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PubMed1993

Teleradiology for dentistry.

As the world enters the "telecosm," the importance of rapid information transfer will grow. It is not unusual for the average American to have a beeper on his or her belt, a cellular telephone in the car, a telephone with remote access answering machine, voice mail, call forwarding, a home fax, and a personal computer networked with a commercial purchasing and information retrieval service such as CompuServe or Prodigy. Conventional cellular telephones, introduced in 1983, numbered approximately 6.4 million in the United States by January, 1992. This is a measure of the importance placed on rapid interpersonal communication. Undoubtedly, patients will begin to expect at least the same degree of efficiency in communications on the part of health care providers, including dentists. There are great potentials for expediting prior approval and reducing costs for dental care as dentists obtain new, lower-priced, direct digital imaging systems, especially as ISDN and electronic mail systems become more available and less costly. It should be possible to reduce insurance costs by minimizing the numbers of clerical staff needed to open, check, and return submitted radiographs. Centralized diagnostic centers for second or expert opinions both for the dental profession and for the insurance carriers are additional pluses. There are potential savings in mailing costs and in reducing travel required of the patient living in a remote region to obtain a second opinion. Transmission using commercially available access to Internet/NSFNET is already possible for a small monthly fee. Nothing, other than a basic personal computer with graphics capabilities, is needed to transmit and receive files once the image is in a digital form. Electronic imaging and image transmission are here.

Computer Communication Networks↗
PubMed1993

Physiatrics at the forefront: physical medicine and rehabilitation in the 1990s.

Physiatry, a specialty title derived from the word "physical," is the second-fastest-growing medical specialty in the United States. The interdisciplinary team-management system is the key to the success of physiatric services. The goal is to maximize functional outcome for physically challenged patients who have any of a broad scope of disorders causing disabilities or pain. Rehabilitation of these patients is cost-effective and provides improved quality of life for those treated. The job of the four excellent Physical Medicine and Rehabilitation (PM&R) training programs in Texas is to educate young physicians with knowledge regarding medicine, general science, electrodiagnostics, and allied health-care science. Young physiatrists may gravitate towards various subspecialties in the field or choose to provide a variety of services to assist other physicians in the management of patients over a prolonged period. In the age of managed competition, costs versus access, and quality-of-care issues, physiatrists must educate physicians, the public, legislators, and insurance carriers (federal, state, workers' compensation, and third-party) as to why rehabilitation should be included in any and every health-care plan.

Education↗
PubMed1993

Reimbursement and pharmacoeconomic perspectives in biotechnology.

Problems associated with reimbursement for biotechnology agents and strategies for solving these problems are reviewed. Because of the many different insurers in the U.S. health care system, a variety of reimbursement strategies have been developed for the biotechnology drugs that are now reaching the market. These strategies can vary by insurer, contract, treatment setting, and patient condition. With the advent of high-cost biotechnology drugs, pharmacists have taken on the additional roles of institutional educators and reimbursement specialists. Case studies involving three biotechnology agents illustrate how insurers deal with reimbursement for these drugs. Thrombolytic agents are reimbursed under Medicare, but the diagnosis-related-group (DRG) payment for myocardial infarction was not changed until two years after alteplase was marketed. Septic shock therapies potentially face similar reimbursement problems, which are compounded because the drugs can be lifesaving--leading to longer hospital stays. When filgrastim is administered, the amount reimbursed depends on the treatment setting. When claims for biotechnology agents are denied, the institution or provider should contact the payer to provide the needed information (in the case of missing information) or to discuss payer policies that may need review. Through proper case management, pharmacists and other institutional personnel can ensure reimbursement for these lifesaving biotechnology therapies.

Biotechnology↗
PubMed1993

Contemporary issues in the treatment of alcohol dependence.

Alcoholism treatment has certainly come of age since its inception with the founding of Alcoholics Anonymous in 1935. Although AA is a "fellowship" and is not considered "treatment" per se, the growth and proliferation of professional treatment programs has spawned a significant new sector in the health care industry, with a corresponding rise in health care cost. Because the social cost due to the destructiveness of alcoholism is enormous, however, treatment appears to be a cost beneficial investment for society, both in terms of dollars expended and in terms of the lessening of human misery. Inpatient and outpatient programs appear to be effective, but simplistic comparisons are to be avoided because their populations are frequently much different, with patients with poor prognosis indicators showing up more frequently in inpatient settings. Although outpatient treatment is undeniably cheaper initially, appreciable long-term savings may not be realized because of the greater tendency for recidivism in outpatient-treated groups. Taken as a whole, studies of treatment outcome and cost effectiveness support the view that contemporary alcoholism treatment should provide multiple levels of care, with appropriate matching of patients, depending on severity and various demographic factors. This matching may be difficult to realize in actual practice because of the wide variability among alcoholic patients. Although some patient-treatment matching criteria are now in use by insurance carriers and treatment providers, the long-term efficacy of these criteria have not been tested adequately. In the end, it may evolve that the best determinant of assignment to a particular treatment level or modality might best be done by a responsible clinician exercising good judgment based on experience and training. Appropriate legal and financial accountability for this decision should be based on standards of reasonableness, consistent with criteria used in the treatment of other medical and surgical conditions. The alcoholism clinician is performing a valuable service to humanity and to society. Social policies should support this effort by making available appropriate facilities and programs for treatment, and by promoting access through destigmatization and favorable payment and reimbursement systems.

Aftercare↗
PubMed1993

Private medical insurance among Philadelphia residents diagnosed with AIDS.

We used medical insurance information gathered on each Philadelphia resident with AIDS to examine time trends in private medical insurance at the time of diagnosis. The proportion of AIDS patients with private medical insurance decreased from 51.9% in July-December 1988 to 28.6% in July-December 1991. During the same time period, an increasing proportion of people diagnosed with AIDS were female, poor, members of minority groups, or abusers of injection drugs. A discrete multivariate model showed that the (point) prevalence of private medical insurance at AIDS diagnosis decreased significantly with time, even after adjustment for changes with time in the age, gender, race, estimated income, history of injection drug use, and history of homosexual contact of those who were affected with AIDS. Thus the decreasing prevalence of private medical insurance among people newly diagnosed with AIDS does not simply reflect changes in the demographic and behavioral characteristics of the people affected.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Genetic testing for cancer predisposition: behavioral science issues.

The discovery of major cancer susceptibility genes is likely to create strong pressures for clinical testing from biotechnology companies, insurance carriers, the medical community, and the public. However, before genetic testing for cancer predisposition is made widely available, we must identify the optimum strategies to enhance informed decision making, minimize adverse psychologic consequences, and promote adherence to recommended surveillance. This report provides an overview of behavioral research in these areas and, on the basis of this literature, presents suggestions for developing effective and ethical genetic testing protocols.

Causality↗