Supplemental staffing: nursing personnel pools. Care in point: McCutchon v. Mutual (354 Sw 2d 759 - LA.).
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Female↗
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Results for “Insurance Pools”
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[The nursing care insurance law].
By establishing an independent statutory nursing care insurance, the security of patients in need of nursing care and the organisation of nursing care will be placed on a new basis. For instance, the bill provides for substantially extended benefits for home care and also includes benefits for long-term care in nursing homes into the general risk pool. The nursing care funds yet to be founded will receive the service guarantee for the organisation of nursing care, negotiate contracts with the respective nursing institutions and monitor their quality. Although the envisaged range of benefits covered by the statutory nursing care insurance has been noticeably extended it remains doubtful whether these benefits will be sufficient or whether there will still be the need for supplemental income support payments for nursing care. Moreover, the set of tools for regulation remains contradictory as the regulating competences of the Federal Government and those of the nursing care funds overlap. The Medical Service of the Statutory Health Insurance will be given extended responsibilities regarding the examination of individual cases, including the determination of the degree of a patient's need for nursing care, checking the possibility of rehabilitation and giving advice for individual care. Apart from that, it will assume new duties in the fields of quality assurance of the nursing care institutions and consulting the nursing care funds.
Persons with Disabilities↗
Equity in out-of-pocket payments for hospital care: evidence from India.
BACKGROUND: The lack of formal health insurance and inadequate social safety nets cause families in most low-income countries to finance health spending through out-of-pocket (OOP) payments, leaving poor families unable to insure their consumption during periods of major illnesses. OBJECTIVE: To examine how well the Indian healthcare system protects households of differing living standards against the financial consequences of unanticipated health shocks. DATA: The data are drawn from the 52nd round of National Sample Survey, a nationally representative socioeconomic and health survey conducted in 1995-1996. The sample comprises 24,379 (3.84%) households where a member was hospitalized during the 1-year reference period. METHODS: We estimate, using ordinary least squares, the relationship between household consumption (proxy for ability to pay) and OOP payments for hospitalization. We also estimate the relationship between consumption and OOP share in consumption. RESULTS: Our results indicate that both utilization (payments) and the consequent financial burden (payment share) increases with increasing ability to pay (ATP). While this relationship is retained across the different subgroups (e.g., gender, social code, region, etc.), comparisons across groups indicate horizontal inequities including differences in both degrees of progressivity and the redistributive effect. CONCLUSION: The finding that OOP payments do not decline with ATP could be an indication of: (1) the lack of insurance which implies that the better-off must pay from OOP to secure quality health care and (2) the absence of risk-pooling or prepayments mechanisms which poses financial impediments to the consumption of health care by the poor.
Data Collection↗
Health insurance coverage and the risk of decline in overall health and death among the near elderly, 1992-2002.
BACKGROUND: Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time. OBJECTIVE: We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage. METHODS: We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals. RESULTS: People who were uninsured at baseline had a 35% (95% confidence interval [CI] 12-62%) higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health (pooled adjusted relative risk 1.43, 95% CI 1.28-1.63), but they were equally likely to die (pooled adjusted relative risk 0.96, 95% CI 0.73-1.27). Of the 1512 people who were uninsured at baseline, 220 (14.6%) died; of those who died, only 70 (31.8%) were still uninsured at the HRS interview prior to death. CONCLUSIONS: Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population's health status over time and the attendant higher mortality associated with this. Most deaths among the uninsured occur after individuals have gained either public or private health insurance.
Cohort Studies↗
Employee choice of consumer-driven health insurance in a multiplan, multiproduct setting.
OBJECTIVE: To determine who chooses a Consumer-Driven Health Plan (CDHP) in a multiplan, multiproduct setting, and, specifically, whether the CDHP attracts the sicker employees in a company's risk pool. STUDY DESIGN: We estimated a health plan choice equation for employees of the University of Minnesota, who had a choice in 2002 of a CDHP and three other health plans--a traditional health maintenance organization (HMO), a preferred provider organization (PPO), and a tiered network product based on care systems. Data from an employee survey were matched to information from the university's payroll system. PRINCIPAL FINDINGS: Chronic illness of the employee or family members had no effect on choice of the CDHP, but such employees tended to choose the PPO. The employee's age was not related to CDHP choice. Higher-income employees chose the CDHP, as well as those who preferred health plans with a national provider panel that includes their physician in the panel. Employees tended to choose plans with lower out-of-pocket premiums, and surprisingly, employees with a chronic health condition themselves or in their family were more price-sensitive. CONCLUSIONS: This study provides the first evidence on who chooses a CDHP in a multiplan, multiproduct setting. The CDHP was not chosen disproportionately by the young and healthy, but it did attract the wealthy and those who found the availability of providers more appealing. Low out-of-pocket premiums are important features of health plans and in this setting, low premiums appeal to those who are less healthy.
Choice Behavior↗
A basic strategy for financing long term care.
As pressure mounts to contain Medicaid long term care spending, short-range "quick fixes" must be avoided. Three such false solutions in particular have shortcomings that may actually exacerbate long term care's financial dilemma because they are based on inadequate definitions of the problem. Two of these proposals--legislation to broaden family responsibility toward institutionalized elders on Medicaid and expanded state power to put liens on such elders' real property--err by trying to mandate "caring" and are predicated on a misunderstanding of the "spend-down" problem. The other proposal--to provide tax incentives to family members who care for elders--requires a large administrative apparatus, assumes an elasticity of supply that may not exist, and could disrupt the "gift relationship" on which family exchanges are often based. What is needed is a strategy with short term, intermediate, and long term objectives that move toward an insurance approach. The short term plan should lay the groundwork for intermediate strategy and control costs by changing rate-setting methods and putting limits on facility construction. The intermediate plan should change the problem's definition from one of merely controlling Medicaid long term care expenditures to one of efficiently managing state resources for the elderly through the development of state financing and local delivery systems that target older persons in greatest need. An effective means of doing this is through the creation of social/HMOs, which have five key features: integration of service responsibility and authority; flexibility in organizational design; balanced clientele; pooled prepaid funding; and financial risk for the provider organization. Finally, the long term strategy should transfer much of the long term care financial burden from individuals and state Medicaid agencies to insurance mechanisms. Many individuals would thus avoid impoverishment caused by health care spending and Medicaid would greatly reduce its caseload. Insurance coverage is an appropriate funding mechanism, moreover, in that relatively few persons will ever incur high costs.
Aged↗
The relation of body size to plasma levels of estrogens and androgens in premenopausal women (Maryland, United States).
We analyzed data from a cross-sectional study of 107 premenopausal women to evaluate the relations of height, weight, and body mass index (BMI) with plasma hormone levels. Participants were 20- to 40-year old women residing in Maryland (United States), whose reported menstrual cycle lengths were not more than 35 days and whose measured weights for height were 85 to 130 percent of 'desirable' based on 1983 Metropolitan Life Insurance tables. Fasting blood specimens were collected on each of days 5-7, 12-15, and 21-23 of every participant's menstrual cycle and pooled to create follicular, midcycle, and luteal phase samples, respectively, for analysis. Adjusted for age, taller women had significantly higher follicular-phase plasma-estradiol levels (percent difference/cm = 1.5, 95 percent confidence interval [CI] = 0.3-2.7, and heavier women had significantly lower plasma sex-hormone binding globulin (SHBG) levels averaged across the menstrual cycle phases (percent difference/kg = -1.2; CI = -1.9-(-0.6). Body weight within the range studied, however, was not related significantly to the concentration of SHBG-bound estradiol during any phase of the menstrual cycle. The results of this cross-sectional study suggest a possible mechanism by which height may influence breast cancer risk.
Adult↗
The declining complete denture patient pool in dental schools.
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Clinical Competence↗
Life Care at Home: a new model for financing and delivering long-term care.
In this paper we describe the Life Care at Home (LCAH) concept, a new long-term care insurance and service delivery model that combines the financial and health security of a continuing care retirement community (CCRC) with the freedom and independence of living at home. LCAH retains risk pooling for long-term care and provides other benefits and guarantees of CCRCs, including unlimited nursing home care. Because subscribers live in their own homes as long as they can, LCAH costs are substantially lower than those of CCRCs and more individuals can participate. Our market research indicates that LCAH has strong appeal among the elderly. We suggest that LCAH has a market potential of 10% to 25% of all elderly.
Aged↗
Future prospects of voluntary health insurance in Thailand.
Voluntary health insurance schemes in Thailand are still under development and have yet to seriously address the questions of equity and efficiency, while private health insurance is limited to people who can afford the premium. One form of insurance, commonly known as the health insurance card scheme, was first introduced as the Health Card Program in 1983. This program is based on risk sharing of health expenditures, with no cost sharing, in a voluntary health insurance prepayment scheme. With the uncertain performance of the Thai economy, program sustainability and the efficient use of resources are major concerns. The Health Card Program needs enough enrollees to ensure a sufficient pool of risks. This study looks at health card purchase and utilization patterns, using data from Khon Kaen Province, and finds that employment, education levels and the presence of illness are significant factors influencing card purchase. The last factor is related to the problem of adverse selection of the program; families with symptoms of sickness are more likely to buy cards, resulting in greater use of health services. The results also show an improvement in accessibility to health care and a high level of satisfaction among card holders, both key objectives of the program. It is suggested that changes in the health card system could enable it to evolve into a community-based compulsory health insurance scheme for rural areas.
Adolescent↗
Consumer decision making in the individual health insurance market.
This paper summarizes the results from a study of consumer decision making in California's individual health insurance market. We conclude that price subsidies will have only modest effects on participation and that efforts to reduce nonprice barriers might be just as effective. We also find that there is substantial pooling in the individual market and that it increases over time because people who become sick can continue coverage without new underwriting. Finally, we show that people prefer more-generous benefits and that it is difficult to induce people in poor health to enroll in high-deductible health plans.
California↗
A shared responsibility. US employers and the provision of health insurance to employees.
Employer-based health insurance is the backbone of the U.S. system of health insurance coverage. Yet it has been slowly eroding, and if these trends continue greater numbers of Americans are likely to be uninsured or without affordable coverage. Employer coverage has marked advantages, including benefits to employers and a natural risk pool that offers better benefits at lower cost than individual coverage, and is highly valued by employees. The shift of health care costs from employers who do not cover their workers to other parts of the economy is substantial. Very little attention has been given to policies that might strengthen and expand employer coverage. It will be important to shore up employer coverage both to curb its recent erosion and to build toward a more comprehensive system of health insurance.
Adult↗
Correlation between the effects of fosfomycin and chloramphenicol on Escherichia coli.
It was speculated that the increase of the UDP-GlcNAc pool observed with chloramphenicol can modulate the residual PEP:UDP-GlcNAc-enolpyruvate activity of fosfomycin-treated cells. This provided an explanation on how chloramphenicol can insure the formation of enough UDP-MurNAc-pentapeptide to sustain peptidoglycan synthesis at a rate that will antagonize fosfomycin-induced lysis.
Bacteriolysis↗
Human T-cell lymphotropic virus type III (HTLV-III) infection: how it can affect you, your patients, and your anesthesia practice.
The effects of the current HTLV-III epidemic are of considerable significance to the general public and health care system. It is a new disease with diverse ramifications . . . not all of which are understood. Many drugs are being evaluated in clinical trials, but at present, they are not expected to be able to rid an infected individual of HTLV-III. There is hope for an effective vaccine, but its development is not anticipated in the near future. For now, prevention of exposure is our only means of decreasing HTLV-III transmission. We will be caring for increasing numbers of patients with HTLV-III infection. Some of these patients will have AIDS or ARC. However, a much larger pool of patients will have asymptomatic, unrecognized HTLV-III infections. Therefore, all of our patients should be treated with good hygienic practices. Appropriate guidelines can help insure our safety as well as that of our patients. The evidence is overwhelming that HTLV-III is spread sexually, by injection of contaminated blood, and from mother to fetus. Our highest personal risk for becoming infected with HTLV-III is by parenteral introduction via contaminated needles or other sharp objects. We must realize that despite the routine close contact with blood and body secretions of patients inherent to our profession, we are at little risk for becoming infected. Furthermore, with care and vigilance, we can protect our patients from risk of infection with not only HTLV-III, but a wide variety of other infectious agents as well.
Acquired Immunodeficiency Syndrome↗
Market failure? Individual insurance markets for older Americans.
This study examines the viability of tax credits and nongroup markets for covering uninsured adults ages fifty to sixty-four. We find that adults in this age group covered by nongroup plans tend to be healthier and wealthier than the average for their peers, yet more of them go without care and experience high medical bills relative to their incomes. Individual-market premiums rise steeply with age in most states and are well above employer-group rates. Costs are likely to be unaffordable for most uninsured older adults, even with large tax credits or in states with community rating. These findings indicate a need to include risk and age pooling to reach the uninsured in this age group.
Fees and Charges↗
Universal access to health care: a practical perspective.
Policy disconnected from economic reality is bad policy. Neither government financed health insurance nor an employer mandated health insurance approach are in the national interest. Higher national priorities compel a reallocation of resources from consumption to investment. This need not, however, cause an abandonment of efforts to deal with the problems of the uninsured and other health reforms. Successful health care reform is achievable provided it is responsive to higher priorities for economic growth. A strong economy and the production of wealth are indispensable to economic justice. Toward this end, a program of universal access is proposed whereby families and individuals are required to pay for their own health insurance up to a fixed percentage of disposable personal income before public payments kick in. Government's chief role is to establish a standard package of cost-effective benefits to be offered by all insurance carriers, the cost of which is approximately 40 percent less than conventional insurance coverage because of the elimination of reimbursement for clinically non-efficacious and cost-ineffective services. Public financing is relegated to a residual role in which subsidies are targeted on the needy. Much of the momentum for cost control is transferred to consumers and private insurers, both of whom acquire a vested interest in obtaining value for money. Uniform rules for underwriting, eligibility, and enrollment practices guard against socially harmful practices such as experience rating and exclusion of preexisting conditions. The household responsibility and equity plan described herein could free up as much as $90 billion or more for public investment in economic growth and national debt reduction while assuring access to health care regardless of ability to pay. Economic revitalization will be assisted by changes in household savings. With health care no longer a free good and government social programs concentrated on the truly needy, individual propensity to save will increase, thereby enlarging the pool of capital for financing investments in economic growth. Putting more responsibility for health care financing on households with an ability to pay also serves to reinforce and expand the work ethic. Privatizing responsibility by severing health insurance from the workplace connection improves the geographic and occupational mobility of labor, diminishes employer tendencies to discriminate against hiring the disabled and older employees, and eliminates a major source of labor unrest.(ABSTRACT TRUNCATED AT 400 WORDS)
Community Participation↗
The impact of managed care on the existence of equilibrium in health insurance markets.
This study examines the existence of equilibrium in insurance markets when the number of insurance policy attributes is increased (i.e., managed care is introduced). Individuals choose an insurance contract from an endogenous choice set. The introduction of managed care improves the ability of low risks to distinguish themselves from high risks. This may yield equilibrium in cases when it would not exist in an FFS-only environment. However, managed care expands the product space in which a pooling policy could break a separating equilibrium. Thus, existence of equilibrium in an FFS-only environment does not imply existence with managed care.
Fee-for-Service Plans↗
Variation of employee benefit costs by age.
Health care, pension, and disability plans account for the bulk of employers' benefit costs, as defined in this article. Because those costs tend to rise as employees get older, the age structure of the workforce affects not only employers' costs but ultimately their competitiveness in global markets. How much costs vary depends in large part on the structure of the benefits package provided. The method a company chooses to finance benefits generally varies with its size. This article focuses primarily on the benefit practices of large, private employers. In the long run, such employers pay the costs associated with the demographics of their workers, whereas small employers can often pool costs with other companies in the community. In addition, small employers often offer fewer benefits, and the costs and financing of those benefits are subject to the insurance markets and state regulations. The discussion of benefit packages is illustrated by case studies based on benefits that are typical for three types of organizations--a large traditional company such as steel, automobile, and manufacturing; a large financial services company such as a bank or health care organization; and a medium-sized retail organization. The case studies demonstrate the extent to which the costs of typical packages vary and reveal that employers differ radically in the incentives they offer employees to retire at a specific time. An employer can shift the variation in cost by age by changing the structure of the benefit program. The major forces that drive age differences in benefit costs are the time value of money (the period of time available to earn investment income and the operation of compound interest) and rates of health care use, disability, and death. Those forces apply universally, in the United States and elsewhere, and they have not changed in recent years. However, the marketplace and the prevalence of various types of benefit programs have changed, and those changes have generally resulted in less cost variation by age and more frequent employer selection of benefit packages that exhibit less variation by age.
Adult↗