SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
This document amends VA's medical regulations to set forth a mechanism for determining copayments for inpatient hospital care and outpatient medical care. This is necessary to implement provisions of the Veterans Millennium Health Care and Benefits Act and to set forth exemptions from copayment requirements as mandated by statute.
A key aim of the evaluation of the Fort Bragg Demonstration was to determine whether delivering services through a continuum of care lowered expenditures on mental health services. The evaluation clearly showed that expenditures were actually higher in the Demonstration. Critics of the evaluation claimed that the evaluation's perspective on costs was too narrow-in particular, that the Demonstration produced cost shifting and cost offset that were not captured by the evaluation. New data allow us to include a broader array of costs: mental health services received outside the catchment areas, general medical services for the children themselves, and mental health services used by family members. Results showed that reductions in other costs do partially offset higher expenditures on mental health services for children at the Fort Bragg Demonstration. However, even when broader costs are included, total family expenditures are still substantially higher at the Demonstration.
A random sample of American Legion members in six states who had served in the Armed Forces during the Vietnam Era was conducted through a mailed questionnaire, in order to determine patterns of usage of Veterans Administration health facilities, as well as attitudes toward the VA and experiences at these facilities. Of the 6810 male respondents, 42.0% had served in Southeast Asia. These subjects were categorized according to their level of combat in South Vietnam. Thirty-six percent of those who had served in Southeast Asia had used VA health facilities, compared to only 18% of men who served elsewhere. Among Southeast Asia veterans, combat level was an important predictor of extent of usage of VA facilities for problems of both physical and mental health. Combat level was also associated with lack of basic and major medical insurance. While men with lower incomes tended to make greater use of VA mental health facilities, nearly one-fourth of mental health users had family incomes above $30,000. Despite their greater usage of the VA, men with higher combat levels expressed lower feelings of security about this agency, and rated its staff less helpful and of lower quality than did men who experienced lower levels of combat. On the other hand, higher combat veterans thought themselves better informed about VA services. Men who had gone to the VA for mental health assistance reported a disturbingly low frequency of having been asked basic questions that relate to possible diagnosis of post-traumatic stress disorder (PTSD), questions related to combat, which may be one of its etiologic factors, or other questions relating to their military history. Because combat level in Vietnam veterans is a major determinant of both attitudes toward and utilization of VA health facilities, the VA as well as other health agencies which deal with Vietnam veterans should be especially sensitive to this factor, and should take it into consideration when evaluating veterans' physical and mental health.
The Medicare Catastrophic Coverage Act of 1988 is described, and its impact on health-care delivery is discussed. The act will expand Medicare coverage of inpatient hospital care and will also provide payment for outpatient prescription drugs and home i.v. therapy. For the prescription drug benefit, deductible and coinsurance payments will be phased in, and Medicare will establish payment limits. A per diem fee schedule will be established to pay for the supplies and services used in home i.v. therapy. Providers of home therapy must have qualifications specified by the act. Pharmacists will have an important role in ensuring that patients understand and comply with their drug therapy once they leave the hospital. As members of the home health-care team, pharmacists will be involved in identifying candidates for home care, instructing patients in the use of sophisticated medical equipment, and monitoring the safety and efficacy of therapy. Medicare beneficiaries will help finance the new coverage by paying a flat premium; in addition, all individuals eligible for Medicare will pay supplemental premiums based on their federal income tax liability. Congress, however, will come under pressure to lower or freeze these premiums. Hospitals and pharmacists should cooperate in urging Congress to provide adequate funding for services specified by the catastrophic coverage act.
Psychiatric service delivery was studied over a 6-year period in the Province of Saskatchewan, which has had comprehensive universal medical insurance since 1962. That experience is relevant to current issues of costs and quality of care, methods of financial reimbursement and organization of service delivery. A unique patient-centered data base permitted the examination of significant differences between the private and public service delivery sectors in volumes and types of patients treated as well as treatment costs. A dominant picture emerged of distinct types of patients that differ significantly in terms of severity and duration of illness, as well as in the amount of resources they consume. Their differing needs for intervention and prevention should be taken into account in mental health care planning.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Restoring financial incentives to encourage patients to shop for the lowest prices for medical care underlies current procompetitive health financing proposals. This paper analyzes the impact of one such financial incentive--cost-sharing in health insurance--on patients' provider shopping behavior. Using data from the 'Health Insurance Study', the relationship of cost-sharing with the specialty type of the primary care provider and with the costliness of the selected provider is investigated. The results were mixed as to whether patients who have only catastrophic coverage seek lower priced physicians than patients who have free care; however, any differences were small. Even among the well-educated, who are likely to be more efficient than the less educated at obtaining comparative price information, the effects of cost-sharing on the costliness of the selected medical care provider were minimal.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
This chapter describes a systematic approach to the art of collection for services rendered, based primarily on a pay-as-you-go philosophy. A system of internal office-controlled billing, timed so that the statements reach the patients on the last day of the billing month instead of the first day of the following month, unequivocally works more smoothly in the author's office than external computerized billing did. Suggestions to effect and maintain a collection ratio of at least 95 percent have been enumerated. The use of a new statement-and-insurance form facilitates billing, keeping ahead of insurance applications for patients, and advising the front office of other internal tasks to be performed. Finally, the importance of the general ledger, under the supervision of the ophthalmologist's accountant and in conjunction with a control procedure (employing the daily master appointment page attached to the ophthalmologist's personal worksheet) is stressed, in order to safeguard the physician's revenue.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.