The financial implications of employer-sponsored health insurance.

PubMed

Natvig, Deborah; Tolbert, Sam

2005-01-01

The purpose of this study was to analyze utilization and costs of employer-sponsored health insurance in select businesses in a rural community in South Carolina. The study was conducted under the auspices of the HR Roundtable of the local Chamber of Commerce, composed of human resources directors from the larger area businesses. Twenty one companies were invited to participate and eight submitted information that was sufficiently complete to analyze. The participating companies employed 6,265 people, of which 5,712 were insured. The data represents a total of 13,057 covered lives. Although the findings cannot be generalized to a broader population, the descriptive data was sufficient to generate a discussion about health care issues for this community and for the group to make preliminary recommendations for collaborative work that may affect the costs of health care coverage for this community.

78 FR 25909 - Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium.... SUMMARY: This document contains proposed regulations relating to the health insurance premium tax credit... who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the...

Public subsidies for employees' contributions to employer-sponsored insurance.

PubMed

Merlis, M

2001-01-01

Proposals to provide or subsidize health insurance for low-income families must take account of the fact that many workers have access to employer-sponsored insurance (ESI), but decline it because of required employee premium contributions. This article considers a tax credit for the employee share of ESI in the context of a broader program of income-based health insurance tax credits. Helping uninsured workers pay for available ESI could be more cost-effective than subsidizing their coverage in the nongroup market. The credit would also be available to workers who were already covered, both for equity reasons and to reduce the incentives for employers to drop coverage or for workers to shift to subsidized individual plans. One key issue is how to prevent employers from reducing their current health plan contributions to take advantage of the new funding. Other design questions considered by the article include whether workers should be able to choose between ESI and nongroup coverage, whether minimum benefit standards should apply for employer plans, and how to achieve a fair balance in subsidies for group and nongroup coverage.

Insurance Coverage for Weight Loss

PubMed Central

Jarlenski, Marian P.; Gudzune, Kimberly A.; Bennett, Wendy L.; Cooper, Lisa A.; Bleich, Sara N.

2013-01-01

Background Given the prevalence of obesity and associated chronic conditions among U.S. adults, wellness benefits are an increasingly popular approach to promoting weight loss. Purpose The goal of the study was to assess overweight and obese adults’ beliefs about the helpfulness of insurance coverage of weight loss–related benefits, their willingness to pay for such benefits, and whether these opinions differ by individuals’ weight or health insurance type. Methods A national survey was fielded in 2012 am ong non-pregnant, overweight and obese adults who had seen a primary care provider in the past year (n=600). Descriptive statistics summarized beliefs about which weight loss–related benefits would be helpful, willingness to pay for such benefits, and agreement about whether health insurers should be able to charge more to obese individuals. Multivariable logistic regression was employed to determine whether beliefs differed by weight category or health insurance type. Analyses were conducted in July 2012. Results The majority (83%) of respondents cited a specific benefit as helpful. Those with private health insurance had a higher probability (89%, 95% CI=86%, 93%) of endorsing any benefit as helpful relative to those with other types of health insurance. Being obese relative to overweight was associated with greater support (57% vs 39%, p<0.05) for preventing health insurers from charging higher premiums to obese individuals. Conclusions In this sample of overweight adults, a large proportion endorsed the value of weight loss–related benefits offered by health plans. However, only about one third were willing to pay extra for them, and half disagreed with the notion that health plans should charge more to obese individuals. Given evidence of their effectiveness, wellness benefits should be offered to all individuals. PMID:23597807

Public insurance is increasingly crucial to American families even as employer-sponsored health insurance coverage ends its steady decline.

PubMed

Gould, Elise

2014-01-01

Americans under age 65 rely on a healthy labor market for almost all facets of economic security. While 2012 marked the first year in more than a decade that the employer-sponsored health insurance (ESI) coverage rate for the under-65 population did not decline, employer-sponsored health insurance continues to fail American families. If the coverage rate had not fallen 10.8 percentage points as it did from 2000 to 2012, as many as 29 million more people under age 65 would have had ESI in 2012. Even with the end of its longstanding decline, ESI coverage rates among men and women, white and non-white, high and low income, white and blue collar, young and old remain far lower than they were in 2000. Over this period, the increase in uninsured Americans was not as steep as the fall in ESI because of increases in public coverage, including Medicaid, the Children's Health Insurance Program, and Medicare. These programs were particularly effective in reducing the share of children uninsured over the 2000s. Additionally, key components in the Patient Protection and Affordable Care Act shielded young adults from further coverage losses.

Postoperative outcomes in bariatric surgical patients participating in an insurance-mandated preoperative weight management program.

PubMed

Schneider, Andrew; Hutcheon, Deborah A; Hale, Allyson; Ewing, Joseph A; Miller, Megan; Scott, John D

2018-05-01

Many insurance companies require patient participation in a medically supervised weight management program (WMP) before offering approval for bariatric surgery. Clinical data surrounding benefits of participation are limited. To evaluate the relationship between preoperative insurance-mandated WMP participation and postoperative outcomes in bariatric surgery patients. Regional referral center and teaching hospital. A retrospective review of patients who underwent vertical sleeve gastrectomy or Roux-en-Y gastric bypass between January 2014 and January 2016 was performed. Patients (N = 354) were divided into 2 cohorts and analyzed according to presence (n = 266) or absence (n = 88) of an insurance-mandated WMP requirement. Primary endpoints included rate of follow-up and percent of excess weight loss (%EWL) at postoperative months 1, 3, 6, and 12. All patients, regardless of the insurance-mandated WMP requirement, followed a program-directed preoperative diet. The majority of patients with an insurance-mandated WMP requirement had private insurance (63.9%). Both patient groups experienced a similar proportion of readmissions and reoperations, rate of follow-up, and %EWL at 1, 3, 6, and 12 months (P = NS). Median operative duration and hospital length of stay were also similar between groups. Linear regression analysis revealed no significant improvement in %EWL at 12 months in the yes-WMP group. These data show that patients who participate in an insurance-mandated WMP in addition to completing a program-directed preoperative diet experience no significant benefit to rate of readmission, reoperation, follow-up, or %EWL up to 12 months postoperation. Our findings suggest that undergoing bariatric surgery without completing an insurance-mandated WMP is safe and effective. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Discrepancies in employer-sponsored health insurance among Hispanics, blacks, and whites: the effects of sociodemographic and employment factors.

PubMed

Seccombe, K; Clarke, L L; Coward, R T

1994-01-01

Using a nationally representative sample of employed adults from the 1987 National Medical Expenditure Survey (NMES), this research explores differences in the incidence and predictors of employer-sponsored health insurance among Hispanics, blacks, and whites. The data suggest that: 1) whites are most likely, and Hispanics are least likely, to have employer-sponsored medical insurance in their own name, or in the name of another individual; 2) Hispanics are most likely, and whites are least likely, to be completely uninsured; and 3) the factors which increase the odds of receiving employer-sponsored coverage in one's own name are relatively similar across racial groups, though they differ substantially in magnitude.

An early look at changes in employer-sponsored insurance under the Affordable Care Act.

PubMed

Blavin, Fredric; Shartzer, Adele; Long, Sharon K; Holahan, John

2015-01-01

Critics frequently characterize the Affordable Care Act (ACA) as a threat to the survival of employer-sponsored insurance. The Medicaid expansion and Marketplace subsidies could adversely affect employers' incentives to offer health insurance and workers' incentives to take up such offers. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. We found no evidence that any of these rates have declined under the ACA. They have, in fact, remained constant: around 82 percent, 86 percent, and 71 percent, respectively, for all workers and around 63 percent, 71 percent, and 45 percent, respectively, for low-income workers. To date, the ACA has had no effect on employer coverage. Economic incentives for workers to obtain coverage from employers remain strong. Project HOPE—The People-to-People Health Foundation, Inc.

Employer-sponsored health insurance coverage limitations: results from the Childhood Cancer Survivor Study.

PubMed

Kirchhoff, Anne C; Kuhlthau, Karen; Pajolek, Hannah; Leisenring, Wendy; Armstrong, Greg T; Robison, Leslie L; Park, Elyse R

2013-02-01

The Affordable Care Act (ACA) will expand health insurance options for cancer survivors in the USA. It is unclear how this legislation will affect their access to employer-sponsored health insurance (ESI). We describe the health insurance experiences for survivors of childhood cancer with and without ESI. We conducted a series of qualitative interviews with 32 adult survivors from the Childhood Cancer Survivor Study to assess their employment-related concerns and decisions regarding health insurance coverage. Interviews were performed from August to December 2009 and were recorded, transcribed, and content analyzed using NVivo 8. Uninsured survivors described ongoing employment limitations, such as being employed at part-time capacity, which affected their access to ESI coverage. These survivors acknowledged they could not afford insurance without employer support. Survivors on ESI had previously been denied health insurance due to their preexisting health conditions until they obtained coverage through an employer. Survivors feared losing their ESI coverage, which created a disincentive to making career transitions. Others reported worries about insurance rescission if their cancer history was discovered. Survivors on ESI reported financial barriers in their ability to pay for health care. Childhood cancer survivors face barriers to obtaining ESI. While ACA provisions may mitigate insurance barriers for cancer survivors, many will still face cost barriers to affording health care without employer support.

Employer-sponsored health insurance coverage continues to decline in a new decade.

PubMed

Gould, Elise

2013-01-01

Most Americans, particularly those under age 65, rely on health insurance offered through the workplace. Given continuing high unemployment, it comes as no surprise that the share of Americans under age 65 covered by employer-sponsored health insurance (ESI) eroded for the 11th year in a row in 2011, falling from 58.6 percent in 2010 to 58.3 percent. The situation started deteriorating long before the Great Recession: the share of Americans under age 65 covered by ESI eroded every year from 2000 to 2011, decreasing by a total of 10.9 percentage points. As many as 29 million more people under age 65 would have had ESI in 2011 if the coverage rate had remained at the 2000 level. The decline in ESI coverage has been accompanied by an overall decline in health insurance coverage. The number of uninsured non-elderly Americans was 47.9 million in 2011--11.7 million higher than in 2000. Increasing public insurance coverage, particularly among children, is the only reason the uninsured rate did not rise one-for-one with losses in ESI. In addition, key components in the Patient Protection and Affordable Care Act took effect in 2010, shielding young adults from further coverage losses.

Taking up or turning down: new estimates of household demand for employer-sponsored health insurance.

PubMed

Abraham, Jean Marie; Feldman, Roger

2010-01-01

This study provides new estimates of demand for employer-sponsored health insurance, using the 1997-2001 linked Household Component-Insurance Component of the Medical Expenditure Panel Survey (MEPS). Our focus is on households' decisions to take up coverage through a worker's employer. We found a significant inverse relationship between the out-of-pocket premium and the probability of taking up coverage, with the price effect considerably larger when we used instrumental variables methods to account for endogenous out-of-pocket premiums. Additionally, workers in families with more children eligible for Medicaid were less likely to take up coverage.

Progressive or regressive? A second look at the tax exemption for employer-sponsored health insurance premiums.

PubMed

Schoen, Cathy; Stremikis, Kristof; Collins, Sara; Davis, Karen

2009-05-01

The major argument for capping the exemption of health insurance benefits from income tax is that doing so will generate significant revenue that can be used to finance an expansion of health coverage. This analysis finds that given the state of insurance markets and current variations in premiums, limiting the current exemption could adversely affect individuals who are already at high risk of losing their health coverage. Evidence suggests that capping the exemption for employment-based health insurance could disproportionately affect workers in small firms, older workers, and wage-earners in industries with high expected claims costs. To avoid putting many families at increased health and financial risk, and to avoid undermining employer-sponsored group coverage, any consideration of a cap would have to be combined with coverage for all, changes in insurance market rules, and shared responsibility for financing.

School-Sponsored Health Insurance: Planning for a New Reality

ERIC Educational Resources Information Center

Liang, Bryan A.

2010-01-01

Health care reform efforts in both the Clinton and Obama administrations have attempted to address college and university health. Yet, although the world of health care delivery has almost universally evolved to managed care, school health programs have not. In general, school-sponsored health plans do little to improve access and have adopted…

A structural econometric model of family valuation and choice of employer-sponsored health insurance in the United States.

PubMed

Vanness, David J

2003-09-01

This paper estimates a fully structural unitary household model of employment and health insurance decisions for dual wage-earner families with children in the United States, using data from the 1987 National Medical Expenditure Survey. Families choose hours of work and the breakdown of compensation between cash wages and health insurance benefits for each wage earner in order to maximize expected utility under uncertain need for medical care. Heterogeneous demand for the employer-sponsored health insurance is thus generated directly from variations in health status and earning potential. The paper concludes by discussing the benefits of using structural models for simulating welfare effects of insurance reform relative to the costly assumptions that must be imposed for identification. Copyright 2003 John Wiley & Sons, Ltd.

Uterine fibroid treatment patterns in a population of insured women.

PubMed

Lee, David W; Gibson, Teresa B; Carls, Ginger S; Ozminkowski, Ronald J; Wang, Shaohung; Stewart, Elizabeth A

2009-02-01

To profile women treated for uterine leiomyomas who are covered by commercial insurance from large, self-insured employers in the United States. Retrospective, observational study. Inpatient, outpatient, and prescription drug experience of women with employer-sponsored insurance in the United States. Data were obtained from the MarketScan insurance databases for 1999 through 2004 and weighted to represent the population of women with employer-sponsored health insurance in the United States. None. The proportion of women with clinically significant leiomyomas was determined in each year, based on inpatient and outpatient medical claims with diagnostic codes indicating leiomyoma. Patient characteristics, comorbidities, prescription drug treatments, and surgical interventions were profiled in 2004. Approximately 1% of women had clinically significant leiomyomas. Comorbid genital or menstrual conditions were common and much more prevalent for women with leiomyomas. Of women with leiomyomas, 18.4% received no surgical or prescription drug treatment, whereas 16.8% received only surgical treatment, 22.4% received only prescription drug treatment, and 42.4% received both. Hysterectomy was the most common surgical treatment. Generalizing from this sample, we estimate that 443,445 women with employer-sponsored insurance in the United States had clinically significant leiomyomas in 2004.

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

PubMed

Trish, Erin E; Herring, Bradley J

2015-07-01

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans' transactions with employers and the other concentration measure representing insurers' bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. Copyright © 2015 Elsevier B.V. All rights reserved.

How Do Health Insurer Market Concentration and Bargaining Power with Hospitals Affect Health Insurance Premiums?

PubMed Central

Trish, Erin E.; Herring, Bradley J.

2017-01-01

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006–2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans’ transactions with employers and the other concentration measure representing insurers’ bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. PMID:25910690

[Clinical safety data management in company non-sponsored trials].

PubMed

Saito, Akiko; Sakai, Junko; Kurihara, Masaaki; Kami, Masahiro; Kanda, Yoshinobu; Mori, Shin-ichiro; Takaue, Yoichi; Ohashi, Yasuo

2003-09-01

There is currently no harmonized way in Japan to manage safety data which are obtained during clinical trials supported by Government funds. There are two types of clinical trials, 'sponsored trials(sponsored by industrial companies)' and 'non-sponsored trials(funded by the Government, etc.)'. The Japanese Ministry of Health and Welfare has issued many of pharmaceutical laws(GCP, GPMSP etc.) for the regulation of sponsored trials, while none has ever established for non-sponsored trials, thus leaving the most important quality control/assurance unregulated. In this manuscript we discuss that the simple application of pharmaceutical laws to government-sponsored trials can not be a proper answer because of the different nature of the two types of trials.

Parental employment, family structure, and child's health insurance.

PubMed

Rolett, A; Parker, J D; Heck, K E; Makuc, D M

2001-01-01

To examine the impact of family structure on the relationship between parental employment characteristics and employer-sponsored health insurance coverage among children with employed parents in the United States. National Health Interview Survey data for 1993-1995 was used to estimate proportions of children without employer-sponsored health insurance, by family structure, separately according to maternal and paternal employment characteristics. In addition, relative odds of being without employer-sponsored insurance were estimated, controlling for family structure and child's age, race, and poverty status. Children with 2 employed parents were more likely to have employer-sponsored health insurance coverage than children with 1 employed parent, even among children in 2-parent families. However, among children with employed parents, the percentage with employer-sponsored health insurance coverage varied widely, depending on the hours worked, employment sector, occupation, industry, and firm size. Employer-sponsored health insurance coverage for children is extremely variable, depending on employment characteristics and marital status of the parents.

Employment-Related Health Insurance: Federal Agencies' Roles in Meeting Data Needs

PubMed Central

Wiatrowski, William; Harvey, Holly; Levit, Katharine R.

2002-01-01

Employer-sponsored health insurance accounts for almost one-third of all health care spending. As health care cost growth accelerates affecting the availability of employer-sponsored insurance and depth of coverage, the importance of timely and accurate information for measuring and monitoring these changes and formulating policy options increases. Identifying a growing gap between the need for and availability of data to inform policy on employment-related health insurance issues, the Office of Management and Budget (OMB) established a committee of Federal agency representatives to evaluate and advise data collection efforts. This article reports on the committee's current efforts, focusing on evaluation of results from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) and the National Compensation Survey (NCS). PMID:12500352

Employment-related health insurance: federal agencies' roles in meeting data needs.

PubMed

Wiatrowski, William; Harvey, Holly; Levit, Katharine R

2002-01-01

Employer-sponsored health insurance accounts for almost one-third of all health care spending. As health care cost growth accelerates affecting the availability of employer-sponsored insurance and depth of coverage, the importance of timely and accurate information for measuring and monitoring these changes and formulating policy options increases. Identifying a growing gap between the need for and availability of data to inform policy on employment-related health insurance issues, the Office of Management and Budget (OMB) established a committee of Federal agency representatives to evaluate and advise data collection efforts. This article reports on the committee's current efforts, focusing on evaluation of results from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) and the National Compensation Survey (NCS).

12 CFR 250.412 - Interlocking relationships between member bank and insurance company-mutual fund complex.

Code of Federal Regulations, 2014 CFR

2014-01-01

... and insurance company-mutual fund complex. 250.412 Section 250.412 Banks and Banking FEDERAL RESERVE... between member bank and insurance company-mutual fund complex. (a) The Board has been asked whether... fund's incorporated investment manager-advisor, (3) the insurance company sponsoring and apparently...

12 CFR 250.412 - Interlocking relationships between member bank and insurance company-mutual fund complex.

Code of Federal Regulations, 2013 CFR

2013-01-01

... and insurance company-mutual fund complex. 250.412 Section 250.412 Banks and Banking FEDERAL RESERVE... between member bank and insurance company-mutual fund complex. (a) The Board has been asked whether... fund's incorporated investment manager-advisor, (3) the insurance company sponsoring and apparently...

12 CFR 250.412 - Interlocking relationships between member bank and insurance company-mutual fund complex.

Code of Federal Regulations, 2012 CFR

2012-01-01

... and insurance company-mutual fund complex. 250.412 Section 250.412 Banks and Banking FEDERAL RESERVE... between member bank and insurance company-mutual fund complex. (a) The Board has been asked whether... fund's incorporated investment manager-advisor, (3) the insurance company sponsoring and apparently...

The Take-Up of Employer-Sponsored Insurance Among Americans with Mental Disorders: Implications for Health Care Reform.

PubMed

Zuvekas, Samuel H

2015-07-01

Little is known about how take-up of private health insurance coverage differs between those with and without mental disorders. This study seeks to fill this gap by using data from the 2004-2008 Medical Expenditure Panel Survey to examine differences in offers and take-up of employer-sponsored insurance (ESI) among adults aged 27-54. Little evidence that mental disorders are associated with take-up of offers of ESI coverage was found. This suggests that take-up rates in the Affordable Care Act (ACA) marketplaces by those with and without mental disorders may be similar. The ACA is especially important to Americans with mental disorders, many of whom lack access to ESI coverage to pay for mental health treatment either through their own job or through a spouse's job.

12 CFR 250.412 - Interlocking relationships between member bank and insurance company-mutual fund complex.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and insurance company-mutual fund complex. 250.412 Section 250.412 Banks and Banking FEDERAL RESERVE... and insurance company-mutual fund complex. (a) The Board has been asked whether section 32 of the... investment manager-advisor, (3) the insurance company sponsoring and apparently controlling the fund. (b) X...

12 CFR 250.412 - Interlocking relationships between member bank and insurance company-mutual fund complex.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and insurance company-mutual fund complex. 250.412 Section 250.412 Banks and Banking FEDERAL RESERVE... and insurance company-mutual fund complex. (a) The Board has been asked whether section 32 of the... investment manager-advisor, (3) the insurance company sponsoring and apparently controlling the fund. (b) X...

Declines in Employer-Sponsored Insurance between 2000 and 2008: Examining the Components of Coverage by Firm Size

PubMed Central

Vistnes, Jessica; Zawacki, Alice; Simon, Kosali; Taylor, Amy

2012-01-01

Objective To examine trends in employer-sponsored health insurance coverage rates and its associated components between 2000 and 2008, to provide a baseline for later evaluations of the Affordable Care Act, and to provide information to policy makers as they design the implementation details of the law. Data Sources Private sector employer data from the 2000, 2001, and 2008 Medical Expenditure Panel Survey-Insurance Component (MEPS-IC). Study Design We examine time trends in employer offer, eligibility, and take-up rates. We add a new dimension to the literature by examining dependent coverage and decomposing its trends. We investigate heterogeneity in trends by firm size. Data Collection The MEPS-IC is an annual survey, sponsored by the Agency for Healthcare Research and Quality and conducted by the U.S. Census Bureau. The MEPS-IC obtains information on establishment characteristics, whether an establishment offers health insurance, and details on up to four plans. Principal Findings We find that coverage rates for workers declined in both small and large firms. In small firms, coverage declined due to a drop in both offer and take-up rates. In the largest firms, offer rates were stable and the decline was due to falling take-up rates. In addition, enrollment shifted toward single coverage and away from dependent coverage in both small and large firms. For small firms, this shift was due to declining offer and take-up rates for dependent coverage. In large firms, offers of dependent coverage were stable but take-up rates dropped. Within the category of dependent coverage, the availability of employee-plus-one plans increased in all firm size categories, but take-up rates for these plans declined in small firms. PMID:22250730

Insurance-mandated preoperative diet and outcomes after bariatric surgery.

PubMed

Keith, Charles J; Goss, Lauren E; Blackledge, Camille D; Stahl, Richard D; Grams, Jayleen

2018-05-01

Despite a lack of demonstrated patient benefit, many insurance providers mandate a physician-supervised diet before financial coverage for bariatric surgery. To compare weight loss between patients with versus without insurance mandating a preoperative diet. University hospital, United States. Retrospective study of all patients who underwent laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy over a 5-year period, stratified based on whether an insurance-mandated physician-supervised diet was required. Weight loss outcomes at 6, 12, and 24 months postoperation were compared. Linear mixed-models and backward-stepwise selection were used. P<0.05 was considered significant. Of 284 patients, 225 (79%) were required and 59 (21%) were not required to complete a preoperative diet by their insurance provider. Patients without the requirement had a shorter time to operation from initial consultation (P = .04), were older (P<.01), and were more likely to have government-sponsored insurance (P<.01). There was no difference in preoperative weight or body mass index or co-morbidities. In unadjusted models, percent excess weight loss was superior in the group without an insurance-mandated diet at 12 (P = .050) and 24 (P = .045) months. In adjusted analyses, this group also had greater percent excess weight loss at 6 (P<.001), 12 (P<.001), and 24 (P<.001) months; percent total weight loss at 24 months (P = .004); and change in body mass index at 6 (P = .032) and 24 (P = .007) months. There was no difference in length of stay or complication rates. Insurance-mandated preoperative diets delay treatment and may lead to inferior weight loss. Published by Elsevier Inc.

Computerized Management Information and Reporting Systems for Sponsored Projects.

ERIC Educational Resources Information Center

Rodman, John A.; Peters, Carl M.

1980-01-01

The effective management of the university depends on the research office providing usable, accurate, timely, and accessible information regarding sponsored programs. The utilization of automated systems to store, access, and manage information is seen as essential. (MLW)

Obesity weight management and bariatric surgery case management programs: a review of literature.

PubMed

Echols, Jennie

2010-01-01

The proportion of Americans with clinically severe obesity has vast implications for the nation's healthcare system since this population have twice as many chronic medical conditions as people with normal weight. Through the use of review of literature, this article (a) describes the types of weight loss programs; (b) reviews the results from studies on effectiveness of bariatric surgery; and (c) identifies recommendations for obesity and bariatric surgery case management programs. Disease management companies appear to be concentrating on general weight loss strategies associated with wellness and other condition-specific disease management products, whereas larger national healthcare companies with at-risk and insurance products offer specific bariatric surgery management products. Case management programs within healthcare systems, health management organizations, and insurance companies are frequently faced with the management of individuals with morbid obesity and, increasingly, those who are requesting or have undergone bariatric surgery. Research shows that morbid obesity is a disease that remains generally unresponsive to diet and drug therapy but appears to respond well to bariatric surgery. Research findings suggest that surgical treatment is more effective than pharmacological treatment of weight loss and the control of some comorbidities associated with obesity. The number of Americans having weight loss surgery increased by 804% between 1998 and 2004, which appears to be a driver for the recent development of obesity disease management and bariatric surgery case management programs. Although the immaturity and lack of studies citing outcomes of obesity disease and case management programs limit the identification of best practices based on outcomes, emerging practices can be identified and recommendations for case management can be formulated. In addition to primary prevention and treatment programs for obesity, this article describes program

Tax Subsidies for Employer-Sponsored Health Insurance: Updated Microsimulation Estimates and Sensitivity to Alternative Incidence Assumptions

PubMed Central

Miller, G Edward; Selden, Thomas M

2013-01-01

Objective To estimate 2012 tax expenditures for employer-sponsored insurance (ESI) in the United States and to explore the sensitivity of estimates to assumptions regarding the incidence of employer premium contributions. Data Sources Nationally representative Medical Expenditure Panel Survey data from the 2005–2007 Household Component (MEPS-HC) and the 2009–2010 Insurance Component (MEPS IC). Study Design We use MEPS HC workers to construct synthetic workforces for MEPS IC establishments, applying the workers' marginal tax rates to the establishments' insurance premiums to compute the tax subsidy, in aggregate and by establishment characteristics. Simulation enables us to examine the sensitivity of ESI tax subsidy estimates to a range of scenarios for the within-firm incidence of employer premium contributions when workers have heterogeneous health risks and make heterogeneous plan choices. Principal Findings We simulate the total ESI tax subsidy for all active, civilian U.S. workers to be $257.4 billion in 2012. In the private sector, the subsidy disproportionately flows to workers in large establishments and establishments with predominantly high wage or full-time workforces. The estimates are remarkably robust to alternative incidence assumptions. Conclusions The aggregate value of the ESI tax subsidy and its distribution across firms can be reliably estimated using simplified incidence assumptions. PMID:23398400

Individual insurance: health insurers try to tap potential market growth.

PubMed

November, Elizabeth A; Cohen, Genna R; Ginsburg, Paul B; Quinn, Brian C

2009-11-01

Individual insurance is the only source of health coverage for people without access to employer-sponsored insurance or public insurance. Individual insurance traditionally has been sought by older, sicker individuals who perceive the need for insurance more than younger, healthier people. The attraction of a sicker population to the individual market creates adverse selection, leading insurers to employ medical underwriting--which most states allow--to either avoid those with the greatest health needs or set premiums more reflective of their expected medical use. Recently, however, several factors have prompted insurers to recognize the growth potential of the individual market: a declining proportion of people with employer-sponsored insurance, a sizeable population of younger, healthier people forgoing insurance, and the likelihood that many people receiving subsidies to buy insurance under proposed health insurance reforms would buy individual coverage. Insurers are pursuing several strategies to expand their presence in the individual insurance market, including entering less-regulated markets, developing lower-cost, less-comprehensive products targeting younger, healthy consumers, and attracting consumers through the Internet and other new distribution channels, according to a new study by the Center for Studying Health System Change (HSC). Insurers' strategies in the individual insurance market are unlikely to meet the needs of less-than-healthy people seeking affordable, comprehensive coverage. Congressional health reform proposals, which envision a larger role for the individual market under a sharply different regulatory framework, would likely supersede insurers' current individual market strategies.

Why Weight? An Analytic Review of Obesity Management, Diabetes Prevention, and Cardiovascular Risk Reduction.

PubMed

Igel, L I; Saunders, K H; Fins, J J

2018-05-21

In this review, we examine one of the ironies of American health care-that we pay more for disease management than disease prevention. Instead of preventing type 2 diabetes (T2DM) by treating its precursor, obesity, we fail to provide sufficient insurance coverage for weight management only to fund the more costly burden of overt T2DM. There is a vital need for expanded insurance coverage to help foster a weight-centric approach to T2DM management. This includes broader coverage of anti-diabetic medications with evidence of cardiovascular risk reduction and mortality benefit, anti-obesity pharmacotherapy, bariatric surgery, weight loss devices, endoscopic bariatric therapies, and lifestyle interventions for the treatment of obesity. The fundamental question to ask is why weight? Why wait to go after obesity until its end-stage sequelae cause intractable conditions? Instead of managing the complications of T2DM, consider preventing them by tackling obesity.

Insurance in clinical research

PubMed Central

Ghooi, Ravindra B.; Divekar, Deepa

2014-01-01

Aims and Objectives: Sponsors need to pay for management of all serious adverse events suffered by subjects in a clinical trial and to compensate for injuries or deaths related to the trial. This study examines if insurance policies of trials, cover all contingencies that require reimbursement or compensation. Materials and Methods: Insurance policies of trials submitted to Sahyadri Hospitals between January 2013 and December 2013 were studied, with respect to the policy period, the limit of liability, deductibles, and preconditions if any. Results: All the policies studied had some deficiencies, in one respect or the other and none had a provision to pay full compensation if required. Some insurers have put in preconditions that could jeopardize the payment of compensation to subjects. Conclusions: Insurances are complicated documents, and need to be critically examined by the ethics committee before approval of the study documents. PMID:25276622

Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients.

PubMed

Fenny, Ama P; Hansen, Kristian S; Enemark, Ulrika; Asante, Felix A

2014-07-24

The National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients. A structured questionnaire was used to collect data from 523 respondents diagnosed with malaria and prescribed malaria drugs from public and private health facilities in 3 districts across Ghana's three ecological zones. Collected information included initial examinations performed on patients (temperature, weight, age, blood pressure and pulse); observations of malaria symptoms by trained staff, laboratory tests conducted and type of drugs prescribed. Insurance status of patients, age, gender, education level and occupation were asked in the interviews. Of the 523 patients interviewed, only 40 (8%) were uninsured. Routine recording of the patients' age, weight, and temperature was high in all the facilities. In general, assessments needed to identify suspected malaria were low in all the facilities with hot body/fever and headache ranking the highest and convulsion ranking the lowest. Parasitological assessments in all the facilities were also very low. All patients interviewed were prescribed ACTs which is in adherence to the drug of choice for malaria treatment in Ghana. However, there were no significant differences in the quality of malaria treatment given to the uninsured and insured patients. Adherence to the standard protocol of malaria treatment is low. This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in the country. The results show that about 16

Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients

PubMed Central

2014-01-01

Introduction The National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients. Method A structured questionnaire was used to collect data from 523 respondents diagnosed with malaria and prescribed malaria drugs from public and private health facilities in 3 districts across Ghana’s three ecological zones. Collected information included initial examinations performed on patients (temperature, weight, age, blood pressure and pulse); observations of malaria symptoms by trained staff, laboratory tests conducted and type of drugs prescribed. Insurance status of patients, age, gender, education level and occupation were asked in the interviews. Results Of the 523 patients interviewed, only 40 (8%) were uninsured. Routine recording of the patients’ age, weight, and temperature was high in all the facilities. In general, assessments needed to identify suspected malaria were low in all the facilities with hot body/fever and headache ranking the highest and convulsion ranking the lowest. Parasitological assessments in all the facilities were also very low. All patients interviewed were prescribed ACTs which is in adherence to the drug of choice for malaria treatment in Ghana. However, there were no significant differences in the quality of malaria treatment given to the uninsured and insured patients. Conclusion Adherence to the standard protocol of malaria treatment is low. This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in

24 CFR 213.256 - Premiums; insurance upon completion.

Code of Federal Regulations, 2010 CFR

2010-04-01

...; insurance upon completion. (a) Management and Sales Types and Investor Sponsored Projects. (1) Where the..., the mortgagee on the date of the first principal payment shall pay a second premium equal to one-half of one percent of the average outstanding principal obligation of the mortgage for the year following...

22 CFR 62.14 - Insurance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Insurance. 62.14 Section 62.14 Foreign... § 62.14 Insurance. (a) Sponsors shall require each exchange visitor to have insurance in effect which... amount of $10,000; and (4) A deductible not to exceed $500 per accident or illness. (b) An insurance...

77 FR 47573 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-09

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 40 and 46 [REG-136008-11] RIN 1545-BK59 Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes... on issuers of certain health insurance policies and plan sponsors of certain self-insured health...

Insurance and Risk Management at the National Outdoor Leadership School.

ERIC Educational Resources Information Center

Chu, Lantien

1990-01-01

Describes how an outdoor program specializing in wilderness expeditions approaches risk management, liability, and insurance. Discusses maintaining good communications with insurance agents, managing crisis situations, participating in program audits, reading the fine print, international insurance coverage, and the basis for insurance premiums.…

Premium growth and its effect on employer-sponsored insurance.

PubMed

Vistnes, Jessica; Selden, Thomas

2011-03-01

We use variation in premium inflation and general inflation across geographic areas to identify the effects of downward nominal wage rigidity on employers' health insurance decisions. Using employer level data from the 2000 to 2005 Medical Expenditure Panel Survey-Insurance Component, we examine the effect of premium growth on the likelihood that an employer offers insurance, eligibility rates among employees, continuous measures of employee premium contributions for both single and family coverage, and deductibles. We find that small, low-wage employers are less likely to offer health insurance in response to increased premium inflation, and if they do offer coverage they increase employee contributions and deductible levels. In contrast, larger, low-wage employers maintain their offers of coverage, but reduce eligibility for such coverage. They also increase employee contributions for single and family coverage, but not deductibles. Among high-wage employers, all but the largest increase deductibles in response to cost pressures.

Insurance: School Business Management Handbook No. 2.

ERIC Educational Resources Information Center

Rogers, E. Lloyd

The second revision of this handbook was developed as a practical tool for insurance management for school administrators. The question-and-answer format has been used to enable the busy school administrator to quickly locate and identify his immediate area of concern. The insurance areas discussed are: insurance on real and personal property…

The Administration of Sponsored Programs. Handbook for Developing and Managing Research Activities and Other Projects.

ERIC Educational Resources Information Center

Beasley, Kenneth L.; And Others

Designed as a standard reference and training resource for administrators and project managers, this handbook discusses how to plan, organize, and manage sponsored projects in any organizational setting. It provides detailed, how-to-do-it information and many resources for: negotiating grants, awards, and contracts; organizing a sponsored projects…

Continuing Professional Education of Insurance and Risk Management Practitioners: A Comparative Case Study of Customer Service Representatives, Insurance Agents and Risk Managers

ERIC Educational Resources Information Center

Krauss, George E.

2009-01-01

The purpose of this study is to understand how selected insurance practitioners learn and developed in their practices setting. The selected insurance practitioners (collectively customer service representatives, insurance agents, and risk managers) are responsible for the counseling and placement of insurance products and the implementation of…

Modeling insurer-homeowner interactions in managing natural disaster risk.

PubMed

Kesete, Yohannes; Peng, Jiazhen; Gao, Yang; Shan, Xiaojun; Davidson, Rachel A; Nozick, Linda K; Kruse, Jamie

2014-06-01

The current system for managing natural disaster risk in the United States is problematic for both homeowners and insurers. Homeowners are often uninsured or underinsured against natural disaster losses, and typically do not invest in retrofits that can reduce losses. Insurers often do not want to insure against these losses, which are some of their biggest exposures and can cause an undesirably high chance of insolvency. There is a need to design an improved system that acknowledges the different perspectives of the stakeholders. In this article, we introduce a new modeling framework to help understand and manage the insurer's role in catastrophe risk management. The framework includes a new game-theoretic optimization model of insurer decisions that interacts with a utility-based homeowner decision model and is integrated with a regional catastrophe loss estimation model. Reinsurer and government roles are represented as bounds on the insurer-insured interactions. We demonstrate the model for a full-scale case study for hurricane risk to residential buildings in eastern North Carolina; present the results from the perspectives of all stakeholders-primary insurers, homeowners (insured and uninsured), and reinsurers; and examine the effect of key parameters on the results. © 2014 Society for Risk Analysis.

[Hospital risk management from the viewpoint of insurers].

PubMed

Gausmann, Peter; Petry, Franz Michael

2004-10-01

The present article deals with the significance of risk management in hospitals from the viewpoint of liability insurers. From the perspective of insurance companies, the liability risk of a hospital and its personnel has considerably increased during the past 25 years. The present risk situation is characterized by a growing number of reported liability cases, as well as by an enormous increase of average compensation claims. This development has led some insurance companies to financial deficits in the segment of hospital liability. While some insurers have withdrawn their activities from this market segment, others have reacted by raising their premiums. Since in Germany the premiums usually depend on the number of beds held by a hospital, the problem of rising premiums is exacerbated by the general increase of the number of clinical cases in the face of a parallel reduction of the number of beds. In the process of finding new criteria or methods for adequate premium calculation, a key role will be played by the individual future risk development of a hospital and by the evaluation of this risk by its insurance company. An extensive system of clinical quality management supported by elements of risk management will have persistent positive effects on the development of individual insurance premiums and on the insurability of clinical liability. Risk management is defined as the totality of measures taken by a company to identify risks that could lead to reduced success. Clinical risk management must be regarded in the context of a general trend that is not limited to the field of health service. In this process, the handling of errors and their causes plays a central role. Further variants of hospital risk management are the technical and economic risk management, both of which are increasingly important and are in part implemented in the German legislation. Clinical risk management has originated from the U.S., where as early as in the nineteen

7 CFR 2.44 - Administrator, Risk Management Agency and Manager, Federal Crop Insurance Corporation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for the transaction of the business of the Federal Crop Insurance Corporation and the Risk Management... 7 Agriculture 1 2010-01-01 2010-01-01 false Administrator, Risk Management Agency and Manager... Management Agency and Manager, Federal Crop Insurance Corporation. (a) Delegations. Pursuant to § 2.16(a)(4...

Illness-associated productivity costs among women with employer-sponsored insurance and newly diagnosed breast cancer.

PubMed

Meadows, Eric S; Johnston, Stephen S; Cao, Zhun; Foley, Kathleen A; Pohl, Gerhardt M; Johnston, Joseph A; Ramsey, Scott D

2010-04-01

Determine lost work time and job attrition for incident breast cancer (BC). The cases were employed women, aged 18 to 64, with BC identified by a validated algorithm between 1999 and 2005, from claims (MarketScan) and attendance databases. Controls without cancer were matched 3:1 on age, comorbidity, and index year. First-year mean disability days were 60 (cases, N = 880) versus 5 (controls, N = 2640) (P < 0.001). The first-year disability costs were $4900 for cases versus $385 for controls (P < 0.001). In years 2 through 4, the disability days and associated costs were similar for the cases versus controls. After 4 years, 56.4% of cases were still enrolled in the employer-sponsored insurance programs compared to 6.5% of controls (P < 0.001). The lost work associated with BC is substantial in the first year after diagnosis. Employee retention is much higher for BC cases versus controls.

[Health management in private health insurance].

PubMed

Ziegenhagen, D J; Schilling, M K

2000-09-01

German private health insurance faces new challenges. The classical tools of cost containment are no longer sufficient to keep up with ever increasing expenses for health care, and international competitors with managed care experience from their home markets are on the point of entering business in Germany. Although the American example of managed care is not fully compatible with customer demands and state regulations, some elements of this approach will gradually be introduced. First agreements were signed with networks or individual preferred providers in outpatient care and rehabilitation medicine. Insurance companies become more and more interested in supporting evidence based guidelines and programmes for disease and case management. The pros and cons of various other health management tools are discussed against the specific background of the quite unique German health care system.

Employer-sponsored health insurance: are employers good agents for their employees?

PubMed

Peele, P B; Lave, J R; Black, J T; Evans, J H

2000-01-01

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.

Employer-Sponsored Health Insurance: Are Employers Good Agents for Their Employees?

PubMed Central

Peele, Pamela B.; Lave, Judith R.; Black, Jeanne T.; Evans III, John H.

2000-01-01

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. PMID:10834079

Insurance. School Business Management Handbook No. 2. Revised.

ERIC Educational Resources Information Center

Rogers, E. Lloyd

To provide a practical tool for school insurance management, information concerning various types of insurance coverage and the policy forms used is provided in this handbook. Using a question and answer format the material is presented in eight chapters covering the following areas: (1) insurance on real and personal property; (2) liability…

Insurers' medical loss ratios and quality improvement spending in 2011.

PubMed

Hall, Mark A; McCue, Michael J

2013-03-01

The Affordable Care Act's medical loss ratio (MLR) regulation requires insurers to spend 80 percent or 85 percent of premiums on medical claims and quality improvements. In 2011, insurers falling below this minimum paid more than $1 billion in rebates. This brief examines how insurers spend their premium dollars--particularly their investment in quality improvement activities--focusing on differences among insurers based on corporate traits. In the aggregate, insurers paid less than 1 percent of premiums on either MLR rebates or quality improvement activities in 2011, with amounts varying by insurer type. Publicly traded insurers had significantly lower MLRs in each market segment (individual, small group, and large group), and were more likely to owe a rebate in most segments compared with non-publicly traded insurers. The median quality improvement expenditure per member among nonprofit and provider-sponsored insurers was more than the median among for-profit and non-provider-sponsored insurers.

Weight Management

MedlinePlus

... Expectations & Goals Healthier Lifestyle Healthier Lifestyle Physical Fitness Food & Nutrition Sleep, Stress & Relaxation Emotions & Relationships HealthyYouTXT Tools Home » Weight Management Weight Management Fear of weight gain keeps a ...

24 CFR 213.275 - Nature of the Cooperative Management Housing Insurance Fund.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Nature of the Cooperative Management Housing Insurance Fund. 213.275 Section 213.275 Housing and Urban Development Regulations Relating... Nature of the Cooperative Management Housing Insurance Fund. The Cooperative Management Housing Insurance...

24 CFR 213.275 - Nature of the Cooperative Management Housing Insurance Fund.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Nature of the Cooperative Management Housing Insurance Fund. 213.275 Section 213.275 Housing and Urban Development Regulations Relating... Nature of the Cooperative Management Housing Insurance Fund. The Cooperative Management Housing Insurance...

24 CFR 213.275 - Nature of the Cooperative Management Housing Insurance Fund.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Nature of the Cooperative Management Housing Insurance Fund. 213.275 Section 213.275 Housing and Urban Development Regulations Relating... Nature of the Cooperative Management Housing Insurance Fund. The Cooperative Management Housing Insurance...

24 CFR 213.275 - Nature of the Cooperative Management Housing Insurance Fund.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Nature of the Cooperative Management Housing Insurance Fund. 213.275 Section 213.275 Housing and Urban Development Regulations Relating... Nature of the Cooperative Management Housing Insurance Fund. The Cooperative Management Housing Insurance...

24 CFR 213.275 - Nature of the Cooperative Management Housing Insurance Fund.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Nature of the Cooperative Management Housing Insurance Fund. 213.275 Section 213.275 Housing and Urban Development Regulations Relating... Nature of the Cooperative Management Housing Insurance Fund. The Cooperative Management Housing Insurance...

NATIONAL EMPLOYER HEALTH INSURANCE SURVEY (NEHIS)

EPA Science Inventory

The National Employer Health Insurance Survey (NEHIS) was developed to produce estimates on employer-sponsored health insurance data in the United States. The NEHIS was the first Federal survey to represent all employers in the United States by State and obtain information on all...

Effects of employer-sponsored health insurance costs on Social Security taxable wages.

PubMed

Burtless, Gary; Milusheva, Sveta

2013-01-01

The increasing cost of employer contributions for employee health insurance reduces the share of compensation subject to the Social Security payroll tax. Rising insurance contributions can also have a more subtle effect on the Social Security tax base because they influence the distribution of money wages above and below the taxable maximum amount. This article uses the Medical Expenditure Panel Survey to analyze trends in employer health insurance contributions and the distribution of those costs up and down the wage distribution. Our analysis shows that employer health insurance contributions increased faster than overall compensation during 1996-2008, but such contributions grew only slightly faster among workers earning less than the taxable maximum than they did among those earning more. Because employer health insurance contributions represent a much higher percentage of compensation below the taxable maximum, health insurance cost trends exerted a disproportionate downward pressure on money wages below the taxable maximum.

Diffusion-Weighted Imaging Outside the Brain: Consensus Statement From an ISMRM-Sponsored Workshop

PubMed Central

Taouli, Bachir; Beer, Ambros J.; Chenevert, Thomas; Collins, David; Lehman, Constance; Matos, Celso; Padhani, Anwar R.; Rosenkrantz, Andrew B.; Shukla-Dave, Amita; Sigmund, Eric; Tanenbaum, Lawrence; Thoeny, Harriet; Thomassin-Naggara, Isabelle; Barbieri, Sebastiano; Corcuera-Solano, Idoia; Orton, Matthew; Partridge, Savannah C.; Koh, Dow-Mu

2016-01-01

The significant advances in magnetic resonance imaging (MRI) hardware and software, sequence design, and postprocessing methods have made diffusion-weighted imaging (DWI) an important part of body MRI protocols and have fueled extensive research on quantitative diffusion outside the brain, particularly in the oncologic setting. In this review, we summarize the most up-to-date information on DWI acquisition and clinical applications outside the brain, as discussed in an ISMRM-sponsored symposium held in April 2015. We first introduce recent advances in acquisition, processing, and quality control; then review scientific evidence in major organ systems; and finally describe future directions. PMID:26892827

Insurance Contract Analysis for Company Decision Support in Acquisition Management

NASA Astrophysics Data System (ADS)

Chernovita, H. P.; Manongga, D.; Iriani, A.

2017-01-01

One of company activities to retain their business is marketing the products which include in acquisition management to get new customers. Insurance contract analysis using ID3 to produce decision tree and rules to be decision support for the insurance company. The decision tree shows 13 rules that lead to contract termination claim. This could be a guide for the insurance company in acquisition management to prevent contract binding with these contract condition because it has a big chance for the customer to terminate their insurance contract before its expired date. As the result, there are several strong points that could be the determinant of contract termination such as: 1) customer age whether too young or too old, 2) long insurance period (above 10 years), 3) big insurance amount, 4) big amount of premium charges, and 5) payment method.

The effect of the Americans With Disabilities Act upon medical insurance and employee benefits.

PubMed

Brislin, J A

1992-03-01

The Americans With Disabilities Act will have a significant impact upon plan sponsors and the administration of an employee benefit plan. Prior to the July 26, 1992 effective date, a plan sponsor or trustee should meet with the plan's attorney, provider and other insurance advisers and review the effect ADA will have upon the plan. The EEOC will be issuing additional interpretive rules before the effective date of ADA, and there will be numerous court challenges after the effective date. Plan sponsors and trustees should keep abreast of the developments as they occur. Before a benefit change or premium adjustment is made, it should be reviewed with legal counsel to assure that it conforms to ADA's insurance exemption. Plan sponsors and trustees should have legal counsel, the provider and the plan's insurance advisers develop the documentation that will enable the plan to establish ADA's insurance exemption to defend any legal challenge.

75 FR 30106 - Terrorism Risk Insurance Program; Litigation Management Submissions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

... DEPARTMENT OF THE TREASURY Terrorism Risk Insurance Program; Litigation Management Submissions... U.S.C. 3506(c)(2)(A)). Currently, the Terrorism Risk Insurance Program Office is seeking comments... or by mail (if hard copy, preferably an original and two copies) to: Terrorism Risk Insurance Program...

The Tax Exclusion for Employer-Sponsored Insurance Is Not Regressive-But What Is It?

PubMed

White, Joseph

2017-08-01

Conventional wisdom says that the tax exclusion for employer-sponsored health insurance (ESI) is "regressive and therefore unfair." Yet, by the standard definition of regressive tax policy, the conventional view is almost certainly false. It confuses the absolute size of the tax exclusion with its proportional effect on income. The error results from paying attention only to the marginal tax rate applied to ESI benefits as a portion of income and ignoring the fact that benefits are normally a much larger share of income for people with lower wages. This article explains the difference and then considers other distributional effects of ESI. It suggests that ESI-for those who receive it-further redistributes toward those with lesser means or greater need. The most evident effect is by need, favoring employees with families over those without. Yet there is good reason to believe there is also a redistribution by income, with the package of wages plus benefits being less unequal than wages alone would be. Therefore reformers should be much more careful before criticizing either ESI or its subsidy through the tax code as "unfair," especially as the likelihood of enacting something better in the United States seems quite low. Copyright © 2017 by Duke University Press.

Improving the economic and humanistic outcomes for diabetic patients: making a case for employer-sponsored medication therapy management

PubMed Central

Pinto, Sharrel L; Kumar, Jinender; Partha, Gautam; Bechtol, Robert A

2013-01-01

Background The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees. Methods Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman’s test was used to determine changes in outcomes due to the nonparametric nature of the data. Results The mean number of visits to a physician’s office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed. Conclusion Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program. PMID:23610526

Weight Management

MedlinePlus

... For Reporters Meetings & Workshops Follow Us Home Health Information Weight Management English English Español Weight Management Obesity is a ... at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information ... Disease Urologic Diseases Endocrine Diseases Diet & Nutrition ...

Universal health insurance through incentives reform.

PubMed

Enthoven, A C; Kronick, R

1991-05-15

Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

Type 2 diabetes detection and management among insured adults.

PubMed

Dall, Timothy M; Yang, Weyna; Halder, Pragna; Franz, Jerry; Byrne, Erin; Semilla, April P; Chakrabarti, Ritashree; Stuart, Bruce

2016-01-01

The Centers for Disease Control and Prevention estimates that 28.9 million adults had diabetes in 2012 in the US, though many patients are undiagnosed or not managing their condition. This study provides US national and state estimates of insured adults with type 2 diabetes who are diagnosed, receiving exams and medication, managing glycemic levels, with diabetes complications, and their health expenditures. Such information can be used for benchmarking and to identify gaps in diabetes detection and management. The study combines analysis of survey data with medical claims analysis for the commercially insured, Medicare, and Medicaid populations to estimate the number of adults with diagnosed type 2 diabetes and undiagnosed diabetes by insurance type, age, and sex. Medical claims analysis used the 2012 de-identified Normative Health Information database covering a nationally representative commercially insured population, the 2011 Medicare 5% Sample, and the 2008 Medicaid Mini-Max. Among insured adults in 2012, approximately 16.9 million had diagnosed type 2 diabetes, 1.45 million had diagnosed type 1 diabetes, and 6.9 million had undiagnosed diabetes. Of those with diagnosed type 2, approximately 13.0 million (77%) received diabetes medication-ranging from 70% in New Jersey to 82% in Utah. Suboptimal percentages had claims indicating recommended exams were performed. Of those receiving diabetes medication, 43% (5.6 million) had medical claims indicating poorly controlled diabetes-ranging from 29% with poor control in Minnesota and Iowa to 53% in Texas. Poor control was correlated with higher prevalence of neurological complications (+14%), renal complications (+14%), and peripheral vascular disease (+11%). Patients with poor control averaged $4,860 higher average annual health care expenditures-ranging from $6,680 for commercially insured patients to $4,360 for Medicaid and $3,430 for Medicare patients. This study highlights the large number of insured adults with

Health Insurance Coverage among Puerto Rican Adults in Same-Sex Relationships.

PubMed

Gonzales, Gilbert

2017-01-01

The primary objectives of this study were to measure and compare health insurance coverage between nonelderly Puerto Rican adults in cohabiting same-sex relationships and their counterparts in cohabiting different-sex relationships. This study used data from the 2008-2014 Puerto Rican Community Survey on nonelderly adults (18-64 years) in cohabiting same-sex (n=274) and different-sex (n=58,128) relationships. Multinomial logistic regression models estimated differences in primary source of health insurance while controlling for key demographic and socioeconomic characteristics. Compared with men in different-sex relationships, men in same-sex relationships were less likely to have employer-sponsored insurance (ESI). Women in same-sex relationships were less likely than others to have ESI, insurance purchased directly from an insurer, and public health insurance after controlling for socio-demographic factors. Employment-based discrimination and policy barriers may have prevented same-sex couples from enjoying the full benefits associated with marriage and cohabitation in Puerto Rico, including employer-sponsored health insurance.

Brownfields Environmental Insurance and Risk Management Tools Glossary of Terms

EPA Pesticide Factsheets

This document provides a list of terms that are typically used by the environmental insurance industry, transactional specialists, and other parties involved in using environmental insurance or risk management tools.

Port risk management and insurance guidebook

DOT National Transportation Integrated Search

1998-09-01

The overall objective of the guidebook is to provide ports with the basic skills and information needed to establish and maintain appropriate and cost-effective insurance and risk management programs. it is designed to serve as a practical "how-to" m...

Academic investigator-initiated trials and the challenge of sponsor responsibility: the Cologne Sponsor Model.

PubMed

Georgias, Christine; Grunow, Andrea; Olderog, Miriam; May, Alexander; Paulus, Ursula

2012-12-01

With the amendment to the German Drug Law in 2004, the conduct of clinical trials changed by at least two main aspects: (1) The principles of Good Clinical Practice (GCP) were implemented in the national legislation, and (2) for the first time, the function of the sponsor of a clinical trial and the clinical trial itself have become legally binding definitions. By that, legal differences between industrial and academic clinical trials no longer exist. Clinical trials initiated by investigators have to fulfil the same requirements while the entire sponsor responsibility has to be carried out by the Coordinating Investigator or his institution including implementation of a quality management system according to the GCP. The Cologne Sponsor Model is an effective approach with settings, structures, basic features, action, and reporting lines, as well as funding for clinical trials initiated in an academic environment. The University of Cologne assumes the sponsor responsibility for clinical trials organised by the university researchers according to law. Sponsor's duties are delegated to a central operational unit of the sponsor - the Clinical Trials Center Cologne - which further delegates duties to the Coordinating Investigator. Clinical Trials Center Cologne was established in 2002 to support the performance of clinical trials at the university by offering comprehensive advisory and practical services covering all aspects of study planning and conduct. Furthermore, a specialised division of its quality management department acts as an independent sponsor's Quality Assurance Unit. The Clinical Trials Center Cologne has established a quality management system consisting of different components (1) to enable a reasoned decision to subsequent delegation, (2) for risk-based surveillance of trial conduct (audits, monitoring-checks, and reports), and (3) support and training of the Coordinating Investigator. Double functions of persons and departments in the university

The transfer of a health insurance/managed care business.

PubMed

Gavin, John N; Goodman, George; Goroff, David B

2007-01-01

The owners of a health insurance/managed care business may want to sell that business for a variety of reasons. Health care provider systems may want to exit that business due to operating losses, difficulty in complying with regulations, the inherent conflict in operating that business as part of a provider system, or the desire to focus on being a health care provider. Health insurers/HMOs may want to sell all or a portion of their business due to operating losses, difficulty in servicing a particular market, or a desire to focus on other markets. No matter what reason prompts a seller to undertake a sale, a sale of health insurance/managed care business can be a complicated transaction involving a multitude of issues. This article will focus first on the ways in which such a sale may be structured. The article will then discuss some transactional issues that may arise in the negotiations for the sale of a health insurance/managed care business. The article will then focus on some particular legal issues that arise in each sale-e.g., antitrust, HIPAA, regulatory approvals, and charitable issues. Finally, this article will provide an overview of tax structuring considerations.

Evolution of seismic risk management for insurance over the past 30 years

NASA Astrophysics Data System (ADS)

Shah, Haresh C.; Dong, Weimin; Stojanovski, Pane; Chen, Alex

2018-01-01

During the past 30 years, there has been spectacular growth in the use of risk analysis and risk management tools developed by engineers in the financial and insurance sectors. The insurance, the reinsurance, and the investment banking sectors have enthusiastically adopted loss estimation tools developed by engineers in developing their business strategies and for managing their financial risks. As a result, insurance/reinsurance strategy has evolved as a major risk mitigation tool in managing catastrophe risk at the individual, corporate, and government level. This is particularly true in developed countries such as US, Western Europe, and Japan. Unfortunately, it has not received the needed attention in developing countries, where such a strategy for risk management is most needed. Fortunately, in the last five years, there has been excellent focus in developing "InsurTech" tools to address the much needed "Insurance for the Masses", especially for the Asian Markets. In the earlier years of catastrophe model development, risk analysts were mainly concerned with risk reduction options through engineering strategies, and relatively little attention was given to financial and economic strategies. Such state-of-affairs still exists in many developing countries. The new developments in the science and technologies of loss estimation due to natural catastrophes have made it possible for financial sectors to model their business strategies such as peril and geographic diversification, premium calculations, reserve strategies, reinsurance contracts, and other underwriting tools. These developments have not only changed the way in which financial sectors assess and manage their risks, but have also changed the domain of opportunities for engineers and scientists. This paper will address the issues related to developing insurance/reinsurance strategies to mitigate catastrophe risks and describe the role catastrophe risk insurance and reinsurance has played in managing

Risk Management: Getting the Most for Your Insurance Dollars

ERIC Educational Resources Information Center

Abramson, Paul

1973-01-01

Analyze what insurance is intended to do by going through the risk management process: identify exposures to loss, measure their financial impact on the institution, rationalize the means of controlling exposures, prevent loss, and set up a program to minimize the impact of loss through insurance or other means. (Author)

Employer-sponsored insurance, health care cost growth, and the economic performance of U.S. Industries.

PubMed

Sood, Neeraj; Ghosh, Arkadipta; Escarce, José J

2009-10-01

To estimate the effect of growth in health care costs that outpaces gross domestic product (GDP) growth ("excess" growth in health care costs) on employment, gross output, and value added to GDP of U.S. industries. We analyzed data from 38 U.S. industries for the period 1987-2005. All data are publicly available from various government agencies. We estimated bivariate and multivariate regressions. To develop the regression models, we assumed that rapid growth in health care costs has a larger effect on economic performance for industries where large percentages of workers receive employer-sponsored health insurance (ESI). We used the estimated regression coefficients to simulate economic outcomes under alternative scenarios of health care cost inflation. Faster growth in health care costs had greater adverse effects on economic outcomes for industries with larger percentages of workers who had ESI. We found that a 10 percent increase in excess growth in health care costs would have resulted in 120,803 fewer jobs, US$28,022 million in lost gross output, and US$14,082 million in lost value added in 2005. These declines represent 0.17 to 0.18 percent of employment, gross output, and value added in 2005. Excess growth in health care costs is adversely affecting the economic performance of U.S. industries.

NASA and Industry Partners Co-sponsor 2015 Unmanned Aircraft Systems Traffic Management (UTM) Convention

NASA Image and Video Library

2015-08-07

With issues about drones becoming front page news, NASA recently co-sponsored the 2015 Unmanned Aerial Systems Traffic Management Convention. Held at NASA’s Ames Research Center, the event brought together representatives from the public, from industry, academia, government and the international community to shape the future of low-altitude air traffic management.

The experience of weight management in normal weight adults.

PubMed

Hernandez, Cheri Ann; Hernandez, David A; Wellington, Christine M; Kidd, Art

2016-11-01

No prior research has been done with normal weight persons specific to their experience of weight management. The purpose of this research was to discover the experience of weight management in normal weight individuals. Glaserian grounded theory was used. Qualitative data (focus group) and quantitative data (food diary, study questionnaire, and anthropometric measures) were collected. Weight management was an ongoing process of trying to focus on living (family, work, and social), while maintaining their normal weight targets through five consciously and unconsciously used strategies. Despite maintaining normal weights, the nutritional composition of foods eaten was grossly inadequate. These five strategies can be used to develop new weight management strategies that could be integrated into existing weight management programs, or could be developed into novel weight management interventions. Surprisingly, normal weight individuals require dietary assessment and nutrition education to prevent future negative health consequences. Copyright © 2016 Elsevier Inc. All rights reserved.

The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans.

PubMed

Li, Xiaoxue; Ye, Jinqi

2017-09-01

This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance. We exploit state-by-year variation in policy implementation in 1999-2008 and focus on a sample of veterans, who have better access to public insurance than non-veterans. Using data from the Current Population Survey, we find that the parity laws reduce employer-sponsored insurance (ESI) coverage by 2.1% points. The drop in ESI is largely offset by enrollment gains in public insurance, namely through the Veterans Affairs (VA) benefit and Medicaid/Medicare programs. Copyright © 2017 Elsevier B.V. All rights reserved.

Cyber Insurance - Managing Cyber Risk

DTIC Science & Technology

2015-04-01

license under the clause at DFARS 252.227-7013 (a)(16) [Jun 2013]. Cyber Insurance – Managing Cyber Risk Data breaches involving...significant personal information losses and financial impact are becoming increasingly common. Whether the data breach has financial implications for...hundreds of millions of dollars depending on the type and size of the breach. Most states have some type of data breach law requiring notification

InWiM: knowledge management for insurance medicine.

PubMed

Bleuer, Juerg P; Bösch, Kurt; Ludwig, Christian A

2008-01-01

Suva (Swiss National Accident Insurance Fund) is the most important carrier of obligatory accident insurance in Switzerland. Its services not only comprise insurance but also prevention, case management and rehabilitation. Suva's medical division supports doctors in stationary and ambulatory care with comprehensive case management and with conciliar advice. Two Suva clinics provide stationary rehabilitation. Medicine in general, including insurance medicine, faces the problem of a diversity of opinions about the facts of a case. One of the reasons is a diversity of knowledge. This is the reason why Suva initiated a knowledge management project called InWiM. "InWiM" is the acronym for "Integrierte Wissensbasen der Medizin" which can be translated as "Integrated Knowledge Bases in Medicine". The project is part of an ISO 9001 certification program and comprises the definition and documentation of all processes in the field of knowledge management as well as the development of the underlying ITC infrastructure. The knowledge representation model used for the ICT implementation considers knowledge as a multidimensional network of interlinked units of information. In contrast to the hyperlink technology in the World Wide Web, links between items are bidirectional: the target knows the source of the link. Links are therefore called cross-links. The model allows annotation for the narrative description of the nature of the units of information (e.g. documents) and the cross-links as well. Information retrieval is achieved by means of a full implementation of the MeSH Index, the thesaurus of the United States National Library of Medicine (NLM). As far as the authors are aware, InWiM is currently the only implementation worldwide - with the exception of the NLM and its national representatives - which supports all MeSH features for in-house retrieval.

Does Migration Limit the Effect of Health Insurance on Hypertension Management in China?

PubMed

Fang, Hai; Jin, Yinzi; Zhao, Miaomiao; Zhang, Huyang; A Rizzo, John; Zhang, Donglan; Hou, Zhiyuan

2017-10-20

Background: In China, rapid urbanization has caused migration from rural to urban areas, and raised the prevalence of hypertension. However, public health insurance is not portable from one place to another, and migration may limit the effectiveness of this non-portable health insurance on healthcare. Our study aims to investigate whether migration limits the effectiveness of health insurance on hypertension management in China. Methods: Data were obtained from the national baseline survey of the China Health and Retirement Longitudinal Study in 2011, including 4926 hypertensive respondents with public health insurance. Outcome measures included use of primary care, hypertension awareness, medication use, blood pressure monitoring, physician advice, and blood pressure control. Multivariate logistic regressions were estimated to examine whether the effects of rural health insurance on hypertension management differed between those who migrated to urban areas and those who did not migrate and lived in rural areas. Results: Among hypertensive respondents, 60.7% were aware of their hypertensive status. Compared to rural residents, the non-portable feature of rural health insurance significantly reduced rural-to-urban migrants' probabilities of using primary care by 7.8 percentage points, hypertension awareness by 8.8 percentage points, and receiving physician advice by 18.3 percentage points. Conclusions: In China, migration to urban areas limited the effectiveness of rural health insurance on hypertension management due to its non-portable nature. It is critical to improve the portability of rural health insurance, and to extend urban health insurance and primary care coverage to rural-to-urban migrants to achieve better chronic disease management.

Does Migration Limit the Effect of Health Insurance on Hypertension Management in China?

PubMed Central

Fang, Hai; Jin, Yinzi; Zhang, Huyang; A. Rizzo, John; Zhang, Donglan; Hou, Zhiyuan

2017-01-01

Background: In China, rapid urbanization has caused migration from rural to urban areas, and raised the prevalence of hypertension. However, public health insurance is not portable from one place to another, and migration may limit the effectiveness of this non-portable health insurance on healthcare. Our study aims to investigate whether migration limits the effectiveness of health insurance on hypertension management in China. Methods: Data were obtained from the national baseline survey of the China Health and Retirement Longitudinal Study in 2011, including 4926 hypertensive respondents with public health insurance. Outcome measures included use of primary care, hypertension awareness, medication use, blood pressure monitoring, physician advice, and blood pressure control. Multivariate logistic regressions were estimated to examine whether the effects of rural health insurance on hypertension management differed between those who migrated to urban areas and those who did not migrate and lived in rural areas. Results: Among hypertensive respondents, 60.7% were aware of their hypertensive status. Compared to rural residents, the non-portable feature of rural health insurance significantly reduced rural-to-urban migrants’ probabilities of using primary care by 7.8 percentage points, hypertension awareness by 8.8 percentage points, and receiving physician advice by 18.3 percentage points. Conclusions: In China, migration to urban areas limited the effectiveness of rural health insurance on hypertension management due to its non-portable nature. It is critical to improve the portability of rural health insurance, and to extend urban health insurance and primary care coverage to rural-to-urban migrants to achieve better chronic disease management. PMID:29053607

Managing acute cholecystitis among Medicaid insured in New York State: opportunities to optimize care.

PubMed

Stey, Anne M; Greenstein, Alexander J; Aufses, Arthur; Moskowitz, Alan J; Egorova, Natalia N

2018-05-01

Identifying sources of unnecessary cost within Medicaid will help focus cost containment efforts. This study sought to identify differences in surgical management and associated costs of cholecystitis between Medicaid and privately insured in New York State. The New York State all-payer mandatory discharge database from 2003 to 2013, had 297,635 patients with Medicaid (75,512) and privately (222,123) insurance who underwent cholecystectomy for cholecystitis. Patients were stratified by insurance. Four surgical management approaches were delineated based on cholecystectomy timing: primary, interval, emergency, and delayed cholecystectomy. Delayed cholecystectomy was defined as more than one hospital visit from diagnosis to definitive cholecystectomy. Medicaid and privately insured patients were propensity score matched. Surgical management approach and associated costs were compared between matched cohorts. A greater proportion of Medicaid patients underwent delayed cholecystectomy compared to matched privately insured patients, 8.5 versus 4.8%; P < 0.001. Primary initial cholecystectomy was performed in fewer Medicaid compared to privately insured patients, 55.4 versus 66.0%, P < 0.001. Primary initial cholecystectomy was the cheapest surgical management approach, with the median cost of $3707, and delayed cholecystectomy was the most expensive, $12,212, P < 0.001. The median cost per Medicaid patient was $6170 versus $4804 per matched privately insured patient, P < 0.001. The annual predicted cost savings for New York State Medicaid would be $13,097,371, if the distribution of surgical management approaches were proportionally similar to private insurance. Medicaid patients with cholecystitis were more frequently managed with delayed cholecystectomy than privately insured patients, which had substantial cost implications for the New York Medicaid Program.

Working families' health insurance coverage, 1997-2001.

PubMed

Strunk, Bradley C; Reschovsky, James D

2002-08-01

Despite a booming U.S. economy, falling unemployment and moderate health insurance premium growth, the percentage of working Americans and their families with employer-sponsored health insurance failed to increase substantially between 1997 and 2001, according to findings from the Center for Studying Health System Change (HSC) Community Tracking Study Household Survey. There were, however, dramatic changes in the insurance status of people who lacked access to or did not take up employer coverage: fewer uninsured, more public program enrollment and a decline in coverage by individual insurance and other sources. While the State Children's Health Insurance Program (SCHIP) clearly reduced uninsurance among low-income children, evidence also suggests a fair amount of substitution of public insurance for private coverage.

Employer-Sponsored Insurance, Health Care Cost Growth, and the Economic Performance of U.S. Industries

PubMed Central

Sood, Neeraj; Ghosh, Arkadipta; Escarce, José J

2009-01-01

Objective To estimate the effect of growth in health care costs that outpaces gross domestic product (GDP) growth (“excess” growth in health care costs) on employment, gross output, and value added to GDP of U.S. industries. Study Setting We analyzed data from 38 U.S. industries for the period 1987–2005. All data are publicly available from various government agencies. Study Design We estimated bivariate and multivariate regressions. To develop the regression models, we assumed that rapid growth in health care costs has a larger effect on economic performance for industries where large percentages of workers receive employer-sponsored health insurance (ESI). We used the estimated regression coefficients to simulate economic outcomes under alternative scenarios of health care cost inflation. Results Faster growth in health care costs had greater adverse effects on economic outcomes for industries with larger percentages of workers who had ESI. We found that a 10 percent increase in excess growth in health care costs would have resulted in 120,803 fewer jobs, US$28,022 million in lost gross output, and US$14,082 million in lost value added in 2005. These declines represent 0.17 to 0.18 percent of employment, gross output, and value added in 2005. Conclusion Excess growth in health care costs is adversely affecting the economic performance of U.S. industries. PMID:19500165

Drug company-sponsored patient assistance programs: a viable safety net?

PubMed

Choudhry, Niteesh K; Lee, Joy L; Agnew-Blais, Jessica; Corcoran, Colleen; Shrank, William H

2009-01-01

Drug company-sponsored patient assistance programs (PAPs) provide access to brand-name medications at little or no cost and have been advocated as a safety net for inadequately insured patients. Yet little is known about these programs. We surveyed drug company-sponsored PAPs and found much variability in their structures and application processes. Most cover one or two drugs. Only 4 percent disclosed how many patients they had directly helped, and half would not disclose their income eligibility criteria. A better understanding of PAPs might clarify their role in improving access to medications, the adequacy of existing public programs, and their impact on cost-effective medication use.

7 CFR 654.11 - Sponsor(s)' responsibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) shall obtain NRCS approval before modifying a project measure of changing land use to fulfill a... § 654.11 Sponsor(s)' responsibility. (a) On non-Federal land, sponsor(s) are responsible for financing... land involving project measures is responsible either for performing or requiring the performance of O...

Insurance-related and financial challenges reported by managed care enrollees with breast cancer.

PubMed

Klimmek, Rachel; Snow, Denise; Wenzel, Jennifer

2010-10-01

Cancer survivors in the United States often encounter significant challenges in obtaining and paying for medical care. Multiple research studies have examined these issues in Medicare and Medicaid populations and the underinsured, but very little is known about insurance-related challenges encountered by cancer survivors enrolled in private insurance programs such as managed care. This secondary analysis of data explored the insurance-related and financial challenges reported by women enrolled in a managed care organization during cancer treatment and early follow-up. The researchers reviewed semistructured interviews with 14 women with breast cancer near the time of diagnosis, midway through treatment, and after treatment completion. Most women reported considerable stress related to performance of insurance-related tasks during or immediately after treatment, which resulted in negative emotional and psychological experiences. This article presents recommendations for how oncology nurses can intervene to assess and address these challenges and their effects. Future research should examine best practices related to nursing management of insurance-related and financial challenges during cancer.

Health insurance premium tax credit. Final regulations.

PubMed

2013-02-01

This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.These final regulations provide guidance to individuals related to employees who may enroll in eligible employer-sponsored coverage and who wish to enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit.

Work, Health, And Insurance: A Shifting Landscape For Employers And Workers Alike.

PubMed

Buchmueller, Thomas C; Valletta, Robert G

2017-02-01

We examined the complex relationship among work, health, and health insurance, which has been affected by changing demographics and employment conditions in the United States. Stagnation or deterioration in employment conditions and wages for much of the workforce has been accompanied by the erosion of health outcomes and employer-sponsored insurance coverage. In this article we present data and discuss the research that has established these links, and we assess the potential impact of policy responses to the evolving landscape of work and health. The expansion of insurance availability under the Affordable Care Act may have helped reduce the burden on employers to provide health insurance. However, the act's encouragement of wellness programs has uncertain potential to help contain the rising costs of employer-sponsored health benefits. Project HOPE—The People-to-People Health Foundation, Inc.

77 FR 72721 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-06

... Research Trust Fund AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final regulations. SUMMARY... sponsors of certain self-insured health plans to fund the Patient- Centered Outcomes Research Trust Fund...-Centered Outcomes Research Institute (the ``Institute''). Through research, the Institute will assist...

Disability management in a sample of Australian self-insured companies.

PubMed

Westmorland, M; Buys, N; Clements, N

2002-09-20

Disability management (DM) is a term developed in North America and refers to the prevention and management of injury and illness in the workplace. The purpose of this paper is to report findings of an Australian study that examined whether self-insured employers in that country have implemented integrated DM programmes. Key principles underpinning such programmes are explored to identify the extent to which Australian employers have adopted them. Data was collected from 29 self-insured Australian companies in three Australian States using a structured interview format with additional open-ended questions. It was found that companies have in place, to varying degrees, some of the key elements of disability management programmes. However, these elements were often not well integrated in a comprehensive disability management approach. The focus on workplace-based, early intervention in the area of return to work for injured employees was particularly strong, but there was little evidence of formal labour-management committee structures responsible for implementing DM programmes. If the concept of DM is relevant to the Australian environment then this study would suggest that self-insured companies need to undertake further work to develop integrated approaches to preventing and managing disability in the workplace. Several limitations of this study are highlighted and it is concluded that further work in this area is needed.

The impact of insurance coverage and the family on pediatric diabetes management.

PubMed

Watson, Sara E; Kuhl, Evan A; Foster, Michael B; Omoruyi, Adetokunbo O; Kingery, Suzanne E; Woods, Charles; Wintergerst, Kupper A

2017-06-01

The impact of family composition on glycemic control in children with type 1 diabetes remains unclear. We sought to evaluate the relationship between health insurance coverage, family composition, and insulin management, and assess their impact on glycemic control in a pediatric type 1 diabetes population. A retrospective chart review was completed for patients seen in the Pediatric Endocrinology Clinic at the University of Louisville in 2012. The analysis included 729 patients with type 1 diabetes; 268 (37%) had public insurance while 461(63%) had private insurance. Compared with publicly insured patients, privately insured patients had higher rates of intensive insulin management with multiple daily injections (MDI) plans or pump devices (88 vs. 83.2%, p = 0.066) and lower HbA1c levels [8.57 vs. 9.39% (70 vs. 79 mmol/mol), p < 0.001]. Of the 729 patients, 243 were in single-adult homes (33%). Single-adult homes had higher HbA1c levels than two-adult homes, [9.3 vs. 8.6% (78 vs. 70 mmol/mol), p < 0.001]. Among publicly insured, there was no difference in HbA1c levels for single-adult vs. two-adult homes [9.4 (79 mmol/mol), p = 0.868]. For privately insured, patients in single-adult homes had higher HbA1c levels than peers in two-adult homes [9.2 vs. 8.4% (77 vs. 68), p < 0.001]. Insurance type and family composition have significant associative effects on glycemic control and insulin management that may be mitigated by insulin pump therapy. Identifying and addressing factors such as availability of resources, family education, and adult support and supervision, may help improve glycemic control in high-risk pediatric diabetes patients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Population-based worksite obesity management interventions: a qualitative case study.

PubMed

Romney, Martha C; Thomson, Erin; Kash, Kathryn

2011-06-01

Due to the increased prevalence of obesity and associated direct and indirect costs to employers, weight management programs have become an integral component of employer and insurer benefits plans. The programs vary in foci, scope, breadth, and implementation. The aim of this study was to explore promising employer-sponsored population-based obesity management programs. A case study that utilized a telephonic semi-structured questionnaire was conducted with small and large organizations located in different regions of the United States that had been recruited to participate. Eight employers and 1 health care advocacy coalition who met the inclusion criteria were interviewed about features of their weight management programs. The case study revealed a number of themes consistent with reports in the literature and reflecting cited best practices. Key findings include confirmation that weight management is a significant component of the wellness strategy in all participating organizations because employers are invested in population health programs and cost savings. Based upon their experience and knowledge, occupational health specialists are responsible for designing, implementing, managing, and evaluating employee health programs. Almost all employers utilize electronic media as a prominent component of wellness and disease management initiatives. Experience has shown that incentives-both financial and nonmonetary-are effective motivators for employee engagement and outcomes. However, while employers report success, favorable outcomes have been difficult to quantify.

Effective Client Management: Maximizing The Influence of External Sponsors Over Affiliated Armed Groups

DTIC Science & Technology

2017-12-01

MANAGEMENT : MAXIMIZING THE INFLUENCE OF EXTERNAL SPONSORS OVER AFFILIATED ARMED GROUPS by Anders C. Hamlin December 2017 Thesis Co...burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instruction, searching...existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information . Send comments regarding this

Insurer and employer views on pediatric obesity treatment: a qualitative study.

PubMed

Hampl, S E; Davis, A M; Sampilo, M L; Stephens, K L; Dean, K

2013-04-01

The effectiveness of group-based comprehensive, multidisciplinary (stage 3) pediatric weight management programs is backed by a growing body of literature, yet insurance coverage of these programs is scarce to nonexistent, limiting their reach and long-term survival. The objective of this study was to better understand the perspectives of insurers and large employers on the issue of group-based treatment coverage. The authors performed a qualitative study utilizing structured interviews with these stakeholders, following accepted techniques. Six major themes emerged: cost, program effectiveness, corporate social responsibility, secondary parental (employee) benefits, coverage options and new benefit determination. Future efforts to secure payment for group-based pediatric weight management programs should address these key themes. Copyright © 2012 The Obesity Society.

Insurance coverage for massive weight loss panniculectomy: a national survey and implications for policy.

PubMed

Dreifuss, Stephanie E; Rubin, J Peter

2016-02-01

Current panniculectomy coverage guidelines are developed by insurance companies, and surgeons have limited input as to what policies are fair to physicians and patients. In this study, for the first time, plastic surgeons were surveyed nationally to determine their opinions on which coverage criteria are clear, reasonable, and accessible. The objective of this study was to compare how frequently insurance companies use panniculectomy coverage criteria versus how favorably plastic surgeons assess these criteria. United States plastic surgery practices. Panniculectomy coverage criteria were compiled from third-party payors nationally. A survey using these criteria to assess the clarity, accessibility, and reasonability of each criterion was created and distributed to all members of the American Society of Plastic Surgeons. According to survey responses from plastic surgeons, the highest ranking criteria for panniculectomy coverage were "Patient is weight stable for at least 6 months" and "Patient must be at least 18 months post-bariatric surgery." These criteria were required by only 41.3% and 39.7% of insurance providers, respectively. The most common requirement for insurance coverage was "Chronic maceration of skin folds with failure to respond to at least 3 months of treatment with oral or topical medication." This was necessary for coverage by 81% of insurance providers, yet plastic surgeons ranked this criterion 12th of 17 criteria. Here we present a physician assessment of insurance criteria for the coverage of panniculectomy. Given the discrepancy between how favorably a criterion is scored by plastic surgeons and how frequently it is required by third-party payors for coverage, we conclude that more physician involvement in the development of insurance coverage guidelines would be beneficial. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

41 CFR 60-741.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life insurance and other benefit plans. 60-741.25 Section 60-741.25 Public Contracts and Property Management... Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service...

Evaluating Long-Term Disability Insurance Plans.

ERIC Educational Resources Information Center

Powell, Jan

1992-01-01

This report analyzes the factors involved in reviewing benefits and services of employer-sponsored group long-term disability plans for higher education institutions. Opening sections describe the evolution of disability insurance and its shape today. Further sections looks at the complex nature of "value" within a plan, relationship…

Polycystic ovary syndrome and weight management.

PubMed

Moran, Lisa J; Lombard, Catherine B; Lim, Siew; Noakes, Manny; Teede, Helena J

2010-03-01

Polycystic ovary syndrome (PCOS) is a common condition in women of reproductive age, and has reproductive, metabolic and psychological implications. Weight gain and obesity worsen the features of PCOS, while weight loss improves the features of PCOS. While there are potential barriers to successful weight management in young women who do not suffer from PCOS, women with PCOS may experience additional barriers. Weight management strategies in younger women with or without PCOS should encompass both the prevention of excess weight gain and achieving and maintaining a reduced weight through multidisciplinary lifestyle management, comprising dietary, exercise and behavioral therapy, as well as attention to psychosocial stress and practical and physiological barriers to weight management. Further research is warranted in the examination of specific barriers to weight management in women with PCOS, as well as in the determination of optimal components of lifestyle weight management interventions in young women in order to facilitate long-term compliance.

MCBS Highlights: Ownership and Average Premiums for Medicare Supplementary Insurance Policies

PubMed Central

Chulis, George S.; Eppig, Franklin J.; Poisal, John A.

1995-01-01

This article describes private supplementary health insurance holdings and average premiums paid by Medicare enrollees. Data were collected as part of the 1992 Medicare Current Beneficiary Survey (MCBS). Data show the number of persons with insurance and average premiums paid by type of insurance held—individually purchased policies, employer-sponsored policies, or both. Distributions are shown for a variety of demographic, socioeconomic, and health status variables. Primary findings include: Seventy-eight percent of Medicare beneficiaries have private supplementary insurance; 25 percent of those with private insurance hold more than one policy. The average premium paid for private insurance in 1992 was $914. PMID:10153473

[Disease management programs from a health insurer's point of view].

PubMed

Szymkowiak, Christof; Walkenhorst, Karen; Straub, Christoph

2003-06-01

Disease Management Programmes represent a great challenge to the German statutory health insurance system. According to politicians, disease management programmes are an appropriate tool for increasing the level of care for chronically ill patients significantly, while at the same time they can slow down the cost explosion in health care. The statutory health insurers' point of view yields a more refined picture of the chances and risks involved. The chances are that a medical guideline-based, evidence-based, co-operative care of the chronically ill could be established. But also, there are the risks of misuse of disease management programmes and of misallocation of funds due to the ill-advised linkage with the so-called risk compensation scheme (RSA) balancing the sickness funds' structural deficits through redistribution. The nation-wide introduction of disease management programmes appears to be a gigantic experiment whose aim is to change the care of chronically ill patients and whose outcome is unpredictable.

The Balloon Analog Insurance Task (BAIT): a behavioral measure of protective risk management.

PubMed

Essex, Brian G; Lejuez, Carl W; Qian, Rebecca Y; Bernstein, Katherine; Zald, David H

2011-01-01

Prior methods used to assess individual differences related to risk have not focused on an important component of risk management: how willing individuals are to pay for or take actions to insure what they already have. It is not clear whether this type of protective risk management taps into the same individual differences as does risk taking propensity measured by existing risk taking tasks. We developed a novel task to assess protective risk management, the Balloon Analog Insurance Task (BAIT), which is modeled after the Balloon Analog Risk Task (BART). In the BAIT, individuals are forced to decide how much money they are willing to pay in order to insure a specific fraction of their prior winnings given changing but imprecise levels of risk of monetary loss. Participants completed the BART and BAIT for real monetary rewards, and completed six self report questionnaires. The amount of insurance purchased on the BAIT was positively correlated with scores on the Intolerance of Uncertainty Scale and on the Checking scale of the revised Obsessive Compulsive Inventory. Conversely, the amount of insurance purchased was negatively correlated with scores on the Domain Specific Risk Taking Questionnaire, and on the Psychopathic Personality Inventory (PPI). Furthermore, relationships between insurance purchased and these scales remained significant after controlling for the BART in linear regression analyses, and the BART was only a significant predictor for measures on one scale--the PPI. Our results reveal that behavior on the BAIT taps into a number of individual differences that are not related to behavior on another measure of risk taking. We propose that the BAIT may provide a useful complement to the BART in the assessment of risk management style.

How does beneficiary knowledge of the Medicare program vary by type of insurance?

PubMed

McCormack, Lauren A; Uhrig, Jennifer D

2003-08-01

Prior research found that Medicare beneficiaries' knowledge of the Medicare program varied by the type of supplemental insurance they had. However, none of these studies used both multivariate methods and nationally representative data to examine the issue. OBJECTIVES To measure beneficiary knowledge of the Medicare program and to evaluate how knowledge varies by type of supplemental insurance. A mail survey with telephone follow-up to a nationally representative random sample of Medicare beneficiaries, which had a 76% response rate. The purpose of the study was to evaluate the effects of providing the Medicare & You handbook on beneficiary knowledge, information needs, and health plan decision making. A total of 3738 Medicare beneficiaries who completed the survey. A psychometrically validated 22-item index that reflects Medicare-related knowledge in seven different content areas. RESULTS Overall, beneficiaries with a Medicare HMO or non-employer-sponsored supplemental insurance were more knowledgeable about Medicare than those who had Medicare only. In general, beneficiaries tended to be more knowledgeable about issues related to the type of insurance they had (fee-for-service or managed care) than other types of insurance. Higher levels of knowledge about one's own type of insurance may suggest that beneficiaries learn by experience or they learn more about that type of insurance before enrollment. Further research is needed to better understand how and when beneficiaries learn about insurance and what educational strategies are more effective at increasing knowledge.

The Balloon Analog Insurance Task (BAIT): A Behavioral Measure of Protective Risk Management

PubMed Central

Essex, Brian G.; Lejuez, Carl W.; Qian, Rebecca Y.; Bernstein, Katherine; Zald, David H.

2011-01-01

Prior methods used to assess individual differences related to risk have not focused on an important component of risk management: how willing individuals are to pay for or take actions to insure what they already have. It is not clear whether this type of protective risk management taps into the same individual differences as does risk taking propensity measured by existing risk taking tasks. We developed a novel task to assess protective risk management, the Balloon Analog Insurance Task (BAIT), which is modeled after the Balloon Analog Risk Task (BART). In the BAIT, individuals are forced to decide how much money they are willing to pay in order to insure a specific fraction of their prior winnings given changing but imprecise levels of risk of monetary loss. Participants completed the BART and BAIT for real monetary rewards, and completed six self report questionnaires. The amount of insurance purchased on the BAIT was positively correlated with scores on the Intolerance of Uncertainty Scale and on the Checking scale of the revised Obsessive Compulsive Inventory. Conversely, the amount of insurance purchased was negatively correlated with scores on the Domain Specific Risk Taking Questionnaire, and on the Psychopathic Personality Inventory (PPI). Furthermore, relationships between insurance purchased and these scales remained significant after controlling for the BART in linear regression analyses, and the BART was only a significant predictor for measures on one scale - the PPI. Our results reveal that behavior on the BAIT taps into a number of individual differences that are not related to behavior on another measure of risk taking. We propose that the BAIT may provide a useful complement to the BART in the assessment of risk management style. PMID:21738666

Disease management programs in Germany's statutory health insurance system.

PubMed

Busse, Reinhard

2004-01-01

The introduction in 1996 of free choice among sickness funds in Germany was accompanied by a "risk structure compensation" (RSC) mechanism based on average spending by age and sex. Because chronically ill people were not adequately taken into account, competition for newly insured consumers concentrated on the healthy. The introduction in 2002 of disease management programs addresses this problem: Insured people in such programs are treated as a separate RSC category, making them a more "attractive" group that no longer generates a deficit. The degree of sickness fund activities and the fierce dispute with physicians are valid indicators that the incentives work.

Using Medicaid/SCHIP to insure working families: the Massachusetts experience.

PubMed

Mitchell, Janet B; Osber, Deborah S

2002-01-01

Massachusetts was the first State to implement a premium subsidy program for employer-sponsored health insurance, using both Medicaid and State Children's Health Insurance Program (SCHIP) funding. The Insurance Partnership (IP) provides subsidies directly to small employers, and the Premium Assistance Program provides subsidies to their low-income employees. Approximately 3,500 small firms currently participate, most of them offering health insurance coverage for the first time. Approximately 10,000 adults and children are covered through the program, the majority of whom had been uninsured prior to enrolling. Massachusetts' successful experience with premium subsidies offers important lessons for other States wishing to implement similar programs.

Increasing Health Insurance Costs and the Decline in Insurance Coverage

PubMed Central

Chernew, Michael; Cutler, David M; Keenan, Patricia Seliger

2005-01-01

Objective To determine the impact of rising health insurance premiums on coverage rates. Data Sources & Study Setting Our analysis is based on two cohorts of nonelderly Americans residing in 64 large metropolitan statistical areas (MSAs) surveyed in the Current Population Survey in 1989–1991 and 1998–2000. Measures of premiums are based on data from the Health Insurance Association of America and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer-Sponsored Health Benefits. Study Design Probit regression and instrumental variable techniques are used to estimate the association between rising local health insurance costs and the falling propensity for individuals to have any health insurance coverage, controlling for a rich array of economic, demographic, and policy covariates. Principal Findings More than half of the decline in coverage rates experienced over the 1990s is attributable to the increase in health insurance premiums (2.0 percentage points of the 3.1 percentage point decline). Medicaid expansions led to a 1 percentage point increase in coverage. Changes in economic and demographic factors had little net effect. The number of people uninsured could increase by 1.9–6.3 million in the decade ending 2010 if real, per capita medical costs increase at a rate of 1–3 percentage points, holding all else constant. Conclusions Initiatives aimed at reducing the number of uninsured must confront the growing pressure on coverage rates generated by rising costs. PMID:16033490

77 FR 25788 - Request for Information Regarding Stop Loss Insurance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-01

...This document is a request for information regarding the use of stop loss insurance by group health plans and their plan sponsors, with a focus on the prevalence and consequences of stop loss insurance at low attachment points. Given the limited nature of data available, the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments) invite public comments via this request for information.

Employee Benefits: Improvements Needed in Enforcing Health Insurance Continuation Requirements

DTIC Science & Technology

1990-12-01

case involved four Page 1 GAO/HRD-91-37 Health Insurance Continuation Requirements B-241959 employees ; the other involved thousands. Both cases resulted...employer-sponsored group health insurance in certain circumstances.’ Through group health plans, workers and their dependents may obtain hospitalization... worker . Title X was designed to help people in these circumstances. Title X requires private employers with 20 or more employees that offer a group

Comparing employer-sponsored and federal exchange plans: wide variations in cost sharing for prescription drugs.

PubMed

Buttorff, Christine; Andersen, Martin S; Riggs, Kevin R; Alexander, G Caleb

2015-03-01

Just under seven million Americans acquired private insurance through the new health insurance exchanges, or Marketplaces, in 2014. The exchange plans are required to cover essential health benefits, including prescription drugs. However, the generosity of prescription drug coverage in the plans has not been well described. Our primary objective was to examine the variability in drug coverage in the exchanges across plan types (health maintenance organization or preferred provider organization) and metal tiers (bronze, silver, gold, and platinum). Our secondary objective was to compare the exchange coverage to employer-sponsored coverage. Analyzing prescription drug benefit design data for the federally facilitated exchanges, we found wide variation in enrollees' out-of-pocket costs for generic, preferred brand-name, nonpreferred brand-name, and specialty drugs, not only across metal tiers but also within those tiers across plan types. Compared to employer-sponsored plans, exchange plans generally had lower premiums but provided less generous drug coverage. However, for low-income enrollees who are eligible for cost-sharing subsidies, the exchange plans may be more comparable to employer-based coverage. Policies and programs to assist consumers in matching their prescription drug needs with a plan's benefit design may improve the financial protection for the newly insured. Project HOPE—The People-to-People Health Foundation, Inc.

Assessing the Financial Condition of Provider-Sponsored Health Plans.

PubMed

McCue, Michael J

2015-06-01

The aim of this study was to assess the performance of health plans sponsored by provider organizations, with respect to plans generating strong positive cash flow relative to plans generating weaker cash flow. A secondary aim was to assess their capital adequacy. The study identified 24 provider-sponsored health plans (PSHPs) with an average positive cash flow margin from 2011 through 2013 at or above the top 75th percentile, defined as "strong cash flow PSHPs:" This group was compared with 72 PSHPs below the 75th percentile, defined as "weak cash flow PSHPs:" Atlantic Information Services Directory of Health Plans was used to identify the PSHPs. Financial ratios were computed from 2013 National Association of Insurance Commissioners Financial Filings. The study conducted a t test mean comparison between strong and weak cash flow PSHPs across an array of financial performance and capital adequacy measures. In 2013, the strong cash flow PSHPs averaged a cash-flow margin ratio of 6.6%. Weak cash flow PSHPs averaged a cash-flow margin of -0.4%. The net worth capital position of both groups was more than 4.5 times authorized capital. The operational analysis shows that strong cash-flow margin PSHPs are managing their medical costs to achieve this position. Although their medical loss ratio increased by almost 300 basis points from 2011 to 2013, it was still statistically significantly lower than the weaker cash flow PSHP group (P<.001). In terms of capital adequacy, both strong and weak cash-flow margin PSHP groups possessed sufficient capital to ensure the viability of these plans.

Differences in Presentation and Management of Pediatric Facial Lacerations by Type of Health Insurance.

PubMed

Amanullah, Siraj; Linakis, James G; Vivier, Patrick M; Clarke-Pearson, Emily; Steele, Dale W

2015-07-01

Limited data are available regarding differences in presentation and management of pediatric emergency department (PED) patients based on insurance status. The objective of the study was to assess the difference in management of pediatric facial lacerations based on medical insurance status. We conducted a retrospective cohort study with universal sampling of patients with facial lacerations who were treated in an urban PED (45K visits/year) over a one-year period. Demographic features and injury characteristics for patients with commercial (private) insurance and those with Medicaid or Medicare (public) insurance were compared. Of 1235 children included in the study, 667 (54%) had private insurance and 485 (39%) had public insurance. The two groups did not differ in age or gender, arrival by ambulance, location of injury occurrence, mechanism of injury, part of face involved, length or depth of laceration, use of local anesthetic, or method of repair but differed in acuity assigned at triage. Patients with public insurance were found less likely to have subspecialty consultation in bivariable (OR=0.41, 95% CI [0.24-0.68]) and multivariable logistic regression analyses (OR=0.45, 95% CI [0.25-0.78]). Patients with public insurance received procedural sedation significantly less often than those with private insurance (OR=0.48, 95% CI [0.29-0.76]). This difference was not substantiated in multivariable models (OR=0.74, 95% CI [0.40-1.31]). Patients with public insurance received less subspecialty consultation compared to privately insured patients despite a similarity in the presentation and characteristics of their facial lacerations. The reasons for these disparities require further investigation.

NIAID-sponsored 2010 guidelines for managing food allergy: applications in the pediatric population.

PubMed

Burks, A Wesley; Jones, Stacie M; Boyce, Joshua A; Sicherer, Scott H; Wood, Robert A; Assa'ad, Amal; Sampson, Hugh A

2011-11-01

Data from many studies have suggested a rise in the prevalence of food allergies during the past 10 to 20 years. Currently, no curative treatments for food allergy exist, and there are no effective means of preventing the disease. Management of food allergy involves strict avoidance of the allergen in the patient's diet and treatment of symptoms as they arise. Because diagnosis and management of the disease can vary between clinical practice settings, the National Institute of Allergy and Infectious Diseases (NIAID) sponsored development of clinical guidelines for the diagnosis and management of food allergy. The guidelines establish consensus and consistency in definitions, diagnostic criteria, and management practices. They also provide concise recommendations on how to diagnose and manage food allergy and treat acute food allergy reactions. The original guidelines encompass practices relevant to patients of all ages, but food allergy presents unique and specific concerns for infants, children, and teenagers. To focus on those concerns, we describe here the guidelines most pertinent to the pediatric population.

Employer-sponsored health insurance: down but not out.

PubMed

Christanson, Jon B; Tu, Ha T; Samuel, Divya R

2011-10-01

Rising costs and the lingering fallout from the great recession are altering the calculus of employer approaches to offering health benefits, according to findings from the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Employers responded to the economic downturn by continuing to shift health care costs to employees, with the trend more pronounced in small, mid-sized and low-wage firms. At the same time, employers and health plans are dissatisfied and frustrated with their inability to influence medical cost trends by controlling utilization or negotiating more-favorable provider contracts. In an alternative attempt to control costs, employers increasingly are turning to wellness programs, although the payoff remains unclear. Employer uncertainty about how national reform will affect their health benefits programs suggests they are likely to continue their current course in the near term. Looking toward 2014 when many reform provisions take effect, employer responses likely will vary across communities, reflecting differences in state approaches to reform implementation, such as insurance exchange design, and local labor market conditions.

Knowledge, attitudes and management skills of medical practitioners regarding weight management.

PubMed

Mkhatshwa, Vangile B; Ogunbanjo, Gboyega A; Mabuza, Langalibalele H

2016-11-29

Overweight and obesity have become a global problem. Health professionals are poorly prepared in weight management, which has an effect on their attitudes and management skills with regard to overweight and obese patients.Aim and setting: To assess the knowledge, attitudes and management skills of medical practitioners regarding weight management at Odi District Hospital, Gauteng Province, South Africa. We conducted a cross-sectional study on 48 medical practitioners at Odi Hospital between 01 October and 31 October 2013. A self-administered questionnaire was used to assess their knowledge, attitudes and management skills in weight management. The SPSS® statistical software (Version 22) was used for data analysis. A p < 0.05 was considered significant. Fifty medical practitioners were recruited, 48 consented to participate and 28 (58.3%) were male. Their categories were community service doctors (3), medical officers (21), registrars (22) and others (2). Thirty-seven (77.1%) never received training in weight management (p < 0.001). Thirty-two (66.7%) regarded weight management as not confined to a dietician (p < 0.001) and 27 (56.2%) regarded weight management as usually unsuccessful (p = 0.004). Forty-seven (97.9%) provided lifestyle modifications and 43 (89.6%) involved the patient's family in weight management (p < 0.001). More non-registrars [14 (77.8%)] than registrars [8 (38.1%)] measured the body mass index (BMI) routinely (p = 0.013). Few medical practitioners received training in weight management. They regarded weight management as usually unsuccessful and lacked confidence in the same owing to lack of training. They provided lifestyle modifications and involved the patient's family in weight management. Non-registrars measured the BMI routinely. There is a need for training in weight management at undergraduate and post-graduate levels.

Risk management assessment of Health Maintenance Organisations participating in the National Health Insurance Scheme

PubMed Central

Campbell, Princess Christina; Korie, Patrick Chukwuemeka; Nnaji, Feziechukwu Collins

2014-01-01

Background: The National Health Insurance Scheme (NHIS), operated majorly in Nigeria by health maintenance organisations (HMOs), took off formally in June 2005. In view of the inherent risks in the operation of any social health insurance, it is necessary to efficiently manage these risks for sustainability of the scheme. Consequently the risk-management strategies deployed by HMOs need regular assessment. This study assessed the risk management in the Nigeria social health insurance scheme among HMOs. Materials and Methods: Cross-sectional survey of 33 HMOs participating in the NHIS. Results: Utilisation of standard risk-management strategies by the HMOs was 11 (52.6%). The other risk-management strategies not utilised in the NHIS 10 (47.4%) were risk equalisation and reinsurance. As high as 11 (52.4%) of participating HMOs had a weak enrollee base (less than 30,000 and poor monthly premium and these impacted negatively on the HMOs such that a large percentage 12 (54.1%) were unable to meet up with their financial obligations. Most of the HMOs 15 (71.4%) participated in the Millennium development goal (MDG) maternal and child health insurance programme. Conclusions: Weak enrollee base and poor monthly premium predisposed the HMOs to financial risk which impacted negatively on the overall performance in service delivery in the NHIS, further worsened by the non-utilisation of risk equalisation and reinsurance as risk-management strategies in the NHIS. There is need to make the scheme compulsory and introduce risk equalisation and reinsurance. PMID:25298605

Postpartum weight self-management: a concept analysis.

PubMed

Ohlendorf, Jennifer M

2013-01-01

The aim of this concept analysis is to create a clear definition and framework to guide weight self-management research and promotion of healthy weight self-management during the postpartum period. A woman's ability to manage her weight through the postpartum transition has lifelong implications for her weight status. This concept analysis was guided by Walker and Avant (2005). A broad search of sources was performed, yielding 56 articles in which postpartum weight self-management was the main focus. From consideration of the attributes of postpartum weight self-management, a descriptive, situation-specific theory emerged: Postpartum weight self-management is a process by which the transition to motherhood is viewed by the woman as an opportunity to intentionally engage in healthy weight self-management behaviors by minimizing the salient inhibitors and maximizing the salient facilitators to action. This analysis provides a clarification of the process concept of postpartum weight self-management and its consequences, giving direction for measurement, clinical application, and further research. Future nursing interventions and research should be aimed at helping women to view the postpartum period as a normative transition in which they have the opportunity to take charge of their own health and the health of their family.

National Economic Conditions and Patient Insurance Status Predict Prostate Cancer Diagnosis Rates and Management Decisions.

PubMed

Weiner, Adam B; Conti, Rena M; Eggener, Scott E

2016-05-01

The recent Great Recession from December 2007 to June 2009 presents a unique opportunity to examine whether the incidence of nonpalpable prostate cancer decreases while conservative management for nonpalpable prostate cancer increases during periods of national economic hardship. We derived rates of national monthly diagnosis and conservative management for screen detected, nonpalpable prostate cancer and patient level insurance status from the SEER (Surveillance, Epidemiology and End Results) database from 2004 to 2011. We derived monthly statistics on national unemployment rates, inflation, median household income and S&P 500® closing values from government sources. Using linear and logistic multivariable regression we measured the correlation of national macroeconomic conditions with prostate cancer diagnosis and treatment patterns. We evaluated patient level predictors of conservative management to determine whether being insured by Medicaid or uninsured increased the use of conservative management. Diagnosis rates correlated positively with the S&P 500 monthly close (coefficient 24.90, 95% CI 6.29-43.50, p = 0.009). Conservative management correlated negatively with median household income (coefficient -49.13, 95% CI -69.29--28.98, p <0.001). In a nonMedicare eligible population having Medicaid (OR 1.51, 95% CI 1.32-1.73, p <0.001) or no insurance (OR 2.27, 95% CI 1.93-2.67, p <0.001) increased the use of conservative management compared to that in men with private insurance. As indicated by a significant interaction term being diagnosed during the Great Recession increased the Medicaid insurance predictive value of conservative management (OR 1.30, 95% CI 1.02-1.68, p = 0.037). National economic hardship was associated with decreased diagnosis rates of nonpalpable prostate cancer and increased conservative management. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Welfare reform, labor supply, and health insurance in the immigrant population.

PubMed

Borjas, George J

2003-11-01

Although the 1996 welfare reform legislation limited the eligibility of immigrant households to receive assistance, many states chose to protect their immigrant populations by offering state-funded aid to these groups. I exploit these changes in eligibility rules to examine the link between the welfare cutbacks and health insurance coverage in the immigrant population. The data reveal that the cutbacks in the Medicaid program did not reduce health insurance coverage rates among targeted immigrants. The immigrants responded by increasing their labor supply, thereby raising the probability of being covered by employer-sponsored health insurance.

Medical professional liability insurance and its relation to medical error and healthcare risk management for the practicing physician.

PubMed

Abbott, Richard L; Weber, Paul; Kelley, Betsy

2005-12-01

To review the history and current issues surrounding medical professional liability insurance and its relationship to medical error and healthcare risk management. Focused literature review and authors' experience. Medical professional liability insurance issues are reviewed in association with the occurrence of medical error and the role of healthcare risk management. The rising frequency and severity of claims and lawsuits incurred by physicians, as well as escalating defense costs, have dramatically increased over the past several years and have resulted in accelerated efforts to reduce medical errors and control practice risk for physicians. Medical error reduction and improved patient outcomes are closely linked to the goals of the medical risk manager by reducing exposure to adverse medical events. Management of professional liability risk by the physician-led malpractice insurance company not only protects the economic viability of physicians, but also addresses patient safety concerns. Physician-owned malpractice liability insurance companies will continue to be the dominant providers of insurance for practicing physicians and will serve as the primary source for loss prevention and risk management services. To succeed in the marketplace, the emergence and importance of the risk manager and incorporation of risk management principles throughout the professional liability company has become crucial to the financial stability and success of the insurance company. The risk manager provides the necessary advice and support requested by physicians to minimize medical liability risk in their daily practice.

Government-Sponsored Programs on Structures Technology

NASA Technical Reports Server (NTRS)

Noor, Ahmed K. (Compiler); Malone, John B. (Compiler)

1997-01-01

This document contains the presentations from the joint UVA/AIAA workshops on Government-Sponsored Programs on Structures Technology, held on April 6, 1997 in Kissimmee, Florida and on September 4, 1997 in Hampton, Virginia. Workshop attendees were the Members and Friends of the AIAA Structures Technical Committee. The objectives of the workshops were to: (a) provide a forum for discussion of current government-sponsored programs in the structures area; (b) identify high-potential research areas for future aerospace systems; and (c) initiate suitable interaction mechanisms with the managers of structures programs.

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 1 2011-07-01 2009-07-01 true Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance...

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 1 2013-07-01 2013-07-01 false Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance...

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 41 Public Contracts and Property Management 1 2012-07-01 2009-07-01 true Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance...

Out-of-pocket health care expenditures, by insurance status, 2007-10.

PubMed

Catlin, Mary K; Poisal, John A; Cowan, Cathy A

2015-01-01

Out-of-pocket health care spending in the United States totaled $306.2 billion in 2010 and represented 11.8 percent of total national health expenditures, according to the Centers for Medicare and Medicaid Services' National Health Expenditure Accounts. Spending by people with employer-sponsored health insurance and those covered by Medicare accounted for over 80 percent of total out-of-pocket spending. People without comprehensive medical coverage accounted for less than 8 percent of all out-of-pocket expenditures in 2010. Between 2007 and 2010 per person out-of-pocket spending grew most rapidly for people primarily covered by employer-sponsored insurance and declined for people primarily covered by Medicare and those without coverage. Project HOPE—The People-to-People Health Foundation, Inc.

45 CFR 2552.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2010 CFR

2010-10-01

... § 2552.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Foster Grandparent Program as specified...

45 CFR 2552.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2013 CFR

2013-10-01

... § 2552.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Foster Grandparent Program as specified...

45 CFR 2552.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2014 CFR

2014-10-01

... § 2552.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Foster Grandparent Program as specified...

45 CFR 2552.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2012 CFR

2012-10-01

... § 2552.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Foster Grandparent Program as specified...

45 CFR 2552.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2011 CFR

2011-10-01

... § 2552.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Foster Grandparent Program as specified...

45 CFR 2551.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2010 CFR

2010-10-01

... § 2551.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Senior Companion Program as specified in...

45 CFR 2551.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2011 CFR

2011-10-01

... § 2551.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Senior Companion Program as specified in...

45 CFR 2551.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2014 CFR

2014-10-01

... § 2551.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Senior Companion Program as specified in...

45 CFR 2551.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2012 CFR

2012-10-01

... § 2551.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Senior Companion Program as specified in...

45 CFR 2551.22 - What are the responsibilities of a sponsor?

Code of Federal Regulations, 2013 CFR

2013-10-01

... § 2551.22 What are the responsibilities of a sponsor? A sponsor is responsible for fulfilling all project management requirements necessary to accomplish the purposes of the Senior Companion Program as specified in...

Value-based insurance plus disease management increased medication use and produced savings.

PubMed

Gibson, Teresa B; Mahoney, John; Ranghell, Karlene; Cherney, Becky J; McElwee, Newell

2011-01-01

We evaluated the effects of implementing a value-based insurance design program for patients with diabetes in two groups within a single firm. One group participated in disease management; the other did not. We matched members of the two groups to similar enrollees within the company that did not offer the value-based program. We found that participation in both value-based insurance design and disease management resulted in sustained improvement over time. Use of diabetes medications increased 6.5 percent over three years. Adherence to diabetes medical guidelines also increased, producing a return on investment of $1.33 saved for every dollar spent during a three-year follow-up period.

Health insurance disparities among racial/ethnic minorities in same-sex relationships: an intersectional approach.

PubMed

Gonzales, Gilbert; Ortiz, Kasim

2015-06-01

We examined disparities in health insurance coverage for racial/ethnic minorities in same-sex relationships. We used data from the 2009 to 2011 American Community Survey on nonelderly adults (aged 25-64 years) in same-sex (n = 32 744), married opposite-sex (n = 2 866 636), and unmarried opposite-sex (n = 268 298) relationships. We used multinomial logistic regression models to compare differences in the primary source of health insurance while controlling for key demographic and socioeconomic factors. Adults of all races/ethnicities in same-sex relationships were less likely than were White adults in married opposite-sex relationships to report having employer-sponsored health insurance. Hispanic men, Black women, and American Indian/Alaska Native women in same-sex relationships were much less likely to have employer-sponsored health insurance than were their White counterparts in married opposite-sex relationships and their White counterparts in same-sex relationships. Differences in coverage by relationship type and race/ethnicity may worsen over time as states follow different paths to implementing health care reform and same-sex marriage.

A health insurance tax credit for uninsured workers.

PubMed

Zelenak, L

2001-01-01

This paper describes a new system of tax credits to help low-income workers pay for health insurance. The system would be designed to subsidize health insurance coverage for workers who are currently uninsured, or who pay high premiums for nongroup insurance. Anyone age 19 or older who is not covered by Medicaid, Medicare, or employer-sponsored health insurance would be eligible for a health insurance tax credit (HITC), administered through the Internal Revenue Service. The base amount of the proposed credit would be $2,000 per year for each covered individual, but this amount would be adjusted for the individual's age and sex, according to the effect of age and sex on the cost of insurance coverage. The base amount of the credit would be reduced by $150 for every $1,000 by which a person's income exceeded 200% of the federal poverty level, thus limiting HITC eligibility to lower-income workers. To encourage participation in the credit program, most of the credit would be available through an advance payment system, with final reconciliation after year's end.

31 CFR 1030.210 - Anti-money laundering programs for housing government sponsored enterprises.

Code of Federal Regulations, 2014 CFR

2014-07-01

... activities. The program must be approved by senior management. A housing government sponsored enterprise... housing government sponsored enterprises. 1030.210 Section 1030.210 Money and Finance: Treasury... TREASURY RULES FOR HOUSING GOVERNMENT SPONSORED ENTERPRISES Programs § 1030.210 Anti-money laundering...

Insurance against climate change and flood risk: Insurability and decision processes of insurers

NASA Astrophysics Data System (ADS)

Hung, Hung-Chih; Hung, Jia-Yi

2016-04-01

1. Background Major portions of the Asia-Pacific region is facing escalating exposure and vulnerability to climate change and flood-related extremes. This highlights an arduous challenge for public agencies to improve existing risk management strategies. Conventionally, governmental funding was majorly responsible and accountable for disaster loss compensation in the developing countries in Asia, such as Taiwan. This is often criticized as an ineffective and inefficient measure of dealing with flood risk. Flood insurance is one option within the toolkit of risk-sharing arrangement and adaptation strategy to flood risk. However, there are numerous potential barriers for insurance companies to cover flood damage, which would cause the flood risk is regarded as uninsurable. This study thus aims to examine attitudes within the insurers about the viability of flood insurance, the decision-making processes of pricing flood insurance and their determinants, as well as to examine potential solutions to encourage flood insurance. 2. Methods and data Using expected-utility theory, an insurance agent-based decision-making model was developed to examine the insurers' attitudes towards the insurability of flood risk, and to scrutinize the factors that influence their decisions on flood insurance premium-setting. This model particularly focuses on how insurers price insurance when they face either uncertainty or ambiguity about the probability and loss of a particular flood event occurring. This study considers the factors that are expected to affect insures' decisions on underwriting and pricing insurance are their risk perception, attitudes towards flood insurance, governmental measures (e.g., land-use planning, building codes, risk communication), expected probabilities and losses of devastating flooding events, as well as insurance companies' attributes. To elicit insurers' utilities about premium-setting for insurance coverage, the 'certainty equivalent,' 'probability

The role of the health insurance industry in perpetuating suboptimal pain management.

PubMed

Schatman, Michael E

2011-03-01

Unlike pain practitioners, health care insurers in the United States are not expected to function according to a system of medical ethics. Rather, they are permitted to function under the business "ethic" of cost-containment and profitability. Despite calls for balancing the disparate agendas of stakeholders in pain management in a pluralistic system, the health insurance industry has continued to fail to take the needs of suffering chronic pain patients into consideration in developing and enacting their policies that ultimately dictate the quality and quantity of pain management services available to enrollees. This essay examined these self-serving strategies, which include failure to reimburse services and certain medications irrespective of their evidence-bases for clinical efficacy and cost-efficiency; "carving out" specific services from interdisciplinary treatment programs; and delaying and/or interrupting the provision of medically necessary treatment. Blatant and more subtle strategies utilized by insurers to achieve these ethically questionable goals are examined. Additionally, this essay addressed some of the insurance industry's efforts to delegitimize chronic pain and its treatment as a whole. The author concludes that the outlook for chronic pain sufferers is not particularly bright, until such time that a not-for-profit single-payer system replaces the current treatment/reimbursement paradigm. Wiley Periodicals, Inc.

Implementation and Clinical Outcomes of an Employer-Sponsored, Pharmacist-Provided Medication Therapy Management Program.

PubMed

Theising, Katie M; Fritschle, Traci L; Scholfield, Angelina M; Hicks, Emily L; Schymik, Michelle L

2015-11-01

Our objective was to describe the implementation and clinical outcomes of an employer-sponsored, pharmacist-provided medication therapy management (MTM) program for health plan beneficiaries with diabetes mellitus and/or hypertension. We conducted a single-center retrospective medical record review. The setting was a Pharmacy MTM Clinic at a self-insured health system consisting of six hospitals and several ancillary facilities. A total of 161 health plan beneficiaries with diabetes identified during annual wellness screenings for the health plan in 2012 and 225 health plan beneficiaries with diabetes and/or hypertension identified during annual wellness screenings for the health plan in 2013 were referred to the MTM clinic based on specific criteria. In 2012 the health system expanded its existing wellness program by implementing a voluntary diabetes care program for health plan beneficiaries with uncontrolled diabetes (hemoglobin A(1c) [A1C] 7% or higher); a similar program was added for hypertension for the 2013 plan year. All participants' A1C and blood pressure results were tracked from the date of their wellness screening through the end of the plan year. The pharmacists involved had the capability to directly implement drug regimen changes according to hospital protocol or provide recommendations to the physician, as specified by the referring physician. For the 2012-2013 plan year, the mean difference in A1C from baseline to program completion was -0.38% (95% confidence interval [CI] -0.58 to -0.18%, p<0.05). For beneficiaries with a baseline A1C of 7% or higher, the mean difference was -0.69% (95% CI -0.99 to -0.39%, p<0.05). For the 2013-2014 plan year, the mean difference in A1C from baseline to program completion was -0.62% (95% CI -0.81 to -0.44%, p<0.05). In that year, the mean difference in A1C for beneficiaries with A1C 7% or higher was -0.97% (95% CI -1.23 to -0.72%, p<0.05). For those referred for hypertension, a mean difference of -13 mm Hg (95

Flood Insurance in Canada: Implications for Flood Management and Residential Vulnerability to Flood Hazards

NASA Astrophysics Data System (ADS)

Oulahen, Greg

2015-03-01

Insurance coverage of damage caused by overland flooding is currently not available to Canadian homeowners. As flood disaster losses and water damage claims both trend upward, insurers in Canada are considering offering residential flood coverage in order to properly underwrite the risk and extend their business. If private flood insurance is introduced in Canada, it will have implications for the current regime of public flood management and for residential vulnerability to flood hazards. This paper engages many of the competing issues surrounding the privatization of flood risk by addressing questions about whether flood insurance can be an effective tool in limiting exposure to the hazard and how it would exacerbate already unequal vulnerability. A case study investigates willingness to pay for flood insurance among residents in Metro Vancouver and how attitudes about insurance relate to other factors that determine residential vulnerability to flood hazards. Findings indicate that demand for flood insurance is part of a complex, dialectical set of determinants of vulnerability.

"Wrapping Up" Your Construction Insurance.

ERIC Educational Resources Information Center

Ferraro, Mark

1998-01-01

School facility managers are beginning to use a special insurance-management technique called wrap-up. The project owner purchases a bulk construction insurance policy consisting of general liability, excess liability, workers' compensation, and builders' risk insurance. Wrap-ups ensure competitive pricing, safety incentives, lower claims costs,…

Your Insurance Dollar. Money Management.

ERIC Educational Resources Information Center

Baran, Nancy H., Ed.

This booklet provides some practical guidelines for determining total insurance needs, examining options, and comparing costs. It discusses how to fit insurance costs into an overall financial plan, the necessity of adequate liability coverage, and the importance of keeping policies up to date. The next four sections highlight the basic types of…

Employer-sponsored health insurance in New York: findings from the 2003 Commonwealth Fund/HRET survey.

PubMed

Edwards, Jennifer N; How, Sabrina; Whitmore, Heidi; Gabel, Jon R; Hawkins, Samantha; Pickreign, Jeremy D

2004-05-01

A 2003 Commonwealth Fund/Health Research and Educational Trust survey of 576 New York State firms found that, in order to manage rising health costs, employers are increasing the share of the insurance premium that employees pay, delaying the start of benefits, and increasing cost-sharing at the point of service. This has enabled employers to preserve health benefits, but has raised costs for workers and their families. On average, workers' contributions for family coverage rose 54 percent, from $1,392 per year in 2001 to $2,148 per year in 2003. During that time period, fewer workers selected family coverage. Employers are receptive to a wide range of approaches to make coverage more available and affordable for their employees, but they have limited familiarity with public programs that could cover their lower-wage workers, such as Healthy New York, Family Health Plus, or Child Health Plus.

[Insurance system. Prevention from viewpoint of the insurer].

PubMed

Brechtbühl, P

1978-12-01

The purpose of an insurance must not be restricted to the payment of claims to those insured persons who suffered a loss, for loss prevention is much preferable to claim settlement. A whole range of different institutions and measures has been established by the Swiss insurers, in which many insurance branches participate. The loss preventing activities can be listed as follows:--Activities of the fire insurers to prevent and fight fires. This is the prevailing duty of the Consulting Agency for Fire Prevention (BfB) as well as the Fire Prevention Service for Industry and Trade (BVD).--Activities of the accident insurers to prevent accidents. The fight against accidents, mostly traffic accidents, in sports and at home is the foremost task of the Swiss Council for the Prevention of Accidents (BfU), an institution created by the Conference of Accident Insurance Managers (UDK) and the Swiss National Accident Insurance Fund (SUVA).--The Health Service in life insurance, after all the periodical medical examinations and consultations granted by many insurers to their insured persons, as well as the pamphlets aiming at health education published by several Companies and finally institutions and measures to promote fitness, e.g. VITA-Parcours.

[Laboratory management fee in national health insurance; what is required from clinical laboratory physicians? --message from Chairpersons].

PubMed

Kimura, Satoshi; Koshiba, Masahiro

2013-06-01

The laboratory management fee (LMF) in national health insurance ("Kentai-Kensa-Kanri-Kasan" in Japanese) has had a major impact on Japanese clinical laboratories, especially in recent years. In 2012, the fee was raised to approximately 5,000 yen per admitted patient. In order to address this national support, clinical pathologists are required to increase their knowledge and skills. On the other hand, there are insufficient clinical pathologists in Japan. In order to solve this problem, the Japanese Society of Laboratory Medicine (JSLM) approved a new license for Qualified Clinical Laboratory Managing Physicians (CLMPs), in addition to Certified Clinical Laboratory Physicians (CCLPs). The requirements to become a CLMP are less strict than for CCLP. There are approximately 500 CLMPs and 600 CCLPs in this country. The aim of this symposium was to offer opportunities to increase attendees' clinical skills, especially CLMPs and young clinical pathologists. Four CCLPs were chosen as speakers from a university hospital, a major city hospital, a medium-sized acute care hospital, and a university hospital anatomical pathologist, together with a chief medical technologist from a university hospital. All the speakers presented their ideal role models of clinical pathologists matching LMF requirements. JSLM together with the Japanese Association of Clinical Laboratory Physicians (JACLaP) sponsored this symposium. It was a successful meeting with more than two hundred attendees.

Significant factors of aviation insurance and risk management strategy: an empirical study of Taiwanese airline carriers.

PubMed

Lin, Yi Hsin; Chang, Yu Hern

2008-04-01

Aviation insurance premiums have become a heavy burden for the airline industry since September 11, 2001. Although the industry must constantly balance its operations between profitability and safety, the reality is that airlines are in the business of making money. Therefore, their ability to reduce cost and manage risk is a key factor for success. Unlike past research, which used subjective judgment methods, this study applied quantitative historical data (1999-2000) and gray relation analysis to identify the primary factors influencing ratemaking for aviation insurance premiums. An empirical study of six airlines in Taiwan was conducted to determine these factors and to analyze the management strategies used to deal with them. Results showed that the loss experience and performance of individual airlines were the key elements associated with aviation insurance premiums paid by each airline. By identifying and understanding the primary factors influencing ratemaking for aviation insurance, airlines will better understand their relative operational strengths and weaknesses, and further help top management identify areas for further improvement. Knowledge of these factors combined with effective risk management strategies, may result in lower premiums and operating costs for airline companies.

41 CFR 60-300.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life... VETERANS, AND ARMED FORCES SERVICE MEDAL VETERANS Discrimination Prohibited § 60-300.25 Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service company, health...

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service company, health...

Unfulfilled translation opportunities in industry sponsored clinical trials.

PubMed

Smed, Marie; Getz, Kenneth A

2013-05-01

Knowledge generated by site representatives through their participation in clinical trials is valuable for testing new products in use and obtaining final market approval. The leverage of this important knowledge is however challenged as the former direct relationships between in-house staff in the industry and site representatives are changing. The process of clinical trials has increased in complexity over the years, resulting in additional management layers. Besides an increase in internal management layers, sponsors often also outsource various tasks related to clinical trials to a CRO (Contract Research Organization) and thereby adding another link in the relationships between site and sponsor. These changes are intended to optimize the time-consuming and costly trial phases; however, there is a need to study whether valuable knowledge and experience is compromised in the process. Limited research exists on the full range of clinical practice insights obtained by investigators during and after clinical trials and how well these insights are transferred to study sponsors. This study explores the important knowledge-transfer processes between sites and sponsors and to what extent sites' knowledge gained in clinical trials is utilized by the industry. Responses from 451 global investigative site representatives are included in the study. The analysis of the extensive dataset reveals that the current processes of collaboration between sites and the industry restrict the leverage of valuable knowledge gained by physicians in the process of clinical trials. These restrictions to knowledge-transfer between site and sponsor are further challenged if CRO partners are integrated in the trial process. Copyright © 2013 Elsevier Inc. All rights reserved.

Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity - a systematic review.

PubMed

Ananthapavan, J; Peterson, A; Sacks, G

2018-05-01

Curbing the obesity epidemic is likely to require a suite of interventions targeting the obesogenic environment as well as individual behaviour. Evidence suggests that the effectiveness of behaviour modification programmes can be enhanced by financial incentives that immediately reward weight loss behaviour. This systematic review investigated the effectiveness of incentives with a focus on assessing the relative effectiveness of incentives that target different behaviours as well as factors of importance when implementing these programmes in real-world settings (health insurer settings). A narrative review of the academic and grey literature including a variety of study designs was undertaken. Twenty studies met inclusion criteria and were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results suggest that incentivizing weight loss is effective in the short term while the incentives are in place. There are various incentive designs, and although the relative effectiveness of each of these on weight loss is not clear, it appears that positive incentives increase the uptake into programmes and may reduce dropouts. As with other weight loss initiatives, there is a need to explore ways to maintain weight loss in the longer term - incentives for weight maintenance could play a role. © 2017 World Obesity Federation.

Health Insurance Disparities Among Racial/Ethnic Minorities in Same-Sex Relationships: An Intersectional Approach

PubMed Central

Ortiz, Kasim

2015-01-01

Objectives. We examined disparities in health insurance coverage for racial/ethnic minorities in same-sex relationships. Methods. We used data from the 2009 to 2011 American Community Survey on nonelderly adults (aged 25–64 years) in same-sex (n = 32 744), married opposite-sex (n = 2 866 636), and unmarried opposite-sex (n = 268 298) relationships. We used multinomial logistic regression models to compare differences in the primary source of health insurance while controlling for key demographic and socioeconomic factors. Results. Adults of all races/ethnicities in same-sex relationships were less likely than were White adults in married opposite-sex relationships to report having employer-sponsored health insurance. Hispanic men, Black women, and American Indian/Alaska Native women in same-sex relationships were much less likely to have employer-sponsored health insurance than were their White counterparts in married opposite-sex relationships and their White counterparts in same-sex relationships. Conclusions. Differences in coverage by relationship type and race/ethnicity may worsen over time as states follow different paths to implementing health care reform and same-sex marriage. PMID:25880954

76 FR 70510 - Federal Employees' Group Life Insurance Program: New Federal Employees' Group Life Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees' Group Life Insurance Program: New Federal Employees' Group Life Insurance (FEGLI) Premiums AGENCY: Office of Personnel Management. ACTION: Notice... [[Page 70511

Trouble with Your Liability Insurance? Here's Why.

ERIC Educational Resources Information Center

AGB Reports, 1985

1985-01-01

The insurance industry is in trouble, which means problems for colleges and universities--especially in the area of liability insurance. Some strategies for higher education are discussed, including risk-management programs, self-insurance, catastrophic or excess insurance, and risk-management consortia. (MLW)

Alternative liability insurance: a physician-owned captive insurance company.

PubMed

Lee, G F

1991-06-01

The physician-owned captive insurance company is a lesser known but dynamic alternative to commercial insurance. The Physicians Reimbursement Fund, Ltd., was founded in 1975 in response to the malpractice crisis of that year. The company insures about 100 physicians in high-risk specialties. Approximately one half are obstetrician-gynecologists. Innovative management has enabled this company to operate successfully at a fraction of the premium charged by typical insurance companies. Fourteen years of experience have demonstrated the ability of this company to successfully serve the needs of the community.

Therapy and Weight Management (For Teens)

MedlinePlus

... site Sitio para adolescentes Body Mind Sexual Health Food & Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Therapy and Weight Management KidsHealth / For Teens / Therapy and Weight Management What's ...

[Allocation decisions of health insurance rehabilitation managers--An explorative case study concerning stroke rehabilitation].

PubMed

Hasenbein, U; Wallesch, C-W

2003-12-01

We investigated processes of and subjective reasons for resource allocation in three out of four rehabilitation specialists of a regional office of a major health insurance. Decisions of health insurance personnel include approval of and duration of rehabilitation treatment and choice of clinical provider. Insurance specialists are mainly involved in documentation and coordination, whereas decisions mainly follow expert recommendations, mainly of the medical service. Allocation is based primarily on somatic impairment and disability, psychosocial function, motivation and rehabilitation potential are regarded as secondary. Goals and expected results of rehabilitation are neither individually defined nor their achievement evaluated. Decision processes are dominated by routines and agreements. Only exceptionally, defined rules and procedures are applied. Active case management is hampered by a highly specialized internal structure of the investigated insurance fund. The optimal fulfillment of individual requirements for a limited-time rehabilitation treatment is the central criterion for decision making. However, the specialists lack detailed information concerning appropriateness, quality and efficacy of rehabilitation providers, especially when taking patient-related variables into account. Instead, they trust that only high-quality institutions are contracted. Systematic control and feedback of rehabilitation results is not available. The surveyed rehabilitation managers do not include cost aspects in their decision-making. They would regard this as alien to a member- and patient-oriented policy. Improvement potentials with respect to rehabilitation case management are being reviewed.

Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.

PubMed

Abdus, Salam; Hudson, Julie; Hill, Steven C; Selden, Thomas M

2014-08-01

Both Medicaid and the Children's Health Insurance Program (CHIP), which are run by the states and funded by federal and state dollars, offer health insurance coverage for low-income children. Thirty-three states charged premiums for children at some income ranges in CHIP or Medicaid in 2013. Using data from the 1999-2010 Medical Expenditure Panel Surveys, we show that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. Among children with family incomes above 150 percent of the federal poverty level, a $10 increase in monthly premiums is associated with a 1.6-percentage-point reduction in Medicaid or CHIP coverage. In this income range, the increase in uninsurance may be higher among those children whose parents lack an offer of employer-sponsored insurance than among those whose parents have such an offer. Among children with family incomes of 101-150 percent of poverty, a $10 increase in monthly premiums is associated with a 6.7-percentage-point reduction in Medicaid or CHIP coverage and a 3.3-percentage-point increase in uninsurance. In this income range, the increase in uninsurance is even larger among children whose parents lack offers of employer coverage. Project HOPE—The People-to-People Health Foundation, Inc.

Comparison of medicines management strategies in insurance schemes in middle-income countries: four case studies.

PubMed

Kaplan, Warren A; Ashigbie, Paul G; Brooks, Mohamad I; Wirtz, Veronika J

2017-01-01

Many middle-income countries are scaling up health insurance schemes to provide financial protection and access to affordable medicines to poor and uninsured populations. Although there is a wealth of evidence on how high income countries with mature insurance schemes manage cost-effective use of medicines, there is limited evidence on the strategies used in middle-income countries. This paper compares the medicines management strategies that four insurance schemes in middle-income countries use to improve access and cost-effective use of medicines among beneficiaries. We compare key strategies promoting cost-effective medicines use in the New Rural Cooperative Medical Scheme (NCMS) in China, National Health Insurance Scheme in Ghana, Jamkesmas in Indonesia and Seguro Popular in Mexico. Through the peer-reviewed and grey literature as of late 2013, we identified strategies that met our inclusion criteria as well as any evidence showing if, and/or how, these strategies affected medicines management. Stakeholders involved and affected by medicines coverage policies in these insurance schemes were asked to provide relevant documents describing the medicines related aspects of these insurance programs. We also asked them specifically to identify publications discussing the unintended consequences of the strategies implemented. Use of formularies, bulk procurement, standard treatment guidelines and separation of prescribing and dispensing were present in all four schemes. Also, increased transparency through publication of tender agreements and procurement prices was introduced in all four. Common strategies shared by three out of four schemes were medicine price negotiation or rebates, generic reference pricing, fixed salaries for prescribers, accredited preferred provider network, disease management programs, and monitoring of medicines purchases. Cost-sharing and payment for performance was rarely used. There was a lack of performance monitoring strategies in all

Tools for Successful Weight Management in Primary Care

PubMed Central

Turer, Christy Boling

2015-01-01

Obesity is one of the most pervasive and costly public-health problems. Clinicians need effective tools to address weight management in primary care, including evaluation and communication methods, guideline-based weight-management interventions, and safe and effective weight-loss medications and surgery. The objective of this Grand-Rounds presentation is to provide practicing clinicians with the latest information regarding effective ways to care for and communicate with patients about weight loss; evidence-based guidelines for selecting weight-management therapies; and safety, efficacy, and adverse effects of weight-loss medications and surgery. PMID:26218666

[Backache in insurance companies : Occupational health management].

PubMed

Thielscher, C; Hahn, E; Klumpp, M; Lindenberg, B; Matusiewicz, D

2016-12-01

The article examines how big German insurance companies handle back pain in terms of occupational health management (OHM). Narrative interviews with experts from 8 out of the 20 biggest enterprises were conducted. Musculoskeletal diseases are the number one or number two reason for sick leave. All enterprises offer OHM; there is a variety of measures, e. g., sport, massage, advice, ergonomics, healthy food and leadership training. The measures are hardly ever evaluated. The literature is controversial whether or which OHM measures are effective. In our sample few measures were evaluated; for more evidence based treatment this should be changed.

Sponsored Programs.

ERIC Educational Resources Information Center

College and University Business Administration, 1980

1980-01-01

General administrative principles and procedures applicable to any type of program sponsored by external funds, including the federal government, are examined. Contracts, grants, and cooperative agreements are the devices for authorizing sponsored programs. Since the institutions assume full legal responsibility for the programs and for fulfilling…

Weight expectations, motivations for weight change and perceived factors influencing weight management in young Australian women: a cross-sectional study.

PubMed

Holley, Talisha J; Collins, Clare E; Morgan, Philip J; Callister, Robin; Hutchesson, Melinda J

2016-02-01

To examine young Australian women's weight expectations, motivations for weight change and perceived factors influencing weight management, and to determine if these factors differ by age, BMI, marital status, education or income. Cross-sectional study. An online survey captured respondents' weight, height, ideal weight, main reasons for wanting to change their weight and challenges to managing their weight. Online survey in Australia. Six hundred and twenty women aged 18-30 years currently living in Australia who completed the survey between 31 July and 30 September 2012. Approximately half of participants (53·1 %) were a healthy weight, 25·2 % overweight and 19·0 % obese. Women unhappy at their current weight (78·1 %) reported a median ideal weight -12·3 % less than their current weight. The key motivators for weight change were to improve health (24·4 %, ranked 1), feel better in oneself (22·3 %) and improve self-confidence (21·5 %). Lack of motivation, time constraints because of job commitments and cost were the most commonly reported factors influencing weight management. Age, BMI, marital status, education and income were found to influence weight expectations, motivations for weight change and/or factors perceived to influence weight management. The findings suggest potential implications for weight management interventions and public health messaging targeting young women, to improve long-term health outcomes. Strategies that promote the health benefits of physical activity and healthy eating, feeling better about oneself and improved self-confidence, and address the main factors influencing weight management including lack of motivation, time constraints and cost, may be used to engage this target group.

Health insurance--a challenge in India.

PubMed

Presswala, R G

2004-01-01

In India, indemnity health insurance started about 3 decades ago. Mediclaim was the most popular product. Indian insurers and multinational companies have not been enthusiastic about starting health insurance in spite of the availability of a good market because health insurers have historically incurred losses. Losses have been caused by poor administration. Because it is a small portion of their total businesses, insurers have never tried sincerely to improve deficiencies or taken special interest. Hospital management and medical specialists have the spirit of entrepreneurship and are prepared to learn quickly and follow managed care principles, though they are not currently practiced in India. Actuarial data from the health insurance industry is sparse, but data from alternative sources will be helpful for starting managed healthcare. In my opinion, if properly administered, a "limited" managed care product with appropriate precautions and premium levels will be successful and profitable and will compete with present indemnity products in India.

A Qualitative Study of the Relationship between a Banking IT Troubled Project and the Executive Project Sponsor's Project Management Maturity Level

ERIC Educational Resources Information Center

Northcraft, Terry G.

2017-01-01

This qualitative study examined the effect the level of project management maturity a banking IT project sponsor has on project success. Project management maturity is gauged by the amount of modern project management training, knowledge and organizational skills an individual or organization has and applies to their project lifecycle experiences.…

Correlates of Body Mass Index, Weight Goals, and Weight-Management Practices among Adolescents

ERIC Educational Resources Information Center

Paxton, Raheem J.; Valois, Robert F.; Drane, J. Wanzer

2004-01-01

The study examined associations among physical activity, cigarette smoking, body mass index, perceptions of body weight, weight-management goals, and weight-management behaviors of public high school adolescents. The CDC Youth Risk Behavior Survey provided a cross-sectional sample (n = 3,089) of public high school students in South Carolina.…

Can an employer-based health insurance system be just?

PubMed

Jecker, N S

1993-01-01

It is America's distinctive practice to tie private health insurance to employment, and recent proposals have tried to retain this link through mandating that all employers provide health insurance to their employees. My primary approach to these issues is neither economic, nor historical, nor political but ethical. After a brief historical overview, I outline a general approach to evaluating the ethical significance of linking the distributions of distinct goods. I examine whether an unjust distribution of jobs spoils justice in the distribution of health insurance, taking as a central example gender inequities in employment and exploring their impact on job-based health insurance. Second, I explore the possibility that justly awarding jobs guarantees justice in employment-sponsored insurance. However, linking the distributions of different goods remains problematic, because such links inevitably undermine equality by enabling the same individuals to enjoy advantages in many different distributive areas. Finally, I examine recent proposals to reform America's health care system by requiring all employers to provide health insurance to their employees. I argue that such proposals lend themselves to the same ethical problems that the current system does and urge greater attention to alternative reform options.

Tax subsidies for private health insurance - july 2009 update.

PubMed

Burman, Len; Khitatrakun, Surachai; Goodell, Sarah

2009-07-01

Tax subsides for employer-sponsored health insurance are the largest subsidy for private health insurance and support key mechanisms of the U.S. insurance system, but they overwhelmingly benefit high-wage employees. When employers purchase or provide insurance for their employees, their contributions to the premium are excluded from income and payroll taxes. This tax exclusion provided more than $100 billion in income and payroll tax subsidies in 2002. High-income workers benefit more from these subsidies than those with lower incomes because of their higher marginal tax rate. Applying the tax exclusion in their respective tax brackets means high-income families (those earning more than $200,000) receive a subsidy worth one-third of the premium, while the lowest income families receive a subsidy worth just 10 percent. Despite these issues, ESI is a successful mechanism in many ways, covering a significant majority of Americans and providing a good pooling mechanism.

Toward a Middle-Range Theory of Weight Management.

PubMed

Pickett, Stephanie; Peters, Rosalind M; Jarosz, Patricia A

2014-07-01

The authors of this paper present the middle-range theory of weight management that focuses on cultural, environmental, and psychosocial factors that influence behaviors needed for weight control. The theory of weight management was developed deductively from Orem's theory of self-care, a constituent theory within the broader self-care deficit nursing theory and from research literature. Linkages between the conceptual and middle-range theory concepts are illustrated using a substruction model. The development of the theory of weight management serves to build nursing science by integrating extant nursing theory and empirical knowledge. This theory may help predict weight management in populations at risk for obesity-related disorders. © The Author(s) 2014.

7 CFR 622.10 - Sponsors.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS Qualifications § 622.10 Sponsors. (a) Watershed projects are sponsored by one or more local organizations qualifying as sponsors. All watershed plans shall be sponsored...

7 CFR 622.10 - Sponsors.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS Qualifications § 622.10 Sponsors. (a) Watershed projects are sponsored by one or more local organizations qualifying as sponsors. All watershed plans shall be sponsored...

7 CFR 622.10 - Sponsors.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS Qualifications § 622.10 Sponsors. (a) Watershed projects are sponsored by one or more local organizations qualifying as sponsors. All watershed plans shall be sponsored...

7 CFR 622.10 - Sponsors.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS Qualifications § 622.10 Sponsors. (a) Watershed projects are sponsored by one or more local organizations qualifying as sponsors. All watershed plans shall be sponsored...

7 CFR 654.14 - Duration of sponsor(s)' responsibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

... performed by force account, division of work, or performance of work methods, the sponsor(s)' O&M responsibilities begin on the date the work or portion thereof is completed as determined by NRCS, except for completed work located on Federal lands which are subject to special-use permits. The O&M agreement shall...

A distributional assessment of Rhode Island's Catastrophic Health Insurance Plan (CHIP)

PubMed Central

Lord, Blair M.

1984-01-01

Since 1975, Rhode Island has operated a government-sponsored catastrophic health insurance program that is consistent in spirit with several of the national health insurance proposals. An important but often overlooked effect of such a program is its effect on the distribution of income. Actual claims data for the years 1975-79 are available for the Rhode Island program permitting direct estimation of an average benefit per family and an average tax burden per family in each of 12 income classes. This permits an assessment of the program's redistributional effects. PMID:10310850

Association of Insurance Expansion With Surgical Management of Thyroid Cancer.

PubMed

Loehrer, Andrew P; Murthy, Shilpa S; Song, Zirui; Lubitz, Carrie C; James, Benjamin C

2017-08-01

26% increased rate of undergoing a thyroidectomy (incident rate ratio, 1.26; 95% CI, 1.04-1.52; P = .02) and a 22% increased rate of neck dissection (incident rate ratio, 1.22; 95% CI, 1.07-1.37; P = .002) for treating cancer compared with control states. The 2006 Massachusetts health reform, which is a model for the Affordable Care Act, was associated with a 26% increased rate of thyroidectomy for treating thyroid cancer. Our study suggests that insurance expansion may be associated with increased access to the surgical management of thyroid cancer. Further studies need to be conducted to evaluate the effect of healthcare expansion at a national level.

44 CFR 61.14 - Standard Flood Insurance Policy Interpretations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.14 Standard Flood Insurance Policy Interpretations. (a... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Standard Flood Insurance...

44 CFR 61.14 - Standard Flood Insurance Policy Interpretations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.14 Standard Flood Insurance Policy Interpretations. (a... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Standard Flood Insurance...

44 CFR 61.14 - Standard Flood Insurance Policy Interpretations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.14 Standard Flood Insurance Policy Interpretations. (a... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Standard Flood Insurance...

44 CFR 61.14 - Standard Flood Insurance Policy Interpretations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.14 Standard Flood Insurance Policy Interpretations. (a... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Standard Flood Insurance...

44 CFR 61.14 - Standard Flood Insurance Policy Interpretations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.14 Standard Flood Insurance Policy Interpretations. (a... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Standard Flood Insurance...

Equivalent weight loss for weight management programs delivered by phone and clinic.

PubMed

Donnelly, Joseph E; Goetz, Jeannine; Gibson, Cheryl; Sullivan, Debra K; Lee, Robert; Smith, Bryan K; Lambourne, Kate; Mayo, Matthew S; Hunt, Suzanne; Lee, Jae Hoon; Honas, Jeffrey J; Washburn, Richard A

2013-10-01

Face-to-face (FTF) weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by FTF clinic or group conference calls (phone). Randomized equivalency trial in 295 overweight/obese men/women (BMI = 35.1±4.9, Age = 43.8±10.2, Minority = 39.8%). Weight loss (0-6 months) was achieved by reducing energy intake between 1,200 and 1,500 kcal/day and progressing physical activity (PA) to 300 min/week. Weight maintenance (7-18 months) provided adequate energy to maintain weight and continued 300 min/week of PA. Behavioral weight management strategies were delivered weekly for 6 months and gradually reduced during 7-18 months. A cost analysis provided a comparison of expenses between groups. Weight change from baseline to 6 months was -13.4 ± 6.7% and -12.3 ± 7.0% for FTF clinic and phone, respectively. Weight change from 6-18 months was 6.4 ± 7.0% and 6.4 ± 5.2%, for FTF clinic and phone, respectively. The cost to FTF participants was $789.58 more per person. Phone delivery provided equivalent weight loss and maintenance and reduced program cost. Ubiquitous access to phones provides a vast reach for this approach. Copyright © 2013 The Obesity Society.

44 CFR Appendix A to Part 62 - Federal Emergency Management Agency, Federal Insurance Administration, Financial Assistance...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Federal Emergency Management... 62 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... OF CLAIMS Pt. 62, App. A Appendix A to Part 62—Federal Emergency Management Agency, Federal Insurance...

Dental insurance: will it help or hinder adoption of caries management practices?

PubMed

Anderson, Maxwell H

2007-05-01

Whether public or private dental insurance will provide benefits for caries management practices is a business decision. The foundation for this decision is multifactorial and continually changing as the values of the purchasers and health care consumers evolve. Understanding the dynamics involved in allocating finite health care resources will help those who advocate for caries management inform decision makers about the potential benefits of these strategies.

Effects Of The ACA's Health Insurance Marketplaces On The Previously Uninsured: A Quasi-Experimental Analysis.

PubMed

Goldman, Anna L; McCormick, Danny; Haas, Jennifer S; Sommers, Benjamin D

2018-04-01

Descriptive studies have suggested that the Affordable Care Act's (ACA's) health insurance Marketplaces improved access to care. However, no evidence from quasi-experimental studies is available to support these findings. We used longitudinal survey data to compare previously uninsured adults with incomes that made them eligible for subsidized Marketplace coverage (138-400 percent of the federal poverty level) to those who had employer-sponsored insurance before the ACA with incomes in the same range. Among the previously uninsured group, the ACA led to a significant decline in the uninsurance rate, decreased barriers to medical care, increased the use of outpatient services and prescription drugs, and increased diagnoses of hypertension, compared to a control group with stable employer-sponsored insurance. Changes were largest among previously uninsured people with incomes of 138-250 percent of poverty, who were eligible for the ACA's cost-sharing reductions. Our quasi-experimental approach provides rigorous new evidence that the ACA's Marketplaces led to improvements in several important health care outcomes, particularly among low-income adults.

Managing medical and insurance information through a smart-card-based information system.

PubMed

Lambrinoudakis, C; Gritzalis, S

2000-08-01

The continuously increased mobility of patients and doctors, in conjunction with the existence of medical groups consisting of private doctors, general practitioners, hospitals, medical centers, and insurance companies, pose significant difficulties on the management of patients' medical data. Inevitably this affects the quality of the health care services provided. The evolving smart card technology can be utilized for the implementation of a secure portable electronic medical record, carried by the patient herself/himself. In addition to the medical data, insurance information can be stored in the smart card thus facilitating the creation of an "intelligent system" supporting the efficient management of patient's data. In this paper we present the main architectural and functional characteristics of such a system. We also highlight how the security features offered by smart cards can be exploited in order to ensure confidentiality and integrity of the medical data stored in the patient cards.

State variation in health insurance coverage for U.S. citizen children of immigrants.

PubMed

Acevedo-Garcia, Dolores; Stone, Lisa Cacari

2008-01-01

In this paper we compare health insurance coverage for U.S. citizen children in all-citizen and mixed families in the fifteen states with the largest share of children in mixed families. Insurance coverage is lower and state variation in coverage is higher for children in mixed families vis-à-vis children in all-citizen families. The main challenges for states are tackling uninsurance among all low-income children and addressing the very low rates of employer-sponsored insurance for all low-income children and for children in all mixed families, regardless of income. We discuss state policy options to address the needs of children in mixed families.

Equivalent weight loss for weight management programs delivered by phone and clinic

PubMed Central

Donnelly, Joseph E.; Goetz, Jeannine; Gibson, Cheryl; Sullivan, Debra K.; Lee, Robert; Smith, Bryan K.; Lambourne, Kate; Mayo, Matthew S.; Hunt, Suzanne; Lee, Jae Hoon; Honas, Jeffrey J.; Washburn, Richard A.

2013-01-01

Objective Face-to-face weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by face-to-face (FTF) clinic or group conference calls (phone). Design and Methods Randomized equivalency trial in 295 overweight/obese men/women (BMI = 35.1±4.9, Age = 43.8±10.2, Minority = 39.8%). Weight loss (0–6 months) was achieved by reducing energy intake between 1,200– 1,500 kcal/day and progressing physical activity to 300 minutes/week. Weight maintenance (7–18 months) provided adequate energy to maintain weight and continued 300 minutes/week of physical activity. Behavioral weight management strategies were delivered weekly for 6 months and gradually reduced during months 7–18. A cost analysis provided a comparison of expenses between groups. Results Weight change from baseline to 6 months was −13.4 ± 6.7% and −12.3 ± 7.0% for FTF clinic and phone, respectively. Weight change from 6 months to 18 months was 6.4 ± 7.0% and 6.4 ± 5.2%, for FTF clinic and phone, respectively. The cost to FTF participants was $789.58 more person. Conclusions Phone delivery provided equivalent weight loss and maintenance and reduced program cost. Ubiquitous access to phones provides a vast reach for this approach. PMID:23408579

The relationship between employer health insurance characteristics and the provision of employee assistance programs.

PubMed

Zarkin, G A; Garfinkel, S A

1994-01-01

Workplace drug and alcohol abuse imposes substantial costs on employers. In response, employers have implemented a variety of programs to decrease substance abuse in the workplace, including drug testing, health and wellness programs, and employee assistance programs (EAPs). This paper focuses on the relationship between enterprises' organizational and health insurance characteristics and the firms' decisions to provide EAPs. Using data from the 1989 Survey of Health Insurance Plans (SHIP), sponsored by the Health Care Financing Administration (HCFA), we estimated the prevalence of EAPs by selected organizational and health insurance characteristics for those firms that offer health insurance to their workers. In addition, we estimated logistic models of the enterprises' decisions to provide EAPs as functions of the extent of state substance abuse and mental health insurance mandates, state-level demographic variables, and organizational and health insurance characteristics. Our results suggest that state mandates and demographic variables, as well as organizational and health insurance characteristics, are important explanatory variables of enterprises' decisions to provide EAPs.

Skin in the game: Does paying for obesity treatment out of pocket lead to better outcomes compared to insurance coverage?

PubMed

Ard, Jamy D; Emery, Matt; Cook, Miranda; Hale, Erica; Frain, Annette; Lewis, Kristina H; Song, Eunyoung

2017-06-01

To determine whether insurance coverage for medical weight loss treatment was associated with different program engagement and weight loss outcomes compared to those who paid out of pocket. One-year outcomes from an academic medical weight management program were used to compare two groups: employees (n = 480) with insurance coverage ("covered") versus nonemployees (n = 463) who paid out of pocket ("self-pay"). Demographics and weight were abstracted from medical records. Socioeconomic status was estimated using neighborhood demographics. Group differences in weight were analyzed using generalized linear modeling adjusted for age, baseline BMI, sex, program type, and neighborhood socioeconomic status. Covered patients were younger (46.5 ± 10.6 vs. 51.6 ± 12.5) with a lower BMI (38.5 ± 7.5 vs. 41.3 ± 9.9) compared to self-pay (P < 0.001). Self-pay patients resided in higher annual per capita income neighborhoods (+$4,545, P < 0.001). Program dropout was lower for covered patients (12.7% vs. 17.6%, P = 0.03). There was no significant difference in 12-month weight loss between groups in adjusted models; covered patients lost 13.4%, compared to 13.6% for self-pay. Data from an academic medical weight management program suggest that individuals with access to insurance coverage for nonsurgical obesity treatment have lower levels of attrition and similar levels of participation and outcomes as those who pay out of pocket. © 2017 The Obesity Society.

Insurance and Prevention: Why and How?

ERIC Educational Resources Information Center

Ungarelli, Donald L.

1984-01-01

Stressing importance of insurance coverage for the buildings and contents of libraries, this article covers insurance history, the modern insurance industry, examples of loss experiences, prevention and preparedness, risk management, appraisals and valuations of property, insurance options, and lack of recognition of protective and preventive…

The generalizability of NCI-sponsored clinical trials accrual among women with gynecologic malignancies.

PubMed

Mishkin, Grace; Minasian, Lori M; Kohn, Elise C; Noone, Anne-Michelle; Temkin, Sarah M

2016-12-01

Enrollment of a representative population to cancer clinical trials ensures scientific reliability and generalizability of results. This study evaluated the similarity of patients enrolled in NCI-supported group gynecologic cancer trials to the incident US population. Accrual to NCI-sponsored ovarian, uterine, and cervical cancer treatment trials between 2003 and 2012 were examined. Race, ethnicity, age, and insurance status were compared to the analogous US patient population estimated using adjusted SEER incidence data. There were 18,913 accruals to 156 NCI-sponsored gynecologic cancer treatment trials, ovarian (56%), uterine (32%), and cervical cancers (12%). Ovarian cancer trials included the least racial, ethnic and age diversity. Black women were notably underrepresented in ovarian trials (4% versus 11%). Hispanic patients were underrepresented in ovarian and uterine trials (4% and 5% versus 18% and 19%, respectively), but not in cervical cancer trials (14 versus 11%). Elderly patients were underrepresented in each disease area, with the greatest underrepresentation seen in ovarian cancer patients over the age of 75 (7% versus 29%). Privately insured women were overrepresented among accrued ovarian cancer patients (87% versus 76%), and the uninsured were overrepresented among women with uterine or cervical cancers. These patterns did not change over time. Several notable differences were observed between the patients accrued to NCI funded trials and the incident population. Improving representation of racial and ethnic minorities and elderly patients on cancer clinical trials continues to be a challenge and priority. Copyright © 2016 Elsevier Inc. All rights reserved.

Health insurance take-up by the near-elderly.

PubMed

Buchmueller, Thomas C; Ohri, Sabina

2006-12-01

To examine the effect of price on the demand for health insurance by early retirees between the ages of 55 and 64. Administrative health plan enrollment data from a medium-sized U.S. employer. The analysis takes advantage of a natural experiment created by the firm's health insurance contribution policy. The amount the firm contributes toward retiree health insurance coverage depends on when a person retired and her years of service at that date. As a result of this policy, there is considerable variation in out-of-pocket premiums faced by individuals in the data. This variation is independent of the nonprice attributes of the health insurance plans offered and is plausibly exogenous to individual characteristics that are likely to affect the demand for insurance. A probit model is used to estimate the decision to take-up employer-sponsored health insurance by early retirees between the ages of 55 and 64. Demand for insurance is measured as a function of out-of-pocket premiums and a set of individual characteristics. We find that price has a small but statistically significant effect on the decision to take up coverage. Estimated price elasticities range from -0.10 to -0.16, depending on the sample. The implied elasticities are comparable with results found in previous studies using very different data. Our estimates indicate that policy proposals for a Medicare buy-in or a nongroup tax credit will have a modest impact on take-up rates of near-elderly retirees.

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management.

PubMed

Atinga, Roger A; Mensah, Sylvester A; Asenso-Boadi, Francis; Adjei, Francis-Xavier Andoh

2012-06-22

In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana's ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Study's findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation.

45 CFR 2553.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2011 CFR

2011-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... staff positions in the sponsor organization and/or project service area. (f) Establish risk management...

45 CFR 2553.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2014 CFR

2014-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... staff positions in the sponsor organization and/or project service area. (f) Establish risk management...

45 CFR 2553.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2012 CFR

2012-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... staff positions in the sponsor organization and/or project service area. (f) Establish risk management...

45 CFR 2553.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2013 CFR

2013-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... staff positions in the sponsor organization and/or project service area. (f) Establish risk management...

Health economics of weight management: evidence and cost.

PubMed

Kouris-Blazos, Antigone; Wahlqvist, Mark L

2007-01-01

is too much reliance on health workers to treat the problem, especially doctors, who have not been given additional resources to manage obesity outside a typical doctor's consultation. Gross has recommended that further changes should be made to Medicare, private health insurance, and workplace and tax legislation to give people financial incentives to change their behaviour because obesity should not just be treated by governments as a public health problem but also as a barrier to productivity and a drain on resources. A Special Report of the WMCACA (Weight Management Code Administration Council of Australia) (www.weightcouncil.org) on the "Health Economics of Weight Management" has been published in the Asia Pacific Journal of Clinical Nutrition in September 2006. This report explores the cost benefit analysis of weight management in greater detail.

Policy tenure under the U.S. National Flood Insurance Program (NFIP).

PubMed

Michel-Kerjan, Erwann; Lemoyne de Forges, Sabine; Kunreuther, Howard

2012-04-01

In the United States, insurance against flood hazard (inland flooding or storm surge from hurricanes) has been provided mainly through the National Flood Insurance Program (NFIP) since 1968. The NFIP covers $1.23 trillion of assets today. This article provides the first analysis of flood insurance tenure ever undertaken: that is, the number of years that people keep their flood insurance policy before letting it lapse. Our analysis of the entire portfolio of the NFIP over the period 2001-2009 reveals that the median tenure of new policies during that time is between two and four years; it is also relatively stable over time and levels of flood hazard. Prior flood experience can affect tenure: people who have experienced small flood claims tend to hold onto their insurance longer; people who have experienced large flood claims tend to let their insurance lapse sooner. To overcome the policy and governance challenges posed by homeowners' inadequate insurance coverage, we discuss policy recommendations that include for banks and government-sponsored enterprises (GSEs) strengthening their requirements and the introduction of multiyear flood insurance contracts attached to the property, both of which are likely to provide more coverage stability and encourage investments in risk-reduction measures. © 2011 Society for Risk Analysis.

[Introduction of disease management programmes in Germany as reflected by differing interests of health insurance companies and the federal association of statutory health insurance physicians].

PubMed

Erler, A

2002-11-01

On 1st January 2002 a law was enacted by the German Federal Government reorganising the reinsurance pool known as the "risk compensation scheme" (RSA) of the German health insurance system. This enactment contemplates a gradual restructuring of the RSA to shift from a system that considered only certain demographic criteria to one that reflects actual morbidity rates, with the shift to be phased in before full implementation by 2007. The enactment also introduced disease management programmes (DMP) for patients with certain chronic illnesses. Insurance companies will now receive additional payments from the RSA for patients with a chronic condition who are enrolled in a DMP. The intent is to improve the poor medical care for chronically ill patients in Germany - as had been stated by the advisory council of the Concerted Action in Health Care - and to reduce the natural tendency of insurance companies to prefer young healthy members over chronically ill patients. Possible consequences of the legal changes are discussed from the point of view of the various insurance companies as well as the Federal Association of Statutory Health Insurance Physicians.

7 CFR 226.16 - Sponsoring organization provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... a meals times rates payment system. In those States which implement this optional method of reimbursement, such disbursements may not exceed the rates times the number of meals documented at each facility...-time staff person for each 50 to 150 day care homes it sponsors. As part of its management plan, a...

7 CFR 226.16 - Sponsoring organization provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... a meals times rates payment system. In those States which implement this optional method of reimbursement, such disbursements may not exceed the rates times the number of meals documented at each facility...-time staff person for each 50 to 150 day care homes it sponsors. As part of its management plan, a...

Stand-alone health insurance tax credits aren't enough.

PubMed

Jackson, L; Trude, S

2001-07-01

Using health insurance tax credits to help reduce the ranks of the nearly 43 million uninsured Americans has attracted broad bipartisan support in Congress. But tax credits alone will not help many sick or older people obtain affordable coverage, according to an expert panel at an April 10, 2001, conference sponsored by the Center for Studying Health System Change (HSC). To make tax credits a viable option for eligible people, the individual insurance market would need significant reforms or a better way to spread risk-similar to large employers-over a large and varied population. This Issue Brief highlights critical issues policy makers should consider when crafting tax credit proposals, including the use of purchasing pools.

Risk Management and Insurance. Guidelines for Higher Education.

ERIC Educational Resources Information Center

Adams, John F.

Insurance companies, following the campus unrest of the late 1960's and early 1970's, became rather wary of insuring college and university campuses because of the great amount of risk involved. As a study committee found, however, the risk of insuring educational facilities had been overestimated due to widespread newspaper and television…

45 CFR 2551.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2014 CFR

2014-10-01

... project and carry out its project management responsibilities. (c) Employ a full-time project director to... the sponsor organization and/or project service area. (f) Establish risk management policies and... responsibility for securing maximum and continuing community financial and in-kind support to operate the project...

45 CFR 2551.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2012 CFR

2012-10-01

... project and carry out its project management responsibilities. (c) Employ a full-time project director to... the sponsor organization and/or project service area. (f) Establish risk management policies and... responsibility for securing maximum and continuing community financial and in-kind support to operate the project...

45 CFR 2551.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2013 CFR

2013-10-01

... project and carry out its project management responsibilities. (c) Employ a full-time project director to... the sponsor organization and/or project service area. (f) Establish risk management policies and... responsibility for securing maximum and continuing community financial and in-kind support to operate the project...

45 CFR 2551.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2011 CFR

2011-10-01

... project and carry out its project management responsibilities. (c) Employ a full-time project director to... the sponsor organization and/or project service area. (f) Establish risk management policies and... responsibility for securing maximum and continuing community financial and in-kind support to operate the project...

Urban Flood Risk Insurance Models as a Strategy for Proactive Water Management Policies

NASA Astrophysics Data System (ADS)

Graciosa, M. C.; Mendiondo, E. M.

2006-12-01

To improve the water management through hydrological sciences, novel integration strategies could be underpinned to bridge up both engineering and economics. This is especially significant in developing nations where hydrologic extremes are expressive while the financial resources to mitigate that variability are scarce. One example of this problem is related to floods and their global and regional consequences. Floods mainly cause disasters in terms of human and material losses. In 2002, more than 30% of extreme climatic events occurred worldwide were floods, representing 42% of fatalities and 66% of material losses, mostly related to reactive policies. Throughout the last century, hydrological variability and rapidly growing of urban areas have developed new environmental problems in Brazilian cities, such as inundation occurrences on non-planned river basins. One of the causes of flood impacts is that public funds (national, state or municipal) have barely introduced wise proactive polices to follow up rapidly growing urban areas. Inexistent flood-risk-transfer mechanisms have caused the so-called `flood poverty cycle' due to reactive polices that have been increasing flood losses and, sometimes, became flood disasters. Flood risk management (FRM) is part of pro-active policies to mitigate inundation losses, in order to sustain environmental, social and economic aspects. Concepts and principles of FRM are part of a process that encompasses three phases: (1) preparedness stage, that consists in structural and non-structural actions to prevent and protect potential risk areas, such as early warning systems and scenarios development; (2) control stage, that refers to help actions and protection facilities during the event, and (3) restoration stage, that is related to rebuild affected areas, restore the river dynamics and transfer the socio-economic risks through flood insurances. Flood risk insurances agree to the goals of losses mitigation programs. Their use is

When weight management lasts. Lower perceived rule complexity increases adherence.

PubMed

Mata, Jutta; Todd, Peter M; Lippke, Sonia

2010-02-01

Maintaining behavior change is one of the major challenges in weight management and long-term weight loss. We investigated the impact of the cognitive complexity of eating rules on adherence to weight management programs. We studied whether popular weight management programs can fail if participants find the rules too complicated from a cognitive perspective, meaning that individuals are not able to recall or process all required information for deciding what to eat. The impact on program adherence of participants' perceptions of eating rule complexity and other behavioral factors known to influence adherence (including previous weight management, self-efficacy, and planning) was assessed via a longitudinal online questionnaire given to 390 participants on two different popular weight management regimens. As we show, the regimens, Weight Watchers and a popular German recipe diet (Brigitte), strongly differ in objective rule complexity and thus their cognitive demands on the dieter. Perceived rule complexity was the strongest factor associated with increased risk of quitting the cognitively demanding weight management program (Weight Watchers); it was not related to adherence length for the low cognitive demand program (Brigitte). Higher self-efficacy generally helped in maintaining a program. The results emphasize the importance of considering rule complexity to promote long-term weight management. 2009 Elsevier Ltd. All rights reserved.

Weight Management, Weight Perceptions, and Health-Compromising Behaviours Among Adolescent Girls in the COMPASS Study.

PubMed

Raffoul, Amanda; Leatherdale, Scott T; Kirkpatrick, Sharon I

2018-06-16

Evidence suggests associations between weight management intentions, weight perceptions, and health-compromising behaviours among adolescent girls. Drawing on cross-sectional data for 21,456 girls, we employed multinomial logistic regression to examine whether smoking, binge drinking, and breakfast-skipping were associated with weight management intentions and weight perceptions. According to self-reported heights and weights, 61.4% of girls were in the healthy weight category. However, most reported trying to manage their weight, with 58% trying to lose, 4.5% trying to gain, and 18% trying to maintain their weight. Smokers were more likely than non-smokers to report intentions to lose, gain, or maintain weight versus to do nothing. However, smokers were less likely than non-smokers to perceive themselves as underweight or overweight versus about the right weight. Binge drinkers were more likely than other girls to report an intention to gain and less likely to be trying to maintain their weight versus doing nothing, and breakfast-skippers were more likely to report trying to lose or gain weight but less likely to report trying to maintain weight versus doing nothing. Binge drinkers and breakfast-skippers were more likely than non-binge drinkers and non-breakfast-skippers, respectively, to perceive themselves as underweight, overweight or very overweight versus about the right weight. In sum, the majority of girls reported trying to manage their weight, and those engaging in other health-compromising behaviours were more likely to do so, though the exact nature of the associations differed by behaviour. Recognition of shared underlying risk factors for this clustering of behaviours may inform comprehensive health promotion efforts.

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management

PubMed Central

2012-01-01

Background In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. Methods A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana’s ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. Results The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Conclusion Study’s findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation. PMID:22726666

Yogurt and weight management.

PubMed

Jacques, Paul F; Wang, Huifen

2014-05-01

A large body of observational studies and randomized controlled trials (RCTs) has examined the role of dairy products in weight loss and maintenance of healthy weight. Yogurt is a dairy product that is generally very similar to milk, but it also has some unique properties that may enhance its possible role in weight maintenance. This review summarizes the human RCT and prospective observational evidence on the relation of yogurt consumption to the management and maintenance of body weight and composition. The RCT evidence is limited to 2 small, short-term, energy-restricted trials. They both showed greater weight losses with yogurt interventions, but the difference between the yogurt intervention and the control diet was only significant in one of these trials. There are 5 prospective observational studies that have examined the association between yogurt and weight gain. The results of these studies are equivocal. Two of these studies reported that individuals with higher yogurt consumption gained less weight over time. One of these same studies also considered changes in waist circumference (WC) and showed that higher yogurt consumption was associated with smaller increases in WC. A third study was inconclusive because of low statistical power. A fourth study observed no association between changes in yogurt intake and weight gain, but the results suggested that those with the largest increases in yogurt intake during the study also had the highest increase in WC. The final study examined weight and WC change separately by sex and baseline weight status and showed benefits for both weight and WC changes for higher yogurt consumption in overweight men, but it also found that higher yogurt consumption in normal-weight women was associated with a greater increase in weight over follow-up. Potential underlying mechanisms for the action of yogurt on weight are briefly discussed.

Characteristics of project management at institutions sponsoring National Library of Medicine MedlinePlus Go Local*

PubMed Central

Olney, Cynthia A.; Backus, Joyce E. B.; Klein, Lori J.

2010-01-01

Objectives: Through interviews with the National Library of Medicine's MedlinePlus Go Local collaborators, an evaluation team sought to identify process characteristics that are critical for long-term sustainability of Go Local projects and to describe the impact that Go Local projects have on sponsoring institutions. Methods: Go Local project coordinators (n = 44) at 31 sponsor institutions participated in semi-structured interviews about their experiences developing and maintaining Go Local sites. Interviews were summarized, checked for accuracy by the participating librarians, and analyzed using a general inductive methodology. Results: Institutional factors that support Go Local projects were identified through the interviews, as well as strategies for staffing and partnerships with external organizations. Positive outcomes for sponsoring institutions also were identified. Conclusions: The findings may influence the National Library of Medicine team's decisions about improvements to its Go Local system and the support it provides to sponsoring institutions. The findings may benefit current sponsoring institutions as well as those considering or planning a Go Local project. PMID:20098657

The Sponsored Film.

ERIC Educational Resources Information Center

Klein, Walter J.

For public relations professionals and would-be sponsors of films, this book provides guidelines for understanding the film medium and its potential as a persuasive force in industry, government, organizations, and religious orders. For filmmakers, it brings together practical information needed to survive in the sponsored-film industry and to…

Public insurance expansions and crowd out of private coverage.

PubMed

Marquis, M Susan; Long, Stephen H

2003-03-01

The extent to which persons enrolling in new public insurance programs substitute the public coverage for private insurance is of concern to policy makers. To look at the extent of the substitution resulting from new state programs that cover a broad base of the low-income population and to look at the responses of both families and employers. The March CPS for 1991-1993 and 1997-1998 were used to study the responses of families. Two large national surveys of employers with information about the employment-based system in 1993 and 1997 were used to study employer responses. The analysis looks at changes in coverage and employer offer rates before and after the public insurance expansions in selected states and compares these changes to those in a control group in states without expansions. Coverage by private insurance for low-income persons in states with expansions fell by more than expected based on the control states, indicating some substitution of public coverage for private insurance. Changes in employee coverage in own-employer sponsored insurance accord with this result. The expansion of public insurance has a bigger effect on employer offer decisions when a large share of its workers is eligible for public programs. The results show a significant substitution of public insurance for private coverage in the expansions studied. However, endogeneity of state expansion policies and possible confounding with other policy changes temper the conclusions. More recent public insurance expansions as part of the State Childrens' Health Insurance Program have adopted a range of methods to limit crowd out. Future research is needed to evaluate whether these procedures and rules have succeeded.

The Changing Dynamics Of US Health Insurance And Implications For The Future Of The Affordable Care Act.

PubMed

Graves, John A; Nikpay, Sayeh S

2017-02-01

The introduction of Medicaid expansions and state Marketplaces under the Affordable Care Act (ACA) have reduced the uninsurance rate to historic lows, changing the choices Americans make about coverage. In this article we shed light on these changing dynamics. We drew upon multistate transition models fit to nationally representative longitudinal data to estimate coverage transition probabilities between major insurance types in the years leading up to and including 2014. We found that the ACA's unprecedented coverage changes increased transitions to Medicaid and nongroup coverage among the uninsured, while strengthening the existing employer-sponsored insurance system and improving retention of public coverage. However, our results suggest possible weakness of state Marketplaces, since people gaining nongroup coverage were disproportionately older than other potential enrollees. We identified key opportunities for policy makers and insurers to improve underlying Marketplace risk pools by focusing on people transitioning from employer-sponsored coverage; these people are disproportionately younger and saw almost no change in their likelihood of becoming uninsured in 2014 compared to earlier years. Project HOPE—The People-to-People Health Foundation, Inc.

The relationship between doctors' and nurses' own weight status and their weight management practices: a systematic review.

PubMed

Zhu, D Q; Norman, I J; While, A E

2011-06-01

It has been established that health professionals' smoking and physical activity influence their related health-promoting behaviours, but it is unclear whether health professionals' weight status also influences their related professional practices. A systematic review was conducted to understand the relationship between personal weight status and weight management practices. Nine eligible studies were identified from a search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and Chinese databases. All included studies were cross-sectional surveys employing self-reported questionnaires. Weight management practice variables studied were classified under six practice indicators, developed from weight management guidelines. Syntheses of the findings from the selected studies suggest that: normal weight doctors and nurses were more likely than those who were overweight to use strategies to prevent obesity in-patients, and, also, provide overweight or obese patients with general advice to achieve weight loss. Doctors' and nurses' own weight status was not found to be significantly related to their referral and assessment of overweight or obese patients, and associations with their relevant knowledge/skills and specific treatment behaviours were inconsistent. Additionally, in female, primary care providers, relevant knowledge and training, self-efficacy and a clear professional identity emerged as positive predictors of weight management practices. This review's findings will need to be confirmed by prospective theoretically driven studies, which employ objective measures of weight status and weight management practices and involve multivariate analyses to identify the relative contribution of weight status to weight management. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

Health Insurance Take-up by the Near-Elderly

PubMed Central

Buchmueller, Thomas C; Ohri, Sabina

2006-01-01

Objective To examine the effect of price on the demand for health insurance by early retirees between the ages of 55 and 64. Data Source Administrative health plan enrollment data from a medium-sized U.S. employer. Study Design The analysis takes advantage of a natural experiment created by the firm's health insurance contribution policy. The amount the firm contributes toward retiree health insurance coverage depends on when a person retired and her years of service at that date. As a result of this policy, there is considerable variation in out-of-pocket premiums faced by individuals in the data. This variation is independent of the nonprice attributes of the health insurance plans offered and is plausibly exogenous to individual characteristics that are likely to affect the demand for insurance. A probit model is used to estimate the decision to take-up employer-sponsored health insurance by early retirees between the ages of 55 and 64. Demand for insurance is measured as a function of out-of-pocket premiums and a set of individual characteristics. Principal Findings We find that price has a small but statistically significant effect on the decision to take up coverage. Estimated price elasticities range from −0.10 to −0.16, depending on the sample. Conclusions The implied elasticities are comparable with results found in previous studies using very different data. Our estimates indicate that policy proposals for a Medicare buy-in or a nongroup tax credit will have a modest impact on take-up rates of near-elderly retirees. PMID:17116109

44 CFR 61.17 - Group Flood Insurance Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.17 Group Flood Insurance Policy. (a) A Group Flood Insurance Policy (GFIP) is a... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Group Flood Insurance Policy...

44 CFR 61.17 - Group Flood Insurance Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.17 Group Flood Insurance Policy. (a) A Group Flood Insurance Policy (GFIP) is a... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Group Flood Insurance Policy...

44 CFR 61.17 - Group Flood Insurance Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.17 Group Flood Insurance Policy. (a) A Group Flood Insurance Policy (GFIP) is a... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Group Flood Insurance Policy...

44 CFR 61.17 - Group Flood Insurance Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.17 Group Flood Insurance Policy. (a) A Group Flood Insurance Policy (GFIP) is a... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Group Flood Insurance Policy...

44 CFR 61.17 - Group Flood Insurance Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.17 Group Flood Insurance Policy. (a) A Group Flood Insurance Policy (GFIP) is a... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Group Flood Insurance Policy...

Estimating the Tradeoff Between Risk Protection and Moral Hazard with a Nonlinear Budget Set Model of Health Insurance*

PubMed Central

Kowalski, Amanda E.

2015-01-01

Insurance induces a tradeoff between the welfare gains from risk protection and the welfare losses from moral hazard. Empirical work traditionally estimates each side of the tradeoff separately, potentially yielding mutually inconsistent results. I develop a nonlinear budget set model of health insurance that allows for both simultaneously. Nonlinearities in the budget set arise from deductibles, coinsurance rates, and stoplosses that alter moral hazard as well as risk protection. I illustrate the properties of my model by estimating it using data on employer sponsored health insurance from a large firm. PMID:26664035

The Patient Protection and Affordable Care Act and the regulation of the health insurance industry.

PubMed

Jha, Saurabh; Baker, Tom

2012-12-01

The Patient Protection and Affordable Care Act is a comprehensive and multipronged reform of the US health care system. The legislation makes incremental changes to Medicare, Medicaid, and the market for employer-sponsored health insurance. However, it makes substantial changes to the market for individual and small-group health insurance. The purpose of this article is to introduce the key regulatory reforms in the market for individual and small-group health insurance and explain how these reforms tackle adverse selection and risk classification and improve access to health care for the hitherto uninsured or underinsured population. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Addressing health care market reform through an insurance exchange: essential policy components, the public plan option, and other issues to consider.

PubMed

Fronstin, Paul; Ross, Murray N

2009-06-01

HEALTH INSURANCE EXCHANGE: This Issue Brief examines issues related to managed competition and the use of a health insurance exchange for the purpose of addressing cost, quality, and access to health care services. It discusses issues that must be addressed when designing an exchange in order to reform the health insurance market and also examines state efforts at health reform that use an exchange. RISK VS. PRICE COMPETITION: The basic component of managed competition is the creation an organized marketplace that brings together health insurers and consumers (either as individuals or through their employers). The sponsor of the exchange would set "rules of engagement" for participating insurers and offer consumers a menu of choices among different plans. Ultimately, the goal of a health insurance exchange is to shift the market from competition based on risk to competition based on price and quality. ADVERSE SELECTION AND AFFORDABILITY: Among the issues that need to be addressed if an exchange that uses managed competition has a realistic chance of reducing costs, improving quality, and expanding coverage: Everyone needs to be in the risk pool, with individuals required to purchase insurance or face significant financial consequences; effective risk adjustment is essential to eliminate risk selection as an insurance business model--forcing competition on costs and quality; the insurance benefit must be specific and clear--without standards governing cost sharing, covered services, and network coverage there is no way to assess whether a requirement to purchase or issue coverage has been met; and subsidies would be necessary for low-income individuals to purchase insurance. THE PUBLIC PLAN OPTION: The public plan option is shaping up to be one of the most contentious issues in the health reform debate. Proponents also believe of a public plan is necessary to drive private insurers toward true competition. Opponents view it as a step toward government-run health

44 CFR 75.13 - Review by the Federal Insurance Administrator.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Review by the Federal Insurance Administrator. 75.13 Section 75.13 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance...

China's Insurance Regulatory Reform, Corporate Governance Behavior and Insurers' Governance Effectiveness.

PubMed

Li, Huicong; Zhang, Hongliang; Tsai, Sang-Bing; Qiu, Aichao

2017-10-17

External regulation is an important mechanism to improve corporate behavior in emerging markets. China's insurance governance regulation, which began to supervise and guide insurance corporate governance behavior in 2006, has experienced a complex process of reform. This study tested our hypotheses with a sample of 85 firms during 2010-2011, which was obtained by providing a questionnaire to all of China's shareholding insurance companies. The empirical study results generally show that China's insurance governance effectiveness has significantly improved through strict regulation. Insurance corporate governance can improve business acumen and risk-control ability, but no significant evidence was found to prove its influence on profitability, as a result of focusing less attention on governance than on management. State ownership is associated with higher corporate governance effectiveness than non-state ownership. Listed companies tend to outperform non-listed firms, and life insurance corporate governance is more effective than that of property insurers. This study not only contributes to the comprehensive understanding of corporate governance effectiveness but also to the literature by highlighting the effect of corporate governance regulation in China's insurance industry and other emerging economies of the financial sector.

48 CFR 47.102 - Transportation insurance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Transportation insurance... MANAGEMENT TRANSPORTATION General 47.102 Transportation insurance. (a) The Government generally (1) retains... assumed responsibility. The cost of this insurance to the carrier shall be part of the transportation cost...

48 CFR 47.102 - Transportation insurance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Transportation insurance... MANAGEMENT TRANSPORTATION General 47.102 Transportation insurance. (a) The Government generally (1) retains... assumed responsibility. The cost of this insurance to the carrier shall be part of the transportation cost...

48 CFR 47.102 - Transportation insurance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Transportation insurance... MANAGEMENT TRANSPORTATION General 47.102 Transportation insurance. (a) The Government generally (1) retains... assumed responsibility. The cost of this insurance to the carrier shall be part of the transportation cost...

48 CFR 47.102 - Transportation insurance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Transportation insurance... MANAGEMENT TRANSPORTATION General 47.102 Transportation insurance. (a) The Government generally (1) retains... assumed responsibility. The cost of this insurance to the carrier shall be part of the transportation cost...

48 CFR 47.102 - Transportation insurance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Transportation insurance... MANAGEMENT TRANSPORTATION General 47.102 Transportation insurance. (a) The Government generally (1) retains... assumed responsibility. The cost of this insurance to the carrier shall be part of the transportation cost...

Sum Insured Determination for Cereal, Citrus and Vineyards in the Spanish Agricultural Insurance System

NASA Astrophysics Data System (ADS)

Lozano, C.; Tarquis, A. M.; Gómez-Barona, J. A.

2012-04-01

In general, insurance is a form of risk management used to hedge against a contingent loss. The conventional definition is the equitable transfer of a risk of loss from one entity to another in exchange for a premium or a guaranteed and quantifiable small loss to prevent a large and possibly devastating loss being agricultural insurance a special line of property insurance. Agriculture insurance, as actually are designed in the Spanish scenario, were established in 1978. At the macroeconomic insurance studies scale, it is necessary to know a basic element for the insurance actuarial components: sum insured. When a new risk assessment has to be evaluated in the insurance framework, it is essential to determinate venture capital in the total Spanish agriculture. In this study, three different crops (cereal, citrus and vineyards) cases are showed to determinate sum insured as they are representative of the cases found in the Spanish agriculture. Crop sum insured is calculated by the product of crop surface, unit surface production and crop price insured. In the cereal case, winter as spring cereal sowing, represents the highest Spanish crop surface, above to 6 millions of hectares (ha). Meanwhile, the four citrus species (oranges, mandarins, lemons and grapefruits) occupied an extension just over 275.000 ha. On the other hand, vineyard target to wine process shows almost one million of ha in Spain. A new method has been applied to estimate crop sum insured in these three cases. Under the maximum economic impact assumption, the maximum market price has been used to insurance each species. Depending on crop and reliability of the data base available, the insured area or insured production has been used in this estimation. When for a certain crop varieties or type of varieties show different insurance prices a geometric average was used as average insurance price for that particular crop. One extreme difficult case was vineyards, where differentiate prices based on

Weight management in the performance athlete.

PubMed

Manore, Melinda M

2013-01-01

Management of weight is an ever-increasing challenge in societies where good tasting food is convenient, relatively inexpensive, and abundant. Developing a weight management plan is essential for everyone, including athletes that expend high amounts of energy in their sport. This brief review addresses the concept of dynamic energy balance and dietary approaches that can be successfully used with active individuals to facilitate weight loss, while retaining lean tissue and minimizing risks for disordered eating. Emphasis is placed on teaching athletes the benefits of consuming a low-energy-dense diet (e.g. high-fiber, high-water, low-fat foods), which allows for the consumption of a greater volume of food that is satiating but reduces energy intake. Other dietary behaviors important for weight loss or weight maintenance after weight loss are also emphasized, such as eating breakfast, spreading food and protein intake throughout the day, eating after exercise, elimination of sweetened beverages, and avoiding fad diets. As the general population becomes heavier, more young athletes will come to their sport needing to alter bodyweight or composition to perform at their peak. Health professionals need to be prepared with effective and evidence-based dietary approaches to help the athletes achieve their bodyweight goals. Copyright © 2013 Nestec Ltd., Vevey/S. Karger AG, Basel.

Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium Tax Credit. Final regulations.

PubMed

2015-12-18

This document contains final regulations on the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the Medicare and Medicaid Extenders Act of 2010, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, and the Department of Defense and Full-Year Continuing Appropriations Act, 2011. These final regulations affect individuals who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges, sometimes called Marketplaces) and claim the health insurance premium tax credit, and Exchanges that make qualified health plans available to individuals and employers.

44 CFR 61.13 - Standard Flood Insurance Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.13 Standard Flood Insurance Policy. (a) Incorporation of forms. Each of the... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Standard Flood Insurance...

44 CFR 61.13 - Standard Flood Insurance Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.13 Standard Flood Insurance Policy. (a) Incorporation of forms. Each of the... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Standard Flood Insurance...

44 CFR 61.13 - Standard Flood Insurance Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.13 Standard Flood Insurance Policy. (a) Incorporation of forms. Each of the... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Standard Flood Insurance...

44 CFR 61.13 - Standard Flood Insurance Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE COVERAGE AND RATES § 61.13 Standard Flood Insurance Policy. (a) Incorporation of forms. Each of the... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Standard Flood Insurance...

UPMC MyHealth: managing the health and costs of U.S. healthcare workers.

PubMed

Parkinson, Michael D; Peele, Pamela B; Keyser, Donna J; Liu, Yushu; Doyle, Stephen

2014-10-01

Workplace wellness programs hold promise for managing the health and costs of the U.S. workforce. These programs have not been rigorously tested in healthcare worksites. To evaluate the impact of MyHealth on the health and costs of UPMC healthcare workers. Five-year observational study conducted in 2013 with subgroup analyses and propensity-matched pair comparisons to more accurately interpret program effects. UPMC, an integrated health care delivery and financing system headquartered in Pittsburgh, Pennsylvania. Participants included 13,627 UPMC employees who were continuously enrolled in UPMC-sponsored health insurance during the study period and demonstrated participation in MyHealth by completing a Health Risk Assessment in both 2007 and 2011, as well as 4,448 other healthcare workers employed outside of UPMC who did not participate in the program. A comprehensive wellness, prevention, and chronic disease management program that ties achievement of health and wellness requirements to receipt of an annual credit on participants' health insurance deductible. Health-risk levels, medical, pharmacy, and total healthcare costs, and Healthcare Effectiveness Data and Information Set performance rates for prevention and chronic disease management. Significant improvements in health-risk status and increases in use of preventive and chronic disease management services were observed in the intervention group. Although total healthcare costs increased significantly, reductions in costs were significant for those who moved from higher- to the lowest-risk levels. The contrast differences in costs between reduced- and maintained-risk groups was also significant. Matched pair comparisons provided further evidence of program effects on observed reductions in costs and improvements in prevention, but not improvements in chronic disease management. Incorporating incentivized health management strategies in employer-sponsored health insurance benefit designs can serve as a useful

Legal and ethical obligations to conduct a clinical drug trial in Australia as an investigator initiated and sponsored study for an overseas pharmaceutical company.

PubMed

Beran, Roy G

2004-01-01

Most multi-centre trials are both financed and sponsored by the pharmaceutical company involved. What follows will map the path adopted for an investigator initiated and sponsored study for a new indication of an established medication. The chief investigators of a company-sponsored, investigator-initiated, multi-centre, placebo-controlled study of an established medication, Pharmaceutical Benefit Scheme (PBS) listed for treatment of one condition but trialled in the management of another condition (trial of off-label use), were approached to submit a protocol to repeat the type of study with a different compound. The new study would test a different agent, also PBS listed, for the same condition as in the initial study and with the same off-licence application. The company would finance the study, provide the medication and matched placebo but only review the investigator-initiated protocol which would be sponsored by the principal investigator. This required the investigator to implement the trial, as would normally be done by the pharmaceutical company, yet also act as its principal investigator. The principal investigator, with colleagues and a Clinical Research Organisation (CRO), developed a protocol, adapted for the new agent, and submitted it for approval. Upon acceptance a contract was negotiated with the pharmaceutical company which had to overcome jurisdictional conflicts between common law and civil law legal systems. A CRO was contracted to undertake administrative functions which dictated special contractual agreements to overcome possible conflicts of interest for a sponsor/investigator to protect patient interests. There was need to find indemnification insurance with jurisdictional problems, co-investigators, ethics committee approvals and finance management as just some of the difficulties encountered. The paper will outline how these obstacles were overcome and how ethical and legal issues were respected through compromise. The ethical and legal

Turkish Compulsory Earthquake Insurance (TCIP)

NASA Astrophysics Data System (ADS)

Erdik, M.; Durukal, E.; Sesetyan, K.

2009-04-01

Through a World Bank project a government-sponsored Turkish Catastrophic Insurance Pool (TCIP) is created in 2000 with the essential aim of transferring the government's financial burden of replacing earthquake-damaged housing to international reinsurance and capital markets. Providing coverage to about 2.9 Million homeowners TCIP is the largest insurance program in the country with about 0.5 Billion USD in its own reserves and about 2.3 Billion USD in total claims paying capacity. The total payment for earthquake damage since 2000 (mostly small, 226 earthquakes) amounts to about 13 Million USD. The country-wide penetration rate is about 22%, highest in the Marmara region (30%) and lowest in the south-east Turkey (9%). TCIP is the sole-source provider of earthquake loss coverage up to 90,000 USD per house. The annual premium, categorized on the basis of earthquake zones type of structure, is about US90 for a 100 square meter reinforced concrete building in the most hazardous zone with 2% deductible. The earthquake engineering related shortcomings of the TCIP is exemplified by fact that the average rate of 0.13% (for reinforced concrete buildings) with only 2% deductible is rather low compared to countries with similar earthquake exposure. From an earthquake engineering point of view the risk underwriting (Typification of housing units to be insured, earthquake intensity zonation and the sum insured) of the TCIP needs to be overhauled. Especially for large cities, models can be developed where its expected earthquake performance (and consequently the insurance premium) can be can be assessed on the basis of the location of the unit (microzoned earthquake hazard) and basic structural attributes (earthquake vulnerability relationships). With such an approach, in the future the TCIP can contribute to the control of construction through differentiation of premia on the basis of earthquake vulnerability.

24 CFR 213.266a - Insurance fund obligations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Insurance fund obligations. 213... Insurance fund obligations. A mortgage endorsed for insurance under section 213 of the Act shall be the obligation either of the Cooperative Management Housing Insurance Fund or of the General Insurance Fund. The...

Mobile Apps for Weight Management: A Scoping Review.

PubMed

Rivera, Jordan; McPherson, Amy; Hamilton, Jill; Birken, Catherine; Coons, Michael; Iyer, Sindoora; Agarwal, Arnav; Lalloo, Chitra; Stinson, Jennifer

2016-07-26

Obesity remains a major public health concern. Mobile apps for weight loss/management are found to be effective for improving health outcomes in adults and adolescents, and are pursued as a cost-effective and scalable intervention for combating overweight and obesity. In recent years, the commercial market for 'weight loss apps' has expanded at rapid pace, yet little is known regarding the evidence-based quality of these tools for weight control. To characterize the inclusion of evidence-based strategies, health care expert involvement, and scientific evaluation of commercial mobile apps for weight loss/management. An electronic search was conducted between July 2014 and July 2015 of the official app stores for four major mobile operating systems. Three raters independently identified apps with a stated goal of weight loss/management, as well as weight loss/management apps targeted to pediatric users. All discrepancies regarding selection were resolved through discussion with a fourth rater. Metadata from all included apps were abstracted into a standard assessment criteria form and the evidence-based strategies, health care expert involvement, and scientific evaluation of included apps was assessed. Evidence-based strategies included: self-monitoring, goal-setting, physical activity support, healthy eating support, weight and/or health assessment, personalized feedback, motivational strategies, and social support. A total of 393 apps were included in this review. Self-monitoring was most common (139/393, 35.3%), followed by physical activity support (108/393, 27.5%), weight assessment (100/393, 25.4%), healthy eating support (91/393, 23.2%), goal-setting (84/393, 21.4%), motivational strategies (28/393, 7.1%), social support (21/393, 5.3%), and personalized feedback (7/393, 1.8%). Of apps, 0.8% (3/393) underwent scientific evaluation and 0.3% (1/393) reported health care expert involvement. No apps were comprehensive in the assessment criteria, with the majority

Economic benefits of sponsored clinical trials on pharmaceutical expenditures at a medical center in Taiwan.

PubMed

Shen, Li-Jiuan; Chou, Hua; Huang, Chih-Fen; Chou, Guann-Miaw; Chan, Wing Kai; Wu, Fe-Lin Lin

2011-07-01

Concerns exist regarding the additional cost of patient care when patients are enrolled in clinical trials at hospitals. To assess the avoidance of drug costs by conducting sponsored clinical trials, a retrospective analysis evaluating drug cost avoidance in all sponsored clinical trials was conducted in 2008 at the most prominent medical center in Taiwan. The National Health Insurance (NHI) reimbursement prices of either the investigated drugs or the standardized drug therapy for each specific disease were used to calculate the cost avoidance. Drug cost avoidance from sponsored clinical trials per year, per trial, per patient, in different therapeutic areas, and in different phases was analyzed. Three quarters of the cost avoidance in drug expenditures from 194 sponsored clinical trials were estimated. All cost values are in US Dollars. Around $11.2 million was avoided at the center in 2008. The average value of cost avoidance was $58,000/trial-year or $3,900/participant-year. The early-phase trials and phase III trials accounted for 25% and 56% of all trials, respectively, while they constituted 32% and 49% of the total costs avoided, respectively. The most frequently conducted and highest cost-avoiding trials were those for antineoplastic agents, especially targeted therapy which accounted for 85% of the total cost avoidance of anti-cancer trials. This study demonstrates the profoundly positive economic impact on the healthcare system in Taiwan by sponsored clinical trials. To understand the trend of economic benefits of the trials on pharmaceutical expenditure, it would be important to analyze the cost avoidance of trials regularly in an institution. Copyright © 2011 Elsevier Inc. All rights reserved.

Weight management in community pharmacy: what do the experts think?

PubMed

Um, Irene S; Armour, Carol; Krass, Ines; Gill, Timothy; Chaar, Betty B

2013-06-01

The increasing prevalence of obesity and overweight adults creates a significant public health burden and there is great potential for pharmacists to be involved in the provision of weight management services, other than the mundane supply of commercial products. In order to provide optimal services that can be integrated into the healthcare system, a best practice model for weight management services in community pharmacy should be in place. We sought experts' and key stakeholders' opinions on this matter. (1) To identify components of a best practice model of a weight management service feasible in Australian community pharmacy. (2) To identify the role of pharmacists and the training requirements to up-skill pharmacists to competently provide weight management services. (3) To elicit any practical suggestions that would contribute to successful implementation of weight management services in pharmacy. Australian primary care sector. Semi-structured interviews were conducted with a purposive sample of 12 participants including Australian experts in obesity and representatives of main Australian professional organisations in pharmacy. Interviews were digitally recorded, transcribed verbatim and thematically analysed using the framework approach. Recommended components of pharmacy-based weight management services and training requirements. Participants perceived two potential roles for pharmacists involved in weight management: health promotion and individualised service. Multi-component interventions targeting all three areas: diet, physical activity and behaviour change were emphasised. Physical assessment (e.g. weight, waist circumference measurements), goal setting, referral to allied healthcare professionals and on-going support for weight maintenance were also proposed. Participants suggested pharmacists should undergo formal training and identified various training topics to improve pharmacists' knowledge, attributes and skills to acquire competencies

44 CFR 59.22 - Prerequisites for the sale of flood insurance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... flood insurance. 59.22 Section 59.22 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program GENERAL PROVISIONS Eligibility Requirements § 59.22 Prerequisites for the sale of flood insurance. (a) To...

44 CFR 59.22 - Prerequisites for the sale of flood insurance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... flood insurance. 59.22 Section 59.22 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program GENERAL PROVISIONS Eligibility Requirements § 59.22 Prerequisites for the sale of flood insurance. (a) To...

44 CFR 59.22 - Prerequisites for the sale of flood insurance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... flood insurance. 59.22 Section 59.22 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program GENERAL PROVISIONS Eligibility Requirements § 59.22 Prerequisites for the sale of flood insurance. (a) To...

44 CFR 59.22 - Prerequisites for the sale of flood insurance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... flood insurance. 59.22 Section 59.22 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program GENERAL PROVISIONS Eligibility Requirements § 59.22 Prerequisites for the sale of flood insurance. (a) To...

The impact of maternity length-of-stay mandates on the labor market and insurance coverage.

PubMed

Sabik, Lindsay M; Laugesen, Miriam J

2012-01-01

To understand the effects of insurance regulation on the labor market and insurance coverage, this study uses a difference-in-difference-in-differences analysis to compare five states that passed minimum maternity length-of-stay laws with states that waited until after a federal law was passed. On average, we do not find statistically significant effects on labor market outcomes such as hours of work and wages. However, we find that employees of small firms in states with maternity length-of-stay mandates experienced a 6.2-percentage-point decline in the likelihood of having employer-sponsored insurance. Implementation of federal health reform that requires minimum benefit standards should consider the implications for firms of differing sizes.

The demand for health insurance coverage by low-income workers: can reduced premiums achieve full coverage?

PubMed

Chernew, M; Frick, K; McLaughlin, C G

1997-10-01

To assess the degree to which premium reductions will increase the participation in employer-sponsored health plans by low-income workers who are employed in small businesses. Sample of workers in small business (25 or fewer employees) in seven metropolitan areas. The data were gathered as part of the Small Business Benefits Survey, a telephone survey of small business conducted between October 1992 and February 1993. Probit regressions were used to estimate the demand for health insurance coverage by low-income workers. Predictions based on these findings were made to assess the extent to which premium reductions might increase coverage rates. Workers included in the sample were selected, at random, from a randomly generated set of firms drawn from Dun and Bradstreet's DMI (Dun's Market Inclusion). The response rate was 81 percent. Participation in employer-sponsored plans is high when coverage is offered. However, even when coverage is offered to employees who have no other source of insurance, participation is not universal. Although premium reductions will increase participation in employer-sponsored plans, even large subsidies will not induce all workers to participate in employer-sponsored plans. For workers eligible to participate, subsidies as high as 75 percent of premiums are estimated to increase participation rates from 89.0 percent to 92.6 percent. For workers in firms that do not sponsor plans, similar subsidies are projected to achieve only modest increases in coverage above that which would be observed if the workers had access to plans at unsubsidized, group market rates. Policies that rely on voluntary purchase of coverage to reduce the number of uninsured will have only modest success.

School Insurance: Managing the Local Program. Bulletin, 1959, No. 23

ERIC Educational Resources Information Center

Finchum, R. N.; Viles, N. E.

1959-01-01

This study is the second in a series of publications by the Office of Education on school insurance. Data for this study were adapted from many sources. Among these sources were books of a technical nature, professional magazine articles, State insurance guides, research studies, insurance rating schedules, insurance company bulletins, and…

Impact of parental weight status on a school-based weight management programme designed for Mexican-American children.

PubMed

Moreno, J P; Johnston, C A; Hernandez, D C; LeNoble, J; Papaioannou, M A; Foreyt, J P

2016-10-01

While overweight and obese children are more likely to have overweight or obese parents, less is known about the effect of parental weight status on children's success in weight management programmes. This study was a secondary data analysis of a randomized controlled trial and investigated the impact of having zero, one or two obese parents on children's success in a school-based weight management programme. Sixty-one Mexican-American children participated in a 24-week school-based weight management intervention which took place in 2005-2006. Children's heights and weights were measured at baseline, 3, 6 and 12 months. Parental weight status was assessed at baseline. Repeated measures anova and ancova were conducted to compare changes in children's weight within and between groups, respectively. Within-group comparisons revealed that the intervention led to significant decreases in standardized body mass index (zBMI) for children with zero (F = 23.16, P < .001) or one obese (F = 4.99, P < .05) parent. Between-group comparisons indicated that children with zero and one obese parents demonstrated greater decreases in zBMI compared to children with two obese parents at every time point. The school-based weight management programme appears to be most efficacious for children with one or no obese parents compared to children with two obese parents. These results demonstrate the need to consider parental weight status when engaging in childhood weight management efforts. © 2015 World Obesity.

The Role of a Provider-Sponsored Health Plan in Achieving Scale and Integration.

PubMed

Johnson, Steven P

2016-01-01

In pursuit of two primary strategies-to become an integrated delivery network (IDN) on the local level and to achieve additional overall organizational scale to sustain operations-Health First, based in Rockledge, Florida, relies on the success of its provider-sponsored health plan (PSHP) as a critical asset. For Health First, the PSHP serves as an agent for holding and administering financial risk for the health of populations. In addition, we are learning that our PSHP is a critical asset in support of integrating the components of our care delivery system to manage that financial risk effectively, efficiently, and in a manner that creates a unified experience for the customer.Health First is challenged by continuing pressure on reimbursement, as well as by a substantial regulatory burden, as we work to optimize the environments and tools of care and population health management. Even with strong margins and a healthy balance sheet, we simply do not have the resources needed to bring an IDN robustly to life. However, we have discovered that our PSHP can be the vehicle that carries us to additional scale. Many health systems do not own or otherwise have access to a PSHP to hold and manage financial risk. Health First sought and found a not-for-profit health system with complementary goals and a strong brand to partner with, and we now provide private-label health plan products for that system using its strong name while operating the insurance functions under our license and with our capabilities.

Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China

PubMed Central

Shan, Linghan; Wu, Qunhong; Liu, Chaojie; Li, Ye; Cui, Yu; Liang, Zi; Hao, Yanhua; Liang, Libo; Ning, Ning; Ding, Ding; Pan, Qingxia; Han, Liyuan

2017-01-01

Objective China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. Methods A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. Results There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Conclusion Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that

Public health emergencies and the public health/managed care challenge.

PubMed

Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

2002-01-01

The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

How to Dance with Your Insurance Company.

ERIC Educational Resources Information Center

Mobley, Michael

1984-01-01

Explains how experiential programs and organizations can improve relationships with their insurance companies by understanding the insurance industry's perspective and techniques of risk management. Suggests 22 specific items of information that experiential education organizations should share with insurers to demonstrate understanding and…

Strengthening insurance partnerships in the face of climate change - Insights from an agent-based model of flood insurance in the UK.

PubMed

Crick, Florence; Jenkins, Katie; Surminski, Swenja

2018-04-25

Multisectoral partnerships are increasingly cited as a mechanism to deliver and improve disaster risk management. Yet, partnerships are not a panacea and more research is required to understand the role that they can play in disaster risk management and particularly disaster risk reduction. This paper investigates how partnerships can incentivise flood risk reduction by focusing on the UK public-private partnership on flood insurance. Developing the right flood insurance arrangements to incentivise flood risk reduction and adaptation to climate change is a key challenge. In the face of rising flood risks due to climate change and socio-economic development insurance partnerships can no longer afford to focus only on the risk transfer function. However, while expectations of the insurance industry have traditionally been high when it comes to flood risk management, the insurance industry alone will not provide the solution to the challenge of rising risks. The case of flood insurance in the UK illustrates this: even national government and industry together cannot fully address these risks and other actors need to be involved to create strong incentives for risk reduction. Using an agent-based model focused on surface water flood risk in London we analyse how other partners could strengthen the insurance partnership by reducing flood risk and thus helping to maintain affordable insurance premiums. Our findings are relevant for wider discussions on the potential of insurance schemes to incentivise flood risk management and climate adaptation in the UK and also internationally. Copyright © 2018. Published by Elsevier B.V.

The availability and marginal costs of dependent employer-sponsored health insurance.

PubMed

Miller, G Edward; Vistnes, Jessica; Buettgens, Matthew; Dubay, Lisa

2017-01-21

In this study, we examine differences by firm size in the availability of dependent coverage and the incremental cost of such coverage. We use data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) to show that among employees eligible for single coverage, dependent coverage was almost always available for employees in large firms (100 or more employees) but not in smaller firms, particularly those with fewer than 10 employees. In addition, when dependent coverage was available, eligible employees in smaller firms were more likely than employees in large firms to face two situations that represented the extremes of the incremental cost distribution: (1) they paid nothing for single or family coverage or (2) they paid nothing for single coverage but faced a high contribution for family coverage. These results suggest that firm size may be an important factor in policy assessments, such as analyses of the financial implications for families excluded from subsidized Marketplace coverage due to affordable offers of single coverage or of potential rollbacks to public coverage for children.

Self-Management Patient Education and Weight Loss

ERIC Educational Resources Information Center

Stombaugh, Angela M.

2010-01-01

Self-management of a disease is defined as "having or being able to obtain, the skills and resources necessary to best accommodate to the chronic disease and its consequences" (Holman & Lorig, 1992, p. 309). Self-management has been used in the management of several chronic conditions and this model may be useful in the management of weight loss.…

77 FR 46612 - New Animal Drugs; Change of Sponsor; Change of Sponsor Address; Azaperone; Miconazole, Polymyxin...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-06

... 524 [Docket No. FDA-2012-N-0002] New Animal Drugs; Change of Sponsor; Change of Sponsor Address.... ACTION: Final rule. SUMMARY: The Food and Drug Administration (FDA) is amending the animal drug regulations to reflect a change of sponsor for two new animal drug applications (NADAs) from Janssen...

Disordered Weight Management Behaviors, Nonprescription Steroid Use, and Weight Perception in Transgender Youth.

PubMed

Guss, Carly E; Williams, David N; Reisner, Sari L; Austin, S Bryn; Katz-Wise, Sabra L

2017-01-01

Disordered weight management behaviors are prevalent among youth; recent case reports suggested that these behaviors might also be common in transgender youth. We studied associations of gender identity with disordered weight management behaviors, nonprescription steroid use, and weight perception among transgender and cisgender (nontransgender) high-school students in Massachusetts. Data were analyzed from the 2013 Massachusetts Youth Health Survey, an anonymous survey in a random sample of Massachusetts public high schools. Respondents were divided into three groups: transgender (n = 67), cisgender male (n = 1,117), and cisgender female (n = 1,289). Fisher's exact tests and multivariable logistic regression models were used to examine unhealthy weight management behaviors in the past 30 days: fasting >24 hours, vomiting, diet pill use, and laxative use; nonprescription steroid use; and self-perceived weight status. Analyses controlled for age, race/ethnicity, and body mass index. Compared with cisgender males, transgender adolescents had higher odds of fasting >24 hours (adjusted odds ratio [AOR] = 2.9, confidence interval [CI] = 1.1-7.8), using diet pills (AOR = 8.9, 95% CI = 2.3-35.2) and taking laxatives (AOR = 7.2, 95% CI = 1.4-38.4). Transgender youth had higher odds of lifetime use of steroids without a prescription than male cisgender respondents (AOR = 26.6, 95% CI = 3.5-200.1). Compared with cisgender females, transgender respondents had higher odds of perceiving themselves as healthy weight/underweight when they were overweight/obese (AOR = 2.4, 95% CI = 1.5-4.1). Transgender youth disproportionately self-reported unsafe weight management behaviors and nonprescription steroid use compared with cisgender youth. Clinicians should be aware of this increased risk among transgender youth. Research is needed to further understand these disparities and to inform future interventions. Copyright © 2016 Society for Adolescent Health and

Low birth weight in Kansas.

PubMed

Guillory, V James; Lai, Sue Min; Suminski, R; Crawford, G

2015-05-01

Low birth weight (LBW) is associated with infant morbidity and mortality. This is the first study of LBW in Kansas using vital statistics to determine maternal and health care system factors associated with LBW. Low birth weight. Determine if prenatal care, maternal socio-demographic or medical factors, or insurance status were associated with LBW. Birth certificate data were merged with Medicaid eligibility data and subjected to logistic regression analysis. Of the 37,081 single vaginal births, LBW rates were 5.5% overall, 10.8% for African Americans, and 5% for White Americans. Lacking private insurance was associated with 34% more LBW infants (AOR 1.34; 95% CI 1.13-1.58), increased comorbidity, and late or less prenatal care. Low birth weight was associated with maternal medical comorbidity and with previous adverse birth outcomes. Insurance status, prenatal care, and maternal health during pregnancy are associated with LBW. Private insurance was consistently associated with more prenatal care and better outcomes. This study has important implications regarding health care reform.

Managing water utility financial risks through third-party index insurance contracts

NASA Astrophysics Data System (ADS)

Zeff, Harrison B.; Characklis, Gregory W.

2013-08-01

As developing new supply capacity has become increasingly expensive and difficult to permit (i.e., regulatory approval), utilities have become more reliant on temporary demand management programs, such as outdoor water use restrictions, for ensuring reliability during drought. However, a significant fraction of water utility income is often derived from the volumetric sale of water, and such restrictions can lead to substantial revenue losses. Given that many utilities set prices at levels commensurate with recovering costs, these revenue losses can leave them financially vulnerable to budgetary shortfalls. This work explores approaches for mitigating drought-related revenue losses through the use of third-party financial insurance contracts based on streamflow indices. Two different types of contracts are developed, and their efficacy is compared against two more traditional forms of financial hedging used by water utilities: Drought surcharges and contingency funds (i.e., self-insurance). Strategies involving each of these approaches, as well as their use in combination, are applied under conditions facing the water utility serving Durham, North Carolina. A multireservoir model provides information on the scale and timing of droughts, and the financial effects of these events are simulated using detailed data derived from utility billing records. Results suggest that third-party index insurance contracts, either independently or in combination with more traditional hedging tools, can provide an effective means of reducing a utility's financial vulnerability to drought.

Compensating wage differentials and the impact of health insurance in the public sector on wages and hours.

PubMed

Qin, Paige; Chernew, Michael

2014-12-01

This paper examines the trade-off between wages and employer spending on health insurance for public sector workers, and the relationship between coverage and hours worked. Our primary approach compares trends in wages and hours for public employees with and without state/local government provided health insurance using individual-level micro-data from the 1992-2011 CPS. To adjust for differences between insured and uninsured public sector employees, we create a matched sample based on an employee's propensity to receive health insurance. We assess the relationship between state contribution to the health plan premium, state-level healthcare spending, and the wages and hours of state and local government employees. We find modest reductions in wages are associated with having employer-sponsored health insurance (ESHI), although this effect is not precisely measured. The reduction in wages associated with having ESHI is larger among non-unionized workers. Further, we find little evidence that provision of health insurance increases hours worked. Copyright © 2014 Elsevier B.V. All rights reserved.

44 CFR 73.3 - Denial of flood insurance coverage.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1316 OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 § 73.3 Denial of flood insurance... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Denial of flood insurance...

44 CFR 73.3 - Denial of flood insurance coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1316 OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 § 73.3 Denial of flood insurance... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Denial of flood insurance...

44 CFR 73.4 - Restoration of flood insurance coverage.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1316 OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 § 73.4 Restoration of flood insurance... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Restoration of flood insurance...

A biomedical and feminist perspective on women's experiences with weight management.

PubMed

Allan, J D

1994-10-01

Weight concerns and dieting have become so normative for U.S. women that weight is the lens through which experience is viewed. The obsession with weight and dieting among women is considered by feminists to be one result of the oppression by women resulting from questionable weight standards and weight control programs that foster a view of overweight as a sign of addiction and lack of control. Feminist critique is used to deconstruct both the literature related to weight standards and health and the research on weight loss/weight management. Feminist and ethnographic methods are used to describe successful and unsuccessful experiences with weight management of 20 Euro-American women who had participated in a 1985 weight study and agreed to be reinterviewed. Success at weight management was examined from a biomedical perspective using Body Mass Index (BMI) norms and from a feminist perspective using participants' subjective definitions of success. Based upon BMI, only 8 members of the study group were defined as successful, whereas based upon the women's perspectives, 11 members were successful. Participants' definitions of successful weight management were divergent from biomedical definitions and could be categorized into three perspectives: biomedical, reframed normal weight, and holistic. Women who ascribed to the biomedical definition of success embodied the cultural ideal of thinness by adhering to an underweight weight norm. Participants using the reframed normal weight definition of success rejected biomedical weight norms and created their own weight norms. The holistic perspective on success involved the use of a broader, health-focused definition of successful weight management and offers some directions for revising current health promotion care relative to weight.

The likely effects of employer-mandated complementary health insurance on health coverage in France.

PubMed

Pierre, Aurélie; Jusot, Florence

2017-03-01

In France, access to health care greatly depends on having a complementary health insurance coverage (CHI). Thus, the generalisation of CHI became a core factor in the national health strategy created by the government in 2013. The first measure has been to compulsorily extend employer-sponsored CHI to all private sector employees on January 1st, 2016 and improve its portability coverage for unemployed former employees for up to 12 months. Based on data from the 2012 Health, Health Care and Insurance survey, this article provides a simulation of the likely effects of this mandate on CHI coverage and related inequalities in the general population by age, health status, socio-economic characteristics and time and risk preferences. We show that the non-coverage rate that was estimated to be 5% in 2012 will drop to 4% following the generalisation of employer-sponsored CHI and to 3.7% after accounting for portability coverage. The most vulnerable populations are expected to remain more often without CHI whereas non coverage will significantly decrease among the less risk averse and the more present oriented. With its focus on private sector employees, the policy is thus likely to do little for populations that would benefit most from additional insurance coverage while expanding coverage for other populations that appear to place little value on CHI. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

UNION-SPONSORED RETRAINING PROGRAMS.

ERIC Educational Resources Information Center

HOOS, IDA R.

UNION-SPONSORED TRAINING PROGRAMS WERE PROVIDED IN THE SAN FRANCISCO BAY AREA TO UPGRADE SKILLS OF MARINE COOKS AND STEWARDS, SHIPS' RADIO OPERATORS, JOURNEYMAN PLUMBERS AND GASFITTERS, AND MEMBERS OF THE INTERNATIONAL BROTHERHOOD OF ELECTRICAL WORKERS (IBEW). THESE PROGRAMS WERE THE ONLY COHESIVE UNION SPONSORED CURRICULA IN THAT AREA. MAJOR…

Understanding What Is in Your Insurance Policies.

ERIC Educational Resources Information Center

Kahn, Steven P.

This document outlines the various types of insurance policies and their functions to help school administrators improve their management of risk. Eight exhibits highlight information on the following topics: the five basic sections of all insurance policies; key property insurance clauses; general liability; school board legal liability; the…

41 CFR 105-72.401 - Insurance coverage.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Insurance coverage. 105... § 105-72.401 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired with Federal funds as provided to property owned by the...

48 CFR 970.3501-1 - Sponsoring agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Sponsoring agreements. 970... Sponsoring agreements. (a) The contract award document constitutes the sponsoring agreement between the... the purpose and mission of the FFRDC. (c) Other elements of the sponsoring agreement which shall be...

48 CFR 970.3501-1 - Sponsoring agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Sponsoring agreements. 970... Sponsoring agreements. (a) The contract award document constitutes the sponsoring agreement between the... the purpose and mission of the FFRDC. (c) Other elements of the sponsoring agreement which shall be...

48 CFR 970.3501-1 - Sponsoring agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Sponsoring agreements. 970... Sponsoring agreements. (a) The contract award document constitutes the sponsoring agreement between the... the purpose and mission of the FFRDC. (c) Other elements of the sponsoring agreement which shall be...

45 CFR 1226.12 - Sponsor employees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Sponsor employees. 1226.12 Section 1226.12 Public Welfare Regulations Relating to Public Welfare (Continued) CORPORATION FOR NATIONAL AND COMMUNITY SERVICE PROHIBITIONS ON ELECTORAL AND LOBBYING ACTIVITIES Sponsor Employee Activities § 1226.12 Sponsor employees...

Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China.

PubMed

Shan, Linghan; Wu, Qunhong; Liu, Chaojie; Li, Ye; Cui, Yu; Liang, Zi; Hao, Yanhua; Liang, Libo; Ning, Ning; Ding, Ding; Pan, Qingxia; Han, Liyuan

2017-06-02

China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that insurance programmes bring to members

Community College Students' Health Insurance Enrollment, Maintenance, and Talking With Parents Intentions: An Application of the Reasoned Action Approach.

PubMed

Huhman, Marian; Quick, Brian L; Payne, Laura

2016-05-01

A primary objective of health care reform is to provide affordable and quality health insurance to individuals. Currently, promotional efforts have been moderately successful in registering older, more mature adults yet comparatively less successful in registering younger adults. With this challenge in mind, we conducted extensive formative research to better understand the attitudes, subjective norms, and perceived behavioral control of community college students. More specifically, we examined how each relates to their intentions to enroll in a health insurance plan, maintain their current health insurance plan, and talk with their parents about their parents having health insurance. In doing so, we relied on the revised reasoned action approach advanced by Fishbein and his associates (Fishbein & Ajzen, 2010; Yzer, 2012, 2013). Results showed that the constructs predicted intentions to enroll in health insurance for those with no insurance and for those with government-sponsored insurance and intentions to maintain insurance for those currently insured. Our study demonstrates the applicability of the revised reasoned action framework within this context and is discussed with an emphasis on the practical and theoretical contributions.

Conceptual Model of Weight Management in Overweight and Obese African-American Females.

PubMed

Sutton, Suzanne M; Magwood, Gayenell S; Nemeth, Lynne S; Jenkins, Carolyn M

2017-04-01

Weight management of overweight and obese (OWO) African-American females (AAFs) is a poorly defined concept, leading to ineffective treatment of overweight and obesity, prevention of health sequelae, and risk reduction. A conceptual model of the phenomenon of weight management in OWO AAFs was developed through dimensional analysis of the literature. Constructs were identified and sorted into the dimensions of perspective, context, conditions, process, and consequences and integrated into an explanatory matrix. Through dimensional analysis, weight management in OWO AAFs was characterized as a multidimensional concept, defined from the perspective of weight loss in community-dwelling AAFs. Behaviors associated with weight management are strongly influenced by intrinsic factors and extrinsic conditions, which influence engagement in the processes and consequences of weight management. The resulting conceptual model of weight management in OWO AAFs provides a framework for research interventions applicable in a variety of settings. © 2016 Wiley Periodicals, Inc.

Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers.

PubMed

Odusola, Aina O; Stronks, Karien; Hendriks, Marleen E; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A

2016-01-01

Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider-insurer relationships; automated administration systems; and tailoring guidelines/patient education. By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.

7 CFR 621.45 - Flood insurance studies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 6 2011-01-01 2011-01-01 false Flood insurance studies. 621.45 Section 621.45... § 621.45 Flood insurance studies. As requested by the Federal Emergency Management Agency (FEMA), and within the limits of available resources, NRCS carries out flood insurance studies of various types under...

7 CFR 621.45 - Flood insurance studies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Flood insurance studies. 621.45 Section 621.45... § 621.45 Flood insurance studies. As requested by the Federal Emergency Management Agency (FEMA), and within the limits of available resources, NRCS carries out flood insurance studies of various types under...

Impact of 2 employer-sponsored population health management programs on medical care cost and utilization.

PubMed

Mattke, Soeren; Serxner, Seth A; Zakowski, Sarah L; Jain, Arvind K; Gold, Daniel B

2009-02-01

Integrated health management programs combining disease prevention and disease management services, although popular with employers, have been insufficiently researched with respect to their effect on costs. To estimate the overall impact of a population health management program and its components on cost and utilization. STUDY DESIGN, SETTING, AND PARTICIPANTS: Observational study of 2 employer-sponsored health management programs involving more than 200,000 health plan members. We used claims data for the first program year and the 2 preceding years to calculate cost and utilization metrics, and program activity data to determine program uptake. Using an intent-to-treat approach and regression-based risk adjustment, we estimated whether the program was associated with changes in cost and utilization. Data on program fees were unavailable. Overall, the program was associated with a nonsignificant cost increase of $13.75 per member per month (PMPM). The wellness component alone was associated with a significant increase of $20.14 PMPM. Case and disease management were associated with a significant decrease in hospital admissions of 4 and 1 per 1000 patient-years, respectively. Our results suggest that the programs did not reduce medical cost in their first year, despite a beneficial effect on hospital admissions. If we had been able to include program fees, it is likely that the overall cost would have increased significantly. Although this study had important limitations, the results suggest that a belief that these programs will save money may be too optimistic and better evaluation is needed.

A Process Manual: Staff Development in American-Sponsored Overseas Schools.

ERIC Educational Resources Information Center

Anderson, Carrel M.; Schaffer, Raymond, Jr.

This manual is written for those responsible for staff development in American-sponsored overseas schools (ASOS). Program management for staff development planning is divided into seven categories: (1) mission statement preparation; (2) needs assessment survey; (3) goal statements preparation; (4) staff objectives preparation; (5) activities…

24 CFR 213.276 - Allocation of Cooperative Management Housing Insurance Fund income or losses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... period in which Cooperative Management Housing Insurance Fund operations shall result in a net income, or loss, the Commissioner shall allocate such net income or such loss to the General Surplus Account, to the Participating Reserve Account, or to both, as he may determine to be in accordance with sound...

Insights into managed care--operational, legal and actuarial.

PubMed

Melek, S P; Johnson, B A; Schryver, D

1997-01-01

Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others.

Conflicts between Public Car Insurance and Public Medical Insurance in Japan: International Comparison Survey

PubMed Central

SAKAGUCHI, Kazuki; MORI, Koichiro

2014-01-01

This paper clarifies essential issues regarding conflicts between public car insurance and public medical insurance in Japan, presenting the findings of an international survey to detect similar problems in other countries and discussing possible options for the resolution of these problems. Three essential issues are important to note: (i) Different prices between the two systems of public insurance provide stakeholders with the irrelevant incentive to apply public medical insurance in the case of car accidents; (ii) Public medical insurance sometimes covers medical expenses due to car accidents, although it should not cover them in principle; and (iii) The costs are imposed on tax payers unconsciously when people use public medical insurance for car accidents. Five findings were obtained from the international survey: (1) Most countries have compulsory car insurance; (2) Private insurance companies manage the financial affairs of compulsory car insurance in most developed countries; (3) Fault for casualties is not considered in the compensation of medical expenses in most countries; (4) Japan is unique in that people can choose between the two systems of public insurance; and (5) Prices for the same medical services differ between the two systems of public insurance in only a few countries. In consideration of the above findings, we provide five options for the resolution of this issue from the viewpoint of victim relief. PMID:25624784

Conflicts between Public Car Insurance and Public Medical Insurance in Japan: International Comparison Survey.

PubMed

Sakaguchi, Kazuki; Mori, Koichiro

2014-04-01

This paper clarifies essential issues regarding conflicts between public car insurance and public medical insurance in Japan, presenting the findings of an international survey to detect similar problems in other countries and discussing possible options for the resolution of these problems. Three essential issues are important to note: (i) Different prices between the two systems of public insurance provide stakeholders with the irrelevant incentive to apply public medical insurance in the case of car accidents; (ii) Public medical insurance sometimes covers medical expenses due to car accidents, although it should not cover them in principle; and (iii) The costs are imposed on tax payers unconsciously when people use public medical insurance for car accidents. Five findings were obtained from the international survey: (1) Most countries have compulsory car insurance; (2) Private insurance companies manage the financial affairs of compulsory car insurance in most developed countries; (3) Fault for casualties is not considered in the compensation of medical expenses in most countries; (4) Japan is unique in that people can choose between the two systems of public insurance; and (5) Prices for the same medical services differ between the two systems of public insurance in only a few countries. In consideration of the above findings, we provide five options for the resolution of this issue from the viewpoint of victim relief.

Patients transferred for emergency upper extremity evaluation: does insurance status matter?

PubMed

Eberlin, Kyle R; Hartzell, Tristan L; Kuo, Phoebe; Winograd, Jonathan; Day, Charles

2013-03-01

Academic institutions receive many patients transferred specifically for hand surgery evaluation. The purpose of this study was to evaluate the demographics and insurance status of patients transferred for this reason. A retrospective review was performed of 155 transferred and 1017 nontransferred patients with a primary hand diagnosis during 3 summer months at two urban academic institutions. Patients were evaluated for insurance status/type, medical comorbidities, employment status, and reason for transfer. Insurance was defined as present/absent and favorable/unfavorable, with unfavorable defined as Medicaid or state-sponsored insurance. Reason for transfer or presenting diagnosis was separated by category. The mean age was similar between groups, but a higher percentage of transfer patients were men (69.9 percent versus 59.7 percent; p < 0.05). The percentage of insured patients was similar (92.9 percent versus 93.2 percent), but the number with no insurance or undesirable insurance was greater for transferred patients (30.1 percent versus 22.9 percent; p < 0.05). Patients with poor or no insurance were twice as likely to be inappropriately transferred (OR, 2.17; p = 0.03). Transferred patients were less likely to be employed (55.1 percent versus 64.8 percent; p < 0.05); however, the percentages of workers' compensation (13.5 percent versus 14.6 percent) and diabetes (6.41 percent versus 6.10 percent) cases were similar. Common reasons for transfer were closed fractures/dislocations (21.9 percent), infection (17.4 percent), and amputation/devascularization (17.4 percent). Patients transferred to tertiary care centers for emergency upper extremity evaluation have a higher rate of undesirable or no insurance and are more likely to be male or unemployed.

Designing for psychological change: individuals' reward and cost valuations in weight management.

PubMed

Hsu, Anne; Blandford, Ann

2014-06-26

Knowledge of the psychological constructs that underlie behavior offers valuable design opportunities for persuasive systems. We use the decision theory, which describes how behavior is underpinned by reward-cost valuations, as a framework for investigating such psychological constructs to deliver design objectives for weight management technologies. We applied a decision theory-based analysis in the domain of weight management to understand the rewards and costs that surround individuals' weight management behaviors, with the aim of uncovering design opportunities for weight management technologies. We conducted qualitative interviews with 15 participants who were or had been trying to lose weight. Thematic analysis was used to extract themes that covered the rewards and costs surrounding weight management behaviors. We supplemented our qualitative study with a quantitative survey of 100 respondents investigating the extent to which they agreed with statements reflecting themes from the qualitative study. The primary obstacles to weight management were the rewards associated with unhealthy choices, such as the pleasures of unhealthy foods and unrestricted consumption in social situations, and the significant efforts required to change habits, plan, and exercise. Psychological constructs that supported positive weight management included feeling good after making healthy choices, being good to oneself, experiencing healthy yet still delicious foods, and receiving social support and encouraging messages (although opinions about encouraging messages was mixed). A rewards-costs driven enquiry revealed a wide range of psychological constructs that contribute to discouraging and supporting weight management. The constructs extracted from our qualitative study were verified by our quantitative survey, in which the majority of respondents also reported similar thoughts and feelings. This understanding of the rewards and costs surrounding weight management offers a range

Designing for Psychological Change: Individuals’ Reward and Cost Valuations in Weight Management

PubMed Central

Blandford, Ann

2014-01-01

Background Knowledge of the psychological constructs that underlie behavior offers valuable design opportunities for persuasive systems. We use the decision theory, which describes how behavior is underpinned by reward-cost valuations, as a framework for investigating such psychological constructs to deliver design objectives for weight management technologies. Objective We applied a decision theory–based analysis in the domain of weight management to understand the rewards and costs that surround individuals’ weight management behaviors, with the aim of uncovering design opportunities for weight management technologies. Methods We conducted qualitative interviews with 15 participants who were or had been trying to lose weight. Thematic analysis was used to extract themes that covered the rewards and costs surrounding weight management behaviors. We supplemented our qualitative study with a quantitative survey of 100 respondents investigating the extent to which they agreed with statements reflecting themes from the qualitative study. Results The primary obstacles to weight management were the rewards associated with unhealthy choices, such as the pleasures of unhealthy foods and unrestricted consumption in social situations, and the significant efforts required to change habits, plan, and exercise. Psychological constructs that supported positive weight management included feeling good after making healthy choices, being good to oneself, experiencing healthy yet still delicious foods, and receiving social support and encouraging messages (although opinions about encouraging messages was mixed). Conclusions A rewards-costs driven enquiry revealed a wide range of psychological constructs that contribute to discouraging and supporting weight management. The constructs extracted from our qualitative study were verified by our quantitative survey, in which the majority of respondents also reported similar thoughts and feelings. This understanding of the rewards and

Weight management and physical activity throughout the cancer care continuum.

PubMed

Demark-Wahnefried, Wendy; Schmitz, Kathryn H; Alfano, Catherine M; Bail, Jennifer R; Goodwin, Pamela J; Thomson, Cynthia A; Bradley, Don W; Courneya, Kerry S; Befort, Christie A; Denlinger, Crystal S; Ligibel, Jennifer A; Dietz, William H; Stolley, Melinda R; Irwin, Melinda L; Bamman, Marcas M; Apovian, Caroline M; Pinto, Bernardine M; Wolin, Kathleen Y; Ballard, Rachel M; Dannenberg, Andrew J; Eakin, Elizabeth G; Longjohn, Matt M; Raffa, Susan D; Adams-Campbell, Lucile L; Buzaglo, Joanne S; Nass, Sharyl J; Massetti, Greta M; Balogh, Erin P; Kraft, Elizabeth S; Parekh, Anand K; Sanghavi, Darshak M; Morris, G Stephen; Basen-Engquist, Karen

2018-01-01

Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society. © 2017 American Cancer Society.

Primary-Care Weight-Management Strategies: Parental Priorities and Preferences

PubMed Central

Turer, Christy Boling; Upperman, Carla; Merchant, Zahra; Montaño, Sergio; Flores, Glenn

2015-01-01

Objective Examine parental perspectives/rankings of the most important weight-management clinical practices; and, determine whether preferences/rankings differ when parents disagree that their child is overweight. Methods Mixed-methods analysis of a 32-question survey of parents of 2-18 year-old overweight children assessing parental agreement that their child is overweight, the single most important thing providers can do to improve weight status, ranking AAP-recommended clinical practices, and preferred follow-up interval. Four independent reviewers analyzed open-response data to identify qualitative themes/subthemes. Multivariable analyses examined parental rankings, preferred follow-up interval, and differences by agreement with their child’s overweight assessment. Results Thirty-six percent of 219 children were overweight, 42% were obese, and 22% severely obese; 16% of parents disagreed with their child’s overweight assessment. Qualitative analysis of the most important practice to help overweight children yielded 10 themes; unique to parents disagreeing with their children’s overweight assessments was, “change weight-status assessments.” After adjustment, the three highest-ranked clinical practices included, “check for weight-related problems,” “review growth chart,” and “recommend general dietary changes” (all P<.01);” parents disagreeing with their children’s overweight assessments ranked “review growth chart” as less important, and “reducing screen time” and “general activity changes” as more important. The mean preferred weight-management follow-up interval (10-12 weeks) did not differ by agreement with children’s overweight assessments. Conclusions Parents prefer weight-management strategies that prioritize evaluating weight-related problems, growth-chart review, and regular follow-up. Parents who disagree that their child is overweight want changes in how overweight is assessed. Using parent-preferred weight-management

Primary-Care Weight-Management Strategies: Parental Priorities and Preferences.

PubMed

Turer, Christy Boling; Upperman, Carla; Merchant, Zahra; Montaño, Sergio; Flores, Glenn

2016-04-01

To examine parental perspectives/rankings of the most important weight-management clinical practices and to determine whether preferences/rankings differ when parents disagree that their child is overweight. We performed mixed-methods analysis of a 32-question survey of parents of 2- to 18-year-old overweight children assessing parental agreement that their child is overweight, the single most important thing providers can do to improve weight status, ranking American Academy of Pediatrics-recommended clinical practices, and preferred follow-up interval. Four independent reviewers analyzed open-response data to identify qualitative themes/subthemes. Multivariable analyses examined parental rankings, preferred follow-up interval, and differences by agreement with their child's overweight assessment. Thirty-six percent of 219 children were overweight, 42% obese, and 22% severely obese; 16% of parents disagreed with their child's overweight assessment. Qualitative analysis of the most important practice to help overweight children yielded 10 themes; unique to parents disagreeing with their children's overweight assessments was "change weight-status assessments." After adjustment, the 3 highest-ranked clinical practices included, "check for weight-related problems," "review growth chart," and "recommend general dietary changes" (all P < .01); parents disagreeing with their children's overweight assessments ranked "review growth chart" as less important and ranked "reducing screen time" and "general activity changes" as more important. The mean preferred weight-management follow-up interval (10-12 weeks) did not differ by agreement with children's overweight assessments. Parents prefer weight-management strategies that prioritize evaluating weight-related problems, growth-chart review, and regular follow-up. Parents who disagree that their child is overweight want changes in how overweight is assessed. Using parent-preferred weight-management strategies may prove useful

44 CFR 73.4 - Restoration of flood insurance coverage.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Restoration of flood... AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1316 OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 § 73.4 Restoration of flood insurance...

44 CFR 73.4 - Restoration of flood insurance coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1316 OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 § 73.4 Restoration of flood insurance... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Restoration of flood...

Incorporating a Weight Management Skills Workshop in Pharmacy Curricula in Australia

PubMed Central

Krass, Ines; Armour, Carol; Gill, Timothy; Chaar, Betty B.

2016-01-01

Objective. To develop, implement, and evaluate a competency-based weight management skills workshop for undergraduate pharmacy students in an Australian university. Design. A 3-hour workshop titled “Weight Management in Pharmacy” was implemented with a cohort of fourth-year undergraduate pharmacy students (n=180). Learning activities used included case-based learning, hands-on experience, role-play, and group discussion. Assessment. A 22-item attitudinal survey instrument and the validated Obesity Risk Knowledge (ORK-10) scale were administered at baseline and postworkshop to evaluate the impact of this educational workshop. There was significant improvement in the students’ ORK scores and students’ perceived level of self-confidence in performing weight management skills. Conclusion. An educational workshop designed to enhance professional competencies in weight management ensured graduates were “service-ready” and had the appropriate knowledge, skills, and attributes to deliver patient-centered pharmacy-based weight management services. PMID:27293236

Incorporating a Weight Management Skills Workshop in Pharmacy Curricula in Australia.

PubMed

Um, Irene S; Krass, Ines; Armour, Carol; Gill, Timothy; Chaar, Betty B

2016-05-25

Objective. To develop, implement, and evaluate a competency-based weight management skills workshop for undergraduate pharmacy students in an Australian university. Design. A 3-hour workshop titled "Weight Management in Pharmacy" was implemented with a cohort of fourth-year undergraduate pharmacy students (n=180). Learning activities used included case-based learning, hands-on experience, role-play, and group discussion. Assessment. A 22-item attitudinal survey instrument and the validated Obesity Risk Knowledge (ORK-10) scale were administered at baseline and postworkshop to evaluate the impact of this educational workshop. There was significant improvement in the students' ORK scores and students' perceived level of self-confidence in performing weight management skills. Conclusion. An educational workshop designed to enhance professional competencies in weight management ensured graduates were "service-ready" and had the appropriate knowledge, skills, and attributes to deliver patient-centered pharmacy-based weight management services.

Captive insurance companies.

PubMed

Strauss, Peter

2014-01-01

The landscape of the business world is changing; and now, more than ever, business owners are recognizing that life is filled with risks: known risk, calculated risk, and unexpected risk. Every day, businesses thrive or fail based on understanding the risk of owning and operating their business, and business owners are recognizing that there are alternative risk financing mechanisms other than simply taking out a basket of standard coverage as recommended by your friendly neighborhood agent. A captive insurance company is an insurance company established to provide a broad range of risk management capabilities to affiliated companies. The captive is owned by the business owner and can provide insurance to the business for potential future losses, whether or not the losses are already covered by a commercial carrier or are "self-insured." The premiums paid by your business are tax deductible. Meanwhile, the premiums that your captive collects are tax-free up to $1.2 million annually.

Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

PubMed Central

Odusola, Aina O.; Stronks, Karien; Hendriks, Marleen E.; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A.

2016-01-01

Background Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Results Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA. PMID:26880152

17 CFR 229.1104 - (Item 1104) Sponsors.

Code of Federal Regulations, 2010 CFR

2010-04-01

... describe the sponsor's form of organization. (b) Describe the general character of the sponsor's business... regarding the size, composition and growth of the sponsor's portfolio of assets of the type to be...

A Guide for Setting Up a Church-Sponsored Nursery School.

ERIC Educational Resources Information Center

Hostrawser, Sara

This document provides a guide for setting up a church-sponsored nursery school. Chapter One outlines the verbal-cognitive model of preschool education which emphasizes interaction between teacher and child. Perceptual, motor, cognitive, social, emotional, and language objectives are indicated. Chapter Two covers aspects of school management such…

Provider-sponsored HMOs: make, buy, or joint venture?

PubMed

Clay, S B

1997-03-01

Providers can sponsor their own HMOs in one of three ways: by creating their own HMO, by joint venturing with an existing HMO, or by purchasing an existing HMO. When selecting the best option, providers must consider various market conditions. Managed care penetration in the area, potential competitive responses of existing HMOs, market demand, provider reputation, and provider marketing ability will all influence the feasibility of each option. Providers also must examine their own organizational identity, their ability to raise the necessary capital to start an HMO, their managed care expertise and risk contracting experience, and their information systems capabilities.

Obesity: Risk factors, complications, and strategies for sustainable long-term weight management.

PubMed

Fruh, Sharon M

2017-10-01

The aims of this article are to review the effects of obesity on health and well-being and the evidence indicating they can be ameliorated by weight loss, and consider weight-management strategies that may help patients achieve and maintain weight loss. Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as "obesity," "overweight," "weight loss," "comorbidity," "diabetes," cardiovascular," "cancer," "depression," "management," and "intervention." Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%-10% range, and above, can significantly improve health-related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal-setting and increased consultation frequency can greatly improve the success of weight-management programs. Nurse practitioners have key roles in establishing weight-loss targets, providing motivation and support, and implementing weight-loss programs. With their in-depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight-management strategies deployed in clinical practice. ©2017 American Association of Nurse Practitioners.

Lorcaserin for weight management

PubMed Central

Taylor, James R; Dietrich, Eric; Powell, Jason

2013-01-01

Type 2 diabetes and obesity commonly occur together. Obesity contributes to insulin resistance, a main cause of type 2 diabetes. Modest weight loss reduces glucose, lipids, blood pressure, need for medications, and cardiovascular risk. A number of approaches can be used to achieve weight loss, including lifestyle modification, surgery, and medication. Lorcaserin, a novel antiobesity agent, affects central serotonin subtype 2A receptors, resulting in decreased food intake and increased satiety. It has been studied in obese patients with type 2 diabetes and results in an approximately 5.5 kg weight loss, on average, when used for one year. Headache, back pain, nasopharyngitis, and nausea were the most common adverse effects noted with lorcaserin. Hypoglycemia was more common in the lorcaserin groups in the clinical trials, but none of the episodes were categorized as severe. Based on the results of these studies, lorcaserin was approved at a dose of 10 mg twice daily in patients with a body mass index ≥30 kg/m2 or ≥27 kg/m2 with at least one weight-related comorbidity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia, in addition to a reduced calorie diet and increased physical activity. Lorcaserin is effective for weight loss in obese patients with and without type 2 diabetes, although its specific role in the management of obesity is unclear at this time. This paper reviews the clinical trials of lorcaserin, its use from the patient perspective, and its potential role in the treatment of obesity. PMID:23788837

Lorcaserin for weight management.

PubMed

Taylor, James R; Dietrich, Eric; Powell, Jason

2013-01-01

Type 2 diabetes and obesity commonly occur together. Obesity contributes to insulin resistance, a main cause of type 2 diabetes. Modest weight loss reduces glucose, lipids, blood pressure, need for medications, and cardiovascular risk. A number of approaches can be used to achieve weight loss, including lifestyle modification, surgery, and medication. Lorcaserin, a novel antiobesity agent, affects central serotonin subtype 2A receptors, resulting in decreased food intake and increased satiety. It has been studied in obese patients with type 2 diabetes and results in an approximately 5.5 kg weight loss, on average, when used for one year. Headache, back pain, nasopharyngitis, and nausea were the most common adverse effects noted with lorcaserin. Hypoglycemia was more common in the lorcaserin groups in the clinical trials, but none of the episodes were categorized as severe. Based on the results of these studies, lorcaserin was approved at a dose of 10 mg twice daily in patients with a body mass index ≥30 kg/m(2) or ≥27 kg/m(2) with at least one weight-related comorbidity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia, in addition to a reduced calorie diet and increased physical activity. Lorcaserin is effective for weight loss in obese patients with and without type 2 diabetes, although its specific role in the management of obesity is unclear at this time. This paper reviews the clinical trials of lorcaserin, its use from the patient perspective, and its potential role in the treatment of obesity.

Sales management coaching: a model for improved insurance company performance.

PubMed

Carter, Tony

2006-01-01

Of all the things sales managers do to develop salespeople, many people believe the most important one is coaching. Coaching is defined as using skills, experience, and direction to help someone improve their performance. Coaching consists primarily of giving people feedback to reinforce what they do well while suggesting ways and means to improve. Coaching implies that everybody can improve and hopefully everybody wants to get better at what they do. Many sales managers erroneously believe that they have to be better than the person they are coaching at the skill set they are discussing in order to be a useful coaching resource to that person. To be a good coach requires an understanding of the skills being discussed and a desire to help someone improve in the performance of their job. The sales manager who knows how to provide that feedback will have more productive, effective, satisfied, and motivated salespeople. This paper provides an overview of the coaching sequence and the skills required to make it work with some comment on how this was successfully applied to a major national insurance company. Sales Management styles vary, and what works for one person may not work for another. Effective Sales Management Coaching can provide sales managers with the skills to help salespeople grow and develop professionally.

7 CFR 622.10 - Sponsors.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS Qualifications § 622.10 Sponsors. (a) Watershed projects are... the use of nonstructural or structural measures shall be sponsored by organizations that, individually... project cost and all operation and maintenance costs. (b) To receive Federal assistance for project...

The Volume Of TV Advertisements During The ACA's First Enrollment Period Was Associated With Increased Insurance Coverage.

PubMed

Karaca-Mandic, Pinar; Wilcock, Andrew; Baum, Laura; Barry, Colleen L; Fowler, Erika Franklin; Niederdeppe, Jeff; Gollust, Sarah E

2017-04-01

The launch of the Affordable Care Act was accompanied by major insurance information campaigns by government, nonprofit, political, news media, and private-sector organizations, but it is not clear to what extent these efforts were associated with insurance gains. Using county-level data from the Census Bureau's American Community Survey and broadcast television airings data from the Wesleyan Media Project, we examined the relationship between insurance advertisements and county-level health insurance changes between 2013 and 2014, adjusting for other media and county- and state-level characteristics. We found that counties exposed to higher volumes of local insurance advertisements during the first open enrollment period experienced larger reductions in their uninsurance rates than other counties. State-sponsored advertisements had the strongest relationship with declines in uninsurance, and this relationship was driven by increases in Medicaid enrollment. These results support the importance of strategic investment in advertising to increase uptake of health insurance but suggest that not all types of advertisements will have the same effect on the public. Project HOPE—The People-to-People Health Foundation, Inc.

Effectiveness of hypnosis as an adjunct to behavioral weight management.

PubMed

Bolocofsky, D N; Spinler, D; Coulthard-Morris, L

1985-01-01

This study examined the effect of adding hypnosis to a behavioral weight-management program on short- and long-term weight change. One hundred nine subjects, who ranged in age from 17 to 67, completed a behavioral treatment either with or without the addition of hypnosis. At the end of the 9-week program, both interventions resulted in significant weight reduction. However, at the 8-month and 2-year follow-ups, the hypnosis clients showed significant additional weight loss, while those in the behavioral treatment exhibited little further change. More of the subjects who used hypnosis also achieved and maintained their personal weight goals. The utility of employing hypnosis as an adjunct to a behavioral weight-management program is discussed.

Antipsychotic induced weight gain in schizophrenia:mechanisms and management.

PubMed

Rege, Sanil

2008-05-01

The aim of the present paper was to describe the mechanisms and management of antipsychotic-induced weight gain in schizophrenia patients. A comprehensive literature review of all available articles on the mechanisms and management of antipsychotic-induced weight gain was done by searching databases PsychINFO and PubMed. A summary of the available guidelines for monitoring of antipsychotic-induced weight gain and metabolic syndrome is also provided. There has been a substantial increase in the number of studies investigating the mechanisms and management of antipsychotic-induced weight gain after 2002. These include advances in the understanding of pharmacogenomics of weight gain and several randomized controlled trials (RCTs) evaluating pharmacological and psychological treatments to promote weight loss. The most effective strategy for prevention of weight gain is the choice of antipsychotic medication with low weight gain potential. In individuals with established weight gain and metabolic issues, switching to an antipsychotic agent with lower weight gain potential and/or lifestyle modifications with physical activity are most effective in promoting weight loss. Pharmacological agents such as orlistat and sibutramine are effective in general obesity but have not been sufficiently evaluated in antipsychotic-induced weight gain. The case to prescribe routine pharmacological treatment to promote weight loss is weak. Long-term, pragmatic studies are required to inform clinical practice. Weight gain in schizophrenia is associated with significant physical and psychological morbidity. Achieving an optimal trade-off between effectiveness and side-effects of antipsychotic agents, although difficult, is achievable. This should be based on three main principles: (i) a shared decision-making model between the patient, clinician and carer(s) when choosing an antipsychotic; (ii) a commitment to baseline and follow-up monitoring with explicit identification of the responsible

44 CFR Appendix B to Part 62 - National Flood Insurance Program

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false National Flood Insurance Program B Appendix B to Part 62 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Emergency Management Agency (FEMA)) may enter into an arrangement with individual private sector insurance...

On the regulator-insurer interaction in a structural model

NASA Astrophysics Data System (ADS)

Bernard, Carole; Chen, An

2009-11-01

In this paper, we provide a new insight to the previous work of Briys and de Varenne [E. Briys, F. de Varenne, Life insurance in a contingent claim framework: Pricing and regulatory implications, Geneva Papers on Risk and Insurance Theory 19 (1) (1994) 53-72], Grosen and Jørgensen [A. Grosen, P.L. Jørgensen, Life insurance liabilities at market value: An analysis of insolvency risk, bonus policy, and regulatory intervention rules in a barrier option framework, Journal of Risk and Insurance 69 (1) (2002) 63-91] and Chen and Suchanecki [A. Chen, M. Suchanecki, Default risk, bankruptcy procedures and the market value of life insurance liabilities, Insurance: Mathematics and Economics 40 (2007) 231-255]. We show that the particular risk management strategy followed by the insurance company can significantly change the risk exposure of the company, and that it should thus be taken into account by regulators. We first study how the regulator establishes regulation intervention levels in order to control for instance the default probability of the insurance company. This part of the analysis is based on a constant volatility. Given that the insurance company is informed of regulatory rules, we study how results can be significantly different when the insurance company follows a risk management strategy with non-constant volatilities. We thus highlight some limits of the prior literature and believe that the risk management strategy of the company should be taken into account in the estimation of the risk exposure as well as in that of the market value of liabilities.

78 FR 38483 - Area Risk Protection Insurance Regulations and Area Risk Protection Insurance Crop Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

...The Federal Crop Insurance Corporation (FCIC) finalizes the Area Risk Protection Insurance (ARPI) Basic Provisions, ARPI Barley Crop Insurance Provisions, ARPI Corn Crop Insurance Provisions, ARPI Cotton Crop Insurance Provisions, ARPI Forage Crop Insurance Provisions, ARPI Grain Sorghum Crop Insurance Provisions, ARPI Peanut Crop Insurance Provisions, ARPI Soybean Crop Insurance Provisions, and ARPI Wheat Crop Insurance Provisions to provide area yield protection and area revenue protection. These provisions will replace the Group Risk Plan (GRP) provisions in 7 CFR part 407, which includes the: GRP Basic Provisions, GRP Barley Crop Provisions, GRP Corn Crop Provisions, GRP Cotton Crop Provisions, GRP Forage Crop Provisions, GRP Peanut Crop Provisions, GRP Sorghum Crop Provisions, GRP Soybean Crop Provisions, and GRP Wheat Crop Provisions. The ARPI provisions will also replace the Group Risk Income Protection (GRIP) Basic Provisions, the GRIP Crop Provisions, and the GRIP-Harvest Revenue Option (GRIP-HRO). The GRP and GRIP plans of insurance will no longer be available. The intended effect of this action is to offer producers a choice of Area Revenue Protection, Area Revenue Protection with the Harvest Price Exclusion, or Area Yield Protection, all within one Basic Provision and the applicable Crop Provisions. This will reduce the amount of information producers must read to determine the best risk management tool for their operation and will improve the provisions to better meet the needs of insureds. The changes will apply for the 2014 and succeeding crop years.

Insurance and Quality of Care for Adults with Acute Asthma

PubMed Central

Ferris, Timothy G; Blumenthal, David; Woodruff, Prescott G; Clark, Sunday; Camargo, Carlos A

2002-01-01

OBJECTIVE The relationship between health care insurance and quality of medical care remains incompletely studied. We sought to determine whether type of patient insurance is related to quality of care and subsequent outcomes for patients who arrive in the emergency department (ED) for acute asthma. DESIGN Using prospectively collected data from the Multicenter Airway Research Collaboration, we compared measures of quality of pre-ED care, acute severity, and short-term outcomes across 4 insurance categories: managed care, indemnity, Medicaid, and uninsured. SETTING AND PARTICIPANTS Emergency departments at 57 academic medical centers enrolled 1,019 adults with acute asthma. RESULTS Patients with managed care ranked first and uninsured patients ranked last on all 7 unadjusted quality measures. After controlling for covariates, uninsured patients had significantly lower quality of care than indemnity patients for 5 of 7 measures and had lower initial peak expiratory flow rates than indemnity insured patients. Patients with managed care insurance were more likely than indemnity-insured patients to identify a primary care physician and report using inhaled steroids in the month prior to arrival in the ED. Patients with Medicaid insurance were more likely than indemnity-insured patients to use the ED as their usual source of care for problems with asthma. We found no differences in patient outcomes among the insurance categories we studied. CONCLUSIONS Uninsured patients had consistently poorer quality of care and than insured patients. Despite differences in indicators of quality of care between types of insurance, we found no differences in short-term patient outcomes by type of insurance. PMID:12472926

Exploring the need for interventions to manage weight and stress during interconception.

PubMed

Huberty, Jennifer; Leiferman, Jenn A; Kruper, Abbey R; Jacobson, Lisette T; Waring, Molly E; Matthews, Jeni L; Wischenka, Danielle M; Braxter, Betty; Kornfield, Sara L

2017-02-01

Interventions to manage weight and stress during the interconception period (i.e., time immediately following childbirth to subsequent pregnancy) are needed to promote optimal maternal and infant health outcomes. To address this gap, we summarize the current state of knowledge, critically evaluate the research focused on weight and stress management during the interconception period, and provide future recommendations for research in this area. Evidence supports the importance of weight and stress management during the reproductive years and the impact of weight on maternal and child health outcomes. However, evidence-based treatment models that address postpartum weight loss and manage maternal stress during the interconception period are lacking. This problem is further compounded by inconsistent definitions and measurements of stress. Recommendations for future research include interventions that address weight and stress tailored for women in the interconception period, interventions that address healthcare providers' understanding of the significance of weight and stress management during interconception, and long-term follow-up studies that focus on the public health implications of weight and stress management during interconception. Addressing obesity and stress during the interconception period via a reproductive lens will be a starting point for women and their families to live long and healthy lives.

Risk, Ambiguity, and Insurance.

DTIC Science & Technology

1984-10-01

ambiguous, insurance firms are reluctant to market coverage. The oae of nulear power provides a graphic example. Neither risk managers of nuclear... kowledgeable about their chances of an accident than are insurance companies who have detailed records (of. Svenson, 1981). Note specifically that for low...nuclear power plants (SlovL et al., 1983). ore generally, people may consider events that can only occur once in a lifetime, such as death or a serious

Management initiatives in a community-based health insurance scheme.

PubMed

Sinha, Tara; Ranson, M Kent; Chatterjee, Mirai; Mills, Anne

2007-01-01

Community-based health insurance (CBHI) schemes have developed in response to inadequacies of alternate systems for protecting the poor against health care expenditures. Some of these schemes have arisen within community-based organizations (CBOs), which have strong links with poor communities, and are therefore well situated to offer CBHI. However, the managerial capacities of many such CBOs are limited. This paper describes management initiatives undertaken in a CBHI scheme in India, in the course of an action-research project. The existing structures and systems at the CBHI had several strengths, but fell short on some counts, which became apparent in the course of planning for two interventions under the research project. Management initiatives were introduced that addressed four features of the CBHI, viz. human resources, organizational structure, implementation systems, and data management. Trained personnel were hired and given clear roles and responsibilities. Lines of reporting and accountability were spelt out, and supportive supervision was provided to team members. The data resources of the organization were strengthened for greater utilization of this information. While the changes that were introduced took some time to be accepted by team members, the commitment of the CBHI's leadership to these initiatives was critical to their success. Copyright (c) 2007 John Wiley & Sons, Ltd.

ENSO-Based Index Insurance: Approach and Peru Flood Risk Management Application

NASA Astrophysics Data System (ADS)

Khalil, A. F.; Kwon, H.; Lall, U.; Miranda, M. J.; Skees, J. R.

2006-12-01

Index insurance has recently been advocated as a useful risk transfer tool for disaster management situations where rapid fiscal relief is desirable, and where estimating insured losses may be difficult, time consuming, or subject to manipulation and falsification. For climate related hazards, a rainfall or temperature index may be proposed. However, rainfall may be highly spatially variable relative to the gauge network, and in many locations data are inadequate to develop an index due to short time-series and the spatial dispersion of stations. In such cases, it may be helpful to consider a climate proxy index as a regional rainfall index. This is particularly useful if a long record is available for the climate index through an independent source and it is well correlated with the regional rainfall hazard. Here, ENSO related climate indices are explored for use as a proxy to extreme rainfall in one of the departments of Peru -- Piura. The ENSO index insurance product may be purchased by banks or microfinance institutions (MFIs) to aid agricultural damage relief in Peru. Crop losses in the region are highly correlated with floods, but are difficult to assess directly. Beyond agriculture, many other sectors suffer as well. Basic infrastructure is destroyed during the most severe events. This disrupts trade for many micro-enterprises. The reliability and quality of the local rainfall data is variable. Averaging the financial risk across the region is desirable. Some issues with the implementation of the proxy ENSO index are identified and discussed. Specifically, we explore (a) the reliability of the index at different levels of probability of exceedance of maximum seasonal rainfall; (b) the potential for clustering of payoffs; (c) the potential that the index could be predicted with some lead time prior to the flood season; and (d) evidence for climate change or non-stationarity in the flood exceedance probability from the long ENSO record. Finally, prospects for

Managing moral hazard in motor vehicle accident insurance claims.

PubMed

Ebrahim, Shanil; Busse, Jason W; Guyatt, Gordon H; Birch, Stephen

2013-05-01

Motor vehicle accident (MVA) insurance in Canada is based primarily on two different compensation systems: (i) no-fault, in which policyholders are unable to seek recovery for losses caused by other parties (unless they have specified dollar or verbal thresholds) and (ii) tort, in which policyholders may seek general damages. As insurance companies pay for MVA-related health care costs, excess use of health care services may occur as a result of consumers' (accident victims) and/or producers' (health care providers) behavior - often referred to as the moral hazard of insurance. In the United States, moral hazard is greater for low dollar threshold no-fault insurance compared with tort systems. In Canada, high dollar threshold or pure no-fault versus tort systems are associated with faster patient recovery and reduced MVA claims. These findings suggest that high threshold no-fault or pure no-fault compensation systems may be associated with improved outcomes for patients and reduced moral hazard.

Moral Hazard: How The National Flood Insurance Program Is Limiting Risk Reduction

DTIC Science & Technology

2016-12-01

Management and Budget, Paperwork Reduction Project (0704-0188) Washington DC 20503. 1. AGENCY USE ONLY (Leave blank) 2. REPORT DATE December...assessment, floodplain management , and flood insurance. A study of the NFIP concludes that aspects of the program limit risk reduction...floodplain management , risk assessment, disaster recovery, flood insurance claim, pre-flood insurance rate map 15. NUMBER OF PAGES 123 16. PRICE CODE

Assessment of Processes of Change for Weight Management in a UK Sample

PubMed Central

Andrés, Ana; Saldaña, Carmina; Beeken, Rebecca J.

2015-01-01

Objective The present study aimed to validate the English version of the Processes of Change questionnaire in weight management (P-Weight). Methods Participants were 1,087 UK adults, including people enrolled in a behavioural weight management programme, university students and an opportunistic sample. The mean age of the sample was 34.80 (SD = 13.56) years, and 83% were women. BMI ranged from 18.51 to 55.36 (mean = 25.92, SD = 6.26) kg/m2. Participants completed both the stages and processes questionnaires in weight management (S-Weight and P-Weight), and subscales from the EDI-2 and EAT-40. A refined version of the P-Weight consisting of 32 items was obtained based on the item analysis. Results The internal structure of the scale fitted a four-factor model, and statistically significant correlations with external measures supported the convergent validity of the scale. Conclusion The adequate psychometric properties of the P-Weight English version suggest that it could be a useful tool to tailor weight management interventions. PMID:25765163

Health insurance and use of medical services by men infected with HIV.

PubMed

Katz, M H; Chang, S W; Buchbinder, S P; Hessol, N A; O'Malley, P; Doll, L S

1995-01-01

Among 178 HIV-infected men from the San Francisco City Clinic Cohort (SFCCC), we examined the association between health insurance and use of outpatient services and treatment. For men with private insurance, we also assessed the frequency of avoiding the use of health insurance. Men without private insurance reported fewer outpatient visits than men with fee-for-service or managed-care plans. Use of zidovudine for eligible men was similar for those with fee-for-service plans (74%), managed-care plans (77%), or no insurance (61%). Use of Pneumocytstis carinii pneumonia prophylaxis was similar for those with fee-for-service (93%) and managed-care plans (83%) but lower for those with no insurance (63%). Of 149 men with private insurance, 31 (21%) reported that they had avoided using their health insurance for medical expenses in the previous year. In multivariate analysis, the independent predictors of avoiding the use of insurance were working for a small company and living outside the San Francisco Bay Area. Having private insurance resulted in higher use of outpatient services, but the type of private insurance did not appear to affect the use of service or treatment. Fears of loss of coverage and confidentiality may negate some benefits of health insurance for HIV-infected persons.

75 FR 13147 - Integrity Life Insurance Company, et al.;

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-18

... Management, at (202) 551-6795. SUPPLEMENTARY INFORMATION: The following is a summary of the application. The... Insurance Products Fund III, Variable Insurance Products Fund II, nor Fidelity Management and Research... both--of stocks or both--of domestic and domestic and foreign issuers foreign issuers using fundamental...

A design of mathematical modelling for the mudharabah scheme in shariah insurance

NASA Astrophysics Data System (ADS)

Cahyandari, R.; Mayaningsih, D.; Sukono

2017-01-01

Indonesian Shariah Insurance Association (AASI) believes that 2014 is the year of Indonesian Shariah insurance, since its growth was above the conventional insurance. In December 2013, 43% growth was recorded for shariah insurance, while the conventional insurance was only hit 20%. This means that shariah insurance has tremendous potential to remain growing in the future. In addition, the growth can be predicted from the number of conventional insurance companies who open sharia division, along with the development of Islamic banking development which automatically demand the role of shariah insurance to protect assets and banking transactions. The development of shariah insurance should be accompanied by the development of premium fund management mechanism, in order to create innovation on shariah insurance products which beneficial for the society. The development of premium fund management model shows a positive progress through the emergence of Mudharabah, Wakala, Hybrid (Mudharabah-Wakala), and Wakala-Waqf. However, ‘model’ term that referred in this paper is regarded as an operational model in form of a scheme of management mechanism. Therefore, this paper will describe a mathematical modeling for premium fund management scheme, especially for Mudharabah concept. Mathematical modeling is required for an analysis process that can be used to predict risks that could be faced by a company in the future, so that the company could take a precautionary policy to minimize those risks.

BRCA Genetic Testing and Receipt of Preventive Interventions Among Women Aged 18-64 Years with Employer-Sponsored Health Insurance in Nonmetropolitan and Metropolitan Areas - United States, 2009-2014.

PubMed

Kolor, Katherine; Chen, Zhuo; Grosse, Scott D; Rodriguez, Juan L; Green, Ridgely Fisk; Dotson, W David; Bowen, M Scott; Lynch, Julie A; Khoury, Muin J

2017-09-08

Genetic testing for breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations can identify women at increased risk for breast and ovarian cancer. These testing results can be used to select preventive interventions and guide treatment. Differences between nonmetropolitan and metropolitan populations in rates of BRCA testing and receipt of preventive interventions after testing have not previously been examined. 2009-2014. Medical claims data from Truven Health Analytics MarketScan Commercial Claims and Encounters databases were used to estimate rates of BRCA testing and receipt of preventive interventions after BRCA testing among women aged 18-64 years with employer-sponsored health insurance in metropolitan and nonmetropolitan areas of the United States, both nationally and regionally. From 2009 to 2014, BRCA testing rates per 100,000 women aged 18-64 years with employer-sponsored health insurance increased 2.3 times (102.7 to 237.8) in metropolitan areas and 3.0 times (64.8 to 191.3) in nonmetropolitan areas. The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased from 37% in 2009 (102.7 versus 64.8) to 20% in 2014 (237.8 versus 191.3). The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased more over time in younger women than in older women and decreased in all regions except the West. Receipt of preventive services 90 days after BRCA testing in metropolitan versus nonmetropolitan areas throughout the period varied by service: the percentage of women who received a mastectomy was similar, the percentage of women who received magnetic resonance imaging of the breast was lower in nonmetropolitan areas (as low as 5.8% in 2014 to as high as 8.2% in 2011) than metropolitan areas (as low as 7.3% in 2014 to as high as 10.3% in 2011), and the percentage of women who received mammography was lower in nonmetropolitan areas in earlier years but was similar in later years

Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system.

PubMed

Boonen, Lieke H H M; Schut, Frederik T

2011-04-01

We investigate the impact of the transition towards managed competition in the Dutch health care system on health insurers' contracting behaviour. Specifically, we examine whether insurers have been able to take up their role as prudent buyers of care and examine consumers' attitudes towards insurers' new role. Health insurers' contracting behaviour is investigated by an extensive analysis of available information on purchasing practices by health insurers and by interviews with directors of health care purchasing of the four major health insurers, accounting for 90% of the market. Consumer attitudes towards insurers' new role are investigated by surveys among a representative sample of enrollees over the period 2005-2009. During the first four years of the reform, health insurers were very reluctant to engage in selective contracting and preferred to use 'soft' positive incentives to encourage preferred provider choice rather than engaging in restrictive managed care activities. Consumer attitudes towards channelling vary considerably by type of provider but generally became more negative in the first two years after the reform. Insurers' reluctance to use selective contracting can be at least partly explained by the presence of a credible-commitment problem. Consumers do not trust that insurers with restrictive networks are committed to provide good quality care. The credible-commitment problem seems to be particularly relevant to the Netherlands, since Dutch enrollees are not used to restrictions on provider choice. Since consumers are quite sensitive to differences in provider quality, more reliable information about provider quality is required to reduce the credible-commitment problem.

What could family income be if health insurance were more affordable?

PubMed

Young, Richard A; Devoe, Jennifer E

2012-10-01

Adjusted for inflation, household income has been relatively flat since the mid-1990s, but the inflation rate of employer-sponsored health insurance has been greater than both household income growth and general inflation for 50 years. We estimated the effect on average family income if health insurance inflation matched the general inflation rate since 1996, and those savings were given to employees as income. We used data from the Medical Expenditure Panel Survey, the Milliman Medical Index, and other federal sources to model the relationship between private health insurance costs and household income over the last 15 years. If the cost of family health care costs had kept pace with the Consumer Price Index (CPI) rate since 1996, the average family income could have been $8,410 higher in 2010 ($68,805 versus $60,395), 13.9% more than actual earnings. If health care costs had not exceeded the CPI rate since 1996 and if all the excess costs were converted into employee wages, median family income could be substantially higher today.

Insurance Type and Access to Health Care Providers and Appointments Under the Affordable Care Act.

PubMed

Alcalá, Héctor E; Roby, Dylan H; Grande, David T; McKenna, Ryan M; Ortega, Alexander N

2018-02-01

Millions of adults have gained insurance through the Affordable Care Act (ACA). However, disparities in access to care persist. This study examined differences in access to primary and specialty care among patients insured by private individual market insurance plans (both on-exchange and off-exchange) and Medicaid compared with those with employer-sponsored insurance. Using data from the 2014 and 2015 California Health Interview Survey, logistic regression analyses were used to calculate the odds of being unable to access primary care providers, access specialty care providers and receive a needed doctor's appointment in a timely manner, with insurance type serving as the independent variable. Interaction terms examined if the expiration of the ACA's optional Medicaid primary care fee increase in 2014 modified any of these associations. Findings showed poorer access to providers among those insured through Medicaid and the individual market (whether purchased through the state's health insurance exchange or off-exchange) relative to employer-based insurance. Poor access to primary care providers was seen among private coverage purchased via exchanges, relative to private coverage purchased on the individual market. In addition, findings showed that reduction of Medicaid fees coincided with reduced ability to see primary care providers. However, a similar trend was seen among those with employer-based coverage, which suggests that this change may not be attributable to reductions in Medicaid fees. Despite ACA-related gains in insurance coverage, those with on-exchange and off-exchange individual private insurance plans and Medicaid encounter more barriers to care than those with employer-based insurance.

48 CFR 235.017-1 - Sponsoring agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Sponsoring agreements. 235.017-1 Section 235.017-1 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM... Sponsoring agreements. (c)(4) DoD-sponsoring FFRDCs that function primarily as research laboratories (C3I...

Use of a mobile phone diary for observing weight management and related behaviours.

PubMed

Mattila, Elina; Lappalainen, Raimo; Pärkkä, Juha; Salminen, Jukka; Korhonen, Ilkka

2010-01-01

We studied self-observations related to weight management recorded with a Wellness Diary application on a mobile phone. The data were recorded by 27 participants in a 12-week study, which included a short weight management lecture followed by independent usage of the Wellness Diary. We studied the validity of self-observed weight, and behavioural changes and weight patterns related to weight management success. Self-observed weight data tended to underestimate pre- and poststudy measurements, but there were high correlations between the measures (r >or= 0.80). The amount of physical activity correlated significantly with weight loss (r = 0.44) as did different measures representing healthy changes in dietary behaviours (r >or= 0.45). Weight changes and the weekly rhythms of weight indicated a strong tendency to compensate for high-risk periods among successful weight-losers compared to unsuccessful ones. These preliminary results suggest that the mobile phone diary is a valid tool for observing weight management and related behaviours.

The role of social media in online weight management: systematic review.

PubMed

Chang, Tammy; Chopra, Vineet; Zhang, Catherine; Woolford, Susan J

2013-11-28

Social media applications are promising adjuncts to online weight management interventions through facilitating education, engagement, and peer support. However, the precise impact of social media on weight management is unclear. The objective of this study was to systematically describe the use and impact of social media in online weight management interventions. PubMed, PsycINFO, EMBASE, Web of Science, and Scopus were searched for English-language studies published through March 25, 2013. Additional studies were identified by searching bibliographies of electronically retrieved articles. Randomized controlled trials of online weight management interventions that included a social media component for individuals of all ages were selected. Studies were evaluated using 2 systematic scales to assess risk of bias and study quality. Of 517 citations identified, 20 studies met eligibility criteria. All study participants were adults. Because the included studies varied greatly in study design and reported outcomes, meta-analysis of interventions was not attempted. Although message boards and chat rooms were the most common social media component included, their effect on weight outcomes was not reported in most studies. Only one study measured the isolated effect of social media. It found greater engagement of participants, but no difference in weight-related outcomes. In all, 65% of studies were of high quality; 15% of studies were at low risk of bias. Despite the widespread use of social media, few studies have quantified the effect of social media in online weight management interventions; thus, its impact is still unknown. Although social media may play a role in retaining and engaging participants, studies that are designed to measure its effect are needed to understand whether and how social media may meaningfully improve weight management.

A Police and Insurance Joint Management System Based on High Precision BDS/GPS Positioning

PubMed Central

Zuo, Wenwei; Guo, Chi; Liu, Jingnan; Peng, Xuan; Yang, Min

2018-01-01

Car ownership in China reached 194 million vehicles at the end of 2016. The traffic congestion index (TCI) exceeds 2.0 during rush hour in some cities. Inefficient processing for minor traffic accidents is considered to be one of the leading causes for road traffic jams. Meanwhile, the process after an accident is quite troublesome. The main reason is that it is almost always impossible to get the complete chain of evidence when the accident happens. Accordingly, a police and insurance joint management system is developed which is based on high precision BeiDou Navigation Satellite System (BDS)/Global Positioning System (GPS) positioning to process traffic accidents. First of all, an intelligent vehicle rearview mirror terminal is developed. The terminal applies a commonly used consumer electronic device with single frequency navigation. Based on the high precision BDS/GPS positioning algorithm, its accuracy can reach sub-meter level in the urban areas. More specifically, a kernel driver is built to realize the high precision positioning algorithm in an Android HAL layer. Thus the third-party application developers can call the general location Application Programming Interface (API) of the original standard Global Navigation Satellite System (GNSS) to get high precision positioning results. Therefore, the terminal can provide lane level positioning service for car users. Next, a remote traffic accident processing platform is built to provide big data analysis and management. According to the big data analysis of information collected by BDS high precision intelligent sense service, vehicle behaviors can be obtained. The platform can also automatically match and screen the data that uploads after an accident to achieve accurate reproduction of the scene. Thus, it helps traffic police and insurance personnel to complete remote responsibility identification and survey for the accident. Thirdly, a rapid processing flow is established in this article to meet the

A Police and Insurance Joint Management System Based on High Precision BDS/GPS Positioning.

PubMed

Zuo, Wenwei; Guo, Chi; Liu, Jingnan; Peng, Xuan; Yang, Min

2018-01-10

Car ownership in China reached 194 million vehicles at the end of 2016. The traffic congestion index (TCI) exceeds 2.0 during rush hour in some cities. Inefficient processing for minor traffic accidents is considered to be one of the leading causes for road traffic jams. Meanwhile, the process after an accident is quite troublesome. The main reason is that it is almost always impossible to get the complete chain of evidence when the accident happens. Accordingly, a police and insurance joint management system is developed which is based on high precision BeiDou Navigation Satellite System (BDS)/Global Positioning System (GPS) positioning to process traffic accidents. First of all, an intelligent vehicle rearview mirror terminal is developed. The terminal applies a commonly used consumer electronic device with single frequency navigation. Based on the high precision BDS/GPS positioning algorithm, its accuracy can reach sub-meter level in the urban areas. More specifically, a kernel driver is built to realize the high precision positioning algorithm in an Android HAL layer. Thus the third-party application developers can call the general location Application Programming Interface (API) of the original standard Global Navigation Satellite System (GNSS) to get high precision positioning results. Therefore, the terminal can provide lane level positioning service for car users. Next, a remote traffic accident processing platform is built to provide big data analysis and management. According to the big data analysis of information collected by BDS high precision intelligent sense service, vehicle behaviors can be obtained. The platform can also automatically match and screen the data that uploads after an accident to achieve accurate reproduction of the scene. Thus, it helps traffic police and insurance personnel to complete remote responsibility identification and survey for the accident. Thirdly, a rapid processing flow is established in this article to meet the

The application of the Yerkes-Dodson law in a childhood weight management program: Examining weight dissatisfaction

USDA-ARS?s Scientific Manuscript database

Our objective was to determine the effect of dissatisfaction with one's weight on outcomes in a weight management program. Participants included 149 children between the ages of 11 and 14 years who were enrolled in an intensive weight loss intervention. All participants had a body mass index (BMI) ...

41 CFR 109-40.113 - Insurance against transportation hazards.

Code of Federal Regulations, 2012 CFR

2012-01-01

... transportation hazards. 109-40.113 Section 109-40.113 Public Contracts and Property Management Federal Property..., TRANSPORTATION, AND MOTOR VEHICLES 40-TRANSPORTATION AND TRAFFIC MANAGEMENT 40.1-General Provision § 109-40.113 Insurance against transportation hazards. The policy of the Government with respect to insurance of its...

41 CFR 109-40.113 - Insurance against transportation hazards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... transportation hazards. 109-40.113 Section 109-40.113 Public Contracts and Property Management Federal Property..., TRANSPORTATION, AND MOTOR VEHICLES 40-TRANSPORTATION AND TRAFFIC MANAGEMENT 40.1-General Provision § 109-40.113 Insurance against transportation hazards. The policy of the Government with respect to insurance of its...

Head-to-head randomized trials are mostly industry sponsored and almost always favor the industry sponsor.

PubMed

Flacco, Maria Elena; Manzoli, Lamberto; Boccia, Stefania; Capasso, Lorenzo; Aleksovska, Katina; Rosso, Annalisa; Scaioli, Giacomo; De Vito, Corrado; Siliquini, Roberta; Villari, Paolo; Ioannidis, John P A

2015-07-01

To map the current status of head-to-head comparative randomized evidence and to assess whether funding may impact on trial design and results. From a 50% random sample of the randomized controlled trials (RCTs) published in journals indexed in PubMed during 2011, we selected the trials with ≥ 100 participants, evaluating the efficacy and safety of drugs, biologics, and medical devices through a head-to-head comparison. We analyzed 319 trials. Overall, 238,386 of the 289,718 randomized subjects (82.3%) were included in the 182 trials funded by companies. Of the 182 industry-sponsored trials, only 23 had two industry sponsors and only three involved truly antagonistic comparisons. Industry-sponsored trials were larger, more commonly registered, used more frequently noninferiority/equivalence designs, had higher citation impact, and were more likely to have "favorable" results (superiority or noninferiority/equivalence for the experimental treatment) than nonindustry-sponsored trials. Industry funding [odds ratio (OR) 2.8; 95% confidence interval (CI): 1.6, 4.7] and noninferiority/equivalence designs (OR 3.2; 95% CI: 1.5, 6.6), but not sample size, were strongly associated with "favorable" findings. Fifty-five of the 57 (96.5%) industry-funded noninferiority/equivalence trials got desirable "favorable" results. The literature of head-to-head RCTs is dominated by the industry. Industry-sponsored comparative assessments systematically yield favorable results for the sponsors, even more so when noninferiority designs are involved. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Tax-exempt bonds and sponsored research.

PubMed

Ballard, Frederic L

2003-01-01

"Sponsored research," wherein a business corporation or the government pays a portion of the cost of research activities carried out by a university or hospital, is increasingly important both for state institutions and for Section 510(c)(3) organizations. Sponsored research arrangements that are not properly structured can jeopardize the status of tax-exempt bonds issued to finance the facility at which the sponsored research occurs. While these rules have been difficult to apply in practice, properly structured agreements can provide funding for research without undue risk. This Article discusses the multiple pieces of guidance put forth by the Internal Revenue Service to clarify the many issues and tiers of analysis necessary to ensure a properly-structured sponsored research agreement.

Professional liability insurance in Obstetrics and Gynaecology: estimate of the level of knowledge about malpractice insurance policies and definition of an informative tool for the management of the professional activity

PubMed Central

2011-01-01

Background In recent years, due to the increasingly hostile environment in the medical malpractice field and related lawsuits in Italy, physicians began informing themselves regarding their comprehensive medical malpractice coverage. Methods In order to estimate the level of knowledge of medical professionals on liability insurance coverage for healthcare malpractice, a sample of 60 hospital health professionals of the obstetrics and gynaecology area of Messina (Sicily, Italy) were recluted. A survey was administered to evaluate their knowledge as to the meaning of professional liability insurance coverage but above all on the most frequent policy forms ("loss occurrence", "claims made" and "I-II risk"). Professionals were classified according to age and professional title and descriptive statistics were calculated for all the professional groups and answers. Results Most of the surveyed professionals were unaware or had very bad knowledge of the professional liability insurance coverage negotiated by the general manager, so most of the personnel believed it useful to subscribe individual "private" policies. Several subjects declared they were aware of the possibility of obtaining an extended coverage for gross negligence and substantially all the surveyed had never seen the loss occurrence and claims made form of the policy. Moreover, the sample was practically unaware of the related issues about insurance coverage for damages related to breaches on informed consent. The results revealed the relative lack of knowledge--among the operators in the field of obstetrics and gynaecology--of the effective coverage provided by the policies signed by the hospital managers for damages in medical malpractice. The authors thus proposed a useful information tool to help professionals working in obstetrics and gynaecology regarding aspects of insurance coverage provided on the basis of Italian civil law. Conclusion Italy must introduce a compulsory insurance system which could

The Influence of Sleep Disordered Breathing on Weight Loss in a National Weight Management Program

PubMed Central

Janney, Carol A.; Kilbourne, Amy M.; Germain, Anne; Lai, Zongshan; Hoerster, Katherine D.; Goodrich, David E.; Klingaman, Elizabeth A.; Verchinina, Lilia; Richardson, Caroline R.

2016-01-01

Study Objective: To investigate the influence of sleep disordered breathing (SDB) on weight loss in overweight/obese veterans enrolled in MOVE!, a nationally implemented behavioral weight management program delivered by the National Veterans Health Administration health system. Methods: This observational study evaluated weight loss by SDB status in overweight/obese veterans enrolled in MOVE! from May 2008–February 2012 who had at least two MOVE! visits, baseline weight, and at least one follow-up weight (n = 84,770). SDB was defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was weight change (lb) from MOVE! enrollment to 6- and 12-mo assessments. Weight change over time was modeled with repeated-measures analyses. Results: SDB was diagnosed in one-third of the cohort (n = 28,269). At baseline, veterans with SDB weighed 29 [48] lb more than those without SDB (P < 0.001). On average, veterans attended eight MOVE! visits. Weight loss patterns over time were statistically different between veterans with and without SDB (P < 0.001); veterans with SDB lost less weight (−2.5 [0.1] lb) compared to those without SDB (−3.3 [0.1] lb; P = 0.001) at 6 months. At 12 mo, veterans with SDB continued to lose weight whereas veterans without SDB started to re-gain weight. Conclusions: Veterans with sleep disordered breathing (SDB) had significantly less weight loss over time than veterans without SDB. SDB should be considered in the development and implementation of weight loss programs due to its high prevalence and negative effect on health. Citation: Janney CA, Kilbourne AM, Germain A, Lai Z, Hoerster KD, Goodrich DE, Klingaman EA, Verchinina L, Richardson CR. The influence of sleep disordered breathing on weight loss in a national weight management program. SLEEP 2016;39(1):59–65. PMID:26350475

Team sponsors in community-based health leadership programs.

PubMed

Patterson, Tracy Enright; Dinkin, Donna R; Champion, Heather

2017-05-02

Purpose The purpose of this article is to share the lessons learned about the role of team sponsors in action-learning teams as part of community-based health leadership development programs. Design/methodology/approach This case study uses program survey results from fellow participants, action learning coaches and team sponsors to understand the value of sponsors to the teams, the roles they most often filled and the challenges they faced as team sponsors. Findings The extent to which the sponsors were perceived as having contributed to the work of the action learning teams varied greatly from team to team. Most sponsors agreed that they were well informed about their role. The roles sponsors most frequently played were to provide the teams with input and support, serve as a liaison to the community and serve as a sounding board, motivator and cheerleader. The most common challenges or barriers team sponsors faced in this role were keeping engaged in the process, adjusting to the role and feeling disconnected from the program. Practical implications This work provides insights for program developers and community foundations who are interested in building the capacity for health leadership by linking community sponsors with emerging leaders engaged in an action learning experience. Originality/value This work begins to fill a gap in the literature. The role of team sponsors has been studied for single organization work teams but there is a void of understanding about the role of sponsors with multi-organizational teams working to improve health while also learning about leadership.

Making Better Re/Insurance Underwriting and Capital Management Decisions with Public-Private-Academic Partnerships

NASA Astrophysics Data System (ADS)

Michel, G.; Gunasekera, R.; Werner, A.; Galy, H.

2012-04-01

Similar to 2001, 2004, and 2005, 2011 was another year of unexpected international catastrophe events, in which insured losses were more than twice the expected long-term annual average catastrophe losses of USD 30 to 40bn. Key catastrophe events that significantly contributed these losses included the Mw 9.0 Great Tohoku earthquake and tsunami, the Jan. 2011 floods in Queensland, the October 2011 floods in Thailand, the Mw 6.1 Christchurch earthquake and Convective system (Tornado) in United States. However, despite considerable progress in catastrophe modelling, the advent of global catastrophe models, increasing risk model coverage and skill in the detailed modelling, the above mentioned events were not satisfactorily modelled by the current mainstream Re/Insurance catastrophe models. This presentation therefore address problems in models and incomplete understanding identified from recent catastrophic events by considering: i) the current modelling environment, and ii) how the current processes could be improved via: a) the understanding of risk within science networks such as the Willis Research Network, and b) the integration of risk model results from available insurance catastrophe models and tools. This presentation aims to highlight the needed improvements in decision making and market practices, thereby advancing the current management of risk in the Re/Insurance industry. This also increases the need for better integration of Public-Private-Academic partnerships and tools to provide better estimates of not only financial loss but also humanitarian and infrastructural losses as well.

"Aging Out" of Dependent Coverage and the Effects on US Labor Market and Health Insurance Choices.

PubMed

Dahlen, Heather M

2015-11-01

I examined how labor market and health insurance outcomes were affected by the loss of dependent coverage eligibility under the Patient Protection and Affordable Care Act (ACA). I used National Health Interview Survey (NHIS) data and regression discontinuity models to measure the percentage-point change in labor market and health insurance outcomes at age 26 years. My sample was restricted to unmarried individuals aged 24 to 28 years and to a period of time before the ACA's individual mandate (2011-2013). I ran models separately for men and women to determine if there were differences based on gender. Aging out of this provision increased employment among men, employer-sponsored health insurance offers for women, and reports that health insurance coverage was worse than it was 1 year previously (overall and for young women). Uninsured rates did not increase at age 26 years, but there was an increase in the purchase of non-group health coverage, indicating interest in remaining insured after age 26 years. Many young adults will turn to state and federal health insurance marketplaces for information about health coverage. Because young adults (aged 18-29 years) regularly use social media sites, these sites could be used to advertise insurance to individuals reaching their 26th birthdays.

How College Students Search the Internet for Weight Control and Weight Management Information: An Observational Study

ERIC Educational Resources Information Center

Senkowski, Valerie; Branscum, Paul

2015-01-01

Background: Few studies have attempted to examine how young adults search for health information on the Internet, especially information related to weight control and weight management. Purpose: The purpose of this study was to determine search strategies that college students used for finding information related to weight control and weight…

The cost-effectiveness of weight management programmes in a postnatal population.

PubMed

Rawdin, A C; Duenas, A; Chilcott, J B

2014-09-01

The aim of the study was to estimate the cost-effectiveness of a weight management programme including elements of physical exercise and dietary restriction which are designed to help women lose excess weight gained during pregnancy in the vulnerable postnatal period and inhibit the development of behaviours which could lead to future excess weight gain and obesity. A mathematical model based on a regression equation predicting change in weight over a fifteen year postnatal period was developed. The model included programme effectiveness and resource data based on a randomized controlled trial of a weight management programme implemented in a postnatal population in the United States. Utility and mortality data based on body mass index categories were also included. The model adopted a National Health Service (NHS) and personal social services (PSS) perspective, a lifetime time horizon and estimated the cost effectiveness of a weight management programme against a no change comparator in terms of an incremental cost-effectiveness ratio (ICER). The baseline results show that the difference in weight between women who received the weight management programme and women who received the control intervention was 3.02 kg at six months and 3.53 kg at fifteen years following childbirth. This results in an ICER of £7355 per quality adjusted life year (QALY) for women who were married at childbirth. The estimated ICER would suggest that such a weight management programme is cost-effective at a NICE threshold of £20,000 per QALY. However significant structural and evidence based uncertainty is present in the analysis. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Managing Weight: What Do People with an Intellectual Disability Want from Mobile Technology?

PubMed

Smyth, Phil; McDowell, Claire; Leslie, Julian C; Leader, Geraldine; Donnelly, Mark; Simpson, Elizabeth; Skelly, Laura

2017-01-01

Obesity is a significant health challenge. People with Intellectual Disability (ID) are particularly vulnerable to developing obesity. Mobile technology has been developed to support the management of weight and obesity in the form of apps, although not with people with an ID in mind. As a result existing off-the-shelf weight management apps currently available may not be functional in supporting weight reduction within this population. This paper presents the results of consultations with people with ID regarding weight management, comfort with mobile technology and desired characteristics in apps designed for people with ID that target weight management.

[Accidents at work and occupational diseases trend in agriculture insurance management. The contribution of INAIL data's for the knowledge of a worrying phenomenon].

PubMed

Calandriello, Luigi; Goggiamani, Angela; Ienzi, Emanuela; Naldini, Silvia; Orsini, Dario

2013-01-01

The author's describe accidents at work and occupational diseases outcome's measure in Agricolture insurance management acquired through statistical approach based on data processing provided by INAIL Bank data. Accident's incidence in Agricolture is compared to main insurance managements, using frequency index of accidents appearance selected on line of work and type of consequence. Concerning occupational diseases the authors describes the complaints and compensation with the comparison referring the analysis to statistical general data. The data define a worrying phenomenon.

Traumatic brain injury rehabilitation: case management and insurance-related issues.

PubMed

Pressman, Helaine Tobey

2007-02-01

Traumatic brain injury (TBI) cases are medically complex, involving the physical, cognitive, behavioral, social, and emotional aspects of the survivor. Often catastrophic, these cases require substantial financial resources not only for the patient's survival but to achieve the optimal outcome of a functional life with return to family and work responsibilities for the long term. TBI cases involve the injured person, the family, medical professionals such as treating physicians, therapists, attorneys, the employer, community resources, and the funding source, usually an insurance company. Case management is required to facilitate achievement of an optimal result by collaborating with all parties involved, assessing priorities and options, coordinating services, and educating and communicating with all concerned.

The Role of Social Media in Online Weight Management: Systematic Review

PubMed Central

Chopra, Vineet; Zhang, Catherine; Woolford, Susan J

2013-01-01

Background Social media applications are promising adjuncts to online weight management interventions through facilitating education, engagement, and peer support. However, the precise impact of social media on weight management is unclear. Objective The objective of this study was to systematically describe the use and impact of social media in online weight management interventions. Methods PubMed, PsycINFO, EMBASE, Web of Science, and Scopus were searched for English-language studies published through March 25, 2013. Additional studies were identified by searching bibliographies of electronically retrieved articles. Randomized controlled trials of online weight management interventions that included a social media component for individuals of all ages were selected. Studies were evaluated using 2 systematic scales to assess risk of bias and study quality. Results Of 517 citations identified, 20 studies met eligibility criteria. All study participants were adults. Because the included studies varied greatly in study design and reported outcomes, meta-analysis of interventions was not attempted. Although message boards and chat rooms were the most common social media component included, their effect on weight outcomes was not reported in most studies. Only one study measured the isolated effect of social media. It found greater engagement of participants, but no difference in weight-related outcomes. In all, 65% of studies were of high quality; 15% of studies were at low risk of bias. Conclusions Despite the widespread use of social media, few studies have quantified the effect of social media in online weight management interventions; thus, its impact is still unknown. Although social media may play a role in retaining and engaging participants, studies that are designed to measure its effect are needed to understand whether and how social media may meaningfully improve weight management. PMID:24287455

Weight management and its role in breast cancer rehabilitation.

PubMed

Demark-Wahnefried, Wendy; Campbell, Kristin L; Hayes, Sandra C

2012-04-15

Overweight and obesity are risk factors for postmenopausal breast cancer, and many women diagnosed with breast cancer, irrespective of menopausal status, gain weight after diagnosis. Weight management plays an important role in rehabilitation and recovery because obesity and/or weight gain may lead to poorer breast cancer prognosis, as well as prevalent comorbid conditions (eg, cardiovascular disease and diabetes), poorer surgical outcomes (eg, increased operating and recovery times, higher infection rates, and poorer healing), lymphedema, fatigue, functional decline, and poorer health and overall quality of life. Health care professionals should encourage weight management at all phases of the cancer care continuum as a means to potentially avoid adverse sequelae and late effects, as well as to improve overall health and possibly survival. Comprehensive approaches that involve dietary and behavior modification, and increased aerobic and strength training exercise have shown promise in either preventing weight gain or promoting weight loss, reducing biomarkers associated with inflammation and comorbidity, and improving lifestyle behaviors, functional status, and quality of life in this high-risk patient population. Copyright © 2012 American Cancer Society.

Weight Management Belief is the Leading Influential Factor of Weight Monitoring Compliance in Congestive Heart Failure Patients.

PubMed

Lu, Min-Xia; Zhang, Yan-Yun; Jiang, Jun-Fang; Ju, Yang; Wu, Qing; Zhao, Xin; Wang, Xiao-Hua

2016-11-01

Daily weight monitoring is frequently recommended as a part of heart failure self-management to prevent exacerbations. This study is to identify factors that influence weight monitoring compliance of congestive heart failure patients at baseline and after a 1-year weight management (WM) program. This was a secondary analysis of an investigative study and a randomized controlled study. A general information questionnaire assessed patient demographics and clinical variables such as medicine use and diagnoses, and the weight management scale evaluated their WM abilities. Good and poor compliance based on abnormal weight gain from the European Society of Cardiology (> 2 kg in 3 days) were compared, and hierarchical multiple logistic regression analysis was used to identify factors influencing weight monitoring compliance. A total of 316 patients were enrolled at baseline, and 66 patients were enrolled after the 1-year WM program. Of them, 12.66% and 60.61% had good weight monitoring compliance at baseline and after 1 year of WM, respectively. A high WM-related belief score indicated good weight monitoring compliance at both time points [odds ratio (OR), 1.043, 95% confidence interval (CI), 1.023-1.063, p < 0.001; and OR, 2.054, 95% CI, 1.209-3.487, p < 0.001, respectively). Patients with a high WM-related practice score had good weight monitoring compliance at baseline (OR, 1.046, 95% CI, 1.027-1.065, p < 0.001), and patients who had not monitored abnormal weight had poor weight monitoring compliance after the 1-year WM program (OR, 0.244, 95% CI, 0.006-0.991, p = 0.049). Data from this study suggested that belief related to WM plays an important role in weight monitoring compliance.

Bariatric surgery insurance requirements independently predict surgery dropout.

PubMed

Love, Kaitlin M; Mehaffey, J Hunter; Safavian, Dana; Schirmer, Bruce; Malin, Steven K; Hallowell, Peter T; Kirby, Jennifer L

2017-05-01

Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; P<.001); primary care physician letter of necessity (P<.0001); laboratory testing (P = .019); and evaluation by cardiology (P<.001), pulmonology (P<.0001), or psychiatry (P = .0003). Using logistic regression to control for co-morbidities, longer diet requirement (odds ratio [OR] .88, P<.0001), primary care physician letter (OR .33, P<.0001), cardiology evaluation (OR .22, P = .038), and advanced laboratory testing (OR 5.75, P = .019) independently predicted surgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, P<.0001). Many prebariatric surgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. Copyright © 2017

Can weight management programs in worksites reduce the obesity epidemic?

USDA-ARS?s Scientific Manuscript database

Worksites can potentially be important locations for weight management programs that contribute to curbing the national obesity epidemic. In published studies, weight loss programs targeting overweight and obese employees have been relatively more effective for weight loss than programs for preventi...

From managed care to consumer health insurance: the fall and rise of Aetna.

PubMed

Robinson, James C

2004-01-01

This paper documents Aetna's fall as the nation's largest managed care plan and its subsequent reemergence as a smaller but more profitable multiproduct insurer. The paper emphasizes the transformation in corporate goals, product design, organizational structure, information technology, product mix, premiums, cash flow, net income, and share prices. Disciplined underwriting and pricing have restored the firm to profitability and set the foundation for new growth. The implications for the health care system as a whole are less unambiguously positive.

Evolutionary dynamics of collective index insurance.

PubMed

Pacheco, Jorge M; Santos, Francisco C; Levin, Simon A

2016-03-01

Index-based insurances offer promising opportunities for climate-risk investments in developing countries. Indeed, contracts conditional on, e.g., weather or livestock indexes can be cheaper to set up than conventional indemnity-based insurances, while offering a safety net to vulnerable households, allowing them to eventually escape poverty traps. Moreover, transaction costs by insurance companies may be additionally reduced if contracts, instead of arranged with single households, are endorsed by collectives of households that bear the responsibility of managing the division of the insurance coverage by its members whenever the index is surpassed, allowing for additional flexibility in what concerns risk-sharing and also allowing insurance companies to avoid the costs associated with moral hazard. Here we resort to a population dynamics framework to investigate under which conditions household collectives may find collective index insurances attractive, when compared with individual index insurances. We assume risk sharing among the participants of each collective, and model collective action in terms of an N-person threshold game. Compared to less affordable individual index insurances, we show how collective index insurances lead to a coordination problem in which the adoption of index insurances may become the optimal decision, spreading index insurance coverage to the entire population. We further investigate the role of risk-averse and risk-prone behaviors, as well as the role of partial correlation between insurance coverage and actual loss of crops, and in which way these affect the original coordination thresholds.

AGU Sponsors Two Congressional Science Fellows

NASA Astrophysics Data System (ADS)

Chell, Kaitlin

2010-06-01

AGU will sponsor not one, but two Congressional Science Fellows (CSF) for the 2010-2011 fellowship term. Beginning in September, Jason Day and Ilya Fischhoff each will spend a year working in the congressional office of a U.S. senator or representative or in the office of a congressional committee. Both fellows were selected in March by AGU's Committee on Public Affairs after a competitive interview process. Their terms will mark the 33rd year AGU has sponsored a CSF and the first year AGU has ever sponsored two CSFs at one time.

Effectiveness of workplace weight management interventions: a systematic review

USDA-ARS?s Scientific Manuscript database

Background: A systematic review was conducted of randomized trials of workplace weight management interventions, including trials with dietary, physical activity, environmental, behavioral and incentive based components. Main outcomes were defined as change in weight-related measures. Methods: Key w...

Public Health Policy in Support of Insurance Coverage for Smoking Cessation Treatments

PubMed Central

Schwartz, Robert; Haji, Farzana; Babayan, Alexey; Longo, Christopher; Ferrence, Roberta

2017-01-01

Insurance coverage for evidence-based smoking cessation treatments (SCTs) promotes uptake and reduces smoking rates. Published studies in this area are based in the US where employers are the primary source of health insurance. In Ontario, Canada, publicly funded healthcare does not cover SCTs, but it can be supplemented with employer-sponsored benefit plans. This study explores factors affecting the inclusion/exclusion of smoking cessation (SC) benefits. In total, 17 interviews were conducted with eight employers (auto, retail, banking, municipal and university industries), four health insurers, two government representatives and three advisors/consultants. Overall, SCT coverage varied among industries; it was inconsistently restrictive and SCT differed by coverage amount and length of use. Barriers impeding coverage included the lack of the following: Canadian-specific return on investment (ROI), SC cost information, employer demand, government regulations/incentives and employee awareness of and demand. A Canadian evidence-based calculation of ROI for SC coupled with government incentives and public education may be needed to promote uptake of SCT coverage by employers. PMID:28617238

Public Health Policy in Support of Insurance Coverage for Smoking Cessation Treatments.

PubMed

Schwartz, Robert; Haji, Farzana; Babayan, Alexey; Longo, Christopher; Ferrence, Roberta

2017-05-01

Insurance coverage for evidence-based smoking cessation treatments (SCTs) promotes uptake and reduces smoking rates. Published studies in this area are based in the US where employers are the primary source of health insurance. In Ontario, Canada, publicly funded healthcare does not cover SCTs, but it can be supplemented with employer-sponsored benefit plans. This study explores factors affecting the inclusion/exclusion of smoking cessation (SC) benefits. In total, 17 interviews were conducted with eight employers (auto, retail, banking, municipal and university industries), four health insurers, two government representatives and three advisors/consultants. Overall, SCT coverage varied among industries; it was inconsistently restrictive and SCT differed by coverage amount and length of use. Barriers impeding coverage included the lack of the following: Canadian-specific return on investment (ROI), SC cost information, employer demand, government regulations/incentives and employee awareness of and demand. A Canadian evidence-based calculation of ROI for SC coupled with government incentives and public education may be needed to promote uptake of SCT coverage by employers. Copyright © 2017 Longwoods Publishing.

Referrals for pediatric weight management: the importance of proximity.

PubMed

Ambler, Kathryn A; Hagedorn, Douglas W J; Ball, Geoff D C

2010-11-01

Limited access to weight management care can have a negative impact on the health and well-being of obese children and youth. Our objectives were to describe the characteristics of clients referred to a pediatric weight management centre and explore potential differences according to proximity. All demographic and anthropometric data were abstracted from standardized, one-page referral forms, which were received by a pediatric weight management centre in Edmonton, AB (Canada) between April, 2005 and April, 2009. Referrals (n = 555; 52% male; age [mean +/- standard deviation]: 12.4 +/- 2.6 y; BMI: 32.3 +/- 6.8 kg/m2; BMI percentile: 98.4 +/- 1.7; BMI z-score: 2.3 +/- 0.4) were received from 311 physicians. Approximately 95% of referrals were for boys and girls classified as obese or very obese. Based on postal code data, individuals were dichotomized as either living within (local; n = 455) or beyond (distant; n = 100) the Edmonton Census Metropolitan Area. Numerous families resided several hundred kilometres away from our centre. Overall, distant clients were taller, weighed more, and were more overweight than their local counterparts. For distant clients, the degree of overweight was higher in youth versus children. Pediatric weight management services must be designed to optimize access to health services, especially for distant clients who may be at increased obesity-related health risk.

Captive insurance: is it the right choice for your insurance exposures?

PubMed

Frese, Richard C

2015-12-01

Potential benefits of a captive insurance company include: Broader coverage Improved cash flow and stability. Direct access to reinsurance markets. Tax advantages. Better handling and control of risk management and claims. Potential drawbacks and challenges include: Startup capitalization. Underwriting losses. Administration and commitment.

Healthy Eating and Exercise: Strategies for Weight Management in the Rural Midwest

ERIC Educational Resources Information Center

Nothwehr, Faryle; Peterson, N. Andrew

2005-01-01

Obesity prevalence has increased dramatically in the United States. Rural areas have been especially affected, yet few weight management studies have been conducted in these populations. This study was designed to assess weight management attitudes and strategies used when rural adults in particular attempt to lose weight, employing measures that…

Group health plans and health insurance issuers relating to coverage of preventive services under the Patient Protection and Affordable Care Act. Final rules.

PubMed

2012-02-15

These regulations finalize, without change, interim final regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services under provisions of the Patient Protection and Affordable Care Act.

Risk segmentation in Chilean social health insurance.

PubMed

Hidalgo, Hector; Chipulu, Maxwell; Ojiako, Udechukwu

2013-01-01

The objective of this study is to identify how risk and social variables are likely to be impacted by an increase in private sector participation in health insurance provision. The study focuses on the Chilean health insurance industry, traditionally dominated by the public sector. Predictive risk modelling is conducted using a database containing over 250,000 health insurance policy records provided by the Superintendence of Health of Chile. Although perceived with suspicion in some circles, risk segmentation serves as a rational approach to risk management from a resource perspective. The variables that have considerable impact on insurance claims include the number of dependents, gender, wages and the duration a claimant has been a customer. As shown in the case study, to ensure that social benefits are realised, increased private sector participation in health insurance must be augmented by regulatory oversight and vigilance. As it is clear that a "community-rated" health insurance provision philosophy impacts on insurance firm's ability to charge "market" prices for insurance provision, the authors explore whether risk segmentation is a feasible means of predicting insurance claim behaviour in Chile's private health insurance industry.

Weight outcomes audit for 34,271 adults referred to a primary care/commercial weight management partnership scheme.

PubMed

Stubbs, R James; Pallister, Carolyn; Whybrow, Stephen; Avery, Amanda; Lavin, Jacquie

2011-01-01

This project audited rate and extent of weight loss in a primary care/commercial weight management organisation partnership scheme. 34,271 patients were referred to Slimming World for 12 weekly sessions. Data were analysed using individual weekly weight records. Average (SD) BMI change was -1.5 kg/m² (1.3), weight change -4.0 kg (3.7), percent weight change -4.0% (3.6), rate of weight change -0.3 kg/week, and number of sessions attended 8.9 (3.6) of 12. For patients attending at least 10 of 12 sessions (n = 19,907 or 58.1%), average (SD) BMI change was -2.0 kg/m² (1.3), weight change -5.5 kg (3.8), percent weight change -5.5% (3.5), rate of weight change -0.4 kg/week, and average number of sessions attended was 11.5 (0.7) (p < 0.001, compared to all patients). Weight loss was greater in men (n = 3,651) than in women (n = 30,620) (p < 0.001). 35.8% of all patients enrolled and 54.7% in patients attending 10 or more sessions achieved at least 5% weight loss. Weight gain was prevented in 92.1% of all patients referred. Attendance explained 29.6% and percent weight lost in week 1 explained 18.4% of the variance in weight loss. Referral to a commercial organisation is a practical option for National Health Service (NHS) weight management strategies, which achieves clinically safe and effective weight loss. Copyright © 2011 S. Karger AG, Basel.

Child health insurance coverage: a survey among temporary and permanent residents in Shanghai.

PubMed

Lu, Mingshan; Zhang, Jing; Ma, Jin; Li, Bing; Quan, Hude

2008-11-17

Under the current healthcare system in China, there is no government-sponsored health insurance program for children. Children from families who move from rural and interior regions to large urban centres without a valid residency permit might be at higher risk of being uninsured due to their low socioeconomic status. We conducted a survey in Shanghai to describe children's health insurance coverage according to their migration status. Between 2005 and 2006, we conducted an in-person health survey of the adult care-givers of children aged 7 and under, residing in five districts of Shanghai. We compared uninsurance rates between temporary and permanent child residents, and investigated factors associated with child health uninsurance. Even though cooperative insurance eligibility has been extended to temporary residents of Shanghai, the uninsurance rate was significantly higher among temporary (65.6%) than permanent child residents (21.1%, adjusted odds ratio (OR): 5.85, 95% confidence interval (95% CI): 4.62-7.41). For both groups, family income was associated with having child health insurance; children in lower income families were more likely to be uninsured (OR: 1.96, 95% CI: 1.40-2.96). Children must rely on their parents to make the insurance purchase decision, which is constrained by their income and the perceived benefits of the insurance program. Children from migrant families are at even higher risk for uninsurance due to their lower socioeconomic status. Government initiatives specifically targeting temporary residents and providing health insurance benefits for their children are urgently needed.

Risk Preferences, Probability Weighting, and Strategy Tradeoffs in Wildfire Management.

PubMed

Hand, Michael S; Wibbenmeyer, Matthew J; Calkin, David E; Thompson, Matthew P

2015-10-01

Wildfires present a complex applied risk management environment, but relatively little attention has been paid to behavioral and cognitive responses to risk among public agency wildfire managers. This study investigates responses to risk, including probability weighting and risk aversion, in a wildfire management context using a survey-based experiment administered to federal wildfire managers. Respondents were presented with a multiattribute lottery-choice experiment where each lottery is defined by three outcome attributes: expenditures for fire suppression, damage to private property, and exposure of firefighters to the risk of aviation-related fatalities. Respondents choose one of two strategies, each of which includes "good" (low cost/low damage) and "bad" (high cost/high damage) outcomes that occur with varying probabilities. The choice task also incorporates an information framing experiment to test whether information about fatality risk to firefighters alters managers' responses to risk. Results suggest that managers exhibit risk aversion and nonlinear probability weighting, which can result in choices that do not minimize expected expenditures, property damage, or firefighter exposure. Information framing tends to result in choices that reduce the risk of aviation fatalities, but exacerbates nonlinear probability weighting. © 2015 Society for Risk Analysis.

Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria.

PubMed

Sidorov, Jaan; Shull, Robert; Tomcavage, Janet; Girolami, Sabrina; Lawton, Nadine; Harris, Ronald

2002-04-01

remained statistically significant after controlling for age, sex, HMO enrollment duration, presence of a pharmacy benefit, and insurance type. Program patients also achieved higher HEDIS scores for HbA(1c) testing as well as for lipid, eye, and kidney screenings (96.6, 91.1, 79.1, and 68.5% among program patients versus 83.8, 77.6, 64.9, and 39.3% among nonprogram patients, P < 0.05 for all measures). Among 1,074 patients with HbA(1c) levels measured in a HEDIS chart audit, 35 of 526 (6.7%) program patients had a level >9.5%, as compared with 79 of 548 (14.4%) nonprogram patients. In this HMO, an opt-in disease management program appeared to be associated with a significant reduction in health care costs and other measures of health care use. There was also a simultaneous improvement in HEDIS measures of quality care. These data suggest that disease management may result in savings for sponsored managed care organizations and that improvements in HEDIS measures are not necessarily associated with increased medical costs.

Unique barriers and needs in weight management for obese women with fibromyalgia.

PubMed

Craft, Jennifer M; Ridgeway, Jennifer L; Vickers, Kristin S; Hathaway, Julie C; Vincent, Ann; Oh, Terry H

2015-01-01

The aim of this study was to identify barriers, needs, and preferences of weight management intervention for women with fibromyalgia (FM). Obesity appears in higher rates in women with fibromyalgia compared to the population at large, and no study to date has taken a qualitative approach to better understand how these women view weight management in relation to their disease and vice versa. We designed a qualitative interview study with women patients with FM and obesity. Women (N = 15) were recruited by their participation in a fibromyalgia treatment program (FTP) within the year prior. The women approached for the study met the following inclusion criteria: confirmed diagnosis of FM, age between 30 and 60 years (M = 51 ± 6.27), and body mass index (BMI) ≥ 30 (M = 37.88 ± 4.87). Patients completed questionnaire data prior to their participation in focus groups (N = 3), including weight loss history, physical activity data, the Revised Fibromyalgia Impact Questionnaire (FIQR), and the Patient Health Questionnaire 9-item (PHQ-9). Three focus group interviews were conducted to collect qualitative data. Consistent themes were revealed within and between groups. Patients expressed the complex relationships between FM symptoms, daily responsibilities, and weight management. Weight was viewed as an emotionally laden topic requiring compassionate delivery of programming from an empathetic leader who is knowledgeable about fibromyalgia. Patients view themselves as complex and different, requiring a specifically tailored weight management program for women with FM. Women with FM identify unique barriers to weight management, including the complex interrelationships between symptoms of FM and health behaviors, such as diet and exercise. They prefer a weight management program for women with FM that consists of an in-person, group-based approach with a leader but are open to a tailored conventional weight management program. Feasibility may be one of the biggest barriers

Weight outcomes audit in 1.3 million adults during their first 3 months' attendance in a commercial weight management programme.

PubMed

Stubbs, R James; Morris, Liam; Pallister, Carolyn; Horgan, Graham; Lavin, Jacquie H

2015-09-10

Over sixty percent of adults in the UK are now overweight/obese. Weight management on a national scale requires behavioural and lifestyle solutions that are accessible to large numbers of people. Evidence suggests commercial weight management programmes help people manage their weight but there is little research examining those that pay to attend such programmes rather than being referred by primary care. The objective of this analysis was to evaluate the effectiveness of a UK commercial weight management programme in self-referred, fee-paying participants. Electronic weekly weight records were collated for self-referred, fee-paying participants of Slimming World groups joining between January 2010 and April 2012. This analysis reports weight outcomes in 1,356,105 adult, non-pregnant participants during their first 3 months' attendance. Data were analysed by regression, ANOVA and for binomial outcomes, chi-squared tests using the R statistical program. Mean (SD) age was 42.3 (13.6) years, height 1.65 m (0.08) and start weight was 88.4 kg (18.8). Mean start BMI was 32.6 kg/m(2) (6.3 kg/m(2)) and 5 % of participants were men. Mean weight change of all participants was -3.9 kg (3.6), percent weight change -4.4 (3.8), and BMI change was -1.4 kg/m(2) (1.3). Mean attendance was 7.8 (4.3) sessions in their first 3 months. For participants attending at least 75 % of possible weekly sessions (n = 478,772), mean BMI change was -2.5 kg/m(2) (1.3), weight change -6.8 kg (3.7) and percent weight change -7.5 % (3.5). Weight loss was greater in men than women absolutely (-6.5 (5.3) kg vs -3.8 (3.4) kg) and as a percentage (5.7 % (4.4) vs 4.3 % (3.7)), respectively. All comparisons were significant (p < 0.001). Level of attendance and percent weight loss in the first week of attendance together accounted for 55 % of the variability in weight lost during the study period. A large-scale commercial lifestyle-based weight management programme had a significant impact on weight loss

Insurers' policies on coverage for behavior management services and the impact of the Affordable Care Act.

PubMed

Edelstein, Burton L

2014-01-01

The impact of the Affordable Care Act (ACA) on dental insurance coverage for behavior management services depends upon the child's source of insurance (Medicaid, CHIP, private commercial) and the policies that govern each such source. This contribution describes historical and projected sources of pediatric dental coverage, catalogues the seven behavior codes used by dentists, compares how often they are billed by pediatric and general dentists, assesses payment policies and practices for behavioral services across coverage sources, and describes how ACA coverage policies may impact each source. Differences between Congressional intent to ensure comprehensive oral health services with meaningful consumer protections for all legal-resident children and regulatory action by the Departments of Treasury and Health and Human Services are explored to explain how regulations fail to meet Congressional intent as of 2014. The ACA may additionally impact pediatric dentistry practice, including dentists' behavior management services, by expanding pediatric dental training and safety net delivery sites and by stimulating the evolution of novel payment and delivery systems designed to move provider incentives away from procedure-based payments and toward health outcome-based payments.

“Will Employers Drop Health Insurance Coverage because of the Affordable Care Act?” Health Affairs 32(9): 1522–1530

PubMed Central

Buchmueller, Thomas; Carey, Colleen; Levy, Helen G.

2014-01-01

Since the passage of the Affordable Care Act, there has been considerable speculation about how many employers will stop offering health insurance once the major coverage provisions of the Act take effect. While some observers predict little aggregate effect, others believe that 2014 marks the beginning of the end for our current system of employer- sponsored insurance. We address the question “how will employer health insurance offering respond to health reform?” using theoretical and empirical evidence. First, we describe economic models of why employers offer insurance. Second, we recap the relevant provisions of health reform and use our economic framework to consider how they may affect employer offers. Third, we review the various predictions that have been made on this subject. Finally, we offer some observations on interpreting early data from 2014. PMID:24019355

14 CFR 151.37 - Sponsor eligibility.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Sponsor eligibility. 151.37 Section 151.37 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS... particular airport a sponsor must— (a) Be a public agency, which includes for the purposes of this part only...

14 CFR 151.37 - Sponsor eligibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Sponsor eligibility. 151.37 Section 151.37 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS... particular airport a sponsor must— (a) Be a public agency, which includes for the purposes of this part only...

Effectiveness of Hypnosis as an Adjunct to Behavioral Weight Management.

ERIC Educational Resources Information Center

Bolocofsky, David N.; And Others

1985-01-01

Subjects (N=109) completed a behavioral weight-management program either with or without the addition of hypnosis. Both interventions resulted in significant weight reduction. At the eight-month and two-year follow-ups, the hypnosis clients showed significant additional weight loss and were more likely to have achieved and maintained their…

Effectiveness of Workplace Weight Management Interventions: a Systematic Review.

PubMed