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Biomedical subjects

E D Kinney

Publications and source records attributed to E D Kinney.

At least 19 recordsLinked to original sources
PubMed2001

Chronic Illness and health insurance-related job lock.

Job duration patterns are examined for evidence of health insurance-related job lock among chronically ill workers or workers whose family member is chronically ill. Using Cox proportional hazard models to indicate the effect of health insurance and health status on workers' job duration we allow for more general insurance effects than that shown in the existing literature. Data for workers in Indiana predating the Health Insurance Portability and Accountability Act (HIPAA) are used to examine the potential effect of HIPAA on job mobility. Among the workers in this sample who relied on their employer for coverage, chronic illness reduced job mobility by about 40 percent as compared with otherwise similar workers who did not rely on their employer for coverage. Results reported here identify previously under-appreciated job lock among chronically ill workers and workers whose family member is chronically ill, clarify how one best researches job lock, and indicate the potential effect of policies aimed at alleviating job lock and promoting inter-employer worker mobility.

Career Mobility↗
PubMed2000

Does chronic illness affect the adequacy of health insurance coverage?

Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Preexisting condition exclusions were a major source of inadequate insurance, though not the only cause. Our results emphasize the impact of enforcing the Health Insurance Portability and Accountability Act (HIPAA) of 1997, which limits preexisting condition exclusions.

Adult↗
PubMed1995

Collaborative QI in community-based long term care.

BACKGROUND: In a statewide demonstration project funded by The Robert Wood Johnson Foundation, the state of Indiana, vendors, clients and Indiana University researchers began working together in 1992 to use quality improvement (QI) techniques to improve the delivery of community-based long term care services. QI STRATEGIES: These collaborators, working with state Area Agencies on Aging (AAAs) case managers, are implementing two strategies--Normative Treatment Planning (NTP), which standardizes the clinical assessment of client needs and the prescription of services by case managers, and the Client Feedback System (CFS), a systematic method for obtaining feedback from long term care clients on the quality of in-home services. CURRENT STATUS: This community-based long term care project has been implemented in AAAs throughout the state of Indiana. In January 1995 the state's 16 AAAs were randomly assigned to four experimental or control groups to assess the project's effectiveness. In the interim, clients are surveyed by telephone every six months to evaluate their satisfaction with services and clinical needs. LESSONS LEARNED: The experience suggests several lessons: (1) build on existing and successful activities; (2) involve a wide range of participants, not just innovators; (3) obtain buy-in from trade and professional associations that represent program participants; (4) turn national attention given to the program into an asset; (5) conduct separate data collection to evaluate an intervention's success; (6) visit the field often; (7) pay as much attention to program implementation as to development; and (8) provide ongoing, informal educational opportunities for the field. SUMMARY AND CONCLUSIONS: This project has resulted in significant movement toward a shared quality improvement vocabulary, information system, and a shared vision of high-quality home care.

Aged↗
PubMed1995

Malpractice reform in the 1990s: past disappointments, future success?

State governments, the federal government, interest groups, and researchers have proposed various approaches to reform the malpractice system. Malpractice reforms fall into two generations. First-generation reforms are those adopted by states beginning in the 1970s chiefly to reduce claim frequency and severity and thereby improve the malpractice system primarily from the perspective of providers and insurers. Scholars and interested constituencies developed second-generation reforms, such as use of medical practice guidelines to set the standard of care, various no-fault approaches, enterprise liability, mandated alternative dispute resolution, and scheduling damages, to streamline the adjudication and compensation system from the perspective of claimants and providers. Research indicates that first-generation reforms have not been very effective in achieving the compensation and deterrence goals of tort, whereas second-generation reforms hold greater promise of doing so. This analysis of state and federal legislation indicates that states, and more recently Congress, have been reluctant to adopt second-generation reforms but continue to promote and/or adopt first-generation reforms. The strength of the provider lobby, concerns of health care reformers about the relationship between defensive medicine and health system costs, and lack of an organized consumer force for second-generation malpractice reform are important explanations of why the states and Congress have not embraced second-generation reforms. Furthermore, federal and state legislative interest in second-generation reforms, although never high, is waning in the current health care reform debate.

Consumer Advocacy↗
PubMed1994

Notes from the insurance underground: how the chronically ill cope.

This report from the field is an account of the experience of individuals with multiple sclerosis (MS) in Indiana in getting and keeping private health insurance. The report presents the findings of a telephone survey of individuals with MS in Indiana. While survey respondents were generally able to obtain health insurance through the Medicare program or employer-based private health insurance plans, many experienced formidable barriers to adequate and affordable health insurance, such as preexisting exclusions, cancellations, high premiums, and coinsurance. Respondents adopted a variety of strategies to keep private health insurance, including selectivity in submitting claims, which worked to reduce their health insurance coverage. Our findings raise two crucial questions: (1) to what extent are the chronically ill forced to take extraordinary measures to get and keep health insurance? and (2) to what extent do insurer practices in pricing insurance and determining coverage of benefits actually make health insurance even more inadequate and unaffordable for the chronically ill? These two questions are critical in understanding the full dimensions of the health insurance crisis in the United States today.

Actuarial Analysis↗
PubMed1992

Standards for the care of diabetes. Origins, uses and implications for third-party payment.

Standards of care are those principles that define the appropriate environment, process, and procedures necessary for quality medical care and optimal health outcomes. The initial impetus to develop standards of care came from the medical profession when it attempted to define quality of care. More recently, standards defining the medical necessity of diagnostic tests or procedures have been developed at the request of public and private third-party payors. These efforts are the natural outgrowth of two decades of health-care delivery research and technology assessment examining the effectiveness of various medical procedures. This article reviews the development of standards by the medical profession, emphasizing current standard-setting activities of private organizations and the federal government. This study examines the characteristics of a good process for developing credible medical standards to guide patient care and the payment for that care. This study also discusses how the American Diabetes Association used this process in developing standards for care of patients with diabetes mellitus and implementation problems encountered because of coverage policy of public and private health insurer programs.

Diabetes Mellitus↗
PubMed1991

Controlling large malpractice claims: the unexpected impact of damage caps.

Indiana's comprehensive malpractice reforms, inaugurated in 1975, include a cap on damages, a mandated medical review before trial, and a state insurance fund to pay claims equal to or greater than $100,000. We have found that the amount of compensation going to claimants with such large malpractice claims in Indiana is, on average, substantially higher than in Michigan and Ohio. Indiana's mean claim severity between 1977 and 1988 was $404,832, while the means for Michigan and Ohio were $290,022 and $303,220, respectively, with the difference between these three means being highly significant. Although data on claim and claimant characteristics reveal considerable interstate variation, the results of regression analyses show that Indiana claim payment amounts are higher than Michigan or Ohio payments, independent of the effect of factors such as sex, age, severity of injury, allegations of negligence, and year of settlement.

Cost Control↗