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At least 271 records · Page 15Linked to original sources
PubMed1975

Hypertension. Management in a prepaid health care project.

Previous studies have shown that care for hypertension in clinical practice is not optimal. This study consists of a review of medical records of 101 hypertensive patients enrolled in a community prepaid health care project, in which all direct costs to patients are eliminated and in which patients are known to have geographical access to care. The results show that even under such conditions, there are deficiencies in what is done in the diagnosis and management of hypertension (process of care). Furthermore, recorded blood pressures in the medical records indicate that 34% of identified patients had diastolic pressures greater than 95 mm Hg at the time of last visit for hypertension.

Adult↗
PubMed1980

Even when it's giving out money, HEW can't escape controversy.

No one in the medical community argues that the federal government's kidney disease program isn't worthwhile. But the providers of kidney treatment are giving the Health Care Financing Administration a hard time on the issue of federal reimbursement. The agency is moving slowly, because a misstep in the kidney program could endanger the prospects for broader health insurance proposals.

Ambulatory Care Facilities↗
PubMed1986

Consumer acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial.

Do consumers find the care provided by health maintenance organizations (HMOs) and that provided in the fee-for-service (FFS) system equally acceptable? To address this question, we randomly assigned 1,537 people ages 17 to 61 either to FFS insurance plans that allowed choice of physicians or to a well-established HMO. We also studied 486 people who had already selected the HMO (control group). Those who had chosen the HMO were as satisfied overall with medical care providers and services as their FFS counterparts. The typical person assigned to the HMO, however, was significantly less satisfied overall relative to FFS participants. Attitudes toward specific features of care favored both FFS and HMO, depending on the feature rated. Four differences (length of appointment waits, parking arrangements, availability of hospitals, and continuity of care) favored FFS; two (length of office waits, costs of care) favored the HMO. HMO versus FFS differences in ratings of access to care and availability of resources mirror differences in the organizational features of these two systems that are generally considered responsible for the significantly lower medical expenditures at HMOs. Regardless of their origin, less favorable attitudes toward interpersonal and technical quality of care in the HMO have marked consequences: dissatisfaction and disenrollment.

Adolescent↗
PubMed1977

Health status, socioeconomic status and utilization of outpatient services for members of a prepaid group practice.

When evaluating the effectiveness of medical care programs, one concern is whether receipt of care is based upon health care needs or upon socioeconomic status. This study describes the relation between health status and socioeconomic status and attempts to determine which has the greater effect on ambulatory care utilization. The study setting was an operating HMO serving a cross-sectional membership of nearly 200,000 persons. Outpatient utilization data were derived from the medical records of a five per cent sample of health plan members for 1969 and 1970. Social, economic, situational, and attitudinal data were provided by 2,603 respondents in a household interview survey. Since a population's perceived health status may reflect health need, information from the survey provided measures of health status that ranged from specific symptoms and complaints to a general measure of perceived health status. Although the findings varied somewhat according to which variables were considered, they generally showed health status to correlate more highly than socioeconomic factors with the utilization of services in this medical care system. An exception was the use of preventive services, which was not significantly related to health status measures but rather, for women, to education and, to a lesser extent, income.

Absenteeism↗
PubMedDate not supplied

Medical savings accounts: in the spotlight on Capitol Hill.

Medical savings accounts (MSAs) have emerged as one of the key health care proposals under consideration in the 104th Congress. These tax-free accounts, which are viewed as an alternative to traditional "comprehensive" health care coverage, would allow individuals and their employers to set aside money to pay for major health care expenses. Depending on how they are designed, MSAs could have significant implications for HMOs and other managed care arrangements.

Cost Sharing↗
PubMed1982

The insurance medical. Practical procedures.

The insurance medical examination is an integral part of day to day general practice. On a busy day it may develop into a race against the clock with short cuts made despite the handsome remuneration. In this article Dr Breidahl has outlined the disadvantage to our patients of taking these short cuts and in particular the opportunities missed for preventive medicine.

Australia↗
PubMed1996

Managing medical savings accounts.

Medical savings accounts (MSAs) are a new option being considered by policy makers as an alternative medical benefit cost-control technique. This article begins with a detailed description of MSAs as they are currently being considered and discusses the advantages and disadvantages from the perspective of the employer and employee. Some states are already recognizing the use of MSAs for state income tax purposes, and the author provides examples of these.

Cost Sharing↗
PubMed1998

The need for single-payer catastrophic health insurance.

Both physicians and patients are becoming increasingly frustrated with the decreasing flexibility of our health-care system. Forty-one million citizens remain uninsured while ill patients in managed-care plans find themselves subject to bureaucratic hurdles in attempting to obtain necessary care. Rather than relying on the market place to provide affordable insurance to patients, physicians should embrace single-payer catastrophic coverage. A government insurance program should be enacted that covers all medical bills that exceed a $15,000 deductible annually for families and a $10,000 deductible annually for individuals. Patients could then purchase plans through the private sector to cover these deductibles. While such a plan would require a tax increase, premiums would decrease, health insurance would become more affordable to low wage earners, and more treatment decisions would be made by physicians and patients.

Connecticut↗
PubMed1993

Insurance benefits coverage for persons with spinal cord injuries: determining differences across payors.

This investigation represents a preliminary step in determining differences in benefits coverage among three types of rehabilitation insurance payors (Catastrophic payors, which include Automobile No-Fault and Workers' Disability Compensation; Medicaid; and Third-party private payors). Subjects in this study were 122 spinal cord injury (SCI) outpatients who received their initial rehabilitation at the University of Michigan Medical Center and at the Rehabilitation Institute of Michigan. Insurance benefits received by them were examined across the following areas: accessible housing, transportation, personal attendant care services, professional outpatient services and adapted equipment. Results indicated differences across the three payors, with catastrophically-sponsored SCI outpatients receiving more benefits than SCI outpatients sponsored by public Medicaid or by private third-party insurance. Implications and recommendations for further studies are briefly discussed.

Adult↗
PubMed1987

Health insurance and the demand for medical care: evidence from a randomized experiment.

We estimate how cost sharing, the portion of the bill the patient pays, affects the demand for medical services. The data come from a randomized experiment. A catastrophic insurance plan reduces expenditures 31 percent relative to zero out-of-pocket price. The price elasticity is approximately -0.2. We reject the hypothesis that less favorable coverage of outpatient services increases total expenditure (for example, by deterring preventive care or inducing hospitalization).

Analysis of Variance↗
PubMed1977

A prepaid medical plan. Cost, use, and effects in a retirement home.

A model experience of a prepaid medical plan for a group of people is analyzed. No-barrier cost and physician access lead to altered use characteristics. Among these are increased physician, nurse, and nursing home use, and decreased hospital use. The overall cost is increased. Any comprehensive health-care plan that would propose comprehensive first-dollar coverage would likely encounter similar use characteristics.

Aged↗
PubMed2002

[100 years with certificates: Danish Society of Insurance Medicine 1902-2002].

Danish Society of Insurance Medicine was formed in 1902 as an association between the Danish Society of Accident Insurance and the Danish Society of Life Insurance Medicine, both founded a year before. The purpose of the society is to apply and to further the scientific basis of insurance medicine. The meetings also play a role as a forum for discussions. The members of the society are all working part-time in an insurance company in Denmark (in contrast to many other countries where it is a full-time job). The members are mainly specialists in medicine and surgery. During the first half life of the society nearly all members were high-qualified doctors, i.e. professors and consultants at a university hospital in Copenhagen usually with a doctoral degree. These prominent doctors had a significant influence on insurance medicine in Denmark. The managing directors of the Insurance Companies were invited to the meetings. Many scientific works and textbooks were written on the subject. The society arranges two meetings yearly - one concerning with life insurance and one with accident-insurance medicine. Previously, the question put to the medical adviser was always "Which impairments can still be insured?", but today the question is the opposite "Which impairments are not insurable?" The members have increased to currently 112, still only men, but today the members are younger, comprise fewer professors and fewer with a doctoral degree. During the last 6 years, all interested members in the insurance companies have been invited to the meetings, providing a broader input for the discussions. The topic of the meeting is of current interest: new laws or a new treatment of a disease (medication, surgery) which has been introduced. One to three speakers open the meeting, followed by a discussion. The meetings are always concluded with a light meal and a glass of wine, in earlier days also with cigars and Danish schnaps. 190 meetings have been held during the last 100 years. Often the speakers are members of the society. In the future the Danish Society of Insurance Medicine will face new challenges as regards to the communication of knowledge about new diseases and new treatments in the light of with biostatistics and new insurance products.

Denmark↗
PubMed2006

A projection of the impact of lipid-lowering therapy on high-risk employee disability and medical costs.

OBJECTIVE: The objective of this study was to examine the impact of introducing rosuvastatin calcium on direct and indirect costs among patients at high risk for coronary heart disease. METHODS: An economic simulation model was developed to project the number of cardiovascular events and associated direct and indirect costs under varying treatment scenarios. RESULTS: In an average-sized commercial health plan with 210,000 covered lives and 9,336 high-risk patients, an uptake of rosuvastatin by 11% of high-risk patients would result in eight fewer cardiovascular events, a net savings of 0.85 million dollars in direct medical costs and a net savings of 36,404 dollars in productivity loss over a period of 5 years. The overall reduction in total costs is equivalent to 1735 dollars per rosuvastatin-treated patient. CONCLUSIONS: At current statin prices, the use of rosuvastatin could lead to fewer cardiovascular events and lower direct and indirect costs.

Cardiovascular Diseases↗
PubMed1995

Medical savings accounts.

Let's take a walk down memory lane. Think real hard. Remember the good old days when patients came to your office, you diagnosed their illnesses, and you prescribed courses of treatment that your training and experience told you were necessary? Either patients paid you directly or you billed their insurance companies. And, if you decided hospitalization was needed, your patients stayed there until you decided they were well enough to go home. You and your patients made the necessary decisions.

Financing, Personal↗
PubMedDate not supplied

The Medicare Catastrophic Coverage Act of 1988 and its impact on employer-sponsored retiree medical plans.

The Medicare Catastrophic Coverage Act of 1988 (MECCA) significantly enlarges the scope of federally funded health care benefits for elderly Americans. Since Medicare's inception in 1965, several inadequacies have become apparent, especially the absence of coverage for catastrophic illnesses. Now MECCA inhibits the potential financial ruin of elderly Americans faced with overwhelming, extended medical costs. The Act is budget-neutral and can reduce employers' Social Security payroll tax costs. However, the costs and complications of the maintenance-of-effort provision refunds and potential employee resistance to raised Medicare premiums, which could force some beneficiaries to cancel Part B participation and increase reliance on employer-sponsored plans, do pose problems for employers. Options and alternatives to these new opportunities and concerns are detailed herein.

Aged↗
PubMed2004

Implementation of the diagnosis procedure combination in specific-function hospitals.

A Nobel medical payment system, the Diagnosis Procedure Combination (DPC), was implemented in Nippon Medical School Hospital and 81 other specific-function hospitals in 2003. This payment system depends on the length of hospital stay and diagnosis and medical procedures, and differs from the existing payment system, which depends on a piece rate. The daily payment differs for among almost 2,500 groups of DPC defined by the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and procedures, such as operations (K and J codes of the existing payment system). One of the most important outcomes may be a decrease in lengths of hospital stay, because the range of mean lengths of stay in specific-function hospitals has been officially stated to be 14 to 30 days, and the difference between the longest and shortest mean is almost double. The new medical payment system should stimulate competition among hospitals. In order to decrease the length of stay, we developed clinical pathways for patients undergoing surgery, such as laparoscopic cholecystectomy, gastrectomy, and inguinal hernia operations, as well as clinical protocols for the surgical procedures, such as percutaneous transhepatic cholangiodrainage (PTCD) and percutaneous endoscopic gastrostomy (PEG). Health care is undergoing a challenging transition, and we must improve patient care and clinical practice.

Critical Pathways↗
PubMed1978

Assessing the timeliness of ambulatory medical care.

The extent to which individuals receive necessary and timely care (timeliness) is one dimension of the process of care that has received little attention. Timeliness can be viewed as the interaction between patient care-seeking behavior and system accessibility,both of which are expected to influence the effectiveness of medical care. This study examines the provider's assessment of the timeliness of care received in the department of medicine of a prepaid program. Provider judgments are found to be significantly related to the provider's perception of problem severity and to the patient's prognosis. Anaylsis of patient-reported problem status one week later are also found to be related to the timeliness of care. Implications of timeliness assessments for monitoring and improving access and care-seeking behavior are discussed.

Ambulatory Care↗
PubMed2001

Medical savings accounts in Singapore: a critical inquiry.

With the United States currently experimenting with medical savings accounts (MSAs), it is appropriate to revisit the Singapore experience, where the practice has been in place for a decade and half. Singapore runs a modern, effective health system at a fraction of the cost of most systems operating in the developed West. Although MSAs contribute to the framework of a cultural rhetoric of personal responsibility for health care, this article argues that the heart of the Singapore system of health funding, with its financial discipline, is government control of inputs and outputs and strict rationing of health services according to wealth.

Cost Control↗