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PubMedDate not supplied

Health care professionals' perceptions of the role of pharmacogenomic data.

OBJECTIVE: To explore the perceptions of health care professionals in examining the uses of pharmacogenomic data. METHODS: A mailed questionnaire elicited respondent perceptions of how the use of pharmacogenomic information would impact the provision of health-related services (7-point scale: 7=strongly increase to 1=strongly decrease). Respondents were also asked to describe their level of agreement to statements related to how pharmacogenomic information should be used (7-point scale: 7=strongly agree to 1=strongly disagree). One-sample t tests were used to investigate significant differences from the midpoint value of each scale. Survey participants were attendees of a policy conference entitled.Pharmacogenomics: Implications for Patients, Providers, and Payers. sponsored by the university college of pharmacy. RESULTS: Respondents believed the use of pharmacogenomic information would affect several areas of health care, including the cost of insurance premiums (P<0.001), the use of confidential medical information (P=0.024), patient access to therapy (P=0.005), and the impact of physician/patient preferences in selecting treatment choices (P<0.001). Furthermore, respondents felt it should be used to help treat patients (P<0.001), help patients/physicians make therapy choices (P<0.001), create treatment guidelines (P<0.001), conduct research (P<0.001), justify refusals of therapy (P=0.014), and budget for future expenditures (P<0.001). Respondents also believed the information should not be used for setting copay amounts (P=0.002), determining insurance premiums (P<0.001), or in the negotiation of insurance contracts (P<0.001). CONCLUSION: The respondents to this survey appeared optimistic about the use of pharmacogenomic information, and their responses provided a proactive framework to discuss the potential use and misuse of this technology.

Journal Article↗
PubMed2001

Breast cancer: a socioeconomic and racial comparison in northwest Louisiana.

A tumor registry data review on breast cancer populations seen at two hospitals in North Louisiana was completed in order to determine if race is independent of socioeconomic status (SES) factors related to breast cancer stage at diagnosis. The North Louisiana tumor registry identified 1183 patients diagnosed with breast cancer between 1987 and 1991, 304 patients from Louisiana State University Health Science Center (LSUHSC), a state supported hospital providing predominantly indigent care, and 879 patients from a private hospital (PH) serving predominantly insured patients. Hospital site was used as a proxy for SES (LSUHSC low, PH high). The patient populations differed significantly by age, racial makeup, and stage at presentation. Both white and African-American patients seen at PH had more stage 0 disease compared with LSUHSC (9.2% and 2.7%). White patients seen at PH had more stage I cancer as compared to white patients at LSUHSC (31.3% and 19.2%) or African-American patients at either PH or LSUHSC (19.4% and 19.9%). The frequency of stage III/IV cancer was higher in African-American patients at both LSUHSC (30.1%) and PH (29.0%) and white patients at LSUHSC (24.0%) as compared to white patients at PH (14.7%). Two hundred and nine patients were available for individual interview and specific definition of SES. LSUHSC patients were predominantly indigent (83% indigent and without insurance), while only 10% of PH patients lacked insurance. This study provides further support that the SES of white patients influences breast cancer stage at presentation. African-American patients, however, presented with more advanced breast cancer stages regardless of SES. Factors influencing African-American patient's disease stage are not limited to defined SES factors. Further studies are needed to define barriers and develop intervention strategies.

Breast Neoplasms↗
PubMed2002

Practical considerations for conducting effective billing audits.

Healthcare organizations need to ensure that they are in compliance with government regulations, especially with the increased vigilance by the HHS Office of Inspector General (OIG) in investigating fraud and abuse. After an OIG audit of claims submitted to Medicare by its teaching and resident physicians, the Clinical Practices of the University of Pennsylvania (CPUP), Philadelphia, Pennsylvania, entered into a settlement that included significant financial penalties and a five-year corporate integrity agreement. Lessons learned from the experience may be helpful to other providers in ensuring that their billing practices are in regulatory compliance. As a precautionary measure, providers can undertake their own audits, whether routine or focused. Audits can help providers uncover areas of potential abuse and take steps to correct the problems.

Financial Audit↗
PubMedDate not supplied

Workers' perspectives on mandated employer health insurance.

There is renewed discussion of using employer mandates as a strategy for decreasing the number of uninsured Americans. California recently passed the Health Insurance Act of 2003, the first state-based "play-or-pay" legislation in nearly a decade. To better understand workers' perceptions, the California HealthCare Foundation commissioned NORC at the University of Chicago to conduct a survey to assess workers' views on mandated employer coverage. We found that the vast majority of workers support such a mandate--regardless of whether they are insured--although there is some variation regarding how extensive the mandate should be.

Adolescent↗
PubMed1995

"Auctoritas" psychiatric expert system shell.

We present a short description of a complex psychiatric computer expert system, including functions that help the physicians and the hospital staff in the administrative, diagnostic, therapeutic, statistical, and scientific work. There are separate data-storing, health insurance-supporting, or simple advisory programs, but we can not avail a system--in our country--that provides us with all these functions together. Hence the aim of our program is to produce a universal computer system that makes the patients' long distance follow-up possible. Our diagnostic expert system shell, which is appropriate for using the symptoms and criteria scheme of the internationally accepted diagnostic systems such as DSM and ICD, helps to archive homogeneous, up-to-date psychiatric nosology; this is essential for the correct diagnostic, statistical, and scientific work. Let us introduce our expert system. It consists of four parts: administration, diagnostic decision support system, activities concerning treatment, and statistics. The part called "Administration" contains all data about actual and emitted in-patients and out-patients, including their particulars and data necessary for health insurance (duration of treatment, diagnosis); here we find and edit medical documents. The most important part of the "Auctoritas" system is the "Diagnostic decision support system." In practice, expert systems use decision trees with yes-no logic, fuzzy logic, and pattern matching on the basis of the method of deduction; and backward chaining or forward chaining on the basis of the direction of deduction. Our system uses the methods of fuzzy logic and backward chaining. In other medical disciplines, good results are achieved by applying the pattern matching method; to make validity and verification researches, however, these systems are inappropriate. The diagnoses relying on the up-to-date psychiatric diagnostic systems--DSM-IV and ICD-X--are based on classical logic and can be correctly validated and verified. Hence we have chosen the fuzzy logic, which is the up-to-date extension of classical logic and influences the validity and verification researches, for the construction of our system. The diagnostic part is a shell that can be filled up optionally with knowledge bases of the DSM-IV, ICD-X, or other diagnostic systems and has the following structure. The diagnostic course is biphased as we can differ symptoms and criteria (duration of the illness, aethyological factors). We managed to extend the traditional applications using yes-no logic with three factors that make the system more sensitive and flexible. These are the scaling, sorting by importance of symptoms, and reliability-validity results. The "scaling" means that the physician scales the input symptoms by severity; this influences the statistical probability of the possible diagnoses. "Sorting by importance" is gauging certain symptoms by importance in a syndrome. Finally the third point, "reliability-validity results," means taking account of the latest validity values of a certain disorder of the used diagnostic system--according to the latest validity researches--and the diagnostical reliability of our expert system. The "Activity concerning treatment" is a practical part of our program that contents the examination and therapy scheduling and monitoring results. Under the point of "Statistics," we can prepare all data of the patients in various ways. In summary, the "Auctoritas" computer system is a global database managing the newly-developed advisory system; it is appropriate for managing a complete hospital network system for the continuing individual long-distance observation of patients. It collects all the necessary information of one patient in one file. The long-term benefit is that it can compile and process large amounts of information about the patients and help physicians come to scientific conclusions for research and publications.

Decision Making, Computer-Assisted↗
PubMed1979

Primary care in Durham County: who gives care to whom?

The purpose of this study is to describe quantitatively the primary health care system of a defined population. The ambulatory care services of private practices and institutions in Durham County, North Carolina were sampled four times during 1975-1976 to determine the relative contributions to primary care made by specified types of practice and sources of care. All the institutions and 96 per cent of practicing physicians participated. Utilization of primary care services was analyzed by race, sex, age and health insurance status. One striking finding is the predominant role in the delivery of primary care played by the private specialists practicing in the community in contrast to the relatively small role of the university teaching hospital. Another important finding is the low proportion of blacks and Medicaid patients served by these community physicians. Thirdly, removal of legal and financial barriers has made little impact as yet on the patterns of health care delivery established before the institution of mandatory integration of health services. Since these findings have broad implications for health care delivery, this study warrants replication in other settings.

Adolescent↗
PubMedDate not supplied

Taking California health insurance into the 21st Century.

California's system of financing and delivering health care is coming apart at the seams. High costs and large numbers of uninsured leave too many of the state's residents vulnerable to illness and exorbitant health care bills. A plan to reform the system must include: universal access, cost containment, equitable financing, a choice of systems, a unified plan, shared risk, and a greater emphasis on disease prevention.

California↗
PubMed2006

Financing mental health services in low- and middle-income countries.

Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed. International evidence suggests that charging patients for mental health services results in levels of use which are below socially efficient levels as the benefits of the services are distributed according to ability to pay, resulting in inequitable access to care. Private health insurance poses three main problems for mental health service users: exclusion of mental health benefits, limited access to those without employment and refusal to insure pre-existing conditions. Social health insurance may offer protection to those with mental health problems. However, in many low- and middle-income countries, eligibility is based on contributions and limited to those in formal employment (therefore excluding many with mental health problems). Tax-funded systems provide universal coverage in theory. However, the quality and distribution of publicly financed health care services makes access difficult in practice, particularly for rural poor communities.

Developing Countries↗
PubMed1997

[New labor relations and workers' health in Argentina: challenges and perspectives for epidemiology]

This paper analyzes changes in labor relations, legislation pertaining to work-related diseases and accidents, and the impact on workers' health in Argentina (1989-1995). The data indicate an increase in unemployment, underemployment, self-employment, and new hiring practices. The study shows the mechanisms by which the state has delegated responsibility for prevention of work-related risks to the private insurance sector. The theoretical discussion of causality thus acquires a political/practical dimension. The data show an increase in work-related accidents following labor reform. Research by universities, NGOs, and labor unions reveal changes in health profiles for salaried, self-employed, and underemployed workers. The three National Meetings on Employment and Health (1992-1994) established an area of exchange between academic and workers' knowledge, with some 128 presentations, research projects, and studies, pointing to an enhanced field for epidemiological surveillance and intervention. The paper reviews the surveys performed by the National Confederation of Workers in Education and the Public Employees' Association.

Journal Article↗
PubMed1993

Medical school policies regarding medical students and HIV infection.

PURPOSE: To ascertain how medical schools address several difficult policy issues regarding medical students and HIV (human immunodeficiency virus), and to examine whether schools' policies differ according to the incidences of HIV in the schools' locations. METHOD: Between January 5, 1990, and March 20, 1991, 15-minute telephone interviews were conducted with spokespersons (deans or other policymakers) at 42 U.S. medical schools: the 14 in areas of high incidence of HIV, the ten in areas of low incidence, and a convenience sample of 18 in areas of medium incidence. The interview questions were about preventing HIV infection, reporting HIV infection, confidentiality, screening for HIV infection, limiting clinical activities, counseling, hepatitis B vaccination, prophylactic zidovudine administration, and disability and health insurance. RESULTS: A total of 16 schools, including seven of the 14 in high-incidence areas, had no policy regarding medical students with HIV infection. No strong statistically significant difference was found between the responses of schools in low-incidence areas and those of schools in high-incidence areas. No medical school routinely tested its students for HIV. CONCLUSIONS: Schools should do more to ensure that students remember and follow the guidelines about preventing occupational exposure to HIV; in addition, prior to screening for HIV, schools should ensure that students are provided with appropriate levels of health, life, and disability insurance.

AIDS Serodiagnosis↗
PubMed2006

Should providers be allowed to extra bill for uncovered services? Debate, resolution, and sequel in Japan.

Japan has managed to provide universal coverage at relatively low cost by containing prices and restricting the conditions for which services can be billed in the compulsory social health insurance (SHI) program. However, decline in Japan's economic growth ushered in new actors backed by the prime minister who proposed that the providers should be allowed to extra bill for services not covered by the SHI. In 2004 they took the strategy of drawing the attention of the public to areas where the rigidity of the current prohibition appeared to be unfair and ridiculous. They were opposed by the Ministry of Health, Labor, and Welfare and the Japan Medical Association, who strongly objected on the grounds of safety and equity. The compromise reached by the two ministers in charge led to a clarification of the services that are to be covered and of the process for extending coverage to new procedures and drugs. The prohibition on extra billing has remained essentially unchanged, but the momentum for deregulation has been lost. In 2005 an alternate proposal was made to contain SHI expenditures by introducing a global cap on health expenditures and increasing out-of-pocket payment. Although this proposal was not fully adopted, the gradual decline in SHI benefit levels could lead to a renewed move to allow extra billing.

Accounts Payable and Receivable↗
PubMed1996

Ways of thinking about the long-term care of the baby-boom cohorts.

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers--the generational equity/crisis perspective and the generational investment/gradual adjustment perspective are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.

Aged↗