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At least 955 records · Page 53Linked to original sources
PubMed2001

[Rehabilitation and pensioning. Social network assimilates the HIV patient poorly].

For HIV patients, the social security net contains considerable gaps; for example, more than one-half of the unemployed patients under 55 receive no pension; in the case of those who go on to develop AIDS, the figure is 30%. Apparently, recognition of inability to work depends on the severity of the disability. Nor does the statutory regulation of rehabilitation measures do justice to those infected with HIV. Despite their higher morbidity, they are under-represented by a factor of 10 in comparison with the average in the general population when it comes to medical rehabilitation. While formerly, the HIV-infected were granted a disablement pension relatively quickly, today the pension insurance carriers appear to be adopting a more restrictive attitude, and often grant a pension for only a limited period. Furthermore, the legislation took effect at the beginning of 2001, has also made early pensioning more difficult.

Disability Evaluation↗
PubMed2001

Reinsurance of health insurance for the informal sector.

Deficient financing of health services in low-income countries and the absence of universal insurance coverage leaves most of the informal sector in medical indigence, because people cannot assume the financial consequences of illness. The role of communities in solving this problem has been recognized, and many initiatives are under way. However, community financing is rarely structured as health insurance. Communities that pool risks (or offer insurance) have been described as micro-insurance units. The sources of their financial instability and the options for stabilization are explained. Field data from Uganda and the Philippines, as well as simulated situations, are used to examine the arguments. The article focuses on risk transfer from micro-insurance units to reinsurance. The main insight of the study is that when the financial results of micro-insurance units can be estimated, they can enter reinsurance treaties and be stabilized from the first year. The second insight is that the reinsurance pool may require several years of operation before reaching cost neutrality.

Community Health Planning↗
PubMed2001

Evaluation and reporting requirements of the disability examiner.

Critics of the system within which IMEs occur might argue that there is in fact no such entity as a truly impartial evaluation because the practitioner always is aware of the source of payment for the visit and will color opinions in favor of that payor. Nonetheless, the ethical practitioner has no problem whatsoever refuting that rather cynical attitude. First, payment for any type of clinical visit must come from somewhere. Most importantly, always keep in mind what is in the best medical interest of the person you are examining, and you will avoid virtually all ethical dilemmas. To illustrate obvious examples, if a claimant has the objective impairments of herniated disc with associated radiculopathy, it makes no medical sense, and would certainly be unethical, to allow unrestricted RTW to a physical job. That clearly would not be in the best interest of a patient you were treating, nor should that be your opinion for an IME. Similarly, a person without any objective impairment documented after careful search is not well served by a continuing program of medications, time off work, useless modalities, and a growing "sickness" frame of mind. That would definitely not be in their best interest, and your opinion for a treatment case or for an IME should reflect that without hesitation. Once you make a consistent habit of always invoking what you truly believe to be in the best medical interest of the examinee, the long-term interests of the other involved parties will also be well served as a consequence. The insurance company will not be asked to either continue paying treatment and wage replacement costs for someone who could safely work, nor will it be forced to accumulate the unnecessary expenses of recurrent injuries to an injured worker returned to work prematurely. By faithfully adhering to the simple principle of not swaying from the best interest of the examinee, you might lose referral business from some sources. Certain employers, case managers, insurance carriers, attorneys, or others might want to rely on your opinion in all cases, perhaps to conclude that claimants are rarely if ever impaired (or at least not from work or auto accident-related events). Your practice and your reputation are much better off without that business. A well-planned and carefully performed IME, resulting in a detailed, understandable, and defensible report with the elements outlined in this article, will serve you and your referring sources well.

Disability Evaluation↗
PubMed2001

Dental benefits--expanding access to dental care.

The Executive Director of the National Association of Dental Plans presents statistics describing recent trends in product mix, growth in voluntary benefits and referral plans, geographic concentration, and industry consolidation in the dental benefits industry. Current issues include dental workforce, the economy, human resources policies, and regulation. The issue of quality oral health care is identified as needing consensus definition by the entire dental industry.

Health Insurance Portability and Accountability Ac↗
PubMed2001

[Screening lowers breast cancer mortality. Motivate your patients for mammography].

Breast cancer is the most common malignant disease in women under 70, and the most common cause of death in those under 50. Causal prophylaxis is unknown. Only early diagnosis prior to the onset of lymphogenic or hematogenic metastasization improves the prognosis. Since the early nineteen-sixties, large-scale studies have shown that screening mammography can reduce mortality. Furthermore, early diagnosis enables breast-conserving treatment in up to 70% of cases. Disadvantages of screening mammography currently under discussion are the radiation burden, the number of false-positive diagnoses prompting biopsy and incurring costs. In Germany, the cost of screening mammography in women with no relevant history or clinical symptoms is not borne by the state-affiliated health insurance carriers. Currently, ongoing pilot projects are investigating quality-controlled early diagnosis with mammography.

Adult↗
PubMed1997

The Ohio Blue Cross conversion: building an opposition.

With good reason, there has been loud public opposition to the proposed sale of Blue Cross of Ohio to Columbia/HCA Healthcare Corporation. If approved, the deal would allow the hospital giant also to control insurance coverage for one and a half million subscribers. Many aspects of the deal are alarming, but foremost is that assets belonging to the public would be sold to a private corporation. As States of Health goes to print, the Department of Insurance decision whether to approve the sale has not been released, though news stories indicate the answer is no. Regardless of the decision, consumers won: without their intervention, regulators were expected to give the deal pro forma approval. Instead, the public was quickly educated, and the deal received the scrutiny it deserves.

Blue Cross Blue Shield Insurance Plans↗
PubMed1997

The Ohio Blue Cross conversion: building an opposition.

In March, state insurance regulators rejected the bid of Blue Cross of Ohio to sell the business to Columbia/HCA, saying it would not be in the public interest. The decision came as a shock to those who assumed the transaction would get pro forma approval. The fact that it received press, public, and regulatory attention is due largely to the efforts of a coalition of consumer interests, supported by Community Catalyst. This issue of States of Health outlines how Community Catalyst and other groups successfully focused and strengthened opposition to a deal that disposed of public assets without public participation or representation.

Blue Cross Blue Shield Insurance Plans↗