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PubMed1995

Questions and answers on health insurance benefit issues.

This Issue Brief addresses eight topics in the areas of health insurance and health care costs. Using a question and answer format, the discussion draws largely on EBRI research and the EBRI Databook on Employee Benefits, third edition. In 1993, U.S. expenditures on health care were $884.2 billion, and they are projected to reach $2,173.7 billion by 2005, increasing at a projected average annual rate of 7.8 percent. Health care spending accounted for 13.9 percent of Gross Domestic Product (GDP) in 1993 and is projected to reach 17.9 percent of GDP by 2005. Among the factors contributing to the increase in health care costs are the growth in the number of individuals with traditional reimbursement health insurance coverage, the rapid expansion of technology and treatment options, and demographic factors such as the aging of the population. In 1993, employers, both public and private, spent $235.6 billion on group health insurance, accounting for 6.2 percent of total compensation. Group health insurance is the fastest growing component of total compensation, increasing at an average annual rate of 13.7 percent from 1960 to 1993. An increasing number of employees are required to make a cash contribution to their health insurance plan premium. In 1993, 61 percent of full-time employees in medium and large private establishments who participated in an employee only health insurance plan were required to make a contribution to the premium, up from 27 percent in 1979. In 1993, 185.3 million persons under age 65 had health insurance coverage, while 40.9 million people--or about 18.1 percent of the nonelderly population--received neither private health insurance nor publicly financed health coverage. Of those individuals who had health insurance coverage, 60.8 percent, or 137.4 million persons, received their health insurance through an employment-based plan. In 1993, 15.2 percent of the nonelderly population without health insurance coverage were noncitizens. In six states noncitizens represented a higher proportion of the total uninsured population than individuals in the nation as a whole. An increasing number of employers are self-funding their health insurance plans. In 1994, 74 percent of employers with 500 or more employees self-funded their health insurance plans, up from 63 percent in 1993. An estimated 22 million full-time employees in private industry and state and local governments participated in a self-funded employment-based health insurance plan.(ABSTRACT TRUNCATED AT 400 WORDS)

Data Collection↗
PubMed2004

Silence of the fathers: early X inactivation.

X chromosome inactivation is the mammalian answer to the dilemma of dosage compensation between males and females. The study of this fascinating form of chromosome-wide gene regulation has yielded surprising insights into early development and cellular memory. In the past few months, three papers reported unexpected findings about the paternal X chromosome (X(p)). All three studies agree that the X(p) is imprinted to become inactive earlier than ever suspected during embryonic development. Although apparently incomplete, this early form of inactivation insures dosage compensation throughout development. Silencing of the X(p) persists in cells of extraembryonic tissues, but it is erased and followed by random X inactivation in cells of the embryo proper. These findings challenge several aspects of the current view of X inactivation during early development and may have profound impact on studies of pluripotency and epigenetics.

Animals↗
PubMed1996

[Drugs and occupational accident].

In a case of a fatal occupational accident (construction worker, fall from roof, urine test positive for cocaine and THC, e.g. cannabis) the question arised to what extent those drug-related occupational accidents occur. In the literature only few cases, mainly dealing with cannabis influence, have been reported, however, a higher number is suspected. Cocaine and other stimulating drugs (amphetamine) are more often used to increase physical fitness. By direct or indirect interference with vigilance these compounds may provoke accidents. Due to the lack of a legal basis proving of the influence of drugs at the working place is still very limited, although highly sensitive chemical-toxicological assay procedures are available to detect even the chronic abuse (in hair). In the general conditions of accident insurances a compensation is excluded when alcohol is involved, but drugs are not mentioned. It is indeed difficult to establish a concentration limit for drugs like that existing for alcohol (1.1%). In each case the assay of the drug involved and exact knowledge of its specific effects is in an essential prerequisite to prove the causal relationship.

Accidents, Occupational↗
PubMed1998

Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market.

Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in many countries. RACPs based on demographic variables only are insufficient, because they leave ample room for cream skimming. However, the implementation of improved RACPs does not appear to be straightforward. A solution might be to supplement imperfect RACPs with a form of mandatory pooling that reduces the incentives for cream skimming. In a previous paper it was concluded that high-risk pooling (HRP), is a promising supplement to RACPs. The purpose of this paper is to compare HRP with two other main variants of mandatory pooling. These variants are called excess-of-loss (EOL) and proportional pooling (PP). Each variant includes ex post compensations to insurers for some members which depend to various degrees on actually incurred costs. Therefore, these pooling variants reduce the incentives for cream skimming which are inherent in imperfect RACPs, but they also reduce the incentives for efficiency and cost containment. As a rough measure of the latter incentives we use the percentage of total costs for which an insurer is at risk. This paper analyzes which of the three main pooling variants yields the greatest reduction of incentives for cream skimming given such a percentage. The results show that HRP is the most effective of the three pooling variants.

Capitation Fee↗
PubMed1995

[Transformations in the transition between work activity and retirement in Europe: new stakes for social security].

"The tendency towards early retreat from the work force observed in Europe over the past years can be attributed to social security measures other than old age security, and is not simply due to an advancing retirement age. Two programmes have been especially favoured for protecting ageing workers: disability insurance and unemployment insurance. Preretirement compensation packages have also facilitated the early departure of these workers from the labour force, whether employed or not. Such emerging models in the transition from work activity to retirement are revealing, both in terms of the social restructuring of the life cycle, and the overhaul of the social safety net. These transformations are analyzed in conclusion in relation with their potential role in new stakes for social security." (SUMMARY IN ENG AND SPA)

Developed Countries↗
PubMed1991

[Assessing accidental damage to the integrity of the eye with preexisting damage].

According to the insurance law, compensation for damage of integrity has to be realized only in cases of accident caused damage of integrity. In cases of preexisting damage on the affected eye the evaluation is simple: Total damage minus non accidental cause integrity damage is equal to accident caused damage of integrity. More difficult is the evaluation in cases of preexisting damage on the partner eye. According to the visual function of the non affected eye (first eye) the basic value of the accident eye (second eye) amounts in case of total loss between 30 and 70%. Values in between in cases of partial damages are explained by means of a three-dimensional graphic.

Diagnosis, Differential↗
PubMed2003

Inpatient hospital care for work-related injuries and illnesses.

BACKGROUND: The aim of this study was to compile nationally representative statistics describing inpatient hospital care for patients with work-related injuries and illnesses covered under workers' compensation (WC) insurance in the United States. METHODS: Three years of data (1997-1999) from the Nationwide Inpatient Sample (NIS) were used to describe WC inpatient stays with respect to patient and hospital characteristics, principal diagnoses, number and type of procedures provided, total charges, length of stay, and time from admission to administering of the principal procedure. RESULTS: Approximately 209,139 WC hospitalizations occurred annually, representing 0.62% of all inpatient admissions. The average total charge per WC hospitalization was 14,966 dollars. After adjusting for the type of diagnosis and other factors, WC hospital care was found to involve 13-24% more procedures, have a slightly longer (4%) length of stay, and take 23-54% less time from admission to the principal procedure than inpatient care for comparable diagnoses paid by other sources. Inpatient care for disc and spinal disorders paid by WC had 16% higher charges than similar non-WC cases. Three-year trends showed a steady decline in the number of WC hospitalizations between 1997 and 1999 but a sharp 16% rise in total charges per WC stay. CONCLUSIONS: This research provides an initial foundation for understanding the extent and nature of hospitalized care for injured workers in the US and identifying significant trends in the delivery of care.

Adolescent↗
PubMed1982

1086 consecutive injuries caused by glass.

A prospective study of 1086 consecutive injuries caused by glass showed that the mean age of the patients was 15 years and there was a 7 : 3 male to female ratio. The home (35 per cent), public places (31.3 per cent) and places of work (21.1 per cent) were the main locations where these accidents occurred. Although most of the injuries were mild, 3 case histories illustrate that some of them were extremely serious. 4.6 per cent of patients requiring immediate admission to hospital. Extrapolation of the figures indicates that approximately 210,000 people attend hospital each year in England and Wales for treatment of an injury caused by glass. The annual cost to the National Health Service is about 7,500,000 pounds but the full financial implications of these injuries in terms of compensation and insurance payments must be much greater. Suggestions are made of ways to reduce the incidence of these injuries from road traffic accidents and accidents with plate glass and glass containers.

Accident Prevention↗
PubMed1986

Compensation and negotiation in the siting of hazardous-waste facilities.

The transport and storage/disposal of hazardous materials is clearly of fundamental importance to the continuing economic and social well-being of the industrialized world. This is also an extremely difficult area for public policy, since it involves potentially large risks, and unresolved technical and economic uncertainties make informed consensus among affected stakeholders difficult. This paper will briefly review current policy options for siting storage/disposal facilities for toxic wastes. Emphasis will be on policies which are economically efficient and which provide incentives to various stakeholders to participate constructively in negotiating equitable risk-sharing solutions to the problems of interest. In particular, incentives based on compensation and insurance will be discussed in light of experience from several countries.

Humans↗
PubMed2005

Does "the injury poverty trap" exist? A longitudinal study in Bavi, Vietnam.

In this study we concentrate on injuries and affected households' capacities to earn incomes. A longitudinal study was performed in Bavi district, Vietnam, with the specific objectives to investigate: (1) the affects of injuries on incomes by comparing income changes in injured and non-injured individuals; (2) the affect of injuries on social mobility by estimating households' relative risk of dropping into poverty for households with and without injuries and estimating the relative risk of escaping from poverty for households without and with injuries. The propensity score matching method using a logit model was used for data analysis. The results show that on average, the loss per household is estimated at VND 1,084,000 (USD 72) for poor and VND 2,598,000 (USD 173) for non-poor, equivalent to 11 (9) and 15 (13) working months of an average person in the poor and non-poor group, respectively, during 1999 (2001). The relative risk of dropping into poverty for non-poor households with and without injuries equal to 1.21 (p=0.08) and the relative risk of escaping from poverty between poor households without and with injuries equal to 0.96 (p=0.39). In conclusion, it has been argued that the introduction of user fees created a poverty trap and thus their removal may be a solution. However, user fees are only a part of the burden on households. Loss of income during the illness period is likely to be a problem of the same magnitude. A successful solution must thus follow two tracks: prepayment of health care and some insurance based compensation of income losses during the illness period. Both reforms, if they are persistent, must be done within the resource limits of the local society. If the risk of catastrophic illness is more evenly spread across the society, it would increase the general welfare even if no more resources are provided.

Data Collection↗