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PubMed2002

Implications of genetic testing for the insurance industry: the UK example.

This report summarises the controversy of genetic tests and insurance, with a focus on the UK situation during the past decade. UK experience provides insight for future strategies to help people with genetic disadvantages make insurance provision for themselves and their families. Non-disclosure of genetic test results (already carried out for clinical purposes) may not benefit people at risk of genetic disorders or with positive genetic tests. The pressure of geneticists over a decade to prevent disclosure to insurers may have masked opportunities to use insurance to provide help for people with genetic disadvantages. To seize the opportunities now, there must be collaboration, not conflict. Politicians, geneticists, social scientists and all elements of the insurance industry can contribute to wise solutions.

Advisory Committees↗
PubMed1996

Health and economic implications of a work-site smoking-cessation program: a simulation analysis.

In this article, we examine the health and economic implications of a workplace smoking-cessation program by using a simulation model that includes, among its novel features, consideration of long-term as well as short-term implications and evaluation of the effects of employee turnover on benefits derived by both the firm and the broader community. As a result of employee turnover, approximately half of the program-generated benefits are realized by the community outside the firm. Still, smoking cessation is a very sound economic investment for the firm, and is particularly profitable when long-term benefits are included, with an eventual benefit-cost ratio of 8.75. Saving life-years at a cost of $894 each, the program is more cost-effective than most of the conventional medical care covered by the firm's insurance. Nevertheless, the intervention successfully addresses only a fraction of the costs that smoking imposes on the firm.

Absenteeism↗
PubMedDate not supplied

Health insurance for type 1 diabetes mellitus: US competition and French coverage.

Chronic diseases present a major challenge to individuals, health professionals, and policy makers. Disease burdens and fears of a lifelong condition are complicated by the volatility of health insurance. Individuals with type 1 diabetes mellitus face these challenges daily. Treatment needs persist despite changes in individual health insurance or health plan coverage, yet this costly and devastating disease does not discriminate economically. The demands for care are the same for the under- and uninsured as they are for the fully insured. As life expectancy lengthens for individuals with type 1 diabetes mellitus, a greater potential exists for significant variability in coverage. This article presents a review and analysis of health insurance issues among adults 18-64 years old and extrapolates the consequences for those in the United States (US) with type 1 diabetes mellitus. Comparisons are made with the French health care system, ranked 1st by the World Health Organization in 2000.

Diabetes Mellitus, Type 1↗
PubMed1998

Life table analysis.

Life table analysis is an effective way to present and evaluate survival data in a number of circumstances. The summary tables and survival curves that are commonly seen in the medical literature are frequently derived through life table analysis. A basic understanding of life table construction is of benefit to the medical director who wishes to abstract comparative mortality data from study reports. This article reviews the basic methodology of life table analysis with a particular focus on handling right-censored study participants as withdrawals.

Humans↗
PubMed1995

Termination of employment.

The following questions and recommendations, taken from Jeffrey Hirsch & William Farrell's Labor and Employment in Rhode Island, provide a synopsis of the basic issues which employers should consider before making a decision to fire an employee: 1. Review all documentation and other company records considered when making the decision. Make sure all stated policies were followed by management. 2. Interview all managers who provided input on the decisions. 3. Be satisfied that the decision was made for the correct reason. 4. Was the employee aware that termination was likely? Can you document that awareness? 5. Was the individual given an opportunity to improve his or her performance? 6. Has the company discharged others for similar reasons in the past? 7. Has the company acted promptly and avoided relying on "stale" offense? 8. Is the employee protected by anti-discrimination statutes? (i.e. race, age, sex, national origin, handicapped or religion)? 9. Meet with the employee personally; do not discharge by phone or letter unless absolutely necessary. 10. Have a "passive" management witness at the meeting. 11. Conduct the meeting in a private area where other employees will not be able to see or hear the discussion. 12. Both the executive and management witness should prepare file memoranda concerning what is said at the discharge meeting. 13. Always tell the employee the reason for her or his discharge. 14. Discuss health insurance continuation (COBRA). 15. Discuss life and disability insurance, and pension/profit sharing status. 16. Discuss other issues, such as references and out placement policies. By taking the time to follow these suggestions and answer these questions, an employer can feel more secure that the termination has been conducted properly, and minimize the chances of becoming implicated in legal action related to the termination.

Employment↗
PubMed2003

Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study.

BACKGROUND AND AIMS: The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls. METHODS: A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised. RESULTS: In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31-246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3-13)) although no specific disease or patient characteristics were identified as associated with such difficulties. CONCLUSIONS: This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices.

Adolescent↗
PubMed1995

[MEDRISK--an expert system for medical risk assessment].

The Munich Reinsurance Company has developed a rule-based expert system for assessing substandard risk in life, disability and accidental death benefit. It is one of the most comprehensive medical expert systems yet conceived and currently includes entries for over 7500 impairment terms. Based on the most up-to-date insurance medical knowledge MEDRISK allows underwriters, irrespective of their level of experience, to process both simple and highly complex cases. The system which takes account of the interactive effect that can exist between different impairments as well as the influence which occupational factors can exert, always produces consistent and case-specific decisions. The number of impairments and types of insurance included in MEDRISK can be expanded. After tests at Munich Re and at a number of insurance companies, the system ist now ready to be launched in German speaking markets.

Artificial Intelligence↗
PubMed1984

A result-oriented medical information system. An alternative to the conventional approach.

A result-oriented medical information system at the Gulf Oil Corporation is described. Mortality data acquired mostly from routine company operations have been used to calculate standardized mortality ratios (SMRs) and life expectancy. Results show that male employees at the age of 20 have a life expectancy of 74.8 years. Compared with the U.S. general population at age 20 with a life expectancy of 71.8 years, Gulf employees have an advantage of exactly three years. Such an advantage may seem small, but it is equivalent to the gain that could be achieved if all deaths from cancer were eliminated in the United States, a hypothetical and impossible situation. These life expectancy data have the potential for use by the company to influence insurance premiums traditionally set by life insurance companies as well as to aid in the management of the company's pension fund. The SMR for all causes for the male employees is 0.82, significantly decreased in comparison with that of the U.S. general population. This favorable experience has been referred to as "the healthy worker effect." Cause-specific SMRs show a generalized pattern of deficits, some of which are statistically significant. None showed a significant increase. Seventy-six percent of the male deaths occurred among employees aged 65 years or older. If these annuitants (those alive at the beginning of the study) were not included and only the active workers were studied, an SMR of only 0.54 would be obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗
PubMed2003

Recurrent PSA after prostatectomy for prostate cancer: implications of PSA doubling time.

After radical prostatectomy for prostate cancer, men frequently develop detectable levels of prostate specific antigen (PSA). A slow rate of increase, as characterized by the PSA doubling time (PSADT) is the principal marker for a favorable prognosis. Data and results presented in 2 recent clinical articles studying cohorts of men with clinical stage T1/T2 prostate cancer are reviewed and used to develop mortality analyses. Life-table analysis shows a mortality ratio of 257% at 5 years for Gleason score < 8, PSA recurrence > 2 years after surgery for clinical stage T1/T2 disease, and PSA doubling time (PSADT) > 10 months. Markov modeling using transition probabilities derived from the clinical articles to develop a life table analysis yields a mortality ratio of 145% at 10 years for similar patients.

Adult↗