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Biomedical subjects

C N Oberg

Publications and source records attributed to C N Oberg.

At least 19 recordsLinked to original sources
PubMed1997

Appropriate and necessary healthcare: new language for a new era.

Conceptual and language changes are necessary to accompany the paradigm shift from fee-for-service medicine to managed care. Medical necessity is an inadequate and ambiguous term defined differently by providers, payers, patients, and legislators. The attempt by legislators in Minnesota to develop a universal standard benefits set for healthcare services strikingly underscores the need to define relevant terminology to accompany the transition to managed care. We suggest the term appropriate and necessary healthcare as a state-of-the-art term for the new era of managed care.

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

Ethics and Medicaid: a new look at an old problem.

Recent proposals to reform Medicaid, driven primarily by the need for cost containment, rarely pay explicit attention to values. This paper presents the Medicaid Values Framework, the authors' interpretation of a set of societal ideals embodied in Title XIX of the Social Security Amendments of 1965. The Framework comprises seven interlocking values that are stratified into three interdependent tiers--access, quality, and equity. We use the access and equity tiers to analyze treatment of Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) recipients under Medicaid. We document striking inequities in eligibility standards and in funding for the two groups--inequities that unexpectedly fail to translate into marked disparities in access to Medicaid. In conclusion, we comment on why the present inequities exist and why they are ethically unacceptable.

Aid to Families with Dependent Children↗
PubMed1992

From data to policy ... to politics. The Minnesotans health care plan for universal access to care.

Calls for major reform of the health care delivery system have been sounded at both the state and federal level. However, given the lack of consensus on health care reform at a federal level, more than half of the states are developing initiatives for universal access to care. In 1989, the Minnesota legislature created the Health Care Access Commission to develop a blueprint for universal access in Minnesota. To assist this effort, we studied the extent and nature of uninsurance and underinsurance within the state. In this article we report the findings of that study and discuss how the findings were first used to develop recommendations for universal access legislation. We then describe the fate of the legislation. Finally, we describe the veto and the creation of HealthRight, the recently enacted plan for health care reform bill in Minnesota. This plan simultaneously expands access to care and aims to contain health care costs.

Adult↗
PubMed1991

Prenatal care use and health insurance status.

Many observers explain the prevalence of inadequate prenatal care in the United States by citing demographic or psychosocial factors. But few have evaluated the barriers faced by women with different health insurance status and socioeconomic backgrounds. In this study of 149 women at six hospitals in Minneapolis, insurance status was significantly related to the source of prenatal care (p less than .0001). Private physicians cared for 52 percent of privately insured, 23 percent of Medicaid-insured, and two percent of uninsured women. Public clinics were the primary source of care for Medicaid and uninsured women, who, compared to privately insured women, experienced longer waiting times (p less than .001) during prenatal visits and were more likely (p less than .01) to lack continuity of care with a provider. Multiple measures, including expanding Medicaid eligibility, may help correct these problems.

Adult↗
PubMed1990

Barriers and motivators to prenatal care among low-income women.

Substantial evidence exists which links prenatal care to improved birth outcomes. However, low-income and nonwhite women in the United States, who are at greatest risk for poor birth outcomes, continue to receive the poorest prenatal care. The purpose of this study was to identify and compare barriers and motivators to prenatal care among women who lived in low-income census tracts. The stratified sample included recently delivered white, black and American Indian women who received adequate, intermediate, and inadequate prenatal care. Interviews were conducted which focused primarily on the women's perceptions of problems in obtaining prenatal care and getting to appointments. Results indicated that women with inadequate care identified a greater number of barriers and perceived them as more severe. Psychosocial, structural, and socio-demographic factors were the major barriers, while the mother's beliefs and support from others were important motivators. The predictive power of selected barrier variables was examined by a regression analysis. These variables accounted for 50% of the variance in prenatal care use. The results affirm the complexity of prenatal care participation behavior among low-income women and the dominant influence of psychosocial factors. Comprehensive, coordinated and multidisciplinary outreach and services which address psychosocial and structural barriers are needed to improve prenatal care for low-income women.

Adult↗
PubMed1990

Medically uninsured children in the United States: a challenge to public policy.

This article is an examination of the nature and extent of the problem presented by medically uninsured children in the United States. First, the characteristics of the uninsured population are explored with a description of how age, family income, and employment status disproportionately affect families with children. Second, the Medicaid program and its historically inadequate response to this growing problem of uninsured children is examined. Third, the relationship between insurance status and the health and development of children is discussed. Finally, recent public policy initiatives that have been enacted or proposed to address this inequity in the present health care system are reviewed with a recommendation to establish a "Universal Maternal and Child Health Program."

Adolescent↗
PubMed1990

Medically uninsured children in the United States: a challenge to public policy.

This article is an examination of the nature and extent of the problem presented by medically uninsured children in the United States. First, the characteristics of the uninsured population are explored with a description of how age, family income, and employment status disproportionately affect families with children. Second, the Medicaid program and its historically inadequate response to this growing problem of uninsured children is examined. Third, the relationship between insurance status and the health and development of children is discussed. Finally, recent public policy initiatives that have been enacted or proposed to address this inequity in the present health care system are reviewed with a recommendation to establish a "Universal Maternal and Child Health Program."

Adolescent↗
PubMed1987

Medicaid and managed health care: enrollment in HMOs and other alternative health systems.

In summary, Medicaid enrollment in HMOs has increased substantially in recent years following legislation which enhanced utilization of these managed health care plans. As of December 1985, there were over 600,000 Medicaid recipients enrolled in 92 HMOs in 21 states and the District of Columbia. Medicaid recipients represent only 3 percent of total HMO enrollment, but this percentage is certain to increase in the coming years. The Medicaid enrollees are in plans which are characteristically older and larger in size, with close to three-fourths in federally qualified HMOs. They are enrolled almost exclusively in HMOs in the West and Midwest regions. Medicaid enrollment in for-profit plans (48.7%) is a significantly larger proportion compared to the total HMO enrollment (35%). However, only 29.2 percent of Medicaid HMOs are for-profit compared to over 50 percent for total HMOs. The increased utilization by states of HMOs and other managed health care plans is partially driven by a need to control costs. Advocates of such systems, however, would also argue that the enrollment of Medicaid recipients into HMOs will eventually improve the quality care for these individuals. Certainly, the greater utilization of preventive services, which is a major incentive within the HMO model, should result in less acute and fragmented health care. The care provided by the HMO is designed to be coordinated and cost-effective. In addition, enrollment in HMOs would allow the Medicaid recipient to blend into the emerging competitive health care system. It would also provide incentives to dismantle the two-tiered health care infrastructure which has evolved over the past two decades. There are others who question the feasibility of the HMO model for this population. They voice concern about the the inability to articulate their health care needs. A recent Rand Corporation report from Seattle, Washington addressed such concerns and appeared to demonstrate poorer health and greater hospitalization for a low-income group enrolled in HMOs compared to the traditional, free, fee-for-service (FFS) care. These findings, however, should be viewed cautiously, since low-income enrollees that were included in the study were not allowed to make use of the HMO's program to educate recipients about how to access the system. This may have had a significant effect on the health outcomes experienced by the experimental group. It is imperative that additional studies be conducted. In addition, as we witness the increased utilization of managed health care by Medicaid recipients, an emphasis on education is essential not only for the recipients but for the providers as well.

Data Collection↗