scholarly journals Competition between health maintenance organizations and nonintegrated health insurance companies in health insurance markets

2015 ◽  
Vol 5 (1) ◽  
Author(s):  
Edmond Baranes ◽  
David Bardey
Keyword(s):  
Health Insurance ◽  
Health Maintenance Organizations ◽  
Insurance Companies ◽  
Insurance Markets ◽  
Health Maintenance ◽  
Health Insurance Markets ◽  
Health Insurance Companies

Open Source Approach for Mitigating Misinformation Risk in Complementary and Alternative Medicine Practices

2014 ◽  
Vol 3 (1) ◽  
pp. 1-11
Author(s):  
Venugopal Gopalakrishna-Remani ◽  
Mary Helen Fagan
Keyword(s):  
Alternative Medicine ◽  
Open Source ◽  
Health Maintenance Organizations ◽  
Insurance Companies ◽  
Health Maintenance ◽  
Medical Practitioners ◽  
Alternative Medicines ◽  
Development Framework ◽  
Health Insurance Companies ◽  
Proper Diagnosis

Patients and health maintenance organizations are spending approximately $47 billion annually on innovative alternative medical techniques such as aromatherapy, biofeedback, chiropractic manipulation, homeopathy and others. Health insurance companies, drug regulation agencies, medical practitioners and educated patients are demanding more reliable information concerning these alternative medicines and complementary processes. While these approaches have been successful, the community of stakeholders is demanding scientifically proven, evidence-based validation of the materials and practices. Validation is essential to formalize the use of alternative medicines and complementary treatments. However there are very few peer reviewed journal articles and a lack of approval methodologies in this field, which may be related symptoms. Another key problem is the lack of accurate knowledge about the proper diagnosis-treatment match. This may result in negligence risk for practitioners or opportunity lost risk for patients who miss access to a potential remedy. The open source approach evolved in the information technology field out of the free public software movement, which has been effective for knowledge creation, collaboration and sharing across disciplines and cultures. For example, the authors all have free Internet browsers and utility software. Therefore, the authors investigated applying the 'open source' ideology as a potential methodology for solving these problems. They developed an alternative medicine knowledge development framework to facilitate creating, collaborating on, and sharing innovations in the field.

Open Source Approach for Mitigating Misinformation Risk in Complementary and Alternative Medicine Practices

2015 ◽  
pp. 1915-1926
Author(s):  
Venugopal Gopalakrishna-Remani ◽  
Mary Helen Fagan
Keyword(s):  
Alternative Medicine ◽  
Open Source ◽  
Health Maintenance Organizations ◽  
Insurance Companies ◽  
Health Maintenance ◽  
Medical Practitioners ◽  
Alternative Medicines ◽  
Development Framework ◽  
Health Insurance Companies ◽  
Proper Diagnosis

Patients and health maintenance organizations are spending approximately $47 billion annually on innovative alternative medical techniques such as aromatherapy, biofeedback, chiropractic manipulation, homeopathy and others. Health insurance companies, drug regulation agencies, medical practitioners and educated patients are demanding more reliable information concerning these alternative medicines and complementary processes. While these approaches have been successful, the community of stakeholders is demanding scientifically proven, evidence-based validation of the materials and practices. Validation is essential to formalize the use of alternative medicines and complementary treatments. However there are very few peer reviewed journal articles and a lack of approval methodologies in this field, which may be related symptoms. Another key problem is the lack of accurate knowledge about the proper diagnosis-treatment match. This may result in negligence risk for practitioners or opportunity lost risk for patients who miss access to a potential remedy. The open source approach evolved in the information technology field out of the free public software movement, which has been effective for knowledge creation, collaboration and sharing across disciplines and cultures. For example, the authors all have free Internet browsers and utility software. Therefore, the authors investigated applying the 'open source' ideology as a potential methodology for solving these problems. They developed an alternative medicine knowledge development framework to facilitate creating, collaborating on, and sharing innovations in the field.

Community Rating And Sustainable Individual Health Insurance Markets In New Jersey

2004 ◽  
Vol 23 (4) ◽  
pp. 167-175 ◽  
Author(s):  
Alan C. Monheit ◽  
Joel C. Cantor ◽  
Margaret Koller ◽  
Kimberley S. Fox
Keyword(s):  
Health Insurance ◽  
New Jersey ◽  
Insurance Markets ◽  
Community Rating ◽  
Individual Health ◽  
Health Insurance Markets

scholarly journals Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

2021 ◽  
Author(s):  
Silke Piedmont ◽  
Anna Katharina Reinhold ◽  
Jens-Oliver Bock ◽  
Enno Swart ◽  
Bernt-Peter Robra
Keyword(s):  
Health Insurance ◽  
Emergency Care ◽  
Third Party ◽  
Insurance Companies ◽  
Prehospital Emergency Care ◽  
Health Related ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Health Insurance Companies ◽  
Reported Data

Abstract Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful. Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016. Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care. Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.

scholarly journals Thriving in a changing world – opportunities and challenges for private health insurance companies

2018 ◽  
Vol 1 (2018/1) ◽  
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Health Impact ◽  
Insurance Market ◽  
Insurance Companies ◽  
Full Potential ◽  
Global Trends ◽  
Health Insurance Companies ◽  
Health Insurance Market

The health insurance market in Poland reflects global trends – such as the rising awareness of personal health impact on quality of life. As a consequence, the health insurance market has seen substantial growth during the last years, which is forecasted to continue at over 20 percent more than life or P&C insurance globally. However, private health insurance has not yet unlocked its full potential.

scholarly journals Day Surgery Development Aspects in Slovakia

2020 ◽  
Vol 31 (2) ◽  
pp. 477
Author(s):  
Beáta Gavurová ◽  
Adela Klepáková ◽  
Ladislava Ivančová
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Pilot Study ◽  
Healthcare System ◽  
Social Groups ◽  
Day Surgery ◽  
Insurance Companies ◽  
Social Sphere ◽  
The Social ◽  
Health Insurance Companies

The day surgery is a highly effective tool for providing health care which has been used in Slovakia only for the last decade. The unified system of payment for inpatient or outpatient (day care) surgeries causes the reduction of health insurance companies´ spending. Incorrectly configured and economically demotivating system of refunding is a cause of lagging behind the European average in utilization of day surgery. Without the evaluation of day surgery it is not possible to link the progress in the social sphere, which leads to the restriction of day surgery availability for some social groups and thus the subsequent stagnation of day surgery in Slovakia. This contribution presents a pilot study conducted in Slovakia and its partial findings focused on the development and trends in the implementation of day surgery in order to increase the efficiency healthcare system.

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