Voluntary Health Insurance Coverage in California, 1952 to 1963—Report of the Bureau of Research and Planning

More than seven out of every ten of an estimated civilian population of 17.3 million people in California were covered under some form of voluntary health insurance at the close of 1963.Between 1952 and 1963, the number of Californians covered for hospital expenses increased from 5.7 million to 12.3 million; for surgical expenses from 5.4 million to 11.6 million; and for regular medical expenses from 3.0 million to 10.1 million.The percentage covered by health insurance also rose significantly: for hospitalization, from 51.3 to 71.0 per cent; for surgical, from 48.2 to 67.1 per cent; and for regular medical from 27.2 to 57.9 per cent. The rate of increase in hospitalization coverage was slightly higher in California than in the total U.S.; however, the per cent of persons covered remains lower. For surgical coverage, both the rate of increase and the per cent covered are lower in California. For regular medical, growth rates in California and in the U.S. were similar, however the over-all per cent covered is significantly higher in California.Major medical coverage, which has shown the fastest growth rate, covered only 0.4 per cent of the U.S. population in 1952 and 17.1 per cent by the end of 1963. Comparable figures for California are not available.     

Environment Under the Federal Employees Health Benefits Program: A Report of the Bureau of Research and Planning, California Medical Association

Active and retired federal employees, together with their dependents, represent the single largest group of persons enrolled in any voluntary health insurance program in the United States. The extent of their coverage and enrollment is of particular interest to physicians in California since this state has the largest proportion of all federal employees enrolled among all states. Of the almost 5(3/4) million federal employees and their dependents, enrollment in California was almost 609,000 or slightly over 10 per cent of all those covered. Better than 3 out of 5 individuals covered were enrolled in service type plans both in the U.S. and in California. Of all persons enrolled in comprehensive group practice and individual practice plans in the U.S., almost one-half were in California alone. Almost 4 out of 5 individuals enrolled were in high option plans. "... an indication that most employees were satisfied with their initial choice of plans."     

Participation of California Physicians in Emergency Medical Care Panels, Report of Bureau of Research and Planning

Over 40 per cent of all California physicians belonged to some type of emergency medical care panel during 1961. Of these physicians, almost 60 per cent were affiliated with hospital panels and 27 per cent with County Society panels. Other findings indicate the following facts about physician participation in emergency care panels:...84 per cent of physicians who participate do so on a voluntary basis, with 16 per cent belonging to panels on a compulsory basis....higher than average per cents of physicians belong to such panels in rural areas....compulsory membership is more prevalent in hospital panels than in County Society panels.     

Hospital Bills—What Portion Is Paid by Insurance?—Report of Bureau of Research and Planning

A two-year survey result—ending some 18 months ago and just released—reveals that 68 per cent of all short-stay hospital discharges had hospitalization coverage. Insurance paid three-fourths or more of the bill for over 75 per cent of those covered.One-half of the discharges in the 65+ age group were covered. Almost 60 per cent of this group had three-fourths or more of the hospital bill paid by voluntary health insurance.The 65+ group with family income under $4,000 had better protection than age groups under age 45.The highest per cent of coverage was in the 45 to 64 age group where over 75 per cent of the discharges had coverage, with insurance paying more than three-fourths of the bill. This is the group which is likely to retain coverage upon retirement.     

Traffic Deaths—A Preliminary Study of Urban and Rural Fatalities in California

An analysis by the California Department of Public Health of California Highway Patrol reports for 1961 showed that traffic accidents injured one and one-half times as many people per 1,000 population in rural California counties (under 50,000 people) as in urban counties (over 500,000 people), also persons injured in rural counties were almost four times as likely to die of their injuries as those injured in urban counties.A death certificate study was undertaken of 782 traffic deaths (excluding pedestrians) occurring in rural and urban California counties during 1961. Accidents occurring in rural counties tended to be single vehicle accidents which resulted in less severe injuries, while those in urban counties tended to be two vehicle and multiple vehicle accidents resulting in more serious injuries. The anatomic distribution of injuries was the same for both urban and rural accidents. However, people dying in rural accidents more frequently died at the scene of the accident, died sooner after injury, and died of less serious injuries than did those injured in urban accidents. For injuries where theoretically few lives should be salvaged by prompt emergency care, the time between injury and death was about the same in urban as in rural counties. Where such care should delay or prevent death because the injury was possibly or probably salvageable, those injured in rural counties died more quickly.Thirty-two per cent of fatalities in rural counties happened to urban and out-of-state residents, while only 12 per cent of fatalities in urban counties were to rural or out-of-state residents, suggesting that traffic accidents to non-residents may place an excessive load upon medical care resources in rural areas.     

Disability under social security; medical evaluation and decision as to rehabilitation

Recent amendments to the Social Security Act give privileges to persons who are found to be disabled. In California, the State Bureau of Vocational Rehabilitation has responsibility for determining whether or not an applicant is disabled within the meaning of the Act. Each applicant must submit medical evidence provided by his own physician or by a hospital. The evidence is reviewed by both a physician and a counselor, who determine not only whether disability exists but also whether rehabilitation services might be helpful. In the first 9,000 cases in which determinations were made, 49 per cent of applicants were found to be disabled and 51 per cent not; but in recent months the proportion found disabled has increased. Diseases of the circulatory system and nervous system, including late effects of cerebrovascular accidents, were the largest groups of conditions causing disability. Psychoneurotic conditions and orthopedic and respiratory disorders were next in order. Some 10 to 15 per cent of applicants were referred for rehabilitation services, but of these only about one in six is accepted for rehabilitation, and only half of those accepted actually receive the services. Thus, it appears that only one per cent of workers applying for disability benefits are getting the services made available through state and federal sources to restore them to productive employment. Physicians need to be alert to opportunities provided in programs such as these to utilize all facilities to round out the full cycle of medical care.     

DISABILITY UNDER SOCIAL SECURITY—Medical Evaluation and Decision as to Rehabilitation

Recent amendments to the Social Security Act give privileges to persons who are found to be disabled. In California, the State Bureau of Vocational Rehabilitation has responsibility for determining whether or not an applicant is disabled within the meaning of the Act. Each applicant must submit medical evidence provided by his own physician or by a hospital. The evidence is reviewed by both a physician and a counselor, who determine not only whether disability exists but also whether rehabilitation services might be helpful.In the first 9,000 cases in which determinations were made, 49 per cent of applicants were found to be disabled and 51 per cent not; but in recent months the proportion found disabled has increased. Diseases of the circulatory system and nervous system, including late effects of cerebrovascular accidents, were the largest groups of conditions causing disability. Psychoneurotic conditions and orthopedic and respiratory disorders were next in order.Some 10 to 15 per cent of applicants were referred for rehabilitation services, but of these only about one in six is accepted for rehabilitation, and only half of those accepted actually receive the services. Thus, it appears that only one per cent of workers applying for disability benefits are getting the services made available through state and federal sources to restore them to productive employment. Physicians need to be alert to opportunities provided in programs such as these to utilize all facilities to round out the full cycle of medical care.     

Coverage of genetic technologies under national health reform.

This article examines the extent to which the technologies expected to emerge from genetic research are likely to be covered under Government-mandated health insurance programs such as those being proposed by advocates of national health reform. Genetic technologies are divided into three broad categories; genetic information services, including screening, testing, and counseling; experimental technologies; and gene therapy. This article concludes that coverage of these technologies under national health reform is uncertain. The basic benefits packages provided for in the major health reform plans are likely to provide partial coverage of experimental technologies; relatively broad coverage of information services; and varying coverage of gene therapies, on the basis of an evaluation of their costs, benefits, and the degree to which they raise objections on political and religious grounds. Genetic services that are not included in the basic benefits package will be available only to those who can purchase supplemental insurance or to those who can purchase the services with personal funds. The resulting multitiered system of access to genetic services raises serious questions of fairness.     

BRONCHIAL ASTHMA—Patterns of Morbidity and Mortality in the United States, 1951-1959

On a nationwide basis, bronchial asthma occurs at the rate of 23 cases per 1,000 population. Young males develop bronchial asthma more readily and more severely than young females. Males dying from asthma outnumber females 2 to 1.Eight per cent of the asthmatic persons in the United States have not sought medical attention for this condition. Repeated attacks of severe bronchial asthma increase the likelihood of premature death.Approximately 6,000 deaths due to asthma occur annually in the United States, with a seasonal increase during the winter months. The estimated fatality rate of asthma in the general population is 1.5 deaths per 1,000 asthmatics.     

Low-birth-weight effects of demographic and socioeconomic variables and prenatal care in Pima County,Arizona.

Low birth weight is the major determinant of infant mortality. Continuing declines in infant mortality in the United States are due to the use of neonatal intensive care services; less progress has been made toward preventing low birth weight. I examined how the demographic, socioeconomic, and health services use variables affected rates of low birth weights in Pima County, Arizona, in 1985. Women at greatest risk of having the smallest infants were those younger than 21 years and those with fewer than 6 prenatal visits. Nulliparous women with fewer than 6 prenatal visits showed a still greater risk of having an infant of low birth weight. Women without medical insurance coverage had babies with the lowest mean birth weights, as well as significantly fewer prenatal visits. As the number of uninsured in the United States increases, the effect of lack of insurance among pregnant women becomes increasingly important. To prevent low-weight births, comprehensive maternity care services must be available to all pregnant women regardless of ability to pay.     

基于老年人口卫生服务分析的医保效果评价

目的 通过对某省老年人口卫生服务需求、利用、就医流向及费用负担等卫生服务指标进行测算,了解现行医保制度的实施效果。方法 通过抽取某省第五次卫生服务调查的老年人群数据,对社会人口学特征、卫生服务需求与利用、医疗卫生费用负担及住院流向等指标进行测算与分析。结果 不同医保制度下,老年人口卫生服务需求与利用存在差异性,且在住院就医服务的选择上尚未形成合理格局,卫生费用负担较重。结论 某省现行医保制度对老年人口的经济保护力度仍有待提高,应调整医保制度卫生福利包的覆盖范围并提高补偿水平,通过政策倾斜构建合理就医格局,进而减轻老年人口的疾病经济负担。     

Access to medical care for documented and undocumented Latinos in a southern California county.

To determine local access to medical care among Latinos, we conducted telephone interviews with residents of Orange County, California. The survey replicated on a local level the national access surveys sponsored by the Robert Wood Johnson Foundation. We compared access among Latino citizens of the United States (including permanent legal residents), undocumented Latinos, and Anglos, and analyzed predictors of access. Among the sample of 958 respondents were 137 Latino citizens, 54 undocumented Latinos, and 680 Anglos. Compared with Anglos, Latino citizens and undocumented immigrants had less access to medical care by all measures used in the survey. Although undocumented Latinos were less likely than Latino citizens to have health insurance, by most other measures their access did not differ significantly. By multivariate analysis, health insurance status and not ethnicity was the most important predictor of access. Because access to medical care is limited for both Latino citizens and undocumented immigrants, policy proposals to improve access for Latinos should consider current barriers faced by these groups and local differences in access to medical care.     

Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente

ObjectiveTo compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California.MethodsThe adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators.ResultsThe per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS.ConclusionsThe widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology.

What is already known on this topic

Comparisons of healthcare systems in different countries have to be undertaken with great care but can be instructiveThe overall healthcare system in the United States is more expensive than the NHS and population health outcomes are no betterThe US healthcare system comprises many discrete and unique subsystems, including the health maintenance organisations

What this paper adds

An integrated, non-profit health maintenance organisation in California (Kaiser Permanente), with over six million members, costs about the same as the NHS but performs considerably betterKaiser''s superior performance is mainly in prompt and appropriate diagnosis and treatmentThese findings challenge the widely held view that the NHS is efficient and that its inadequacies are mainly due to underinvestment     

Professional Registered Nurses in the United States and California, 1962—Report of the Bureau of Research and Planning

• Figures on professional registered nurses recently made available indicate that the ratio of active nurses to population in California in 1962 was 327 per 100,000 persons. The comparable figure nationally was 298/100,000. California ranked twentieth out of the 50 states and the District of Columbia.The percentage of all nurses actively engaged in nursing is considerably lower in California than in the total United States: 60.4 per cent compared with 65.3 per cent. This indicates that the shortage of nurses in California is more attributable to underutilization of potential manpower than to its absence.There are some identifiable categories of nurses in California in which the utilization of personnel is particularly low, as compared with other states. In terms of rates of utilization, the group of nurses over 60 years of age are most noticeably under-utilized, while in terms of numbers, married nurses could provide the greatest supply of extra nurses were their employment rate in the state equal to the national rate.The recruiting potential is a very great one, however, as this report indicates.     

MORTALITY RATE FROM SKIN CANCER

Cancer of the glabrous skin (exclusive of cancer of the superficial mucous membranes, melanoma, sarcoma and other rare skin tumors) is a highly curable disease. However, the mortality rate based on United States Public Health Service statistics for the State of California and an analysis of 35 fatalities occurring in 2,122 cases as observed over a 20-year period in the Visible Tumor Clinic at the University of California, is approximately 1.65 per cent to 1.75 per cent.Skin cancer could theoretically approach a 100 per cent cure rate with two simple rules: Firstly, the patient should seek proper medical advice early for all suspicious growths, moles or warts. Secondly, after an exact diagnosis is made by biopsy, the first treatment given by the physician, whether surgical, chemosurgical, electrosurgical or x-ray, should be complete and adequate, for the first time is the “golden opportunity” for cure.     

Insuring Care: Paperwork,Insurance Rules,and Clinical Labor at a U.S. Transgender Clinic

What is a clinician to do when people needing medical care do not have access to consistent or sufficient health insurance coverage and cannot pay for care privately? Analyzing ethnographically how clinicians at a university-based transgender clinic in the United States responded to this challenge, I examine the U.S. health insurance system, insurance paperwork, and administrative procedures that shape transgender care delivery. To buffer the impact of the system’s failure to provide sufficient health insurance coverage for transgender care, clinicians blended administrative routines with psychological therapy, counseled people’s minds and finances, and leveraged the prestige of their clinic in attempts to create space for gender nonconforming embodiments in gender conservative insurance policies. My analysis demonstrates that in a market-based health insurance system with multiple payers and gender binary insurance rules, health care may be unaffordable, or remain financially challenging, even for transgender people with health insurance. Moreover, insurance carriers’ “reliance” on clinicians’ insurance-related labor is problematic as it exacerbates existing insurance barriers to the accessibility and affordability of transgender care and obscures the workings of a financial payment model that prioritizes economic expediency over gender nonconforming health.     

Health Insurance Coverage and Its Impact on Medical Cost: Observations from the Floating Population in China

Background

China has the world''s largest floating (migrant) population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population.

Methods

A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost.

Results

82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects'' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost.

Conclusion

For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost.     

Economic Aspects of “Whiplash” Injury

The term “whiplash,” used to describe a neck injury received in an automobile accident, has no foundation in medical science to support the complaints of persons suing for damages. The term is gaining unwarranted popularity as a term describing an injury, even though there are no clinical or pathological findings to support it.“Whiplash” cases today account for an estimated 30 per cent of all injuries in automobile accidents. Direct compensation for damages paid to persons injured in automobile accidents in the United States in 1961 amounted to approximately one billion, seven hundred million dollars. It has been estimated that five hundred and eighty million dollars of that amount was paid in compensation on allegation of neck injuries.     

Continuing Medical Education Tuition: A Survey of Charges

A survey was carried out on the tuition charged for continuing medical education (CME) programs offered by a variety of providers. These included schools of medicine throughout the United States, national organizations and societies, state-wide organizations and societies located in California, and a small group of hospitals in or near Sacramento, California.The fees charged for continuing medical education (expressed in this article as the amount in dollars that a physician must pay for one hour of approved Category I credit) may vary from nothing to more than $20 an hour. The average charge per hour for CME courses sponsored by medical colleges in the United States ranged from none to $11.19 during 1976 and 1977. Recent data indicate that most schools have increased tuition for CME courses because of inflation. Many schools of medicine provide CME through grand rounds, conferences and special lectures at no cost to participants. Similarly, in a small sample of hospitals in California, CME was found to be available at a minimal charge to physicians.Some CME programs are more costly because fees may include the expenses of honored visiting faculty, and costs of food or social activities. There may be further expense if travel is required, although these additional costs may be offset by the benefits of study in a relaxed atmosphere away from practice and office pressures.