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PubMed1992

A survey of state insurance commissioners concerning genetic testing and life insurance.

Rapid advances in genetic testing have stimulated growing concern about the potential for misuse of genetic data by insurance companies, employers, and other third parties. Thus far, reports of genetically based discrimination in life insurance have been anecdotal. Reasoning that state insurance commissioners were likely to be aware of (1) the extent of current use of and interest in genetic tests by life insurers and (2) consumer complaints about insurance being denied because of genetic condition or because of genetic test results, we conducted a survey of that group. We received responses from 42 of the 51 jurisdictions. Our results suggest (1) that those who regulate the life insurance industry do not yet perceive genetic testing to pose a significant problem in how insurers rate applicants, (2) that life insurers have much legal latitude to require genetic tests, and (3) that so far few consumers have formally complained to commissioners about the use of genetic data by life insurers.

Adult↗
PubMed1990

[Epidemiologic study of persons having group 2 insurance in Denmark. 1. Historical development, social and demographic differences between health insurance groups 1 and 2].

The majority of adults in Denmark can choose between the forms of health insurance 1 and 2. Persons insured in Group 2, on payment of a premium, obtain certain perquisites as compared with Group 1, primarily they may consult general practitioners and specialists of their own choice. Since the introduction of the Health Insurance Law in 1976, the number of persons insured in Group 2 has decreased to 3.8% of those insured in 1988. More than 3/4 of these have been insured in Group 2 since 1976. The number of new group 2 insured persons has remained relatively stable at about 3,000 persons per annum. The average age in Group 2 is 58.3 years as compared with 45.0 years in Group 1. 60% live in the region of the capital. The number of economically and socially well established persons in Group 2 is markedly higher than in Group 1, particularly in the higher age groups where the mortality in Group 2 insured persons is considerably lower than in Group 1 insured persons.

Adolescent↗
PubMed2003

By the way, doctor. Three years ago, my husband went to a sleep clinic for his snoring. He was diagnosed with moderate sleep apnea and given a continuous positive airway pressure (CPAP) device. He has been sleeping like a baby ever since--and so have I. Here's my question: when he reapplied for life insurance, his rating went from super-preferred to borderline insurable. Is there that much risk, even though he faithfully wears his mask every night? I would warn anyone who has a snoring problem to get life insurance before going to the sleep clinic!

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Fees and Charges↗
PubMed2004

Expanding insurance coverage through tax credits, consumer choice, and market enhancements: the American Medical Association proposal for health insurance reform.

Recent reports showing an increase in the number of uninsured individuals in the United States have given heightened attention to increasing health insurance coverage. The American Medical Association (AMA) has proposed a system of tax credits for the purchase of individually owned health insurance and enhancements to individual and group health insurance markets as a means of expanding coverage. Individually owned insurance would enable people to maintain coverage without disruption to existing patient-physician relationships, regardless of changes in employers or in work status. The AMA's plan would empower individuals to choose their health plan and give patients and their physicians more control over health care choices. Employers could continue to offer employment-based coverage, but employees would not be limited to the health plans offered by their employer. With a tax credit large enough to make coverage affordable and the ability to choose their own coverage, consumers would dramatically transform the individual and group health insurance markets. Health insurers would respond to the demands of individual consumers and be more cautious about increasing premiums. Insurers would also tailor benefit packages and develop new forms of coverage to better match the preferences of individuals and families. The AMA supports the development of new health insurance markets through legislative and regulatory changes to foster a wider array of high-quality, affordable plans.

American Medical Association↗
PubMed1998

Changes in benefit payments and health insurance premiums among firms switching health insurance carriers.

Employer-purchased group health insurance is a major source of funding in the US healthcare system, accounting for approximately one third of each healthcare dollar spent. Surprisingly, little is known about employers' behavior in purchasing health insurance or the circumstances leading employers to switch health insurance carriers. We descriptively analyzed data for a cohort of 95 insured groups between 1985 and 1991 to determine the frequency with which employers switch health insurance carriers and the growth pattern in premiums and benefit payments before the switch was made. Thirty-seven percent of groups switched carriers during the study period, with at least five groups switching each year from 1987 through 1991. The groups that switched insurance carriers experienced higher average annual rates of growth in benefit payments than those that did not switch (18% versus 11%). Groups that switched did not have significantly higher observed premium growth rates than those that did not switch, suggesting that employers decided to switch insurers before absorbing an increase in premiums. However, some firms that switched experienced below average increases in both benefit payments and premiums, indicating that premiums and anticipated premium increases are not solely responsible for the decision to switch health insurance carriers.

Cohort Studies↗
PubMed2004

Inequality of access to surgical specialty health care: why children with government-funded insurance have less access than those with private insurance in Southern California.

OBJECTIVE: More than 25 million children in the United States are dependent on federal and state medical insurance programs for their health care needs. In California, 3.25 million children depend on Medi-Cal for their health insurance. In Southern California alone, the figure is as high as 1.81 million. However, 9.30 million children nationally and 1.55 million in California have no health insurance. Various public policies that would increase enrollment in these programs are being discussed to address this problem. However, before their implementation, it is important to understand what impact such policies would have on the actual delivery of health care to this patient population. In California, 2 predominant health care delivery models exist for Medi-Cal: a fee-for-service (so-called regular or straight Medi-Cal) and a managed care plan. One third of the children in Medi-Cal in the state are enrolled in the fee-for-service plan with the remainder in the managed care plan, whereas in Southern California, this figure is slightly lower at 28% in the fee-for-service plan. The objective of this study was to determine the number of otolaryngologists in Southern California who would offer a new patient appointment for an evaluation for tonsillectomy for a child with commercial insurance versus government-funded (Medi-Cal) insurance through direct contact with the physician and to determine whether the surgeon would offer to perform the procedure or refer the patient to another institution and to identify the specific reason(s) for any disparity in access to health care. METHODS: A written questionnaire was sent via regular mail to 303 otolaryngologists in the Southern California area in 2003. RESULTS: A total of 100 fully completed questionnaires were received. Ninety-seven surgeons would offer an office appointment to a child with commercial insurance as compared with only 27 for a child with Medi-Cal. Of those 27 surgeons, 8 would then refer the child to another physician to perform the surgery, and only 19 would actually offer to perform surgery, if indicated. Reasons provided for not offering an office appointment or surgery for the child with Medi-Cal include excessive paperwork and/or administrative burdens (96%), low monetary reimbursement for the surgery (92%), and low monetary reimbursement for the office visit (87%). CONCLUSIONS: There is a tremendous inequality of access to surgical specialty health care for children with government-funded insurance when compared with those with commercial insurance in Southern California. Physicians indicate that this disparity is related to excessive administrative burdens and low monetary reimbursement. The implications of our findings on public health care policies are discussed.

California↗
PubMed1993

[Screening of insurance applicants: experience in international insurance medicine].

Following a brief historical look at international developments in medical examinations of life insurance applicants, the paper goes on to examine the criteria used today for screening in clinical medicine. There are great similarities between the main reasons for screening in clinical medicine and insurance medicine. On the one hand, there is the need to detect a disease early in its history. On the other, the need to identify risk factors. The procedures used by life insurers are also described. The USA is taken as an example to show the direction that international developments are taking. Future aspects are considered with particular regard to future availability of genetic tests. An insurance medical discussion on genetic tests is followed by a description of the debate on the ethics of biotechnology in the Council of Europe and European Parliament. A conceivable scenario is developed which assumes the future availability of genetic test results in doctors' surgeries. The decisive factor here is that the insurer continues to have full knowledge of the applicant's state of health at the time of application. Only by this way can antiselection be avoided. This is followed by a detailed representation of the responsibility that insurance medicine and insurers have in connection with screening modalities. Genetic tests are not used by insurers today. There exists a kind of wait-and-see attitude which amounts to something like a moratorium. The time until further decisions are made should be used to gather further scientific findings and also to correct possible misconceptions at all relevant levels.

Cross-Cultural Comparison↗
PubMed1992

How much insurance is enough? What to look for in a long term care insurance policy.

LTC insurance is a valuable financial tool to help pay for pending LTC. However, LTC insurance is not for everyone. For those who could benefit from a policy, questions arise as to how much to buy and what consumer options to purchase in a policy. Insurance is most appropriate for couples with assets of $110,000 or more, excluding their house, car, and personal belongings. Single persons with a need to protect assets should have at least $40,000 in assets. These individuals have smaller need for LTC insurance to protect assets for their children. How much insurance to buy depends on the cost of LTC and the financial resources of the person. Premiums for LTC insurance are level. A company cannot raise the premiums for an individual, but may request an increase for a class of people. With the potential that premiums may increase and that buying power of income may decline, the policy should be affordable both at time of purchase and in future. Policies pay a specified benefit amount for a specified benefit period. In deciding how much insurance to buy, it is advisable to buy a higher benefit amount for a shorter benefit period. This provides the greatest likelihood of receiving the policy's maximum benefit. The deductible amount should be between 20 and 100 days. In selecting a policy, the most important criterion is the company itself.(ABSTRACT TRUNCATED AT 250 WORDS)

Decision Making↗
PubMed1991

Who cares for the care givers? Lack of health insurance among health and insurance personnel.

OBJECTIVE: --To analyze the health insurance status of physicians, other health personnel, and insurance industry personnel. DESIGN: --The study was based on data collected by the US Bureau of the Census in the March 1991 Current Population Survey for six groups of workers in health care occupations and three classifications of insurance employees. This survey included 6182 civilian health personnel and 1498 insurance workers under the age of 65 years. RESULTS: --Of civilian health personnel under the age of 65 years, 9% (90% confidence interval [CI], 8.2% to 9.8%) are uninsured, equivalent to 834,000 persons, including 15,000 (90% CI, 5000 to 25,000) physicians. Among insurance workers, 5.1% (90% CI, 3.9% to 6.2%) are uninsured. While 6% (90% CI, 4.2% to 7.9%) of those working in physicians' offices are uninsured, 52.2% (90% CI, 48.2% to 56.3%) receive no employer contribution toward their coverage. More than a fifth of nursing home employees lack insurance coverage, as do nearly a quarter of the 1.868 million health care workers with annual incomes less than $10,000. CONCLUSION: --Nearly a million health care and insurance workers are themselves uninsured and at high risk for being unable to obtain needed care.

Health Workforce↗
PubMed2004

The interaction of partial public insurance programs and residual private insurance markets: evidence from the US Medicare program.

A ubiquitous form of government intervention in insurance markets is to provide compulsory, but partial, public insurance coverage and to allow voluntary purchases of supplementary private insurance. This paper investigates the effects of such programs on insurance coverage for the risks not covered by the public program, using the example of the US Medicare program. I find that Medicare does not have substantial effects-in either direction-on coverage in residual private insurance markets. In particular, there is no evidence that Medicare is associated with reductions in private insurance coverage for prescription drug expenditures, an expenditure risk not covered by Medicare. Medicare is, however, associated with a shift in the source of prescription drug coverage, from employer-provided coverage to Medicare HMOs.

Aged↗
PubMed2004

[Genetic screening of patients with familial hypercholesterolemia and insurability for life insurance policies and disability cover policies].

In the Netherlands, people with familial hypercholesterolaemia (FH) have been actively screened since 1994 by means of DNA analysis. Recently, the Stichting Opsporing Erfelijke Hypercholesterolemie (Foundation for the Detection of Familial Hypercholesterolaemia) initiated a large scale-screening programme aimed at finding all 40,000 people. The Dutch ministry of Health, Welfare and Sport is providing the financial support. Genetic screening has social implications and raises questions on insurability. The Dutch Medical Examination Act prohibits insurers from posing questions about untreatable, serious inheritable conditions for insured sums under a certain value: for life-insurance policies < [symbol: see text] 150,000 and for disability-cover policies < [symbol: see text] 30,000 in the 1st year and < [symbol: see text] 20,000 in the 2nd year and following years. The Health Council of the Netherlands has defined FH as a serious disease, but one which responds well to treatment. Therefore insurers can request information for the purpose of an accurate risk classification. Insurance contracts can be accepted at normal rates if the target value of LDL-cholesterol < 4 mmol/l and additional risk factors such as smoking and an abnormal BMI are absent; the risk is determined by the phenotype and clinical factors and not by the genotype.

DNA Mutational Analysis↗
PubMed2004

[Demands on and benefit from insurance-orientated hospital management - findings from qualitative interviews with executive members of statutory health insurance].

PURPOSE: Starting from the fact that statutory health insurance bodies are increasingly important hospital stakeholders, the article focuses on the question of demands on and benefit from an insurance-orientated hospital management. METHOD: A methodological approach is chosen which takes the views of the stakeholder health insurance as a starting point: Semi-structured interviews were conducted with 14 executives of different statutory health insurance. Data analysis was based on the "zusammenfassende Inhaltsanalyse" (literal translation: summarizing content analysis), developed by Mayring. RESULTS: From the participants' points of view the highly regulated relationship between hospitals and insurances offers opportunities for active development. The analysis of expectance distinguishes between five areas of demand: "Hospital services", "service development", "case management", "management of conflicts/reviews" and "budget negotiations". Within these areas dimensions of demand are differentiated. Most participants feel that an insurance-oriented hospital management is beneficial to the hospital. CONCLUSION: A number of specific demands is identified on which management activities can be based. Hospitals need to consider carefully the benefit of insurance-orientation and suitable measures in the light of hospital-specific aims and strategies.

Budgets↗
PubMed1992

Financing universal health insurance: taxes, premiums, and the lessons of social insurance.

In a society with strong antitax sentiment and large government deficits, the enactment of universal health insurance is blocked by an impasse over financing. The two chief mechanisms for funding universal health insurance are taxes and insurance premiums. Taxes and premiums are not distinct entities; rather, a spectrum of financing methods exists with varying tax-like and premium-like features. Premium-like financing tends to be voluntary and earmarked for health care, with coverage contingent upon making payments and payments going to private insurance firms. Tax-like financing, in contrast, tends to be mandatory and not earmarked for health care, with coverage not dependent upon making payments and payments going to governments. Over the past century, most industrialized nations have developed highly popular social insurance programs to cover periods of retirement, disability, unemployment, and payment for medical care. Social insurance constitutes a blend of tax-like and premium-like features, offering lessons that might assist in breaking the current impasse over universal health insurance financing.

Fees and Charges↗
PubMed1999

Why not private health insurance? 1. Insurance made easy.

How realistic are proposals to expand the financing of Canadian health care through private insurance, either in a parallel stream or an expanded supplementary tier? Any successful business requires that revenues exceed expenditures. Under a voluntary health insurance plan those at highest risk would be the most likely to seek coverage; insurers working within a competitive market would have to limit their financial risk through such mechanisms as "risk selection" to avoid clients likely to incur high costs and/or imposing caps on the costs covered. It is unlikely that parallel private plans will have a market if a comprehensive public insurance system continues to exist and function well. Although supplementary plans are more congruous with insurance principles, they would raise costs for purchasers and would probably not provide full open-ended coverage to all potential clients. Insurance principles suggest that voluntary insurance plans that shift costs to the private sector would damage the publicly funded system and would be unable to cover costs for all services required.

Canada↗
PubMed1999

[Medical confidentiality towards employers,health insurance medical services and health insurance companies from the point of view of a medical society].

In the Federal Republic of Germany, the medical discretion is protected by criminal law section 203, by section 9 of the medical professional law, and by the state law regarding data protection. Patient's secret may only be revealed if the patient agrees, if a law demands or allows the revelation, or if a legal good of higher value facilitates the revelation. The employer may be informed about the fact of sickness of an employed and about the results of an occupational medical screening but not about diagnosis and therapy. Under specific circumstances, the health insurance companies have the right to demand revelation from the physician if this is legally permitted or if the patient agrees. Certified hospitals have to reveal certain data to the insurance companies. Medical services of health insurances have the right to demand certain data from the physician if a health insurance company has ordered an expert witness opinion or examination and if the revelation is necessary for this examination. If it is suspected that there is a mismanagement about the numbers of beds occupied by patients in a hospital, the medical service of a health insurance may examine all patient's records related to the health insurance of interest. There exists no legal rights or duties to reveal information to private health insurance companies. The revelation of patient's data to such companies is most commonly not allowed.

Confidentiality↗