Gain in Insurance Coverage and Residual Uninsurance Under the Affordable Care Act: Texas, 2013–2016

Pickett, Stephen; Marks, Elena; Ho, Vivian

doi:10.2105/ajph.2016.303510

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…Competitive advantages of any service enterprise can be obtained by offering the high-quality services to achieve customer’s satisfaction and their patronage decision toward service providers (Hussain, 2016; Wang et al , 2004; Ladhari et al , 2017). Thus, service providers, such as health insurance companies, need to understand the requirement of customer’s need in terms of service quality to provide the maximum satisfaction for their existing and potential customers (Pickett et al , 2017; Saeida Ardakani et al , 2015; Kolstad and Chernew, 2009; Choi et al , 2004; Munnukka et al , 2015). Huang et al (2011) proposed that firm’s service quality has a positive influence on both customers’ satisfaction and their patronage behavioral decision toward the selection of a product or service.…”

Section: Introductionmentioning

confidence: 99%

Customer’s patronage decision toward health insurance products

Rahman

Fattah

Zaman

et al. 2018

APJML

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Purpose The purpose of this paper is to examine the influence of service quality, customer’s satisfaction and religiosity on customer’s patronage decision toward health insurance products. The paper also assesses the influence of religiosity on customer’s patronage decision. The influence of customers’ satisfaction as mediation between service quality and customer’s patronage decision was also measured. Design/methodology/approach A structured questionnaire was developed and administered to a sample of 200 respondents. This research applied the exploratory factor analysis, the confirmatory factor analysis and the structural equation modeling to test the proposed hypotheses. Findings The findings indicate that customers’ religiosity behavior has a significant influence on customer’s patronage decision for selecting health insurance products. The results also indicated that the role of customer’s satisfaction as a mediator in between the relationship of service quality and customer’s patronage decision is significant. Research limitations/implications This research is a cross-sectional study consisting of 200 respondents. In addition, the elements of the sample were Malaysian customers using health insurance products and services. Practical implications This study suggests that customers of health insurance products are more concerned with perceived service quality and perceived satisfaction. The role of religiosity also plays a dominant role. As a result, managers of the health insurance service providers need to focus more on benefits of service varieties centered toward their target customers in order to gain higher patronage decision of health insurance products. Originality/value The study sought to address the gap of religiosity aspects in health insurance products through intensive literature and offer a conceptual framework that tested service quality, customer’s satisfaction and religiosity in one integrated model under the perspective of health insurance industry. More importantly, it also examines the influence of religiosity on patronage behavior, thus shedding insights into the opportunities for understanding consumers in detail.

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Section: Introductionmentioning

confidence: 99%

Customer’s patronage decision toward health insurance products

Rahman

Fattah

Zaman

et al. 2018

APJML

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“…Finally, findings of higher likelihoods of uncontrolled diabetes among those enrolled in the ACA plans may be linked to our earlier note that some of the largest groups enrolling in the ACA’s marketplace insurance between 2013 and 2016 were those reporting fair to poor health, Hispanic individuals, individuals aged 50-64 years, and those reporting their highest education as a high school diploma. 16 Thus, it is likely that those enrolled in ACA plans were already facing health inequities, where, for example, past work has identified that individuals with lower education had worse health outcomes and were more likely to die earlier. 31 However, we identified that among those enrolled in the ACA marketplace insurance, that the probability of having non-target A1Cs and separately having uncontrolled A1Cs decreased over time, thereby indicating that those on the ACA marketplace insurance saw gains, even though disparities between those not enrolled persisted.…”

Section: Discussionmentioning

confidence: 99%

“… 15 In terms of health insurance types, there is also evidence that some of the largest groups enrolling in the ACA’s marketplace insurance between 2013 and 2016 were those reporting fair to poor health, Hispanic individuals, individuals aged 50-64 years, and those reporting their highest education as a high school diploma. 16 Furthermore, efforts to identify factors linked to A1C thresholds (i.e., target ranges and controlled levels) are valuable because they can assess a critical, and potentially modifiable aspect of T2D that may be influenced by individual-level, geospatial, and geopolitical factors.…”

Section: Introductionmentioning

confidence: 99%

Examining Health Inequities in A1C Control over Time across Individual, Geospatial, and Geopolitical Factors among Adults with Type 2 Diabetes: Analyses of a Sample from One Commercial Insurer in a Southern State

Towne,

Ory,

Zhong

et al. 2024

J Prim Care Community Health

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Introduction: Type 2 diabetes impacts millions and poor maintenance of diabetes can lead to preventable complications, which is why achieving and maintaining target A1C levels is critical. Thus, we aimed to examine inequities in A1C over time, place, and individual characteristics, given known inequities across these indicators and the need to provide continued surveillance. Methods: Secondary de-identified data from medical claims from a single payer in Texas was merged with population health data. Generalized Estimating Equations were utilized to assess multiple years of data examining the likelihood of having non-target (>7% and ≥7%, two slightly different cut points based on different sources) and separately uncontrolled (>9%) A1C. Adults in Texas, with a Type 2 Diabetes (T2D) flag and with A1C reported in first quarter of the year using data from 2016 and 2019 were included in analyses. Results: Approximately 50% had A1Cs within target ranges (<7% and ≤7%), with 50% considered having non-target (>7% and ≥7%) A1Cs; with 83% within the controlled ranges (≤9%) as compared to approximately 17% having uncontrolled (>9%) A1Cs. The likelihood of non-target A1C was higher among those individuals residing in rural (vs urban) areas ( P < .0001); similar for the likelihood of reporting uncontrolled A1C, where those in rural areas were more likely to report uncontrolled A1C ( P < .0001). In adjusted analysis, ACA enrollees in 2016 were approx. 5% more likely (OR = 1.049, 95% CI = 1.002-1.099) to have non-target A1C (≥7%) compared to 2019; in contrast non-ACA enrollees were approx. 4% more likely to have non-target A1C (≥7%) in 2019 compared to 2016 (OR = 1.039, 95% CI = 1.001-1.079). In adjusted analysis, ACA enrollees in 2016 were 9% more likely (OR = 1.093, 95% CI = 1.025-1.164) to have uncontrolled A1C compared to 2019; whereas there was no significant change among non-ACA enrollees. Conclusions: This study can inform health care interactions in diabetes care settings and help health policy makers explore strategies to reduce health inequities among patients with diabetes. Key partners should consider interventions to aid those enrolled in ACA plans, those in rural and border areas, and who may have coexisting health inequities.

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“…According to the Insurance Regulatory and Development Authority of India (IRDAI) norms, the customer may easily switch or port their existing health insurance policy to another insurance company in the case of perceived poor customer service, claim settlement issues, additional cover facility offered by any other company, and availability of better option or transparency concerns due to the health insurance company reputation (ET 2019 ; IRDAI 2020 ). In mature markets like financial services, customer retention provides a number of intrinsic benefits to the firms (Harrison and Ansell 2002 ; Pickett et al 2017 ). The current study is an initial attempt to examine the role of insurance company reputation, insurance service performance, and positive and negative affect in facilitating customer retention in the health insurance sector and the moderating influence of customer inertia.…”

Section: Introductionmentioning

confidence: 99%

Health insurance policy renewal: an exploration of reputation, performance, and affect to understand customer inertia

2021

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The aim of the study is to understand the role of insurance company reputation, performance, and positive/negative affect on health insurance policy customer retention and the moderating influence of customer inertia. A structured questionnaire was used for data collection. Covariance-based structural equation modeling was employed to assess the hypothesized relationships between the variables. The findings revealed that reputation, performance, and affect influenced customer retention in insurance sector. Positive affect had greater impact on customer retention in comparison to other constructs. Further, customer inertia was an important moderating influence on the negative affect for health insurance policy customer retention. To the best of our knowledge, the present study is the first of its kind that attempts to investigate customer inertia in the health insurance sector in an emerging market context, i.e., India. Customer inertia has not been much studied in light of company reputation, performance, and positive and negative affect in the health insurance milieu. The research findings may help health insurance companies understand the importance of reputation, performance, customer retention, and inertia while marketing insurance services.

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Gain in Insurance Coverage and Residual Uninsurance Under the Affordable Care Act: Texas, 2013–2016

Abstract: Many population subgroups have benefited from the ACA's Marketplace, but approximately 3 million Texas residents still lack health coverage. Adopting the ACA's Medicaid expansion is a means to address the lack of coverage.

Cited by 7 publications

References 11 publications

Customer’s patronage decision toward health insurance products

Customer’s patronage decision toward health insurance products

Examining Health Inequities in A1C Control over Time across Individual, Geospatial, and Geopolitical Factors among Adults with Type 2 Diabetes: Analyses of a Sample from One Commercial Insurer in a Southern State

Health insurance policy renewal: an exploration of reputation, performance, and affect to understand customer inertia

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