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PubMed2006

Private-sector research ethics: marketing or good conflicts management? The 2005 John J. Conley Lecture on Medical Ethics.

Pharmaceutical companies are major sponsors of biomedical research. Most scholars and policymakers focus their attention on government and academic oversight activities, however. In this article, I consider the role of pharmaceutical companies' internal ethics statements in guiding decisions about corporate research and development (R&D). I review materials from drug company websites and contributions from the business and medical ethics literature that address ethical responsibilities of businesses in general and pharmaceutical companies in particular. I discuss positive and negative uses of pharmaceutical companies' ethics materials and describe shortcomings in the companies' existing ethics programs. To guide employees and reassure outsiders, companies must add rigor, independence, and transparency to their R&D ethics programs.

Biomedical Research↗
PubMed1986

Health and medical care in Sweden.

The Swedish health care system is funded by a government-sponsored health insurance scheme and is structured on a regional basis. This system has provided a high level of care, reflecting a continuing commitment by the major political parties. Private practice does persist on a limited scale.

Hospitals↗
PubMedDate not supplied

Health care cost containment: how Pittsburgh is addressing the challenge.

Rapidly escalating health care costs have the public and private sectors searching for methods to provide health care benefits in a more efficient manner. Efforts have also been underway at the community level with the development of health care coalitions created to build consensus toward a fair solution for all parties affected. With the assistance of the Robert Wood Johnson Foundation and many local co-sponsors, the Pittsburgh Program for Affordable Health Care (PPAHC) was organized to address health care cost containment issues in the greater Pittsburgh area. One of the means by which PPAHC chose to achieve this was through the development of a Model Utilization Management Program. This is a document containing community-sanctioned administrative and clinical standards for utilization review which take into consideration the needs and concerns of providers, purchasers, and consumers, and which have a goal of reducing medically unnecessary inpatient hospitalization while concurrently maintaining quality of and access to care. This article describes both the process and the product of PPAHC's efforts toward health care cost containment in Pittsburgh, specifically focusing on its utilization management component.

Community Participation↗
PubMed2005

The Latino Healthcare Professionals Project: responding to the diverse needs of the 21st century.

The Latino Healthcare Professionals Project (LHPP) is a privately-funded initiative to provide healthcare management training to first-generation educated Latino bilingual and bicultural upper division university students planning careers in healthcare. This unique curriculum, scholarship, and mentorship program is based in the Health Care Administration (HCA) Program at California State University Long Beach (CSULB). Initially funded by The Sisters of St. Joseph Healthcare Foundation, LHPP has been sponsored by several organizations, including Kaiser Permanente and the Health Care Foundation for Orange County, with a shared commitment to increase the diversity of trained Latino managers in the healthcare field. Since its inception in 1995,168 students have participated in LHPP, with demonstrated success in improved student performance, retention, participation in the health professional work force, and continuing educational achievements. This article discusses the need for Latino healthcare professionals, current issues facing the Latino population with regard to higher education and family involvement, and barriers affecting Latino students' ability to complete a four-year baccalaureate degree. Information on the projectincludes a description of the LHPP mission and goals, curriculum and core components, as well as the project's structure, process, and outcomes.

California↗
PubMed2004

The distributional consequences of a Medicare premium support proposal.

This article analyzes the distributional consequences of enacting a particular premium support proposal known as Breaux-Frist I. Under the proposal, the federal government would contribute a certain amount toward the purchase of Medicare coverage, based on the premiums charged by different health plans. Beneficiaries could choose something akin to the traditional fee-for-service option or a privately sponsored ealth plan such as a health maintenance organization. The article simulates the expected distributional impacts in three areas: among beneficiaries who choose to retain fee-for-service coverage, between different geographic areas, and according to various beneficiary characteristics. We find that the legislation would result in increased premiums for beneficiaries remaining in the Medicare fee-for-service program as a result of unfavorable selection; lead to a geographic redistribution in premium payments, with those living in areas with high levels of Medicare expenditures paying more; and a much lower financial burden than is the case now for near-poor beneficiaries who do not have full Medicaid coverage. Finally, the article discusses how these results compare to those that may occur under the premium support demonstration project, beginning in 2010, established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Aged↗
PubMed2005

Medicare program; Medicare prescription drug benefit. Final rule.

This final rule implements the provisions of the Social Security Act (the Act) establishing and regulating the Medicare Prescription Drug Benefit. The new voluntary prescription drug benefit program was enacted into law on December 8, 2003 in section 101 of Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173). Although this final rule specifies most of the requirements for implementing the new prescription drug program, readers should note that we are also issuing a closely related rule that concerns Medicare Advantage organizations, which, if they offer coordinated care plans, must offer at least one plan that combines medical coverage under Parts A and B with prescription drug coverage. Readers should also note that separate CMS guidance on many operational details appears or will soon appear on the CMS website, such as materials on formulary review criteria, risk plan and fallback plan solicitations, bid instructions, solvency standards and pricing tools, plan benefit packages. The addition of a prescription drug benefit to Medicare represents a landmark change to the Medicare program that will significantly improve the health care coverage available to millions of Medicare beneficiaries. The MMA specifies that the prescription drug benefit program will become available to beneficiaries beginning on January 1, 2006. Generally, coverage for the prescription drug benefit will be provided under private prescription drug plans (PDPs), which will offer only prescription drug coverage, or through Medicare Advantage prescription drug plans (MA PDs), which will offer prescription drug coverage that is integrated with the health care coverage they provide to Medicare beneficiaries under Part C of Medicare. PDPs must offer a basic prescription drug benefit. MA-PDs must offer either a basic benefit or broader coverage for no additional cost. If this required level of coverage is offered, MA-PDs or PDPs, but not fallback PDPs may also offer supplemental benefits through enhanced alternative coverage for an additional premium. All organizations offering drug plans will have flexibility in the design of the prescription drug benefit. Consistent with the MMA, this final rule also provides for subsidy payments to sponsors of qualified retiree prescription drug plans to encourage retention of employer-sponsored benefits. We are implementing the drug benefit in a way that permits and encourages a range of options for Medicare beneficiaries to augment the standard Medicare coverage. These options include facilitating additional coverage through employer plans, MA-PD plans and high-option PDPs, and through charity organizations and State pharmaceutical assistance programs. See sections II.C, II.J, and II.P, and II.R of this preamble for further details on these issues. The proposed rule identified options and alternatives to the provisions we proposed and we strongly encouraged comments and ideas on our approach and on alternatives to help us design the Medicare Prescription Drug Benefit Program to operate as effectively and efficiently as possible in meeting the needs of Medicare beneficiaries.

Aged↗
PubMed1997

The Medicare mall. Will Washington like what it built?

"Shopping spree" doesn't begin to describe it. Next year, 38 million seniors will begin choosing their health care coverage from a menu crammed with options. Medicare Plus Choice means just that: HMOs, provider-sponsored plans, private-pay options, medical savings accounts, and more. It also means a bevy of new rules--and risks--for everyone.

Aged↗
PubMed1991

Empire and the business of health insurance.

I examine the development of privately provided insurance since World War II, giving special attention to Empire Blue Cross, and argue that the competition between employers and unions for the loyalty of workers after the passage of the Taft-Hartley Act helped diffuse private health insurance benefits already favored by federal policies. For-profit insurers did not challenge the privileged status of Blue Cross plans because they recognized the political benefits that the plans offered and because they did not wish to offend the plans' sponsors. A relatively easy and profitable business, health insurance has been greatly disturbed by the system inflation accompanying the introduction of Medicare and Medicaid programs. Now self-insurance and various managed-care schemes are major threats. The future may bring consolidation and the strengthening of pools, just the opposite of today's system fragmentation.

Blue Cross Blue Shield Insurance Plans↗
PubMed2000

Effect of Medicaid managed care on pregnancy complications.

OBJECTIVE: This study examined the impact of managed care on hospital obstetric outcomes in Medicaid-sponsored women. METHODS: The study sample consisted of a total of 525,517 maternal deliveries for singleton births from three payer groups, Medicaid managed care, Medicaid fee-for-service, and private managed care in 439 short-term-stay nonfederal hospitals in California and Florida. Quality of care comparisons were made using six indicators. Data were derived from linked computer files of birth certificates, hospital discharge abstracts, Medicaid eligibility records, Medicaid health care claims, and surveys of hospital characteristics. RESULTS: The overall multivariate likelihood of an adverse maternal outcome during hospitalization for a delivery was not significantly different between Medicaid managed care and Medicaid fee-for-service groups in California and Florida. However, mothers in the Medicaid managed care group compared with mothers in the private managed care group experienced a higher likelihood of eclampsia (California) (adjusted odds ratio = 1.26; 95% confidence interval 1.05, 1.57; P = .04). CONCLUSION: Overall, managed care has not adversely affected pregnancy outcomes in Medicaid-sponsored women. Yet, payer system changes may be insufficient to achieve complete parity of outcomes relative to private managed care patients.

California↗
PubMedDate not supplied

[Centralized purchasing of essential drugs, a priority for the health care systems of developing countries].

Health sector reform is a key priority of many governments throughout the world. Drug supply systems are a major element of public health policy design in Africa, where 90% of drugs are imported. The WHO Essential Drugs Program and the UNICEF sponsored Bamako Initiative have, since the late 1980s, promoted the rational use of essential drugs and attempted to ensure a sustainable drug supply through the implementation of cost recovery schemes and quality assurance mechanisms in public health services. A new market for drugs is emerging within this framework and there is growing competition for its control. Government medical stores are all too often bankrupt and the private sector is expensive, catering mainly for the middle to upper classes of urban areas. An intermediate alternative. Essential Drugs Purchasing Offices (EDPOs), has been proposed to balance social objectives and economic constraints. Some of the experimental strategies have given promising results. However, their implementation raises a number of questions: What is the role of the EDPO? Should it promote public health issues in general or focus purely on drug availability? What is the most appropriate legal status? Public or private? For profit or not? How should the investment capital be structured? In drugs or in funds? With ample provision or a tight budget? How should drug purchases be managed? Where should drugs be purchased? How much? How often? According to which procedures? How should the distribution of drugs be organized? Supplying everyone? Pushing supplies or pulling purchasers in? The answers to these questions, analysis of the reasons for success and failure and the dissemination of the information gathered should identify priorities for action and future research and define a framework for expansion. These are the objectives of the "Concerted Action for the Development of EDPO in Sub-Saharan African Countries" which is supported by the European Union (DG XII).

Africa↗
PubMedDate not supplied

Low-income women's perceptions of family planning service alternatives.

A sample of 665 low-income women from a predominantly rural area of north central Florida rated the value of 25 features of family planning providers and reported their perceptions of how characteristic each feature was of different types of providers. A well-trained, trustworthy and friendly staff, the presence of a doctor if you need one and a staff that is gentle with the examination were the most desirable features of family planning services. The respondents' perceptions of public health clinics suggest that the strongest qualities of such facilities are that they treat people from different backgrounds, accept Medicaid, are easy to find and teach you how to avoid pregnancy and how to take care of yourself and stay healthy. Features thought most characteristic of private physician services were a well-trained staff, privacy and the presence of a doctor if you need one. Voluntary organizations were seen as providing services for people of different backgrounds, having a friendly staff, serving as a referral agency and teaching about staying healthy and avoiding pregnancy. However, voluntary organizations were rated lower than public health clinics or private physicians on nearly all features. The total scores for public health clinics and private physicians were not significantly different from each other, but both were noticeably higher than the score for voluntary organizations. Ethnicity affected ratings dramatically, with black respondents clearly more favorable toward public health clinics and private physicians than white respondents; conversely, whites were more positive toward voluntary organizations than were blacks. For many of these low-income respondents, the high ratings of private physicians may have represented their expectations rather than their actual experience.

Adolescent↗
PubMed1991

Community-based plan for treating human immunodeficiency virus-infected individuals sponsored by local medical societies and an acquired immunodeficiency syndrome service organization.

Individuals infected with human immunodeficiency virus frequently experience difficulty finding medical care from private physicians. Fear of occupational exposure, prejudice, lack of knowledge, and financial loss have all been cited as reasons for the reluctance of primary care physicians to accept patients with acquired immunodeficiency syndrome into their practices. To meet the medical needs of all patients infected with human immunodeficiency virus, this Virginia community adopted a voluntary rotational referral plan to provide primary care for all such individuals. The program required the cooperation of a voluntary pool of internists and family practitioners and an acquired immunodeficiency syndrome service organization with a volunteer physician advisor to coordinate referrals of unassigned patients. No physician received more than three referrals per year. During the 2 years of operation, 118 referrals were made to 30 physicians. Regular educational seminars were provided with medical updates and consultation support was provided. This locally based program appears to be meeting the acquired immunodeficiency syndrome challenge in this community and may have applicability to other communities as well.

Attitude of Health Personnel↗
PubMedDate not supplied

Transferring health and family planning service innovations to the public sector: an experiment in organization development in Bangladesh.

The International Centre for Diarrhoeal Disease Research, Bangladesh, has launched a field experiment in two rural thanas of Bangladesh to test the transferability of its successful health and family planning experiment in Matlab to the Ministry of Health and Population Control service system. This paper reviews the Matlab experiment with particular attention to its organization and identifies elements for transfer. The intervention strategy and operations research design of the new experiment are discussed. The proposed design follows an organization development strategy in which collaborative diagnostic research is used to foster institutional change.

Bangladesh↗
PubMed2001

Premium subsidies for employer-sponsored health coverage: an emerging state and local strategy to reach the uninsured.

With nearly 75 percent of the uninsured living in households with at least one full-time worker, there has been renewed policy interest in strategies to expand coverage by subsidizing employer-sponsored insurance. Six of the 12 nationally representative communities that the Center for Studying Health System Change (HSC) tracks have premium assistance, or subsidy, programs planned or underway. Policy makers are enthusiastic about the potential to expand coverage through these programs, but enrollment has been modest to date. This Issue Brief examines operational challenges facing subsidy programs, such as how to structure a benefits package within budgetary and regulatory constraints and how to attract employers and employees without displacing existing private contributions to premiums. It also discusses the trade-offs policy makers may face to resolve these challenges in the context of rising premiums and a slowing economy.

Financing, Government↗