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Biomedical subjects

N S Fleming

Publications and source records attributed to N S Fleming.

11 recordsLinked to original sources
PubMed1992

The impact of the Texas 1989 motorcycle helmet law on total and head-related fatalities, severe injuries, and overall injuries.

The State of Texas implemented a mandatory total motorcycle helmet law for all operators and passengers, effective September 1, 1989. In this study the impact of this intervention on frequency of both total and head-related fatalities, severe injuries, and overall injuries for operators during the subsequent year was quantified. This quantification is important because 26 states in the United States fail to have strict, mandatory helmet laws. The Box-Tiao time-series intervention methodology is used to estimate secular trends before and changes after the implementation of the law, analyzing Department of Public Safety monthly injury accident data for a period of 6 years collected from traffic accident reports filed for each motorcycle injury accident. Trends in fatalities and injuries (except for head-related deaths) estimated before implementation of the law approximated the 9.4% average annual decline in motorcycle registrations. Additional declines of 12.6% and 57.0%, respectively, were estimated for total and head-related fatalities during the year after the law was implemented. Declines of 13.1% and 54.6% were estimated for severe injuries for total and head-related accidents. Declines of 12.3% and 52.9% were found for total and head-related injuries overall.

Confidence Intervals↗
PubMed1992

Physician payment reform: how will medical specialties fare under the new Medicare fee schedule?

In 1989, the federal government legislated a major overhaul of the Medicare payment system for physician services, to be implemented beginning in January 1992. Under the new plan, payments will be set according to a national fee schedule based primarily on a "resource-based relative value scale." This article summarizes the development of the new payment system and explores the likely impact of its implementation on medical and surgical specialties.

Economics, Medical↗
PubMed1988

Approaches to primary care. Physician capitation.

The first author, as a consultant to the Office of Prepaid Health Care, reviewed the financial status of nine IPAs for federal qualification in 1987. He found little to suggest any methodology being used for constructing primary care physician (PCP) capitation reimbursement systems. This article draws upon statistical theory and presents hypothetical examples to structure better financial arrangements based on five criteria: stop-loss reinsurance deductible levels, capitation of services related to physician practice, minimum panel size (number of patients) for capitation, stratified capitation, and inclusion of all PCPs in the capitation arrangement.

Capitation Fee↗
PubMed1983

The impact of outpatient department and emergency room use on costs in the Texas Medicaid Program.

Medicaid claims data for a 35% random sample (n = 146,167) of persons receiving benefits from Aid to Families with Dependent Children, and who were eligible for Medicaid in Texas in 1980 are used to examine the impact of outpatient department (OPD)/emergency room (ER) care. Average cost is estimated for OPD/ER and private physician (MD) visits. Persons are also classified by primary source of care. Data on age, race, sex, residence, and months eligible in 1980 permitted prediction of statistically adjusted differences between OPD- and MD-oriented persons for number of ambulatory visits, probability of hospitalization, 1980 total costs, and both hospital episode institutional amount paid and length of stay. OPD/ER visits were found to be $23 more expensive than MD visits. OPD-oriented persons had fewer ambulatory visits, slightly more hospitalizations, greater total and episode costs, and longer lengths of stay than did MD-oriented persons. Potential cost savings are projected.

Adolescent↗
PubMed1983

Sociodemographic differences in access to vision care among adults in the United States, 1974-1975.

Access to refractive care is examined by comparing uncorrected and corrected (with eyeglasses or contact lenses) distance visual acuity across eight race-sex-economic status groups. Of those with less than 20/20 uncorrected distance visual acuity, the age-adjusted proportion using corrective lenses is examined across these sociodemographic groups to assess unmet need in vision care. Measurements of distance visual acuity were obtained for 2,828 adults aged 25-74 years from the national probability sample selected for the 1974-1975 National Health and Nutrition Examination Augmentation Survey. Questionnaire responses were collected on usual correction. Individuals were classified by race, sex, and economic status. Weighted least squares categoric data analysis showed that blacks, males, and nonpoor persons have a higher proportion with 20/20 uncorrected distance vision than whites, females, and poor persons. Individuals who are white, male, and nonpoor are more likely to have 20/20 corrected distance vision than their counterparts.

Adult↗
PubMedDate not supplied

Applying total quality management (TQM) to health care administration.

Author Neil S. Fleming, Ph.D., ASQC, C.Q.E., approaches quality management from a more theoretical perspective, relating it to dimensions of predictability and responsiveness. He couples these with achieving the optimal balance between prevention, appraisal and failure with the goal of producing the lowest possible total quality costs.

Costs and Cost Analysis↗
PubMedDate not supplied

The erosion of physician-patient privilege and patient confidentiality.

With the proliferation of third party payers for health care who exercise utilization management, there has been an erosion of the physician-patient privilege and patient confidentiality. The kinds of medical information obtained by third party payers under the guise of claims administration violate the spirit if not the actual laws pertaining to physician-patient communication. It presents three episodes involving the first author in which that communication was violated by third parties administering health care benefits. Recommendations are made to protect that confidentiality in this era of increasing cost management.

American Medical Association↗