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At least 1,765 records · Page 98Linked to original sources
PubMed1991

Utilization management as a cost-containment strategy.

Utilization management (UM) is now an integral part of most public and private health plans. Hospital review, until recently the primary focus of UM, is associated with a reduction in bed days and rate of hospital cost increases. These reductions appear to have had limited impact on aggregate health care costs because of increases in unmanaged services. In the future, with electronic connectivity between payers and providers and the use of clinical guidelines and computer-based decision-support systems, the need for prospective case-level reviews will be reduced. With these changes, UM programs are likely to become more acceptable to providers and patients.

Cost Control↗
PubMedDate not supplied

Breaking down the barriers.

The Prudential Center for Health Care Research is studying TennCare to identify barriers to early prenatal care.

Adult↗
PubMed1983

Increasing radiographer productivity by an incentive point system.

Because of a very low technologist productivity in their Radiology Department, the authors describe a Productive Point System they developed and implemented to solve this personnel problem. After establishing the average time required to perform all exams, point credits (one point for every ten minutes utilized) were assigned to each exam performed, thereby determining an index of production. A Productive Index of 80% was considered realistic and was the equivalent of 192 points for a 40-hour work week. From 1975 to 1978 personal productivity increased from 79% to 113%. This resulted in an average yearly fiscal savings of over $20,000.00 for this three-year period. There was also a significant improvement in exam efficiency and quality, job attitude, personnel morale, and public relations. This program was highly successful because technologist acceptance and cooperation was complete, and this occurred mainly because the system supports the normal occupational goals and expectations of technologists.

Efficiency↗
PubMed1989

Mandatory assignment. What hath it wrought in Massachusetts?

The national precedent set in 1986--when Chapter 475, mandating Medicare assignment in Massachusetts, became law--has spread across the United States as other states seek to control physicians' incomes under the Medicare program. While some form of mandatory assignment is the law in at least a dozen states, the Bay State's law currently remains the most restrictive in the country. The effects of Chapter 475 continue to ripple through the health care system and are sure to intensify as the national debate heats up over the future of the Medicare program. The article explains the theoretical and practical reasons why mandatory Medicare assignment affects access to medical care, jeopardizes the number of physicians who will choose to treat Medicare patients, and ties the professional licensure process not to clinical expertise but to acceptance of a broad social-entitlement program.

Attitude of Health Personnel↗
PubMed1980

Physicians' charges under Medicare: assignment rates and beneficiary liability.

Under Medicare's Part B program, the physician decides whether to accept assignment of claims. When assignment is accepted, the physician agrees to accept as full payment Medicare's allowed charge. Physicians' acceptance of assignment is of considerable importance in relieving the beneficiaries of the burden of the costs of medical care services. This factor and the beneficiaries' liabilities for premiums, the annual deductible, and coinsurance are analyzed in considerable detail in this report. Data from physicians' claims for services in 1975 show that 45.8 percent of the services and 47.2 percent of the charges were assigned for the aged. There were wide variations in the rate of acceptance of assignment by physician specialty, and by age, race, and residence of beneficiaries. Total beneficiary liability from the deductible, coinsurance, and from unassigned claims amounted to 37.7 percent of total physicians' charges due. When the premium which the beneficiary pays for Part B is included, beneficiary liability rises to 69.2 percent of total physicians' charges due.

Aged↗
PubMed1999

Breast cancer screening in underserved women in the Bronx.

This article reports the results of mammography screening among socioeconomically disadvantaged women in Bronx, NY using a federally funded low-cost or no-cost cancer screening service. The New York State Department of Health provided funds for the uninsured through the Bronx Breast Health Partnership. All women < or = 40 years underwent screening mammography using both a mobile van unit and hospital-based mammographic x-ray unit, both American College of Radiology (ACR) accredited. Return visits were coordinated by a follow-up clinic at Montefiore Medical Center using a patient navigator who acted as an advocate for patients with abnormal screening findings. The overall detection rate of 12.9 per 1000 women screened was significantly higher than the New York State detection rate of 6 per 1000 and 5.1 per 1000 nationally. Availability of a patient navigator was an essential factor in the effectiveness of the work-up of problem cases. Low-cost or no-cost breast cancer screening programs can improve the availability, accessibility, acceptability, and utilization of mammography among underserved and uninsured women who are least likely to be screened otherwise.

Adult↗
PubMed1998

Plan your organization's Medicare risk strategy using enrollment, disenrollment data.

Data File: We've expanded this month's column to feature the details of two studies on Medicare enrollment and disenrollment trends--important information that can help you fine-tune your Medicare risk strategy. You'll find the top counties poised for growth, a report card on how HMOs are retaining or losing their members, and tips for spotting plans that could spell trouble because of volatile membership.

Aged↗
PubMed1978

The annual Pap test: a dubious policy success.

The annual Pap test became a recommended standard for American women without ever having been subjected to controlled trials to estimate its efficacy and effectiveness. After more than 30 years of routine use, the Pap test fails to meet most of the generally accepted criteria for a mass screening program. The policy persists, however, because the nation's ideology supports the maximum utilization of new technologies; and special interest groups have promoted the test as the major weapon in the "War on Cancer." With some exceptions, this is a questionable allocation of public and private health resources.

American Cancer Society↗
PubMed1999

What every general practitioner should know about the laser vision correction revolution.

With tens of millions of Americans potential candidates for laser vision correction (LVC), increasing numbers of patients are asking their general practitioners for advice and information on this revolutionary procedure. The following article will provide general practitioners a broad view of LVC, including valuable data and resources to share with their patients. The latest techniques in LVC--including step-by-step descriptions of the procedures and clinical outcomes--are outlined in detail, along with what steps MCOs are taking to address this growing trend.

Astigmatism↗
PubMed1975

Levels of serum complement components in patients undergoing renal dialysis.

Following acceptance to a renal dialysis therapy program, 13 patients underwent serial examination of the serum complement system for periods of 6 to 12 months. Serum levels of C3 and C4 were examined at monthly intervals before the first dialysis of each month. The patients suffered from various primary renal diseases, including glomerulonephritis, obstructive uropathy with chronic pyelonephritis, nephrosclerosis and chronic nephropathy of undetermined nature. Levels of serum C3 were depressed at some time during the study period in all patients. Serum C4 levels were normal. The depression of serum C3 levels was significant and prolonged in nine patients. There seemed to be no relationship between the nature of the basic disease and the depression of serum C3 levels. Caution should be exercised in attributing depressed C3 levels to a particular type of underlying renal disease in patients on renal dialysis.

Complement C3↗
PubMed2002

[Epidemiological study on childhood asthma aged 0 to 14, in Kaifeng city].

OBJECTIVE: To understand childhood asthma from age 0 to 14 in Kaifeng city and the relevant risk factors, effects of therapy and costs. METHODS: Eleven thousand children aged 0 to 14 were chosen in Gulou area, Shunhe area using cluster sampling. RESULTS: (1) The overall prevalence of childhood asthma was 1.16% sex ratio 1.72:1. Significant difference was found among every age group (P < 0.001), with the highest from 0 to 3, the prevalence rate in industrial area was significantly higher than that of residential area, with a ratio of 2.13:1 (P < 0.001). (2) Major relevant factors were found to be: history of hypersensitivity, upper respiratory infection and family history; while nationalities, history of contact with pets were not found to be related to childhood asthma (P > 0.05). (3) The expenditure was significantly different between non-specific therapy and specified therapy (P < 0.001). Among those children with asthma, 89.8% did not get specified treatment and the average expenditure was 2,375.2 Yuan per year, which was 10.2% of accepted specified therapy, namely under GINA program, with average expenditure 653.68 Yuan every year. CONCLUSION: The result of this study provided scientific basis for child asthma prevention and cure in this area.

Adolescent↗
PubMed2002

[Screening of 40-year-olds--400,000 men and women attended].

Over the period 1984-99, 400,000 Norwegian men and women aged 40-42 attended cardiovascular screenings carried out by the national health screening service. The data are available for research on application to the Norwegian Institute of Public Health. Details on the data and applications procedures are given in this article.

Adult↗