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PubMed2006

Comparison of alcohol treatment and costs after implementation of medicaid managed care.

OBJECTIVE: To examine the impact of a mandatory managed care behavioral health program on utilization and cost of alcohol treatment services for high-risk Medicaid patients. STUDY DESIGN: Pre-post nonequivalent comparison group design to compare managed care clients with fee-for-service (FFS) clients in terms of behavioral treatment costs and use. METHODS: Study subjects were adult Medicaid enrollees diagnosed with alcohol abuse or alcohol dependence. Chi-square tests and analysis of variance were used to determine significant differences between managed care and FFS programs in characteristics of the subjects, service use rates, and intensity of care. A regression model was used to examine predisposing, enabling, and need factors that might explain cost differences between programs. RESULTS: The managed care site had reduced behavioral healthcare costs compared with the FFS site. However, the regression analysis, which explained 35% of the variance in behavioral health service cost per user, showed that treatment cost was not significantly lowered by the managed care intervention once predisposing and need factors were controlled for. Nineteen percent of the variance in cost was explained by increased mental health comorbidity and 12% by drug comorbidity. CONCLUSION: Consistent with other studies, the results show lower behavioral healthcare costs after the managed care intervention because of changes in management practices, service substitution, and negotiation of lower hospital fees. However, the managed care influence was insignificant in explaining cost variation between sites due to higher morbidity in the FSS site post managed care.

Adult↗

PubMed1986

Mandatory supervised antabuse therapy in an outpatient alcoholism program: a pilot study.

We instituted a program of mandatory supervised antabuse therapy in an outpatient alcoholism clinic for patients who wish to remain connected to the clinic but who have continued to drink repeatedly. Almost 60% of 68 patients who agreed to this regimen achieved significant periods of sobriety. These preliminary findings suggest that a controlled trial of this approach is warranted.

Adult↗

PubMed1991

Impact of a mandatory Medicaid case management program on prenatal care and birth outcomes. A retrospective analysis.

This study examined the impact of Philadelphia's mandatory Medicaid case management program (HealthPASS) on adequacy of prenatal care and birth outcomes among enrollees. A sample of 217 deliveries for HealthPASS patients at the Hospital of the University of Pennsylvania (HUP) during 1988 was compared with a matched sample of 1988 deliveries at HUP for whom the payor was Pennsylvania's traditional fee-for-service Medicaid program. Inpatient charts for all 434 subjects were abstracted for information on sociodemographic characteristics, substance use during pregnancy (cigarettes, alcohol, and drugs), course and extent of prenatal care, and birth outcomes including birth weight, gestational age, and mortality. No significant differences were detected between HealthPASS and Medicaid groups, suggesting that the mandatory managed care program neither improved nor impeded access to needed services. These results were not surprising in view of the fact that HealthPASS actually did little to change provider or patient behavior with respect to obstetrical care. Both the HealthPASS and Medicaid groups experienced low rates of adequate prenatal care (39%) and high rates of low birth weight (20%). Also disturbing was the finding that at least 46% of women smoked during pregnancy, at least 20% drank alcohol, and at least 17% used cocaine. These findings support the need for continued efforts to improve both access to, and content of, prenatal care for the urban poor.

Adolescent↗

PubMed1989

Patients' reactions and physician-patient communication in a mandatory surgical second-opinion program.

To assess patients' reactions to a mandatory second surgical opinion program and to measure the accuracy of communication between these patients and their physicians, questionnaires were sent to New York City municipal employees, retirees, and dependents who had received second-opinion consultations. The most frequent reactions, among 902 respondents, were that the consultations provided reassurance (59%), helped in deciding whether to proceed with surgery (49%), and provided a chance to ask important questions (29%). Relatively few patients felt that the program caused anxiety (12%) or confusion (5%). Patients were generally pleased with the administrative aspects of the program but less satisfied with the consultant physicians they had seen. Twelve percent of patient-physician pairs disagreed about the advice that had been communicated in their second-opinion consultation visits. Nonconcordance rates varied greatly with the nature and complexity of the advice rendered and were higher among patients who stated that their consultants' explanations were not thorough and understandable. In addition to their cost-containment functions, mandatory surgical second-opinion programs can be supportive and informative. Systematic feedback from patients can be used to enhance these strengths, to correct programmatic deficiencies, and to improve the accuracy of communication.

Attitude↗

PubMedDate not supplied

Mandatory education via the computer: cost-effective, convenient, and creative.

With reduced budgets, few resources, minimal time allotted for education, and a long list of topics to cover, staff development and inservice educators often find it difficult to implement cost-effective, comprehensive mandatory education programs. Upper Valley Medical Center's annual mandatory education program via the computer was created to address these issues and resulted in substantial cost-savings as well as increased employee satisfaction.

Attitude of Health Personnel↗

PubMed2005

Moving to mandatory Medicaid managed care in Ohio: impacts on pregnant women and infants.

BACKGROUND: Understanding the impacts of Medicaid managed care on pregnant women is critical because Medicaid covers more than a third of all births nationally, many under managed care arrangements. OBJECTIVES: We sought to examine the impacts of mandatory Health Maintenance Organization (HMO) enrollment on prenatal care use, smoking, and birth weight for Medicaid-covered pregnant women in Ohio. RESEARCH DESIGN: Impact estimates are derived from a pre-post design with a comparison group, using Ohio birth certificate data linked to Medicaid enrollment files. Between April 1993 and April 1995 is the baseline period and October 1997 to June 1998 is the post-period. The treatment group consists of deliveries in 6 counties that implemented mandatory HMO enrollment in the mid 1990s; the comparison group consists of deliveries in 4 counties with voluntary HMO enrollment. SUBJECTS: Medicaid-covered deliveries to 24,799 non-Hispanic white women with no college education living in Ohio. MEASURES: Seven outcomes are analyzed: first trimester care; last trimester or no care; adequate prenatal care; inadequate prenatal care; smoking during pregnancy; and birth weight. RESULTS: Our findings indicate that mandatory HMO enrollment in Ohio's Medicaid program had positive effects on prenatal care and led to reductions in maternal smoking. No effects were found on birth weight. CONCLUSIONS: Even with the improvements related to Medicaid managed care, rates of inadequate prenatal care and maternal smoking remain relatively high. Addressing the underlying risk factors that are facing poor women and further expanding public programs may be critical to achieving further progress.

Birth Weight↗

PubMed1982

Impact of a mandatory second-opinion program on medicaid surgery rates.

The effect of the Massachusetts second-opinion program on the volume of elective surgery in the Medicaid population was assessed using two approaches: a study of the program experience and surgery decisions of 2,501 program referrals, and an analysis of Medicaid surgery rates before and after program implementation. Nonconfirmation rates, which averaged 14.5 per cent, varied by procedure from 4 per cent for cholecystectomy to 26 per cent for disc surgery. The patient's surgery decision was related to the outcome of the second-opinion consultation: 85.5 per cent of the confirmed patients had the originally proposed operation, as compared with 31 per cent of the nonconfirmed patients. In the year after program implementation, the program was associated with a 20 per cent reduction in the volume of those procedures covered by the program. The greatest percentage declines were for hysterectomies, meniscectomies, hemorrhoidectomies and tonsillectomies/adenoidectomies. The decline in surgery rates was attributed both to a direct effect on patients referred to the program and to a sentinel effect whereby fewer operations were proposed. We conclude that the mandatory second-opinion program in Massachusetts saved Medicaid $3 to $4 for every dollar spent.

Costs and Cost Analysis↗

PubMed1995

Intimidation, coercion and resistance in the final stages of the South Asian Smallpox Eradication Campaign, 1973-1975.

This paper reviews episodes during 1973-1975 when American physician-epidemiologists in South Asia, working under the auspices of the World Health Organization, intimidated local health officials and resorted to coercive methods in the final stages of the Smallpox Eradication Programme. While intimidation and coercion were successful in the short-run in ensuring disease containment, they evoked health-professional and popular resentments, and the long-term effect may have been to foster negative attitudes toward subsequent vaccination campaigns. At the very least these episodes suggest a need for paying attention to actual and perceived abuses when global health measures are introduced from 'above' into regional settings.

Asia↗

PubMed2004

Child protection: a neglected area of pediatric residency training.

BACKGROUND: Child maltreatment is prevalent in Canadian society, and medical professionals are frequently required to provide care in these cases. Physician knowledge and training in child protection have been questioned. This study examined the experience, perceived adequacy of training, and perceived competency of Canadian pediatric residents in child protection. METHODS: Structured questionnaires were sent to child protection program directors (CPPDs), pediatric program directors (PPDs) and pediatric residents at the 16 Canadian pediatric academic centers. Data were analyzed using descriptive statistics, chi(2)-analyses, a Mann-Whitney test, and linear regression. RESULTS: Responses were obtained from 15 of 16 CPPDs, all 16 PPDs, and 190 of 348 (54.6%) residents. All programs provided didactic teaching sessions. Only 3 programs had mandatory clinical rotations, 9 programs offered clinical electives, and 7 programs did not offer any specific clinical experience in child protection. Half of the residents had seen 5 or fewer cases of maltreatment. Residents and program directors most commonly rated the training as "somewhat adequate, needs improvement" with a significant minority rating it as "poor, inadequate." Residents' self-rating of competency was positively associated with number of years of training and number of cases of maltreatment seen. Almost all residents (92%) felt that they needed further training in child protection, including 85% of graduating residents. Some of the residents (16.4%) did not anticipate dealing with child protection cases as practicing pediatricians. CONCLUSIONS: Canadian pediatric residents receive little exposure and limited training in child abuse and neglect. As a result, even senior pediatric residents feel poorly trained. These results highlight the need to establish effective training programs for residents in child protection.

Attitude of Health Personnel↗

PubMedDate not supplied

Religious exemptions to the immunization statutes: balancing public health and religious freedom.

Given the AAP's 1997 position statement on religious exemptions to medical care, authors consider whether failure to immunize a child is medical neglect. Although acknowledging that it is, they argue that parental decisions not to vaccinate on the basis of religious beliefs should be permitted.

Child↗

PubMed1999

Should childhood immunisation be compulsory?

Immunisation is offered to all age groups in the UK, but is mainly given to infants and school-age children. Such immunisation is not compulsory, in contrast to other countries, such as the United States. Levels of immunisation are generally very high in the UK, but the rates of immunisation vary with the public perception of the risk of side effects. This article discusses whether compulsory vaccination is acceptable by considering individual cases where parents have failed to give consent or have explicitly refused consent for their children to be immunised. In particular, the rights of: a parent to rear his/her child according to his/her own standards; the child to receive health care, and the community to be protected from vaccine-preventable infectious disease are considered. The conclusion of the article is that compulsory vaccination cannot, with very few exceptions, be justified in the UK, in view of the high levels of population immunity which currently exist.

Child↗

PubMed2006