Return to work and productive activities following a spinal cord injury: the role of income and insurance.

STUDY DESIGN: We analyzed longitudinal data on secondary outcomes from participants in a telerehabilitation study. OBJECTIVES: To examine the factors affecting return to productive activities and employment and the time to these events following a spinal cord injury (SCI). SETTING: A large southeastern rehabilitation hospital in the United States. METHODS: We used hazard regression models to analyze data from newly injured people (n=111) participating in an educational intervention post discharge who were followed for up to 2 years. Outcomes were time to return to productive activities and employment. RESULTS: Increasing age and being on Medicaid significantly decreased the likelihood of returning to productive activities (P<0.01), while being white (P<0.05) and having a higher median income (P<0.001) significantly increased this probability. The same factors, bar being on Medicaid, affected the return to employment. Whites returned to productive activities 2.5 times sooner than African Americans and employment twice as fast (P<0.001). Being in the 75th income percentile compared with the 25th shortened time to employment by 209 days. CONCLUSION: Findings here suggest that income and race affect the time to return to productivity and employment, while being on Medicaid also has a role in general post injury productivity.

Why are workers uninsured? Employer-sponsored health insurance in 1997.

This study examines the number of workers in firms offering employee health plans, the number of workers eligible for such plans, and participation in employer-sponsored insurance. Data from the February 1997 Contingent Worker Supplement to the Current Population Survey indicate that 10.1 million workers are employed by firms offering insurance but are not eligible. Not all of these workers are eligible for coverage, most often because of hours of work. Our results indicate that 11.4 million workers rejected coverage when it was offered. Of those, 2.5 million workers were uninsured. Workers cited high cost of insurance most often as the primary factor for refusing coverage.

Market incentives, plan choice, and price increases.

The Federal Employees Health Benefits Program (FEHBP) has attracted considerable interest for its ability to control health care costs. We examine the impact of the FEHBP's maximum dollar contribution on incentives to select low-cost plans and the growth in insurance premiums over time. Unless the maximum dollar contribution is pegged to a low-price plan, few enrollees select such plans. Moreover, premiums rise at least five percentage points per year faster among plans below this fixed subsidy level than they do in plans above it. Our results have important implications for the design of similar market-based approaches.

Covering uninsured children and their parents: estimated costs and number of newly insured.

The Child Health Insurance Program (CHIP) supplies $20.4 billion over 5 years and nearly $50 billion over 10 years to extend health insurance to uninsured children with family incomes up to 200 percent of poverty. This article analyzes the March 1997 Current Population Survey, estimating the number of children likely to be eligible for CHIP or currently eligible for Medicaid. Of the 8.6 million parents of uninsured children, four out of five were uninsured at the time of the survey. Expanding coverage to parents as well as children could make program participation more attractive and simplify the enrollment process. If 75 percent of uninsured parents of CHIP eligible children participated, 1.7 million parents could be insured, costing federal and state governments $4 billion. Another 3.4 million parents would be insured by expanding Medicaid to cover uninsured parents of Medicaid-eligible children.

Health insurance among children: the role of expanded Medicaid coverage.

This study uses data from the National Longitudinal Survey of Youth to track the health coverage of parents in the year before and the year in which their children enroll in Medicaid. Use of such longitudinal data, compared to cross-sectional data, provides more insight into the dynamics of health insurance coverage and expansions in Medicaid. Using these data, we find that approximately 16% of newly enrolled Medicaid children likely had access to private insurance through a parent. Moreover, most of the children enrolling in Medicaid were previously uninsured. We find little substitution of private for public health insurance among families living at or near the federal poverty line.

The impact of HMOs on hospital-based uncompensated care.

Managed care in general and HMOs in particular have become the vehicle of choice for controlling health care spending in the private sector. By several accounts, managed care has achieved its cost-containment objectives. At the same time, the percentage of Americans without health insurance coverage continues to rise. For-profit and not-for-profit hospitals have traditionally financed care for the uninsured from profits derived from patients with insurance. Thus the relationship between growth in managed care and HMOs, hospital "profits," and care for the uninsured represent an important policy question. Using national data over an eight-year period, we find that a ten-percentage point increase in managed care penetration is associated with a two-percentage point reduction in hospital total profit margin and a 0.6 percentage point decrease in uncompensated care.

The impact of the family planning supply environment on contraceptive intentions and use in Morocco.

Although the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. However, few prior studies have quantified the magnitude of this facilitating or enabling effect of family planning services, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992-95 period is related to contraceptive intentions in 1992; individual-, household-, and community-level determinants of contraceptive behavior; and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. Evidence of a significant enabling or facilitating role of family planning services is found, and the results also suggest that family planning program factors influence contraceptive intentions in important ways.