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At least 19 recordsLinked to original sources
PubMedDate not supplied

The impact of public-sector expenditures for contraceptive services in California.

A methodology previously used to calculate the number of unintended pregnancies averted nationally through publicly funded contraceptive services has been adapted for a state-level analysis in California. An estimated 136,800 unintended pregnancies--which would result in approximately 36,000 births, 85,100 abortions and 15,700 miscarriages--are averted each year because publicly funded contraceptive care is available from clinics and private physicians in California. Federal and state expenditures of $46 million for contraceptive services in California in FY 1989 resulted in an estimated savings of $232-$509 million in public costs for abortions, for prenatal and maternity care and for medical care, welfare and supplementary nutritional programs during the first two years after a birth. These savings represent an average of $7.70 saved for each dollar spent to provide contraceptive services. This savings/cost ratio is 75 percent higher than that previously estimated for the United States as a whole.

Abortion, Induced↗
PubMed1999

If diabetes is a public health problem, why not treat it as one? A population-based approach to chronic illness.

It is increasingly acknowledged that diabetes and other chronic illnesses are major public health problems. Medicare and many managed health care organizations have recognized the enormous personal and societal costs of uncontrolled diabetes in terms of complications, patient quality of life, and health care system resources. However, the current system of reactive acute-episode focused disease care practiced in many settings does not adequately address this public health problem. An alternative proactive, population-based approach to chronic illnesses such as diabetes is proposed and illustrated. This multilevel systems approach addresses supportive and inhibitory social-environmental factors at multiple levels (personal, family, health care team, work, neighborhood, community). Key disciplines contributing to a population-based approach to diabetes include epidemiology, behavioral science, health care services, public health, health economics, and quality of life professions. Current and potential contributions of each of these disciplines are illustrated and an integrative, population-based systems approach to diabetes management and prevention of complications is proposed. This approach is also seen as applicable to other chronic illnesses.

Chronic Disease↗
PubMedDate not supplied

Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse.

In this article, we describe an evidence-based stepped care approach to improving the care of chronic illness in organized health care systems. We review the common principles that have been found to improve the management and outcomes of patients with major depression, asthma, diabetes, and congestive heart failure. These population-based methods to improve care of chronic illness require reorganizing the roles of specialists, primary care physicians, and nurses.

Asthma↗
PubMed1995

Obtaining telephone numbers for a rural Medicaid population: issues for outreach and research.

This study examined the accuracy and costs of determining whether rural, low-income Medicaid recipients did or did not have a phone, and of obtaining phone numbers for those who did. For a random sample of 209 families, we compared phone information obtained from phone books and directory assistance with information obtained from department of social services (DSS) records. DSS records identified 51% of the sample as having phones, compared with 19%-25% for phone books and directory assistance. For identifying families as having no home phone or a phone with a number that matched the one in the DSS record, phone books or directory assistance corresponded with DSS records in 52%-57% of the sample. Using phone books or directory assistance was up to 3.2 times more costly than using DSS records. The study highlighted the need to establish policies to promote the exchange of information between social services and public health agencies and researchers.

Community Health Planning↗
PubMed1995

New York City's 1993 child immunization day: planning, costs, and results.

OBJECTIVES: This study evaluates New York City's Child Immunization Day (1993), with emphasis on the cost and effects of a mass campaign and the use of strategies from developing nations in an inner-city context. METHODS: The methodology was designed to (1) document the planning and implementation process, (2) analyze the number and characteristics of children in the target group, and (3) estimate costs. RESULTS: Neither the social mobilization nor the political will that characterize successful campaigns in developing nations occurred in New York City's campaign. Despite substantial time and effort from both private and public agencies, turnout for the event was low. In total, 2647 families and 5237 children were assessed for health care and insurance needs, 2949 children were immunized at a cost of about $279 per immunized child, and 7236 vaccines were administered. CONCLUSIONS: The differences between inner cities and developing nations have a bearing on strategies used in planning and implementing mass campaigns. New strategies need to be forged from a blending of these contexts to create effective campaigns in industrialized inner cities.

Child Health Services↗
PubMed1999

Population-based and opportunistic screening and eradication of Helicobacter pylori. An analysis using trial baseline data. Leeds H. pylori Study Group.

OBJECTIVES: To examine whether screening and eradication of Helicobacter pylori by population-based invitation or opportunistic screening by general practitioners reduces costs to the National Health Service (NHS) of treating dyspepsia. METHODS: A limited dependent, variable, two-step regression analysis was used to explore the baseline annual health care costs of dyspepsia for men and women aged 40-49 enrolled in the Leeds H. pylori screening and eradication trial. RESULTS: Epidemiological and clinical questionnaires, general practitioner notes, and 13C urea breath test results were available for 4,754 individuals. After adjusting for covariates H. pylori was associated with a 6.7% increased probability of incurring gastrointestinal-related NHS costs (p < .0001) in the population aged 40-49. Additionally, H pylori increased average costs in those who seek medical care (p = .001). In consequence, H. pylori is associated with an average increased cost to the NHS of 0.30 Pound per year (95% CI: 0.17 Pound to 0.45 Pound) per adult aged 40-49. In those consulting for dyspepsia, the increased cost to the NHS was 1.04 Pounds per year (95% CI: 0.42 Pound to 1.75 Pounds) per patient. The cost of population screening and treatment would not be recovered in reduced dyspepsia costs in the lifetime of those screened. Assuming laboratory-based serology screening is used opportunistically in patients presenting with dyspepsia, it is estimated that costs would be recouped in 18 years. CONCLUSIONS: This observational data set suggests that the costs of screening and treatment in all individuals aged 40-49 or in those presenting in primary care with dyspeptic symptoms are unlikely to be attractive on the basis of cost savings alone.

Adult↗