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PubMed1975

Mortality factors in diabetes. A 20 year mortality study.

The life expectancy of well controlled diabetics has been considered to be approximately that of the normal individual. A 20 year prospective study of the mortality of diabetics who applied for life insurance to the Equitable Life Assurance Society did not confirm this. The study population comprised 10,538 individuals with an average exposure of 7.9 years. During the period of the study 1,478 deaths were recorded, giving a mortality ratio of 335%. Mortality decreased with increasing age at diagnosis of diabetes. Mortality increased with increasing duration of the disease. Mortality was lowest in cases treated by diet only. Mortality in cases with poor control was two and one-half times that of cases with good control. Albuminuria on examination was an extremely unfavorable prognostic factor. Hypertension had a particularly adverse effect on the diabetic as compared to the non-diabetic, especially at ages under 40.

Adolescent↗
PubMed2002

[Current status and the future of insurance medicine].

The key objective of insurance medicine is the scientific based assessment of long term prognosis of a single person with respect to mortality, morbidity and disability. This is always determined in comparison to the standard population or an ideal standardised population. The evaluation of morbidity, mortality and disability is always linked to certain insurance products such as life insurance, disability cover, health insurance or derivates of these products. Additionally, insurance medicine creates the claims evaluation guidelines which are in accordance with established classifications and guidelines of other medical associations. Due to different and various reasons, insurance medicine in Germany has shown substantial deficits in the past years and decades, mostly in the areas of methodology, scientific basis, guidelines and quality control. In order to meet future challenges specific to this industry such as demographic change, longevity and new insurance covers, the discipline of German insurance medicine requires some reorganisation.

Adult↗
PubMed1998

Genetics and insurance in Britain: why more than just the Atlantic divides the English-speaking nations.

The British Government's official advisory committee on genetics has recommended a moratorium on the disclosure of genetic test results for life insurance until predictions based on such tests can be validated as actuarially important. In contrast, the trade association of the British insurance industry believes that genetic tests relating to eight conditions can yield information useful for life insurance. Although the Government has yet to respond, the debate is already moving on to genetic testing and the funding of health care for the elderly.

Advisory Committees↗
PubMedDate not supplied

Emergency medical services workforce in the city of Santo Domingo.

UNLABELLED: Santo Domingo is the largest city in the Dominican Republic. In recent years this city has experienced a significant increase in ambulance services. OBJECTIVE: To describe the current emergency medical services (EMS) workforce trends in Santo Domingo. METHODS: This was a cross-sectional descriptive study. Emergency medical services providers working within the city of Santo Domingo filled out a nine-item self-administered questionnaire. RESULTS: A total of 101 providers, 48 volunteer and 53 paid, returned the survey (response rates of 75% and 91.4%, respectively). The volunteers showed a mean of 7.48 +/- 2.02 years of involvement in EMS, whereas the paid providers had a mean of 3.58 +/- 2.91 years. When asked about planned long-term involvement in EMS, 93.8% of the volunteers responded positively, compared with 58.5% of the paid group. Nine (16.98%) of the paid providers were not satisfied with their jobs, whereas all the volunteers (100%) stated that they were satisfied; 46 (86.8%) and 27 (50.9%) of the paid providers agreed that better salary and better work hours, respectively, would influence their satisfaction. Among the volunteers, 40 (83.3%) stated that occupational health insurance would improve job satisfaction; and 39 (81.3%) stated that life insurance would bring satisfaction to their job. Logistic regression analysis showed no predictive association between job satisfaction and years of service (p = 0.342). CONCLUSION: Volunteers appeared to be less educated but with a higher long-term interest in EMS. Salary and better work hours seem to be important factors affecting satisfaction of paid providers, whereas occupational health and life insurance appear to affect the satisfaction of volunteers.

Adult↗
PubMed2004

Relationships between treated hypertension and subsequent mortality in an insured population.

OBJECTIVE: To investigate if a mortality differential exists between insurance policyholders with treated hypertension and policyholders who are not under such treatment, where both groups are noted to have the same blood pressure at the time of policy issue. BACKGROUND: Hypertension is a known mortality risk factor in the insured and general population. Treatment for hypertension is very common in the insured population, especially as age increases. At the time of insurance application, a subset of individuals with treated hypertension will have blood pressures that are effectively controlled and are in the normal range. These individuals often meet established preferred underwriting criteria for blood pressure. In some life insurance companies, they may be offered insurance at the same rates as individuals who are not hypertensive with the same blood pressure. Such companies make the assumption that the pharmacologically induced normotensive state confers no excess risk relative to the natural normotensive state. Given the potential pricing implications of this decision, we undertook an investigation to test this hypothesis. METHODS: We studied internal data on direct and reinsurance business between 1975 and 2001 followed through anniversaries in 2002 or prior termination with an average duration of 5.2 years per policy. Actual-to-expected analyses and Cox proportional hazards models were used to assess if a mortality differential existed between policyholders coded for hypertension and policyholders with the same blood pressure that were not coded as hypertensive. RESULTS: Eight thousand six hundred forty-seven deaths were observed during follow-up in the standard or preferred policy cohort. Within the same blood pressure category, mortality was higher in policyholders identified as treated hypertensives compared with those in the subset of individuals who were not coded for hypertension. This finding was present in males and females and persisted across age groups in almost all age-gender-smoking status subsets examined. The differential in mortality was 125% to 160% of standard mortality based on the ratio of actual-to-expected claims. CONCLUSION: In this insured cohort, a designation of treated hypertension is associated with increased relative mortality compared to life insurance policyholders not so coded.

Actuarial Analysis↗
PubMed1998

Societal and personal costs of obesity.

The economic costs of obesity can be broken down into three levels: 1. DIRECT COSTS: Costs to the community, related to the diversion of resources to the diagnosis and treatment of diseases directly related to obesity, as well as the treatment of obesity itself. These costs have been estimated to vary between 1-5% of total healthcare costs for various countries. Usually, the cost of obesity alone has been calculated, although it is known that the costs associated with being overweight [body mass index (BMI) 25-30 kg/m2] are also substantial because of the large proportion of individuals involved. These constitute costs to the health service (visits to general practitioners, consultations with medical specialists, hospital admissions and medication). 2. SOCIETAL OR INDIRECT COSTS: These costs are related to the loss of productivity caused by absenteeism, disability pensions and premature death. There is a lack of good economic analysis on this subject, although research from Sweden, Finland and the Netherlands has clearly shown that obesity is associated with increased sick leave and disability pensions. 3. PERSONAL COSTS: Obese subjects may earn less than their lean counterparts because of job discrimination (related to the stigma associated with obesity, or due to diseases and disabilities caused by obesity). Many insurance companies (particularly life insurance) charge higher premiums with increasing degrees of overweight. Obesity is further related to poor physical functioning and limitations in daily life. Some of these require assistance or adaptations which may be costly for an individual. In conclusion, there is much indirect information that obesity and overweight contribute substantially to healthcare-related costs. Data on aspects such as societal costs and personal costs are too fragmentary to allow calculation of the expenses involved. An appropriate analysis of all costs associated with obesity is important in order to persuade responsible bodies to develop strategies towards the prevention and long-term management of obesity.

Absenteeism↗
PubMed2000

Structured settlement annuities, part 1: overview and the underwriting process.

Structured settlement underwriting is the underwriting of medically impaired lives for the purchase of an annuity to fund the settlement. Other than risk assessment, structured settlement (SS) underwriting has little in common with traditional life insurance underwriting. Most noteworthy of these differences is the relative lack of actuarial data on which to base decisions about mortality and the necessity for prospective thinking about risk assessment. The purpose of this paper is to provide a foundation for understanding the structured settlement business and to contrast the underwriting of structured settlements with that of traditional life insurance. This is the first part of a two-part article on SS annuities. Part 2 deals with the mortality experience in SS annuitants and the life-table methodology used to calculate life expectancy for annuitants at increased mortality risk.

Compensation and Redress↗
PubMedDate not supplied

Willingness to pay for rural health insurance through community participation in India.

The main objective of this article is to examine the willingness to pay for a viable rural health insurance scheme through community participation in India, and the policy concerns it engenders. The willingness to pay for a rural health insurance scheme through community participation is estimated through a contingent valuation approach (logit model), by using the rural household survey on health from Karnataka State in India. The results show that insurance/saving schemes are popular in rural areas. In fact, people have relatively good knowledge of insurance schemes (especially life insurance) rather than saving schemes. Most of the people stated they are willing to join and pay for the proposed rural health insurance scheme. However, the probability of willingness to join was found to be greater than the probability of willingness to pay. Indeed, socio-economic factors and physical accessibility to quality health services appeared to be significant determinants of willingness to join and pay for such a scheme. The main justification for the willingness to pay for a proposed rural health insurance scheme are attributed from household survey results: (a) the existing government health care provider's services is not quality oriented; (b) is not easily accessible; and, (c) is not cost effective. The discussion suggests that policy makers in India should take serious note of the growing influence of the private sector and people's willingness to pay for organizing a rural health insurance scheme to provide quality and efficient health care in India. Policy interventions in health should not ignore private sector existence and people's willingness to pay for such a scheme and these two factors should be explicitly involved in the health management process. It is also argued that regulatory and supportive policy interventions are inevitable to promote this sector's viable and appropriate development in organizing a health insurance scheme.

Attitude to Health↗
PubMed2001

Patient data confidentiality and patient rights.

There has been a recent trend to gather and record more comprehensive and more detailed personal medical information in computerized databases. Retrieval and access are much easier from electronic records than from hard copies stored in the archives of care-providing institutions. The Institute of Medicine voiced concern that these developments raised numerous problematic issues, the most disturbing of which is a much more widespread and systematic violation of privacy via what they called 'authorized abuse', i.e. authorized users abusing their access privileges. Other worries stemmed from the sharing of patient information among different entities. Multitudes of organizations receive information about patients' health records, often without their knowledge or consent. These include care providers, insurers, pharmacists, employers, life insurance companies and marketing firms. This article addresses the issues of medical data ownership and some health data-recording problems to which we propose co-ownership and co-documentation as part of the solution. We believe that a cooperative approach will help to maintain greater accuracy of personal medical data, written in language that can be shared and understood by the consumers and not one couched in terminology understandable only to professional personnel and to delegate the power to the patient to decide when and to whom to give authorization for its use by a third party and for research.

Confidentiality↗
PubMed1988

The development of antisocial behaviour and sudden violent death.

In order to detect possible relationships between antisocial behaviour and the incidence of "sudden violent death" in young people, information relating to mortality in antisocial Swedish adolescents has been traced and compiled. A register was drawn up covering those young persons (1,056; 832 boys and 224 girls; mean age 16 years) who were admitted to Swedish probationary schools during the period 1 January - 31 December 1967. Using the registers of immigration and emigration, and causes of death kept by SCB (Statistiska Centralbyrån), mortality occurring between 1 January 1967 - 31 December 1985 was tabulated. One hundred and ten boys (13%) and 22 girls (10%) had died. The deaths had occurred at a rate of approximately seven new deaths per observation year, the youngest being still in their teens when they died. For comparison, the criteria set up by insurance companies for life insurance premiums are based on a death expectancy for healthy Swedish boys and girls in the age groups corresponding to the subjects under observation of 1.2-3.1% for boys and 1.1-2.6% for girls. Eighty-eight percent of the dead boys and 77% of the dead girls had died "sudden violent deaths" - accidents, suicides, death from uncertain causes, murder/manslaughter, or alcohol/drug abuse. For both sexes, death from uncertain causes and suicides were the most frequent single causes of death. Death as a direct result of alcohol/drug abuse occurred only in boys. The results give support to the assumption that a link exists between childhood environment, the development of antisocial behaviour/mental insufficiency and a "sudden violent death" at an early age.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗