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PubMed1999

Finance issue brief: insurance reform.

Individual and small group market reforms are intended to increase access to health insurance. The majority of the working uninsured are employed by small businesses, prompting state legislatures to make changes in the small group market. Many states did this on their own; however, to ensure that health insurance was reaching the most people possible, the federal government enacted the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This act required states without extensive law in the small group and individual insurance market to enact laws to comply with provisions such as guaranteed issue, guaranteed renewal, preexisting conditions, portability and nondiscrimination. It also delved into other areas, including long-term care, inpatient care after childbirth, medical savings accounts and mental health parity.

Health Benefit Plans, Employee↗
PubMed2001

Body mass index and mortality in an insured population.

OBJECTIVE: This study was conducted to explore the relationship between body mass index (BMI) and mortality in an insured population issued policies at standard rates or rated only for build using contemporary analytic techniques. BACKGROUND: Many factors influence the relationship between build and mortality. Recent clinical literature on this subject often employs multivariate statistical techniques to better define this relationship and reduce the influence of confounders. BMI, a common surrogate variable for build in clinical literature, is our variable of choice in studying the relationship between build and mortality. METHODS: We studied internal data on direct and reinsurance business issued between 1975 and 1998 at standard rates or rated only for build. The policies were followed till termination (death or lapse) or to the end of 1999. The average policy duration was 4.7 years. Cox proportional hazards model runs were used to study the multivariate relationship between mortality and BMI in moderately over- and underweight insured individuals. RESULTS: During follow-up, 4105 deaths were observed. Mortality was noted to very with BMI, most significantly in middle-aged male nonsmokers. Consistent with reports from the clinical literature, significant factors influencing the BMI-mortality relationship in this insured population included issue age and smoking status. CONCLUSIONS: BMI is a predictor of statistically significant mortality differentials in insured populations. The strength of the BMI-mortality relationship was found to vary by age, gender, and smoking status. In our study population, the male nonsmoker subgroups tended to exhibit the strongest graded relationship between hazard of death and increasing or decreasing BMI.

Adolescent↗
PubMed2002

Understanding the motivations of long-term care insurance owners: the importance of retirement planning.

This article is based on two recent reports by the American Council of Life Insurers (ACLI) that illuminate the reasons why individuals purchase private long-term care insurance in both the group and individual markets. This information suggests that a younger and more diverse group of individuals are becoming increasingly interested in private long-term care insurance and that workplace education linkage the purchase of long-term care insurance to retirement planning may promote coverage.

Adult↗
PubMed2002

Access to health care: health insurance considerations for young adults with special health care needs/disabilities.

Youth with special health care needs/disabilities want what all youth in America want: independence, health, friends, and jobs. Yet, between 19 and 23 years of age (depending on the state), youth with special health care needs/disabilities often find little availability of health insurance or health providers that were an essential part of why they survived and now are looking to participate in adult society. This article reviews the complex system of health insurance options that young adults with special health care needs/disabilities face as they move from pediatric to adult health insurance systems. Yet because of a maze of different eligibility criteria, many of these options are not available to young adults with special health care needs, and they are left with out health insurance. Similarly, the issues surrounding health provider reimbursement often leave the young adult with special health care needs without health care professionals who can manage their complex health conditions as they transition into adulthood. In conclusion, this article outlines what steps could be taken by associations and the health policy, advocacy, and governmental communities to improve the situation.

Adolescent↗
PubMed2000

Genetic testing for breast and ovarian cancer: implications for life insurance.

As the science of genetic testing progresses, the debate surrounding the uses of genetic information intensifies. In February, President Clinton signed an executive order prohibiting federal agencies from using such information to make hiring, promotion, or placement decisions. Concerns about privacy and discrimination have led many states to propose or enact statutes that prohibit health insurers from using genetic test results in their underwriting decisions. However, few statutes address access to these results by the life insurance industry. This Issue Brief summarizes the current debate on whether life insurers should have access to genetic testing information for breast and ovarian cancer, and provides actuarial insight into the potential effect of such testing on the voluntary term insurance market.

Breast Neoplasms↗
PubMed2003

Implications of genetic testing: discrimination in life insurance and future directions.

This article examines the possibility of genetic discrimination in life insurance and discusses the inability of current Australian legislation to deal adequately with genetic test result information. Genetic information has certain features that distinguish it from other medical information and thus a specialist legislative package is required to regulate its use. This article outlines how current practices in the life insurance industry are inconsistent with notions of human rights. Several legislative options are suggested and examined. Given the negative and damaging impact that adverse selection is likely to have on the life insurance industry should the use of all genetic test results be prohibited, an approach which modifies the current regime is recommended. This includes a comprehensive review scheme and the introduction of additional insurance products tailored to individuals suffering from various genetic illnesses or predispositions to future disease.

Australia↗
PubMed1992

[Insurance medicine and accident surgery].

A definition of insurance medicine is presented with due consideration for national peculiarities (social insurances) in Switzerland. The historical development from original trauma-directed accident medicine to the present-day insurance medicine with its more comprehensive nature is shown with particular consideration being given to the close connection with traumatology (trauma surgery/orthopaedic surgery). The guarantee of smooth-running and constructive cooperation between traumatologists and welfare organizations is one of the major tasks of doctors employed in insurance companies, whose sphere of influence and qualifications are under discussion.

Accidents↗
PubMed2003

Insurance status of HIV-infected adults in the post-HAART era: evidence from the United States.

In the United States, universal public insurance is only available for the elderly. But unlike most other major diseases, HIV/AIDS predominantly affects the nonelderly. The result is that insurance availability and public programme participation are linked to disease progression in a complicated way. This paper uses data from a unique, nationally representative sample of HIV-infected adults receiving medical care, to describe the relationship between disease progression and insurance coverage in the United States. We find that public insurance is the predominant source of coverage for those in care for HIV, and that coverage increases as disease progresses. Those with public coverage have substantial work experience and earnings capacity, but do not work. This suggests that reforms allowing HIV positive (+) patients to maintain public coverage while returning to work could increase employment and earnings significantly. More speculatively, it suggests that the United States system for financing health care is not well-equipped to deal with epidemics that afflict a population in its prime work years.

Adult↗
PubMed2003

Risk factors for ill health insurance claims.

OBJECTIVES: This study examined the information available at application for income protection insurance, to determine if any factors were predictive of a claim. The strength and significance of such factors were assessed and a predictive model was developed. BACKGROUND: The factors underlying life assurance risks are well known, but this is not the case for income protection insurance. For accurate underwriting of income protection insurance, it is important to know what information available at application has power to predict a claim. Improving the scientific accuracy of underwriting is good business practice, as well as answering the demands of disability legislation. METHODS: We studied all data available at application for 959 current claimants and 1417 non-claimants, using a case-control study design. Information included applicants' description of their occupation, marital status, build and habits, plus a questionnaire asking about their personal health. For some applicants medical reports were available as well. Information was transcribed onto a database, and univariate and multivariate analyses were performed. A predictive scoring system was established and its performance measured by receiver operating characteristic curves. RESULTS: Significant associations with claiming were found for many variables, including age (odds-ratio 1.04, p < 0.001), height (0.11, p = 0.03), smoking (2.10, p < 0.001), abstinence from alcohol (1.56, p = 0.01), recent medical advice (1.34, p = 0.06), and having had a lower gastrointestinal disorder (1.51, p = 0.04). Using all the information from the application, a predictive model was constructed. This model had good predictive power with an area under the receiver operating characteristic curve of 72%. CONCLUSIONS: Classical underwriting factors were generally shown to have predictive power for income protection insurance. The predictive scoring strengthens the scientific basis for underwriting and could be developed to simplify and expedite the underwriting process.

Actuarial Analysis↗
PubMedDate not supplied

Quality of life and changes in health insurance in long-term home care.

Changes in health insurance and concomitant changes in quality of life in patients receiving long-term home parenteral nutrition care were explored. A decrease in quality of life and increase in depression were significantly associated with a change of insurance providers. Knowing the importance of health insurance as a family economic resource, nurses working in these settings may be alert for potential socio-emotional problems when health insurance providers change or coverage is less. Policymakers also have an opportunity to ease the financial burden of long-term disease management by expanding coverage for prescription drugs in Medicare benefits.

Adult↗
PubMed2005

Use of a new comprehensive insurance benefit for smoking-cessation treatment.

INTRODUCTION: Uncertainty about levels of employee use of an insurance benefit for smoking-cessation treatment has presented a barrier to employers considering the adoption of such coverage. This study examined self-reported awareness and use of a new insurance benefit for smoking-cessation treatment among a sample of Wisconsin state employees, retirees, and adult dependents. METHODS: We evaluated the self-reported use of insurance coverage for smoking-cessation treatment during the first 2 years of its availability to the Wisconsin state employee, retiree, and adult dependent population. We conducted analyses of responses to smoking-related questions in 2001 and 2002 cross-sectional surveys of insured state employees, retirees, and adult dependents, weighted to represent this population. RESULTS: In 2002, benefit use among smokers aware of the benefit was 39.6%, and benefit use among smokers unaware of the benefit was 3.5%. Only 27.4% of smokers were aware of the benefit in 2002; use among all smokers was 13.6%. Of all smokers, 30.4% used smoking-cessation treatment medication (over-the-counter or covered) in 2002. Smoking prevalence was 15.6% in 2001 and 13.2% in 2002. CONCLUSION: In an educated employee population, self-reported smoking-cessation treatment benefit use was modest among all smokers during its first 2 years of availability. Benefit awareness was low in this educated population, which may help explain low use rates, particularly given the 30% of all smokers who attempted to quit smoking with the help of smoking-cessation treatment medication. These data provide use-rate estimates for states contemplating adoption of an evidence-based smoking-cessation treatment benefit.

Adult↗
PubMed2006

[Permanent disability and the insurance estimation process].

INTRODUCTION: The casualties are indemnified according to two processes. First by transaction on rate proposition of insurance physicians, and the second process on rate proposition by a medical expert assigned by law-court. Indemnification scale failure justifies the Interafrican Conference of insurance Markets code adoption. MATERIAL AND METHOD: Six insurance societies and the Automotive Guarantee Fund were debtors. Only 627 victims had been indemnified between 1986 and 2003. Expert valuations done at forensic medicine service were the support of the investigation. Inquired parameters were insurance societies, regulation type, aftermaths and the retained prejudices. The data collected on computer card have been analyzed by software Epi Info. RESULTS: The partial permanent inabilities fixed since its adoption differ to inabilities fixed before this adoption. Transaction process concerned 567 victims (90.4%). Sixty victims were indemnified by judicial way. According to process type, the rates fixed in judicial process were 61.6% middle permanent partial inabilities. After 1997, there have observed a decrease in the high and middle permanent partial inabilities in the two processes. The appreciation of the pretium doloris is more subjective but must repair the aftermaths. The middle pretium was majority in the two processes, before and after 1997 with a high decrease of the middle pretium in the transaction process (-15.07) and a small pretium increase of 10.98 points. CONCLUSION: A common scale code has decreased the judicial litigation concerning casualties in spite of scales' limits. Only the patients with important aftermaths arrive in the judicial process since 1997.

Disability Evaluation↗
PubMedDate not supplied

Helping members of a community-based health insurance scheme access quality inpatient care through development of a preferred provider system in rural Gujarat.

We describe and analyse the experience of piloting a preferred provider system (PPS) for rural members of Vimo SEWA, a fixed-indemnity, community-based health insurance (CBHI) scheme run by the Self-Employed Women's Association (SEWA). The objectives of the PPS were (i) to facilitate access to hospitalization by providing financial benefits at the time of service utilization; (ii) to shift the burden of compiling a claim away from members and towards Vimo SEWA staff; and (iii) to direct members to inpatient facilities of acceptable quality. The PPS was launched between August and October 2004, in 8 subdistricts covering 15,000 insured. The impact of the scheme was analysed using data from a household survey of claimants and qualitative data from in-depth interviews and focus group discussions. The PPS appears to have been successful in terms of two of the three primary objectives--it has transferred much of the burden of compiling a health Insurance claim onto Vimo SEWA staff, and it has directed members to inpatient facilities with acceptable levels of technical quality (defined in terms of structural Indicators). However, even under the PPS, user fees pose a financial barrier, as the insured have to mobilize funds to cover the costs of medicines, supplies, registration fee, etc. before receipt of cash payment from Vimo SEWA. Other barriers to the success of the PPS were the geographic Inaccessibility of some of the selected hospitals, lack of awareness about the PPS among members and a variety of administrative problems. This pilot project provides useful lessons relating to strategic purchasing by CBHI schemes and, more broadly, managed care in India. In particular, the pragmatic approach taken to assessing hospitals and identifying preferred providers is likely to be useful elsewhere.

Community Health Planning↗
PubMed1991

[High and low use of insurance benefits. A comparison of 2 Norwegian municipalities--Båtsfjord in Finnmark and Vik in Sogn and Fjordane].

Health insurance benefits and social welfare support has been investigated in two municipalities in Norway, Båtsfjord in the northernmost part of the country and Vik, in the county of Sogn and Fjordane in the western region. Båtsfjord is mainly a fishing community and 30% of the inhabitants aged 16-66 were receiving health insurance benefits, as compared to 8% in Vik, where the main sources of income are agriculture, industry and tourism. More than half of the insurance benefits contributions were permanent pensions. In addition 12% of the population in Båtsfjord and 1% in Vik received social welfare benefits. Most of the recipients of these benefits were younger than 35 years. The authors discuss the main reasons for these differences in public economic support among residents of the two municipalities. Factors such as level of education, conditions on the labour market and attitudes among the population and health personnel concerning public economic assistance through the health insurance system seem to be conducive to the steadily higher consumption of public welfare benefits.

Adolescent↗
PubMed1990

Effects of tort reforms and other factors on medical malpractice insurance premiums.

We use state-level data on physician malpractice premiums, claims, and awards, provided by insurance companies for the years 1974 to 1986, to evaluate the effectiveness of the various tort reforms that have been legislated during the 1970s and 1980s. In addition to the tort reforms, our analysis of premiums considers insurers' anticipated losses, returns on investments, the type of insurer, and premium regulation. Our results suggest that the only reforms that significantly lower premiums are those that either impose a cap on the amount of physician liability or reduce the amount of time a plaintiff has to initiate a claim. We also find that premiums are lower when states regulate rates by requiring prior approval of premiums. In addition, it appears that the observed cyclicality in premiums is due, in part, to fluctuations in the real interest rates available to insurers as returns on investments. Unfortunately, we did not find as strong a link between the determinants of premiums, claims, and awards as might be expected.

Fees and Charges↗
PubMed1990

Health insurance coverage of Minnesota farm families.

This study of 1,482 farm families assesses the extent and cost of health insurance coverage among Minnesota farm families and finds that these families are buying less insurance coverage than urban families, while paying a higher proportion of their income for these premiums. More than three-fourths of the farm families surveyed buy their health insurance plan themselves and pay for it out of pocket. Their plans, on average, are slightly less expensive than employer-provided plans in urban areas, but they provide much less coverage and have more copayments and deductibles. Unlike their urban counterparts, who often choose health plans for convenience of location or freedom to choose physicians, farmers generally choose plans on the basis of costs and services provided. About 7 percent of farm families are without insurance, and many others are underinsured because they cannot afford to purchase an adequate plan.

Cost Control↗
PubMed1989

The emergence of a health insurance system in a developing country: the case of South Korea.

In an attempt to understand the social forces and the economic and political conditions under which new social policies emerge in developing countries, this study outlines factors affecting the introduction of the health insurance system in South Korea. The emergence of the South Korean health insurance system was influenced by changing labor needs of the industrial sector, increasing social expectations, external and international pressures, increasing medical costs, and class conflict. These pressures compelled the South Korean government to respond to demands for the introduction of new social welfare policies in the 1970s. In the case of South Korea, the new health insurance system resulted from the government's attempts to cope with political, economic, and social pressures rather than from an ideological commitment to the well-being of the population. The resulting insurance system was a way to maintain the social order and legitimacy of the regime, and a means to promote the health of groups important to defense or production.

Humans↗
PubMed1986

The health insurance plight of patients with sickle cell disease.

Despite chronic illness that requires routine medical follow-up as well as occasional acute care and hospitalizations, many persons with sickle cell disease (SCD) are not getting the care that they need. The primary reason for lack of proper care is due to the patients' lack of health insurance coverage. This paper will examine the problem of health insurance coverage among persons with chronic illnesses using SCD as a model. It is speculated by the author that persons who suffer from other chronic illnesses may also experience similar problems in obtaining health coverage. Supporting data for this report are derived from a survey on the health insurance status of a randomly selected group of SCD patients treated at the Howard University Center for Sickle Cell Disease. This survey revealed that 20 percent of 70 adult and pediatric patient respondents had no form of health insurance coverage.

Adolescent↗