Adolescents without health insurance

Article Abstract:

Many adolescents living in the United States have no health insurance and, as a result, do not receive the medical services they need. Currently 4.6 million out of 31 million children between the ages of 10 and 18 years have no health insurance. Between 1979 and 1986, the number of adolescents without health insurance rose 25 percent because Medicare coverage was cut while the prevalence of poverty increased. Forty-one percent of uninsured adolescents live in families with incomes below the poverty line. There is a full-time worker in the household of approximately 50 percent of the uninsured adolescents who live with a parent. Factors other than family income that are linked to lack of insurance for adolescents include Hispanic ethnicity, little parental education and parental self-employment. Possible approaches to ameliorating this problem were recently presented by the Office of Technology Assessment of the United States Congress. One major proposal is to require employers to offer health insurance and pay a substantial proportion of the premiums for employees who work a minimum number of hours (such as 18 or 30) per week. Another plan is to loosen Medicaid eligibility requirements so more families are covered. If the two proposals were combined, virtually all uninsured adolescents could receive medical insurance coverage.

Health aspects, Standards, Medically uninsured persons, Teenagers, Youth, Poor, Medicaid, Insurance

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From the health care financing administration

Article Abstract:

The authority for Medicare was established by Title XVIII of the Social Security Act. This law specifically establishes the guidelines for medical service which can be provided by doctors, dentists, chiropractors and podiatrists. The procedures which are covered are expansive, but certain services such as cosmetic surgery and annual check-ups are specifically excluded from coverage. The law is broad and allows the inclusion of new procedures when "reasonable and necessary" as decided by the Secretary of Health and Human Services. The procedure used to examine the 20 to 30 procedures which are annually evaluated for inclusion into the classification of approved procedures involves having the Health Care Financing Administration review the specific cases. In general, the individual Medicare contractors make the preliminary decision about which services are included under the heading of "reasonable and necessary"; however, in some cases a specific central decision is required. An example of this is the review which is underway to determine if heart transplantation will be a covered procedure. A listing of the procedures which are currently under review was published in the Federal Register on Jan 30, 1989 (page 4302).

Medicare, United States. Centers for Medicare and Medicaid Services

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Court-ordered reimbursement for unproven medical technology: circumventing technology assessment

Article Abstract:

Court-ordered reimbursement for treatment with unproven medical technology may bypass scientific assessment and legitimize insurance coverage of these practices. This in turn, not only poses a risk to public health but also contributes to escalating health care costs. In six cases between 1980 and 1989, insurance companies were sued and ordered to reimburse patients for treatment that was widely held among the medical community to be unsafe or ineffective. Courts ruled in favor of the insurance carriers on the basis that ambiguities in the terms of the insurance contract should be ruled in favor of the carrier. Currently, the judicial system rarely uses published, peer-reviewed medical science and favors the testimony of live witnesses. To stop this trend, contract language should be improved to avoid ambiguities and the courts should use peer-reviewed scientific material in their decision making. Also, the courts should use their own, impartial scientific experts to interpret data instead of encouraging adversarial expert testimony.

Usage, Evidence, Expert, Expert evidence, Medical technology

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