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PubMed1992

How much insurance is enough? What to look for in a long term care insurance policy.

LTC insurance is a valuable financial tool to help pay for pending LTC. However, LTC insurance is not for everyone. For those who could benefit from a policy, questions arise as to how much to buy and what consumer options to purchase in a policy. Insurance is most appropriate for couples with assets of $110,000 or more, excluding their house, car, and personal belongings. Single persons with a need to protect assets should have at least $40,000 in assets. These individuals have smaller need for LTC insurance to protect assets for their children. How much insurance to buy depends on the cost of LTC and the financial resources of the person. Premiums for LTC insurance are level. A company cannot raise the premiums for an individual, but may request an increase for a class of people. With the potential that premiums may increase and that buying power of income may decline, the policy should be affordable both at time of purchase and in future. Policies pay a specified benefit amount for a specified benefit period. In deciding how much insurance to buy, it is advisable to buy a higher benefit amount for a shorter benefit period. This provides the greatest likelihood of receiving the policy's maximum benefit. The deductible amount should be between 20 and 100 days. In selecting a policy, the most important criterion is the company itself.(ABSTRACT TRUNCATED AT 250 WORDS)

Decision Making↗
PubMed2000

'If you pay, we'll operate immediately'.

OBJECTIVES: To study the attitudes of health care staff in four postcommunist countries towards taking gifts from their clients--and their confessed experience of actually taking such gifts. DESIGN: Survey questionnaire administered to officials including health care staff, supplemented by focus-group discussions with the general public. SETTING: Ukraine, Bulgaria, Slovakia and the Czech Republic. PARTICIPANTS: A quota sample of 1,307 officials including 292 health care staff, supplemented by stratified national random samples of 4,778 ordinary members of the public and in-depth interviews or focus-group discussions involving another 323. MAIN MEASUREMENTS: Explicit justifications and willingness to accept offers, reported frequency of offers, and personal confessions to accepting "money and expensive presents" as well as smaller gifts. RESULTS: Health care staff were far more inclined than the average official or public servant to accept "money or an expensive present" if offered, far more inclined to justify asking clients for "extra payments", and far more inclined to confess that they had actually taken gifts from clients recently. Judged by their own confessions, hospital doctors were only rivalled by traffic police and customs officials for taking money or expensive gifts from their clients. CONCLUSIONS: Poor pay does not explain why doctors so often took large gifts from their clients. Moral self justification, opportunity, and bargaining power are much more effective explanations.

Attitude of Health Personnel↗
PubMed1987

Family out-of-pocket expenditures for health care: United States, 1980.

Information on out-of-pocket health care expenditures for families in 1980 is presented in this report. The data discussed here were gathered through the national household sample of the National Medical Care Utilization and Expenditure Survey (NMCUES). Information for the year 1980 was collected on health problems, health care received, expenditures for care, health insurance, and related topics from approximately 6,800 families in the U.S. civilian, noninstitutionalized population. All individuals who are in institutions or in the military are excluded from this analysis as are all families with military heads of family, even if they have civilian members. For this report, a family was initially defined as: two or more persons living together who were related either by blood, marriage, adoption, or a formal foster care relationship; or as a single person living outside such relationships. Because these data were collected throughout an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time, and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of health care expenditures are calculated in terms of annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals.

Adult↗
PubMed1996

The private costs of HIV/AIDS.

AIM: To identify and, where possible, measure and value the private costs related to HIV/AIDS, that is, those costs that fall on the person with HIV/AIDS and the family/household/informal caregivers. METHOD: Twenty-five people living with HIV - ranging from asymptomatic seropositive people, to people with AIDS - were followed prospectively to obtain information concerning the private costs (broadly defined) incurred. The participants resided in the Auckland, Hamilton, Wellington and Christchurch areas. RESULTS: Private direct costs rise steeply as the illness progresses, from around $100 per month for asymptomatic people to around $400 per month for people with AIDS. Both indirect costs (foregone income) and intangibles (measured by a range of indicators) were also considerable. CONCLUSION: The private costs of HIV/AIDS, defined in terms of direct, indirect and intangible costs, are significant and burdensome. Costing studies which ignore them will conceal, confuse and mislead.

Adult↗
PubMed1999

Faulty judgment, expert opinion, and decision-making capacity.

An assessment of decision-making capacity is the accepted procedure for determining when a person is not competent. An inferential gap exists between the criteria for capacity specific abilities and the legal requirements to understand relevant information and appreciate the consequences of a decision. This gap extends to causal influences on a person's capacity to decide. Using a published case of depression, we illustrate that assessors' uses of diagnostic information is frequently not up to the task of bridging this inferential gap in a justifiable way. We then describe cases of faulty judgement which challenge the understanding of diagnostic causal influences. These cases help to clarify the nature of the expertise required for capacity assessments. In practice, the requirements of decision-making capacity are often abandoned to other considerations due to a lack of requisite expertise. The legal policy supporting decision-making capacity as a means to protective intervention is justified only if the requisite expertise is developed. We propose the requisite expertise to be developed in the long term as a distinct multidisciplinary endeavour.

Beneficence↗
PubMed1993

The influence of hearing aid cost on perceived benefit in older adults.

Self-report hearing handicap scales are gaining widespread acceptance among clinicians as a technique for quantifying hearing aid benefit. Both auditory and nonauditory (e.g., personality, health, motivation) factors contribute to an individual's response to hearing loss and ultimately to perceived hearing aid benefit. Among the recognized extra-audiological variables, financial concerns may influence a hearing aid user's expectations regarding hearing aid benefit. The present study compared self-perceived benefit in 26 insured and 26 uninsured new hearing aid wearers using the Hearing Handicap Inventory for the Elderly (HHIE). HHIE scores at 3 weeks and 6 mo postfitting were equivalent between groups. The findings suggest that the HHIE may be used as an index of hearing aid benefit without concern that the source of funds required to purchase amplification may act as an uncontrolled variable.

Aged↗
PubMed2000

Household spending on health care.

OBJECTIVES: This article examines changes in household spending on health care between 1978 and 1998. It also provides a detailed look at household spending on health care in 1998. DATA SOURCES: Data on household spending are from Statistics Canada's Family Expenditure Survey for survey years between 1978 and 1996, and from the annual Survey of Household Spending for 1997 and 1998. ANALYTICAL TECHNIQUES: Proportion of after-tax spending was calculated by subtracting average personal income taxes from average total expenditures and then dividing health care expenditures by this figure. Per capita spending was calculated by dividing average household spending by average household size. Constant dollar figures and adjustments for inflation were calculated using the Consumer Price Index (1998 = 100) to control for the effect of inflation over time. MAIN RESULTS: Almost every Canadian household (98.2%) reported health care expenditures in 1998, spending an average of close to $1,200, up from around $900 in 1978. In 1998, households dedicated a larger share of their average after-tax spending (2.9%) to health care than they did 20 years earlier (2.3%). Health insurance premiums claimed the largest share (29.8%) of average health care expenditures, followed by dental care, then prescription medications and pharmaceutical products.

Budgets↗
PubMedDate not supplied

[Family expenses caused by pediatric hospitalization in Niamey (Niger)].

In Niger, 54.4% of the population live below the poverty level (less than 750 FF per year per person). The government is currently implementing a policy to reduce medical costs, including those of hospitals. We carried out a study during the rainy and dry seasons of 1994-1995, of 80 children, randomly selected, who had been admitted to the pediatric ward of Niamey National Hospital. The total expenditure of their families, due to their hospitalization, was recorded and analyzed. The total expenses of the family were 151.8 (+/- 100.0) to 185.5 (+/- 118.9) FF depending on where the drugs were purchased (wholesale or private). Medical expenses accounted for 98.0 (+/- 48.3) to 119.8 (+/- 57.2) FF, that is 60.0 to 64.5% of total expenses. Non-medical expenses (transport, food, presents) accounted for 61.7 to 65.7 FF, 35.4 to 39.9%. Total daily expenses were 23 to 41.7 FF for the five main diseases. In 66 cases, the costs were paid by the father (82.5%), with the mother or another person paying in 7 cases (8.8%). Only 24 families (30%) paid the hospital fee (10.5 FF). Twenty-seven families were exempted and 22 avoided payment. The cost of medical analysis was 32.6 (+/- 31.3) FF and this was paid by the hospital. The total cost (total family expenditure + hospital expenditure) of a stay in a pediatric unit was 316.5 to 350.4 FF, which is equivalent to 8 to 10 times the mean annual individual expenditure on health in urban areas of Niger. Measures have already been introduced to encourage the prescription of generic drugs and a number of measures are currently under discussion for lowering the cost to families of hospital and health center care and for improving the cost effectiveness of treatment.

Adolescent↗
PubMed2001

Relationship between life satisfaction and postretirement employment among older women.

Although older persons' engagement in postretirement employment has been perceived to foster successful aging, the relationship between postretirement employment and elders' perceived quality of life has not been empirically tested. This article analyzes the effects of postretirement employment on older women's life satisfaction by comparing those who continued to work or (re)entered the labor market with those who did not engage in paid work after the receipt of their first Social Security benefits. The findings show that postretirement employment in itself does not contribute to older women's life satisfaction, but financial resources and especially the older women's concerns about their own financial situation are potent determinants of their life satisfaction. The need to incorporate the role of financial resources and subjective financial satisfaction in the theoretical framework for elders' perceived quality of life is discussed.

Aged↗
PubMed1997

Asset and Health Dynamics Among the Oldest Old: an overview of the AHEAD Study.

This chapter provides background information for the study of Asset and Health Dynamics Among the Oldest Old (AHEAD), a prospective panel survey of persons born in 1923 or earlier who were residing in the community at the time of the 1993 baseline. Interviews were sought with both spouses in married households, and an overall total of 8,222 were completed. We review the interdisciplinary scientific issues that motivated the study, describe the fundamental design decisions that structured AHEAD, and summarize the content in the core and experimental modules. The study provides unusually detailed data on cognition, family structure and transfers, and assets. Data are presented on sample selections, response rates, and oversamples of minority groups. Basic descriptive data on the demographic, health, and socioeconomic attributes of respondents also are presented. Plans for future waves of AHEAD are described, including a next-of-kin interview for decreased respondents.

Aged↗
PubMed2005

[Willingness to pay for ecosystem services of urban river in Shanghai].

The contingent valuation method (CVM) is one of the most dominating and standard techniques for eliciting the willingness to pay (WTP) for the ecosystem services provided by environment and resources. Taking Zhangjiabang Creek, a model project in the comprehensive management of urban river in China, as a case study, 800 payment card CVM questionnaires were surveyed and 646 as useful questionnaires were feed back in August 2003, then, the mean WTP, 195.07 - 253.04 Yen per person every year in the future 3 years, to the ecosystem services of the urban river was got in the payment card CVM study, and the figure was compared to some other river CVM studies. Distribution shape and range of WTP were probed, and the regression relationship between respondents WTP and their socioeconomic information such as income, education level, donation experience, and environmental attitude was discussed, what's important, an environmental economics explanation was given to the regression results. Some biases which influence the mean WTP of payment card CVM are inspected and corresponding countermeasures were seriously noticed and implemented in the survey. Finally the critiques and controversies that CVM is faced with were advanced, but the reliability of CVM is also given based upon environmental decision-making theory.

China↗
PubMedDate not supplied

Who chooses prepaid medical care: Survey results from two marketings of three new prepayment plans.

Employees joining or not joining three newly marketed prepayment plans were surveyed during the first marketing period and during another open enrollment period 18 months later. In the 1973 survey the respondents were 149 subscribers (family contracts covering 568 persons) to the new plans and 224 nonjoiners (a total of 802 persons in their families)--all employees of Rochester's largest industry. In the 1975 survey the respondents were employees of several companies. They included 326 joiner families (1,101 persons) and 145 nonjoiner families (483 persons). There were no significant differences in previous out-of-pocket health expenditures between joiners and nonjoiners. Their self-reported health ratings did not differ; disability over the last 2 weeks was about the same. Physician utilization rates and inpatient rates were similar, except for the spouses of subscribers to one plan. However, the joiners were younger, had lived in Rochester for a shorter period, and had made less use of physicians in private practice. The three prepayment plans appealed to different population groups. The Network joiners were young, low-income families, mostly from the city. The Group Health joiners were young families with few children who especially valued availability, accessibility, and comprehensiveness. Health Watch joiners were older couples who preferred to use the traditional avenues to health care.

Adult↗
PubMed2007

Economic expenditures associated with instrumental caregiving roles of adult siblings of persons with severe mental illness.

Siblings of persons with mental illness who assume primary caregiving roles experience substantial and tangible economic impacts associated with this responsibility. This study investigated mailed survey responses collected from 156 adult siblings of persons with mental illness from New York State to examine instrumental costs associated with providing support to siblings with illness. Genders of both siblings, severity of the relatives' mental illness, and number of surviving parents in the family distinguished those occupying primary caregiving responsibility from those not in primary roles. Current caregivers incurred greater instrumental costs in the form of financial expenses, time spent in care activities, and crisis involvement than did those who were not primary care providers. Additional demographic and behavioral factors related to siblings with and without illness were associated with specific dimensions of instrumental expenditure. As siblings become increasingly engaged in caregiving, social service professionals must assume leadership in promoting programs and policies that meaningfully support family involvement for relatives with mental illness.

Activities of Daily Living↗
PubMed1999

Insurance coverage for prescription drugs: effects on use and expenditures in the Medicare population.

BACKGROUND: Although most of the elderly are covered by Medicare, they potentially face large out-of-pocket costs for their health care because of excluded services. Aside from nursing home care, the exclusion of prescription drugs is one of the most significant. Several earlier policy initiatives have proposed adding prescription drug coverage to the Medicare program. To determine the effects of such an expansion, one must account for the potential increase in the demand for prescription drugs from providing insurance coverage. METHODS: The study uses a new data source, the RAND Elderly Health Supplement to the 1990 Panel Study of Income Dynamics (PSID). The endogenity of insurance coverage is tested using instruments that exploit the longitudinal nature of the data. Equations are estimated on 910 persons (> or = 66 years) using a two-part model. RESULTS: Insurance coverage for prescription drugs significantly increases the probability of use, but not of total expenditures, among those who use prescription drugs. However, insurance coverage significantly lowers out-of-pocket expenditures, thereby decreasing the financial burden on elderly households associated with prescription drug use. Medicaid coverage has effects that are smaller than those for private insurance, but the magnitude is less precisely estimated. These findings imply that if prescription drug coverage were added to Medicare, expected expenditures on drugs would rise by on average $83 for each elderly Medicare beneficiary (in 1990 dollars), although this increase is significant only at the 90% level. If the benefit had been included under Medicare, expected spending on prescription drugs by the elderly would have risen by approximately 20%, or $2.6 billion in 1990.

Aged↗
PubMed1981

Protecting the personal funds of the mentally retarded: new federal regulations.

In July 1980 the federal government established new requirements for protecting the personal funds of residents of intermediate care facilities for the mentally retarded. The regulations grew out of dissatisfaction with state laws and with the Department of Health and Human Services' earlier regulations governing facilities receiving Medicare and Medicaid funds, and were a response to the Medicare-Medicaid Anti-Fraud and Abuse Amendments of 1977. The new regulations give patients the choice of managing their own financial affairs, appointing a representative to manage them, or authorizing the facility to hold, safeguard, and account for their funds. Facilities' responsibilities include informing residents of their rights and obligations concerning their funds, keeping records of all transactions involving funds held for residents, allowing residents or representatives reasonable access to funds and records, keeping residents' and institutional monies separate, and using existing agencies such as public guardians' offices to address the cases of incompetent residents who lack representatives. HHS has assigned primary enforcement responsibility to state Medicaid agencies.

Financial Management↗
PubMed2002

Entrepreneurial "mining" of the dying: viatical transactions, tax strategies and mind games.

Conceptually, entrepreneurship is seen as the engine that drives a robust economy, promotes a favorable quality of life, and assures the availability of the attributes needed for meaningful living. However, like many popular concepts in this world, its limitations are normally not well acknowledged. A grouping of entrepreneurial ventures which as recently come into existence deals with the personal fiscal issues associated with the end-of-life phase of the human cycle. While generally praised as humanitarian services for society, that are assuredly within legal bounds, these activities have potentially significant negative implications. When examined from an ethical perspective, some questionable practices became apparent. Three such undertakings in particular have to do with the terminally ill and are examined in this paper. The first, viatical transactions, is defined as the transfer of a life insurance policy's ownership to someone who does not have an insurable interest in the life of the insured individual. The second, creative tax shelters for wealthy people involved in estate planning, involves hiring unrelated parties, particularly those who are young and in failing health, to do the dying for the principal. The third, mind games, involves curtailing the use of medical resources for the dying. The justification for this is rationing scarce medical resources.

Aged↗
PubMed1975

Cost-sharing and prior authorization effects on Medicaid services in California: part I. The beneficiaries' reactions.

In January 1972, California initiated a cost-sharing "experiment" as a means of containing rising costs of the Medicaid program. Beneficiaries who had some personal assets were required to pay a token amount for each doctor visit or prescription. This was expected to deter unnecessary services without affecting really needed care. An interview survey was made of beneficiaries continuously in copayment status throughout the 18 months of the experiment. Most beneficiaries had poor knowledge of the program, and tended to confuse copayment with the concurrent constraint of prior authorization for certain classes of service. The beneficiaries reported that the copayment was almost always collected, and most thought it had not affected their health care, but a significant 17 per cent throught it had reduced the care available to them, and these 17 per cent were for the most part in households with high medical need.

Aged↗
PubMed2001

Can I afford free treatment?: Perceived consequences of health care provider choices among people with tuberculosis in Ho Chi Minh City, Vietnam.

Vietnam has a well-organised National TB Control Programme (NTP) with outstanding treatment results. Excellent prospect of cure is provided free of charge. Still, some people prefer to pay for their TB treatment themselves in private clinics. This is a potential threat to TB control since no notification of cases treated in the private sector occurs, and there is no control of the effectiveness of treatment provided in private clinics. Using a qualitative approach within a grounded theory framework, this study explores health-seeking behaviour among people with TB, applying a specific focus on reasons for choices of private versus pubic health care providers. The study identifies a number of characteristics of private TB care, which both seem attractive to patients and at the same time contrast sharply with the structure of the NTP strategy. These include flexible diagnostic procedures, no administrative procedures to establish eligibility for treatment, flexible choices of drug regimens, non-supervised treatment (no DOT), no tracing of defaulters in the household, no official registration of TB cases and thus less threat to personal integrity. A possibility to demand individualised service through the use of fee-for-service payments directly to physicians also seems attractive to many patients. A number of the components of the NTP strategy that have been put in place in order to secure optimal public health outcomes are lacking in the private sector. A dilemma for TB control is that this seems to be an important reason for why many people with TB opt for private providers where quality of care is virtually uncontrolled. The global threat of TB has led to calls for forceful measures to control TB. However, based on the findings in this study it is argued that the use of rigid approaches to TB control that do not encompass a strong component of responsiveness towards the needs of individuals may be counterproductive for public health.

Anecdotes as Topic↗