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Biomedical subjects

J Gabel

Publications and source records attributed to J Gabel.

At least 55 records · Page 3Linked to original sources
PubMed1986

The emergence and future of PPOs.

A new development in the restructuring of American health care is the dramatic growth of preferred provider organizations (PPOs). Based on a national telephone survey, this paper assesses the future direction of PPOs by examining segments of the market that are believed to be lead indicators of future activity. It includes analyses of "new" versus "old" PPOs, the ten largest PPOs, and the entrance of hospital chains into the insurance market. We conclude that the dramatic growth of PPO enrollment in 1985 is likely to continue in the future, but with increased movement toward vertical integration and joint ventures among providers and insurers.

Cost Control↗
PubMed1986

Preferred provider organizations: today's models and tomorrow's prospects.

Preferred provider organizations (PPOs) have recently attracted much attention as an alternative to both traditional fee-for-service medicine and health maintenance organizations. To examine their development and structure, we conducted a telephone survey with executives of more than 130 operational PPOs. We describe typical examples of the three most common types of PPOs-those sponsored by providers, insurers, and entrepreneurs-and identify problems each faces in the increasingly competitive health care environment. We then cite approaches that innovative PPOs are using to deal expressly with these problems.

Blue Cross Blue Shield Insurance Plans↗
PubMed1985

Effect of outflow pressure on lung lymph flow in unanesthetized sheep.

Studies in anesthetized animals have shown that the flow rate from lung lymphatics (QL) depends on the pressure at the outflow end of the vessels (Po). We tested this in unanesthetized sheep prepared with chronic lung lymph cannula. We measured QL with the lymph cannula held at various heights above the olecranon and calculated Po as the height + QL X cannula resistance. QL decreased with increases in Po (delta QL/delta Po = -8.2 +/- 6.4 microliter X min-1 X cmH2O-1, mean +/- SD). We increased QL by raising left atrial pressure or infusing Ringer solution or Escherichia coli endotoxin and found that QL was even more sensitive to Po (delta QL/delta Po = -32 +/- 22). Cannula resistance caused a 9-70% reduction in QL. Changes in QL caused by increasing Po were not associated with changes in lymph protein concentration for up to 330 min. This indicates that increases in Po shunt lymph away from cannulated vessels but do not substantially effect microvascular filtration rate. The shunted lymph may flow into other vessels or collect in the lung. We conclude that QL does not accurately represent microvascular filtration rate because it depends on the cannula resistance and position at which the investigator chooses to place the cannula.

Animals↗
PubMed1981

Contextual conditioning and the US preexposure effect in conditioned fear.

A series of five experiments was carried out in which fear of context caused by exposure to shocks was manipulated by signaling the shocks with a discrete stimulus, signaling the days during which shocks occurred with a session-long stimulus, or switching the context between exposure and the subsequent test. All these manipulations influenced fear of the context in the manner predicted by the Rescorla-Wagner associative model. Following this, all the rats were given conditioning trials with shock and a different discrete stimulus. All preexposure treatments produced consistent and reliable interference with conditioning with the exception of signaling the shocks with a discrete stimulus, which greatly reduced interference. These results are interpreted as being consistent both with a cognitive explanation of the US exposure effect, which claims that animals learn that shocks are unpredictable during conditioning and this knowledge retards future conditioning when they are predictable, and with an adaptation explanation, which claims that unpredictable shocks produce chronic fear and this fear through either a change in adaptation level or through emotional exhaustion renders the shocks less reinforcing during the conditioning test.

Adaptation, Psychological↗
PubMed1981

Contamination of caudal mediastinal node efferent lymph in sheep.

Many investigators have used the chronic sheep lung lymph preparation to collect caudal mediastinal node (CMN) efferent lymph. These investigators have assumed that the lymph collected with the preparation is almost pure lung lymph. We examined 17 sheep for possible systemic contamination to the lymph, and in each sheep we found one to five lymph vessels that ran from the diaphragm to the CMN. Contamination from these vessels would not be eliminated in the chronic sheep preparation. We estimated the flow rate from these vessels to be 3.0 +/- 2.6 (SD) ml/h in anesthetized sheep. This represents 25-60% of the lymph flow rate in the chronic lymph preparation. In five sheep, we also located 1-4 esophageal lymph vessels that entered th CMN. These results show that lymph collected with the chronic sheep lung lymph preparation contains a significant nonpulmonary contamination.

Animals↗
PubMedDate not supplied

Psychiatric illness in the first-degree relatives of persons reporting multiple chemical sensitivities.

The multiple chemical sensitivities (MCS) syndrome is characterized by unexplained physical and psychiatric complaints attributed by patients and some of their physicians to low-level chemical exposures. In this study, we interviewed 15 subjects with MCS and 21 controls about their first-degree relatives using the Family History-Research Diagnostic Criteria (FH-RDC). Subjects with MCS were more likely than controls to report their relatives to have major depression, alcoholism, panic disorder, obsessive-compulsive disorder, and antisocial personality disorder. They were also likely to have past suicide attempts, and to have received some form of psychiatric treatment (hospitalization, medication or electroconvulsive therapy, or counseling). Nearly 30% of the relatives of subjects with MCS were reported to have MCS themselves. Possible reasons for the findings are discussed.

Adult↗
PubMedDate not supplied

Ten ways HMOs have changed during the 1990s.

The same forces that encouraged the expansion of managed care also brought about change in health maintenance organizations (HMOs). Using data from annual surveys of the Association of American Health Plans and other sources, this paper examines ten major changes in the HMO industry during the 1990s, including the growth of for-profit plans and the relative decline of nonprofits; the shift from vertically integrated group/staff models to virtually integrated individual practice associations/network models; industry consolidation through mergers and acquisitions; increased patient cost sharing; and the shift to capitation payment of primary care physicians. Current research is unable to show whether these changes have led to improved quality of care or patient satisfaction.

Economic Competition↗
PubMedDate not supplied

Medicare beneficiaries' costs of care in the last year of life.

This paper profiles Medicare beneficiaries' costs for care in the last year of life. About one-quarter of Medicare outlays are for the last year of life, unchanged from twenty years ago. Costs reflect care for multiple severe illnesses typically present near death. Thirty-eight percent of beneficiaries have some nursing home stay in the year of their death; hospice is now used by half of Medicare cancer decedents and 19 percent of Medicare decedents overall. African Americans have much higher end-of-life costs than others have, an unexpected finding in light of their generally lower health care spending.

Aged↗