of Latest INQUIRY Journal

"How Do Households Choose Their Employer-Based Health Insurance?" by Jean- Marie Abraham, William B. Vogt, Martin S. Gaynor -- This study found that price influences workers' selection of employer-based health coverage, and that price sensitivity varies depending on marital status, wealth, and the number of employer coverage offers a household has. Results indicate that as wages increase, households are more likely to opt for complete household coverage; alternatively, lower-income households are less likely to choose plans with coverage for all family members. Op-out payments -- compensation offered by employers to not take health coverage -- also influences choice and switching from one employer plan to another, when an alternative is available.

"Money and Mandates: Relative Effects of Key Policy Levers in Expanding Health Insurance Coverage to All Americans," by Jeanne M. Lambrew and Jonathan Gruber -- This analysis examined scenarios -- involving an employer mandate, individual mandate and tax subsidies -- to gauge their impact on expanding health coverage to all Americans. Results suggest that only a mandate requiring individuals to obtain insurance would cover all the uninsured; neither an employer mandate nor generous subsidies alone would be adequate, and even together they would not achieve universal coverage. An employer mandate would shift coverage to the employer system, and some could lose their employer coverage if a new, voluntary purchasing pool and generous subsidies were introduced. Federal costs would be highest with combined employer and individual mandates. Universal coverage could be achieved with lower subsidies and an individual mandate, but would mean higher out-of-pocket costs for individuals.

"Effects of Public Premiums on Children's Health Insurance Coverage: Evidence from 1999 to 2003," by Genevieve Kenney, Jack Hadley and Fredric Blavin -- Using 2000-2004 data from the Current Population Survey, this study found that raising premiums for public health insurance programs reduced enrollment in those public programs. While this could generate savings for states, and some children who forgo public coverage would have private insurance instead, other children would end up uninsured. Findings show that premiums had the greatest effect on lower-income families.

"Insurance Premiums and Insurance Coverage of Near-Poor Children," by Jack Hadley, James D. Reschovsky, Peter Cunningham, Genevieve Kenney and Lisa Dubay. This analysis showed that higher public premiums are associated with a lower probability of near-poor children being enrolled in public insurance programs. Additionally, it found an association between higher public premiums and a greater probability of near-poor children being uninsured or having private coverage. Results imply that increases in both public and private premiums are likely to leave more near-poor children without any insurance.

"Effects of Premium Increases on Enrollment in SCHIP: Findings from Three States," by Genevieve Kenney, R. Andrew Allison, Julia F. Costich, James Marton, and Joshua McFeeters - Examining enrollment in the State Children's Health Insurance Program in Kansas, Kentucky and New Hampshire, this study found premium increases associated with lower caseloads in all three states and earlier disenrollment in Kentucky and New Hampshire. Premium hikes led to greater disenrollment among lower-income children in New Hampshire and nonwhite children in Kentucky.

"Access to Health Insurance, Barriers to Care, and Service Use among Adults with Disabilities," by Anna S. Sommers - This study looked at adults with various levels of disability and found all disabled groups reporting more unmet need and higher medical service use than non-disabled adults with the same insurance status. Low-income adults who were less disabled, but still work-limited had the greatest problems with access to health coverage, and more than one-third were uninsured.

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Why take out world health insurance - a true story?

The tour bus from the Danish tour operator turned into the car park in front of the hotel, which was our drop off point in Hurghada, Egypt. I left the tour bus, said my goodbyes to the others and jumped onto a local bus home to downtown Hurghada – a trip of about

20 minutes. As I walked up the hill on the final stretch to my apartment, it felt good to be home, both in general and in particular in relation to my beautifully clean toilet. But I had barely stepped inside, when it all started... I spent the period between midday and 6 pm commuting between the bed and the toilet, first in a relatively controlled manner but diarrhoea and vomiting escalated all too quickly. Then came the stomach cramps, almost as if my intestines were being cut with a barber’s knife. The sweat poured off me, my pulse raced and, when I discovered blood in my vomit, something had to be done.

My flatmate wasn’t home, and the nearest hospital was in the next town of El Gouna, about a 30-40 minute taxi ride from Hurghada. But I knew there was no way I could stay in the apartment on my own any longer. Fumbling, I grabbed my belongings and stumbled down to the main road like a drunkard. The taxi driver was not entirely sure whether to take me or not, but my pleading mixture of pigeon English and Arabic made him realise that I was not drunk, just desperate to get to a hospital.

The trip seemed to take forever, until we finally arrived at El Gouna hospital, one of the most modern hospitals in Egypt, with a 24-hour emergency ward. I was shown into the preliminary examination room, and from then on things happened quickly. Barely an

hour later, I was admitted and found myself alone in a 2-bed room with – an important point – a separate toilet. I was given a drip and pumped full of fluid andelectrolytes. A steady flow of doctors and nurses examined me, took samples, administered medicine, etc. I found out that I could expect to remain in hospital for a couple of days.

A couple of days…. It felt immediately reassuring, as if I was in safe hands, but what about payment...? Would my world health insurance policy cover the costs and would I have to pay up first then wait for reimbursement? All treatment in Egypt requires payment in cash by the patient, which is completely fair in such a poor country. But diving instructors are not millionaires.... I reached for my mobile phone and congratulated myself on always keeping the details for my IHI world health insurance card in my wallet. So, armed with the emergency telephone number and my policy number, I sent a text message to a friend in Denmark and asked her to contact IHI’s 24-hour emergency service in Denmark on my behalf. Even the effort of this simple task made me slump back into the pillows exhausted, where I dozed off thanks to the cramp-relieving and pain-killing medication I had already been given. Not long after, my mobile phone rang. “Hello Heidi, this is Thomas from IHI

in Denmark. I heard from your friend that you need some help down there?”.

Rarely have I been SO happy to receive a call on my mobile! Thomas asked me about the symptoms, where I was, telephone numbers, fax numbers, the doctor responsible, etc., and surprisingly quickly he ended the call with a “Take care of yourself, and we’ll set the wheels in motion at our end. I will just speak to one of our consultants, but it sounds like a clear cut case to me. Just tell the hospital’s accounts department that you are covered by world health insurance and we will arrange for payment to be made directly to them, unless I call you back within half an hour. OK?”. Relieved, I put the mobile phone down and drifted back to sleep, secure in the knowledge that the financial side of the matter was under control.

2-3 days later, I was discharged from the hospital in El Gouna, still resembling a drowned rat but improving rapidly. After a week in bed at home in my apartment, I was back at the diving centre and again fully occupied training new divers or guiding experienced ones. This was what I had travelled all the way from the cold north to Egypt to do during my sabbatical year away from the normal job market.

The matter was finally closed when in April 2003 I returned to Denmark and sent in the original receipts to my contact person at IHI. The service was again streamlined and personal and even extra expenses for transport and other things, which in a country such as Egypt are difficult to get receipts for, were no problem. I was able to give amounts and a couple of bills written in Arabic and a reference to standard practice in the country, and that was that.

I have travelled quite a lot in my 31-year life and had already learned to take out travel insurance before the trip to Egypt. But I have never before dealt with an organisation as professional as IHI. They did what was most important at the time the crisis arose. They took the burden off me, handled everything based on my input and let me concentrate on getting better. I didn’t have any idea of what was going on behind the scenes, that was just fixed. Professional, personal and extremely efficient.

I would like to thank everyone at IHI who was involved in my case – you made a difference. I know where I will advise my friends and family to get their world health insurance......

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