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PubMed1994

Health care utilization: the effect of extending insurance to adults on Medicaid or uninsured.

Current health care system reform proposals center on reducing the number of uninsured by extending private health insurance coverage. Discussion has also included enrolling Medicaid recipients in private programs. Much of the deliberation concerning extending coverage has centered on cost, but largely has not addressed the implications for health care utilization by these groups. If private insurance is extended to those currently uninsured as well as the Medicaid population, what impact will it have on utilization? Using data from the 1987 National Medical Expenditure Survey, the results of this analysis show that utilization would increase for the uninsured if private insurance benefits were extended, whereas utilization would decrease for those with Medicaid, however, the magnitude of the increase depends on the type of care.

Adult↗
PubMed1998

The association of insurance type with costs of dispensed drugs.

This study examines the association between types of prescription drug insurance coverage and the unit cost of dispensed drugs. Logistic regression and ordinary least squares regression were used to assess differences in the use of brand name and generic drugs and the unit cost of dispensed brand name or generic drugs across four insurance categories: Medicaid, private third party, indemnity, and uninsured. The results show that private third-party and indemnity prescriptions were more likely to be dispensed with brand name drugs. Also, indemnity patients and the uninsured were dispensed brand name and generic drugs with lower unit costs. The findings have ramifications for the design of prescription drug insurance benefits and suggest that physicians may respond to the economic situation of their patients when prescribing drugs.

Cross-Sectional Studies↗
PubMed1984

Insurance plan effects on dental provider treatment patterns for elderly patients. An experimental economics approach.

Three hundred forty-six dentists, randomly selected from the population of Washington State Dental Association members, volunteered to participate in a controlled experiment of treatment planning for elderly patients. Experimental oral health problems were designed that conform to the prevailing actual distribution of dental and related systemic disease among the elderly population of the United States. Each volunteer dentist constructed two treatment plans for the presenting dental problem: 1) a treatment plan to optimize oral health, ignoring the hypothetical patient's financial status and insurance coverage; and 2) a treatment plan given the particular dental insurance plan and patient financial status incorporated in the case. Results suggest that increasingly comprehensive insurance coverage does not necessarily lead to uniform, monotonic increases in total dental expenditures. Rather, the incremental substitution of different services for one another appears to be the dominant effect of increased coverage, with the singular exception of coverage for fixed prosthodontia . The key implication of these findings is that careful design of improved insurance benefit plans for the elderly could widen the range of dental services provided without necessarily increasing total treatment cost.

Aged↗
PubMed1993

Current status of tests for periodontal disease.

The methods applied to the diagnosis of periodontal disease are changing. Historically, static clinical and radiographic parameters have formed the basis of the periodontal evaluation. As the limitations of these traditional procedures became clear, several new techniques have been proposed as diagnostic tests for periodontal disease. These tests are based on improved understanding of the pathogenesis of periodontal disease, and can be considered in three categories: assessment of physical changes in the periodontium, the bacterial infection, and the host response to the infection. Several technical questions must be addressed before these tests can be widely utilized. These specific concerns include such matters as the information available from the tests (e.g., Does the test provide a measure of disease severity or identify the site, region, or patient experiencing active disease?), the most appropriate test configurations, the statistical analysis of data from trials examining the accuracy of the tests, and selection of patients who would benefit from these procedures. Last, several important practical issues must be examined before these tests can be expected to gain widespread acceptance. These include familiarization of dental practitioners with the use of diagnostic tests and the medical laboratory, the role of regulatory agencies in determining the claims made by these tests, and the medical/dental insurance benefits provided for these services.

Antibodies, Bacterial↗
PubMed1986

The insanity defense to suicide.

The certification of suicide as the manner of death can result in either the complete loss or a significant reduction in life insurance benefits to the victim's survivors. It is, thus, not uncommon for these beneficiaries to contest suicide as the manner of death. Insanity is a recognized defense in law against suicide. It is recognized in law that, in some cases, an insane man cannot intentionally destroy himself. However, it is also recognized that life insurers can exclude suicide by an insane man from coverage. This article discusses the common law doctrines upon which the insanity defense to suicide is based, with references to judicial opinions from cases which involve contested suicides and the issue of insanity.

Coroners and Medical Examiners↗
PubMed2006

The use of state workers' compensation administrative data to identify injury scenarios and quantify costs of work-related traumatic brain injuries.

PROBLEM: Traumatic brain injury (TBI) is a public health problem but little is known about the nature of that problem in the working population. METHOD: The author used a national definition to identify cases in Washington State from workers' compensation (WC) hospital billing data, quantified the cost of WC insurance benefits using actuarial cost estimates, and identified high risk industries using ANSI Z16.2 typology. RESULTS: There were 928 cases of TBI with a lifetime claim cost of $159 million from the Washington State Fund (1994-2001). Sixty percent of injuries resulted in death or disability. The highest risks of TBI are concentrated in 16 industrial insurance risk classes and the highest costs in 19 North American Industry Classification codes. Injury scenarios were identified for nine industrial insurance risk classes. CONCLUSIONS: TBI is a disabling and costly workplace injury in the state of Washington, affecting even teenagers and seniors who are not generally considered to be part of the workforce. Injury typology codes provide useful information for improving workplace safety. IMPACT ON INDUSTRY: This research provides industry with quantitative information regarding the cost of work-related traumatic brain injury and the usefulness of using workers' compensation claims data to reduce the burden of workplace injury.

Adult↗
PubMed1997

[Suicide and life insurance. Evaluation of suicide cases].

A retrospective evaluation of 521 life assurance contracts belonging to 468 persons who had committed suicide within the first 3 years of contract was performed. Contract data such as tarif, sum assured and duration do not differ from those of the other customers. Except for a few there were hardly any persons who acquired life assurance under speculative purposes, such as the intention to gain financial advantages for their relatives at the expense of the community of all insured persons by claiming life insurance benefits after suicide. By means of these results, one can easily state that the 3 years' exemption period according to the German rules and regulations for life assurance is an effective barrier against misuse in case of suicide. The incidence of suicide cases among all mortality cases cannot be established due to peculariarities of the German insurance market. Other evaluations were performed as to age, sex and marital status of the persons involved, the point in time when suicide was performed, the methods chosen and possible motives. Psychiatric problems such as depression and addiction can be found in the past medical history of many persons. The criterium of exclusion of free will was found in 14.4 percent of all cases.

Female↗
PubMed1989

Expanding insurance coverage to alternative types of psychotherapists: demand and substitution effects of direct reimbursement to social workers.

When insurance benefits for outpatient psychotherapy are expanded to cover alternative (less expensive) types of providers, lower reimbursements from beneficiaries' use of these providers may offset reimbursement increases attributable to any concomitant increase in demand for services. In this paper, outpatient claims data from Massachusetts Blue Shield for 1979-83 are used to estimate demand and substitution effects of a state mandate of direct reimbursement to social workers, starting April 1, 1982. Empirical results for the first year of the mandate showed that while the percentage of beneficiaries using the benefit did not change from 1981, eligible social workers in the state treated 10% of "new" users of the outpatient benefit and 2% of "continuing" users. While the substitution effect predominated, the particular characteristics of the Massachusetts case limit more general applicability of the results.

Ambulatory Care↗
PubMed1984

Psychological autopsies in court.

The crucial concept for defining suicide is intention. A major purpose of the psychological autopsy is to clarify the pre-mortem intentions of the victim, now deceased. This article reports cases in which the issue of suicide vs. accident came to trial because insurance benefits were at issue. Currently, the courts, in considering to what extent mental disorders impair the capacity for intentional self destruction, evaluate each case independently according to its own unique set of facts.

Adult↗
PubMed2000

What if prospective clients knew how managed care impacts psychologists' practice and ethics? An exploratory study.

Modal responses to items from a recent survey of independent practitioners regarding the impact of managed care on their practices and ethics (Murphy, DeBernardo, & Shoemaker, 1998) were presented to participants as the responses of a hypothetical independent practitioner. Participants were asked to consider seeing this hypothetical practitioner both before and after being informed of the practitioner's responses to the managed care survey. Results indicate that when participants were informed of the practitioner's views toward managed care, their own attitudes toward therapy changed significantly. Specifically, compared to uninformed participants, informed participants were significantly more likely to believe that managed care would have a negative impact on treatment and significantly less likely to see an independent practitioner, use insurance benefits, expect to benefit from treatment, expect to form a strong working relationship, and trust that the practitioner would work in their best interest. Implications regarding ethics and informed consent are discussed.

Attitude of Health Personnel↗
PubMed2004

Linkage with primary medical care in a prospective cohort of adults with addictions in inpatient detoxification: room for improvement.

OBJECTIVE: To identify patient characteristics and health care experiences associated with primary care linkage after alcohol or drug detoxification. DATA SOURCES/STUDY SETTING: Primary data collected over two years. Subjects were adults without primary medical care, in an urban residential detoxification program. STUDY DESIGN: A prospective cohort study in the context of a randomized trial of a linkage intervention, and an expansion of Medicaid benefits. DATA COLLECTION/EXTRACTION METHODS: Data were collected by interview assessment of predisposing, enabling, and illness variables. Linkage was defined as self-report of at least one visit with a primary care clinician during follow-up. PRINCIPAL FINDINGS: Of 400 subjects, 63 percent linked with primary medical care. In a multivariable model adjusting for randomization assignment, predisposing, enabling, and illness variables, women, those with no recent incarceration, those with support for abstinence by family or friends, and those who had visited a medical clinic or physician recently were significantly more likely to link with primary care. Those with health insurance during follow-up were also more likely to link. Recent mental health or addictions treatment utilization and health status were not associated with linkage. CONCLUSIONS: A substantial proportion of adults with addictions do not link with primary medical care. These data suggest that efforts could be focused on those least likely to link, that contacts with mental health and addictions treatment providers are underutilized opportunities for these efforts, and that health policy changes such as expanding health insurance benefits may improve entry of substance-dependent patients into primary medical care.

Adult↗
PubMed2002

Mapping public policy on genetics.

The mapping of the human genome and related advances in genetics are stimulating the development of public policies on genetics. Certain notions that currently prevail in public policy development overall--including the importance of protecting privacy of information, an interest in cost-effectiveness, and the power of the anecdote--will help determine the future of public policy on genetics. Information areas affected include discrimination by insurers and employers, confidentiality, genetic databanks, genetic testing in law enforcement, and court-ordered genetic testing in civil cases. Service issues address clinical standards, insurance benefits, allocation of resources, and screening of populations at risk. Supply issues encompass funding of research and clinical positions. Likely government actions include, among others: (1) Requiring individual consent for the disclosure of personal information, except when such consent would impose inordinate costs; (2) licensing genetic databases; (3) allowing courts to use personal information in cases where a refusal to use such information would offend the public; (4) mandating health insurers to pay for cost-effective genetic services; (5) funding pharmaceutical research to develop tailored products to prevent or treat diseases; and (6) funding training programs.

Attitude↗
PubMed1988

The structure and function of dental-care markets. A review and agenda for research.

The growth of dental health services over the past 15 years has produced several issues in dentistry. Because economic markets are the cornerstone of dental delivery in the US, informed responses to these issues require a thorough understanding of dental-care markets. The empirical literature is reviewed to examine the structure of dental markets, to assess the major determinants of market equilibrium, and to examine the social and health consequences of dental-care markets. Results reveal that while dental markets are imperfectly competitive, it is unclear whether prices exceed competitive levels. Little is known about the effects of dental markets on public oral health and society. Future research is proposed in two broad areas: 1) updating early studies conducted when few Americans had dental insurance benefits; and 2) path-breaking research to advance our knowledge of dental-care markets in particular and medical-care markets in general.

Community Participation↗
PubMed1993

Alcohol and accidents in Switzerland--a critical review.

The analysis of alcohol-related traffic accidents points to a negative relationship between the average amount of alcohol consumed and the percentage of alcohol-related accidents. The data show that the officially registered problem-rates among drivers under the influence of alcohol depend primarily neither on consumption trends nor on general preventive factors, but, rather on the capacity for accident detection, the recording practices of the authorities and a less tolerant public opinion. Regional differences in the willingness to enforce control measures are related to varying cultural drinking contexts. The under-reporting of occupational accidents reflects an undue emphasis in insurance statistics which are based on a guilt/moral concept which is used to justify sanctions, such as cuts in insurance benefits. It is clear from the empirical evidence, that the broad press coverage on 'alcohol-related' ski accidents proves to be a typical case of problem amplification.

Accidents↗
PubMedDate not supplied

Mission-driven marketing: a rural example.

Marketing receives little attention in the academic healthcare management literature, possibly because it is associated with pursuit of profit rather than community benefit. However, a marketing perspective can be applied to the pursuit of the traditional missions of healthcare delivery organizations. Mission-oriented market selection criteria could include characteristics such as relevance to mission, underserved or vulnerable population status, resistance to care, limited resources, and low accessibility. A survey conducted in a rural county is used to demonstrate ways that underserved market segments can be identified and targeted. In the market surveyed, men used less medical care than women; depressed people and those with low levels of education used less medical care than people without these characteristics. Consumers were more likely to defer care because of cost if they lacked health insurance coverage, were female, were under age 55, had fair health status, were depressed, and were chronically ill. Marketing strategies worthy of consideration relate to price (e.g., free care, coupons and sales for eligible individuals), distribution (e.g., visiting nurses, malls and fairs, occupational medicine programs), product (e.g., satisfaction, waiting time, attractiveness, assertive follow-up), and promotion (education about insurance benefits, facilitating development of regular sources of care, health education).

Adult↗
PubMed1999

[Chronic low back pain in 40-year olds in 12 Norwegian counties].

In this study, a questionnaire and a short interview were used to estimate the prevalence of chronic low back pain alone and low back pain together with other musculo-skeletal pains among 40-year-old women and men in 12 Norwegian counties (a total of 67,338 persons). On average 2.4% of men and 1.7% of women had only chronic low back pain, while 5.7% of men and 9.2% of women in addition had other pains as well. Persons with low back pain only were approximately equally distributed across the counties. Greater variations across the counties and between the sexes were found in persons with additional pain. The duration of the pain did not vary significantly between the sexes or across the counties, but the duration was on average two years longer in cases of multi-cause pain. Reduced capacity for work because of pain was approximately equally distributed between the sexes and the groups. More women than men were unable to do their daily work. About one third in both groups (more men than women) had been absent from work because of pain during the last year. More women than men in both groups received national insurance benefits. Persons with only low back pains were approximately equally represented across all levels of education and regardless of marital status, while people with multi-cause pain were overrepresented among those with low levels of education and among the divorced.

Adult↗
PubMedDate not supplied

[Psychosomatic aspects in orthopedic legal assessment].

AIM: Complaints in orthopaedics that are not sufficiently explainable can be caused (partly) by psychosomatic disorders. A manual psychosomatic disorders for legal assessment in orthopaedics will be supplied. METHOD: Diagnoses essential for orthopaedics are classified by DSM-IV and ICD-10 in consideration of the current literature; evaluation was performed under legal assessment criterions. RESULTS: The most important complaints that are often poorly explainable results in musculoskeletal pain. Since a sensorial perception of pain is combined with emotions, emotions and psychic disorders can be perceived as pain. The most important diagnoses for assessing not sufficiently explainable complaints by somatic cause are "somatoform pain disorder", "somatization disorder", "undifferentiated somatoform disorder", "conversion disorder", "hypochondriasis", "body dysmorphic disorder", "maior depression", "dysthymic disorder", "posttraumatic stress disorder", and "adjustment disorder". The relevance of psychosomatic comorbidity in legal assessment is possible in all affairs of civil and social law. Private accident insurances exclude psychic and psychosomatic diseases from all insurance benefits. CONCLUSION: When composing legal assessments in orthopaedics, especially on pain, the knowledge of psychosomatic (co)morbidity is necessary for meeting the different causes of the complaints. Under awareness of possible psychosomatic disorders, additional psychosomatic legal assessments can be recommended and understood as well.

Diagnosis, Differential↗