摘要:

As the number of dental insureds and the amount of insured expenditures have increased over the past decade, so has interest in determining insurance effects on dental demand among employer groups and their insureds. Using Pennsylvania Blue Shield (PBS) employer group data representing 50–65% of all PBS insureds, the authors estimate the own-effect of basic insurance rates (diagnostic, preventive, restorative, endodontic, extraction services) and the cross-effects of riders A (crowns and oral surgery), B (prosthodontics), C (periodontics), and D (orthodontics) insurance rates on annual basic expenditures for 1975–1979. Results indicate a consistently positive relationship between basic insurance rates and expenditures. Orthodontic insurance rates have positive cross-effects on basic expenditures, suggesting basic–orthodontic complementarities. Although not statistically significant, potential substitution relationships may exist between basic and oral surgery, prosthodontic, and periodontic services. The implications of these findings for plan design and public oral health are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Health and long-term care planning for an aging population is an important and necessary function for both the public and private sector. Unfortunately, efforts at planning have often been limited by difficulties in making estimates and forecasts of chronic disease prevalence in the population. These difficulties are a direct result of the natural history of chronic diseases that normally have long presymptomatic stages. Because of this characteristic, predictions of the magnitude of chronic disease prevalence in the United States often fail to reflect an important dimension of the health state of the population: that there is a sizeable proportion of chronic disease prevalence and risk existing in the population in a preclinical phase. The authors present a strategy for obtaining more complete estimates of chronic disease prevalence. This approach entails the creation of an illness–death model representing the natural history of individual chronic diseases and the application of the model to infer morbidity incidence and prevalence patterns from national mortality statistics. They illustrate the approach with an example of lung cancer and discuss the applications of the outputs of the modeling strategy for health care resource planning.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A project to improve physician performance in colorectal cancer screening was evaluated as part of an ambulatory quality assurance program. A minimum standard was adopted requiring a digital examination and stool test for occult blood at annual check-ups of patients aged 40 years and older. During a 3½-year period, three different intervention strategies for improved compliance with the standard were sequentially implemented and assessed: educational meeting, retrospective feedback of group compliance rate, and retrospective feedback of individual compliance rate compared with that of peers. A pretest/posttest design was employed in evaluating the first two intervention strategies. Neither strategy resulted in significant improvement in compliance. Monthly feedback of individual performance ranked with that of peers was then implemented in a randomized clinical trial utilizing a crossover design. During the first 6-month period, the physicians receiving feedback (group 1) improved from 66.0% to 79.9% (P <0.001), while the control group (group 2) also improved, from 67.5% to 76.6% (P <0.001), suggesting a spillover effect. During the second 6-month period, group 2 received feedback and group 1 did not. Group 1 stabilized at approximately 80% while group 2 continued to improve from 76.6% to 84.0% (P <0.001). Behavior changes persisted at 6 and 12 months after intervention.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The purpose of this project was to develop and evaluate a program to teach medical students how to order diagnostic tests in a cost-effective manner. The 1-month educational program included a seminar, a simulated patient-care exercise, special case presentations by students, newsletters about diagnostic tests, and concurrent review of patients' bills. Content analysis of answers to open-ended questions and pretests and posttests were used to measure differences in the study and control groups. Although students said the program was useful, no significant differences were found in students' knowledge, attitudes, or simulated test-ordering behavior. The authors conclude that the lack of improvement in objective measures limits the potential effectiveness of restricted efforts such as this one and that the discrepancy between the subjective and objective measures reinforces the need for more rigorous evaluations of programs that teach cost-effective diagnostic test use.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

In health status index construction quantitative values for different states of health are frequently obtained by presenting written descriptions to raters whose values are elicited using one or more methods. In this study the authors examined the influence of several aspects of this measurement process upon the quantitative results obtained. They prepared a set of written descriptions of health states, each state being described in both a standard point-form and a narrative format. The narrative format was written in the first person singular, and listed all symptoms or problems associated with the state, whereas the point-form description included only the most severe symptom or problem. Values for these states were elicited from a group of 64 patients using two commonly employed methods, the standard gamble of Von Neumann and Morgenstern and category rating. The results indicate that the type of scenario presented to the rater and the sequence in which the methods of assessment were used had a major influence on the results. This work indicates that there is a need to examine systematically the process of obtaining quantitative values before reliance can be placed upon the results.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Underlying the continuing emphasis on access by health services researchers and policymakers is the assumption that patients having poorer access will receive less than appropriate health care, other things being equal. However, recent research results typically have not supported this assumption, and the nature and importance of relationships between access and use still remain unclear. Most published studies have sought to define general relationships that are descriptive of the behavior of all patients in a population facing access problems. The authors use interview data to show that significant relationships between satisfaction with access and use of services can be found if segments of the population, homogeneous in terms of age, sex, or other characteristics, are considered separately. This approach is based on the assumption that dissatisfaction with a particular dimension of access may be salient for some groups of patients but not others, and it is consistent with the view that patients' beliefs and perceptions are important determinants of health behavior.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID