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At least 523 records · Page 29Linked to original sources
PubMed1998

[Carcinoid tumors of the lung and asbestos. Clinical aspects for insurance medicine].

Lung dust analyses were performed on tumor-free lung tissue from surgical samples of 28 carcinoid tumors. The measured levels in one surgical sample may easily be correlated with the increased asbestos load of the lung due to the patients' occupation as stone mason. No evidence supporting the correlation of increased chronic asbestos load of the lungs and the development of typical carcinoid tumors of the lung was found.

Adolescent↗
PubMed1992

Endarterectomy with arterial dilators: surgical technique.

A simplified technique of semi-closed endarterectomy with arterial dilators that insures complete removal of intimal fragments was used by the authors. Complications, such as arterial wall penetration and residual intimal fragments, are reduced. This technique has proven useful in aortoiliac and short-segment femoral artery endarterectomy. It is also helpful for proximal anastomosis of femoral/popliteal/tibial in situ bypass where termination of saphenous vein cannot reach femoral artery.

Arterial Occlusive Diseases↗
PubMed2004

[Oncologic surgical procedures in ambulatory and brief inpatient surgery].

The number of surgical interventions in an outpatient clinic setting has continuously increased. An important advantage of such approach is the low infection rate. From an economic point of view, this setting leads to lower costs and, subsequently, lower charges to the health insurance companies according to the today's contracts. However, an essential prediction for surgical interventions in an outpatient clinic setting is that there is no increased risk compared with interventions of hospitalized patients. Taking this in consideration, we conclude that the very specific onco-surgical interventions can only be executed in a hospital setting because of their risk profile and the characteristics of tumor patients.

Ambulatory Surgical Procedures↗
PubMed1980

A combined treatment program for the management of locally recurrent breast cancer following chest wall irradiation.

Locally recurrent breast cancer involving the previously irradiated chest wall and skin is a difficult but manageable problem. A detailed oncological evaluation is initially undertaken to determine the extent of local and systemic disease. Local infection, if present, is controlled by topical therapy with 0.5% silver nitrate in conjunction with well-planned, aggressive radiotherapy to the areas of tumor recurrence. Concomitant, hormonal, and/or cytotoxic chemotherapy is administered if evidence of systemic involvement is detected. Biopsies of the ulcer margin are performed with surgical excision and débridement as indicated, followed by sequential skin grafting. Seven patients are presented in whom circumferential ulcer biopsies, radiation therapy, skin grafting, and topical silver nitrate therapy were carried out with control and resolution of local symptoms in all cases. It is not essential to have initial tumor control in order to insure graft take. This program has particular application to the poor risk surgical patient, with or without evidence of systemic disease.

Adult↗
PubMed1994

An alternative health-care reimbursement system--application of arthroscopy and financial warranty: results of a 2-year pilot study.

The results of a 2-year pilot study on an alternative health-care reimbursement system are presented. This innovative system includes a 2-year warranty by the providers to protect the insured and insurer from additional expenses. It is based on the advantages of arthroscopy. This system provided access, choice, and affordability for 111 patients from a managed care environment who were predetermined to be orthopedic surgical candidates. The unique features included unlimited free consultations and office radiographs. Payment was made only if a patient had surgery. This single fee included all related physician and hospital charges for surgery and any subsequent service for the next 2 years under the warranty. The profit margin for the providers was based on the application of arthroscopy, which anticipated reduction in the customary hospitalization. Accountability was provided by reporting of surgical indications and incidence. The surgical incidence of 42% was less than what was projected. The health maintenance organization insurer saved in excess of $125,000.00. Both the hospital and the surgeon earned more than under existing reimbursement systems.

Arthroscopy↗
PubMed1966

Voluntary health insurance coverage in California, 1952 to 1963.

More than seven out of every ten of an estimated civilian population of 17.3 million people in California were covered under some form of voluntary health insurance at the close of 1963. Between 1952 and 1963, the number of Californians covered for hospital expenses increased from 5.7 million to 12.3 million; for surgical expenses from 5.4 million to 11.6 million; and for regular medical expenses from 3.0 million to 10.1 million. THE PERCENTAGE COVERED BY HEALTH INSURANCE ALSO ROSE SIGNIFICANTLY: for hospitalization, from 51.3 to 71.0 per cent; for surgical, from 48.2 to 67.1 per cent; and for regular medical from 27.2 to 57.9 per cent. The rate of increase in hospitalization coverage was slightly higher in California than in the total U.S.; however, the per cent of persons covered remains lower. For surgical coverage, both the rate of increase and the per cent covered are lower in California. For regular medical, growth rates in California and in the U.S. were similar, however the over-all per cent covered is significantly higher in California. Major medical coverage, which has shown the fastest growth rate, covered only 0.4 per cent of the U.S. population in 1952 and 17.1 per cent by the end of 1963. Comparable figures for California are not available.

California↗
PubMed2005

[Needs of health insurers regarding surgery for the aged in Germany].

The increasing proportion of elderly persons presents one of the most urgent problems to European societies and has a decisive effect on social insurance systems. Costs are rising rapidly due to longer life and the falling number of births. Health care is especially hard-hit because of medical progress and growing numbers of procedures during old age. Despite these problems, the German health care system is still effective. In contrast to neighboring European states, there are neither waiting lists nor rationing of services. With respect to financing, future developments cannot be predicted. Planning scenarios taking enormously higher costs into account often result in demands for rationing, which the German health insurance companies do not accept. This study examines economic figures from the largest German health insurer and attempts to draw a picture of future health care for old people. New possibilities for prevention and resourcing and the need for rationing are discussed. The first, promising projects in these respects have already been started, with the aim of better health and quality of life for the elderly.

Aged↗
PubMed2005

Economic modeling comparing trauma and general surgery reimbursement.

BACKGROUND: The viability of trauma care as a surgical subspecialty is continually challenged by economic pressures related to reimbursement and opportunity costs. METHODS: The literature was examined for articles focused on economic implications of a trauma focused surgical practice. Economic forecasting techniques were applied using a recalculating spreadsheet to examine charge and revenue generation comparing the effects of numerous variables affecting a trauma or general surgical service. RESULTS: Elective general surgery practices derive the majority of revenues from procedural services, whereas trauma practices derive the majority of revenues from evaluation and management. Only centers with high admission volume can expect trauma surgeons to cover salary and expenses, predictably in association with high opportunity costs. CONCLUSION: The differences in time, effort, and patient volume required for a trauma surgeon to generate revenues comparable to an elective practice are dramatic. The current system creates disincentives for surgeons to participate in trauma care.

Elective Surgical Procedures↗
PubMed1976

Reach for tomorrow.

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMed1998

Tricuspid valve surgery and intraoperative echocardiography: factors affecting survival, clinical outcome, and echocardiographic success.

BACKGROUND: The impact of echocardiographic-guided treatment on outcome after tricuspid valve (TV) surgery is not well defined. OBJECTIVES: The purpose of this study was to determine clinical and echocardiographic factors associated with adverse outcomes after TV surgery and determine the role of intraoperative echo (IOE) in facilitating successful outcomes after TV surgery. METHODS: Four hundred and one patients (279 females, mean age 60 years) underwent TV surgery and other concomitant cardiac surgery at a single institution and were followed clinically and by echocardiography during a 10-year period. RESULTS: Decreased survival after TV surgery was associated with: preoperative increased New York Heart Association (NYHA) functional classification (relative risk [RR]=2.02), increased left ventricular dysfunction by echocardiography (RR=1.28), and use of a TV replacement strategy (RR=2.92). Decreased event-free survival after TV surgery was associated with concomitant coronary artery bypass grafting (RR=2.97). Late echocardiographic failure (3 to 4+ tricuspid valve regurgitation [TR]) after TV surgery was associated with increased severity of TR on preoperative echocardiogram (odds ratio [OR]=1.91). Decreased late echocardiographic failure after TV surgery was associated with the use of a TV annuloplasty ring with a repair strategy (OR=0.40). The surgical plan was altered at the time of surgery to insure a successful outcome in 32 (10%) of 335 patients based on IOE findings. CONCLUSIONS: Adverse outcomes after TV surgery can be predicted by several preoperative clinical and echocardiographic variables. IOE is useful in improving immediate, but not late, outcomes after TV surgery.

Adult↗
PubMedDate not supplied

The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus.

Of 232 morbidly obese patients with non-insulin-dependent diabetes mellitus referred to East Carolina University between March 5, 1979, and January 1, 1994, 154 had a Roux-en-Y gastric bypass operation and 78 did not undergo surgery because of personal preference or their insurance company"s refusal to pay for the procedure. The surgical and the nonoperative (control) groups were comparable in terms of age, weight, body mass index, sex, and percentage with hypertension. The two groups were compared retrospectively to determine differences in survival and the need for medical management of their diabetes. Mean length of follow-up was 9 years in the surgical group and 6.2 years in the control group. The mean glucose levels in the surgical group fell from 187 mg/dl preoperatively and remained less than 140 mg/dl for up to 10 years of follow-up. The percentage of control subjects being treated with oral hypoglycemics or insulin increased from 56.4% at initial contact to 87.5% at last contact (P = 0.0003), whereas the percentage of surgical patients requiring medical management fell from 31.8% preoperatively to 8.6% at last contact (P = 0.0001). The mortality rate in the control group was 28% compared to 9% in the surgical group (including perioperative deaths). For every year of follow-up, patients in the control group had a 4.5% chance of dying vs. a 1.0% chance for those in the surgical group. The improvement in the mortality rate in the surgical group was primarily due to a decrease in the number of cardiovascular deaths.

Adult↗
PubMed2003

Discharge destination after dysvascular lower-limb amputations.

OBJECTIVE: To examine postacute care rehabilitation services use after dysvascular amputation. DESIGN: State-maintained hospital discharge data from the Maryland Health Services Cost Review Commission were analyzed. SETTING: Maryland statewide hospital discharge database. PARTICIPANTS: Persons discharged from nonfederal acute care hospitals from 1986 to 1997 with a procedure code for lower-limb amputation (ICD-9-CM code 84.12-.19), excluding toe amputations. Those persons with amputations due to trauma, bone malignancy, or congenital anomalies were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Postacute care service utilization. RESULTS: There were 16,759 discharges with an amputation procedure over this period. The average age was 69.3+/-14.3 years, and 51.9% were men. Black persons comprised 42.4% of the sample. Diabetes was present in 42.0%, and peripheral vascular disease was noted for 66.1% of amputees. Amputations were at the foot (19.4%), transtibial (38.1%), and transfemoral (42.4%) levels. The largest proportion (40.6%) of patients was discharged directly home after acute care, 37.4% went to a nursing home, 9.2% went home with home care, and 9.6% were discharged to an inpatient rehabilitation unit. From 1986 to 1997, there were downward trends in the rate of discharges directly home and corresponding upward trends in nursing home and inpatient rehabilitation dispositions. CONCLUSIONS: Inpatient rehabilitation use is infrequent after dysvascular amputation. Prospective studies are necessary to examine outcomes for persons receiving rehabilitation services in different care settings to define the optimal rehabilitation venue for functional restoration.

Aged↗
PubMed1978

How do health-maintenance organizations achieve their "savings"?

Health-maintenance organizations have been suggested as a way to stop spiraling medical costs. Although many of the arguments have been largely rhetorical, theoretical considerations suggest that the shift from fee for service to a fixed budget for the providers (physicians and hospitals) will result in substantial savings. Total costs (premium and out-of-pocket) for enrollees are 10 to 40 per cent lower than those for comparable people with health insurance. Enrollees in health-maintenance organizations have about as many ambulatory visits as comparison groups. Most of the cost differences are attributable to hospitalization rates about 30 per cent lower than those of conventionally insured populations. These lower hospitalization rates, in turn, are due almost entirely to lower admission rates; the average lenth of stay shows little difference. There is no evidence that health-maintenance organizations reduce admissions in discretionary or "unnecessary" categories; instead, the data suggest lower admission rates across the board.

Ambulatory Care↗
PubMed1985

Surgical streams in the flow of health care financing. The role of surgery in national expenditures: what costs are controllable?

The dollar flow in United States medical care has been analyzed in terms of a six-level model; this model and the gross 1981 flow data are set forth. Of the estimated $310 billion expended in 1981, it is estimated that $85-$95 billion was the "surgical stream", i.e., that amount expended to take care of surgical patients at a variety of institutional types and including ambulatory care and surgeons' fees. Some of the determinants of surgical flow are reviewed as well as controllable costs and case mix pressures. Surgical complications, when severe, increase routine operative costs by a factor of 8 to 20. Maintenance of high quality in American surgery, despite new manpower pressures, is the single most important factor in cost containment. By voluntary or imposed controls on fees, malpractice premiums, case mix selection, and hospital utilization, a saving of $2.0-$4.0 billion can be seen as reachable and practical. This is five per cent of the surgical stream and is a part of the realistic "achievable" savings of total flow estimated to be about +15 billion or 5 per cent.

Cost Control↗
PubMed2005

The role of epilepsy surgery in southern Africa.

Epilepsy surgery plays an important role in the management of patients with medically refractory temporal lobe epilepsy and lesional epilepsies. When performed early in the course of the illness, surgery can render many patients seizure-free and greatly improve their quality of life. In southern Africa, as in many developing nations, thousands of patients could benefit from epilepsy surgery, but inequalities in healthcare provision mean that ready access to surgical facilities is largely restricted to those with private healthcare insurance. Over the past 5 years, more than 250 patients have had epilepsy surgery in Cape Town; the cause of epilepsy in six of these individuals was neurocysticercosis resulting from central nervous system infection by the larval stage of the pork tapeworm (Taenia solium), which is a common cause of epilepsy in the tropics. In all cases, surgery was successful, with patients becoming seizure-free and reporting a much improved quality of life.

Africa, Southern↗