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At least 37 records · Page 2Linked to original sources
PubMed1977

Private health insurance in 1975: coverage, enrollment, and financial experience.

More improvement in the scope than in the quality of private health insurance coverage took place during 1975. Four-fifths of the population under age 65 was covered for hospital and surgical care, and nearly that proportion was protected against the costs of physicians' in-hospital visits, X-ray and laboratory examinations, and prescribed out-of-hospital drugs. The $33.6 billion in premiums paid by consumers resulted in the return of only $28.9 billion in benefits, which covered just 44% of their total personal health care expenditures. Major-medical insurance, held by an estimated 43% of the population, helped to overcome some of the deficiencies of private insurance--dollar limitations on health care services, ceilings on the duration of hospital stays, and exclusions for some types of care. It also provided economic protection against catastrophic expenses. Premiums and subscription income rose faster than benefits as private insurers attempted to keep their coverage in line with rising health care costs. The overall underwriting gain was due largely to a $952.4 million gain in group business by the insurance companies.

Adult↗
PubMed1997

Medical claims profiles of subjects with temporomandibular joint disorders.

The primary goal of this study was to evaluate the claims profiles of subjects with TMJ disorders relative to a control group without the disorders and to provide a characterization of the type of healthcare services received and the associated costs of healthcare for patients with TMJ disorders. The administrative data base of a major medical insurer was used to compare the claims history of 1,819 patients diagnosed with TMJ disorders to matched controls. The analysis was based only on medical claims. The study found that total medical claim payments for the patients with TMJ disorders were double that of the subjects without TMJ disorders, and similarly, the utilization of institutional and professional care services was found to be approximately twice as high, though not uniformly distributed across all Major Diagnostic Categories, physician specialties or types of service. The level and nature of the differences in the quantity and costs of healthcare between subjects with and without TMJ disorders were unexpectedly large. The majority of these differences were attributed to conditions that were not usually considered related to TMJ disorders. These utilization and cost differences extended, in varying degrees, over a wide range of diagnostic and healthcare provider categories.

Adolescent↗
PubMed2000

Analytic dimensions of a prescription-medication benefit in medicare.

BACKGROUND: Many analysts believe that the lack of coverage for outpatient prescription medications represents a conspicuous deficiency in the Medicare benefits package. OBJECTIVE: This paper uses insurance theory to design and estimate the costs of a Medicare catastrophic-medication outpatient benefit. RESULTS: For efficiency and equity purposes, and to accommodate the tradeoff between the cost to the federal government and the insurance value of such a benefit to Medicare enrollees, we favor a benefit that would be means-tested by employing deductibles, coinsurance rates, and catastrophic limits, all of which would be progressively graduated for 7 household income classes. For equity reasons, we propose that the government's share of the medication benefit be financed from the general tax fund, using the progressive income tax. Another source of potential savings within the Medicare program that could pay for a medication benefit would be elimination of fraud, waste, and abuse. CONCLUSIONS: Because our proposal addresses both the efficiency and equity dimensions of a Medicare outpatient medication benefit, we believe it is worthy of serious consideration by both policymakers and Congress.

Aged↗
PubMed1996

[Supply of opioid analgesics to outpatients with cancer pain].

INTRODUCTION: Treatment of chronic cancer pain with strong opioids is indicated in about 60-70 % of patients. Surprisingly, these very potent analgesics are prescribed with great reservations in many countries, including Germany. The aim of our investigation was to analyse the supply of opioid analgesics to outpatients with cancer pain in the region of Hannover, which has about 1.1 million inhabitants. METHODS: In Germany special prescription forms, i. e. triplicate forms, have to be used for the prescription of strong opioids. At the time when our investigation took place prescriptions for outpatients had to be renewed every 7 days. For two observation periods of 6 months lasting from January to June 1988 and from January to June 1991 all of the opioid prescription forms that had been issued by general practitioners for clients of the AOK Hannover (one of the major medical insurance companies) were evaluated. The reasons for prescribing opioids were analysed by recording the diagnosis. The individual treatment period on an outpatient basis during these 6 months was determined, excluding, e. g. days of hospitalization. RESULTS: During the two observation periods only 16.2 % (1988) and 19.5 % (1991) of the practitioners in the region of Hannover prescribed strong opioids to outpatients. The majority of the practitioners consisted of general practitioners and specialists in internal medicine. Although these two groups mainly function as family doctors who are responsible for the basic therapeutical needs of their patients, only 22.6-33.8 % of these doctors prescribed opioids to outpatients. In two-thirds of the patients, cancer pain was the reason for prescribing the drug. The total number of patients with a prescription for cancer pain was 164 in 1988 and 196 in 1991. Altogether 1002 prescription forms in 1988 and 1065 prescription forms in 1991 had been issued for these patients. Applied to the individual treatment period as an outpatient, only 36.0 % of the patients in 1988 and 32.1 % in 1991 received a regular prescription of strong opioids every 7 days. The mean time interval between separate prescriptions was 16.8 +/- 25.4 days in 1988 and 19.4 +/- 29.1 days in 1991. Accordingly, the majority of patients with chronic cancer pain had been supplied with opioids only occasionally. CONCLUSION: Our data indicate a significant undertreatment of outpatients suffering from cancer pain. Taking into account the estimated total number of patients suffering from cancer, only 14.5 % (1988) and 19.0 % (1991) of all outpatients in need of strong opioids were supplied sufficiently with those analgesics. Comparing the results from the observation period in 1988 with the results from 1991 it becomes obvious that the situation has not changed. There are different reasons for the insufficiency of opioid treatment: many physicians as well as their patients are still afraid of the side effects of strong opioids. Therefore, it is necessary to improve education concerning this issue. The legal restrictions on the use of narcotics and their complexity are another important reason for doctors not to prescribe strong opioids. In 1993 the regulations were simplified; nevertheless, this has not led to a profound change in the attitude of the prescribing practitioners. Thus, further changes in legislation seem to be necessary so that the requirements for the prescription of strong opioids do not differ from other drugs.

English Abstract↗