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The provocative advice of health policymakers in endorsing private health insurance, as a critical tool for health reforms, is well-reckoned as a deterrent to mounting healthcare expenditure in the wake of the public health insurance quagmire. However, scholarly evidence has condemned the ineffectiveness of private health insurance in containing out-of-pocket expenditure. In this backdrop, we carried out a nuanced investigation of the coverage pattern of private health insurance policies. We examined the one-year billing information of private health insurance holders hospitalized in a multi-specialty teaching hospital. We found that private health insurance fails to provide full coverage, leading to underinsurance though minimal financial protection was extended. Moreover, reimbursement patterns under various cost heads are also discussed. We conclude by emphasizing the need for future research to fill the knowledge gap. We claim methodological novelty in its approach to data collection.

The provocative advice of health policymakers in endorsing private health insurance, as a critical tool for health reforms, is well-reckoned as a deterrent to mounting healthcare expenditure in the wake of the public health insurance quagmire. However, scholarly evidence has condemned the ineffectiveness of private health insurance in containing out-of-pocket expenditure. In this backdrop, we carried out a nuanced investigation of the coverage pattern of private health insurance policies. We examined the one-year billing information of private health insurance holders hospitalized in a multi-specialty teaching hospital. We found that private health insurance fails to provide full coverage, leading to underinsurance though minimal financial protection was extended. Moreover, reimbursement patterns under various cost heads are also discussed. We conclude by emphasizing the need for future research to fill the knowledge gap. We claim methodological novelty in its approach to data collection. [ABSTRACT FROM AUTHOR]

The Affordable Care Act has significantly reduced the number of uninsured individuals in the U.S. yet millions of insured Americans lack adequate coverage or face substantial health-related financial risks. In this study, we conduct an analysis of a nationally representative sample to generate up-to-date evidence on the association between insurance types and demographic factors and the probability of cost-related underinsurance among continuously insured, lower-income adults in the U.S. We extend the previously established definition of underinsurance by including a measure of subjective financial burden. Our estimates suggest that 33.2% of lower-income individuals in our sample were underinsured, with a fourth of them meeting two or three criteria. We also find that Medicaid beneficiaries were significantly less likely than others to experience underinsurance. Our findings provide evidence that underinsurance is a major concern, and expansion of coverage alone may not suffice to protect individuals from financial risks and cost barriers to health care use. [ABSTRACT FROM AUTHOR]

Even when heavily subsidized, a substantial portion of people choose to forgo purchasing health insurance coverage. In this note, I introduce an explanation for this phenomenon which does not assume choice errors, incorrect beliefs, differently priced uncompensated care, or information asymmetries. When individuals are incapable of freely trading off health and wealth and the initial allocation of goods is suboptimal from their perspective, the standard result of demand for actuarially fair insurance in a single good world does not generalize to the health insurance context. Thus, people might not purchase full health insurance coverage even if it is priced at actuarially fair levels. I argue that this situation is particularly likely to occur in the low‐income population, and hence it is relevant for the achievement of universal health coverage. [ABSTRACT FROM AUTHOR]

Background: People with incomes below the Federal Poverty Level (FPL) do not qualify for health insurance subsidies and may not be eligible for Medicaid. Patients in this Medicaid Coverage Gap may have difficulty paying for their medications.Objective: To estimate medication adherence and the prevalence of underinsurance among chronic condition patients in the Medicaid Coverage Gap.Methods: A retrospective cohort study was conducted using 2014-2016 data extracted from the Medical Expenditure Panel Survey. The sample included non-elderly patients with prescription fills (≥2) for at least one of five chronic conditions (hypertension, hyperlipidemia, diabetes, depression and anxiety disorder) and income below the FPL. Medication adherence was measured using Medication Possession Ratio (MPR), and adjusted using patient demographics, health conditions, and health care utilization. The prevalence of underinsurance also was examined.Results: Of the 316 patients, 60.4% were female, with an average age of 50, and an average of 3 health conditions. The weighted MPR was 72.0% and 44.6% had an adjusted MRP ≥80%. Nearly 80% of the patients were either continuously uninsured (21.6%) or underinsured (59.0%).Conclusions: A significant proportion of chronic condition patients in Medicaid Coverage Gap were underinsured and less than half were adherent to their medications. [ABSTRACT FROM AUTHOR]

The underinsurance of property is pervasively and persuasively promoted as an indicator of risk and riskiness and, in Western nations, is assumed to be aligned with socio-economic disadvantage. Yet, the solution – in its most simple form, buying more insurance – lacks critical interrogation of what the problem actually is. To understand underinsurance better, we map house and contents underinsurance across two municipalities in Australia's island state of Tasmania, and observe that the existing delineation of disadvantage and advantage between these two places is muted in relation to insurance – underinsurance does not straightforwardly map onto disadvantage. We provide an alternative explanation: that underinsurance is not a risk for households per se and does not represent riskiness on behalf of these households. Rather, it is indicative of household agency that produces place-specified responses within the processes of financialisation and marketisation. We observe that the growth in renting, driven in part by housing financialisation, is associated with property underinsurance. The history of renting as temporary and marginal informs renter decision making not to insure, and thus current financialised changes in housing co-produce rather than ameliorate underinsurance. We also conclude that in negating or resisting insurance marketisation, households garner everyday financial and material adaptative capacity by underinsuring. [ABSTRACT FROM AUTHOR]

This article documents that the amount of coverage carried by U.S. households is inadequate when compared to a human life value and a life insurance needs calculator. Households with dependents are particularly underinsured. Several reasons are suggested as a cause of the underinsurance. Cost is a common reason given for not owning adequate insurance, but analysis of actual premiums shows that it is a misperception. Lack of consumer education or inappropriate assumptions are more likely causes for being underinsured. [ABSTRACT FROM AUTHOR]

Discusses the growing extent of health uninsurance and underinsurance among the non-elderly in the United States. Proposals for addressing the issue; Evaluation of the proposals; Considerations regarding the beneficiaries, cost, payor, administrative usability, equitable treatment of subgroups; Consistency with traditional American social values.

Recent price transparency laws are designed to better inform patients as they compare hospital options and "shop" for health care services. In addition to prices, underinsured patients seeking care need information on financial assistance, discounts, payment plans, and upfront payment requirements to compare the affordability of care across hospitals. Little is known about the availability of this information and the experience of prospective patients seeking it. We contacted a random sample of 10% of general short-term hospitals across the United States in this "secret shopper" telephone study to assess financial options and navigation challenges faced by underinsured patients in need of a non-emergency procedure. The administrative friction was substantial. Most hospitals have 3 siloed offices for (1) financial assistance, (2) payment plans and discounts, and (3) upfront payment requirements. All relevant offices were unreachable in 3 attempted calls at 18.1% of hospitals. Among hospitals with available information, the majority have financial options for patients: 86.7% of hospitals offer financial assistance and 97.0% of hospitals offer payment plans to underinsured patients for non-emergency care. The length and terms of payments plans varied widely for hospital-administered and third-party financing arrangements. Upfront payments were sometimes required, potentially posing barriers for patients without cash or credit access., Competing Interests: Conflicts of interest Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials., (© The Author(s) 2024. Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc.)

We analyse the effect of behavioural biases on entrepreneurs' decisions to insure their firms against different kinds of corporate risks. We use a large sample of 2,295 Italian small and medium enterprises (SMEs), finding that they under-insure themselves. Since SMEs should insure more - in proportion - compared to bigger companies, analysing the reasons for this underinsurance is relevant to improve entrepreneurs' decisions and help their firms, but also from a policy-making point of view. We link corporate insurance choices with the entrepreneurs' personal characteristics and behavioral traits as well as with their households' financial choices. Our methodology uses stepwise regressions to discern which variables are statistically significant. In our results, we find that entrepreneurs not only underinsure their firms but also themselves, thus exposing themselves, their firms and their families to high idiosyncratic risk. We find that these suboptimal decisions are affected by behavioural biases such as overconfidence, over-optimism, risk misperceptions, and stubbornness, even though in a not straightforward manner. We measure both the overall effect on the number of insurances underwritten and on the specific type of insurance contract. In general, we find that relatively bigger firms do buy more insurance, and that trust in insurance companies is a key driver to insurance purchasing, as well as the estimated probability of suffering damages in the future. In contrast, entrepreneurs do underwrite fewer insurance contracts if their firms caused or suffered damages in the past, but also if they possess personal insurances, thus treating them as substitutes for firm insurance. Since SMEs represent a very important part not only of the Italian economy but also of the economy of many other countries, analyzing their insurance-related decisions is relevant because understanding the determinants that may lead entrepreneurs to mitigate the risks they face is beneficial not only for them and their firms but also for the economy as a whole. [ABSTRACT FROM AUTHOR]

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In undertaking what we believe is the first national-scale study of its kind, we provide methodologically transparent, statistically robust insights into associations and potential unfolding effects of house and contents under-insurance. We identify new dimensions in the complex relationship between householders and insurance, including the salience of interpersonal – and likely institutional – trust. Under-insurance is (re)produced along socio-economic and geographical lines, with those of lower socio-economic status or living in cities more likely to be under-insured. Should a disaster strike, such communities are likely to suffer further disadvantage, especially if governments continue to shift the responsibility for risk onto households. Our findings support the observation that insurance can contribute to increasing socio-economic urban polarisation in light of natural disasters. We conclude by considering how under-insurance may contribute to growing urban social stratification, as well as how it may produce situated ethical and political responses that exceed neoliberal aspirations. [ABSTRACT FROM AUTHOR]

The global property protection gap in natural catastrophe risk has widened steadily over the past 40 years. In historical terms, we find that most underinsurance of extreme events is for climate-related events such as flood and windstorm, but in expected terms, earthquakes comprise the largest share of underinsurance. Using a framework to define the protection gap in historical and expected terms, this paper breaks down the gap by geography and risk type and presents an empirical analysis of the key drivers of the gap. First, uninsured expected Cat losses are estimated using models that combine geophysical vulnerability maps, economic exposure data and insurance market information. Second, each country's expected (or optimal) property insurance penetration is modelled and compared to actual penetration to derive a measure of property underinsurance. Third, we explore the factors that affect property insurance demand, applying regression analysis to an unbalanced panel data set that includes 53 countries observed over a 15-year period. Several significant economic, financial market, sociodemographic, cultural and institutional variables are identified. The results lead to a taxonomy of the root causes of underinsurance and a set of proposed measures to narrow the protection gap. [ABSTRACT FROM AUTHOR]

The U.S. crop insurance market has several features that set it apart from other insurance markets. These include explicit government subsidies with an average premium subsidy rate of about 60% in recent years, and the legislative requirement that premium rates be set at actuarially fair levels, where the federal government sets rates and pays all costs related to insurance policy sales and services. Bearing these features in mind, we examine the extent to which farmers’ crop insurance choices conform to economic theory. A standard expected utility maximization framework is constructed to analyze trade-offs between higher risk protection and larger subsidy payments. We decompose the effect of coverage level on expected utility into insurance, premium loading, and subsidy transfer effects where the loading effect vanishes if rates are actuarially fair. Given an actuarially fair premium, we infer that a rational farmer should choose either the coverage level with the highest premium subsidy or a higher coverage level. Evidence from a large insurance unit-level dataset contradicts this theoretical inference, and so suggests anomalous insurance decisions. In a novel application of the mixed logit framework, we show that the probability an insurance product is chosen declines as out-of-pocket premium expenditures increase, even though higher values of these expenditures should reflect improved grower welfare. Premium expenditures appear to be more salient than the uncertain future benefits they support. We apply our regression to the recent trend yield adjustment innovation in crop insurance. [ABSTRACT FROM AUTHOR]

This study seeks to estimate the extent of underinsurance among Malaysian families in 2012. Underinsurance is quantified by the extent to which the citizens in a country are inadequately covered by the life insurance protection. To measure underinsurance, we use the concept of the life insurance protection gap as proposed by Swiss Re (2004). The mortality protection gap is the difference between the resources needed and the resources available. The resources needed refer to the resources the surviving dependents require for income replacement, debt repayment and other major expenses. The resources available refer to those resources actually available to the dependents from financial assets, social security and life insurance coverage. The data collected are simulated using the Monte Carlo simulation process. Statistical analysis of the results of the simulation runs indicates that, on average, the extent of underinsurance in Malaysia is about RM500,000 per household. [ABSTRACT FROM AUTHOR]

Lung transplantation is a well-established treatment for patients with advanced lung disease. The evaluation of a candidate for transplantation is a complex task and involves a multidisciplinary team that follows the patient beyond the postoperative period. Currently, the mean time on the waiting list for lung transplantation in the state of São Paulo, Brazil, is approximately 18 months. For Brazil as a whole, data from the Brazilian Organ Transplant Association show that, in 2014, there were 67 lung transplants and 204 patients on the waiting list for lung transplantation. Lung transplantation is most often indicated in cases of COPD, cystic fibrosis, interstitial lung disease, non-cystic fibrosis bronchiectasis, and pulmonary hypertension. This comprehensive review aimed to address the major aspects of lung transplantation: indications, contraindications, evaluation of transplant candidates, evaluation of donor candidates, management of transplant recipients, and major complications. To that end, we based our research on the International Society for Heart and Lung Transplantation guidelines and on the protocols used by our Lung Transplant Group in the city of São Paulo, Brazil. [ABSTRACT FROM AUTHOR]

We use microdata to show that young households with children are underinsured against the risk that an adult member of the household dies. This empirical finding can be explained by a macroeconomic model with human capital risk, age-dependent returns to human capital investment, and endogenous borrowing constraints due to limited contract enforcement. When calibrated, the model quantitatively accounts for the observed life-cycle variation in life insurance holdings, financial wealth, earnings, and consumption inequality. The model also predicts that reforms making consumer bankruptcy more costly will substantially increase the volume of both credit and insurance. (JEL D14, D91, G22, J13, J24) [ABSTRACT FROM AUTHOR]

Introduction Underinsurance is a barrier to vaccination among children. Information on vaccination among adults aged ≥18 years by insurance status is limited. This study assesses vaccination coverage among adults aged ≥18 years in the U.S. in 2012 by health insurance status and access to care characteristics. Methods The 2012 National Health Interview Survey data were analyzed in 2014 to estimate vaccination coverage among adults aged ≥18 years by health insurance status for seven routinely recommended vaccines. Results Influenza vaccination coverage among adults aged ≥18 years without or with health insurance was 14.4% versus 44.3%, respectively; pneumococcal vaccination coverage among adults aged 18–64 years with high-risk conditions was 9.8% versus 23.0%; tetanus and diphtheria toxoid (Td) coverage (age ≥18 years) was 53.2% versus 64.5%; tetanus, diphtheria, and acellular pertussis (Tdap) coverage (age ≥18 years) was 8.4% versus 15.7%; hepatitis A (HepA) coverage (age 18–49 years) was 16.6% versus 19.8%; hepatitis B (HepB) coverage (age 18–49 years) was 27.5% versus 38.0%; shingles coverage (age ≥60 years) was 6.1% versus 20.8%; and human papillomavirus (HPV) coverage (women aged 18–26 years) was 20.9% versus 39.8%. In addition, vaccination coverage differed by insurance type, whether respondents had a regular physician, and number of physician contacts. Conclusions Overall, vaccination coverage among adults aged ≥18 years is lower among uninsured populations. Implementation of effective strategies is needed to help improve vaccination coverage among adults aged ≥18 years, especially those without health insurance. [ABSTRACT FROM AUTHOR]

The article offers information on the healthcare related financial problems and underinsurance in Rhode Island Department of Health. Topics discussed include the U.S. Affordable Care Act aimed to reduce uninsurance with its impact on underinsurance, data from the Rhode Island Behavioral Risk Factor Surveillance System survey conducted by the department with support from the U.S. Centers for Disease Control and Prevention, and financial hardships of Medicaid recipients.

An essay is presented which discusses cost sharing in relation to the author's views about whether patient responsibility for costs should change the physician-patient relationship in America as of 2015. It states that cost sharing can be effective in helping to reduce health care prices and consumption in the U.S. Out-of-pocket costs for patients are examined, along with underinsurance issues and access to medical care. The U.S. Patient Protection and Affordable Care Act is assessed.

As the climate changes and extreme weather events become more common, the role of house and contents insurance in managing risks is garnering more attention. There is concern, as insurance is a key safety net in contemporary life, that significant levels of house and contents underinsurance are placing individuals and communities at undue risk. Yet, the phenomenon of underinsurance is under-researched. Informed by a document analysis of findings from a multi-modal project investigating the experiences and perspectives of insured and uninsured households in bushfire-prone Australia, we identify underinsurance as a complex phenomenon that is variably co-constituted at different scales – households, landscapes, and markets. To better understand what principles can be meaningfully applied for addressing underinsurance, we present four pertinent and novel themes – place (contextualising rates of underinsurance), integration (integrating insurance with other disaster management mechanisms), hegemony (dismantling hegemonic risk discourses including reference to 'shared responsibility'), and solidarity (in insurance, and through disaster and climate responses). We conclude that addressing inequality and inequity remains paramount given the multifarious reasons why households may be underinsured. Strategies for addressing disasters and global environmental change should be socially just and inclusive irrespective of whether or not households have insurance. • In a changing climate, significant rates of house and contents underinsurance are receiving increasing attention. • A multi-modal project investigated experiences of insured and uninsured households in bushfire-prone Australia. • Many factors contribute to house and contents underinsurance and these vary with scale – households, landscapes and markets. • Useful principles for addressing underinsurance are place, integration, hegemony, and solidarity. • Addressing inequality and inequity remains paramount irrespective of whether or not households have insurance. [ABSTRACT FROM AUTHOR]

The positive effects of Medicaid expansions have been extensively documented in the literature. However, it is not clear whether the reform has had an equally meaningful effect with respect to underinsurance, which is the state of having health insurance yet lacking adequate coverage or facing substantial financial risks upon usage of services. Based on a quasi-experimental difference-in-differences approach, we analyzed the data from a nationally representative sample to estimate the effect of Medicaid expansion on the probability of underinsurance among the non-elderly low-income adult population of the U.S. We found no evidence of significant changes in the likelihood of underinsurance due to Medicaid expansion during the first 4 years after the ACA implementation. However, a supplementary analysis of the longer-term impact (2018-2019) suggests that there might be a time lag between Medicaid expansion and its effect on underinsurance. It is important to realize that expansion of coverage alone may not be sufficient to protect millions of Americans, particularly those with low incomes, from underinsurance. It is, therefore, crucial for policymakers to build legislative frameworks that protect individuals from excessive healthcare expenses and prevent treatment avoidance or delay.

The article discusses the views of life insurance industry executives such as Megan Beer and Brett Clark on challenges faced by the industry and the need for increasing customers engagement and to address customers financial protection needs. Topics include concern over proposed Future of Financial Advice (FOFA) amendments and underinsurance issues, focus on importance of rehabilitation and increasing life expectancy, and direct marketing of life insurance and its impact of the industry.

In the employer-sponsored insurance market that covers most Americans; many workers are "underinsured." The evidence shows onerous out-of-pocket payments causing them to forgo needed care, miss work, and fall into bankruptcies and foreclosures. Nonetheless, many higher-paid workers are "overinsured": the evidence shows that in this domain, surplus insurance stimulates spending and price inflation without improving health. Employers can solve these problems together by scaling cost-sharing to wages. This reform would make insurance better protect against risk and guarantee access to care, while maintaining or even reducing insurance premiums. Yet, there are legal obstacles to scaled cost-sharing. The group-based nature of employer health insurance, reinforced by federal law, makes it difficult for scaling to be achieved through individual choices. The Affordable Care Act's (ACA) "essential coverage" mandate also caps cost-sharing even for wealthy workers that need no such cap. Additionally, there is a tax distortion in favor of highly paid workers purchasing healthcare through insurance rather than out-of-pocket. These problems are all surmountable. In particular, the ACA has expanded the applicability of an unenforced employee-benefits rule that prohibits "discrimination" in favor of highly compensated workers. A novel analysis shows that this statute gives the Internal Revenue Service the authority to require scaling and to thereby eliminate the current inequities and inefficiencies caused by the tax distortion. The promise is smarter insurance for over 150 million Americans. [ABSTRACT FROM AUTHOR]

To identify differences in groups of children with special healthcare needs (CSHCN) identified as underinsured by two alternate definitions and discuss implications for policy decisions based on using one definition over another. Secondary data from the National Survey of CSHCN 2005/2006 were analyzed. Only CSHCN who were continuously-insured for 12 months were included in analyses. We identified groups of underinsured CSHCN using two general definitions ('economic' and 'attitudinal') and three mutually-exclusive groups (identified by both definitions, identified by attitudinal but not economic, and identified by economic but not attitudinal). Key variables included demographics and condition characteristics. Different underinsurance rates were identified [attitudinal = 30.9 % (n = 11,470); economic = 22.7 % (n = 8,447)] with fair agreement by kappa score (κ = 0.3194; Z = 65.91; p > 0.0001). Differences across mutually-exclusive groups included family income ≥400 % FPL (attitudinal only = 34.2 %, economic only = 16.3 %, both = 18.4 %; p < 0.001) and high severity (attitudinal only = 42.5 %, economic only = 68.5 %, both = 69.9 %; p < 0.001). CSHCN who needed equipment/supplies/home health (OR = 1.31, p < 0.001) had increased odds of being identified as underinsured by the economic, but not attitudinal definition. CSHCN with private insurance had increased odds of being identified by attitudinal only or both definitions, but not by economic only (AO: OR = 1.41, p < 0.001; BOTH: OR = 2.36, p < 0.001). Despite overlap between the two definitions, choosing either one excludes some CSHCN, potentially underestimating the extent of underinsurance and masking important findings related to specific conditions characteristics. A definition that comprehensively identifies and describes underinsurance is vital to translating health insurance coverage expansion into benefit packages that meet complex health and service needs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Millions of adults will gain Medicaid or private insurance in 2014 under the Affordable Care Act, and prior research shows that underinsurance is common among middle-income adults. Less is known about underinsurance among low-income adults, particularly those with public insurance. OBJECTIVE: To compare rates of underinsurance among low-income adults with private versus public insurance, and to identify predictors of being underinsured. DESIGN: Descriptive and multivariate analysis of data from the 2005-2008 Medical Expenditure Panel Survey. PARTICIPANTS: Adults 19-64 years of age with family income less than 125 % of the Federal Poverty Level (FPL) and full-year continuous coverage in one of four mutually exclusive insurance categories ( N = 5,739): private insurance, Medicaid, Medicare, and combined Medicaid/Medicare coverage. MAIN MEASURES: Prevalence of underinsurance among low-income adults, defined as out-of-pocket expenditures greater than 5 % of household income, delays/failure to obtain necessary medical care due to cost, or delays/failure to obtain necessary prescription medications due to cost. KEY RESULTS: Criteria for underinsurance were met by 34.5 % of low-income adults. Unadjusted rates of underinsurance were 37.7 % in private coverage, 26.0 % in Medicaid, 65.1 % in Medicare, and 45.1 % among Medicaid/Medicare dual enrollees. Among underinsured adults, household income averaged $6,181 and out-of-pocket spending averaged $1,115. Due to cost, 8.1 % and 12.8 % deferred or delayed obtaining medical care or prescription medications, respectively. Predictors of underinsurance included being White, unemployed, and in poor health. After multivariate adjustment, Medicaid recipients were significantly less likely to be underinsured than privately insured adults (OR 0.22, 95 % CI 0.17-0.28). CONCLUSIONS: Greater than one-third of low-income adults nationally were underinsured. Medicaid recipients were less likely to be underinsured than privately insured adults, indicating potential benefits of expanded Medicaid under health care reform. Nonetheless, more than one-quarter of Medicaid recipients were underinsured, highlighting the importance of addressing cost-related barriers to care even among those with public coverage. [ABSTRACT FROM AUTHOR]

Study Design. Multivariate analysis of prospectively collected registry data. Objective. To determine the effect of payor status on complication rates after spine surgery. Summary of Background Data. Understanding the risk of perioperative complications is an essential aspect in improving patient outcomes. Previous studies have looked at complication rates after spine surgery and factors related to increased perioperative complications. In other areas of medicine, there has been a growing body of evidence gathered to evaluate the role of payor status on outcomes and complications. Several studies have found increased complication rates and inferior outcomes in the uninsured and Medicaid insured. Methods. The Spine End Results Registry (2003-2004) is a collection of prospectively collected data on all patients who underwent spine surgery at our 2 institutions. Extensive demographic data, including payor status, and medical information were prospective[y recorded as described previously by Mirza et al. Medical complications were defined in detail a priori and were prospectively recorded for at least 2 years after surgery. Using univariate and multivariate analysis, we determined risk of postoperative medical complications dependent on payor status. Results. A total of 1591 patients underwent spine surgery in 2003 and 2004 that met our criteria and were included in our analysis. With the multivariate analysis and by controlling for age, patients whose insurer was Medicaid had a 1.68 odds ratio (95% confidence interval: 1.23-2.29; P = 0.001) of having any adverse event when compared with the privately insured. Conclusion. After univariate and multivariate analyses, Medicaid insurance status was found to be a risk factor for postoperative complications. This corresponds to an ever-growing body of medical literature that has shown similar trends and raises the concern of underinsurance. [ABSTRACT FROM AUTHOR]

Underinsurance for vaccines presents financial barriers to vaccination. Preventive services coverage is of interest in national healthcare reform. To assess vaccine benefits coverage in private health plans. Private health insurance carriers were surveyed December 2008-June 2009 on policies regarding vaccine coverage in fully insured plans. Carriers were identified as multi-state, state-specific Blue Cross or local-independent carriers. Plan types included HMO, PPO, POS and 'other.' Full benefits coverage was defined as having benefits without a copay or coinsurance for a recommended vaccine. Analyses were conducted to examine associations between carrier type, plan type, and full benefits coverage. Fifty-one carriers (response rate = 56 %) provided data for 78 unique plans, reflecting over 47 million private plan enrollees. Full benefits coverage was highest for combined tetanus/diphtheria/acellular pertussis (74 %) and lower for pneumococcal conjugate (72 %), rotavirus (72 %), human papillomavirus (71 %), hepatitis A (68 %), meningococcal conjugate (67 %), inactivated influenza (67 %), live attenuated influenza (63 %) and zoster (57 %) vaccines. Compared with plans offered by state-specific Blue Cross carriers, significantly higher proportions of multi-state carriers and local independent carriers had plans with full benefits coverage for vaccines ( p < 0.05). Compared with PPO and 'other' plans, significantly higher proportions of HMO and POS plans had full benefits coverage for vaccines ( p < 0.05). In this national study, levels of underinsurance for immunization leave room for improvement. State-specific Blue Cross plans and indemnity or high-deductible plans are least likely to offer full coverage for recently recommended vaccines, and may face changes with incorporation of 'essential health benefits' requirements. [ABSTRACT FROM AUTHOR]

It discusses the impact of direct insurance on the brand value of the product. It suggests that direct insurance plans, if well executed, may serve a good purpose in the advertising by the insurance industry. It adds that reasonable amount of money paid to the policyholders may turn out to be effective in terms of their seeing more value in the goods and services offered by the company. It explores the benefits of direct insurance in solving the serious underinsurance problem. It presents the issue related to the poor quality products which can cause significant damage to the industry as the result of direct insurance. It concludes that direct insurance is more suitable for commoditized insurance products of good quality and which are sustainable for the industry.

Each year at least hundreds,and often thousands of Americans lose their homes to natural disasters striking populated areas. Tens of thousands lose their homes to single-instance fires, floods, or other catastrophes. The majority of these homeowners are underinsured, meaning they have less insurance than it will cost to rebuild their homes. This Article analyzes whether such underinsurance indicates correctible inefficiencies in the residential property insurance markets. The Article identifies two inefficiencies:(1) Inadequate information, which impairs informed pricing decisions by purchasers; and (2) Dispute costs (such as litigation) in the instances of loss exceeding coverage. The Article proposes addressing these inefficiencies by adopting a mandatory disclosure, provided at the time of purchase or renewal of insurance based on the Energy Guide program labeling appliances for energy consumption, and in turn then barring litigation on adequacy of coverage. [ABSTRACT FROM AUTHOR]

Underinsurance is most commonly defined as the state in which people with medical coverage are still exposed to financial risk. We argue that the adequacy of health insurance coverage should also be assessed in terms of the adequacy of specific benefits coverage and access to care. Underinsurance can be understood conceptually as comprising three separate domains: ( a) the economic features of health insurance, ( b) the benefits covered, and ( c) access to health services. The literature provides ample evidence that people who are underinsured have high financial risk and face barriers in access to care similar to those who are completely uninsured. In response to the growing recognition of the problems associated with underinsurance, the Patient Protection and Affordable Care Act of 2010 includes numerous provisions designed to limit costs to consumers, to assure a minimum set of benefits, and to enhance access to care, especially primary care. [ABSTRACT FROM AUTHOR]