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At least 1,423 records · Page 79Linked to original sources
PubMed1990

Containing Ontario's hospital costs under universal insurance in the 1980s: what was the record?

In recent years the Ontario government has been concerned that the proportion of public expenditures devoted to health care is at an all-time high. In addition, the media have devoted considerable attention to specific incidents that may represent inadequate funding of hospital services. To shed light on the debate on health care expenditures we analysed the trend in expenditures of Ontario's hospital sector in the 1980s in terms of the amount of inputs (e.g., labour) used to produce hospital services (e.g., a patient-day or admission) and after adjustment for general inflation. As in the 1970s the number of inputs grew relatively slowly during the 1980s. Inputs per patient-day grew at an annual rate of 0.46% and inputs per admission at an annual rate of 2.4%. Cost increases were largely accounted for by hospital wage increases; this could have been due to Ontario's rapidly expanding economy. These findings indicate that Ontario has continued to be successful in containing the number of inputs used in the hospital sector. However, after two decades of substantial success with publicly acceptable cost control, the government faces increased scrutiny as the media and the public focus attention on several areas of perceived inadequate funding in health care services.

Costs and Cost Analysis↗
PubMed1981

A working model for allied health clinical practice.

Allied health educators are expected to have exemplary clinical skills. Opportunities to practice are often limited in the academic setting. One method for insuring the maintenance of clinical skills among allied health faculty is a professional practice clinic. The University of Texas School of Allied Health Sciences at Houston, in conjunction with a teaching affiliate, Hermann Hospital, has opened a free-standing nutrition clinic on a fee-for-service basis. Reasons for establishing a clinical practice included: 1) to provide opportunities for faculty to practice; 2) to provide a teaching laboratory; 3) to provide a community service; 4) to provide a mechanism for research with defined groups; and 5) to facilitate faculty development with fee-generated income. A partnership model between the university and hospital was proposed which included the organizational structure, description of services, fee schedule, and funding base. Evaluation areas will include: impact on educational program, effectiveness as health counselors, faculty and staff growth, and generated income as profit.

Ambulatory Care Facilities↗
PubMed2000

[Model project for updating neonatal screening in Bavaria: concept and initial results].

The newborn screening programme in Bavaria was confronted with several problems. Number of disorders and process quality no longer complied with screening guidelines. Mixed financing, distributed between the state (PKU, galactosaemia) and health insurances (hypothyroidism) had promoted an increasing dissipation of the system. Notified participation rates had dropped to < 80%. Increasing need for a second screening due to early discharge was an additional challenge. To overcome these problems, and considering the availability of improved screening methodology (tandem mass spectrometry) the programme was reorganised. The project, which started on Jan 1, 1999, is based on a cooperation model between laboratory (logistics, analysis), universities (treatment, scientific evaluation), and public health services (coordination, tracking). Time of blood sampling was predated to the third day of life. Screening was extended to biotinidase deficiency, congenital adrenal hyperplasia (CAH) and by introduction of tandem mass spectrometry for screening of many other disorders (besides PKU). Insurances now finance complete laboratory analysis which was transferred to the private sector. To enable all newborn to participate, the names of screened children are matched against birth lists by public health services on a regional basis. Recalls and conspicuous results are consistently followed up until disorders are either excluded or confirmed. Two clinical hotlines were established in the children's hospitals of the universities in Munich (Southern Bavaria) and in Erlangen (Northern Bavaria). Written consent is required for participation in the programme. Participation in the new programme could be continually increased; coverage is > 95% since April. In several cases screening was made up for not tested children by contacting their parents. Omitted screening was mostly due to misunderstandings regarding testing responsibility or lost samples. Altogether 52 cases of disorder were found in the 87,000 newborn screened until August 1999. Hence, the detection rate of children affected by inborn errors of metabolism was about twice as high than before changes. Among the newly screened diseases CAH was detected most often (11 cases). In 22 cases diagnosis was based on the use of tandem mass spectrometry. Among these (besides PKU, 9 cases) MCAD deficiency (6 cases) was detected most frequently. Whereas recall rates of most disorders were < 0.1%, screening for CAH still revealed a high recall rate, particularly in premature births. Second screening due to early discharge (< 48 h) was required in 1.3%. About 20% of pending recalls required contacting birth hospitals, doctors, midwives or parents. So far all affected children could be brought to treatment in time.

Female↗
PubMed1995

[Problems of national health insurance reimbursement revision, especially for laboratory tests].

The reimbursement fees for laboratory tests are lowered at every revision of Health Insurance Reimbursement (HIR), carried out every 2 years. This leads to the financial trouble for laboratory operation in university hospitals as well as general hospitals. Medical care costs in Japan account for 6% of GNP and is not as high as that in advanced countries such as USA, Canada, and Germany. The Central Pharmaceutical Affairs Councils gives manufacturing and sales approval for in-vitro diagnostics after examination of the applied documents. The Committee on Application of Medical Care Remuneration in the Japan Medical Association decides the following; Propriety of reimbursement establishment for new in-vitro diagnostics, reimbursement fees for new in-vitro diagnostics, propriety of reimbursement establishment for medical devices and propriety of reimbursement for new drugs. The MOSS (Market-Oriented, Sector-Selective) approach was initiated also in the in-vitro diagnostics field in January 1985 the target of which is to abolish the economic barrier and relax regulations in Japan. The Ministry of Health and Welfare lowered the reimbursement fees based on actual prices in commercial laboratories, which is very low because of price dumping through excess competition. In future, we would like to propose additional reimbursement fees for in-house emergency tests. Furthermore, we would like to request the judgment fee for diagnosis of myelogram, immunoelectrophoresis and isoenzymes for which clinical laboratory physicians play a role.

Clinical Laboratory Techniques↗
PubMed1996

Analysis of health insurance cover for reproductive immunology.

The objective of this study was to document the current state of health insurance cover for reproductive immunology in the USA. A survey of couples who had given birth to a child within the last 2 years while they were being treated with lymphocyte immunotherapy at the Reproductive Medicine Clinic of the Finch University of Health Sciences/The Chicago Medical School (FUHS/CMS), North Chicago, IL, USA, produced 61 completed questionnaires from couples in 16 states, representing a response rate of 55%. The Reproductive Medicine Clinic at the FUHS/CMS is a major centre that treats couples with reproductive immunological problems. These couples had experienced repeated pregnancy losses that were diagnosed as immunological in nature. This prospective study documents the insurance reimbursement of couples receiving lymphocyte immunotherapy who subsequently became parents. The findings indicate that 80% of couples had insurance claims initially denied for reproductive immunotherapy-related services. The most common reason given for a denied claim was that the treatment was experimental. Couples took further action and almost all received cover. Cover for immunotherapy-related services averaged 65% of the cost. The percentage of expenses covered by the insurance was quite variable. The survey indicates that insurance cover is provided if patients are willing to take action.

Abortion, Spontaneous↗
PubMedDate not supplied

Doctor Dean's prescription for health care reform.

One of the nation's smallest states is taking big steps to ensure universal access to health care for all of its citizens. Vermont will create a purchasing pool of public employees, individuals, and businesses who will enroll in a consolidated community-rated insurance plan. A new dispute resolution system will try to remove malpractice suits from the courtroom. Vermont's efforts are needed to show that states can and should develop universal systems of care, so that when a national system is produced states will be the only logical choice to run it.

Cost Control↗
PubMed1994

Sowing the seeds of reform in 1994.

The prospects for reforming health care financing revolve around five questions: (1) Will Congress mandate universal coverage? (2) Will Congress require employers to pay most of the cost of employee coverage? (3) Will Congress authorize effective limits on health care spending? (4) What role should regional health alliances play in the reformed system? (5) How much change in health insurance arrangements can be implemented over the remainder of this decade? The author argues that the prospects are slight for quickly implementing reforms as sweeping as those that President Clinton has proposed. But prospects are good for beginning a process that will lead to universal coverage and effective cost controls. The key is the creation of regional alliances.

Cost Savings↗
PubMed1993

Selection in a preferred provider organization enrollment.

OBJECTIVE: The study was conducted to determine whether favorable or adverse selection occurred in a preferred provider organization (PPO) enrollment. DATA SOURCES AND STUDY SETTING: Secondary data sources were used to conduct a retrospective study of the utilization of health services and the demographic characteristics of the population involved in the first open enrollment in a new university-based PPO. The PPO under study, sponsored by the University of Michigan (UM) Medical Center, was offered to all 43,005 UM employees, dependents, and retirees. STUDY DESIGN: We analyzed insurance company payments during the one-year period prior to the enrollment to compare the utilization patterns of those who enrolled in the PPO with those who did not. DATA COLLECTION: Prior health care utilization data were obtained from Blue Cross-Blue Shield of Michigan on the entire university population for one year prior to the start of the PPO. Demographic data were obtained from the personnel office of the university. PRINCIPAL FINDINGS: The PPO group had a younger median age than the non-PPO group; the sex distribution was roughly similar for the two groups. In the PPO group 57 percent of all contracts were family contracts compared with only 30 percent in the non-PPO group. The PPO group experienced 20.6 percent lower inpatient payments per member, and 9.4 percent lower outpatient payments per member in the year prior to the enrollment. These differences resulted in an overall 18.7 percent lower payment per member for the PPO group in the year prior to their enrollment. CONCLUSIONS: The results show, based on prior insurance payments, that this PPO received favorable selection during the open enrollment, a finding consistent with favorable selection found in early HMO enrollment.

Academic Medical Centers↗
PubMedDate not supplied

The 1991 Pennsylvania Senate race and national health insurance.

Voter interest in reform of the American health care system played a central role in the November 5 come-from-behind reelection victory of Democratic Senator Harris Wofford of Pennsylvania over Republican candidate Richard Thornburgh. In a post-election poll of 1,000 Pennsylvania voters, over 50 percent identified "national health insurance" as one of two issues that mattered most in deciding how to vote. And 21 percent of voters said the issue was the "single most important factor" in their voting decision. The results of the Pennsylvania Senate race suggest that universal health care has arrived as a mainstream political issue and that political candidates who fail to address the issue do so at their peril.

Attitude to Health↗
PubMed2001

Cost analysis of ERCP in a university hospital.

BACKGROUND: A detailed analysis of the costs of ERCP is needed to provide medical staff, hospital administrators, and health care insurers with a solid basis for decision making. METHODS: An incremental cost analysis was performed from the hospital perspective. Cost calculations were based on a prospective registration of materials, labor time, and equipment needed to perform 204 ERCPs in a tertiary care center. RESULTS: Annual fixed cost related to the organization of the ERCP-unit amounted to $136,213. Variable costs per procedure, including labor and material costs, amounted to $344 and $961 for diagnostic and therapeutic procedures, respectively. Average reimbursement was $221. For the actual situation in our unit, with about 900 procedures yearly and a ratio diagnostic versus therapeutic procedures of 35 to 65, a net yearly loss because of the performance of ERCP activities amounts to $608,038. Theoretical measures to decrease costs could reduce this loss to $394,798, with an average loss of $439 per procedure. CONCLUSIONS: This analysis of costs related to performance of ERCPs clearly shows that ERCP is not sufficiently reimbursed. From our model, it appears that increasing the reimbursement rate for therapeutic procedures to $600 per procedure would generate a net positive balance.

Adolescent↗
PubMedDate not supplied

Health care cost containment strategies: the Jordanian experience.

Jordan's relative success in containing costs is the result of public financing of the health insurance system, the health care system reform strategy, and expanding the primary care network, which allows for cost containment and universal access based on the need for services rather than the ability to pay. The shift of costs from the public to the private sector must be curtailed. The determinants of health care (i.e. environment; human biology; life style; and health care system) are the main factors that determine future spending on health.

Cost Control↗
PubMed1994

Survey of health planning proposals.

It is important that physicians participate in the debate and planning process that will ultimately guide how we reform the way health care is financed and delivered in the United States. Herein is offered a perspective on the problem, one which is not necessarily appreciated by health planners. While we deliver the best quality of care in the world to most of our population, our system has been severely criticized because we fail to provide for access to a substantial minority of our population. Additionally, the cost of the product is considerably greater than that in comparable countries. Attempts to control costs without diminishing quality have introduced expensive complexities into our system without any real success in cutting costs. Several proposals have been advanced to address the issues of cost and access. One of these is a single payer system, common in Europe and Canada, whereby a single agent or group of agents finances all health care through universal rules and means. A system operating in Hawaii is a simple employer mandate to provide health insurance. A uniquely American plan is the Jackson Hole Plan or Managed Competition (now called "Managed Cooperation"). This system is currently popular among national health planners, and involves a defined minimum managed health plan offered by various groups of providers to employees and individuals through health plan purchasing cooperatives. This plan is interesting, but has not been implemented in any jurisdiction, and it is not certain it would accomplish its goals in practice since it is difficult to predict behavior of all parties to such a system.

Health Care Costs↗
PubMed1988

Scheduling mammograms for asymptomatic women.

A decision theoretic model was used to investigate the relative importance of risk level, radiation hazard, mammographic accuracy, and cost in mammographic screening decision. The model uses woman-specific medical and family history facts and clinic-specific information regarding mammographic accuracy and practice to profile both woman and clinic, and to formulate periodic screening recommendations. Model parameters were varied extensively to investigate the sensitivity of screening schedules to input values. Multivariate risk was estimated within the program using published data from the Breast Cancer Detection Demonstration Project 5-year follow-up study. Radiation hazard estimates were developed from published radiation physics and radioepidemiologic risk data. Benchmark values for mammographic sensitivity and specificity under screening conditions were calculated from Breast Cancer Detection Demonstration Project data. Procedural costs used in the analysis were varied around values reflecting conditions at the Washington University Medical Center. Mortality advantages of early versus late breast cancer detection were accounted for using Health Insurance Plan of New York case survival rates. Results are compared with published screening policies to provide insight into implicit assumptions behind those policies. This analysis emphasizes the importance of accounting for variations in clinical accuracy under screening circumstances, in costs, in radiation exposure, and in woman-specific risk when recommending mammographic screening.

Aged↗
PubMed2005

Descriptive epidemiology of affective disorders in multiple sclerosis.

BACKGROUND: Affective disorders present an important clinical challenge in multiple sclerosis (MS). Due to prohibitive sample size requirements, population-based studies have not yet provided an adequate description of the underlying epidemiology of this association. OBJECTIVE: To describe the epidemiology of affective disorders in MS in a general population sample. METHODS: The study presented here accessed administrative data from a universal healthcare insurance plan in the Canadian province of Alberta. Physician billing data recorded in the Alberta Health Care Insurance Plan was used to identify members of the population >15 years of age with and without MS. Crude and stratified estimates of the association between affective disorders and MS were made. Logistic regression analysis was used to evaluate statistical interactions and to provide adjusted estimates of the association. RESULTS: The estimated prevalence of MS in the population within the targeted age range (2.3 million individuals) was 386/100,000 and that of affective disorders was 7.7%. As expected, an association between MS and affective disorders was identified (crude relative prevalence: 2.2). The association varied in strength over age-sex categories. Although the prevalence of affective disorder was higher in women with MS than men with MS, the association of MS with affective disorders was stronger in men. The strength of association declined with age in both men and women. Affective disorder prevalence in people with MS becomes similar to that of the general population in older age groups. CONCLUSION: Affective disorders occur with an increased frequency in MS. This is true in men and women and across all relevant age groups, although the association gets weaker with advancing age. Higher frequencies of affective disorder occur in women with MS than in men with MS. The frequency of affective disorder in people with MS is highest in the 25-44 age group, and declines in older age categories.

Adolescent↗