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PubMed1995

The impact of health insurance on an African-American population with colorectal cancer.

This study evaluates the impact of health insurance as a substitute for social class on tumor location, presentation, stage, grade, and age-adjusted survival in an African-American population. Patients were stratified by insurance into two groups: group 1 (private insurance and Medicare parts A & B) and group 2 (Medicaid, Medical Charity, self-pay, uninsured, or unemployed). A total of 212 patients were evaluated. Of these, 210 patients were insured or had Medical Charity, and two were uninsured. The type of health insurance did not significantly affect age-adjusted survival. However, age and stage at presentation were positive predictors of age-adjusted survival. Higher socioeconomic status was associated with group 1 health insurance.

Age Factors↗
PubMed1995

[Positive experiences in Scandinavian patient insurance].

Voluntary insurance for the compensation of patients for damage sustained in health care was introduced in Sweden 20 years ago and similar systems exist in Finland, Denmark and Norway. This type of insurance is, or is in the process of becoming, statutory. The basic principle is that the apportioning of blame to any individual(s) is not a prerequisite for compensation to be paid out for injury sustained by a patient. Owing to hospital proprietors and care givers having taken out patient insurance policies with approved insurance companies, it has been possible for damages to be compensated in accordance with current insurance norms and the frequency of lawsuits arising from injury sustained in health care has been minimised. This type of insurance is universally accepted, and has often enabled unfortunate confrontations between doctors and patients to be avoided.

Clinical Competence↗
PubMedDate not supplied

Health insurance and health status: implications for financing health care reform.

Self-reported health status measures from the 1987 National Medical Expenditure Survey indicate significant differences among each of five population groups defined by current health insurance coverage. These differences in health status imply that the groups are likely to exhibit different patterns of expenditures, even if enrolled in the same health insurance after health care reform. The healthiest group along most dimensions is the population covered by employer-sponsored insurance, followed in order by the population with nongroup private insurance, the uninsured population, the population that qualifies for public coverage based on income, and the population that qualifies for public coverage based on medical need. While the general health and mental health of the uninsured are slightly worse in comparison to the privately insured, the uninsured have fewer chronic health problems. The uninsured who recently lost private insurance or who live in working families are significantly healthier than the long-term or low-income and nonworking uninsured.

Adolescent↗
PubMed1975

Equity in paying for health care services under a national insurance system.

The debate over the future of the health care delivery system evolves around the policy issue of what constitutes a fair distribution of the medical services which are considered essential to prolonging life, curing disease, and relieving pain. A case can be made that a socially equitable distribution implies that consumption of medical services is independent of the consumer's income and payment for them unrelated to utilization. The present paper examines to what extent the provisions for financing a national health insurance system are likely to advance or hinder the fair distribution of health care services. Almost all bills specify a mix of direct (cost-shared) and indirect (prepaid) financing. When cost-sharing is based on the quantity of services or on the level of medical expenditure, it helps divert medical care and health insurance benefits to high-income persons at the expense of their low-or moderate-income counterparts. When indirect payments or premium levels are determined by insurance risks rather than by income, they may be too high for persons with moderate means, and are likely to exclude such persons from the national insurance program. When health insurance is tied to salaried employment, it discriminates against the unemployed and the self-employed. To rectify such inequities, some NHI proposals specify separate insurance plans for the disadvantaged. Such programs, which require income-testing to determine eligibility, are likely to be plagued by administrative complications currently engulfing other means-tested social welfare programs. The present paper makes some recommendations for the purpose of avoiding these difficulties and fostering equity in health care.

Deductibles and Coinsurance↗
PubMed1994

Bond ratings, debt insurance, and hospital operating performance.

In this study, the operating performances of not-for-profit community hospitals are compared among groups partitioned by bond ratings, level of debt insurance coverage, and number of bond rating services. The analysis indicates that the performances of hospitals with full debt insurance coverage resulting in AAA ratings are significantly lower than those of hospitals with partial debt insurance and with AA ratings or better. Indeed, the hospitals with full debt insurance resemble those with partial insurance that are rated BBB to A. These findings have implications for managerial action choices. Hospitals seeking external funding to improve their operating performance may consider the costs and benefits of full insurance coverage.

Analysis of Variance↗
PubMed1993

A survey of medical directors of life insurance companies concerning use of genetic information.

Rapid advances in our ability to test persons presymptomatically for genetic diseases have generated increasing concern that genetic information will be abused by insurance companies. Reasoning that the insurance companies may have the strongest interest in using genetic data and that the medical directors of those companies with responsibility for rating applicants would be a good source of information on the use of such data, we conducted a large survey of medical directors of North American life insurance companies. We received responses from 27 medical directors. Our results suggest that (1) few insurers perform genetic tests on applicants, but most are interested in accessing genetic test information about applicants that already exists; (2) the degree of insurers' interest in using genetic test results may depend on the face amount of the policy applied for and on the specificity and sensitivity of the test; (3) many companies employ underwriting guidelines with respect to certain genetic conditions but may not always have specific actuarial data in house to support their rating decisions; (4) a considerable degree of subjectivity is involved in most insurers' rating decisions; and (5) some of the medical directors who responded to our survey are not fully informed about certain basic principles of medical genetics.

Ethics, Medical↗
PubMedDate not supplied

Insurance coverage of special foods needed in the treatment of phenylketonuria.

Optimal medical management of phenylketonuria (PKU) requires the use of special low-phenylalanine foods for many years. For women with PKU, elevated maternal blood levels of phenylalanine even at conception can lead to fetal damage. Despite this need, private health insurance, Medicaid, and other public health programs often exclude the cost of these foods from their benefits. The New York State Department of Health conducted a survey of metabolic disorders treatment centers to elucidate the problems PKU patients have obtaining and paying for the special foods essential to their care. Payment for special foods was denied to nearly half of those with private health insurance policies and was covered for only 10 percent of Medicaid-eligibles. A public program for children with special health care needs covered these food costs in upstate New York but not in New York City. There is no program of assistance for adults who are not eligible for Medicaid and who do not have private insurance coverage of special foods. At present, many private health insurance policies and public programs do not cover the costs of low-phenylalanine foods other than infant formula. Payment for this essential part of the management of PKU should be mandated for all public programs for persons with chronic illnesses, public medical assistance (Medicaid) programs, and private health insurance. There is a need for a public program to assist adults with PKU who are not eligible for Medicaid and who do not have health insurance that covers these costs.

Adolescent↗
PubMed1996

[International developmental trends in life insurance medicine 1971-1995].

This retrospective of the eventful quarter of a century up to 1995 presents in brief sketches an international survey of developments with a bearing on insurance medicine. It identifies principle events in the field of clinical medicine that have had an effect on long-term prognoses and shows how they have been accounted for in the process of rating on the basis of insurance medicine prognoses. It highlights the main aspects of the scenarios from the 1970s down to the early years of the 1990s and illuminates in detail the developments in Germany. Finally, in the chapter "Life insurance medicine in the year 2000", there is a cautious "forecast on our own behalf", which names eleven points of development which contain possible messages for the future. In the final comment, the concern is expressed that life insurers and the insurance industry as a whole have not yet fully recognized the cost-benefit effect of insurance medical officers. A major role is played in this context by the increasingly important ethical guidelines.

Forecasting↗
PubMed1997

Charges for obstetric liability insurance and discontinuation of obstetric practice in New York.

BACKGROUND: The study objective was to determine whether New York physicians facing higher charges for obstetric liability insurance coverage are more likely to discontinue obstetric practice than physicians experiencing lower levels of increases in liability insurance charges. METHODS: We performed a physician-level analysis of factors predicting discontinuation of hospital-based obstetric practice by 1989 for physicians active in obstetrics in 1980. We examined both physicians who became completely clinically inactive in New York between 1980 and 1989, and physicians who remained clinically active but restricted their hospital practice to areas other than obstetrics. Multiple logistic regression models were used to analyze predictors of discontinuation of obstetrics, including regional malpractice insurance charges, physician characteristics, and practice characteristics. RESULTS: Although increases in malpractice insurance charges differed considerably among regions within New York State, there was no association between level of increase of charges for liability insurance and discontinuation of obstetric practice. A greater number of years since medical licensure was associated both with complete discontinuation of hospital practice in New York and selective discontinuation of obstetrical practice. Compared with obstetrician-gynecologists, family physicians were less likely to become completely clinically inactive. Among physicians who remained clinically active in hospital care, however, family physicians were less likely than obstetrician-gynecologists to continue to include obstetrics in their practice. CONCLUSIONS: There is no relationship between the level of increase in liability insurance premiums and the likelihood of discontinuing obstetric practice in New York. Discontinuation of obstetric practice appears to mainly reflect trends in the physician's life cycle of practice activity and in the scope of family and general practice.

Costs and Cost Analysis↗
PubMed1995

Playing by the rules and losing: health insurance and the working poor.

Using a sample of 7,734 employed adults from the National Medical Expenditure Survey, this research compares the sources of health insurance coverage and the antecedents of employer-sponsored insurance among the working poor to those at higher income thresholds. Concern with the working poor is warranted because they constitute the majority of the uninsured, they do not qualify for public health programs, and their health insurance benefits have eroded substantially. The data reveal that (1) the working poor are only one-third as likely to receive insurance from their employer as are the non-poor, and are over five times as likely to be without insurance from any source; (2) employment characteristics are critical antecedents of employer-sponsored insurance and, as a set, explain variation in coverage beyond that provided by human capital/socioeconomic factors; and (3) most employment characteristics have a similar effect on the odds of coverage across income categories, except for unionization and minimum wages. Implications for health care reform are addressed.

Adolescent↗
PubMed1997

The impact of insurance type and forced discontinuity on the delivery of primary care.

BACKGROUND: The effect of managed care on important attributes of primary care is poorly understood. Of particular concern is the potential for annual bidding on managed care contracts, which may cause forced discontinuity of care. We examined the effect of insurance type and insurance-mandated disruption in continuity of care on the quality of primary care. METHODS: A cross-sectional study design was used to examine 1839 patient visits to 138 community-based primary care physicians. The quality of primary care delivery was measured with the Components of Primary Care Instrument, a patient-reported indicator of physician knowledge of the patient, interpersonal communication, coordination of care, continuity of care, and patients' preference to see their regular physician. RESULTS: No significant differences in any of the five indicators of primary care quality were found between patients with independent provider association/preferred provider organization (IPA/PPO) and fee-for-service insurance. Patients with IPA/PPO health insurance were four times as likely as patients with fee-for-service insurance to report a forced change in their primary care physician (P < or = .01). Individuals forced to change their physician because of changes in their health care insurance scored significantly lower on all five indicators of primary care quality (P < or = .01). CONCLUSIONS: The quality of primary care appears to be less dependent on the payment system than on the maintenance of the patient-physician relationship. Forced disruption of continuity of care is detrimental to patient receipt of quality primary care, and is a potential negative consequence of annual bidding for managed care contracts.

Adult↗
PubMed1998

[Incidence of operations in Switzerland related to insurance status].

Several studies reported in the literature show that surgical procedures can be carried out for other than clinical indications. In Switzerland, no statistics on the "demography" of surgical procedures are available. But an earlier analysis of the "Swiss Health Survey 1992/93" gave first indications on differences in rates of surgical procedures (hysterectomy, appendectomy, tonsillectomy and operation of the hip and gallbladder) by sex, educational status and region. This study, based on the same datasource (N = 10792), reveals an additional link with the health insurance status. The prevalence of surgical procedures is higher in privately insured than in persons with only basic insurance, independent of age, sex and region. The highest rates of surgical procedures (except tonsillectomy) are found among privately insured persons with a low educational status. Among 25-74 year old privately insured women, the lifetime-prevalence of a hysterectomy is 30% with low and 13% with high educational status (p < .001). The corresponding prevalences of at least one of the mentioned surgical procedures (without tonsillectomy) are 49% versus 28% (p < .001). As these are lifetime-prevalences, these rates do not necessarily reflect the actual surgical procedures. However, an analysis of the period of operation for hysterectomy and for the gallbladder shows the same pattern as the mentioned lifetime-prevalences. Higher rates among privately insured are also a frequent finding in the international literature. These findings should stimulate patients to ask for a "second opinion". Furthermore, there is an urge for the implementation of general hospital statistics to verify such findings. In addition, the scientific consensus on the indication of several surgical procedures should be promoted on the way to more evidence-based-medicine.

Adolescent↗
PubMed2006

Genetic testing and private insurance--a case of "selling one's body"?

Arguments against the possible use of genetic test results in private health and life insurance predominantly refer to the problem of certain gene carriers failing to obtain affordable insurance cover. However, some moral intuitions speaking against this practice seem to be more fundamental than mere concerns about adverse distributional effects. In their perspective, the central ethical problem is not that some people might fail to get insurance cover because of their 'bad genes', but rather that some people would manage to get insurance cover because of their 'good genes'. This paper tries to highlight the ethical background of these intuitions. Their guiding idea appears to be that, by pointing to his favourable test results, a customer might make an attempt to 'sell his body'. The rationale of this concept is developed and its applicability to the case at issue is critically investigated. The aim is to clarify an essential objection against the use of genetic information in private insurance which has not yet been openly addressed in the academic debate of the topic.

Commerce↗
PubMed1991

Structure, process, effectiveness and efficiency of the check and review system in Japan's health insurance.

Keeping medical costs at an adequate and affordable level cannot be realized by the efforts of medical facilities alone, nor by the revision of fee schedules and price schedules of drugs in Japan's health insurance systems. Rationalization and improvement in the efficiency of all of the systems, including the various insurance organizations and the organizations for review and payment, are imperative. This paper first examines the system of review and payment for insurance claims under Japan's health insurance systems with emphasis on three main points, namely (1) qualification checks, (2) check and review of insurance claims and (3) computerization of the screening process. Relevant issues facing the check and review system are then discussed.

Cost Control↗
PubMed1991

Genetic predictive testing and private insurances.

Genetic information is a potential tool for selection of job applicants and of candidates for insurance. Social implications of genetic information may represent a threshold for the access to health care facilities. Some of the issues related to the use of predictive genetic information by private life and health insurance companies are discussed. They include the potential threat for the privacy of the individual and his relatives, the pressure to undergo genetic testing and the social consequences of the use of genetic information by private insurance companies. The justified financial interests of insurance companies and the interests of the individual to have his privacy protected and to be able to partake in social attainments have to be brought into balance. A ban on genetic testing in connection with access to insurances and a limitation to the use of existing genetic information have been suggested by the Dutch Health Council. This approach to the problem should be adopted throughout the European Communities, so that medical progress does not turn out to be against the interests of the consumer.

AIDS Serodiagnosis↗
PubMed2005

State laws on insurance coverage for bariatric surgery: help or a hindrance?

BACKGROUND: The purpose of this study was to determine which states have proposed or passed laws regarding insurance coverage for bariatric surgery and to obtain feedback from bariatric surgeons/programs regarding the effectiveness of these laws. METHODS: The Departments of Insurance in all 50 states and the District of Columbia in the United States and all members of the American Society for Bariatric Surgery were surveyed. RESULTS: Responses were obtained from all states and the District of Columbia, and 16 responses were received from the bariatric surgeons/programs. Michigan law requires all Health Maintenance Organizations to pay for all medically necessary treatments or procedures in general, such that if bariatric surgery can be shown to be medically necessary, it should be covered. Four states (Louisiana, Ohio, South Carolina, and Tennessee) have proposed state laws regarding bariatric surgery coverage, and four states (Georgia, Indiana, Maryland, and Virginia) have such laws in effect. However, none of the state laws that were passed "mandate" coverage, but rather "recommend" coverage or mandate that the insurer offer the coverage, for which the insurer can charge additional premiums. Although the numbers of responses from bariatric surgeons/programs were few, all of their responses were in agreement that the state laws have not increased insurance approvals for bariatric surgery and, in some cases, has made it more difficult to obtain approval. CONCLUSION: So far, the laws that have been passed have not adequately addressed the problems with decreasing coverage of bariatric surgery. Recommendations for future legislation are discussed.

Bariatric Surgery↗
PubMed2004

Epilepsy and insurance in the UK: an exploratory survey of the experiences of people with epilepsy.

We investigated problems in obtaining insurance as reported by people with epilepsy who were members of a major United Kingdom patient organisation. Information was collected via questionnaires mailed to a random sample of the membership, 347 of whom replied. Overall, 62% of respondents reported experiencing a problem obtaining insurance coverage (increased premiums, restricted coverage, or outright refusal). Thirty-six percent of respondents reported having been refused one or more types of insurance on the grounds of their epilepsy. Although the low response rate to the study represents an important source of bias, extrapolation from our figures suggests a problem prevalence rate of at least 10%. Adoption of an evidence-based and standardised approach to informing assessments of risk is vital if insurance companies are to provide fair and reasonable terms for insurance coverage to their clients with epilepsy.

Adult↗
PubMed1998

The health insurance puzzle: a new approach to assessing patient coverage preferences.

Previous studies of preferences for health insurance benefits have required individuals to make a series of complex and repetitive decisions, and have assumed that all insured benefits are desirable. This study reports the development and testing of a simple, innovative instrument to measure preferences for health insurance benefits. The newly developed instrument (Puzzle) is designed to allow subjects to select health benefits in a way that underscores the trade-offs dictated by budgets and costs. A "puzzle-like" frame representing budget constraints and "puzzle piece" benefit cards proportionately sized to represent the premium price of a single year's coverage comprise the instrument. In a comparison procedure (Money Game), participants "purchase" individual benefits by exchanging "play" money for benefit tokens. The Puzzle's utility was assessed by examining the convergence of results from both instruments and the subject's ratings of and preference for the instruments. One hundred five elderly Medicare enrollees seen in the general Internal Medicine outpatient clinic of a major southeastern teaching hospital were interviewed. Subjects answered interviewer-administered questionnaires and completed both the Puzzle and the Money Game. Both McNemar's test and Kendall's tau-b indicated a high degree of concordance between benefit choices made using the two instruments. Descriptive statistics demonstrated that the Puzzle was clear, easy to use, understandable, and preferred to the Money Game. The results suggest that the Puzzle is a promising tool for assessing health insurance coverage preferences under circumstances of limited expenditures, which can be modified for use with various populations who face limited insurance benefits.

Aged↗