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PubMed2006

[Diagnosis and gene analysis of congenital hemolytic anemia].

Congenital hemolytic anemia is relatively uncommon and tends to be left undiagnosed because unusual special tests outside health insurance adaptation are needed for the diagnosis. To diagnose properly these patients, we instituted a comprehensive examination system for hemolytic anemia in Fukuoka University Hospital in 1990. In addition to basic laboratory tests, investigation of hemoglobin, SDS-PAGE analysis of red blood cell membrane proteins, a complete panel of red cell enzyme measurements and gene analysis were included. The red cell enzyme measurements was facilitated by the automation on the COBAS MIRA instrument (NIPPON ROCHE). By such a comprehensive examination, we have identified and confirmed 382 cases of congenital hemolytic anemia which otherwise would have escaped detection during the period October 1990 to September 2005 in our institution. SDS-PAGE procedure contributed to the diagnosis of 24 cases of band 3 deficiency, 13 cases of band 4.2 deficiency and 13 cases of band 4.1 deficiency. Hemoglobin studies uncovered 20 cases of abnormal hemoglobins, 126 cases of beta thalassemia and 7 cases of alpha thalassemia. Red cell enzyme measurements were also contributory to the diagnosis of 29 cases of hemolytic anemia in which enzyme levels were reduced.

Anemia, Hemolytic, Congenital↗
PubMed1992

State health insurance initiatives: what the literature is telling us.

The absence in the United States of a comprehensive national health insurance system has left a significant number of people either without coverage or with only partial (and inadequate) coverage. Individual states have sought to remedy this through a number of initiatives, but the majority have been incremental in nature, not universal. Sifting through the extensive literature on what states are doing and have been doing, the author reveals the nature of their attempts (and their infrequent successes) and provides issues and questions that must be dealt with before a system acceptable--and accessible--to all can be achieved.

Health Benefit Plans, Employee↗
PubMed1990

Orthotopic liver transplantation in The Netherlands. The results and impact of a medical technology assessment.

In 1985 Dutch health care authorities and health insurance companies initiated a large-scale technology assessment (TA) of liver transplantation (LTx) in The Netherlands. The 10-year experience of the existing programme in the University Hospital Groningen was investigated. Topics included were patient flow, selection policies, survival, quality-of-life, costs, need, supply of donor organs and organisational aspects. Estimation of the consequences of a non-transplantation scenario allowed for the execution of a cost-effectiveness analysis. Results showed clear improvement by LTx of survival and quality-of-life, though to a lesser degree than expected. Costs of the first transplantation year amounted to Dfl 180,000 (approx US $90,000). The cost-effectiveness ratio ranged from Dfl 47,000 to Dfl 133,000 per life year gained. No overt imbalance between need and donor supply existed or was expected in the near future. The impact of this study is related to the informational value and to the contribution to the decision-process. Even at its appearance in 1988, the final report provided health policy makers with new information. Health policy concerning LTx was considerably influenced, as a rule in agreement with the study conclusions. We conclude the Dutch case study to be an example of a useful and efficient TA.

Costs and Cost Analysis↗
PubMed1995

Hope in federalism? What can the states do and what are they likely to do?

Although ERISA is a barrier to state health care reform, its hurdle is not as formidable as the financial and political constraints that state governments face. As the states themselves confess, they cannot solve this problem alone (National Governors Association 1993); but if they must, they will focus on the incremental, "low-cost" reform options--insurance reforms and Medicaid managed care. Connecticut Representative Courtney perhaps summarized state sentiment best: "Maybe we shouldn't be using the word 'reform'; it raises expectations" (Spencer-Molloy 1994b). Indeed, states will proceed more cautiously now than just a year ago because the federal failure accentuated the political gamble of health care reform and made the future prospect of transferring federal funds to state governments appear very bleak. Unfortunately, such cautious reforms will not move us toward the goal of universal (or statewide) coverage, a goal that seemed within our grasp only two years ago.

Health Care Reform↗
PubMed2001

The enactment of national health insurance: a Boolean analysis of twenty advanced industrial countries.

The scholarly literature on health care politics has generated a series of hypotheses to explain U.S. exceptionalism in health policy and to explain the adoption of national health insurance (NHI) more generally. Various cultural, institutional, and political conditions are held to make the establishment of some form of national health insurance policy more (or less) likely to occur. The literature is dominated by national and comparative case studies that illustrate the theoretical logic of these hypotheses but do not provide a framework for examining the hypotheses cross-nationally. This article is an initial attempt to address that void by using Boolean analysis to examine systematically several of the major propositions that emerge from the case study literature on the larger universe of twenty advanced industrial democracies. This comparative analysis offers considerable support for the veto points hypothesis while still finding each of the factors examined to be relevant in certain scenarios. We conclude with a discussion of the implications of these findings for future research and for advocates of national health insurance in the United States.

Causality↗
PubMed1999

Mohs micrographic surgery referral patterns: the University of Missouri experience.

BACKGROUND: Mohs micrographic surgery (MMS) provides a higher cure rate for nonmelanoma skin cancer (NMSC) than other forms of therapy. The American Academy of Dermatology has published recommended guidelines for MMS referral. However, factors other than the location, size, and type of NMSC may often affect the referral process. OBJECTIVE: To tabulate and analyze the rates of referral of NMSC for MMS by the dermatology clinics within the University of Missouri system. Data obtained for every biopsy-proven basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) diagnosed at each of our four dermatology clinics during the 3-year period of October 1993-September 1996 were cross-referenced with our Mohs surgery clinic logbook to identify which patients had been referred for MMS. RESULTS: During the study period, 19.2% of NMSC patients diagnosed were referred for MMS. However, there was significant disparity in referral rates among our four clinics. When the skewed data from our Veterans Administration Hospital clinic were discounted, the overall referral rate from the other clinics was found to be 30.8%. CONCLUSION: Our finding of a 30.8% referral rate of NMSC for MMS (27. 4% for SCC and 32.9% for BCC) within our university dermatology system is similar to the rates found in previous studies by the Mayo Clinic and Brooke Army Medical Center. MMS referral patterns are affected by many factors besides whether the NMSC meets MMS criteria, including the preference of each individual referring physician, patient, and involved insurance carrier.

Basal Cell Carcinoma↗
PubMed2006

Recombinant therapeutics: from bench to bedside (if your health plan concurs).

A talented medical student at our institution was recently diagnosed with multiple sclerosis (MS). beta interferon was prescribed; however, her annual cap from student health insurance coverage for outpatient drug expenses is only Dollars 3000, a sum that would be exceeded within 3 months and leave her without coverage for symptomatic medications also required for her care. Unable to pay for the treatment from personal resources, she qualified to receive beta interferon without cost from a universal access program established by the manufacturer. Unfortunately, it was evident within a few months that she had a poor therapeutic response, so her physician prescribed natalizumab. Her health care plan requires that infusion therapy be given at the hospital's infusion center, yet for various reasons, the drug was not yet approved by the formulary. She remains unable to receive the drug.

Antibodies, Monoclonal↗
PubMed1998

Slipping through the safety net: implications for women's health.

The failure of the 104th Congress to pass legislation that would have provided universal health care coverage has created gaping holes in the health care safety net for the working poor. As a result, the number of Americans without health insurance, which was 37 million in 1992, could reach 50 million in 1998. Current changes in welfare policy, centered on reform of the joint federal-state program Aid to Families with Dependent Children (AFDC), have further redefined the safety net for the poor. These changes may jeopardize the health of poor women as any change in eligibility requirements for AFDC also limits eligibility for Medicaid. Given the financial and social difficulties facing poor women, a growing number of researchers are redefining what constitutes research on women's health. Research is needed on how the high rates of health problems and few health resources of poor racial/ethnic minority women affect their quality of life.

Eligibility Determination↗
PubMedDate not supplied

Homeless children and families: clinical and research issues.

The rapid increase in the number of homeless children and families has focused attention on understanding the health and related needs of this vulnerable group. This paper describes challenges associated with providing health care to homeless children and evaluation of those services. Data are presented from the Nursing Center for the Homeless of the School of Nursing at the State University of New York at Buffalo. Health services provided to homeless children and families (N = 470) documented that more than half (56%) were covered by health insurance and had received age-appropriate preventive health care. Of the children seen, 50% were considered well and 30% were diagnosed as having upper respiratory infections, skin problems, and/or gastrointestinal disorders. Health teaching for parents was the most frequent nursing intervention (50%), while 20% of the children were referred to community agencies. Factors that impede data collection and provision of health services for the homeless population are discussed, including suggestions for treatment and research approaches.

Child↗
PubMed1997

Health care information and the protection of personal privacy: ethical and legal considerations.

During the early 1990s, the U.S. government addressed the issue of providing universal health care to all its citizens. Although this issue has not been completely resolved, centralization of electronic data and sharing of health care information among insurers and providers have been pursued. The emergence of electronic data banks in health care has raised another issue: each citizen's right to privacy compared with the collective benefit to society when critical data on quality assurance and scientific research are shared by an array of network users. The choices we face are difficult, and the solution may necessarily reflect a compromise that alters traditional beliefs in the right to personal privacy. However, Congress can take the initiative by enacting statutes to ensure that sensitive information contained in electronic patient records is not divulged without a patient's consent and is protected against fraudulent access and abuse.

Computer Security↗
PubMed1999

Online solution for tracking payer data.

Keeping on top of constantly changing managed care policy requirements can be labor intensive and prone to error. At the University of Missouri Health Sciences Center, over 20 percent of patients are under managed care arrangements for services. The center maintains over 50 contracts with insurers. The medical center thus faces the logistical nightmare of keeping information regarding insurer contact information, pre-certification and prior-authorization policies up-to-date and accessible to front-line clerical and nursing support staff. The medical center is trying to solve the problem by keeping real-time information stored on an easily accessible, searchable Web site.

Contract Services↗
PubMed2002

Ethics in medicine: students' opinions on disclosure of true diagnosis.

AIM: To determine students opinions about diagnosis disclosure to the patient and other interested parties. METHODS: During 2000/2001 academic year, an anonymous survey was conducted among the first-year (200 questionnaires) and sixth-year medical students (200 questionnaires) at the Zagreb University School of Medicine. Students were asked what they would say about the diagnosis to the patient, patients family, friend, employer, colleague from work, health insurance agent, another physician, or medical student, if the diagnosis was inoperable lung carcinoma in a 20- and 66-year-old patient vs bacterial pneumonia in patients of the same age. The possibilities were to tell the truth, lie, or refuse to disclose the diagnosis. RESULTS: The response rate was 55%. Students would disclose the true diagnosis to the patient, patients family, friend, and employer in case of benign disease more often than in case of malignant disease (p<0.001). Patient's age did not affect students' opinions. Most students would rather refuse to say anything than lie if they would not want to say the truth. Students would more often tell the truth to the patient and patient's family then to a health insurance agent, another physician, or medical student, less often to patient's friend and employer, and rarely to the patient's colleague from work. First-year students would generally tell the truth more often than sixth-year students (p<0.001). There were almost no differences in the opinions between male and female students. CONCLUSION: The strongest influence on students choice on whether or not to disclose the diagnosis had the severity of disease, person they would disclose the information to, and the academic year they attended, implicating that such important ethical issues should be discussed during the studies.

Croatia↗
PubMed2004

Protection in eye of beholder. Courts send mixed messages about the sanctity of medical files in the face of federal subpoenas for patients' abortion records.

With three trials under way on lawsuits challenging the Partial Birth Abortion Act, hospitals have been dragged into a drama involving medical-record privacy. It's providing a lesson on how little protection HIPAA offers in court. "We sought to find a way to produce those records in a way that would not embarrass our patients," said a counsel for the University of Michigan Hospitals and Health Centers, left.

Abortion, Illegal↗
PubMed1996

Legal considerations in infectious diseases and dentistry.

Dentists, similar to other professionals subject to legal regulation, often have an overly simple view of the legal system. Communicable diseases present questions on the cutting edge of the law, and, as the previous discussion makes perhaps painfully clear, there is considerable uncertainty on many important legal points. Legal uncertainty is often a reflection of social or scientific uncertainty. Clear answers emerge less from the words of lawyers and judges than from the actions of professionals themselves, who ultimately set the standard of care. In any area of legal uncertainty, the dentist is best advised to adhere to the best scientific information available and to meet the ethical standards of the profession.

Centers for Disease Control and Prevention, U.S.↗
PubMed1979

Can China's health care be transplanted without China's economic policies?

China's economic policies of the past 25 years have shaped its present health-care system. China's leadership has decided to have neither a national health-insurance system nor a national health service. Instead, it decided that its health system would mirror the workings of its industrial and agricultural system. Decisions to minimize imports, ban private economic activity, assign university graduates on a compulsory basis, control wages, maintain a large domestic standing army and prevent professions or universities from acquiring independent status led directly to the present system of medical care. Consequently, transplantation of China's striking achievements in health-care delivery to the United States or other countries is unlikely to occur in the absence of transfer of the underlying economic policies.

Agriculture↗