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Biomedical subjects

J M Swint

Publications and source records attributed to J M Swint.

10 recordsLinked to original sources

Prospective economic evaluation of lead poisoning prevention programs.

This paper illustrates an economic methodology for the prospective evaluation of individual lead poisoning screening and prevention programs. A method is presented for prospectively estimating the prevalence and expected health consequences of lead poisoning in an urban population. The economic costs of these consequences are calculated and cost-benefit analysis is used to complete the evaluation. A case study is developed to illustrate the potential utility of the model as a framework for the prospective evaluation of programs under funding consideration.

Child, Preschool

Estimates of preventive versus nonpreventive medical care demand in an HMO.

Multiple regression analysis is used to investigate whether medical services in a large HMO are distributed primarily on the basis of need and predisposing factors (such as health status, age and sex) or according to enabling characteristics (such as coinsurance and income) of the population. Equations are formulated to estimate the likelihood and volume of preventive visit demand, nonpreventive visit demand and hospital admissions for a sample of 3,892 individuals enrolled in the Kaiser Foundation Health Plan of Portland, Oregon. The results indicate that predisposing and need factors are the main determinants of nonpreventive visits and hospital utilization, while enabling characteristics are important determinants (along with age and education) of preventive utilization. There are marked differences in the impact of explanatory factors on utilization by dependents (children) versus nondependents (adults).

Adult

A multivariate analysis of the likelihood and volume of preventive visit demand in a prepaid group practice.

An economic framework for the investigation of the demand for preventive medical care services is suggested and empirical models for the likelihood and volume of preventive physician visits are specified. These are tested using data on 3,892 individuals enrolled in the Kaiser Foundation Prepaid Health Plan of Portland, Oregon. Preventive visits, delineated by the Kaiser Clinical Behavioral Classification System, included general medical examinations, eye examinations, well-child care and immunization services. Multiple regression is used to estimate the likelihood of preventive visits for all persons and the volume of preventive visits for users. Income and coinsurance were the most significant economic variables in the likelihood equation, possessing the expected positive and negative signs, respectively. The usual findings of a positive education effect and negative family size effect were supported by the results. The economic variables were less significant in the volume equations than in the likelihood equations, suggesting that system and physician effects may neutralize these factors. Females were more likely to make a preventive visit than were males and the relatively young and old were the heaviest age-group users of preventive care. Perceived helath status did not appear to significantly affect preventive care demand.

Adult

An economic evaluation of a genetic screening program for Tay-Sachs disease.

The resolution of policy questions relating to medical genetic screening programs will not be without considerable difficulty. Examples include such issues as the optimal degree of screening program expansion, the relative values of screening for different genetic diseases, the appropriate sources of program funding (public vs. private), and the relative value of funding expanded genetic screening programs vs. research directed toward elimination of genetic traits themselves. Information on the net impact of the relevant alternatives is greatly needed, and this need will increase if the National Genetics Act receives funding approval. We have provided what is hopefully a contribution toward this end. While our analysis pertains to a specific disease and a specific screening program for that disease, the methodology is readily generalizable to other genetic diseases, as well as programs of any size or structure. Hopefully, this will serve to stimulate further research efforts that we believe are needed for the objective consideration of resource allocation alternatives.

Cost-Benefit Analysis

The application of economic analysis to evaluation of alcoholism rehabilitation programs.

We have presented an algorithm designed to facilitate the application of economic analysis to the evaluation of individual alcoholism rehabilitation programs. In doing so we have attempted to delineate the limitations of such analyses as well as the type and value of information they provide. After a brief review of the basic principles of cost-benefit analysis and a listing of the economic costs of alcoholism, a case study was developed as an heuristic device to illustrate the algorithm and the potential utility of cost-benefit analysis, particularly when used in conjunction with sensitivity analysis, as a logical framework for the evaluation effort.

Absenteeism

Cost-benefit analysis of fluoridation in Houston, Texas.

Most previous cost-benefit analyses of fluoridation programs have been retrospective in approach and have biased their results in favor of fluoridation. This study performed a prospective cost-benefit analysis of fluoridating a segment of the water supply for Houston, Texas, and explicitly introduced and evaluated the time pattern of the costs and benefits. It was shown that neglect of the time structure of the costs and benefits would significantly bias the results. A benefit-cost ratio of 1.51 and a net present value (or "social profit") of $1,102,970 were found. The results are biased downwards and should be considered a lower bound. Thus the results indicate an investment in a fluoridation program by Houston would be a socially profitable one.

Adolescent