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At least 811 records · Page 45Linked to original sources
PubMed1995

Role of previous claims and specialty on the effectiveness of risk-management education for office-based physicians.

We analyzed the medical malpractice claims data of 1,903 physicians between 1981 and 1990 to assess the efficacy--a reduced incidence of future claims and decreased payout in the event of a claim--of risk-management education for office-based physicians. Physicians were participants in the Oregon Medical Association's medical liability program and represented all recognized specialties and all geographic areas of the state. Each physician's claim and payout history before and after 4 sequential risk-management education programs was entered into a random-effects probit model that allowed for a longitudinal rather than a cross-sectional analysis. For most physicians, there was increased claim vulnerability following 1 or 2 risk-management education courses but decreased vulnerability after additional courses. Among all physicians, having a previous claim substantially increased the risk for a future claim. Risk for an additional claim doubled (from 7% to 14%) for physicians who had a claim in the previous year. Of all specialists who have had claims, anesthesiologists (reduction in claims incidence from 18.8% to 9.1% and in payout from 14.6% to 5%) and obstetrician-gynecologists (reduction in claims incidence from 23.3% to 15.2% and in payout from 11.6% to 4.2%) benefit most from cumulative risk-management education.

Humans↗
PubMed1995

[Obligation to verify information by the life insurance carrier in overly generalized responses to application questions].

According to supreme court practice which to some extent has been criticized in literature, life assurance companies are obliged, to establish clear circumstances before closing of contract. Should reasonable queries with the client, intermediary or attending physician be neglected, for instance in case of a reply being held too general in respect of the state of health, so the risk exists, that due to this behaviour the right of rescission or avoidance, respectively, cannot be claimed any more because of offending the preliminary contractual obligation to notify.

Germany↗
PubMed1995

[Expert evaluation of private drug prescriptions].

We propose a structured assessment of private prescriptions presented to the German Health Funds for reimbursement. A flow chart is presented. Given a medical indication, prescriptions in the context of clinical studies and possible legal exclusions should be identified. The expert opinion may be directed by Medicine Guidelines, regional contracts and court rulings. The individual case assessment should be combined with structural advice.

Drug Prescriptions↗
PubMed1995

Responses to a payment policy denying professional charges for diagnostic imaging by nonradiologist physicians.

OBJECTIVE: To assess the impact of a payment policy denying reimbursement for the imaging-related professional services of nonradiologist physicians by comparing the use of and expenditures for diagnostic imaging examinations before and after implementation of the policy. DESIGN: Retrospective economic evaluation of claims and expenditures for diagnostic imaging examinations filed by physicians practicing in the 20 US counties having the greatest number of United Mine Workers of America Health and Retirement Funds (hereafter referred to as Funds) beneficiaries. SETTING: Insurance claims database of Funds beneficiaries, most of whom are elderly and live in rural communities and small towns. INTERVENTION: The January 1, 1993, implementation of a reimbursement policy denying payment of professional claims for diagnostic imaging of nonradiologist physicians. MAIN OUTCOME MEASURES: Numbers and types of eligible claims and Funds payments for diagnostic imaging examinations during the year before and after the intervention, normalized for changes in the number of beneficiaries. RESULTS: Despite the rejection of $811,466 in claims disallowed by the policy, the Funds paid 12% more for diagnostic imaging performed in the 20 counties we studied during 1993 than during 1992. The Funds reimbursed 41% more claims per beneficiary for diagnostic imaging in 1993 than in 1992 (t = -8.03, P < .0001). The absolute number of professional claims per beneficiary increased more than did technical or global claims. CONCLUSIONS: Despite a payment policy designed, in part, to reduce the Funds' imaging-related expenditures, the physicians we studied filed more claims, leading to greater expenditures. An increased number of self-referred technical claims and greater referral to hospital radiology departments likely account for most of the observed increases in utilization and costs.

Cost Control↗
PubMed1993

[Physician's statement concerning whiplash injuries. Significance of supplementary information].

The frequency of insurance cases following traffic accidents involving the whiplash mechanism is increasing in Norway. The economic consequences are obviously great, both for the individual patient and for society. Declarations by medical specialists may be of vital importance when assessing the degree of medical invalidity. We have investigated some of the information provided by 27 patients who were submitted for assessment of medical invalidity after traffic accidents. In eight of these cases, the information in reports from their usual doctor or physiotherapist varied from the case history described by the patient. In all these cases, a previous history of neck pain was found in the health reports, but was not mentioned, and was partly denied, by the patients. Our results underline the importance of supplementary information.

Accidents, Traffic↗
PubMed1995

Understanding the factors behind the decision to purchase varying coverage amounts of long-term care insurance.

OBJECTIVE: This article examines the factors related to an individual's decision to purchase a given amount of long-term care insurance coverage. DATA SOURCE AND STUDY SETTING: Primary data analyses were conducted on an estimation sample of 6,545 individuals who had purchased long-term care (LTC) insurance policies in late 1990 and early 1991, and 1,248 individuals who had been approached by agents but chose not to buy such insurance. Companies contributing the two samples represented 45 percent of total sales during the study year. STUDY DESIGN: A two-stage logit-OLS (ordinary least squares) choice-based sampling model was used to examine the relationship between the expected value of purchased coverage and explanatory variables that included: demographic traits, attitudes, risk premium, nursing home bed supply, and Medicaid program configurations. DATA COLLECTION: Mail surveys were used to collect information about individuals' reasons for purchase, attitudes about long-term care, and demographic characteristics. Through an identification code, information on the policy designs chosen by these individuals was linked to each of the returned mail surveys. The response rate to the survey was about 60 percent. PRINCIPAL FINDINGS: The model explains about 47 percent of the variance in the dependent variable-expected value of policy coverage. Important variables negatively associated with the dependent variable include advancing age, being married, and having less than a college education. Variables positively related include being male, having more income, and having increasing expected LTC costs. Medicaid program configuration also influences the level of benefits purchased: state reimbursement rates and the presence of comprehensive estate recovery programs are both positively related to the expected value of purchased benefits. Finally, as the difference between the premium charged and the actuarially fair premium increases, individuals buy less coverage. CONCLUSIONS: An important finding with implications for policymakers is that changes in Medicaid policy affect the decisions of consumers regarding the acquisition of private LTC policies as well as the level of protection chosen. This is particularly important to states interested in pursuing public-private partnerships in long-term care financing.

Actuarial Analysis↗