Health Maintenance Organizations

Health maintenance organizations and similar pre-paid health plans are an alternative form of health care available to Medicare beneficiaries in some areas of the country. While proponents of HMOs have argued that these plans may be better suited than fee-for-service medicine to provide care to an older population, HMOs have played a relatively small role in health care of the elderly. This paper traces federal health policy relating to HMOs and Medicare and describes obstacles to HMO Medicare programs stemming from those policies. It then examines the Massachusetts experience in HMO program development as a case study of how state policy can play a critical role in implementation of policy objectives at a local level. The paper demonstrates how an active state policy involving the executive and legislative branches, elder advocacy groups, and the private sector created a public-private partnership to develop HMO programs for the Medicare population. When this paper was completed, however, Medicare HMO development in Massachusetts was at a standstill, waiting for several critical problems of federal policy to be resolved.     

HMOs and the Future of Student Mental Health Services

Abstract

The health maintenance organization (HMO) is likely to have a prominent position under national health insurance, which will have a strong systematizing effect on the nation's health services. Over the past two years the University of Massachusetts mental health services have provided benefits at both the university and a private medical group practice. Experience has shown that a university which already provides broad services to a large student population can extend itself to the university community including its faculty and staff. Several advantages of this development, as well as some significant problems, are discussed. As the HMO grew and quality services were established, it became feasible for the private medical group to develop its own mental health component. Based on this and other experiences in mental health delivery systems, certain conclusions are drawn about the ways universities can develop HMOs and some recommendations are made for national mental health planning.     

Family health care decision making

How do families choose a health plan when offered the option of insurance or a Health Maintenance Organization (HMO)? Choices are influenced by health consumerism, decision variables, family health needs, family composition, family socioeconomic status, and knowledge about HMOs. Subjects in the research reported here chose insurance or one of four HMOs; control subjects had no HMOs available. The model is estimated with LOGIT regression, yielding a pseudoR ² of.22 for the adjusted model. Participation in the decision process, number of chronic illnesses, and knowledge about HMOs all are significantly and positively associated with choosing an HMO; also, young adults are more likely than older adults to choose HMOs. The consumerism variable fails to attain significance. LOGIT analysis of the adjusted model indicates that the model predicted 72% of plan choices correctly. Suggested research for other family forms, for the poor, and for the elderly's health plan choices are discussed.     

Health Maintenance Organizations: Legislative and Training Implications

The Health Maintenance Organization Act of 1973 provides Americans with the opportunity to join prepaid group health plans. HMOs are not a panacea for the ills that beset our health delivery system but their emphasis on health maintenance and preventive interventions will provide new social work practice and student training opportunities. This article reviews and analyzes the major features of the HMO Act. Expanded roles for social work practitioners are discussed and suggestions are made for strengthening social work training programs in order to prepare social work professionals for practice in HMOs and in the health care field.     

Met needs and unmet needs, and satisfaction among Social HMO members

This article reports on a survey of 800 members of four Social HMO demonstration sites, who were receiving home-based, community-based, and short-term institutional services under the demonstration's expanded community care benefits. The survey asked whether members needed help in 11 areas, whether they received help in each area from an informal caregiver, whether they wanted more help from the Social HMO, and whether help provided by both was adequate. Satisfaction with the program and with service coordination was also assessed. The adequacy of informal care differed by problem area, as did the help desired from the Social HMO and its responsiveness. Members were less satisfied when they had weaker informal care, were African American, and when they received inadequate help from the plan with ADLs, transportation, medical access, and managing money. Members were more satisfied when they were professionals, home owners, knew their service coordinator's name (or how to contact her), and received help with their problems. The findings point to the importance of clarifying divisions of labor with informal caregivers, as well as possible expansions in responsibilities for service coordinators and benefits beyond traditional boundaries.     

The practice and perceptions of RRI—A gender perspective

Little is known to date about the practice and perceptions of RRI among researchers in Europe as well as the integration of the gender dimension into everyday RRI practices. This lack was addressed by two large-scale surveys that were launched in the course of the EU-funded MoRRI project (Monitoring the evolution and benefits of RRI, Contract number RTD-B6-PP-00964-2013, Duration 09/2013–03/2018). The analysis shows that the institutional environment positively influences the degree of RRI activities and the general attitudes towards more responsible research and innovation: researchers working in an institutional environment that systematically supports the practice of RRI are more active in RRI practices than researchers who do not rely on such structures. For the gender equality dimension, this means that institutions with a gender equality plan (GEP) in place are more inclined to support female researchers than institutions without such institutional incentives. Furthermore, researchers with experiences in EU-funded projects are more likely to be engaged in RRI activities. Even if female researchers have a stronger inclination to engage with society than their male counterparts, gender competence proves to be the relevant distinguishing criterion. Gender competent researchers are more often involved in other RRI activities.     

Health Beliefs of College Students Born in the United States,China, and India

Abstract

The authors surveyed 243 urban public university students who were born in the United States, China, and India to compare the health beliefs of the China-born, India-born, and US-born students. Although the China- and India-born students shared beliefs in many preventive and therapeutic practices of Western medicine with the US-born students, they retained some of their traditional health beliefs. This suggests that student health service clinicians should assess students' cultural beliefs and individualize healthcare for students from different countries     

Managing Out

ABSTRACT

With the advent of welfare reform and managed care, the nature of managerial practice has increasingly shifted from a primary focus on internal operations to a more external, community focus which involves actively monitoring and managing the boundary between the external environment and internal organizational arrangements. This article explores the boundary spanning aspects of community practice, the related theories of inter-organizational relations, and the process of “managing out” by those in top management and middle management positions in human service organizations.     

Living Arrangements,Knowledge of Health Risks,and Stress as Determinants of Health-Risk Behavior Among College Students

Abstract

The association of knowledge of health risks, living arrangements, and perceived stress with health-risk behaviors was examined in a sample of college students included in the Health Promotion and Disease Prevention Supplement of the National Health Interview Survey. Regressions of each health-risk behavior (dependent variable) were performed on the predicted correlates. Although knowledge was not associated with participation in physical activity or smoking, the study found that students who knew more about the harmful effects of alcohol drank less, and those with greater knowledge of health risks practiced fewer risky behaviors. Students living independently were more likely to smoke, and those living in residence halls were less like to do so. Drinking, however, was more common among students living in residence halls or independently than among those living at home. Hall residents engaged in more group physical activity than other students did, but their physical activity was unrelated to health-risk behaviors. Stress was associated with smoking but not with other health practices. The findings suggest that smoking may be less influenced by health knowledge and more associated than drinking is with a response to stress. Drinking appears to be a social activity associated with living among peers and is potentially modifiable by increased knowledge about the effects of alcohol on health.     

DO HMO PLANS REDUCE HEALTH CARE EXPENDITURE IN THE PRIVATE SECTOR?

The cost containment performance of health maintenance organization (HMO) plans relative to non‐HMOs is examined using data from the 2000 Medical Expenditure Panel Survey. When various compounding factors are controlled for, among the privately insured, nonelderly population, HMO enrollment is found to contain neither total health care spending nor total insurance payment, though it reduces total out‐of‐pocket expenditure. We further find that this result is not attributed to selectivity in health plan choice due to health risk. The favorable cost sharing for enrollees and the distinct reimbursement schemes in HMO plans seem to account for no significant overall cost saving. (JEL I11, C25)     

A limit approaching pop-up message reduces gambling expenditures,except among players with a financially focused self-concept

Responsible gambling (RG) tools that guide electronic gaming machine (EGM) players to set a pre-set money limit on their gambling expenditures are known to reduce excessive gambling. However, not all EGM players who use a limit-setting RG tool will adhere to their limit. We hypothesized that limit adherence is facilitated by informing players that their limit is approaching (and when their limit is reached), but undermined by a financially focused self-concept (FFS). Accordingly, EGM players (N = 88) were provided seed funds to gamble with on a slot machine in a simulated virtual reality casino. They were randomly assigned to receive a limit reminder both when their limit was approaching and again when their limit was reached (experimental condition) or just when their limit was reached (control condition). Players in the experimental condition were more likely to stop playing before reaching their money limit compared to players in the control condition. However, this was observed among players who are low, but not high, in FFS. Unexpectedly, condition (control vs experimental) was unrelated to playing beyond the money limit and FFS did not moderate this relation. Results suggest that individual difference factors, like FFS, can undermine the utility of RG tools.     

The effectiveness of health care cost management strategies: a review of the evidence

This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evolution of the health care delivery system and affect health care costs. Between 1987 and 1993, total enrollment in health maintenance organizations (HMOs) increased from 28.6 million to 39.8 million, representing an additional 11.2 million individuals, or 4 percent of the U.S. population. At the same time, new forms of managed care organizations emerged. Enrollment in preferred provider organizations increased from 12.2 million individuals in 1987 to 58 million in 1992, and enrollment in point-of-service plans increased from virtually none in 1987 to 2.3 million individuals in 1992. In addition, the percentage of traditional fee-for-service plans with some form of utilization review increased to 95 percent in 1990 from 41 percent in 1987. Measuring the effects of the changing delivery system on the costs and quality of health care services has been a difficult task, resulting in considerable disagreement as to whether or not costs have been affected. In a recent report, the Congressional Budget Office recognizes two new major findings. First, managed care can provide cost-effective health care at a level of quality comparable with the care typically provided by a fee-for-service plan. Second, independent practice associations can be as effective as group- or staff-model HMOs under certain conditions. In the future, we are likely to see a continued movement of Americans into managed care arrangements, an increase in the number of physicians forming networks, a reduction in the number of insurers, an increase in the number of employers joining coalitions to purchase health care services for their employees, and a health care system that is generally more concentrated and vertically integrated.     

Human Organ Donation: Does Knowledge Correlate with Intention?

Abstract

One increasing form of social distress in the USA today is the increasing number of ill Americans who die while awaiting a life-saving organ (Satel, 2008). While organ donation is a life saving practice supported by 95 per cent of Americans, only half of the U.S. population is registered to donate organs. To explore this discrepancy between attitudes and behaviors relating to organ donation, 135 New Yorkers completed an anonymous 25-item survey to assess individuals' accurate knowledge of organ donation and their organ donor practices. Results support the researchers' two hypotheses: (a) individuals who possess more accurate information about organ donation practices are more likely to be organ donors (r=.225, p<.01) and (b) are more likely to have had experience with organ donation, either directly or indirectly (r =.247, p <.01). These findings have implications for the organ donation community, specifically the focus of campaigns that seek to increase the number of registered organ donors.     

Oral health among student veterans: Effects on mental and physical health

Abstract

Objective: The purpose of this study was to explore differences in oral health among students by military service status in postsecondary settings. Participants: Secondary data were obtained from the American College Health Association’s 2011–2014 National College Health Assessment II. Method: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with maximum likelihood multiple logistic regression. Results: Service member and veteran students are at greater risk for neglecting health behaviors associated with positive oral health, including that they were less likely to get dental exams and that those who deployed in the past were the least likely to be practicing good oral health. Conclusions: The results suggest that improving oral health will contribute to improving health and mental health outcomes in this population, and provide important information for health specialists working with service members and veterans on college campuses.     

Integrating a Family-Centered Approach into Social Work Practice with Families of Children and Adolescents with Disabilities

Abstract

This article identifies a family-centered practice construct for working with children and adolescents with disabilities and their families. The experiences of these families have shifted considerably over the past 30 years. A legislative and historical context provides the basis for an understanding of present policies and practices that influence current approaches to service delivery. Though family-centered practice is emphasized in various practice settings, there is still a need to integrate this philosophy into social work practice with children and adolescents with disabilities and their families. In order to enhance the ability of the social worker to integrate this construct into practice, a framework for exploring the experiences of children, adolescents and families is provided. This framework provides an overview of factors related to the individual child, the family and siblings for the social worker to consider when working with these families. The social worker's role as collaborator, advocate, team member and family resource is highlighted.     

Kin and non-kin foster care—findings from a National Survey

This article uses national data to look at the differences between children in kinship and non-kinship care arrangements. Three groups are compared: children in non-kin foster care, children in kinship foster care, and children in “voluntary” kinship care. Children in voluntary kinship care have come to the attention of child welfare services, are placed with kin, but unlike those in kinship foster care, these children are not in state custody. Findings suggest that children in the kin arrangements faced greater hardships than those in non-kin care. They more often lived in poor families and experienced food insecurity. They were more likely to live with a non-married caregiver who was not working and did not have a high school degree. And fewer kin than expected received services to overcome these hardships. In addition, nearly 300,000 children lived in voluntary kinship care arrangements; these children are of particular concern because they are not in state custody and therefore may or may not be monitored by a child welfare agency.     

Agency Practices Affecting Social Workers Who Treat Substance-Abusing Clients

Abstract

This study interviewed 115 MSWs with substance abuse training working in general social service agencies to determine if they viewed their settings as facilitating or hindering their work with substance-abusing clients. This study builds on the work of Lightfoot and Orford (1986) who found that social workers were more hindered than helped by their agencies' practices regarding substance-abusing clients.

Results: A majority of workers viewed their agencies as facilitating substance abuse-related work through support from supervisors and administrators, availability of substance abuse training, workers' freedom to choose clients, and opportunities to supervise others on substance abuse-related issues. Supervisor data corroborated these findings. This is a hopeful sign for the profession contrasting with considerable social work literature documenting the profession's historic ambivalence toward substance-abusing clients.     

Editorial

Immigrants from Asian countries who are living in Canada are more likely to live with extended families than Canadian-born seniors. This article focuses on the living arrangements of 161 South Asian immigrant seniors in Edmonton, Alberta, Canada, and examines the relative importance of various factors that influence living arrangements. Demographic characteristics were associated with living arrangements; seniors who immigrated when they were young and were married were the most likely to live independently. Logistic regression analyses suggest that economic and cultural factors were more important than health and availability of kin factors in explaining living arrangements, after controlling for demographic and immigration variables.     

Power play: the use of space to control and signify power in the workplace

ABSTRACT

The findings of this article emerge from an eight-month study examining career identity practices amongst a select group of fitness professionals in the U.K. We examine how the inter-relationship between physical and social space can denote how power is acquired, displayed, and used by individuals interacting in a shared space. The findings show that power is signified through spatial practices as individuals negotiate through triadic space, creating an identity of space and place for both trainer and client that identifies power, and signifies who has power. Fitness professionals with high levels of symbolic power are able to subvert organizational spatial norms to better serve themselves and their clients, while those with lower levels of symbolic power are forced to, or choose to, negotiate or abdicate space to others. These findings are relevant to a wide range of occupations where self-employment and contract workers interact in shared space.     

Ethical leadership,intrapreneurship, service innovation performance and work engagement in chambers of commerce and industry

ABSTRACT

The main purpose of this study which examines how it can be more effective in terms of organizational and managerial aspects with chambers of commerce and industry affiliated to The Union of Chambers and Commodity Exchanges of Turkey is to analyze the relationships between ethical leadership, work engagement, intrapreneurship, and service innovation behavior. In addition, it is to determine the role of mediation of work engagement effecting on intrapreneurship and service innovation behavior. For this purpose, quantitative analysis methods have been adopted. The data collected from 568 employees who were employed in chambers of commerce and industry operating in Turkey were analyzed. For the validity and reliability of the measurement tools, confirmatory factor analysis, the model’s good fit values and the AMOS Structural Equation Model were used. It was found that ethical leadership had statistically significant effect on employee engagement, intrapreneurship and the subscales of service innovation behavior (employee service innovation behavior and new service development). The results showed that work engagement partially mediated with ethical leadership effecting on intrapreneurship, ethical leadership effecting on the subscales of service innovation behavior. It is thought that the study is important in terms of providing empirical contributions to the ethical leadership, service innovation, intrapreneurship and work engagement literature. Finally, there are some limitations of the study and some suggestions are offered for future studies.