摘要:

A rationale is presented for considering demand management as well as supply management (managed care) in the current debate on health care reform. Demand management is the support of individuals so that they may make rational health and medical decisions based on a consideration of benefits and risks. The concept of demand for medical services is examined within a theoretical framework of four components: morbidity, perceived need, patient preference, and nonhealth motives. Two components, perceived need and patient preference, are suggested to offer considerable potential for making utilization more appropriate and reducing costs. Current demand services and potential hazards related to their continued expansion are discussed.

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

As we stand at the doorway to the twenty-first century, we are witnessing the restructuring of American health care from a fragmented cottage industry to an actual health care system. This new system is emerging from a foundation of managed care and will be built upon the pillars of prevention. One of the reasons this phenomenon is occurring so rapidly is that capitated managed care shifts to providers the financial risk for the health care needs of an enrolled population. Once providers accept financial risk, it is imperative to assess and manage the medical, health, and economic risks of the enrolled population. Under these incentives, quality-driven, cost-effective care takes on new meaning to physicians. In fact, this new managed care environment begins to merge personal health and public health in such a way that the delivery system will begin to provide personal-based health care from a population- based perspective. Furthermore, the incentives and rewards for maintaining the health of a population will finally be present.

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Periodic preventive medicine examinations generally rely on a standardized approach. In addition, they are often performed by physicians with only limited training in preventive medicine. Evaluation of a corporate-based program led to the prototype development of an artificial intelligence (AI)-based expert system to collect information from employees and make very specific recommendations for primary practitioners. Unique features include the customizing of questions for each subject and the selection of information to be acquired, both based on answers to previous questions. Recommendations are highly person specific and fall into four categories: laboratory testing, primary physician testing, counseling, and referral. The AI approach allows for easy updating of recommendations in order to meet changes in local preventive resources and national recommendations.

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The agricultural industry has been ranked among the most hazardous. Yet, it has been alleged that occupational injuries and fatalities are seriously underreported. Access to quality agricultural injury data poses a special problem. The purpose of this study was to investigate the concordance of reporting of fatal agricultural injuries between death certificate data and the Newspaper Clipping Service data in the state of Minnesota, utilizing a surveillance system developed by the University of Minnesota.Between September 1, 1981, and August 31, 1986, a total of 350 agricultural fatalities were identified in Minnesota; 82% were identified through death certificate data and 67% through the Newspaper Clipping Service. Differences in reporting between the two data sources were noted for gender, age, injury type, anatomical site, source, mechanism of injury, and multiple versus single injury. If only death certificates had been utilized, 18% of the fatalities would have been missed. Although it is apparent that death certificate data have an advantage over the Newspaper Clipping Service data for fatality reporting of specific variables, this study revealed that death certificate surveillance alone will miss mortality data and detection of certain potential risk factors.Suggestions for improving surveillance of agricultural fatalities are identified. However, until relevant changes are made, it will be essential to use a combination of data sources that include the Newspaper Clipping Service to identify agricultural injury fatalities accurately.

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Given the occupational risks of hazardous waste workers, this study was conducted to explore possible differences in medical surveillance practices among blue and white collar workers. Demographic and medical surveillance data were collected from 636 white collar and 206 blue collar trainees, enrolled in health and safety training courses. Overall, 4.5% of the trainees reported being ill or injured because of hazardous substances. Significant differences (P< .0001) were noted between groups; blue collar trainees were more likely to have been ill or injured. Differences also existed for medical surveillance enrollment; 32% of the white collar trainees report enrollment compared to 19% of the blue collar trainees (P= .004). This study indicates that blue collar trainees are more likely to be injured and less likely to be enrolled in medical surveillance programs. Issues of illness and injury, as well as medical surveillance enrollment, must be addressed; ensuring that all workers receive medical surveillance needed to prevent occupational illness in the hazardous waste field.

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Ethical dilemmas involving confidentiality issues are frequently encountered in occupational medicine. The occupational physician faces a unique challenge because in many circumstances, a physicianpatient relationship, in the ordinary or legal sense, may not exist. The occupational physician ofien faces a conflicting interest between the employee's desire for privacy and the employer's legitimate need to know. The occupational physician must carefully balance these interests for the benefit of society and the parties involved. Occupational physicians also work in a wide variety of practice situations, and the ethical and legal duty of confidentiality may vary substantially with these roles.This article provides an overview of the ethical and legal requirements of confidentiality in the workplace. The constitutional, statutory, and common law framework governing the treatment of employee medical information, as well as defenses to liability, are discussed. Recent legislative changes such as the Americans with Disabilities Act, and new challenges such as the proper handling of HIV information, present unique confidentiality problems.

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study concerns the update of cause-specific mortality among coke oven workers. Updated information provides 3 decades of work history and vital status follow-up on 15,818 workers. Mortality patterns are summarized by race, cumulative exposure, and period of follow-up. The findings are consistent with those from earlier assessments, indicating that occupational exposure to coke oven emissions is associated with significant excess mortality from cancer of the respiratory system and of the prostate. Depending on the segment of the population considered, the respiratory cancer risk for coke oven workers ranged as high as 4.45 times that for non-oven workers. Relative risk values for cancer of the prostate ranged as high as 1.93. Rates of respiratory cancer across period of follow-up are declining, suggesting that the implementation of emissions control and occupational exposure limits has been beneficial.

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Statutory protection for personal health information privacy is in clear need of reform. With few exceptions, current legal safeguards provide uneven coverage and limited protection. Absence of a uniform federal code of fair health information practices leaves individual rights in health information compromised, exposes data users, and poses a potential threat to the integrity of the data. Current legislative proposals for national health care reform seek to standardize privacy protection while simultaneously facilitating usage of personal health information in an electronic data network. Reform provisions for confidentiality of health data will establish explicit duties for “health information trustees” and should strengthen privacy safeguards in the workplace.

ISSN:1076-2752    

出版商:OVID    

年代:1995

数据来源: OVID