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PubMed1980

Demographic factors in the disability determination process: a logistic approach.

Identifying the demographic factors that affect the likelihood of being allowed disability insurance benefits under the social security program is important in assessing the operation of that program and has been the focus of continuing research. Previous studies in this area, which have been limited to cross-tabular analyses of aggregated data and the examination of a few variables at a time, have uncovered apparently sizable differences in the probability of allowance by age, sex, race, and other demographic characteristics. This article uses a much more rigorous statistical technique--a logit maximum likelihood procedure--to examine the same question. That technique permits exploration of the relationship between a particular characteristic and the probability of allowance while controlling for the effect of other characteristics considered in the analysis. The findings show that cardiovascular primary diagnoses had a higher probability of allowance than did almost all other primary diagnoses. Mobility restrictions, older age at the onset of disability, and residence in States with temporary disability programs also were associated with a higher probability of allowance. Applicants who were black or from the South were found to have a lower probability of allowance. In general, those results applied to both men and women.

Demography↗
PubMed1980

Report of the Universal Social Security Coverage Study Group: executive summary.

Authorized under the 1977 amendments to the Social Security Act, the Universal Social Security Coverage Study Group was established at the direction of Congress by the Secretary of Health, Education, and Welfare in 1978. Its 2-year mission was to examine the feasibility and desirability of mandating coverage under the social security program for Federal workers and for noncovered employees of State and local governments and private nonprofit organizations. The group reviewed the coverage held by workers who would be affected, developed options for and alternatives to mandatory coverage, analyzed the effects of each option and alternative, and consulted with other Government agencies and with members of the public. To assess public attitudes, testimony was received from private citizens, public officials, and representatives of interested organizations at public hearings held in seven locations. In the following executive summary, sections refer to chapters in the full report.

Feasibility Studies↗
PubMedDate not supplied

Trends in malpractice litigation.

Physicians who make mistakes are not necessarily negligent, contrary to prevailing opinion in the medical community. The article discusses the legal concepts of "standard of care" and "proximate cause." The incidence of favorable jury verdicts in those cases in which malpractice suits are litigated is quite high. The effects of insurance company policies in decisions about settlements on the incidence of claims is discussed and alternatives are suggested. The prevailing belief that a consent form with a patient's signature on it is sufficient to prevent a malpractice suit is also discussed.

Informed Consent↗
PubMed1979

Reimbursing hospice care: a Blue Cross and Blue Shield perspective.

The Associations' "Initial Statement on Hospice Care and Payment for Hospice Services" comprises three criteria and many recommendations. The statement can guide local Plans and other third party payers, wary of repeating past mistakes that increased costs without improving care.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

In the courts.

Explore the source record for details and available documents.

Cost Control↗
PubMed1995

Quick fixes?

Are states' HMO laws solving the problem? When Steve and Michelle Bauman brought home their newborn daughter last May, they had no idea that her death would help prompt New Jersey legislators to action. Yet cases like theirs, most often involving HMOs' policies on coverage for infant delivery, are leading state lawmakers into a whole new--and controversial--area of policymaking.

Female↗
PubMed1995

Do shifts toward service industries, part-time work, and self-employment explain the rising uninsured rate?

It is conventional wisdom that the increase in the number of uninsured people during the 1980s was due, in part, to systematic trends in employment, specifically: 1) shifts from full-time to part-time jobs and to self-employment; and 2) changes in the industrial mix of employment, especially toward the service industries. This paper uses the March Current Population Survey data from 1980 through 1987 to measure the contribution of these factors to the rise in the uninsured. In the first case, we find the premise of rising part-time work and self-employment to be untrue. In the second case, less than 15% of the decline in health insurance over this period was due to employment shifting from higher-coverage to lower-coverage industries. Instead, the decline resulted from falling coverage rates across all industries. This is not to dismiss the possible importance of such employment trends over decades, but to emphasize the need to investigate other causes of the change during recent years.

Data Collection↗
PubMed1995

Potential methods to reduce risk selection and its effects.

Risk differences are inherent with voluntary enrollment or choice of health plans. If these desirable features are to be maintained, risk differences must be assessed and payments to plans adjusted. Perfect prediction of individual level costs is impossible, but it is feasible to approximate costs for large groups of employees joining a purchasing cooperative. When people within an employee group or cooperative can choose among different health plans, there is much more opportunity for risk selection. A fair but powerful referee to determine adjustment methods within the cooperative's zero-sum setting may reduce markedly the potential for selection problems.

Actuarial Analysis↗
PubMed1995

The practice of risk adjustment.

This article focuses on risk adjustment under health care reform. It examines reasons for risk adjustment, how those reasons affect the method of adjustment, and practical issues that arise in the process of adjusting for risk. The paper concludes that adjusting payments to health plans makes the most sense. It advocates a risk adjustment agency that is regionally based and supportive of the public good. For risk adjustment to work, there must be a well-defined market and barriers to entry and exit.

Actuarial Analysis↗
PubMed1995

[Expert assessment within the scope of legal social determination of the extent of economic responsibility of insurance for analytic psychotherapy].

Expert Opinions and Social Insurance Tribunal Rulings on the Scope of Medical Insurance Cover for Analytic Psychotherapy.--In Germany at present medical insurance cover is more or less automatic for a bone-marrow transplant costing anything up to 100,000 dollars--an operation where the death of the patients is by no means infrequent. In view of this state of affairs it is hard to comprehend the refusal on the part of insurance cover reviewers to approve ongoing cover for analytic psychotherapy beyond the 240-hour limit. In the case presented here, privately financed continuation by some 180 hours demonstrated that this prolongation and intensification of therapy was in fact essential to ensure the success of the treatment.

Expert Testimony↗