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PubMed2000

Congenital heart disease among school children in Alexandria, Egypt: an overview on prevalence and relative frequencies.

A study was undertaken to determine the prevalence and relative frequencies of congenital heart diseases diagnosed by echocardiography among school children in Alexandria, Egypt. The study was conducted during a 1-year period (1 May 1995-1 May 1996) at the Students' Health Insurance Hospital, which is a referral center for all health insurance units, providing an echocardiography service. The prevalence of congenital heart diseases (CHD) among school children accounted for 1.01/1,000. There was a male predominance in cases of pulmonary stenosis and single ventricle, while in cases of patent ductus arteriosus, mitral valve prolapse, and partial atrioventricular canal there was a female predominance. The commonest cardiac defects were ventricular septal defects, pulmonary stenosis, and atrial septal defects. Pulmonary stenosis ranked the second commonest defect and is a peculiar finding in our Egyptian population. The mere presence of these cardiac defects in school children is an indicator of the poor quality of care provided to this growing childhood population.

Child↗
PubMed1987

Medicare and Medicaid programs; benefit period determinations, drug regimen reviews and other technical changes--HCFA. Final rule.

Under the Hospital Insurance Program (Medicare--Part A), payment for covered inpatient hospital and skilled nursing facility (SNF) services is available for a limited number of days during each benefit period or "spell of illness." Current Medicare regulations reflect the statutory provision under section 1861(a) of the Social Security Act (Act) that a beneficiary's benefit period begins on the day he or she is furnished inpatient hospital or SNF services and ends when he or she has not been "an inpatient of a hospital nor an inpatient of a skilled nursing facility" (as defined under sections 1861(e)(1) and (j)(1) of the Act, respectively) for 60 consecutive days. These final regulations: Specify that a beneficiary is an "inpatient" of a SNF and is therefore prolonging a spell of illness in a SNF only if the care received by the beneficiary meets skilled level of care conditions and establish certain presumptions which Medicare intermediaries may use in determining whether skilled level of care conditions have been met during a SNF stay. These regulations also provide that a pharmacist must perform drug regimen reviews in intermediate care facilities (ICFs). In addition Section 405.702 of the regulations is amended to remove certain cross-references that are now outdated and unnecessary.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Hearings by administrative law judges of certain Medicare claims--HCFA, SSA. General notice.

This notice is to advise the public that the Social Security Administration's Office of Hearings and Appeals (SSA, OHA) has recently been given temporary jurisdiction over Medicare Part B, Supplementary Medical Insurance, Administrative Law Judge (ALJ) hearings. Medicare Part A, Hospital Insurance, ALJ hearings and Medicare entitlement matters continue under SSA, OHA's jurisdiction.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Integration of leprosy control into general health care system: observations from a state with low endemicity.

The study was undertaken as part of operational research to assess the level of integration of leprosy services into general health care system in 24 low or moderately endemic states/union territories by the Ministry of Health and Family Welfare, Government of India. Himachal Pradesh was one of the nine randomly selected states for the study. Out of the 12 districts in the State, 2 were selected randomly for the study. In each of the selected districts, 8 health facilities (that included a district hospital, an urban hospital/urban health centre, an Employees' State Insurance Hospital, a community health centre and a primary health centre) and 9 sub-centres were surveyed. Selection was done randomly at each stage. Data were collected on training in leprosy of general health care staff, availability of drugs for MDT in the system and maintenance of leprosy records by the staff of the system. The study showed mixed results. About half (53.2%) of the existing medical officers, 83.9% of health supervisors and 96.8% of multi-purpose workers were trained in leprosy. But only 31.3% of medical officers were able to diagnose leprosy and most of them were relying on vertical staff and skin specialists for confirmation. MDT services were provided by 20% of rural and 66.7% of urban health facilities that were acting as treatment centres. None of the health facilities had 3 months' stock of all types of blister packs, as per the guidelines of the Government of India. None of the sub-centres was involved in MDT delivery. However, reporting as per SIS formats was universal. The study emphasized the need for training and better management of MDT drug stock.

Delivery of Health Care, Integrated↗
PubMed1979

Universal health insurance in Canada: history, problems, trends.

This paper describes the universal health insurance program in Canada and identifies the historical events and social values leading to its adoption. Universal hospital insurance was adopted in 1958, ten years before medical insurance, as a result hospital-based patterns of practice were solidified. Through cost sharing, the federal government influenced the provinces to enact relatively uniform universal plans. From 1951 to 1971 health care expenditures rose rapidly to 7.3% of the gross national product (GNP), but have since decreased and stabilized at about 6.9%. In contrast, health care in the United States represents 8.6% of GNP. Hospital use also increased rapidly in Canada to 1970 but appears to have stabilized and decreased slightly in this decade. Physician incomes rose rapidly before 1971, but since then the increases have slowed and relative incomes of physicians have fallen. Althouth the percent of GNP spent for health care has leveled, there are still substantial annual increases in expenditures that are paid for by government. Two federal initiatives, Bill C-37 and the Lalonde Report, have their roots in cost containment; Bill C-37 transfers greater taxing authority from the federal government to the provinces. To meet the goal of containing costs, provincial governments are moving in the direction of regionalization, decentralization, and greater coordination. In the short term, the provinces have limited hospital budgetary increases to percentages less than the rate of inflation. Cost constraints may be long overdue. Imposing fiscal limits encourages rational planning. It does not appear that the health of Canadians will be adversely affected or essential benefits curtailed by present budgetary restrictions or reorganization.

Adult↗
PubMed1997

A health insurance scheme for hospital care in Bwamanda District, Zaire: lessons and questions after 10 years of functioning.

A voluntary insurance scheme for hospital care was launched in 1986 in the Bwamanda District in northwest Zaire. The paper briefly reviews the rationale, design and implementation of the scheme and discusses its results and performance over time. The scheme succeeded in generating stable revenue for the hospital in a context where government intervention was virtually absent and external subsidies were most uncertain. Hospital data indicate that hospital services were used by a significantly higher proportion of insured patients than uninsured people. The features of the environment in which the insurance scheme thrived are discussed and the conditions that facilitated its development reviewed. These conditions comprise organizational-managerial, economic-financial, social and political factors. The Bwamanda case study illustrates the feasibility of health insurance-at least for hospital-based inpatient care-at rural district level in sub-Saharan Africa, but also exemplifies the managerial and social complexity of such financing mechanisms.

Adult↗
PubMed2005

The need to legislate the health-care industry in the state of Washington to protect health-care workers from back injury.

There is an epidemic of health-care worker back injury in the State of Washington. Voluntary programs are not keeping pace with the increasing back injury rates to health-care workers. Adding all the health-care industry SIC codes, hospitals, nursing homes, home health and residential care puts health-care as the leading industry in the State of Washington for back injury. Licensed practical nurses, nurses aides, and registered nurses account for the majority of all claims in the health-care industry. Self-insured hospitals led the state for lost time compensable back injuries between 1993 and 2001, and combined Washington State Fund and self-insured health-care hospitals and nursing homes led all other industries for compensable soft-tissue disorders of the neck, back, and upper extremities. Legislation is needed to protect this group of workers in this type of industry. A bill will be re-introduced in the 2006 session that calls for hospitals to implement back injury prevention programs through either the Zero-Lift model, with nursing staff use of lift equipment, or the Lift-Team model, with a specially trained team using lift equipment, or a combination of the two, for all shifts. The State of Washington should provide funding, through savings created by back injury prevention programs, for small rural health-care institutions to assist them in compliance with the legislation.

Back Injuries↗
PubMed2003

California bonanza? Providers and insurers cheer mandatory health insurance law, but business interests look at legal challenge to newly signed bill.

Consider it Gov. Gray Davis' going-away present to the state's hospitals, insurers and physician groups. The California Health Insurance Act of 2003 could mean increased revenue for hospitals. Doctors like Brian Johnston, left, say the bill has been a long time coming and are pleased with the legislation, but others are concerned about what effects the mandatory insurance law will have on small businesses.

California↗
PubMed2003

Types of hysterectomy. Comparison of characteristics, hospital costs, utilization and outcomes.

OBJECTIVE: To compare hospital costs, patient characteristics and outcomes of 3 hysterectomy techniques--abdominal, vaginal and laparoscopically assisted vaginal (LAVH). STUDY DESIGN: A cross-sectional analysis was performed using patients discharged from Florida hospitals in 2000 with hysterectomy as the primary procedure. To avoid differences due to unrelated complications, records indicating cancer or other major non-hysterectomy-related procedure were excluded from the analysis. A total of 23,191 records were used to compare the 3 techniques on hospital costs and length of stay, controlling for patient differences in complicating diagnoses and related procedures. RESULTS: Consistent with previous studies, patients undergoing LAVH had higher hospital costs, shorter lengths of stay and no difference in surgical complications from either vaginal or total abdominal hysterectomy, even after controlling for patient comorbidities. Other factors affecting hospital costs and length of stay were patient race, type of insurance, hospital ownership and location. CONCLUSION: LAVH is still more expensive than vaginal and total abdominal hysterectomy but offers a speedier recovery, with no measurable difference in the rate of complications. Further research is warranted to ascertain differences in readmission rates across the techniques and to investigate the process used to select which hysterectomy technique is used for a given patient.

Adult↗
PubMed1989

An appraisal of organizational response to fiscally constraining regulation: the case of hospitals and DRGs.

Results from analysis of 227,771 discharge abstracts from 68 short-term, acute-care hospitals and from interviews with a stratified random selection of 24 of the 68 chief executives of these hospitals demonstrate that institutions perceive implementation of DRGs as fiscally constraining, especially in light of other resource-constraining conditions (an increase in unemployment resulting in fewer people with hospitalization insurance, in addition to severe cuts in Medicaid rolls and budget). Hospitals responded to DRGs by decreasing the use of affected resources or services available to the hospitalized Medicare patient. In order to survive a more economically stringent marketplace, hospitals no longer protected the traditional core within the Medicare inpatient market. They opted instead to change practices and products at the unregulated margins of the DRG system.

Aged↗
PubMed1985

Patient opinion survey for 58 hospitals.

A consumer's opinion survey was carried out, using the same questionnaire in 58 social insurance hospitals. The rate of collection was 67.2 percent. Evaluations were higher for medical and nursing care, and lower for dietary service and ward accommodation. It is interesting that the results of the consumer survey for each hospital very nearly coincide with the business evaluation of the central governing body. Periodic surveys, using the same questionnaires, are planned for time series studies aimed at improving the quality of hospital care.

Consumer Behavior↗
PubMedDate not supplied

Hospital self-insurance offers some advantages.

Practically all large employers are faced with the problem of providing economical employee insurance in its benefits program. Hospitals have some unique advantages over some other employers in terms of being able to provide self-insurance and eliminate most of the costs of sustaining an insurance carrier.

Health Benefit Plans, Employee↗
PubMedDate not supplied

[The SUVA (Swiss Accident Insurance Association) statistics and quality control].

Overall quality control in medicine takes place on various levels: Physician--Hospital--Insurer--Authorities, each having different requirements. Comparative standards are rather seldom. A model for a comparative standard for insurer purposes, the medical statistics package SUMEST' is presented. This model is diagnoses oriented and includes parameters for the severity of the accident, cost of treatment and treatment outcome, all based on 5-year data pool results.

Accidents, Occupational↗