Research on managed care organizations in rural communities.
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Delivery of Health Care↗
Biomedical subjects
S Krein
Publications and source records attributed to S Krein.
NorthMed HMO.
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Health Maintenance Organizations↗
Rural radiology: who is producing images and who is reading them?
The purpose of this study is to identify the local availability and trends in local availability of imaging technology and interpretation services in rural hospitals in the northwestern United States during the period between 1991 to 1994. Another objective is to describe hospital and community factors associated with the diffusion of image production and interpretation services. The information for this study was gathered through telephone surveys of rural hospital administrators in eight northwestern states in 1991 and 1994. The availability of magnetic resonance imaging (MRI) equipment, computed tomography (CT) scanners, ultrasonography equipment, and dedicated mammography equipment increased between 1991 and 1994. The increases in MRI units were primarily in mobile equipment, while ultrasonography and mammography equipment increases were primarily fixed hospital-based units. In 1994, image interpretation in the rural hospitals was provided by both primary care and radiology physicians. Forty-six (11.5%) of the rural hospitals had no on-site radiology services and only 73 (18%) had daily radiology services. Between 1991 and 1994, 12 hospitals gained at least once-a-week radiology services, but 24 lost all radiology services. Teleradiology availability more than doubled during the three years. Radiology technology has diffused widely into rural communities in this region of the United States at differing rates for large and small hospitals. Radiologists are available to these hospitals only 46 percent of the days each year, with more days of availability in the larger hospitals and fewer days in the smaller hospitals. Teleradiology capability is increasing more rapidly in the larger hospitals that have radiologists more readily available.
Diagnostic Imaging↗
Rural enrollment in MinnesotaCare.
Many rural Americans remain underserved and uninsured. Attempts to initiate national health care reform and universal health insurance coverage have stalled. The impetus to continue reform and universal coverage efforts has shifted back to the state level. Minnesota's health reform efforts resulted in the 1992 MinnesotaCare legislation, which included a subsidized insurance program. As of October 21, 1995, a total of 91,140 people were enrolled in MinnesotaCare. Enrollees are found in every county in the state and represent approximately 2.1% of Minnesota's total population and 2.4% of the state's population under age 65. Estimates of Minnesotans who are uninsured and therefore potentially eligible for this subsidized insurance plan range from 6% to 13%. MinnesotaCare enrollment estimates vary from a high of 10.8% of Red Lake County's population who are under age 65 and report incomes over 100% of the poverty level to a low of 1.5% for similar residents of Nicollet County. Counties with the lowest percentage of MinnesotaCare enrollees are clustered in southern Minnesota, especially the southeastern counties. Those with the highest percentage of enrollees appear to cluster in central Minnesota. MinnesotaCare enrollment is negatively associated with the size of the county's minority population and population density.
Adolescent↗
Availability of rural Minnesota obstetric services: is it a problem?
In the late 1980s several published articles predicted a crisis in the availability of obstetric care due to declining numbers of rural obstetrical providers. Several state and national studies documented the adverse impact of malpractice and time demands on both urban and rural physicians. But only limited information is available to document current trends in rural obstetrical practice and assess whether or not the predicted crisis occurred. This study sought to provide that updated information for rural Minnesota. A telephone survey of all rural Minnesota obstetrical providers was used to document the number, location, and specialty of rural obstetrical providers, their practice limitations, and plans for future practice. This data was combined with state perinatal statistics for each county to further assess obstetrical care availability and perinatal outcomes. All rural Minnesota obstetricians and certified nurse midwives provide obstetrical care as did 69 percent of all rural family physicians. Only 27 percent of rural obstetrical providers put any type of restrictions on their obstetrical practices. During the past year, 67 currently practicing rural physicians have stopped providing obstetrical care while 55 new obstetrical providers have begun rural practice. Two to 3 percent of current rural providers plan to retire or discontinue obstetrical services during the next five years. The provider demographics from the survey identified eight counties with no prenatal providers, and 12 additional communities of decreased provider availability. However, only two of the counties with no prenatal providers and five of the counties with areas of limited providers had increased percentages of adverse prenatal outcomes such as low birthweight or late prenatal care. This study concluded that Minnesota does not have a serious statewide problem with availability of rural obstetrical providers. However, a few isolated regions of the state have limited provider availability, including limited availability of local high-risk services and consultants.
Catchment Area, Health↗
Effects of alcohol on event-related brain potentials produced by viewing a simulated traffic signal.
The P-300 event-related brain potential was monitored during simulated traffic signal tasks for 10 subjects who were tested at three levels of mean blood alcohol content: 0.00%, 0.06%, and 0.13%. A significant increase in latency occurred for the 0.13% level indicating that an increased mental processing time was required to determine if a red or a green light had been presented.
Adult↗
Expanding rural managed care: enrollment patterns and prospects.
This paper synthesizes national data on rural HMO enrollment in commercial plans, Medicaid HMOs and prepaid plans, and Medicare risk-based plans. Although most rural counties now are included in the service area of at least one commercial HMO, rural HMO enrollment rates are still very low. The expansion of HMO capacity to serve rural enrollees, the continued implementation of Medicaid waivers, and the recent passage of the Balanced Budget Act of 1997 with substantial Medicare program revisions suggest increased rural managed care enrollment in the future.
Data Collection↗