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At least 289 records · Page 16Linked to original sources
PubMed1997

Winners and losers under medical savings accounts.

As legislators wait to see how the MSA approach to health care reform plays out in the laboratory of the states, authors Marilyn Moon, Len M. Nichols and Susan Wall have put the numbers to work. The researchers simulated the effects of introducing MSAs into the health insurance market. What they found is what critics of MSAs suspected: As the young and healthy shift to MSAs, the premiums for those left in the remaining insurance pool will escalate. However, the authors conclude that if you are male, young and healthy, you stand to gain a lot from the MSA experiment.

Cost Sharing↗
PubMed1992

Reoperation and mortality after surgical treatment of benign prostatic hypertrophy in a large prepaid medical care program.

The incidence of reoperation and mortality after prostatectomy was studied in 8,219 men who underwent surgical treatment for benign prostatic hypertrophy between 1976 and 1987 while they were members of the Kaiser Permanente Medical Care Program, Northern California Region. The vast majority (94.5%) received transurethral prostatectomy (TURP). The cumulative 8-year probability of a second prostatectomy was 7.6% after TURP and 2.1% after open prostatectomy. The risk of mortality associated with transurethral prostatectomy relative to open prostatectomy was 1.6 (95% confidence interval 1.2, 2.1) 8 years postsurgery. The increased risk of mortality associated with transurethral prostatectomy was most prominent during the first 5 years postsurgery (relative risk 1.8, 95% confidence interval 1.3, 2.5) and declined to 1.1 (95% confidence interval 0.8, 1.6) for deaths occurring after the first 5 years. The finding of an increased risk of mortality associated with transurethral prostatectomy is consistent with other studies and is unexplained.

Aged↗
PubMed1976

Women and national health insurance: issues and solutions.

An effective national health insurance program should provide adequate, continuous, and comprehensive coverage for all. In framing current proposals, it seems that policy makers have not adequately considered differences in medical care utilization and needs between men and women. The inequities which result occur primarily because women now have two central sources of medical care--an obstetrician/gynecologist and a general practitioner or internist-while men have only one. The article delineates four issues of particular importance to women: 1) eligibility provisions which insure women through their husbands' policies; 2) benefit structures which exclude aspects of reproductive health services and/or fail to explicitly recognize women's two central sources of care; 3) provider certification provisions which exclude free-standing clinics and/or nonphysician personnel, and 4) incentives for reform of health delivery which force women to choose between their two current sources of care. The analysis concludes that current proposals contain provisions which, if enacted, would lead to inequities for women. Alternative solutions which might be explored are discussed and principles which could serve as guidelines for developing specific proposals are presented.

Community Participation↗
PubMed1988

Financing health care for disabled children.

Information about health care use, charges, and out-of-pocket expenses is critical to the development of an equitable and efficient treatment system for disabled children. Data from the 1980 National Medical Care Utilization and Expenditure Survey were used, and differences in use, charges, and out-of-pocket expenses for children with and without limitations in their activities due to chronic health problems are described. The results indicate that children limited in their activities used more medical services than other children, especially hospital-based services and services provided by health professionals other than physicians. Charges and out-of-pocket expenses were two to three times higher on average for disabled children, compared with other children. Charges and out-of-pocket expenses were also skewed; 10% of the sample children accounted for more than 60% of total charges and out-of-pocket expenses for the disabled population. The skewed distribution of out-of-pocket expenses suggests that financial burdens are unevenly shared by families of disabled children. Several public policy options designed to result in a more equitable distribution of financial risks are discussed.

Adolescent↗
PubMed1988

Health care utilization and costs for diseases of the circulatory system in a corporate setting.

This article presents the health care utilization and costs for diseases of the circulatory system among 14,162 employees and their spouses based on medical insurance claims data analysis. Diseases of the circulatory system ranked first among insurance claims and costs accounting for 23% ($4.6 million) of the plan's total health care costs ($19.7 million) for the 1984 policy year. Overall, 57% of these expenditures were for hospital care, the proportion for hospital costs being as high as 64% for heart diseases and as low as 20% for hypertension. Male employees had higher utilization for both in-hospital and out-patient services than females. Utilization rates and costs dramatically increased for individuals 50 years or older. Costs for surgical and diagnostic procedures amounted to 8% of the total costs of circulatory system disorders. This article provides an example of the utility of claims analysis for morbidity surveillance. The analyses and parameters measured herein can be viewed as prerequisites to the development of health care management and health promotion strategies aimed at reducing health care cost for diseases of the circulatory system in a corporate setting.

Adult↗
PubMed2000

Supplemental insurance and mortality in elderly Americans. Findings from a national cohort.

CONTEXT: As the burden of out-of-pocket health care expenditures for Medicare beneficiaries has grown, the need to assess the relationship between uncovered costs and health outcomes has become more pressing. OBJECTIVE: To assess the relationship between risk for out-of-pocket expenditures and mortality in elderly persons with private supplemental insurance. DESIGN: Retrospective cohort study using proportional hazards survival analyses to assess mortality as a function of health insurance, adjusting for sociodemographic, access, and case mix-health status measures. SETTING: The 1987 National Medical Expenditure Survey, a representative cohort of the US civilian population, linked to the National Death Index. PARTICIPANTS: A total of 3751 persons aged 65 years and older. MAIN OUTCOMES MEASURES: Five-year mortality rate. RESULTS: After 5 years, 18.5% of persons at low risk for out-of-pocket expenditures, 22.5% of those at intermediate risk, and 22.6% of those at high risk had died. After multivariate adjustment, a significant linear trend (P = .02) toward increasing mortality with increasing risk category was observed. Compared with the low-risk group, persons in the intermediate-risk group had an adjusted hazard ratio of 1.2 (95% confidence interval, 0.9-1.6), whereas those in the high-risk group had an adjusted hazard ratio of 1.4 (95% confidence interval, 1.0-1.9). CONCLUSIONS: Increasing risk for out-of-pocket costs is associated with higher subsequent mortality among elderly Americans with supplemental private coverage. Although research is needed to identify which specific components of out-of-pocket expenditures are adversely associated with health outcomes, findings support policies to decrease out-of-pocket health care expenditures to reduce the risk for premature mortality in elderly Americans.

Aged↗
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↗
PubMed1998

Health care for all.

Explore the source record for details and available documents.

Costs and Cost Analysis↗
PubMed1979

The relative emphasis upon physician practice and organizational affairs of a consumer council in a prepaid group practice health plan.

This paper examines the topics of interest to a consumer advisory council in the Health Insurance Plan of Greater New York, a prepaid group practice. Data are derived from observations of consumer council meetings. Topics considered by the council dealt with (a) health plan services, (b) health plan structure, and (c) consumer council structure, process, and organizational role. The council was primarily interested in retaining and expanding existing services, facilitating utilization of services by enrollees, and achieving broader enrollee representation on the board of directors. These interests are directed toward the organizational context within which care is provided and do not relate to physician-patient encounters. Individual enrollees in prepaid group practice may be concerned with the physician-client relationship but consumer representatives are concerned only with the organization-client relationship.

Community Participation↗
PubMed2006

[Integrated Health Care in cardiology].

Integrated Health Care forces rethinking of all partners. Health care providers need to cooperate and have to face an emerging competition among themselves. Health insurance companies are no longer the common enemy, but a business partner on an individual basis. Rethinking has already commenced. The Barmer insurance company has initiated a considerable number of similar contracts with respect to Integrated Health Care in cardiology. One of the first contracts was agreed upon at Recklinghausen (it is reported later in this volume) and a couple of them have been concluded in the Berlin/Brandenburg region (which are also reported in this volume).A special feature is the support for the general disease management programs that have been initiated in light of the new laws beginning in 2000. The Barmer company will enroll some 500,000 patients with coronary artery disease in these programs.

Adolescent↗
PubMed2006

[Integrated health care at Bad Krozingen].

This paper reports in detail on a project of Integrated Health Care in cardiology at Bad Krozingen, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.

Cardiology↗
PubMed2006

[Integrated health care at Hamburg].

This paper reports in detail on a project of Integrated Health Care in cardiology at Hamburg, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.

Cardiology↗
PubMed2006

[Integrated health care at Lübeck].

This paper reports on a project of Integrated Health Care in cardiology at Lübeck, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.

Cardiology↗
PubMed2006

[Integrated health care at Recklinghausen].

This paper reports in detail on a project of Integrated Health Care in cardiology at Recklinghausen, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.

Cardiology↗