PubMed · 10258202
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A S Hansen. 1982. Utilization review.. https://pubmed.ncbi.nlm.nih.gov/10258202/
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This paper provides a brief summary of the Medicaid prescription drug benefit. It explains the mechanisms being used by states to control their prescription drug spending within the Medicaid program. The paper also highlights some of the concerns that have been expressed with these mechanisms and the litigation that has been initiated in several states as a result of these efforts. It takes a closer look at three states with cost-containment strategies that have been the focus of increased scrutiny.
Selective soil remediation aims to reduce costs by cleaning only the fraction of an exposure unit (EU) necessary to lower the average concentration below the regulatory threshold. This approach requires a prior stratification of each EU into smaller remediation units (RU) which are then selected according to various criteria. This paper presents a geostatistical framework to account for uncertainties attached to both RU and EU average concentrations in selective remediation. The selection of RUs is based on their impact on the postremediation probability for the EU average concentration to exceed the regulatory threshold, which is assessed using geostatistical stochastic simulation. Application of the technique to a set of 600 dioxin concentrations collected at Piazza Road EPA Superfund site in Missouri shows a substantial decrease in the number of RU remediated compared with single phase remediation. The lower remediation costs achieved by the new strategy are obtained to the detriment of a higher risk of false negatives, yet for this data set this risk remains below the 5% rate set by EPA region 7.