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PubMedDate not supplied

Hampshire HealthConnect. A local effort increases access to health care for the uninsured.

In the absence of universal coverage, there is a need to develop solutions at a local and state level to the dramatic rise in the uninsured. This article summarizes a local countywide effort to address this issue in a rural area. Key ingredients for success include both hospital leadership (they have significant resources at their disposal), extensive community involvement (to maintain momentum for the program), and local physician leadership (physicians are, in essence, forgoing income in return for a formalization of who is eligible for the free care program).

Community Participation↗
PubMed1997

Countervailing agency: a strategy of principaled regulation under managed competition.

Despite the failure of recent attempts to reform health care, strategies of managed competition remain the dominant prescription for government oversight of managed care. A number of assumptions and prescriptions in the conventional managed competition model are challenged. More specifically, externalities in the costs and benefits associated with health care and asymmetric information between providers and patients make it unlikely that a managed care system designed to be responsive to consumers will, in practice, produce socially desirable outcomes. An alternative approach for the regulation of managed care more explicitly protects the role of health care professionals as agents for their patients while defining the appropriate role of managed care as the agent for broader societal interests. This strategy of "countervailing agency-" acknowledges that oversight of managed care inevitably involves value-laden choices. It is based on institutional arrangements and regulatory strategies that are intended to balance competing interests and values.

Capitation Fee↗
PubMed2000

Purchasing cooperatives for small employers: performance and prospects.

Health insurance purchasing cooperatives were established in the early to mid-1990s for the purpose of making health insurance more affordable and accessible for small employers. Extensive interviews at six cooperatives reveal that while some cooperatives enrolled large numbers of small employers, most have won only small market shares and a number have struggled for survival, not always successfully. They have allowed small employers to offer individual employees choice of health plans, but none has been able to sustain lower prices than are available in the conventional market. Among the important impediments to their success are limited support from health plans and conflicts over the role of insurance agents.

Group Purchasing↗
PubMed1972

Ribonucleotide reductase activity of synchronized KB cells infected with herpes simplex virus.

The replication of herpes simplex virus (HSV) is unimpeded in KB cells which have been blocked in their capacity to synthesize deoxyribonucleic acid (DNA) by high levels of thymidine (TdR). Studies showed that the presence of excess TdR did not prevent host or viral DNA replication in HSV-infected cells. In fact, more cellular DNA was synthesized in infected TdR-blocked cells than in uninfected TdR-blocked cells. This implies that the event which relieved the TdR block was not specific for viral DNA synthesis but allowed some cellular DNA synthesis to occur. These results suggested that HSV has a means to insure a pool of deoxycytidylate derivatives for DNA replication in the presence of excess TdR. We postulated that a viral-induced ribonucleotide reductase was present in the cell after infection which was not inhibited by thymidine triphosphate (TTP). Accordingly, comparable studies of the ribonucleotide reductase found in infected and uninfected KB cells were made. We established conditions that would permit the study of viral-induced enzymes in logarithmically growing KB cells. A twofold stimulation in reductase activity was observed by 3 hr after HSV-infection. Reductase activity in extracts taken from infected cells was less sensitive to inhibition by exogenous (TTP) than the enzyme activity present in uninfected cells. In fact, the enzyme extracted from infected cells functioned at 60% capacity even in the presence of 2 mm TTP. These results support the idea that a viral-induced ribonucleotide reductase is present after HSV infection of KB cells and that this enzyme is relatively insensitive to inhibition by exogenous TTP.

Carbon Isotopes↗
PubMed1994

Financial risk, accountability and outcome management: using data to manage and measure clinical performance.

As health care reform and components of managed competition begin to infiltrate the health care system, health care providers will be facing significant challenges over the next several years in responding to priorities that mandate the delivery of appropriate, comprehensive, cost-efficient high quality care. Changes in financial risk, increasing accountability, performance documentation, and outcome measurements will hold providers more responsible for the input and output of services provided. In an effort to respond to these challenges, health care providers will have to rely on integrated data systems to identify opportunities for improvement in an effort to more effectively manage and measure the impact of health care delivery as patients move through the health care system.

Competitive Medical Plans↗
PubMed1995

HMO survival: determination of optimal size.

The concept of prepaid health care as embodied by health maintenance organizations (HMOs) provides variety in the provision and coverage of health care benefits. This is important in the development of a diverse and appropriate health care system for the US. HMOs were developed to provide a cost-effective, alternative form of health care delivery and financing to ensure access and continuity. HMOs can achieve this only by sustaining organizational viability. A survivor analysis modelling technique is employed to analyze the optimal size of HMOs by region model type and profit status over the period from 1977 through 1986. A determination of an optimal size category establishes a survival criterion for HMOs. A minimum enrollment of at least 25,000 members should be achieved as quickly as possible. This minimum standard can be used as a guide for initial success, however a higher enrollment in the 40,000 to 60,000 member range appears necessary for longer-term survival.

Actuarial Analysis↗
PubMed1996

Reforming the health care system: implications for health care marketers.

Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

Cost-Benefit Analysis↗