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PubMed2000

Occupational health in Argentina.

Argentina is within the denominated "new industrialised countries", with the characteristic of having high contrasts in the urban population, based on service and industry, and in the rural population, based on agriculture and cattle, still the main sources of wealth in the country. The process of globalisation and the need to compete hard in international markets have provoked high unemployment and the transfer of workers from a formal market to an informal one. Legislation on occupational health is old and it is in the process of being updated. The system of prevention, assistance and compensation for accidents at work and for occupational illnesses has changed from being optative for employers, to the compulsory hiring of private insurance companies. The Government keeps the role of supervisor of the system. There are enough professionals in occupational health, hygiene and safety but not occupational nurses. The teaching is given by many universities and professional associations, some of which have an active profile in the occupational health of the country.

Accidents, Occupational↗
PubMedDate not supplied

Learning from the Aloha State.

Since 1974, Hawaii has required its employers to provide health insurance to all employees working at least 20 hours a week. More recently, the state created a new program to cover the "gap group" of 50,000 uninsured residents, along with a new program to create a "seamless system of health care" for all Aloha State residents. And Hawaii has managed to insure nearly all of its citizens while keeping the annual price of health insurance at nearly half of that paid in many mainland states ($1,300 per person and $4,000 per family). At the same time, life expectancy is the highest in the nation and infant mortality is among the lowest. In seeking to reform a dysfunctional national insurance system, policymakers should learn from the Hawaiian experience, which shows that small business can live with an employer mandate, universal coverage can cut costs by encouraging early preventive care, and a dominant payer can reduce administrative expenses.

Cost Control↗
PubMed2003

[Role of laboratory medicine in medical care--from the point of view of a manager].

The Japanese health insurance system has been praised because of the comprehensive coverage of medical costs. The long lifespan of Japanese, the longest in the world, however, because economic conditions are getting worse and medical costs are increasing with the increase of aged people in Japan, the health insurance system is under pressure. The Japanese government is going to start to reduce costs of medical care by applying a system like the DRG/PPS system in the USA, called Diagnosis Procedure Combination(DPC), next year in university hospitals. Under the DPC system, laboratory tests will be non-profit. We have to change the management style of clinical laboratories to cut costs for tests and labor as much as possible, choose tests selectively, respond rapidly to clinical needs, and utilize information technology efficiently for processing of laboratory data. Therefore, corresponding to changes in the medical care system, laboratory medicine has been changing. Commercial clinical laboratories are expanding their pressure in hospitals, and in-hospital laboratories are having a very hard time coping with the pressure. Since laboratory medicine is an essential part of clinical practice, we do not have to be antagonistic.

Clinical Laboratory Techniques↗
PubMed1994

Development of total medical material distribution management system.

Since September 1992, attempts have been made at Kagoshima University Hospital to develop the Medical Material Distribution Management System which helps to realize optimal hospital management as a subsystem of the Total Hospital Information System of Kagoshima University (THINK). As this system has been established, it has become possible for us to have an accurate grasp of the flow and stock of medical materials at our hospital. Furthermore, since September 1993, the Medical Material Distribution Management System has been improved and the Total Medical Material Distribution Management System has been smoothly introduced into the site of clinical practice. This system enables automatic demands for fees for treatment with specific instruments and materials covered by health insurance. It was difficult to predict the effect of this system, because no similar system had been developed in Japan. However, more satisfactory results than expected have been obtained since its introduction.

Hospital Distribution Systems↗
PubMed1998

The Latina Breast Cancer Control Study, year one: factors predicting screening mammography utilization by urban Latina women in Massachusetts.

This study identifies factors associated with screening mammography utilization for Latina women age 40 and older in two Massachusetts cities, who are predominantly of Caribbean origin. It is a cross-sectional survey based on an area probability sample, using bilingual Latina interviewers. Sixty-one percent of the sample was Latina, 99% of whom were interviewed in Spanish. Ethnicity, educational attainment, and acculturation were unrelated to recent screening. While distinct healing traditions were found among some Latinas, their use was unrelated to screening. Higher fatalism scores had a bivariate association with lower probability of screening. In a logistic regression, predictors were having health insurance or access to free care; having discussed mammography with a physician in the past 2 years; the difference between 67 and respondent's age (negative coefficient); and city of residence. Having a regular source of care was a predictor when substituted for insurance status. Insurance status and age principally determine whether subjects are screened, mediated by access to physician services and whether physicians recommend screening. Results suggest that universal medical insurance, and efforts to influence physician practices, are key to promoting screening mammography among this population.

Adult↗
PubMed2005

The effects of price competition and reduced subsidies for uncompensated care on hospital mortality.

OBJECTIVE: To determine whether hospital mortality rates changed in New Jersey after implementation of a law that changed hospital payment from a regulated system based on hospital cost to price competition with reduced subsidies for uncompensated care and whether changes in mortality rates were affected by hospital market conditions. DATA SOURCES/STUDY SETTING: State discharge data for New Jersey and New York from 1990 to 1996. Study Design. We used an interrupted time series design to compare risk-adjusted in-hospital mortality rates between states over time. We compared the effect sizes in markets with different levels of health maintenance organization penetration and hospital market concentration and tested the sensitivity of our results to different approaches to defining hospital markets. DATA COLLECTION/EXTRACTION METHODS: The study sample included all patients under age 65 admitted to New Jersey or New York hospitals with stroke, hip fracture, pneumonia, pulmonary embolism, congestive heart failure, hip fracture, or acute myocardial infarction (AMI). PRINCIPAL FINDINGS: Mortality among patients in New Jersey improved less than in New York by 0.4 percentage points among the insured (p=.07) and 0.5 percentage points among the uninsured (p=.37). There was a relative increase in mortality for patients with AMI, congestive heart failure, and stroke, especially for uninsured patients with these conditions, but not for patients with the other four conditions we studied. Less competitive hospital markets were significantly associated with a relative decrease in mortality among insured patients. CONCLUSIONS: Market-based reforms may adversely affect mortality for some conditions but it appears the effects are not universal. Insured patients in less competitive markets fared better in the transition to price competition.

Adult↗
PubMed2002

Behavioral health and managed care contracting under SCHIP.

This Policy Brief examines behavioral health managed care contracting under separately administered State Children's Health Insurance Programs (SCHIP), i.e., programs that operate under the direct authority of Title XXI of the Social Security Act rather than as expansions of Medicaid. Most separate SCHIP programs buy managed care style health insurance for some or most of their enrolled children. Because Title XXI provides states with far greater administrative flexibility than Medicaid with respect to coverage and benefit design, provision of services, and administration of managed care arrangements,studying separate SCHIP managed care products sheds important light on how states might approach insurance and managed care design generally in the area of behavioral health were Medicaid modified through section 1115 demonstration or federal statutory authority to permit greater latitude. To conduct this analysis, two nationwide databases maintained by the George Washington University Center for Health Services Research and Policy (CHSRP) were used: a database consisting of all Medicaid MCO-style managed care contracts in use in Calendar Year 2000; and a nationwide database consisting of contracts used by separate SCHIP programs for the same calendar year. As of the point of collection in 2000 there were 33 such separate programs; according to CMS' latest website information, that total has now reached 35. Both sets of contracts were analyzed and separated into their components by lawyers experienced in managed care contract analysis and interpretation. The data were entered into working tables that organize the contents of the contracts into a series of searchable domains.

Child↗
PubMed1996

National health insurance consumption and chronic symptoms following mild neck sprain injuries in car collisions.

OBJECTIVE: To map the extent of sick leave and number of claims made for health insurance among persons who had suffered neck sprain (whiplash) injuries in traffic accidents, and to map subjective feeling of health and quality of life among patients several years after the injury. DESIGN: A retrospective study of neck sprain injuries after car accidents and a comparison to the patients' use of sick leave caused by neck pain prior to the accident. SETTING: The Emergency Clinic at The University Hospital in Trondheim, Norway. SUBJECTS: 426 patients with neck sprain injuries after car accidents during 1985-1990. MAIN OUTCOME MEASURES: Information from Trondheim Social Security office about sick leave, and results from 345 patients who answered a questionnaire with respect to quality of life measures. RESULTS: 27% had been reported sick during the period after the car accident, and 5% had claimed health insurance, 58% reported sustained symptoms linked to the accident. CONCLUSIONS: Many reported sustained symptoms after neck sprain injuries, 16% of them reported being in a bad state of health.

Accidents, Traffic↗
PubMedDate not supplied

Medicaid: lessons from a decade.

Drawing on a decade of analysis and examination of the Medicaid program, this paper assesses what we have learned about Medicaid--its role, its successes, and its setbacks. In the absence of universal coverage for health and long-term care, Medicaid is a critical component of our social safety net, taking on the highest-risk, sickest, and often most expensive populations from private insurance and Medicare. Yet the substantial costs to federal and state governments incurred in filling this role, especially in lean economic times, remain its greatest challenge.

Foundations↗
PubMed1994

Mandated benefits: a misguided effort.

The U.S. Congress is toying with the creation of universally mandated benefits for health care, most specifically in the health care reform proposal offered by the Clinton Administration. The notion of mandated benefits has already become a part of the health care scene in insurance and managed care plans. Instead of benefiting U.S. citizens as a whole, however, mandated benefits are likely to result in a reduction in health care accessibility and quality. The reason is that mandated benefits consume a continuously growing portion of the health care pie. Deming demonstrated that quality brings lower costs, but to obtain quality we must commit adequate resources. The free allocation of resources is negated by mandated benefits.

Cost-Benefit Analysis↗
PubMed1994

Changes in insurance status and access to care for persons with AIDS in the Boston Health Study.

The purpose of this study was to measure unmet needs and changes in insurance status for persons with acquired immunodeficiency syndrome (AIDS). Thirty-six percent of the study's Boston-area respondents (n = 305) had a change in insurance coverage between AIDS diagnosis and interview. Medicaid coverage increased from 14% to 41%. Pneumocystis carinii pneumonia prophylaxis was nearly universal. Only 5% did not receive zidovudine, and intravenous drug users were at higher risk. Approximately 14% to 15% of patients reported problems in obtaining medical and dental services; Blacks, homeless persons, and those who were not high school graduates were at higher risk. Use of selected treatments for which there were clear clinical guidelines was adequate, yet disadvantaged groups were more likely than other persons with AIDS to face obstacles to other services.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Health insurance characteristics and health care evaluations among persons with rheumatic diseases in California.

OBJECTIVE: To describe the health insurance characteristics of a sample of persons with rheumatic diseases, to review their evaluations of health care, and to identify the health insurance characteristics associated with those evaluations. METHODS: Data were obtained from a mail survey of a random sample of persons (n = 2,484) on mailing lists of participating rheumatic disease organizations. The survey included specific aspects of health insurance coverage, demographic and health status information, and evaluations of health care. RESULTS: In California, managed care plans (MCPs) were providing health care to 59% of respondents under age 65. Among respondents under age 65, prescription drug coverage was almost universal, 60% had seen a plan rheumatologist, and 17% had been unable to obtain referrals to specialists (with significantly more respondents in MCPs reporting this problem). Among respondents age > or =65, 37% had seen a plan rheumatologist, and 11% reported being unable to obtain referrals to specialists. Overall, drug coverage was less common in this age group, although 90% of those in MCPs had drug coverage. Relatively few respondents in either age group knew about coverage for physical or occupational therapy or for assistive devices. Patient evaluations were more positive for non-MCPs. Limitation in access to physicians was the strongest predictor of poor evaluations of health plans and physician care. Having seen a plan rheumatologist was associated with more positive evaluations. CONCLUSION: Surveys of patient satisfaction or patient evaluations are required by many regulatory bodies. Managed care organizations should carefully evaluate whether limitations in access or services are worth the generalized negative perceptions that they may create among patients.

Adult↗
PubMed1999

Physician Health Research Conference (Estes Park, Colorado--September 15-17, 1996): progress report one year later.

The 1996 Physician Health Research Conference was the first conference to focus exclusively on research issues and methods for impaired physicians. The conference was initiated by James Shore, M.D., professor and chairman of the Department of Psychiatry in the School of Medicine at the University of Colorado Health Sciences Center and superintendent of the Colorado Psychiatric Hospital, and Stephen Dilts, M.D., Ph.D., medical director of the Colorado Physician Health Program and clinical professor of psychiatry at the University of Colorado Health Sciences Center. Forty participants represented a wide range of national organizations. The conference was supported by contributions from the American Medical Association, American Psychiatric Association, Colorado Physician Health Program, Colorado Physician Insurance Program, and the Department of Psychiatry and Colorado Psychiatric Hospital at the Health Sciences Center. In addition, the conference was cosponsored by the American Academy of Addiction Psychiatry, the American Society of Addiction Medicine, and the Federation of State Physician Health Programs. This paper summarizes the formal presentations of the conference.

Adult↗
PubMed2004

Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients.

OBJECTIVE: This study tested the hypothesis that weight-reduction (bariatric) surgery reduces long-term mortality in morbidly obese patients. BACKGROUND: Obesity is a significant cause of morbidity and mortality. The impact of surgically induced, long-term weight loss on this mortality is unknown. METHODS: We used an observational 2-cohort study. The treatment cohort (n = 1035) included patients having undergone bariatric surgery at the McGill University Health Centre between 1986 and 2002. The control group (n = 5746) included age- and gender-matched severely obese patients who had not undergone weight-reduction surgery identified from the Quebec provincial health insurance database. Subjects with medical conditions (other then morbid obesity) at cohort-inception into the study were excluded. The cohorts were followed for a maximum of 5 years from inception. RESULTS: The cohorts were well matched for age, gender, and duration of follow-up. Bariatric surgery resulted in significant reduction in mean percent excess weight loss (67.1%, P < 0.001). Bariatric surgery patients had significant risk reductions for developing cardiovascular, cancer, endocrine, infectious, psychiatric, and mental disorders compared with controls, with the exception of hematologic (no difference) and digestive diseases (increased rates in the bariatric cohort). The mortality rate in the bariatric surgery cohort was 0.68% compared with 6.17% in controls (relative risk 0.11, 95% confidence interval 0.04-0.27), which translates to a reduction in the relative risk of death by 89%. CONCLUSIONS: This study shows that weight-loss surgery significantly decreases overall mortality as well as the development of new health-related conditions in morbidly obese patients.

Adult↗