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Health services, health status, and work loss.

The numbers of workdays lost because of illness, coupled with records of health service utilization patterns, were studied to establish possible links between health status and different forms of prepayment coverage. The records of industrial workers at four branches of the same company were analyzed. Records of employees with broad-benefit coverage were compared with those who had less-comprehensive indemnity coverage. A free choice of providers was available to the study population. Data for workers covered by the broader plans revealed fewer medical admissions to hospitals, more surgical admissions, and more outpatient physician visits. As hypothesized, their number of days absent from work were lower. Because few of these results were statistically significant, caution is necessary in their interpretation. Some aspects of the project warranting further consideration are discussed. Data suggest a positive correlation between breadth of health plan coverage and health status, with possible economic benefits to be derived from such coverage. The data also indicate the desirability of additional investigations to be based on employers' and health plan records, that involve other types of populations and other benefit options.

Absenteeism

The fate of mental health services in health care reform: I. A system in crisis.

The U.S. health care system is in the midst of a severe crisis. More than 50 million Americans are uninsured or underinsured. Medicare and Medicaid are not adequately serving populations in need. Analyses and reform proposals are often based on biased interpretations of data, resulting in confusion and heated debate. To avoid jeopardizing psychiatric care in a national health care reform movement, we must understand the causes of the national crisis. In the first part of a two-part paper, the author describes factors such as demographic trends and limitations in public health coverage that have contributed to the crisis. Outcomes of the current system include higher morbidity and mortality among the uninsured and a high prevalence of untreated illness. The author reviews direct and indirect costs of health care and concludes that in attempts to solve the difficult equation of access, cost, and quality, mental health services are in serious jeopardy.

Cost Control

The fate of mental health services in health care reform: II. Realistic solutions.

In the second part of a two-part paper, the three major proposals for U.S. health care reform--the government-sponsored model, the employment-based model, and the market reform model--are reviewed. Barriers to their success include the current economic crisis, the lack of a clear consensus, and the high costs of the proposals. Most proposals limit the extent of psychiatric coverage; some exclude such coverage from minimum benefit packages, an area of concern for clinicians. The author concludes that any substantial health care reform is unlikely in the near future. A thoughtful, realistic, and yet vigorous strategic plan is needed now to forestall the possible exclusion of significant mental health coverage. The basic elements of such a plan are reviewed.

Cost Control

[Study on availability of dental health services for children in health center--correlation between attendance of 3-year-old children at dental health services and caries prevalence].

The purpose of this study was to evaluate the dental health services for children in a health center. The samples were 316 children who had 3-year-old dental examination at a health center in Tokyo. The analysis was carried out by a computer using the results of the children's oral status and of their mothers', questionnaires and past records showing when and how many times they had attended such activities. The results were as follows: 1. Attendance of children at dental services showed the effectiveness in preventing dental caries, and it was suggested that attendance at least 3 times before the age of 18 months should be the most effective way to decrease the dental caries in the 3-year-olds. 2. According to the questionnaires, time of going to bed, snacks time, and the habit of thumb-sucking at the age of 3 years, and stopping the habit of bottle-feeding and of night breast-feeding at 18 months of age showed a great correlation concerning the number of dental caries in the 3-year-olds. 3. The more often the children had attended the dental services, the more often their behavior for eating snacks and toothbrushing changed for the better. 4. The more the mothers had dental caries, the more was the number of dental caries in their children and moreover their attendance at the dental services was less.

Adult

A survey of mental health service coverage within health maintenance organizations.

This 1978 national survey of all operating Health Maintenance Organizations (HMOs) provided information on the current status of mental health services utilization and service coverage within HMOs. It achieved a 68 per cent response rate. Approximately 90 per cent (108) of the HMOs offered mental health services through basic or supplemental coverage plans; HMO organization characteristics reflected relative heterogeneity; the mean monthly costs for basic health plan coverage (physical and mental health services) were $33.85 (for individuals) and $95.15 (for families); HMOs reported lower physical and mental health hospital utilization and higher ambulatory utilization when compared to more traditional forms of health insurance coverage. The present coverage and uitlization of mental health services within HMOs reflect greater variability of benefits and utilization within HMOs. There is need for further studies of mental health utilization in relation to organizational structure and delivery pattern relationships within HMOs.

Delivery of Health Care