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Results for “Mandatory Programs”

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At least 109 records · Page 6Linked to original sources
PubMed2005

National estimates of the effects of mandatory Medicaid managed care programs on health care access and use, 1997-1999.

OBJECTIVE: We sought to explore how mandatory Medicaid managed care programs affect access to care and use among full-year Medicaid beneficiaries not receiving SSI or Medicare. RESEARCH DESIGN: We used data from the 1997 and 1999 National Survey of America's Families. To establish what Medicaid beneficiaries' access and use would have been in the absence of Medicaid managed care (MMC) and to control for unobserved county differences, we estimated difference-in-difference models using a comparison group of privately insured individuals who we would not expect to be affected by MMC. RESULTS: We found weaker effects of MMC programs for children than adults. The strongest result is that mandatory HMO programs lower the probability of Medicaid adults using emergency rooms, when implemented alone or in combination with Primary Care Case Management (PCCM) programs. PCCM programs reduced the number of visits among adults but had little effect on other measures of access and use. There was less preventive care in mandatory HMO counties for women, suggesting that the federally required external quality review may be appropriate. CONCLUSION: The effects of Medicaid managed care vary with the type of program, and policy makers should not expect programs that rely on PCCMs to have the same effects as those that incorporate mandatory HMO enrollment. Moreover, none of the program models had strong and consistent effects across the indicators of access and use that we considered.

Adult↗
PubMed2000

Effect of different types of Medicaid managed care on childhood immunization rates.

Medicaid managed care can improve access to prevention services, such as immunization, for low-income children. The authors studied immunization rates for 7,356 children on Medicaid in three managed care programs: primary care case management (PCCM; n = 4,605), a voluntary HMO program (n = 851), and a mandatory HMO program (n = 1,900). Immunization rates (3:3:1 series) in PCCM (78%) exceeded rates in the voluntary HMO program (71%), which in turn exceeded those in the mandatory HMO program (67%). Adjusting for race, urban residence, and gender, compared to children in PCCM, children in the voluntary HMO program were less likely to complete the 3:3:1 series (OR = 0.75, CI = 0.63, 0.90), and children in the mandatory HMO program were even less likely to complete the series (OR = 0.59, CI = 0.51, 0.68). Results differed by individual HMOs. Monitoring of outcomes for all types of managed care by Medicaid agencies is imperative to assure better disease prevention for low-income children.

Child, Preschool↗
PubMed1995

A standardized patient program in a mandatory geriatrics clerkship for medical students.

This article describes the development and implementation of a new standardized patient program in a required geriatrics clinical clerkship for fourth-year medical students. A student survey was also conducted to provide evaluations of the program and to determine the frequency with which students' clinical skills are directly evaluated by faculty. Thirty-six percent reported never having been observed while obtaining a history and 24% having been observed only once; 26% had never been observed while completing a physical examination and 39% had been observed only once. The implementation of a standardized patient program provided students with direct feedback on their clinical skills and was rated positively, (good, very good, or outstanding) by 76% of the students.

Clinical Clerkship↗
PubMed2002

Ovarian cancer in BRCA-positive women: vigilance is mandatory despite screening programs.

A young BRCA-1 positive woman turned out to have advanced stage ovarian cancer despite an ensuring check-up 4 months earlier. Much remains unknown regarding the efficacy of screening programs, when applied to individuals predisposed for an inherited malignancy. Therefore, vigilance is mandatory when dealing with women with a positive family history of mammarian and/or ovarian cancer.

Adult↗
PubMedDate not supplied

Evaluation of Alabama's mandatory continuing education program for reasonableness, access, and value.

BACKGROUND: As a measure of quality control, the Alabama Board of Nursing subjected the regulations for mandatory continuing education (MCE) for licensure to an evaluation of their impact and effectiveness. This study focused on licensees' perceptions of the regulations regarding reasonableness, access, and value. METHOD: Evaluation research methods were used to answer research questions related to the rules governing continuing education (CE) requirements for nursing licensure. Data were obtained from a survey of a random sample (N = 406) of RNs and licensed practical nurses. Both qualitative and quantitative methods were applied to data analysis. FINDINGS: Requirements for CE were perceived as reasonable; however, concerns were identified related to cost, access, and quality of presentations. Licensees perceived CE to be of value, and applied CE to decision-making and action in nursing practice. Chi-square analysis was significant to license type related to selected variables (e.g., rights and responsibilities). Qualitative analysis provided insight regarding licensees' concerns and recommendations for change. CONCLUSION: Mandatory continuing education (MCE) plays a significant role in promoting competence in nursing practice and is a mechanism for enhancing public protection. A high noncompliance rate on the MCE audit has ramifications for enforcement regulations.

Alabama↗
PubMed1984

A cost-benefit analysis of California's mandatory premarital screening program for syphilis.

As do most states, California requires premarital serologic tests for syphilis. The Venereal Disease Research Laboratory (VDRL) test and a fluorescent treponemal antibody-absorbed (FTA-ABS) are often used in series for this purpose. In 1979 in California, there were approximately 300,000 persons tested premaritally, but only 35 were found to have asymptomatic infectious syphilis (incidence=0.012%). Including all the direct costs of this screening program, the yearly costs of premarital screening is $8.5 million or almost $240,000 per case found. If one takes into account the sensitivities and specificities of the tests, one still has 6 false-negative and 90 false-positive tests using the 1979 figures. The benefits of the program are the number of cases of congenital syphilis that are prevented. Using a worse-case method, no more than 1.5% of the cases of syphilis detected would result in a case of congenital syphilis. The estimated benefits would result in a savings of approximately $161,000. The economic costs of the premarital screening program far outweigh the benefits.

California↗