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PubMed2003

Going for the green. As higher premiums and stable medical costs fuel health plans' profits, providers say time is right to win bigger reimbursement.

Thanks to higher premiums and a slowing of medical cost growth, the second quarter brought soaring profits at health plans across the nation. Hospitals plan to escalate their push for higher reimbursement while the iron is hot. Yet Oxford Health Plans President and CEO Charles Berg, left, says big profits don't paint the whole picture.

Data Collection↗
PubMed2003

A formula for successfully competing in non-US health insurance markets.

Many insurers in non-US markets are experiencing difficulties in developing managed care strategies to combat increasing medical costs. Some attempts to transport managed care techniques outside of the US have failed. Although it is difficult to determine the exact causes of failure, some common threads exist. When these common characteristics are explored, fundamental building blocks will emerge. When introduced, these fundamentals can lead to increased efficiency, thereby paving the way to successful managed care development in non-US markets.

Asia, Southeastern↗
PubMed1953

The general practitioner in industrial medicine.

Most industrial injuries are treated by physicians who have a general practice in addition to their industrial work. Because of the increasing number and seriousness of industrial injuries, better preparation for treatment is required in the patient's interest and for reasonable economy. The trend toward centralization of industrial medical facilities, increasing before and during World War II, has been somewhat reversed; the general practitioner now has an opportunity to take a useful place in the care of injured employees.A physician dealing with industrial cases must be prepared to give immediate emergency treatment, to comply with the procedures of insurance carriers, and to refer cases which he is not skilled or equipped to handle. As a personal physician having the confidence of the patient he can secure greater cooperation from all parties concerned in industrial disability and can sometimes promote a more rapid recovery.

Family Practice↗
PubMed1954

Faulty healing in the lower extremities; vascular deficiency as a complication in industrial injuries.

The failure of injuries of the lower extremities to heal properly can often be traced in older persons to arteriosclerosis obliterans. In industry this condition presents a serious problem to older workers, to employers and to insurance carriers. In persons with severe varicosis or those who have had extensive thrombophlebitis, ulcers of the leg may develop following bruising of the skin in the region of the ankle.A third and little recognized condition is edema with or without induration of the skin and subcutaneous structures of the leg, with or without the existence of varicose veins and without evidence of cardiac or renal disorders. This condition is often associated with the absence of or marked diminution of the production of hydrochloric acid by the stomach. An accompanying diminution in or absence of pepsin may occur. It is corrected slowly by taking with each meal small amounts of dilute hydrochloric acid. When pepsin is deficient, the enzyme papain is given.

Arteriosclerosis Obliterans↗
PubMed1992

[Severe disability. Part 2: The difficult comparison with same age probands].

With their texts on Schwerpflegebedürftigkeit, the legislators have set the interpreters of legal texts a difficult task. In practice, attempts by the "users" of such texts to find solutions inexorably lead to aporias. Responsible for decision-taking is the health insurance carrier, with the physician exclusively acting as a counsellor on the medical aspects. The advised comparisons with persons of identical age with the intention of establishing Schwerpflegebedürftigkeit is not required by the legislator, and it is not easy to see what sense it is supposed to make. The corresponding guidelines drawn up by the leading associations are not unequivocal and are therefore open to misunderstanding.

Disability Evaluation↗
PubMedDate not supplied

Genetics and the moral mission of health insurance.

Deciding whether genetic differences among individuals are morally relevant to health insurance requires us to ask, What kind of good is health care? and, What principles should govern its distribution? There are good reasons to doubt that "actuarial fairness" is an adequate description of genuine fairness in health insurance.

Actuarial Analysis↗
PubMedDate not supplied

Insurance for the insurers. The use of genetic tests.

Genetic testing raises concerns that individuals will be denied health insurance (and thus, effectively, access to health care), or that employers will screen to eliminate potentially costly workers. Although we as a society do not yet concur on the degree to which private businesses have a responsibility to promote social justice, several different policy alternatives might allow us to weigh the interests of insurers, as businesses, against the interests of citizens in a responsible manner.

Eligibility Determination↗