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PubMed2002

Advancing the role of nonprofit health care.

This article comes out of a series of discussions among a diverse group of chief executive officers (CEOs) and other leaders of nonprofit hospitals, long-term care facilities, health maintenance organizations, and other insurance providers, including several nonprofit Blue Cross Blue Shield (BCBS) plans. The group was convened as part of Howard Berman's Walter J. McNerney Fellowship project. (Berman is CEO of Excellus, Inc., a nonprofit Blue Cross Blue Shield affiliate that insures the health of more than 2.15 million people in upstate New York. He was awarded the McNerney Fellowship in April 2001 by the Health Research and Educational Trust, an American Hospital Association affiliate. The Fellowship goes annually to at least one fellow to highlight or pursue work that will provide new insights into how different sectors of the health care system can better work together for improved outcomes.) The group has met several times over the past year around a shared concern: the current challenges to nonprofit health care organizations and the future role for nonprofits in the re-visioning and creation of an American health care system that is characterized by universal access, patient-centered quality, and national affordability. Members have supported the public relations campaign of the "Alliance for Advancing Nonprofit Health Care," an effort initiated by the Caucus, an independent group of nonprofit BCBS plans. The group continues to explore the need for a broad-based coalition of providers, insurers, and other organizations to effectively protect and enhance the role of nonprofit health care.

Community Health Planning↗
PubMed1997

Factors influencing effect of mammography screening in a university workplace.

The purpose of this study was to examine the relationship between theoretically identified variables and participation in mammography screening in a university workplace. A sample of 1093 women 50 and over returned a questionnaire following the offer of a free workplace breast cancer screening. Anderson's Behavioral Model of Health Services Use identified factors predisposing and enabling women to have mammograms. Predisposing variables included attitudes and experience related to mammography. Enabling variables included income, willingness to pay for mammography, health insurance coverage, and regular source of health care. Comparisons were made among: (i) those who were screened in the workplace, (ii) those who were screened elsewhere, and (iii) those who were not screened. Differences in perceived barriers, perceived benefits, practice of breast self-examination (BSE), and education surfaced. Results indicated, among other things, that women who were older, had no more than 12 years of education, had a family member with breast cancer, and were proficient with breast self-examination were more likely to have participated in the university work-site screening.

Breast Neoplasms↗
PubMed2000

The effect of health care delivery systems on admission to and treatment at an inpatient dermatology unit.

The University of Miami Department of Dermatology has maintained an active inpatient unit. Analysis of data from a 12 month period from 1995-1996 showed 562 admissions. Cutaneous lymphoma, psoriasis, and chronic wounds accounted for over half the admissions. Most patients were insured by a fee-for-service system, and compared to patients insured by managed care systems or patients who were indigent, fee-for-service patients had the shortest length of stay. Using a case mix severity index, indigent patients had the greatest disease severity followed by fee-for-service patients. Patients enrolled in managed care systems had the least severity suggesting that factors other than disease severity alone may play a role in determining why patients are admitted.

Adult↗
PubMed1988

Measuring quality in medical case management programs.

Private insurers and health care providers alike currently offer medical case management programs as a means of containing costs and enhancing the quality of care for patients with high-cost illnesses or injuries. Since 1986, Brandeis University's Bigel Institute for Health Policy has been involved in a project to evaluate medical case management programs. The study found that such programs have become popular because of the perception that high-cost patients are typically handled inefficiently. The study also found that greater attention needs to be given to developing systematic ways to measure and monitor the quality of the case management process and its effect on outcomes.

Catastrophic Illness↗
PubMed1975

Screening for endometrial cancer.

Since Gusberg's description in 1947 of adenomatous hyperplasia (15), the role of precursors in the development of endometrial carcinoma has been well studied. There is now no doubt that in many patients histologic precursors can be demonstrated in the endometrial cavity prior to the development of invasive cancer. At this point in the continuum, interruption by hysterectomy or other therapy will insure the patient's health. We have discussed a wide variety of techniques designed to provide cytologic or histologic samples of the endometrium that are highly effective in the detection of early neoplasia. As a goal, universal endometrial sampling on a periodic basis is probably impractical and may be unecessary or undesirable. However, surely the patient at high risk for endometrial cancer requires close periodic screening. The high-risk category may be expanded to include others beyond the group of hypertensive, diabetic, obese, anovulatory, nulliparous women. It should include patients with irregular vaginal bleeding, those with a strong family history of genital and breast cancer, those patients receiving hormone therapy, and patients in the menopausal years who experience changes in the menstrual pattern. With intelligent and aggressive application of outpatient screening, uterine cancer can be diagnosed when patients are virtually completely curable, thus resulting in further reduction in mortality from this disease.

Adenocarcinoma↗
PubMed1979

Let's keep residents out of community hospitals.

Attracted by the prestige and higher insurance reimbursements that a university affiliation is likely to bring, community hospital boards have been encouraging the growth of residency programs within community hospitals. The author (who remains anonymous) states that besides increasing the cost of health care, this has compromised the quality of patient care and medical education by requiring physicians who are not trained as educators to asssume responsibility for the educational needs of residents. In hospitals having short residency rotations, the problems are compounded because teaching programs require residents to perform a certain number of procedures in a given period of time. This requirement forces some residents to perform procedures before they obtain the kind of exposure and practice that would otherwise take place. The author believes university hospitals shold train residents for board certification and community hospitals shold concentrate on serving the communities. Conversely, rotating residents through community hospitals exposes them to common medical problems and routine procedures and techniques.

General Surgery↗
PubMedDate not supplied

The new equilibrium.

This is the eighth and final article based on his recently completed Harvard University Ph.D. dissertation, "The Struggle for Control of California's Health Care Marketplace."

California↗
PubMed1992

Dentistry and national health insurance.

Access to dental care is not equitable in the United States. The dental health of the population varies widely by socioeconomic status. Private dental insurance coverage has peaked at about 40% of the population, and benefits are variable. Dentistry is not included in Medicare and is optional for adults under Medicaid. Inflation is greater than for all goods and services. There is considerable administrative waste, and quality is variable. In this author's opinion, only a national system with universal coverage, one set of benefits, a single payer, a cap on expenditures, and no participation by insurance companies that is increasingly based on salaried consumer-or community-owned group practices with dentist input into decision making can hope to solve the existing problems.

Dental Care↗
PubMed2002

Switching costs, price sensitivity and health plan choice.

We investigate the extent to which sensitivity to health plan premiums differs across individuals according to characteristics related to the cost of switching plans. Our results indicate substantial variation in price sensitivity related to expected health care costs: younger, healthier employees are between two and four times more sensitive to price than employees who are older and who have been recently hospitalized or diagnosed with cancer. We also find evidence of status quo bias: estimated premium elasticities are significantly higher for new hires than for incumbent employees. Simulations combining our results with actuarial data illustrate the cost implications of risk-related differences in price elasticity.

Adult↗
PubMed2005

Access to antiretroviral therapy among HIV/AIDS patients in Khon Kaen Province, Thailand.

This study attempted to identify the factors associated with the access to antiretroviral therapy (ARV) among HIV/AIDS patients in Khon Kaen Province, Thailand. We collected medical and sociodemographic data from the medical charts of adult patients living in the province who received medical services at two public hospitals in the province. The study period was from December 1, 2001 to February 28, 2002. Total 593 outpatients were included in the analysis. One hundred and forty-six patients (24.6%) received ARV. A logistic regression analysis was conducted to identify the factors associated with the use of ARV. Patients who were covered by the Civil Servant Medical Benefit Scheme were significantly more likely to receive ARV than those who were covered by the Universal Coverage Scheme (UC), a publicly-funded medical insurance (OR = 12.43; 95% CI = 6.03-25.62). The results of this study indicated that there were inequalities in access to and use of ARV among HIV/AIDS patients by health insurance status. The current government announced that they would include ARV in the benefits package of UC. It would be important to monitor how this policy will improve the access to ARV among HIV/AIDS patients.

Adult↗
PubMed2006

An analysis of California Assembly Bill 2185: mandating coverage of pediatric asthma self-management training and education.

OBJECTIVE: To summarize for the California Legislature the evidence on the medical effectiveness of pediatric asthma self-management training and education (PASMTE), including the use of peak flow meters, spacers, and nebulizers and the impact that mandated coverage of these services and devices under Assembly Bill (AB) 2185 would have on total health care expenditures, monthly premiums, health services utilization, and the public's health. MEDICAL EFFECTIVENESS FINDINGS: The review of the literature finds that PASMTE is medically effective and has favorable effects on the health of children with symptomatic asthma, as well as reduces asthma-related emergency room visits and hospitalizations. There was inadequate evidence to assess the effectiveness of the three medical devices independently of PASMTE. COST AND UTILIZATION FINDINGS: One-hundred percent of children in health maintenance organization (HMO) plans in California are already covered for PASMTE, with fewer having coverage for the specific medical devices. However, despite full coverage of PASMTE in HMOs, these services are underutilized. We expect that the enactment of AB 2185 would increase utilization of PASMTE among children who are currently covered by 10 percent as a result of increased awareness of current coverage by all HMOs and increased awareness of the importance of these services. We estimate that this increased utilization by children who are already covered may result in a total statewide premiums increase of $170,000 or 0.006 percent, equal to one to two cents per member per month (PMPM). PUBLIC HEALTH FINDINGS: It is estimated that the public health impact of the mandate, as a result of new utilization of PASMTE by 10 percent of children who are already covered, would reduce the number of school days missed because of asthma per year by 158,000; the number of children reporting restricted activity days by 6,020; the number of emergency department visits by 350; and the number of hospitalizations by 1,105. LEGISLATIVE ACTION: AB 2185 passed the legislature after being amended six times. The bill as it was signed into law did not mandate coverage for PASMTE, as all HMOs in California presently reported covering these services. However, the bill retained the mandate for coverage of the three medical devices, as their coverage was not as universal across health plans.

Asthma↗
PubMed1993

Health reform: setting the agenda for long term care.

The White House Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, is expected to release its prescription for health care reform this month. From the outset, Clinton's mandate was clear: to provide universal coverage while reining in costs for delivering quality health care. Before President Clinton was even sworn into office, he had outlined the major principles that would shape the health reform debate. Global budgeting would establish limits on all health care expenditures, thereby containing health costs. Under a system of managed competition, employers would form health alliances for consumers to negotiate for cost-effective health care at the community level. So far, a basic approach to health care reform has emerged. A key element is universal coverage--with an emphasis on acute, preventive, and mental health care. Other likely pieces are employer-employee contributions to health care plans, laws that guarantee continued coverage if an individual changes jobs or becomes ill, and health insurance alliances that would help assure individual access to low-cost health care. What still is not clear is the extent to which long term care will be included in the basic benefits package. A confidential report circulated by the task force last month includes four options for long term care: incremental Medicaid reform; a new federal/state program to replace Medicaid; a social insurance program for home and community-based services; or full social insurance for long term care. Some work group members have identified an additional option: prefunded long term care insurance.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Policy↗
PubMed2005

Valuing a hypothetical cure for rheumatoid arthritis using the contingent valuation methodology: the patient perspective.

OBJECTIVE: A willingness-to-pay (WTP) survey measures the value of a given intervention in money terms. We examined the WTP of Canadian patients with rheumatoid arthritis (RA) for a hypothetical cure for RA under private and public scenarios. The validity of the survey was explored by studying the association between WTP and variables thought to be associated with WTP and randomly-varied variables of the survey materials. METHODS: A telephone survey was carried out in a sample of 121 patients with RA from 5 rheumatologists affiliated with the McGill University Health Centre. In advance, patients had been sent a 4-page brochure providing a comprehensive description of the disease (including photos or no photos). The hypothetical cure for RA was presented through 2 scenarios: a private insurance implying an annual premium and a public coverage requiring additional income taxes. The survey included questions related to their WTP, socioeconomic status (ability to pay), general health, opinion about the performance of the healthcare system, and their opinion about the difficulty of the survey. For elicitation of WTP, patients were randomized to one of 3 payment cards. Mailed questionnaires concerning RA health status were also completed. A series of univariate comparisons and multivariate ordered logit regressions were carried out to examine the association of WTP and patient and study variables. RESULTS: Patients were willing to pay annually significantly more for the private program (mean 1190 Canadian dollars) than for the public program (mean 502 Canadian dollars). Annual WTP was associated with age, household income, site of care (private program), private health insurance, opinion about the performance of the public healthcare system (public program), and presence of brochure photos. The payment card did not affect WTP for either program. CONCLUSION: The WTP survey was well understood and accepted by the patients with RA. Although measures of RA-specific health status (e.g., Health Assessment Questionnaire) were not found to be associated with WTP, many variables thought to be associated with WTP were found to be related in the expected directions. Since WTP for the private program was higher than that for the public program, our study design did not fully capture altruistic valuations of RA patients. Thus, our estimates represent a lower bound on patients' WTP for an RA cure.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Nuclear medicine equipment and PET cameras in Greece and abroad].

TO THE EDITOR: Referring to recent discussions among many of our colleagues in Greece and to what Greek newspapers write about programming to buy more SPET and PET cameras in Greece and also relating to the usefulness of the PET camera, I would like to mention the number of PET cameras now functioning in many European countries and the important contribution of this new camera in diagnostic nuclear medicine. About 40% of the papers presented at the European Association of Nuclear Medicine Scientific Meeting last year, referred to studies performed by PET camera. In oncology, the PET camera may increase the diagnostic efficacy of SPET camera studies by about 30%. Unfortunately the PET camera is not used for all nuclear medicine applications and not all insurance companies agree to pay in full the cost of diagnostic procedures performed by the PET camera. Nuclear Medicine Societies of Greece should strongly suggest to the Ministries of Health and Education to provide public and especially university hospitals with a reasonable number of PET cameras. Also more SPET cameras should be bought to reach a ratio of at least one SPET camera per 100,000 inhabitants.

English Abstract↗