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PubMedDate not supplied

Does prevention of cardiovascular diseases lead to decreased cost of illness? Twenty years of experience from Finland.

BACKGROUND: During the past 20 years the age-standardized cardiovascular disease mortality rate has declined in Finland by 50%. The aim of this study was to examine the social cost consequences of this decline. METHODS: The prevalence-based cost-of-illness analysis was applied to estimate both direct and indirect costs of cardiovascular disease in 5-year intervals from 1972 to 1992 (in 1992 prices). Summary data from the national registers covered all persons with cardiovascular disease who were treated, received sickness insurance benefits, or died from the disease. RESULTS: Direct health care costs increased, but the decline in indirect costs overcompensated that increase. The total cost among all persons age 35 and over, including the retired, was $2.7 billion in 1972 and $2.6 billion in 1992, which is a 4% decrease. In the age group of 35-64 years the total costs fell from $2.5 billion to $1.9 billion (25%). In terms of cost per capita the decline was 26 and 40% in the respective age groups. CONCLUSIONS: The costs of cardiovascular disease decreased since 1972. However, total costs declined clearly less than the cardiovascular disease mortality rate. This implies that considerable savings in total costs, especially in direct health care costs, may not be expected as a result of even very successful prevention programs.

Adult↗
PubMed1994

Chronic pain--the end of the welfare state?

The problem of low back pain has reached epidemic proportions in the industrialized nations. The predicament of back pain is common, 30-40% of our populations from 10-65 years old report such trouble to occur on a monthly basis. In 1-8% this results in work-disabling back pain. Only in very few of these patients can physicians diagnose a definite pathoanatomical cause for the pain. It can be deduced that psychosocial factors, including insurance benefits are of importance for this variation. Sweden, with 100% sickness benefits, has the highest disability rate. Few non-surgical methods have proven effective in rendering the patient better for him to return to work. Even fewer studies demonstrate any benefit from surgery, simple open removal of a proven disc hernia being the only exception. For patients with unproven diagnostic labels such as facet arthritis, degenerative disc disease, internal disc resorption and instability, no evidence exists that any type of surgery is cost-effective. More attention must be paid to illness behaviour by anyone treating chronic low back pain syndromes (> 3 months). Such psychological reactions to an originally nociceptive pain stimulus somewhere in the motion segment, must be elucidated and addressed, before embarking on risky and expensive treatment modalities including surgery. It is time for all of us, politicians as well as physicians, to distinguish what types of support will contribute to our nations' future and which ones will undermine it. Our welfare systems are at stake.

Chronic Disease↗
PubMed1992

A survey of state insurance mandates covering alcohol and other drug treatment.

This article reports the results of a survey of health insurance mandate legislation for alcohol and other drug treatment in the 50 states through spring 1991. A total of 23 states (including the District of Columbia) requires insurance carriers to provide coverage for alcohol and other drug treatment. This paper compares the provisions in these states at the present time and contrasts these provisions with those in effect in 1981. The paper concludes with a discussion of the policy objectives states pursue through enactment of such legislation and the outcomes brought about by the mandates.

Alcoholism↗
PubMed1992

Financing a national health insurance.

Financing national health insurance is a topic that has been discussed for a long time in the United States. It is also of relevance for less developed countries, in particular in the Far East where some countries have just introduced or are on the brink of introducing national health insurance. Furthermore, there is an urgent need to consult those former socialist countries wishing to introduce a national health insurance system. The paper deals with basic principles of health insurance and specific elements of a (compulsory) social health insurance in detail.

Financing, Organized↗
PubMed1988

Medico-economic implications of industrial hand injuries in India.

625 five consecutive cases of industrial hand injuries attending the Employee's State Insurance Hospital, Jaipur, have been studied from 1983 to October 1986. The incidence of injuries was 36 per 10,000 workers per year. 47% were due to entrapment of the hand in active machines, 25% occurred during lifting and transportation of heavy objects and 12% while handling tools. The injuries resulted in residual deficit in 55% of cases and were serious enough to require absence from work of more than four weeks in 48% of cases. On an average 35 days were lost per injured worker. The average economic loss per injured worker was Rs. 6900 (approximately pounds 275) for workers in the wage-range of Rs. 5400 to 19,200 (pounds 216 to pounds 768) per annum.

Accidents, Occupational↗
PubMed1996

Pooling public and private funds in the patient's interest: the case for long-term care insurance.

Although the extent of medical care in France may be thought adequate, the same does not apply to the social medicine sector. The Assurance-maladie paid 87.7% of hospital health expenditure in 1994, whereas direct funding of home assistance amounted to only 9%. In contrast, a recent Legos study (Bungener M. et al. Le bilan économique et financier du secteur médico social, Université de Paris IX, Legos, Janvier 1994) [1] estimated that home assistance costs represent 41-50% of medical-social expenditure. When people are unable to manage because of the high costs of their invalidity, the social security system comes to their assistance, although only under Draconian conditions involving compulsory "family support commitments" and the state's claim on the inheritance of the beneficiary (total costs for hospital admission and boarding and the dual limits of 1000F liabilities and 250,000F net assets for home assistance). The elderly well appreciate the severity of this problem and are deeply distressed by the thought of dependency. Many, however, live under the illusion that the social security system or, to a lesser extent, the mutual funds will come to their assistance, although the problems involved lie partly outside their remits. We therefore need to design new systems to allow the elderly to finance their costs should they become dependant.

Aged↗
PubMedDate not supplied

The German health care system: structure and changes.

The German health care system has often been viewed by American policy makers as a model for a system that controls costs and provides coverage to virtually all of its citizens, while maintaining a private market for the delivery of most services. Nevertheless, German policy makers are as concerned as their American counterparts about the increasing share of national income devoted to health care. To control rising health care costs, the German government, after two decades of cost control interventions, has enacted a major health care reform aimed at reducing structural deficits of the current system and enhancing competition within the system. We review the general structure of the German health care system and analyze its specific problems. We also discuss its accomplishments and present the recently enacted health care reform.

Ambulatory Care↗
PubMed2004

Factors influencing the costs of workers' compensation.

This article presents several factors believed to have shaped the costs of workers' compensation. Of these factors, the most notable influence on claims severity is related to the way medical care is delivered to treat occupational injuries and illnesses. Although medical care providers may have some influence on the other factors responsible for increased claims severity, such as attorney costs and differences in state workers' compensation laws, they have a tremendous impact on the way medical care is delivered and its resultant costs. This places physicians, nurse practitioners,physical therapists, chiropractors, nurses, and physician assistants in a unique role of being able to assist US business in improving productivity through a reduction in workers' compensation costs.

Age Factors↗
PubMed2004

The art of directing a workers' compensation claim: personal observations on the role of the workers' compensation claim adjuster.

Workers' compensation claims are becoming more complex and expensive every day. One of the contributing factors for the increase is the aging workforce as well as federal legislation such as the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA). The workforce is aging, mobile, and educated about their rights. The key to avoiding spiraling costs is a strong safety and claims program that is sponsored by senior management,valued by the employees, and implemented by the entire company.

Eligibility Determination↗
PubMed2006

Financial burden of tobacco use: an employer's perspective.

To assist in determining whether employer-sponsored smoking cessation programs can be justified on cost-effectiveness grounds, a review was performed to examine the costs imposed on employers by smoking and the extent to which employers can recover those costs through successful smoking cessation programs. The magnitude of the costs (or cost savings) imposed by employee tobacco use depends on workplace factors, including medical coverage (before and after retirement), disability and life insurance benefits, level of exposure to workplace pollutants associated with smoking-related diseases, employee turnover rate, current smoke-free area policy, smoking breaks policy, cost of providing smoking areas, and type of retirement pension plan.

Air Pollution, Indoor↗
PubMed2005

Work-related hand injuries in Ontario: an historical perspective.

Worker's compensation legislation was enacted in Ontario almost 90 years ago. Workers injured on the job gave up their right to sue employers and received no-fault compensation from an independent, employer-funded body called the Workmen's Compensation Board. Three academic health sciences centers in Ontario that are recognized for their commitment to patient care, research, and education compose part of the Specialty Program network with the Ontario Workplace Safety and Insurance Board (WSIB). Statistical data from the WSIB database for workers with hand injuries from 1996 to 2003 show an increase in fractures from fall injuries in the group of women older than 60 that may be related to osteoporosis, a common condition in this group.

Accidents, Occupational↗
PubMed2005

The relationship between HAART use and employment for HIV-positive individuals: an empirical analysis and policy outlook.

OBJECTIVE: This study jointly analyzes the determinants of the use of highly active antiretroviral therapy (HAART) along with the determinants of employment status for human immunodeficiency virus (HIV)-positive individuals. METHODS: Data from the HIV Cost and Services Utilization Study (HCSUS) were analyzed using a bivariate probit model. HSCUS collected data on 2864 individuals in 180 clinics, hospitals and private practices in 28 urban areas and 24 clusters of rural counties in the United States. We used data from the baseline interview to categorize individuals as employed or unemployed and for the determination of HAART use. RESULTS: The empirical results suggest that individuals taking HAART have an increased likelihood of working and that individuals with private health insurance are more likely to use HAART compared to individuals with public health insurance coverage or no coverage. CONCLUSIONS: Due to the fact that employment of HIV-positive is directly related to HAART use, policymakers need to look to the private health insurance industry and public program to increase access to HAART. Suggested models for consideration are mandating insurance benefits and ADAP expansion.

Adolescent↗
PubMed2005

The set-up.

Explore the source record for details and available documents.

Aging↗
PubMed2005

State laws on insurance coverage for bariatric surgery: help or a hindrance?

BACKGROUND: The purpose of this study was to determine which states have proposed or passed laws regarding insurance coverage for bariatric surgery and to obtain feedback from bariatric surgeons/programs regarding the effectiveness of these laws. METHODS: The Departments of Insurance in all 50 states and the District of Columbia in the United States and all members of the American Society for Bariatric Surgery were surveyed. RESULTS: Responses were obtained from all states and the District of Columbia, and 16 responses were received from the bariatric surgeons/programs. Michigan law requires all Health Maintenance Organizations to pay for all medically necessary treatments or procedures in general, such that if bariatric surgery can be shown to be medically necessary, it should be covered. Four states (Louisiana, Ohio, South Carolina, and Tennessee) have proposed state laws regarding bariatric surgery coverage, and four states (Georgia, Indiana, Maryland, and Virginia) have such laws in effect. However, none of the state laws that were passed "mandate" coverage, but rather "recommend" coverage or mandate that the insurer offer the coverage, for which the insurer can charge additional premiums. Although the numbers of responses from bariatric surgeons/programs were few, all of their responses were in agreement that the state laws have not increased insurance approvals for bariatric surgery and, in some cases, has made it more difficult to obtain approval. CONCLUSION: So far, the laws that have been passed have not adequately addressed the problems with decreasing coverage of bariatric surgery. Recommendations for future legislation are discussed.

Bariatric Surgery↗
PubMed1995

The role of the rehabilitation physician in the postacute continuum.

Compared to just 10 years ago, the US health care terrain looks much different today. In 1985, hospitals were the hub of a bustling delivery system that focused on acute care services and undervalued primary or preventive care. Health insurance benefits created incentives for consumers to use hospitals where their care was fully reimbursed, and discouraged office visits for which there were hefty copayments. Today, admissions into acute care hospitals are screened by none other than those same primary care physicians. These gatekeepers often have more authority over patient services and referrals than do the specialists and the hospitals. Financial incentives have made a 180 degrees shift, now motivating consumers to use outpatient care and office visits to satisfy the majority of their health care needs. Moreover, there are currently health care providers actively delivering a wide range of treatments and services that were not available or "covered" a decade ago. The migration of treatment out of hospitals into the vast frontier of postacute care has revolutionized our thinking about how patients receive treatment, in what locations, and by whom. This article describes the trends in financing and in clinical innovation that have contributed to the expansion of postacute alternatives. The factors that most clearly contribute to new opportunities facing rehabilitation physicians in postacute care are discussed, as are the added competencies required of those who choose to take a leadership role in the postacute delivery system. A case study of one model "managed care system" where the rehabilitation specialists are driving the care is presented. The future for rehabilitation specialists who are positioned to participate in setting the standards for high-quality postacute and chronic care in a future marketplace dominated by managed care is discussed.

Aged↗