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G H DeFriese

Publications and source records attributed to G H DeFriese.

62 records · Page 4Linked to original sources
PubMed1975

On paying the fiddler to change the tune: further evidence from Ontario regarding the impace of universal health insurance on the organization and patterns of medical practice.

This paper compares the findings from a 1973 community household interview survey conducted in Sault Ste. Marie, Ontario, with the findings from a similar study conducted in 1968 in the same city by a research team from the World Health Organization. Sault Ste. Marie is the site of the first Canadian consumer-sponsored prepaid group practice. Opposition by the private, solo practice sector of this community to this new modality of medical practice was considerable. Since 1969, with the introduction of universal health insurance in Ontario, the cost and benefit differences between solo and group practice medical care have been eliminated. By comparing the findings from the 1973 study with similar data from the 1968 WHO survey, observations can be made about the impact of universal health insurance on the organization and patterns of medical practice. Implications for the United States are important in view of the recent passage of the Health Maintenance Organization Act of 1973 and the expected enactment of some form of national health insurance.

Consumer Behavior↗
PubMedDate not supplied

Cost-benefit and cost-effectiveness analysis for health promotion programs.

Health promotion programs have been hailed as having great potential to help solve the problem of rapidly increasing health care costs. In order to assess whether health promotion programs are "worth it," some kind of cost-benefit or cost-effectiveness analysis must be included as part of program evaluation. This article provides a basic introduction to the concepts of cost-benefit and cost-effectiveness analysis, compares them, and presents a simple procedure for performing a basic cost-effectiveness analysis. The potential for health promotion programs to impact on the rising costs of medical care is discussed.

Cost-Benefit Analysis↗
PubMedDate not supplied

Assuring access to dental care for low-income families in North Carolina. The NC Institute of Medicine Task Force Study.

Following publication of the Task Force's recommendations for improving dental care access among low-income populations, North Carolina has taken several steps forward. The Division of Medical Assistance and the NC Dental Society are forming an advisory committee (comprising Medicaid patients, providers, and representatives from all elements of organized dentistry in the state) to review dental coverage and reimbursement rates. Using existing state funds, the NC Office of Research, Demonstrations and Rural Health Development has recruited 15 additional dentists and 1 dental hygienist to practice in community facilities serving low-income and uninsured patients. In 1999, the NC General Assembly revised the NC Dental Practice Act. Now, under the general direction of a licensed public health dentist, specially trained public health dental hygienists can perform oral health screenings and preventive and educational services outside the public school setting. The NC Institute of Medicine has begun exploring how to use dental hygienists to expand preventive dental services to underserved populations in federally-funded community or migrant health centers, state-funded health clinics, and the not-for-profit clinics that serve predominantly Medicaid, low-income or uninsured populations. A report is to be sent to the Governor and the Joint Legislative Commission on Governmental Operations no later than May 1, 2000. In 1999, the General Assembly directed the NC State Board of Dental Examiners to establish a procedure for streamlined licensing of dentists and dental hygienists who have been practicing in other states. This should increase the number of qualified dental practitioners in the state. The proposed rules governing the new licensing pathway are to be prepared by May 15, 2000. The Board of Dental Examiners will determine which new procedures will be needed to allow less burdensome and more timely entry of qualified out-of-state licensed applicants, while still affording the public the same protection as under current law and procedures. The NC Institute of Medicine is organizing a work group to study the feasibility of new residency programs in pediatric dentistry in addition to the current program located in Chapel Hill. The Institute will present a report to the General Assembly, no later than May 1, 2000. On April 1, 1999, the state Medicaid program authorized use of ADA Procedure Code 1203, which allows reimbursement for the application of dental fluoride varnishes without a full prophylaxis. It also authorized pediatricians, nurse practitioners, or physician's assistants to apply these varnishes to the teeth of young children, allowing more rapid dissemination of this proven preventive procedure among the state's low-income children. Implementation began in Carolina Access II and III project sites in the fall, 1999, and should spread statewide in 2000. Furthermore, the General Assembly's 1999 session expanded NC Health Choice to cover dental sealants, fluoride treatment, simple extractions, stainless steel crowns, and pulpotomies. Since publication of the Task Force Report in May 1999, considerable forward movement has taken place. It was apparent that the problems associated with poor dental care were severe, of immediate concern, and needed a broad, nonpolitical analysis followed by action from public and private-sector policy makers and shapers. The key recommendation of the Task Force (to increase the level of payment to dentists for services provided to Medicaid beneficiaries) was not acted on in the 1999 session of the General Assembly, but it was seriously discussed in legislative hearings and will be considered further in the year 2000 legislative session. Given the number of problems surrounding adequate health care for North Carolina's low-income populations, inquiries such as that described here can point the way to the concrete and feasible steps that need to be taken. (ABSTRACT TRUNCATED)

Adolescent↗
PubMedDate not supplied

Physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting. Report for the US Preventive Services Task Force.

Physical activity has been associated with the prevention and control of several medial conditions that are major causes of death and disability in the United States. The criterion-based approach adopted by the US Preventive Services Task Force is used to objectively evaluate the evidence regarding the effectiveness of physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting. This evaluation addresses: (1) the burden of suffering attributable to physical inactivity; (2) the efficacy of physical activity in disease prevention in regard to six medical conditions; and (3) the characteristics of the intervention in terms of simplicity, cost, safety, acceptability, and patient compliance. Based on consideration of the evidence for each of these issues, specific recommendations are made regarding the role of physical activity counseling in routine clinical practice. In addition, practical guidelines are presented to aid clinicians in physical activity counseling.

Adult↗