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Setting up an in-office independent medical examination company.
In a time of declining reimbursement for patient care services, establishing an in-office IME company enables orthopedic practices to generate additional revenue to subsidize clinical activities without compromising the credibility and integrity of their physicians; however, the decision to enter the medical/legal consultation business should be considered carefully. A thorough analysis of the industry, applicable laws, costs-versus-benefits, and the local marketplace is critical in helping the practice to evaluate the feasibility of establishing the new business and develop a product that is well differentiated. The practice should approach the day-to-day management of the IME company with the same careful attention that it pays to the management of its orthopedic service. This includes creating a staffing and information technology infrastructure that supports the new business and allows for its growth. An attitude of continuous learning whereby the physician-reviewer seeks out information about the customer's needs and market shifts enables the practice to respond swiftly to these needs and shifts and further position itself as an innovative provider of medical/legal services.
[Modular nursing system in pediatric ambulatory care according to nursing insurance legislation XI].
UNLABELLED: In the compulsory nursing insurance according to German legislation, the assessed degree of disablement in children is dependent on their daily quantitative need for nursing care with respect to 19 distinctive items belonging to the four sectors "personal hygiene", "mobility", "nutrition", and "household duties", that exceeds normal age-dependent requirements. In ambulatory nursing, exactly that care is given to the clients. OBJECTIVE: Are there typical combinations of items scoring positively, delivering the basis for a simplified billing schedule? DESIGN AND METHODS: 4500 records from the expert assessment of children < 18 years underwent a hierarchical cluster analysis (SPSS, Ward's method). RESULTS: The resulting dendrogram revealed distinct relationships between items. The items clustered into 4 main groups. Each cluster comprised items with a common thematic relationship (A = household duties, B = mobility, C = personal hygiene, D = nutrition/leaving one's home--scoring positively may indicate extra severe disablement). CONCLUSION: Remarkably enough, the resulting four clusters are very similar to the four sectors as defined by legislation (see above), although each single item is assessed independently. Our results are similar to that found in adults (Michel et al., 1998). Here we deliver the statistical basis for a modularised system of ambulatory paediatric nursing care, or its costing.
Pain and public policy.
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Disclosing personal information for research purposes.
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Promoting the legal rights of older adults. Role of the primary care physician.
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Re: The association of the involvement of financial compensation with the outcome of cervicobrachial pain that is treated conservatively, by Rasmussen et al.
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Using medicare databases for outcomes research in rehabilitation medicine.
With the advent of computerized billing for healthcare services, claims data have become useful in academic medicine. One of the largest suppliers of these types of data is Medicare, the US Government's healthcare insurance organization for the elderly and disabled. Because Medicare patients often require rehabilitation, this type of data can be useful in rehabilitation outcomes studies. Despite several significant limitations to Medicare billing data, Medicare claims data are powerful tools with which to analyze concepts in physical medicine and rehabilitation.
Association between workers' compensation and outcome following multidisciplinary treatment for chronic pain: roles of mediators and moderators.
OBJECTIVE: To determine whether the tendency for chronic pain patients who receive Workers' Compensation to show a poorer response than non-compensated patients to pain treatment can be accounted for by mediating factors; to assess whether moderating factors can distinguish subgroups of Workers' Compensation recipients who react very poorly to treatment from compensated patients who respond well. DESIGN: Outcome study based on archives. SETTING: Multidisciplinary pain treatment center. PATIENTS: Of 214 patients, 158 had complete data. OUTCOME MEASURE: Blind ratings of narrative discharge summaries written by the Pain Treatment Center staff. RESULTS: A significant negative relationship between receiving Workers' Compensation and outcome was mediated by a pessimistic belief in the ability to return to former occupation. Moderator effects showed that Workers' Compensation recipients with high initial pain and a history of pain-related surgery fared worse than any other group. Moreover, Workers' Compensation recipients not characterized by high pain and a history of surgery responded as well as noncompensated patients. CONCLUSIONS: The inadequate response to pain programs shown by Workers' Compensation recipients may be partly understood in terms of well-defined mediating factors, which may admit to amelioration via clinical intervention. Moreover, Workers' Compensation patients should not be considered high risks for failure by sole virtue of their compensation status. Multifactor assessment methods may be needed to identify that portion of compensation recipients who are actually at appreciable risk for treatment failure so that appropriate adjustments in treatment regimen may be made.
Association of work attitudes and mental health with level or type of income support received by unemployed people with disabilities.
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Supervisor personal liability for ADA discrimination. Emerging issues for hospital administrators and physicians.
This article discusses emerging and conflicting trends in recent Americans with Disabilities Act discrimination legal decisions in which plaintiffs seek compensatory or punitive damages directly from supervisors and their employers, creating potential issues of personal liability for physicians or hospital administrators, for example. Also addressed in the article are potential problems employers face if supervisors are held personally liable for Americans with Disabilities Act discrimination.
Barriers to successful dietary control among pregnant women with phenylketonuria.
PURPOSE: The teratogenic effects of maternal PKU are preventable, yet affected babies continue to be born. This study's purpose was to identify barriers to successful dietary control among pregnant women with PKU. METHODS: An interview-based study was conducted of women with PKU who were known to metabolic disease clinics in three states and pregnant during 1998 to 2000. Medical records were used to document timing of metabolic control. RESULTS: Of 24 women in the study, only 8 (33%) initiated the diet before pregnancy. Of 22 medical records received, only 12 (55%) indicated control of blood phenylalanine levels before 10 weeks' gestation. Risk factors for late dietary control included young age and belief that treatment costs complicated the diet. Although all of the women expressed confidence in the metabolic clinic staff, few perceived their obstetricians were knowledgeable about the maternal PKU diet. Of 13 women enrolled in state-based assistance programs, 9 (69%) reported proof of pregnancy was required for eligibility. Many women using private insurance reported their insurers were unwilling to pay for medical foods. When the data were stratified according to state of residence, differences were observed in the rate of live-born infants, prepregnancy medical food use, average travel time to the metabolic clinic, and gestational week when metabolic control was achieved. CONCLUSION: Our study's findings may be used to target educational messages to women with PKU and to direct future research directions. For example, obstetric knowledge of maternal PKU needs further evaluation. Discrepancies should be resolved between maternal PKU medical recommendations and the policies of third party-payers. The disparities in financial assistance and services available to pregnant women with PKU residing in different states should be examined further.
Chronic lymphocytic leukemia: economic burden and quality of life: literature review.
The purpose of this review was answer 2 main questions: what is the impact of chronic lymphocytic leukemia (CLL) on the patient's quality of life and how great is the economic burden of this disease on the health care payers and providers. Patients with CLL typically do not receive any treatment soon after the initial diagnosis. Although there is no known cure for CLL yet, when treated, the patients receive aggressive and expensive therapies (eg, chemotherapy or bone marrow transplantation). A rigorous and systematic literature review was performed of English-language articles published in 1990-2002. It was supplemented with additional articles published before 1990 for completeness and additional references to fill the gaps identified in the published medical literature. The literature on the quality of life (QOL) of CLL patients is very limited. We identified only 8 articles, and none of them analyzed the QOL in untreated CLL patients. Because CLL is a disease affecting adults, especially the elderly, all 8 studies measured the QOL in the adult population. QOL difficulties include fear of death and disability, problems gaining employment or health insurance, and fatigue. No specific leukemia or CLL instruments but general QOL instruments (eg, I-HRQL) were identified and some cancer-specific ones (eg, EORTC QLQ-C30, FACT-G, FACT Anemia, FACT-Fatigue). Interestingly, a FACT-Bone Marrow Transplant instrument exists, although we found no study on CLL that used it. Even the literature on the economic burden of CLL is very limited. We identified 13 studies on the cost of CLL: Most of them were cost-identification or cost-comparison studies, and 5 dealt with the cost-effectiveness of medical interventions to treat CLL. Cost drivers identified for CLL were the chemotherapy costs, intravenous immunoglobulin costs, transplantation costs, and costs associated with the differential staining cytotoxicity assay. We identified very few articles on the QOL of CLL patients and therefore cannot draw strong conclusions about the key QOL predictors. Nevertheless, patients with anemia were found to have a better QOL if they had higher hemoglobin counts and good response to erythropoietin treatment. The articles published seem to demonstrate that the older the age of the patient was, the poorer the QOL. The main cost drivers identified for CLL were related to the treatment chosen (eg, chemotherapy, bone marrow transplantation). There are hints that higher costs often result from the delivery of non-optimal therapy that leads to adverse events, infections, and drug resistance. In summary, the impact of this disease on the health care budget of the different health care providers and payers as well as on the patient's QOL is substantially unknown, calling for appropriate economic and QOL studies.
Back pain and sickness absence [Proceedings].
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Irrational determinants of the place of psychiatric treatment.
Observations of 392 women admitted to a psychiatric hospital indicated that 24 were well suited to treatment in a day center and that 208 could feasibly be treated there. However, only 59, or 28 per cent of those for whom day care was feasible, were able to take advantage of that alternative. The others were excluded by financial limitations, refusal to accept the day center option, administrative delays, and inaccurate classification of treatment setting. The authors believe that underuse of the day center was due as much to doctors' inexperience, personal biases, and unfamiliarity with the facilities as it was to psychopathology and financial realities. They found that many clinicians were not aware of the factors that affect their decisions about the use of a partial hospitalization setting.
Health insurance: a dilemma for parents of the mentally retarded.
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Work and disability at the age of 30 years. A sociomedical study of a birth-cohort from Bergen. III. Disability as related to medical, psychological and educational background.
This article deals with occupational disability at the age of 30 years, seen the light of medical, psychological and educational background. The study is based on a cohort of 1570 persons, all live births in 1940 of mothers then residing in Bergen. This birth-cohort was followed-up in the compulsory school system at age 14 years, and again at age 30 years, concluding at 1st June 1971. Only those of the cohort residing in Norway on 1st June 1971, a total of 1331 persons, are included in the present analysis. The diagnoses discussed are based on data obtained from disability pension case records, from the National Insurance Institution files and from the Public Welfare office files. Results of medical and psychological examinations made on a stratified random sample of the cohort are also used. Thirty-seven persons (2.8%) of the total of 1331 were found to be disabled according to the criteria set for this study. The prevailing primary diagnosis was mental disorder, as 25 of the disabled had this diagnosis, oligophrenia being dominant. The former pupils in the different types of compulsory school attended at age 14 years show a frequency of disability at age 30 years as follows: junior high school 0.8%, continuation school 1.3%, elementary school classes for slow learners 10.7%, special schools for the educable mentally retarded 32.7%, and receiving services for the mentally retarded, 97.0%.
The coverage priorities of disabled adult Medi-Cal beneficiaries.
Medi-Cal, like other Medicaid programs around the U.S., has been pressed to cut its budget. We report the results of a project using the CHAT (Choosing Healthplans All Together) exercise, designed to ascertain the priorities of disabled adult Medi-Cal beneficiaries to inform any decisions regarding Medi-Cal benefits. Participants voiced greatest interest in maintaining a wide spectrum of benefits and access to a large pool of providers and were most willing to restrict pharmacy benefits. The resulting findings may be of value to legislators drafting Medicaid proposals that revise benefits for this vulnerable population.