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At least 487 records · Page 27Linked to original sources
PubMed2005

The changing face of access to family physician services in rural Florida.

OBJECTIVES: This study's purpose was to determine whether access to services performed by Florida family physicians in rural areas is changing and whether the recent changes in the availability or cost of professional liability insurance may be influencing service provision. METHODS: We conducted a survey of all family physicians in rural Florida, asking about changes in health care services and procedures provided, insurance coverage and premiums, satisfaction with practice, and plans for future practice. RESULTS: Of the 204 respondents, 96 (49.5%) indicated that they have decreased or eliminated some health care services during the last year. Overall, 69.8% decreased or eliminated vaginal deliveries, 66.2% Cesarean sections, 56.6% endoscopies, 50.9% hospital-based surgeries, 50.7% emergency room coverage, 40.8% office-based surgeries, and 33.6% mental health services. Malpractice premiums increased a mean of 98.5%. Difficulty with finding or paying for insurance was listed as an important factor both by those reducing or eliminating services and by those planning to leave the community within the next 2 years. CONCLUSIONS: Access to some services provided by family physicians in rural areas is decreasing and may be influenced by recent changes in professional liability insurance costs and other factors in Florida. Given the number of states currently experiencing similar insurance cost changes, access to health care in rural areas may be affected nationwide.

Adult↗
PubMed2004

[Hospital risk management from the viewpoint of insurers].

The present article deals with the significance of risk management in hospitals from the viewpoint of liability insurers. From the perspective of insurance companies, the liability risk of a hospital and its personnel has considerably increased during the past 25 years. The present risk situation is characterized by a growing number of reported liability cases, as well as by an enormous increase of average compensation claims. This development has led some insurance companies to financial deficits in the segment of hospital liability. While some insurers have withdrawn their activities from this market segment, others have reacted by raising their premiums. Since in Germany the premiums usually depend on the number of beds held by a hospital, the problem of rising premiums is exacerbated by the general increase of the number of clinical cases in the face of a parallel reduction of the number of beds. In the process of finding new criteria or methods for adequate premium calculation, a key role will be played by the individual future risk development of a hospital and by the evaluation of this risk by its insurance company. An extensive system of clinical quality management supported by elements of risk management will have persistent positive effects on the development of individual insurance premiums and on the insurability of clinical liability. Risk management is defined as the totality of measures taken by a company to identify risks that could lead to reduced success. Clinical risk management must be regarded in the context of a general trend that is not limited to the field of health service. In this process, the handling of errors and their causes plays a central role. Further variants of hospital risk management are the technical and economic risk management, both of which are increasingly important and are in part implemented in the German legislation. Clinical risk management has originated from the U.S., where as early as in the nineteen-seventies instruments and methods have been developed to avoid errors. Important application fields are anesthetics, surgery, orthopedics, and obstetrics. Risk management is primarily a task of the internal personnel of a hospital. The support by external consultants promises additional benefits for the hospital. Measures of classical risk management usually are essential elements of any quality management system; as such, they are therefore certifiable. Certification alone, however, does not prove the sustained efficiency of a risk-prevention system.

Humans↗
PubMed1992

Special report on liability and insurance. An update on assignment of patient benefits under ERISA.

While the holdings in Davidowitz and Arkansas Blue Cross & Blue Shield arose in different contexts, they both reflect the courts' increasing willingness to consider the importance of cost containment in the health insurance arena, even though patient accessibility to health care may be restricted as a result. If the holding in Davidowitz is not successfully appealed, providers may need legislative relief in order to retain their ability to take valid assignments of patient claims for payment from ERISA plans. It is uncertain whether such legislation can be sought at the state level or must instead come from Congress due to ERISA preemption of state legislation. Clearly, the district court decision on remand in Arkansas Blue Cross & Blue Shield will be closely watched for any light it may shed on this question. On a pragmatic note, providers who have not entered into "participation" agreements with insurers or other private payors may now have a greater incentive to do so, and "nonparticipating" providers who continue to obtain assignments from patients in order to collect directly from insurers or other private payors should determine on a case-by-case basis whether the source of the patient's benefits is a group health plan--which is likely to fall under ERISA and may contain nonassignment provisions--or some other form of coverage. For an additional perspective on insurers' responses to copayment waivers, see Newsletter, Vol. 6, No. 10, October 1991, at 7.

Arkansas↗
PubMedDate not supplied

Measuring physician readiness to change cancer screening: preliminary results.

Our objective was to describe the development and validation of an instrument for measuring physician readiness to change cancer screening and counseling. We designed a cross-sectional survey of primary care physicians. Participants were 745 enrollees in the Copic Insurance Company, a physician liability insurer of more than 80% of Colorado's physicians. A large percentage of physicians do not perceive a need to change their screening patterns for eligible patients in both mammography and Pap tests. Approximately one third of the physicians are contemplating screening more of their patients within the next six months for sigmoidoscopy, clinical skin, and oral cavity exams and counseling more of their patients on skin protection and dietary fat. Few physicians are planning significant changes in cancer screening and counseling within the next month. Scales of readiness to change screening and counseling, as well as an overall readiness-to-change scale, had high internal consistency: .81, .65, .84, for screening, counseling, and overall, respectively. We conclude that readiness to change may be a useful construct for determining if and when physicians may be willing to make behavior changes. Moreover, the assessment of physician readiness to change may facilitate the tailoring of interventions designed to foster physician behavior change and improve patient care.

Attitude of Health Personnel↗
PubMed2004

[Insurance for civil responsibility in professional medicine: insurance systems and coverage for posterity].

The author presents the systems of medical liability insurance available on the Belgian market; they are at the moment based on loss occurrence, claims made or fact occurrence. The systems based on loss occurrence and on claims made impose the provision of an additional premium. Problems connected with changing the insurance company are touched upon, including sometimes a necessity to provide a precedence premium.

Belgium↗
PubMed1980

How self-insurance can offer more for the money.

The author examines the three services that conventional liability insurance carriers offer to hospitals and shows how self-insurance combined with a good risk management program may provide these services better and more cost-effectively.

Financial Management↗
PubMed2005

Effects of a professional liability crisis on residents' practice decisions.

OBJECTIVE: Pennsylvania, like many states, is in a professional liability crisis characterized by escalating cost and decreasing availability of liability insurance. Medical and surgical specialists have experienced especially large increases in insurance premiums. The objective of this study was to estimate the impact of liability concerns during a professional liability crisis on Pennsylvania residents' decisions regarding their future practice. It was hypothesized that liability concerns would negatively affect Pennsylvania residents' propensity to practice in the state following residency. METHODS: Statewide mail surveys were completed in 2003 by 68 Pennsylvania residency program directors and 360 residents nearing the end of their training in anesthesiology, general surgery, emergency medicine, obstetrics and gynecology, orthopedics, and radiology residencies. RESULTS: One third of residents in their final or next-to-last year of residency planned to leave Pennsylvania because of the lack of availability of affordable malpractice coverage. Although, in general, residents' geographic decisions are influenced by a range of factors, those who are about to leave Pennsylvania named malpractice costs as the primary reason 3 times more often than any other factor. Seventy-one percent of residency program directors reported a decrease in retention of residents in the state since the onset of the professional liability crisis. For some programs the decreases were very large. CONCLUSION: An environment of mounting liability costs in Pennsylvania appears to have dissuaded substantial numbers of residents in high-risk specialties from locating their clinical practices in the state. The impact of decreased resident retention on the future availability of specialist services in high-cost states merits close monitoring.

Adult↗
PubMed2002

A multitude of strains add up to one big headache. Feeling the pressure?

A multitude of strains--most beyond the control of health care executives--are converging to create major headaches for hospitals and systems. Skyrocketing insurance premiums, surging drug spending, Medicaid cuts, a staffing crisis and huge hikes in liability insurance rates contribute to the unprecedented confluence of pressures. And there's more.

Drug Costs↗
PubMed1980

Regional variations in the determinants of professional liability claims.

The problem of professional liability claims and impact on the medical care market has become increasingly important in recent years. Professional liability insurance premiums, and the practice of defensive medicine by physicians in response to potential professional liability claims, have been cited as partly responsible for the increasing costs of medical care. This study is an analysis of factors which influence the probability of a professional liability claim occurring for physicians in each of the four Census Regions. The data analyzed are from the Eleventh Periodic Survey of Physicians conducted by the American Medical Association in 1977, in which respondents indicated whether they had a professional liability claim filed against them. A logit analysis suggests that variations across Census Regions in population characteristics, availability of medical resources and supply of legal services are determinants of the occurrence of claims.

Catchment Area, Health↗
PubMed1981

What to look for in a directors and officers liability policy.

In today's litigious climate, hospitals and their trustees are vulnerable to claims in a number of areas. Most hospitals indemnify their trustees through a general liability insurance policy or a separate directors and officers policy. This article discusses what a directors and officers liability policy covers and what hospital boards should look for in such coverage.

Governing Board↗