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Biomedical subjects

R G Frank

Publications and source records attributed to R G Frank.

At least 145 records · Page 8Linked to original sources
PubMed1986

Hypnosis and behavioral treatment in a worksite smoking cessation program.

In the initial study, 48 subjects of the total (N = 63) ultimately used, were assigned to one of three treatments: four hypnotic sessions with a booster, two hypnotic sessions, or two hypnotic and two behavioral sessions with a booster. A follow-up group was later recruited composed of 15 subjects who received four hypnotic sessions and a booster session with less time between sessions. The results indicated no difference in smoking cessation 6 months after treatment regardless of the frequency, length between sessions, or addition of behavioral methods. Successful subjects were more educated, less able to utilize their imagination, and had fewer smokers at home.

Behavior Therapy↗
PubMed1986

Per case prospective payment for psychiatric inpatients: an assessment and alternatives.

Psychiatric hospitals and clinics are exempted from the Medicare prospective payment system. In this paper we examine the appropriateness of the DRG classification system for psychiatric patients and argue that, using this system as the basis of payment, two types of problems are likely to arise. We categorize these problems as "risks to hospitals" and "risks to patients" and examine the existing literature to determine whether these risks are likely to be significant. We propose a different approach to paying prospectively for psychiatric care, and suggest modifications that could be made to the structure of PPS to mitigate negative incentives embedded in the current system. Although the main focus of the paper is on the unit of payment, we also make some observations about issues arising in connection with the level of payment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

The predictors of HMO enrollee populations: results from a national sample.

This study is the first to use a national data set to analyze the kinds of people who enroll in HMOs versus conventional insurance, whether or not they faced a choice. Our explanatory variables include two measures of health: reported health status and number of medical conditions. Although neither variable proved to be significant, our coefficient estimates suggest that ill health increases the probability of being enrolled in an HMO, as does larger family size. The income elasticity of HMO enrollment is -.64, which suggests that families of modest means are a natural clientele of HMOs.

Adult↗
PubMed1986

A review of studies of the impact of insurance on the demand and utilization of specialty mental health services.

Insurers and employers perceive the demand for mental health care to be highly responsive to the terms of insurance. Better coverage, it is believed, would increase demand, increasing expenditures through use of services that may be discretionary in nature. This article attempts to shed light on this issue by summarizing and evaluating the results of more than 40 published and unpublished studies. The major criterion for inclusion was the availability of information on the size of the population covered, so that rates of utilization could be calculated. More recent studies are emphasized. If research at the population level using aggregate utilization as a dependent variable is the "first generation of research," studies of individual use over a period of a year constitutes the "second generation." The emerging research on episodes of treatment represents a new "third generation" of studies. If some progress can be made on issues of ways in which patients form expectations about their treatment and its cost, this new generation of research promises to model demand response more precisely to coverage terms that change within a year, such as deductibles or limits.

Ambulatory Care↗
PubMed1986

The Columbian exchange: American physiologists and neuroscience techniques.

Neurophysiological techniques, far from being mere manual or instrumental procedures, are intimately bound up with the concepts and social processes of experimental physiology. This proposition is argued by examining the prepublication history of four important technical innovations in 20th-century neurophysiology, and their associated innovators: the vacuum-tube amplifier (Lucas, Williams, and Forbes, 1912-1922); the cathode-ray oscillograph (Gasser, Newcomer, and Erlanger, 1919-1923); single-fiber recording (Adrian, Zotterman, Forbes, Davis, and Gasser, 1912-1926); and the intracellular microelectrode (Graham, Gerard, Ling, Hodgkin, and Nastuk, 1940-1950). From these episodes I conclude that: each technique has its own set of conceptual presuppositions, limitations, and biases--in a word, techniques are idea-laden; techniques have an inertia of use that is overcome often only in unusual circumstances of crisis or opportunity; techniques, in their origin, evaluation, demonstration, and diffusion, are embedded in a network of social contacts among researchers; and 4) techniques evolve with favorite biological materials that, by fitting the apparatus and the questions asked, also impose limits on the concepts educed from that preparation.

Amplifiers, Electronic↗
PubMed1985

The psychiatric DRGs. Are they different?

The relative homogeneity of medical, surgical, and psychiatric diagnosis-related groups (DRGs) are examined. Using data from the State of Maryland and the Health Care Financing Administration we studied the amount of variation in resource utilization within the DRGs. The estimated coefficients of variation of resource utilization for the surgical DRGs were found to be significantly smaller than those estimated for both medical and psychiatric DRGs. The authors were unable to reject the hypothesis that the coefficients of variation for medical and psychiatric DRGs were different. These results suggest that hospitals are at substantial but equal risk under a DRG-based payment system for both medical and psychiatric DRGs.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1985

Pricing and location of physician services in mental health.

Puzzling results of a positive association between the number of physicians per capita and the level of fees for physician services have been reported in the literature. These results may be due to misspecification of econometric models and use of data aggregated across medical specialties. It is hypothesized that the unusual results would not persist with a carefully specified econometric model for a single medical specialty. A general model of pricing and location of physician's services is applied to the market for psychiatrist's services. The results imply that the market for psychiatrist's services operates in a manner consistent with the predictions of the competitive model.

Fees, Medical↗
PubMed1985

Depression and adrenal function in spinal cord injury.

Of 32 patients with spinal cord injury, 14 had a DSM-III diagnosis of depressive disorder: 12 had major depression (five with melancholia) and two were dysthymic. In those with major depression, a dexamethasone suppression test lacked sensitivity (30%) and specificity (50%).

Adolescent↗
PubMed1985

Direct costs and expenditures for mental health care in the United States in 1980.

Estimates of direct costs and expenditures for mental health care in 1980 are presented in this analysis. Besides estimates for the specialty mental health sector, the general medical sector, and the human service sector (schools and the criminal justice system), the authors include transportation costs and expenditures for transfer payments. They obtained a low total estimate of $19.2 billion and a high total estimate of $22 billion. Comparisons with previous estimates indicate an annual growth rate in real costs for mental health care of about 1.7 percent since 1971.

Community Mental Health Centers↗
PubMed1985

The impact of Medicaid benefit design on length of hospital stay and patient transfers.

The authors examined how the Medicaid hospital benefit structure affects the length of stay of psychiatric inpatients and transfers to state mental hospitals and nursing homes. They hypothesized that length-of-stay and discharge patterns would depend on five classes of variables: patient characteristics, diagnosis, mental health status, hospital characteristics, and benefit structure. Analysis of 976 Medicaid cases showed that the variables together accounted for only 17 percent of the variation in patient length of stay; benefit structure alone accounted for 6 percent of the variation, slightly less than the diagnostic variables. A patient's clinical status was the most important predictor of transfer to state mental hospitals, although benefit structure had a significant effect. It had no effect on patient transfers to nursing homes. The authors discuss the implications of the findings for designing prospective payment systems for psychiatric patients under Medicare.

Hospitals, State↗
PubMed1985

The competitive effects of HMOs: a review of the evidence.

Despite the major methodological strides that have been made in the study of the competitive impact of HMOs and the considerable information gained from case studies, the formulation of substantive conclusions relating to HMO market penetration is in its infancy. In this review of recent studies of the competitive impact of HMOs, which concentrates on the econometric evidence, the authors found several anomalies concerning HMO impact in the market for hospital services, and make suggestions for methodological improvements. They introduce the notion of the role of employers in the insurance purchase decision as a key element in developing a complete model of health plan choice. They conclude with a proposal for a research agenda for studying the growing impact of HMOs on traditional health care coverage.

Blue Cross Blue Shield Insurance Plans↗
PubMed1984

Psychological response to amputation as a function of age and time since amputation.

Much of what is known about the psychological response to amputation is derived from studies of veterans. Most recent amputees come from a different group; they are typically older and have experienced medical problems prior to their amputation. In order to investigate the effects of age and time since amputation on psychological response, 66 amputees were assessed by the Symptom Checklist-90, Beck Depression Inventory and interviewed. When classified by time since amputation and by age, the results indicate that older amputees exhibited less depression and fewer psychological symptoms: in contrast, younger amputees evidenced increased depression and psychological symptomatology the longer the time since their amputation.

Adaptation, Psychological↗
PubMed1983

Hypnosis compared to relaxation in the outpatient management of chronic low back pain.

Chronic low back pain (CLBP) presents a problem of massive dimensions. While inpatient approaches have been evaluated, outpatient treatment programs have received relatively little examination. Hypnosis and relaxation are two powerful techniques amenable to outpatient use. Seventeen outpatient subjects suffering from CLBP were assigned to either Self-Hypnosis (n = 9) or Relaxation (n = 8) treatments. Following pretreatment assessment, all subjects attended a single placebo session in which they received minimal EMG feedback. One week later the subjects began eight individual weekly treatment sessions. Subjects were assessed on a number of dependent variables at pretreatment, following the placebo phase, one week after the completion of treatment, and three months after treatment ended. Subjects in both groups showed significant decrements in such measures as average pain rating, pain as measured by derivations from the McGill Pain Questionnaire, level of depression, and length of pain analog line. Self-Hypnosis subjects reported less time to sleep onset, and physicians rated their use of medication as less problematic after treatment. While both treatments were effective, neither proved superior to the other. The placebo treatment produced nonsignificant improvement.

Back Pain↗