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Biomedical subjects

R Feldman

Publications and source records attributed to R Feldman.

At least 127 records · Page 7Linked to original sources
PubMed1992

Insurer competition and protection from risk redefinition in the individual and small group health insurance market.

Analyses of problems in the health insurance market usually focus on the individual and small group market. Consumers in this market who experience an illness or diagnosis of illness in one time period are likely to have their future risk redefined by insurers. Despite the fact that risk-averse consumers should desire protection against redefinition of risk, policies featuring that protection currently are not common in the individual and small group market. Contracts offering that protection must either be offered by pools that can guarantee replenishment of good risks over time, or be multiperiod contracts. Risk replenishment is impossible for individuals and may be technically difficult for many small groups. Also, the terms of multiperiod contracts with a single insurer may be unattractive to individuals and small groups, given the current structure of the market. Multiperiod contracts with a pool, rather than an individual insurer, may make it possible for individuals and small groups to enjoy the same advantages as consumers who obtain employment-based health insurance through large firms.

Consumer Advocacy↗
PubMed1991

Coronary angioplasty using new 6 French guiding catheters.

Coronary angioplasty (PTCA) was performed with specially constructed 6-French guiding catheters with an internal lumen of 0.051 inches. In 154 patients these guiding catheters were used in a variety of configurations in conjunction with miniature balloon-on-a-wire dilatation catheters in 1.5 to 3.5 mm sizes to perform PTCA. Overall patient success was 94%. PTCA was attempted in 24 totally occluded arteries with a success rate of 83% and 174 stenoses with a success rate of 97%. 6 French guiding catheters can be used to successfully perform PTCA.

Adult↗
PubMed1991

Note. Evaluating exclusionary interventions.

In evaluation research, some interventions are designed to affect both the subjects that receive the intervention and those that do not. Preferred provider organizations (PPOs) are an example, because if they are successful, PPOs will direct patients away from non-preferred providers towards preferred providers. When the intervention affects all subjects, the excluded group cannot serve as a control group if one wishes to estimate the experience of subjects in the absence of the intervention. That estimate must come from subjects completely unaffected by the treatment.

Contract Services↗
PubMed1991

The alpha-L-(1----2)-trirhamnopyranoside epitope on the group-specific polysaccharide of group B streptococci.

A number of epitope specificities associated with the group antigen (group B polysaccharide) of group B streptococci have been identified in a polyclonal antiserum induced in rabbits by a nonencapsulated variant strain of group B streptococci. This was achieved by using a series of oligosaccharide inhibitors, obtained by both synthetic and degradative procedures, to inhibit the binding of the group B polysaccharide to the polyclonal antiserum. While the dominant epitope expressed in the antiserum was alpha-L-Rhap(1----2)alpha-L-Rhap(1----2)alpha-L-Rhap, specificities associated with alpha-L-Rhap and alpha-L-Rhap(1----3)alpha-D-Galp(1----3)beta-D-Glcp-NAc(1----4)alp ha-L-Rhap were also identified. The dominant expression of the former epitope is consistent with its terminal location on the group antigen and also with highly branched multiantennary structure of this antigen. Antibodies specific for the alpha-L-trirhamnopyranoside epitope were purified by affinity chromatography, using the synthetic trisaccharide glucitol as the hapten. Oligosaccharide inhibition studies indicate that the specificity of these antibodies is identical to that of a murine monoclonal antibody induced by the same nonencapsulated strain of group B streptococci.

Animals↗
PubMed1991

Lipid composition and biosynthesis in the gingiva of the domestic cat.

Periodontal disease in the domestic cat may assume debilitating and serious consequences; however, little is known of the biochemical composition or metabolism of feline gingiva in health or disease. In this report the chemical composition and metabolism of gingival lipids from inflamed an non-inflamed sites is presented and compared to other species with naturally occurring periodontitis. The neutral and phospholipid composition of feline gingiva was found to be distinct from that of porcine and human. As a measure of de novo lipid synthesis, the total incorporation of 14C-acetate into fractionated lipid components was determined and revealed an approximate 2 to 3 fold decrease in inflamed versus non-inflamed gingiva. The decrease in 14C-acetate incorporation appeared to result from a 2-fold increase in free acetate pools in inflamed compared to non-inflamed gingival samples, since total lipase and phospholipase activity were comparable in inflamed and non-inflamed gingiva and total lipid composition was not changed between inflamed and non-inflamed sites. These data are similar to those reported for periodontally involved human gingival tissue and suggest a common effect of periodontal inflammation on lipid metabolism in both species.

Acetates↗
PubMed1991

A simultaneous equations model of employer strategies for controlling health benefit costs.

We estimated a simultaneous equations model of employer health insurance cost control strategies and their effectiveness in reducing health plan premiums. We hypothesized that as premiums increase, employers will shop more actively for health plans, place incentives on providers to control medical care costs, increase employee cost sharing for medical care, and be more likely to offer an HMO. In turn, we expected each of these strategies, except offering an HMO, to reduce average health plan premiums. The model was estimated with 1985 data from a sample of 922 Minnesota employers. We found that high premiums are related to three of the proposed cost control strategies. Employers with higher premiums shop more, are more likely to seek provider incentives, and offer an HMO. However, these employers appear to have lower employee cost sharing. Employers with higher employee cost sharing and those that offer an HMO had lower health plan premiums.

Community Participation↗
PubMed1991

Strategies employed by HMOs to achieve hospital discounts: a case study of seven HMOs.

This article is a summary of seven health maintenance organization (HMO) case studies focusing on strategies used to obtain favorable prices for inpatient hospital services. All of the HMOs stressed that the effort should be based on the local environment and should accommodate the special circumstances of organization of physicians' practices and hospitals, as well as the structure of the HMO and its strategic plan for growth.

Health Care Coalitions↗
PubMed1990

Hemoccult screening in detecting colorectal neoplasm: sensitivity, specificity, and predictive value. Long-term follow-up in a large group practice setting.

STUDY OBJECTIVE: To determine the sensitivity, specificity, and predictive value of Hemoccult II tests for detecting colorectal neoplasm (colorectal carcinoma or polyp or both). STUDY DESIGN: Prospective analyses of asymptomatic patients (greater than or equal to 45 years) followed for 4 years after screening with Hemoccult II testing and retrospective analyses of patients, with known colorectal carcinoma or polyps or both who had Hemoccult II testing within 2 years of diagnosis. SETTING: A large, health maintenance organization practice. MEASUREMENTS AND MAIN RESULTS: In the prospective analysis, the sensitivity of Hemoccult II was 50% for colorectal carcinoma diagnosed within 1 year of testing, 43% within 2 years, and 25% within 4 years. For polyps, sensitivity was 36% at 1 year, 28% at 2 years, and 17% at 4 years. Specificity was 99%. The predictive value of a positive test for colorectal carcinoma was 8% at 1 year, 10% at 2 years, and 11% at 4 years. On the basis of the retrospective analyses, the sensitivity of Hemoccult II for colorectal carcinoma diagnosed within 1 year of testing was 66% and was 61% within 2 years. Many of these patients had symptoms when tested. CONCLUSIONS: An asymptomatic patient age 45 or older with a positive Hemoccult II test has about a chance of 1 in 10 for having colorectal carcinoma and a 1-in-3 chance of having either a colorectal carcinoma or polyp: The same patient with a negative Hemoccult test has a 0.2% chance of having a colorectal carcinoma diagnosed within 2 years of testing and a 0.7% chance of having a polyp. Within 4 years of testing the chance increases to 0.5% for colorectal carcinoma and 1.5% for polyps. If Hemoccult II slides are the only screening method used for detecting asymptomatic colorectal neoplasms, 50% to 60% of lesions will remain undetected. Clinical interpretation of Hemoccult screening requires appreciation of its limits as well as its benefits.

Aged↗
PubMed1990

Effects of HMOs on the creation of competitive markets for hospital services.

Why do health maintenance organizations (HMOs) use particular hospitals, and do they concentrate patients in hospitals where they obtain low prices? We answered these questions with a study of six HMOs in four large metropolitan areas in 1986. A two-part model was estimated for the probability that a hospital would be used and the demand for general inpatient admissions at hospitals that were used. Four staff-network plans in our study do shop for hospital services on the basis of price more than was generally believed. However, two independent practice association (IPAs) plans use more hospitals in the community and do not concentrate patients effectively at hospitals that offer the lowest prices.

Bed Occupancy↗
PubMed1990

Contracts between hospitals and health maintenance organizations.

This article describes the contractual relations that are emerging between health maintenance organizations (HMOs) and hospitals. Six HMOs in four large metropolitan areas provided information on 102 hospital contracts. The authors found that the HMOs are becoming more aggressive in placing hospitals in competition with each other for HMO patients. Staff and network HMOs are able to obtain a higher concentration of patients and substantially larger discounts for inpatient services than are individual practice association (IPA) plans in this study.

Competitive Bidding↗
PubMed1990

An integrated approach to family therapy training for psychiatric residents.

Unlike nonmedical family therapists, psychiatric family therapists are able to evaluate and treat both the biological and psychosocial components of a problem. They can integrate knowledge of biology, psychopharmacology and individual psychodynamics with family systems theory and family therapy skills. A family therapy training program is presented as a model which prepares psychiatric residents for this unique role. This model emphasizes the importance of having psychiatrists as family therapy teachers, the use of both systems and psychodynamic perspectives in teaching about families, and the principle of presenting concepts and interventive techniques at successively greater levels of difficulty. Illustrative examples are presented. A minimum of two years of family therapy training and supervision is recommended during a four year residency program.

Adult↗
PubMed1990

Health economics: a report on the field.

This study documents who health economists are, what they do, and what they think about professional and policy issues. Using primary data obtained through a mail survey of 518 health economists, we found that health economists are well trained by the standards of their profession. Most are employed in noneconomics departments in universities, where they spend their time very differently from their cousins in economics departments. There is a clear dichotomy in policy views among health economists. The characterization of the field as composed of "narrow" neoclassicists and "broad" eclecticists is supported by our data.

Career Mobility↗
PubMed1990

Policy and research on health manpower regulation: never too late to deregulate?

Research on health manpower regulation has reached a consistent conclusion for the last two decades that is likely to carry into the 1990s: deregulate. Research has progressed in recent years, however, and research in the 1990s will be quite different from that of the past two decades. While the battle cry "never too late to deregulate" will continue to be heard, the "easy" targets, those markets with the least extensive or least important information asymmetry, have already been attacked. What is (or should be) finally emerging in the 1990s is a more challenging appraisal of health manpower regulation, one that recognizes greater complexity in health care markets and consumer preferences than has been recognized in past research. Lessons for the 1990s include the need to recognize, accept, and study information asymmetry and its consequences, and to more closely analyze the hypothesis that occupational interest groups, while meeting their self-interest, also may be serving the commonwealth. Such a reorientation leads us to ask different questions of regulation in future research, all directing attention to the informational attributes of markets: (1) How much information asymmetry exists in different health care markets, and how important is it? In which information-asymmetric markets is manpower regulation most likely to benefit consumers? (2) How can information asymmetry between consumers and providers be reduced, thereby facilitating deregulation? (3) How many regulations, of what type, are consumers willing to eliminate, for what benefits? Simplistic policy recommendations are less likely with this new orientation, and there is a great deal of interesting research awaiting health services researchers.

Consumer Behavior↗
PubMed1990

Changing physician behavior: does medical review of Part B Medicare claims make a difference?

This study attempts to determine whether the implementation of mandatory review of Medicare Part B claims for medical necessity has resulted in physicians submitting fewer medically unnecessary claims. After summarizing the literature on the effectiveness of various methods for changing physician practices, we compare the rate at which physicians submitted medically unnecessary claims before and after HCFA imposed mandatory review screens. We find that, consistent with expectations from the literature, the screens are only marginally effective (at best) in reducing the rate at which medically unnecessary claims are submitted. We make some suggestions for lowering this rate.

Cost Control↗
PubMed1990

[Atypical chest pain: study by the hydrochloric acid provocation test].

Evaluation by means of gastroenterological and cardiological methods. The purpose of this paper was to study the origin of chest pain (CP) in patients with normal and pathological coronary arteries as characterized by coronary arteriogram (CA). Sixteen normal control individuals (X 27 years -7 females and 9 males) were studied by means of esophageal manometry (EM) with a 3 way catheter perfused by a low compliance capillary system. Twenty-one patients with chest pain were studied and divided according to coronary arteriogram in normal (NC) and pathological arteries (PC). They were simultaneously studied by means of EM, heart rate/pressure product (RPP), and 12 lead ECG monitoring. After a basal period they were given a Bernstein's provocative chest pain test, and after each of its stages we determined in a simultaneous fashion CP, EM, ECG and RPP. In 61.9% of the patients abnormal basal EM was found. It was characterized by increase in HPZ, duration, propagation velocity and pressure of the peristaltic waves: as well as an increase in the percentage of aperistaltic waves. In 14.2% of the patients the Hydrochloric provocative test was positive. The only statistically significant datum was the heart rate/RPP relationship. We conclude that in future studies it would be of interest to combine 24 hour monitoring EM and pH as well as a more sensitive provocation test such as edrophonium chloride.

Adolescent↗