Switching health insurers: the role of price, quality and consumer information search

__Abstract__ We examine the impact of price, service quality and information search on people’s propensity to switch health insurers in the competitive Dutch health insurance market. Using panel data from annual household surveys and data on health insurers’ premiums and quality ratings over the period 2006–2012, we estimate a random effects logit model of people’s switching decisions. We find that switching propensities depend on health plan price and quality, and on people’s age, health, education and having supplementary or group insurance. Young people (18–35 years) are more sensitive to price, whereas older people are more sensitive to quality. Searching for health plan information has a much stronger impact on peoples’ sensitivity to price than to service quality. In addition, searching for health plan information has a stronger impact on the switching propensity of higher than lower educated people, suggesting that higher educated people make better use of available health plan information. Finally, having supplementary insurance significantly reduces older people’s switching propensity

Valve replacement in octogenarians: increased early mortality but good long-term result

Between January 1983 and December 1990, 20 patients aged 80 years or older underwent valvular surgery. The patients' ages varied from 80 to 87 years (mean, 82 ± 1.5 years). The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective, two urgent, and three emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. Six patients (30%) had an uneventful hospital stay, and the other 14 (70%) experienced several post-operative complications. The operative mortality rate was 15± (three patients). All patients before operation were in NYHA (New York Heart Association) class III and IV and all survivors remained in NYHA class I or II. The survivors have been followed from 6 to 70 months (mean 20 ± 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement in octogenarians can be performed, despite the high rate of post-operative complications, with increased but acceptable mortality. Long-term results are goo

Synthesis and characterization of aluminium-phosphorus adducts: X-ray crystal structures of Cl3Al·P(SiMe3)3·C7H8 and Br3Al·P(SiMe3)3·C7H8

The anempted dehalosilylatio reactions between AIX3 (X = C1. Br) and P(SiMe3)3 in toluene in 1:1 mole ratios afforded only the adducts C13Al-P(SiMe3)3 (I) and BrAl-P(SiMe)3 (II). respectively. Compounds I and II were characterized by 1H, 13C, 27Al. and 31P solution NMR spectroscopy, as well as partial elemental analysis In addition, the solid state structures of the toluene solvates of I and U weve determined by single-crystal X-ray analysis. Chanacterization revealed that the solid solvated adducts I and 1i are isostructural and their crystals are isomorphous. In each compound. the Al and the P atoms reside in tetrahedral environments, with each X3 P(SiMe3)3 (X = CL Br) molecule associated with one interstitial toluene molecule in the crystals. These adducts are noteworthy in that they possess exremely short, essentially equal Al-P bond lengths [For 1: AI-P = 2.392(4) A and for H: AI-P = 2.391(6) Ȧ], which are the shortest found to date in aluminum-phosphorus molecular species

Reactions of phenylaluminium compounds with E (SiMe 3) 3 (E= P or AS): X-ray crystal structures of Ph 3 Al· E (SiMe 3) 3 (E= P or As) and Ph 2 (Cl) Al· P (SiMe 3) 3

The independent reactions of Ph3Al with E(SiMe3)3 (E = P or As) in 1:1 mole ratios afforded the adducts Ph3Al'E(SiMe3)3 [E = P (I) and As (II), respectively]. The attempted dehalosilylation reactions between PI12AICI and E(SiMe3)3 (E = P or As) in 1:1 mole ratios yielded only the adducts Ph2(Cl)Al.E(SiMe3)3 [E = P (III) and As (IV)]. The adduct Ph(Cl)2Al«P(SiMe3)3 (V) was isolated from the reaction of equimolar amounts of PhAlCl2 and P(SiMe3)3. Compounds I-V were characterized by NMR spectroscopy and partial elemental analysis. In addition, the solid-state structures of I-III were determined by single-crystal X-ray analysis. Compound I crystallizes in the monoclinic space group P2\ln (C2A5), while H crystallizes in the triclinic space group P UQ1), each with two discrete molecules per asymmetric unit. Crystals of compound III belong to the orthorhombic space group P2i2i2i(D24)- Compounds I-III are the first structurally-characterized compounds to contain phenyl-substituted Al centres bonded to heavier pnicogen atoms

The associations between serum brain-derived neurotrophic factor, potential confounders, and cognitive decline: A longitudinal study

Brain-derived neurotrophic factor (BDNF) plays a role in the maintenance and function of neurons. Although persons with Alzheimer's disease have lower cortical levels of BDNF, evidence regarding the association between circulating BDNF and cognitive function is conflicting. We sought to determine the correlates of BDNF level and whether BDNF level was prospectively associated with cognitive decline in healthy older adults. We measured serum BDNF near baseline in 912 individuals. Cognitive status was assessed repeatedly with the modified Mini-Mental Status Examination and the Digit Symbol Substitution test over the next 10 years. We evaluated the association between BDNF and cognitive decline with longitudinal models. We also assessed the association between BDNF level and demographics, comorbidities and health behaviors. We found an association between serum BDNF and several characteristics that are also associated with dementia (race and depression), suggesting that future studies should control for these potential confounders. We did not find evidence of a longitudinal association between serum BDNF and subsequent cognitive test trajectories in older adults, although we did identify a potential trend toward a cross-sectional association. Our results suggest that serum BDNF may have limited utility as a biomarker of prospective cognitive decline

The Dutch health insurance reform: switching between insurers, a comparison between the general population and the chronically ill and disabled

Background: On 1 January 2006 a number of far-reaching changes in the Dutch health insurance system came into effect. In the new system of managed competition consumer mobility plays an important role. Consumers are free to change their insurer and insurance plan every year. The idea is that consumers who are not satisfied with the premium or quality of care provided will opt for a different insurer. This would force insurers to strive for good prices and quality of care. Internationally, the Dutch changes are under the attention of both policy makers and researchers. Questions answered in this article relate to switching behaviour, reasons for switching, and differences between population categories. Methods: Postal questionnaires were sent to 1516 members of the Dutch Health Care Consumer Panel and to 3757 members of the National Panel of the Chronically ill and Disabled (NPCD) in April 2006. The questionnaire was returned by 1198 members of the Consumer Panel (response 79%) and by 3211 members of the NPCD (response 86%). Among other things, questions were asked about choices for a health insurer and insurance plan and the reasons for this choice. Results: Young and healthy people switch insurer more often than elderly or people in bad health. The chronically ill and disabled do not switch less often than the general population when both populations are comparable on age, sex and education. For the general population, premium is more important than content, while the chronically ill and disabled value content of the insurance package as well. However, quality of care is not important for either group as a reason for switching. Conclusion: There is increased mobility in the new system for both the general population and the chronically ill and disabled. This however is not based on quality of care. If reasons for switching are unrelated to the quality of care, it is hard to believe that switching influences the quality of care. As yet there are no signs of barriers to switch insurer for the chronically ill and disabled. This however could change in the future and it is therefore important to monitor changes.