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At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

[The Oregon state health plan for access to health services: the context, elaboration and characteristics].

The Oregon Health Plan is the first explicit and public attempt to establish the priority of health services by a systematic assessment of their cost-effectiveness. The need to solve major health problems such as increasing costs or the effectiveness and equity of health services as well as the debate developed around the plan, deserves a detailed review. This article describes the health care context where the plan took place, reviews the most important elements of its elaboration, analyzes methods used and summarizes the main reactions to the plan.

Cost-Benefit Analysis↗
PubMedDate not supplied

California's use of health statistics in child health planning.

The California Health Plan for Children, 1979, compiled by the Committee on Health Planning of California, District IX of the American Academy of Pediatrics, is an extensive report on health problems unique to the children of California. Since its publication, many local and state health agencies have been using it as a guide and source of data in their planning efforts for child and youth health. The creation of the plan demonstrated a successful working relationship between health care practitioners and biostatisticians, the acceptance by health professionals of the use of health statistics in planning, the different uses of health statistics in formulating recommendations, and an approach to organizing and summarizing large bodies of data. Nevertheless, our experience indicates that although collection systems for data on population, mortality, natality, morbidity, and health services statistics abound, their use in community health planning for subpopulations is still limited by problems in the definition, validity, and completeness of the data elements. The establishment of an individualized data system for the entire population, to be developed, coordinated, and controlled by one central agency, could be a significant step toward solving these long-standing problems in our data systems.

Adolescent↗
PubMed1997

Approval of information collection requirements for the joint interim rules for health insurance portability for group health plans, and the individual market health insurance reform: portability from group to individual coverage; federal rules for access in the individual market; state alternative mechanisms to federal rules--IRS, DOL, HCFA. Interim rules with request for comments; approval of information collection requirements.

On April 8, 1997, the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (Departments) published joint interim rules governing the access, portability and renewability requirements for group health plans and issuers offering group health insurance coverage in connection with a group health plan. The rules implemented changes made to certain provisions of the Internal Revenue Code of 1986 (Code), the Employee Retirement Income Security Act of 1974 (ERISA), and the Public Health Service Act (PHS Act) enacted as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In the April 8 publication, the Departments submitted the group market information collection requirements, for, among other things, establishing creditable coverage, notice of special enrollment rights, and notice of pre-existing condition exclusion periods, to be Office of Management and Budget (OMB) for emergency review under the Paperwork Reduction Act of 1995 (PRA 95). In addition, on April 8, 1997 the Department of Health and Human Services submitted the HIPAA individual market information collection requirements to OMB for emergency review under the PRA 1995. This document amends the April 8 Federal Register documents to properly display the OMB control numbers.

Career Mobility↗
PubMedDate not supplied

Consumer-directed health plans and the RAND Health Insurance Experiment.

Today's consumer-directed health plans, with their high deductibles, bear a strong resemblance to the high-deductible plan of the RAND Health Insurance Experiment (HIE), although they come into a post-managed-care world. The high deductibles and the tools of managed care should complement each other, the former directed primarily at the initiation of care for an episode of illness and the latter at the costliness of episodes, especially ongoing chronic disease episodes. Although the RAND experiment established the effects of varying prices to patients, future experiments with how physicians respond to the various tools of managed care may be useful.

Community Participation↗
PubMed1996

[Reflections on health planning and on health reform in Brazil].

The authors considered carefully the brazilian social policies at the regimes of populism and militarism as well as at the democratic transition following the presupposition that the social planning in Latin America emerged as an instrument for social policies formulation. The authors also considered some tendencies of the Latin America Planning, emphasizing the Strategic Focus of the Health Program formulated by the Public Health School of Medellin; the Strategic Thought elaborated by Mario Testa; and the Strategic Situational Planning developed by Carlos Matus.

Brazil↗
PubMed2001

The role of health plans in tobacco control.

Health plans play an important role in tobacco control. In this chapter we present an overview of the scientific research on health plan involvement in clinical and community interventions regarding tobacco use. Also included are interventions that have been undertaken by health plans to lower smoking rates among their members and the general population. We conclude with a new model that can be used to engage health plans in tobacco control efforts and a case study that outlines how one health plan has implemented this new model.

Community Health Planning↗
PubMed2006

Use of board certification and recertification of pediatricians in health plan credentialing policies.

CONTEXT: Health plans conduct credentialing processes to select and retain qualified physicians who will provide high-quality care to their subscribers. One of the tools available to health plans to help ensure physician competence is assessment of board certification status. OBJECTIVE: To determine the credentialing policies of health plans regarding the use of board certification and recertification for general pediatricians and pediatric subspecialists. DESIGN, SETTING, AND PARTICIPANTS: Telephone survey conducted February through July 2005 of credentialing personnel from a US national sample of 244 health plans stratified by enrollment size, Medicaid proportion, and for-profit or not-for-profit status. MAIN OUTCOME MEASURES: Proportion of health plans that require general or subspecialty board certification at initial contract or at any time during association with the plan and recertification to maintain credentialing or to bill as a specialist or subspecialist; percentage of physicians credentialed in each health plan and credentialing goals for each plan regarding the proportion of physicians to be board certified. RESULTS: Response rate was 193 of 244 (79%). Overall, 174 (90%) of the plans do not require general pediatricians to be board certified at the time of initial credentialing, and only 41% ever require a general pediatrician to become board certified. Similarly, only 80 (40%) ever require subspecialists to become board certified in their subspecialty. Although 80 of 192 (41%) report requiring recertification of general pediatricians, almost half do not have a time frame in which recertification must occur. Seventy-seven percent of plans allow physicians to bill as subspecialists with expired certificates. CONCLUSIONS: These findings, although specific to pediatrics, likely apply to other primary care disciplines and raise questions regarding the ability of plans to ensure initial or continued competence of their credentialed physicians. Growing public concern regarding patient safety, as well as demonstrated patient preferences for certified physicians, will likely result in greater emphasis on quality assessments in physician credentialing.

Certification↗
PubMed1993

[A survey of goals and the utilization of numerical goals in the health planning of 47 prefectures].

Health plans of 47 prefectural governments based on the Medical Law of 1985, were evaluated regarding four health planning factors: final goal, implementation plan, development of resources, and evaluation planning. Results of the evaluation showed that 8.5% of the 47 prefectures had defined future level of health based on numerical goals. On the other hand, all of the prefectures had developed numerical goals specifying the number of hospital beds in each medical district. A major component of health planning is improvement in the accomplishment of the implementation plan. There were 14 prefectures which had numerical goals for the upgrading of facilities and for manpower development to meet future health care activities. The following factors are required in the health planning to meet the needs for improving the health status of the population. 1) Including in the future health goals, in addition to the number of medical bed in regional areas, objective levels of health that should be attained. 2) Development of practical plans for evaluation of effectiveness of health planning.

Health Planning↗
PubMed2004

A new kind of "health plan".

These new "health plans" are personalized, consumer-specific action plans created partially by and individually for consumers. They are aimed at improving consumers' overall health, reducing their risks for expensive and life-diminishing diseases, improving their self-management of chronic conditions they already have, and generally improving their quality of life, insofar as broadly defined "health improvement" will achieve that. This new form of "health plan" has been adopted by one of the major proponents of prospective health, Duke University Health System in Durham, NC.

Community Participation↗