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PubMed1988

Actuarial status of the HI and SMI Trust Funds.

This article is adapted from the 1988 Annual Reports of the Medicare Board of Trustees. It presents a summary of the current financial and actuarial status of the Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) Trust Funds. The Board found that the present financing schedule for the HI program is sufficient to ensure the payment of benefits over the next 17-20 years if the intermediate (II-A and II-B) assumptions underlying the estimates are realized. Although steps have been taken to reduce the rate of growth in payments to hospitals, the Board urges Congress to take remedial measures to bring future HI program costs and financing into balance. The Board found the SMI program to be actuarially sound but recommends that Congress take action to curtail the rapid growth in that part of Medicare.

Actuarial Analysis↗
PubMed1992

Actuarial status of the Social Security and Medicare programs.

The Boards of Trustees for the two Social Security and the two Medicare Trust Funds recently released their annual reports to Congress detailing the operations of the trust funds during 1991 and their projected financial status for future years. Based on the Trustees' best estimates, the reports show: The Federal Old-Age and Survivors Insurance (OASI) Trust Fund will be able to pay benefits for about 50 years. Congress will eventually need to take action to assure the long-range financing of the program. The Federal Disability Insurance (DI) Trust Fund will be able to pay benefits for only about 5 years and is not adequately financed. As a result, the Board is required to make a separate report to the Congress on the unfavorable financial condition of this trust fund. The Board urges that prompt legislative action be taken to improve the financial integrity of the trust fund, after a review of the disability program. The Federal Hospital Insurance (HI) Trust Fund will be able to pay benefits for only about 10 years and is severely out of financial balance in the long-range. The Trustees urge the Congress to take additional actions designed to control HI program costs either through specific program legislation or as a part of enacting comprehensive health care reform. The Federal Supplementary Medical Insurance (SMI) Trust Fund is financed on a year-by-year basis and, on this limited basis, is adequately financed. The Trustees urge the Congress to take additional actions designed to control SMI costs either through specific program legislation or as part of enacting more comprehensive health care reform.

Budgets↗
PubMedDate not supplied

Gender differences in practice patterns of Ontario family physicians (McMaster medical graduates).

This study examined the extent to which physician gender influences practice patterns. Data came from the Ontario Hospital Insurance Plan billing profiles of general practitioner and family medicine graduates of McMaster University School of Medicine. The women physicians studied were more likely to be certified in family medicine than the men and a higher proportion of their patients were female. Women were more likely to be working part time, billed during fewer months of the year, earned less, and saw fewer patients. They provided greater numbers of services in psychotherapy and counselling and ordered more laboratory tests; associated with this were higher costs per service and per patient. Women offered a less diverse mix of services than men. They provided fewer hospital, emergency room, and intrapartum services and a lower proportion of women included house calls, after-hours work, hospital, emergency room, surgical or intrapartum services in their service mix. Thus these women appeared more likely to restrict their practices to the office setting and to provide a higher proportion of psychosocial care. The overall impact of these sex differences in practice patterns on the health care system requires further exploration.

Family Practice↗
PubMed1988

Medico-economic implications of industrial hand injuries in India.

625 five consecutive cases of industrial hand injuries attending the Employee's State Insurance Hospital, Jaipur, have been studied from 1983 to October 1986. The incidence of injuries was 36 per 10,000 workers per year. 47% were due to entrapment of the hand in active machines, 25% occurred during lifting and transportation of heavy objects and 12% while handling tools. The injuries resulted in residual deficit in 55% of cases and were serious enough to require absence from work of more than four weeks in 48% of cases. On an average 35 days were lost per injured worker. The average economic loss per injured worker was Rs. 6900 (approximately pounds 275) for workers in the wage-range of Rs. 5400 to 19,200 (pounds 216 to pounds 768) per annum.

Accidents, Occupational↗
PubMedDate not supplied

Idiopathic ulcerative colitis in Istanbul: clinical review of 204 cases.

A clinical review of 204 cases of idiopathic ulcerative colitis (IUC) seen in an insurance hospital in Istanbul during a period of nine years is presented. The criteria of diagnosis were based on history and results of rectosigmoidoscopic, biopsy, and barium-enema examinations. In the majority of cases (74 per cent), the disease manifested in the mild form, despite a history of one to five years' duration at the time of diagnosis. These patients usually had single attacks, with recovery in reponse to treatment. The mortality rate for the whole series was 3.9 per cent. Death occurred in eight cases of patients who had the severe form of the disease involving the entire colon, with fulminating courses. One additional death was due to an accident. Treatment consisted of a high-protein, low residue diet, vitamins, rest, sulfa drugs and steroids. Azathioprine, in addition, was used in fulminating cases. Surgery supplemented medical therapy in 19 cases. Indications for surgical treatment were resistance to medical management, cancer, and polyposis. Only two patients (1.0 per cent) were found to have cancer during the follow-up period. These two were operated upon. Idiopathic ulcerative colitis is not a rare entity; with awareness and use of appropriate diagnosis facilities, more cases are being discovered.

Adolescent↗
PubMed1979

Competition in the delivery of medical care.

One approach to reform of the medical-care-delivery system emphasizes the development of constructive competition among providers of health care. In this article we describe competition among providers in Minneapolis-St. Paul, one of the few areas that can provide information concerning the practicality of this type of reform. We have found that competition has helped to reduce hospitalization, contain costs and improve access to medical services. At the same time it has focused attention on consumer satisfaction with medical services, increased the range of consumer choice and given consumers better information about providers. Certain public and private measures could facilitate the development of similar competition in other communities.

Ambulatory Care↗
PubMed1979

The competitive response of Blue Cross and Blue Shield to the health maintenance organization in Northern California and Hawaii.

The health maintenance organization (HMO) can provide an alternative to the predominant form of health care delivery in the United States, fee-for-service. Although market penetration of the HMO is relatively low in most parts of the country, the HMO has achieved a significant market share in a number of states. This paper examines the competitive response of Blue Cross and Blue Shield to the introduction of the HMO in two geographic regions with significant HMO activity, northern California and Hawaii. The evidence obtained from extensive interviews indicates that Blue Cross and Blue Shield plans have responded to HMO competitive pressure by establishing their own HMOs and by altering traditional procedures. HMO competition has stimulated Blue Cross and Blue Shield to make greater cost control efforts and to offer larger benefit packages. These results can have important policy implications for the role that HMOs are to play in cost containment.

Blue Cross Blue Shield Insurance Plans↗
PubMed1987

Relationship between patient race and the intensity of hospital services.

This study reviews evidence on whether services in United States hospitals vary by racial groupings of patients. The focus is on both equity and quality of hospital services. Patients with the diagnosis of pneumonia were studied at 16 randomly selected hospitals. The services and outcomes studied include five measures of the intensity of diagnostic and therapeutic services received by patients, and death rates during hospitalization. Multiple regression was used to control for patient health status at the time of entry into the hospital. Results are presented both before and after controlling for the effects of differences in the services offered between hospitals and patient payment sources. Our findings suggest that nonwhite pneumonia patients received fewer hospital services than expected on the basis of their health characteristics, and that their hospital lengths of stay were longer than expected. These findings were apparent when the hospitals were examined in aggregate and within individual institutions. No consistent differences in death rates were apparent. Possible explanations for these results are discussed. From our data, we conclude that patient race remains a potentially significant characteristic in determining the intensity of care provided to patients in hospitals, which is not explained by differences among racial groups in health status, source of payment, or site of hospitalization.

Black or African American↗
PubMed1992

Evaluation of emerging technologies for coronary revascularization. Participants in the National Heart, Lung, and Blood Institute Conference on the Evaluation of Emerging Coronary Revascularization Technologies.

Despite significant advances in coronary angioplasty, the problems of restenosis, chronic total occlusion, diffuse disease, and abrupt closure after the procedure remain to be solved. New devices that address these problems continue to evolve. Although a controlled clinical trial is the ultimate test of any device, rapid device design changes and resource limitations require evaluating which of the new devices justify a full clinical trial. A registry mechanism for this initial evaluation is proposed and detailed. Payment for procedures using new devices is a problem for industry, insurers, hospitals, and physicians. It is proposed that reimbursement be based on the service performed rather than the device used to perform it. Costs beyond the clinical costs should be borne by the sponsor of the device. Financial conflict of interest is a recognized problem in new device evaluation. It is not always practical to insist on exclusion from the evaluation process of individuals with a financial stake in the outcome, but disclosure of the presence of such a financial interest is recommended in the reporting of results.

Angioplasty, Balloon, Coronary↗