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At least 19 recordsLinked to original sources
PubMed1978

Private health insurance plans in 1976: an evaluation.

Private health insures collected a record $39.4 billion in premiums and returned $35 billion in benefits to their subscribers in 1976--a reflection of the steadily rising cost of health care, higher utilization, and the demand for expanded services. The industry experienced a net underwriting loss of $611 million, mainly because claims and operating expenses under insurance-company group business ran 3 percent above premium income. About 77 percent of the civilian population had some form of private hospital insurance, and about the same percentage had some form of surgical insurance. Lesser proportions were covered for other types of care. An estimated 12--13 percent of the population under age 65 had no economic protection against the costs of illness or health-related care--under either a private insurance plan or public program. Although virtually all of the aged were covered by Medicare, some 13--15 million bought private insurance, most of it under plans that covered some or all of the gaps in the Federal program.

Age Factors↗
PubMed1989

[Resection and reconstruction of the carina with separate two-lung high-frequency jet ventilation].

Carinal resection and reconstruction via a right transpleural approach in an hypoxemic patient provides difficult maintenance of satisfactory gas exchange when one lung ventilation is inadequate. The present case report concerns a 62-year-old patient with chronic obstructive airways disease and a carinal squamous cell carcinoma. He underwent tracheobronchial reconstruction surgery by Barclay's procedure through a right postero-lateral thoracotomy. During resection and reconstruction phases, the gas exchange was maintained by a new technic: high-frequency-jet-ventilation (HFJV) with two small-bore catheters through the endotracheal tube and JVHF ventilators adjusted to the compliance of each lung (high for the right lung, low for the left one). No circulatory changes were observed during the sutures lines phase (90'). The oximeter and the arterial blood gas values show an adequate procedure. The immediate post operative period was unremarkable and uncomplicated. The histological diagnosis was squamous cell carcinoma involving the carina with one metastatic pretracheal lymph node and microscopic infiltration of the left main bronchus resection margin. Sixteen grays postoperative radiotherapy was required. Ten months after the patient is alive, without tumor recurrence. HFJV greatly facilitates surgery by avoiding endobronchial intubation with large cuffed tubes into the surgical field. In patients with low pulmonary reserve, bilateral lung HFJV is required: two JVHF ventilators with different ranges delivering separate ventilation to the right and left lungs avoid left hypoventilation and right surgical emphysema and insure good surgical conditions.

Anastomosis, Surgical↗
PubMed1978

[Insuring the possibility of surgical interventions on the "dry" liver under experimental conditions].

Experimentally on 116 dogs it has been found that intravascular shunts of a big diameter or those controlled by means of extracorporal shunts ensure stable hemodynamic indices, approximately the initial ones. The isolated hypothermal perfusion protects, in its turn, the liver from an ischemic trauma and prolongs the safety period of the liver blood flow break to 40 minutes and more.

Animals↗
PubMedDate not supplied

[Damage through surgical risk. A persistent challenge].

No surgical act is innocuous and a complication is not inevitably the result of a mistake. Improved definition of the risk involved should allow a new approach to compensation for damages to be envisaged. Publicly or privately sponsored mutual insurance is worth considering for application of the single European act. Without questioning the concept of professional responsibility, a response should be prepared adapted for damages due to medicosurgical accidents for which a fault cannot be demonstrated. By stimulating enlightened reflection, the present study should allow acceptance of this persistent challenge.

France↗
PubMed1975

Comparison of provincial surgical rates in 1968.

Studies have been made of age- and sex-adjusted 1968 provincial rates for individual surgical procedures. For elective and discretionary operations, such as tonsillectomy and adenoidectomy, hysterectomy, vein stripping and lens extraction, provincial rates varied by approximately 100 percent. Newfoundland, with few surgeons and hospital beds, had the lowest discretionary rates, and Alberta, which ranked hgih both for surgeons and hospital beds, the highest. Interprovincial differences were of smaller magnitude for non-discretionary surgery (radical mastectomy, cesarean section, colectomy., lobectomy, etc.). Ther were statistically significant correlations between numbers of surgeons and elective and discretionary surgical rates and between numbers of hospital beds and bed use in the provinces. The effect of disease prevalence on discretionary surgical rates was minimized because the rates were age- and sex-adjusted. Provincial organization of, and payment for, medical services has been similar. Hence, the ratio of surgical personnel to population in each province is postulated as a major determinant of the differing interprovincial rates.

Age Factors↗
PubMed1985

Physician DRGs.

DRG-based reimbursement for inpatient services is an option currently being considered by federal policy makers, but little is known about how physician DRGs might work. We performed simulations of potential impacts, using Medicare claims from four states. Although physician-related inpatient costs associated with surgical DRGs were quite homogeneous, those associated with medical admissions varied dramatically. This suggests that DRG payment could be a lottery, with inequitable losses for some physicians and windfall gains for others. Potential gains and losses were also found to be systematically related to the specialty of the attending physician. General practitioners and ophthalmologists would gain financially on average, whereas medical specialists and some surgical specialists would incur net losses. These differences may be due to the triaging of more seriously ill patients within a given DRG to certain specialists.

Costs and Cost Analysis↗
PubMed1985

The teaching hospital's growing surgical caseload.

A competitive marketplace potentially creates new pressures for teaching hospitals. To assess possible trends in teaching hospitals' caseload, we studied surgical utilization in 1972 and 1981 using two national data sets. The percentage of total patients hospitalized for surgery increased in teaching hospitals between 1972 and 1981. Nonteaching hospitals adopted several new procedures, such as hip arthroplasty. However, increased volume attributable to the spread of procedures to additional hospitals was small when compared with volume increases experienced by hospitals that performed these procedures in 1972. Teaching hospitals' caseloads grew for well-established surgical procedures such as cholecystectomy, delivery, and mastectomy and for newer, high-technology procedures such as hip arthroplasty and coronary artery surgery. Overall surgical case complexity was relatively high in teaching hospitals in 1972, and the disparity with nonteaching hospitals increased during the decade. Distribution of surgical patients by payment source varied appreciably among surgical procedures, but not among hospitals by teaching status. Teaching hospitals were successful in attracting patients from 1972 to 1981; however, several new pressures are emerging that should be watched.

Commission on Professional and Hospital Activities↗
PubMed1987

An access-oriented negotiated fee schedule. The Caterpillar experience.

This paper describes the system used by Caterpillar Corporation (CAT) in Peoria, Illinois, to reimburse surgeons. The CAT system assures access for Caterpillar employees and their families to a selection of qualified surgeons, while achieving cost savings through improvements in processing of surgical claims and negotiation of selected fees. CPT-4 codes are recorded for greater accuracy, when indicated, surgical services that have been incorrectly unbundled are rebundled, and the appropriateness of surgical assistant charges is reviewed. A "degree of difficulty" relative value scale (DODRVS) of surgical services is periodically revised as technology changes. The DODRVS multiplied by a regional factor, determined by local market research, establishes the fee that CAT will pay the surgeon. Balance billing is permitted if the patient (1) is informed in advance by the surgeon that the fee will be higher than CAT will pay, and (2) knows that the service can be obtained from other local surgeons who will accept the CAT fee. The goal of the CAT method of surgeon reimbursement is to gain physician support for an access-oriented, market-driven negotiated fee schedule. Compared with a resource-based relative value scale RBRVS) methodology, the CAT system is not formula-driven and depends on physician acceptance.

Fee Schedules↗
PubMed1988

Fine-needle aspiration cytology of mesenchymal tumors of the breast.

This report describes the fine-needle aspiration (FNA) cytologic findings of 15 cases of sarcomas involving the breast out of a combined series of 2,064 breast FNA biopsies, including 580 malignancies, thereby accounting for 2.6% of all the malignant breast tumors. The series consisted of 14 women and one man with a mean age of 48.4 yr (range, 29-63). There were eight cases of cystosarcoma phyllodes, including one malignant cystosarcoma phyllodes. Three benign cystosarcoma phyllodes had a significant concomitant atypical epithelial hyperplasia, which lead to a misdiagnosis of carcinoma in two of the cases. The third case was correctly identified as recurrent cystosarcoma phyllodes. In retrospect, features suggestive for cystosarcoma phyllodes and unusual for breast carcinoma include increased numbers of naked nuclei and hypercellular stromal fragments. Sarcomatous patterns in our four metaplastic carcinomas included chondrosarcoma (two cases), malignant fibrous histiocytoma (MFH) (one case), and fibrosarcoma (one case). Two additional pure primary MFHs (both of which had electron microscopic confirmation) and one metastatic fibrosarcoma to the breast were encountered. Recognition of unusual cytologic patterns for breast carcinoma should suggest the possibility of a primary or metastatic sarcoma to the breast. Potential pitfalls for misdiagnosis include the presence of atypical epithelial hyperplasia in some cases of cystosarcoma phyllodes, along with occasional cases having patterns indistinguishable from a fibroadenoma. The pleomorphic and bizarre cellular features can suggest the diagnosis of metaplastic and pure sarcomas of the breast, although the potential exists for confusion with very poorly differentiated carcinoma. FNA diagnosis of sarcomatous lesions of the breast is essential in order to insure proper surgical treatment.

Adult↗