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Insurance contracts

H Karimi, S A Motevalian, M Momeni, M Ghadarjani
Understanding the cost of burn treatment is very important for patients, their families, governmental authorities and insurance companies. It alleviates patient and familial stress, provides a framework for better use of resources, and facilitates better performance between burn centers. Hospital burn costs can provide a basis for authorities to budget for acute burn treatment, for further management of chronic complications, and for planning prevention and public educational programs in Iran. To identify costs we used data from our burn registry program...
December 31, 2015: Annals of Burns and Fire Disasters
Helmuth Cremer, Jean-Marie Lozachmeur, Pierre Pestieau
This paper studies the design of long term care (LTC) insurance contracts in the presence of ex post moral hazard. While this problem bears some similarity with the study of health insurance (Blomqvist, 1997) the significance of informal LTC affects the problem in several crucial ways. It introduces the potential crowding out of informal care by market care financed through insurance coverage. Furthermore, the information structure becomes more intricate. Informal care is not publicly observable and, unlike the insurer, caregivers know the true needs of their relatives...
September 27, 2016: Journal of Health Economics
P Kalbe
The reform of occupational insurance medical treatment in 2011 also resulted in many changes for occupational insurance consultants in private practice. The transformation of the physicians participating in treatment status (H-Arzt) to accident insurance consultant status (D-Arzt) has resulted in a significant increase in numbers in outpatient fields, which in some cases leads to increased competition. The tentative flexibilization of the conditions for participation of a D‑Arzt is welcomed but must be broadened to safeguard the future...
October 14, 2016: Der Unfallchirurg
Mauricio Avendano, Heta Moustgaard, Pekka Martikainen
This paper uses individual-level longitudinal data on working-age Finns to examine the health effects of economic fluctuations during a period of economic decline (1989-1996) and recovery (1997-2007) in Finland. We used a nationally representative, longitudinal sample formed by linking population, employment and mortality registers (n = 698,484; 7,719,870 person-years). We implemented a region fixed-effect model that exploits within-regional variations over time in the unemployment rate to identify the effect of economic fluctuations on mortality, controlling for individual employment transitions...
October 11, 2016: European Journal of Epidemiology
Alicia Atwood, Anthony T Lo Sasso
Network design is an often overlooked aspect of health insurance contracts. Recent policy factors have resulted in narrower provider networks. We provide plausibly causal evidence on the effect of narrow network plans offered by a large national health insurance carrier in a major metropolitan market. Our econometric design exploits the fact that some firms offer a narrow network plan to their employees and some do not. Our results show that narrow network health plans lead to reductions in health care utilization and spending...
September 21, 2016: Journal of Health Economics
Denise Menonna-Quinn
The focus of health care has moved toward prevention, and insurance companies are supporting preventive practices that enable their members to remain healthy. Many insurance companies have recorded healthy tips delivered by phone, employed case managers to assist patients in keeping physician appointments, created dedicated hot lines staffed by nurses, and developed resource centers. However, specific instances arise when insurance companies do not allow patients to have certain procedures because of contract language that was previously negotiated between the employer or individual and the insurance company...
October 1, 2016: Clinical Journal of Oncology Nursing
Robert D Lieberthal
Long-term health insurance provides consumers with protection against persistent, negative health shocks. While the stochastic rise in medical spending growth may make some health risks harder to insure, financial assets could act as a hedge for medical spending growth risk. The purpose of this research was to determine whether such hedges exist. The results of this study were two-fold. First, the asset classes with the strongest statistical evidence as hedges were bonds, not stocks. Second, any strategy to hedge medical spending growth involved shorting assets i...
August 2016: Appl Finance Account
Julia K Ostermann, Anne Berghöfer, Frank Andersohn, Felix Fischer
BACKGROUND: Numerous drugs used in the treatment of psychiatric disorders are substrates of cytochrome P450 enzymes and are potential candidates for drug-drug interactions (DDIs). METHODS: Claims data of a German statutory health insurance company from severely mentally ill patients who registered in an integrated care contract from August 2004 to December 2009 were analysed. We measured time periods of concomitant prescription of drugs that have been reported to interact via cytochrome P450, with a focus on drugs acting as strong inhibitors...
2016: BMC Health Services Research
Lauren N Whiteman, Carlton Haywood, Sophie Lanzkron, John J Strouse, Adrian H Batchelor, Anthony Schwartz, Rosalyn W Stewart
OBJECTIVES: Poor oral health can have a negative impact on overall health. This is especially concerning for individuals with sickle cell disease (SCD), an inherited blood disorder that affects hemoglobin and can lead to an increased risk of infection and hyperalgesia. Because the majority of individuals with SCD have Medicaid insurance and no dental coverage, we provided free basic dental care to individuals with SCD to determine whether it decreased overall healthcare utilization. METHODS: Through a contract with a private dental office, we provided free basic dental care (eg, cleanings, fillings, x-rays) to individuals with SCD...
September 2016: Southern Medical Journal
William Riley, Les W Meredith, Rebecca Price, Kristi K Miller, James W Begun, Mac McCullough, Stanley Davis
OBJECTIVE: To evaluate the association of improved patient safety practices with medical malpractice claims and costs in the perinatal units of acute care hospitals. DATA SOURCES: Malpractice and harm data from participating hospitals; litigation records and medical malpractice claims data from American Excess Insurance Exchange, RRG, whose data are managed by Premier Insurance Management Services, Inc. (owned by Premier Inc., a health care improvement company)...
August 22, 2016: Health Services Research
Elizabeth A Stuart, Colleen L Barry, Julie M Donohue, Shelly F Greenfield, Kenneth Duckworth, Zirui Song, Elena M Kouri, Cyrus Ebnesajjad, Robert Mechanic, Michael E Chernew, Haiden A Huskamp
BACKGROUND AND AIMS: Global payment and accountable care reform efforts in the US may connect more individuals with substance use disorders (SUD) to treatment. We tested whether such changes instituted under an 'Alternative Quality Contract' (AQC) model within the Blue Cross Blue Shield of Massachusetts' (BCBSMA) insurer increased care for individuals with SUD. DESIGN: Difference-in-differences design comparing enrollees in AQC organizations with a comparison group of enrollees in organizations not participating in the AQC...
August 12, 2016: Addiction
Melody W Mulaik
It is important to remain current on the latest edit and modifier guidelines from the AMA, CMS, and your contracted payors. Failure to use modifiers correctly can result in under- or overpayments and can put a provider at risk of penalties. Also, since payors vary in how they adjudicate claims with modifiers, it is important to monitor payments for claims with modifiers to make certain you are being paid correctly.
May 2016: Radiology Management
Domino Determann, Mattijs S Lambooij, Esther W de Bekker-Grob, Arthur P Hayen, Marco Varkevisser, Frederik T Schut, G Ardine de Wit
Within a healthcare system with managed competition, health insurers are expected to act as prudent buyers of care on behalf of their customers. To fulfil this role adequately, understanding consumer preferences for health plan characteristics is of vital importance. Little is known, however, about these preferences and how they vary across consumers. Using a discrete choice experiment (DCE) we quantified trade-offs between basic health plan characteristics and analysed whether there are differences in preferences according to age, health status and income...
September 2016: Social Science & Medicine
Sandra M Terra, John Zimmerling
PURPOSE/OBJECTIVES: The underlying guiding principles of case management services and practices of the Case Management Body of Knowledge include the following: "Case managers must possess the education, skills, knowledge, competencies, and experiences needed to effectively render appropriate, safe, and quality services to clients/support systems" and "Case management services are offered according to the clients' benefits as stipulated in their health insurance plans (http://www.cmbodyofknowledge...
September 2016: Professional Case Management
Frank Diamond
No abstract text is available yet for this article.
June 2016: Managed Care
Maria Polyakova
Conventional wisdom suggests that if private health insurance plans compete alongside a public option, they may endanger the latter's financial stability by cream-skimming good risks. This paper argues that two factors may contribute to the extent of cream-skimming: (i) degree of horizontal differentiation between public and private options when preferences are heterogeneous; (ii) whether contract design encourages choice of private insurance before information about risk is revealed. I explore the role of these factors empirically within the unique institutional setting of the German health insurance system...
September 2016: Journal of Health Economics
Ron Howrigon
Because of their involvement with the Affordable Care exchanges, the national insurance companies have reported significant financial losses. As a result, there will soon be significant payer pressure to reduce medical expenses. To succeed in future negotiations with the payers, medical practices must understand the needs of the payers and then play to those needs. The author is a former managed care executive with more than 25 years of experience managing provider networks and implementing payer strategies for some of the largest payers in the United States...
May 2016: Journal of Medical Practice Management: MPM
Liran Einav, Amy Finkelstein, Raymond Kluender, Paul Schrimpf
"Big data" and statistical techniques to score potential transactions have transformed insurance and credit markets. In this paper, we observe that these widely-used statistical scores summarize a much richer heterogeneity, and may be endogenous to the context in which they get applied. We demonstrate this point empirically using data from Medicare Part D, showing that risk scores confound underlying health and endogenous spending response to insurance. We then illustrate theoretically that when individuals have heterogeneous behavioral responses to contracts, strategic incentives for cream skimming can still exist, even in the presence of "perfect" risk scoring under a given contract...
April 2016: American Economic Journal. Applied Economics
Carrie H Colla, Alexander J Mainor, Courtney Hargreaves, Thomas Sequist, Nancy Morden
The effectiveness of different types of interventions to reduce low-value care has been insufficiently summarized to allow for translation to practice. This article systematically reviews the literature on the effectiveness of interventions to reduce low-value care and the quality of those studies. We found that multicomponent interventions addressing both patient and clinician roles in overuse have the greatest potential to reduce low-value care. Clinical decision support and performance feedback are promising strategies with a solid evidence base, and provider education yields changes by itself and when paired with other strategies...
July 8, 2016: Medical Care Research and Review: MCRR
Bob Herman
No abstract text is available yet for this article.
March 28, 2016: Modern Healthcare
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