Capitation and informatics

When physicians, hospitals, and allied health professionals bill for services they render, their information processing requirements are relatively simple, at least compared to those of capitated organizations. When payers (insurers or employers) accept financial risk for the health care services of beneficiaries, they have usually invested in claims processing, membership tracking, and, under managed care, utilization review and provider profiling systems. But payers, for the most part, have not invested in electronic collection of clinical information about beneficiaries, nor have they tended to keep all claims they have processed in electronic form for study after accounts are settled and payments disbursed. In this article, we will explore why informatics is so important to capitated organizations and why payers that have traditionally taken financial risk for insuring the health care costs of populations are also learning about the importance of informatics.     

LET''''S MAKE ENGLISH MORE EXCITING

"Teacher, what are we going to do next class?" This is an exciting question which I often hear from my students. As an English conversation teacher, I can make the learning of English either a dull and boring duty, or an exciting adventure. It is very important that I make my students hate missing my class, and keep them guessing just what will happen the next time! Let us consider some important ways that any teacher can help his other students want to do their     

Freedom of movement vs. exclusion: a reinterpretation of the "insider"-"outsider" divide in the European Union

"This article argues that the question of free movement vs. exclusion within the European Union (EU) can be addressed satisfactorily only if we move away from the narrow state-centrism inherent in the current debate. What is required is to 'open' the state concept and examine the implications of state-society relations for EU policy making. Once this is done, it can be seen that the exclusionist stance of the immigration policy and the essentially intergovernmental nature of the policy making are due to an implicit contract between states and constituents implied by the concepts of nationality and citizenship. According to this perspective, the focus on the state or the political elite alone is too one-sided and misses the more complex factors bearing upon EU policy making in this area."     

Immigration to the Federal Republic of Germany as a demographic and social problem

"Addressing the question of immigration to Western Europe and especially to Germany from east and southeast Europe and from developing countries of the South, this article considers whether such immigration can compensate for reductions in population in developed countries. It is argued that the demographic deficits of an aging population can only be corrected to a limited extent through immigration. Any solution, in order to be effective, must include a simultaneous increase in the birthrates of Germany and other European Community countries. With particular regard to future social development in Germany and the EC, it would be advisable for governments to effect measures that will provide both for controlled admissions of immigrants from outside the EC and an increase in local reproductive capabilities."     

An evaluation of population projection errors for census tracts

"In this article we evaluate the accuracy and bias of projections of total population and population by age group for census tracts in three counties in Florida. We use [U.S. census] data from 1970 and 1980 and several simple extrapolation techniques to produce projections for 1990; we then compare these projections with 1990 census counts and evaluate the differences. For the total sample, we find mean absolute errors of 17%-20% for the three most accurate techniques for projecting total population and find no indication of overall bias. For individual age groups, mean absolute errors range from 20%-29%." This is a revised version of a paper presented at the 1993 Annual Meeting of the Population Association of America.     

Managed care information needs: a summary perspective

The key to survival in managed care is management of financial risk. You need to know what is in your contract and what you are obligated to do for which population during which period. Information systems can be an enormous help in managing managed care contracts and the financial risks they entail, but poorly selected and configured information systems will do little good for the organization that licenses them. The most important activity of a physician executive who is moving his or her organization into managed care contracting is to lead the process to define the functional requirements for information the organization will need to manage managed care contracts successfully.     

《新西兰文化与认同感·序言》

《新西兰文化与认同感·序言》大卫·诺维茨比尔·威尔莫特著涂开益徐永安译编选本书的初衷,源出编者在讨论新西兰民族认同感与文化的基本命题时,对于人们所持方式的关注。我们俩人一致认为,当时的争论有两点失之偏颇：一是如何准确理解被称之为文化的这种奇特现象,二...     

Analgesia produced in women by genital self-stimulation

This study investigated the relative effectiveness of specific genital regional self-stimulation in elevating pain thresholds. Anecdotal reports in humans suggest that sexual activity and orgasm decrease a wide variety of human responses to pain and touch, but the phenomenon has not been evaluated objectively. Two types of self-stimulation, pressure and pleasurable, were applied by 10 women to the anterior vaginal wall, the posterior vaginal wall, and the clitoris. Significant increases in pain thresholds but not tactile thresholds occurred when pressure stimulation was applied to the anterior wall of the vagina or when "pleasurable" self-stimulation was applied to any of the three areas. Tactile thresholds were not significantly affected by any genital stimulation condition. However, there was a significant increase in tactile threshold but not pain thresholds in the distraction control condition. On the basis of these findings, we conclude that (a) a sensation of pleasure evoked by genital stimulation can elevate pain thresholds, (b) these pleasurable stimuli were not general "distractants" because they elevated pain thresholds but not tactile thresholds differentially, and (c) genital pleasurable stimuli activate an analgesic process that is distinct from a distraction process.     

Implications of ERISA for health benefits and the number of self-funded ERISA plans

This Issue Brief provides an overview of the issues relating to the Employee Retirement Income Security Act of 1974 (ERISA) and health benefit plans, the major case law relating to ERISA and health plans, and the implications of the preemption of state regulations for health plan sponsors and participants. It also presents the latest data on the number of health plan participants in self-funded ERISA plans. Finally, it presents a summary of current legislative proposals that would attempt to amend ERISA. Under the framework ERISA established for employee benefit plans, the regulation of employment-based health benefit plans has evolved into a two-tiered system in which both federal and state laws play important roles. The Supreme Court has interpreted ERISA's "savings" and "deemer" clauses to mean that insured plans are subject to regulations directly at the federal level and indirectly at the state level, while self-funded plans are regulated exclusively at the federal level. The ERISA statute and the courts' interpretations of the Act have created a sharp controversy over how employee health benefit plans are provided and administered, with state regulators and consumer advocates on one side of the debate and plan sponsors (e.g., employers and unions) on the other. State regulators and consumer advocates tend to favor more regulation, and in many instances greater regulation at the state level, which they argue would provide more protections for consumers. However, employers and unions (or any plan sponsors) think ERISA preemption is very important to their ability to provide innovative and cost-effective health benefits for their employees, and assert that ERISA's present structure should be preserved. The U.S. General Accounting Office (GAO) found that 44 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1993, up from 39 million (33 percent of those in ERISA plans) in 1989. The Employee Benefit Research Institute (EBRI), using the same methodology as GAO with 1995 data, estimated that 48 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1995. When policymakers look to amend ERISA, they should consider whether the change to ERISA will produce a higher level of quality for consumers than is being provided under the present system and will continue to do so in the future. Policymakers must also decide whether quality of care is better enhanced by health plans' greater exposure to liability or by market forces. If policymakers decide that increased exposure to liability is the route to go, will consumers be able to enjoy any potential improvement in quality or will more individuals end up uninsured because of increased costs and not be able to get any care regardless of the quality?     

Immigration dilemmas

Recent trends in immigration to Poland are reviewed, including both voluntary migration and migration forced by extreme political or economic circumstances. Data are also presented on illegal immigrants and on their countries of origin.