Insurers, health

Other factors, such as the patient s age, financial problems that may be associated with a long-term illness, family cooperation and interest in the patient, and the adequacy of health insurance cover-age (which may be of great concern to the patient)... 

In countries with an existing (social) health insurance system, it is usually rather simple do receive a close-to-reality estimate of the provider Costs-of-Illness. The insurance pays the bills of general practitioners, specialists, hospitals, pharmacies, laboratories, etc. so that the total costs per patient can easily be determined. However, in some countries we cannot receive this data, and sometimes confidentiality regulations do not permit the transfer of insurance data, so that, for instance, provider costs of difference phases of HIV/AIDS can be calculated. In this case, a sample of patient files has to be analyzed with permission of the patients so that the provider costs can be recorded. 

However, we know hardly anything on these costs. Providers document all costs and health insurances keep files with all expenditure. Households have no documentation on such costs, and direct household costs are hardly recovered by health insurances. Thus, there is a major research field waiting to be covered. Merely Bozette et al. (2001) based their cost assessment on household documentations, but they do not sufQciently distinguish between household and provider costs. 

Liu et al. (2002) also calculated the economic cost of an HIV infection for the employer. Based on a simulation model to predict the comprehensive lifetime economic costs of HIV-infected workers to an employer, they predicted total lifetime costs of US 90,000 for the employer, whereas 2/3 are direct expenses on health insurance premium, life insurance premium, benefits, etc., and 1/3 loss of productivity. 

In the Netherlands, associations of the pharmaceutical industry play a role in selfregulation, particularly in relation to drug promotion and advertising. Consumer organizations have a formal presence on the Social Health Insurance Council. 

Retail pharmacy Pharmacy Board criteria, plus Health Insurance Commission Pharmacist Pharmacist Pharmacist (for drug items only) Pharmacist Pharmacist Pharmacist (annual renewal) Pharmacist Pharmacist... 

Where salary rates are low, some way of increasing them, or providing other incentives such as transport or housing allowances and health insurance, must be sought. Good salaries and benefits not only help to attract and retain employees, they also help to minimize cormption. 

To better understand managed care and the reasons for its growth, it is useful to discuss the evolution of payment mechanisms for health care from no insurance, to traditional indemnity insurance, to managed care. In the no-insurance model, the patient selects a health care provider and then pays the provider directly for health care goods and services. The choice of health care provider and the type and number of services provided are limited only by the financial constraints of the patient. The problem with this model is that the patient is exposed to potentially catastrophic health care expenses. Health insurance was developed as a way to protect patients against this risk. Health insurance often is provided through the employer and prior to the mid-1980s was likely to be indemnity fee-for-service insurance. In this traditional insurance... 

Source Book of Health Insurance Data. Washington, DC Health Insurance Association of America, 1999. 

The average wage of the nonsalaried laborers can be obtained from Chemical Week s annual plant site issue (see references for Chapter 2) or the U. S. Department of Labor. This average wage does not include retirement benefits, social security, workman s compensation, company health insurance contributions, stock options, holidays and vacations, and other fringe benefits. These benefits... 

Overweight people should pay higher health insurance premiums. 

Ninety-one percent of people in America recognize Bill Clinton. Anyone with a body mass index greater than thirty should pay higher health insurance premiums. 

George Kaplan has shown that US states with greater inequality have higher rates of violence, more disability, more people without health insurance, less investment in education and literacy, and poorer educational outcomes, all of which he calls structural characteristics. Moreover, the socioenvironmental characters of population areas are importantly related to the mortality rates, independent of the characters of individuals. In addition, personal and socioeconomic risk factors cluster together in areas of low income and high mortality. In a thorough local study of Alameda County, California, Kaplan examined parts of the pathways linking social class and mortality. His basic claim is that health inequality is correlated to social instability, which is in turn correlated to the lack of investment in structural characteristics, such as education, proximity of healthful food outlets, pharmacies, accessibility of transportation, etc. 

None for category I of the population (represented 37% in 1987). The participation is 100% for the rest of the population unless they take out health insurance against it. An annual deductible is applied to insured groups which also acts as a maximum level of user participation None... 

Switzerland Combination of annual deductibles and percentage cost-sharing rates Per diem co-payments for hospitalization User sharing in drug consumption costs, which varies between different health insurance schemes. Negative lists of medicines exclude consumption from public coverage... 

Dirkey Mostly private providers who apply payment per act (FFS) schemes in their bills Social health insurance covers the totality of costs, although specific rates are applied to uninsured groups All social health insurance schemes apply percentage rates of user participation for medicines (in out-patient visits)... 

We start by considering the (free) health insurance market. An actuarially fair insurance premium is one that equals the expected value of its yield in health... 

Voluntary insurance would be the market solution to uncertainty for risk-averse individuals. In this context, the user chooses the optimum co-insurance rate. Theory offers some analytical results on optimal health insurance contract designs.1 The consumer decides the extent of the coverage and the optimum co-insurance rate, and ultimately the price to be paid for the premium. In competitive markets, with actuarially fair premiums, the optimum co-insurance rate varies between individuals and depends on the risk of falling sick and the price elasticity of demand. 

There is some controversy in the theoretical literature about the relationship between health insurance and efficiency. Puig-Junoy3 has conducted an excellent review of this issue. The scope of the welfare loss associated with health insurance has also been the object of empirical research with econometric procedures. 

The moral hazard associated with health insurance is twofold that which occurs ex ante, which consists in failing to prevent health problems because he or she knows that he or she is protected in the event of falling ill, and expost moral hazard, which is what occurs when rational consumers consume quantities that are greater than the optimum once they fall ill, because the marginal cost for the co-insured patient is lower than the marginal cost of production. 

The experiment conducted by the Rand Corporation in the late 1970s, designed as a large-scale experiment in order to overcome this methodological difficulty, is already a classic in the field of health economics.22 It consisted in allocating 16 different 3-5-year health insurance schemes at random to a broad sample of people distributed geographically in six different areas of the USA. The co-payment rates varied from 0 per cent to 95 per cent, depending on the scheme and the services provided. The data supplied by the... 

Feldstein, M. (1973), The welfare loss of excess health insurance , Journal of Political Economy, 81, 251-80. 

Newhouse, J. et al. (1993), Free for All Lessons from the Rand Health Insurance Experiment, Cambridge Harvard University Press. 

Manning, W.G. et al. (1987), Health insurance and the demand for medical care evidence from a randomized experiment , American Economic Review, 11,251-77. 

Schmeinck, W. (1994), Overview of the German health insurance system , in E. Mossialos (ed.), Cost Containment, Pricing and Financing of Pharmaceuticals in the European Community the Policy-makers View, London London School of Economics and Pharmetrica, pp. 161-6. 

In a nationwide interview survey conducted in the fall of 2001 by Peter D. Hart Research Associates, Inc., respondents were asked whether genetic research will result in medical treatments and cures for diseases. Forty percent said that it will almost certainly happen, and 53% said that it will probably happen (Peter D. Hart, 2001). When asked whether many serious diseases will be eradicated as a result of genetic research, 20% said that it will almost certainly happen and 54% said that it will probably happen. The responses on genetic discrimination are particularly interesting. When asked whether health insurance companies will use genetic information to deny people coverage if they are predisposed to diseases, 32% said that it will... 

B. If your health insurance company could get the results of a genetic test that showed whether you were more likely to get sick in the future, what impact, if any, would this have on your willingness to take the test ... 

FIGURE 1.9. Percentage Willing to Undergo Genetic Testing if Results Were Available to Employers, Health Insurers, and Life Insurers (by race/ethnicity). 

H More Likely Employer 0 More Likely Health Insurance H More Likely Life Insurance... 

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