Health Insurance

This article will focus on health insurance. It will provide an analysis of government and commercial health insurance plans and programs. Topics covered include employer-sponsored health insurance, fee-for-service plans, managed fee-for-service plans, health maintenance organizations (HMO), preferred provider organizations (PPO), point of service plans (POS), Medicare, Medicaid, and the 2010 Affordable Care Act. The issues associated with healthcare reform and universal healthcare will be addressed.

Keywords Employer-Sponsored Health Insurance; Fee-for-Service Plans; Healthcare Reform; Health Insurance; Health Maintenance Organizations; Medicaid; Medicare; Preferred Provider Organizations

Insurance & Risk Management > Health Insurance

Overview

Health insurance, which refers to insurance against bodily injury, disablement, or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness, is available in the United States through government and private providers. In the United States, the commercial (or private) health insurance industry and the government (or public) health insurance industry serve different populations and offer a wide range of benefits and plans. The commercial health insurance industry offers plans, including fee-for-service plans, managed fee-for-service plans, health maintenance organizations (HMO), preferred provider organizations (PPO), and point-of- service plans (POS). The main government health insurance programs include Medicaid and Medicare. In 2010, the Patient Protection and Affordable Care Act (PPACA) of 2010—commonly called the Affordable Care Act (ACA) or Obamacare after its major backer President Barack Obama—sought to reform a number of aspects of the US health insurance industry, as well as improve the access to and quality of healthcare services.

US Modern Public & Private Health Insurance Systems

The US modern public and private health insurance systems began in the early 1900s. The US private health insurance industry, as it is known today, began in 1929 when Baylor Hospital began offering prepaid hospital coverage to 1,200 teachers. This program was the beginning of what later became known as Blue Cross Insurance. Private health insurance programs grew in number and popularity during World War II, when most wages were frozen as part of the war effort. Private companies that could not offer increased salaries began offering health benefits packages to attract potential employees. Blue Cross health insurance offered forty-three plans by 1943. The tax foundation for the employer-sponsored health insurance system and employer benefit plans in general was established in 1913 when Congress passed the Sixteenth Amendment legalizing the individual and corporate income tax. Corporations, which were not taxed on company-paid fringe benefits, began to deduct the cost of these benefits from their corporate income taxes. Employers in the twenty-first century continue to balance the health insurance benefits they pay to employees with the tax exemptions offered by the Internal Revenue Service.

Variance within Health Insurance Plans

Health insurance plans vary in the benefits and services they offer, their costs, their eligibility requirements, and their approach to pricing or establishing premiums. The history of Blue Cross insurance or premium pricing is illustrative of premium pricing history for the insurance industry as a whole. In the early- and mid-1900s, Blue Cross insurance practiced a community ratings system. The community rating system refers to a pricing method used by insurers that establishes premiums based on the cost of insuring specific geographic areas. In the beginning, Blue Cross charged all plan members the same amount for coverage. The community ratings system was replaced by experience-rated premiums in which premiums are established based on the anticipated cost of insuring a specific individual or demographic subgroup (Carlstrom, 1994). "Blues plans today differ considerably from one another in such areas as market share, management philosophy, and the types of products they offer to their three primary market segments--individual, small group, and large group" (Aronovitz, 1994, p. 5).

Plans such as these have often had very strict guidelines regarding who they would cover and why. For example, in the past, it was likely that anyone who wanted private coverage would have to undergo a thorough medical examination. They might not receive coverage for a prior medical condition, and this could leave them paying hundreds or even thousands of dollars in out-of-pocket expenses. Insurance companies such as the Blues have not been enthusiastic about healthcare reform because it cuts into profit margins. Reforms enacted under the 2010 Affordable Care Act (ACA) forced insurers to accept everyone, regardless of their state of health, and to cover them for prior conditions. This means insurers must pay out hundreds of thousands of dollars (possibly millions) in coverage that they formerly would never have paid.

Health insurance, possibly more than any other employee benefit or social insurance, is considered necessary for health and well-being. As a result, government, businesses, and society are in constant negotiation over how vital healthcare should be provided and financed.

Applications

Private & Public Health Insurance

In the United States, private and public health insurance is available based on eligibility factors. Variables that have influenced health insurance eligibility include employment status, employer coverage, age, income, disability, pre-existing conditions, and location. The following sections describe and analyze private and public health insurance. Issues addressed include benefit plans, government regulation, benefit financing, and member perception of benefits.

Private Health Insurance

Private health insurance plans include group coverage or individual coverage. Group health insurance is generally available through an employer. Factors that influence the availability of group health insurance include the size of the company and job classification. For example, hourly-wage workers are less likely to be eligible for group health insurance through their employers than salaried workers. Individual health insurance, generally more expensive than group health insurance, is available for purchase outside of an employment relationship. Individual health insurance plans tend to have more limited coverage and more pre-existing condition clauses than group health insurance. Individuals have historically chosen private health insurance plans based on factors such as availability, eligibility, individual health needs and history, pre-existing health conditions, the services provided, the costs and affordability, the location of services, and limitations on services.

Differing Health Insurance Plans

There are a wide range of private health insurance plans, including fee-for-service plans, managed fee-for-service plans, health maintenance organizations (HMO), preferred provider organizations (PPO), and point-of-service plans (POS). These plans vary in costs and services provided (Sullivan, 1992):

• Fee-for-Service Plans: Plans that pay the full benefit no matter where employees or their dependents receive treatment.
• Managed Fee-for-Service Plans: Plans that use cost-containment and utilization reviews to balance conflicting needs of employer and employee by steering employees away from high-cost inpatient hospital stays and providing financial incentives to use lower-cost alternatives.
• Health Maintenance Organizations (HMOs): Prepaid healthcare system in which the participating physicians assume the financial risk for providing care to members.
• Preferred Provider Organizations (PPOs): Prepaid health-care system in which the participating physicians assume the financial risk for providing care to members.
• Point of Service Plans: A plan which combines traditional fee-for-service and an HMO.

Government Regulation of Commercial Health Insurance

The federal government regulates commercial (or private) health insurance. The Consolidated Omnibus Budget Reconciliation Act (COBRA) and other federal laws establish the parameters for health benefit plans. Employee health plans, along with numerous other benefits, are regulated by the Employee Retirement Income Security Act (ERISA) of 1974, which sets minimum standards for most voluntarily established benefits plans in private industry in order to provide protection for individuals in these plans. Employee health benefit plans generally include coverage such as the COBRA provision to provide some workers and their families with the right to continue their health coverage for a limited time after the loss of a job, primary medical care, hospitalization coverage, mental health benefits, newborn and maternity health benefits, and cancer rights protections. In some instances, federal regulations specify the types of benefit plans that companies make available to their employees. For example, the Health Maintenance Organization Act of 1973, referred to as the HMO Act, established a dual-choice provision that required employers with twenty-five or more employees to offer federally certified HMO options alongside traditional indemnity insurance plans. The HMO Act facilitated the rapid expansion of the HMO model or plan into the health insurance system. The HMO Act also had the effect of lowering insurance costs for some large companies and increasing insurance costs for many small and medium-sized companies (Carlstrom, 1994).

Employee-Sponsored Health Insurance

The design of employee-sponsored health insurance and employee benefit plans, in general, has changed significantly since the 1970s. Reasons for the shift in employee benefit plan design include the shift in thinking from a paternalistic management approach to employee empowerment. In the employee benefits environment of most organizations and institutions, employees are required to assume responsibility for making appropriate benefit plan choices. New employee empowerment benefit design plans include flex and defined contribution benefit plans. Employee benefit plans are increasingly managed through self-service benefits administration tools such as human resource information systems and benefits databases. Employers, acknowledging and responding to changes in demographics such as more working mothers and single-parent households, began to rethink the traditional “one size fits all” benefits concept and designed a wider range of benefit plans to meet the needs of the increasingly heterogeneous workforce. New benefit plan designs include flex plans and defined contribution benefit plans (Randolph, 1995).

Health Benefit Plan Financing

Health benefit plans are financed with a wide range of financial tools and approaches. Health insurance plans are generally funded by employer contributions, employee contributions, or some combination of funding arrangements agreed upon through negotiation and bargaining. Variables that affect plan financing include government regulations, organizational resources, plan sponsor and plan members relationship and negotiations, plan enrollment, and plan coverage. Employers finance employee benefit plans through four main tactics or approaches: Pooling, self-funding, captive insurance, and voluntary employee beneficiary associations (VEBA). The federal government regulates and oversees how employee benefit plans are financed to protect the interests of the labor force and their families. Organizations without sufficient funds to pay out retirement benefits and pensions, healthcare claims, or leave benefits potentially harm individual employees and the economic health of the nation in general. The federal government regulates and encourages certain sorts of employee benefit plan financing through tax exemptions and deductions and discourages the use of other employee benefit plan financing options through restrictions, regulations, and penalties (Halterman, 2000).

Costs of Employee-Sponsored Health Insurance & Benefit Plans

According to the International Foundation of Employee Benefit Plans, few employees understand the costs associated with employee-sponsored health insurance and employee-sponsored benefit plans in general. The International Foundation of Employee Benefit Plans, originally called the National Conference of Health and Welfare Plan Trustees and Administrators, was established in 1954. The International Foundation of Employee Benefit Plans, which encourages employers to engage in employee benefit plan education, believes that employee appreciation of and knowledge about benefits contributes to workplace productivity. To fully appreciate the employee benefits that they receive, employees must become familiar with their value. Employers spend significant financial and human capital resources on benefit plan coverage and administration. For example, in June 2013, the Bureau of Labor and Statistics reported that approximately one-third of employers’ costs per worker went to benefits, with 7.7 percent of that being health insurance, which helps to illustrate the connection between plan costs and efforts and directions in benefits design and administration. The cost of healthcare for employees in only rising (Lagasse, 2022). Employers, also referred to as plan sponsors, are increasingly offering healthy lifestyle and wellness programs to their employees to promote healthy lifestyle choices and potentially reduce healthcare plan costs. Ultimately, employees who understand the true costs and expenses associated with employer-sponsored benefits plans may appreciate the financial commitment made by their employers and be more willing to share the cost of benefits.

Government Health Insurance Programs

The federal and state governments provide health insurance to the elderly, unemployed, and disabled. Government health insurance programs are a form of social insurance. Social insurance refers to any insurance program carried out or mandated by a government to provide economic assistance to the unemployed, the elderly, or the disabled. Examples of social insurance programs include Social Security, disability insurance, survivor insurance, unemployment insurance, and Medicare and Medicaid insurance for those aged sixty-five and older or for very low-income Americans. In 2012, social insurance programs accounted for 44 percent of federal government spending. By 2016, human services spending accounted for 73 percent of government spending with 28 percent going to Medicare and Medicaid (DeSilver, 2017). Social insurance differs significantly from welfare programs. For example, participation in social insurance programs is usually mandatory or is induced by substantial fiscal subsidies. Social insurance is not an intentional form of income redistribution (Feldstein, 2005).

Medicaid & Medicare

Medicaid is a federal program that provides health insurance coverage to qualifying very low-income Americans, particularly among those over age sixty-five and children under eighteen. Medicare is the program that provides people over sixty-five with medical care. It also provides support for persons with certain disabilities and people of all ages who have end-stage renal disease (kidney failure). Medicare has become far more complicated than it was in its original form. There are four sections to Medicare: A, B, C, and D. Respectively, they cover hospital insurance, medical insurance, advantage plans, and prescription drug coverage. One of the ongoing problems for the Medicare program has been to continue to provide the health insurance required by seniors and persons with disabilities at the same time as trying to contain costs. Like Medicaid, Medicare also has variations in practice among states, which also leads to some confusion over and frustration with the program.

Disability Insurance

There are a number of ways that insurance for disability can be provided. First, there is private insurance, which may contain coverage for short- and long-term disability. These are usually group plans through an employer. Since not everyone can return to work immediately after an injury or illness, short- and long-term disability was established to support people during periods of rehabilitation. These programs were established in order to prevent people from losing their incomes during a long illness or after an injury.

The largest program in the country for persons with disabilities is Social Security Disability Insurance (SSDI). It consists of a monthly premium paid out to individuals who have a permanent impairment. This is administered by the Social Security Administration and provides a monthly income for individuals who are unable to work due to the nature or severity of their disability or individuals who are able to work but earn less than the amount SSDI determines is the substantial gainful activity level. In addition to the primary program, there is also the Supplemental Security Income (SSI). This is a "means-tested income assistance program for aged, blind, and disabled individuals (regardless of prior workforce participation)" (Social Security Advisory Board, 2001, p. 6). To qualify for the latter, a person must have a permanent impairment, be over the age of eighteen, and not own any property.

One of the primary issues with respect to SSDI and SSI is the adjudication system. There have been ongoing concerns and formal complaints that the system is unfair and even somewhat arbitrary. The rules that provide for acceptance or denial of a person's disability have varied from state to state, as has the rate of allowance and denial. Therefore, depending on where one lives, it might be easier to gain supplementary income and, in other places, more difficult. Many people are forced to obtain legal counsel to secure disability benefits.

Despite these concerns, the agency long had no effective mechanism to provide the information needed to understand the degree to which the programs' own policies and procedures—including their uneven implementation—have caused inconsistent outcomes in different regions of the country and different parts of the disability system (Social Security Advisory Board, 2001, p. 4). Beginning in 2001, the Social Security Advisory Board has compiled and released reports containing data on the disability program and determination process to improve transparency and increase accountability for such procedural inconsistencies (Social Security Advisory Board, 2012).

Since SSDI’s enactment in 1956, our ideas and perceptions of what a person with a disability can and cannot do have radically altered. There have been significant technological advances that some say enable persons with even more complicated conditions to work full-time or part-time. The SSDI program has not kept up with the times and has continued to operate in the same way since its inception. In addition to these difficulties, adjudicators are trained differently across the states, and this leads to a wide variance in the ability to understand the experience of living life with a disability. The Social Security Advisory Board (2006) has proposed a number of reforms to address such long-standing issues. Most importantly, it recognizes the need to redefine disability criteria in light of changes to the workplace and the government’s emphasis on empowering individuals of all abilities to contribute to society (Social Security Advisory Board, 2006).

Healthcare for Children

There is perhaps no issue as salient and distressing as that of the millions of Americans who are uninsured. In 2012, an estimated 48 million Americans were uninsured, 7 million of them were children under eighteen (DeNavas-Walt, Proctor & Smith, 2013). According to DeVoe (2007), "children from lower socioeconomic backgrounds have poorer health outcomes. These health disparities are due, in part, to barriers in accessing medical care and utilizing primary care services" (DeVoe, et al., 2007, p. 511). Libby (2006) further explains that "one specific vulnerable and often low-income population is children and adolescents involved with child welfare. Children in contact with child welfare systems have been shown to be particularly vulnerable to health and mental health problems…" (Libby, 2006, p. 40). The problem continued into the twenty-first century though it was slightly alleviated by the Affordable Care Act. In 2021, 27.5 million Americans were uninsured, and 3.9 million children under the age of 19 had no health insurance. The number of uninsured Americans became particularly troubling during the COVID-19 pandemic (Mykyta, et al., 2022 & Tolbert et al., 2022).

The Children’s Health Insurance Program (CHIP) is a health program that emerged in 1997 from the collapse of the Clinton administration's efforts at healthcare reform in 1994. CHIP is part of Medicaid and provides health insurance to many children below the age of nineteen. States have a great deal of leeway in deciding how to administer the program. Very few government programs besides CHIP and Medicaid provided health insurance to very poor or uninsured children. Problems have occurred with these programs, however, from inadequate state funding for CHIP, and children on Medicaid were reported to have to wait longer for appointments than children with private pay insurance. Physician access for children on Medicaid was also poor (Roy, 2011; Grady, 2011).

The State of the Uninsured

Of the uninsured in 2012, 35.1 million were native-born Americans, 3.3 million were naturalized citizens, and 9.5 million were foreign-born noncitizen residents. Among adults aged eighteen to sixty-four, 15.3 million full-time workers were uninsured as compared to 13.1 million part-time workers who were uninsured—together representing 28.4 million, or more than half, of the uninsured that year (DeNavas-Walt, Proctor & Smith, 2013). This strongly suggests that a high percentage of employers do not provide healthcare insurance to their employees. Changes have occurred since 2012 that indicate the number of insured Americans has risen. In 2021, 27.5 million Americans were uninsured, and 3.9 million children under the age of 19 had no health insurance. Sixty-six percent of Americans had private health insurance compared to 35.7 with public (Keisler & Bunch, 2022).

Smith (2008) suggests there is a strong correlation between lack of insurance and poor health: "While it is difficult to separate the consequences of being uninsured from the factors that contribute to being uninsured (e.g., lack of employment, lower income), evidence indicates a strong correlation between not having insurance and not receiving regular healthcare and thus having poor health" (p. 147).

The problem of being uninsured creates a cycle of social problems. An uninsured person tends to avoid going to the doctor because of the inability to pay. As a result, any nascent condition the individual may have will likely be far worse by the time he or she does see a doctor. This creates the necessity for complicated testing and treatment that is far more expensive than if it had been dealt with at the beginning. Thus, the patient ends up in a vicious cycle in which he or she cannot pay for insurance but ends up owing hundreds and possibly thousands of dollars for medical care. He or she may be put on a public plan, supplemented by private insurance company premiums, a pattern that ultimately contributes to rates increasing.

One of the reasons many go uninsured is due to a decline in employers providing healthcare benefits. "The recent drop in ESI [Employer-Sponsored Insurance] coverage was due partly to a decline in health benefit offers by small employers, but also to fewer workers being 'eligible' for coverage or electing to participate in employers' plans" (Smith, 2008, p. 41).

Issues

Healthcare Reform

Healthcare is very much on the minds of Americans. Former Democratic presidential candidate Hillary Rodham Clinton made healthcare her platform in 2008 and insisted that universal healthcare was achievable. Although affordable healthcare for everyone sounded like a positive step forward, the American public was not sure enough of that statement to support her election as president. The American healthcare system is bound to the insurance industry and has always been a fee-for-service system. To add to the dilemma, universal healthcare does not have universal support of the American people or the medical profession.

The Affordable Care Act of 2010

Since the passage of the Affordable Care Act (ACA) of 2010, insurers have been required to cover preventive services without a deductible, copayment, or other out-of-pocket expense; extend coverage to children with existing medical conditions; cover young-adult children up to age twenty-six on their parents’ plans; spend most of their premiums on benefits to consumers rather than on administrative costs; and provide justification for rate increases. Starting in 2014, insurers were longer be allowed to set annual dollar limits on coverage, reject anyone based on preexisting medical conditions, discriminate against women, or restrict or deny coverage to those who participate in clinical trials. ACA also expanded Medicare coverage through the state governments (US Department of Health & Human Services, 2013).

At the time of its passage, the Affordable Care Act was the most substantial overhaul of the US healthcare system since the passage of Medicare and Medicaid during the Johnson administration in the mid-1960s. Although it encountered intense opposition from the general public, medical professionals, and various public officials and had numerous problems and glitches in its start-up, the ACA dramatically improved the affordability of and access to health insurance.

In addition, the Affordable Care Act as it was passed in 2010 proposed to expand Medicaid coverage and benefits and address the issues of substandard healthcare for children by increasing Medicaid payment rates to healthcare providers to help ensure access to primary care providers for more low-income children. Children could no longer be denied coverage for preexisting conditions and will no longer have annual or lifetime caps placed on their health insurance. For very poor or uninsured families, the ACA provides tax credits and vouchers to help with quality health insurance coverage (Children’s Defense Fund, 2012). Additionally, the ACA allowed parents to keep their children on their policy until age twenty-six.

Seniors also benefitted from the Affordable Care Act in its inclusion of additional preventative care benefits through Medicare, lowering the cost of prescription drugs, and including incentives to physicians who treat Medicare patients or who provide primary care in regional areas with doctor shortages. In prior years, seniors did not have consistent access to quality healthcare and services (Centers for Disease Control, 2007). To further address this issue, the Affordable Care Act increased the number of checks and balances to ensure best practices in nursing homes in order to assure seniors and their family members of quality care.

There were signifcant obstacles the ACA and Americans in general faced in terms of health insurance in the 2020s. The ACA faced significant challenges during the Trump administration. A major campaign promise Trump made was a total repeal of the ACA on the basis that it was unconstitutional. While that did not happen, his administration made significant changes to the plan that did not favor the American people. However, not only did the Supreme Court rule the ACA was constitutional, the Biden-Harris administration strengthened many parts (Commonwealth Fund, 2018). The COVID-19 pandemic of 2020 was a public health crisis that highlighted the importance of health as Americans who were generally healthy had less dire consequences than those with pre-existing medical conditions. Access to healthcare is one of the main ways Americans stay healthy.

Conclusion

The insurance business remains an integral part of the US healthcare system in the twenty-first century. Even with all the changes implemented under the Affordable Care Act, it will take a great deal of time and a determined effort to encourage employers to sponsor health insurance plans for their employees, to assist the uninsured in signing up for coverage, to ensure that insurers and employers comply with ACA provisions, and to make necessary changes to Social Security.

Terms & Concepts

Community Rating System: A pricing method used by insurers that establishes premiums based on the cost of insuring specific geographic areas.

Congress: The United States government legislature granted the power to make laws.

Employee Benefits: A collection of non-wage compensation elements, including but not limited to income protection, services, and income supplements for employees, provided in whole or in part by employer payments.

Employee Retirement Income Security Act: The federal legislation that governs the administration and design of employer pension, health, and welfare plans.

Experience-Rated Premiums: A pricing method used by insurers in which premiums are established based on the anticipated cost of insuring a specific individual or demographic subgroup.

• Federal Government: A form of government in which a group of states recognizes the sovereignty and leadership of a central authority while retaining certain powers of government.
• Federal Poverty Level: The guidelines issued annually by the US Department of Health and Human Services used to determine eligibility in a wide variety of Federal and State programs.
• Fee-for-Service Plans: Plans that pay the full benefit no matter where employees or their dependents receive treatment.
• Health Insurance: The insurance of human beings against bodily injury, disablement or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness.
• Health Maintenance Organizations: Prepaid healthcare system in which the participating physicians assume the financial risk for providing care to members.
• Insurance: A contract under which one undertakes to pay or indemnify another as to loss from certain specified contingencies or perils.
• Managed Fee-for-Service Plans: Plans which use cost-containment and utilization reviews to balance conflicting needs of employer and employee by steering employees away from high-cost inpatient hospital stays and providing financial incentives to use lower-cost alternatives.

Preferred Provider Organizations: Prepaid healthcare system in which the participating physicians assume the financial risk for providing care to members.

Point of Service Plan: A health plan that combines traditional fee-for-service and an HMO.

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Tolbert, J., Drake, P., & Damico, A. (2022, Dec. 19). Key facts about the uninsured population. Retrieved June 16, 2023, from https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population

U.S. Department of Health & Human Services. (2013). Key features of the Affordable Care Act by year. Retrieved November 15, 2013November 13, 2013, from: http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html

Warner, D. C. (2012). Access to health services for immigrants in the USA: From the Great Society to the 2010 Health Reform Act and after. Ethnic & Racial Studies, 35, 40–55. Retrieved November 21, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=69603629

Suggested Reading

Brown, M. (2006). Funding retiree health benefits. Journal of Accountancy, 202, 74-75. Retrieved July 6, 2007, from EBSCO Online Database Business Source Complete. http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=22040205&site=ehost-live

Chou, S., Liu, J., & Hammitt, J. (2003). National health insurance and precautionary saving: Evidence from Taiwan. Journal of Public Economics, 87(9/10), 1873-1894. Retrieved July 2, 2007, from EBSCO Online Database Business Source Complete. http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=10925389&site=ehost-live

Dhingra, S. S., Zack, M. M., Strine, T. W., Druss, B. G., & Simoes, E. (2013). Change in health insurance coverage in Massachusetts and other New England states by perceived health status: Potential impact of health reform. American Journal of Public Health, 103, e107–e114. Retrieved November 21, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=87069057

Ferguson, R., & Leistikow, D. (2000). Problems with health insurance. Financial Analysts Journal, 56, 14-29. Retrieved July 6, 2007, from EBSCO Online Database Business Source Complete. http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=4017582&site=ehost-live

Qingyue, M., Beibei, Y., Liying, J., Jian, W., Baorong, Y., Jun, G., & Paul, G. (2011). Expanding health insurance coverage in vulnerable groups: A systematic review of options. Health Policy & Planning, 26, 93–104. Retrieved November 21, 2013 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=58614084