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Key findings and implications for workplace mental health
Published in Takenori Mishiba, Workplace Mental Health Law, 2020
In Japan, laws stipulate that an employee should receive a generous income and job security if the onset or exacerbation of an illness or disorder is found to be work-related. These benefits are, at least in terms of the Labor Standards Act and the Civil Code, more generous than those provided to an employee in the event of a personal illness or injury. In the countries studied, however, not so many stress-related disorders other than posttraumatic stress disorder (PTSD) were recognized as work-related illnesses. Instead, employers in Europe continue to pay wages to individuals with a personal illness or injury. In addition, job and income security and support for a return to work are provided by law. In the US, there are limited legal protections for individuals with a personal illness or injury. If, however, an individual with a job or applying a job can perform the essential functions of his or her position as a result of reasonable accommodations, the individual can seek redress for employment discrimination via the ADA. The Family and Medical Leave Act provides for unpaid leave for a maximum of 12 weeks per year and for reinstatement in one’s previous position. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) ensures that private medical insurance plans cover mental health issues in a manner equivalent to their coverage of physical ailments. The Affordable Care Act ensures that individuals with a pre-existing condition are covered by private insurance.
Falling Through the Safety Net
Published in Kant Patel, Mark Rushefsky, Healthcare Politics and Policy in America, 2019
There is another insurance practice, very much related to experience rating, that leads to some people being uninsured and others being underinsured. This is the practice of insurance underwriting. Underwriting occurs when an insurance company refuses to insure workers in an entire firm (a practice known as “redlining”), or individuals with preexisting conditions. Examples of redlined firms included “those characterized by an older work force (over age fifty-five) or high employee turnover, those engaged in seasonal work or exposed to hazardous working conditions, those lacking an employer-employee relationship, and those ‘known to present frequent claims submissions’” (Zellers, McLaughlin, and Frick 1992, 174–175). Those with preexisting conditions, such as cancer, diabetes, or AIDS, and those with conditions that are likely to result in costly claims in the future may be denied insurance either permanently or during a specified time. In addition, limits may be placed on payments to such individuals. An alternative practice is to raise all the premiums for the groups significantly, sometimes to prohibitive levels. It is not just insurance companies that engage in this practice. Employers that self-insure, and thus do not come under state regulation as do insurance companies, can also deny claims. Another thing companies can do is simply fire workers with high healthcare costs. This apparently happened with workers with disabilities as firms sought to limit their healthcare costs (see Pereira 2003).
Public Health and Free Markets
Published in Ruth E. Groenhout, Care Ethics and Social Structures in Medicine, 2018
On the regulated insurance model, both customers and companies face government regulation, so this is a system that moves along the spectrum away from a free market toward a much higher level of state control. Citizens, on this model, are required to carry insurance, usually with some form of subsidy provided for lower income purchasers. Insurance providers are required to offer a particular range of coverage, and either the rates they can charge or the level of profit they can make is regulated (treating them, in effect, like utilities, rather than as independent businesses). Insurance companies are generally very limited in terms of denial of coverage; they are not allowed to exclude individuals with pre-existing conditions or to limit their customer base to the healthiest while excluding sicker patients from coverage. Lifetime caps on coverage are prohibited in many regulated insurance systems.
Preexisting conditions in older adults with mild traumatic brain injuries
Published in Brain Injury, 2021
Justin E. Karr, Grant L. Iverson, Harri Isokuortti, Anneli Kataja, Antti Brander, Juha Öhman, Teemu M. Luoto
The current study has limitations that affect the generalizability of the findings. First, participants were only recruited from the ED, although older patients with MTBI are less likely to seek medical care following injury (44). Second, participants were recruited from a single hospital, limiting the representativeness of the sample beyond the population in surrounding areas of Tampere, Finland. Third, there is significant missing data with regard to clinical signs of injury, including LOC, amnesia, and GCS score. In turn, analyses pertaining to these signs of injury were conducted on different subsamples of the overall cohort because a listwise deletion approach would have resulted in the exclusion of a very large portion of participants. This type of missingness is not uncommon in the ED, in which these injury characteristics are not consistently documented. Lastly, the study was cross-sectional, and did not involve an assessment of functional outcome. Discharge location was likely associated with acute outcome, but patients who discharged to continued care settings may have arrived at the ED from these settings. In such a case, home discharge may have not been an option but due to the cross-sectional nature of the study, pre-injury living accommodation is unknown. Although most patients had preexisting conditions, the actual impact of these conditions on treatment and functional outcome among these patients remains unknown and requires future investigation.
Misallocation of Demand and the Persistent Non-emergent Use of the Emergency Department Post-Healthcare Reform
Published in Hospital Topics, 2020
In spite of the criticism from its opponents, the ACA has had numerous positive characteristics. First, it aimed at lowering healthcare costs by making preventive care free. In fact, in 2015, the cost of healthcare services increased only by five percent, as compared to an annual increase of 3 to 4 percent before 2010.4 Second, the ACA requires all insurance plans to cover 10 essential health benefits that include treatment of mental health, addiction, and chronic diseases without which many patients may end up in emergency rooms. Third, insurance companies can no longer deny anyone coverage for pre-existing conditions. Insurance companies cannot drop such individuals or raise their premiums if they get sick. Fourth, the ACA eliminates lifetime and annual coverage limits. Fifth, children can stay on their parents’ health insurance plans up to the age of 26. For example, in 2012, more than three million previously uninsured young people were added.5 Sixth, states must set up insurance exchanges or use the Federal government’s exchange. Both of those methods make it easier to shop around. Seventh, it provides tax credits on premiums by expanding Medicare to 138 percent of federal poverty level, and providing this coverage to adults without children for the first time. Eighth, it will eliminate the “Medicare doughnut hole” gap in coverage by 2019.6 Ninth, businesses with more than 50 employees must offer health insurance to their employees, providing tax credits to help with the costs.
What can we do to help young cancer survivors minimize financial hardship in the United States?
Published in Expert Review of Anticancer Therapy, 2019
Zhiyuan Zheng, Xuesong Han, Jingxuan Zhao, K. Robin Yabroff
Several federal-level health policies can help mitigate financial hardship in young cancer survivors. An early provision of the Affordable Care Act went into effect in year 2010, which required health plans from the individual market and employers to offer dependent child coverage up to age 26 years, regardless of their student status, residence, or marital status[9]. However, young adults ≥26 years may still find challenges in gaining and maintaining private coverage if their employer does not offer health insurance[10]. Moreover, the ACA also included provisions to allow individual purchase of private health insurance through the Marketplace and eliminated pre-existing condition exclusions and annual and lifetime caps. The Congress passed the legislation of ‘Deferment for Active Cancer Treatment Act of 2018’, which allowed cancer patients to postpone payments on public student loans while undergoing active cancer treatments[11]. Because young adults represent the highest proportion of uninsured in the United States, state-level efforts such as the expansion of eligibility for Medicaid coverage may also help low income young cancer survivors maintain health insurance coverage.