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PubMed1992

Private insurance reform in the 1990s: can it solve the health care crisis?

A number of health insurance reform proposals have surfaced at the state governmental level in the United States. These include Medicaid expansion for the below-poverty or near-poverty uninsured, state subsidy to individuals and/or businesses for the purchases of health insurance, risk pools for the medically uninsurable, insurance industry-initiated reforms within the small group market, the promotion of "stripped down" insurance plans that reduce premium cost, and state mandating of employer-sponsored health insurance for the employed uninsured. All of these insurance reform proposals have serious limitations: (1) they fail to address the inequities of the underwriting principle by which older and sicker people pay more for health insurance than the young and healthy population; (2) they extend the illogical linkage of employment and health insurance; and (3) they do not slow the rate of health cost inflation nor do they contain a mechanism to finance broader health coverage through savings within the health sector. An alternative to insurance reform is the establishment of a social insurance program that brings the entire population into a single risk pool.

Adult↗
PubMed2005

Managed care and long-term care: a potential solution?

This brief summarizes research by Sparer (2003) and Hughes (2002) on managed care issues for people with long-term care needs. Managed care has been proposed as a solution to the difficult problem of managing the health of this complex population. Sparer's research examines the reasons behind the failure of states' attempts to encourage commercial managed care plans to take on this task. He argues that understanding these reasons can yield important lessons for the mostly provider-sponsored plans that currently serve the long-term care population, as well as for states, that aim to save money and better serve this population. Hughes' evaluation of a small, provider-sponsored organization found that when the organization became a managed care provider, it faced significant organizational challenges that forced it to become more efficient. Importantly, it showed that the use of capitation reimbursed the plan more effectively than fee for service, increased the range of services provided to clients, and maintained client satisfaction; however, capitation did not affect the rate of nursing home admission.

Capitation Fee↗
PubMed1983

Private credentialing of health care personnel: an antitrust perspective. Part Two.

Having argued in Part One against extensive judicial or regulatory interference with private personnel credentialing in the health care field, this Article now shifts its focus to emphasize the anticompetitive hazards inherent in credentialing as practiced by professional interests. Competitor-sponsored credentialing is shown to be a vital part of a larger cartel strategy to curb competition by standardizing personnel and services and controlling the flow of information to health care consumers. Instead of altering the conclusions reached in Part One, however, Part Two sets forth a new and hitherto unexplored agenda for antitrust enforcement, one that the authors believe will increase the quantity and quality of information available to consumers and offer a fairer competitive environment to individuals and groups disadvantaged by the denial of desirable credentials. The specific targets singled out for antitrust scrutiny are (1) the practice of "grandfathering," by which new candidates for credentials are required to meet tougher requirements than were met by existing credential holders; (2) agreements to standardize educational programs if they go beyond setting and applying accrediting standards and impair the freedom of institutions to decide independently whether to offer unaccredited training; (3) agreements by which independent certifying or accrediting bodies limit the nature or scope of competition among themselves; and (4) mergers and joint ventures in credentialing and accrediting. The legal theory supporting antitrust attacks in the latter two categories is strengthened by the apparently original insight that commercial information and opinion are themselves articles of commerce such that agreements and combinations restricting their nature and output can be characterized as restraints of trade. Among the many self-regulatory institutions in the health care field whose operation or sponsorship is called into question by the analysis herein are the leading medical specialty boards, the Liaison Committee on Medical Education, various accrediting and certifying bodies in the allied health occupations, and the Joint Commission on Accreditation of Hospitals.

Accreditation↗
PubMed1995

HPCC and the National Information Infrastructure: an overview.

The National Information Infrastructure (NII) or "information superhighway" is a high-priority federal initiative to combine communications networks, computers, databases, and consumer electronics to deliver information services to all U.S. citizens. The NII will be used to improve government and social services while cutting administrative costs. Operated by the private sector, the NII will rely on advanced technologies developed under the direction of the federal High Performance Computing and Communications (HPCC) Program. These include computing systems capable of performing trillions of operations (teraops) per second and networks capable of transmitting billions of bits (gigabits) per second. Among other activities, the HPCC Program supports the national supercomputer research centers, the federal portion of the Internet, and the development of interface software, such as Mosaic, that facilitates access to network information services. Health care has been identified as a critical demonstration area for HPCC technology and an important application area for the NII. As an HPCC participant, the National Library of Medicine (NLM) assists hospitals and medical centers to connect to the Internet through projects directed by the Regional Medical Libraries and through an Internet Connections Program cosponsored by the National Science Foundation. In addition to using the Internet to provide enhanced access to its own information services, NLM sponsors health-related applications of HPCC technology. Examples include the "Visible Human" project and recently awarded contracts for test-bed networks to share patient data and medical images, telemedicine projects to provide consultation and medical care to patients in rural areas, and advanced computer simulations of human anatomy for training in "virtual surgery."

Computer Communication Networks↗
PubMed2006

Federal communication about obesity in the Dietary Guidelines and checkoff programs.

The new Dietary Guidelines for Americans focus on obesity prevention. They recommend increased consumption of whole grains, fruits, vegetables, fish, and low-fat dairy products, within a balanced diet whose total calories have been moderately reduced. Meanwhile, other well-known and well-funded federally sponsored consumer communications promote increased total consumption of beef, pork, and dairy products, including energy dense foods such as bacon cheeseburgers, barbecue pork ribs, pizza, and butter. These latter communications are sponsored by the federal government's commodity promotion programs, known as "checkoff" programs. The programs are established by Congress, approved by a majority of the commodity's producers, managed jointly by a producer board and the U.S. Department of Agriculture, and funded through a tax on the producers. The federal government enforces the collection of more than 600 million US dollars annually in mandatory assessments, approves the advertising and marketing programs, and defends checkoff communication in court as the federal government's own message-in legal jargon, as its own "government speech." Federal support for promoting fruits and vegetables is small by comparison. The checkoff programs recently have become more clearly identified as federal programs. After a recent decision by the U.S. Supreme Court upholding the constitutionality of the checkoff programs, calls for consistency with the Dietary Guidelines may get louder. The current inconsistencies in federal communication undermine the effectiveness of the Dietary Guidelines as an antidote to the shortcomings of the private sector market for information about weight and obesity.

Advertising↗
PubMed1988

Productivity and selected indicators of care in maternity and infant care and children and youth projects according to sponsorship.

Bureau Common Reporting Requirements (BCRR) data tapes for Fiscal Year 1980 were analyzed to determine whether the type of sponsoring agency influenced the productivity or indicators of care of Maternity and Infant Care and Children and Youth Projects. Sponsors were classified as either health department or non-health department, health department or major medical center, or public or private in three separate sets of analyses. Some of these analyses indicated that special projects that were either health department or public agency sponsored were more likely to have more non-medical patient encounters and more health education and social work staff for a given level of expenditures. Although publicly sponsored projects employed fewer physician equivalents than did the non-public projects, those physicians were more productive. Despite these differences in encounters, staffing, and utilization of physicians, there were no differences in available measures of the process of care between categories of projects in any of the analyses.

Child↗
PubMed1990

A new elderly support system in rural areas in Shanghai.

"In early 1987, we started an experiment in the rural areas in Shanghai suburbs on how to replace the elderly support system then in effect, which was funded by the community, with one that was to be jointly supported by the State, the community and private individuals. The two-year experiment has yielded a new elderly support system applicable to China's rural areas that have a more developed economy and a fairly large number of collectively owned township enterprises.... This article gives a brief introduction to the economic and social background and characteristics of the system."

Adult↗
PubMed2005

Harnessing genomics to improve health in the Eastern Mediterranean Region - an executive course in genomics policy.

BACKGROUND: While innovations in medicine, science and technology have resulted in improved health and quality of life for many people, the benefits of modern medicine continue to elude millions of people in many parts of the world. To assess the potential of genomics to address health needs in EMR, the World Health Organization's Eastern Mediterranean Regional Office and the University of Toronto Joint Centre for Bioethics jointly organized a Genomics and Public Health Policy Executive Course, held September 20th-23rd, 2003, in Muscat, Oman. The 4-day course was sponsored by WHO-EMRO with additional support from the Canadian Program in Genomics and Global Health. The overall objective of the course was to collectively explore how to best harness genomics to improve health in the region. This article presents the course findings and recommendations for genomics policy in EMR. METHODS: The course brought together senior representatives from academia, biotechnology companies, regulatory bodies, media, voluntary, and legal organizations to engage in discussion. Topics covered included scientific advances in genomics, followed by innovations in business models, public sector perspectives, ethics, legal issues and national innovation systems. RESULTS: A set of recommendations, summarized below, was formulated for the Regional Office, the Member States and for individuals.* Advocacy for genomics and biotechnology for political leadership;* Networking between member states to share information, expertise, training, and regional cooperation in biotechnology; coordination of national surveys for assessment of health biotechnology innovation systems, science capacity, government policies, legislation and regulations, intellectual property policies, private sector activity;* Creation in each member country of an effective National Body on genomics, biotechnology and health to:- formulate national biotechnology strategies- raise biotechnology awareness- encourage teaching and training of biotechnology- devise integration of biotechnology within national health systems. CONCLUSION: The recommendations provide the basis for a road map for EMR to take steps to harness biotechnology for better and more equitable health. As a result of these recommendations, health ministers from the region, at the 50th Regional Committee Meeting held in October 2003, have urged Member States to establish national bodies of biotechnology to formulate a strategic vision for developing biotechnology in the service of the region's health. These efforts promise to raise the profile of genomics in EMR and increase regional cooperation in this exciting new field.

Editorial↗
PubMed1989

Fostering primary and secondary prevention in public policy for pregnant adolescents.

The diverse factors associated with sexuality among adolescents and the specific issues related to contraception in this developmentally diverse group result in complexity in policy formation. The future of an adolescent may be determined solely on the basis of access to supportive physical and emotional services funded by public and private sector monies. The purpose of this paper is to briefly present contemporary and social policies regarding pregnant adolescent health care. Suggestions as to how these policies can be translated into public adolescent health models are provided. The strategies will be related to primary and secondary public policy interventions.

Adolescent↗
PubMed1985

Health care for some: a Nigerian study of who gets what, where and why?

The persistent underdevelopment of health in the Third World belies the optimism of the "Health care for all by the year 2000" campaign. In order to understand the underdevelopment of health, it is essential to examine the historical evolution of specific health systems. These ideas are developed in a case study of health care in Kano State, Nigeria. The nature and contemporary development of the health care system, which includes state voluntary agency and private sector outlets for Western scientific medicine and a large and varied traditional medicine sector, are examined. Although the deepening health care crisis may potentially spur a reconsideration of priorities and strategies, past experience suggests that a stubborn retention of a pared-down and increasingly unjust version of the present system is more likely.

Health Resources↗
PubMed1998

Risk management and data: managed care company perspective.

As both public and private health plans move increasingly to managed care, a vigorous debate is occurring about how to ensure health care quality for the American public, while at the same time managing the cost of that care. Health plans generate large volumes of data related to their networks and providers, plan sponsors, member care, and medical protocols. This data can help assure quality, and at the same time help managed care organizations deal with one of the most critical tasks facing them--risk management. This paper may be helpful in providing an outline of two key areas--managed care liability for quality of patient care, and privacy and confidentiality concerns from a managed care organization perspective--followed by suggestions to avoid or minimize liability.

Confidentiality↗
PubMed1997

Endocrine disruptors and reproductive development: a weight-of-evidence overview.

It is clear that the endocrine system presents a number of target sites for the induction of adverse effects by environmental agents (Fig. 1). There are numerous examples demonstrating that reproductive and developmental processes may be exquisitely sensitive to exposure and there are clear effects induced by presumed endocrine-disrupting chemicals in a variety of species. The concerns raised by studies of wildlife and humans place added significance on a better understanding of the myriad of effects attributed to endocrine disruptors. But there remains a large void between the study of relatively high exposure levels used in laboratory settings versus the relatively low levels found in the general environment. It is also equally clear that the term "endocrine disruption' has been applied to situations where the biological basis is far from conclusive. This may be a moot point in situations where populations are experiencing adverse effects on reproduction, but as scientists we must be vigilant of the appropriate use of descriptive terminology, particularly in cases where public awareness and concern are as great as this. Not only is there a need for better test procedures (both in vivo and in vitro) to characterize the potential of environmental agents to disrupt endocrine function in laboratory species, but there is also a need for a more comprehensive understanding of the normal physiological processes associated with reproduction and development in those wildlife species studied. At the same time, obtaining better information on the transport, fate and bioavailability of chemicals released into the environment remains an important but imposing task. The goals of risk characterization are to carefully delineate cause-and-effect relationships, define the dose-response relationships, and determine whether environmental exposures exceed acceptable levels. A concerted research effort is needed to fill the voids in our knowledge and reduce the large uncertainties that exist today. Only then can regulatory actions take place within the confines of legislative mandates, remediation strategies and considerations of international use and transport. Towards this end, the US Environmental Protection Agency (EPA) sponsored two workshops in 1995 (Ankley et al. 1996, Kavlock et al. 1996) at which groups of international scientists began the process of identifying research needs. Similar efforts also took place in several European countries at about the same time (Danish Environmental Protection Agency 1995, Medical Research Council 1995, Umweltbundesamt 1995). More recently, a Working Group on Endocrine Disruptors has been established within the Committee on the Environment and Natural Resources of the US Government's National Science and Technology Council. The objectives of this Working Group are to (1) formulate a framework for identifying research needs related to the health and ecological effects of endocrine-disrupting chemicals; (2) conduct an inventory of on-going federal research programs; and (3) identify research gaps and facilitate a co-ordinated research plan to address them. These efforts were largely completed in the Fall of 1996 and the information will be made available via the Internet (http;@www.cpa.gov/endocrine). The group also plans to work more broadly with other governments and private industry and public interest groups conducting research on this tissue to co-ordinate research and disseminate scientific information. Persons wishing to know more about this effort should contact the authors. The issue of endocrine disruption has raised the consciousness of many researchers, both within and outside the toxicology community, and has attracted considerable public and political interest. We now have the beginnings of international co-operation to identify the most important scientific uncertainties and to dedicate resources to address the critical gaps. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed1984

Report of a planning conference concerning an international network of food data systems (INFOODS).

A small international planning conference on the topic of "An International Network of Food Data Systems" was held on January 30 to February 5, 1983, at the Rockefeller Conference and Study Center, in Bellagio, Italy. It was sponsored through the Food, Nutrition and Poverty Subprogramme of the United Nations University and supported by various US government agencies, private foundations, and the food industry. Participants included representatives from FAO, WHO, IUNS, and IUFoST. The purpose was to explore the needs for, and current limitations of, food composition data bases, especially in the international context, and to propose what was needed. The conference focused on the design and scope of an organization to be called INFOODS (International Network of Food Data Systems) which would promote international participation and cooperation in the acquisition and interchange of quality data on the nutrient composition of foods, beverages, and their ingredients in forms appropriate to meet the needs of government agencies; nutrition scientists; health and agriculture professionals; policy makers and planners; food producers, processors, and retailers; consumers. The conference identified the more important aspects of INFOODS to include: 1) a network of regional data centers; 2) an organizational/administrative framework for various expert task forces; 3) the generator and repository of special international data bases; 4) the stimulator of national data base programs; 5) a general and specific resource for persons and organizations interested in food composition data on a worldwide basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Computers↗
PubMed2006

The effects of expanded mental health benefits on treatment costs.

BACKGROUND: Mental health disorders represent one of the most common problems facing adults in the labor force. It is estimated that within a 12-month period nearly 30% of the US population experiences some diagnosable mental health or addictive disorder. This study examines the impact that corporate benefit policies can have on mental health treatment costs. AIMS: To measure the effects of a change in mental health benefit design on treatment expenditures for employees of a large US-based company. METHODS: Data came from mental health treatment administrative claims and eligibility information provided by the company and a comparable set of claims for a randomly selected control group for the years 1995-1998. We measure the effect of a change in mental health benefits consisting of three major elements: a company-wide effort to destigmatize mental illness; reduced cost-sharing for mental health treatment; and the implementation of a provider network that emphasized access to non-physician mental health specialists. We use a two-part regression model within a difference in differences framework to examine outpatient, pharmaceutical, and combined outpatient and pharmaceutical expenditures between the treatment company and the control group. RESULTS: We find that the program led to a statistically significant dollar 17 increase in outpatient costs (excluding pharmaceutical costs) per employee. Similar to outpatient care we find that the benefit change was associated with a statistically significant increase in pharmaceutical costs of about dollar 15. DISCUSSION: The results reveal that the mental health benefit expansion at the company led to a significant increase in aggregate mental health expenditures among employees. However, the aggregate increase in cost masks a number of interesting underlying trends in mental health utilization. First, conditional upon any mental health treatment, mental health costs were virtually unchanged before and after the benefit change. Conditional on any use, outpatient and pharmaceutical expenditures went in opposite directions, with outpatient expenditures falling and pharmaceutical expenditures increasing. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Private sector initiatives can increase use of mental health care treatment through decreased cost-sharing, improved access to specialty providers, and destigmatization of mental disorders. IMPLICATIONS FOR HEALTH CARE POLICY FORMULATION: Given that the vast majority of people in the US get their health insurance through employer-sponsored health insurance, efforts on the part of the private sector to recognize and treat serious chronic illnesses such as mental disorder in a proactive manner should be encouraged. IMPLICATIONS FOR FUTURE RESEARCH: While the aggregate cost of corporate initiatives to improve access to quality mental health care is frequently examined, it is also important to decompose the aggregate cost changes into effects from a change in the rate of initiation and changes in utilization conditional upon initiation.

Adolescent↗
PubMed1975

On paying the fiddler to change the tune: further evidence from Ontario regarding the impace of universal health insurance on the organization and patterns of medical practice.

This paper compares the findings from a 1973 community household interview survey conducted in Sault Ste. Marie, Ontario, with the findings from a similar study conducted in 1968 in the same city by a research team from the World Health Organization. Sault Ste. Marie is the site of the first Canadian consumer-sponsored prepaid group practice. Opposition by the private, solo practice sector of this community to this new modality of medical practice was considerable. Since 1969, with the introduction of universal health insurance in Ontario, the cost and benefit differences between solo and group practice medical care have been eliminated. By comparing the findings from the 1973 study with similar data from the 1968 WHO survey, observations can be made about the impact of universal health insurance on the organization and patterns of medical practice. Implications for the United States are important in view of the recent passage of the Health Maintenance Organization Act of 1973 and the expected enactment of some form of national health insurance.

Consumer Behavior↗
PubMed1993

[Making census data accessible to local users in the public and private sectors].

The authors outline ways in which government statistical offices can make census data available to local public- and private-sector users. Several computer programs, including REDATAM-Plus and Geographical Information Systems, are discussed. "The successful implementation of the use of the census data at the local level will require that...national agencies facilitate the institutionalization of technology transfer by providing, among other things, technical support, training at a distance, data and cartography standards, and solutions to data protection issues." The geographical focus is on Latin America and the Caribbean. (SUMMARY IN ENG)

Americas↗
PubMed1999

Mental health carve-outs: effects and implications.

To control the rise in expenditures and to increase access to mental health and substance abuse (MH/SA) services, a growing number of employers and states are implementing a "carve-out." Under this arrangement, the sponsor separates insurance benefits by disease or condition, service category, or population and contracts separately for the management of care and/or associated risks. A carve-out allows a unique set of managed care techniques to be applied to a subset of particularly costly or complex benefits. This article describes various carve-out models, discusses the potential advantages and disadvantages of a full carve-out, and summarizes recent public and private sector research regarding the strategy's effects on access and use, cost savings and shifting, and quality of care. It concludes by discussing approaches to the assessment and monitoring of the processes and outcomes associated with a MH/SA carve-out.

Contract Services↗
PubMed1995

The use of case management services in long-term care insurance policies.

This article presents findings from a recently completed Health Insurance Association of America-sponsored survey that sought to measure the extent to which long-term care insurers utilize case/care management services in their policies. The survey sought to measure the extent to which long-term care insurers paid for newer, long-term care alternatives. Contrary to previous findings in the literature, the survey results show that case management services are typically delivered through a combination of internal and external networks, and are utilized primarily by insurers in employer markets. In light of national health care reform, these survey results indicates a need to reexamine the role of case management in delivering long-term care services, particularly within private financing mechanisms such as long-term care insurance.

Case Management↗