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PubMed1992

Financing universal health insurance: taxes, premiums, and the lessons of social insurance.

In a society with strong antitax sentiment and large government deficits, the enactment of universal health insurance is blocked by an impasse over financing. The two chief mechanisms for funding universal health insurance are taxes and insurance premiums. Taxes and premiums are not distinct entities; rather, a spectrum of financing methods exists with varying tax-like and premium-like features. Premium-like financing tends to be voluntary and earmarked for health care, with coverage contingent upon making payments and payments going to private insurance firms. Tax-like financing, in contrast, tends to be mandatory and not earmarked for health care, with coverage not dependent upon making payments and payments going to governments. Over the past century, most industrialized nations have developed highly popular social insurance programs to cover periods of retirement, disability, unemployment, and payment for medical care. Social insurance constitutes a blend of tax-like and premium-like features, offering lessons that might assist in breaking the current impasse over universal health insurance financing.

Fees and Charges↗
PubMed2003

Preempting genetic discrimination and assaults on privacy: report of a symposium.

At a symposium in June, 2002, biomedical researchers, clinicians, legal experts, policymakers, and representatives of the insurance industry and the advocacy community gathered to address issues of genetic privacy and discrimination; and to identify research, legal, and policy gaps needing to be filled. They concluded that over the next decade, as more genetic information becomes available and the public becomes more aware of individual risks, concerns about privacy and discrimination will become increasingly important. Documented cases of genetic discrimination are rare and largely anecdotal, yet individuals with genetic conditions harbor significant fears about discrimination. Current laws enacted to protect individuals from workplace and insurance discrimination offer some measure of protection, but leave many unfilled gaps. Moreover, the use of genetic information in potentially discriminatory ways is not limited to employment and insurability. Existing laws do little to protect people seeking life, disability, or long-term care insurance. And the courts have used genetic information in a wide variety of cases including paternity, criminal, and tort (personal injury) cases. Genetic information that might jeopardize an individual's right to privacy may also be obtained in the course of research studies, including through the collection of DNA and tissue samples. The insurance industry, State and Federal agencies, and the advocacy community are all making efforts to address some of these gaps through legislation and education of clinicians, the public, and policy makers.

Employment↗
PubMed2005

Gatekeepers in sickness insurance: a systematic review of the literature on practices of social insurance officers.

Decisions concerning entitlement to sickness benefits have a substantial impact on the lives of individuals and on society. In most countries, such decisions are made by staff of private or public insurance organisations. The work performed by these professionals is debated, hence more knowledge is needed on this subject. The aim of the present study was to review scientific studies of the practices of social insurance officers (SIOs) published in English, Danish, Norwegian and Swedish. Studies were searched for in literature databases, in reference lists, and through personal contacts. Analyses were made of type of study, areas investigated, research questions, theories used, and the results. Sixteen studies were included. SIOs and several other actors are responsible for applying measures to minimise sick-leave and promote return to work (RTW). The studies focusing on coordination of such measures revealed that SIOs felt unsure about how to handle their contacts with clients and other actors. One study indicated that the SIOs, partly due to lack of time, accepted the recommendations of physicians instead of making their own judgments about granting sickness benefits. While all SIOs must make decisions concerning entitlement to sickness benefits on a daily basis, few of the reviewed studies scrutinised the actual granting of sickness compensation. The studies were also deficient in that they investigated the decision latitude of the SIOs from a very limited perspective, mainly on an individual level and often primarily in relation to colleagues and/or clients rather than to the laws and regulations of the sickness insurance. The concepts and framework in this area of research need to be developed to facilitate elucidation of the interaction between different actors in local spheres, professionals in different disciplines, and between welfare staff and individual citizens.

Certification↗
PubMed1978

Work and disability at the age of 30 years. A sociomedical study of a birth-cohort from Bergen. II. Frequency of disability.

An attempt is made here to quantify occupational disability at the age of 30 years. The term disability is used in a broader sense than defined in the National Insurance Scheme, and covers all permanent occupational disability irrespective of cause. Disability is evaluated in terms of earned income and in accordance with the definition used under the National Insurance Scheme. The study is based on a cohort of 1570 persons, all live births in 1940 of mothers then residing in Bergen. Relevant information on earned incomes and on disability pensions was extracted from the files of the National Insurance Institution for 1331 persons of the cohort residing in Norway on 1st June 1971. Among the 30-year-old men residing in Norway the frequency of disability irrespective of cause was 3.1%, whereas the proportion receiving disability pension was 1.8%. The difference of 1.3% is explained mainly by the fact that alcoholism in itself is not accepted as grounds for a disability pension. Of the women, 88.3% were married. Among these, 0.7% were receiving disability pension. Of the unmarried women in the cohort, 20% (10 persons) were found to be disabled, irrespective of cause. They were all receiving disability pension.

Adult↗
PubMed2003

With health comes work? People living with HIV/AIDS consider returning to work.

Many people living with HIV/AIDS (PHAs) ham experienced significant improvements in their health over the last few years, to the point that many are considering returning to work. The objectives of this study were to develop a model of return to work which could apply to chronic illnesses with a fluctuating or uncertain course. Issues related to health, work and return to work were explored using in-depth interviews with 20 PHAs in Toronto, Canada, who had been on long-term disability for at least five years. Data were analyzed using a grounded theory approach. Contextual factors like the approach of disability and health (drug) insurance plans and intervening conditions like PHAs' current activities influenced their consideration of returning to work and the strategies they employed as a result of considering such a return. More than two-thirds of the sample had undertaken more activities as their health improved. The three study participants who had returned to work either had an opportunity for a low-risk trial of work or could return to their old job. Employers and disability compensation plan administrators, assisted by AIDS service organizations and governments, can facilitate return to work for PHAs by reducing the risks of and removing the barriers to returning to work.

Acquired Immunodeficiency Syndrome↗
PubMed1980

Forecast for health service executives: rapidly rising compensation.

Total cash compensation for health service executives should increase at an annual rate of 9 to 10 percent in the next few years. Retirement income, life insurance, long-term disability coverage, and general perquisites will likewise improve. Health service executives receive proportionately lower cash compensation (salary plus bonuses), judged by their institutions' operating budgets, than executives in the for-profit sector.

Administrative Personnel↗
PubMed1987

Long-term care policies: defusing a financial time bomb.

Most Americans have little or no private health insurance for chronic illness or disability, largely because of forces restricting the development of a market for long-term care insurance. Properly structured incentives could alter this situation and help defuse a financial time bomb confronting the nation. Spending for long-term care has grown dramatically in the last 20 years and is expected to continue escalating. The question is who will pay for it. Considerable room exists to increase private insurance's proportion of long-term care expenses, which are now largely paid by the patient out-of-pocket or by Medicaid. The current market, however, is under-developed because demand is thin and private third-party insurers are reluctant to write policies. But the potential demand is substantial because of the increasing elderly population. To develop a long-term care insurance market, tax incentives should be offered, the elderly need to be educated about the limited coverage provided by Medicare, and beneficiaries need to be made aware that relying on Medicaid's safety net could lead to impoverishment.

Aged↗
PubMedDate not supplied

Employer services.

Reduction of workers' compensation costs is a competitive advantage for businesses. Insurers offer many services, such as loss prevention programs and disability management, to help employers minimize the financial impact of workplace injuries and diseases.

Canada↗
PubMed1996

Are alternative long-term-care programs needed for adults with chronic progressive disability?

Long-term care planning for middle-aged adults with progressive neurological impairment is a largely unexplored area. The purpose of this study was to examine factors that place individuals with progressive disability at risk for institutional placement and identify whether innovative long-term care preferences would be used if available. The sample of 102 clients with a diagnosis of multiple sclerosis (N = 92) or other progressive illnesses (N = 10) was mostly female, married and Caucasian, with an average age of 48 years. The social support network of family and friends was small; most tangible aid was provided by family members. Seventy percent of the participants used community services, the most common being a home-health aide (44%) and professional nursing services (21%). Medicaid insurance, severity of functional disability and lack of social support were associated with greater use of community services. Participants could foresee using long-term care alternatives such as a community residence (65%), adult day healthcare (63%) and family respite (46%), although these services were regarded with some ambivalence. With their knowledge of community resources, nurses are in a key position to make early assessments of clients' present and future care needs and to suggest needed modifications in living arrangements to avoid premature institutionalization.

Activities of Daily Living↗
PubMed1994

[Special dentistry assistance. An evaluation of the revised ruling 1990].

Public Health insurance provision of dental care for patients with a physical, mental, dental or medical handicap has been reorganized in 1990. In order to evaluate this reorganization, general dental practitioners, dentists in hospital clinics or institutions for the handicapped as well as dentists employed as advisors to local health insurance authorities were interviewed. Results show that, until now, the reorganization has not resulted in an increase of seeking dental care by handicapped patients at the general dental practitioner's. The reorganization seems to have taken place in too much haste, thus not leading to the desired provision of dental care for handicapped patients.

Dental Care for Persons with Disabilities↗