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PubMedDate not supplied

Consumer-centered vs. job-centered health insurance.

Most employees and their dependents in the United States have health insurance provided by the employer or labor-management health and welfare fund. In this system, employees and their families lose their health insurance when the breadwinner loses his or her job while, at the same time, a Medicaid beneficiary can lose Medicaid eligibility by getting a job, even a poorly paid one. Most health insurance pays the doctor on the basis of fee-for-service and the hospital on the basis of cost-reimbursement, rewarding both with more revenue for providing more and more costly services. The insured employee has little or no incentive to seek out a less costly provider. There are no rewards for economy in this system. It should be little wonder, then, that health care costs are out of control. There are alternative financing and delivery systems with built-in incentives to use resources economically, but, the author of this article asserts, their ability to compete and attract patients with their superior economic efficiency is blocked by many laws and government programs. The author believes that the most effective and acceptable way to get costs under control, and at the same time achieve universal coverage, would be through a system of fair economic competition. He discusses his Consumer Choice Health Plan proposal and describes how one of the main barriers to competition is today's system of job-linked health insurance.

Commerce↗
PubMedDate not supplied

Battery-powered health insurance? Stability in coverage of the uninsured.

This study assesses the stability of Americans' health insurance status over a four-year period. Relatively few Americans were continuously uninsured for the four years 1996 to 1999, but a sizable number of the uninsured lacked a stable source of coverage. At least as many people were repeatedly uninsured as experienced a single gap in otherwise stable coverage. Given these dynamics, policymakers should think of "uninsured" as referring not to people, but rather to gaps in coverage over time. Reforms that stop short of universal coverage should be evaluated in terms of their likely effects on the continuity and stability of coverage.

Adolescent↗
PubMed2004

Predictors of Urban fathers' involvement in their child's health care.

OBJECTIVE: Fathers make important contributions to many aspects of children's well-being, but relatively few studies have evaluated father involvement in their child's health care. The objective of this study was to explore the extent to which fathers are involved in their children's health care and identify those factors that are associated with greater involvement. METHODS: A convenience sample of 104 English-speaking, urban fathers with children younger than 7 years were recruited to complete an anonymous, structured interview. Fathers self-reported the number of well-child visits (WCVs) that they had ever attended and which factors had influenced their attendance. Bivariate and multivariate analyses were used to identify those factors that predicted greater involvement. RESULTS: Eighty-nine percent of the fathers had attended at least 1 WCV. Fifty-three percent had high involvement, ie, had attended > or =40% of the American Academy of Pediatrics recommended visits for their child's age. In multivariate modeling, factors that were significantly associated with high involvement in attending WCVs included attendance at the child's delivery (odds ratio [OR]: 7.3 [1.7-30.4]), younger child age (OR: 0.96 [0.94-0.99]), older father age (OR: 1.2 [1.2-1.3]), the child's having health insurance (OR: 4.1 [1.3-12.0]), and having >1 child (OR: 0.22 [0.06-0.72]). CONCLUSIONS: The factors identified suggest ways that pediatric providers can support fathers' involvement in their children's health care. Providers should focus on encouraging greater involvement early, especially for younger fathers and those with older children. In addition, support of universal health coverage for children might, in addition to other obvious benefits, enhance a father's engagement with his child's health care.

Adult↗
PubMed1994

Health care reform in The Netherlands, Sweden, and the United Kingdom.

The experiences of three European countries that are actively engaged in reforming their health care systems--the Netherlands, Sweden, and the United Kingdom--point to a degree of convergence in the types of reforms being pursued. European experiences also offer a number of lessons for the United States. These include the importance of government intervention in the health care market to ensure universal coverage, the key role of primary care in ensuring access to basic health services and in containing costs, and the need to create a strong purchasing or insurance function to hold providers accountable on behalf of patients. The pace and scope of reform are affected significantly by the political process in each country.

Economic Competition↗
PubMed2001

Reproductive health in eastern Europe: a collaborative training project in Romania.

Since the fall of the Berlin Wall, fundamental political changes in eastern Europe have affected the Soviet-style health care systems that formerly provided basic care for everyone. Many of these systems have collapsed, and the new systems of social insurance that have replaced them often are inadequate. Advanced Training in Reproductive Health in Romania aimed to create an authority in family planning and reproductive health in selected Romanian university centers and to improve training and research capabilities. Initially, the project had 2 main goals: to provide advanced training in reproductive health and family planning to Romanian obstetrics-gynecology specialists from the main university centers-which would allow them to train other physicians (obstetricians, gynecologists, and general practitioners) and medical students-and to develop, test, and finalize specific training materials in Romanian to be used by the new trainers.

Education, Medical, Graduate↗
PubMed1982

Antitrust and health care: provider controlled health plans and the Maricopa decision.

The health care industry is one which traditionally has discouraged its members from engaging in competition. For years, many within the profession have espoused a guild mentality and have viewed professional societies as the proper centers of health care's economic universe. This guild mentality has recently been challenged by proponents of a market mentality, theoreticians who argue that limited combinations of health care providers called "health plans," which serve insurance as well as service functions, can make the health care industry more efficient. Proponents of the guild mentality have been dealt a severe blow by the Supreme Court and its decision in Arizona v. Maricopa County Medical Society. There the Court found the price-fixing by two Arizona medical societies to be illegal per se under applicable antitrust law. This Article outlines the background on competition and the guild mentality in the health care industry. After a brief discussion of the standards of antitrust analysis, the Article analyzes the Maricopa case, by first summarizing the Court's use of strict antitrust criteria, and then by extending the analysis to an application of a more lenient standard. Next, the Article compares the provider controlled independent practice association ("IPA")--one form of insurance plan proposed by market model advocates--with the Maricopa-type plan. Finally, the Article concludes that, not only is the special form of IPA that qualifies as a "health plan" an excellent way to promote efficiency in the health care industry, but also its procompetitive goals and effect allow it to survive even the strictest, Maricopa-type antitrust scrutiny.

Arizona↗
PubMed2002

Tobacco cessation counseling among underserved patients: a report from CaReNet.

OBJECTIVES: The purpose of our study was to determine the frequency of smoking cessation counseling in relation to insurance status in a practice-based research network. STUDY DESIGN: We administered a modified National Ambulatory Medical Care Survey (NAMCS), with an additional payment category to identify uninsured patients, quarterly to 100 random patients at each practice site for 1 year. POPULATION: The study population included the patients at the 7 practices within the Colorado Research Network (CaReNet), associated with the Department of Family Medicine, University of Colorado Health Science Center. OUTCOMES MEASURED: We measured the prevalence of smoking and the frequency of cessation counseling. RESULTS: Of 2773 visits analyzed, 1443 were made by adults who were either was uninsured (39%), had Medicaid (22%), or had private or a health maintenance organization insurance (private/HMO; 40%). Smoking prevalence was significantly greater in uninsured patients (30%) and Medicaid patients (31%), compared with private/HMO patients (22%) (P =.008). However, those smokers with private/HMO insurance were more likely to receive tobacco counseling (50%) than Medicaid (41%) and uninsured (25%) patients (P &lt.001). After controlling for potential confounders, this difference remained significant. CONCLUSIONS: Although smoking is more common among Medicaid and uninsured patients, these smokers are less likely to receive counseling. Possible explanations for this disparity include lack of access to cessation interventions or lower quality of care for underserved patients. This finding may have implications for achieving national public health goals on smoking cessation.

Adolescent↗
PubMedDate not supplied

The president's child immunization initiative--a summary of the problem and the response.

After only 24 days in office, President Bill Clinton announced a comprehensive childhood immunization initiative designed to assure that all children in the United States lead healthier lives by receiving age-appropriate immunizations against preventable diseases such as polio, mumps, measles, whooping cough, and diphtheria. As part of his economic stimulus proposal, the President requested $300 million for Fiscal Year 1993 to reinforce the nation's immunization infrastructure by providing funding for communities to extend clinic hours, provide more staff, and increase information and education efforts and for the planning and implementation of a national immunization tracking system. In its Fiscal 1994 budget request, the Administration asked for a doubling of the Centers for Disease Control and Prevention's immunization program funding to $667 million. In cooperation with key congressional committees, the Administration has also prepared legislation that would provide recommended childhood vaccines to States for free distribution to health care providers who serve children enrolled in Medicaid or who don't have health insurance that covers immunization services. Providers could not charge for the vaccine but could charge a fee for administration. State Medicaid programs would also be required to reimburse providers reasonably for vaccine administration. This measure is designed to improve universal access to immunization services by helping to remove financial barriers that impede children from being immunized at the appropriate age.

Child↗
PubMed1994

The payers' automation challenge.

Despite some success stories, most of the nation's 300 commercial insurers and hundreds of managed care plans are in the earliest stages of using electronic data interchange for health care transactions. However, there are some encouraging signs of progress in the effort to shift to EDI, as more payers offer providers incentives to automate. Payers blame the relatively slow progress on cost, the absence of universally accepted standard electronic formats and uncertainties over the political debate on health reform. But providers say many commercial payers are moving too slowly to automate and are expecting providers to bear too much of the financial burden.

Blue Cross Blue Shield Insurance Plans↗
PubMed2006

The role of government in health care: a societal issue.

The history of the role of government in health care is briefly reviewed and more fully discussed in the United States since the establishment of Medicare 40 years ago. Data and other evidence of the unintended consequences of this historic event are presented, identifying thorny and onerous issues that government has created, showing failed attempts at band-aid solutions, and suggesting that our present health care system is in disarray and cannot be rectified by the "incrementalism" approach. The establishment of a high-level commission jointly endorsed by the President of the United States and Congress is recommended to consider and analyze scrupulously all the components of our health care complex and provide a "roadmap" toward achieving a universal health care system that is culturally acceptable, affordable, and of optimal quality while avoiding its administration and total control by an ultimately rigid and unwieldy governmental or insurance-industry bureaucracy.

Academic Medical Centers↗
PubMed2006

[Stages and barriers in cancer screening behaviour of 45 to 60-year old men--results of an empirical study].

UNLABELLED: Between 2002 and 2004 the Centre of Applied Health Sciences of the University of Lüneburg carried out a research project concerning the cancer screening behaviour of men. Within a standardised survey all men aged 45 - 60 years of a local health insurance company were interviewed by a postal questionnaire about their cancer screening behaviour including their main reasons to engage or not to engage in the (insurance financed) cancer screening tests. 337 questionnaires could be analysed. As a theoretical framework, the "transtheoretical model" of Prochaska et al. was used to characterise the men according to their degree of readiness to engage in cancer screening tests. RESULTS: 25% of the men were regularly engaged in cancer screening tests. 40% have been engaged at least once or were in the stage of "preparation" to do so in the near future. 35% were resistant to undergo cancer screening tests. Anxiety concerning the check-up itself or the possibility to have a positive result were the main barriers for men not to engage in cancer screening. As an important factor to overcome such barriers, these men mentioned the need for better communication between doctors and patients. To improve cancer screening behaviour, this was considered more important than general information campaigns or organisational changes concerning the check-ups.

Adult↗
PubMed2003

A national survey of surgical antibiotic prophylaxis in Turkey.

OBJECTIVE: To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN: A cross-sectional, country-wide survey. SETTING: Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS: Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS: A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS: Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95 0.225-0.772; P < .001) were associated with inappropriate prophylaxis. CONCLUSION: Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

Antibiotic Prophylaxis↗
PubMed2003

The impact of telemedicine on patients' cost savings: some preliminary findings.

This study evaluated patients' cost savings in a telehealth project at the University of Arkansas for Medical Sciences' (UAMS) during 1998-2002. Differences in patients' cost savings from telemedicine were assessed by gender, age, ethnicity, education, occupation, annual household income, health insurance status, and household and community size. Variables examined for patients' cost savings included travel distance for medical care, missed days at work, and family expenses. The study population consisted of self-selected telemedicine patients in rural Arkansas (N = 410 consults). Results suggest that without telemedicine, 94% of patients would travel greater than 70 miles for medical care; 84% would miss one day of work; and 74% would spend $75-$150 for additional family expenses. With telemedicine, 92% of patients saved $32 in fuel costs; 84% saved $100 in wages; and 74% saved $75-$150 in family expenses. Patients living alone (p < 0.001) and in smaller rural communities (p = 0.002) were significantly more likely to miss one day of work without telemedicine than patients with larger households and those residing in larger rural communities. Females (p = 0.040) and patients with a annual household income over $25,000 (p = 0.005) were significantly more likely to have family expenses over $150 without telemedicine than males and patients with a household income of $25,000 or less.

Adolescent↗