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PubMedDate not supplied

Use of medical care after a community-based health promotion program: a quasi-experimental study.

PURPOSE: To assess the effects of health promotion on the use of medical care services in a community setting. DESIGN: Quasi-experimental, multiple time points, case-comparison group. SETTING: Community health center in Ottawa, Canada. SAMPLE: 520 volunteer participants in a health promotion program and 932 matched comparison subjects. INTERVENTION: The health promotion program consisted of a weekend workshop on health behaviors, lifestyle assessment, and identification of weekly goals for change. This was followed by 18 months of support (5 group sessions, weekly telephone calls, and optional individual sessions). MEASUREMENT: Computerized data on health care use 6 months before, 18 months during, and 6 months after the program were obtained from Ontario's universal Health Insurance Plan (OHIP). These data were used to determine the number and system costs of visits made by participants and comparisons. RESULTS: When controlling for baseline differences through analysis of covariance, program participants were found to have higher costs and more visits for ambulatory care during the first year (p < .01) and second year (p < .05) of follow-up. Participants used significantly more diagnostic services than comparisons during both years of follow-up. Participants were also more likely to use more counseling and psychotherapy services in year 1 (relative risk, 1.53; 95% confidence interval, 1.28, 1.81) and year 2 (relative risk, 1.57; 95% confidence interval, 1.31, 1.89). No differences were found between participant and comparison groups in visits for medical consultations and assessments or preventive services. CONCLUSION: No evidence shows that this health promotion program reduced use in this population over the 2-year follow-up period.

Analysis of Variance↗
PubMed1990

Problems prompt second thoughts about Mass. universal health plan.

Support for Massachusetts' universal health insurance law has eroded since being signed into law 2 1/2 years ago. A budget crisis has made a political issue out of the law's cost, but providers now fear the cost estimates are vastly underestimated. And a network of interconnected compromises is in danger of coming apart.

Economics, Hospital↗
PubMed1989

Potential for inpatient-outpatient substitution with diagnosis-related groups.

Through analysis of data from the universal health insurance system in Manitoba, Canada, surgical diagnosis-related groups (DRG's) with the greatest potential for inpatient-outpatient substitution are identified. Candidates for both "inpatient shift" and "outpatient shift" are discussed. It is also suggested that determination of the procedure chiefly responsible for hospital admission complements approaches to improve the DRG classification system by measuring severity of illness. Thus, health care planners' efforts may be facilitated in establishing effective payment systems, though definitive guidelines are not provided.

Aged↗
PubMed2000

[Medical ethics in the world's market. Hippocratic fidelity or enterprise fidelity].

The advance which resulted in the mean survival increase from 50 to 75 years between 1920 and 1990 also provoked the rise in health care costs, and the so called "health crisis". In order to contain it, market tactics were put to action, health care was considered a commodity, patients "consumers" and hospitals or physicians "providers". Economists, accountants and business advisors in charge of "Health Maintenance Organizations" (HMO) started the very profitable activity of intervening between patients and physicians. Rationing, use of general practice guides, suboptimal treatments, risk avoidance and other market tactics changed the practice of a profession into a business enterprise. The HMO decides if, when, how and how much will be given to any "consumer". Use of technology more impersonal and easily administered is the leading feature of to-day's medicine over the intellectual activity of the physician who hears, understands, makes the physical examination, diagnosis and treatment. The increasing depreciation of his task obliges the physician to enlarge the number and decrease his communication with his patients. His fiduciary obligation is subordinated to market needs and his practice increasingly compromises his moral integrity. The HMO boasts of the quality of the service given, this is the timely use of to-day's appropriate resources. Nobody wants the 1950 car or medical practice. Tomorrow's practice however depends on increasing knowledge, that is, on research, an activity which is not the HMO object. The academic-medical center, the very place where the interaction of teaching and investigating promotes the excellence is discriminated by the HMO because of its compromise with fiduciary activity imposed by 2500 years of jewish-christian philosophy. The future of these institutions (state's Cinderella's) is progressively compromised; when we loose them how long will it take to recover them? The politicians are always ready to create new hospitals, after they are built consuming large amounts of money, they become disinterested. All hospitals in our country are completely active only 4 hours/day, their physicians travel afterwards to their diverse places of activity consuming much of their time in getting there and complying with the bureaucratic tasks imposed by HMO. In our country with 14% unemployment and 1/3 of the population without any health coverage, the institution of universal health insurance is mandatory. Preventive medicine is not effective for people who lack the means for adequate nutrition, education or transportation, they do not visit doctors or use medicines.

Delivery of Health Care↗
PubMed1975

Emergency department use at two Hamilton hospitals.

This report compares emergency department use at two urban Hamilton hospitals. One mainly serves lower socioeconomic and industrial groups and the other predominantly suburban residents. Although the groups served are different, the patterns of use at both hospitals were found to be similar. Over one third of visits at both are classified as nonurgent. The urban industrial hospital has higher proportions of visits that are nonurgent, by men and due to trauma. However, other parameters such as arrival time, use of ambulance, proportion admitted, percentage of emergencies, percentage of repeat visits, use of radiology and laboratory facilities and proportions of visits in different categories of presenting complaint were similar at the two hospitals. Similarities in use patterns may be due to universal health insurance, for 90% of users have medical insurance and have family doctors.

Adult↗
PubMed1994

Health Care Reform: A Caucus of Asian American Health Workers' Perspective.

PURPOSE OF THE PAPER: The purpose of this paper is to offer an American Public Health Association &lpar;APHA&rpar;/Caucus of Asian American Health Workers' &lpar;CAAHW&rpar; perspective on health care reform. Dr. William Chen, the CAAHW Chair had asked the author, a Caucus member to present the Caucus' perspective on health care reform as part of a special session that was held during the 1993 APHA annual meeting in San Francisco. This paper is based on the oral presentation made. SUMMARY OF METHODS UTILIZED: The author reviewed the September 7, 1993 draft of the President's Health Care Reform proposal, other related papers, and the literature on Asian and Pacific Islander American health care needs. This was followed by a discussion of major issues and concerns with the CAAHW Chair and key members. This paper has undergone review by the Caucus chair and his reviewers whom he selected and thus is endorsed as the CAAHW's perspective on health care reform. PRINCIPAL FINDINGS: The CAAHW applauds President Clinton for his leadership in introducing much&shy;needed reform in the U.S. health care system. However, the CAAHW wants to point out that access to medical care is not equivalent to utilizing and benefiting from services. Three issues of special concern to Asian Pacific Islander Americans are: &lpar;1&rpar; cultural sensitivity and relevancy of health services; &lpar;2&rpar; adequacy of racial/ethnic specific health data; and &lpar;3&rpar; due representation and input to key health policy&shy;making and administrative bodies. CONCLUSIONS: The CAHW supports universal health insurance for all Americans and is particularly concerned that cultural sensitivity and appropriateness be assured for all populations. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: This paper calls attention to Asian Pacific Islander Americans as the nation's fastest growing minority that is largely foreign&shy;born and extremely heterogenous and the need for culturally sensitive services. KEY WORDS: Asian Pacific Islander Americans; health care reform; health policy; cultural sensitivity.

Journal Article↗
PubMedDate not supplied

Setting health care priorities: Oregon's next steps.

Since the proposal was first broached in 1987, a storm of controversy has engulfed Oregon's plan to prioritize the health care services offered to its Medicaid recipients. After two years of debate, community consultation, and public opinion polls, the Oregon Health Services Commission was mandated in 1989 to study prioritization as part of a package of bills enacted as the Oregon Basic Health Services Act. In March 1990 the commission released a draft list of ranked health care services for public comment... As part of the ongoing debate, the Hastings Center and the Wesley Foundation sponsored a two-day meeting in January 1991 in Wichita, Kansas, to provide opportunity for thoughtful, in-depth, informal analysis of the OBHSA model for health care reform...a majority felt that OBHSA, in the framework of progress toward larger reform goals, is an experiment worth trying. Some felt that even if OBHSA doesn't attain its larger goals it should be tried since it will extend access and may lead to better health outcomes among the poor. But the general view was that OBHSA is a valuable experiment only to the extent that it leads to a statewide system of universal health insurance in Oregon without creating special burdens for the state's poor....

Biomedical Technology↗
PubMed2001

Feature selection for examining behavior by pathology laboratories.

Australia has a universal health insurance scheme called Medicare, which is managed by Australia's Health Insurance Commission. Medicare payments for pathology services generate voluminous transaction data on patients, doctors and pathology laboratories. The Health Insurance Commission (HIC) currently uses predictive models to monitor compliance with regulatory requirements. The HIC commissioned a project to investigate the generation of new features from the data. Feature generation has not appeared as an important step in the knowledge discovery in databases (KDD) literature. New interesting features for use in predictive modeling are generated. These features were summarized, visualized and used as inputs for clustering and outlier detection methods. Data organization and data transformation methods are described for the efficient access and manipulation of these new features.

Artificial Intelligence↗
PubMed2003

[Four years on a waiting lists for surgery--an expensive option. Millions in lost production while waiting for an orthopedic intervention].

This study was performed in order to determine the cost to society (in terms of loss of production) of having patients on paid sick-leave while on a waiting list for elective orthopedic surgery. All patients on surgical waiting lists receiving sick-leave benefits for the same diagnosis as for the planned procedure, specifically for lumbar disc herniation, lumbar spinal stenosis, and certain knee and shoulder diagnoses (not including arthritis), were identified at two large Swedish orthopedic clinics. These diagnoses were chosen since there is evidence that surgery can reduce pain and disability and also improve work ability. The number of days on sick-leave was determined individually as was each subject's reimbursement from universal health insurance. These benefits were treated as equal to the production losses caused by their inability to work according to the so-called Human Capital Method. 159 patients on the waiting lists were on sick-leave. The average waiting time varied between one and two years for the diagnoses included. Forty-four of the patients were granted temporary or permanent disability pensions while awaiting surgery. The costs for paid sick-leave together with future costs for those granted permanent disability pensions were almost 90 million SEK (almost 90 million USD). This amount corresponded to the cost of more than 2000 disc operations or more than 1000 total hip replacements. Instead of being spent on sick-leave this money ought to be used to shorten the waiting time for surgery.

Cost of Illness↗
PubMed2004

Health care reforms in Poland.

This paper examines the shape of the recently reformed health care system in Poland. Until December 31,1998 everyone had access to free health care and the medical institutions were financed by the State. Since January 1, 1999, under the provisions of the Universal Health Insurance Act, hospitals became independent from the State budget and gained more financial resources for their activities. 17 regional health insurance funds contract for medical services with hospitals and individual practices. Most services provided to the insured are paid by the funds that receive premiums, but some are still financed from the State budget. The revised legislation on Medical Care Establishments intended to create a better management of health care institutions and administrative control over the quality of care. The system has been severely criticised: it is too bureaucratic, there are too many insurance funds, patients have experienced problems with access to health care, particularly to special treatment or to treatment available outside the area of the health insurance fund to which the patient belongs. The new Minister for Health suggested that the 17 funds should be replaced by 5 "health funds" that would finance health care and be closely connected to the local government answerable for their activities. This paper will deal with the scope of health care packages, the conditions of provision of health services, obligations of health care providers, patient rights, and the quality of health care.

Delivery of Health Care↗
PubMed1991

British Columbia sends patients to Seattle for coronary artery surgery. Bypassing the queue in Canada.

Concern about waiting lists for elective procedures has become a highly visible challenge to the universal health insurance program in Canada. In response to lengthening queues for patients waiting for cardiac surgery, British Columbia made contracts with four Seattle hospitals to send a total of 200 patients for coronary artery bypass surgery. This article examines the cause of the queue for cardiac surgery in British Columbia and the events that led to outside contracting. Global hospital budgets and restrictions on capital expansion have limited hospital capacity for cardiac surgery. This constrained supply, combined with periodic shortages in critical care nurses and cardiac perfusion technologists, has resulted in a rapid increase in the waiting list. Reducing wide variations in the lengths of queues for individual surgeons may afford an opportunity to reduce long waits. While the patient queue for cardiac surgery has sparked a public debate about budget limits and health care needs, its clinical impact remains uncertain.

British Columbia↗
PubMedDate not supplied

Policy options for a national health care plan.

Renewed interest in a national health care scheme has inspired several proposals ranging from an expansion of Medicaid and Medicare to government sponsored universal health insurance. The current task for nurses is to understand all the options and select the one most appropriate for both the profession and the nation's health.

American Medical Association↗
PubMed1978

Patients of internists in hospital outpatient departments and in private practice.

To test the contention that patients in outpatient departments and private practices differ, variables were assessed that might affect both the process and the outcome of medical care. Two groups of 60 patients consulting nine Montreal internists who worked in both private practice and in an outpatient department of a university teaching hospital were surveyed. The internists served as their own controls. The two groups of patients were compared for 57 demographic, socioeconomic, access, utilization, attitudinal and current medical status variables. Financial factors were minimized by the existence of universal health insurance. The outpatient group was found to be older, less fluent in English, less likely to be employed, less educated, less wealthy, more dependent on public transportation, more disabled, more likely to use ambulatory services, more anxious about health, and more sceptical about physicians, yet more dependent on them than the private practice group. The outpatient group tended to have more active, significant medical conditions and to receive more prescriptions for medication than the private practice group, in contrast to the national patterns in the practice of internal medicine in the United States. Medical educators, researchers, administrators and providers of health care who have assumed that these two groups of patients are comparable must re-evaluate their practices.

Adult↗
PubMed1997

Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma.

OBJECTIVE: To determine whether the use of inhaled and nasal glucocorticoids is associated with an increased risk of ocular hypertension or open-angle glaucoma. DESIGN: Case-control study. SETTING: Québec universal health insurance program for all elderly (registered in the Régie de l'assurance maladie du Québec [RAMQ] database). PATIENTS: Enrollees in the RAMQ database aged 66 years and older. The 9793 case patients were ophthalmology patients with a new diagnosis of borderline glaucoma or open-angle glaucoma or were newly started on treatment for ocular hypertension or glaucoma between 1988 and 1994. The 38,325 control patients were randomly selected among noncases with ophthalmologist visits in the same month and year as the case event (index date). MAIN OUTCOME MEASURES: The odds ratio (OR) of ocular hypertension or open-angle glaucoma was determined in patients using inhaled or nasal glucocorticoids relative to nonusers, using conditional logistic regression analysis. The OR was adjusted for age, sex, diabetes mellitus, systemic hypertension, use of ophthalmic and oral glucocorticoids, and characteristics of health care system use in the year before the index date. RESULTS: Overall, current use of inhaled and nasal glucocorticoids was not associated with an increased risk of ocular hypertension or open-angle glaucoma. Current users of high doses of inhaled steroids prescribed regularly for 3 or more months were at an increased risk with an OR of 1.44 (95% confidence interval, 1.01-2.06). CONCLUSION: Prolonged administration of high doses of inhaled glucocorticoids increases the risk of ocular hypertension or open-angle glaucoma. This finding suggests that in these patients intraocular pressure monitoring may be warranted.

Administration, Inhalation↗
PubMed1998

Rationing of hospital services in the Australian health system.

This article reports on the rationing in the Australian hospital sector and explains why it has been undertaken. It also briefly overviews the Australian health system in order to provide a necessary background for the issue of rationing itself. Rationing of hospital services has occurred because governments in Australia have limited hospital sector resources trying to ensure the containment of their health budgets. The resources available to hospitals have been insufficient to ensure that the supply of services meets the demand for such services. Therefore, in order to contain hospital budgets rationing has been required. Medicare, the universal health insurance system, assures that access to public hospital services is on the basis of clinical needs. However, due to the federal nature of government in Australia, the available services are determined by health system structural interrelationships and direct government regulation. For example, services provided in the community sector, and funded by the Commonwealth government, are prime candidates for being removed from the hospital sector by State/Territory governments. Similarly, expensive services with a wide range of usage are candidates for regulation to contain costs.

Australia↗
PubMedDate not supplied

Health insurance in Mexico: achieving universal coverage through structural reform.

Fairness in finance is an intrinsic and challenging goal of health systems. Mexico recently devised a structural reform that responds to this challenge. Through a new system of social protection in health that will offer public insurance to all citizens, the reform is expected to reduce catastrophic and out-of-pocket spending while promoting efficiency, more equitable resource distribution, and better-quality care. This paper analyzes the reform, focusing on financial features, expected benefits, and future challenges. It also highlights aspects of relevance for other countries that are striving to formulate and implement health policies to promote universal social protection and fair financing.

Health Care Reform↗
PubMedDate not supplied

Direct reimbursement of nurse practitioners in health insurance plans of research universities.

The purpose of this study was to explore the nature of health insurance coverage research universities offer their employees and the extent to which these employers offer options providing for reimbursement of services of independent nurse practitioners. A request for health insurance documents mailed to 77 public research universities resulted in a response rate of 83 per cent. A total of 75 per cent sent usable descriptions of insurance coverage for analysis. Among the respondents, 69 per cent (n = 40) reported offering insurance through Blue Cross/Blue Shield companies. Nursing services reimbursed generally included traditional nursing care such as private duty nursing and home health care. Coverage of nursing services that overlap with traditional medical practice, such as prenatal care and labor and delivery services of nurse midwives, anesthesia services of nurse anesthetists, psychiatric services of nurse specialists, and primary care nursing services of nurse practitioners, was less evident. Findings generally indicated that in spite of the presence of enabling or mandatory state legislation for third-party reimbursement of nursing services, legislation is not being implemented in many states by employers in their purchase of group policies.

Data Collection↗