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PubMed1980

The many elements of cost control.

For Blue Cross and Blue Shield Plans, cost containment is not a new concern but an activity that has been carried on for years. It has now been given new emphasis by the urgencies of inflation and the new focus of national attention on health care costs as one of its more conspicuous phenomena-chiefly a result of the inflation but often mistaken for, and mislabeled as, a cause.

Blue Cross Blue Shield Insurance Plans↗
PubMed1980

Social security financing.

After nearly 2 years of study, the 1979 Advisory Council on Social Security submitted its findings and recommendations in December. In February the Bulletin published the Executive Summary of the Council's report. Because of the continuing wide public interest in the future of social security financing, the Council's detailed findings and recommendations on that subject are published below. The Council unanimously reports that all current and future beneficiaries can count on receiving the payments to which they are entitled. Among the recommendations it calls for are partial financing with nonpayroll-tax revenues. Suggested changes include hospital insurance (HI) financed through portins of personal and corporate income taxes and a part of the HI insurance payroll tax diverted to cash benefits with the balance of this tax repealed. The Council also recommends that the social security cash benefits program be brought into long-run actuarial balance--with a payroll-tax rate increase in the year 2005. It rejects the idea of a value-added tax as being inflationary. Parenthetical remarks represent additional views of the Council members cited.

Cost Allocation↗
PubMed1977

Private industry health insurance plans: type of administration and insurer in 1974.

This report examines the major forms of administration of private health insurance plans. Plans are classified according to whether they are employer-only or joint worker-employer-operated and according to whether they are negotiated or not. A further focus of examination that often reflects industry patterns is whether the plans cover workers of a single employer or involve multi-employer arrangements. These classifications of administration and the method of insuring benefits are examined in terms of proportions of workers with specified plan characteristics and health benefits.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

[Economic mechanisms in decreasing the level of hospitalizations].

Increase of the role of primary health care and decrease of hospitalizations is a pressing medical and economic problem. However, rather often it is beneficial for a medical institution to hospitalize a patient. In order to create stimuli for decreasing the level of hospitalization, medical institutions are to have a share in the economy due to non-hospitalization. Proper validation of the share of the resultant economy is needed to realize this principle.

Cost Savings↗
PubMedDate not supplied

Modeling and evaluation of continuity of care in a staff model HMO.

The concept of continuity in medicine refers to the delivery of care in an uninterrupted and coordinated manner and in accordance with the patient's medical needs. Many diseases and symptoms require serial observation and treatment over long periods and are interwoven with the patient's personal and social circumstances. We believe that the depth of a primary care provider's understanding of a patient is directly proportional to the total length of interaction between the patient and provider. We have reviewed the published studies in this area, and modeled continuity of care in an HMO clinic. The patients' ages, their visiting patterns, and the length of their interactions with their doctors were synthesized stochastically. We now propose a new way of defining continuity of care, the Fundamental Continuity of Care Index (FCCI), and recommend its use. Hospitals, insurance companies, and governments should be aware of the benefits of continuity and all physicians should commit themselves to longitudinal care for their patients.

Adolescent↗
PubMed1998

[Clinical and economic cost-benefit relations in treatment of patients with coronary heart disease].

Economic evaluation of medical treatment in terms of costs and utility has gained increasing interest within the medical community and in political discussions. In particular this applies for highly prevalent diseases such as coronary artery disease, still the most common cause of death in the western world. Health economy studies can be performed from different perspectives (e.g., hospital, insurance company, society) and with various approaches (e.g., cost-utility analysis, cost minimization). Those will be discussed for the primary prevention of myocardial infarction, coronary stent implantation, and for rehabilitation programs after myocardial infarction, serving as examples. Health-economical analyses provide data to compare treatment strategies beyond a certain speciality. However, economic evaluation is only one step within the medical assessment process and does not per se imply the political allocation of financial resources.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

[Out-of- pocket expenditures during hospitalization of young leukemia patients with state medical insurance in two Mexican hospitals].

OBJECTIVE: To estimate out-of-pocket expenditures for health care during the first hospitalization of children treated for leukemia in two hospitals of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social-IMSS-). MATERIAL AND METHODS: A cross-sectional study was conducted in Mexico City and Leon, Guanajato, Mexico in 1997. The study population consisted of the parents of 51 children under 15 years of age diagnosed with leukemia, who were hospitalized for the first time in two IMSS hospitals. A questionnaire was applied to participants to obtain direct and indirect expenditures during that period. Consumer price indexes (1997-2002) were used to estimate expenditure prices for 2002. Average expenditures and catastrophic expenditures were estimated. Factors associated with expenditures were analyzed using a linear regression model in which the dependent variable was the total household expenditures during hospitalization. RESULTS: The average household cost per hospitalization was 7,318 pesos, 86% of which corresponded to medical care and 14% to indirect costs. Catastrophic expenditures occurred in 14% of households. In 47% of household expenditures exceeded 100% of the total household income during the hospitalization period. Expenditures during hospitalization were associated with place of residence, income level, and type of medical insurance. CONCLUSIONS: Being an IMSS policyholder decreased out-of-pocket expenditures, but not complementary expenditures, which may still be unaffordable for a large segment of the population. For more than a half of the households studied, continuity of care was compromised, as expenditures during the first hospitalization entailed using up savings, going into debt, and/or selling household property.

Child↗