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Prenatal care comparisons among privately insured, uninsured, and Medicaid-enrolled women.

Women without health insurance and those covered by Medicaid have been shown to obtain prenatal care later in pregnancy and make fewer visits for care than do women with private insurance. Factors that keep women from obtaining care include inadequate maternity care resources, difficulty in securing financial coverage, and the psychosocial issues of pregnancy. This study identified and compared prenatal care use patterns, insurance coverage changes, and psychosocial factors among 149 women in Minneapolis, MN, with private health insurance, Medicaid, and no health insurance. Little information has been available on the insurance status of women at the start of pregnancy and the paths subsequently taken to obtain financial coverage for prenatal care.

Depressive Disorder↗

PubMed1990

Implementing and maintaining a private pharmacokinetics practice.

The development and maintenance of a private-practice pharmacokinetics service is described. A contracted pharmacokinetics service has been in place at Georgia Baptist Medical Center, a 525-bed hospital, for the past eight years. Physician support, inhouse study results, and literature documentation of the benefits of scheduling drug concentration determinations were used to convince hospital administrators of the value of a pharmacokinetics service. Services were reimbursed by increasing the fee charged for each drug concentration determination, with payment made to the pharmacokinetics service on a monthly basis. The service is associated with the pathology department for administrative purposes. Each member of the pharmacokinetics service is credentialed by the medical staff. The group trains part-time personnel to provide services when needed. Services provided by the group but not required by the contract include collecting quality assurance data, conducting research, serving on hospital committees, writing newsletter articles, conducting inservice-education programs, and providing clinical interventions for nonconsultation patients. This private-practice pharmacokinetics service provides high-quality services and is well accepted within the institution.

Drug Information Services↗

PubMed1990

[Heart center surgery in the private hospital: heart surgery in the hospital with covering physicians].

Based upon the experiences at the "Herzzentrum Hirslanden" Zurich it is demonstrated that heart surgery and invasive cardiology, including cardiac catheterization and PTCA, can readily be performed by surgeons and cardiologists in private practice at a private hospital not receiving any government funds. The needs for additional heart surgical beds in the greater area of Zurich is confirmed. Manpower needed and necessary apparative infrastructure are discussed and present activities at the "Herzzentrum Hirslanden" illustrated. Finally problems with medical insurance companies covering the cost are dealt with.

Cardiac Surgical Procedures↗

PubMed1989

Restructuring the Federal Employees Health Benefits Program: the private sector option.

The Federal Employees Health Benefits Program (FEHBP) needs to contain its costs. This paper recommends reforms of FEHBP that would substantially lower costs. As a first step, FEHBP should offer each employee a high and low option from a single conventional carrier, plus several HMO alternatives. FEHBP's practice of offering employees a choice of conventional carriers is virtually unheard of in the private sector. Cost control is more likely when carriers compete for employment groups rather than for individual employees. In addition, my analysis suggests that FEHBP should self-insure, competitively select third-party administrators (TPAs), one for each region of the country, aggressively manage program costs through preadmission certification and DRGs, and allow Medicare-eligible annuitants to enroll in Medicare HMOs and receive the government contribution. All of these reforms have been successfully implemented elsewhere, either by private employers or state or federal governments. These reforms would yield savings of at least $500 million annually for taxpayers and additional savings for federal employees.

Cost Control↗

PubMed1989

Pension coverage among private wage and salary workers: preliminary findings from the 1988 survey of employee benefits.

Based on data for private wage and salary workers in May 1988, this article examined pension coverage under two types of employer-sponsored pension plans. Some of the factors associated with employer-financed pension coverage were also examined, and comparisons were made to findings on pension coverage of full-time workers in 1972, 1979, and 1983. "Covered" workers were defined as those actually participating in a pension plan. Among all private sector employees studied, 34 percent were covered by a "basic" pension plan (most of which, presumably, were defined benefit plans), and 14 percent were covered by a pretax retirement savings plan--a subtype of defined contribution plan. With 7 percent of the respondents covered by both types of plans, the total coverage rate under employer-sponsored plans was 41 percent. Twelve percent of the respondents reported that they had contributed to an IRA in 1987. The reported IRA usage was somewhat higher among those already covered by a pension plan than among noncovered workers. Six percent of the respondents were not covered by an employer-sponsored plan but were contributing to an IRA, yielding a total of 47 percent who were participating in either an employer-sponsored or an individual retirement plan. While it was assumed--as in previous studies--that all "basic" coverage was being funded by employers, only four-fifths of those in pretax retirement savings plans reported that employers were also contributing to these plans. The remainder of the analysis was restricted to coverage under employer-financed plans, and it was further restricted to full-time workers. A total of 46 percent of these workers were covered under employer-financed pension plans--33 percent covered only by a basic plan, 7 percent covered only by a pretax plan, and 6 percent dually covered. Among men, the coverage rate was 49 percent, compared with 43 percent among women. Several individual and job-related characteristics were found to be associated with employer-financed pension coverage among full-time employees. Coverage rates were quite low among workers under age 25, but were substantially higher among those aged 35-59. Pension coverage was also low among those with less than 5 years of employment on the job, but relatively high among those with 5 years or more of job tenure. Coverage rate differences by race were not substantial. Whites reported a coverage rate of 47 percent, compared with 42 percent among blacks and 45 percent among other races.(ABSTRACT TRUNCATED AT 400 WORDS)

Employment↗

PubMed1989

Trends in private medical insurance ownership: lessons for the public sector.

Data on ownership of private medical insurance were collected from a fully national sample of over 1000 adults. Findings were compared with those of a study undertaken in 1981. Private medical insurance was owned by 40% of the sample, an increase from the 35% ownership in the earlier study. The increase has been predominantly amongst nonMaori New Zealanders and women have increased ownership more than men. Insurance ownership was most common amongst the middle age group (36-50 years) but it has increased significantly amongst the older groups. Greatest areas of growth in ownership were in Auckland and Wellington where proportionate ownership was 52% and 50% respectively. Medical insurance was employer provided amongst 15% of those with insurance, the same proportion as found in the earlier study. Employer subsidy to insurance was evident also. Major reasons to take out insurance were for primary care purposes, so as to overcome the cost barrier to general practitioner services. Other reasons mentioned included avoidance of waiting for treatment and increase in choice of specialist or hospital. Reasons for giving up insurance were cost of premium, disillusionment with benefits and disqualification through age or illness.

Adolescent↗

PubMed1986

Long-term care for the elderly: public dreams and private realities.

The health care policy and provider community is struggling to come to grips with the dual problems of the burgeoning "old-old" population that is putting an increasing strain on nursing home bed supplies, and the increasing difficulty of paying for long-term care through Medicaid budgets and out-of-pocket payments by the individuals and families affected. The Reagan administration's approach to the problem is away from public solutions and toward private ones. This paper reviews the trend toward privatization in long-term care for the elderly, raises some concerns about these trends, and concludes with some alternative suggestions.

Aged↗

PubMed1986

Insuring the uninsured through private action: ideas and initiatives.

The growing issue of health coverage for the uninsured has no single solution, but private initiatives hold promise for some alleviation. The keys to increasing coverage are: more insurance pooling (to share risk and management); different insurance products, especially ones featuring better spending controls (to be attractive yet affordable at the low end of the market); and subsidy plus information (to encourage voluntary enrollment). Lack of insurance is not a problem for employees in large workplaces because relatively low prices and high incomes, as well as employer and tax code paternalism, assure coverage to almost 100% of workers in large groups. People on their own or in small groups, as well as increasing numbers of dependents of workers in large groups, are significantly disadvantaged in comparison. Considerable progress should be possible privately, but no one should expect large improvements without more cultural change or social intervention.

Blue Cross Blue Shield Insurance Plans↗

PubMed1988

Optometric services and private health insurance.

This article provides an overview of the private health insurance system and its relevance to optometric practice. The extent of private health coverage in the U.S. and the projected decline of fee-for-service income mandates a working knowledge of the insurance system by optometrists and their staff members. The coverage of eye examinations and related services is dependent upon the diagnosis. Using a well-designed fee slip will expedite claims processing for patients and reduce insurance paperwork for the practitioner. Fee slip design and implementation are discussed in detail and illustrated with clinical examples.

Adult↗

PubMed1987

The provision and financing of medical care for AIDS patients in US public and private teaching hospitals.

The National Association of Public Hospitals and the Association of American Medical Colleges' Council of Teaching Hospitals conducted a detailed survey on hospital care to patients with acquired immunodeficiency syndrome (AIDS) in major US public and private teaching institutions in 1985. The 169 hospitals treating patients with AIDS that responded to the survey reported providing inpatient services to 5393 patients with AIDS. These patients accounted for 171,205 inpatient days and 8806 inpatient admissions, with an average length of stay of 19 days. The average costs and revenue for patients with AIDS per day were $635 and $482, respectively, with Medicaid representing the most frequent third-party payer. The average inpatient cost per patient per year was $20,320. Using Centers for Disease Control estimates of 18,720 patients diagnosed as having AIDS and alive during any part of 1985, we estimate that the total cost of inpatient care for patients with AIDS was $380 million for that year. We also found significant regional and ownership differences in source of payment for patients with AIDS and regional differences in revenues received for AIDS treatment. Results indicate that the costs of treating patients with AIDS will profoundly affect major public and private teaching institutions, but that public teaching hospitals in states with restrictive Medicaid programs will be most adversely affected.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Private medical insurance--to have or not to have.

Reasons for taking out or deciding against private medical insurance were studied by a telephone survey in a random sample of 389 Wellington households with telephones. Nearly 47% were covered by a medical insurance policy, the majority through group schemes, and that cover varies significantly by household income and age. For both those with medical insurance, and those with no policy, the main advantages seen were rapid and convenient access to hospital care, followed by security against future costs, and then to pay doctor's bills. Only a very small number (17) of households had claimed private hospital costs in the past year and the greatest use made of the policy was to pay general practitioner costs.

Adult↗

PubMed1987

An audit of surgery in 100 patients over 75 years in a private hospital.

OBJECTIVE: To determine what operations are being done on patients over 75 years in a private hospital, to observe performance in terms of justification, morbidity and mortality. METHOD: Retrospective audit of 100 patients over 75 years having surgery at an Adelaide private hospital. RESULTS: Cystoscopy, inguinal herniorrhaphy, cataract and colon surgery were the most common procedures. One patient died--probably from a leaking aortic abdominal aneurysm. Four patients had significant morbidity in the form of burst abdomen, ruptured femoral-popliteal bypass graft, biliary collection requiring reoperation and cardiac arrhythmia requiring a pacemaker. Twenty three other patients had minor morbidity. No unnecessary operations were detected.

Aged↗

PubMed1986

An investigation into private sector nursing and residential home care for the elderly in north Wales.

In January 1984 two questionnaires were sent to private homes for the elderly in an area of north Wales with a high concentration of private beds. The first questionnaire was completed by eight nursing homes and 13 residential homes for the elderly and the second questionnaire for each of 321 residents - 154 in the former and 167 in the latter.The two types of homes were compared for staffing levels, facilities available and the degree of dependency of residents. As expected the degree of dependency of the residents in nursing homes was higher than in residential homes but even so the degree of dependency in residential homes was found to be high. The isolation of many residents was evident. Twenty three per cent of residents had come directly to the homes on moving into the area. The problems arising for general practitioners visiting a number of different homes and for homes having many different doctors visiting are highlighted.The need for adequate consultation and assessment prior to admission and periodic reassessment is demonstrated in the light of the recent changes to the supplementary benefit regulations. It was found that at least 20% of the residents had their fees supplemented by the Department of Health and Social Security. The need for greater collaboration between the two different registration authorities under the new legislation (Registration of Homes Act 1984) and with the general practitioners providing general medical services is demonstrated.

Aged↗

PubMed1985

Percentage of anaesthetic fee refunded to patients by schedule-using private medical insurers in New Zealand.

Refunds for anaesthetic services payable to patients by schedule-using private medical insurers or agencies have not been realistically adjusted for inflation or growth in incomes. Patients receive a lower actual refund than that usually implied by the insurers. If private anaesthetic fees had increased in line with award weekly wages, the average refund to patients would have been approximately 50% for most of the period 1968-1981.

Anesthesia↗

PubMed1985

[Postpartum sterilization and the private practitioner].

A postpartum programme of sterilization was initiated by private practitioners at the Paarl Hospital in 1968. The unit was later taken over by the University of Stellenbosch and a total of 4704 procedures had been completed by the end of 1983. Most of the doctors trained in the method are now in private practice. The sterilization-to-delivery ratio of 1 in 5 indicates that +/- 200 000 postpartum sterilizations would be requested in South Africa, if the Paarl figures are projected to the rest of the country. The most effective method of mobilizing our medical manpower would be a fair fee per procedure. South Africa cannot afford the present continued burden of unwanted and unplanned births.

Female↗

PubMed1979

Black-white differences in private pensions: findings from the retirement history study.

This article compares older black workers and older white workers on coverage under private pension plans, the receipt of pension benefits upon retirement, and the job characteristics associated with both coverage and receipt. Data are from the 1969 and 1975 interviews of the Retirement History Study and describe pre-ERISA conditions among persons in their late fifties to mid-sixties. Black workers were much less likely than white workers to have been covered by a private pension on their longest job. Moreover, among those who were covered, they were less likely to have received benefits. The racial differences appear to result in part from subtantial differences on job characteristics, particularly industry.

Black or African American↗

PubMed1979

Private-sector services for low-income psychiatric outpatients. D.C. Institute of Mental Hygiene Washington, D.C.

A community-based, nonprofit outpatient clinic in Washington, D.C., has been successful in using the medical model to provide high-quality services to low-income patients. In 13 years it has grown from five staff members and 17 patients to a part-time staff of 74 and a patient population of 1500. Hours of direct service have increased from 1000 to more than 40,000 per year. The clinic has matched the services provided in the city's public mental health clinics at a fraction of the cost. It receives no direct federal funding and only minimal assistance from state and local governments. It exemplifies the contribution the private sector can make in creatively serving the economically disadvantaged. Fiscal reality and patient demand emphasize the need for a strong and ongoing partnership between the private and public sectors if that population is to be served.

Awards and Prizes↗

PubMed1977

[Public and private hospital care--an economic approach (author's transl)].

In an investigation involving over 1,000 patients, the LEGOS group (Univ. de Dauphine) has studied the two sectors which co-exist in the French hospital service--the public sector and the private profit--making sector. This paper gives the economic results of the investigation. The private clinics function in a commercial framework and define a privileged area of treatment related to the "cost" of the medical activities which occur in this sector. The public hospital aims at satisfying certain needs, in particular those associated with emergencies, and economic considerations are only considered in the last resort. These conclusions are drawn from observations on medically defined situations treated in the two sectors and on medical activities occurring in them.

Economics, Hospital↗