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At least 1,657 records · Page 92Linked to original sources
PubMedDate not supplied

Professionalism, regulation, and the market: impact on accountability for quality of care.

This paper examines the interplay of professionalism, regulation, and the market in shaping accountability on the part of hospitals, physicians, and health plans. We pay particular attention to the role of accreditation. We review the development of accountability and examine its recent evolution in the context of changing information technology, consumer demands, the decline of the staff- and group-model HMO, and the reemergence of health care cost inflation. The market is emerging as the dominant influence on accountability; this development will require changes in the roles and structure of regulation, professionalism, and accreditation in assuring accountability.

Accreditation↗
PubMedDate not supplied

Health plans' strategies to control prescription drug spending.

A number of recent studies have documented the sizable impact of consumer cost sharing without accounting for the other drug management strategies being adopted simultaneously. This qualitative case study of five of California's largest health plans examines the strategies and methods used to control prescription drug use and spending. Higher cost sharing is being used increasingly. Concurrently, major administrative efforts directed at physicians-including rules, incentives, and education-are being undertaken. These efforts have focused on lowering the cost per prescription by emphasizing generic substitution and therapeutic interchange of less costly drugs.

California↗
PubMedDate not supplied

Taking on racial and ethnic disparities in health care: the experience at Aetna.

Among the nation's health plans, Aetna is considered the industry leader in efforts to eliminate racial and ethnic disparities in health care. This Perspective describes the work of a task force led by Aetna's chairman and CEO, charged with a number of strategic activities including cultural competency training and the identification of disparities occurring within the Aetna membership population. The cornerstone of this quality-of-care initiative is a successful and ongoing data collection enterprise. Aetna is putting the data to work in its chronic disease management, breast health, and African American Preterm Labor Prevention and Breastfeeding programs.

Data Collection↗
PubMedDate not supplied

Employment-based health benefits and public-sector coverage: opportunity for leadership.

In this commentary, Helen Darling, speaking from the large-employer perspective, responds to James Robinson's paper on the mature health insurance industry, which faces declining opportunities with employer-based health benefits and growing but less appealing public-sector opportunities for management and other services. The similar needs of public and private employers and payers provide an opportunity for leadership, accelerating innovation and using value-added services to improve safety, quality, and efficiency of health care for all.

Adult↗
PubMedDate not supplied

Real health plans manage care.

The public sector might seem to be an appealing growth opportunity to commercial insurers confronted by stalled private-sector coverage expansion, but whether these insurers have the means and motivation to deliver value to Medicare and Medicaid is unproven. State Medicaid purchasers in particular have found alternative sources for care management and have sound reasons to question whether industry-leading commercial insurers will be responsive to their needs.

Health Benefit Plans, Employee↗
PubMed2006

Improving tomorrow's health care with today's tools: a conversation with Larry C. Glasscock. Interview by John K. Iglehart.

The chairman and CEO of WellPoint Inc. provides some factual background on one of the nation's largest health insurers, which covers 34.2 million lives. Its own employees are offered the opportunity to join a consumer-directed health plan, which gives the company some real-life data on which to base its strategies in the marketplace. Glasscock believes that future reform efforts in his company and at the national level must focus on improving quality and affordability, reducing the number of uninsured Americans, and improving the health of those insured by WellPoint and everyone else.

Blue Cross Blue Shield Insurance Plans↗
PubMed2000

Who's a supervisor?

Explore the source record for details and available documents.

Administrative Personnel↗
PubMed2003

Report questioned.

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Conflict of Interest↗
PubMed1991

Different rates of acceptance of health examination among the people under 2 separate health insurance programs in Japan.

The entire population in Japan is covered by either workplace-based health insurance program or region-based health insurance program. While both programs were originally for curative medical care, only the former program has recently extended its financial support to preventive health examination. The attitude of the people toward health examination was studied in Miyagi prefecture in north-east Japan by questionnaires with more than 32,000 respondents to examine whether the difference in health insurance reflect on the rates of acceptance of 4 health examination items (i.e., blood pressure measurement, chest x-ray taking, and 2 screening tests for stomach and cervical cancer). Throughout the 4 items, the rate of acceptance was higher among those who were covered by workplace-based health insurance than among those covered by regional health insurance. The difference is large for the insured and less so for the family dependents of the insured. Further analysis for the preferred opportunities for health examination such as personal examination at clinics in contrast to region-based mass examination showed that the weight of clinics was quite large for the insured of national health insurance and their family dependents (i.e., 50% or even larger) but it was less so for the people covered by workplace-based insurance.

Blood Pressure Determination↗
PubMed2006

Anemia as a predictor of cardiovascular events in patients with elevated serum creatinine.

Patients with anemia and patients with chronic kidney disease have elevated risks for cardiovascular disease. Available studies have been too small to provide details about the relationship or to provide for extensive covariate control. In a large insurance database with linked laboratory values, records of women with serum creatinine >1.2 mg/dl and men with serum creatinine >1.4 mg/dl, identified from July 2000 through June 2003, were sought, and the insurance claims searches for hospitalizations that were associated with myocardial infarction, coronary revascularization, unstable angina, stroke, or congestive heart failure. New onset of dialysis also was sought. Multivariate Poisson regression was used to estimate rate ratios for these events at various hemoglobin (Hb) levels, with adjustment for patient characteristics and previous event history. Among 88,657 patients with high serum creatinine, the risk for hospitalization with myocardial infarction was two to five times higher in anemic (Hb <12 g/dl) patients than in people with Hb from 12.0 to 12.9 g/dl. A similar but less dramatic pattern of higher incidence of coronary revascularization was observed with lower Hb levels. Risks for hospitalization with congestive heart failure declined regularly with increasing Hb levels from a doubling of risk at Hb <10 g/dl to a 61% decrease at 15 g/dl, both relative to 12.0 to 12.9 g/dl. The risk for progression to dialysis was only slightly elevated (7 to 34%) in anemic patients. Anemia raises the risk for cardiovascular disease in patients with elevated serum creatinine.

Age Distribution↗
PubMed1995

The politics of health care reform in the United States, 1992-1994: a historical review.

In an analysis of the sociopolitical context of the debate on health care reform in the United States, the author focuses on the political events that led to the election of a Democratic administration in 1992; the evolution of the White House task force on health care reform and the interests and positions it represented; the connection between economic and political power in the United States; and the reasons for the defeat of the health care reform proposal. This historical analysis questions some of the dominant interpretations of the failure to reform health care, which assume that the U.S. population was not yet ready for these reforms.

Health Care Reform↗