Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Insurance Carriers”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,423 records · Page 79Linked to original sources
PubMed1998

Disabled doctors: the insurance industry seeks a second opinion.

This article focuses on disability in the professional work force, especially among physicians, and includes a background on private disability insurance in the United States, a discussion of problems experienced by the insurance industry over the past few years, a review of relevant case law on private disability, and legal and clinical issues involved in performing independent medical evaluations.

Disability Evaluation↗
PubMed1998

A discrete choice model of drug abuse treatment location.

OBJECTIVE: To identify short-term drug abuse treatment location risk factors for ten large, self-insured firms starting January 1, 1989 and ending December 31, 1991. DATA SOURCES/STUDY SETTING: Study population selected from a large database of health insurance claims for all treatment events starting January 1, 1989 and ending December 31, 1991. STUDY DESIGN: A nested binomial logit method is used to estimate firm-specific patterns of treatment location. The differences in treatment location patterns among firms are then decomposed into firm effects (holding explanatory variables constant among firms) and variable effects (holding firm-specific parameters constant). PRINCIPAL FINDINGS: Probability of inpatient drug treatment is directly related to the type of drug diagnosis. The most important factors are diagnoses of drug dependence (versus drug abuse) and/or a cocaine dependence. Firm-specific factors also make a substantive difference. Controlling for patient risk factors, firm-specific probabilities of inpatient treatment vary by as much as 87 percent. Controlling for practices of firms and their insurance carriers, differing patient risk profiles cause probabilities of inpatient treatment to vary by as much as 69 percent among firms. Use of the outpatient setting increased over the three-year period. CONCLUSIONS: There are two plausible explanations for the findings. First, people beginning treatment later in the three-year period had less severe conditions than earlier cases and therefore had less need of inpatient treatment. Second, drug abuse treatment experienced the same trend toward the increased use of outpatient care that characterized treatment for other illnesses in the 1980s and early 1990s.

Adult↗
PubMed1998

[Pneumonia in ambulatory care patients. Choice of antibiotics for therapy of community-acquired pneumonia].

According to the statistics prepared by health insurance carriers community-acquired pneumonia has an incidence of some 300,000 to 400,000 cases per year. In old age (more than 80 years), the mortality rate increases from 20 to 2000 per 100,000 head of the population, that is, by a factor of 100. The former classification into "typical" and "untypical" pneumonia has now been abandoned, the modern approach being that of "calculated antibiotic therapy" that involves the placing of patients in "risk groups". To each risk group a probable pathogen spectrum is assigned and a recommendation for the selection of an appropriate antibiotic then made. Thus, for example, for the pathogen spectrum in group 1 (ambulatory patients under 60 years of age and no major secondary diseases), the macrolides are the antibiotics of first choice. The procedure to be followed in the other risk groups and in the event of treatment failures is discussed. Criteria that identify the need for hospitalization are presented.

Aged↗
PubMed1998

Factors important in the purchase of partnership long-term care insurance.

OBJECTIVE: To understand the factors important in the purchase of long-term care insurance through the Robert Wood Johnson Foundation Partnership for Long-Term Care. DATA SOURCES: Information on the Partnership programs, telephone surveys, data on Partnership purchasers, and random sample frames. STUDY DESIGN: Logistic regression analysis is used to examine characteristics associated with the purchase of a Partnership insurance policy. Independent variables are health status, demographic and financial characteristics, knowledge, and attitudes. DATA COLLECTION: A telephone survey of Partnership purchasers and a random sample of the population in each Partnership state were conducted. Survey questions included health status, opinions about long-term care and long-term care insurance, financial planning, demographic characteristics, and income and assets. PRINCIPAL FINDINGS: Important in the purchase of a Partnership policy were variables associated with education and knowledge about long-term care. Other important factors include attitudes and health status. Partnership purchase is associated with higher income and asset levels up to a point, with the effect plateauing and decreasing at the highest income and asset levels. CONCLUSIONS: Improved education and knowledge are important in increasing long-term care insurance purchase. Attitudes about having a caregiver, and about the government's role in paying for long-term care as well as the potential purchaser's willingness to consider nursing home care affect policy purchase. Also associated with Partnership policy purchase are better health and middle income and asset levels.

Aged↗
PubMed1998

The coming of age of the Delta Dental Plan of Massachusetts, 1966-1996.

In the early nineteen fifties prepaid dental health insurance came of age on the West Coast. Because of the hard work of members of the Massachusetts Dental Society, dental insurance became available in Massachusetts in 1966. During the early eighties the Massachusetts Dental Service Corporation completed its separation from the dental society, and in 1985 achieved its independence from their management company, Blue Cross. This paper highlights the creative growth strategies of the start up company, Delta Dental of Massachusetts, that over the past decade has become the number one dental insurance group statewide.

History, 20th Century↗
PubMed1998

Enzyme replacement therapy for Gaucher's disease: the early Canadian experience.

BACKGROUND: The management of severe Gaucher's disease was dramatically improved by the development of enzyme replacement therapy. However, this treatment is very costly (currently about $21,000 per infusion for adults at the starting dose recommended by the manufacturer). The goal of this study was to determine how enzyme replacement therapy was being prescribed and financially supported in various parts of Canada. In addition, demographic and outcome information was elicited. METHODS: Prescribing physicians were identified through professional associations and with the help of the manufacturer of the enzyme preparations used for the treatment of Gaucher's disease. The physicians were surveyed by questionnaire in July 1995. The study included all patients in Canada who had received enzyme replacement therapy for Gaucher's disease before July 1, 1995. RESULTS: A total of 25 patients (15 children and 10 adults) with type 1 Gaucher's disease, the common nonneuronopathic variant of the disease, were receiving enzyme replacement therapy by the end of 1995. The indications for treatment included massive splenomegaly, growth failure, and severe bony, hematologic and pulmonary complications of the disease; no patients with mild disease were receiving treatment. Treatment regimens varied markedly (from 12 to 160 units of enzyme/kg per month). All the patients were reported to have responded well to therapy, based on serial measurements of hematologic indices, liver and spleen volumes, and numbers of bony crises as well as patients' subjective impressions. Financial support for therapy varied markedly from one province to another. None of the reporting physicians was aware of any patients with severe Gaucher's disease who were denied therapy as a result of inability to pay for the medication. Various agencies provided financial support for therapy, including both federal and provincial governments, private insurance carriers and the commercial supplier of the enzyme. In Ontario provincial health care officials accepted the development, by a multidisciplinary panel of medical experts, of formal guidelines for determining eligibility, on the basis of objective medical criteria, for reimbursement for enzyme replacement treatment. INTERPRETATION: Although some differences were found across the country with respect to the details of treatment, the indications for enzyme replacement therapy and the selection of severely affected patients were similar in the various provinces. However, financial support was inconsistent and varied among provinces and patients. This will prove to be a challenge in future, not only with respect to this disease but also for other diseases for which effective, expensive therapy has been developed.

Adult↗
PubMed1999

Boom or bust.

Explore the source record for details and available documents.

Humans↗
PubMed1998

Risk management and the claims process.

This article explores certain risk management techniques and the role these techniques play in the investigation and evaluation of claims. The claims experience of one carrier, Medical Liability Mutual Insurance Co., is provided. A general overview of the elements involved in a claims investigation is provided.

Dental Records↗