Biomedical subjects
Publications and source records attributed to D G Cave.
In a recent study, the average treatment pattern of HMO-based primary care physicians is found to be significantly less expensive than that of indemnity-based primary care physicians. This difference is because the HMO-based physicians' style of medical practice is less hospital-intensive.
A study indicates that prescription card service and mail-order drug programs cost employers more money than a traditional indemnity offering because of the significant increase both in the number of claimants and in the paid charges per claimant. Focusing attention only on cost, however, may hamper the overall quality of care delivered under a health benefits program.
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In their efforts to contain healthcare costs, employers are attempting to control volume and intensity (VI) of services growth. A new volume performance standard described in this article would allow employers to set annual VI growth targets with their network sponsors.
The goal of capitation is to place gatekeepers at financial risk for the services the deliver. However, third party payers should provide gatekeepers with some type of protection against random and systematic risk transfer. Gatekeeper physicians' other alternative is to reduce this risk on their own by actively marketing services to healthier individuals and creating barriers to care for their sicker patients. Thus, the proper balance of risk transfer will result in the most cost-efficient, quality gatekeeper networks. However, even with the right balance of risk transfer, capitation may provide incentive for some physicians to withhold necessary services to further increase their profit margins-making quality of care a key concern. Thus, practice guidelines should be developed to ensure quality is not affected. These guidelines afford explicit criteria on how gatekeepers should respond in specific clinical situations.
This article outlines a health care benefits strategy that combines features of the multiple HMO choice approach and the point-of-service approach. Although this plan design may not be appropriate for all employers, it may provide the greatest long-term cost savings for employers with high HMO enrollment, according to the author.
Realizing that corporate America may have limited control over how and when medical services are delivered, employers are beginning to attack the demand side of the health-care equation. That is, improving employee health status should result in a lower demand for medical services. However, to realize significant medical-claims savings, employers must encourage the least healthy employees both to enroll in work-site health-promotion programs and to permanently change their health-risk behaviors. One way to accomplish these objectives is to shift more financial risk onto employees by redesigning the company's medical benefit plan. As the 1990s progress and as medical costs continue to spiral upward, we are bound to observe greater employer involvement in employees' life-styles, both at work and at home. The bounds of discrimination and privacy laws will be tested as companies employ more restrictive policies and benefit plan designs to encourage employees to modify current poor-risk behaviors.
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A retrospective analysis over a 2-year period was carried out to compare the limitations in the use of the Silastic Cup vacuum extractor and forceps as the preferred instrument for operative vaginal delivery. Whilst the use of the vacuum extractor was associated with less maternal morbidity (54.9% episiotomy rate; 20.9% nil analgesia) and comparable neonatal problems, an increased failure rate (6.5%) was demonstrated in comparison to forceps delivery (0.7% failed vaginal delivery rate). A comparison of their use for rotational vaginal delivery failed to reveal any significant difference in maternal or neonatal outcome apart from an increased failure rate (30%) to complete vaginal delivery after application of the vacuum extractor. It is concluded that the vacuum extractor is a comparable instrument for midcavity or lift-out instrumental delivery but Kielland's forceps may still be a more appropriate instrument for rotational vaginal delivery.
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Community rating of employer group health maintenance organization (HMO) capitation premiums results in low premiums for some groups and high premiums for other groups, as compared with the marginal costs of providing services. In effect, low health risk groups are cross subsidizing high health-risk groups in an HMO. This has caused several inefficiencies in the health plan marketplace, which have directly benefited higher-risk groups. For this reason, certain low-risk groups are searching for new strategies to improve market efficiency. One strategy is Community Rating by Class (CRC), a system which adjusts community rated capitation premiums by broad-based risk factors. This article examines CRC as a strategy to help reduce the inefficiencies caused by current federal regulations. In regressions predicting future year total family health expenditures, the CRC Model achieved an R2 value of 0.211. This value was over half the R2 value of an experience rated approach, based on prior year utilization and expenditure variables. Family size accounted for 80% of the variance explained by the CRC Model. The results indicate that the CRC rating approach may be a good mechanism to correct for cross subsidization of employer group capitation premiums.
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Direct contracting with hospitals on a per diem or per case basis offers advantages for many large self-insured employers, this author points out. He outlines the process for negotiating these arrangements and discusses some of the effects.
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This paper presents the experience, in a District General Hospital, of using an elasticated silicone ring applied to the Fallopian tubes by the laparoscope. It is concluded that this is a safe and effective method of female sterilization, with good patient acceptance.
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The efficacy of the MiMark endometrial cell sampler in the cytological assessment of endometrium was evaluated in 101 patients with postmenopausal bleeding. The apparatus was successful in daignosing all but one of the endometrial carcinomas in the series. Reports of its accuracy in diagnosing endometrial hyperplasia and other endometrial pathology cannot be substantiated.