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At least 343 records · Page 19Linked to original sources
PubMed1992

Return to work of road accident victims claiming compensation for personal injury.

Road accidents resulting in personal injury are an increasing cost to society. This study is based on 609 accident victims (of whom 521 survived injury) who were in employment when injured and whose claims for personal injury were settled for 5000 pounds or more by one insurance company over 2 years. It examines survivors' residual disablement, return to work and involvement with rehabilitation services. Data on a representative sample of 101 cases are analysed in more detail to identify possible 'predictors' of return to work. Both univariate and stepwise logistic regression analysis suggest that return to work is less associated with clinical variables, on which much medical advice on return to work is based, than with such other variables as time off work, absence of psychological problems and younger age. Very low rates of referral to rehabilitation may indicate that a rehabilitative approach to cost containment is underutilized in comparison with the traditional emphasis on preventive measures and enhanced medical treatment. More effective rehabilitation, however, may require new approaches to clinical case management, especially in orthopaedic departments where most personal injury claimants are treated.

Accidents, Traffic↗
PubMed2001

Methodology for identifying patients at high risk for osteoporotic fracture.

BACKGROUND: Osteoporotic fractures are associated with significant morbidity, mortality, and health care costs. OBJECTIVE: The purpose of this paper is to present and validate a mathematical model that managed care organizations can apply to administrative claims data to help locate members at risk for osteoporotic fracture and estimate future fracture rates. METHODS: Using known risk factors from previous clinical studies, 92,000 members of a large Midwest health plan were placed in 1 of 4 risk categories based on historical claims markers: demographic/lifestyle (age, sex, smoking, alcoholism); steroid use; medical history (previous osteoporotic fracture, ordinary bone fracture, osteoporosis diagnosis, bone mineral density test); or steroid use with medical history. Logistic regression was used to assign a probability of fracture for the 4 groups over the next 2 years. These predictions were compared with actual fracture rates, and refined models were produced. The models were then validated by applying them to current data and comparing the predicted fracture rate for each group to known results. RESULTS: The model predicted that 1.26% of the study members would experience osteoporotic fracture over the next 2 years; the actual result was 1.27%. Within the 4 risk groups, the predicted fracture rates were lower than the actual rates for the demographic risk group (0.87% predicted vs 0.97% actual) and higher than the actual rates for the steroid use (1.78% predicted vs 1.58% actual), medical history (5.90% predicted vs 4.94% actual), and the steroid use with medical history groups (7.80% predicted vs 6.42% actual). CONCLUSION: The application of this risk model to an administrative claims database successfully identified plan members at risk for osteoporotic fracture.

Aged↗
PubMed2002

Alternative health insurance schemes: a welfare comparison.

In this paper, we present a simple model of health insurance with asymmetric information, where we compare two alternative ways of organizing the insurance market. Either as a competitive insurance market, where some risks remain uninsured, or as a compulsory scheme, where however, the level of reimbursement of loss is to be determined by majority decision. In a simple welfare comparison, the compulsory scheme may in certain environments yield a solution which is inferior to that obtained in the market. We further consider the situation where the compulsory scheme may be supplemented by voluntary competitive insurance; this situation turns out to be at least as good as either of the alternatives.

Actuarial Analysis↗
PubMed2002

Reforming China's urban health insurance system.

China's urban health insurance system is mainly consisted of labor insurance schemes (LIS) and government employee insurance scheme (GIS). LIS is a work unit-based self-insurance system that covers medical costs for the workers and often their dependents as well. GIS covers employees of the State institutions, is financed by general revenues. Since 1980s, China has implemented series of health insurance system reforms, culminating in the government's major policy decision in December of 1998 to establish a social insurance program for urban workers. Compared with the old insurance systems under LIS and GIS, the new system expands coverage to private sector employees and provides a more stable financing with its risk pool at the city level. Despite of these advantages, implementation of China's health insurance reform program is faced with several major challenges, including risk transfer from work units to municipal governments, diverse need and demand for health insurance benefits, incongruent roles of the central and regional governments. These challenges may reflect practical difficulties in policy implementation as well as some deficiencies in the original program design.

China↗
PubMed1999

Technology assessment: relationship to coverage issues--a case for temporary coverage decisions.

Making appropriate coverage decisions has the potential of impacting patient outcomes. In both the public and private sectors, great diversity exists in the methodology and process used to make coverage decisions. Because definitional issues are important, they are described in this article. The underpinning of coverage decisions are a commitment to certain methodological principles, including embracing evidence-based medicine. The role of the federal government and local entities in regard to evidence production and process as well as methodology used to formulate policy decisions is complex and requires resolution. A temporary coverage decision can be a helpful tool when no consensus exists.

Evidence-Based Medicine↗
PubMed2000

Measuring immunization coverage.

OBJECTIVE: Information about immunization coverage comes from five major sources: the National Immunization Survey, the National Health Interview Survey, retrospective school-entry surveys, the Health Plan Employer Data and Information Set (HEDIS) measures reported by managed care plans, and assessments performed on clinics and private practices. In this article, we describe the methodology of the major surveys, discuss technical and policy issues in measuring immunization coverage, and identify issues that must be addressed to harmonize immunization rates calculated from different sources. METHODS AND TOPICS: We describe the (1) design and methodology of the five major sources of immunization coverage assessments, (2) issues and controversies in measuring immunization coverage, and (3) preliminary efforts to harmonize calculation of immunization coverage. Technical and policy issues involve dose and interval requirements, which vaccines are included in the series-completion calculations, and who is excluded from each method of calculation. CONCLUSIONS: The purpose of measuring up-to-date immunization coverage determines the way that it is measured. The tension between measuring immunization coverage to monitor population protection against disease and measuring immunization coverage to determine how well the health care delivery system is working leads to different ways of selecting a sample and reporting coverage. These differences create confusion for the public policymakers who try to identify problems and to set priorities for immunization efforts. Although some unavoidable differences may occur because of differences in purpose of the measurement, greater harmonization is possible.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

Relationships among work climate, absenteeism, and salary insurance in teaching hospitals.

This two-tier study, involving employees at a university health centre, explored the relationship between work climate and absenteeism, and also looked at the relationship between work climate and salary insurance. Study findings show that the more positive the perception of work climate, the less employees have the tendency to stay away from work or to stay longer on salary insurance. Regression analyses showed that absenteeism can be predicted significantly by specific work climate indicators such as "challenge," "conflict," and "cooperation." Also, the length of time receiving salary insurance benefits can be predicted by the indicators "trust and support" and "warmth."

Absenteeism↗
PubMed2003

How to improve organ donation: results of the ISHLT/FACT poll.

BACKGROUND: Worldwide organ shortages remain a long-standing problem. Efforts to address this have ranged from attempts to improve public awareness to modified mandated choice systems; most have been unsuccessful. In the face of this intractable problem, increased consideration has been given to direct and indirect compensation, and in certain countries, black markets for organs have developed. To examine the attitudes of the transplant medical community regarding these issues, we surveyed members of the International Society for Heart and Lung Transplantation (ISHLT) in conjunction with the Foundation for the Advancement of Cardiac Therapies (FACT). METHODS/RESULTS: We asked for opinions about how to improve organ donation. Of 739 respondents, 75% supported presumed consent, and 39% identified it as the single best way to increase donation; improved public education was a distant second (18%). Seventy percent supported indirect compensation (e.g., payment of funeral expenses, donation to a charity of the family's choice), and 66% opposed direct compensation (e.g., tax credit, life insurance benefit). When asked whether next of kin should be consulted regarding organ donation, and 84.2% responded affirmatively. However, of these individuals, 77.2% did not think that consultation should be required if the potential donor already had signed a donor card. MEMBERSHIP: Our membership dramatically favors indirect over direct compensation as a way of increasing organ donation. The majority also favors the wishes of the individual over the family in determining donor status. However, presumed consent is the single best way to significantly improve organ donation, according to the majority of our respondents. More effort should be directed toward policy in these areas as opposed to improving public education, which has failed to yield satisfactory results.

Attitude of Health Personnel↗
PubMed1994

Insurance--a dental viewpoint. Part II: Sickness and accident.

It is a very fortunate dentist indeed who survives an average 40-year working life without suffering illness or an accident. This will normally keep the dentist away from work and the ability to earn for a period of time. In the worst cases the disability may prevent a return to normal work with disastrous effects upon career earnings. Insurance against loss of earnings has therefore a very high priority.

Dentists↗
PubMed1995

Radical changes for the financing of dental treatment in The Netherlands.

The first of January 1995 brought several profound changes in Dutch dental care. As of that date, a considerable number of dental treatments are no longer covered by basic health insurance. This decision, made by the Minister of Public Health, Welfare and Sports, Dr E Borst, is one with major consequences.

Adolescent↗
PubMed2000

Aspects of the failed back syndrome: role of litigation.

OBJECTIVE: A review that attempts to identify the mechanism and causation of persistent or recurring low back pain. DESIGN: A personal assessment of clinical features with a selective review of the literature. RESULTS: Thirty to forty per cent of our population aged 10-65 years report that back trouble occurs on a monthly basis and in 1% to 8% this interferes with work. A definite patho-anatomical cause for the pain is demonstrable in only a minority. It can be deduced that psychosocial factors, including insurance benefits are of importance for this variation. CONCLUSIONS: Neither non-operative nor surgical procedures have a major impact on the capacity for work in this substantial minority of backache sufferers. The main risk factors identified are: Wrong diagnosis, repeated medical certificates for sickness benefits, failed surgery, symptoms incongruous with signs or imaging, multiple spinal procedures, poor social support and poor motivation, psychological illness, clinical depression before or after injury or operation. Pending compensation and delays in settlement are important additional features in claimants for compensation. For patients with unproven diagnostic labels such as 'pain-behaviour', no evidence exists that any type of surgery is cost effective.

Humans↗