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PubMed1999

Psychiatric co-morbidity and hospital utilization in the general medical sector.

BACKGROUND: This article provides evidence about the relationship between psychiatric disorders, physical disorders and hospital use in the general medical sector using a broadly based survey of the US population. METHODS: The data are from the 1989 National Health Interview Survey. This survey contains medical and mental health evaluations for the entire sample. In a multivariate framework, the author estimates the effect of mental illness on the probability of being admitted to a general hospital, the number of admissions and the length of stay. RESULTS: Hospital use in the general medical sector is significantly higher for persons with coexisting physical and psychiatric conditions than for those with no psychiatric disorders. For a wide range of medical conditions, the predicted number of hospital admissions and the length of a hospital stay increase substantially when the physical illness is accompanied by a psychiatric condition. CONCLUSIONS: One implication of this finding is that economic evaluations of alternative psychiatric treatments should consider any differences in hospital costs related to the treatment of coexisting medical conditions. Another implication pertains to health care systems where insurers have some discretion over which individuals to insure. In the absence of adequate adjustments in insurance payments for high-risk potential enrollees, psychiatrically disabled persons may have more limited access to health insurance.

Cross-Sectional Studies↗
PubMed2003

Access to specialty medical care for children with mental retardation, autism, and other special health care needs.

Access to specialty medical care among children with mental retardation, autism, or other types of special health care needs was examined. Results from a national survey indicate that over a third of the children with autism, over a fifth with mental retardation, and over a fifth with other types of special health care needs had problems obtaining needed care from specialty doctors in the preceding year. The most common problems included getting referrals and finding providers with appropriate training. Children with unstable health conditions, autism, or those whose parent was in poor health were at greater risk for problems. Primary Medicaid coverage and public secondary health coverage were associated with fewer access problems. Implications for health services for children with special health care needs are discussed.

Adolescent↗
PubMed1991

[Alcohol and insurance in the Netherlands].

Ethyl-Alcohol is a very big problem in the world, but not a new addict. Drinking of more than 280 g. a week is disastrous for the most organs. The nervous system, the liver, the heart und circulatory system, even the bones and muscles will be damaged. With more than six-hundred-thousand victims in the Netherlands the alcohol addict is a great problem for the insurance business. Road accidents, health problems after several years, disability and early death, plays a role in the insurance policies.

Alcoholism↗
PubMed1999

[Evaluation of residual working capacity with lung function studies].

Lung diseases are one of the most frequent causes of permanent occupational disability. The assessment of the insured person's remaining ability to work by evaluating the respiratory parameters is by no means trivial. Nevertheless, no clear overview has been published yet. In this paper tables and evaluation schemes are presented for the quick and reliable assessment of the degree of the occupational disability of persons with respiratory diseases.

Disability Evaluation↗
PubMed2006

[Options for a future risc structure compensation in Germany].

UNLABELLED: AIM OF THE ARTICLE: The risc structure compensation scheme within the German compulsory health insurance system is intended to enforce the principle of solidarity all over the statutory health insurance and not only within the different sickness funds. Differences in the contribution rates should not reflect different risc profiles, but the differences of the efficiency in social care. The criticism against the current adjustment system in Germany is multifarious and points e. g. on the missing orientation to morbidity. This article follows the question, whether this criticism is valid. METHODS: The variables and methods, which are currently used to calculate the risc structure adjustment are discussed and compared to an alternative proposal for the future form of the risc structure adjustment, which includes both a higher orientation to riscs and incentives for social health insurance funds to decline the costs for the social care system on long-term. RESULTS: Currently, for the calculation of the risc structure adjustment the following variables are used: age, sex, income, number of family members who are exempted from contributions and persons who get occupational disability pension, and number of insured persons who are registered to an accredited Disease-Management-Program (DMP). Especially the last variable includes a high control effort, because the higher co-payments of the adjustment system are aligned to the voluntariness of participation and active collaboration of the patients in DMP. The argument, a further development to a morbidity-oriented risc structure adjustment leads to less cost management of the sickness funds is not totally correct, because not actual, but standardised costs are the basis for compensation. On the other hand the morbidity determined cost components should not totally be adjusted, as a proper distribution of savings to the risc structure adjustment and the single funds would still be an incentive for cost management and prevention. CONCLUSION: An ongoing refining of the risc structure adjustment might cause new incentive problems. Instead a morbidity orientated risc structure compensation scheme should leave a part of the savings due to better social care structures in the sickness funds and should include outpatient care parameters. The change to a new honorarium system could create a better data basis for this improved form of risc structure adjustment in the future.

Cost Sharing↗
PubMed2002

Prevalence, expenditures, utilization, and payment for persons with MS in insured populations.

OBJECTIVE: To determine the prevalence, expenditures, and utilization of enrollees with MS relative to all enrollees in privately insured, Medicare, and Medicaid populations. METHODS: The authors used insurer administrative billing data to identify persons with MS, their insured medical expenditures and utilization, and benchmark general insured population expenditures and utilization. Three samples of insurer billing data were analyzed: nationally representative samples for the privately insured (1994 through 1995) and Medicare (1996 though 1997) populations, and Medicaid data for disabled (1991 through 1996) populations from six states. RESULTS: Using 2 years of diagnoses on claims, the prevalence of MS in the privately insured population was 24 per 10,000, 36 per 10,000 in the Medicare population, and 71 per 10,000 in the Medicaid disabled population. Annual insured expenditures were $7,677 per privately insured enrollee with MS vs $2,394 for all privately insured enrollees, $13,048 per Medicare beneficiary with MS compared with $6,006 for all Medicare beneficiaries, and $7,352 per Medicaid disabled recipient with MS vs $4,088 per disabled recipient without MS. Home health expenditures were very high for Medicare beneficiaries with MS and nursing facility expenditures were very high for Medicaid disabled recipients with MS. A small proportion of enrollees with MS accounted for most expenditures. CONCLUSIONS: Insured enrollees with MS are two to three times more expensive than average insured enrollees. If the premiums that employers or governments pay health insurers and the capitation amounts that insurers pay health care providers do not account for these higher costs, a disincentive is created for the enrollment and care of persons with MS.

Adolescent↗
PubMed1997

[Regional differences of results of disability assessment for domestic health care needs in 1995 and possible explanations].

In 1995 a statutory nursing care insurance was set up in Germany. The MDK (Medical Service of Health Care Insurance Institutions) has been asked to evaluate the eligibility of the individual patients. Within a few months after this body began its work, strong regional differences in incidence became visible. A survey of 1995 MDK records from Bavarian counties was selected to determine whether and how sociodemographic or socioeconomic variables may explain these differences. An age incidence rate of nursing care, standardised according to age and sex, was correlated with a variety of explanatory factors. Only two variables in the multiple regression model were statistically significant: the refusal rate by local MDK officials and the regional supply of outpatient care facilities. Further work is needed to improve the process of evaluation and to minimise unexplained regional differences.

Aged↗
PubMed1994

[The extent of disability pensions based on educational background. Disability pensions in the period 1967-1992 in a group born 1949 in Bergen].

The authors discuss recruitment to disability pension in groups of former pupils of different types of school in the school system in Bergen in the 1950s. The study is based on a cohort of 1,570 persons, all live births from 1940 of the mothers then residing in Bergen. This birth-cohort was followed up in the school system in Bergen at the age of 14 years and up to the end of 1992. Information on disability pensions was extracted from the files of the National Insurance Administration for the years 1967-92. The prevalence of disability pension of former pupils of different types of school reached a peak at the end of 1992, i.e. at the age of 52 years, as follows: Former pupils of the regular secondary schools, i.e. junior high school and continuation school, 6.8% and 12.7% respectively, former pupils of elementary school classes for slow learners 25.9%, of special schools for the educable mentally retarded 59.6% and for those receiving the services for the mentally retarded, 100%.

Cohort Studies↗
PubMed1997

Workplace injuries and the role of insurance: claims costs, outcomes, and incentives.

Workplace disability and workers' compensation systems were designed in the first 3 decades of the twentieth century with 3 major objectives. The first objective was to reduce the inequities and uncertainties in compensating disabled and injured workers inherent in the previously existing tort based system. The second was to create appropriate employer incentives for safety by internalizing the costs of accidents to the firm. The third, and perhaps little appreciated at the time for its impact on the provision of care and the healing process of injured workers, was to introduce a no fault, prefunded insurance mechanism to guarantee certain benefits to workers injured on the job. Throughout its history, there have been periodic attempts to reform the workers' compensation system. During the past 15 years there has been a growing body of theoretic and empiric social science research that suggests that many of the attempted reforms have not necessarily worked as planned. Indeed, it has become clear that the workers' compensation system, through its varying financial incentives on the system participants, and the differing levels of information that are available, may itself play an important and perhaps not benign role in the outcomes and costs for treating injured workers. The existing research is summarized and some new evidence on the workers' compensation insurance effect is provided.

Accidents, Occupational↗
PubMed1985

Education and employability of young cardiac patients.

Between 1966-1980, 136 young cardiac patients were categorized as disabled in accordance with the National Act of Rehabilitation. To study their fate a questionnaire was circulated to them: 96 patients responded, all were 15 years of age or more at the time of the study; 31.2% attended middle or higher school education and 63.3% were employed; 45.9% were skilled and 54.1% unskilled workers; 2.2% were unemployed, which was very close to the general youth unemployment rate. Work was provided for unemployed patients in their homes but they needed additional financial support. The benefits for the young disabled cardiac patients include health insurance, vocational training, payment of boarding school fees and financial support. Nevertheless the focus of the team dealing with these patients should be their preparation for employment.

Adolescent↗
PubMedDate not supplied

Access to health services in Ireland for people with Multiple Sclerosis and Motor Neurone Disease.

We conducted a telephone questionnaire to determine the utilisation of hospital and community based services by patients with Motor Neurone Disease and Multiple Sclerosis in Ireland. 94 MND and 188 MS patients participated in the study. MND patients were more likely to have free medical care than MS patients, despite legislation favouring the converse. Severely disabled MND patients were more successful at accessing free community-based services than were severely disabled MS patients. Private medical insurance conferred no advantage when obtaining services or purchasing equipment. Many patients were unaware of the specific roles of the various clinical professionals. There are significant deficiencies in patients' ability to access multidisciplinary services. Voluntary organisations often bridge the gap in service provision. An investment in services for people with chronic neurological disability is urgently required.

Community Health Services↗