Biomedical subjects

Tami L Mark

Publications and source records attributed to Tami L Mark.

30 records · Page 2Linked to original sources

PubMed2002

Access to new medications to treat schizophrenia.

Between 1989 and 1997, the Food and Drug Administration approved four new-generation antipsychotic medications for use in the treatment of schizophrenia. This article examines factors associated with the use of new antipsychotic medications as compared with traditional antipsychotic medications from patient interviews, medical records, and a physician survey administered at schizophrenia treatment sites around the country as part of the Schizophrenia Care and Assessment Program. The following variables were significantly associated with a higher probability of receiving an atypical antipsychotic medication in multiple regression analysis at p < .05: female, younger age, younger age of onset, non-African American, having a higher Positive and Negative Syndrome Scale-Negative Syndrome subscale score. Some physician characteristics were statistically significant in the bivariate results but not in the multivariate analyses. Access to new atypical antipsychotic medications is dependent on more than clinical characteristics. In particular, barriers to access may exist for African Americans. Physician access to information about advances in drug therapies also may play a substantial role in the rate of diffusion of new medications.

Adult↗

PubMed2002

Trends in inpatient detoxification services, 1992-1997.

The paper examines trends in the use of inpatient substance abuse detoxification provided at general hospitals using data from the Healthcare Utilization and Cost Project - National Inpatient Survey. Most persons who received inpatient detoxification did not also receive rehabilitation while an inpatient. The percentage receiving rehabilitation declined between 1992 and 1997 from 38.9% to 21.1%. The decrease in the probability of receiving rehabilitation occurred across gender, age, region, insurance status, income levels, diagnoses, admission source, and discharge destination. Two other notable trends are that average length of stay for detoxification dropped by one third over the six-year period, from 7.7 days to 5.2 days and the percentage of admissions through the emergency room increased from 35.6% to 40.1%. Detoxification offers an opportunity to link patients with rehabilitation. This analysis indicates that those opportunities may be missed.

Adolescent↗

PubMed2002

Axial length in applanation tonometry.

PURPOSE: To investigate the clinical applicability of a physical principle that suggests that a large globe offers less resistance to applanation than a smaller one. SETTING: Referral practice, Bridgeport, Connecticut, USA. METHODS: The correlation between axial length and applanation tonometry in 513 adult eyes, arbitrarily chosen from a referral practice, was examined using regression analysis. RESULTS: A statistically significant negative correlation was found; that is, for every 1.0 mm increase in axial length, the tonometry value was 0.29 units lower (P =.0002). In women, the mean axial length was 1.04 mm shorter and the mean intraocular pressure 0.54 mm Hg higher than in men. CONCLUSIONS: Globe size influenced applanation tonometry readings. Hence, when the tonometry record does not fit the clinical findings, axial length measurement may help interpret its significance.

Adult↗

PubMed2002

The business case for quality mental health services: why employers should care about the mental health and well-being of their employees.

Employers are very concerned about rising mental health care costs. They want to know whether their health care spending is improving the health of workers, and whether there is a productivity payback from providing good mental health care. This article addresses the subject of employee depression and its impact on business. The literature suggests that depressed individuals exert a significant cost burden for employers. Evidence is mounting that worker depression may have its greatest impact on productivity losses, including increased absenteeism and short-term disability, higher turnover, and suboptimal performance at work. Although there is no conclusive evidence yet that physical health care costs decrease when depression is effectively treated, there is growing evidence that productivity improvements occur as a consequence of effective treatment, and those improvements may offset the cost of the treatment.

Cost of Illness↗

PubMed2002

Trends in mental health insurance benefits and out-of-pocket spending.

BACKGROUND: Insurance benefits can have a large effect on whether one is able to access health care services. Mental health and substance abuse (MHSA) insurance coverage has typically been less generous than that of general health services. AIMS OF THE STUDY: This paper examines trends in the generosity of private insurance benefits for mental health (MH) services in the United States from 1987 to 1996. The paper estimates the benefit-induced change in insurance payments for MH services that would have been made by typical health plans between 1987 and 1996 holding constant utilization of individuals at the 1987 level so that the changes in effective benefits could be isolated. METHODS: Trends in mental health benefits were measured using two nationally representative household surveys of the U.S. civilian non-institutionalized population, the 1987 National Medical Expenditure Survey (NMES) and the 1996 Medical Expenditure Panel Survey (MEPS). Data on utilization and expenditures from the NMES/MEPS were used to simulate what the average person would have paid out-of-pocket under typical insurance plans in 1987 and in 1996. RESULTS: The study finds that limits on MH coverage, such as limits on reimbursed days of care, became more prevalent from 1987 to 1996, but that consumer cost-sharing rates declined. The simulations indicate that private insurance would have paid for a lower proportion of total spending in 1996 (60.1 percent) as compared to 1987 (65.8 percent). DISCUSSION: Despite the fact that limits on mental health services became more prevalent over the time-period evaluated, out-of-pocket expenditures did not increase as significantly because there was a corresponding increase in coinsurance covered by health plans. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Trends in plan design negatively affected those with high costs who are likely to surpass their limits and positively affected coverage for those with minimal use due to lower cost-sharing. These trends also indicate that persons in the most need, those with high utilization, particularly of inpatient care, experienced a decline in coverage while those with less intensive needs may have experienced a slight increase. IMPLICATIONS FOR HEALTH POLICIES: Out-of-pocket spending in both years of the study was substantial suggesting that improved health care coverage, such as that mandated in parity legislation, could improve access to care for persons needing mental health treatment. IMPLICATION FOR FURTHER RESEARCH: Additional research is needed to understand how trends in out-of-pocket spending and insurance benefits have influenced access to care.

Adolescent↗

PubMedDate not supplied

National spending on mental health and substance abuse treatment by age of clients, 1997.

This article examines 1997 national expenditures on mental health and substance abuse (MH/SA) treatment by 3 major age groups: 0-17, 18-64, and 65 and older. Of the total $82.4 billion in MH/SA expenditures, 13% went to children, 72% to adults, and 15% to older adults. MH/SA treatment expenditures made up 9% of total health care expenditures on children, 11% of total health care expenditures on adults, and 3% of total health care expenditures on older adults. Across the 3 age groups, distinct differences emerged in the distribution of MH/SA expenditures by provider-type. For example, about 85% of spending for youth was for specialty MH/SA providers, compared to 76% for adults and 51% for older adults. In addition, 33% of MH/SA spending for older adults went to nursing home care, while other age groups had almost no expenditures in nursing homes. Age-specific estimates enable policymakers, providers, and researchers to design programs and studies more appropriately tailored to specific age groups.

Adolescent↗

PubMedDate not supplied

Using stated preference modeling to forecast the effect of medication attributes on prescriptions of alcoholism medications.

OBJECTIVE: The objective of this study was to forecast physicians' preferred rate of prescriptions of alcoholism medications given different medications attributes (i.e., efficacy, side effects, compliance, price, mode of administration, method of action). METHODS: Stated preference modeling was used. Data came from a survey of 1388 physicians specializing in addiction medication (65% response rate). Physicians were given four hypothetical scenarios, each in which they were asked to choose between prescribing one of two hypothetical alcoholism medications with given attributes or prescribing no medication. RESULTS: Prescribing decisions were elastic with respect to the efficacy of the medication (1.35 and 1.65 using two efficacy measures). A 10% increase in the percentage of patients who would remain abstinent on the medication would lead to a 13.5% increase in the percentage of patients prescribed the medication. Prescribing decisions were inelastic with respect of nonserious side effects (-0.24), compliance (0.80), and price (-0.25). The market share of alcoholism medications with extremely favorable characteristics (i.e., 80% abstinence rate, a 95% no heavy drinking rate, a 10% side effect rate, a 80% compliance rate, and a price of US dollars 0.25) was predicted to be 53%, and 47% of the population would not be prescribed a medication to prevent alcoholism. CONCLUSIONS: The market share of new medications to treat alcoholism among addiction specialists could surpass the low usage rates of existing medications if those medications have better attributes. However, prescription levels may not reach that expected for treatment of other diseases.

Alcohol Deterrents↗

PubMedDate not supplied

Risk adjustment for people with chronic conditions in private sector health plans.

BACKGROUND: Although the problem of adverse selection into more generous health insurance plans has been the focus of previous work, risk adjustment systems have only recently begun to be implemented to blunt its effect. OBJECTIVES: This study examines the ability of the leading risk adjustment systems to predict health care expenditures for people with chronic conditions, using claims and enrollment data from 2 large employers. RESEARCH DESIGN: Predictive errors and total financial losses/gains are compared for different risk adjustment approaches (primarily hierarchical condition categories [HCCs] and adjusted clinical groups) for several chronic conditions. RESULTS: One of the best performing risk adjustment systems was a regression-based HCC method, which had an average under-prediction error rate of 9% or 6%, depending on the employer. In comparison, more typical actuarial risk adjustments based on just age, gender, and prevailing area wages lead to a prediction error of at least 50%. We did not find evidence that payments for particular chronic conditions would be consistently and significantly under- or overestimated. CONCLUSION: The leading risk adjustment approaches substantially reduce the incentives for adverse selection but do not eliminate them.

Adolescent↗

PubMedDate not supplied

What drove private health insurance spending on mental health and substance abuse care, 1992-1999?

Trends in MH/SA treatment spending from 1992 to 1999 were examined using employer claims data from approximately 1.7 million covered lives in each year. The analysis finds that employer-based private insurance spending on MH/SA treatment did not keep pace with total employer-based private insurance spending or general price inflation. MH/SA spending dropped from 7.2 percent of total private insurance spending in 1992 to 5.1 percent in 1999. The decline was attributable to a dramatic decrease in inpatient MH/SA treatment--specifically, the probability of admissions and average length-of-stay.

Actuarial Analysis↗

PubMedDate not supplied

The decline in receipt of substance abuse treatment by the privately insured, 1992-2001.

This study examines underlying trends in substance abuse services financed by private insurance. Analyses are based on the 1992 and 2001 Medstat MarketScan database, a claims database from large employers. The percentage of beneficiaries using any substance abuse services declined by 23 percent from 1992 to 2001 (from 0.64 percent of enrollees to 0.49 percent of enrollees). This decline was evident in all categories: inpatient, outpatient, and pharmaceutical usage. Substance abuse spending per covered life (in constant dollars) dropped from about $21.16 in 1992 to about $5.58 in 2001 [corrected]

Adolescent↗

PubMedDate not supplied

U.S. spending for mental health and substance abuse treatment, 1991-2001.

Spending for mental health and substance abuse (MHSA) treatment in the United States totaled dollar 104 billion in 2001, representing 7.6 percent of all health care spending. The nominal MHSA annual spending growth rate from 1991 to 2001 was 5.6 percent, almost one percentage point below the growth rate for all health care (6.5 percent). During this period, Medicaid has increased to be the largest payer of mental health care, with prescription drugs the fastest-growing spending component. Private insurance payment for substance abuse actually dropped in real dollars, increasing the public share of substance abuse spending.

Data Collection↗

PubMedDate not supplied

Barriers to the use of medications to treat alcoholism.

In 1994, naltrexone became the first medication approved by the Food and Drug Administration as an adjunct in alcoholism treatment in almost fifty years. Despite evidence of its efficacy, use of naltrexone is not widespread. Patient and physician focus groups were used to identify reasons naltrexone has not been prescribed more widely. Barriers to its widespread use include a lack of awareness, a lack of evidence of efficacy in practice, side effects, time for patient management, a reluctance to take medications, medication addiction concerns, Alcoholics Anonymous (AA) philosophy, and price. The study indicates that medications to treat alcoholism must overcome numerous barriers before becoming widely accepted.

Alcoholism↗