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PubMed1979

The competitive response of Blue Cross and Blue Shield to the health maintenance organization in Northern California and Hawaii.

The health maintenance organization (HMO) can provide an alternative to the predominant form of health care delivery in the United States, fee-for-service. Although market penetration of the HMO is relatively low in most parts of the country, the HMO has achieved a significant market share in a number of states. This paper examines the competitive response of Blue Cross and Blue Shield to the introduction of the HMO in two geographic regions with significant HMO activity, northern California and Hawaii. The evidence obtained from extensive interviews indicates that Blue Cross and Blue Shield plans have responded to HMO competitive pressure by establishing their own HMOs and by altering traditional procedures. HMO competition has stimulated Blue Cross and Blue Shield to make greater cost control efforts and to offer larger benefit packages. These results can have important policy implications for the role that HMOs are to play in cost containment.

Blue Cross Blue Shield Insurance Plans↗
PubMed1987

Relationship between patient race and the intensity of hospital services.

This study reviews evidence on whether services in United States hospitals vary by racial groupings of patients. The focus is on both equity and quality of hospital services. Patients with the diagnosis of pneumonia were studied at 16 randomly selected hospitals. The services and outcomes studied include five measures of the intensity of diagnostic and therapeutic services received by patients, and death rates during hospitalization. Multiple regression was used to control for patient health status at the time of entry into the hospital. Results are presented both before and after controlling for the effects of differences in the services offered between hospitals and patient payment sources. Our findings suggest that nonwhite pneumonia patients received fewer hospital services than expected on the basis of their health characteristics, and that their hospital lengths of stay were longer than expected. These findings were apparent when the hospitals were examined in aggregate and within individual institutions. No consistent differences in death rates were apparent. Possible explanations for these results are discussed. From our data, we conclude that patient race remains a potentially significant characteristic in determining the intensity of care provided to patients in hospitals, which is not explained by differences among racial groups in health status, source of payment, or site of hospitalization.

Black or African American↗
PubMed2006

Prescription drug expenditures and population demographics.

OBJECTIVE: To provide detailed demographic profiles of prescription drug utilization and expenditures in order to isolate the impact of demographic change from other factors that affect drug expenditure trends. DATA SOURCES/STUDY SETTING: Demographic information and drug utilization data were extracted for virtually the entire British Columbia (BC) population of 1996 and 2002. All residents had public medical and hospital insurance; however their drug coverage resembled the mix of private and public insurance in the United States. STUDY DESIGN: A series of research variables were constructed to illustrate profiles of drug expenditures and drug utilization across 96 age/sex strata. DATA COLLECTION/EXTRACTION METHODS: Drug use and expenditure information was extracted from the BC PharmaNet, a computer network connecting all pharmacies in the province. PRINCIPAL FINDINGS: Per capita drug expenditures increased at an average annual rate of 10.8 percent between 1996 and 2002. Population aging explained 1.0 points of this annual rate of expenditure growth; the balance was attributable to rising age/sex-specific drug expenditures. CONCLUSIONS: Relatively little of the observed increase in drug expenditures in BC could be attributed to demographic change. Most of the expenditure increase stemmed from the age/sex-specific quantity and type of drugs purchased. The sustainability of drug spending therefore depends not on outside forces but on decisions made by policy makers, prescribers, and patients.

Adolescent↗
PubMed2004

Double filtration plasmapheresis for the treatment of a rheumatoid arthritis patient with extremely high level of c-reactive protein.

A 68-year-old-male who was diagnosed as having rheumatoid arthritis (RA) 7 years previously was admitted the Chiba Social Insurance Hospital due to general fatigue, spiking fever, and appetite loss. Blood tests showed extremely high levels of C-reactive protein (CRP, 318.5 mg/dL), and hypergammapathy (IgG 3228 mg/dL, IgA 905 mg/dL, IgM 2537 mg/dL) and high titers of rheumatoid factor (RAPA 40960X). He was diagnosed as having RA with vasculitis, according to interstitial pneumonitis, cutaneous nodules and polyneuropathy. Prednisolone (30 mg/day) was prescribed, however, myeloperoxidase-antineutrophil cytoplasmic antibody proved to be positive (86EU) and cyclophosphamide (50 mg/day) was added one week later. Additionally, IgM K-chain M-protein was revealed and the differentiation between auto-immune and hematologic diseases was required for further drug prescriptions. Therefore, double filtration plasmapheresis (DFPP) was initiated weekly. Hematologic diseases were negated and the hypergammapathy was improved. C-reactive protein and MPO-ANCA decreased to the normal level after three sessions (IgG 1064 mg/dL, IgA 331 mg/dL, IgM 94 mg/dL, CRP 0.04 mg/dL) and the patients symptoms improved. Prednisolone was tapered and he was discharged. It was suggested that the case presented here was quite rare, having an extremely high level of CRP which was successfully managed by DFPP.

Aged↗
PubMed2000

Lung nodules: dual-kilovolt peak analysis with CT--multicenter study.

PURPOSE: To test the following hypothesis: The greater the increase in the mean computed tomographic (CT) number of a radiologically indeterminate lung nodule from the CT number on a 140-kVp CT image to that on an 80-kVp CT image, the more likely the nodule is benign (ie, contains calcium). MATERIALS AND METHODS: Two hundred forty indeterminate lung nodules were prospectively studied at four institutions: Mayo Clinic Scottsdale, Ariz (n = 160); Mayo Clinic Rochester, Minn (n = 50); Shiga Health Insurance Hospital, Otsu, Japan (n = 25); and Duke University Medical Center, Durham, NC (n = 5). Of the 240 nodules, 157 met the entrance criteria for this study and had a diagnosis. All nodules included were solid, 5-40-mm diameter, relatively spherical, homogeneous, and without visible evidence of calcification or fat. Each nodule was evaluated by using 3-mm-collimation, nonenhanced CT scans with both 140- and 80-kVp x-ray beams. RESULTS: There were 86 (55%) benign and 71 (45%) malignant nodules. The median increase in the nodule mean CT number from the CT number on 140-kVp images to that on 80-kVp images was 2 HU for benign nodules and 3 HU for malignant nodules. This difference was not statistically significant. The area under the receiver operating characteristic curve was 0.505. CONCLUSION: Dual-kilovolt peak analysis with current CT technology does not appear to be helpful in the identification of benign lung nodules.

Adult↗
PubMed1992

Evaluation of emerging technologies for coronary revascularization. Participants in the National Heart, Lung, and Blood Institute Conference on the Evaluation of Emerging Coronary Revascularization Technologies.

Despite significant advances in coronary angioplasty, the problems of restenosis, chronic total occlusion, diffuse disease, and abrupt closure after the procedure remain to be solved. New devices that address these problems continue to evolve. Although a controlled clinical trial is the ultimate test of any device, rapid device design changes and resource limitations require evaluating which of the new devices justify a full clinical trial. A registry mechanism for this initial evaluation is proposed and detailed. Payment for procedures using new devices is a problem for industry, insurers, hospitals, and physicians. It is proposed that reimbursement be based on the service performed rather than the device used to perform it. Costs beyond the clinical costs should be borne by the sponsor of the device. Financial conflict of interest is a recognized problem in new device evaluation. It is not always practical to insist on exclusion from the evaluation process of individuals with a financial stake in the outcome, but disclosure of the presence of such a financial interest is recommended in the reporting of results.

Angioplasty, Balloon, Coronary↗