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PubMed1992

The '90s paradigm shift for electronic claims.

In the development of any new industry, certain events signal a paradigm shift. Those affected by the "new way" finally seem to grasp that change is inevitable. The paradigm shift has begun for electronic claims submission.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

For the good of the child.

Legislative activities of the past 10 years have led many hospitals to develop grassroots advocacy programs that focus on specific issues. At Cardinal Glennon Children's Hospital, St. Louis, advocacy efforts involve employees, physicians, board members, and others. Situated near the Missouri-Illinois border, Cardinal Glennon serves patients from both states and deals with the legislatures and government agencies of each. Cardinal Glennon has formed alliances with children's hospitals in Missouri and in Illinois to lobby for fair funding from both states' Medicaid programs. Cardinal Glennon has formed a public policy committee that evaluates issues, sets priorities, and identifies trends. Hospital staff work with legislators from both states, inviting them for a first-hand look at children's needs. The hospital has also formed the Letter-Writing Advocacy Committee. Committee members write their representatives, stating their viewpoint on specific issues. Cardinal Glennon sponsors the Southern Illinois Perinatal Program. The hospital is also home to Missouri's regional poison control center, which in 1991 saved the state of Missouri $400,000 in Medicaid funds and saved private insurance carriers approximately $2.2 million. Cardinal Glennon's advocacy efforts extend beyond specific hospital programs, however, Hospital representatives often testify to legislative committees on more universal issues such as child abuse, lead poisoning, primary care needs, and trauma care.

Catholicism↗
PubMed1992

Universal basic benefits preempt mandated benefits.

Many states seek to expand health care access to uninsured people. As part of their efforts, states must define a basic level of health services to which all residents would have access. Presumably, this level of services would be leaner than that now covered by most health care policies. As it is, private insurers are already mandated by all states to include certain benefits, which differ widely from state to state. However, simple fairness argues that once a state defines a basic level of health services, that level should function as a floor for everyone and replace the previously mandated benefits (which, nonetheless, may be a useful guide in defining a basic level of health services).

Health Services Accessibility↗
PubMed1991

Health insurance in the health administration curriculum.

Managers and policymakers knowledgeable in the delivery and financing of health care are needed in the health care industry, and health administration programs can meet this need by expanding course offerings which consider the role and operations of insurers. This paper surveys the major topics in the field of health insurance and presents a course overview for an introduction to the field of health insurance for health administration students.

Actuarial Analysis↗