This study assesses whether Minnesota's high-risk insurance pool is successful at insuring those denied health insurance coverage because of preexisting medical conditions. Eight hundred and twenty-nine individuals who had been denied health insurance coverage were interviewed. At the time of the survey, 80 percent of the sample had obtained coverage, 22 percent through the state's high-risk insurance pool. Seventeen percent remained uninsured. Logistic regression was used to identify correlates of remaining uninsured. Younger age and less education were significantly associated with being uninsured versus enrolling in the high-risk pool. Younger age, less education, unemployment, being non-White, and having worse mental health were significantly associated with being uninsured versus having non-high-risk pool insurance. Despite the presence of a large high-risk pool in Minnesota, specific groups are identified as being at risk for remaining uninsured after being denied health insurance.

This paper addresses how medical care financing issues may impact on the process and outcome of asthma care. Because asthma-specific data are scarce, an attempt has been made to extrapolate from an understanding of payment issues for chronic illness in general to the specific case of asthma. First, some broad features of the effect of payment systems on health care delivery are reviewed. How financing of care for the individual patient affects financial access to care is then examined. Next, financing of care at the provider level is discussed, and fee-for-service and prepaid systems are compared with respect to how individual patients with chronic illness may be treated differently. Financing at the health insurance plan level, particularly with regard to benefits and quality of care, then is explored. Finally, knowledge gaps are highlighted, as are some of the difficulties encountered in investigating this topic.