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PubMed1980

[Utilization of medical services].

In order to measure all effects of a community intervention program such as the NRP 1A "Primary prevention of cardiovascular disease in Switzerland", use of health services should be taken into account, too. Data from the cross-sectional baseline assessment in the Swiss-German town of Aarau and the Swiss-French town of Nyon show that women had significantly more physician office visits than men (42.9 and 33.9% within three months). Women also had more hospital admissions (21.7 and 13.4% over a period of two years). There were no differences regarding sick-days (11.7 and 10.2% within three months). There was a significant difference between the two parts of the country: there were more hospital admissions in the Swiss-French town. Males indicated that a considerable fraction of the reasons for the last physician visit was a preventive health control, without the presence of any signs or symptoms. The differences found in this study are in partial agreement with several large data systems of Swiss health insurance carriers. Persons participating only after intensive recruitment use health services more than the group of those volunteering. The level of use correlates inversely with the social class and, among women only, with cigarette smoking. An intervention program has to make a special effort to include those who do not volunteer right away.

Adolescent↗
PubMed1995

Taming the CAT Fund: two decades of challenges.

The CAT Fund on September 30 announced a 68 percent emergency surcharge to settle approximately $108 million in unpaid claims. Physicians across the state are asking how--and why--this happened. The Society's general counsel takes an historical look at the fund and offers a realistic solution to curtail similar "surprises" in the future.

Financing, Organized↗
PubMedDate not supplied

In the courts.

Explore the source record for details and available documents.

Cost Control↗
PubMed1995

Responses to a payment policy denying professional charges for diagnostic imaging by nonradiologist physicians.

OBJECTIVE: To assess the impact of a payment policy denying reimbursement for the imaging-related professional services of nonradiologist physicians by comparing the use of and expenditures for diagnostic imaging examinations before and after implementation of the policy. DESIGN: Retrospective economic evaluation of claims and expenditures for diagnostic imaging examinations filed by physicians practicing in the 20 US counties having the greatest number of United Mine Workers of America Health and Retirement Funds (hereafter referred to as Funds) beneficiaries. SETTING: Insurance claims database of Funds beneficiaries, most of whom are elderly and live in rural communities and small towns. INTERVENTION: The January 1, 1993, implementation of a reimbursement policy denying payment of professional claims for diagnostic imaging of nonradiologist physicians. MAIN OUTCOME MEASURES: Numbers and types of eligible claims and Funds payments for diagnostic imaging examinations during the year before and after the intervention, normalized for changes in the number of beneficiaries. RESULTS: Despite the rejection of $811,466 in claims disallowed by the policy, the Funds paid 12% more for diagnostic imaging performed in the 20 counties we studied during 1993 than during 1992. The Funds reimbursed 41% more claims per beneficiary for diagnostic imaging in 1993 than in 1992 (t = -8.03, P < .0001). The absolute number of professional claims per beneficiary increased more than did technical or global claims. CONCLUSIONS: Despite a payment policy designed, in part, to reduce the Funds' imaging-related expenditures, the physicians we studied filed more claims, leading to greater expenditures. An increased number of self-referred technical claims and greater referral to hospital radiology departments likely account for most of the observed increases in utilization and costs.

Cost Control↗
PubMedDate not supplied

Tuberculosis in office settings: the anxiety and the reality.

Using three case studies as examples, the director of a major insurance carrier's employee health service shares his perspective on the importance of the early identification of potential exposures, screening for tuberculosis, and communicating to employees. He emphasizes that "an appropriate level of vigilance" can prevent or minimize a significant number of workplace exposures.

Adult↗
PubMed1994

Primary care in transition.

It is generally agreed that too few physicians have chosen careers in primary care. The advent of managed care as a popular method of health care provision is now affecting primary care physicians in ways that may further discourage enthusiasm for the practice of primary care and have an unintended negative effect on the primary care physician supply. In addition, the early implementation of the resource-based relative value scale by Medicare and some insurance carriers has been less beneficial to primary care physicians than expected and may even have been harmful to general internists. Efforts to improve the position of primary care physicians in relation to payers and among peers are hindered by the fact that, as a group, primary care physicians are less affluent, less influential, and greatly outnumbered by their more specialized colleagues. Consequently, some of the support currently directed toward primary care may be more apparent than real. My proposals, which aim both to protect and to enhance primary care practice, are the creation of separate primary care fee schedules and separate primary care budgets within health plans, changes in consumer protection rules that intrude on primary care practice, and the development of statewide primary care associations for mutual support and greater bargaining power. Some aspects of contracting and gatekeeping require further study.

Career Choice↗
PubMed1994

CTD: carpal tunnel syndrome, the facts and myths.

Recognition of the need for risk control of occupational injuries and prevention programs has led to many new studies demonstrating that occupational diseases are multifactorial in etiology, and that a specific job may not be the primary cause for occurrence. As a result of the many causes, myths about work-related injuries have developed. CTDs are the majority of occupational injuries. Individual risk factors are a better predictor of development of CTD and CTS than are job-related factors. Risk for carpal tunnel syndrome is closely related to general physical condition. Improved general health and health prevention programs may reduce an individual's risk level for developing a cumulative trauma injury. Risk measurement systems now allow employers to establish programs with measurable results. Since assessing the individual risk factors provides the best opportunity to attain the goal of prevention, the next step is for employee, employers, insurance carriers and the medical profession to establish concurrent prevention programs based on human risk factor evaluation systems.

Adult↗