Acute Coronary Syndrome Treatment Costs from the Perspective of the Supplementary Health System

AbstractBackground:Acute coronary syndrome (ACS) is defined as a “group of clinical symptoms compatible with acute myocardial ischemia”, representing the leading cause of death worldwide, with a high clinical and financial impact. In this sense, the development of economic studies assessing the costs related to the treatment of ACS should be considered.Objective:To evaluate costs and length of hospital stay between groups of patients treated for ACS undergoing angioplasty with or without stent implantation (stent+ / stent-), coronary artery bypass surgery (CABG) and treated only clinically (Clinical) from the perspective of the Brazilian Supplementary Health System (SHS).Methods:A retrospective analysis of medical claims of beneficiaries of health plans was performed considering hospitalization costs and length of hospital stay for management of patients undergoing different types of treatment for ACS, between Jan/2010 and Jun/2012.Results:The average costs per patient were R$ 18,261.77, R$ 30,611.07, R$ 37,454.94 and R$ 40,883.37 in the following groups: Clinical, stent-, stent+ and CABG, respectively. The average costs per day of hospitalization were R$ 1,987.03, R$ 4,024.72, R$ 6,033.40 and R$ 2,663.82, respectively. The average results for length of stay were 9.19 days, 7.61 days, 6.19 days and 15.20 days in these same groups. The differences were significant between all groups except Clinical and stent- and between stent + and CABG groups for cost analysis.Conclusion:Hospitalization costs of SCA are high in the Brazilian SHS, being significantly higher when interventional procedures are required.

Report of the State Claims Agency on Compensation for Thalidomide Survivors

Report of the State Claims Agency on Compensation for Thalidomide Survivors Click here to download PDF 279KB

Review of VHI Claims Cost Control

Review of VHI Claims Cost Control Click here to download PDF 568KB

Supplementary Report of the HIA to the Minister for Health, in accordance with Section 7E(1)(b) of the Health Insurance Acts, 1994-2009 (Redacted Version)

The purpose of this Supplementary Report is to advise on how the budgetary measures impact on the conclusions in relation to tax credits and stamp duty included in the Authority’s November 2011 Report. in doing so, we will assess the direct impacts and we will discuss some scenarios. However, the Authority’s advice in this area relies on projections of the health insurance market and, in light of the above, there is considerable uncertainty surrounding any projections of how claims inflation or the market size may develop, even in the short and medium terms. Supplementary Report of the HIA to the Minister for Health, in accordance with Section 7E(1)(b) of the Health Insurance Acts, 1994-2009 (Redacted Version) Click here to download PDF 3.2mb

Review of Measures to Reduce Costs in the Private Health Insurance Market 2013

This report was prepared independently by Mr McLoughlin with the insurers support, for consideration by the Minister for Health and the insurers.  All parties were very conscious of the importance of respecting competition law when dealing with issues such as prices and costs. The Phase 1 report contains 32 recommendations under 9 headings as follows: Most of the recommendations in the Phase 1 report could be implemented on an administrative basis, while a small number, if adopted, would require legislation. Some of the key recommendations to drive down costs are can be summarised as follows: Controlling costs in private health insurance Care settings and use of resources Age structure of the market Clinical audit and utilisation management Industry approach to private psychiatry Fraud, waste and abuse Chronic disease management Claims processing Admission and discharge procedures and processes. Most of the recommendations in the Phase 1 report could be implemented on an administrative basis, while a small number, if adopted, would require legislation.

Review of Measures to Reduce Costs in the Private Health Insurance Market 2014

5.11.2014 This report was prepared independently by Mr McLoughlin with the support of the health insurers, and the Health Insurance Authority, for consideration by the Minister for Health and the insurers.  All parties were very conscious of the importance of respecting competition law when dealing with issues such as prices and costs. The work of the Group has been conducted in two phases, with the first phase report published on 26 December 2013. The Phase 1 report sets out the context, establishment, membership and terms of reference for both phases of the Groups work.  The report also outlines the legislative provisions for private health insurance in Ireland, the objectives of both phases of the review and the approach and methodology followed. Phase 2 of the process focused on the compilation and analysis by the Health Insurance Authority (HIA) of claims data to assess the cost drivers for health insurance, the effects of medical technology and innovations on costs, and claims processing issues.The report and submissions from relevant stakeholders which were examined and considered under the Phase 2 Review can be downloaded below. Download the Review of Measures to Reduce Costs in the Private Health Insurance Market 2014 -  Independent Report to the Minister for Health and Health Insurance Council here. Submissions received HSE Submission to Pat McLoughlin, Chair of Review Group IHAI submission 11 April 2014 IHCA submission to Chair 1 May 2014 Insurance Ireland submission Society of Actuaries in Ireland submission St. Patricks Mental Health Services submission April 2014 St John of Gods Submission        

Tackling inequalities in life expectancy in areas with the worst health and deprivation: England

While overall health outcomes in England has improved during the last Labour administration - inequalities in health has increased, according to the latest report published by the House of Commons Public Accounts Committee today. People living in the poorest communities in England are more likely to die two years earlier than people living in more affluent neighbourhoods, leading to 3,335 premature mortality the report claims. Between, 1997 and 2010, the NHS budget has doubled and the country is more prosperous than ever before, yet the gap in life expectancy between the poorest areas and the national average grew by 7% for men and 14% for women, the committee concluded.

Equity considerations in health care: An axiomatic bargaining approach

The general issues of equity and efficiency are placed at the center of the analysis of resource allocation problems in health care. We examine them using axiomatic bargaining theory. We study different solutions that have been proposed and relate them to previous literature on health care allocation. In particular, we focus on the solutions based on axiomatic bargaining with claims and suggest that they may be particularly appealing as distributive criteria in health policy. Finally, we present the results of a survey that tries to elicit moral intuitions of people about resource allocation problems and their different solutions.

Self-selection and risk selection on the Swiss health insurance market

Abstract This thesis presents three empirical studies in the field of health insurance in Switzerland. First we investigate the link between health insurance coverage and health care expenditures. We use claims data for over 60 000 adult individuals covered by a major Swiss Health Insurance Fund, followed for four years; the data show a strong positive correlation between coverage and expenditures. Two methods are developed and estimated in order to separate selection effects (due to individual choice of coverage) and incentive effects ("ex post moral hazard"). The first method uses the comparison between inpatient and outpatient expenditures to identify both effects and we conclude that both selection and incentive effects are significantly present in our data. The second method is based on a structural model of joint demand of health care and health insurance and makes the most of the change in the marginal cost of health care to identify selection and incentive effects. We conclude that the correlation between insurance coverage and health care expenditures may be decomposed into the two effects: 75% may be attributed to selection, and 25 % to incentive effects. Moreover, we estimate that a decrease in the coinsurance rate from 100% to 10% increases the marginal demand for health care by about 90% and from 100% to 0% by about 150%. Secondly, having shown that selection and incentive effects exist in the Swiss health insurance market, we present the consequence of this result in the context of risk adjustment. We show that if individuals choose their insurance coverage in function of their health status (selection effect), the optimal compensations should be function of the se- lection and incentive effects. Therefore, a risk adjustment mechanism which ignores these effects, as it is the case presently in Switzerland, will miss his main goal to eliminate incentives for sickness funds to select risks. Using a simplified model, we show that the optimal compensations have to take into account the distribution of risks through the insurance plans in case of self-selection in order to avoid incentives to select risks.Then, we apply our propositions to Swiss data and propose a simple econometric procedure to control for self-selection in the estimation of the risk adjustment formula in order to compute the optimal compensations.

Iowa Medical Malpractice Closed Claim Study: For Claims Closed from 2001 through 2005, December 2006

Requested claim data from insurance companies in order to provide a snapshot portrayal of Iowa's malpractice insurance market.

Nutrigenomics for Global Health: Ethical Challenges for Underserved Populations

Nutrigenomics covers disparate fields of nutrition science and has been defined in many different ways. In fact, this emerging field of science has multiple facets, many of which do not generate the same ethical issues. In particular, different ethical issues emerge concerning the extent to which nutrigenomics may actually improve global health, i.e., in terms of worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders. Nutrigenomics raises many hopes and expectations on that score. However it remains unclear and controversial whether nutrigenomics studies and their actual or potential applications will actually benefit developing countries and their populations. Different forces may drive the choice of research priorities and shape the claims that are made when communicating the goals or the results of nutrigenomics studies and applications. This article proposes to assess expectations and claims in nutrigenomics, with respect to their respective potential impact on global health and the ethical issues they raise. Nutrigenomics is and should be more than premature claims and much debated promises about personalized nutritional interventions on individuals. Beyond questionable commercial claims, nutrigenomics is also knowledge about and recognition of the considerable impacts of underfeeding and malnutrition on the genome (and epigenome) integrity and stability. As such, nutrigenomics research is a valuable opportunity to revive and give strength to the debate about the unacceptable consequences of hunger and malnutrition worldwide, and to support a newly and potentially significant convergence in research priorities that could benefit both developed and developing countries.

Setilement of motor accidents claims with special reference to Kerala

The accident toll on our road traffic is staggering. Obviously this appalling toll of life and.health represents heavy economic loss in addition to human tragedy. the enormous increase in the number of motor vehicles with its rash, negligent and reckless use by unscrupulous, inexperienced and dangerous drivers in the most miserably managed roads coupled with concomitant hazards would draw our attention that Accident Prevention, and Accident compensation are thoroughly two compatiable aims. Proposed solutions to the traffic Problems abound. Preventive efforts concentrated on each of the variables the driver, the road and the vehicle are all being initiated. Still it is a Will the .Motor Vehicles are not considered as dangerous machines. Motoring activity is found useful.A competent and specially trained police force has to be created to deal with the traffic offences in a more scientific ways.The term ‘legal representative needs to be defined on the constructive aspects of relation and dependence.Services of legal aid and public counsels shall necessarily be extended to the poor Motor Accident victims.Timely reporting and timely investigation of Motor Accidents cases will reduce the number of fraudulent claims. There are instances where cases are taken in to investigation after several months of occurrence.It is hoped that the suggestions made above as a result of the present study, if pwgninto practice, may make a humble contribution to the prevention sssof motor accidents and to a faster and speedier settlement of motor accident compensation claims.

Conjugated linoleic acid and human health: a critical evaluation of the evidence

Purpose of review: This review critically evaluates studies investigating the effects of conjugated linoleic acid on human health, including effects on body composition, blood lipids, liver metabolism, insulin sensitivity and immune function. It focuses mainly on human intervention studies, but includes some reference to animal and cellular studies which provide insight into potential molecular mechanisms of action of conjugated linoleic acid. Recent findings: Human studies continue to report inconsistent effects of conjugated linoleic acid on human health. Some of these reports are based on overinterpretation of marginal effects of supplementation. Recent data suggest that the effects of the substance may be isomer dependent and that cis-9, trans-11 and trans-10, cis-12 conjugated linoleic acids have opposing effects on blood lipids and on metabolism in adipocytes and hepatic cells. Summary: Claims that conjugated linoleic acid is beneficial for health remain as yet unconvincing. Human studies investigating the effects of conjugated linoleic acid supplements have tended to use mixtures of isomers and have been inconsistent. More recent studies have attempted to use relatively pure preparations of single isomers and these studies suggest that the effects of conjugated linoleic acid may be isomer-specific. These recent data suggest a relative detrimental effect of trans-10, cis-12 conjugated linoleic acid on blood lipids. There appears to be little effect of conjugated linoleic acid on immune function and the effects on insulin sensitivity remain unclear.

Probiotics: their potential to impact human health

Probiotics—live microorganisms that when administered in adequate amounts confer a health benefit on the host—have been studied for both human and animal applications, and worldwide research on this topic has accelerated in recent years. This paper reviews the literature on probiotics, describes how probiotics work in human ecosystems, and outlines the impact of probiotics on human health and disease. The paper also addresses safety issues of probiotic use, suggests future developments in the field of probiotics, and provides research and policy recommendations. Product considerations and potential future developments regarding probiotics also are discussed. The authors conclude that controlled human studies have revealed a diverse range of health benefits from consumption of probiotics, due largely to their impact on immune function or on microbes colonizing the body. Additional, well-designed and properly controlled human and mechanistic studies with probiotics will advance the essential understanding of active principles, mechanisms of action, and degree of effects that can be realized by specific consumer groups. Recommendations include establishment of a standard of identity for the term “probiotic,” adoption of third-party verification of label claims, use of probiotics selectively in clinical conditions, and use of science-based assessment of the benefits and risks of genetically engineered probiotic microbes.