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Was the Affordable Care Act (ACA) effective in the U.S. territories? This paper explores this question by examining the impact of the ACA's dependent mandate and Medicaid expansion in Puerto Rico. The dependent mandate led to a 4.3 percentage point increase in health insurance coverage for Puerto Rican young adults due to increased employer-sponsored insurance coverage, and the Medicaid Expansion increased Medicaid coverage by 2.4 percentage points. The impact of both policies in Puerto Rico is smaller than in the mainland, highlighting the importance of considering how federal legislation affects territories with economic and health environments dissimilar to the mainland. [ABSTRACT FROM AUTHOR]

This article estimates the effect of labor-market concentration on labor compensation across the US private sector since 2000. The authors distinguish between concentration in local labor markets and local product markets while guarding against bias from confounded product-market concentration. The analysis extends beyond wages to rates of employment-based health insurance coverage. Reported results suggest negative effects of labor-market concentration on labor compensation. These effects are exacerbated when product-market concentration is higher or when workers are older. [ABSTRACT FROM AUTHOR]

Background: Although one's socioeconomic status affects health outcomes, limited research explored how South Korea's National Health Insurance (NHI) system affects mortality rates. This study investigated whether health insurance type and insurance premiums are associated with mortality. Methods: Based on the National Health Insurance Service-Health Screening cohort, 246,172 men and 206,534 women aged ≥ 40 years at baseline (2002–2003) were included and followed until 2019. Health insurance type was categorized as employee-insured (EI) or self-employed-insured (SI). To define low, medium, and high economic status groups, we used insurance premiums at baseline. Death was determined using the date and cause of death included in the cohort. Cox proportional hazard models were used to analyze the association between insurance factors and the overall and cause-specific mortality. Results: The SI group had a significantly higher risk of overall death compared to the EI group (adjusted hazard ratio (HR) [95% confidence interval]: 1.13 [1.10–1.15] for men and 1.18 [1.15–1.22] for women), after adjusting for various factors. This trend extended to death from the five major causes of death in South Korea (cancer, cardiovascular disease, cerebrovascular disease, pneumonia, and intentional self-harm) and from external causes, with a higher risk of death in the SI group (vs. the EI group). Further analysis stratified by economic status revealed that individuals with lower economic status faced higher risk of overall death and cause-specific mortality in both sexes, compared to those with high economic status for both health insurance types. Conclusion: This nationwide study found that the SI group and those with lower economic status faced higher risk of overall mortality and death from the five major causes in South Korea. These findings highlight the potential disparities in health outcomes within the NHI system. To address these gaps, strategies should target risk factors for death at the individual level and governments should incorporate such strategies into public health policy development at the population level. Trial registration: This study was approved by the Institutional Review Board of Chungbuk National University Hospital (CBNUH-202211-HR-0236) and adhered to the principles of the Declaration of Helsinki (1975). [ABSTRACT FROM AUTHOR]

Background and Aims: Longitudinal change in income is crucial in explaining cardiovascular health inequalities. However, there is limited evidence for cardiovascular disease (CVD) risk associated with income dynamics over time among individuals with type 2 diabetes (T2D). Methods: Using a nationally representative sample from the Korean National Health Insurance Service database, 1 528 108 adults aged 30–64 with T2D and no history of CVD were included from 2009 to 2012 (mean follow-up of 7.3 years). Using monthly health insurance premium information, income levels were assessed annually for the baseline year and the four preceding years. Income variability was defined as the intraindividual standard deviation of the percent change in income over 5 years. The primary outcome was a composite event of incident fatal and nonfatal CVD (myocardial infarction, heart failure, and stroke) using insurance claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for potential confounders. Results: High-income variability was associated with increased CVD risk (HRhighest vs. lowest quartile 1.25, 95% CI 1.22–1.27; Ptrend <.001). Individuals who experienced an income decline (4 years ago vs. baseline) had increased CVD risk, which was particularly notable when the income decreased to the lowest level (i.e. Medical Aid beneficiaries), regardless of their initial income status. Sustained low income (i.e. lowest income quartile) over 5 years was associated with increased CVD risk (HRn = 5 years vs. n = 0 years 1.38, 95% CI 1.35–1.41; Ptrend <.0001), whereas sustained high income (i.e. highest income quartile) was associated with decreased CVD risk (HRn = 5 years vs. n = 0 years 0.71, 95% CI 0.70–0.72; Ptrend <.0001). Sensitivity analyses, exploring potential mediators, such as lifestyle-related factors and obesity, supported the main results. Conclusions: Higher income variability, income declines, and sustained low income were associated with increased CVD risk. Our findings highlight the need to better understand the mechanisms by which income dynamics impact CVD risk among individuals with T2D. Structured Graphical Abstract This study investigates the association between income dynamics over five years and incident composite cardiovascular outcomes in non-elderly individuals with type 2 diabetes. Our graphical abstract highlights significant associations between cardiovascular risk and income metrics, including income variability (standard deviation of percent change), changes in income status (rise and decline), and cumulative number of years in low- or high-income status. [ABSTRACT FROM AUTHOR]

How accurate are Americans' perceptions of the material benefits associated with union membership, and do these perceptions influence their support for, and interest in joining, unions? We explore these questions in a preregistered, survey experiment conducted on a national sample, representative of the US population on a number of demographic benchmarks (n = 1,430). We find that Americans exhibit large and consistent underestimates of the benefits associated with unionization, as compared to evidence from the Bureau of Labor Statistics and peer-reviewed academic research. For example, 89% of Americans underestimated the life-time income premium associated with union membership, 72% underestimated the percentage of union members who receive health insurance from their employer, and 97% overestimated the average union dues rate. We next randomly assigned half of the participants to receive a brief, informational correction conveying results of academic and government research on the material benefits associated with union membership, or not. Those who received the correction reported 11.6% greater interest in joining a union, 7.8% greater support for unions, and 6.9% greater interest in helping to organize a union in their workplace, as compared to the control group. These results suggest that, overall, Americans tend to underestimate the material benefits associated with unionization, misperceptions of these benefits are causally linked to Americans' support for unionization, and correcting these misperceptions increases a range of pro-union sentiments in the American mass public. [ABSTRACT FROM AUTHOR]

Many community-rated health insurance markets include risk equalization (also known as risk adjustment) to mitigate risk selection incentives for competing insurers. Empirical evaluations of risk equalization typically quantify selection incentives through predictable profits and losses net of risk equalization for various groups of consumers (e.g. the healthy versus the chronically ill). The underlying assumption is that absence of predictable profits and losses implies absence of selection incentives. This paper questions this assumption. We show that even when risk equalization perfectly compensates insurers for predictable differences in mean spending between groups, selection incentives are likely to remain. The reason is that the uncertainty about residual spending (i.e., spending net of risk equalization) differs across groups, e.g., the risk of substantial losses is larger for the chronically ill than for the healthy. In a risk-rated market, insurers are likely to charge a higher profit mark-up (to cover uncertainty in residual spending) and a higher safety mark-up (to cover the risk of large losses) to chronically ill than to healthy individuals. When such differentiation is not allowed, insurers face incentives to select in favor of the healthy. Although the exact size of these selection incentives depends on contextual factors, our empirical simulations indicate they can be non-trivial. Our findings suggest that – in addition to the equalization of differences in mean spending between the healthy and the chronically ill – policy measures might be needed to diminish (or compensate insurers for) heteroscedasticity of residual spending across groups. [ABSTRACT FROM AUTHOR]

The article "Voluntary Health Insurance in the GSVG" provides an overview of the various options for voluntary health insurance within the framework of the GSVG. The GSVG provides, among other things, for continued insurance coverage upon leaving mandatory insurance and the possibility of establishing health insurance coverage for certain family members. In addition, § 9 GSVG allows for the receipt of sickness benefits in the event of incapacity for work due to illness through the conclusion of supplementary insurance. Continued insurance coverage immediately follows the end of the previous health insurance to ensure uninterrupted insurance coverage. Continued insurance in the statutory health insurance is an important instrument to enable uninsured individuals to be included in the solidarity community and protect them from the risks and premiums of private health insurance. [Extracted from the article]

The purpose of this study is to incorporate the international health insurance model/models for a symbiotic benefits to medical tourists and health insurance companies. This study is based on the extensive analysis of articles published regarding health insurance for tourists and medical tourism. Objective of study is "to adopt the health insurance models for growth of health insurance premium and medical tourism in India". Content analysis has been adopted in this study. Literature confirms that the influx of medical tourism is positively related with growth of health insurance, when innovative model/models of health insurance are incorporated strategically for the medical tourists in India. According to the study results, adoption and implementation of international based model/models of health insurance for medical tourists is a trigger point for the growth of health insurance fund in India and it changes the perception of medical tourists towards India as economical destination in case of medical emergencies. The scope of study is to recognize international health insurance model/models in digitalized era for the growth of health insurance premium and medical tourism in India. [ABSTRACT FROM AUTHOR]

Incentive-based health insurance applications have been implemented to trigger lower insurance premiums when the individual follows healthy living habits. It has been recognised that this benefit notwithstanding, consumers' perceptions related to such applications in the life-insurance field and health tracking are not necessarily positive. Recent research has recognised that psychological ownership, a mental state wherein one feels a technology or application to be his or her own, plays a crucial role in individuals' willingness to adopt and use new technologies. It has been suggested that many digital applications and platforms possess unique empowering and co-creative features that offer special potential to facilitate the emergence of psychological ownership and satisfy the underlying needs. The aim of our study, proceeding from these premises, was to identify and thematize hurdles to take-up of incentive-based health insurance applications with regard to meeting needs that drive development of psychological ownership. We achieved this by conducting a thematic analysis of perceptions of consumers who were not willing to adopt a specific application of the relevant type. The resulting framework, which recognises 14 thematized hurdles in all, holds important implications for scientific and managerial use both. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to estimate the effect of the state‐based reinsurance programs through the section 1332 State Innovation Waivers on health insurance marketplace premiums and insurer participation. Data Source: 2015 to 2022 Robert Wood Johnson Foundation Health Insurance Exchange Compare Datasets. Study Design: An event study difference‐in‐differences (DD) model separately for each year of implementation and a synthetic control method (SCM) are used to estimate year‐by‐year effects following program implementation. Data Collection/Extraction Methods: Not applicable. Principal Findings: Reinsurance programs were associated with a decline in premiums in the first year of implementation by 10%–13%, 5%–19%, and 11%–17% for bronze, silver, and gold plans (p < 0.05). There is a trend of sustained declines especially for states that implemented their programs in 2019 and 2020. The SCM analyses suggest some effect heterogeneity across states but also premium declines across most states. There is no evidence that reinsurance programs affected insurer participation. Conclusion: State‐based reinsurance programs have the potential to improve the affordability of health insurance coverage. However, reinsurance programs do not appear to have had an effect on insurer participation, highlighting the need for policy makers to consider complementary strategies to encourage insurer participation. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic in 2020 enhanced the need for commercial health insurance to address the sudden and overwhelming healthcare costs faced by families. This also led to an increase in the demand for health insurance services requiring insurance companies to innovate and develop suitable services. However, in the context of China, despite the huge potential for growth, health insurance market faces numerous challenges such as inadequate availability of tailored services, educational issues, income limitations, and emphasis on social insurance. To examine the issues and consider areas for improvements, this research investigated the impacts and effects of commercial health insurance from a macro perspective and considered potential recommendations to enhance the effective demand. This paper performed an empirical investigation by using the short panel data for regression analysis. The data was collected over ten years (2010 to 2019) involving 31 provinces in China to establish a fixed effect model. It employed FE and FGLS method to compare and analyze the impact of 9 factors while the health insurance premium was set as the dependent variable. Results showed that domestic economic development led to increasing residents' wealth and consumption levels has increased, including healthcare investments. Elevating the awareness of people through education can promote the development of the commercial health insurance demand, but the influence of urbanization level and the aging of the population remain to be demonstrated. [ABSTRACT FROM AUTHOR]

The article describes a waqf-based hospital in Indonesia to show continuity and change in the development of waqf-based Islamic hospitals, which began in the Prophetic era and has survived until today. The findings show there are several transformations from waqf-based hospitals in medieval and early modern Islam where many of the founders, from the Sultan and the elites of the Islamic dynasty to the donors, come from the civil and private sector, for instance, Ḥājj Roemani, the founder of Hospital Roemani Muhammadiyah, an entrepreneur with the same background as Hakim Muhammad Said of Hamdard Pakistan. Also, there is a shift from what is called "free healthcare service to the needy and poor", which is generally understood as fully free, to the several features of changes ranging from a very nominal charge, reduction of the cost, and health insurance with low premiums subsidized by the state for the needy and poor. The shifting influence of the hospital management model towards a commercial, even though the hospital itself is waqf based, whose essential character is non-profit. We argue this is due to the human population growth and the challenges of the emergence of various diseases until the pandemic, increasing the need for health funds. Hence, the hybrid scheme of Islamic philanthropy funds is needed and can make this hospital an institution that not only plays a role in the socio-economic development in the health sector but extends to other socioeconomic sectors. [ABSTRACT FROM AUTHOR]

This study aims to manage the two most common and critical disruptions of Iranian health insurance (declining market share and errors in predicting the indemnities) by proposing a novel data-driven methodology for calculating its insurance premium. Here, using the optimal machine learning algorithm selected using a Bayesian best-worst method, insurers are classified based on their preparedness for causing disruptions. Then, the indemnity of each group of insureds is predicted. Finally, the appropriate premium for each group of insureds is calculated separately using a new mathematical optimization model. The results of our real-life case study guarantee the insurer's profitability and reduction of its bankruptcy risk even by announcing lower premiums. [ABSTRACT FROM AUTHOR]

The Pharmacare Act, Bill C-64, was passed by Canada's House of Commons in June 2024 and is awaiting final approval by the Senate. However, the bill does not establish universal, public pharmacare as recommended by the government's Advisory Council and previous national inquiries. Instead, it fills the gaps in Canada's existing systems of drug payment, which is financed through private insurance plans. The bill also falls short in establishing the Canadian Drug Agency, leaving it vulnerable to interference and potentially toothless. Amendments are needed to align the bill with recommendations for a cost-effective and robust universal, public pharmacare program. [Extracted from the article]

The pricing's premium in an insurance for the health sector is influenced by the claims ratio of its subscribers, which generates high levels of fluctuation and uncertainty. The objective of this research is the application of the actuarial individual risk models, collective risk and credibility model, together with the application of the failure rate technological model and the Black-Scholes financial options model as tools for estimating pricing's premium for the insurance and health industry in Colombia. Based on the claims and the total costs of the historical claims, the models are applied to ensure optimal premiums for coverage of the aggregate losses of the claims. In the end, comparing these models and approaching a definition of an optimal method. The importance of the research settles in the high commitment, responsibility and financial impact of managing and mitigating the impact of actuarial risk, proposing new methodologies through an optimal estimation level in premiums to certify proper functioning of the sector entities in matters of costs, sustainability and service compliance in the sector. [ABSTRACT FROM AUTHOR]

Health insurance coverage in the United States is highly uncertain. In the post-Affordable Care Act (ACA), pre-COVID United States, we estimate that while 12.5% of individuals under 65 are uninsured at a point in time, twice as many--one in four--are uninsured at some point over a 2-y period. Moreover, the risk of losing insurance remained virtually unchanged with the introduction of the landmark ACA. Risk of insurance loss is particularly high for those with health insurance through Medicaid or private exchanges; they have a 20% chance of losing coverage at some point over a 2-y period, compared to 8.5% for those with employer-provided coverage. Those who lose insurance can experience prolonged periods without coverage; about half are still uninsured 6 mo later, and almost one-quarter are uninsured for the subsequent 2 y. These facts suggest that research and policy attention should focus not only on the "headline number" of the share of the population uninsured at a point in time, but also on the stability and certainty (or lack thereof) of being insured. [ABSTRACT FROM AUTHOR]

Using data from the US Census Bureau's Household Pulse Survey, we analyzed the likelihood of loss of health insurance and enrollment into new health coverage during the early months of the COVID‐19 pandemic. Loss of employment was associated with a significant increase in the likelihood of loss of health insurance and, specifically, an increase in the likelihood of employer‐sponsored health insurance. However, individuals in Medicaid expansion states experienced a lower likelihood of loss of health insurance compared with individuals in nonexpansion states. At the same time, there was a statistically significant increase in Medicaid enrollment in expansion states, by 3.2 percentage points. Reemployment or acquiring employment was associated with a gain in health insurance coverage. During an economic downturn, eligibility, and coverage gaps leave many without affordable coverage options, and the pandemic will likely bring renewed attention to gaps in Medicaid coverage in nonexpansion states. [ABSTRACT FROM AUTHOR]

Objective: There is limited evidence on the association of sustained low-income status, income changes, and all-cause mortality risk in individuals with type 2 diabetes (T2D).Research Design and Methods: Using the Korean Health Insurance Service database, we studied 1,923,854 adults with T2D (aged ≥30 years) without cardiovascular disease and cancer, who were enrolled from 2009 through 2012 and followed to the end of 2020 (median 10.8 years of follow-up). We defined income levels based on the amount of health insurance premiums and categorized them into quartiles, the first being the low-income group, and assessed the income status annually in the preceding 5 years. Cox proportional hazards models were used to quantify the association of low-income status and income changes with mortality, with adjustment for sociodemographic factors, comorbidities, and diabetes duration and treatment.Results: Participants who consecutively had low income showed a higher risk of mortality (hazard ratio [HR] 1.19; 95% CI 1.16-1.22), compared with those who had never been in the low-income group. This association was much stronger for consecutive recipients of Medical Aid, reflecting very-low-income status (HR 2.26; 95% CI 2.16-2.36), compared with those who had never been Medical Aid beneficiaries. Sustained low- and very-low-income status was associated with increased risk of mortality, specifically for younger adults (aged<40 years) and males. Those who experienced declines in income between the first (preceding 5 years) and the last (baseline) time points had an increased risk of mortality, regardless of baseline income status.Conclusions: Among Korean adults with T2D, sustained low-income status and declines in income were associated with increased risk of mortality. [ABSTRACT FROM AUTHOR]

Health insurance premiums account for a significant portion of the cost base of U.S. corporations. A recent study finds that health insurance premiums increase for firms that experience positive profit shocks, suggesting that the U.S. health insurance market is not perfectly competitive. Motivated by this finding and the economic importance of health insurance premiums, this is the first study to examine firms' earnings management incentives in the face of insurance carriers with strong bargaining power. We use an innovative data set for a large sample of U.S. firms with detailed information on insurance premiums and insurance plan characteristics. Using an economic shock to insurance firms' bargaining power and difference- in-differences tests, we find that firms manage their reported earnings downward when insurance providers have strong bargaining power. We further show that this effect is more pronounced in settings in which there are ex ante reasons to expect stronger incentives to manage earnings downward. We also provide preliminary evidence suggesting that downward earnings management has the intended effect of mitigating future increases in health insurance premiums. Our analyses highlight an inefficient health insurance market as an important determinant of firms' financial reporting choices. [ABSTRACT FROM AUTHOR]

The presence of ex-ante moral hazard could undermine the potential gain from expanding health insurance coverage in developing nations. To test the proposition, this study utilizes a nationally representative longitudinal survey with Indonesia's health insurance for poor policy in 2014 as the quasi-experimental case study. The country represents developing nations that undergo a massive and rapid expansion of health insurance coverage. The empirical approach combines a matching and difference-in-differences method to obviate potential bias of the selectivity nature of health insurance provision and time-invariant unobserved factors. The findings suggest the presence of ex-ante moral hazard in the form of the less people using trash cans associated with the introduction of the subsidized health insurance premium. The results add empirical findings of a negative side effect of expanding health insurance coverage in developing nations. [ABSTRACT FROM AUTHOR]

Background: With the delayed eradication of coronavirus disease 2019 (COVID-19), people with disabilities, a socially vulnerable class of individuals, face aggravated hardships caused by a pause in support services and lack of care due to stricter social distancing policies combined with the challenges of their disabilities. Given this background, we aim to investigate COVID-19 infection and mortality rates among people with disabilities, who face heightened physical and mental health threats amidst the COVID-19 pandemic. Methods: Gender, age, health insurance premiums, the Charlson Comorbidity Index (CCI), the severity of the disability, and the type of disability were compared among people with disabilities who had been infected with or died from COVID-19 using the nationally representative National Health Insurance Service (NHIS)-COVID-19 database (DB). Results: We found that the COVID-19 infection rate was higher among those with low income, those with severe disability, and those with "other" disabilities (ie, speech disabilities, hepatic dysfunction, respiratory dysfunction, facial disfigurement, intestinal fistular/urinary disability, epilepsy, intellectual disability, autistic disorder, and mental disorders). The mortality rate was markedly higher (ie, 15.90 times higher, odds ratio [OR]: 15.90, 95% confidence interval [CI]: 6.16 - 41.06) among people aged 80 years or older as compared with those aged 60 years or younger. The odds for mortality were 2.49 times higher (OR: 2.49, 95% CI: 1.33 - 4.64) among people with severe disabilities as compared with mild disabilities. Conclusion: Among people with disabilities, we found that COVID-19 infection rates differed according to income level, severity of the disability, and disability type, while the COVID-19 mortality rates differed according to age and severity of the disability. [ABSTRACT FROM AUTHOR]

We estimate the effect of employers providing health insurance and contributing towards health insurance premiums on employee job tenure. Using merged 2008–2018 data from the Job Tenure Supplement and Annual and Social Economic Supplement of the Current Population Survey, we find that employer health insurance is associated with one additional year of job tenure. We find that a thousand dollar increase in employer contributions to health insurance is associated with at least 83 additional days of job tenure, compared to less than 10 additional days for a thousand dollar increase in wages. [ABSTRACT FROM AUTHOR]

How should payment systems of means-tested benefits be designed to improve the financial situation of needy recipients most effectively? We study this question in the context of mandatory health insurance in Switzerland, where recipients initially receive either a cash transfer or subsidized insurance premiums (a form of in-kind transfer). A federal reform in 2014 forced cantons (i.e. states) to universally switch to in-kind provision. We exploit this setting based on a difference-in-differences design, analyzing eight years of rich individual-level accounting data and applying a machine learning approach to identify cash recipients prior to the reform. We find that switching from cash to in-kind transfers persistently reduces the likelihood of late premium payments by about 20% and of government debt collection for long-term missed payments by approximately 12%. There is no evidence for a negative spillover effect on the timely payment of the non-subsidized co-pay bills for health services after the regime change. [ABSTRACT FROM AUTHOR]

We propose a new approach for estimating the state-level direct and indirect economic cost of obesity in the United States for the time period 1996 to 2018. Our unique top-down methodology integrates a prevalence-based method with various medical-level costs, economic, demographic, and socio-economic factors. Using this approach, we investigate the relationship between the estimates of the total obesity-related costs and the health insurance premium by state in order to evaluate the state burden of obesity. Our estimate of the total national economic cost attributed to obesity is approximately $422 billion in 2018, representing about 2% of the national GDP for the same year. Using exponential smoothing models, we forecast that the total cost would reach $475 billion in 2021 without accounting for the impact of COVID-19 on obesity. The top states driving the cost estimates are California, Texas, New York, and Florida. A bootstrapping technique is employed to the state-level estimated cost in order to determine the average cost per person. We hope that our study will promote interest in this topic and open discussion for further research in this area. [ABSTRACT FROM AUTHOR]

The paper investigates the factors underlying COVID-19 vaccine and booster hesitancy in the United States, and the efficacy of various incentives or disincentives to expand uptake. We use cross-sectional, national survey data on 3,497 U.S. adults collected online from September 10, 2021 to October 20, 2021 through the Qualtrics platform. Results from a multinomial logistic regression reveal that hesitancy and refusal were greatest among those who expressed a lack of trust either in government or in the vaccine's efficacy (hesitancy relative risk ratio, or RRR: 2.86, 95% CI: 2.13–3.83, p<0.001). Hesitancy and refusal were lowest among those who typically get a flu vaccine (hesitancy RRR: 0.28, 95% CI: 0.21–0.36, p<0.001; refusal RRR: 0.08, 95% CI: 0.05–0.13, p<0.001). Similar results hold for the intention to get a booster shot among the fully vaccinated. Monetary rewards (i.e., lottery ticket and gift cards) fared poorly in moving people toward vaccination. In contrast, the prospect of job loss or increased health insurance premiums was found to significantly increase vaccine uptake, by 8.7 percentage points (p<0.001) and 9.4 percentage points (p<0.001), respectively. We also show that the motivations underlying individuals' hesitancy or refusal to get vaccinated vary, which, in turn, suggests that messaging must be refined and directed accordingly. Also, moving forward, it may be fruitful to more deeply study the intriguing possibility that expanding flu vaccine uptake may also enhance willingness to vaccinate in times of pandemics. Last, disincentives such as work-based vaccination mandates that would result in job loss or higher health insurance premiums for those who refuse vaccination should be strongly considered to improve vaccine uptake in the effort to address the common good. [ABSTRACT FROM AUTHOR]

Global health experts use a health system perspective for research on social health protection. This article argues for a complementary actor perspective, informed by the social resilience framework. It presents a Saving4Health initiative with women groups in rural Tanzania. The participatory qualitative research design yielded new insights into the lived experience of social health protection. The study shows how participation in saving groups increased women's collective and individual capacities to access, combine and transform five capitals. The groups offered a mechanism to save for the annual insurance premium and to obtain health loans for costs not covered by insurance (economic capital). The groups organized around aspirations of mutual support and protection, fostered social responsibility and widened women's interaction arena to peers, government and NGO representatives (social capital). The groups expanded women's horizon by exposing them to new ways of managing financial health risk (cultural capital). The groups strengthened women's social recognition in their family, community and beyond and enabled them to initiate transformative change through advocacy for health insurance (symbolic capital). Savings groups shape the evolving field of social health protection in interaction with governmental and other powerful actors and have further potential for mobilization and transformative change. [ABSTRACT FROM AUTHOR]

Migrant workers are an important component of China's labor market, playing a vital role in economic development and social stability. In the face of significant health risks related to their work, migrant workers remain largely under-represented in China's health insurance system despite their eligibility to participate in several programs. To achieve China's goal of universal healthcare coverage, migrant workers are targeting populations. The objective of this paper is to understand the factors associated with migrant workers' participation in health insurance programs. This analysis draws from a survey of 3,342 migrant workers that was conducted by China Agricultural University in 2013. A multinomial logit model was performed to identify the determinants of migrant workers' health insurance participation. Our findings suggest that the highest rates of un-insurance were observed for females, the elderly, those with lower levels of education, income, or lower self-reported health status, and migrant workers in the construction industry. They are the most vulnerable populations and susceptible to various health and occupational hazards. Besides the high enrollment rates of migrant workers in the New Rural Cooperative Medical Scheme, the scheme's lack of portability needs a complete "Inter-province" balancing reimbursement networking platform to be built. Furthermore, establishing a multi-level medical security system that is accessible and affordable may serve the goal of improving health insurance participation among migrant workers. [ABSTRACT FROM AUTHOR]

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Objectives: In January 2014, the Affordable Care Act (ACA) preexisting condition protections prohibited coverage denials, premium increases, and claim denials on the basis of preexisting conditions. This study aimed to examine changes in coverage and premiums and out-of-pocket spending after the implementation of the preexisting condition protections under the ACA.Methods: We identified adults aged 18 to 64 years with (n = 59 041) and without preexisting conditions (n = 61 970) from the 2011-2013 and 2015-2017 Medical Expenditure Panel Survey. We used a difference-in-differences and a difference-in-difference-in-differences approach to assess the associations of preexisting condition protections and changes in insurance coverage, premium contributions, and out-of-pocket spending after the ACA. Simple and multivariable logistic or multivariable 2-part models were fitted for the full sample and stratified by family income (low ≤138% federal poverty level [FPL]; middle 139%-400% FPL; and high > 400 FPL).Results: The ACA increased nongroup insurance coverage to a similar extent for individuals with or without preexisting conditions at all income levels. Decreases in premium contributions were observed to a similar extent among families with nongroup private coverage regardless of declinable preexisting condition status, whereas no significant changes were observed among families with group coverage. We found greater decreases in out-of-pocket spending for individuals with preexisting conditions than those without conditions among both individuals covered by nongroup and group insurance, and a greater difference was observed among those covered by nongroup insurance (difference-in-difference-in-differences -$279; 95% confidence interval -$528 to -$29).Conclusions: The ACA protections were associated with decreases in out-of-pocket spending among adults with preexisting conditions. [ABSTRACT FROM AUTHOR]

Background: The government of Sierra Leone introduced Social Health Insurance Scheme as a measure to remove financial barriers that beset the people in accessing health to ensure universal coverage. Under this policy, the citizens were encouraged to subscribe to the scheme to avoid out of pocket payment for healthcare at the point of use. This study was conducted to find out the predictors of willingness among the people to pay for health insurance premium. Methods: A cross-sectional study design was employed in six selected districts in Sierra Leone. Quantitative data was collected for this study through the use of semi-structured questionnaire with a sample size of 1185 respondents. Data was analysed into descriptive and inferential statistics using the contingent valuation model. Statistical analysis was run at 5% significant level using Stata version 14.0 software. Results: The results showed that majority of the respondent are willing to join and pay a monthly premium of Le 10 000 (US$1.03) with an estimated mean contribution of about Le 14 089 (US$1.44) and the top five predictors of willingness to pay (WTP) were household monthly income, age, district of resident, gender, and educational qualification. Conclusion: The findings on predictors of WTP premium of Sierra Leone National Social Health Insurance (SLeNSHI), suggests that the socio-demographic characteristics of the population are important in premium design and payment. Efforts at improving the socio-economic statuses of the population could be helpful in premium design and payment. [ABSTRACT FROM AUTHOR]

Simple Summary: The standards of veterinary medicine are increasingly approaching those of human medicine. As a result, the cost of veterinary medicine is also rising noticeably. For many veterinarians and also pet owners, the question therefore arises as to whether animal health insurance is a possible solution. Based on a thought model, we have classified pet owners into four groups according to their willingness to pay and their dispensable funds. We found that animal health insurance can reduce price discussions, but reaches its limits as soon as an animal owner can afford neither the veterinary costs nor a monthly insurance premium. Background: Owners often feel the cost of veterinary care is too high, as there remains a limited understanding of the cost of health care in human and veterinary medicine alike. Pet health insurance is often seen as a universal solution. However, especially for patient owners with few financial resources, both the bill at the vet and the monthly premium for pet health insurance can become a challenge. Hypothesis: Pet health insurance can prevent or ease many price discussions at the vet, but it does not offer a solution for patient owners with little financial means. Methods: In order to verify for which patient owners pet health insurance can be a solution, four theoretical groups were formed depending on the patient owner's willingness to pay and his/her dispensable funds based on a theoretical model. Results: Dispensable funds are a factor that cannot be influenced by the veterinary surgeon. However, low dispensable funds as a result of an insufficient willingness to save (whether due to a lack of financial education or a lack of will) can be solved by pet health insurance. Willingness to pay, on the other hand, can be influenced by empathetic communication from the veterinary surgeon and thus also from pet health insurance. Nevertheless, situations remain where pet health insurance is not a solution either, because owners can neither afford the veterinary costs nor a premium for a pet health insurance. [ABSTRACT FROM AUTHOR]

Nearly 30% of documented agricultural workers, that is, those who are authorized to work in the U.S. and may be eligible for government‐sponsored Medicaid coverage, lacked health insurance coverage in 2016. We estimate the impact of the 2014 state‐level Medicaid expansions that were part of the Affordable Care Act (ACA) on farm workers' health insurance coverage, health care utilization, and labor supply. Using confidential individual‐level data from the National Agricultural Workers Survey (NAWS) for the decade between 2007 and 2016, we employ a difference‐in‐differences econometric model to compare workers in states that expanded Medicaid in 2014 to workers in states that did not. We find that, following the ACA Medicaid expansions, documented agricultural workers experience a 12‐percentage point (24%) increase in the likelihood of having health insurance, which is entirely driven by an increase in the likelihood of having a government‐sponsored health insurance plan. We do not detect a decrease in private (employer‐sponsored or worker‐acquired) health insurance coverage. Further, we find no evidence that the ACA Medicaid expansions led to a decline in farm workers' labor supply; in fact, our results imply that there was a small increase in farm workers' hours. In a number of falsification tests, we also show that the Medicaid expansions do not appear to have an impact on undocumented (unauthorized) farm workers' health care utilization, and there was no increase in Medicaid payments for health services among this group of farm workers who were largely ineligible for Medicaid. [ABSTRACT FROM AUTHOR]