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On the Swiss market there exist various different accident insurance schemes and systems. Private accident insurance which is offered by the private insurers, date back to the middle of the 19th century. Since 1912 accident insurance is compulsory for all employees working in particularly dangerous industries, since 1984 it covers all employees in the country. In Switzerland there exists no general compulsory accident insurance. To perform as insurance carriers are qualified: private insurance companies, the Swiss Accident Insurance Company, and a number of the social health (sickness) insurers. Depending on the insurance system there are different approaches to renumerate the health costs. In the various social insurance systems the patient is rather free to chose his doctor and hospital (among those who have a contract with the insurer); in private insurance he is completely free. Yet the billing systems and the applicable rates and tarifs differ considerably. There are trends to simplify these systems and bring them more into mutual accordance. Due to the important rise of the health costs in Switzerland, there exists the danger that possible simplifications will bring about more public influence yet less private initiative and less incentives to really control costs without lessening the patients' possibilities.
The purpose of an insurance must not be restricted to the payment of claims to those insured persons who suffered a loss, for loss prevention is much preferable to claim settlement. A whole range of different institutions and measures has been established by the Swiss insurers, in which many insurance branches participate. The loss preventing activities can be listed as follows:--Activities of the fire insurers to prevent and fight fires. This is the prevailing duty of the Consulting Agency for Fire Prevention (BfB) as well as the Fire Prevention Service for Industry and Trade (BVD).--Activities of the accident insurers to prevent accidents. The fight against accidents, mostly traffic accidents, in sports and at home is the foremost task of the Swiss Council for the Prevention of Accidents (BfU), an institution created by the Conference of Accident Insurance Managers (UDK) and the Swiss National Accident Insurance Fund (SUVA).--The Health Service in life insurance, after all the periodical medical examinations and consultations granted by many insurers to their insured persons, as well as the pamphlets aiming at health education published by several Companies and finally institutions and measures to promote fitness, e.g. VITA-Parcours.
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Rapid advances in genetic testing have stimulated growing concern about the potential for misuse of genetic data by insurance companies, employers, and other third parties. Thus far, reports of genetically based discrimination in life insurance have been anecdotal. Reasoning that state insurance commissioners were likely to be aware of (1) the extent of current use of and interest in genetic tests by life insurers and (2) consumer complaints about insurance being denied because of genetic condition or because of genetic test results, we conducted a survey of that group. We received responses from 42 of the 51 jurisdictions. Our results suggest (1) that those who regulate the life insurance industry do not yet perceive genetic testing to pose a significant problem in how insurers rate applicants, (2) that life insurers have much legal latitude to require genetic tests, and (3) that so far few consumers have formally complained to commissioners about the use of genetic data by life insurers.
The majority of adults in Denmark can choose between the forms of health insurance 1 and 2. Persons insured in Group 2, on payment of a premium, obtain certain perquisites as compared with Group 1, primarily they may consult general practitioners and specialists of their own choice. Since the introduction of the Health Insurance Law in 1976, the number of persons insured in Group 2 has decreased to 3.8% of those insured in 1988. More than 3/4 of these have been insured in Group 2 since 1976. The number of new group 2 insured persons has remained relatively stable at about 3,000 persons per annum. The average age in Group 2 is 58.3 years as compared with 45.0 years in Group 1. 60% live in the region of the capital. The number of economically and socially well established persons in Group 2 is markedly higher than in Group 1, particularly in the higher age groups where the mortality in Group 2 insured persons is considerably lower than in Group 1 insured persons.
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OBJECTIVE: --To analyze the health insurance status of physicians, other health personnel, and insurance industry personnel. DESIGN: --The study was based on data collected by the US Bureau of the Census in the March 1991 Current Population Survey for six groups of workers in health care occupations and three classifications of insurance employees. This survey included 6182 civilian health personnel and 1498 insurance workers under the age of 65 years. RESULTS: --Of civilian health personnel under the age of 65 years, 9% (90% confidence interval [CI], 8.2% to 9.8%) are uninsured, equivalent to 834,000 persons, including 15,000 (90% CI, 5000 to 25,000) physicians. Among insurance workers, 5.1% (90% CI, 3.9% to 6.2%) are uninsured. While 6% (90% CI, 4.2% to 7.9%) of those working in physicians' offices are uninsured, 52.2% (90% CI, 48.2% to 56.3%) receive no employer contribution toward their coverage. More than a fifth of nursing home employees lack insurance coverage, as do nearly a quarter of the 1.868 million health care workers with annual incomes less than $10,000. CONCLUSION: --Nearly a million health care and insurance workers are themselves uninsured and at high risk for being unable to obtain needed care.
In a society with strong antitax sentiment and large government deficits, the enactment of universal health insurance is blocked by an impasse over financing. The two chief mechanisms for funding universal health insurance are taxes and insurance premiums. Taxes and premiums are not distinct entities; rather, a spectrum of financing methods exists with varying tax-like and premium-like features. Premium-like financing tends to be voluntary and earmarked for health care, with coverage contingent upon making payments and payments going to private insurance firms. Tax-like financing, in contrast, tends to be mandatory and not earmarked for health care, with coverage not dependent upon making payments and payments going to governments. Over the past century, most industrialized nations have developed highly popular social insurance programs to cover periods of retirement, disability, unemployment, and payment for medical care. Social insurance constitutes a blend of tax-like and premium-like features, offering lessons that might assist in breaking the current impasse over universal health insurance financing.
Analyses of problems in the health insurance market usually focus on the individual and small group market. Consumers in this market who experience an illness or diagnosis of illness in one time period are likely to have their future risk redefined by insurers. Despite the fact that risk-averse consumers should desire protection against redefinition of risk, policies featuring that protection currently are not common in the individual and small group market. Contracts offering that protection must either be offered by pools that can guarantee replenishment of good risks over time, or be multiperiod contracts. Risk replenishment is impossible for individuals and may be technically difficult for many small groups. Also, the terms of multiperiod contracts with a single insurer may be unattractive to individuals and small groups, given the current structure of the market. Multiperiod contracts with a pool, rather than an individual insurer, may make it possible for individuals and small groups to enjoy the same advantages as consumers who obtain employment-based health insurance through large firms.
Using data from the Current Population Survey, this article shows that low-income workers were much less likely to have employer-sponsored insurance in 1989 than they were in 1979. For example, workers earning $6.00 per hour in 1989 were over 10 percentage points less likely to have employer sponsored health insurance than were workers earning $3.51 per hour in 1979 (the constant dollar equivalent of $6.00 per hour in 1989). The decline in employer sponsored coverage was confined to low income workers; coverage levels did not decline for workers earning $30,000 per year and more. The paper explores two types of explanations for the decline in coverage among low-income workers. First, the decline might have resulted from increases in the price of medical care, the cost of administering health insurance, and from a breakdown in the small group insurance market. Second, the decline might have resulted from changes in the structure of the economy that changed the types of jobs available to low-income workers. Since coverage declines among the self-employed parallel coverage declines among the employed, it seems likely that increases in the price of health insurance are a larger part of the cause for coverage declines than are changes in the structure of the economy, but further research on this question is needed.
The physician-owned captive insurance company is a lesser known but dynamic alternative to commercial insurance. The Physicians Reimbursement Fund, Ltd., was founded in 1975 in response to the malpractice crisis of that year. The company insures about 100 physicians in high-risk specialties. Approximately one half are obstetrician-gynecologists. Innovative management has enabled this company to operate successfully at a fraction of the premium charged by typical insurance companies. Fourteen years of experience have demonstrated the ability of this company to successfully serve the needs of the community.
By the mid-1990s there will be more than 500,000 young adults in the United States over the age of 21 with a cardiac malformation. Presently more than half of this population is denied insurance coverage entirely or in part because of their preexisting condition. Because some did not have coverage and because of uncertainty about whom to see for their cardiology care, patients assessed in NHS-II who were evaluated by their physician on an annual basis before the age of 21 were seen by a cardiologist only every 10 years after the age of 21. However, they have been shown by NHS-II to be well-educated, productive in the workplace, and to share an equal place in society with the general population. Their health-care costs are decidedly lower after the age of 21 than before. This group represents a microcosm of a general society of more than 37 million Americans who, for various reasons, are not insured. Dr. Wiener described an American health-care system in crisis. Smaller companies are no longer able to afford health insurance for all their employees, especially for those with preexisting conditions, because of an industry pricing concept based on a claims-experience standard rather than a community standard. The insurance industry, the government, and patients are demanding medical cost-containment. Health-care costs, 12.2% of the gross national product in 1990, are climbing, and no end to this increase is presently in sight.(ABSTRACT TRUNCATED AT 250 WORDS)
A health policy consultant with 20 years of experience in public and private health insurance, and particularly multiple choice systems, suggests the evidence is in on our national effort to contain costs through competition, HMOs, and multiple choice health plans. Specifically, we have learned that 1) multiple choice plans are not containing costs for employers, 2) while group and staff model HMOs contain costs, few have cut employers' costs in multiple choice health plans, and 3) group and staff model HMOs' capacity to contain costs has not been matched by insurers' managed care plans. Three options for insurers and HMOs to offer employers are outlined. The options are aimed at changing the behavior of providers so they offer lower cost health care.
During 1975-76 a no-fault compensation system for treatment injuries in dentistry and failures within prosthodontics was introduced in Sweden. The guarantee insurance scheme for prosthetic treatment has changed somewhat during the years and, in 1987, became mandatory for all dentists in Sweden. All necessary retreatment not included in the National Dental Insurance Scheme (eg allergy to dental materials, all treatment following radiotherapy-related xerostomia) is included. For fixed prosthodontics, all replacements are covered by the scheme for the first 2 years. For removable prosthodontics, this is limited to the first year. A patient may choose any dentist in Sweden to carry out the retreatment. The claim system is simple and the number of cases has steadily increased, probably because dentists are becoming more familiar with the system and are willing to use it. The costs are paid for by private practitioners, the Public Dental Service and private dental laboratories. The insurance files are available for research purposes.
This report examines the major forms of administration of private health insurance plans. Plans are classified according to whether they are employer-only or joint worker-employer-operated and according to whether they are negotiated or not. A further focus of examination that often reflects industry patterns is whether the plans cover workers of a single employer or involve multi-employer arrangements. These classifications of administration and the method of insuring benefits are examined in terms of proportions of workers with specified plan characteristics and health benefits.
According to the new Accident Insurance Law, in Switzerland it is mandatory for all employees to be insured against accidents and occupational diseases. The legal bases, organization and implementation of this mandatory social accident insurance are described. Discussed in particular are the specific Swiss features, such as the inclusion of non-occupational accidents (leisure-time accidents), and special medical aspects in the assessment of incapacity, injury and occupational diseases.