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This qualitative study explores how individuals understand health insurance concepts and make health insurance purchase decisions. The study sought to develop a model of the health insurance decision-making process.

This study used semi-structured interview questions and the micro-moment time-line interview technique with newly hired employees to discuss the steps that individuals follow when making health insurance decisions. The researcher used an open coding approach to analyze the steps listed by each participant, and emergent themes were used to code all interview transcripts in Atlas.ti.

This study identified information tactics used by individuals when evaluating health insurance documentation. The findings also shed light on the personal reflection individuals undertake when making their health insurance choices.

The information needs and preferred information sources identified in this study will be of interest to information professionals and human resources officers providing assistance with health insurance enrolment.

The findings demonstrating that participants characterized their health insurance choice as a shared decision is a novel contribution of this study.

Key State Blue Cross and Blue Shield Plan (a disguised case of an actual BCBS Plan) is the merged product of three state plans. Initially burdened with a reputation of poor customer service, Key State's executives decided to invest heavily in service improvement, eventually achieving superior levels. Key State's high-quality customer service emerged as a true competitive advantage for its customers, who were primarily businesses and health benefits consultants who influenced corporate purchasers of health insurance. The Key State brand came to be synonymous with personal service, security, choice, and dependability. But the health care insurance market was changing under Key State's feet. Spiraling costs meant that high-quality service became less of a competitive advantage as employers were lured by low-cost, low-service providers. Many employers cut or dropped health care benefits entirely, swelling the ranks of the under- and uninsured, who in turn were extremely price-sensitive when shopping for health insurance on their own. Finally, the health care insurance market was being revolutionized by financial institutions willing to hold health benefit accounts and pay providers directly, thereby eliminating the need for Key State as a mediator. Key State executives were aware of these changes but were challenged by the mindset, culture, and organizational design custom-fit to their business accounts. The case asks the reader to consider whether Key State has the right number of target markets, whether it should have one brand or several for its different target markets, what it should do for the uninsured, and how it should improve its brand experience in light of the industry's changing landscape. All of these decisions will have significant implications for the organizational design of Key State.

To better understand the challenges involved in a successful health insurance company to cope with a rapidly changing and unpredictable environment; to formulate a new strategy and a new organizational design to accomplish this adaptation.

Disparities in access to health services continue to exist among adults age 65 and older in the United States despite near-universal insurance coverage provided through Medicare. One potential barrier to health service utilization is knowledge of health insurance coverage. Medicare has been drastically restructured in the recent past, and as the program becomes increasingly privatized, Medicare enrollees are left with more choices, but also a more complicated system through which to navigate. This study examines the relationship between Medicare enrollee knowledge of their Medicare health insurance and sociodemographic factors, health status, and the use of health services. Data was analyzed from the National Health Interview Survey (NHIS), a nationally representative study of the U.S. civilian, non-institutionalized, household population. Included in this study were Black, Hispanic, and White respondents aged 65 and older who participated in the NHIS from 2004 to 2009 (N=30,002). The prevalence of a lack of Medicare knowledge appears to be low among Medicare enrollees, with 13% reporting they did not know the answer to one or more questions about their coverage. Age and chronic illness status were found to be related to Medicare plan knowledge, with older adults and those who were not chronically ill more likely to report they did not know some aspect about their Medicare plan. Respondents who reported not knowing at least one question about their Medicare plan reported significantly fewer medical office visits and more time since they last interacted with a doctor, were less likely to have talked with a medical specialist, and have had surgery over the past year. The findings from this study suggest that knowledge of health insurance coverage is an important correlate of health service utilization, which may be shaped by disparities in access to health insurance across the life course.

This study aims to examine how the number of choices consumers have influences provider satisfaction, plan satisfaction and positive word-of-mouth (WOM) in the health insurance industry.

Partial least squares (PLS) and structural equation modeling (SmartPLS) was used to conduct multi-group analysis to analyze the structural models. Data were collected online using Amazon mechanical turk, resulting in 425 respondents.

This study finds that the number of choices consumers have impacts the strength of provider and plan satisfaction and positive WOM. Also, this study finds that provider satisfaction is generally more impactful than plan satisfaction when generating positive WOM.

This study extends reactance theory, satisfaction and WOM based on choice options to the health insurance industry where credence attributes are prevalent and the analysis includes two satisfaction constructs in the structural model, whereas multiple satisfaction constructs are often overlooked.

This chapter summarizes the major determinants of health insurance coverage rates among young adults. Socioeconomic status, demographics, actual and perceived health status, perceived value, and perceived need are all examined in order to determine what the literature reveals regarding each variable and how each variable impacts a young adult's decision to purchase health insurance. Results indicate that socioeconomic status, demographics, perceived value, and perceived need were the most significant determinates of health insurance status of young adults. A conceptual framework is also examined and used to illustrate theoretical implications. Managerial implications for marketing health plans to young adults are also addressed. Finally, policy implications concerning the new Patient Protection and Affordable Care Act are addressed.

This research explores how families coming off of Temporary Assistance to Needy Families (TANF), the national cash welfare program, plan for their health insurance after their automatic benefits expire. Data were collected in focus groups in rural communities and small towns in Oregon. Respondents reported that topics related to health insurance or planning for health insurance are not components of any welfare-to work curriculum, nor are they part of routine conversations with caseworkers. Many respondents reported that we were the first ones to raise these issues with them. Consequently, they had done virtually no planning for when their transitional Medicaid expires despite their serious concerns about access to health care and their previous negative experiences with being uninsured.

In the spirit of Polachek (1975) and the later work of Becker (1985) on the role of specialization within the family, we examine the relationship between fringe benefits and the division of labor within a married household. The provision of fringe benefits is complicated by their non-additive nature within the household, as well as IRS regulations that stipulate that they be offered in a non-discriminatory manner in order to maintain their tax-exempt status. We model family decisions within a framework in which one spouse specializes in childcare and as a result experiences a reduction in market productive capacity. Our model predicts that the forces toward specialization become stronger as the number of children increase, so that the spouse specializing in childcare will have some combination of lower wages, hours worked, and fringe benefits. We demonstrate that to the extent that labor markets are incomplete, the family is less likely to obtain health insurance from the employer of the spouse that specializes in childcare. Using data from the April 1993 CPS we find evidence consistent with our model.

Exemption from hospital charges may appear as an essential policy in order to support the poor. Such policies can function for the fulfillment of governments’ social- and justice-based responsibilities in public hospitals. The purpose of this paper is to investigate the pattern of offering discounts to the poor and the effect of Iran’s recent Health Sector Evolution Plan on it.

The authors conducted analytical research longitudinally on the data related to cash discounts offered to the poor within a teaching hospital. Data were collected through the period of four months, September to December 2013, before the establishment of the Health Sector Evolution Plan, and in the similar months through 2014, after the establishment of the Health Sector Evolution Plan, in order to compare the amount of cash discounts. The type of insurance, length of stay, amount of discounts offered to patients, and total costs of hospital charges were studied and compared by referring to the social working department. Data were analyzed using the χ²-test, Mann-Whitney U test, ANOVA, and regression analysis aided by SPSS 20.

The number of patients offered discounts or exempted from payment in 2014 reduced compared to the number in 2013. The highest rate of demand for discounts was related to patients covered by Emdad Committee followed by those who had no insurance. The ratio of discount to cost in the oncology ward was higher than other groups.

The results of the present study can contribute to the plans of health system policy makers in organizing measures for supporting poor patients toward accessing healthcare services.

According to the Centers for Disease Control and Prevention (CDC), the number of children diagnosed with autism has increased dramatically, especially over the past decade. Most recently, the CDC estimates that an average of one in 88 children have an autism spectrum disorder (ASD). In terms of numbers, this translates into approximately 730,000 people between the ages of 0 and 21 who have ASD. While the primary cause(s) of increases in the identification of autistic students continue to generate debate school officials across the nation need to be prepared for the changing legal landscape associated with children diagnosed with ASD. The primary purpose of this chapter is to provide a detailed legal/policy update of the leading legal considerations and concerns involving K-12 students with autism. The chapter will discuss four specific legal topics involving the identification and eligibility of K-12 students with autism. These four legal topics include: Changes in the New DSM-5 Diagnostic Manuel and its Impact on Legal Definitions of Autism; Insurance Reform and Autism Coverage: A Comparison of the States; Developing Legally Compliant Individualized Education Plans (IEPs) for High-Functioning Students with Autism, and; Recent Legal Developments in Case Law Involving K-12 students who are autistic. The chapter will conclude with a detailed discussion of how today’s school officials can become more legally literate and better serve the legal needs of students with autism in their schools.

Under the Patient Protection and Affordable Care Act (ACA), many low-income consumers have become eligible for government support to buy health insurance. Whether these consumers are able to take advantage of the support and to make sound decisions about purchasing health insurance likely depends on their knowledge and skills in navigating complex financial products. This ability is frequently referred to as “financial literacy.” We examined the level and distribution of consumers' financial literacy across income groups, using 2012 data collected in the RAND American Life Panel, an internet panel representative of the US population. Low financial literacy was particularly prevalent among individuals with incomes between 100% and 400% of the federal poverty level, many of whom will be eligible for health insurance subsidies. In this group, people who are young, less educated, female, and have less income were more likely to have low financial literacy. Our findings suggest the need for targeted policies to support vulnerable consumers in making good choices for themselves, possibly above and beyond the support measures already part of the ACA.