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Biomedical subjects

A I Batavia

Publications and source records attributed to A I Batavia.

At least 19 recordsLinked to original sources
PubMed2003

Karaoke for quads: a new application of an old recreation with potential therapeutic benefits for people with disabilities.

PURPOSE: Karaoke is a recreational activity whereby individuals sing into a microphone along with the melodies and lyrics provided both visually and auditorily by a machine. METHODS: The potential therapeutic benefits of karaoke are explored in terms of increased respiratory strength, endurance, control, and capacity, as well as emotional and physical release for people with disabilities. RESULTS: Although many individuals with disabilities could benefit from this activity, it is likely to be particularly beneficial to people with compromised respiratory systems, such as persons with high-level quadriplegia (tetraplegia). CONCLUSION: This article examines theoretical considerations and proposes a research agenda. Empirical research would be valuable to confirm the potential benefits of karaoke for people with disabilities.

Persons with Disabilities↗
PubMed2001

Changing chairs: anticipating problems in prescribing wheelchairs.

PURPOSE: This article presents a framework for prescribing, ordering, and adapting a new wheelchair, focusing on individual, environmental and wheelchair factors that must be taken into consideration to ensure optimal function. METHOD: A review and analysis was conducted of all factors relevant to the transition to a new wheelchair. Without appropriate planning and implementation, this transition can result in unnecessary expenses, duplication of effort, and possibly even injury to the user and abandonment of the wheelchair. RESULTS: Recommendations are provided to manufacturers, therapists, technicians, users, insurers and physicians, who must work together throughout this process. To the extent feasible, the authors suggest that major changes from the previous wheelchair should be avoided, particularly for people with substantial functional limitations. Therapists and technicians must measure the user accurately, and anticipate those factors that can impede a smooth transition. Insurers and other payors must recognize that changing wheelchairs will often require substantial professional assistance, including several fittings to adjust the new chair to the needs of the user. CONCLUSION: Additional research and case reporting on outcomes of adjusting to a new wheelchair appear warranted.

Equipment Design↗
PubMed2001

Disability, chronic illness, and risk selection.

As high-cost users of health care, people with disabilities or chronic conditions are particularly vulnerable to risk selection. Preferred risk selection, in which insurers avoid enrolling high-risk people, threatens their access to coverage. Adverse selection, in which high-risk people enroll in the most generous plans, compromises the financial viability of plans that are most responsive to their specific needs. The Americans with Disabilities Act prohibits some forms of risk selection, but does not prevent all disability-based distinctions in insurance practices. From a disability perspective, risk selection must be addressed in a manner that: (1) adequately reflects the health care costs of such individuals; (2) eliminates their need to engage in adverse selection; (3) does not stigmatize them; (4) preserves confidentiality of information; (5) uses substantial outcome measures to ensure quality; and (6) creates market conditions that discourage disability-based discrimination. A risk adjuster based on prior use/expenditures or on a diagnostic indicator sensitive to disability issues may be effective. Failure of reform to address risk selection may threaten the viability of a market-based health care system.

Chronic Disease↗
PubMed2001

The ethics of PAS: morally relevant relationships between personal assistance services and physician-assisted suicide.

Although personal assistance services would appear to have no direct connection to the national debate over legalization of physician-assisted suicide, arguments relating to personal assistance have been raised in the debate. Independent living opponents of a right to assisted suicide contend that people with disabilities who do not have access to the basic personal assistance services they need are inherently oppressed, and a society that provides a right to assisted suicide is essentially an accomplice in coercing such individuals to end their lives. Independent living proponents of the right argue that people with disabilities should have control over the assistance they need to achieve all their goals, and access to desired assistance in seeking death may allow some to decide to forgo or postpone what would otherwise be a desperate act. Both sides would agree that personal assistance services are extremely important to people with disabilities, and that universal access to such services will eliminate a major area of contention in the right-to-die debate in the United States.

Activities of Daily Living↗
PubMed2000

So far so good: observations on the first year of Oregon's Death with Dignity Act.

The Supreme Court recognized that states may serve as social laboratories for developing procedures permitting physician-assisted suicide. Oregon has served as the first such laboratory. First-year results suggest the feasibility of implementing a statutory right to physician-assisted suicide successfully in this country, without abuse or negative incident.

Government Regulation↗
PubMed2000

The relevance of data on physicians and disability on the right to assisted suicide: can empirical studies resolve the issue?

Opponents of a right to physician-assisted suicide rely heavily on the results of several empirical studies, particularly data concerning physicians and other health professionals. This commentary concludes that values, not empirical data, must ultimately determine the legality of assisted suicide. Studies cannot resolve the fundamental issue.

Attitude of Health Personnel↗
PubMed1993

Health care reform and people with disabilities.

As a group, people with disabilities or chronic conditions experience higher-than-average health care costs and have difficulty gaining access to affordable private health insurance coverage. While the Americans with Disabilities Act will enhance access by prohibiting differential treatment without sound actuarial justification, it will not guarantee equal access for people in impairment groups with high utilization rates. Health care reform is needed to subsidize the coverage of such individuals. Such subsidization can be achieved under either a casualty insurance model, in which premiums based on expected costs are subsidized directly, or a social insurance model, in which low-cost enrollees cross-subsidize high-cost enrollees. Cost containment provisions that focus on the provider, such as global budgeting and managed competition, will adversely affect disabled people if providers do not have adequate incentives to meet these people's needs. Provisions focusing on the consumer, such as cost sharing, case management, and benefit reductions, will adversely affect disabled people if they unduly limit needed services or impose a disproportionate financial burden on disabled people.

Adolescent↗
PubMed1993

Lessons for states in inpatient ratesetting under the Boren Amendment.

Encouraged by a 1990 Supreme Court decision, Medicaid providers have challenged State inpatient ratesetting methodologies under the Boren Amendment. Procedurally, State assurances to the U.S. Department of Health and Human Services (DHHS) that payment rates meet the Amendment's requirements must be supported by findings based on a reasonably principled analysis. Substantively, rates may fall within a zone of reasonableness, but courts have differed in interpreting and applying the Amendment's terms. Although some courts have found special studies and written findings unnecessary, States that undertake economic analyses to support their findings are more likely to withstand judicial scrutiny. Several applicable economic analyses are proposed.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Use of functional status measures for payment of medical rehabilitation services.

In the search for an appropriate payment system for medical rehabilitation hospitals and units, the use of a functional status measure (FSM) has emerged as a recurring theme. Conceptually, functional status measurement is important because the primary goal of medical rehabilitation is to enhance patient function and independence. Studies indicate that functional status and functional gain are among the best predictors of resource utilization at rehabilitation facilities. This article examines conceptually the use of FSMs in payment for medical rehabilitation in two different types of payment systems--as a means of classifying patients for purposes of determining the applicable payment amount (ie, a "classification system"), and as a means of justifying that payment, or continued payment, for services is appropriate (ie, a "justification system"). Several payment models using an FSM are described and analyzed. An agenda for future research is proposed.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Toward a health services research capacity in spinal cord injury.

Health services research (HSR) is the research field that seeks to examine systematically the organisation, provision, and financing of health care services. There currently is only a rudimentary HSR capacity in the area of spinal cord injury (SCI). To a large extent, the HSR community has not addressed issues concerning persons with SCI, and the disability research and medical rehabilitation communities have not considered issues of HSR that affect the SCI population. However, due to recent changes in (1) the clinical management of SCI; (2) the expectations of persons with SCI, and (3) health care delivery and finance, the time is now ripe for the development of a HSR capacity in SCI. This article summarises current efforts at HSR in SCI in the United States, which have been primarily in the areas of trauma care and medical rehabilitation. It considers an agenda for future health services research in SCI, which must include research on post-rehabilitation health care and personal assistance needs. Finally, this article suggests strategies for developing a comprehensive HSR capacity in SCI.

Health Services Research↗
PubMed1991

Toward a national personal assistance program: the independent living model of long-term care for persons with disabilities.

Long-term care for people with disabilities in this country traditionally has been provided through family members and friends. Federal and state policy has focused primarily on financing professional health care services provided through nursing homes and home health agencies. An alternative to these models of long-term care is the "independent living model," which is based on the provision of services by nonprofessional personal assistants in the disabled person's home. We describe the model and consider why it is not the dominant approach to long-term care in the United States. We go on to assess options for developing a national personal assistance services program based on the independent living framework, discussing how covered services should be defined, how the program should be financed, whether the program should use means testing, how eligibility and level of benefits should be determined, and what role government should play in implementing the program. Several legislative approaches to developing a national program are explored.

Activities of Daily Living↗
PubMed1991

The health insurance coverage of working-age persons with physical disabilities.

In this article, we examine the health insurance status of working-age, physically disabled persons, and particularly the question of whether the public sector insures a disproportionate share of the highest-risk disabled population. We use descriptive statistics to develop an insurance profile of respondents with severe physical disabilities, and multivariate procedures to model differences between privately and publicly insured, disabled persons. Results of logistic regression procedures indicate that respondents with private insurance alone are more likely to have a high functional level, a positive perception of their health, and to be married, than are those with public (or a combination of public and private) insurance. Specific type of disability, age, and wheelchair use were also found to predict the type of insurance, their effects largely mediated by employment status and income.

Adult↗