Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Insurance Selection Bias”

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 937 records · Page 52Linked to original sources
PubMed2006

Health effects of managed care among the near-elderly.

OBJECTIVE: The authors evaluate whether enrolling in a health maintenance organization (HMO) or preferred provider organization (PPO) affects the health of adults ages 55 to 64, relative to fee-for-service plans. METHODS: A nationwide random sample of 4,044 adults with employer-sponsored health insurance is drawn from the 1994 to 2000 waves of the Health and Retirement Study. Multinomial logit regressions are estimated for self-reported general health status, first using a sample of all near-elders, then using subsamples of near-elders with and without longstanding chronic health conditions. The possibility of selection bias into managed care plans is considered and explicitly addressed in model estimation. RESULTS: We find no ill effects of HMOs on health status, and older adults with a history of chronic health conditions actually fare better upon enrolling in these plans. DISCUSSION: More research is needed to understand the reasons for the observed beneficial effects of managed care.

Fee-for-Service Plans↗
PubMed1996

Persistent pulmonary hypertension of the newborn and smoking and aspirin and nonsteroidal antiinflammatory drug consumption during pregnancy.

OBJECTIVE: Prenatal causation of persistent pulmonary hypertension of the newborn (PPHB) is suggested by a specific pattern of pulmonary vascular remodeling observed immediately after birth in some infants with fatal PPHN. The goal of this study was to determine whether PPHN is associated with fetal exposure to: (1) tobacco and marijuana smoking (ie, contributors to fetal hypoxemia), (2) consumption of aspirin and other nonsteroidal antiinflammatory drugs (ie, inhibitors of prostaglandin synthesis), and (3) cocaine use (ie, a contributor to vasospasm). DESIGN: Case-control interview study. SETTING: Two Harvard-affiliated newborn intensive care units. PARTICIPANTS: Mothers of case infants who had PPHN or who met criteria for the referent group. INTERVENTIONS: During July 1985 through April 1989, we interviewed mothers of 103 infants with PPHN and 298 control infants. Because of potential selection bias that might result from recruiting only inborn control infants even though two-thirds of cases were outborn, separate analyses compared the 103 total and 35 inborn infants with PPHN with the 298 inborn control infants. Multivariate analyses were used to adjust for potential confounding factors, including maternal education and Medicaid health insurance (ie, two markers of socioeconomic status), other antenatal factors found to be associated with PPHN (ie, maternal urinary tract infection and diabetes mellitus), and the infant's sex. MAIN OUTCOME MEASURES: Self-reported use or consumption of tobacco, marijuana, cocaine, aspirin, and other nonsteroidal antiinflammatory drugs during pregnancy. RESULTS: The adjusted odds ratios (and 95% confidence intervals) for maternal pregnancy exposures to the factors of principal interest among the total study population were: aspirin, 4.9 (1.6-15.3); and nonsteroidal antiinflammatory drugs, 6.2 (1.8-21.8); for the inborn group they were aspirin, 9.6 (2.4-39.0); and nonsteroidal antiinflammatory drugs, 17.5 (4.3-71.6). Although the association between tobacco smoking during pregnancy and PPHN was elevated in univariate analyses, with odds ratios (and 95% confidence intervals) of 2.0 (1.2-3.4) and 1.3 (0.6-3.3) for total and inborn populations, respectively, the relationship was not significant after adjustment for all other factors in the final logistic regression model. Acknowledged illicit drug use was too infrequent (3.2%) to evaluate. CONCLUSION: Maternal consumption of nonsteroidal antiinflammatory drugs and aspirin during pregnancy or the reasons these drugs were ingested seem to contribute to an increased risk of PPHN.

Adult↗
PubMedDate not supplied

Making capitated Medicare work for women: policy and research challenges.

Growth in capitated Medicare has special ramifications for older women who comprise the majority of Medicare beneficiaries. Older women are more likely than men to have chronic conditions that lead to illness and disability, and they often have fewer financial and social resources to cope with these problems. Gender differences in health status have a number of important implications for the financing and delivery of care for older women under both traditional fee-for-service Medicare and capitation. The utilization of effective preventive interventions, new therapeutic interventions for the management of common chronic disorders, and more cost-effective models of chronic disease management could potentially extend the active life expectancy of older women. However, there are financial and delivery system barriers to achieving these objectives. Traditional FFS Medicare has gaps in coverage of care for chronic illness and disability that disproportionately impact women. Managed care potentially offers flexibility to allocate resources creatively, to develop new models of care, and offer enhanced benefits with lower out-of-pocket costs. However, challenges to realizing this potential under Medicare managed care with unique implications for older women include: possible gender bias in capitation payments, risk selection, inadequacy of risk adjustment models, benefit and market instability, and disenrollment patterns.

Aged↗
PubMed1999

[Hepatitis C. Diagnostic and prognostic aspects from the insurance medicine viewpoint].

Hepatitis C is a chronic infection with potentially serious long-term effects. An acute clinical presentation is the exception, often the disease is only diagnosed through routine screening (e.g. as a blood donor) or work-up for elevated liver enzymes. The silent course of this disease also makes it difficult to interpret epidemiological studies. Potential biases need to be considered which may lead to underestimation or overestimation of prevalence and incidence data. Special attention is needed in evaluating long-term effects as the studies usually deal with small numbers of HCV positives and their selection may not have been randomised. An assessment of the prognosis is difficult, especially in the absence of a series of liver enzyme measurements and if the viral load is unknown. The wide availability of diagnostic tests harbours a potential for anti-selection. Caution is therefore required when designing underwriting guidelines; only well documented cases should be accepted. A response to therapy (e.g. with interferon), alone, does not prove a good prognosis, rather, the course over a 2-year follow-up may give relevant prognostic information.

Cause of Death↗
PubMed1999

The impact of response bias on estimates of health care utilization in a metropolitan area: the use of administrative data.

BACKGROUND: Surveys among the general population are an important method for collecting epidemiological data on health and utilization of health care in that population. Selective non-response may affect the validity of these data. This study examines the impact of response bias on estimates of health care utilization and on risk estimates for utilization in relation to demographic and socioeconomic characteristics, using administrative data on use of health care. METHODS: Data on registered health care utilization were extracted from a health insurance register and linked to respondents (2,934; 62.7%) and non-respondents (1,744) in a personal health interview survey among adult residents from the lower two-thirds income bracket in Amsterdam, the Netherlands. RESULTS: Estimates of registered health care utilization are higher if based on respondents only, than if they are based on the entire target sample. This goes for prescription drugs, specialist medical care, paramedical care, dental care and medical aids, but not for hospital care. Most risk estimates of registered utilization for background characteristics (gender, family composition, marital status, year of settlement, affluence of neighbourhood and ethnicity) differ only slightly and without statistical significance. If different, most estimates based on respondents only are somewhat higher. The largest differences are found for age (average overestimation of risks for age groups 35-64 and 65+ years compared to that of 16-34 years: 16% and 17%, respectively). CONCLUSIONS: In this study, response bias affects estimates of registered health care utilization but hardly affects risk estimates of utilization by background characteristics.

Adolescent↗
PubMed2005

Occupation and parkinsonism in three movement disorders clinics.

BACKGROUND: Few occupational risk factors for Parkinson disease (PD) have been identified. Healthcare, teaching, and farming have been associated with increased risk, while welding has been proposed to accelerate age at PD onset. The aim of the present study was to investigate occupational associations with PD or parkinsonism drawing from three different movement disorders clinics. METHODS: Medical records of 2,249 consecutive patients with PD or parkinsonism from specialty clinics in Sunnyvale, CA, New York, NY, and Atlanta, GA, were reviewed for primary lifetime occupation. Job frequencies were compared with Department of Labor regional statistics. PD diagnosis age and risk of diagnosis < or =50 were determined for each job. RESULTS: Physicians/dentists, farmers, and teachers were significantly more common than expected among PD patients, as were lawyers, scientists, and religion-related jobs. Computer programmers had a younger age at PD diagnosis, and risk of diagnosis < or =50 was greater in computer programmers and technicians. CONCLUSIONS: Consistent with prior studies, healthcare, teaching, and farming were common occupations in Parkinson disease (PD) patients, but welders were not over-represented. Even though several occupations were associated with younger age at PD diagnosis, these results may reflect biases inherent in specialty clinic surveys, including over-representation of younger, employed, and insured patients. Carefully designed analytic studies utilizing appropriate control populations will be required to test hypotheses regarding occupation and PD risk.

Adult↗
PubMed1988

Medicare reimbursement and regression to the mean.

There is evidence that Medicare's payment formula for health maintenance organizations (HMO's) overpays or underpays HMO's in cases of biased selection. There is also evidence that costs of biased groups regress toward the population mean cost, so the incorrect payment is temporary. We found that reimbursement regressed toward the mean for cohorts biased on medical use but not for groups biased on demographic factors. In a simulation of HMO-favorable selection, Medicare lost money in the first 3 years, but, because of regression toward the mean, early losses were recouped by the seventh year.

Aged↗
PubMed1993

Physician gender bias in clinical decisionmaking: screening for cancer in primary care.

There has been increasing interest in gender disparities in clinical decisionmaking. Few studies have examined this issue in nationally representative samples or focussed on primary care. In addition, few of the studies have examined the role of physician gender. The 1987 National Medical Expenditure Survey was used to examine the relationship between physician gender and screening deficiency in women for three gender-sensitive tests (breast examinations, Papanicolaou tests, and mammograms) and one gender-neutral test (blood pressure checks). Women reporting a female physician as their usual provider compared with those reporting a male physician were less likely to be deficient for Papanicolaou tests and mammograms. There was a smaller, but nonsignificant similar trend for breast examinations. No gender bias was evident for blood pressure checks. These results persisted after multivariate adjustment for patient age, race, education, income, insurance status, subjective health status, other health behaviors, and attitude toward health care and health insurance. The results confirm the existence of physician gender bias in clinical decision making and represent one area for quality improvement.

Adult↗
PubMed2002

Self-reported use of mental health services versus administrative records: should we care?

Studies of mental health services have emphasized that people in need are not receiving treatment. However, these studies, based on self-reported use, may not be consistent with administrative records. This study compared self-reports of mental health service use with administrative records in a large representative sample. Respondent reports within the Ontario portion of the 1994/95 Household Component of the National Population Health Survey (NPHS) were individually linked to the provincial mental-health physician reimbursement claims. A total of 5187 Ontarians, aged 12 years or more, reported on their use of mental healthcare within the NPHS and 4621 (89%) consented and were successfully linked to administrative records. Comparisons between the two sources identified that the agreement for any use and volume of use was moderate to low and varied according to select respondent characteristics. These differences affected estimates of the associations with use and volume of use. People who reported high levels of distress reported more visits than those who did not and this effect was stronger in the self-reported data. These results suggest that recall bias may be present. Regardless of the definition of care, access for those in need remains a concern despite universal medical insurance coverage.

Adolescent↗
PubMedDate not supplied

Cost sharing in corporate benefit plans: the cases of Gulf Oil and DuPont.

In 1983 the Health Systems Management Center of Case Western Reserve University contracted with the Business Roundtable Health Initiatives Task Force to use BRT's survey of members as a guide to the top firms who had taken action regarding health care costs and more importantly, had also evaluated the cost implication of that action. The mandate was to draw together representative case studies on seven firms who met those criteria for use in BRT educational seminars and elsewhere. These cases may provide important insight for other companies which are contemplating action regarding their health care costs. They should also lead to further research on alternative actions available and the means of evaluation that should be considered. Most importantly they may provide some methodology for top management to choose among proposals for attacking this burgeoning corporate cost. Two of the case studies selected as representative were DuPont Corporation and Gulf Oil Corporation. Both DuPont and Gulf Oil, increased the level of cost sharing through copayments and deductibles and improved administrative efficiency by consolidating multiple plans into a limited set of options available to all employees nationally under an administrator chosen by competitive bid. Both plans were evaluated by projecting experience that might be expected under the former arrangements with consideration of biases due to adverse selection among options. This was compared with actual experience to reveal substantial savings in each case which should be replicable elsewhere under similar circumstances. Unfortunately, lack of suitable controls and comparisons limits the confidence in the precision of these evaluations.

Deductibles and Coinsurance↗
PubMed2001

A comparison of total hospital costs for percutaneous coronary intervention patients receiving abciximab versus tirofiban.

The purpose of this study was to examine the total hospital costs associated with the receipt of abciximab versus tirofiban for percutaneous coronary intervention (PCI) patients. Hospital billing data for patients with a primary procedure of PCI was examined for the period of July 1998 to June 1999 from HCIA-Sach's Clinical Pathways Database. Data were analyzed for all patient discharges whose records indicated use of abciximab or tirofiban with a PCI. Results are reported for 3,967 patients. Multivariate analysis was used to control for a wide range of factors (GP IIb/IIIa selection, patient demographics, stent use, insurance type, health conditions, admission information, and hospital characteristics) that may influence the cost of hospitalization. A two-stage sample selection model was used to estimate total costs. The first stage of the analysis utilizes a probit regression to determine the factors associated with the likelihood of receiving abciximab versus tirofiban. The second stage of the analysis examines the factors associated with total hospital costs, while controlling for unobserved factors that may be correlated with the patient's likelihood of receiving abciximab. The mean unadjusted cost per hospitalization, including drug costs, was $10,762 (abciximab $10,813 and tirofiban $10,567). After controlling for high-risk indications and selection bias with the two-stage sample selection model, results indicate there was no significant difference in costs associated with the receipt of abciximab versus tirofiban. However, the results also indicate that the two-stage sample selection model may not be needed (lambda was not statistically significant) hence, the cost equation was reestimated using ordinary least-squares methodology (OLS). In the OLS analysis, receipt of abciximab versus tirofiban was associated with a significant reduction in costs ($470 reduction; P = 0.05). This study uses real-world data to examine the total hospital costs for PCI patients who receive abciximab versus tirofiban. Results of the two-stage sample selection model indicate there is no difference in total hospital costs (including drug costs) between abciximab- and tirofiban-treated patients. If the results of the OLS model are considered, a slight decrease in total hospital costs is observed in abciximab recipients. Cost-containment strategies that focus on component costs may not lead to intended overall cost savings.

Abciximab↗
PubMed1996

Peering into the 'black box'. Measuring outcomes of managed care.

Research on the impact of managed care on access, quality, outcomes, and costs of mental health and substance abuse services has been limited because of the lack of generalizability of studies, the "black box" focus of much of the research, the dynamic changes in mental health and substance abuse managed care, and the proprietary nature of the health care industry. This article provides a framework for understanding the organizational, financial, and procedural features of health plans and the effect of these features on the characteristics and flow of patients through health plans and the selection and utilization of treatments. The diverse research priorities of key stakeholders, i.e., public and private purchasers, managed care organizations, providers, and patients and their families, are described along with a broader societal agenda for delineating the outcomes of health care plans. Critical research and methodologic issues in studying the effects of managed care are outlined, including issues related to identifying and selecting appropriate outcome measures and developing appropriate methods for risk adjustment to adequately control for patient selection bias. This article asserts that government, purchasers, health care plans, providers, consumers, and researchers must collaboratively develop resources and research approaches to fully evaluate the effects of managed care. To realize this objective, auspices with reasonable objectivity are needed along with access to necessary data within the black box of health care systems, a cadre of trained investigators, and sufficient research funding, including the development of an all payers fund to support clinical and health services research.

Delivery of Health Care↗
PubMed2001

Demand for health care in Denmark: results of a national sample survey using contingent valuation.

In this paper we use willingness to pay (WTP) to elicit values for private insurance covering treatment for four different health problems. By way of obtaining these values, we test the viability of the contingent valuation method (CVM) and econometric techniques, respectively, as means of eliciting and analysing values from the general public. WTP responses from a Danish national sample survey, which was designed in accordance with existing guidelines, are analysed in terms of consistency and validity checks. Large numbers of zero responses are common in WTP studies, and are found here; therefore, the Heckman selectivity model and log-transformed OLS are employed. The selectivity model is rejected, but test results indicate that the lognormal model yields efficient and unbiased estimates. The results give confidence in the WTP estimates obtained and, more generally, in CVM as a means of valuing publicly provided goods and in econometrics as a tool for analysing WTP results containing many zero responses.

Adolescent↗
PubMed2004

The measurement of contingent valuation for health economics.

In health economics, contingent valuation is a method that elicits an individual's monetary valuations of health programmes or health states. This article reviews the theory and conduct of contingent valuation studies, with suggestions for improving the future measurement of contingent valuation for health economics applications. Contingent valuation questions can be targeted to any of the following groups: the general population, to value health insurance premiums for programmes; users of a health programme, to value the associated programme costs; or individuals with a disease, to evaluate health states. The questions can be framed to ask individuals how much they would pay to obtain positive changes in health status or avoid negative changes in health status ('willingness to pay'; WTP) or how much they would need to be paid to compensate for a decrease in health status or for foregoing an improvement in heath status ('willingness to accept'; WTA). In general WTP questions yield more accurate and precise valuations than WTA questions. Payment card techniques, with follow-up bidding using direct interviews with visual aids, are well suited for small contingent valuation studies. Several biases may be operative when assessing contingent valuation, including biases in the way participants are selected, the way in which the questions are posed, the way in which individuals interpret probabilities and value gains relative to losses, and the way in which missing or extreme responses are interpreted. An important aspect of all contingent valuation studies is an assessment of respondents' understanding of the evaluation method and the valuation task. Contingent valuation studies should measure the potential influence of biases, the validity of contingent valuation tests as measures of QOL, and the reliability and responsiveness of responses. Future research should address equity concerns associated with using contingent valuation and explore contingent valuation as a measure of utility for health states, particularly those that are minor or temporary.

Bias↗
PubMed2001

The relationship between quality and outcomes in routine depression care.

OBJECTIVE: This longitudinal, nonexperimental study examined whether depression treatment provided in concordance with guidelines developed by the Agency for Healthcare Research and Quality (AHRQ) is associated with improved clinical outcomes. METHODS: The medical, insurance, and pharmacy records of a community-based sample of 435 subjects who screened positive for current major depression were abstracted to ascertain whether depression treatment was received and whether it was provided in accordance with AHRQ guidelines. Regression analyses estimated the impact of guideline-concordant treatment on the change in depression severity and on mental and physical health over a six-month period. An instrumental variables analysis was used to check the sensitivity of the results to selection bias. RESULTS: A total of 106 subjects were treated for depression by 105 different primary care and specialty providers. Sixty percent of the sample had current major depression, and about 40 percent had subthreshold depression. Only 29 percent of the patients received guideline-concordant treatment. For patients with major depression, guideline-concordant care was significantly and substantially associated with improved depression severity but not with improvements in overall mental or physical health. The instrumental variables analysis indicated that the standard regression analysis underestimated the treatment effect by 21 percent. For those with subthreshold depression, guideline-concordant care was not associated with improved outcomes. DISCUSSION AND CONCLUSIONS: This community-based, nonexperimental study found a positive relationship between the quality of care for depression and clinical outcomes for patients with major depression in routine practice settings.

Adult↗
PubMed1994

Proposal to reimburse occupational medicine disease and injury claims through third party health insurance.

The current system of compensation for the medical costs of occupational illnesses and injuries, a component of health insurance coverage for most workers in the United States, has recently come under scrutiny in the national health care reform debate. The cost of treatment of these conditions is significant, and there exist numerous disincentives for physicians and patients to use the workers' compensation system. Physicians who treat workers with occupationally related diseases may find compensation for a condition is disputed at the same time that it is excluded from payment by third party insurance coverage, leaving the patient selectively uninsured for at least some medical care services. In addition, most workers' compensation programs have been designed in a way that discourages efficient resource use by providers and claimants. We propose allowing health care providers to bill third party health insurers for all care, including work-related diseases and injuries. Insurers, in turn, would bill workers' compensation programs for associated treatment costs. The potential advantages of such a system include reductions in inefficiency and unfair burdens placed on providers and patients, in reporting bias, and in administrative costs balanced against the risks of insurers excluding workers in high risk occupations from obtaining low cost health insurance and shifting away from employers the administrative burden for workers' compensation.

Accidents, Occupational↗
PubMed2000

Shorter hospital stays for angioplasty patients who receive abciximab.

The purpose of this retrospective study is to examine the effect of abciximab treatment on hospital length of stay for patients undergoing angioplasty in a naturalistic setting. Multivariate analysis was used to control for a wide range of factors (patient demographics, insurance provider, health conditions, admission and discharge information, and hospital characteristics) that may influence length of stay. Estimation was conducted on a sample of 13,384 angioplasty patients via a two-stage sample selection model. In addition, the model was re-estimated for a subgroup of 4,800 patients who underwent angioplasty and were also diagnosed with acute myocardial infarction. The study finds that patients in poorer health were more likely to receive abciximab. After adjusting for high-risk indications and selection bias, results also indicate that angioplasty patients (n = 13,384) who are given abciximab have a significantly shorter length of stay (0.89+/-0.12 fewer days) than those patients who did not receive abciximab. In a subgroup analysis of patients who had an acute myocardial infarction (n = 4,800), patients receiving abciximab were also found to have significantly shorter hospital stays (0.54+/-0.26 fewer days) than patients who did not receive abciximab. These results indicate that there are potential economic benefits for hospitals administering abciximab.

Abciximab↗