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PubMed1988

Providing home care services in a for-profit environment.

It is no surprise that politics and ideology will determine the future of home health and long-term care. Those same forces will also dictate whether home care services will become more or less dependent upon federal support. At the moment the prospects are not promising. Over the last several years our national reimbursement policies have pointed toward more and more stringent use of Medicare home health care benefits, despite the assumptions (and the data) that prospective payment systems might legitimately increase their use. The implementation of tight cost limits, consolidation to ten regional fiscal intermediaries, and increased claim denials have signaled home care agencies that cost containment is the aim of the present conservative administration. Private insurance companies, however, have begun to examine the prospects for long-term care and home care policies. Presently, most home care benefits are available through employment-based policies, which, of course, are nearly useless to the elderly, the major users of home care services. But what if businesses provided more comprehensive health care policies so that their employees could have better protection in the case of long-term illnesses? What if the giant corporation such as IBM, Xerox, General Electric, General Motors, and so forth, established programs to underwrite the cost of long-term care? What if private insurance companies attempted to spread the risks among thousands of policy holders so that long-term care insurance premiums were affordable to most older Americans? Rather than new sources of funding, it is more reasonable to expect that the financing of home care services will be reshaped by innovative reimbursement strategies. The future will probably bring prospective, resource-sensitive, or capitated schemes. There are no easy remedies. We must secure the participation of all sectors of our country--both public and private--in a cooperative endeavor. And at the same time we are struggling to reshape the home care financing system, we must continue the effort to reshape the delivery system itself, because the two go hand-in-glove. It is only then that we can begin to allay one of the major deficiencies of our present health care system--the enormous gap in providing and paying for home health care.

Aged↗
PubMed1990

Magnetic resonance imaging simulator: a teaching tool for radiology.

The increasing use of magnetic resonance imaging (MRI) as a clinical modality has put an enormous burden on medical institutions to cost effectively teach MRI scanning techniques to technologists and physicians. Since MRI scanner time is a scarce resource, it would be ideal if the teaching could be effectively performed off-line. In order to meet this goal, the radiology Department at the University of Pennsylvania has designed and developed a Magnetic Resonance Imaging Simulator. The simulator in its current implementation mimics the General Electric Signa (General Electric Magnetic Resonance Imaging System, Milwaukee, WI) scanner's user interface for image acquisition. The design is general enough to be applied to other MRI scanners. One unique feature of the simulator is its incorporation of an image-synthesis module that permits the user to derive images for any arbitrary combination of pulsing parameters for spin-echo, gradient-echo, and inversion recovery pulse sequences. These images are computed in 5 seconds. The development platform chosen is a standard Apple Macintosh II (Apple Computer, Inc, Cupertino, CA) computer with no specialized hardware peripherals. The user interface is implemented in HyperCard (Apple Computer Inc, Cupertino, CA). All other software development including synthesis and display functions are implemented under the Macintosh Programmer's Workshop 'C' environment. The scan parameters, demographics, and images are tracked using an Oracle (Oracle Corp, Redwood Shores, CA) data base. Images are currently stored on magnetic disk but could be stored on optical media with minimal effort.

Computer Simulation↗
PubMed2002

Conditions for dynamic localization in generalized ac electric fields.

We examine the conditions for dynamic localization of electrons in a periodic potential due to an applied ac electric field. Using a general one-band model, we establish the surprising result that only electric fields that are discontinuous at all changes of sign can lead to exact dynamic localization. We also develop a general procedure for constructing ac fields that yield dynamic localization and derive an "area condition" for such fields. We confirm this result numerically in a multiband simulation.

Journal Article↗