Übertragbare Altersrückstellungen in der privaten Krankenversicherung

2005 ◽  
Vol 54 (1) ◽  
Author(s):  
Johann Eekhoff
Keyword(s):  
Health Insurance ◽  
Market Competition ◽  
Institutional Arrangement ◽  
Insurance Companies ◽  
Insurance Company ◽  
Present Value ◽  
Price Signals ◽  
Insured Person ◽  
Health Insurance Companies ◽  
Will Force

AbstractEven in a capital funded health insurance system, competition between insurance companies is restricted. This is due to the fact that the insured who contribute to the capital fund are not allowed to transfer part of the capital fund if they change the insurer. This article deals with an alternative institutional arrangement, in which each person is assigned an individual portion of the capital fund that is transferred when the insurer is changed. It is asserted that an insurance company will systematically transfer reduced individual capital funds in order to avoid a loss of clients. In a competitive market, this is not a rational behaviour. The correct capital provision for each insured person is the present value of expected reimbursements of health expenditures minus the present value of expected premiums. Market competition will force the insurer to transfer an amount which is close to the necessary individual capital provision. This is the basis for a reaction on price signals by the insured and therefore for competition on the market of health insurance companies.

Medications requiring prior authorization across health insurance plans

2020 ◽  
Vol 77 (8) ◽  
pp. 644-648
Author(s):  
Laney K Jones ◽  
Ilene G Ladd ◽  
Michael R Gionfriddo ◽  
Christina Gregor ◽  
Michael A Evans ◽  
...  
Keyword(s):  
Health Insurance ◽  
External Factors ◽  
Insurance Companies ◽  
Health Insurance Company ◽  
Prior Authorization ◽  
Insurance Company ◽  
Insurance Plan ◽  
Narcotic Analgesics ◽  
Health Insurance Companies ◽  
Effective Use

Abstract Objective To determine the amount of variation in numbers and types of medications requiring prior authorization (PA) by insurance plan and type. Methods Most health insurance companies require PA for medications to ensure safe and effective use and contain costs. We generated 4 lists of medications that required PA during 2017 for commercial, marketplace, Medicaid, and Medicare plans. We aggregated medications according to the generic medication name equivalent using codes and medication names. We compared these medications to assess how many of the medications required PA by 1, 2, 3, or all 4 of the insurance plans. We counted all prescription orders written for a patient age 18 years or older with health plan insurance during 2017 for any of the medications that appeared on the health plan’s PA lists by querying the electronic health record. Results PA was required for 600 unique medications in 2017 across the 4 plans. Of 691,457 prescription orders written for 114,159 members, 31,631 (5%) were written for 1 of the 600 medications that required PA by at least 1 insurance plan. There were 12,540 medication orders (written for 6,642 members) that potentially required PA. The marketplace plan required PA for the greatest number of medications (440), followed by the Medicare (272), commercial (271), and Medicaid (72) plans. The most commonly prescribed classes of medications for which PA was required by at least 1 plan were antihyperlipidemics (22% of orders potentially requiring PA), narcotic analgesics (13%), hypnotics (12%), antidiabetic medications (9%), and antidepressants (9%). For only 25% of medications (151 of 600) was PA required by at least 3 plans, and for only 5% (32 of 600) was PA required by all 4 insurance types. Conclusion Medications requiring PA can differ within a single health insurance company, but this variation may be unavoidable due to external factors.

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.

scholarly journals Development of medical insurance in the Russian Federation. At the crossroads. What's next?

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Igor M. Akulin ◽  
Lubov Yu. Zhiguleva
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health ◽  
Insurance Companies ◽  
Health Insurance System ◽  
National Health Care ◽  
Health Insurance Companies ◽  
Compulsory Health Insurance ◽  
The Russian Federation ◽  
Additional Payment

The RF health care reform is gaining momentum. A thorough consideration should be given to the discussion on the need to exclude health insurance companies from the compulsory health insurance system (CHI). Formation of the National Health Care System of Russia is the main problem of the national health care at this stage of reforms. Additional payment for medical services in the CHI by the general public is not advisable. Changes in the regulatory framework of the CHI system is deemed to be the basis for reforming the system of compulsory and voluntary health insurance in Russia.   

Extending the Boundaries of Medicine

1996 ◽  
Vol 17 (8) ◽  
pp. 263-263
Author(s):  
R J H
Keyword(s):  
Health Insurance ◽  
England Journal ◽  
Alternative Medicine ◽  
New England ◽  
Holistic Approach ◽  
National Institutes Of Health ◽  
Insurance Companies ◽  
Core Content ◽  
Look Ahead ◽  
Health Insurance Companies

Readers may be surprised to see the article "Separation or Synthesis: A Holistic Approach to Therapeutics" in this issue. There are no core content statements related to this article. Yet, from time to time, I exercise my editorial prerogative to publish something that is outside the usual—to stimulate, to look ahead to what may be important in the future, and to provoke our readers. There is a great deal of interest today in alternative medicine. An article in The New England Journal of Medicine reports that nearly one third of Americans use some form of alternative medical therapy.1 There is now an Office of Alternative Medicine at the National Institutes of Health supporting grants in this field, and some health insurance companies recently began providing (for an added premium) coverage for these therapies.

New options for surgeons to improve malnutrition in the outpatient setting

2021 ◽  
Vol 100 (2) ◽  
Keyword(s):  
Health Insurance ◽  
Nutritional Status ◽  
Perioperative Period ◽  
Outpatient Setting ◽  
Surgical Patients ◽  
Insurance Companies ◽  
Negative Factor ◽  
Health Insurance Companies ◽  
Limited Period

Malnutrition is a significant negative factor for surgical patients in the entire perioperative period. However, this factor can be controlled and is easy to detect in the outpatient setting. Starting from May 1, 2020, surgeons have the possibility to prescribe sipping under certain conditions for a limited period of 4 weeks. Thereby they have become able to strongly impact any altered nutritional status both preoperatively and postoperatively. The authors describe scoring questionnaires used for the detection of malnutrition and required by health insurance companies. Additionally, prescribing conditions and potential mistakes in the outpatient setting are analysed.

Gemeinsame Selbstverwaltung: Bedingungen der Aufgabenwahrnehmung

2019 ◽  
Vol 68 (6-7) ◽  
pp. 519-536
Author(s):  
Thomas Gerlinger
Keyword(s):  
Health Insurance ◽  
Medical Profession ◽  
Insurance Companies ◽  
Regulatory Change ◽  
Self Administration ◽  
Insurance Funds ◽  
Health Insurance Companies ◽  
Joint Federal Committee ◽  
Health Insurance Funds ◽  
Regulated Competition

Zusammenfassung Ein vielgestaltiger Wandel in Gesundheitssystem und Gesundheitspolitik erschwert den Verbänden der Ärzte und Krankenkassen die Wahrnehmung ihrer Aufgaben im Rahmen der gemeinsamen Selbstverwaltung. Erstens steigert die mit der Einrichtung des Gemeinsamen Bundesausschusses verbundene transsektorale Ausweitung der korporatistischen Verhandlungssystemen die Komplexität der Akteurs- und Interessenkonstellationen in der gemeinsamen Selbstverwaltung. Zweitens trägt der ordnungspolitische Wandel in Richtung auf einen regulierten Wettbewerb zu einer Binnendifferenzierung der Interessen in der Ärzteschaft und bei den Krankenkassen bei. Drittens erschwert auf der Seite der Ärzteschaft zusätzlich die Ausdifferenzierung von Disziplinen, Versorgungseinrichtungen und -formen sowie von beruflichen Identitäten die für das Funktionieren der gemeinsamen Selbstverwaltung erforderliche Aggregation von Interessen und die Kompromissfindung. Abstract A multi-faceted change in the health system and health policy makes it difficult for associations of doctors and health insurance companies to carry out their tasks within the framework of joint self-government. First, the transsectoral expansion of corporatist bargaining systems associated with the establishment of the Joint Federal Committee increases the complexity of stakeholder and stakeholder constellations in joint self-government. Second, regulatory change towards regulated competition contributes to an internal differentiation of interests in the medical profession and in the health insurance funds. Third, on the side of the medical profession, the differentiation of disciplines and care as well as of occupational identities further complicates the aggregation of interests and compromise-finding necessary for the functioning of joint self-administration.

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