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PubMed1984

An evaluation of subsidized rural primary care programs: III. Stress and survival, 1981-82.

Surveys of a national sample of 193 subsidized rural primary care programs were conducted in 1981 and 1982 to determine what adaptations the programs might anticipate making given a reduction in their subsidy and what actual changes they made after the implementation of new federal policies and in the face of severe economic recession. During the period between the two surveys, nine of the 193 programs closed. The remaining programs changed elements of their operation, finances, and staffing, but these changes do not, in all cases, appear to be a direct response to subsidy reductions or increases. The programs exhibited adaptiveness and strength in the face of a potentially hostile environment.

Financing, Government↗
PubMed2002

Millions of mothers lack health insurance coverage in the United States. Most uninsured mothers lack access both to employer-based coverage and to publicly subsidized health insurance.

Some 5.9 million American mothers caring for young or school-aged children lack health insurance. Although nearly nine in ten uninsured mothers are members of working families, most lack access to affordable coverage through their job or a spouse's job. Most are ineligible for publicly subsidized coverage unless their incomes are far below the poverty line. The millions of uninsured mothers are at high risk of going without needed preventive and primary care. If they become seriously ill, their families can face the prospect of a financial crisis. The nation has made significant progress in extending health care coverage to children in low-income families through Medicaid and the State Children's Health Insurance Program (SCHIP), but no comparable effort has been made to insure the mothers of these children. A few states have started to address the problem by transforming their SCHIPs into family-based programs that also cover low-income parents. Bipartisan legislation under consideration, known as FamilyCare, would encourage this trend by providing more federal funding to states that could be used to extend health insurance to the parents of children already covered by publicly funded programs.

Adult↗
PubMed1992

Hidden costs of mobile mammography: is subsidization necessary?

Two major impediments to an effective mammography program are inaccessibility and cost. This article itemizes the expenses associated with providing a mobile screening program accredited by the American College of Radiology (ACR) during a 3-year period. Mobile Diagnostics Inc. established a mobile mammography service in April 1987. A 36-ft (11-m) van is staffed by two registered technologists. The unit includes on-board processing and educational videotapes. Analysis of expenses for the years 1988, 1989, and 1990 does not include interpretation fees. A total of 3522 patients were examined in 1988, 4232 in 1989, and 5005 in 1990. Fixed operating expenses in 1988 were $70/examination and variable expenses were $13/examination, resulting in an average total cost per examination of $83. Fixed costs in 1989 were $63, variable costs were $15, and total costs were $78 per examination. Fixed costs in 1990 were $55, variable costs were $14, and total costs were $69 per examination. Many third parties, including Medicare, are contemplating a global screening fee in the $50-$60 range. An average payment of $55 would require examination of more than 6500 patients a year or 28 patients a day to break even. Our experience suggests that some form of subsidization may be necessary to sustain a mobile mammography service at those reimbursement levels.

Costs and Cost Analysis↗
PubMed1998

Subsidence of seizure induced by stereotactic radiation in a patient with hypothalamic hamartoma. Case report.

The authors report on a patient who exhibited intractable epilepsy due to an inaccessible hypothalamic hamartoma and subsequently underwent stereotactic radiosurgery. This 25-year-old man had a 24-year history of intractable gelastic and tonic-clonic seizures. Magnetic resonance (MR) imaging performed at examination as well as that performed 30 months earlier demonstrated a nonenhancing and nonprogressive spherical mass, approximately 10 mm in diameter, located on the patient's right side at the floor of the third ventricle. Focal radiation treatment performed with a gamma knife unit administered 36 Gy to the center and 18 Gy to the periphery of the lesion. This treatment resulted in an improvement in seizure control. Before the patient underwent radiosurgery, he suffered from three to six generalized seizures per month in spite of attentive compliance with an anticonvulsant medication regimen. After irradiation of the harmatoma, the frequency of the seizures transiently increased and then subsided 3 months posttreatment. The patient has been free of seizures for the last 21 months, with no neurological or endocrinological complications. Magnetic resonance imaging performed 12 months posttreatment demonstrated complete disappearance of the lesion.

Adult↗
PubMed1982

Strategic piggybacking--a self-subsidization strategy for nonprofit institutions.

Nonprofit institutions often find that their socially worthwhile primary missions generate deficits. The author proposes a strategy for funding these shortfalls that is a synthesis of the specialization and diversified portfolio strategies. Following the method of strategic piggybacking, an organization should acquire or develop a business that is new for the institution and that may be unrelated to the institution's primary mission. The purpose of this new activity is to subsidize, at least in part, the deficit-producing primary mission.

Health Facilities↗
PubMedDate not supplied

Studies of the maintenance of subsidized foster placements in the Casey Family Program.

The Casey Family Program provides a planned, long-term approach to subsidized foster care for the underachievers of the child welfare system. Its concept is a marriage of what foster care professionals know about effectively helping children and what managers know about effectively running organizations. The purpose of our studies of The Casey Family Program was to determine whether the outcomes of its foster placements were predictable from factors that could be known, at least in principle, at the time the placements were made. We built statistical models of placement maintenance based upon characteristics of (a) the foster child; (b) his or her biological family; and (c) the foster family. We used two main sources of data to construct models: archival material on the child and his or her biological family, and caseworker ratings of various aspects of the child and his or her foster family. Information was derived from a sample of 51 children served by the Montana Division of The Casey Family Program to build the models, which in general provided accurate predictions of placement outcomes. The models were then cross-validated with a sample of 55 children from the Idaho Division. There was a substantial amount of shrinkage in the variance accounted for in the cross-validation sample, but outcomes remained largely predictable. To determine whether predictions of placement outcomes could be based upon brief assessments of factors that could be evaluated at the time placements were made, a third study was undertaken. The results of that study implied that ratings of salient characteristics of foster children and foster families based upon as little as a single day's observation could be used to effectively predict placement outcomes. Several aspects of these studies deserve special emphasis. First, the research confirmed that the children served by the Montana and Idaho divisions of TCFP were among the underachievers of the child welfare system whom Jim Casey desired to reach. It also confirmed that the Montana and Idaho divisions were doing an effective job of serving those children. Their placements were generally stable and both foster children and foster families were rated as functioning at levels that ranged from acceptable to good.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗
PubMed1993

[Development of use of subsidized prescription drugs. A comparison of drug consumption requiring subsidy in the county of Storstrøm during the periods 1 January--30 April 1991 and 1 January--30 April 1992].

In all counties in Denmark, the consumption of subsidized prescribed drugs is registered. The drugs are listed in accordance with the international anatomical-therapeutical-chemical classification system and the consumption is listed in defined daily doses and prices. Comparing the first four months of 1991 with the first four months of 1992 in a Danish county (Storstrøms Amt) shows a general increase in the amount of prescribed drugs (mean 11.0%). Ulcer-drugs, antihypertensiva, antibiotics and analgetics have increased more than 20%. The increase in prices has been 3.8%. It is concluded that these sort of statistics justify the debate on drug prescriptions and act as a tool for monitoring drug prescriptions in general practice for wanted groups of drugs. Further refinements of the statistics can be made. The increase in county grants in "running prices" has been nearly constant over the last ten years, except for 1990 due to the introduction of a special law.

Denmark↗
PubMed1993

Subsidence, tip, and hump micromovements of noncoated ribbed femoral prostheses.

The micromovements of 18 ribbed femoral prostheses were measured for two years postoperatively. Repeated roentgen stereophotogrammetric examinations (RSA) were used to measure distal migration of the center of the prostheses and movements of the prosthetic hump and tip. During the first six postoperative months, an increasing number of prostheses migrated significantly. Migration was first observed at the tip. Two years after the operation, one prosthesis had been revised because of pain. Thirteen of 17 remaining prostheses had subsided, 12 displayed hump and 16 tip migration, and eight had rotated about the longitudinal axis of the femur. In these hips, the instant center of rotation ran obliquely through the greater trochanter or the isthmus of the femur. Clinical follow-up examination and measurements on conventional roentgenograms disclosed a correlation between pain, the extent of sclerosis surrounding the prostheses, and the distal migration according to RSA measurements.

Adult↗
PubMedDate not supplied

Health care access of poverty-level older adults in subsidized public housing.

OBJECTIVE: To assess the health status, access and use of health care and unmet health care needs of poverty-level residents of the Seattle Housing Authority over the age of 62. METHODS: An in-person interview survey of a quota sample of community residents. RESULTS: About half of SHA residents reported problems accessing care and sixteen percent reported being denied care. Multivariate analysis showed that encountering barriers of health care use were associated with having insufficient funds for monthly living expenses and lack of transportation. Over 90% of the population knew where to seek health care, so knowledge about sources of care did not appear to be a barrier. SHA residents met or exceeded national goals for completion of six out of nine recommended exams and procedures. SHA residents had unmet needs for services not covered by Medicare or provided by visiting nurse services. CONCLUSIONS: The results suggest that SHA residents know how to access medical care, and that visiting nurse services may be remarkably effective in meeting some medical care needs of SHA residents. It appears access to care by residents of subsidized housing could be improved by addressing transportation and financial barriers, and by providing more services to residents on site.

Aged↗
PubMed1996

Fatigue properties and stem subsidence in wire coil reinforced PMMA bone cement: a preliminary in vitro study.

The longevity of the cemented total hip joint replacement depends on the integrity of the cement fixation with respect to the interfaces of the metal stem and bone, and stress/strain transmission and its distribution. A simple stainless steel wire coil was placed around a tapered stem in a simulated cement mantle to counteract radial- and hoop-stress and dynamic compression-compression tests were performed. The results showed that the wire coil reinforced cement group had a higher fatigue (30%) and strength (35%) up to 10(5) loading cycles. The amount of stem subsidence during fatigue tests of the wire reinforced group was significantly reduced (2.5 times) compared with the control group.

Bone Cements↗
PubMedDate not supplied

Subsidized dental care for young men: its impact on utilization and dental health.

An important part of Norwegian welfare policy is provision of free dental care for children up to the age of 18. After that age some counties have introduced a public subsidy scheme for young people aged 19-20 years, where 75% of their dental care expenses are covered. After the age of 21, all patients have to pay the costs for dental care themselves. The focus of the present work was to examine the effect that the public subsidy scheme for young adults had on demand for dental care, and its effect on dental health. The analyses were performed on 2 extensive sets of survey data. The major finding was that the public subsidy scheme had no effect on demand for dental care. In addition, there was no relationship between whether these young adults were covered by the subsidy scheme and dental health.

Adolescent↗
PubMed1999

Examining the adequacy of quantities available for subsidized antidepressant prescriptions in Australia.

In Australia the Pharmaceutical Benefits Scheme (PBS), a national drug insurance plan, aims to provide around a month's therapy for medication used in chronic conditions. However, there are marked differences among the most commonly used antidepressants in the number of days supply represented by the PBS maximum quantity after adjustment for the defined daily dose (DDD). The DDD is the assumed adult daily dose for a drug and is a WHO drug utilization standard. Whereas the selective serotonin re-uptake inhibitors (SSRIs) and moclobemide largely provide around a month's supply at the DDD, most tricyclic antidepressant (TCA) items provide considerably less than this .A patient tracking study was conducted to determine the average length of time between prescription re-supplies for a number of tricyclic antidepressants and newer antidepressants as a means of measuring the efficiency of PBS supply for the different classes of antidepressant. The number of days between dispensings was similar for patients no matter whether they were taking TCAs, SSRIs or moclobemide, although for the older antidepressants presumably at a much lower prescribed daily dose than the DDD. Care needs to be taken when adjusting usage with the DDD/1000/day unit of measurement in cases where the DDD does not reflect the prescribed daily dose (PDD).

Journal Article↗
PubMed2000

Cross-subsidization in the market for employment-related health insurance.

This paper uses data from the 1987 National Medical Expenditure Survey to examine the nature of equilibrium in the market for employment-related health insurance. We examine coverage generosity, premiums, and insurance benefits net of expenditures on premiums, showing that despite a degree of market segmentation, there was a substantial amount of pooling of heterogeneous risks in 1987 among households with employment-related coverage. Our results are largely invariant to (i) firm size and (ii) whether or not employers offer a choice among plans. Our results suggest the need for caution concerning incremental reforms that would weaken the link between employment and insurance without substituting alternative institutions for the pooling of risks.

Adult↗
PubMed1993

Factors associated with the choice of Norplant by women attending subsidized clinics in the US.

US women attending family planning clinics in Texas, were surveyed to determine which characteristics, experiences, behavior and specific needs were associated with the selection of the contraceptive Norplant. Race, ethnic origin, age and education were unrelated to choice of method. Increased numbers of previous pregnancies, familiarity with the method, dissatisfaction with previous methods, and sources of information about Norplant were associated with its selection. There was significant variation among the clinics in the proportion of patients to which they dispensed the method. Therefore, clinic selection may have influenced the outcomes of contraceptive decisions.

Adolescent↗