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At least 73 records · Page 4Linked to original sources
PubMed2006

Could a federal program to promote influenza vaccination among elders be cost-effective?

BACKGROUND: Influenza-related mortality predominately and disproportionately impacts the elderly. Rates of annual influenza vaccination among the elderly are approximately 65%, far below the Healthy People 2010 target of 90%. We estimated the cost-effectiveness of a 10-year federal program to promote influenza vaccine, intended to increase vaccination rates among persons > or = 65 years old. METHODS: Published estimates regarding influenza-associated mortality rates and vaccine efficacy among the US elderly were used to calculate the number needed to vaccinate (NNV) to prevent one all-cause death due to influenza, as well as the mortality reduction expected from increased vaccination rates. The costs per life-year saved were estimated for a hypothetical federal promotional campaign, patterned after a direct-to-consumer (DTC) advertising program (2006-2015). The base case scenario presumed a 25-percentage-point increase in vaccination rates to 90%; in sensitivity analyses, we examined programs that increased rates by 10-20 points. RESULTS: The base case NNV was 1116 (95% CI: 993-1348). Over the 10-year DTC-style influenza vaccine promotion program, 6516 (5576-7435) elderly lives would be saved. The incremental cost-effectiveness (C/E) of the program was dollar 16,300 (dollar 11,347-dollar 25,174) per life-year saved in 2006 and increased to dollar 199,906 (dollar 138,613-dollar 307,423) per life-year saved by 2015. Overall, the C/E for the 10-year program was dollar 37,621 (dollar 32,644-dollar 43,939) per life-year saved. Programs that yielded a 15-percentage-point increase or less in vaccination rates would have C/E values exceeding dollar 50,000 per life-year saved and save fewer than 4000 total lives. CONCLUSIONS: DTC-style promotional campaigns for influenza vaccine among elders may represent a cost-effective strategy for the federal government to pursue as a means of increasing elders' vaccination rates and reducing influenza-related mortality.

Actuarial Analysis↗
PubMed2004

[The dynamics of lethality and causes of death of the burned for the last 40 years in the Russian Burn Center of Ministry of Health of the Russian Federation].

A comparative analysis of lethality and causes of death of the burned in the Russian Burn Center of Ministry of Health of the Russian Federation for 40 years has shown that general lethality in the Burn Center for this period did not undergo substantial changes and was within 10%. Main causes of death were shock, sepsis and pneumonia. Other causes were of less significance. The authors noted more severe thermal traumas in the nineties and earlier development of complications leading to death.

Adolescent↗
PubMed2006

Meeting the need for state-level estimates of health insurance coverage: use of State and Federal survey data.

OBJECTIVE: Critically review estimates of health insurance coverage available from different sources, including the federal government, state survey initiatives, and foundation-sponsored surveys for use in state policy research. STUDY SETTING AND DESIGN: We review the surveys in an attempt to flesh out the current weaknesses of survey data for state policy uses. The main data sources assessed in this analysis are federal government surveys (such as the Current Population Survey's Annual Social and Economic Supplement, and the National Health Interview Survey), foundation-supported surveys (National Survey of America's Families, and the Community Tracking Survey), and state-sponsored surveys. PRINCIPAL FINDINGS: Despite information on estimates of health insurance coverage from six federal surveys, states find the data lacking for state policy purposes. We document the need for state representative data on the uninsured and the recent history of state data collection efforts spurred in part by the Health Resources Services Administration State Planning Grant program. We assess the state estimates of uninsurance from the Current Population Survey and make recommendations for a new consolidated federal survey with better state representative data. CONCLUSIONS: We think there are several options to consider for coordinating a federal and state data collection strategy to inform state and national policy on coverage and access.

Data Collection↗
PubMed2005

Technology. One small step...

The federal government last month amped up its push for a national health infrastructure, but if the project is to succeed, officials will have to make a stronger business case at the lower level.

Costs and Cost Analysis↗
PubMedDate not supplied

Analysis of interest group influence on federal school meals regulations 1992 to 1996.

Regulatory changes proposed by the US Department of Agriculture in 1994 promised to bring progressive changes to school meals. However, lobbying by interest groups resulted in substantial changes to the final rule. This analysis retrospectively examines the federal school meals policy-making process during 1992 to 1996. Key questions address why the policy changed and what the role of interest groups was in affecting the shape, pace, and direction of the policy. The study provides suggestions for using the experiences of 1992 to 1996 to guide future advocacy efforts and for adapting the approach for application to other food and nutrition policies.

Adolescent↗
PubMed2004

[Chronic diseases of the upper respiratory tracts and the organ of hearing in population of the Central Federal Territory].

The analysis of the occurrence of chronic diseases of the upper respiratory tracts (URT) and the organ of hearing (OH) among population of three regions of the Central Federal Territory with a total population of more than 3.5 million people showed predominant prevalence of OH affection -- 59.0 cases per thousand population. Most common URT diseases are represented by chronic pharyngitis (22.5/1000), chronic tonsillitis (15.9/1000) and chronic rhinitis (13.2/1000). OH diseases in children account for 11.5% of chronic diseases of URT and OH, URT chronic diseases made up 79.1%. In adults it was 36,3 and 58.5%, respectively. In retired persons OH diseases were prevalent -- 67.4%.

Adolescent↗
PubMed2003

Cortical index and size of hand bones: segregation analysis and linkage with the 11q12-13 segment.

BACKGROUND: Bone geometry (BG) and size (BS) are important factors in determining bone fragility. Previous studies have suggested that more than half of BG and BS variation is genetically determined. The possible chromosomal locations of genes involved in BS and BG determination have not been explored. We evaluated the extent and mode of inheritance of the radiographic hand BS index (BSI) and the metacarpal cortical index (MCI), and tested the hypothesis of linkage between these traits and the 11q 12-13 chromosomal region. MATERIAL/METHODS: Hand radiographs and blood samples were collected from 1190 individuals belonging to 349 Chuvasha nuclear families (Russian Federation). Segregation analysis was conducted on a total sample. Transmission disequilibrium testing (TDT) and model-based linkage analyses (MBLA) were performed on a sub-sample of 163 families. RESULTS: The hypothesis of a major gene effect was confirmed for both studied traits. The best-fitting models were Mendelian, with an additive type of inheritance. The inferred major gene explained 50% of the CI and 40% of the BSI variation. The TDT and MBLA results did not permit confirmation of hypotheses about linkage between hand BSI and the 11q 12-13 chromosomal region, but a possible linkage between CI and that region cannot be ruled out. CONCLUSIONS: We support the hypothesis of a major gene effect in the heritability of BSI and MCI. We provide suggestive evidence for possible linkage disequilibrium between MCI and the 11q12-13 chromosomal segment (marker D11S1983), but not for a linkage between BSI and this

Adolescent↗
PubMed1991

Expanding Medicare and employer plans to achieve universal health insurance.

This article presents a proposal for expanding Medicare and employer-based health insurance plans to achieve universal health insurance. Under this proposed health care financing system, employees would provide basic health insurance coverage to workers and dependents, or pay a payroll tax contribution toward the cost of their coverage under Medicare. States would have the option of buying all Medicaid beneficiaries and other poor individuals into Medicare by paying the Medicare premiums and cost sharing. Other uninsured individuals would be automatically covered by Medicare. Employer plans would incorporate Medicare's provider payment methods. This proposal would result in incremental federal governmental outlays on the order of $25 billion annually. These new federal budgetary costs would be met through a combination of premiums, employer payroll tax, income tax, and general tax revenues. The principal advantage of this plan is that it draws on the strengths of the current system while simplifying the benefit and provider payment structure and instituting innovations to promote efficiency.

Costs and Cost Analysis↗
PubMedDate not supplied

Federal sponsorship of cost-effectiveness and related research in health care: 1997-2001.

OBJECTIVES: To describe recent federal sponsorship of cost-effectiveness and related health economics research to provide insight into the functioning of existing research support systems and assess the roles of federal health agencies. METHODS: Using the PubMed database, we identified cost-effectiveness and related publications citing support from a US government entity and published during the period of 1997 through 2001, and audited them for information on funding sources, study type, and content focus. RESULTS: Five Department of Health and Human Services agencies and centers and the Veterans Administration are cited as funders in 74% of 520 federally supported health economics publications we identified. Three-fourths of federally supported publications address five areas of high disease burden: infections, cancer, HIV/AIDS, cardiovascular disease, and substance abuse. Other high burden diseases, including mental health, diabetes, and injuries, receive less attention. Federal support of health economics studies of health education and care delivery-intervention types underexamined in the field-is relatively strong but most often focuses on substance abuse or mental health services. Each of the top federal funders has a distinct funding pattern, but there are substantial areas of overlap within which we could not identify content domains specific to one funder or another. CONCLUSIONS: Federal support of health economics research has paralleled growth in the field. Federal funders support projects consistent with their mission and focus on high-burden disease areas. However, overlapping funding areas, ambiguity concerning agency interests within overlapping content areas, and gaps in some disease and intervention areas suggest that the coordination of health economics research funding could be improved.

Bibliometrics↗
PubMed1989

Including the poor: the fiscal impacts of Medicaid expansion.

This article presents the fiscal impacts of the comprehensive reform of the Medicaid program put forth by the Health Policy Agenda for the American People. Proposed reforms include establishment of improved uniform eligibility standards, improvement in the scope and depth of coverage in state Medicaid programs, and increased provider payment rates. We estimate that expanding Medicaid coverage to all currently uninsured nonelderly persons below the federal poverty line would cost approximately $9 billion. A substantial portion of these costs would offset current spending elsewhere in the health care system. Improvement of state packages and increased provider payment could result in sharp increases in costs. We provide a range of estimates considering both the set of benefits provided and the behavior of the private insurance market.

Costs and Cost Analysis↗
PubMed1997

Total clinical laboratory test volume in Connecticut, 1994-1995.

OBJECTIVE: To measure the volume of clinical laboratory testing in Connecticut during a one-year period. To explore the potential value of such data. DESIGN: Summary and analysis of federal and state clinical laboratory registration/licensure/inspection forms. SETTING: 2,333 clinical laboratory test facilities registered in Connecticut. MAIN OUTCOME MEASURES: The total clinical laboratory output for Connecticut by type of facility and category of technology over a 12-month period. RESULTS: During 1995, 2,333 registered clinical laboratory test facilities performed approximately 65,427,103 analyses in Connecticut. This represents approximately 20 tests per person per year. Thirty-five acute care hospitals performed 59.4%, nine large commercial laboratories 33.2%, 30 small commercial laboratories 1.7%, 1,491 physicians' offices 3.9%, and a miscellaneous group 1% of the tests. Test volumes are further segregated into eight major categories of technology: chemistry 59%, hematology 23.3%, microbiology 5.6%, blood banking 2.9%, coagulation 2.8%, waived tests 2.7%, urine analysis 1.8%, cytology 0.9%, and histology 0.8%. CONCLUSION: For the first time mechanisms are in place to measure essentially all clinical testing for a given area. With minor changes the data collection system could be greatly improved. The possible uses for such a data bank are discussed.

Clinical Laboratory Techniques↗
PubMed2002

Quality, cost, and coverage: examining the federal employees' health insurance plan.

In this article, the author uses a survey of more that 90,000 members of the Federal Employees' Health Benefits Plan (FEHBP) to examine a population whose health care is provided by a regulated market unlike any other market in the United States. Within the FEHBP, the government defines the market and brings buyers and sellers together, guaranteeing each much more security than either is able to obtain in the open market. For the sellers, there is the promise of having a customer for at least a year. For the consumer, there is the promise of being treated like any other customer in spite of preexisting illness or other special health care needs. To assess the success of this plan, the author examines how the consumers perceive the quality of their plans and their overall level of satisfaction and then compares that information to perceived quality and satisfaction among consumers in the open market.

Consumer Behavior↗
PubMed1989

Government funding for organ transplants.

This paper examines the role of the federal and state governments in paying for organ transplants. The first section, descriptive in nature, presents data on the past, current, and projected payment patterns for different kinds of organ transplants under various federal and state programs. The second section, which is normative, considers the three principal arguments for and against government payment for organ transplants. These arguments revolve around efficiency, equity, and communitarian claims, and none of them is wholly satisfactory. The final section, which is policy-oriented, assumes that government financing of organ transplants will continue but will be fiscally constrained, and goes on to analyze a number of important payment policy issues in the light of broader principles. These issues relate to eligibility, comprehensiveness of benefits, reimbursement formulas, entitlement, and level of government. The paper concludes by predicting that as transplant procedures become less constrained by organ supply and more routinely performed, they will lose the privileged political position that they now enjoy and will instead be obliged to compete for scarce governmental resources with other social goods on more equal terms. Government policy should be designed to encourage this competition.

Costs and Cost Analysis↗
PubMed1985

Cystinosis in the Federal Republic of Germany. Coordination and analysis of the data.

In our survey, 101 infants and children with cystinosis were registered in the Federal Republic of Germany. Ninety-five patients showed the infantile type of cystinosis, five the adolescent type and one possibly the adult type. The minimum incidence rate of infantile and adolescent cystinosis in the FRG was 1 patient per 179 000 live-births. In contrast to other countries, cystinotic patients were evenly distributed in the FRG. Patients with cystinosis originated more frequently from rural communities than from large cities. Before 1968 most patients died before reaching terminal renal failure, usually due to uncontrolled disturbances of water and electrolyte metabolism. Since 1976 the causes of death other than uraemia have been rare and most patients with terminal renal failure have entered a renal replacement program.

Adolescent↗
PubMed1991

Life cycle savings and consumption constraints: theory, empirical evidence, and fiscal implications.

"Recent tests of both the pure and the extended life cycle hypothesis have generated inconclusive results on the life cycle behavior of the elderly. We extend the life cycle model by introducing a constraint on the physical consumption opportunities of the elderly which, if binding, imposes a consumption trajectory declining in age. This explains much of the received evidence on the elderly's consumption and savings behavior, in particular declining consumption, and increasing savings and wealth with increasing age. Our analysis of [Federal Republic of Germany] data gives additional support to our theory. We finally draw the implications of the theory on the incidence of consumption and income (wealth) taxes, and on the recent (inconclusive) tests of intergenerational altruism."

Adult↗
PubMed2005

Islet isolation and GMP, ISO 9001:2000: what do we need--a 3-year experience.

Pancreatic islet cell isolation and transplantation has been performed for many years at several institutions. Although all institutions aim to produce high-quality islets, applied standards widely deviate from standards in the pharmaceutical industry. The legal situation within the European Union has changed requirements for setting up and running such a laboratory. The process is now clearly defined as a production of a pharmaceutical and therefore must be licensed by federal authorities. Analysis of workload for establishing an islet isolation program that fulfil GMP and ISO 9001 criteria including an estimation of costs and the impact of such a system on the isolation process. The definition of quality parameters and documentation is a central issue of all islet isolation laboratories. Therefore, GMP and ISO 9001:2000 do not add additional work per se. On the other hand, clear guidelines, a clear policy, working place descriptions, forms, checklists, and, particularly standard operating procedures, are instrumental for smooth functioning within the department. Collection of data such as errors, improvement measures, and preventive measures reduces subsequent costs. A clear definition of responsibilities minimizes organizational problems. Steering of inspection devices prevents bias errors and validating the processes clearly points out incorrect assumptions. Documentation helps to prove the correctness of the production at any time and is of use also for scientific evaluations. We strongly feel that GMP criteria are mandatory and together with an ISO 9001:2000 quality management system offers significant advantages for the process of islet isolation and a continuous improvement process.

Academies and Institutes↗