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PubMed1999

Relationship between modifiable health risks and short-term health care charges.

CONTEXT: If physical inactivity, obesity, and smoking status prove to contribute significantly to increased health care charges within a short period of time, health plans and payers may wish to invest in strategies to modify these risk factors. However, few data are available to guide such resource allocation decisions. OBJECTIVE: To examine the relationship of modifiable health risks to subsequent health care charges after controlling for age, race, sex, and chronic conditions. DESIGN, SETTING, AND PARTICIPANTS: Cohort study of a stratified random sample of 5689 adults (75.5% of total sample of 7535) aged 40 years or older who were enrolled in a Minnesota health plan and completed a 60-item questionnaire. MAIN OUTCOME MEASURE: Resource use as measured by billed health care charges from July 1, 1995, to December 31, 1996, compared by health risk (physical activity, body mass index [BMI], and smoking status). RESULTS: The mean annual per patient charge in the total study population was $3570 (median, $600), and 15% of patients had no charges during the study period. After adjustment-for age, race, sex, and chronic disease status, physical activity (4.7% lower health care charges per active day per week), BMI (1.9% higher charges per BMI unit), current smoking status (18% higher charges), and history of tobacco use (25.8% higher charges) were prospectively related to health care charges over 18 months. Never-smokers with a BMI of 25 kg/m2 and who participated in physical activity 3 days per week had mean annual health care charges that were approximately 49% lower than physically inactive smokers with a BMI of 27.5 kg/m2. CONCLUSIONS: Our data suggest that adverse health risks translate into significantly higher health care charges within 18 months. Health plans or payers seeking to minimize health care charges may wish to consider strategic investments in interventions that effectively modify adverse health risks.

Adult↗
PubMedDate not supplied

A public health nursing practice model: melding public health principles with the nursing process.

There has been a shift in emphasis in public health from the provision of personal health services for individuals to efforts targeted at improving the health of the whole community. Many in public health nursing (PHN) have welcomed this shift, recognizing the important role PHN can play in promoting health and preventing disease for all. There continues to be a need to redefine PHN roles and practice so that public health nurses can participate more effectively. Los Angeles County Department of Health Services Public Health Nursing (LAC PHN) has developed a practice model grounded in nationally recognized components: the public health team, PHN standards of practice, the 10 Essential Public Health Services, Healthy People 2010's 10 Leading Health Indicators and additional local indicators, and the Minnesota Public Health Nursing Interventions Model. The LAC PHN Practice Model provides a conceptual framework that assists in clarifying the role of the public health nurse and presents a guide for public health practice applicable to all public health disciplines.

Community Health Planning↗
PubMed2001

The first year of Health Improvement Programmes; views from Directors of Public Health.

BACKGROUND: The White Paper The new NHS, modern, dependable gave the strategic lead at the local level in the new National Health Service to Health Authorities (Boards in Scotland and Northern Ireland). They are expected to lead the development of strategies that will identify the health needs of local people and what has to be done to meet them. These Health Improvement Programmes (HImPs) will be the local strategy for improving health and health care and the means to achieve national targets for each Health Authority or Board area. METHOD: To assess the strengths and weaknesses of HImP production for 1999, a questionnaire survey was carried out of Health Authorities or Boards throughout the United Kingdom. Participants were all district Directors of Public Health (DsPH) or Chief Administrative Medical Officers (CAMOs). The main outcome measures were the opinions of DsPH or CAMOs on the successes and failures of their local HlmP process. RESULTS: Ninety-three (83.8 per cent) DsPH responded. In just over half of all Health Authorities or Boards (56 per cent) the DsPH had taken the lead in producing the HlmP. Many aspects of the HlmP process went well, including multiagency 'stakeholder' involvement and partnership working, good project management, and agreeing a limited set of priorities for action. Key problems included: the short timescale and late Departments of Health guidance; difficulty in obtaining commitment from some local 'stakeholders'; linking HlmP aspirations with service and financial planning and securing funding for HlmP priority developments. Action plans to improve health and health care services were well developed in 40.5 per cent of HlmPs. This was less so for social services (8.3 per cent). It was too soon to assess the impact of HlmPs on the public's health. CONCLUSIONS: DsPH or CAMOs and local 'stakeholders' have been on a learning curve for HlmP production during 1999. Lessons learnt will translate into better HlmPs for next year. DsPH urged the Departments of Health to fully support HlmPs through resources and management processes so that HlmPs can realize their potential benefits for local populations.

Administrative Personnel↗
PubMedDate not supplied

Subjective health status and health values in the general population.

OBJECTIVE: To explore the relationship between rating-scale evaluation of health-related quality of life ("health value") and two subjective evaluations of health: the SF-36 profile and the five-category perception of general health (excellent, very good, good, fair, and poor). METHODS: This relationship was explored by linear and nonlinear regression analysis of data obtained through face-to-face interviews with a sample of 2,030 persons aged 45-75 years representing the Israeli Jewish urban population in that age group. RESULTS: The main outcome is a mapping assigning health values to the subjective health-status scores, e.g., "good" general health is equivalent to a health value of 76-81, depending on the functional form of the relation. "Poor" health is equivalent to a value of 45-61. The R2 is about 0.3. While the eight scales of the SF-36 were found to be linearly related to health value (R2=0.51), the two summary measures-physical component scale (PCS) and mental component scale (MCS)-were not. The scales measuring general health, vitality, and physical functioning were the main determinants of health value, while the role-performance scales were insignificant. The PCS had a larger effect than the MCS. DISCUSSION: These relationships provide deeper insight into the structure and meaning of the two health-status measures in the general population. They also place earlier determinations of these relationships among sick persons in a broader context and raise several further questions regarding the relationship between health values and health status.

Activities of Daily Living↗
PubMed1998

Confidence in health care at what cost? Results from the 1998 Health Confidence Survey.

This Issue Brief presents the findings from the 1998 Health Confidence Survey. It focuses on Americans' satisfaction with the health care system and their confidence in the system's future. Only 5 percent of Americans give an excellent rating to health care in America today. However, while just over one-half rate health care as excellent, very good, or good, almost one-half (46 percent) rate it as fair or poor. When asked what they consider to be the most critical issue in America today, 15 percent of Americans cite health care. Overall, Americans are not extremely confident about various aspects of health care in the next 10 years. Only 10 percent are extremely confident that they will be able to get the medical treatments they need during this period, while 22 percent are not confident. Americans are even less confident that they will have access to quality health care (26 percent not confident), that they will have enough freedom to choose their health care provider (36 percent not confident), and that they will be able to afford health care without suffering financial hardship (41 percent not confident). The nonelderly population is even less confident about health care once they become eligible for Medicare. Americans are clearly confused about the meaning of managed care and whether they are enrolled in a managed care plan. While 70 percent of those who were determined to be enrolled in a managed care plan label the plan correctly, only 21 percent report that they are currently enrolled in a managed care plan. Most American have opinions about managed care. However, only 28 percent of Americans form their opinions about managed care based on their own personal experience. Twenty-three percent base their opinion on what they learn from family and friends, and 29 percent base it on what they hear or see in the media. While few Americans give managed care an excellent rating, few give it a poor rating. Most Americans rate managed care somewhere in the middle. Americans are particularly concerned about health care costs. Over 30 percent are not satisfied with the cost of their health insurance over the last 2 years, and 37 percent are not satisfied with the health care costs that are not covered by their health plan. These numbers compare with higher satisfaction levels concerning choice of physician, quality of care received, treatments received, hospitals used, and benefits covered by health plans.

Adult↗
PubMed1999

Public attitudes on the U.S. health care system: findings from the 1999 Health Confidence Survey.

This Issue Brief presents the findings from the 1999 Health Confidence Survey (HCS), which focuses on Americans' satisfaction with the health care system today and their confidence in the system's future. It compares findings from the 1999 HCS with those from the 1998 HCS, the first year the survey was conducted. In addition, it includes recent findings from the EBRI's 1999 Health Insurance Preference Survey. The 1999 HCS finds that, in many ways, Americans appear happy with their experience of the health care system. Among those respondents who have received care in the past two years, 57 percent are extremely or very satisfied with the quality of the medical care they received; 32 percent are somewhat satisfied. More than one-half (53 percent) are extremely or very satisfied with their ability to choose their doctor, while 23 percent are somewhat satisfied. Close to one-half are extremely or very satisfied, and 41 percent are somewhat satisfied, with the care they received in general. One-half of Americans with health insurance are extremely or very satisfied with their current health insurance plan. Almost four in 10 are somewhat satisfied. Confidence in many aspects of the health care system is high: 74 percent of Americans are extremely or very confident that their pharmacist will fill their prescription correctly, and 20 percent are somewhat confident. Almost six in 10 are extremely or very confident, and 33 percent are somewhat confident, that they will be able to see a health care specialist if they need one. Just under one-half are extremely or very confident that they are able to choose their own doctor or hospital (48 percent confident, 34 percent somewhat confident); that their doctor's treatment will be based on their health care needs rather than on cost (46 percent confident, 36 percent somewhat confident); and that doctors are up-to-date on information about medicine and medical conditions (46 percent confident, 41 percent somewhat confident). The results of the HCS also reveal several areas of concern. First, there is a great deal of confusion about what managed care is and whether or not individuals are enrolled in managed care programs. As a consequence, many Americans' opinions of managed care are based on what they have been told by others, rather than on their own actual experience with managed care. A second area of concern is that several key groups tend to be less satisfied and less confident about the American health care system. These include individuals in managed care, those in poorer health, and women. While many are satisfied with the health care they have recently received, Americans do not rate the overall health care system highly. They are concerned about escalating health care costs, and they lack confidence in the future of health care in America.

Attitude to Health↗
PubMed2002

Primary health care approach. Its relevance to oral health in Nigeria.

This article discusses the concept of Primary Health Care--an idea which started with the World Health Assembly agreement in 1977 to work resolutely towards the goal of Health for All. This decision was followed by the historic international conference on Primary Health Care at Alma Ata in 1978. Many countries including Nigeria, adopted the primary health care strategy to achieve health for all by the year 2000 (now 2000 and beyond). Since health needs to be seen and dealt with in a holistic manner, oral health is an integral part of health. Strategies for achieving health for all implicitly and must of necessity involve oral health. This article has tried to show the relevance of the strategy of primary health care to oral health. It concludes that primary health care approach is very relevant to oral health in Nigeria.

Community Dentistry↗
PubMed1993

The relationship between health related knowledge, attitudes and dental health behaviours in 14-16-year-old adolescents.

A survey of 3,160 pupils aged 14 to 16 years, attending schools in the 16 districts of the North East Thames Regional Health Authority, was conducted to examine their dental health status, attitudes and behaviour. The objective was to examine factors that might affect the assimilation of dental health education information, attitude modification and behavioural change, both in terms of clinical and psychosocial indicators of dental health. In general the dental health of those surveyed was good. Female pupils from outer London schools with high educational aspirations tended to have better periodontal health, an increased experience of restorative treatment, a greater dental health knowledge and more positive attitudes than the remaining children. Pupils' dental health attitudes could be explained by their present self-care practices in addition to the wish to adopt positive dental health behaviours in the future. Their ability to adopt these was further associated with their positive and negative perceptions of their own dental health. The close association between positive behaviours towards, and feelings of control over future dental health suggested that health attitudes could reflect feelings of empowerment and this was conductive to the adoption of self-care practices. Those pupils who felt empowered were more able to promote their own dental health by means of their positive self-care actions. On the other hand those groups of pupils which appeared less able to assimilate dental health information, which had less positive attitudes and were therefore unable to promote their own dental health through the adoption of self-care practices, could be identified.

Adolescent↗
PubMed1996

[Legitimizing and responsibilities of public health reports: public health reports or social court reports?].

Since 1970 various initiatives have been taken to improve the information bases of health reporting. However, the efforts made up to now by the Länder, the Federal Government and its corporate bodies are characterised by a lack of experience and shortage of resources; moreover, they are viewed with a critical eye by the public and in the political area. In this contribution the authors describe various topics and delimitations of a health reporting system which go far beyond health statistics and health programmes altogether. The chances of a national health reporting system are based on the assumption that an objective judgement based on expert knowledge and science will be possible and that beyond all particularistic interests, expert knowledge can be organised in a democratic process. Public health reporting varies between two extremes: On the one hand, the current reporting in the media on health-related subjects which is characterised by disagreement among experts, particularistic interests and emotions, and on the other hand the national health reporting, which, on the platform of policy marketing and political image shaping, is suspected of degenerating to a kind of "royal court reporting". A health reporting system based on expert knowledge and characterised by topics with relevance to health policy, expert quality of its information and neutrality to particularistic interests, should go beyond these two extremes. Given the political conditions of budgeting and distribution conflicts, health reporting has to deal with two main aspects: effectiveness and efficiency of employed resources and with the problems of a fair distribution of these resources to provide equal chances in the health sector. What cannot be solved, by questions of procedure, however, is the problem of truth and objective knowledge as well as the problem of confidence. If the general public lacks confidence in national expert knowledge, a society discourse will not lead to political results. Additionally, the argument that medicine is of little importance for health is used to categorically reject a rational investigation of needs and thus to reduce the health system to the status of a modern religious doctrine. Proceeding on the assumption that due to systematic thinking and acting in the field of science, effective medicine symbolises one of the paradigms of progress, then health reporting system can be justified despite the precarious objective knowledge, provided such reporting generates the confidence it deserves thanks to its quality standards and seriousness.

Cost-Benefit Analysis↗
PubMed2006

Health-risk behaviors and health promotion in adolescent and young adult cancer survivors.

A diagnosis of cancer during adolescence, a period characterized by experimentation and risk-taking behaviors, has the potential to derail critical developmental tasks required for successful transition into adulthood. Health professionals caring for adolescents and young adults have an opportunity to influence behavioral practices by correcting knowledge deficits, addressing factors that enhance the survivor's sense of vulnerability to health problems, and providing personalized health counseling that encourages the practice of health promoting behaviors. The approach to health counseling in childhood cancer survivors should consider their unique educational needs related to their cancer experience. Previous investigations of adolescent and young adult survivor health behavior indicate that survivors perceive themselves as more vulnerable to health problems than their peers without cancer and recognize a need to protect their health. However, these perceptions of health vulnerability do not always correlate with health promoting behavioral practices, suggesting that factors other than health perceptions should be investigated to motivate behavioral change. Very few studies have been undertaken to prospectively evaluate the effectiveness of health promotion programs in adolescent and young adult survivors of cancer. The scarcity of knowledge in the issue of health promotion after childhood cancer underscores the need for more research to define 1) the optimal timing of health counseling; 2) the influence of developmental status and neurocognitive function; 3) the most effective methods and venues for health education; 4) the feasibility and cost-effectiveness of health promotion strategies; and 5) psychosocial and economic impediments to practice of healthy behaviors.

Adolescent↗
PubMed2003

Public health context of women's mental health research.

As more attention is directed to the mental health care of women, sex and gender differences in research design and in regulatory policies have interfaced with clinical care and public policy. An emphasis on women's mental health issues in the provision of treatment and care as well as the design of large-scale screening strategies to identify and treat women with mental disorders promises to be effective public health approaches to reducing the burden of mental illness in women. The past decade has seen increased emphasis on women's mental health and sex/gender differences in the federal sector and in the research community. Federal regulations (summarized in the NIH Outreach Notebook) call for the inclusion of women and minorities in NIH-funded clinical research. The regulations also place emphasis on gender analysis of the results of clinical trials, in particular phase III trials, the findings of which are likely to influence practice. There has been substantial progress toward the goal of including women in research, but more remains to be done. A 2000 GAO report titled "Women's Health: NIH Has Increased Its Efforts to Include Women in Research" commended NIH for tracking the number of women in clinical research but the report also noted that relatively few NIH-funded studies, including major clinical trials, had reported findings by gender of study participants. This was seen as an impediment to progress in developing gender-based effective treatments. In the past decade, the women's health field has moved beyond an exclusive emphasis on women's reproductive function to one that defines health as a scientific enterprise to identify clinically important sex and gender differences in prevalence, etiology, course, and treatment of illnesses affecting men and women in the population as well as conditions specific to women. Nonetheless, for mental disorders, women's reproductive function and its impact on mental health conditions is still understudied. Based on the epidemiology of mental disorders, the course of mental disorders in women in relation to reproductive transitions remains an important issue for the mental health field because the burden of mental disorders, such as depression and anxiety, fall disproportionately on women of childbearing and childrearing age. The public health emphasis on women's mental health does not lessen the basic scientific opportunities to be had by a focus on gender and sex differences. A 2001 report of the Institute of Medicine titled "Exploring the Biological Contributions to Health: Does Sex Matter?" underscores the benefit to health care of looking for sex differences at the biological level. Basic and clinical neuroscience research is rapidly accruing a knowledge base that will provide information at the level of genes and cells of the influences of biological sex on mental health outcomes in both women and men. A focus on women's mental health and gender/sex differences research promises to yield improvement in treatments and services and thereby to improve the public health as well as to increase fundamental knowledge about the etiology and neurophysiology of mental disorders.

Ethnicity↗
PubMed1999

Gender differences in structural and behavioral determinants of health: an analysis of the social production of health.

This paper explores aspects of the social production of health by focussing on the ways in which levels of health are shaped by structures of social inequality and behaviors or 'lifestyles'. We address two questions: What is the relative importance of the social, structural and behavioral determinants of health? And, are there gender differences in the determinants of health? These questions are explored using multiple regression analyses of data from the 1994 Canadian National Population Health Survey. Two measures of health are used: subjective health status and the Health Utilities Index (a measure of functional health status). By structural determinants we refer to age, family structure, main activity, education, occupation, income and social support. Behavioral determinants include lifestyle factors related to smoking, drinking, weight and physical activity. Findings indicate that the structures of social inequality are the most important determinants of health acting both independently and through their influence on the behavioral determinants of health. There are very real differences in the factors that predict women's and men's health. For women, social structural factors appear to play a more important role in determining health. Being in the highest income category, working full-time and caring for a family and having social support are more important predictors of good health for women than men. Smoking and alcohol consumption are more important determinants of health status for men than women, while body weight and being physically inactive are more important for women than men. Our findings suggest the value of models which include a wide range of structural and behavioral variables and affirm the importance of looking more closely at gender differences in the determinants of health.

Alcohol Drinking↗
PubMed1995

Health-as-process: a health visiting perspective.

Health visitors are community nurses who define their role specifically in terms of health promotion, although they have often found difficulty in explaining how their seemingly diffuse and unfocused practice achieves this. The grounded theory study reported here set out to uncover some of the hidden processes and features embedded within health visiting, so the practice might be more clearly articulated. This paper reports one aspect of that study, which suggests that health visitors treat health as a lifelong process, involving the accumulation and use of 'resources for health'. The relevance of approaches which appeared both caring and educational will be set in the context of therapeutic nursing and adult education theories. Historically, health visitors have links with both nursing and health education; the analysis presented here helps to clarify the relationships between these different areas of work. The paper will explain how treating health as a process allows multiple competing views and ideas about health and health promotion to be integrated into a manageable form, thus allowing positive health to be promoted within a broad, acceptable socio-cultural context. However, the analysis also highlighted various points at which treating health as a process contradicts the firmly measurable requirements of the market-orientated health service. Nevertheless, where health visitors are sufficiently skilled, and are permitted by their employing authorities to use this approach, it may serve to protect clients from intrusive and accusing interventions, made in the name of health promotion.

Community Health Nursing↗
PubMed2004

Health promotion and health education: advancing the concepts.

BACKGROUND: Health education and health promotion activities are a fundamental requirement for all health professionals. These two paradigms are closely related but are not inter-dependent. Despite this, it is known that many nurses confuse the terms and use them interchangeably. With this in mind, it is necessary to re-conceptualize the terms in an attempt to bring them to a current form of 'maturity'. AIM: The aim of the paper is to provide an up-to-date analysis of health promotion and health education that serves as a conceptual and operational foundation for clinicians and researchers. METHOD: A concept analysis following the criterion-based methods described by Morse and her colleagues was applied to the terms health education and health promotion, using generic and nursing-related literature. RESULTS: The conceptual literature on health education is consistent between generic and nursing-related sources. On the contrary, earlier nursing literature on health promotion is now at odds with more recent socio-political and community action models of health promotion, in that it focuses on individualistic and behavioural forms of 'health promotion'. A significant proportion of later nursing-related literature, however, suggests a maturing of the concept that brings it further in line with a socio-political health promotion agenda. CONCLUSION: While the theoretical and conceptual literature surrounding health education has remained relatively constant and unchanged over the last decade or so, the same cannot be said for the health promotion literature. The evolving dominance of socio-political action in health promotion has overtaken individualistic and behaviourally-related forms. While the recent nursing literature addresses and acknowledges the place of socio-political activity as the mainstay of health promotion interventions, this is largely from a theoretical stance and is not applied in practice.

Concept Formation↗
PubMed2000

Influence of parental gender and self-reported health and illness on parent-reported child health.

BACKGROUND: Although there is clear evidence of the influence of parental factors on child health outcomes, the influence of parental perceptions of their health and illness on the reporting of child health remains primarily unknown. OBJECTIVES: To examine relationships between parents' reporting of their own health and illness with the reporting of their children's health and illness. METHOD: We surveyed parents of a representative population-based sample of children aged 5 to 18 years. One parent of each child completed a written questionnaire including the Child Health Questionnaire, a subjective measure of functional health and well-being, and an assessment of self-reported parental health and illness. Logistic regression models were used to examine relationships between parent and child health and illness. MAIN RESULTS: 5340 parents responded (86% mothers, 14% fathers). After adjusting for confounding effects, parents self-reporting poor health had increased odds of reporting their children with poor health (odds ratio: 7.5), although the effect was modified by parent gender. There were increased odds of mothers with self-reporting poor global health reporting their children with poor global health and illness (odds ratio: 9.0 and 2.5, respectively) that were not observed for fathers. CONCLUSIONS: A mother's self-reported health is strongly associated with her reporting of her child's health; this was not observed for fathers. These results suggest that parental gender should be considered as a mediating factor in the reporting of child health.

Adolescent↗
PubMed1997

National health care reform and the 103rd Congress: the activities and influence of public health advocates.

OBJECTIVES: This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress. METHODS: Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed. RESULTS: The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates. CONCLUSIONS: The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress.

Health Care Reform↗
PubMed2001

Linkage of the Canadian Study of Health and Aging to provincial administrative health care databases in Nova Scotia.

The Canadian Study of Health and Aging (CSHA) was a cohort study that included 528 Nova Scotian community-dwelling participants. Linkage of CSHA and provincial Medical Services Insurance (MSI) data enabled examination of health care utilization in this subsample. This article discusses methodological and ethical issues of database linkage and explores variation in the use of health services by demographic variables and health status. Utilization over 24 months following baseline was extracted from MSI's physician claims, hospital discharge abstracts, and Pharmacare claims databases. Twenty-nine subjects refused consent for access to their MSI file; health card numbers for three others could not be retrieved. A significant difference in healthcare use by age and self-rated health was revealed. Linkage of population-based data with provincial administrative health care databases has the potential to guide health care planning and resource allocation. This process must include steps to ensure protection of confidentiality. Standard practices for linkage consent and routine follow-up should be adopted. The Canadian Study of Health and Aging (CSHA) began in 1991-92 to explore dementia, frailty, and adverse health outcomes (Canadian Study of Health and Aging Working Group, 1994). The original CSHA proposal included linkage to provincial administrative health care databases by the individual CSHA study centers to enhance information on health care utilization and outcomes of study participants. In Nova Scotia, the Medical Services Insurance (MSI) administration, which drew the sampling frame for the original CSHA, did not retain the list of corresponding health card numbers. Furthermore, consent for this access was not asked of participants at the time of the first interview. The objectives of this study reported here were to examine the feasibility and ethical considerations of linking data from the CSHA to MSI utilization data, and to explore variation in health services use by demographic and health status characteristics in the Nova Scotia community cohort.

Aged↗
PubMed2004

HIPAA administrative simplification: standard unique health identifier for health care providers. Final rule.

This final rule establishes the standard for a unique health identifier for health care providers for use in the health care system and announces the adoption of the National Provider Identifier (NPI) as that standard. It also establishes the implementation specifications for obtaining and using the standard unique health identifier for health care providers. The implementation specifications set the requirements that must be met by "covered entities": Health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard (known as "covered health care providers"). Covered entities must use the identifier in connection with standard transactions. The use of the NPI will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the health care system and enabling the efficient electronic transmission of certain health information. This final rule implements some of the requirements of the Administrative Simplification subtitle F of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

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