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PubMed1998

Mental Health Parity Act of 1996: summary of the interim rules relating to group health plans.

The recently released interim rules that govern how group health plans should implement the parity requirement under the Mental Health Parity Act of 1996 (MHPA) are of particular interest to self-funded multi-employer plans. Plans that have not yet been reviewed for MHPA compliance should consider initiating a review as soon as possible. There is no delayed effective date for compliance by multi-employer plans and in addition, a participant or beneficiary could file an action to enforce MHPA's parity requirement.

Government Agencies↗
PubMedDate not supplied

[Suggestions for implementation of DRG in the fields of Orthopaedics and Trauma Surgery for 2004].

OBJECTIVE: The Implementation of a DRG-Variant in Germany - voluntarily since January 1 st, 2003 and obligatory from January 1 st, 2004 - has been leading to uncertainty, particularly in the hospitals, due to fears that currently practised German diagnostic and therapeutic measures will not be financed properly by a DRG-Variant. The G-DRG-Version 1.0 that was drawn up in connection with an executive order law is to a large degree identical to the Australian AR-DRG-Version 4.1. Adjustments to German requirements were made only marginally. Therefore it is necessary for every medical field to investigate by stock-taking to what extent currently practised German diagnostic and therapeutic measures are considered in the G-DRG-Version 1.0 and whether and where modifications and adaptations need to be made. In order to make qualified statements scientific evaluations of possible problems have to be made based German data. Therefore an evaluation was made of the mapping of the medical fields of orthopaedics and trauma surgery. The German Society of Trauma Surgery (DGU), the German Society of Orthopaedy and Orthopaedic Surgery (DGOOC) in cooperation with the DRG-Research-Group of the University Hospital Muenster, the German Hospital Federation (DKG) and the German Medical Association carried out a DRG evaluation project in order to investigate the medical and economical homogeneity of the case groups. METHOD: 12,645 orthopaedic and trauma surgery cases from 23 hospitals - 11 university hospitals and 12 non-university hospitals - were collected within an period of three months and were scientifically evaluated with regard to their performance homogeneity and length of stay homogeneity. RESULTS: The data formed the basis for the proof of suspected deficiencies of mapping of orthopaedic and trauma surgery cases within the G-DRG-Variant. Based on the data and additionally on conclusions of medical experts when the number of cases were small, 14 suggestions for adaptation were proposed and submitted by the deadline of March 31 st, 2003 to the InEK. CONCLUSION: The results of the DRG-Evaluation Project demonstrate the problems of mapping the very heterogenous and complex medical performances of orthopaedy and trauma surgery to a flat rate financing system that is not adapted properly to German conditions. The G-DRG-Variant Version 1.0 does not offer the sufficient possibilities of differentiation that are needed to map the various orthopaedical and trauma surgical measures in Germany.

Cost-Benefit Analysis↗
PubMed2006

A tale of two counties: expanding health insurance coverage for children in California.

During difficult economic times, many California counties have expanded health insurance coverage for low-income children. These Children's Health Initiatives (CHIs) enroll children in public programs and provide new health insurance, Healthy Kids, for those ineligible for existing programs. This article describes the policy issues in implementing the Santa Clara and San Mateo County CHIs, as well as the children's enrollment levels and utilization of services. These CHIs are among the first of the thirty California counties planning or implementing such initiatives. Their success depends on leadership from county agencies that have not traditionally worked closely together, as well as the development of a diverse public and private funding base. This effort to provide universal coverage for all children is important to national policymakers desiring similar goals.

Adolescent↗
PubMed2004

Editor's comment.

Explore the source record for details and available documents.

Bangladesh↗
PubMed2002

Health care use and charges for adolescents enrolled in a title XXI program.

PURPOSE: To examine the use patterns and charges for adolescents with special health care needs (ASHCN) and adolescents engaging in risky behaviors (ARB) and both (BOTH), compared with adolescents with no identified special health care or risky behavior diagnosis (ANIC) in a pool of adolescent enrollees eligible for Title XXI services. METHODS: Claims and encounter data were used to classify 11,459 who had been enrolled in Florida's Healthy Kids Program for 2 consecutive years into 4 groups: ASHCN (n = 1363); ARB (n = 1801); BOTH (n = 773); and ANIC (n = 7522). Monthly per capita inpatient, outpatient, emergency room, and total use and charges were calculated and compared across groups using the Wilcoxon rank sum test, descriptive statistics, and odds ratios. RESULTS: The data indicated that ASHCN, ARB, and BOTH consume significantly more health care services than ANIC and that their higher use and charges are attributable not only to condition-related costs but also to their higher use of non-condition-related services as well. The data also revealed that adolescents with a special health care diagnosis (ASHCN and BOTH) had a higher percentage of costs owing to inpatient stays, whereas adolescents with a risky behavior diagnosis (ARB and BOTH) had a higher percentage of costs owing to emergency room usage. Finally, relevant to the total resources necessary to provide health care for adolescents, the data showed that 65% of the total annual costs of this program emanate from the 35% of adolescents who have special health care needs, engage in risky behaviors, or both. CONCLUSIONS: This study underscores two important points that can be used to ensure that adequate financing, provider network, and service delivery systems are developed to best meet the needs of the adolescent population: (a) the importance of considering the unique needs of adolescents in reimbursement rate setting strategies and (b) the importance of considering category of service utilization in weighting premiums for various groups.

Adolescent↗
PubMed2003

Peer education for HIV prevention in the Socialist Republic of Vietnam: a national assessment.

In 2000, the government of Vietnam conducted the first assessment of its national peer education program for HIV prevention. Twenty (32%) of Vietnam's 61 provinces and urban areas had functioning peer education programs, and program coordinators of all 20 were interviewed regarding their programs. In addition, on-site reviews were done for 10 of the 20 programs, including interviews of peer educators and high-risk persons in each program. The assessment found that a total of 500 peer educators were functioning either independently or as part of one of 79 teams. In the 20 provinces, the peer educators made an estimated 7,000 total contacts per month with high risk persons, but many persons were likely contacted repeatedly. Despite this, coverage was limited: some provinces with high numbers of persons reported with HIV/AIDS had few peer educators. Although most provinces targeted IDU and many targeted CSW, few provinces targeted sex partners of IDU or CSW. The definition of peer education and composition of teams varied substantially by province; only one province included persons living with HIV/AIDS as peer educators. The services provided by peer educators were primarily distributional: delivering information either through word of mouth, pamphlets, or brochures, providing condoms, and sometimes providing clean syringes and needles. Skills building or goal setting interventions aimed at HIV risk reduction were rarely provided. Most provinces had concerns about ongoing funding and sustainability of the programs. Based on the assessment, specific recommendations were provided for strengthening and expanding Vietnam's peer education programs.

Adolescent↗
PubMed2004

Bringing order out of chaos: a culturally competent approach to managing the problems of refugees and victims of organized violence.

The collaborative program of the Transcultural Psychosocial Organization (TPO) provides a community-oriented and culturally sensitive public health response to the psychosocial problems of refugees and victims of organized violence. This paper describes the 9-step model that TPO has developed as a blueprint for each new intervention. Beneficiaries participate in determining priorities and there is an orientation toward culturally competent training, capacity-building, and sustainability. Two cases, one related to Sudanese refugees in Uganda and the other to internally displaced persons and returnees in postwar Cambodia, show how the TPO intervention protocol is adapted to local settings. The paper provides preliminary evaluative comments on the model's performance.

Cambodia↗
PubMed2002

Rural health care in New Zealand: poised for renaissance?

Despite the idyllic potential, many parts of New Zealand's rural health services have continued to struggle for want of a workforce whose retention is not threatened by demanding rosters, heavy workloads and overwhelming bureaucracy. There may now be a basis for cautious optimism that a plan to integrate recommendations and trialled initiatives from the past decade may attract sufficient government funding to see a renaissance for rural primary health care. This paper outlines the elements contributing to what may be a last hope before crisis takes over.

Health Plan Implementation↗
PubMedDate not supplied

[Expanding outpatient rehabilitation].

Up to now, the majority of rehabilitative measures in Germany has been performed in inpatient programmes. In the past 10 years an extension of outpatient rehabilitation can be noted. Because of new social welfare legislation the legal disadvantages for participants in outpatient rehabilitation have been eliminated on the 1st July 2001. In the past year, the Federal Rehabilitation Council as well as various rehabilitation providers have developed further and specified their concepts in outpatient rehabilitation. Concept requirements include still the principles of holism, interdisciplinarity, goal-oriented rehabilitation and team-work of rehabilitation staff. The extension of outpatient rehabilitation in the sphere of German pension insurance scheme is documented by the increase in models respectively regular services and rehabilitative measures. The results of the evaluation suggest, that the outpatient realisation of a comprehensive rehabilitation concept yields comparable results as the inpatient realisation. In some regions there is a strong cooperation between pension insurance institutes and corresponding health insurance companies in order to extend outpatient rehabilitation. A quality assurance program for outpatient rehabilitation will be developed. It can be expected, that the extension of outpatient rehabilitation goes on and that thereby the possibilities of a more flexible medical rehabilitation grow.

Ambulatory Care↗
PubMed2000

Can public health performance standards improve the quality of public health practice?

Recent developments suggest that a national public health performance standards program could succeed in improving the quality of public health practice. Public health standards also may be useful for enhancing accountability and strengthening the science base of public health practice. For national public health performance standards to have a substantial influence on the quality of public health practice, several important issues must be addressed. These include agreement as to the ultimate purpose and appropriate unit of measurement, delineation of the specific qualities to be measured, and expansion of strategies to promote widespread use of public health practice standards.

Health Plan Implementation↗
PubMed2001

Telemedicine in South Africa: success or failure?

A national telemedicine system for South Africa was planned in 1998. In the first phase, starting in 1999, 28 pilot sites were established in six provinces. The initial applications were teleradiology, tele-ultrasound for antenatal services, telepathology and tele-ophthalmology. Telemedicine equipment was connected by ISDN at 256 kbit/s. From January to September 2000, 2663 radiographic studies were performed at the three Northwest Province teleradiology transmission sites, of which 264 studies (10%) were selected for specialist radiologist reporting by teleradiology. From June to August 2000, nine antenatal care tele-ultrasound consultations were performed in the Northern Cape Province and four transfers were avoided through the use of telemedicine. One area of concern is the relatively low usage of the telemedicine system, which raises questions about its cost-effectiveness. The experience of telemedicine in South Africa confirmed, as others have found, that common problems relate to the technical and organizational challenges of introducing telemedicine.

Female↗
PubMed2002

Health care revival renews, rekindles, and revives.

In a Black community in Boston, Mass, a community health center developed a faith-based initiative to improve the health of community residents. In partnership with a steering committee composed of community health advocates, church leaders, and community leaders, the community health center planned and implemented annual Health Care Revival meetings at which screening activities and dissemination of health information are integrated with inspirational singing and scripture readings. The success of the Health Care Revival initiative is demonstrated by an increased use of community health center services after each revival meeting, by participants' evaluations, and by an increase in the number of community health improvement projects begun as a direct result of the Health Care Revival initiative.

Black or African American↗