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PubMed1999

Change, consolidation, and competition in health care markets.

The health care industry is being transformed. Large firms are merging and acquiring other firms. Alliances and contractual relations between players in this market are shifting rapidly. Within the next few years, many markets are predicted to be dominated by a few large firms. Antitrust enforcement authorities like the Department of Justice and the Federal Trade Commission, as well as courts and legislators at both the federal and state levels, are struggling with the implications of these changes for the nature and consequences of competition in health care markets. In this paper we summarize the nature of the changes in the structure of the health care industry. We focus on the markets for health insurance, hospital services, and physician services. We then discuss the potential implications of the restructuring of the health care industry for competition, efficiency, and public policy. As will become apparent, this area offers a number of intriguing questions for inquisitive researchers.

Antitrust Laws↗
PubMedDate not supplied

The general agreement on trade in services: implications for health policymakers.

The General Agreement on Trade in Services (GATS), created under the auspices of the World Trade Organization, aims to regulate measures affecting international trade in services-including health services such as health insurance, hospital services, telemedicine, and acquisition of medical treatment abroad. The agreement has been the subject of great controversy, for it may affect the freedom with which countries can change the shape of their domestic health care systems. We explain the rationale behind the agreement and discuss its scope. We also address the major controversies surrounding the GATS and their implications for the U.S. health care system.

Health Policy↗
PubMed2004

Quality as a system property: section 646 of the Medicare Modernization Act.

The Medicare Trustees' 2004 report indicates that the Part A Hospital Insurance trust fund will be exhausted by 2019. Medicare's sustainable growth rate (SGR) formula for physician reimbursement is widely recognized as being flawed; if it is not reformed, it may result in reduced access to physician services for beneficiaries. MedPAC proposes an alternative to the SGR formula that involves explicit consideration of Medicare program objectives and ensures that payments for physician services be adequate to maintain access. Section 646 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 may provide answers regarding providing high-quality care in fee-for-service Medicare.

Medicare↗
PubMed2001

Childhood neglect and cognitive development in extremely low birth weight infants: a prospective study.

OBJECTIVE: To examine the relationship between child maltreatment and cognitive development in extremely low birth weight infants, adjusting for perinatal and parental risk factors. METHODS: A total of 352 infants with birth weight of <1000 g were followed prospectively for 4 years. The data were analyzed with regard to perinatal and parental risk factors and referrals for suspected child maltreatment to government agencies. Perinatal risk factors included birth weight, gestation, gender, periventricular hemorrhage, ventricular dilation, home oxygen requirement, and necrotizing enterocolitis. Parental risk factors included maternal age, race, marital status, education, and hospital insurance status. Cognitive z scores were calculated at 1, 2, and 4 years, and head circumference z scores were calculated at birth, 2 years, and 4 years. RESULTS: Fifteen percent of infants were referred to child protective services for suspected child maltreatment. The adjusted general cognitive index at 4 years was significantly reduced in infants who were referred for neglect (-17.6; 95% confidence interval: -3.3, -31.9). Infants whose neglect was substantiated had a progressive decline in their cognitive function over time (cognitive z scores: -0.97, -1.37, and -2.05 standard deviations at 1, 2, and 4 years, respectively), compared with non-neglected infants (z scores: -0.04 to -0.36). They had a significantly smaller head circumference at 2 and 4 years but not at birth (adjusted z score at 4 years: -0.812; 95% confidence interval: -0.167, -1.458). Perinatal risk factors and physical disability were not related to maltreatment referral; only parental factors were independent predictors. CONCLUSIONS: Childhood neglect is associated significantly with delayed cognitive development and head growth. Addressing risk factors antenatally and in early childhood may improve outcomes.

Child Abuse↗
PubMed2005

[The debate on lower back pain and its relationship to work: a retrospective study of workers on sick leave].

Lower back pain has a high prevalence among the Mexican working population, with extensive social and economic repercussions. Official figures show that lower back pain accounts for 10.0 to 15.0% of sick leave excuses. However, this fails to identify any relationship between lower back pain and job conditions, since such leave is only granted if it can be shown that the condition was not work-related. The present study shows that such a relationship does in fact exist. A retrospective study examined all cases (n = 210) in which workers were granted sick leave for lower back pain in an IMSS (Mexican Government Health Insurance) hospital in Mexico City during a seven-year period. The results show the association and interactions between debilitating lower back pain and several work-related variables: job position, time-on-the-job, and physical effort and weight-carrying associated with the position. Causes of lower back pain and the difficulty in obtaining accurate, precise back pain diagnosis are discussed. A number of clinical, epidemiological, and legal strategies for the study and prevention of back pain are suggested.

Case-Control Studies↗
PubMed1984

Use of ambulatory care services in three provider plans: interactions between patient characteristics and plans.

A previous study of low-income enrollees in a closed-panel health maintenance organization (HMO) and a Blue Cross/Blue Shield (BC/BS) plan showed that the effect on the use of health services of the age, sex, health status, previous health care use, race, and family size of the enrollees was different in the two plans. We have replicated this study using the same two provider plans but studying a different group of white collar, middle class enrollees. A third plan, an experimental independent practice association (IPA), was also available for analysis. Utilization was defined as use (yes/no) and the quantity of use for those who used services (in standardized dollars). Significant interactions were detected between plan and all of the independent variables but race. The use of services in the HMO was least affected by enrollees' characteristics (age, sex, race, health status, prior use, family size) and use was most sensitive to patient characteristics in BC. In some respects, the IPA was more like the HMO and in other respects more like the BC/BS plan.

Adolescent↗
PubMed1994

A seroepidemiological study of hepatitis C virus (HCV) in an area with a high prevalence of chronic liver disease in the Kyushu district of Japan.

The incidence of hepatitis virus type C (HCV) in an area, Futase, of Iizuka city in Chikuho province in the northeastern part of Fukuoka prefecture in Kyushu, Japan, was estimated by screening sera for anti-HCV antibodies. Titers of anti human T-lymphotropic virus type I (HTLV-I) antibodies and hepatitis virus type B surface antigens (HBs) were also determined. The area of the present study is known to have a particularly high prevalence of chronic liver diseases, because coal mining was the key industry until a few decades ago. Also, in the old days it was rather isolated from the neighboring vicinities by surrounding mountains. The subjects of the present survey were 310 patients (117 males and 193 females) with various chronic diseases who visited Futase Social Insurance Hospital during a two year period from 1991 to 1992. Anti-HCV antibodies were detected in the sera of 55 patients, which is an overall positive rate of 18% (26% in male and 14% in female patients). This is extremely high compared to an estimated nationwide average positive rate of 1.6%. Even in 270 patients with normal liver function, the incidence was as high as 10%. The incidences were particularly high in groups of patients aged 40 through 49, 50 through 59 and 60 through 69, ranging from 20 to 23%, while they were as low as 13 and 17% in those aged 70 through 79 and 80 through 89 years, respectively. A high incidence, 57% was estimated for the patients with impaired liver function due to chronic liver diseases, especially in those concomitantly having diabetes mellitus (DM), 91%. The incidence of anti-HCV antibodies was the highest, 100%, in patients having both liver cirrhosis (LC) and DM. This was followed by those having chronic hepatitis (CH) and DM concomitantly and by those with LC alone, 86% each, and by those with CH alone 44%. Furthermore, the genotypes of the HCV in the sera of nine randomly selected carrier patients who had anti-HCV antibodies, even though they had diseases other than hepatic diseases and their liver functions were normal, were examined by the polymerase chain reaction method employing type-specific primers for DNA amplification. As a result, all the HCV strains were type II. On the other hand, there were no apparent differences in the incidences of HTLV-I in the area of the present study and in neighboring provinces of the same prefecture, Fukuoka.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

HMO blues.

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Blue Cross Blue Shield Insurance Plans↗