Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Insurance Benefits”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed2002

Insurance benefit preferences of the low-income uninsured.

OBJECTIVE: A frequently cited obstacle to universal insurance is the lack of consensus about what benefits to offer in an affordable insurance package. This study was conducted to assess the feasibility of providing uninsured patients the opportunity to define their own benefit package within cost constraints. DESIGN: Structured group exercises. SETTING: Community setting. PARTICIPANTS: Uninsured individuals recruited from clinical and community settings in central North Carolina. MEASUREMENTS: Insurance choices were measured using a simulation exercise, CHAT (Choosing Healthplans All Together). Participants designed managed care plans, individually and as groups, by selecting from 15 service categories having varied levels of restriction (e.g., formulary, copayments) within the constraints of a fixed monthly premium comparable to the typical per member/per month managed care premium paid by U.S. employers. MAIN RESULTS: Two hundred thirty-four individuals who were predominantly male (70%), African American (55%), and socioeconomically disadvantaged (53% earned <$15,000 annually) participated in 22 groups and were able to design health benefit packages individually and in groups. All 22 groups chose to cover hospitalization, pharmacy, dental, and specialty care, and 21 groups chose primary care and mental health. Although individuals' choices differed from their groups' selections, 86% of participants were willing to abide by group choices. CONCLUSIONS: Groups of low-income uninsured individuals are able to identify acceptable benefit packages that are comparable in cost but differ in benefit design from managed care contracts offered to many U.S. employees today.

Adult↗
PubMedDate not supplied

The demand for Medicare supplemental insurance benefits: the role of attitudes toward medical care and risk.

This paper uses data from the 1987 National Medical Expenditure Survey to analyze the role that attitudes toward medical care and risk play in Medicare beneficiaries' demand for supplemental insurance. We investigate the factors affecting the demand for any supplemental insurance as well as specific Medigap benefits, such as coverage for Medicare's gaps in hospital and physician services, skilled nursing facility care, and prescription drug purchases. Our results indicate that attitudes significantly influence beneficiaries' decisions to purchase supplemental insurance and specific benefits with effects that are comparable in magnitude to those of self-reported health measures, education, and asset income.

Aged↗
PubMed1993

Case management services and long-term care insurance benefits.

Early versions of long-term care insurance were medically driven and institutionally biased. By design, these policies discouraged inappropriate or ineffective use of covered services. Newer long-term care policies have sought to meet policyholders' needs for greater flexibility in covered services and eligibility requirements. While significantly increasing the sales potential of these policies, this flexibility also means that insurers now must find a way to ensure that services are used appropriately and cost-effectively. One experienced provider of this "gatekeeping" service is the case management system.

Financing, Government↗
PubMed2005

Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits.

BACKGROUND: The sickness certificate is a major instrument for establishing contact and conveying information between two authorities that have a substantial impact on the life situation and work situation of the patients, as well as on the economic costs of the society. AIM: A study was undertaken to assess the quality of physicians' sickness certificates as a basis for social insurance officers' decisions regarding entitlement to sickness benefits. METHOD: Information on all 2,449 sickness certificates for sick-leave periods exceeding 28 days' sick leave period received at the social insurance offices in one Swedish county during one week in 2002 was coded and analysed. RESULTS: Information provided in the certificates was often not sufficient to allow social insurance officers to determine eligibility for sickness benefits. Qualitative analyses of certificates from general practitioners (GPs) revealed that 21% contained ambiguous statements about the medical disorder, 30% were unclear regarding the assessment of functional capacity, and 22% required additional information on both those aspects. Sickness certificates issued by GPs and physicians under specialist training, as compared with other categories of physicians, more often provided essential data, for example concerning the patient's occupational tasks and type of employment. CONCLUSIONS: Physicians often fail to contribute required information concerning functional capacity and other important aspects when issuing sickness certificates. This limits the use of these documents as a basis for decisions regarding sickness insurance benefits. The practical consequences of incomplete certificates might be delayed payment of benefits and delayed initiation of return to work measures.

Decision Making↗
PubMed1993

The effect on retirees of losing retirement and health insurance benefits.

BACKGROUND AND OBJECTIVES: The recent economic downturn has led to instability in the private health insurance industry. Although loss of medical benefits is assumed to have a negative effect on health, documentation is lacking. LTV Corporation (Ling-Temco-Vought) filed for bankruptcy and interrupted medical insurance for its retirees for six months. METHODS: Using a structured interview format, we surveyed community-living LTV retirees whose medical insurance had been interrupted. We sought to predict health status using a variety of measures. RESULTS: The vast majority of retirees were generally unaffected by the loss of medical benefits. Of the 191 LTV retirees from Youngstown, Ohio, who were interviewed shortly after health benefit loss, 13.8% reported longer-term health effects (continued decline in subjective health status), whereas 8.5% had short-term effects (decline followed by return to good or excellent health status). Although 10.5% of workers experienced serious health problems during the crisis, only one worker was unable to pay for health care as a result of the benefits loss. A discriminant analysis yielded excellent results in predicting longer-term deteriorating health status. CONCLUSIONS: Implications for community-oriented primary care service models are discussed, as well as the utility of demographic targeting for retirees losing health benefits.

Aged↗
PubMed2000

[Analysis of health insurance benefits: material and methods].

The statistical analysis of national health insurance's database, containing a record of the care reimbursed to affiliated members and delivered drugs in the form of special pharmacy codes, enable us to evaluate the follow-up care given to diabetics, to update epidemiological information and to determine the actual cost of diabetes. The method used consisted in the identification of diabetics by isolating patients who received hypoglycemic agents during the 3-month inclusion period followed by a retrospective determination of total reimbursements made through the 128 local health offices (CPAM) located in metropolitan France in order to study the reimbursed care (medical consultations, procedures and drug prescriptions) given to diabetics over the preceding 12 month period. Considering that the pharmacy coding system was still incomplete at the time the study was undertaken, we had to verify that the population selected by the coding system was only partially operational, requiring a calculation involving weighted coefficients. Finally, we needed to take into account the fact that the resulting data contained virtually no information on facilities receiving a once a year total budget allocation (all public hospital).

Adolescent↗
PubMed1995

Questions and answers on health insurance benefit issues.

This Issue Brief addresses eight topics in the areas of health insurance and health care costs. Using a question and answer format, the discussion draws largely on EBRI research and the EBRI Databook on Employee Benefits, third edition. In 1993, U.S. expenditures on health care were $884.2 billion, and they are projected to reach $2,173.7 billion by 2005, increasing at a projected average annual rate of 7.8 percent. Health care spending accounted for 13.9 percent of Gross Domestic Product (GDP) in 1993 and is projected to reach 17.9 percent of GDP by 2005. Among the factors contributing to the increase in health care costs are the growth in the number of individuals with traditional reimbursement health insurance coverage, the rapid expansion of technology and treatment options, and demographic factors such as the aging of the population. In 1993, employers, both public and private, spent $235.6 billion on group health insurance, accounting for 6.2 percent of total compensation. Group health insurance is the fastest growing component of total compensation, increasing at an average annual rate of 13.7 percent from 1960 to 1993. An increasing number of employees are required to make a cash contribution to their health insurance plan premium. In 1993, 61 percent of full-time employees in medium and large private establishments who participated in an employee only health insurance plan were required to make a contribution to the premium, up from 27 percent in 1979. In 1993, 185.3 million persons under age 65 had health insurance coverage, while 40.9 million people--or about 18.1 percent of the nonelderly population--received neither private health insurance nor publicly financed health coverage. Of those individuals who had health insurance coverage, 60.8 percent, or 137.4 million persons, received their health insurance through an employment-based plan. In 1993, 15.2 percent of the nonelderly population without health insurance coverage were noncitizens. In six states noncitizens represented a higher proportion of the total uninsured population than individuals in the nation as a whole. An increasing number of employers are self-funding their health insurance plans. In 1994, 74 percent of employers with 500 or more employees self-funded their health insurance plans, up from 63 percent in 1993. An estimated 22 million full-time employees in private industry and state and local governments participated in a self-funded employment-based health insurance plan.(ABSTRACT TRUNCATED AT 400 WORDS)

Data Collection↗
PubMed1997

Work while receiving disability insurance benefits: additional findings from the New Beneficiary Followup Survey.

From the foregoing analyses, the following picture emerges about persons who work after award of DI benefits: Almost one-quarter of the sample population attempted to reenter the labor force in the 10-year NBS-NBF period. The higher the level of education, the greater the proportion of persons who worked. Younger beneficiaries were more likely to work than older beneficiaries. About half of the beneficiaries who worked did so on a full-time (40-hour-or-more per week) basis. Most beneficiaries worked because of financial need. The profile of reasons for working did not vary across demographic groups and aspects of the first job held. Most beneficiaries began working without attributing this decision to an improvement in their health. Individuals pursued different methods of job search. No single approach emerged as the most successful. Job search modes did not vary for different groups and different jobs. Four activities were most likely to lead to job offers: persons checking where they had worked before, asking a friend, answering an ad, and following up a vocational rehabilitation lead. These findings were not conclusive because small numbers of persons engaged in these activities. Thirty percent of DI workers returned to their preentitlement employer. The beneficiaries' first postentitlement jobs had less exertion, fewer hours, and lower pay than did their job held prior to award. The likelihood of working was the same across a broad range of disabling health conditions. In terms of work return policy, formal work return programs aimed at young beneficiaries and those with higher levels of educational attainment would produce the greatest number of job placements. It appears that no targeting of programs is necessary along gender lines. The anomalous finding of an absence of the relationship between improvement in health and labor-force reentry requires further investigation. Any followup in this area of inquiry should plan to have the data collected close to the time of postentitlement job entry.

Adolescent↗
PubMedDate not supplied

US Supreme Court allows limits on AIDS-related insurance benefits.

In a ruling issued on 10 January 2000 with respect to Doe v Mutual of Omaha Insurance, the US Supreme Court refused to review a lower-court decision allowing an insurance company to limit health-care benefits for AIDS-related claims to less than one-tenth of what it pays under the same policies for expenses related to other illnesses. The lower court had ruled that anti-discrimination legislation does not apply to insurance policies.

Acquired Immunodeficiency Syndrome↗
PubMed2005

The role of consumer knowledge of insurance benefits in the demand for preventive health care among the elderly.

In 1992, the United States Centers for Medicare and Medicaid Services (CMS) introduced new insurance coverage for two preventive services--influenza vaccinations and mammograms. Economists typically assume transactions occur with perfect information and foresight. As a test of the value of information, we estimate the effect of consumer knowledge of these benefits on their demand. Treating knowledge as endogenous in a two-part model of demand, we find that consumer knowledge has a substantial positive effect on the use of preventive services. Our findings suggest that strategies to educate the insured Medicare population about coverage of preventive services may have substantial social value.

Aged↗