Health care reform: The 1993–1994 evolution.

Health care costs in the US continue to increase, as does the number of individuals who lack health care coverage. The magnitude of these critical problems assures that reform of the health care system will continue to be debated over the next decade. Increasing health care costs are associated with increased complexity of services and a greater number of health care providers. As health costs increase and the number of individuals covered by private insurance decreases, states will face increasing pressure to develop effective methods of providing coverage for those without health insurance. Employer mandates will be viewed as one method of extending health coverage. Psychologists must be involved in policy issues so as to ensure the utilization of psychological knowledge and attention to psychological and behavioral health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medicaid managed care and the health reform debate: lessons from New York and California

Nearly every state now encourages (or requires) its Medicaid beneficiaries to enroll in managed care. There is, however, extraordinary variation in every aspect of state managed care policy. In this article, I examine the managed care initiatives of two states, New York and California, and focus on variation in state policy-making environments and on the influence of such variation on efforts to protect the medical safety net. I conclude that California's managed care initiative is less decentralized and pluralistic than New York's, and that California has used its discretion to adopt a strategy designed in part to protect safety-net hospitals. I end with a plea for greater federal control of managed care initiatives, a policy proposal that is at odds with the current trend to increase state authority.     

A snapshot of Australian nursing scholarship 1993-1994

The basedowian exophthalmy is a self-immune originating affection, in which the antigen remains still unknown. It may appear besides the Basedow disease, evoluating in a total independent manner. The clinical diagnosis is done on the basis of small ocular characteristic signs: exopthalmy, oculomotor deficit, optical neuropathy, corneo-conjunctival alterations, being of course supplemented with the complementary endocrinological and immunological explorations. The endocrine exophthalmy represents a serious complication because of the visual risks it implies, and afterwards because of the implied esthetical prejudice. A spontaneous amelioration is possible, but the treatment often proves to be necessary. It will be medical, local and general, and also orbitar radiotherapy and surgical treatment.     

Frequency and cost of health problems in Swiss dairy cows and their calves (1993-1994)

Between July 1993 and July 1994 morbidity and management information related to dairy cows and their calves up to the age of 8 weeks were recorded in 113 randomly selected dairy herds. Also recorded were any costs incurred through disease and prevention. Blood and faeces were analysed with respect to selected pathogens. The health problems most frequently diagnosed in cows were reproductive and udder diseases. Calves suffered most often from diarrhea, omphalitis and pneumonia. The directly disease-related costs per cow-year on average amounted to CHF 139.44 and CHF 4.18 per calf. For prevention, farmers spent on average CHF 10.18 per cow-year. Results from the laboratory analyses indicate that in 68.1% of the farms antibodies against Leptospira hardjo and in 61.9% against Coxiella burnetii were detected. In 8.0% of the farms antibodies against Mycobacterium paratuberculosis were found. Antibodies against BVD virus was present in 99.4% of the farms. Cows from 63.7% farms were infected with gastrointestinal strongylids. Veterinary assistance was required on average 1.96 times per cow-year. In almost all reproductive and puerperal disease cases a veterinarian was consulted while lameness in the majority of cases was treated by the owner. The veterinary profession was hardly ever involved in disease prevention.     

The future of health care reform: Implications of 1994 elections.

The Republicans took control of both houses of Congress in November of 1994 for the 1st time in 42 yrs. Although the magnitude of the Clinton Administration's proposed Health Security Act may well have triggered fears of overcontrol, it is clear that the delivery of psychological care will be changed dramatically by the combined forces of federal and state health reform. R. J. Resnick, President of the American Psychological Association, has appointed the Task Force on Education and Training for Work in Organized Delivery Systems to look at how psychological health care is provided in the new and evolving systems, and to examine how current training programs prepare new psychologists to practice in and around organized health care systems. Dr. Resnick is similarly concerned about standardization of training, training in nontraditional areas of competence, and increased federal recognition and funding of training in psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intestinal parasites among the Southeast Asian laborers in Taiwan during 1993-1994

Medical practice and medical education are undergoing revolutionary changes all over the world. Even though the denominators of change are usually viewed at national and institutional levels, global trends also play an important role, and international co-operation is needed now, more than ever. Thailand with its rapid rate of change serves as an interesting example for review.     

Poisonings in animals: the 1993-1994 report of the American Association of Poison Control Centers

This study was undertaken to compare the detection rate of hepatic space occupying lesion (SOL)s between computed tomography during arterial portography (CT-AP) and magnetic resonance imaging during arterial portography (MR-AP) and the differences in time intensity curve on MR-AP between HCC, metastatic tumor, FNH, and hemangioma. We performed CT-AP and MR-AP in 17 patients including 14 cases of HCC and one each of metastasis, FNH, and hemangioma. MR-AP was performed by Turbo-FLASH sequence. There was no statistically significant difference between CT-AP and MR-AP in detecting satellite lesions in terms of smallest diameter and number of flow defects (p > 0.05). Hemangioma showed rapid enhancement after the first pass and, consequently, the same enhancement as the hepatic parenchyma. MR-AP was comparable to CT-AP in the detection of hepatic SOLs. Hemangioma showed an enhancement pattern different from those of HCC, metastatic tumor, and FNH, which showed patterns similar to each other.     

Alcohol and drug abuse: a retrospective analysis of incidence in a regional hospital 1993-1994

This retrospective study analyzes and compares the incidence of admissions for alcohol and drug (i.e.: heroin and cocaine) induced diseases to the internal medicine service of Locarno Regional Hospital (61 beds plus intensive care unit) between January 1, 1993 and December 31, 1994. Of 4038 admissions, 298 (7.4%) were related to alcoholism and drug addiction. 4.2% of all hospital days were due to alcohol abuse, whereas 3.2% were related to drug abuse (of these 1.8% were for HIV-associated diseases and 0.9% for withdrawal treatment). The male/female ratio was 3:1 in both groups, the average age of women being significantly lower in the alcoholic group (50.5 +/- 14.4 years vs. 58.1 +/- 12.9; p = 0.003). Over 90% of the patients with alcohol-induced conditions continued to consume alcohol. On the contrary, only 16% of the HIV-positive patients were still drug-addicted. The in-hospital mortality was 6% (5% in the alcoholic group; 1.6% and 12%, respectively, in the HIV-negative and HIV-positive groups of drug addicts). This study confirms the high prevalence of diseases related to alcohol and drug abuse. Women are less affected, but show complications of alcohol abuse earlier. Despite the HIV epidemic in our area, the admissions of alcoholics to the hospital are more frequent than those of drug addicts. Most of the drug addicts with an HIV-associated condition are in remission, whereas alcoholics with alcohol-induced diseases continue, for the most part, to be alcohol-dependent.     

Plenty of questions still remain on Clinton''s approach to health care reform

The authors did not detect any differences in the efficacies and tolerance of praziquantel analogs manufactured by various firms (azinox, Russia; pikitor, China; cesol, cisticide, biltricide, Bayer, Merk, Germany, India). These drugs were found highly effective in opisthorchiasis (87.8%) and schistosomiasis (91.7%) and ineffective in fascioliasis. The efficacy and tolerance of azinox, a drug manufactured in this country, was similar to those of its foreign analogs.     

Changes in health plans serving Medicaid, 1993-1996

To better understand the Medicaid managed care market during a period of rapid change, we developed a new data set that links Medicaid enrollment data with health maintenance organization (HMO) industry data for 1993-1996 to analyze Medicaid enrollment in full-risk health plans. Nearly half of the Medicaid enrollees in a fully capitated managed care arrangement were in plans in which Medicaid makes up at least 75 percent of the total enrollment. In addition, the number of Medicaid-only plans has more than doubled since 1993. Commercial-based plans participated increasingly in Medicaid managed care during the period, yet more than half of the plans entering the Medicaid market were newly formed.     

Intervention for improving the coproparasitological diagnosis in the Province of Las Tunas, Cuba, 1993-1994

Control of quality of coproparasitological diagnosis was carried out in the Province Las Tunas, between January and March 1993, It was found that 72% of coproparasitological microscopists had deficiencies related to the diagnosis, due to several causes: The microscopists did not receive any periodical training, as they did not participate at the parasitological section; the microscopists had no manual of reference; they had less than ten years of experience; they did not know the concentration technics that were established in the country. Between July 1993 and January 1994 two Medical Parasitology Courses were imparted. In July 1994 another quality control was performed. 80% of evaluated microscopists obtained good results. Through this study was established the National Parasitology Quality System Control that supports the National Intestinal Parasites Control Program.     

Israel's health policy breakthrough: the politics of reform and the reform of politics

After decades of attempts, Israel has enacted a national health insurance law and begun to substantially change its health care system. I explore the conditions that enabled final passage of the law in light of theories of nonincremental change in pluralist policy systems. I also discuss the implications of this policy breakthrough for links between policy subsystems, leadership, and the establishment of a new policy equilibrium.     

Meningitis: public health issues

This paper describes a case-note review of 25 cases of meningococcal disease which occurred in the six months following distribution of pre-admission antibiotic treatment packs and prophylaxis advice packs. The data showed that while these interventions had improved some aspects of public health, and management of cases and their contacts, further action was needed     

Report of the treasurer, 1993: Health care reform and APA finances.

Presents the Report of the Treasurer regarding the 1993 finances of the American Psychological Association (APA). The report addresses the funding of health care reform efforts, the Second Century membership drive, the Traveling Psychology Exhibit, the $60,000,000 building loan, the dues-exempt criteria, and the status of accounting/investing for divisions. Revenues and expenses are discussed in terms of a comparison between 1992 and 1993 and in terms of major programs. Information is also presented in regard to changes to APA's fund balance or "net worth," the corporate balance sheets for 1990–1993, the refinancing of the building loan, and new nondues revenues. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health commitment: the state of the debate, 1980

This overview of recent mental health commitment litigation and statutes begins with the 1972 decision by a federal district court in Wisconsin that the state's procedures for commitment were constitutionally defective; the case, Lessard v. Schmidt, was a bellwether for the decade. By 1979 three major mental health cases concerning civil commitment reached and were decided by the U.S. Supreme Court--O'Connor v. Donaldson, Addington v. Texas, and Parbam v. J. R. The author reviews the impact of changing standards and procedures on commitment and discusses in some detail the Addington and Parbam cases. He feels that one lesson of those cases is that the positions of the main disputants in the commitment controversy--legal advocates and beleaguered professional--must be compromised. He also discusses the logical culmination of the continuing controversy between law and psychiatry about civil commitment: the committed patient's right to refuse customary treatment.     

Race and health: basic questions, emerging directions

PURPOSE: This paper examines the scientific consensus on the conceptualization of race, identifies why health researchers should analyze racial differences in morbidity and mortality and provides guidelines for future health research that includes race. METHODS: Examines scientific dictionaries and reviews the social science, public health and medical literature on the role of race in health. RESULTS: First, this paper reviews the evidence suggesting that race is more of a social category than a biological one. Variation in genotypic characteristics exists, but race does not capture it. Second, since racial categories have historically represented and continue to reflect the creation of social, economic, and political disadvantage that is consequential for well-being, it is important to continue to study racial differences in health. Finally, the paper outlines directions for a more deliberate and thoughtful examination of the role of race in health. CONCLUSIONS: Race is typically used in a mechanical and uncritical manner as a proxy for unmeasured biological, socioeconomic, and/or sociocultural factors. Future research should explore how clearly delineated environmental demands combine with genetic susceptibilities as well as with specified behavioral and physiological responses to increase the risk of illness for groups differentially exposed to psychosocial adversity.     

Integrity tests: Overlooked facts, resolved issues, and remaining questions.

Comments on W. J. Camara and D. L. Schneider's (see record 1994-23870-001) summary of reports on integrity tests (ITs). It is argued that in reviewing empirical findings about the validity of ITs, they overlooked critical findings regarding how well they work and what they measure. Also, their concerns regarding research on ITs conducted by test publishers are unfounded. (PsycINFO Database Record (c) 2010 APA, all rights reserved)