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https://www.readbyqxmd.com/read/28505704/-compilation-of-second-opinion-programs-in-the-german-statutory-health-insurance
#1
Dawid Pieper, Simone Heß, Tim Mathes
Objective According to a new legislation passed in 2016, patients with an indication for elective procedures have the right to obtain a second opinion. The Federal Joint Committee has not yet provided a list of indications that this legislation will cover. Independently of this, the statutory health insurances can, nonetheless, pay for a second opinion. The aim of this article is to give an overview of current second opinion programs delivered by the statutory health insurance schemes. Methods Websites of all German statutory health insurance schemes (n=117) were searched for second opinion programs and their features in November 2016...
May 15, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28482714/risk-and-impact-of-tuberculosis-in-patients-with-multiple-myeloma
#2
Chun-Kuang Tsai, Leh-Kiong Huon, Shuo-Ming Ou, Ai-Seon Kuan, Chiu-Mei Yeh, Yu-Ting Lee, Yao-Chung Liu, Tzeng-Ji Chen, Jin-Hwang Liu, Chia-Jen Liu
We investigated the risk and impact of mycobacterium tuberculosis (TB) infection in patients with multiple myeloma (MM). We identified 3979 MM patients from Taiwan's National Health Insurance database between 2000 and 2011 and compared the incidence rates of TB infection in these patients with 15,916 randomly selected age-, sex-, and comorbidity-matched subjects without MM. The risk of TB was higher in the myeloma cohort (adjusted hazard ratio [HR] 3.11, 95% confidence interval [CI] 2.41-4.02). Risk factors for MM patients contracting TB were age ≥65 (adjusted HR 1...
May 9, 2017: Leukemia & Lymphoma
https://www.readbyqxmd.com/read/28465821/dow-s-fire-and-explosion-index-a-case-study-in-the-process-unit-of-an-oil-extraction-factory
#3
Zeynab Sadat Nezamodini, Zahra Rezvani, Kumars Kian
INTRODUCTION: The incidence of fires and explosions have led to severe damage in many industries, primarily in industries' financial losses. This study was conducted to estimate losses due to fire and explosion and the impact of control measures on the number of losses applying Dow's Fire and Explosion Index. METHODS: This is a case study conducted in one of the process units of an oil extraction factory. Dow's Fire and Explosion Index Hazard classification guide, 7(th) edition, issued by the American Institute of Chemical Engineers was applied...
February 2017: Electronic Physician
https://www.readbyqxmd.com/read/28464814/was-federal-parity-associated-with-changes-in-out-of-network-mental-health-care-use-and-spending
#4
Susan H Busch, Emma E Mcginty, Elizabeth A Stuart, Haiden A Huskamp, Teresa B Gibson, Howard H Goldman, Colleen L Barry
BACKGROUND: The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act is to eliminate differences in insurance coverage between behavioral health and general medical care. The law requires out-of-network mental health benefits be equivalent to out-of-network medical/surgical benefits. Insurers were concerned this provision would lead to unsustainable increases in out-of-network related expenditures. We examined whether federal parity implementation was associated with significant increases in out-of-network mental health care use and spending...
May 2, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28454870/temporary-jobs-and-the-severity-of-workplace-accidents
#5
Matteo Picchio, Jan C van Ours
INTRODUCTION: From the point of view of workplace safety, it is important to know whether having a temporary job has an effect on the severity of workplace accidents. We present an empirical analysis on the severity of workplace accidents by type of contract. METHOD: We used microdata collected by the Italian national institute managing the mandatory insurance against work related accidents. We estimated linear models for a measure of the severity of the workplace accident...
June 2017: Journal of Safety Research
https://www.readbyqxmd.com/read/28445624/the-role-of-publicly-funded-family-planning-sites-in-health-insurance-enrollment
#6
Jennifer Yarger, Sara Daniel, M Antonia Biggs, Jan Malvin, Claire D Brindis
CONTEXT: Publicly funded family planning providers are well positioned to help uninsured individuals learn about health insurance coverage options and effectively navigate the enrollment process. Understanding how these providers are engaged in enrollment assistance and the challenges they face in providing assistance is important for maximizing their role in health insurance outreach and enrollment. METHODS: In 2014, some 684 sites participating in California's family planning program were surveyed about their involvement in helping clients enroll in health insurance...
April 26, 2017: Perspectives on Sexual and Reproductive Health
https://www.readbyqxmd.com/read/28381338/selective-contracting-and-channelling-patients-to-preferred-providers-a-scoping-review
#7
REVIEW
Romy E Bes, Emile C Curfs, Peter P Groenewegen, Judith D de Jong
Selective contracting by health insurers and channelling patients to contracted providers is crucial in a health care system based on managed competition, as this should lead to better value for money delivery of healthcare. However, an important consequence for enrolees is that health insurers interfere with their choice of care provider. This scoping review aims to find out what is known about selective contracting from the enrolee's perspective. Is it being done and how do enrolees feel about the role of their health insurer in their care provider choice? A literature search was conducted, and, in addition, experts were consulted for extra information and documents...
March 24, 2017: Health Policy
https://www.readbyqxmd.com/read/28375593/va-dental-insurance-program-final-rule
#8
(no author information available yet)
This document revises Department of Veterans Affairs (VA) medical regulations to reflect the codification of the authority for the VA Dental Insurance Program (VADIP), a program through which VA contracts with private dental insurers to offer premium-based dental insurance to enrolled veterans and certain survivors and dependents of veterans. The VA Dental Insurance Reauthorization Act of 2016 codified the authority of the VADIP, and this final rulemaking accordingly revises the authority citation in the VA medical regulations that implement VADIP...
April 4, 2017: Federal Register
https://www.readbyqxmd.com/read/28371945/-linkage-between-promotion-of-employment-and-promotion-of-health-in-the-community-setting-results-of-the-pilot-project-of-the-federal-employment-agency-and-the-statutory-health-insurance
#9
Michael Bellwinkel, Karin Schreiner-Kürten, Kathrin Melzer
The Federal Employment Agency and the Statutory Health Insurance (GKV) have put the link between the promotion of employment and of health to the test by making a joint approach aiming to reach unemployed persons with preventive health services and to maintain or improve their employability. Specialist case workers (Integrationsfachkräfte) of the job centres conducted health consultations, motivating unemployed persons and raising their awareness of their own health as well as enabling them to access health promotion services of health insurance funds on a voluntary basis...
April 3, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28359982/bidirectional-association-between-bell-s-palsy-and-anxiety-disorders-a-nationwide-population-based-retrospective-cohort-study
#10
Chih-Chieh Tseng, Li-Yu Hu, Mu-En Liu, Albert C Yang, Cheng-Che Shen, Shih-Jen Tsai
OBJECTIVE: Bell's palsy and anxiety disorders share numerous risk factors (e.g., immune response, ischemia, and psychological stress). However, there have been no studies on the bidirectional temporal association between the two illnesses. In this study, we used the Taiwan National Health Insurance Research Database (NHIRD) to test the bidirectional association between Bell's palsy and anxiety disorders. We hypothesized that patients with Bell's palsy would have an increased risk of subsequent anxiety disorders later in life and that, conversely, those with anxiety disorders would have an increased likelihood of developing Bell's palsy later in life...
March 27, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28353670/demand-and-signing-of-general-practitioner-contract-service-among-the-urban-elderly-a-population-based-analysis-in-zhejiang-province-china
#11
Yanrong Zhao, Junfen Lin, Yinwei Qiu, Qing Yang, Xinyi Wang, Xiaopeng Shang, Xiaoping Xu
This study aims to examine whether the urban elderly in the Zhejiang Province of China signed contracts with their general practitioner (GP) based on their health service needs, and to further identify the determinants of their demand and signing decisions. A community-based cross-sectional study was conducted in 16 community health service (CHS) institutions in Zhejiang Province, China. The urban elderly over 60 years of age were enrolled when visiting the sampled CHS. Baseline characteristics were compared between participants using Chi-Square tests for categorical variables...
March 29, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28332206/contract-care-in-dentistry-sense-making-of-the-concept-and-in-practice-when-multiple-institutional-logics-are-at-play
#12
Ylva Ulfsdotter Eriksson, Karin Berg, Ulla Wide Boman, Magnus Hakeberg
In 2009 contract dental care was introduced into Sweden's Public Dental Service under a programme called Dental Care for Health (DCH). Previous research has revealed a possible dilemma whereby dental care professionals had the role of insurance agent foisted upon them, as they were assigned the task of 'selling contracts'. Using qualitative interviews, this study explores how these professionals make sense of contract dental care today. Drawing on the concepts of occupational and organisational professionalism, in combination with the institutional logics perspective, we discern that dental care professionals are entangled in multiple rationalities when reasoning about and dealing with DCH...
March 23, 2017: Sociology of Health & Illness
https://www.readbyqxmd.com/read/28316544/a-review-on-methods-of-risk-adjustment-and-their-use-in-integrated-healthcare-systems
#13
Christin Juhnke, Susanne Bethge, Axel C Mühlbacher
INTRODUCTION: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. THEORY AND METHODS: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines...
October 26, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28290918/health-plan-choice-in-the-netherlands-restrictive-health-plans-preferred-by-young-and-healthy-individuals
#14
Romy E Bes, Emile C Curfs, Peter P Groenewegen, Judith D de Jong
In a health care system based on managed competition, health insurers negotiate on quality and price with care providers and are allowed to offer restrictive health plans. It is crucial that enrolees who need care choose restrictive health plans, as otherwise health insurers cannot channel patients to contracted providers and they will lose their bargaining power in negotiations with providers. We aim to explain enrolees' choice of a restrictive health plan in exchange for a lower premium. In 2014 an online survey with an experimental design was conducted on members of an access panel (response 78%; n=3,417)...
March 14, 2017: Health Economics, Policy, and Law
https://www.readbyqxmd.com/read/28284363/-evaluation-of-family-doctor-centred-health-care-in-germany-based-on-aok-rheinland-hamburg-claims-data
#15
Mike Klora, Jan Zeidler, Melanie May, Nils Raabe, J-Matthias Graf von der Schulenburg
BACKGROUND: Health insurance funds in Germany are obliged to offer family doctor-centred health care models (Hausarztzentrierte Versorgung, "HzV"). The participation is voluntary for the insured persons. Participants agree to utilise outpatient specialist care only if their family doctor or general practitioner ("gatekeeper") refers them to a specialist. The aim of this programme is to both strengthen the role of general practitioners and to avoid unnecessary specialist visits and double examinations...
February 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/28274386/willingness-to-pay-for-other-individuals-healthcare-expenditures
#16
A P Borges, A Reis, J Anjos
OBJECTIVES: The need to improve the sustainability of public health expenditure, in a climate of growing pressure on national budgets, inevitably leads to a discussion about resource rationing, and the extent of society's responsibility for those expenditures. To contribute to this discussion empirically, this study evaluated the willingness of Portuguese respondents to pay for other individuals' healthcare expenditures through out-of-pocket payments. STUDY DESIGN: A questionnaire addressed to the general public was developed, with 296 respondents...
March 2017: Public Health
https://www.readbyqxmd.com/read/28264957/provider-offered-medicare-advantage-plans-recent-growth-and-care-quality
#17
Garret Johnson, Zoe M Lyon, Austin Frakt
Hospitals and health systems are increasingly offering their own insurance products, a type of consolidation known as "vertical integration." The relationship between plan-provider vertical integration and quality of care has not been examined extensively or over time. We created a new data set of all vertically integrated Medicare Advantage contracts operating in the period 2011-15 and tracked their characteristics and quality over time. While the percentage of vertically integrated contracts increased slightly between 2011 and 2015, the percentage of all Medicare Advantage enrollees in them declined from 24...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28226336/educational-outreach-to-opioid-prescribers-the-case-for-academic-detailing
#18
Margot Trotter Davis, Brian Bateman, Jerry Avorn
Nonmedical use of opioid medications constitutes a serious health threat as the rates of addiction, overdoses, and deaths have risen in recent years. Increasingly, inappropriate and excessively liberal prescribing of opioids by physicians is understood to be a central part of the crisis. Public health officials, hospital systems, and legislators are developing programs and regulations to address the problem in sustained and systematic ways that both insures effective treatment of pain and appropriate limits on the availability of opioids...
February 2017: Pain Physician
https://www.readbyqxmd.com/read/28210864/pharmacy-benefit-management-companies-do-they-create-value-in-the-us-healthcare-system
#19
Alan Lyles
Pharmacy benefit management companies (PBMs) perform functions in the US market-based healthcare system that may be performed by public agencies or quasi-public institutions in other nations. By aggregating lives covered under their many individual contracts with payers, PBMs have formidable negotiating power. They influence pharmaceutical insurance coverage, design the terms of coverage in a plan's drug benefit, and create competition among providers for inclusion in a plan's network. PBMs have, through intermediation, the potential to secure lower drug prices and to improve rational prescribing...
May 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28161669/impact-of-health-financing-policies-in-cambodia-a-20-year-experience
#20
Tim Ensor, Chhim Chhun, Ton Kimsun, Barbara McPake, Ijeoma Edoka
Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies including health equity funds, vouchers and community health insurance have been complemented by supply side measures to improve service delivery incentives through contracting...
January 26, 2017: Social Science & Medicine
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