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At least 865 records · Page 48Linked to original sources
PubMed1998

[The current situation surrounding pharmacies and pharmacists].

As Japan's society continues to age, the Medical Insurance System has been substantially reviewed. As a result, 1. The medical care system has been separated from the custodial care system with the allocation of medical and custodial care insurance benefits. 2. The basis has been laid in terms of the legal provisions and the medical remuneration requirements for the establishment of a home care system. Amidst the major transformation of Japan's social order in the wake of these moves, the pharmacy and pharmacist are called upon to play a positive role in:1. Fostering the correct use of drugs through the sale of drugs and by filling prescriptions. 2. Assisting patients in self-medication. 3. Being involved in, and supporting, custodial medical care for the elderly and home care. While some 9,000 pharmacists join the profession each year, the situation regarding the training of pharmacists is marked by a serious dilemma between the demand for pharmacists as a medical resource and the practical conditions for obtaining the qualifications of a pharmacist. The system for training pharmacists is about to enter a new era with the review of the university and graduate school courses and the introduction of clinical training in the course. These changes are expected to produce very positive results.

Drug Therapy↗
PubMed1999

Employer-sponsored health insurance and mandated benefit laws.

Regulations for the content of private health plans, called mandated benefit laws, are widespread and growing in the United States, at both state and federal levels. Three aspects of these laws are examined: their current scope; some economic reasons for their existence; and the theory and empirical evidence for their effects in health insurance markets. A growing body of literature suggests that society is paying a high price for enhanced coverage via mandated benefits. These laws increase insurance premiums, cause declines in wages and other fringe benefits, and lead some employers and their workers to forgo health benefits altogether. The cost of mandated benefit laws falls disproportionately on workers in small firms.

Costs and Cost Analysis↗
PubMed1999

A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance funds in Switzerland.

OBJECTIVES: The present investigation focuses on the following questions: 1. Are complementary medical services paid for by a health insurer used in addition to orthodox medical services, or as substitute for them?; 2. If health insurers include complementary medical services in the basic cover, what will be the effect on costs?; 3. If complementary medical services as included in the basic cover, what will be the effect on the policyholders' subjective state of health? STUDY DESIGN: A randomized experiment was set up in which 7500 members of Switzerland's biggest health insurance fund, Helvetia, were offered free supplementary insurance for alternative medicine for 3 years. This simulated a situation in which the experimental group had access to the full range of complementary medical treatments under their health insurance policies. The remaining members in the scheme (670,000) people) formed the control group. To evaluate the effect on costs, we analysed the health insurer's cost and benefits data. In addition, a survey was carried out among random samples of subjects from the experimental group and from the control group using the 36-Item Short-Form Health Survey (SF-36) to examine the effects of including complementary medicine on subjective state of health. RESULTS: The analysis of the cost data shown that subjects used alternative in addition to orthodox medical services. It is also clear that alternative medical treatments are given in combination with orthodox medicine; less than 1% of the experimental group used exclusively alternative medical services. However, as only a very small percentage of experimental subjects (6.6%) took advantage of complementary medicine, no significant impact on overall health costs can be inferred. On the other hand, multiple regressions show that use of complementary medicine has a greater effect on treatment costs than sex, age or language region. Neither at the beginning nor the end of the experiment were any significant differences noted in the scales of the SF-36 between the experimental and the control group. Nor did multiple regressions reveal any effects on subjects' state of health due to the inclusion of complementary medicine in the basic insurance cover.

Adult↗
PubMed2004

The effect of heavy drinking on social security old-age and survivors insurance contributions and benefits.

This article estimates the effects of heavy alcohol consumption on Social Security Old-Age and Survivor Insurance (OASI) contributions and benefits. The analysis accounts for differential earnings and mortality experiences of individuals with different alcohol consumption patterns and controls for other characteristics, including smoking. Relative to moderate drinkers, heavy drinkers receive fewer OASI benefits relative to their contributions. Ironically, for each cohort of 25-year-olds, eliminating heavy drinking costs the program an additional $3 billion over the cohort's lifetime. Public health campaigns are designed to improve individual health-relevant behaviors and, in the long run, increase longevity. Therefore, if programs for the elderly are structured as longevity-independent defined benefit programs, their success will reward healthier behaviors but increase these programs' outlays and worsen their financial condition.

Accidents, Traffic↗
PubMed1992

[Use of health insurance and social benefits among immigrants in Oslo].

An investigation of sickness and social benefits paid during weeks 37 and 39 of 1989 to African and Asian immigrants living in Oslo showed that the consumption of these benefits by this part of the population was much higher than among Norwegian-born persons in the age groups 20 to 66 years. The immigrants received more support and money than the Norwegians did, and for a longer period. They were also younger than the Norwegians. The impaired health status among the immigrants seem to be connected to their poorer working conditions, since many of them had had unskilled jobs involving greater risk to health. A fairly large number of the immigrants receive more or less permanent public benefits. It has been difficult to find suitable jobs, which has led to widespread unemployment among this group of the Oslo population.

Adult↗
PubMed2004

Will insured citizens give up benefit coverage to include the uninsured?

OBJECTIVE: To describe the willingness of insured citizens to trade off their own health benefits to cover the uninsured. DESIGN: Descriptive study of individual and group decisions and decision making using quantitative and qualitative methods. SETTING AND PARTICIPANTS: Twenty-nine groups of citizens (N = 282) residing throughout Minnesota. INTERVENTIONS: Groups participated in Choosing Healthplans All Together (CHAT), a simulation exercise in which participants choose whether and how extensively to cover health services in a hypothetical health plan constrained by limited resources. We describe individual and group decisions, and group dialogue concerning whether to allocate 2% of their premium to cover uninsured children in Minnesota, or 4% of their premium to cover uninsured children and adults. MEASUREMENTS AND MAIN RESULTS: While discussing coverage for the uninsured, groups presented arguments about personal responsibility, community benefit, caring for the vulnerable, social impact, and perceptions of personal risk. All groups chose to insure children; 22 of 29 groups also insured adults. More individuals chose to cover the uninsured at the end of the exercise, after group deliberation, than before (66% vs 54%; P < .001). Individual selections differed from group selections more often for the uninsured category than any other. Nevertheless, 89% of participants were willing to abide by the health plan developed by their group. CONCLUSION: In the context of tradeoffs with their own health insurance benefits, groups of Minnesotans presented value-based arguments about covering the uninsured. All 29 groups and two thirds of individuals chose to contribute a portion of their premium to insure all children and most groups chose also to insure uninsured adults.

Adult↗
PubMed1991

An analysis of capitation rates for prescription medication benefits from an insurance perspective.

The use of capitation payment systems to control costs for prescription medication benefits appears to be increasing. In such a system, risk is transferred to a pharmacist or group of pharmacists. The author examines the nature of that risk, factors that must be considered in setting capitation rates and ways to control risk in a capitation system. An insurance pricing model is used to calculate risk-adjusted capitation rates using observed and hypothetical data, and implications for pharmacists and insurers are discussed.

Capitation Fee↗
PubMed2006

Moral hazard or realised access to care? Empirical observations in Hong Kong.

We examined for the presence of moral hazard among those covered by medical benefits or insurance schemes, whether provided for by employers or privately purchased and stratified by health care provider sector in Hong Kong. Data for this study were derived from the 2002 Thematic Household Survey, covering 24,610 non-institutional residents aged 15 and over, representing 5,353,666 persons after applying population weights. Zero-inflated Poisson or negative binomial models were constructed to examine the association between predisposing, need and enabling factors with inpatient and outpatient utilisation patterns as per Andersen's health behavioural framework. Individuals with insurance or medical benefits were more likely to have been ever admitted in the previous year but did not incur more bed-days. Similarly, those who were covered by insurance or medical benefits had a higher probability of ever visiting a doctor in the previous month but not consuming more episodes. These findings were consistent across the public and private sectors. We propose that our observations mostly reflected realised access that met genuine health need rather than inappropriate overuse of services. A supply-driven public sector and high out-of-pocket co-payments for private services likely explained these findings.

Adolescent↗
PubMed2002

State regulation of private health insurance: prescription drug benefits, experimental treatments, and consumer protection.

This study analyzes the results of 2 surveys sent to state insurance commissioners that focused on policies regulating conventional health insurance and managed care organizations (MCOs) during 2000. Surveys were returned by 49 states and the District of Columbia. Several states have implemented regulations mandating prescription drug coverage. In addition, some states now require health insurers and MCOs to cover the medical care associated with experimental medications and treatments. Some states have also created laws allowing beneficiaries to sue their health insurer or MCO for damages caused by denial of care. These state policies provide a rich source of data for federal policy makers to analyze as they consider new patient protection legislation and amendments to the Employee Retirement Income Security Act.

Consumer Advocacy↗
PubMedDate not supplied

Tax subsidies for health insurance: costs and benefits.

The continued rise in the uninsured population has lead to considerable interest in tax-based policies to raise the level of insurance coverage. Using a detailed microsimulation model for evaluating these policies, we find that while tax subsidies could significantly increase insurance coverage, even very generous tax policies could not cover more than a sizable minority of the uninsured population. For example, a generous refundable credit that costs $13 billion per year would reduce the ranks of the uninsured by only four million persons. We also find that the efficiency of tax policies, in terms of the cost per newly insured, inevitably would fall as more of the uninsured were covered.

Cost-Benefit Analysis↗
PubMed1979

Benefits of self-insured hospitalization programs.

As part of hospitals' continuing efforts to control costs, many have begun to consider implementing self-insured hospitalization programs for their employees. Not only can self-insurance provide cash flow savings and actual cost savings but it can also promote prevention among hospital employees.

Accounts Payable and Receivable↗