Insurability of the psychiatrically ill or those with a past history of psychiatric disorder. The Position of the Canadian Psychiatric Association.
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Canada↗
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Toward a definition of a successful dieter.
The purpose of the research was to examine the characteristics of successful weight losers and to compare the findings with a control group of unsuccessful weight losers. The project was designed around a definition of successful dieters, based on the Metropolitan Life Insurance weight tables. The definition, in fact, was not particularly useful. This article describes the difficulties associated with using the original definition as the inclusion criteria for sample selection, the reanalysis of data using the Body Mass Index (BMI), and finally, the creation of a new definition developed from the construction of weight history based on changes in the BMI as an adult. This article presents the final outcome of what a definition of a successful dieter should consist in future research.
Adult↗
Mortality among bricklayers and carpenters/cabinet makers.
Mortality among members of two medium-sized trade unions, the union of carpenters/cabinet makers and the union of bricklayers, has been studied during the period 1.1.71-31.12.75, primarily to investigate if the greater exposure to dust and organic solvents of the carpenters/cabinet makers caused any increase in the mortality from lung diseases. The study did not reveal any significant differences in mortality regarding any category of diagnoses except suicide, when the analysis was based on the main diagnosis recorded on the death certificate. However, when including underlying causes of death too, statistically significant increased death rates from larynx cancer, asthma, bronchitis and emphysema were found among the bricklayers, as compared with the carpenters/cabinet makers. No explanation can be given for these observations. They may be a result of an unequal distribution of confounding variables in the two groups, or they may reflect various grades and forms of "Healthy Worker" selection. This study is a cross-section study and such studies and longitudinal studies over a period of a few years of occupational mortality are very sensitive to the selection of the occupational groupings. The analysis is based on deaths among life-insured members under the age of 67 years, in the two trade unions. Copies of the death certificates were obtained from the National Health Service and then coded by us along the lines indicated by the NHS.
Adult↗
Economic security for the elderly in India: an overview.
The basic concept of social security is not new in India. Traditionally, a sort of moral economy existed to provide security to older destitute and other vulnerable groups in society. However, gradually, traditional support systems are disappearing, and state-based social security systems have come into existence. Under standardized economic security policies, government is covering retirement benefits for those in the organized sector; economic security benefits for those in the unorganized sector; and old-age pension for rural elderly. These are contributory as well as non-contributory programs. Besides life insurance approaches, savings-linked insurance and Annapurna (food security) are other important programs. However, in terms of coverage, program quality and effectiveness have been largely criticized by social security experts, suggesting immediate reforms to old-age programs.
Aged↗
Understanding insurance: what to know about insurance before you purchase any. Council on Insurance.
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Dentists↗
A survey of smoking and quitting patterns among black Americans.
A sample of adult Black policyholders of the nation's largest Black-owned life insurance company was surveyed in 1986 to add to limited data on smoking and quitting patterns among Black Americans, and to provide direction for cessation initiatives targeted to Black smokers. Forty per cent of 2,958 age-eligible policyholders for whom current addresses were available returned a completed questionnaire. Population estimates for smoking status agree closely with national estimates for Blacks age 21-60 years: 50 per cent never-smokers; 36 per cent current smokers; 14 per cent ex-smokers. Current and ex-smokers reported a modal low-rate/high nicotine menthol smoking pattern. Current smokers reported a mean of 3.8 serious quit attempts, a strong desire and intention to quit smoking, and limited past use of effective quit smoking treatments and self-help resources. Correlates of motivation to quit smoking were similar to those found among smokers in the general population, including smoking-related illnesses and medical advice to quit smoking, previous quit attempts, beliefs in smoking-related health harms/quitting benefits, and expected social support for quitting. Methodological limitations and implications for the design of needed Black-focused quit smoking initiatives are discussed.
Adolescent↗
The challenge of changing healthcare systems.
Healthcare systems are in flux throughout the world. Traditional structures and attitudes are changing. The balance of power between political bodies, payers, providers and patients is being destabilised. New approaches by governments and forward integration by drug companies and payers into care management are all major changes from the past. In the future, healthcare providers, particularly hospitals, will have to complement medical with business skills to survive in a more competitive environment. Experience shows that there is major potential for improvement in terms of radical rethinking of how care is provided (e.g. at least a 30% reduction in hospital days per insured life together with quality-of-care improvements). In particular, the economic value of changes in treatment (e.g. ambulatory surgery, switch to home therapy) should be understood and optimised. In a new world scenario, payers and providers will shape the healthcare environment by introducing novel approaches and integrating healthcare delivery. This process, coupled with the introduction of new approaches to competition and risk sharing by the government, could cause the emergency of high performance and more cost-effective healthcare systems.
Delivery of Health Care↗
Ethical aspects of genetic screening.
Public and professional concern associated with the idea of genetic screening has generated numerous publications on the ethics of genetic screening (e.g. 1-4). Concerns revolve around inadequate consultation before screening is carried out, the unearthing of worrying risks, the use of genetic information in ways that could be disadvantageous to the person involved, stigma, and a phenomenon known as the 'technological imperative', which means that simply because a technology is available there is a tendency to use it. Most reports agree that, in practice, the main ethical problems are likely to involve screening for risk of common diseases of adult life, because of the possible impact on a person's healthy self-image, implications for health and life insurance, and the possibility of commercial exploitation of people who know themselves to be vulnerable. In this paper I do not propose to address these issues directly. I have been invited to discuss this subject as a clinician involved with genetic screening, counselling and prenatal diagnosis for the haemoglobin disorders, the most common serious human recessively inherited diseases. Since we are scientists, any recommendations we make should be based on experience: my aim is to show that experience is often surprising, and that it is often possible to meet public concerns by taking quite simple practical steps.
Ethics, Medical↗
Financial incentives: alternatives to the altruistic model of organ donation.
Improvements in transplantation techniques have resulted in a demand for transplantable organs that far outpaces supply. Present efforts to secure organs use an altruistic system designed to appeal to a public that will donate organs because they are needed. Efforts to secure organs under this system have not been as successful as hoped. Many refinements to the altruistic model have been or are currently being proposed, such as "required request," "mandated choice," "routine notification," and "presumed consent." Recent calls for market approaches to organ procurement reflect growing doubts about the efficacy of these refinements. Market approaches generally use a "futures market," with benefits payable either periodically or when or if organs are procured. Lump-sum arrangements could include donations to surviving family or contributions to charities or to funeral costs. Possibilities for a periodic system of payments include reduced premiums for health or life insurance, or a reciprocity system whereby individuals who periodically reaffirm their willingness to donate are given preference if they require a transplant. Market approaches do raise serious ethical issues, including potential exploitation of the poor. Such approaches may also be effectively proscribed by the 1984 National Organ Transplant Act.
Altruism↗
Obesity, atherosclerosis, and coronary artery disease.
Although several risk factors for heart disease including high blood pressure, diabetes mellitus, and lipid and lipoprotein abnormalities are associated with overweight, overweight is not consistently associated with coronary heart disease risk. Some prospective studies of white men (life insurance cohorts, airline pilots, cancer study volunteers, and the Framingham population) have shown a positive linear relationship of weight to coronary heart disease. Other epidemiologic studies show a negative association, no association, a U-shaped relationship, or a threshold effect. The inconsistencies do not appear to be explained by differences in the definition or distribution of obesity, duration of follow-up, or risk factor distribution. Neither misclassification bias nor confounding by cigarette smoking or chronic disease appears to explain the inconsistencies. No known protective effect of obesity could explain these divergent findings. Inconsistent results with regard to the nature, strength, and linearity of the association between obesity and atherosclerosis do not support the hypothesis that obesity causes atherosclerosis, despite its biological plausibility.
Adult↗
Descriptive epidemiology of body weight and weight change in U.S. adults.
Data on body weight and weight change collected from nationally representative samples of U.S. adults are reviewed. The body mass index (weight [kg]/height [m2]) has a low correlation with height and is used to compare body weights between persons of differing heights. The BMI varies to a greater degree in women than in men. Below the 75th percentile of the BMI distribution, women have lower BMIs than men, whereas at the 75th percentile and above, women have higher BMIs than men. Overweight is defined as a BMI of 27.8 or more in men and of 27.3 or more in women, corresponding to approximately 20% or more above desirable weight in the 1983 Metropolitan Life Insurance Company tables. For persons of average height (men, 5'9"; women, 5'4") this definition is equivalent to a body weight above 85 kg (187 pounds) in men and above 72 kg (158 pounds) in women. Among adults 20 to 74 years of age, 24% of men and 27% of women are overweight, yielding an estimated total of 34 million persons in the United States. The prevalence of overweight increases with age, for both men and women but to a greater degree in women. Blacks and Hispanics have a higher prevalence of overweight than do whites, especially among women. Between 1960 and 1980, the prevalence of overweight among whites increased by 3% in women and by 6% in men. In blacks, however, the prevalence of overweight increased by 7% in women and by 28% in men. Longitudinal body weight measurements taken 10 years apart show that adults younger than 55 years tend to gain weight, whereas those 55 years and older tend to lose weight. The youngest adults gain the most weight, and the oldest adults lose the most weight. In all age groups, women have substantially greater variation in their 10-year weight change than do men.
Adult↗
Getting to know about AIDS.
Through an extensive AIDS education program, Sun Life Insurance prepared its employees for the possibility of AIDS cases within the company. Its focus was on disseminating accurate information, keeping employees up to date, and dealing with AIDS victims compassionately.
Acquired Immunodeficiency Syndrome↗
Living benefit options: another way to finance long term care.
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Health Benefit Plans, Employee↗
Pension plans drift toward diversification.
Following New Jersey's seizure of Mutual Benefit Life Insurance Co. last summer, hospital associations have begun revamping their pension offerings, in some cases steering away from venerable, fixed-income insurance products and into diversified plans such as stock funds, which may offer better returns. But insurer-based plans remain a favorite as many programs stay on the conservative course.
Insurance Carriers↗
Eliminating smoking from the workplace.
Employers are more readily realizing that a nonsmoking policy in the workplace is a more effective way to run their businesses. They are recognizing costs such as productivity losses, increased health and life insurance costs, employer liability for diseases jointly linked to smoking and occupational exposures, absenteeism, passive smoking-induced health care costs among nonsmokers, workers' compensation, and fire losses. Concomitantly, employees are supporting policies that limit smoking to achieve a clean air environment. Former Surgeon General Koop's goal of "a smokefree society by the year 2000" is being recognized by more and more segments of society.
Health Promotion↗
Information technology enters the doctor's office: Part I--Six design and implementation lessons.
Because of a trend toward increased cost escalation outside of the hospital, in the ambulatory care setting, Metropolitan Life Insurance Company initiated an Ambulatory Utilization Review ("AUR") program in 1986. This is an overview of the lessons learned since that time. Some of what was learned was simply--or not so simply--"how to," the subject of this first article in a two-part series. Once this deceptively difficult technology was understood, there were two additional categories of lessons to learn: the extent of expected program results and some unexpected results. This second set of lessons is reviewed in Part II of the article.
Ambulatory Care↗
Information technology enters the doctor's office: Part II--Six lessons about intended ... and unintended ... results.
Part I of this article ("Six Design and Implementation Lessons," Physician Executive, Sept.-Oct. 1993, pp. 46-50) described an ambulatory utilization review (AUR) program designed and implemented by Metropolitan Life Insurance Company and reviewed some of the lessons learned over the past five years. Those lessons pertained to the tasks of inventing a new information technology to measure and evaluate ambulatory care and some of the practical implementation issues associated with review of 30,000 small dollar value claims per day in 19 claim offices nationwide. This article turns to the basic purpose of AUR--to review the medical necessity and appropriateness of ambulatory utilization. One lesson learned about AUR in this context is that AUR works: savings from the program outweigh costs by almost 5:1. The more important lessons, however, stem from understanding how the savings are achieved, and what some of the other unintended benefits of the program are.
Ambulatory Care↗
CFO compensation influenced by organizational size, ownership.
Results of a 1995 compensation survey of healthcare organization chief financial officers (CFOs) indicate that the larger the organization for which the CFO works (as measured by operating revenues), the larger the CFO's compensation package. The survey findings show that CFOs who work for organizations with annual operating revenues of more than $199 million earn an average of $189,300 annually, while CFOs at organizations with operating revenues less than $50 million earn $76,400. Other factors influencing CFOs compensation, according to survey results, include education level, gender, and job responsibilities; geographic location of the employing organization; organizational type (multi-unit system, stand-alone hospital, etc.); and organizational ownership (physician-owned, not-for-profit, etc.) The survey was co-sponsored by the Healthcare Financial Management Association (HFMA) and Aetna Life Insurance and Annuity Company and conducted by Management Compensation Services, a division of Hewitt Associates LLC. It is the first HFMA survey to be devoted entirely to compensation. In previous years, compensation data were obtained as part of CFO profile survey findings.
Data Collection↗