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At least 289 records · Page 16Linked to original sources
PubMed1986

Psychosocial aspects of prolonged ventilator dependency.

Placement of the ventilator-dependent patient must take into consideration the psychosocial aspects of the situation. These include the patient's age, level of emotional and cognitive function, financial status, insurance benefits, cultural and personal-experience influences regarding life-threatening illness and institutionalization, and the availability of suitable caregivers. The hospital provides the greatest physical security but is expensive and allows minimal patient autonomy and family involvement. A nursing home is homier and less expensive, but it must have a staff well trained in the complex care of these patients and someone to oversee execution of the care plan, and its cost may not be adequately reimbursed by private insurance. Home care usually provides the best conditions for the patient, but it requires trained and available health professionals; a committed physician; education of the patient, family, and attendants; a suitable residence; a system for delivery and maintenance of supplies and equipment; and dependable financing; and it must allow the patient increased independence, socialization, and activities of daily living. Ventilator-dependent patients commonly experience fear, feelings of total dependency, and even degradation. Caregivers can relieve these feelings by reassuring the patient about safety measures, by keeping him informed about medical procedures, and by establishing communication.

Home Care Services↗
PubMed2005

Quality based social insurance coverage and payment of the application of a high cost medical therapy: the case of spinal cord stimulation for chronic non-oncologic pain in The Netherlands.

This article describes a project in which a national continuous quality improvement system and a payment scheme were explicitly linked, while introducing an expensive treatment (Spinal Cord Stimulation (SCS)) in the social health insurance benefit package, in The Netherlands. By linking a national CQI system and a payment scheme in a conditional financing policy a steering instrument for future control of the quality of neuromodulation treatment through SCS is created.

Electric Stimulation Therapy↗
PubMed1997

The poor pay more: health-related inequality in Thailand.

This paper examines the equality of utilization for equal need and equity of out-of-pocket expenditure for health services in a large urban area in Thailand. Data from a household health interview survey were used to explore patterns of perceived morbidity, utilization of various treatment sources, and out-of-pocket payment. Financial access to health care, as reflected in medical benefit/ insurance cover, appeared to influence reported illness and hospitalization rates. Gross lack of access to health care amongst lower socio-economic groups was not the main problem in this densely populated urban area because people could choose and use alternative health services according to their ability and willingness to pay. The corollary, however, was an inequitable pattern of out-of-pocket health expenditure by income quintile and per capita. The underprivileged were more likely to pay out of their own pocket for their health problems, and to pay out of proportion to their household income when compared with more privileged groups. Furthermore, the underprivileged were least likely to be covered by government health benefit schemes, in contrast in particular to civil servants, who paid less out of pocket and did not contribute to their medical benefit fund. The private health sector (private clinics and private hospitals) was the major provider of health care to urban dwellers for both outpatient and inpatient services. Policy options for the short and long term to improve the equity of payment systems for health care are discussed.

Financing, Personal↗
PubMed2002

Pilot study of enhanced tobacco-cessation services coverage for low-income smokers.

This study explored the feasibility of covering nicotine replacement therapy (NRT) and paying for pharmacist-delivered smoking cessation counseling at the time of NRT pick-up for low-income, managed Medicaid and Basic Health Plan (a state insurance program) enrollees. A prospective pilot intervention was used at two community health centers (CHCs) and two community pharmacies. Participants were adult managed-Medicaid or Basic Health Plan enrollees who attended the pilot CHCs and smoked. An innovative insurance benefit that included coverage for NRT and $15 payment to the pharmacist to deliver cessation counseling with each prescription fill. Proportion of eligible patients who used the cessation benefit and patient and pharmacist satisfaction with the intervention. During the 9-month intervention, 32 patients at the pilot clinics were referred for NRT and pharmacist-delivered counseling. This number represented roughly 5% of eligible smokers. Of these, 26 received NRT with concomitant pharmacist-delivered cessation counseling at least once. Recipients reported a high level of satisfaction with this intervention. Pharmacists indicated they would continue providing counseling if reimbursement remained adequate and if counseling lasted no longer than 5-10 min. However, 12 (38%) who were referred were no longer insured by the sponsoring plan by the end of the 9-month pilot period. Pharmacist-delivered cessation counseling may be feasible and merits further study. More importantly, this pilot reveals two key obstacles in our low-income, culturally diverse setting: low participation and rapid turnover of insureds. Future interventions will need to address these barriers.

Adolescent↗
PubMed2001

State SCHIP design and the right to coverage.

This Policy Brief is the first in a series of reports examining the design of state SCHIP programs as they near full implementation status. It explores, whether states in their enabling legislation establishing separate SCHIP programs confer upon eligible children an individual legal right to health insurance benefits (i.e., an individual entitlement) under state law, similar to the entitlement that Medicaid eligible children enjoy under federal law. The question of whether states guarantee necessary health coverage for low-income children through the creation of an individual entitlement is fundamental to the study of state policy making under SCHIP.

Child↗
PubMed1986

The proof in law of suicide.

The certification of suicide as the manner of death is frequently contested in court by the victim's survivors, particularly when there are life insurance benefits at stake. The evidence upon which the opinion of suicide is based must, therefore, meet the standard of proof required in law, if it is to be sustained by the courts. This standard of proof and some of its contingent common law doctrines are discussed, with references to several judicial opinions from cases which involved contested suicides.

Coroners and Medical Examiners↗
PubMed1984

Prevention and health promotion in primary care: baseline results on physicians from the INSURE Project on Lifecycle Preventive Health Services.

The INSURE Project on Lifecycle Preventive Health Services is a 3-year feasibility study to develop and test a clinical model of preventive health services, including patient education, in primary medical care as an insurance benefit. Seventy-four primary care physicians in group practices were surveyed regarding their baseline attitudes toward, and practice of, preventive services. Physicians report that they tend to be conscientious in educating their patients about their health risks, although they spend little time in patient education. Physicians are not sanguine about their success in getting their patients to follow their recommendations and tend to harbor doubts about their own efficacy in these areas. Specialty differences exist in these parameters. Physicians evidence contradictory attitudes about prevention. They believe doctors should spend more time providing preventive services but also believe that the lack of insurance reimbursement is an obstacle to providing these services. The concept of structural or sociological ambivalence is advanced to explain this pattern.

Adult↗
PubMed1984

The impact of third-party payment cutbacks on the private practice of psychiatry: three surveys.

Recent cutbacks in private insurance benefits and publicly funded health programs are threatening the access of Americans, particularly the poor and the disabled, to private psychiatric care. The authors present the findings of three surveys that assessed the impact of threatened or actual cuts in third-party payments on the treatment provided by private practitioners. One survey indicated that, contrary to popular opinion, more than half of the psychiatrists in Northern California see severely disturbed Medicaid patients and that they provide outpatient psychiatric services to them for less cost than would public clinics. Two surveys conducted in the Washington, D.C., area indicated that both patients and psychiatrists have suffered from insurance cutbacks, with fewer patients being able to afford intensive private treatment and psychiatrists using reduced fees and less optimal treatment modalities. The fiscal and ethical dilemma posed by the cutbacks and further research needs are also explored.

Affective Disorders, Psychotic↗
PubMed1988

The clinical consequences of payment limitations: the experience of a private psychiatric hospital.

In the search for cost efficiency, psychiatric patients are experiencing greater restrictions on their insurance benefits. Managed psychiatric care may provide a useful alternative to arbitrary benefit limits, but may also interfere with treatment, especially if there is a disagreement between the manager and the responsible clinician. Three clinical vignettes are presented and the implications of possible premature discharge described as a first step in building a research agenda on the clinical consequences of managed psychiatric care.

Baltimore↗
PubMed1994

Blending reform of tort liability and health insurance: a necessary mix.

The thesis of this Article is that making more health insurance benefits available to more people, far from lessening injury victims' proclivity to sue in tort (as conventional wisdom argues), will increase such suits. Thus, it is necessary to accompany any increases in health care coverage with the type of tort reform proposed herein. This reform would allow parties to opt out of the cumbersome and expensive tort claim process with its compensation of noneconomic losses by substituting quicker and surer compensation of any unmet economic losses.

Cost Allocation↗
PubMed2006

Detecting malingering of Ganser-like symptoms with tests: a case study.

A middle-aged man presented with Ganser symptoms. He had been involved in a car crash and was seeking disability insurance benefits. Extensive testing with malinger instruments revealed that he performed below chance on simple memory tests and endorsed a variety of nonexistent symptoms. With this in mind, the authors collected collateral information which showed that the patient was involved in high level sports activities that were difficult to reconcile with the severe cognitive dysfunctions that he claimed to suffer from. The case demonstrates that Ganser-like symptoms deserve close scrutiny, preferably with malinger tests.

Accidents, Traffic↗
PubMed2003

Neonatology and emerging trends in health insurance.

As the cost of healthcare rises, the employers who finance health insurance benefits plans are demanding increased accountability and effectiveness in the management of costly care, such as that delivered in the neonatal intensive care unit. Neonatologists are under increased scrutiny by third-party payors. They should also expect to see closer case management, downgraded reimbursement according to standardized tools for assessing level of care, and closer evaluation of reimbursement for novel and expensive drugs and technologies. Neonatologists need to become more knowledgeable about how the current crisis in cost for employer-funded health plans may affect their practice.

Community Participation↗
PubMed1990

[High frequency long-term analysis and psychoanalytic practice. Utopia and reality].

On the basis of the prognostic study of psychotherapeutic treatment in the Federal Republic and of the evaluation of more than 1000 applications for insurance benefits submitted in the years from 1973 to 1983, it is suggested that high-frequency long-term analysis is the exception rather than the rule and that it is carried on almost exclusively by a small group of "privileged" therapists. The author asks what this implies for the definition of psychoanalysis and for daily treatment practice. Are therapists being trained for a kind of treatment that they will rarely or never practice? The author urges resumption of the discussion of theory and technique of psychoanalysis in which these questions will be considered.

Cost Control↗
PubMed1999

Industry, occupation, and disability insurance beneficiary work return.

This article uses the New Beneficiary Data System to describe the first job held after award of Disability Insurance benefits, in terms of occupation and industry. It examines work activity within sectors of employment, and looks at the issues of whether work return in certain industries and occupations varies according to the demographic characteristics of the beneficiaries. The article also presents data on sector-specific employer accommodations that can aid in sustained work return. Postentitlement work was fairly evenly distributed across occupational and industrial sectors. Persons with higher levels of educational attainment were found to be in white-collar employment sectors. There were noticeable differences in the availability of employer accommodations across postentitlement occupations and industries.

Adolescent↗
PubMed2002

Who switches from Medigap to Medicare HMOs?

OBJECTIVE: To determine the factors affecting whether Medigap owners switch to Medicare managed care plans. DATA SOURCES: The primary data were the 1993-1996 Medicare Current Beneficiary Survey (MCBS) Cost and Use Files. These were supplemented by data available from the Centers for Medicare & Medicaid Services (CMS) website. STUDY DESIGN: Individuals on the MCBS files with Medigap coverage in the period 1993-1996 were included in the study. The person-year was the unit of analysis. We used multivariate logistic regression analysis to determine whether or not a Medigap owner switched to a Medicare-managed care plan during a particular year. Independent variables included measures of affordability, need for services, health insurance benefits, sociodemographics, and supply of managed care plans. PRINCIPAL FINDINGS: We did not detect strong evidence that beneficiaries in poorer health were more likely than others to switch from Medigap coverage to Medicare-managed care. In addition, higher Medigap premiums did not appear to induce beneficiaries to switch into managed care. CONCLUSIONS: We examined selection bias in joining managed care plans among the subset of Medicare beneficiaries who have Medigap policies. No strong evidence of selection bias was found in this population. We conclude that there was no evidence that the Medigap market is becoming prohibitively expensive as a result of unfavorable selection.

Aged↗
PubMed2004

The demographics and economics of complementary alternative medicine.

Limitations of data in regard to complementary and alternative medicine (CAM) concern the tendency to lump types of CAM into broad areas and the lack of strong scientific evidence. Insurance benefit coverage is limited often to two or three types of CAM and is often consumer driven. Scientific evidence is used to justify noncoverage. Americans still are paying a large portion out-of pocket for CAM. Traditional medicine practitioners may find it difficult to recommend CAM treatments to patients given the cost,concern for quality control, side effects, and quality of scientific evidence.Regardless, consumers will continue to use CAM, particularly in chronic conditions, in which patients struggle to find any treatment that may cure their condition or improve their quality of life. Greater study of CAM is needed to determine efficacy, side effects, and cost-effectiveness of appropriate CAM treatments to increase.

Complementary Therapies↗
PubMed2003

Drivers of healthcare expenditures associated with physician services.

OBJECTIVE: To identify and rank the key contributors to increases in healthcare costs for physician services. STUDY DESIGN: We performed regression analysis using state-level physician cost data from the state health expenditure accounts maintained by the Centers for Medicare and Medicaid Services (CMS) and a national, private (commercial) health insurer. RESULTS: We estimated that during 1990 to 2000, nominal physician expenditures per capita grew 4.7% annually. Forty-two percent of this growth was attributable to general price inflation measured by the gross domestic product price deflator. The category of general economic variables and demographics was the next largest contributor to growth at 17%, followed by physician supply and provider structure (12%) and technology and treatment patterns (11%). Operating costs, health status, healthcare regulation, and health insurance benefit and product design comprised the remaining 18% of the growth. CONCLUSIONS: Because physicians are central to the healthcare system in the United States, efforts to contain physician spending reverberate through all healthcare services. The combined effect of an increase in the number and proportion of specialty care physicians, the continued development of clinical approaches for the control of chronic disease, and an aging population requiring intensive medical care imply that the current increase in healthcare expenditures could continue unabated, unless effective cost-control devices are deployed. To be effective, emerging strategies for influencing the affordability of healthcare services are likely to require a greater level of partnership between payers, providers, and other stakeholders.

Adolescent↗