Insurance Carriers
Insurance, Health
Insurance Coverage
Insurance
Insurance, Long-Term Care
Insurance, Life
Nursing Homes
Home Care Services
Homes for the Aged
Internet
Software
User-Computer Interface
Changes in benefit payments and health insurance premiums among firms switching health insurance carriers. (1/85)
Employer-purchased group health insurance is a major source of funding in the US healthcare system, accounting for approximately one third of each healthcare dollar spent. Surprisingly, little is known about employers' behavior in purchasing health insurance or the circumstances leading employers to switch health insurance carriers. We descriptively analyzed data for a cohort of 95 insured groups between 1985 and 1991 to determine the frequency with which employers switch health insurance carriers and the growth pattern in premiums and benefit payments before the switch was made. Thirty-seven percent of groups switched carriers during the study period, with at least five groups switching each year from 1987 through 1991. The groups that switched insurance carriers experienced higher average annual rates of growth in benefit payments than those that did not switch (18% versus 11%). Groups that switched did not have significantly higher observed premium growth rates than those that did not switch, suggesting that employers decided to switch insurers before absorbing an increase in premiums. However, some firms that switched experienced below average increases in both benefit payments and premiums, indicating that premiums and anticipated premium increases are not solely responsible for the decision to switch health insurance carriers. (+info)Nonprofit to for-profit conversions by hospitals, health insurers, and health plans. (2/85)
Conversion of hospitals, health insurers, and health plans from nonprofit to for-profit ownership has become a focus of national debate. The author examines why nonprofit ownership has been dominant in the US health system and assesses the strength of the argument that nonprofits provide community benefits that would be threatened by for-profit conversion. The author concludes that many of the specific community benefits offered by nonprofits, such as care for the poor, could be maintained or replaced by adequate funding of public programs and that quality and fairness in treatment can be better assured through clear standards of care and adequate monitoring systems. As health care becomes increasingly commercialized, the most difficult parts of nonprofits' historic mission to preserve are the community orientation, leadership role, and innovation that nonprofit hospitals and health plans have provided out of their commitment to a community beyond those to whom they sell services. (+info)Employer-sponsored health insurance: are employers good agents for their employees? (3/85)
Employers in the United States provide many welfare-type benefits, such as life insurance, disability insurance, health insurance, and pensions, to their employees. Employers can be viewed as performing an agency role in purchasing pension, health, and other welfare benefits for their employees. An exploration of their competence in this role as agents for their employees indicates that large employers are very helpful to their employees in this arena. They seem to contribute to individual employees' welfare by providing them with valued services in purchasing health insurance. (+info)The role of independent agents in the success of health insurance market reforms. (4/85)
The impact of reforms on the health insurance markets cannot be understood without more information about the role played by insurance agents and a closer analysis of their contribution. An in-depth, qualitative study of insurance-market reforms in seven illustrative states forms the basis for this report on how agents help to shape the efficiency and fairness of insurance markets. Different types of agents relate to insurers in their own ways and are compensated differently. This study shows agents to be almost uniformly enthusiastic about guaranteed-issue requirements and other components of market reforms. Although insurers devise strategies for manipulating agents in order to avoid undesirable business, these opportunities are limited and do not appear to be seriously undermining the effectiveness of market reforms. Despite the layer of cost that agents add to the system, they play an important role in making market reforms work, and they fill essential information and service functions for which many purchasers have no ready substitute. (+info)Controlling the cost of dental care. (5/85)
Methods for controlling dental care expenditures are taking on greater importance with the rapid increase in prepaid dental plans. The use of regulatory systems to monitor provider performance are necessary to prevent gross over-utilization but are unlikely to result in net savings of more than five per cent of total gross premiums. Theoretically, prepaid group dental practice (PGDP) may reduce expenditures by changing the mix of services patients receive. The modest estimated savings and the small number of PGDPs presently in operation limit the importance of this alternative for the next five to ten years. If substantial reductions in dental expenditures are to be obtained, it will be necessary to limit dental insurance plans to cover only those services which have demonstrated cost-effectiveness in improving health for the majority of people. The concept that richer benefit plans may have small marginal effects on improving oral health may not be easy for the public to accept but, until they do, expenditures for dental care will be difficult to control. (+info)Reinsurance of health insurance for the informal sector. (6/85)
Deficient financing of health services in low-income countries and the absence of universal insurance coverage leaves most of the informal sector in medical indigence, because people cannot assume the financial consequences of illness. The role of communities in solving this problem has been recognized, and many initiatives are under way. However, community financing is rarely structured as health insurance. Communities that pool risks (or offer insurance) have been described as micro-insurance units. The sources of their financial instability and the options for stabilization are explained. Field data from Uganda and the Philippines, as well as simulated situations, are used to examine the arguments. The article focuses on risk transfer from micro-insurance units to reinsurance. The main insight of the study is that when the financial results of micro-insurance units can be estimated, they can enter reinsurance treaties and be stabilized from the first year. The second insight is that the reinsurance pool may require several years of operation before reaching cost neutrality. (+info)Why insurers should reimburse for compression stockings in patients with chronic venous stasis. (7/85)
BACKGROUND: Chronic venous stasis ulcers produce substantial morbidity rates and result in a significant expense to society. Fortunately, compression stockings (CS) have been found to reduce the rate of recurrence in patients with previous ulceration. Surprisingly, Medicare and other insurers do not reimburse the expense associated with CS or with patient education (Ed), which is essential to ensure compliance. METHODS: A Markov decision analysis model was used for analysis of the cost-effectiveness of a strategy of reimbursement for CS and Ed (prophylaxis) versus one that does not supply these resources in a 55-year-old patient with prior venous stasis ulceration. The mean time to ulcer recurrence (53 months with CS+Ed; 18.7 months without prophylaxis), the mean time for ulcer healing (4.6 months), the probabilities of hospitalization (12%) and amputation (0.4%) after the development of an ulcer, and quality-adjustment factors (0.80 during ulcer treatment) were derived from the literature. The cost of CS ($300/year) and Ed ($93 for initial evaluation; $58/year; $40/recurrence) and the medical cost of ulcer treatment (average cost, $1621/recurrence) were calculated from our hospital cost accounting system. RESULTS: A strategy of CS and Ed was cost saving, with 0.37 quality-adjusted life years and $5904 saved, compared with a strategy that does not provide these resources. The inclusion of loss of revenue related to absence from work in the analysis increased cost savings to $17,080 during the patient's lifetime. With sensitivity analysis, CS and Ed remained cost-effective (lifetime cost per quality-adjusted life year saved, <$60,000) if amputations and the cost of ulcer treatment were eliminated or if the cost of prophylaxis was increased to 600% of the base-case. The mean time to recurrence in patients with CS and Ed needed to be reduced from 53 months to 21.1 months before this strategy was no longer cost-effective. CONCLUSION: Prophylactic CS and Ed in patients with prior venous stasis ulceration are cost saving, even with the most conservative of assumptions. Insurers should routinely reimburse for these interventions. (+info)Professionalism, regulation, and the market: impact on accountability for quality of care. (8/85)
This paper examines the interplay of professionalism, regulation, and the market in shaping accountability on the part of hospitals, physicians, and health plans. We pay particular attention to the role of accreditation. We review the development of accountability and examine its recent evolution in the context of changing information technology, consumer demands, the decline of the staff- and group-model HMO, and the reemergence of health care cost inflation. The market is emerging as the dominant influence on accountability; this development will require changes in the roles and structure of regulation, professionalism, and accreditation in assuring accountability. (+info)An insurance carrier, also known as an insurer or a policy issuer, is a company or organization that provides insurance coverage to individuals and businesses in exchange for premium payments. The insurance carrier assumes the financial risk associated with the policies it issues, agreeing to pay for covered losses or expenses as outlined in the insurance contract, such as a health insurance policy, car insurance policy, or life insurance policy.
Insurance carriers can be divided into two main categories: life and health insurance companies and property and casualty insurance companies. Life and health insurance companies focus on providing coverage for medical expenses, disability, long-term care, and death benefits, while property and casualty insurance companies offer protection against losses or damages to property (home, auto, etc.) and liabilities (personal injury, professional negligence, etc.).
The primary role of an insurance carrier is to manage the risks it assumes by pooling resources from its policyholders. This allows the company to pay for claims when they arise while maintaining a stable financial position. Insurance carriers also engage in various risk management practices, such as underwriting, pricing, and investment strategies, to ensure their long-term sustainability and ability to meet their obligations to policyholders.
Health Insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons. By purchasing health insurance, insured individuals pay a premium to an insurance company, which then pools those funds with other policyholders' premiums to pay for the medical care costs of individuals who become ill or injured. The coverage can include hospitalization, medical procedures, prescription drugs, and preventive care, among other services. The goal of health insurance is to provide financial protection against unexpected medical expenses and to make healthcare services more affordable.
Insurance coverage, in the context of healthcare and medicine, refers to the financial protection provided by an insurance policy that covers all or a portion of the cost of medical services, treatments, and prescription drugs. The coverage is typically offered by health insurance companies, employers, or government programs such as Medicare and Medicaid.
The specific services and treatments covered by insurance, as well as the out-of-pocket costs borne by the insured individual, are determined by the terms of the insurance policy. These terms may include deductibles, copayments, coinsurance, and coverage limits or exclusions. The goal of insurance coverage is to help individuals manage the financial risks associated with healthcare expenses and ensure access to necessary medical services.
I'm sorry for any confusion, but "insurance" is not a medical term per se. It is an financial concept and a type of risk management where an individual or entity pays a premium to a insurance company in order to receive financial protection or reimbursement against potential losses. In the context of healthcare, insurance typically refers to health insurance, which is a type of coverage that pays for medical, surgical, or hospital costs. Health insurance can be obtained through an employer, purchased directly from an insurance company, or provided by the government.
Long-term care insurance is a type of insurance policy that helps cover the costs of chronic or prolonged illness, disability, or cognitive impairment such as Alzheimer's disease. These policies help pay for services and supports in your home, adult day care centers, respite care, hospice care, assisted living facilities, memory care facilities, and nursing homes.
Long-term care insurance typically covers the following types of services:
1. Personal care services: This includes assistance with activities of daily living (ADLs) such as bathing, dressing, grooming, using the toilet, eating, and moving around.
2. Home health care services: This includes skilled nursing care, physical therapy, occupational therapy, speech therapy, and hospice care provided in your home.
3. Assisted living facilities: This includes room and board, personal care services, and supportive services such as medication management, transportation, and social activities.
4. Nursing homes: This includes skilled nursing care, rehabilitation services, and custodial care in a licensed nursing facility.
Long-term care insurance policies typically have a waiting period (also known as an elimination period) before benefits begin, which can range from 30 to 100 days. The policyholder is responsible for paying for long-term care services during this waiting period. Additionally, premiums for long-term care insurance may increase over time, and policies may have limits on the amount of coverage provided.
It's important to note that long-term care insurance can be expensive, and not everyone will qualify for coverage due to age or health conditions. Therefore, it's essential to carefully consider your options and consult with a licensed insurance professional before purchasing a policy.
Life insurance is a type of insurance policy that provides financial compensation to beneficiaries upon the death of the insured person. The policyholder pays premiums periodically to keep the policy active. In exchange, the insurance company agrees to pay a specified sum to the beneficiaries named in the policy when the insured individual passes away. Life insurance can help ensure that surviving family members or dependents have financial support to cover expenses such as funeral costs, mortgage payments, outstanding debts, and living expenses. There are various types of life insurance policies available, including term life, whole life, universal life, and variable life, each with its own features, benefits, and limitations.
A nursing home, also known as a skilled nursing facility, is a type of residential healthcare facility that provides round-the-clock care and assistance to individuals who require a high level of medical care and support with activities of daily living. Nursing homes are designed for people who cannot be cared for at home or in an assisted living facility due to their complex medical needs, mobility limitations, or cognitive impairments.
Nursing homes provide a range of services, including:
1. Skilled nursing care: Registered nurses and licensed practical nurses provide 24-hour medical care and monitoring for residents with chronic illnesses, disabilities, or those recovering from surgery or illness.
2. Rehabilitation services: Physical, occupational, and speech therapists help residents regain strength, mobility, and communication skills after an injury, illness, or surgery.
3. Personal care: Certified nursing assistants (CNAs) help residents with activities of daily living, such as bathing, dressing, grooming, and using the bathroom.
4. Meals and nutrition: Nursing homes provide three meals a day, plus snacks, and accommodate special dietary needs.
5. Social activities: Recreational programs and social events are organized to help residents stay active and engaged with their peers.
6. Hospice care: Some nursing homes offer end-of-life care for residents who require palliative or comfort measures.
7. Secure environments: For residents with memory impairments, specialized units called memory care or Alzheimer's units provide a secure and structured environment to help maintain their safety and well-being.
When selecting a nursing home, it is essential to consider factors such as the quality of care, staff-to-resident ratio, cleanliness, and overall atmosphere to ensure the best possible experience for the resident.
Home care services, also known as home health care, refer to a wide range of health and social services delivered at an individual's residence. These services are designed to help people who have special needs or disabilities, those recovering from illness or surgery, and the elderly or frail who require assistance with activities of daily living (ADLs) or skilled nursing care.
Home care services can include:
1. Skilled Nursing Care: Provided by registered nurses (RNs), licensed practical nurses (LPNs), or licensed vocational nurses (LVNs) to administer medications, wound care, injections, and other medical treatments. They also monitor the patient's health status, provide education on disease management, and coordinate with other healthcare professionals.
2. Therapy Services: Occupational therapists, physical therapists, and speech-language pathologists help patients regain strength, mobility, coordination, balance, and communication skills after an illness or injury. They develop personalized treatment plans to improve the patient's ability to perform daily activities independently.
3. Personal Care/Assistance with Activities of Daily Living (ADLs): Home health aides and personal care assistants provide assistance with bathing, dressing, grooming, toileting, and other personal care tasks. They may also help with light housekeeping, meal preparation, and shopping.
4. Social Work Services: Provided by licensed social workers who assess the patient's psychosocial needs, connect them to community resources, and provide counseling and support for patients and their families.
5. Nutritional Support: Registered dietitians evaluate the patient's nutritional status, develop meal plans, and provide education on special diets or feeding techniques as needed.
6. Telehealth Monitoring: Remote monitoring of a patient's health status using technology such as video conferencing, wearable devices, or mobile apps to track vital signs, medication adherence, and symptoms. This allows healthcare providers to monitor patients closely and adjust treatment plans as necessary without requiring in-person visits.
7. Hospice Care: End-of-life care provided in the patient's home to manage pain, provide emotional support, and address spiritual needs. The goal is to help the patient maintain dignity and quality of life during their final days.
8. Respite Care: Temporary relief for family caregivers who need a break from caring for their loved ones. This can include short-term stays in assisted living facilities or hiring professional caregivers to provide in-home support.
I couldn't find a specific medical definition for "Homes for the Aged," as it is more commonly referred to in social work or public health contexts. However, I can provide you with some related information:
"Homes for the Aged" are typically residential facilities designed to provide housing, support services, and care for older adults, often with lower levels of medical needs compared to nursing homes. These facilities might offer assistance with activities of daily living (ADLs) such as bathing, dressing, grooming, and managing medications. They can be an alternative to aging in place or moving in with family members.
In a broader public health context, "Homes for the Aged" may fall under the category of congregate housing or assisted living facilities. These settings aim to promote social interaction, autonomy, and independence while offering help with daily tasks and ensuring the safety of their residents.
It is essential to research and visit various facilities to ensure they meet individual needs, preferences, and healthcare requirements when considering Homes for the Aged for yourself or a loved one.
I'm sorry for any confusion, but "Internet" is a term that pertains to the global network of interconnected computers and servers that enable the transmission and reception of data via the internet protocol (IP). It is not a medical term and does not have a specific medical definition. If you have any questions related to medicine or health, I'd be happy to try to help answer them for you!
I am not aware of a widely accepted medical definition for the term "software," as it is more commonly used in the context of computer science and technology. Software refers to programs, data, and instructions that are used by computers to perform various tasks. It does not have direct relevance to medical fields such as anatomy, physiology, or clinical practice. If you have any questions related to medicine or healthcare, I would be happy to try to help with those instead!
A User-Computer Interface (also known as Human-Computer Interaction) refers to the point at which a person (user) interacts with a computer system. This can include both hardware and software components, such as keyboards, mice, touchscreens, and graphical user interfaces (GUIs). The design of the user-computer interface is crucial in determining the usability and accessibility of a computer system for the user. A well-designed interface should be intuitive, efficient, and easy to use, minimizing the cognitive load on the user and allowing them to effectively accomplish their tasks.
An algorithm is not a medical term, but rather a concept from computer science and mathematics. In the context of medicine, algorithms are often used to describe step-by-step procedures for diagnosing or managing medical conditions. These procedures typically involve a series of rules or decision points that help healthcare professionals make informed decisions about patient care.
For example, an algorithm for diagnosing a particular type of heart disease might involve taking a patient's medical history, performing a physical exam, ordering certain diagnostic tests, and interpreting the results in a specific way. By following this algorithm, healthcare professionals can ensure that they are using a consistent and evidence-based approach to making a diagnosis.
Algorithms can also be used to guide treatment decisions. For instance, an algorithm for managing diabetes might involve setting target blood sugar levels, recommending certain medications or lifestyle changes based on the patient's individual needs, and monitoring the patient's response to treatment over time.
Overall, algorithms are valuable tools in medicine because they help standardize clinical decision-making and ensure that patients receive high-quality care based on the latest scientific evidence.