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PubMed1981

Size of households and income disparities.

The author examines "the relation between differentials in size of households, (preponderantly family households including one-person units) and disparities in income per household, per person, or per some version of consuming unit." The analysis is based on data for the United States, the Federal Republic of Germany, Israel, Taiwan, the Philippines, and Thailand.

Demography↗
PubMed2002

Behavioral health and managed care contracting under SCHIP.

This Policy Brief examines behavioral health managed care contracting under separately administered State Children's Health Insurance Programs (SCHIP), i.e., programs that operate under the direct authority of Title XXI of the Social Security Act rather than as expansions of Medicaid. Most separate SCHIP programs buy managed care style health insurance for some or most of their enrolled children. Because Title XXI provides states with far greater administrative flexibility than Medicaid with respect to coverage and benefit design, provision of services, and administration of managed care arrangements,studying separate SCHIP managed care products sheds important light on how states might approach insurance and managed care design generally in the area of behavioral health were Medicaid modified through section 1115 demonstration or federal statutory authority to permit greater latitude. To conduct this analysis, two nationwide databases maintained by the George Washington University Center for Health Services Research and Policy (CHSRP) were used: a database consisting of all Medicaid MCO-style managed care contracts in use in Calendar Year 2000; and a nationwide database consisting of contracts used by separate SCHIP programs for the same calendar year. As of the point of collection in 2000 there were 33 such separate programs; according to CMS' latest website information, that total has now reached 35. Both sets of contracts were analyzed and separated into their components by lawyers experienced in managed care contract analysis and interpretation. The data were entered into working tables that organize the contents of the contracts into a series of searchable domains.

Child↗
PubMed2003

Unmanaged care: towards moral fairness in health care coverage.

Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.

Actuarial Analysis↗
PubMed1991

Dilemmas surrounding the identification of essential rural hospitals.

Criteria are needed for use in designating some rural hospitals as essential so that they may receive state or federal assistance. Three types of criteria are considered in this analysis: hospital volume measures, hospital competitiveness measures, and community need measures. The criteria sets reflect different assumptions about the relationship between need and demand for health services. Analysis of available data reveals that neither hospital volume nor competitiveness is correlated with community need, meaning that different hospitals would be designated as essential under each system. Implications are discussed.

Bed Occupancy↗
PubMed1990

[Epidemiologic studies of various forms of meningitis based on public health reports in West Berlin from 1981 to 1985].

In the Federal Republic of Germany, four types of meningitis must be reported since 1980 instead of the previous two categories (i.e. meningococcal disease and other forms of meningitis). Consequently, various forms of purulent meningitis can be differentiated from viral meningitis. A retrospective study, considering the population of West Berlin, carried out between the years 1981 and 1985, shows the influence of age, nationality and living areas on morbidity and mortality rate. A critical evaluation was undertaken, considering possible changes in management efficiency of public health authorities since the introduction of the new reporting system. Population at high risk, predisposed to develop meningococcal meningitis, are mainly Turkish children living in areas of high population density and poor social structure. The activities of the public health administration seem inadequate. The reported meningitis cases were partly filed wrongly and thus were transmitted wrongly to the Federal Office of Statistics (Statistisches Bundesamt). No substantial scientific epidemiological analysis was performed. The most frequent reaction of public health authorities was disinfection of apartments, day-care centres and schools, as done for example in 67% of the reported meningococcal meningitis cases, although it is well known that there is no reason for room disinfection in droplet-transmitted infection of the nasopharyngeal mucosa. As shown by our results, the differentiation of the reporting system in use since 1980 did not prove advantageous considering the health policy and epidemiological research of prevention in our study area. Disinfection measures are obsolete.

Bacterial Infections↗
PubMed1990

Vulnerability in research: a developmental perspective on research risk.

Assessing potential risks to children who participate in developmental research is a challenging task because children are a heterogeneous population, varying in developmental competencies and in background characteristics. This essay offers a developmental perspective on research risk, emphasizing that children's vulnerability to research risk changes in complex ways: some risks decrease with increasing age, some increase as the child matures, others change in a curvilinear fashion, while some remain essentially stable with development. Because vulnerability in research does not simply decline linearly with age, assessments of research risk must entail multidimensional considerations that vary over developmental time. In a similar manner, individual characteristics of children at any age (e.g., maltreatment, at-risk status, etc.) may also heighten their vulnerability to certain risks which require special consideration by researchers. Finally, this discussion of developmental vulnerability and the principles underlying research ethics suggests that in addition to the conventional risk/benefit analysis, researchers are in an optimal position to establish and maintain standards of decent treatment of children in research that safeguard their rights as research participants. Suggestions for fostering this process in the research community are outlined.

Adolescent↗