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At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

States' control of prescription drug spending: a heterogeneous approach.

In an effort to balance Medicaid budgets, states use prescription drug cost containment tools in unique ways and in varying combinations. We report on the variability in state-level strategies to control the cost of prescription drugs and describe broad state-to-state differences in per beneficiary spending on drugs. This heterogeneity raises the question of appropriate state program variability. Research is needed to determine the medically, ethically, and legally most suitable means of controlling drug costs, especially as the Medicare Part D drug plan will likely recapitulate the prescription drug program variability observed among the states.

Aged↗
PubMedDate not supplied

Pharmaceutical promotion, advertising, and consumers.

Proponents of drug promotion and advertising claim that it is informative and educational; opponents are concerned that the information conveyed encourages inappropriate and unnecessary use. Health Affairs papers by Joel Weissman and colleagues and by Robert Dubois provide some validation for the views of both sides of this debate but do not allow us to draw definitive conclusions about key issues involving inappropriate use of expensive medications and their substitution for cheaper medications that are just as effective. The extent to which consumers have been protected from the rising cost of pharmaceuticals further muddles the picture. However, new insurance benefit designs that threaten to shift more costs to consumers may fuel demand for more comprehensive and balanced information.

Advertising↗
PubMed1982

Consumer choice between dental delivery systems.

This study has attempted to identify the issues on which consumer choice of dental plan depends and to point out the implications both for dentists continuing a traditional fee-for-service practice in the community and those organizing a prepaid group plan. The past decade has been a phenomenal growth in dental insurance and the emergence of alternatives in dental care delivery. Dual choice plans are now available in several areas of the nation, and the growth of these plans has been proceeding slowly but steadily. The future balance between prepaid group plans and fee-for-service plans will depend on the consumer's preference.

Adult↗
PubMed1993

Medicare: trends in reimbursing hospital dental practices.

A survey of dentists working in hospitals found that dental procedures covered under Medicare are not equally reimbursed. Lack of uniform guidelines, appropriate interpretation and universal claim forms lead to problems. Most respondents favor medically adjunctive dental care in the national health care reform.

Aged↗
PubMed2000

The noble lie.

Explore the source record for details and available documents.

Deception↗
PubMed2005

The ins and outs of dental insurance.

BACKGROUND: In the past three decades, dental insurance has become a permanent fixture in the delivery of dental services. Some would argue that this has not been good for dentists. However, none will dispute that it is here to stay and that dentists must make some very important decisions in their practices with regard to dental insurance. This article will explore some of those decisions and offer some guidance on how to decide wisely. CONCLUSIONS: Dental insurance now is a permanent fixture in the delivery of dental care. Each dentist must decide if participation with a dental insurance company is in his or her best interest. To make this decision, a dentist must have as much information as possible to evaluate each specific dental plan. If a dentist does decide to participate, the dentist must know the rules. PRACTICE IMPLICATIONS: Participation with a dental insurance company may influence the dentist-patient relationship. Dentists must be prepared to answer the question, "Why do I need this service if my dental insurance does not cover it?" Non-participation with a dental insurance company may result in a reduced number of new patients.

Computer Communication Networks↗
PubMed2006

Dealing with dental insurance.

Dental insurance companies can have many different policies, with varying requirements depending on the company. This requires a tremendous amount of time on the part of dentists and their office teams to communicate with insurance companies, file all the proper data, acquire predetermination information when required and address a myriad of other factors. By managing this process carefully, practices can save time and labor expenses, especially if patients are well-educated regarding what their dental insurance covers and what it does not.

Dentist-Patient Relations↗
PubMed2006

Imminent suicide: the illusion of short-term prediction.

The concept of imminent suicide is examined. A search of National Electronic Library for Mental Health, the Cochrane Library, PubMed, OVID and MD Consult databases was conducted using the terms "suicide, imminent." The term imminent frequently appears in the mental health literature, finding common usage among clinicians. It is also a legal term of art embedded in civil commitment statutes; duty to warn and protect statutes and case law, usually under the rubric of dangerousness; and in seclusion and restraint policies. Managed care admission protocols may contain imminence criteria for patients at risk for suicide before approving insurance benefits, yet no suicide risk factors exist for the short-term prediction of suicide.

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

Health plan member experience with point-of-service prescription step therapy.

OBJECTIVE: To better understand health plan member experience with point-of-service prescription step-therapy edits and outcomes in terms of drug received. METHODS: Self-administered mailed surveys were sent to 1,000 members who experienced a step-therapy edit from September 1, 2002, through January 31, 2003, for proton pump inhibitors or nonsteroidal anti-inflammatory drugs. Based upon these findings, a second survey was conducted by telephone among 617 members who experienced a step-therapy edit from January through April 25, 2003, and who had no subsequent prescription claim for the drug therapy class associated with the edit. RESULTS: The mailed survey generated a 23% response rate, and the telephone survey generated a 33% response rate. Just over 66% of the mail survey respondents indicated that they contacted their physician directly to try to remedy the situation, while 40% indicated that their pharmacist contacted their physician. Forty-four (44%) percent of members indicated that they received a different medication than was originally prescribed, 15% obtained prior authorization for the brand medication, 11% received no medication, 11% paid full price for the branded medication, 8% got an over-the-counter medication, and 4% received samples from their physician. Approximately 7% sought other means of obtaining coverage (i.e., they used spouse.s insurance) or did not remember the outcome. Member and pharmacy contact with the physician significantly influenced whether the member obtained a medication covered by their health plan (odds ratio [OR] = 6.5; 95% confidence interval [95% CI], 2.76-15.12 and OR = 4.6; 95% CI, 1.96-10.60, respectively). In a separate survey conducted by telephone among a different group of members, insight into reasons why members did not obtain any medication was obtained. Using a closed-ended question, 12% (n = 25) of members indicated receiving no medication. Upon further questioning, however, 32% of those who indicated that they had not received a medication said that they had in fact received a medication to treat their condition some time after the step edit. The second most common reason for not receiving a medication included issues related to cost (i.e., willingness to pay) or affordability (16% and 28%, respectively). CONCLUSIONS: The results of this study suggest that a majority of members receive a medication covered by their health plan subsequent to rejection of a claim for a prescribed drug that is the target of a step-therapy edit. However, there are opportunities for better member and provider communication designed to increase the use of first-line drugs and reduce the number of members paying out-of-pocket or receiving no medication.

Adolescent↗
PubMed2004

Long-term care insurance: care management practice issues.

There are numerous articles about the pros and cons of long-term care insurance. However, for many people it is a solution for funding long-term care when they are in need of these services. The provision of appropriate care management to individuals, providers, and insurers results in a "win-win" for everyone. The article discusses the issues surrounding long-term care financing and delivery from the perspective of the groups mentioned previously.

Case Management↗