PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Insurance Pools”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 577 records · Page 32Linked to original sources
PubMed1983

Problems in private psychiatric insurance.

Insurance coverage for hospitalization in a freestanding psychiatric facility faces challenging, but not insurmountable, difficulties currently and in the immediate future. Relevant issues include: possible reductions in health insurance tax deductibility, so-called "consumer choice" and "pro-competition" options, prospective financing, and cost shifting from government insurance onto private patients. Some problems more specific to private psychiatric hospitals include: misuse of insurance coverage for dubious "therapies," the effects of declining coverage, the "dental versus mental" conflict, the effect of non-physicians entering the provider pool, poor coverage for liaison and consultation psychiatry, inappropriate usage, and confidentiality concerns. Positive future possibilities include: implementation of government insurance programs through private sector contracts, continuing improvement in psychiatric scientific technology, increased accountability efforts, public education, and improvements in psychiatry's relationships with labor and management.

Cost Allocation↗
PubMed1986

Medical screening and monitoring as noted by the insurance industry.

Medical screening and monitoring have a long and varied history as part of the insurance industry's safety and health relations with its policyholders. Many workers' compensation insurance carriers have assisted policyholder management in understanding the requirements of cost-effective health programs, in planning and undertaking steps necessary to comply with state-of-the-art medical practices, and in locating knowledgeable physicians to supervise employee health systems. Managing employees' health and associated records has become, for many employers, a complex operational and regulatory problem because of the amount and type of health information being collected. Administration of group health and accident insurance plans, workers' compensation, treatment for the ill and injured employees, voluntary health screening and counseling programs, preplacement and periodic physical examinations, and control mechanisms for health hazard exposures all contribute to this huge pool of acquired and stored health information.

Humans↗
PubMed2000

A survey of participation in managed care programs by endodontic specialists.

A survey was published in the Quarterly Survey of Dental Practice (QSDP) Special Topics that dealt with contractual agreements in dentistry. This survey evaluated general dental practitioner participation apart from that of dental specialists in general. The Quarterly Survey of Dental Practice survey was modified and used in the present study to specifically determine the participation by endodontists in various contractual insurance agreements, including Preferred Provider Organization and Health Maintenance Organization programs. A 10% sample of practicing endodontists was randomly selected to participate in this survey. Questionnaires (331) were sent out, and 229 or 69% were returned. Total participation by endodontists responding to this survey in any Health Maintenance Organization and/or Preferred Provider Organization insurance plans was 31.3%; however the total percentage of patients treated under these insurance plans was only 6.6%. These results were similar to those in the 1994 survey in which it was shown that 27% of the general dental practitioners and 41% of the dental specialists participated in one or more of these insurance programs and treated respectively, 5% and 9%, of their patients under these plans. Although participation in various managed care programs by endodontists in this survey was close to one-third, the total number of patients treated under these plans was low. Overall patients treated under fee-for-service arrangements by endodontists responding to this survey formed 85.3% of their patient pool. It does not appear from the results of this survey that managed care insurance has a significant impact on the practice of endodontics. It can be postulated that endodontists are unwilling to accept more than a small reduction in fees to join managed care plans, and they also desire to retain full control of their dental practice.

Analysis of Variance↗
PubMed2005

Key performance indicators for the implementation of social health insurance.

Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. For those countries interested in such an extension, it is important to understand what characterises a well performing social health insurance scheme. This article provides a simple framework to analyse key performance issues related to the functions of health financing within the context of social health insurance. The framework first illustrates how performance in the health financing functions of revenue collection, pooling and purchasing affects the realisation of health financing targets of resource generation, optimal resource use and financial accessibility of health services for all. Then, within each health financing function, key performance issues and associated measurable indicators are developed. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. In doing so, policy makers can come closer to achieving universal coverage -- access to appropriate healthcare for all at an affordable cost -- the ultimate goal of social health insurance.

Developing Countries↗
PubMed1995

Determinants of the growth in the Social Security Administration's disability programs--an overview.

This article examines factors affecting the growth in the Social Security Administration's disability programs. We synthesize recent empirical evidence on factors affecting trends in applications and awards for Disability Insurance and Supplemental Security Income (SSI) benefits and duration on the rolls. Econometric analyses of pooled time-series, cross-sectional data for States provide strong evidence of business cycle effects on applications and, to a lesser extent, on awards. Substantial effects of cutbacks in State general assistance programs are also found, especially for SSI. Estimated effects of the aging of the baby boomers, growth in the share of women who are disability insured, the AIDS epidemic, and changes in family structure are also presented. Indirect evidence suggests the importance of programmatic factors, especially for awards, and especially in the mental and musculoskeletal impairment categories. The decline in the average age of new awardees has substantially increased duration, particularly for SSI. As a result, caseload growth would be expected to continue even in the absence of future award growth.

Acquired Immunodeficiency Syndrome↗
PubMed2001

The evolution of Medicare financing policy for graduate medical education and implications for PM&R: a commentary.

Currently, the only explicit payers for graduate medical education (GME) in the United States are the federal and state governments. Of these, Medicare is by far the largest and most predictable payer. Through the prospective payment system, Medicare reimburses teaching institutions for both their direct and indirect costs associated with their GME programs. Because a well-educated workforce benefits patients covered by private, as well as public insurance, various proposals have been advanced to establish an all-payer pool to distribute the financial burden more equitably. Furthermore, Medicare policy affects physician supply. There is increasing recognition of potential physician oversupply, raising policy questions about the government's longstanding support of GME. In comparison with other specialties, physical medical and rehabilitation (PM&R) may receive more favorable treatment under future GME funding plans, for 2 reasons. First, under the formulas used by Medicare, PM&R training slots typically bring in more indirect revenue to teaching hospitals than is consumed in indirect expenses. This makes PM&R a relatively more attractive program to retain in the face of mandated reductions in training slots. Second, in many parts of the country, PM&R is not threatened by oversupply, making cuts less likely. Nevertheless, the high percentage of non-US medical graduates entering PM&R training may make the specialty vulnerable to future reductions in funded training slots.

Education, Medical, Graduate↗
PubMed1997

Hospital costs and severity of illness in three types of elective surgery.

BACKGROUND: If patients who are more severely ill have greater hospital costs for surgery, then health-care reimbursements need to be adjusted appropriately so that providers caring for more seriously ill patients are not penalized for incurring higher costs. The authors' goal for this study was to determine if severity of illness, as measured by either the American Society of Anesthesiologists Physical Status (ASA PS) or the comorbidity index developed by Charlson, can predict anesthesia costs, operating room costs, total hospital costs, or length of stay for elective surgery. METHODS: The authors randomly selected 224 inpatients (60% sampling fraction) having either colectomy (n = 30), total knee replacement (n = 100), or laparoscopic cholecystectomy (n = 94) from September 1993 to September 1994. For each surgical procedure, backward-elimination multiple regression was used to build models to predict (1) total hospital costs, (2) operating room costs, (3) anesthesia costs, and (4) length of stay. Explanatory candidate variables included patient age (years), sex, ASA PS, Charlson comorbidity index (which weighs the number and seriousness of coexisting diseases), and type of insurance (Medicare/Medicaid, managed care, or indemnity). These analyses were repeated for the pooled data of all 224 patients. Costs (not patient charges) were obtained from the hospital cost accounting software. RESULTS: Mean total hospital costs were $3,778 (95% confidence interval +/- 299) for laparoscopic cholecystectomy, $13,614 (95% CI +/- 3,019) for colectomy, and $18,788 (95% CI +/- 573) for knee replacement. The correlation (r) between ASA PS and Charlson comorbidity scores equaled 0.34 (P < .001). No consistent relation was found between hospital costs and either of the two severity-of-illness indices. The Charlson comorbidity index (but not the ASA PS) predicted hospital costs only for knee replacement (P = .003). The ASA PS, but not the Charlson index, predicted operating room and anesthesia costs only for colectomy (P < .03). CONCLUSIONS: Severity of illness, as categorized by ASA PS categories 1-3 or by the Charlson comorbidity index, was not a consistent predictor of hospital costs and lengths of stay for three types of elective surgery. Hospital resources for these lower-risk elective procedures may be expended primarily to manage the consequences of the surgical disease, rather than to manage the patient's coexisting diseases.

Aged↗
PubMed1998

Possible objectives and resulting entitlements of essential health care packages.

The notion of a defined 'core package of essential health care services' has appeared in many different health reform proposals in the 1990s. This paper attempts to explore the possible objectives of the 'core package' component of health care reform. Two board applications are apparent: the use of essential packages to ration scarce public funds and the incorporation of a minimum benefit package into 'managed competition' type reforms, where they constitute a mandated minimum level of private insurance cover. Eight possible objectives for an essential benefit package are described: To protect against catastrophic illness events; to ensure social risk pooling; to improve allocative efficiency in the health system; to eliminate 'high burden of disease' conditions; to improve equity of access to services; to combat cost-escalation; to encourage competition between insurers; and to facilitate public participation and transparency in decision making. Closer examination of objectives reveals that they often conflict, which suggests that a clear understanding of the purpose of reform is essential before it is worthwhile devoting energy to the development of essential benefit packages. It is argued that two main clusters of objectives emerge from the eight described, representing Rawlsian (risk avoidance) and utilitarian (efficiency improvement) social welfare philosophies, respectively. Practical experience suggests that priority setting exercises have been unsuccessful in meeting efficiency objectives, but that they may well be quite useful in fulfilling risk-pooling aims.

Cost-Benefit Analysis↗
PubMed2006

Health disparities and infertility: impacts of state-level insurance mandates.

OBJECTIVE: To determine whether important racial, ethnic, or socioeconomic status (SES) health disparities exist in infertility, impaired fecundity, or infertility treatment. DESIGN: Four waves of the National Survey of Family Growth (NSFG) were pooled. Measures were compared across various race/ethnicity, education, and age groups. PARTICIPANT(S): Data for 31,047 women 15-44 years old from the NSFG were pooled. INTERVENTION(S): Outcomes were compared by whether the women's states of residence had a mandate in place (at least 1 year before the interview) to compel insurers to cover or offer to cover infertility treatment. MAIN OUTCOME MEASURE(S): Infertility status, impaired fecundity, ever having sought infertility treatment. RESULT(S): Infertility is more common for non-Hispanic black women, non-Hispanic other race women, and Hispanic women than for non-Hispanic white women, and both infertility and impaired fecundity are more common for high school dropouts and high school graduates with no college than for 4-year college graduates, and for older women compared with women 29 and younger. Older women, non-Hispanic white women, and women who are more educated (with at least some college) are more likely to have ever received treatment. No evidence has been found that the racial, ethnic, or education disparities are ameliorated by the health insurance mandates. CONCLUSION(S): Racial, ethnic, and educational disparities exist in infertility status and treatment, and educational disparities in impaired fecundity. More study of the impact of infertility treatment mandates on these disparities is needed.

Adolescent↗
PubMed2003

Mortality from breast carcinoma among US women: the role and implications of socio-economics, heterogeneous insurance, screening mammography, and geography.

Despite rapid advances in medicine and beneficial lifestyle changes, the incidence and mortality rate of gynecologic carcinoma remains high worldwide. This paper presents the econometric model findings of the major drivers of breast cancer mortality among US women. The results have implications for public health policy formulation on disease incidence and the drivers of mortality risks. The research methodology is a fixed-effects GLS regression model of breast cancer mortality in US females age 25 and above, using 1990-1997 time-series data pooled across 50 US states and DC. The covariates are age, years schooled, family income, 'screening' mammography, insurance coverage types, race, and US census region. The regressions have strong explanatory powers. Finding education and income to be significantly and positively correlated with mortality supports the 'life in the fast lanes' hypothesis of Phelps. The policy of raising a woman's education at a given income appears more beneficial than raising her income at a given education level. The relatively higher mortality rate for Blacks suggests implementing culturally appropriate set of disease prevention and health promotion programs and policies. Mortality differs across insurance types with Medicaid the worst suggesting need for program reform. Mortality is greater for women ages 25-44 years, females 40-49 years who have had screening mammography, smokers, and residents of some US states. These findings suggest imposing more effective tobacco use control policies (e.g., imposing a special tobacco tax on adult smokers), creating a more tractable screening mammography surveillance system, and designing region-specific programs to cut breast cancer mortality risks.

Adult↗
PubMed1991

Inequities in hospital care, the Massachusetts experience.

This study examined the relationship between patient insurance status and the process and outcome of hospital care in Massachusetts, a state that has had an uncompensated care pool for paying hospitals since 1986. This study examined data on 4,972 patients admitted to a Massachusetts hospital on an emergency basis in 1987 and diagnosed with acute myocardial infarction. We classified these patients into three groups: having fee-for-service insurance, having prepaid coverage through a health maintenance organization (HMO), or being uninsured at the time of hospital admission. Results showed treatment differences by insurance status and significantly greater mortality rates for uninsured patients than for either fee-for-service or HMO patients. Our findings indicate that in Massachusetts the process and outcome of hospital care do differ by insurance status.

Cardiology Service, Hospital↗
PubMed1988

Long-term care financing through Federal tax incentives.

Congress and the Administration are currently exploring various methods of promoting access to long-term care. In this article, an inventory of recent legislative proposals for using the Federal tax code to expand access to long-term care services is provided. Proposals are arrayed along a functional typology that includes tax mechanisms to encourage accumulation of funds, promote purchase of long-term care insurance, or induce the diversion of funds accumulated for another purpose (such as individual retirement accounts). The proposals are evaluated against the public policy objective of encouraging risk pooling to minimize social cost.

Financing, Organized↗
PubMed1988

Life care: new options for financing and delivering long-term care.

Continuing care retirement communities provide full insurance protection for and access to long-term care services. A new model, which retains risk pooling for long-term care and provides benefits and protections similar to continuing care retirement communities, is called life care at home. Life care at home combines the financial and health security of a continuing care retirement community with the freedom and independence of living at home and is affordable to a greater proportion of elderly people. The feasibility of this model is, in part, supported by the fact that nursing home use in the fully insured access-guaranteed continuing care retirement community is not that different from use among the elderly living in the general community.

Age Factors↗
PubMedDate not supplied

[Sample survey of persons insured in statutory health insurance institutions in Hessen--concept and realisation of person-related data base].

Statutory health insurance data are being increasingly used for secondary data research. Longitudinal data can be prepared for research in health care, epidemiology or demand planning, in particular through the person-related nature of the data which is a precondition for the creation of inter-sector and inter-period data sets. This application possibility was introduced in a method study "person-related sampling of statutory health insurance data" and is now translated into practice on a larger scale for the first time in the regional sample "Versichertenstichprobe AOK Hessen/KV Hessen". For the collection and use of these data, model procedures were designed which take account of organisational (data access, contractual agreement, advisory board), technical (sampling, collection and storage of data) and confidentiality (data protection concept, pseudonymisation) aspects. The insured person-related sample may thus serve as a basis for the data pool planned for the national health system (Social Security Regulation 303 a-SGB V).

Community Participation↗
PubMed2006

Massachusetts: more mirage than miracle.

Enactment of the Massachusetts health reform plan stemmed primarily from several factors unique to the state. They were augmented by a questionable rationale that this latest version of health reform would forestall even greater threats ahead to the interests of the state's business community, private insurance policyholders, and taxpayers. The plan's foremost achievement involves development of a "Connector" mechanism to facilitate pooling and purchasing beyond the workplace. However, its successful implementation will be challenged by the complexities of enforcing an individual mandate and changing the long-standing course of an overregulated and high-cost health market.

Health Care Reform↗
PubMed2001

Access to care and functional status change among aged Medicare beneficiaries.

OBJECTIVES: This study examined whether the extra-individual factors of better access to care and supplementary health insurance coverage can prevent, delay, or reverse transitions from functional independence to disability over time. METHODS: Six years of the Medicare Current Beneficiary Survey were pooled, yielding 40,793 transition periods for community residents aged 66 or older. Multinomial logit models of transitions among functional states were estimated, with functional improvement, functional decline, and mortality as outcomes. RESULTS: Insurance coverage and better access to care increased survival chances and reduced the odds of transitions from independence to disability by roughly 30%. Access and supplementary insurance did not appear to affect transitions from less disabled to more disabled states or affect functional improvement. DISCUSSION: The findings support the hypothesized role of extra-individual environmental factors in Verbrugge and Jette's conceptual scheme of the disablement process. Access to care is suggested to make the most difference in delaying or slowing down functional decline among functionally independent elderly persons. Transitions from less severe to more severe states of disability or to death appear to be influenced more by the natural course of chronic diseases, underlying health status, and medical instability.

Activities of Daily Living↗
PubMedDate not supplied

[The SUVA (Swiss Accident Insurance Association) statistics and quality control].

Overall quality control in medicine takes place on various levels: Physician--Hospital--Insurer--Authorities, each having different requirements. Comparative standards are rather seldom. A model for a comparative standard for insurer purposes, the medical statistics package SUMEST' is presented. This model is diagnoses oriented and includes parameters for the severity of the accident, cost of treatment and treatment outcome, all based on 5-year data pool results.

Accidents, Occupational↗