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PubMed1985

Recommendations for the formulation of the Nursing Care Insurance Law.

In Israel, old-age pensions for men aged greater than or equal to 70 years and women aged greater than or equal to 65 years are provided by the National Insurance Institute. A supplementary allowance is given when the pension is the sole income. However, in 1980 these benefits were recognized as insufficient in cases of functional incapacity, so a change in the existing National Insurance Law was considered necessary. A national committee was appointed to formulate the Nursing Care Insurance Law, which would extend the activities of the National Insurance Institute. Monies were to be allocated for personal care, home maintenance, assistance to families and community services. Home care was considered preferable to institutionalization for psychological and social reasons; however, institutionalization was recognized as necessary when home care is no longer feasible in cases of total dependence and illness. Regional Committees and a Central National Committee will be established for planning and supervision. Government surveys were used to determine the percentage of the aged needing help, according to which the overall budget is to be calculated. The Nursing Care Insurance Law was passed in 1983, but so far no agreement has been reached concerning the distribution of monies.

Aged↗
PubMed1982

Effects of health insurance on physicians' fees.

According to conventional wisdom, the growth of health insurance is partly responsible for the rise in physicians' fees; however, to date, convincing empirical evidence is lacking. A standard model of physician fee determination yields unambiguous predictions about insurance effects on fees. Empirical evidence, based on national interview surveys of physicians, shows insurance does affect fees in the predicted direction. Insurance parameter estimates imply that a $1.00 increase in an insurer's fee schedule raises physicians' fees somewhere between $0.13 and $0.35 on average. The higher fees could be associated with higher quality, an issue discussed in the last section.

Economics, Medical↗
PubMed1995

Risky business: long-term care insurance underwriting.

Private insurance is one strategy for financing the large and growing cost of long-term care. Little is known, however, about the extent to which medical underwriting may limit the potential of private insurance to cover nursing home care, or whether the underwriting criteria used in this relatively new market successfully identify high-cost groups. This paper uses data from the National Mortality Followback Survey to address these two questions. We estimate that between 12% and 23% of the population would be rejected for private long-term care insurance because of their health if everyone applied at age 65. These figures rise to between 20% and 31% at age 75. Our simulation results suggest that long-term care insurance underwriting criteria identify individuals who vary substantially in the financial risk they pose to insurers. In most cases, whether a criterion identifies a high-cost group is sensitive to the policy individuals are assumed to buy.

Activities of Daily Living↗
PubMed1995

Role of private insurance in public system source of debate at CHEPA conference.

Supplementary health care insurance is the fastest growing segment of the insurance industry in Canada, but not because of a rise in the number of policy holders. Instead, revenue increase is primarily due to price increases for insured services, such as prescription drugs or semi-private hospital coverage, and the expansion of private coverage into areas vacated by public health insurance. The role of private insurance in the evolving Canadian health care system was debated during a recent conference sponsored by the Centre for Health Economics and Policy Analysis at McMaster University.

Canada↗
PubMed1995

[Genome analysis and health insurance].

In spite of the public opinion that believes genetic testing to be a preferred method of risk assessment before concluding an insurance contract, private medical expenses insurers in Germany do not make any use of this screening procedure. The scrutiny of insurance proposals is restricted to the assessment of the state of health at the moment of underwriting without the proposer having to submit to any medical tests at all. The coverage of presently unknown, i.e. potential, risks, on the contrary, is subject of the health insurance contract. Idea and technique of health insurance business would be contradicted by assessing each individual risk until the prospective damage will be known and charged with the commensurate premium. If an individual has had a specific genetic testing, though, the results of these tests are to be considered in the same way as other medical tests and will need to be declared on proposal forms.

Genetic Diseases, Inborn↗
PubMed1993

Diabetes prevalence from health insurance data: evaluation of estimates by comparison with a population-based diabetes register.

UNLABELLED: At present in Germany, data on the prevalence of diabetes can only be obtained by modelling health insurance data. The National Diabetes Register of the former (East) German Democratic Republic which, between 1960 and 1990, monitored approximately 98% of all diabetic subjects, provides a tool for evaluating epidemiological estimates from other data sources. Therefore, the following data bases were compared for the year 1988: (1) a 5% random-sample (n = 6478) of all subjects insured at a local statutory health insurance company in the city of Dormund; (2) related data from the population-based diabetes register of former East-Berlin and (3) of the former German Democratic Republic. All data were standardized by sex and age according to the 1988 population statistics of the Federal Republic of (West) Germany thus resulting in the apparent diabetes prevalence of the Western part of Germany at that time. RESULTS: total prevalence rates were (1) 4.8%, (2) 4.9%, and (3) 4.4% (p < 0.05). The percentages of insulin-treated patients were (1) 18%, (2) 19%, and (3) 16%, respectively. 54% (1), 37% (p < 0.05) (2), and 42% (p < 0.05) (3), of the patients received oral antidiabetic drugs. It is concluded that the three samples are comparable and that the diabetes prevalence rates as estimated from health insurance data and from the two population-based registers give corresponding conclusions. Sample-based health insurance data may provide a useful and reliable tool for epidemiological studies on diabetes mellitus.

Adult↗
PubMed1993

Insurance incentives for ambulatory surgery.

This study is an attempt to address both the extent to which surgical procedures on an outpatient basis substitute cost-effectively for inpatient procedures, and whether or not an insurance policy's financial incentives increase the volume of outpatient surgical procedures. In particular, given an insurance product of a given composition: What is the probability that the insured will have surgery? and if a surgery does take place, what is the probability that it will occur in an outpatient setting? Finally, the article assesses the implication of such products on the total cost of care by quantifying the insurance plans along two parameters, the relative user price for outpatient versus inpatient surgery and the absolute price for the inpatient surgery. The results indicate that insurance policies that offer relatively lower out-of-pocket payments for ambulatory surgery do not increase the probability that surgery will be done in the ambulatory setting. However, higher out-of-pocket payments for surgery, regardless of site, do reduce the surgery rate. There are other patient and market characteristics, especially the availability of freestanding surgery firms, that do influence the location of surgery.

Ambulatory Surgical Procedures↗
PubMed1996

[Use of dental services and the percentage of persons possessing private dental insurance in Québec].

The utilization of dental health services and the percentage of adult members of a private health dental insurance plan are generally lower in Quebec than in the other Canadian provinces. In this study, results of a telephone survey of a representative sample of Quebec adults aged 18 and over (N = 8,042) show that 58 per cent of interviewed individuals visited a dentist (53 per cent) or a denturologist (five per cent) during the 12 months preceeding the interview. A multivariate analysis indicates that the most strongly associated factors related to the utilization of dental health services are, in decreasing order, edentulousness, income and level of education. About one third (36 per cent) of those surveyed had dental insurance coverage. Age and income are the most strongly associated factors concerning the membership to a dental health insurance plan. Finally, among those with dental insurance coverage, 71 per cent had visited a dentist or a denturologist during the last 12 months compared to 51 per cent of those not insured.

Adolescent↗
PubMedDate not supplied

[The characteristics of actuarial calculations for voluntary medical insurance].

Presents methods of mathematical validation of agreements on voluntary medical insurance. Reduction coefficients are used for determining the onset of the insurer's responsibility after a certain number of invalidity days. The reduction coefficient is regarded as a probability that the insured person recovers not later than by a certain date, and the sequence of these coefficients as function of distribution of the course of invalidity. Use of the actuarial estimations for validating different aspects of voluntary medical insurance helps specify the probable payments and provide the financial stability of insurance companies.

Actuarial Analysis↗
PubMed1996

[The Swiss health insurance carriers in managed care].

The Swiss health care system is currently undergoing radical changes. The balance of power is clearly shifting from the service-providers to the health insurers. Excessive patient demands combined with proliferation of medically unnecessary treatment have led to an inflation of cost equivalent to several billion Swiss francs. Managed Care is a new instrument that enables the insurers to influence patient behavior and, hence, the services offered in an integrated fashion. The key factors necessary for the success of this process are: Clear and timely information with the insured Product design based on precise segmentation Cost effective service-purchasing based on insured requirements Use of insurer-owned service providers to encourage competition The success of Managed Care in Switzerland will largely depend on the readiness of health care stake-holders to adapt, learn, and cooperate in a constructive, professional, and open-minded framework.

Cost Control↗
PubMed1997

An attempt to withdraw coverage by the insurance company in the event of gross negligence. Costs totalling US $ 4.5 million.

In its judgement of 11 June 1993, the Court of Appeal of Brussels upheld the personal liability of a trainee and the in solidum liability of the hospital in a case where an erroneous spinal injection caused permanent paraplegia and incontinence. Although the attempt of withdrawal coverage by the insurance company on base of the concept of gross negligence, did not succeed in this case, it is clear that under the new insurance law of 25 June 1992, several risks will not be covered by the insurance companies in the future. The exemplary list of gross negligence cases, which may be used by the insurance companies, involves predominantly anesthesiology practice. The coverage of several insurance contracts exclude e.g., damages resulting from simultaneous anesthesia, or from the absence of an anesthesiologist during the full course of the surgery and damages resulting from anesthesia in the absence of necessary monitoring and reanimation equipment.

Anesthesia, Spinal↗
PubMed1998

The Swedish National Dental Insurance's periodontal diagnosis. Used on an individual level.

The Swedish National Dental Insurance Board requires a periodontal diagnosis (FKF 2030 86.12GR) from general practitioners before treating patients, a process which is expensive. The Swedish National Dental Insurance-index (SNDI-index) is based on clinical data and radiographs and every tooth is assigned a rating between 0 and 4. From the time of introduction of the Swedish National Dental Insurance plan in 1974, data can have been collected for 1.7 million patients if the regulations were followed according to the Swedish National Dental Insurance Board in Stockholm, Sweden. It is of interest to examine whether all of these collected periodontal data reflect periodontal status. In this study includings 56 individuals, the Swedish National Dental Insurance-index, used on an individual level, correlated significantly with the individual changes in bone support (as percent of toothlength) of the tooth in 1979 (rs = -0.80, t = -9.7, p < 0.001, ci 95% = -0.88(-)-0.68) as well as in 1989 (rs = -0.79, t = -9.5, p < 0.001, ci 95% = -0.87(-)-0.67).

Alveolar Bone Loss↗
PubMed1998

Age- and state-specific prevalence estimates of insured and uninsured persons--United States, 1995-1996.

Lack of health insurance has been associated with delayed health care and increased mortality. Underinsurance (i.e., the inability to pay out-of-pocket expenses despite having insurance) also may result in adverse health consequences. Insurance coverage varies with age and locality, but state-specific estimates of insurance status by age are not regularly published. To characterize insurance coverage status by age, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1995-1996. Because persons aged 55-64 years are not yet eligible for Medicare, may be in fair or poor health, risk eroding retirement savings if they incur major medical expenses, and must pay high individual health premiums, characteristics of uninsured persons aged 55-64 years also were examined. This report summarizes the results of the analysis and indicates that a substantial proportion of all adults are either uninsured or underinsured.

Adult↗
PubMed1998

[Risk assessment expanded accident insurance for children].

Disability is a well known and tragic event for children. While adults are an established group for specific disability insurance cover, children were often neglected in the past. Although parents, organizations and paediatricans are aware of the risk, children specific incidence rates for disability are hardly available. The only sufficient source for some statistical data are the accident statistics because they represent a substantial group of specific cause related disability for children. Incidence rates for disease related chronic severe impairment or disability in children are either derived by single disease research or actuarial calculation of the German Social Disability Registration. Based on this statistical background, an extended accident insurance for children was introduced in Germany covering both accidents and disabling diseases. The key limitation for all variations of this insurance are exclusion clauses for congential diseases and mental disorders. This insurance requires a new approach in underwriting of the health risks. Because of the substantial number of impaired children, a simple decline of substandard cases are unacceptable. The early experience or medical underwriting shows predominantly health impairments of the following types: allergies, bronchial asthma, ectopic eczema (neurodermitis), disorders of speech and articulation, vision disorders and mental impairments. The suggested solution for underwriting of substandard risks is the predetermination of the possible future maximum degree of disability. The need for underwriting guidelines is supported by the market impact of the new disability cover with thousands of insurance policies issued in the first month after introduction.

Adult↗
PubMed1998

Self-reported use of mammography and insurance status among women aged > or =40 years--United States, 1991-1992 and 1996-1997.

In the United States, breast cancer is the most commonly diagnosed malignancy among women and the second leading cause of cancer death. Lack of health insurance coverage often is an important financial barrier to seeking preventive health care such as mammography screenings. To assess mammography use and the impact of insurance status on mammography use, state-specific proportions of women aged > or =40 years who reported receiving a mammogram during the preceding 2 years by insurance status were derived using data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1991-1992 and 1996-1997. This report describes the results of this analysis, which indicate that the percentage of women reporting having had a screening mammogram during the previous 2 years increased, but women with insurance were substantially more likely than women without insurance to have had a mammogram.

Aged↗
PubMed1999

Health insurance coverage of the unemployed: COBRA and the potential effects of Kassebaum-Kennedy.

We use the April 1993 Current Population Survey to examine the health insurance coverage decisions of the unemployed and to simulate the potential effects of the new Kassebaum-Kennedy legislation. After controlling for demographic characteristics, COBRA eligibility raises the probability of health insurance coverage by 0.095, while eligibility for spouse employer insurance increases the likelihood of coverage by 0.318, and eligibility for both increases the likelihood of coverage by 0.341. In our simulations, we find that had Kassebaum-Kennedy been in effect in April 1993, 9.0 percent of the unemployed would be eligible to take up coverage, and the coverage rate of the unemployed would have been increased by 0.85 percent to 1.5 percent from 41.6 percent. Our estimates of the effect of Kassebaum-Kennedy on health insurance coverage are much lower than those reported by the Government Accounting Office prior to the passage of the legislation.

Eligibility Determination↗
PubMed2001

The effect of health on acute care supplemental insurance ownership: an empirical analysis.

The empirical effect of health status on private insurance ownership is a mixture of the effect of health on the demand for insurance (subjected to adverse selection) and its effect on the insurer's underwriting practice (subjected to risk-selection). Using bivariate partial observability probit models, this paper provides an empirical identification of health effects on the probability of application and on the probability of rejection in the Israeli market for acute care supplemental health insurance. The analysis shows that while the reduced-form health effect on ownership is negligible, the structural effects are sizeable and indicate that sicker individuals are more likely to apply, but are also more likely to be rejected. The policy implications of the above findings are discussed in the context of the Israeli health system.

Acute Disease↗
PubMed1998

Supplemental health insurance ownership in Israel: an empirical analysis and some implications.

Many Western nations are implementing (or considering) changes in their health care systems. An integral component of these changes (or debates) refers to the functioning and regulation of the supplementary health insurance market. However, only limited empirical evidence exists on the functioning of the market, which is prone to the problems of moral hazard, adverse selection and risk selection. This paper presents an empirical analysis of ownership patterns of four supplementary insurance policies (acute care, nursing care, dental care and emergency intensive care) in the Israeli population aged 45- 75 in 1993. It further discusses some social policy and regulation issues related to the supplemental health insurance market in the post-1995 era of the Israeli National Health Insurance.

Aged↗