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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↗
PubMed1994

The Clinton health-care reform plan: does it serve the underserved?

During the 1992 presidential campaign, Governor Clinton promised, if elected, to provide leadership from the Oval Office for sweeping, comprehensive reform of the U.S. health-care system to benefit all Americans. The President's ambitious blueprint, as outlined on September 22, 1993, falls short of this pledge. For the majority of the nation's poor and underserved, the proposed plan insufficiently ensures universal access, social equity, comprehensiveness of benefits, affordability, and high-quality health-care services. Requiring all employers to provide, and employees to share the cost of, health-insurance coverage could decrease take-home pay for many of the working poor. In addition, the President's proposed cost-containment efforts, which include global budgetary targets and reductions in Medicare and Medicaid reimbursement, could result in the elimination of over 1.0 million positions in the healthcare field. These potential outcomes are alien to the President's earlier axioms to reform the U.S. health-care system, and to improve the nation's economic climate to foster the creation of more and better-paying jobs.

Health Care Reform↗
PubMedDate not supplied

HIPAA, TB, and me.

Explore the source record for details and available documents.

Adolescent↗
PubMed1993

Hawaii's employer mandate and its contribution to universal access.

Much national debate centers around national models in which an employer mandate plays an important role in providing for health care coverage for all Americans. Hawaii has had the nation's only health insurance employer mandate for almost 20 years, yet little is known nationally about the mandate itself or Hawaii's experience with it. This article describes the long-term effects of Hawaii's employer mandate on health care access and costs, and offers reflections on the potentials of national health care reform based on Hawaii's experience.

Commerce↗
PubMed2004

Rite of passage? Why young adults become uninsured and how new policies can help.

Young adults (ages 19 to 29) are one of the largest and fastest-growing segments of the population without health insurance in the United States. Young adults often lose coverage under their parents' policies at age 19, or when they graduate from high school or college. Nearly two of five college graduates and one-half of high school graduates who do not go on to college will endure a time without health insurance in the first year after graduation. Three policy changes could extend coverage to uninsured young adults and prevent others from losing coverage: extending eligibility for dependents under private coverage through age 23; extending eligibility for Medicaid/CHIP public coverage to age 23; and ensuring that colleges and universities require full-time and part-time students to have insurance, and that they offer coverage to both. Young adults are a relatively low-cost population to insure, and keeping them in insurance pools may lower the average costs of group coverage.

Adolescent↗
PubMed1993

Social contingencies, the aged, and public policy.

Today's older population is notably different than it was a few decades ago, both in well-being and in diversity, a shift that must be acknowledged in public policy. The U.S. social insurance system overprotects against highly likely, predictable, and nonvolatile events at the expense of more unlikely, potentially catastrophic, and less volatile events. The public sector, therefore, should move toward proportionally emphasizing health-related, functionally impairing events rather than income maintenance; the private sector is better suited to insuring against predictable and nonvolatile old-age events. A contingent event scheme would: (a) encourage the growth of long-term-care insurance; (b) help bridge the gap between those arguing for greater "efficiencies" in social welfare spending and those pressing for new universal benefits; and (c) bring a new perspective to the "generational equity" debate.

Aged↗
PubMed2001

Managed care: a view from Europe.

This article summarizes recent developments in the United Kingdom, the Netherlands, Switzerland, and the new Baltic states that reflect the influence of US managed care concepts and practices. We emphasize (a) developments in restructuring traditional health insurance mechanisms by shifting premium and out-of-pocket burdens to consumers so as to constrain demand and costs and (b) reliance on prospective hospital budgets and case management by primary physicians. Social insurance mechanisms and universal coverage remain national tasks as well as basic components of the social structure of most European countries. Full open-market competition between traditional sick funds and private insurance companies and the introduction of for-profit MCOs beholden to their shareholders appears unlikely on other than an experimental basis. Increased competition between providers may well result from the new right of insurers and payers to contract with medical care providers of their choice. It remains to be shown how far these experiments, which differ substantially between the countries examined, will succeed in their objectives and become permanent features of their national systems.

Cost Control↗
PubMed2004

The impact of weight reduction surgery on health-care costs in morbidly obese patients.

BACKGROUND: The treatment of obesity and related comorbidities are significant financial burdens and sources of resource expenditure. This study was conducted in order to assess the impact of weight-reduction surgery on health-related costs. METHODS: This was an observational two-cohort study. The treatment cohort included patients having undergone weight-reduction (bariatric) surgery at the McGill University Health Centre (MUHC) between 1986 and 2002. The control group included age and gender matched obese patients who had not undergone weight-reduction surgery from the Quebec provincial health insurance database (RAMQ). The cohorts were followed for a maximum of 5 years from inception. The primary outcome measure was overall direct healthcare costs. Secondary outcomes included cost analysis by diagnostic category for the treatment of new medical conditions following cohort inception. RESULTS: The cohorts were well-matched for age, gender and duration of follow-up. Patients having undergone bariatric surgery had significant reductions in mean percent initial excess weight loss (67.1%, P <0.001) and in percent change in initial body mass index (34.6%, P <0.001). Bariatric surgery patients had higher total costs for hospitalizations (per 1,000 patients) in the first year following cohort inception (surgery cohort = CDN 12,461,938 dollars; control cohort = CDN 3,609,680 dollars). At 5 years after cohort inception, average cumulative costs for operated patients were CDN 19,516,667 dollars versus CDN 25,264,608 dollars, for an absolute difference of almost CDN 6,000,000 dollars per 1,000 patients. CONCLUSION: Weight-reduction surgery in morbidly obese patients produces effective weight loss and decreases long-term direct health-care costs. The initial costs of surgery can be amortized over 3.5 years.

Body Mass Index↗
PubMed1978

Employee rights to privacy and access to personnel records: a new look.

Do employees really enjoy a so-called right to privacy in their employment relationship? To what extent are their rights violated by the pre-employment screening process? These are the questions discussed in this article by David F. Linowes, Boeschenstein Professor of Political Economy and Public Policy and Science at the University of Illinois and recently chairman of the Privacy Protection Study Commission. Citing the availability of data to a prospective employer through credit card companies, banks, insurance companies, mailing lists, health records, and investigative reporting agencies, Professor Linowes makes the point that little is left unknoun when the investigative process is completed. There is no clear line separating what is relevant and what is privileged. The Study Commission's report to Congress suggests guidelines that would insure fairness to all parties.

Civil Rights↗
PubMed1994

What's the future of health care associations?

The ongoing reconfiguration of the health care universe is leading to a rethinking of health care associations as well. As contributing editor Emily Friedman explains, the blurring of distinctions among hospitals, physician groups, managed care organizations and insurers is causing health care leaders to reassess their strategic priorities. Could a new type of professional association be the ultimate result?

American Hospital Association↗
PubMed1993

[Hypoplastic left heart syndrome. Present experiences and future possibilities].

The authors report experiences from Norwood's staged palliation for hypoplastic left heart syndrome performed in Philadelphia on Norwegian children. Although there is no universal agreement that these children should be operated at all, the Norwegian health authorities have decided that all expenses for transport, examination and treatment shall be covered by the National Health Insurance Scheme. Since 1987 a total of 21 children have been transported to USA for operation. Eight of these children have completed all the planned stages of the operative treatment. Two are waiting for stage 3. 11 children have died. The authors discuss how to proceed with regard to treatment of this complicated patient group in future.

Atrial Function, Left↗