Comparison of public/private health care insurance parameters for independent psychological practice.

Managed care cost-cutting strategies are more prevalent in the private (employer provided) than public (Medicare/Medicaid) health care sectors. The main organizational managed care strategy pertaining to the independent practice of psychology has been the separation of the administration of mental from medical health care though behavioral health carve-outs. These organizations typically offer lower reimbursement rates and have greater preauthorization requirements than non-managed care public plans for the same psychological service. Dispute resolution in the private sector involves lawsuits and state consumer protection programs while public plans utilize internal review and are subject to investigations of provider billing fraud and abuse. Behavioral health carve-outs have reduced mental health care utilization rates with unknown effects upon outcome. There is some evidence that psychologists have chosen to limit practice within the private sector, but national data on the overall effect is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The physicians and abortion

The position of physicians regarding induced abortion in Mexico deserves closer attention. The attitudes of physicians towards induced abortion have been a subject of study in different countries. It has been observed that such attitudes depend on ethical, religious, legal, political, or medical factors. In those countries where abortion is not penalized, physicians sustain different positions regarding this issue. The experiences of some countries indicate that the institutional provision of abortion services is a controversial and politically serious matter, and that offering or denying them generally depends to a great extent on the physician's discretion. In contexts like Mexico, where abortion is penalized, legal and other restrictions do not prevent many physicians from practicing it in a concealed way, generally for profit. On the other hand, even though abortion is recognized as an important social and public health problem, and laws regulate the conditions for its legal practice, the majority of medical professionals and health institutions maintain a conservative and reserved position on this matter. The professional training of physicians and the legal status of induced abortion as a criminal practice, are central elements in their attitudes towards this problem.     

Keeping our elderly out of institutions by putting them back in their homes.

Public assistance for elders' health care often refuses to pay for needed medical treatment in the community, forcing elders into institutions, even when inappropriate. Increasing life expectancy has increased demand for intensive health and personal care services; and, while there has been increased federal support for home and community care, serious gaps are evident in acute and long-term care. Both financial and humanitarian considerations call for greater emphasis on home and community care, including provision of nonmedical in-home services, adult day health care, respite services for caregivers, and improved quality assurance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lipids from Mycobacterium leprae cell wall suppress T-cell activation in vivo and in vitro

The need for an ethics of medical justice in Latin America is asserted in the context of a review of concepts of justice throughout history and of changing governmental perspectives on provision of health care in the US and other developed countries. The current view that individuals are primarily human resources is at odds with a long tradition asserting the intrinsic dignity of human beings. English-speaking bioethicists began in the 1960s to stress the principal of autonomy of patients, recognizing their right to make decisions on their own lives and medical care equally with the physician. At the same time, the US has approved no legislation establishing a right to health care, which is rather regarded as a private good. Governments are increasingly inclined to renounce their role as direct providers of health care. The liberal democratic state until recently understood that it fulfilled its ethical commitment to promoting social justice through provision of health care. Nevertheless, societies that stress the importance of the individual in decision-making and that conceive of health as a private good are confronted with the contradiction of apparently irreconcilable visions. With infinite demand for health services and limited health resources, the discourse of autonomy has slowly been replaced by a discourse of distributive justice. The most appropriate version of distributive justice for Latin America is probably that which affirms the duty of assisting those most in need. The prevalence of malnutrition, misery, and premature death in the world is a clear sign of imbalance. If the essential dignity of all human beings and not just of the elite is to be affirmed, medical justice must become the most urgent priority of Latin America.     

In vitro metabolism of cyanohydroxybutene: formation of a glutathione-S-transferase catalyzed product

This paper examines the financing of elderly health care in Japan for medical institutions, nursing homes, and at home. The analysis demonstrates that the conventional figures for elderly health expenditures in Japan systematically underestimate the real costs by excluding the costs of uninsured services, nursing homes, and home health care. The paper estimates these costs and shows that they add about 10% to the conventional figure for elderly health care costs in Japan. This inquiry also shows how government policy for health care financing shaped distinctive Japanese patterns of elderly care provision. The financing system provided a hidden subsidy--through national health insurance coverage of long-term hospitalization--that encouraged high institutionalization rates of elderly in medical facilities. Public financing for long-term elderly hospitalization, however, has not been matched by government attention to quality of care, resulting in serious quality problems and reflecting a social trade-off between cost and quality. Also, until recently the financing system rarely reimbursed home health care, thereby creating strong disincentives to the development of formal home health care services. This analysis has important implications for reforms now being considered by the Japanese government in the financing and provision of health care for the elderly, especially the limitations of relying on reimbursement price policy. The reforms could have unintended negative consequences for equity, efficiency, and quality of care.     

Examples of foreign countries

In France we are not well aware of the health of people in situation of poverty: they have not resources enough to care of oneself, not knowing the services of social welfare, and not identified by these services. 1) Some studies in Great Britain and in U.S. have followed up some deprived groups with health index on a long duration: life expectancy at birth, number of stillbirths in the group, low birth weight, casualty during childhood, violent deaths among teen agers and young men. Disparities between rich and poor are dramatic, unskilled men have a mortality three times that of professional men; advantage is given to people who had had some education and a steady family home during childhood, compared with those who have not. 2) In France investigations have been more accurate on the health of deprived individuals: where are they taken care of, who cures them for which diseases? According to the results, they are not abandoned. Places for reception and care are many, the public institutions welcome them even without social security guarantee, almost a hundred non profit associations may help them: these discreet institutions are poorly known even by the public administration.     

A health care system of one.

Health care has been, and to large measure remains, an enormous collection of considerably independent professionals, freestanding institutions, highly individualized consumer demands, and laws that vary considerably state by state. To a great extent, health services in the US have been organized and offered as an exchange between individuals, and American practitioners and patients have valued this independence. Over the past decade and a half, however, we have begun to recognize that provision of health care on an individuated basis comes at an enormous cost. Beyond simply the economic cost, there is the growing realization that the "independent" nature of the actions taken by the individuated sectors of our health system can often be characterized as idiosyncratic, unmanaged, uncoordinated, and irrational. One small but critical step toward improving the fractious nature of our health system is to advance the cause of states recognizing the professional licensure of health professionals by other states. Such mutual recognition, long overdue, promises real benefits for patients and, in the long run, for professionals as well. Professional bodies both private and public should focus on patients and their needs when considering any regulatory changes to be made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The activity of trypsin and proteolytic inhibitors in complicated forms of appendicitis in children

Adequate policy of price formation is one condition for effective development of public health under conditions of market economy. The authors present the fundamentals of price formation in public health under conditions of state financing, insurance, and self-support. Price formation should promote the activities of public health institutions, aimed at improving the quality of medical aid to the population and at the creation of conditions for the welfare of medical workers.     

Trends in medical care costs--evolving market forces

Slower growth in medical care costs has been the culmination of lower inflation and significant changes to the U.S. health care system, primarily the movement toward managed care. National health expenditures rose just 4.4 percent in 1996 - the smallest growth since the beginning of the national health expenditure data series. This is also true for the 35 percent gain recorded during 1992-96. The medical care Consumer Price Index (CPI) rose just 2.8 percent in 1997 and was only one-half of a percentage point above the overall CPI. The reduction in spending growth is most evident in hospital expenditures, which clearly reflects the expansion of HMO enrollment in both the private and public sectors. While the issue of quality of care is receiving more attention, this is unlikely to alter the basic direction of health care in the near-term. Cost is likely to remain a dominant factor in shaping the market forces that have significantly changed the delivery and financing of health care. Although trending upward, growth in medical spending is expected to remain relatively moderate as we move into the next century.     

The growth of corporate private hospitals in Malaysia: policy contradictions in health system pluralism

The rapid growth of corporate investment in the Malaysian private hospital sector has had a considerable impact on the health care system. Sustained economic growth, the development of new urban areas, an enlarged middle class, and the inclusion of hospital insurance in salary packages have all contributed to a financially lucrative investment environment for hospital entrepreneurs. Many of Malaysia's most technologically advanced hospitals employing leading specialists are owned and operated as corporate business ventures. Corporate hospital investment has been actively encouraged by the government, which regards an expanded private sector as a vital complement to the public hospital system. Yet this rapid growth of corporately owned private hospitals has posed serious contradictions for health care policy in terms of issues such as equity, cost and quality, the effect on the wider health system, and the very role of the state in health care provision. This article describes the growth of corporate investment in Malaysia's private hospital sector and explores some of the attendant policy contradictions.     

At the starting gate: Research and theory on families and somatic health.

Reviews the books, Family's impact on health: A critical review and annotated bibliography by T. L. Campbell (see record 1987-34495-001); Family-centered medical care: A clinical casebook edited by W. J. Doherty and M. A. Baird (see record 1987-97755-000); and Health, illness, and families edited by D. C. Turk and R. D. Kerns (1985). The field of families and somatic health is a vital one; its research findings have implications for both clinical practice and public policy. Under the rubric of families and health lie a diverse set of topics that span the entire life cycle. They include among others: (a) the impact of family factors on somatic health outcome and conversely the influence of somatic health on family functioning, (b) the effect of family factors on compliance to medical regimens and the adoption of beneficial health practices, (c) family interventions designed to promote health and/or help families deal with chronic disease or acute illness, and (d) the family's influence on health utilization behaviors. The books reviewed here cover these topics quite well. When considered as a group, these three volumes inform the reader about the state of the art of families and health, and suggest future directions. The three volumes reviewed here, taken together, demonstrate the challenging nature of this area of work and provide a useful point of departure for further accomplishments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confidentiality of medical information: Protecting privacy in an electronic age.

Discusses upcoming legislation regarding the confidentiality of medical information. Technology has provided the tools to allow the ease of access to health care information, but legislation is needed to ensure the confidentiality of this personal health information. The author presents some background information on the subject of medical record confidentiality, including 2 forces that are driving Congress to enact privacy protections. The first is the European Union directive that requires all 15 European Union member nations to restrict the export of data to nations that do not have adequate privacy protections in place. The second factor is the Health Insurance Portability and Accountability Act of 1996, which establishes mandates relating to medical record privacy. The author describes recent Congressional hearings that cover key principles that must serve as the foundation for legislation to guarantee privacy of individually identifiable health information. These include the limitation of the use of an individual's health care information to health purposes only and the provision of rights to patients to control how their health information is used. The author concludes by summarizing legislation that has been recently introduced into Congress to protect medical record confidentiality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Visions and revisions: viewpoints on nuclear medicine & health care reform. Part 1: Outcomes research

Although health care reform movements and the strategies that medical societies use to meet the challenges existed long before President Bill Clinton's September 1993 presentation of his reform bill, these strategies have since come into the foreground of medical reform discussions. Medical groups are carefully eying outcomes research as a method to both pinpoint their most effective procedures and to point up the effectiveness of their practice in overall patient care. Practice guidelines promise a way to sift out the optimal procedures and suggest them to all nuclear medicine physicians--to both unify the specialty and perhaps help protect practitioners in malpractice cases. Discussions of the specialty physician workforce question the need and practicality of any policy that substitutes generalists for specialists. And vigilance over the several pieces of legislation currently sifting through Congress alert members of specialty societies about political developments and how to influence congressmen. The question remains, are these strategies being employed in such a way as to best pull a specialty like nuclear medicine through the gantlet and optimize health care provision in the US? This four-part series will explore this question.     

Psychiatry in crisis

Psychiatry today faces sociopolitical, economic, and philosophical pressures that threaten its existence as a valued medical specialty. Recent legislation that decreases the numbers of foreign medical graduates eligible to practice in the United States, increases the numbers of community mental health centers and types of services they offer, and limits federal support of psychiatric education will affect the future of psychiatry as a profession and discipline. Forthcoming legislation and federal health policies will be related to the ability of the profession to demonstrate its unique role in the provision of mental health and health services. The authors offer suggestions for the education of the American public regarding the important role of psychiatry in America's health and mental health care system.     

Health care policy and politics: does the past tell us anything about the future?

The American health care delivery system, and the attitude of the public toward that system, have undergone considerable change during the past two decades. According to the author, the belief during the 1960s that adequate funds were available to broaden access to health services, to enhance their quality and availability, and to support medical innovation, gave way during the 1970s to an awareness of limited resources, to a skepticism about the motives and competence of established institutions, and to a conviction that the system's problems were too complex to be solved easily, if at all. Moreover, the author states, the system has become fragmented and highly competitive; the respect formerly accorded both professionals and institutions has deteriorated; and the government's role in health care delivery is being challenged. The result, the author says, may well be a paralysis of policymaking in health planning, as exemplified by the failure of both public and private institutions to achieve the cost-containment goals of the last decade, either through regulation or competition. To gain perspective on these problems and to determine the direction of the health care delivery system for the 1980s, the author calls for a national health care debate. He suggests four concepts that should be included in such a debate, and recommends a new context of pragmatic idealism in which to conduct it.     

Rehabilitation: Psychology's greatest opportunity?

Rehabilitation (RHB) is one of the fastest growing areas in the health industry. Supported by several key pieces of legislation, psychologists have established themselves as integral health care providers in RHB. Although psychologists have benefited from legislated membership in RHB, most individual psychologists and the psychological associations have not recognized the importance of public policy for the practice of psychology. Escalating health care costs have resulted in major revisions in the manner in which health insurers reimburse treatment. Medicare, the major federal health insurance provider, increasingly has been viewed as a model for the provision of all health care. The historic exclusion of psychologists from Medicare has limited the scope of psychologists' practice and the growth of professional psychology. The recent inclusion of psychologists in Medicare improves but does not solve practice and policy issues confronting psychology. Knowledge of national health policy formulation and greater participation by psychologists in health policy are necessary to secure the scope of professional practice most psychologists expect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The political agenda of health care for African Americans

Health care reform presents both challenges and opportunities for African Americans. On the one hand, reform could result in the closure of black medical institutions and fewer black physicians. On the other hand, reform gives African Americans an opportunity to bargain for available resources to gain equality in health care services. To this end, the Volunteer State Medical Association has been involved in state health care reform. Its goals are to resolve the current financial crisis at black medical institutions; to assist in the survival and development of local black managed care organizations; to assure that all licensed black physicians have continued access to patients; and to develop black-owned health-related businesses. The association has formed the Tennessee Coalition for Quality Health Care, a group of African American politicians, physicians, educators, and health care administrators who can negotiate with state and federal officials in the issue of health care reform.     

The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium

BACKGROUND AND METHODS: In order to elucidate the medical care of patients with human immunodeficiency virus (HIV) infection in the United States, we randomly sampled HIV-infected adults receiving medical care in the contiguous United States at a facility other than military, prison, or emergency department facility during the first two months of 1996. We interviewed 76 percent of 4042 patients selected from among the patients receiving care from 145 providers in 28 metropolitan areas and 51 providers in 25 rural areas. RESULTS: During the first two months of 1996, an estimated 231,400 HIV-infected adults (95 percent confidence interval, 162,800 to 300,000) received care. Fifty-nine percent had the acquired immunodeficiency syndrome according to the case definition of the Centers for Disease Control and Prevention, and 91 percent had CD4+ cell counts of less than 500 per cubic millimeter. Eleven percent were 50 years of age or older, 23 percent were women, 33 percent were black, and 49 percent were men who had had sex with men. Forty-six percent had incomes of less than $10,000 per year, 68 percent had public health insurance or no insurance, and 30 percent received care at teaching institutions. The estimated annual direct expenditures for the care of the patients seen during the first two months of 1996 were $5.1 billion; the expenditures for the estimated 335,000 HIV-infected adults seen at least as often as every six months were $6.7 billion, which is about $20,000 per patient per year. CONCLUSIONS: In this national survey we found that most HIV-infected adults who were receiving medical care had advanced disease. The patient population was disproportionately male, black, and poor. Many Americans with diagnosed or undiagnosed HIV infection are not receiving medical care at least as often as every six months. The total cost of medical care for HIV-infected Americans accounts for less than 1 percent of all direct personal health expenditures in the United States.     

Access to health care for destitute persons at Public Assistance Hospitals in Paris

All legal French residents are entitled to health care. The 1992 regulatory measures, which create a contractual agreement between the government and public medical institutions, aim at facilitating access to health care by resolving the financial obstacles to accessing health care. The Assistance Publique-H?pitaux de Paris (AP-HP) has set up a medical reception center in several hospitals since 1993. This system is integrated in the general structure of each hospital: in some cases, there is a single and centralized unit; in other cases, all departments of the hospital, including the emergency room, are involved in caring for destitute patients. Whatever the type of the structure may be, social workers are a key element to helping the patients recover their social rights. Thirty to seventy-percent of patients visiting these centers regain access to social and health care coverage. The epidemiological survey of the active file of patients revealed that 70% are male, more than 50% are non-French nationals, half of which do not have legal immigration status in France. Homeless people represent 40 to 80% of the population. The average age is around 35. The number of medical visits varies greatly from one hospital to another and range from 20 to 60 per month. The reasons for visiting the center and the identified medical disorders are strongly related to the patients' life conditions and vary significantly with the risk factors related to the social and economic situation. The frequency of some diseases (psychiatric disorders, tuberculosis, infections by the HIV and HCV) is higher in this population than in general population. Delayed visits to the medical center represents a severity factor. The hospitals' mission statement is not only to ensure that patients facing a precarious social and professional situation have equal access to health care, but also to help such patients recover their social rights, facilitate their integration in the society and fight against social exclusion.     

The computer based patient record: a strategic issue in process innovation

Over the past 30 years, a number of social, political, and economic forces have influenced public policy decisions regarding residential services for persons with mental retardation and other developmental disabilities (MR/DD). One of the most striking outcomes of these forces has been a steady decrease of persons with MR/DD residing in state institutions. In this paper we show the changes over the past 30 years in state institutional populations, interstate variability, movement of individuals into and out of state institutions, costs of state institutional care, and state institution closures as a result of social policy.