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PubMed1987

National policy and the medically uninsured.

Although the marketplace discipline imposed on the health care sector appears to be restraining increases in the cost of care, this haphazard and incremental "policy" is having deleterious effects on access to care by the uninsured. To help alleviate this problem within our current price-centered system, I suggest that three options be pursued: create state pools to fund indigent care; broaden insurance coverage availability through the workplace; and create medical individual retirement accounts to pay for long-term care, which would free up more funds for indigent care. We must mold our future health care system during this era of rapid change by developing a coherent policy, with input from both the private and the government sectors, to create an efficient and high-quality system that will provide needed care to all members of society.

Adolescent↗
PubMed1992

Expanding health insurance coverage and the implications for dentistry.

Numerous proposals have been suggested for expanding health insurance coverage to the over 30 million Americans without health insurance. These proposals range from establishing a program of national health insurance modeled after the Canadian system to establishing statewide risk pools. Many of these proposals could have an impact on financial access to dental care for the approximately 120 million people without dental insurance. Dental insurance coverage has been shown to increase access to dental services and improve oral health status. Oral health professionals could facilitate discussions concerning health insurance expansion by informing policymakers about important preventive benefits to be gained by improving access to dental services. Dental public health professionals can serve as a bridge between organized dentistry and health policymakers by providing information to help formulate the priorities and characteristics of a dental health insurance program. This visibility and influence in the health policy arena would be beneficial to dentistry and could ultimately result in greater access to dental services and improved oral health for the uninsured.

Dental Health Services↗
PubMed1990

[Effects of health reform law on the handicapped from the viewpoint of social assistance].

In the legislator's intention, the recent health reform legislation is aimed at strengthening solidarity and self-responsibility, so that our statutory insurance-based health care system may continue to be efficient and financially viable. The essential steering mechanism introduced is a system of fixed amount benefits in the various benefit areas, among them medicaments, technical aids such as wheelchairs, hearing aids, glasses, and various orthopaedic aids. Only part of the guidelines, tables and regulations needed for implementation have however been made available so far. It is therefore impossible as yet to undertake appropriate, objective evaluation of the advantages and disadvantages of the reform for patients and health funds. It may however already be said that, in respect of dentures, transport, as well as burial costs, health fund insurants have to raise considerable extra means, partly touching on the financial substance of many insurants. A hardship/overcharge clause is intended to keep the additional burdens socially compatible. This device however is absolutely insufficient in the case of chronically ill and very severely disabled people, paying no regard to the considerable additional expenses these populations have to incur for participating in general community life. The inclusion of benefits for domiciliary nursing and care is viewed as only a first step. The financial resources for protection against the risk of nursing and care dependency, however, should not come from the statutory health insurance scheme, but be based on a common pool of funds to be financed by the various social protection branches.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed1987

New directions in life care: an industry in transition.

Current approaches to financing long-term care are inadequate; they are even less likely to meet future needs of increasing numbers of disabled and chronically ill elderly persons. While insurers, providers, and policy makers are developing models of risk-pooling that cover long-term care, the industry that first put these concepts into practice is moving in other directions. Despite the success of many continuing-care retirement communities in offering full and affordable long-term care coverage, a new trend emphasizes amenities over comprehensiveness. Sponsorship and consumer demand are contrasted with insurability of risks as key issues for the industry and for policy makers.

Aged↗
PubMed1978

Multivariate estimation of reference ranges.

This paper describes a new method for estimating reference ranges of 21 frequently performed laboratory tests utilizing routine test results of selected hospital patients. Computer programs perform the selection of patient records and the statistical analysis. The patient selection criteria of (1) short hospital stay and (2) short laboratory record provide a data base rich in normal results. The statistical program excludes records with excessive variation, and in repeated data-exclusion passes through the data base progressively narrows the range of acceptability. The decision to exclude a record is based on the "pooled variation." The average value of the "pooled variation" increases as the range is narrowed. This approach insures that the process stops after a few passes, and the most consistent data remain included in the calculation of reference ranges. Statistical properties of the data sets, as well as comparison with normal ranges for healthy subjects and review of 560 clinical charts, support the idea that serviceable reference ranges are obtained. The method is suitable for monitoring the reference ranges of the laboratory at frequent intervals.

Blood Chemical Analysis↗
PubMed1992

Government, private health insurance, and the goal of universal health care coverage.

The Health Insurance Association of America advocates joint efforts by federal and state governments and the private sector to achieve the goal of universal access to health care. It recommends several changes in the small employer market to provide greater predictability and protection to those insured, including establishment of private, not-for-profit reinsurance organizations authorized by the states. State risk pools for uninsurable individuals who are not part of an employer group are also proposed. The federal government role would include expanding Medicaid eligibility and exempting all insured plans from state mandated benefits. HIAA's proposal also stresses the continued growth and use of managed care programs.

Cost Control↗
PubMed1991

Empire and the business of health insurance.

I examine the development of privately provided insurance since World War II, giving special attention to Empire Blue Cross, and argue that the competition between employers and unions for the loyalty of workers after the passage of the Taft-Hartley Act helped diffuse private health insurance benefits already favored by federal policies. For-profit insurers did not challenge the privileged status of Blue Cross plans because they recognized the political benefits that the plans offered and because they did not wish to offend the plans' sponsors. A relatively easy and profitable business, health insurance has been greatly disturbed by the system inflation accompanying the introduction of Medicare and Medicaid programs. Now self-insurance and various managed-care schemes are major threats. The future may bring consolidation and the strengthening of pools, just the opposite of today's system fragmentation.

Blue Cross Blue Shield Insurance Plans↗
PubMed1986

Medical screening and monitoring as noted by the insurance industry.

Medical screening and monitoring have a long and varied history as part of the insurance industry's safety and health relations with its policyholders. Many workers' compensation insurance carriers have assisted policyholder management in understanding the requirements of cost-effective health programs, in planning and undertaking steps necessary to comply with state-of-the-art medical practices, and in locating knowledgeable physicians to supervise employee health systems. Managing employees' health and associated records has become, for many employers, a complex operational and regulatory problem because of the amount and type of health information being collected. Administration of group health and accident insurance plans, workers' compensation, treatment for the ill and injured employees, voluntary health screening and counseling programs, preplacement and periodic physical examinations, and control mechanisms for health hazard exposures all contribute to this huge pool of acquired and stored health information.

Humans↗
PubMed1991

Inequities in hospital care, the Massachusetts experience.

This study examined the relationship between patient insurance status and the process and outcome of hospital care in Massachusetts, a state that has had an uncompensated care pool for paying hospitals since 1986. This study examined data on 4,972 patients admitted to a Massachusetts hospital on an emergency basis in 1987 and diagnosed with acute myocardial infarction. We classified these patients into three groups: having fee-for-service insurance, having prepaid coverage through a health maintenance organization (HMO), or being uninsured at the time of hospital admission. Results showed treatment differences by insurance status and significantly greater mortality rates for uninsured patients than for either fee-for-service or HMO patients. Our findings indicate that in Massachusetts the process and outcome of hospital care do differ by insurance status.

Cardiology Service, Hospital↗
PubMedDate not supplied

[The SUVA (Swiss Accident Insurance Association) statistics and quality control].

Overall quality control in medicine takes place on various levels: Physician--Hospital--Insurer--Authorities, each having different requirements. Comparative standards are rather seldom. A model for a comparative standard for insurer purposes, the medical statistics package SUMEST' is presented. This model is diagnoses oriented and includes parameters for the severity of the accident, cost of treatment and treatment outcome, all based on 5-year data pool results.

Accidents, Occupational↗
PubMed2026

The Childhood Cancer and Leukemia International Consortium (CLIC): Expanding global collaboration in pediatric cancer etiology research.

Childhood cancers are rare, but incidence has risen modestly in countries with robust registration, partly reflecting improved diagnosis. In high-income countries, cancer is the leading cause of disease-related death in children. Marked inequities in incidence, survival, and research capacity underscore the need for large-scale collaboration to identify environmental, genetic, and contextual determinants of risk. The Childhood Cancer and Leukemia International Consortium (CLIC) was established in 2007 to study the etiology of childhood leukemia and later expanded in 2019 to include other childhood cancers, principally solid tumors. CLIC pools harmonized, individual-level data from case-control and cohort studies, obtained through interviews, record linkage (insurance claims, registries), or geographic information systems, and integrates germline genomic data where available. Membership has grown from 13 studies in 9 countries to 57 studies in 21 countries; recruitment spans the early 1960s to the present and encompasses approximately 150,000 cases across all tumor types and 300,000 controls with clinical, demographic, and exposure data, centralized via harmonized data dictionaries at the Data Coordination Center, established in 2014 at the International Agency for Research on Cancer, and supported by a secure analysis platform. Pooled analyses across diverse populations have implicated parental age, prenatal vitamin or folic acid use, mode of delivery, fetal growth, selected congenital anomalies, occupational or household exposures (e.g., pesticides), paternal smoking, and markers of early-life immune modulation (e.g., breastfeeding, daycare attendance) in leukemia risk, informing carcinogen evaluation and prevention. The integration of genetic ancestry and germline susceptibility data is clarifying ancestry-related differences in leukemia biology and outcomes, while confirming risk loci with population-specific effects. CLIC is now adding polygenic risk scores and exposomic data to refine etiologic subtyping and identify modifiable pathways, while broadening representation from underserved regions through partnership-building and capacity-strengthening.

Humans↗
PubMed1989

Physicians who have lost their malpractice insurance. Their demographic characteristics and the surplus-lines companies that insure them.

The present study analyzes demographic data on 920 physicians who lost their coverage and applied to a "surplus-lines" company that insures essentially all applicants. Our analysis reveals that (1) some specialties are heavily overrepresented in the surplus-lines pool, (2) physicians aged 45 to 54 years are also overrepresented, (3) board certification is seen as frequently in the surplus-lines group as in the US physician population, and (4) the percentage of foreign medical graduates in the surplus-lines pool is virtually the same as that in the US physician population. A model of the actuarial process by which claims data can lead to termination of standard coverage suggests that disproportionate representation of high-risk specialties is not simply a function of a high average claims rate. We also show that, in contrast to joint underwriting associations, surplus-lines companies impose high premiums, large deductibles, and restrictions on practice, all of which are likely to reduce the frequency of negligent behavior.

Actuarial Analysis↗
PubMed1992

A controlled auction market is a practical solution to the shortage of transplantable organs.

All attempts relying on pure altruism to meet the demand for transplantable donor organs have failed and continue to fail. The incentive of commercialization of an organ market would seem to be the only practical solution at this time. It is almost impossible to set fixed prices for such priceless items as human organs. The only fair, honest, and feasible approach is the establishment of a free and voluntary national or international auction system under the strict supervision and control of an exclusive, specially created administrative entity free of governmental or other partisan interference. The resultant flow of funds could be enormous and would enhance the welfare of all strata of society. Wealthy buyers would be removed from current waiting lists; the donor pool greatly expanded to perhaps surplus; the resultant money used to relieve the financial burdens on families involved, hospitals, insurance companies--and also used to buy organs for the indigent on waiting lists, pay for surgeries and hospitalization, and thereby increase the income and surgical experience of more surgeons. This proposed new system should include all live as well as brain-dead donors, cadavers and consenting individuals facing purposeful and pointless destruction by judicial execution.

Altruism↗
PubMed1986

A proposal for future funding of chronic and episodic mental illness.

The estimated 1.7 to 2.4 million Americans who suffer from chronic mental illness are poorly served by the current nonsystem of services. No agency at any level is responsible for coordination of funding, treatment, and care. Since the mid-1950s funding has become increasingly fragmented as state mental hospitals have been depopulated, community services have been developed, and federal entitlement programs such as Medicaid, Medicare, and Social Security Disability Insurance have been introduced. To overcome the problems of fragmented funding and uncoordinated services, the authors propose establishment of a new federal entitlement program for the chronic mentally ill that would pool all existing funds regardless of the source. States would be empowered to develop a single administrative agency with responsibility for coordinating a comprehensive program of services.

Chronic Disease↗
PubMed1986

Compensating for biased selection in health insurance.

The focus of interest in HMOs is shifting from simple encouragement of their growth to the design of systems allowing for choice among alternative plans. Problems of adverse and favorable selection of enrollees may prevent effective multiple choice. A trial system, including enrollee surveys and risk pools, is proposed to create incentives for delivery systems to compete on the basis of efficiency and services rather than on selection.

Choice Behavior↗