Insurance Beneficiary Research Articles

유언에 의한 보험수익자 지정·변경의 법률관계

유언에 의한 보험수익자 지정·변경의 법률관계

A Study on Reconstructing the Mechanism of Insurance Beneficiary: Based on the“Trinity”Theory of Contractual Parties

A Study on Reconstructing the Mechanism of Insurance Beneficiary: Based on the“Trinity”Theory of Contractual Parties

Influence of socioeconomic status on the presence of obstructive coronary artery disease and cardiovascular outcomes in patients undergoing invasive coronary angiography

Abstract Background Although it has been documented that low socioeconomic status (SES) is associated with increased risk of mortality and cardiovascular disease (CVD), this issue has not been addressed in patients at high CVD risk. This study was performed to investigate the association of the patient’s SES with the presence of obstructive coronary artery disease (CAD) and long-term cardiovascular outcomes who undergo invasive coronary angiography (ICA). Methods A total of 9,530 patients who underwent ICA for the evaluation and treatment of CAD (66.0 ± 12.3 years and 60.2% male) were retrospectively reviewed. The patients were divided into two groups according to the health insurance type: those with low SES who had the Medical aid program (Medical aid beneficiary [MAB] group; n = 1,436) and those with high SES who had the National Health Insurance program (National Health Insurance beneficiary [NHIB] group; n = 8,094). The primary outcome was a composite of cardiac death, acute myocardial infarction, coronary revascularization, and ischemic stroke. Results Of the study patients, 1,436 (15.1%) were in the MAB group. The prevalence of cardiovascular risk factors was higher in the MAB group compared to the NHIB group. However, the prevalence of obstructive CAD was similar between the two groups (62.8% vs. 64.2%; p = 0.306). During a median follow-up period of 3.5 years (interquartile range, 1.0-5.9 years), the incidence of the composite cardiovascular event was significantly higher in the MAB group than in the NHIB group (20.2% vs. 16.2%, p < 0.001). In multivariable Cox regression analysis, compared to the NHIB group, the MAB group was independently associated with worse clinical outcomes even after controlling for potential confounders (adjusted odds ratio, 1.28; 95% confidence interval, 1.07-1.54; p = 0.006). Conclusions Although CAD prevalence was similar, MABs showed an increased risk of composite cardiovascular events than NHIBs in Korean adults undergoing ICA. This provides additional evidence for the association between low SES and an increased risk of CVD, even in high-risk subjects.

Thrombectomy Use in the United States for Basilar Artery Occlusion in the Era of Neutral Clinical Trials: 2018 to 2020 Analysis of the National Inpatient Sample

Background In 2019 and 2020, 2 randomized trials of basilar artery occlusion (BAO) thrombectomy reported no improvement in functional outcomes with thrombectomy, despite observational evidence. The objective of this study was to assess whether neutral clinical trials may have influenced BAO thrombectomy practice. Methods The National Inpatient Sample (2018–2020) was queried for US patients with BAO, and comparisons were made between patients admitted in 2020 versus 2018 to 2019 for the primary outcome of thrombectomy. Unadjusted and adjusted multivariable regression was used, accounting for demographic and clinical covariates, with propensity‐score matching to balance clinical and hospital‐level characteristics between years. Results Of the 14 945 patients with BAO, 3,605 (24.1%) underwent thrombectomy,with an increase in the unadjusted rate of thrombectomy between 2020 and 2018–2019 (26.9% vs 22.9%, P = 0.04). Following multivariable adjustment, BAO thrombectomy was not independently associated with a year of treatment (adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 0.95–1.54, P = 0.12). Thrombectomy was independently associated with having a NIHSS of 10–19 (OR: 3.67, 95% CI: 2.79–4.83, P < 0.01) or >19 (OR: 5.80, 95% CI: 4.41–7.64) versus a NIHSS of 10, while uinsured patiends hadal owe likelihood of receiving a thombectomy (OR: 0.49, 95% C: 0.26–0.92). These relationships were preserved in the PSM cohort, and admission year lacked association with thrombectomy for BAO (aOR: 1.10, 95% CI: 0.83–1.45, P = 0.52). Conclusion Following publication of neutral BAO randomized clinical trials in late 2019 and 2020, there was no significant change in thrombectomy rate among US patients with BAO. The latest trials support thrombectomy for select patients with moderate‐to‐severe BAO symptoms, and this appears consistent with the practice of US clinicians before these trials.

2022년 보험법 중요 판례 분석

In the field of insurance law, many precedents continue to emerge, and in particular, an important judgment in the field of insurance law was declared in 2022. Judicial precedents are also a mirror through which we can grasp the issues and problems of the society. The insurance system operated in order for the people to be guaranteed through private insurance in preparation for various risks has the characteristics of a speculative contract and a bona fide contract. In addition, many disputes are inevitable due to the nature of the system, such as stipulating various reasons for exemption in insurance terms and conditions. Case law has been an important milestone in the field of insurance so far, including the invalidity of ineffective contracts, the relationship between the obligation to explain insurance contracts under Article 638-3 of the Commercial Act and Article 3, Paragraph 4 of the Act on Regulation of Standard Contract Terms, and the scope of application in the case of exemption from driving without a license. , Intentional exemption of personal insurance, drunk driving, driving without a license, death insurance of others and the effect of lack of consent by the insured, designation and change of insurance beneficiary, requirements for opposition, and unilateral acts without the other party. In various insurance precedents sentenced in 2022, the scope of recognition of subrogation by the insurer, measures to prevent leakage and damage prevention obligations, and the problem of applicability of costs, insurance for the purpose of illegal acquisition of insurance money and Article 103 of the Civil Act, contract invalidity, and aftereffects Issues such as the relationship between the insurance money and the death insurance money, the leakage of the loss insurance money, and the recognition of the subrogation of the right to claim became issues. In these precedents, some rationality and validity are acknowledged. However, in some judgments, there are also disappointing parts. In particular, it is very problematic that the insurer’s subrogation of claim rights is not allowed for voluntary non-payment of indemnity insurance. Reconsideration is required in terms of economics of litigation or reasonable resolution of disputes. Through critical examination of precedents, it is necessary to continue to play the role of a milestone in setting the future direction of precedents in the insurance field.

Safety of prenatal opioid analgesics: Do results differ between public health insurance beneficiary and population-based cohorts?

Pregnant patients with particular types of health insurance may have distinct demographic and medical characteristics that have a biologic effect on associations between opioid analgesics and congenital anomalies (CA). We followed 199,884 pregnant prescription beneficiaries in Ontario, Canada (1996-2018). Opioid analgesics dispensed in the first trimester and CA were identified from universal-access administrative health records. We estimated propensity score adjusted risk ratios (RR) between first trimester exposure and CA (any, major, minor, specific). RRs were compared to those published from an Ontario population-based cohort (N=599,579, 2013-2018). 15,724 (7.9%) were exposed to first trimester opioid analgesics, mainly codeine (58.1%) or oxycodone (21.3%); CA prevalence in exposed was 3.1%. RRs in the beneficiary cohort appeared higher than the population-based cohort for any CA with hydromorphone (RR=2.34, 95% CI: 1.65, 3.30) and oxycodone (RR=1.73, 95% CI: 1.46, 2.05) and major CA with hydromorphone (RR=2.74, 95% CI: 1.91, 3.94) and oxycodone (RR=1.72, 95% CI: 1.42, 2.08). Other RRs that appeared higher in the beneficiary cohort included cardiovascular (codeine, oxycodone), gastrointestinal (oxycodone), musculoskeletal (any, hydromorphone, oxycodone), CNS (oxycodone), chromosomal (codeine), and neoplasm and tumor (oxycodone) anomalies. The beneficiary cohort had higher opioid doses, was younger, had lower socioeconomic status, and greater comorbidities. Increased risks of CA after first trimester opioid analgesics were observed in low-income prescription beneficiaries, and some estimates were higher than a population-based cohort from the same setting. Biological differences associated with younger age, lower socioeconomic status and greater comorbidity may affect generalizability of results from pregnant low-income beneficiaries.

Zaštita prava potrošača kod ugovora o osiguranju života

Life insurance is a special type of activity exerting a strong influence on a country's social and economic structure. Its main field of interest is human life. Life insurance contracts are founded on the basis concept of the legal position of an insured person as the weaker contracting party either due to his/her knowledge of the insurance service and the circumstances surrounding it or due to his/her negotiating position and the financial means put at his/her disposal. The insurer is a trader and professional, which cannot be said for the insured person, who, accordingly, should be ensured protection within the current legal framework. In that sense, it is essential the security and protection of the insurance beneficiary to be provided against all the risks and irregular actions which can be anticipated and prevented. In accordance with the importance of its topic, the paper touches upon the term and characteristics of life insurance contracts. It also includes the definition of life insurance and legal aspects of life insurance contracts, all of which to be followed by a detailed elaboration on the selected topic of the paper, which is reflected in its subtitle-the analysis of consumers (insurance beneficiaries) protection in insurance contracts generally speaking and in life insurance contracts in particular.

Male Hypogonadism Significantly Increases the Risk of Perinatal Birth Complications: Retrospective Analysis of US Claims Data

ABSTRACT Introduction Hypogonadism is common in men with male factor infertility and hormone therapies may improve semen parameters and pregnancy rates in affected men. However, compared to paternal factors such as advanced age, male infertility or obesity, it is uncertain whether hypogonadism itself impacts perinatal birth outcomes and complications. Objective This study evaluates the association between male hypogonadism and perinatal birth complications in the United States. Methods We performed a retrospective analysis of the IBM MarketScan™ Commercial Claims and Encounters database between 2011-2017. We identified birth records using birth or pregnancy-related major diagnostic categories associated with persons age 0. Fathers were considered to be adult (> 18) male individuals with the same family identifier as the neonates listed as either the primary insurance beneficiary or spouse. Birth records were excluded if there was no family identifier or the father was unable to be linked. For each birth, we recorded whether they were preterm, diagnosed as low birth weight, or diagnosed with birth defects. For the fathers linked with each birth record, we determined paternal age, hypogonadism status, geographic region, and other associated comorbidities. Births were stratified based on whether the father had hypogonadism or not and we performed univariate tests for variation. Additionally, we conducted a multivariate logistic model of birth complication (preterm, low weight, or growth defect) against father's age, hypogonadism status, and paternal comorbidities. Results Between 2011 and 2017, paternal hypogonadism was found in 3.97% of fathers among 468,546 birth records. In contrast, no paternal hypogonadism was found in 96.03% of fathers among 468,546 birth records. Overall, our study reveals that paternal hypogonadism is positively associated with perinatal birth complications (odds ratio (OR) 1.10; 95% CI: 1.06, 1.13). Additionally, low birth weight was found in 46, 96% of birth among 196,607 birth records with paternal hypogonadism, follow by preterm birth with 7.64% of birth among 26,886 birth records with paternal hypogonadism. Conclusions Male hypogonadism was associated with a statistically significant increase in perinatal birth complications. However, these results should be interpreted with caution because patients with male hypogonadism are also likely to have male infertility. For hypogonadism to be considered as a separate risk factor for perinatal birth complications further investigation will be needed. Disclosure No

Transportation barriers to health care and mortality risk among the U.S. adults with history of cancer.

121 Background: Lack of transportation delayed medical care for approximately 6 million Americans in 2017. Prior studies showed cancer survivors tend to have more healthcare service use, higher medical cost, and adverse clinical outcomes. It is important to understand the prevalence of, risk factors for, and long-term health consequences of transportation barrier to health care among cancer survivors. Methods: We identified cohorts of adult with history of cancer (n = 25,317) and adults without history of cancer (n = 422,797) from the 2000-2014 National Health Interview Survey (NHIS). Transportation barriers were measured as medical care delay due to lack of transportation in the past 12 months using a survey question. The prevalence of transportation barriers was estimated using multivariable logistic models. Risk of mortality estimated with weighted Cox’s proportional hazards models with age as the time scale, adjusting for sex, race/ethnicity, educational attainment, marital status, region, comorbidities, and survey year. All analyses accounted for complex survey design using SAS statistical software, version 9.4 (SAS Institute Inc.), and SAS callable SUDAAN 11.0.3. Results: After adjustment for sociodemographic factors and comorbidities, the prevalence of transportation barrier were significantly higher among cancer survivors than among respondents without cancer history (2.1% vs 1.6%, p = 0.001, adjusted odd ratio [OR], 1.22; 95% confidence interval (95CI): 1.10-1.35). Cancer survivors with transportation barrier were more likely to be younger, female, Hispanic or Asian/Pacific Islander, less educated, unmarried, public insurance beneficiary or uninsured, and with more comorbidities. Among all participants, cancer survivors with transportation barrier had the highest adjusted mortality risk (hazard ratio [HR]: 2.12, 95CI: 1.81-2.49); followed by cancer survivors without transportation barrier (HR: 1.53, 95CI: 1.42-1.65); and adults without a cancer history with transportation barrier (HR: 1.50; 95CI: 1.45-1.55) compared with adults with neither a cancer history nor transportation barrier. Conclusions: Transportation barriers to health care had a disproportionate impact on cancer survivors, especially those who are underserved, and who have more medical needs. Increased risk of mortality was observed among adults with and without a cancer history who delayed care due to lack of transportation. It highlights the need for efforts to mitigate transportation barriers to medical care during a time of rapid change in transportation and telehealth technology.

Health Insurance Status Is Related to Risk of Mortality and Hospitalization in Korean Maintenance Hemodialysis Patients: A Longitudinal Cohort Study

Background: There has been an increasing incidence of hemodialysis (HD) due to old age and comorbid condition such as diabetes. In general, socioeconomic status (SES) is known as one of the most important risk factors for patient mortality and morbidity. Whether low SES is associated with poorer outcome in HD patients is controversial. This study was performed to evaluate the association of health insurance status as a proxy indicator for SES upon mortality and hospitalization in maintenance HD patients. Methods: We used HD-quality assessment data from the year of 2015 for collecting demographic and clinical data. The subjects were classified into Medical Aid (MA) recipients (low SES) and National Health Insurance (NHI) beneficiary (high SES). We analyzed mortality and hospitalization risk based on health insurance status using Cox proportional hazard model. A total of 35,454 adult HD patients ≥18 years old who received HD treatment more than twice weekly were included in the analysis. Results: The ratio between MA recipient and NHI beneficiary was 76.7 versus 23.3%. The MA recipient group demonstrated younger age and lower proportion of female, diabetes, hypertension, and cerebrovascular accidents compared to the NHI beneficiary group. After adjusting for age, gender, comorbidity, and laboratory parameters, the MA recipient group showed a significantly higher mortality risk compared to the NHI beneficiary group (hazard ratio 1.073 [1.009–1.14], p = 0.025). The MA recipient group was also an independent risk factor for hospitalization after adjusting for age, gender, comorbidities, and laboratory parameters (hazard ratio 1.142 [1.108–1.178], p < 0.001). Conclusion: Low SES as measured by health insurance status was associated with an increased risk of patient mortality and hospitalization in Korean maintenance HD patients.

A OUVIDORIA E SUA CONTRIBUIÇÃO NA SAÚDE SUPLEMENTAR

Uma das mais relevantes inovações que precisamos experimentar é a capacidade de realizar uma comunicação eficiente entre cidadãos/consumidores e as organizações contemporâneas e assim mitigar conflitos. As reflexões sobre a função das Ouvidorias podem representar uma oportunidade para se construir uma linha evolutiva nesta comunicação em busca de relações de consumo de melhor qualidade, respeitando direitos e contribuindo como ferramenta de gestão. Especialmente na saúde suplementar há desafios a serem superados para que as Ouvidorias gozem de maior efetividade na execução de políticas públicas, mas sua atuação pode reforçar um canal de participação, de comunicação e de mediação num processo democrático, tendo como consequência a valorização da cidadania. Com o intuito de contribuir para o debate teórico, o propósito deste projeto foi analisar o processo de construção e atuação das Ouvidorias na saúde suplementar que teve sua exigibilidade a partir da Resolução Normativa-RN 323/13 da Agência Nacional de Saúde Suplementar-ANS, e entender os desafios, potencialidades e limitações para que as Ouvidorias adquirissem maior relevância para planos privados de assistência à saúde. A partir de análises da literatura, documentos, relatórios e entrevistas qualitativas com representantes da sociedade civil, da ANS, além de Ouvidores que atuam na saúde suplementar, compreendemos que a Ouvidoria conceitualmente teria o papel institucional de representar o cidadão/consumidor e procurar ajustar interesses divergentes na busca da redução dos conflitos. Entretanto apesar dos avanços trazidos pela Legislação, na prática o cidadão/consumidor parece não se sentir representado pela Ouvidoria e ainda recorre com frequência a outros canais de representatividade como o Judiciário, ANS ou entidades de defesa do consumidor no momento em que precisa se manifestar. Há um ambiente propenso ao conflito na saúde suplementar no Brasil que vem sensibilizando o Judiciário, Ministério Público, operadoras de saúde, associações representativas do setor privado na área da saúde, ANS e pesquisadores. Esses conflitos têm as mais diferentes motivações por parte dos cidadãos/consumidores: autorização de procedimentos, exames de alto custo, internações, reajustes de preços de mensalidades entre outros. As pesquisas demonstraram também que as Ouvidorias são tidas como boas interlocutoras junto às entidades de defesa do consumidor, mas encontram dificuldades em evidenciar e prevenir conflitos dentro das próprias operadoras de saúde da qual fazem parte. Ao final este projeto oferece como produto, um conjunto de recomendações pensadas para as operadoras de saúde e ANS na busca de boas práticas para um melhor atendimento à sociedade civil, resultado de uma diretriz baseada em pesquisa, vivência e conhecimento do tema proposto no que diz respeito às Ouvidorias e a saúde suplementar.&#x0D; Acesso trabalho na íntegra : https://bibliotecadigital.fgv.br/dspace/handle/10438/29111

Healthcare utilisation and costs for temporomandibular disorders: a descriptive, cross-sectional study

ObjectiveTemporomandibular joint disorder (TMD) requires long-term management and can be a financial burden for patients. Here, we investigated the treatment received by people diagnosed with TMD and its relevant costs.DesignA...

P1545LOW SOCIOECONAMIC STATUS INCREASES MORTALITY RISK IN KOREAN MAINTENANCE HEMODIALYSIS PATIENTS: A LONGITUDINAL COHORT STUDY USING HEMODIALYSIS QUALITY ASSESSMENT DATA

Abstract Background and Aims The number of hemodialysis (HD) patients and their medical expenses are growing rapidly in Korea due to entry into aging society and accompanying diseases such as diabetes and hypertension. Whether low socioeconomic status (SES) affect poorer HD survival is controversial with most reports come from the USA. Therefore, this study was performed to evaluate the effect of SES upon mortality in Korean maintenance HD patients using periodic HD quality assessment data. Method The HD quality assessment has been performed periodically by Health Insurance review and Assessment Service (HIRA) since 2001. We used 4th and 5th HD quality assessment data from the year of 2013 and 2015 respectively for collecting demographic and clinical data. The 4th survey was a sample survey while the 5th survey was a complete enumeration survey. We also collected data on patient comorbidity using the diagnosis codes from the health insurance claims database. The mortality data was collected until Dec 2017. As a proxy indicator reflecting SES, we classified subjects as a Medical Aid (MA) recipients (“low” SES) or a National Health Insurance (NHI) beneficiary (“middle/high” SES). We analyzed mortality risk based on SES using Cox proportional hazard model. Results A total of 21,786 HD patients from 4th survey and 35,454 HD patients from 5th survey were included in the analysis. The ratio between NHI beneficiary and MA recipient was 76.7% versus 23.3%. Mean age of the subjects was 59.0 years old in 4th survey and 60.3 years old in 5th survey. The MA recipients were younger and showed higher proportion of male, shorter duration of HD, lower body mass index (BMI), higher systolic and diastolic blood pressures before HD compared to the NHI beneficiary. The NHI beneficiary demonstrated higher proportion of diabetes, hypertension, cerebrovascular accidents, and dementia compared to the MA recipients. Two groups did not differ in dialysis efficiency presented as single pool Kt/V. A total of 7,173 deaths occurred in 2013 participants, while 7,306 deaths occurred in 2015 participants. After adjusting for age, gender, Charlson’s comorbidity index, BMI, presence of atrial fibrillation, serum albumin, and serum creatinine, MA recipients showed significantly higher mortality risk compared to the NHI beneficiary (hazard ratio 1.162; 95% confidence interval 1.092-1.237, p&amp;lt;0.001 in 4th survey and hazard ratio 1.078; 95% confidence interval 1.013-1.146, p=0.017 in 5th survey). Conclusion Low SES independently increased mortality risk in Korean maintenance hemodialysis patients.

Study of legal problems in Insurance Policies and Inheritance

생명보험은 피보험자가 사망한 후 유족들의 생활을 보장하는 것을 주된 목적으로 하므로 피보험자가 아닌 타인을 보험수익자로 지정하는 것이 통상적인데, 피보험자가 사망하여 피보험자나 보험수익자의 상속인들이 보험금청구권을 취득하는 경우 상속과 관련된 여러 가지 법적 쟁점들이 문제된다. 그러나 상법에서는 이와 관련된 규정을 두고 있지 않아 실무상 혼란을 야기하고 있다. 상속인이 보험수익자가 되는 경우에 보험수익자의 보험금청구권은 타인을 위한 생명보험 계약의 효력으로 당연히 생기는 것으로서 상속재산이 아니라 상속인의 고유재산이 된다. 이 때 당사자의 의사는 보험수익자의 상속인의 지위 뿐 아니라 그 상속비율까지 포함하는 것이라고 보이므로 보험금청구권은 이들의 상속분의 비율에 따라 귀속한다. 상속인이 고유재산으로 보험금청구권을 취득하는 경우 상속채무에 대하여 한정승인을 하거나 상속을 포기하더라도 보험금청구권을 행사하여 보험금을 수령할 수 있게 된다. 보험수익자 중 일부가 보험사고를 발생시킨 경우 당해 보험수익자에 대하여만 상법에 따라 보험자가 면책되며 나머지 수익자들에 대해서는 면책된 부분을 제외한 나머지 보험금만 지급하면 된다. 민법상 상속결격의 경우 소급하여 상속인의 지위를 상실하고 보험의 선의성, 계약자의 의사에 반하므로 해당 법정상속인은 보험금청구권을 취득하지 못한다. 피보험자나 보험수익자의 상속인이 보험금 청구권을 취득하는 경우 고유재산이므로 상속재산분할대상에 포함되지 아니하나, 비록 상속인의 고유재산이더라도 상속인들이 상속인들 사이에 공평을 기하기 위하여 스스로 상속재산 분할협의 대상에 포함시켜 분할하는 것은 사적 자치의 원칙상 유효하다. 상속인 중 일부를 보험수익자로 지정한 경우, 비록 상속인의 보험금청구권은 상속재산이 아니라 상속인의 고유재산에 해당하지만, 피상속인인 보험계약자가 보험료를 지급하였으면 이는 유증이나 사인증여에 준하는 무상처분에 해당하며, 공동상속인 간의 형평을 도모할 필요가 있으므로 특별수익에 준하는 것으로 보아 공동상속인 간의 형평을 심각하게 해하는 사정이 있는 경우에는 반환을 긍정할 수 있고, 유류분을 침해하는 경우에는 유류분반환대상에도 해당할 수 있다.Life insurance s main purpose is ensuring the survival of the bereaved family members after they die, so usually someone who is not an insured person is designated as an insurance beneficiary. If the heirs of the insured or the beneficiary of the insurance obtain the right to claim the insurance, various legal issues occur related to inheritance. However, the commercial law does not have a related regulation, and it causes confusion in practice. If the heir becomes the beneficiary of the insurance, the benefit of the beneficiary of the insurance is the inherentor s own property, not inherited property, as it is due to the effect of the life insurance contract. The intention of the party seems to include not only the status of the heir of the beneficiary but also the inheritance rate of the insurance beneficiary among coinheritor, so the amount calculated under Korean Civil Law is fair. Even if the heir refuses the succession at the time of death of the insured, he/she can take any proceeds. Any beneficiary who intentionally causes the death of the insured is disqualified form receiving the proceeds according to the policy terms. Meanwhile, Korean Civil Law prescribes disqualification of inheriting those who have committed acts referred to in non-ethics behavior. According to the prescription, the disqualification of succession is disqualified form receiving the proceeds according to the policy terms. Although the right to claim insurance is the inheritor s own property and not included in the object of econsultation division of inheritance property, it is valid in principle of private autonomy to include and divide. When one of the inheritors of a insured is designated as a insurance beneficiary, he/she can take death benefits. However, death benefits has certain points of likeness to inheritance in that is it paid by the his death, in some exceptional cases there is special circumstances that harms the equity of other inheritance seriously, the death benefits can be regarded as special benefits in Korean Civil Law. And in this case, death benefit as special benefits can be counted on the basis for legal reserve of inheritance.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary’s current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits.

Low Uptake of Human Papillomavirus Vaccine Among Postpartum Women, 2006-2012.

Young adult women find it acceptable to be offered the human papillomavirus (HPV) vaccine postpartum. Little is known about the practice of administering the HPV vaccine during the postpartum period. The Truven Health Analytics MarketScan Commercial Claims and Encounters database was used to develop a cohort of privately insured 18 to 26-year-old women with uncomplicated live-born pregnancies. Eligibility required no previous doses of HPV vaccine before delivery and continuous insurance enrollment from June 2006 through 1 year postpartum. Descriptive statistics were performed. A total of 51,913 women meet age and enrollment criteria, with 3912 (7.5%) having received any doses of vaccine before their delivery, leaving 48,001 women in this cohort. In the year postpartum, 861 women (1.8%) received any HPV vaccine. Of the women initiating the vaccine, only 337 (39%) completed the three-vaccine series. Women who received the vaccine, compared with women who did not, were younger (21 vs. 23 years old), more often the dependent to the insurance beneficiary (56% vs. 30%), and were more likely to have had an abnormal pap smear in the year prior (19.6% vs. 9.1%) or postdelivery (16.4% vs. 4.9). More women completed the HPV vaccine series when initiated within 2 months postpartum compared with women initiating the vaccine series >2 months postpartum (44% vs. 38%). Postpartum women are eligible for the HPV vaccine, yet very few are receiving it. The postpartum period is a missed opportunity for administration of this cancer-preventing vaccine.

Human Papillomavirus (HPV) Vaccine Uptake Among Commercially Insured Postpartum Women, 2006–2012 [20J

INTRODUCTION: Current rates of HPV vaccination are below goal. Research suggests women find it acceptable to receive the HPV vaccine postpartum. Little is known about current practice patterns for postpartum administration of this vaccine. METHODS: A cohort of privately insured 18–26 year old women with uncomplicated live born pregnancies was analyzed from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Eligibility required continuous insurance enrollment from June 2006 through one year postpartum and no doses of HPV vaccine prior to delivery. The outcome of interest was HPV vaccination in the year postpartum. Descriptive statistics were performed. RESULTS: This cohort included 48,001 women. Eight hundred sixty-one women (1.8%) received any HPV vaccine in the year postpartum and 337 women (0.7%) completed the 3-vaccine series. Women who received the vaccine, compared to women who did not, were younger (21 versus 23 year old), more often the dependent to the insurance beneficiary (56% versus 30%), and had more abnormal pap smears in the year prior (19.6% versus 9.1%) or post delivery (16.4% versus 4.9%). On average the first dose of vaccine was given 150 days postpartum (range 3–365 days). Seventy percent of women attended a postpartum visit. When initiated within 2 months postpartum 44% of women completed the vaccine series compared with 38% of women initiating the vaccine after 2 months postpartum. CONCLUSION: Very few postpartum women eligible for the HPV vaccine are receiving it in this privately insured cohort. This is a missed opportunity for administration of this cancer preventing vaccine.

An Analysis of Emergency Treatment-seeking Characteristics in Elderly Patients in Taiwan in 2010

The aim of this study was to understand the differences in demographic data and emergency department (ED) diagnosis between different age groups of patients. This study is based on data from the 2010 National Health Insurance Research Database published by the Taiwan National Health Research Institutes. We used descriptive statistics and bivariate statistical analysis to obtain the number of emergency visits in 2010. The main variables for analysis included demographic data and treatment-seeking characteristics, such as age, sex, marital status, International Classification of Diseases diagnostic code (International Classification of Diseases, 9th Revision, Clinical Modification), and medical institutions. Data from the cohort sample of the 200,000 random samples taken from the health insurance beneficiary files of the National Health Insurance Research Database found a total 277,384 ED visits during 2010 after exclusion of unusual frequent ED users (hemophilia B or schizophrenia), 58,014(20.91%) of which were attributed to elderly patients. Female patients were predominantly in the elderly ED visits. The average cost of emergency medical expenses, number of ED visits, and subsequent hospitalization are significantly higher in elderly ED patients.

Asset Transfer of Subsidiary of PT ASKES (Persero) and Its Implications for the Utility of Participant Health Security

This research aims to learn about PT AJII transformation process as well as the implications of the transfer concerning service delivery to the National Health Insurance beneficiary. This is a normative empirical research, analyzing provision of the prevailing laws, legal principles and of the practice by carrying out library and field research. Informants of the research were the Primary Commissioner of PT AJII, who acted as internal supervisor of the transfer, member of Social Security Agency Bodies, (BPJS) and experts of social security who provided information and solution about the problems researched. The data obtained were analyzed by using qualitative method. Research result indicated that 80 percent shares of PT AJII were acquiesced, resulting in a transfer of control toward the company. The transfer process was problematic, dilemmatic, and potentially illegal. In addition to the three different legal provisions involved, the transfer also had to comply with both the public interest, that was the stakeholder participants, and the private interests, (shareholder of PT AJII). There was a possibility of illegality. It was on 23 of December 2013 that the transfer process of PT AJII was still in the stage of agreement signing, while the whole process had to end before 1 January 2014. This is in accordance with article 60 paragraph (3) of BPJS Law, that on 1 January 2014 PT Askes was no longer exist. All legal acts on behalf of PT Askes, including the transfer of its subsidiary company, remain intolerant because the management of PT Askes had become the management of BPJS. Additionally, it was also found that the transfer could have an implication to the increase of the service capacity of BPJS and the increase of utility for the participants.

생명보험전매제도의 체계적 연구와 입법론적 수용가능성

Viatical Settlement is part of newly introduced investment businessmodel that has started in US, it can be viewed as secondary market for Viaticalinsurance policies. This article examines the concept and features of "ViaticalSettlement" which derives from Anglo-American legal principles which allowtransfer of life insurance policies. The thesis reviews the institution``s feasibilityin Korea by taking Korea``s legal and social environment into its consideration. The thesis concludes that Viatical Settlement institution is not feasible, and itintroduces an alternative model. As far as the introduction of Viatical Settlementinto Korea is concerned, most have argued against it, but some have viewed itpositively. For instance, in 2009, a motion to introduce Viatical Settlementinstitution was tabled by members of the National Assembly and it even wentinto the deliberation process, though later on, was abrogated. The Korean Commercial Act does not provide for assignment, which isa form of comprehensive transfer of rights and obligations, but Article 731 Clause2 does provide for the limited assignment by the insurance beneficiary. Koreanlegal system requires consent of the insured in life insurance and it deniesinsurable interest in life insurance policies absolutely. Therefore, it can be said that Viatical Settlement institution is not fully accepted in Korea, due to its legalsystem.