Employer's willingness to pay: the case for compulsory health insurance in Tanzania.
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This article documents employers' expenditure on the arrangements for the health care of their employees in one of the least developed countries; Tanzania. The case for compulsory health insurance is considered in the light of the fact that only 3% of the population is employed in the formal sector and could be covered at first. It is shown from a survey of larger employers, outside government, that they were spending on average 11% of payroll on health care for their employees. This demonstrated their lack of satisfaction with the government health services. Nevertheless, those who could readily be covered by insurance were making considerable use of the more expensive government hospital services. It is argued that a compulsory health insurance scheme could be introduced for the formal sector of employment which would cover a wider range of health services at lower cost. The scheme would also have the desirable economic effect of lowering employers' labour costs while making it possible to improve the standards of the government health services. (+info)
Evidence for the Will Rogers phenomenon in migration of employees to managed care plans.
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Employees have increasing opportunities to enroll in managed care plans, and employers tend to favor these plans because of their lower costs. However, lower costs may be the result of selection of healthier patients into managed care plans. This study measured differences in health care utilization across an indemnity plan and a managed care plan, and for all employees together. We found that apparent increases in utilization in both indemnity and managed care plans disappeared when the plans were viewed together, reflecting the migration of sicker patients from indemnity plans to managed care plans. (+info)
HMO market penetration and costs of employer-sponsored health plans.
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Using two employer surveys, we evaluate the role of increased health maintenance organization (HMO) market share in containing costs of employer-sponsored coverage. Total costs for employer health plans are about 10 percent lower in markets in which HMOs' market share is above 45 percent than they are in markets with HMO enrollments of below 25 percent. This is the result of lower premiums for HMOs than for non-HMO plans, as well as the competitive effect of HMOs that leads to lower non-HMO premiums for employers that continue to offer these benefits. Slower growth in premiums in areas with high HMO enrollments suggests that expanded HMO market share may also lower the long-run growth in costs. (+info)
The costs of cancer to a major employer in the United States: a case-control analysis.
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BACKGROUND: Detailed data will be increasingly important in determining the cost of cancer care in the managed care setting. OBJECTIVES: To estimate the full cost of cancer to a major employer in the United States and to determine the nature of the expenditures. STUDY DESIGN: Analysis of medical, pharmaceutical, and disability claims data from 1995 to 1997 for a major employer with more than 100,000 employees. METHODS: The cost of cancer is determined on a per-patient and per-employee basis. Based on a case-control method, cancer patients are matched to individuals with no record of cancer diagnosis or treatment. The incremental cost per employee and the percentage of total healthcare expenditures for cancer are quantified. RESULTS: Approximately $224 per active employee, or 6.5% of the corporation's total healthcare costs, was spent on incremental care for cancer patients in 1997. Medical conditions not directly related to cancer account for approximately half the total excess expenditures for patients with cancer. On average, annual healthcare and disability costs for persons with cancer were approximately 5 times higher than for their counterparts without cancer. CONCLUSIONS: The costs of cancer care are a substantial proportion of healthcare costs for employers. When the full cost of cancer is included in a cost-benefit analysis, expenditures for programs to reduce the risk of cancer in the working population may be justified. Expenditures to reduce the incidence and severity of conditions indirectly associated with cancer may also reduce overall employer healthcare expenses. (+info)
Indirect cost of ischemic heart disease to employers.
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BACKGROUND: The management of healthcare programs by employers requires accurate information about the indirect and direct costs of important chronic diseases. OBJECTIVE: To determine the indirect costs of ischemic heart disease from the perspective of the employer in private industry in the United States. DESIGN: Indirect cost of illness analysis using the human capital approach, taking the perspective of the employer rather than that of society. METHODS: Ischemic heart disease was identified in a proprietary claims database of 3.1 million insured persons using an algorithm based on administrative codes. Economic data were derived from the Bureau of Labor Statistics, the Employment Management Association, and published sources. Work-loss data were taken from the National Center for Health Statistics' Health Interview Survey. The indirect cost was calculated as the sum of the costs due to morbidity and mortality. From the perspective of the employer, morbidity costs come from lost productivity, idle assets, and nonwage factors resulting from absenteeism and mortality costs are expenditures for replacing and retraining workers. This differs from calculations from the societal perspective, in which indirect costs are the value of an individual's lost income--both current and potential. RESULTS: The total indirect cost of ischemic heart disease to employers in private industry was $182.74 per enrollee. Ninety-five percent of the indirect cost was the consequence of work loss due to morbidity rather than of mortality costs. CONCLUSION: From the perspective of the employer, the indirect cost of ischemic heart disease is overwhelmingly due to morbidity costs. (+info)
Job-based health insurance in 2001: inflation hits double digits, managed care retreats.
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Drawing on the results of a national survey of 1,907 firms with three or more workers, this paper reports on several facets of job-based health insurance, including the cost to employers and workers; plan offerings and enrollments; patient cost sharing and benefits; eligibility, coverage, and take-up rates; and results from questions about employers' knowledge of market trends and health policy initiatives. Premiums increased 11 percent from spring 2000 to spring 2001, and the percentage of Americans in health maintenance organizations (HMOs) fell six percentage points to its lowest level since 1993, while preferred provider organization (PPO) enrollment rose to 48 percent. Despite premium increases, the percentage of firms offering coverage remained statistically unchanged, and a relatively strong labor market has continued to shield workers from the higher cost of coverage. (+info)
To offer or not to offer: the role of price in employers' health insurance decisions.
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OBJECTIVE: To estimate the effect of changes in price on employers' decisions to offer health insurance. DATA SOURCES/STUDY SETTING: A 1993 survey of 22,347 private employers in ten states was used. STUDY DESIGN: Probit regression was used to estimate the probability of offering insurance as a function of the price and employer characteristics. For employers who did not offer insurance, a price cannot be directly observed. We estimated price for nonofferors using reported quotes received by recent shoppers and a selection model to correct for differences between recent shoppers and nonshoppers. PRINCIPAL FINDINGS: Changes in price affect decisions to offer insurance; however, even a 40 percent reduction in premiums would lead to only a 2 to 3 percentage point increase in the share of employers offering insurance. Employers of low-wage workers are substantially less likely to offer health insurance than other employers. CONCLUSIONS: Policies to reduce the number of uninsured that focus on increasing the supply of employment-based insurance are unlikely to have the intended effect unless coupled with policies to help low-wage workers afford insurance. (+info)
The impacts of mental health parity and managed care in one large employer group.
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We examine the impacts of a state mental health parity mandate on a large employer group, which simultaneously introduced a managed behavioral health care carve-out. Overall, we find that mental health/substance abuse (MH/SA) costs dropped 39 percent from the year prior to three years after parity, with managed care offsetting increases in demand induced by parity coverage. Managed care was most effective in reducing very high inpatient use among adolescents and children. The effect of the parity mandate on access was ambiguous: While treatment prevalence rose nearly 50 percent, similar increases were observed for groups not subject to the mandate. (+info)