HEALTH
INSURANCE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2003 by ICON Group International, Inc. Copyright ©2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Health Insurance: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83601-9 1. Health Insurance-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail:
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on health insurance. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON HEALTH INSURANCE ................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Health Insurance........................................................................... 4 E-Journals: PubMed Central ..................................................................................................... 111 The National Library of Medicine: PubMed .............................................................................. 112 CHAPTER 2. NUTRITION AND HEALTH INSURANCE .................................................................... 223 Overview.................................................................................................................................... 223 Finding Nutrition Studies on Health Insurance ....................................................................... 223 Federal Resources on Nutrition ................................................................................................. 224 Additional Web Resources ......................................................................................................... 225 CHAPTER 3. ALTERNATIVE MEDICINE AND HEALTH INSURANCE .............................................. 227 Overview.................................................................................................................................... 227 The Combined Health Information Database............................................................................. 227 National Center for Complementary and Alternative Medicine................................................ 228 Additional Web Resources ......................................................................................................... 230 General References ..................................................................................................................... 231 CHAPTER 4. DISSERTATIONS ON HEALTH INSURANCE ................................................................ 233 Overview.................................................................................................................................... 233 Dissertations on Health Insurance ............................................................................................ 233 Keeping Current ........................................................................................................................ 247 CHAPTER 5. PATENTS ON HEALTH INSURANCE........................................................................... 249 Overview.................................................................................................................................... 249 Patents on Health Insurance...................................................................................................... 249 Patent Applications on Health Insurance.................................................................................. 252 Keeping Current ........................................................................................................................ 254 CHAPTER 6. BOOKS ON HEALTH INSURANCE .............................................................................. 257 Overview.................................................................................................................................... 257 Book Summaries: Federal Agencies............................................................................................ 257 Book Summaries: Online Booksellers......................................................................................... 258 The National Library of Medicine Book Index ........................................................................... 267 Chapters on Health Insurance ................................................................................................... 267 Directories.................................................................................................................................. 269 CHAPTER 7. MULTIMEDIA ON HEALTH INSURANCE ................................................................... 271 Overview.................................................................................................................................... 271 Video Recordings ....................................................................................................................... 271 Audio Recordings....................................................................................................................... 274 Bibliography: Multimedia on Health Insurance ........................................................................ 276 CHAPTER 8. PERIODICALS AND NEWS ON HEALTH INSURANCE ................................................ 277 Overview.................................................................................................................................... 277 News Services and Press Releases.............................................................................................. 277 Newsletters on Health Insurance............................................................................................... 279 Newsletter Articles .................................................................................................................... 280 Academic Periodicals covering Health Insurance ...................................................................... 283 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 287 Overview.................................................................................................................................... 287 NIH Guidelines.......................................................................................................................... 287 NIH Databases........................................................................................................................... 289 Other Commercial Databases..................................................................................................... 295 APPENDIX B. PATIENT RESOURCES ............................................................................................... 297
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Overview.................................................................................................................................... 297 Patient Guideline Sources.......................................................................................................... 297 Associations and Health Insurance............................................................................................ 313 Finding Associations.................................................................................................................. 324 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 327 Overview.................................................................................................................................... 327 Preparation................................................................................................................................. 327 Finding a Local Medical Library................................................................................................ 327 Medical Libraries in the U.S. and Canada ................................................................................. 327 ONLINE GLOSSARIES................................................................................................................ 333 Online Dictionary Directories ................................................................................................... 333 HEALTH INSURANCE DICTIONARY .................................................................................... 335 INDEX .............................................................................................................................................. 381
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with health insurance is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about health insurance, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to health insurance, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on health insurance. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to health insurance, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on health insurance. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON HEALTH INSURANCE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on health insurance.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and health insurance, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “health insurance” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •
Clients Without Health Insurance at Publicly Funded HIV Counseling and Testing Sites: Implications for Early Intervention Source: Public Health Reports; Vol. 110, No. 1, Jan.-Feb. 1995. Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Prevention Services, Division of Sexually Transmitted Disease, 1600 Clifton Rd NE, Atlanta, GA, 30333, (404) 639-8002. Summary: The characteristics of clients reporting no health insurance were compared with those reporting any health insurance at publicly funded HIV counseling and testing sites in the United States during 1992. Thirty of 65 funded health departments collect data on self-reported health insurance status. Data were dichotomized into two groups, clients reporting any health insurance versus those reporting none, and
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multivariate logistic models were developed to explore independent associations. Of the 885,046 clients studied, 440,416 reported that they lacked insurance. Clients without health insurance were more likely to be male members of ethnic minorities, adolescents, and HIV seropositive. Incarcerated persons, clients of Hispanic ethnicity, and clients receiving testing during field visits in drug treatment centers and in tuberculosis clinics were less likely to have health insurance. Large numbers of clients receiving publicly funded HIV counseling and testing lack health insurance. Lack of health insurance may interfere with subsequent receipt of needed primary care services among high-risk clients, especially HIV seropositive clients in need of early intervention services.
Federally Funded Research on Health Insurance The U.S. Government supports a variety of research studies relating to health insurance. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to health insurance. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore health insurance. The following is typical of the type of information found when searching the CRISP database for health insurance: •
Project Title: A COHORT STUDY OF ACTIVE AND PASSIVE SMOKING IN KOREA Principal Investigator & Institution: Samet, Jonathan M. Chair and Professor; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2002; Project Start 19-APR-2002; Project End 31-MAR-2004 Summary: Although 50 years of research findings have causally linked active and passive smoking to cancer and other diseases, further epidemiologic research on the risks of tobacco smoking is still needed. One specific need is for studies in countries other than the developed, western countries where the majority studies have been conducted to date. Most of the world's smokers live outside of the western countries, primarily in Asia where a majority of males are smokers in many countries. Background disease rats and distributions of lifestyle risk factors are notably distinct in these populations, particularly in comparison with populations of previously studied western males. The majority of women, largely non-smokers, and children in Asian countries are exposed to environmental tobacco smoke (ETS). This small grant application requests support to establish a cohort study of active and passive smoking and risk for cancer and other diseases among persons receiving health insurance coverage through the Korean Medical Insurance Corporation (KMIC). The KMIC provides coverage to civil
2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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service workers, teachers, and their dependents in the Republic of Korea (South Korea). The total population insured by the KMIC is substantial, accounting for 11% of the country's 43 million residents in 1990. The insured then included approximately 1.2 million workers and an additional 3.4 dependents. A cohort study will be developed using the database of the KMIC. Risk factor information is collected in biennial medical examinations, which are required for the insured workers and are voluntarily completed by dependents. The data collected in the biennial examinations covering smoking and other lifestyle risk for disease and findings from routine laboratory work are also available. Outcomes are tracked through the hospital record system and also by mortality matches. Family members of the insured can be identified through record linkage using the unique identification number of the insured. In an effort to advance understanding of smoking and cancer and other diseases in Asian countries, as well as among Asian Americans, investigators at the Yonsei University and the Johns Hopkins University School of Hygiene and Public Health plan to collaborate in developing and then using this epidemiologic resource to carry out a major program of research on the risks of active and passive smoking in Korea. The Yonsei University has access to the KMIC cohort and already has shown its potential in several reports on cancer and cardiovascular disease. The Johns Hopkins group adds expertise in cohort studies and smoking. This application requests support to establish a comprehensive database in support of the cohort study and to carry out analyses on active and passive smoker and cancer. During the two years of support requested in this small grant application, data will be abstracted from medical records on key exposure variables from exams carried out in 1992 and 1993, providing lifestyle and laboratory data for cohort expected to number approximately 1.6 million adults. Mortality will be tracked from 1992-2003 and inpatient encounters, coded by diagnosis, will be identified for 1998-2003. To demonstrate the potential of the study, an investigation will be carried out on active and passive smoking and lung cancer risk. We intend to set data collection in place to maintain and extend this cohort. The large size of this cohort and the unusually strong possibility for data linkage makes the KMIC population a unique and cost effective study opportunity. This cohort study would have the potential to generate powerful evidence to describe the risk of smoking in a population with distinct background disease rates and distribution of lifestyle risk factors relative to western populations previously studied. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: A PRACTICE-BASED RESEARCH NETWORK OF COMMUNITY HEALTH CARE Principal Investigator & Institution: Maizlish, Neil A.; Community Health Center Network 7700 Edgewater Dr, Ste 220 Oakland, CA 94621 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2003 Summary: A Practice-Based Research Network of Community Health Centers (Infrastructure Development - Category I) The Community Health Center Network (CHCN) is a non-profit organization that provides management services for seven longestablished, community health centers (CHC) in Alameda County, California. The CHCs are staffed by 85 physicians and 40 mid-level practitioners who are safety-net providers for over 60,000 uninsured and Medicaid managed care patients. The patients are largely low-income Latinos, Asians, and African-Americans. CHCN coordinates clinical quality improvement with a committee of medical directors from each CHC and CHCN's medical director. The committee promotes evidence-based guidelines and selects annual topics for the evaluation of clinical performance ("audits"). The audits follow the
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Health Insurance
specifications of HEDIS (e.g., cervical cancer screening, glycemic control in diabetics, appropriate asthma care), and are carried out under the guidance of CHCN's epidemiologist. Technical reports are fed back to medical directors who initiate followup for patients and clinic staff to improve practices. To carry out the audits, CHCN has begun to create a centralized data warehouse based on automated reporting of encounters, commercial laboratory data, enrollment, and free-standing diabetes registries at each CHC. CHCs maintain their own automated practice management systems, but report to CHCN in standardized EDI formats. The warehouse is built on an enterprise database platform (MS SQL Sever), exporting data to standard statistical packages for analysis. Grants from two private foundations help support CHCN's quality improvement activities. CHCN participates in the National Health Disparities Collaborative of the US Bureau of Primary Health Care (BPHC), which provided training in quality improvement techniques. CHCN also participates in the Sentinel Centers Network, a national data standardization project sponsored by BPHC, Johns Hopkins University, and Morehouse School of Medicine. CHCN is an emerging PBRN that seeks to strengthen data collection and analysis infrastructure, and its historical links to Kaiser Permanente - North (KPN). Among priorities as a PBRN is the integration of computerized clinical data from different sources, the creation of disease registries, and, planning intervention research that will use a diabetes registry. CHCN and KPN will jointly develop a research protocol for a diabetes care management intervention adapted from a successful Kaiser educational model. To create and validate a disease registry, algorithms for file linkage will be tested and core data elements in the data warehouse will be compared to information in a sample of medical charts. Ongoing planning with KPN will lead to the development of a research proposal for future funding. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ACCESS ADOLESCENTS
AND
QUALITY
OF
CARE
FOR
LOW-INCOME
Principal Investigator & Institution: Shenkman, Elizabeth A. Associate Professor; Pediatrics; University of Florida Gainesville, FL 32611 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 28-FEB-2003 Summary: The Title XXI initiative represents one of the largest state and federal efforts to provide insurance coverage for uninsured, law-income children and adolescents, the majority of whom will be placed in some type of managed care arrangement. Assessing health care quality in these programs for adolescents is critical because adolescents have unique health care needs; yet face many barriers to obtaining health care that is targeted toward those needs. While most adolescents are healthy, an increasing number are engaging in risk-taking behaviors that have potentially deleterious health effects, such as unprotected sexual activity and substance use. Others have chronic health conditions. The primary aim of the proposed research is to assess the effects of the organizational features of KidCare, Florida's children's health insurance program, on access to and provision of primary and preventive care for enrolled adolescents, ages 12 to 19. Adolescents with diagnoses that are indicative of risky behaviors and those with chronic conditions will be included. We will assess the organizational features of the KidCare Program components and the different MCOs and provider practices participating in MdCare on adolescents' primary and preventive care. The KidCare Program presents a unique opportunity to study 15 different MCOs and insurers, with diverse provider practices, and over 65,000 adolescents. In the proposed research, we will study the following organizational characteristics: 1. General organizational characteristics, 2.
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Marketing and educational strategies for outreach, 3. Financial arrangements with primary care providers, 4. Non-financial arrangements to control costs, 5. Quality assurance approaches, 6. Presence of adolescent wellness and care coordination programs, and 7. Use of technology systems. The following outcomes of care are included: compliance with preventive health care guidelines, health care use and expenditures, health status, missed school days, unmet need, satisfaction with care, and out-of-pocket spending for health care. The research design is quasi-experimental, with data collected prospectively over a two year period. To conduct this study, we will use rich data sets covering a range of adolescents who are enrolled in diverse managed care arrangements associated with Florida's Title XXI initiative. These data sets include person-level health care use and enrollment data supplemented with telephone survey data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ACCESS TO CARE AND HEALTH OUTCOMES IN THE NEAR ELDERLY Principal Investigator & Institution: Smith, Maureen A.; University of Wisconsin Madison 750 University Ave Madison, WI 53706 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): There are widespread concerns that near-elderly Americans (55-64 years old) face increasing barriers to obtaining health care during a time of significant life transitions and deteriorating health. The long-term objective of the proposed research is to examine determinants of access to care, use of services, and health-related outcomes in the near-elderly. The specific aims are to determine the role of 1) significant recent life transitions such as changes in health insurance, health, work, or income, 2) financial and non-financial incentives in a person's current health insurance plan, 3) the healthcare environment (e.g., managed care market share, rural/urban), and 4) family history (e.g., parental health and early life experiences). Disparities in access to care are examined for women and persons with low income or poor health, as these vulnerable subgroups may have additional difficulties overcoming barriers to care. This study builds on the strengths of the Wisconsin Longitudinal Study (WLS). For 44 years, the WLS has followed men and women who graduated from Wisconsin high schools in 1957 (N=10,317) and a randomly selected sibling (N=7,638). Data were collected on mental and physical health, health insurance, socioeconomic status, and occupational histories. WLS project leaders have proposed a new round of telephone and mail surveys in 2002-03 of the surviving graduates and their siblings. This proposal extends the WLS by 1) adding items on health insurance, access to care, use of health services, and health outcomes to the WLS telephone and mail surveys, 2) collecting detailed information on health plan characteristics through a survey of health insurance companies, 3) linking to environmental data from the Area Resource File and Interstudy, and 4) linking eligible sibling records to Medicare enrollment and claims data. Multilevel modeling will be used to separate the effects of individuals, their health plans, there healthcare environment, and their family history in explaining variation in access to care, use of services, and health outcomes. The proposed research will provide valuable information to policymakers and researchers interested in the health and healthcare experiences of the near-elderly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ACCESS TO MEDICAL CARE Principal Investigator & Institution: Cutler, David M. Professor; National Bureau of Economic Research Cambridge, MA 02138 Timing: Fiscal Year 2001 Summary: Concern about whether people have appropriate access to medical services is an important research and public policy issue. On the one hand, recent years have seen a dramatic expansion in health insurance coverage for children and pregnant women, driven in large part by fears that lack of insurance was a significant barrier to medical services for these groups. Expanding insurance coverage to the uninsured who are near elderly (ages 55-64) has also been discussed as a public policy goal. On the other hand, there is growing anxiety that recent changes in the health insurance system may limit access to appropriate medical services, even among those with insurance. The growth of managed care and the cutback in payments from Medicare and Medicaid, for example, may impede the ability of people insured through these systems to access appropriate medical care. And if these changes affect the technology that is available or norms about appropriate medical practice, they could limit access to medical care even among those with generous insurance. Understanding the factors that influence access to medical care, and how these factors are changing over time, can help determine what role public policy should play in the medical care system. The goal of this subproject is to examine the access to medical services for people with different types of insurance, and to determine how the medical care financing system affects this access. The specific aims are: 1. To present descriptive information on the uninsured. 2. To analyze the effect of an individual's insurance status on their access to appropriate medical services; and 3. To examine how the insurance environment as a whole affects access to appropriate medical services for everyone in the population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: AGE, ETHNICITY, AND THE CHRONICALLY ILL UNISURED Principal Investigator & Institution: Becker, Gay; Institute for Health and Aging; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2005 Summary: The overall aim of this qualitative, anthropological research is to explore how chronically ill people in three ethnic minority groups who are uninsured attempt to manage their illnesses, with emphasis on the roles that age and ethnicity play. Four interrelated domains are explored: 1) access to and utilization of health care resources, both formal and informal, including the effect of economic status and financial resources on illness management; 2) interpretations of illness, including use of biomedicine and other systems of medical belief and practice; 3) cultural beliefs about age and illness; and 4) participation of family and friends in illness management. Focusing on these domains enables us to examine illness experience and bodily distress within its social, cultural, and economic context, and thus to pinpoint social, cultural, and economic differences within and between groups. We will examine the full range of this experience by studying 180 individuals, 60 in each of the following groups: African American, Latinos, and Filipino Americans. A subset of 20 from each group will be interviewed longitudinally, with 3 interviews at 6-month intervals. Qualitative analysis will be undertaken in a systematic progression of steps and will be supported by quantitative analysis of health measurement data, measures, and qualitatively-derived data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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•
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Project Title: ALCOHOL AND HOMELESS WOMEN'S USE OF HEALTH SERVICES Principal Investigator & Institution: Gelberg, Lillian; Family Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2005 Summary: (provided by applicant): Alcohol abuse/dependence and physical health problems are quite common among the homeless and their general health-care needs often go unmet. However, much of the existing research is based on samples comprised largely of homeless men. To date, there has been no population-based study of the association between alcohol abuse/dependence and utilization of general health care among homeless women. This study will employ secondary data to analyze the association between alcohol abuse/dependence and use of general health care (inpatient, ambulatory, and preventive) in a community-based probability sample of 974 homeless women in Los Angeles County. We will identify factors that appear to impede or facilitate the use of general health care among homeless women with lifetime alcohol abuse/ dependence. The proposed study directly addresses policy questions prominent in NIAAA's agenda for research on health services and special populations including women, minorities, and victims of violence. First, the majority of homeless women are members of ethnic minority groups and have been victims of violence. Second, homeless women are likely to have multiple health problems requiring general health care. Because homeless women may view such problems as more important than alcohol problems, effective access to general health services may facilitate utilization of and success in alcohol treatment as well. This study will test hypotheses regarding a wide range of predisposing and enabling factors (such as case management, health insurance, and access to public benefits) potentially associated with access to general health services by homeless women with alcohol problems. By documenting the nature and extent of health problems affecting alcohol-using homeless women, their use of general health services, and the extent to which their need for care goes unmet, this study will inform alcohol treatment providers on the value and content of screening/assessment procedures they might employ and the types of general health services for which more effective linkage is needed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ALCOHOL TREATMENT UNDER MANAGED CARE PLANS: ROLE OF HMOS Principal Investigator & Institution: Horgan, Constance M. Director of Research; None; Brandeis University 415 South Street Waltham, MA 024549110 Timing: Fiscal Year 2002; Project Start 29-SEP-1996; Project End 31-JUL-2005 Summary: (provided by applicant): Managed care, ranging from health maintenance organizations (HMOs) to preferred provider organizations (PPOs), has become the predominant form of private health insurance in the U.S. The main objective of this study is to further understand how alcohol services are provided in HMOs, one of the earliest and most common forms of managed care. We build on round 1 of our national survey of managed care organizations (MCOs) regarding alcohol service provision in the 1999 benefit year. The specific aims are to: 1. Describe the provision of alcohol services in HMOs for the 2003 benefit year in terms of both administrative factors (including overall plan characteristics, contracting arrangements, payment methods and risk sharing, and benefit design) and clinical factors (including treatment approaches, utilization management, provider selection, entry into treatment, and quality assurance). 2. Document how the provision of alcohol services in HMOs has changed over a four-
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year time period, and explore what factors influence these changes. 3. Model why some HMOs provide alcohol services internally within the plan and other HMOs choose to carve out alcohol services to specialty managed care vendors. In round 1, we surveyed a sample of MCOs stratified by type of product offerings (HMO vs. PPO) in 60 market areas with NIAAA funding the HMO and NIDA funding the PPO portions of the study. We surveyed 434 MCOs in round 1, including the 283 MCOs that reported HMO products, and achieved a 92 percent response rate. We will conduct round 2 of a telephone survey of these 434 MCOs, as well as a refresher sample in theses 60 market areas regarding their HMO products. Companion funding has already been obtained from NIDA to conduct round 2 surveys of these same MCOs regarding their PPO products. We will continue to collaborate with longitudinal, nationally representative Community Tracking Study (CTS) conducted by the Center for Studying Health Systems Change which provides the sample frame of health plans in the 60 market areas. The proposed study of alcohol treatment services is the first to combine two rounds of a national survey of MCOs within market areas in a prospective design that will allow us to track how the delivery of alcohol services in HMOs evolves within the changing health care market. These changes include: expansion of federal and state substance abuse parity legislation; increased enrollment in behavioral health specialty vendors; increased managed care regulation, particularly state consumer protection laws regarding managed care; and treatment innovations including the approval of naltrexone. This study will provide systematic information on the nature and extent of HMO changes, and their impact on alcohol service delivery, during this time period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ANALYSIS OF FEE-FOR-SERVICE VS MANAGED CARE CSHCN Principal Investigator & Institution: Beane, G Elaine.; Michigan Public Health Institute 2436 Woodlake Circle, Ste 300 Okemos, MI 48864 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-DEC-2002 Summary: Michigan recently implemented a voluntary managed care plan for Children with Special Health Care Needs. From the child/family perspective, a CSHCN managed care plan should ensure the same or better access to health services as the traditional feefor-service CSHCN program. From the managed care contractor perspective, utilization of services under managed care must be as or more efficient than the fee-for-service levels in order to maintain financial viability. The proposed study seeks to investigate the impact of Michigan's managed care program in three areas of fundamental importance to the future viability of such programs: differences in children's utilization of services in a fee-for-service vs. managed care setting; differences in the costs of these services under these two systems of care; and families' and physicians' appraisals of the services they receive or provide under one system vs. another. The study will incorporate four phases of research. Phase 1 calls for the analysis of state CSHCN encounter data to calculate baseline utilization patterns for children with one of 12 common CSHCN qualifying diagnoses. Baseline data will reflect the three-year period (1996-1998) prior to implementation of CSHCN managed care. Phase 2 involves analysis of CSHCN managed care encounter data to calculate utilization and costs for managed care enrollees for the initial two years of the plan (1999-2000), focusing on the same 12 qualifying diagnoses. Managed care utilization and cost data will be compared with similar data from the fee-for-service population during the same time period. In addition, individual pre-post analyses will compare the utilization of individual children who transfer into the managed care plan with their own utilization from previous years in the fee-for-service system. In Phase 3, services authorized under
Studies 11
managed care enrollees' Individualized Health Care Plans (IHCPs) will be compared with actual utilization by the same patients, as well as with baseline utilization patterns. Phase 4 involves mailed surveys of parents of CSHCN, to include both managed care and fee-for-service participants. For managed care participants, survey items will explore parents' satisfaction with the plan, including completion of the IHCP, coordination of care, and access to services within and beyond the scope of the IHCP. For fee-for-service participants, survey items will explore the coordination of care in the absence of IHCPs and parents' experiences seeking prior authorization of services. A concurrent survey of CSHCN managed care providers will explore their use of IHCPs, their administrative experience with both CSHCN arrangements, and their perceptions of changes brought about by CSHCN managed care. In total, the three phases of research will allow us to better describe the structure and delivery of services under CSHCN managed care, to understand the extent to which CSHCN managed care facilitates or constrains access to health services, and to assess the economic impact of implementing a managed care plan for this population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ARTHRITIS AMONG LATINOS: A STUDY BASED ON NATIONAL DATA Principal Investigator & Institution: Abraido-Lanza, Ana F. Sociomedical Sciences; Columbia University Health Sciences New York, NY 10032 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 31-MAY-2003 Summary: The broad aim of this study is to assist in uncovering factors underlying the observed differences between Latinos (Hispanics) and non-Latinos in the prevalence rate of arthritis and associated levels of disability. This information can ultimately guide policy and intervention programs to reduce physical disability and promote health in this population. According to recent national data, Latinos arthritis have a higher arthritis prevalence rate, but among those with arthritis, more Latinos than non-Latino whites report activity limitations (CDC, 1996a). Reasons for these differences are unknown, but may include disparities in sociodemographic factors, access to health care, and acculturation factors. Therefore, the aims of the proposed study are to: (1) examine whether socioeconomic factors (e.g., income, education) and health insurance coverage account for differences in the prevalence of arthritis among Latinos and nonLatino whites, (2) document levels of disability, both in activities of daily living and inability to work, among Latinos and non-Latino whites with arthritis, and identify sociodemographic (e.g., income, education, type of occupation) and health care factors (e.g., lack of health insurance, quality of health care) that predict disability in the different groups; and examine whether health care factors explain the differences in disability levels of Latinos vs. non-Latino whites after controlling for sociodemographic variables, (3) examine the effects of nativity status (U.S. vs. foreign-born) and length of time in the U.S. (acculturation) on arthritis prevalence and disability. These issues will be examined using data from the National Health Interview Survey (NHIS) on Disability, Phase I: Person and Condition Data, 1994. The proposed study will control for age and SES differences between the various ethnic groups, and conduct detailed analyses by Latino groups. This study will, therefore, contribute to a systematic program of research attempting to understand arthritis prevalence and disability among understudied populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ASSESSING THE VARIABILITY IN TIME TO TREATMENT IN SURGERY Principal Investigator & Institution: Chassin, Mark R. Health Policy; Mount Sinai School of Medicine of Nyu of New York University New York, NY 10029 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 29-SEP-2002 Summary: Many factors influence patients' decisions to seek medical care when they experience symptoms of illness. Different factors influence the ability of patients to enter the health care system once they decide they wish to. Yet a different set of considerations affect the provision of timely and effective care. For a number of surgical conditions, delays in providing definitive care are especially likely to increase the frequency of serious adverse outcomes, including death, immediate complications, and long-term disability. For these delay-sensitive conditions, we currently understand very little about the relationship between time to treatment and outcomes, which components of this total time are the most important determinants of outcome, and which components may be modifiable. Past work has focused on conditions such as myocardial infarction and trauma and has emphasized particular segments of time (e.g., time from injury to hospital; time from onset of chest pain to emergency room door). None has articulated a conceptual framework that encompasses the full range of factors that might influence delays. These include patient factors (knowledge, beliefs, and coping strategies), physician factors (knowledge, diagnostic acumen), hospital factors (availability of diagnostic tests and operating rooms), and health system factors (health insurance, utilization management, gatekeeping). We propose to study three delaysensitive conditions: appendicitis, ectopic pregnancy, and intestinal obstruction. In phase 1, we will review medical records retrospectively to establish the relationship between overall time to treatment and health outcomes and to examine variability in different components of this time. Multivariate analysis will permit us to examine the effect of time to treatment after adjustment for age and comorbid conditions. In phase 2, we will gather data concurrently from patients and their physicians, as well as from medical records, to assess the full range of patient, physician, and health system factors contributing to variability in time to treatment. These analyses will substantially improve our understanding of the relationship between time to treatment and health outcomes. Studying three conditions will permit some initial observations about how unique or generalizable these relationships are in different clinical settings. These data may also lead to hypotheses about which factors associated with delays might be modifiable, leading to the design of specific interventions to reduce delays and improve outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: BARRIERS TO ENROLLING THE ELDERLY IN CANCER TRIALS Principal Investigator & Institution: Gross, Cary P. Internal Medicine; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2001; Project Start 03-AUG-2001; Project End 31-JUL-2006 Summary: (provided by applicant): BACKGROUND: Elderly patients are currently underrepresented in cancer clinical trials. As a result, new evidence may not be generalizable to the population group that carries the greatest burden of illness. Access to clinical trials also offers patients the opportunity to receive the newest treatments and meticulous clinical care. In order to ensure that the clinical trial system is relevant and accessible to all patients with cancer, it is important to identify specific barriers to the enrollment of elderly cancer patients. SPECIFIC AIMS: 1) To identify demographic and
Studies 13
clinical characteristics of elderly cancer patients that are associated with clinical trial participation; 2) To identify institutional and organizational determinants of trial participation for elderly cancer patients; 3) To identify research centers that are particularly successful in enrolling elderly cancer patients into clinical trials, and determine whether the investigators' attitudes and enrollment strategies at these centers are different from those at centers that are less successful at enrolling elderly patients; and 4) To identify attitudes of elderly cancer patients towards participation in clinical trials. RESEARCH PLAN: First, we will perform a population-based analysis of barriers to the participation of elderly cancer patients with breast, prostate, lung, and colon cancer in clinical trials sponsored by the National Cancer Institute. The SEER-Medicare data will be used to estimate characteristics of incident cancer patients in the population. We will analyze the impact of patient and hospital characteristics, and health system factors such as managed care market penetration on the recruitment of elderly patients. Guided by these findings, we will then perform qualitative studies of elderly cancer patients as well as clinical investigators to ascertain their attitudes toward the participation of elderly patients in clinical trials. CAREER DEVELOPMENT PLAN: My career goal is to become an independent investigator, focusing on the quality of care for elderly patient with cancer-specifically on how new cancer therapies for elderly patients are evaluated and disseminated. In order to attain the necessary skills, I will work closely with my mentors on a rigorous program of research and independent study. Additionally, I will receive formal training in the Masters of Public Health program in Health Policy and Administration. SIGNIFICANCE: We hypothesize that patient reluctance, investigator attitudes, and the lack of insurance coverage for direct medical costs are crucial barriers to trial participation for elderly cancer patients. It is our hope that this work will facilitate the development of targeted and novel approaches to overcoming these barriers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BOTANICAS IN ETHNIC HEALTHCARE Principal Investigator & Institution: Jones, Michael O. Professor; Inst for Social Sci Research; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-DEC-2002 Summary: (APPLICANT'S ABSTRACT): The families of nearly half of Los Angeles County's 8.8 million residents came from Latin America, the Caribbean and the American South. Because 38% of Latinos and 22% of African Americans lack health insurance, they have limited access to preventive medicine and often delay professional treatment. Botanicas have burgeoned as an alternative health resource. However, little is known about the spiritual, counseling and herbal practices they offer--whom they treat, how or why, and the nature, number, sources, efficacy or safety of the herbal therapies they dispense or employ. This project will document the ethnomedical and spiritual systems of botanicas, providing detailed case studies, interviews and observational data regarding diagnostic and treatment approaches as well as provider beliefs with particular attention to herbal therapies including sources, collection, processing and therapeutic uses of medicinal plants. Results of the study can contribute to increasing the quality of clinical research that evaluates the efficacy of traditional indigenous systems of medicine by discovering the most frequently used plants for the most commonly treated ailments as well as revealing the cultural context of health beliefs and therapeutic practices. While attention has been paid to testing Chinese herbs and selected plants in mainstream Euro-American culture, other traditions remain largely
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unexplored. Much of the botanical and pharmacological research that has been conducted lacks information on the harvesting of plants (season, time of day, state of plant development), storage, preparation, dosage and route of administration-crucial data for clinical trials evaluating the safety and efficacy of herbal medicine as it is actually practiced. Previous research also often misses ethnographical details of the social, symbolic and ritual aspects of plant collection, preparation and usage that may influence the outcome of therapy. This study seeks to uncover such ethnobotanical and ethnographic information, which can serve in future to help educate health personnel about aspects of the ethnomedical and spiritual approaches relied upon by many immigrants and advance the design of methods for testing possible effectiveness of these treatment approaches. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CAHPS II Principal Investigator & Institution: Cleary, Paul D. Associate Professor; Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2002; Project Start 30-SEP-1995; Project End 31-MAY-2007 Summary: This application proposes a program of research, development, and evaluation that will advance the state of the field with respect to the design, collection, and use of consumers' assessments of health care for purposes of informing health care choices and improving health care quality. The specific goals of the proposed project are to: 1) maintain and refine existing CAHPS products, including the Experience with Care and Health Outcomes (ECHO) survey and the CAHPS analysis program (CAHPS macro), 2) further develop and test surveys and reports that assess nursing home performance, group practices, and care of persons with mobility impairments, 3) develop and test new survey modules and protocols that address individual clinician performance, PPO performance and patient safety, 4) test and evaluate new data collection methodologies, including use of the Internet and Interactive Voice Recognition, 5) develop, test, and evaluate new approaches to reporting CAHPS data to consumers, purchasers, and providers, 6) develop, implement and evaluate new approaches to facilitating quality improvement through the use of CAHPS data, and 7) evaluate new and conventional approaches to facilitating consumers' use of CAHPS data to inform their health care decisions and improve the quality of care they receive. The applicants are a consortium of experts in consumer survey design, report development, experimental psychology, quality improvement, evaluation research, and community-based dissemination methods from the Department of Health Care Policy in the Harvard Medical School, Baruch College at City University of New York, the Center for Survey Research at the University of Massachusetts, The Department of Psychology at Harvard University, the Center for Measuring Rehabilitation Outcomes at Boston University, the National Committee for Quality Assurance, the New England Medical Center, the Academy of Educational Development (AED), and several nationally known independent researchers and consultants. This consortium (hereafter referred to as the "Harvard team") proposes maintaining continuity in the CAHPS development process by continuing critical activities and well established collaborations from the CAHPS I project, while expanding the team substantially to bring new skills, perspectives and expertise to the project. Similarly, the team has maintained close contact with collaborating demonstration sites from CAHPS I and has established new relationships with public and private organizations that share an interest in refining and assessing CAHPS products for improved decision making and quality improvement. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CAHPS II Principal Investigator & Institution: Hays, Ronald D.; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2002; Project Start 30-SEP-1995; Project End 30-APR-2007 Summary: This proposed 5-year research project builds on previous work done in the Consumer Assessment of Health Plans Study (CAHPS (R) I), funded by AHRQ from 1995 to 2001. The project has 4 primary objectives: 1) To conduct a 5-year project of research designed to advance knowledge about effective reporting of health plan and physician performance for consumers, purchasers, children with special health care needs, and other audiences; 2) To evaluate the usefulness of CAHPS (R) survey and reports for quality improvement; 3) To derive new survey items and reports for the institutional setting, group practice, individual physicians, PPOs, and persons with mobility impairments; and 4) To assess the cultural comparability of CAHPS (R) data by race/ethnicity and language. The project also will maintain survey and reporting products developed in CAHPS (R)I. The study will consist of a program of systematic research to advance the state of science on reporting, including development and testing of reporting templates for providers of health care, children with special health care needs, person with mobility impairment, and non-English languages. In addition, the investigators will collect information on existing activities and methods for quality improvement (QI) by health plans, physician groups and individual providers, develop survey items to facilitate QI efforts, design performance reports, develop QI implementation methods and tools, and conduct QI demonstrations with the CAHPS (R) survey and targeted item set. Finally, the investigators will finalize the group level and nursing home CAHPS (R) survey instruments, develop targeted items for persons with mobility impairment and PPO settings, develop an individual provider level CAHPS (R) survey, evaluate the need for specific dialects for the Spanish CAHPS (R) survey, translate the core survey into additional languages, assess the cultural comparability of the CAHPS (R) survey in different subgroups, explore new data collection techniques, and evaluate new methods for scoring CAHPS (R) survey items and composites. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CANCER CARE OUTCOMES RESEARCH & SURVEILLANCE CONSORTIUM Principal Investigator & Institution: Ayanian, John Z. Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2001; Project Start 28-SEP-2001; Project End 31-AUG-2006 Summary: We propose to participate as a Primary Data Collection and Research (PDCR) site in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium by studying population-based cohorts of patients with colorectal cancer and lung cancer in 9 Northern California counties that include the San Francisco, Oakland, San Jose, and Sacramento metropolitan areas. Our proposal is a collaborative effort of the Harvard Medical School, Northern California Cancer Center, Cancer Surveillance Program of Sacramento, California Cancer Registry/Public Health Institute, and Northern California Kaiser Permanente Division of Research. We propose 3 specific aims focused on sociodemographic differences in care: 1) To evaluate the relation of patients' race, ethnicity, socioeconomic status, insurance coverage, gender, and age to processes of care; 2) To assess the effect of sociodemographic factors on patients' outcomes; and 3) To combine medical record and surrey data with larger datasets to obtain improved
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estimates of sociodemographic effects on processes and outcomes of cancer care. In special studies, we will survey surgeons to assess beliefs and characteristics associated with processes of care and outcomes for colorectal cancer, and we will use electronic data from Kaiser Permanente to assess surveillance practices, quality of non-cancer care, and use of hospice services by patients with colorectal and lung cancer after their initial diagnosis and treatment. Our PDCR team will make substantial contributions to the Consortium, including rapid ascertainment of ethnically diverse, population-based cohorts; rigorous data collection from pathology facilities, medical records, and cancer patients or their next-of-kin; conceptual, clinical, and statistical expertise in analyses of pooled Consortium data; and innovative special studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CARDIOVASCULAR HEALTH AND STROKE PREVENTION Principal Investigator & Institution: Gibbons, Gary; Director; Morehouse School of Medicine Atlanta, GA 30310 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CERTIFIED SAFE FARM EVALUATING HEALTH INSURANCE CLAIMS Principal Investigator & Institution: Donham, Kelley Jon. Professor; Occupational & Environ Health; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Agriculture is one of the most hazardous industries in the US. A recent systematic review of farm safety interventions found little evidence of the interventions being effective. The Certified Safe Farm (CSF) program has shown exceptional potential to become a widely used effective intervention model. Our pilot results show a 17% reduction in total farm related injury and illness costs and 35% reduction in the costs covered by insurance. These results are very promising, but they are self-reported, and may be subject to bias. We propose to validate these results in this new proposed study, which has large sample sizes and measures success with actual health insurance claims data. Iowa Farm Bureau Federation, Wellmark Blue Cross Blue Shield of Iowa, and AgriSafe Network are our active partners. The specific aims of this project are to: 1. Enroll 600 Iowa farmers into the CSF program who are members of the Iowa Farm Bureau Federation and have Wellmark health insurance coverage through Iowa Farm Bureau Federation. 2. Provide CSF services (agricultural occupational health screenings, education, and on-farm safety reviews) to each of the enrolled farmers twice during the four-year project. 3. Provide safety and health education to CSF farm families on a continual basis. 4. Conduct retrospective and prospective analyses of health insurance claims data for the 600 CSF farmers and at least 2400 control farmers who are also Iowa Farm Bureau-Wellmark insurees. 5. Analyze the association of health outcomes and demographic, farm production, health, insurance, and farm hazard characteristics. 6. Utilize project findings to build an ongoing CSF program in collaboration with insurance and agribusiness partners. The CSF program has shown to be well received among farmers, feasible to implement, and transportable to different farming situations. It has shown to reduce farm hazards, increase the use of personal protective equipment, reduce respiratory symptoms, and decrease farm-related injury and illness costs. This proposal aims to take this program to the next level - a sustainable
Studies 17
ongoing program linked with farm organizations, insurance companies, and agribusinesses. Positive results from this study will provide justification for the private sector to invest in the CSF program. With insurance and agribusiness participation, this program has the potential to achieve high participation rates among farmers and make a significant difference in reducing the burden of injuries and illnesses in US agriculture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHANGING MEDICAID: TAKE-UP, WELFARE, AND FERTILITY Principal Investigator & Institution: Shore-Sheppard, Lara; National Bureau of Economic Research Cambridge, MA 02138 Timing: Fiscal Year 2001; Project Start 06-JUL-2001; Project End 30-JUN-2004 Summary: (provided by applicant): Over the past fifteen years, the U.S. government has implemented a series of changes in the social safety net that dramatically altered the provision of public health insurance to low-income women and children. Beginning in the late 1980s and early 1990s, laws were passed that expanded Medicaid eligibility for poor pregnant women and for poor children. Welfare system changes implemented during the mid-1990s encouraged welfare recipients to work and leave welfare, but assured them that public health insurance benefits would continue. More recently, the commitment to publicly-provided health insurance was expanded further with the passage of legislation authorizing the largest increase in public spending on insurance for children in three decades. Despite interest by policymakers and previous researchers in examining the effects of these changes, important questions remain about their implications. To improve understanding of the impacts of publicly-provided health insurance, this proposed research has three specific aims. First, to examine the factors determining the extent to which eligible children enroll in Medicaid. Second, to examine how changes in the relationship between cash assistance and public health insurance for single mothers affect the health insurance coverage of single mothers, particularly the fraction of time spent with private insurance, public insurance, and uninsured. The effects of these changes on the welfare participation and employment of single women will also be examined. Third, to estimate the impact of expanded public health insurance for pregnant women and children on fertility. Detailed panel data on insurance, income, employment, welfare participation, and fertility from the Survey of Income and Program Participation (SIPP) will be used. The Survey of Program Dynamics, the 1990 Census microdata, and a survey of closed welfare cases from Ohio will also be used for some analyses. The data will be analyzed using a variety of estimation techniques appropriate to panel data, including descriptive analyses, static models, switching models and duration models. As eligibility for Medicaid may be endogenous, exogenous variation in the impact of federally-mandated expansions by state, time, and age as well as business-cycle variation will be used to identify the models. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CHILD MENTAL HEALTH AND MENTAL HEALTH SERVICE USE Principal Investigator & Institution: Ganz, Michael L. Maternal and Child Health; Harvard University (Sch of Public Hlth) Public Health Campus Boston, MA 02460 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 30-SEP-2003 Summary: The current mental health care system for children is fragmented, poorly coordinated, and is in crisis. Current knowledge of the system is therefore imperative. The purpose of this project is to examine the family, socio-economic (SES), clinical, and
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insurance correlates of mental health conditions and related services for children in the United States and to provide a baseline for tracking changes in the system over time. This project is motivated by the fact that little is known about mental health- related service use for children and how key factors, including insurance characteristics influence the use of those services, especially based on current national surveys. It is also motivated by the fact that changes in financing methods for health insurance coverage for children may have important implications for access and utilization of needed services for children with mental health conditions. Furthermore, little is known about how child mental health conditions and mental health services use impacts the family. In order to begin to address these gaps, I propose the project described in this application. The specific aims of this project are: - Characterize the population of children (< 21 years) in the United States that have mental health conditions with respect to family, socio-economic, clinical, and insurance coverage factors. - Estimate utilization and expenditure patterns and sources of payment for overall health care and care within specific categories of services by age, diagnostic, insurance coverage groups, and family characteristics. - To assess the impact of a child's mental health condition on maternal employment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHILDREN WITH CHRONIC HEALTH CONDITIONS: FAMILY IMPACT Principal Investigator & Institution: Kuhlthau, Karen A.; Massachusetts General Hospital 55 Fruit St Boston, MA 02114 Timing: Fiscal Year 2001; Project Start 24-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): This project examines the consequences of having a child with chronic conditions on parental labor force outcomes (labor force participation, employment, hours worked, and wage) and use of employer-based health insurance and child care. We hypothesize that maternal labor force participation will be reduced for women with a chronically ill child and that the effect will be greater for married women. Among co-resident fathers, we anticipate that having a child with a chronic health condition will increase labor force participation because of the specialization of roles within a family. We anticipate that among employed women, having a child with a chronic condition will increase use of employer-based health insurance and will decrease use of using non- relative child care compared to employed women with apparently healthy children. This study will use the National Longitudinal Survey of Youth Child Data. Public policies such as the Supplemental Security income program and private workplace policies such as sick leave time are based on assumptions about parents' behavior relative to their child's health status. Yet little is known about how a child's health status influences family labor force and child care decisions. This study will provide context to these ongoing policy debates. The project will also provide information useful to families as they seek to understand their experience in the context of the experience of others and to physicians who can use the information to provide anticipatory guidance to patients and their families. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CHRONIC PELVIC PAIN AFTER PELVIC INFLAMMATORY DISEASE Principal Investigator & Institution: Haggerty, Catherine L. Epidemiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260
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Timing: Fiscal Year 2001; Project Start 01-AUG-2001 Summary: Pelvic Inflammatory Disease (PID), is the general term to describe clinically suspected infection of the upper pelvic tract. PID is associated with a number of morbidities, including chronic pelvic pain. However, very little is known about the etiology or consequences of chronic pelvic pain following PID. The proposed research will analyze data from an ongoing randomized clinical trial, the PID Evaluation and Clinical Health (PEACH) Study. Additionally, outpatient, emergency department, and hospital medical records will be collected and abstracted to determine PID-relatedness and primary visit diagnosis. For all PID-related visits for which medical records are obtained, billing records will also be gathered. The specific aims of this project are: 1) to examine predictors of chronic pelvic pain following an episode of PID; 2) to determine whether women with chronic pelvic pain are more likely to use the healthcare system than those without, to determine whether they use it more intensely, and to determine whether use varies with the grade of pain intensity and disability; 3) to estimate the total cost of medical care for women following PID and to determine whether the costs are higher for women with chronic pelvic pain; 4) and to determine the impact of chronic pelvic pain following pelvic inflammatory disease on quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CLAIMS DATA PROJECT Principal Investigator & Institution: Kahn, Katherine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001 Summary: The purpose of this study is to evaluate the utility of claims data as a data source to evaluate quality of care in new onset rheumatoid arthritis; to measure the quality of care for patients with new onset rheumatoid arthritis with regard to arthritis co-morbid conditions and health care maintenance, and to identify factors associated with better attainment of quality standards. This study will prospectively follow a cohort of 400 patients with new onset rheumatoid arthritis for two years through patient surveys and claims data. Subjects will be enrolled through one large managed care organization (MCO) located in Southern California which represents an average of 2.8 million covered lives per year. Using a claims based algorithm, the 1998 through 1999 claims data for this MCO will be screened for incident cases of rheumatoid arthritis. Patients between ages 18 and 62 will be eligible for enrollment. A screening survey which will ascertain 1) whether a patient has been diagnosed with rheumatoid arthritis and/or 2) if the patient meets the 1987 American Rheumatism Association (ARA) criteria for rheumatoid arthritis by self report will be sent by mail to all eligible patients to invite participation. The first 400 responding patients who have had a prior diagnosis or meet the ARA criteria will be enrolled. Patients will complete telephone surveys which assess health status every six during the study. By using data elements from claims data, patient self report. and medical records, the structure, process, outcomes and quality of care will be assessed. Items measured in the claims data will be validated through the patient self report and medical record review. This study will inform us regarding the predictive value of claims data for identifying patients with rheumatoid arthritis and describing utilization. It will also describe the utility of claims data for assessing the process and quality of care for rheumatoid arthritis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DISPARITIES
COMMUNICATION,
PERSPECTIVES,
&
CHILD
ASTHMA
Principal Investigator & Institution: Lieu, Tracy A. Associate Professor; Harvard Pilgrim Health Care, Inc. 93 Worcester St Wellesley, MA 02481 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by applicant): Eliminating racial and ethnic disparities in health care is a national priority. Minority children bear a disproportionate share of the burden of asthma, a leading cause of childhood morbidity. Recent studies have found that African-American and Latino children are less likely to be using needed preventive asthma medications than White children are, even when health insurance is equalized. Culturally tailored interventions hold promise to close such gaps. However, scant information is available to suggest how such interventions should be designed. Specific Aims and Research Plan. This innovative project will pair qualitative and quantitative methods to study African-American, Latino, and White children with persistent asthma. We will: 1. Identify elements of effective communication in clinical interactions; 2. Determine other key factors leading to under-use of preventive medications; and 3. Lay the foundation for developing tools to enhance effective clinical decision-making that incorporates parent and child perspectives. In the Qualitative Phase, we will audiotape clinical interactions and conduct semi-structured interviews with parents and providers. The qualitative results will suggest specific possible interventions to reduce disparities. In the subsequent Survey Phase, we will test the generalizability of hypotheses from the qualitative research. We will conduct a retrospective cohort study in two large, diverse populations, linking data from telephone interviews with parents, surveys of providers, and computerized data on asthma medications and other health care use. The unique strengths of this research include our ability to study the parent-child-provider interaction using different and complementary data sources, our access to computerized data, and our plan to identify areas of similarity and contrast among different racial/ethnic groups using both qualitative and quantitative methods. Projected Findings and Policy Implications: Our results will identify specific elements of effective communication and decision making for African-American, Latino, and White families. This information is critical to the design of effective, culturally tailored interventions to eliminate disparities in health care for childhood asthma and other chronic diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: COMMUNITY TRIAL TO INCREASE CANCER SCREENING ADHERENCE Principal Investigator & Institution: Fox, Sarah A.; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 31-MAR-2002 Summary: Certain cancer screening tests are effective in early detection, most notably, the tests used for breast, cervical, and colorectal cancers. These tests, all of which are endorsed by the U.S. Preventive Task Force for women over age 50, include mammography, clinical breast examination (CBE), Pap smear, and fecal occult blood test (FOBT). In spite of widespread endorsement, many women do not systematically receive these tests. This is especially true for certain subpopulations -- Hispanics, pooper women, and women without health insurance. For example, as recently as 1996, only 24 percent of Hispanic patients over age 50 in Los Angeles County reported receiving regular mammograms. This is a randomized trial involving a sample of primary care physicians drawn from 29 contiguous communities in Los Angeles. The trial has four
Studies 21
specific aims: 1) develop, pretest, and implement a multifaceted physician intervention designed to increase physician use and referral rates for breast, cervical, and colorectal cancer screening for underscreened female patients, 2) identify and track for two years the screening rates of female patients over age 50 for mammography, CBE, Pap, and FOBT, 3) compare the intervention versus control to estimate the cost effectiveness ratio for the intervention relative to the control, and 4) evaluate the effectiveness of the proposed intervention in achieving its stated goals. The intervention to be tested is a CME workshop that incorporates cancer control content, communication skill training, and cultural competence training to increase patient adherence to screening; patient brochures for physicians practices; 3 post CME reminder/evaluations; and a 1 year and a 2 year post workshop patient chart audit feedback. The physician intervention will be evaluated using a randomized two-group design, while the patients' records and survey data will provide the behavioral data to assess patient adherence to screening for the three cancers. Although much is known about barriers to breast cancer screening relative to other cancers, we know far less about cultural and communication barriers to breast, cervical and colorectal cancer screening. We also need to learn about cultural and communication barriers that affect patients who otherwise have assess to care. This multifaceted physician intervention is highly exportable, especially to managed care settings. Since southern California is moving rapidly toward managed care predominance, this experiment has the potential to be highly marketable and influential with the majority of future providers who care about screening adherence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CONSUMER ASSESSMENTS OF HEALTH PLANS STUDY (CAHPS) II Principal Investigator & Institution: Garfinkel, Steven; Managing Research Scientist; American Institutes for Research 3333 K St Nw Washington, DC 20007 Timing: Fiscal Year 2002; Project Start 24-JUN-2002; Project End 31-MAY-2007 Summary: This project will (1) advance empirical knowledge of health care quality measurement and reporting through a carefully planned, long-term program of research, (2) study alternatives for integrating CAHPS data with other quality indicators, (3) bring new theoretical grounding to CAHPS, and (4) move CAHPS research into practice more effectively by developing methods for new sponsors and audiences. The research design includes a series of integrated projects in the areas of instrumentation and survey procedures, reporting quality information, using CAHPS measures for quality improvement, and evaluating CAHPS implementation and effects. The specific projects include: (a) Maintenance of the CAHPS Survey and Reporting Kit, (b) Updates of the CAHPS analytic strategy, with particular attention to developing the theoretical basis and practical applications for the assessment of entities with small populations, (c) Continued development of the instrument and survey procedures for G-CAHPS, NH-CAHPS, and PWMI-CAHPS, (d) Development of IP-CAHPS, PPO Questions, translations, and Web data collection procedures for CAHPS, (e) Laboratory studies of CAHPS evaluability, narratives, and framing, especially among persons with low educational attainment and literacy, (f) Electronic reporting, especially for parents of children with special health care needs and persons with low computer literacy, (g) Report templates development and a Final Report on the results of the 5-year reporting research program, (h) Use of G-CAHPS for Q1 with group practices in Oklahoma that primarily serve the Native American population and practices that serve the general Medicaid population, (i) Use of NH-CAHPS for QI in Tennessee, and (j) Evaluation of a social marketing intervention to promote effective CAHPS dissemination and use in
22 Health Insurance
Oklahoma, using G-CAHPS, CSHCN CAHPS, and the electronic report template. These projects will improve the measurement and reporting of CAHPS information, focus CAHPS on the units of analysis and aspects of care most salient to the public, and develop the new methods and understanding about quality needed to broaden the acceptance and use of CAHPS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CONVENTIONAL INFERTILITY THERAPY VS FAST TRACK TO IVF Principal Investigator & Institution: Reindollar, Richard H.; Beth Israel Deaconess Medical Center St 1005 Boston, MA 02215 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2005 Summary: This study is designed to determine the cost-effectiveness of a fast track to in vitro fertilization (IVF) infertility therapy by conducting a randomized prospective clinical trial to compare its success rates and costs to that of conventional therapy. Eligible couples with a female partner aged 25-39 years and a male partner without severe male factor infertility will be randomized to either a conventional treatment or a fast track to IVF arm. Infertility is a major health problem in the United States. Primary or secondary infertility affects 10-15 percent of American couples and costs billions of dollars annually in medical costs and lost productivity. Projections show that 5-6.3 million women will be infertile in the year 2000, and 5.4-7.7 million women will be infertile in 2025. In recent years, infertility diagnostic evaluations have been streamlined because of the increased success of treatment strategies. Unlike many other areas of medicine in which treatment is based on the specific clinical diagnosis, new standardized infertility treatments are now used for nearly all causes of infertility. Conventional treatments for infertility have extremely variable protocols, success rates, patient access, and costs to both patients and insurance carriers. For most infertility treatments, success rates are lower than natural rates in fertile couples, and for some therapies, particularly gonadotropin- induced ovulation, the frequency of multiple births is unacceptably high. In contrast, success rates for the most technologically advanced methods, particularly IVF, have not only surpassed those of gonadotropinbased conventional treatments, but are now higher than natural fertility rates. IVF and related strategies have been modified successfully to reduce adverse events, particularly multiple births. Costs and insurance coverage have a direct effect on access to infertility services and the choice of treatment. Massachusetts is one of only five states that require insurance carriers to provide comprehensive coverage for infertility treatment, including IVF. Even in these states, affected couples are usually required to have failed conventional infertility therapy before coverage for IVF is authorized, despite the higher rate of adverse events and lower pregnancy rates of conventional treatments. The proposed study takes advantage of two local features: (1) The BIDMC/Boston IVF/HVMA is the largest infertility treatment center in the United States, treating over 2,300 new patient couples each year. During the study's two-year enrollment period, approximately 1,200 eligible couples per year will be available for recruitment, and 800 will be enrolled. (2) Because insurance coverage for infertility is required by Massachusetts law for all participants, the choice of therapeutic alternatives is not affected by the patients' ability to pay for treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CO-OCCURING DRUG AND MENTAL DISORDERS IN YOUTH Principal Investigator & Institution: Heflinger, Craig A. Associate Professor; None; Vanderbilt University 3319 West End Ave. Nashville, TN 372036917
Studies 23
Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-AUG-2003 Summary: (Applicant's Abstract) In response to PA-97-005, the proposed project will develop descriptive information and test hypotheses regarding population characteristics, service use, and service outcomes of youth with co-occurring drugrelated and mental disorders. Important differences in the service use patterns and outcomes will be examined for youth with co-occurring disorders. Previously collected data from three large-scale research projects about child and adolescent behavioral health services will be reanalyzed as a cost-effective way of obtaining additional insights into the needs and experiences of this population. These existing data sets provide comprehensive youth, family, and service use information. Each data set includes administrative data (with encounter or claims data with diagnostic, services, and provider information) and interview data (with comprehensive youth, family, and service data for approximately 1000 adolescents with documented drug use and mental health problems). As part of the hypothesis testing, models of service utilization and outcomes for youth with co-occurring drug-related and mental disorders will be developed and tested. Individual, familial, community, and service system factors that affect service access and use will be examined, based on a theoretical framework. In addition, sources of variation in access and service use will be examined for multiple cohorts, including youth of different genders and different racial groups. The project builds on program of health services research by the Principal Investigator that has focused on child, adolescent, and family behavioral health issues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CORE--CARE UNDER CONSTRAINTS Principal Investigator & Institution: Boyd, Elizabeth; Assistant Professor; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, NJ 08901 Timing: Fiscal Year 2001 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORE--COMPLEMENTARY MANAGEMENT
DATA
COLLECTION
AND
Principal Investigator & Institution: Hauser, Robert M. Vilas Research Professor of Sociology; University of Wisconsin Madison 750 University Ave Madison, WI 53706 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Core C: Much of the WLS data required for the WLS program of projects is already in hand or will be collected in proposed telephone and mail surveys. However, several additional data collection activities are essential for the projects proposed herein or for other related projects that are being proposed independently. These data will extend the range of research that WLS participants and other scholars may undertake using the WLS and related data resources. We will centralize these activities in a single project core in order to share staff and other resources, to coordinate sampling designs across complementary activities, and to assure quality data matching, management, security, and documentation. All supplementary data will be equally available to WLS projects and to public data users, either directly or through our secure data enclave. The goals and activities of the Core are summarized in the following specific aims: (1) matching WLS records for graduates and siblings born in Wisconsin to official birth records; (2) linking records of WLS graduates, siblings, and parents to additional years (post-1998) of the National Death
24 Health Insurance
Index (NDI-Plus); (3) collecting bio-medical data and bio-markers from sub samples of graduates and siblings; (4) linking WLS records to the Wisconsin state tumor registry; (5) conducting a survey of Wisconsin health insurance plans; (6) linking respondent locations to local health resources using the.Area Resource File and Interstudy data; (7) linking older siblings' records to Medicare enrollment and claim data; (8) collecting and linking data on elementary schools attended by the graduates (from Wisconsin state historical archives); (9) linking WLS records to Wisconsin Worker's Compensation records; (10) linking WLS records to SSA earnings and disability benefit records; (11 ) completing the geocoding of addresses of WLS participants throughout the course of the study and linking them to local area data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CORE--DIABETES DEVELOPMENTAL RESEARCH Principal Investigator & Institution: Gavin, James R. President; Morehouse School of Medicine Atlanta, GA 30310 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORE--PRIMARY ACCESS BARRIERS TO CARE Principal Investigator & Institution: Carrasquillo, Olveen; Assistant Professor of Medicine and Heal; Columbia University Health Sciences New York, NY 10032 Timing: Fiscal Year 2003; Project Start 10-FEB-2003; Project End 31-JAN-2008 Summary: The Institute of Medicine's report on racial and ethnic disparities noted that factors such as ability to pay or insurance are the most significant barriers to equitable care and "must be addressed as an important first step to eliminating disparities." In this research core we will examine the impact of such primary barriers on racial and ethnic disparities in access to health care. The core will consist of seven investigators including physicians-investigators from various disciplines, health policy and health service researchers and economists. All have established programs of research in financial barriers to care and have funded projects examining minority populations. This research core will focus on five specific areas: (1) monitor ongoing trends in health insurance and how such barriers affect disparities in the areas of mental health, diabetes care, and cardiovascular disease; (2) the contribution of additional financial barriers to racial and ethnic disparities among the insured population; (3) whether changes in the health care system during the 1990s helped reduce or worsen existing racial and ethnic disparities in access to care; (4) how future changes in the health care delivery system may affect disparities; (5) the impact of primary access barriers on the health care systems that deliver care to persons in minority communities. To achieve these aims, we will: (a) establish a resource center for interdisciplinary studies consisting of a data repository of the diverse datasets used by individual members of this core and a data manager who will serve as a local expert on these datasets; (b) form collaborations between core investigators who are leading experts in primary barriers among minority populations and the community-based organizations that are developing products to help residents in northern Manhattan overcome such financial barriers; (c) facilitate cross-fertilization of ideas and methodological approaches to carry out investigations within the specific focus areas of investigations under this core. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies 25
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Project Title: CORE--SYSTEMS INTERACTION Principal Investigator & Institution: Boyer, Carol A. Director; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, NJ 08901 Timing: Fiscal Year 2001 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: COVERAGE, ORGANIZATION OF CARE, AND COLORECTAL SCREENING Principal Investigator & Institution: Schneider, Eric C. Assistant Professor of Medicine; Health Policy and Management; Harvard University (Sch of Public Hlth) Public Health Campus Boston, MA 02460 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2005 Summary: (provided by applicant): The Institute of Medicine recently issued a report calling for improvements in the quality of cancer prevention services. Colorectal cancer is the third leading cause of cancer-related mortality. Colorectal cancer screening could substantially reduce the morbidity and mortality of this disease, yet screening rates are surprisingly low. Insurance coverage and the management practices of health plans may be critical factors if we are to increase screening rates. We propose to analyze data from two national survey samples and to develop a new survey of health plan medical directors to examine insurance coverage and managed care as determinants of colorectal cancer screening. The specific aims of the study are: (1) Using national data from the Behavioral Risk Factor Surveillance System (BRFSS), we will assess rates of colorectal cancer screening before and after the Medicare program instituted first-dollar insurance coverage for colorectal cancer screening in 1998; (2) Using the Medicare Current Beneficiary Survey (MCBS), we will assess whether colorectal cancer screening rates are higher among Medicare beneficiaries enrolled in managed care health plans compared to those with fee-for-service insurance controlling for other confounding factors. Additionally, we will examine whether disparities in colorectal cancer screening rates for socioeconomic minorities are smaller for managed care enrollees than for others; (3) Using structured interviews of health plan medical directors, we will evaluate and compare the quality management programs of health plans that have high colorectal cancer screening rates and those with lower rates. Results of this study can guide the enactment of health policies that will increase rates of colorectal cancer screening and thereby reduce the incidence of colorectal cancer and its associated morbidity and mortality. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DEMAND FOR ALCOHOL TREATMENT SERVICES Principal Investigator & Institution: Bhattacharyra, Jayanta; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001; Project Start 01-MAR-2000; Project End 31-MAR-2002 Summary: The financing of treatment for alcoholism has undergone significant change over the past decade. Managed care organizations now dominate the market for private alcohol treatment services. In particular, "carve- out" organizations that specialize in mental health and substance abuse care, including alcohol treatment, have become especially important in the market. Despite this growing trend, little research has been done on the generosity of the benefits offered by these organizations with regard to
26 Health Insurance
treatment for alcoholism. This project seeks to fill this gap in the knowledge base. We will examine benefit information from a large "carve-out" managed behavioral health plan that provides service to millions of patients across the nation. Linking this benefit information to patient-specific claims information, we will explore the relationship between the use and costs of alcoholism treatment services and the generosity of the insurance plans. We will focus, in particular, on the effects of co-payments, deductibles, and limits on insurance. From these descriptive studies, we will proceed to develop and estimate a dynamic economic model of the demand for alcohol treatment services. This model will incorporate the complex pricing schemes induced by the structure of cost sharing mechanisms in modern health insurance plans. Also, it will allow for uncertainty in the effects of expenditures on alcoholism treatment on health. Using estimates from this dynamic model, we will simulate the effects of various policies on costs and use of alcohol treatment services. For example, using our framework, we will be able to accurately estimate the costs of parity legislation for alcoholism treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DENTAL ACCESS & COSTS FOR CHILDREN IN A SCHIP PROGRAM Principal Investigator & Institution: Damiano, Peter C. None; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: (provided by applicant): Dental care is among the areas of highest unmet need for lower-income children. Dental insurance is an important factor related to the use of dental services by children. High unmet need has encouraged most state SCHIP programs to include dental benefits, however, little is known about program effects on access to care and costs. Iowa's combination SCHIP and Medicaid programs provide a natural experiment for evaluating the effect of different types of dental insurance models on the use and costs of services for children in these programs. Three different types of dental insurance plans operate in the S-SCHIP program (indemnity, open access panel and closed panel HMO) and one in the M-SCHIP and Medicaid programs (Medicaid fee-for-service). The specific aims of this study include: (1) determine dental services utilization for children in the Iowa SHIP and Medicaid programs, (2) determine the factors related to unmet dental need (i.e., not meeting professional guidelines for an annual dental check-up) for children, (3) determine the factors related to 'self-reported' unmet dental need for children, and (4) determine the costs associated with providing dental care for children in Iowa's SHIP and Medicaid programs and whether there is pent-up demand for dental care. These aims will be evaluated using administrative data from the SHIP and Medicaid programs and survey data from program enrollees. The central hypothesis is that the type of dental insurance plan will be significantly related to access to dental care and that the traditional fee-for-service Medicaid and closed panel HMO model programs will have lower access to care due to more limited provider panels. Other predisposing factors (e.g., age, child's reported health status, time without dental insurance) will also be evaluated following the Health Behavior Model as the conceptual basis for the analyses. Programmatic costs will be evaluated by applying plan reimbursement rates to utilization of services. Pent-up demand will be evaluated by determining (1) if dental care costs were higher when the SHIP program first began, and (2) if individual costs were higher when children first joined SHIP or Medicaid. The long-range goal is to improve policymakers' understanding of dental care costs and to provide them with information that can increase access to dental care. The
Studies 27
results should help to realize the Healthy People 2010 goal of improving dental access to low-income children and adolescents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DIALYSIS FACILITY MANAGEMENT Principal Investigator & Institution: Eisenstein, Eric L. Medicine; Duke University Durham, NC 27706 Timing: Fiscal Year 2002; Project Start 12-SEP-2002; Project End 31-AUG-2004 Summary: Taken by Applicant): Medicare's End-Stage Renal Disease (ESRD) program is the only public program that provides health insurance coverage for a specific disease. ESRD patients typically survive fewer than five years after beginning renal dialysis. During this time they average 1.9 hospitalizations per year, for a total of 14 days. Previous studies have reported significant variations in a dialysis facility management practices, treatment costs and profitability. However, little is known about the relationships between dialysis facility characteristics and long-term dialysis patients' clinical and economic outcomes. We hypothesize that dialysis facility characteristics primarily influence total medical costs by modifying dialysis patient hospital events (frequency and type). Additionally, we hypothesize that changes in dialysis facility management practices may improve long-term clinical outcomes for dialysis patients and for the ESRD system as a whole. However, these changes may also increase dialysis facility operational costs. Using information from three consecutive years of incident dialysis patients with a minimum of one and a maximum of three years follow up on all patients, this project will evaluate these hypotheses. Follow-up will begin on the 91 days after dialysis initiation and continue until death or renal transplantation. After adjusting for differences in patient clinical characteristics, we will define the impact of dialysis facility characteristics on dialysis patients: (1) mortality (survival and life expectancy), (2) morbidity (hospitalization rates and event-free survival, death, or hospitalization) and (3) total medical costs (dialysis treatment, hospitalization, physician and supplies). We will then assess the economic attractiveness (cost-effectiveness or cost-savings) of dialysis facility management practices that improve dialysis patient long-term clinical outcomes and develop decision models for the dissemination of study results. Through these aides, dialysis patients, providers, payers and policy maker will be able to: determine how dialysis facility management practices impact long-term clinical and economic outcomes and identify optimal management practices to improve survival or decrease total medical costs for dialysis patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HERNIATION
DISABILITY
OUTCOMES
IN
INTERVERTEBRAL
DISC
Principal Investigator & Institution: Atlas, Steven J.; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, NH 03755 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2007 Summary: The overall objective of the proposed research is to improve work-related treatment recommendations and outcomes of care for patients with low back pain caused by an intervertebral disc herniation (IDH). In working-age populations, sciatica due to an IDH is a common cause of low-back problems resulting in disability. Despite being such a common and costly problem, the effect of medical treatment on workrelated disability is poorly understood. Regardless of whether the symptoms are attributed to a work-related event or not, there is limited information on disability
28 Health Insurance
outcomes associated with IDH treatment. Therefore, we propose to use the unique clinical resources of the Spine Patient Outcomes Research Trial (SPORT) and the National Spine Network (NSN) to study disability and health-related quality of life outcomes among patients with an IDH. Patients who are work-eligible will be classified at baseline according to disability coverage (workers' compensation or private disability insurance), and outcomes over time will be examined. Our specific aims are: 1) To identify baseline patient features associated with receiving disability compensation at the initial study visit; 2) Among work-eligible IDH patients grouped by initial disability compensation status, to compare surgical discectomy or non-surgical treatment with respect to: a) disability outcomes (subsequent work and compensation status), and b) change in health-related quality of life, symptoms, and satisfaction with care; 3) To evaluate the cost-effectiveness of surgical or non-surgical treatment according to initial disability compensation status. Accurate assessment of the effects of surgical or nonsurgical treatment on disability, work, and quality of life outcomes may lead to improved treatment recommendations for patients with this common and costly condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DISPARITIES IN CHILD & FAMILY HEALTH CARE EXPENDITURES Principal Investigator & Institution: Newacheck, Paul W. Institute for Health Policy Studies; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2004 Summary: Specific Aims: Prompted by a series of federal initiatives, the health services research community is focused on identifying and documenting disparities in health and health care among racial/ethnic groups as well as across the income distribution. However, little of this growing body of work has addressed disparities of the economic burden of illness. The objective of this project is to examine the extent to which disparities exist in out-of-pocket health care expenses for children and families, and the role that health insurance plays in reducing or eliminating disparities. The specific aims of this project are: 1) Do disparities exist in out-of-pocket expenditures among children and families with different incomes? 2) Do disparities exist in out-of-pocket expenditures among children and families with different racial/ethnic characteristics? 3) To what extent does health insurance coverage mediate these disparities? and 4) To what extent have there been changes since 1977 in disparities in out-of-pocket expenditures for children and families with different incomes and different race/ethnic characteristics? Research Design and Methods: This study will utilize three national health care expenditures surveys conducted for the Agency for Healthcare Research and Quality and its predecessor agencies: the 1977 National Medical Care Expenditure Survey, the 1987 National Medical Expenditure Survey, and the 1997 Medical Expenditure Panel Survey. We will conduct all analyses using families and then sample children as the unit of analysis. A unique aspect of our study is the analysis of expenditure data at the individual child level and the family level. In all analyses financial burden, the dependent variable, is operationalized in two ways: 1) as the ratio of annual out-of-pocket health care expenses to annual family income multiplied by 100 and 2) whether out-of-pocket health care expenses reach certain catastrophic thresholds (e.g. 15% of family income). To address specific aims 1 and 2 above, a series of crosssectional analyses, incorporating bivariate and multivariate methods, will be conducted using the 1997 MEPS. Bivariate analysis will be used to assess whether disparities exist on an unadjusted basis. Multivariate analysis, including linear and logistic regression,
Studies 29
will be used to assess whether disparities exist on an adjusted basis. Also using the 1997 MEPS, a hierarchical regression analysis will be used to assess whether health insurance is associated with a diminution of income and racial/ethnic disparities in financial burden (aim 3). For the trend analysis (aim 4), a regression-based differences-indifferences approach will be employed to assess changes in disparities over time. This analysis will incorporate pooled data from all three surveys. At least 3 products are expected: a paper describing disparities in financial burden across income and among racial/ethnic groups using family level data; a paper aimed at a pediatric audience that describes disparities using children as the unit of analysis; and a paper describing changes in the distribution of financial burden across income and race/ethnicity from 1977-97. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DO REPORTING BIASES MITIGATE DISPARITY ESTIMATES? Principal Investigator & Institution: Fiscella, Kevin; Co-Director; Family Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, NY 14627 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-AUG-2005 Summary: Background: Self-report survey data show little difference in crude mammography rates by race. In contrast, Medicare claims and HEDIS mammography data show large disparities. We hypothesize that African Americans over-estimate their use of preventive care more than whites based on stereotype threat. Stereotype threat refers to apprehension by respondents that their behavior will reinforce stereotypes regarding their social group. Aims: 1) To determine whether there are discrepancies between racial/ethnic disparities in preventive care derived from self-report measures and those derived from Medicare claims. 2) To examine potential explanations for possible over-reporting of preventive care by racial and ethnic minorities. 3) To examine potential explanations for possible under-representation of preventive care to minorities in Medicare claims. Methods: We use Medicare Current Beneficiary Survey to examine these aims. We compare estimates of racial disparity in mammography, sigmoidoscopy, and PSA testing based on self-report with estimates from corresponding Medicare claims. We systematically examine other explanations for discrepancy in disparity age, education, income and source of care by sequentially adjusting for these factors. Significance: The National Health Care Disparities Report will rely heavily on self-report to monitor disparities in health care. It is thus critical to determine whether reporting biases associated with race affect the validity of these estimates. Furthermore, erroneous conclusions regarding the absence of racial/ethnic disparities in preventive care may result in missed opportunities to reduce racial/ethnic disparities in health such as racial/ethnic disparities in breast, colon, or prostate cancer mortality. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DRUG USE DISORDERS AND HEALTH SERVICES UTILIZATION Principal Investigator & Institution: Greenfield, Shelly F.; Mc Lean Hospital (Belmont, Ma) Belmont, MA 02478 Timing: Fiscal Year 2001; Project Start 01-JUN-1998; Project End 31-MAY-2003 Summary: This is a request for a Mentored Clinical Scientist Development Award (K08). The candidate proposes to use this award to develop a research career in treatment and services research for individuals with drug use disorders. The goals of the career development plan are to (1) develop the methodologic expertise required to test hypotheses derived from specific clinical populations in studies of the general
30 Health Insurance
population, (2) gain greater expertise in understanding specific predictors of and barriers to obtaining treatment among individuals with drug use disorders, and (3) develop the skills necessary to implement a specific study of treatment services utilization based on results gained from the proposed studies conducted during the award period. These career development goals are in concert with the research plan, which will consist of three studies, each designed to build on increasing knowledge as acquired during the award period. The overall aim of the research plan is to extend and amplify our understanding of the impact of sociodemographic characteristics, psychiatric comorbidity, severity and type of drug use disorder, and insurance status on patterns of treatment services utilization in individuals with drug use disorders. A series of three studies will use data from a general population sample derived from the national Comorbidity Study and the Mental Health Supplement of the Ontario Health Survey to determine the impact of these factors on: 1. Whether individuals with drug use disorders obtain treatment services, 2. When individuals with drug use disorders obtain treatment services, and 3. What type of treatment services are used by individuals with drug use disorders. This research plan will explore three central hypotheses: 1. Sociodemographic characteristics and psychiatric comorbidity will be the important predictors of treatment services use among those with less severe drug use disorders. 2. Sociodemographic characteristics and psychiatric comorbidity will be less important predictors of treatment services use than insurance status among those with more severe drug use disorders, and 3. Patterns of treatment services utilization will vary by specific drug type. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DYNAMICS OF FAMILY DISADVANTAGE AND CHILDHOOD ASTHMA Principal Investigator & Institution: Baydar, Nazli; Family and Child Nursing; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: This study would investigate childhood asthma longitudinally in the family context. It is likely that a child?s asthma condition and the family?s resources influence each other. These reciprocal relations are likely to operate, at least partly, through family-level asthma control activities. The proposed research seeks to investigate the components of the process that may result in an increase in asthma burden, leading to an increase in its economic and non-economic costs for the family. This study would be different from macro-level studies of the cost of asthma in that it would focus on the family-level processes that link asthma to its impact on family resources, and the way available family resources, in turn, impact asthma. An empirical study of the reciprocal relationship between the family resources and asthma does not exist to date, although this approach has been considered conceptually. This study would extend the previous research of the investigators by examining the impact of having a child with asthma and the burden of this condition (as evidenced by indicators of functional limitations and acute exacerbations) on the family resources, which are defined as family economic resources, parents? time availability for care, access and barriers to healthcare. This impact may partly operate through asthma control activities that are undertaken by the family. Asthma control activities include healthcare utilization, control of environmental irritants, and reduction of exposure to respiratory infections. The proposed research would also investigate the impact of a family?s resources on the asthma control activities that are undertaken by the family, ultimately impacting asthma status. Data from two sources, MEPS and NLSY, would be used. The 1996 and 1997 panels of the
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Medical Expenditure Panel Surveys (MEPS) provide detailed information on family resources, child health, health service utilization, and cost of healthcare for a period of two years for each panel. The National Longitudinal Survey of Youth (NLSY) for 19792000 provides long term information on a national cohort of mothers and their children. The proposed analyses would provide information regarding the nature of the linkage that results in families with limited resources who have children who have asthma that is more threatening to functional status and with more frequent acute exacerbations. By investigating the family-level processes, it would be possible to identify policy targets that may be keys to stopping the cycle that leads to an increase in a child?s asthma burden. The longitudinal approach and the focus on the process that links asthma and family resources may bring a better understanding to this issue than the cross-sectional and static framework that was used in much of prior research. Macro-level policies regarding health insurance availability, employee leave benefits, administration of medications in schools, and child care for children with asthma are a few examples that would also be informed by the proposed study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OUTCOMES
DYSVASCULAR
AMPUTEES:
REHABILITATION
USE
AND
Principal Investigator & Institution: Dillingham, Timothy R. Associate Professor; Physiology; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 10-AUG-1998; Project End 31-MAY-2003 Summary: The purpose of the study is to examine the rate of hospitalization of nursing home patients. Behavioral models used in the study are based on contingency theory and resource dependence theory. Data come from a sample of residents in 30 nursing homes in five states linked to Medicare claims data, On-line Survey of Certification Automated Records (OSCAR) and Area Resource File (ARF) data. The goal is to separate the proportion of explained variation in hospitalization rates that is due to market and facility factors from the portion explained by resident characteristics. Part of the analysis will focus on two potentially avoidable causes for hospitalization: dehydration and diabetics who are admitted with a primary admission diagnoses of hyperglycemia or hypoglycemia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EARLY DISCHARGE AND INFANT MORTALITY Principal Investigator & Institution: Malkin, Jesse D.; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2003; Project Start 20-JAN-2003; Project End 31-DEC-2004 Summary: (provided by applicant): Of the 4 million infants born in the United States each year, about 20,000 (5 out of 1,000) die during the neonatal period and another 10,000 die after the neonatal period but before their first birthday. Some of these deaths are caused by conditions that can be treated successfully if they are diagnosed promptly. One factor that may influence whether such conditions are diagnosed quickly is the length of a well-appearing newborn's postpartum stay, because signs of congenital heart disease, infection, and other health problems may not be evident until two or more days after delivery. Although many studies have examined health effects of early postpartum discharge, few studies have considered mortality as an outcome. The investigators propose to assess the association between early discharge and neonatal mortality using an administrative database from California that captures about three million births
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between 1991 and 1999. The primary objective of the proposed analysis is to test the hypothesis that newborns discharged early are at increased risk of dying during the neonatal period relative to newborns with longer stays. The investigators will perform unadjusted analyses, multivariate analyses to control for observed confounders, and instrumental variable estimation to mitigate biases due to unobserved confounders. The investigators will also perform analyses of high-risk sub-populations. The secondary objective of the proposed analysis is to test the hypothesis that newborns discharged early are at increased risk of hospital readmissions during the neonatal period relative to newborns with longer stays. The investigators will also describe time trends in early discharge, neonatal mortality, and hospital readmission rates. An improved understanding of these issues will provide policymakers, health plans, hospitals, providers, and patients with information that can be used to help make more informed decisions about newborn lengths of stay. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ECONOMIC DETERMINANTS OF MORTALITY Principal Investigator & Institution: Dow, William C. Assistant Professor; Health Policy and Administration; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2004 Summary: This study seeks to better understand the role of economic factors in explaining mortality patterns, particularly in low-income populations. Our focus is on the role of the health insurance system, and more specifically, how large changes in the health insurance coverage of a population might influence mortality. In order to synergistically begin to build a body of empirical regularities, we propose to analyze the causal effects of actual large insurance expansions in different settings. One set of analyses will examine the mortality effects of the implementation of the Medicare and Medicaid programs in the United States during the 1960's, which have received surprisingly little study. A parallel set of analyses will build on previous work examining a large expansion in insurance coverage in Costa Rica during the 1970's. The project also includes a methodological investigation of the effects of the common practice of analyzing regionally aggregated mortality data instead of individual-level micro data. This project is expected to yield important new information in understanding the effect of health insurance on mortality patterns themselves, and on explaining socioeconomic differences in health. This knowledge is important not only for these two countries, but for many other countries as well as they debate large-scale reforms of their health insurance systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ECONOMICS OF FORMULARY DESIGN AND MENTAL HEALTH POLICY Principal Investigator & Institution: Huskamp, Haiden A. Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 31-MAY-2007 Summary: (provided by applicant): Prescription drugs have become an increasingly important component of mental health treatment and the costs of psychotropic drugs have increased rapidly in recent years. However, there are major gaps in our knowledge about the economics of psychotropic drug treatment. This Mentored Research Scientist Development Award would allow Dr. Haiden Huskamp, a health economist with
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expertise in mental health policy and economic institutions, to supplement her economic tools with the knowledge and skills needed to conduct clinically-relevant and policysignificant research on the economics of prescription drugs used in the treatment of mental illnesses. The specific aims of this career development proposal are to: 1) develop a greater understanding of clinical decision-making related to the use of psychotropic drugs; 2) acquire basic knowledge of psychopharmacology; and 3) expand knowledge of the important economic institutions influencing the prescription drug market. In this undertaking, Dr. Huskamp will be guided by her sponsor, Richard Frank, PhD, and cosponsors, Andrew Nierenberg, MD, and Ernst Berndt, PhD. Her career development plan includes guided study with Dr. Nierenberg on clinical issues related to treatment decision-making and Drs. Berndt and Frank on economic institutions of the pharmaceutical market, as well as coursework and participation in psychopharmacological "Grand Rounds," relevant seminar series, and professional meetings. Dr. Huskamp will use the knowledge and skills developed through these career development activities to conduct three research projects. The first project examines the effect of generic entry in the class of selective serotonin reuptake inhibitors (SSRls) on utilization patterns, costs, and market share among antidepressants as well as the competitive response of brand antidepressant manufacturers with respect to drug prices and promotional spending. The second project assesses the economic incentives created by three-tier drug formularies and how these arrangements affect costs, utilization patterns, and adherence to treatment guidelines in a non-elderly population. This project includes an economic welfare analysis of the tradeoffs associated with restrictive formularies. The third project examines the effect of a three-tier formulary on psychotropic drug costs and utilization patterns in a retiree population and explores the impact of formularies on the mental health costs of adding a prescription drug benefit to Medicare and on access to appropriate psychotropic drug treatment under such a benefit. The proposed plan of career development will provide Dr. Huskamp the training, mentoring, time and resources to develop the skills that will put her in a position to lead independent research on the economics of pharmaceutical treatment for mental illnesses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ECONOMICS OF MANAGED BEHAVIORAL HEALTH CARE Principal Investigator & Institution: Scheffler, Richard M. Distinguished Professor; None; University of California Berkeley Berkeley, CA 94720 Timing: Fiscal Year 2001; Project Start 10-APR-2000; Project End 31-MAR-2005 Summary: This is an application for a Senior Scientist Awar5d to study the new economic relationships in mental health services created through the advent and growth of managed care, capitation, decentralization, and market competition within the U.S. health care system. Three different, ut interrelated, projects are proposed. The first is a study of the impact of managed care on the supply and income dynamics of the mental health work force, as well as on the supply patterns and staffing ratios of managed care organizations (MCOs). The aim is to clarify the cost- effectiveness and optimal mix of various types of mental health providers across types of MCOs and geographical regions of the United States. The second project is a translation of empirical findings into policy implications and recommendations for the public financing of mental health care services, based on a prior five-year study of California's legislative attempt to reform the state's mental health care system by decentralizing the financing and administration of care to local mental health authorities. The aim is to delineate in a clear and comprehensive way where, via legislatively mandated unleashing of market forces (risk
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shifting, changing financial incentives, and competition), publicly funded mental health care systems are heading and what the economic impact of the changes will be nationwide based on the lessons learned from California's Program Realignment implementation. The third study is an analysis of the policy-making underpinning the passage and implementation of the 1996 Mental Health Parity Act. The aim is to understand why and how political and economic factors interact in the regulation of mental health insurance, an area of inquiry that have heretofore remain virtually unexplored by health economists and political scientists. These projects, to be conducted under the auspices of the School of Public Health and the Center for Mental Health Services Research at the University of California-Berkeley, are designed, in terms of overall research career development, to enhance skills on two levels: applied policy analysis and methodological rigor. In the first case, the projects afford the opportunity for concentrated analysis of the policy implications of empirical data, and thus an opportunity to inform ongoing and future policy deliberations at the state and federal levels, with respect to the cost, delivery, and quality of mental health care. In the second case, new approaches to econometric modeling of mental health provider, practice, and market characteristics are needed to sort out and clarify the complex economic relationships in markets with a high level of managed care penetration and increasing competition. Until those relationships are better understood, it is difficult to assess the impact of managed care in the face of apparent cost reductions achieved through changes in price and utilization. The first project proposed here, in particular, lays out that challenge. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EFFECT OF HEALTH ON EDUCATION OUTCOMES OF YOUNG CHILDREN Principal Investigator & Institution: Guarino, Cassandra; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2004 Summary: (provided by applicant): The effect of health impairment on educational outcomes is a topic of great policy relevance. It has been relatively under-researched, however, due to the paucity of data that include detailed measures of both health and school performance and to the difficulty of separating the impact of health on education from the impact of education on health. The proposed study investigates the relationship between the health status and educational performance of kindergarten children and effectively overcomes these two obstacles. First, the study uses a newly released data set that contains more detailed and appropriate measures of the variables of interest than any data set hitherto collected on a large scale for children in this age group. Second, given the young age of the children involved in the study and the longitudinal nature of the data set, problems associated with the endogenous effects of education on health are considerably mitigated. The study will (1) assess the strength of the association between health status and the cognitive skills of children entering the kindergarten class of 1998-1999, (2) assess the effect of health status on changes in the cognitive skills of these children over time, and (3) determine how the effect of health status on cognitive development varies by child and family characteristics, such as minority status, income, and access to health insurance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EFFECTS OF MANAGED CARE GROWTH ON CHARITY CARE Principal Investigator & Institution: Keane, Christopher R. Health Services Administration; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2008 Summary: (provided by the applicant): The candidate's most general career goal is to independently conduct high quality research that will leverage improvements in access to health services. A related career goal is to advance theoretical understanding of transformations of public health and medical systems and how these changes affect access to services by vulnerable populations. His proposed research agenda and training program have been fashioned to catalyze development of research skills needed to meet his research and career goals. The proposed research agenda is to study several mechanisms through which increases in managed care may have affected provision of care for the uninsured by local health departments (LHDs) and physicians. The candidate will examine the extent to which increases in managed care have: a) diverted Medicaid revenues away from LHDs, reducing their cross-subsidization and provision of care for the uninsured; and b) decreased the Medicaid revenue and overall revenue of physicians, leading to a decrease in their provision of charity care. He also will examine the extent to which increases in managed care have: a) decreased physicians' autonomy (indicated by decreased ownership, decreased perceived clinical freedom, and increased size of practice), leading to decreased charity care; and b) increased discontinuation and privatization of LHD services resulting in a decrease in LHDs' ability to assure access of the uninsured. This research will aid development of strategies for improving access to health services among the uninsured. The analyses will require that the candidate learn new techniques of statistical analyses and application of theories from the fields of health economics and the sociology of health institutions and professions. Through courses and regular interaction with a statistical mentor, he will acquire new statistical analytical skills. To analyze and interpret physician responses to organizational and financial incentives and constraints on the provision of charity care, the candidate will study the theoretical and empirical literature on physician agency, including physician motives and power under the complex conditions accompanying increased HMO and Medicaid managed care penetration. He will study this literature through formal courses and through interaction with mentors, applying this knowledge to the analyses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EMERGENCY CONSEQUENCES
DEPARTMENT
CROWDING:
CAUSES
AND
Principal Investigator & Institution: Asplin, Brent; Health Partners Research Foundation 8100 34Th Ave S Minneapolis, MN 55425 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2007 Summary: (provided by applicant): Dr. Brent Asplin is an emergency physician at Regions Hospital in St. Paul, MN; a research clinician at HealthPartners Research Foundation; and Assistant Professor of Emergency Medicine at the University of Minnesota. This award will provide a foundation for Dr. Asplin?s future work as an independent health services researcher. Dr. Nicole Lurie, Special Advisor to the Dean of the University of MN Medical School and Medical Advisor to the MN Commissioner of Health, will mentor him during this award. Dr. Lurie is a nationally prominent health services researcher with extensive research experience in the areas of access to care, health disparities, and the health care safety net. She has research experience in the
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emergency department (ED) setting and also is ideally positioned to maximize the policy impact of Dr. Asplin?s research activities. HealthPartners Research Foundation (HPRF) will provide institutional support for Dr. Asplin during the award period. HPRF is a non-profit public domain research institution with an annual research budget over $9 million. Despite reports that ED crowding is widespread and serious, no empirical work exists to define ED crowding, demonstrate its consequences, or propose solutions. This application includes research projects for each of three factors that contribute to ED crowding: input, throughput, and output factors. Project CHANGE will determine if an Advanced Access (AA) appointment system in the HealthPartners Medical Group (HPMG) reduces ED utilization rates. The ED Crowding Project has the following primary specific aim: To develop feasible and reproducible measures of ED crowding. Administrative and survey data will be collected in two phases at eight EDs. The reasons for ED crowding will be categorized as input, throughput, or output. The relationship between ED crowding and hospital inpatient bed availability will be studied, and adverse events associated with crowding will be described. The ED Access Project has the following primary specific aim: To determine the availability and timing of outpatient appointments for medical and surgical conditions requiring urgent ED followup care according to insurance status. A national telephone survey will be conducted assessing the availability of urgent follow-up appointments for patients with private insurance, Medicaid, or no insurance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EMPLOYER BASED INSURANCE AND THE VULNERABLE Principal Investigator & Institution: Long, Stephen B.; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001 Summary: This project will use data from the 1993, 1997, and 2001 Robert Wood Johnson Foundation Employer Health Insurance Surveys to study how changes in health care markets have affected access to insurance coverage for two vulnerable populations: workers in low wage businesses and workers employed in rural areas. Specifically, the project will use the three employer surveys to assess the effects of health care market structure on employer decisions to offer insurance the benefits and types of plans offered, and the out-of-pocket cost burden for these populations. The project also will examine whether the structure of the local health care safety net affects employers' offers of insurance of insurance, providing a unique test of the "crowd out" hypothesis from the perspective of employers. Lastly, the project will develop a simulation model to predict the effect of varying market structure on the distribution of employment-based coverage and on out-of-pocket costs for workers in low wage businesses and rural workers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: END-OF-LIFE PLANNING AND WELL-BEING IN LATE LIFE Principal Investigator & Institution: Carr, Deborah S. Assistant Professor; University of Wisconsin Madison 750 University Ave Madison, WI 53706 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The proposed research will investigate the impact of individual- and couple-level end-of-life planning on the economic, psychological and physical well-being of midlife men and women. End-of-life planning includes economic preparations (e.g., preparation of wills, life insurance), health-related preparations (e.g.,
Studies 37
advance directives, long-term care insurance), and psychological preparations (e.g., indepth discussions with family members). The analyses will use data from the Wisconsin Longitudinal Study, a sample survey of men and women who graduated Wisconsin high schools in 1957, and who were re-interviewed in 1964, 1975, and 1992-93. Our analyses will also use data obtained in the 2002 WLS: from the: (1) graduates; (2) their selected sibling; (3) the currently married spouses of the graduates and siblings; and (4) the widowed spouses of graduates and siblings who have died since 1992. Retrospective accounts of planning behavior will be obtained from widowed persons and respondents who have recently lost a parent, in order to explore linkages between past planning behavior and current well-being for persons who have already experienced death of a close relative. Specific hypotheses will be derived from two theoretical frameworks: a modified expectancy-value framework, and the stress paradigm. Our broad research objectives are to: (1) document the patterns and predictors of end-of-life planning strategies adopted by older adults and (2) evaluate the extent to which spouses accurately report one another's end-of-life preferences, and to identify the predictors of accurate reports. These research goals are critically important today, as public policies and medical technologies afford older adults greater control over when, how and where they will die. We will use multivariate techniques to test hypotheses derived from the specific aims. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EPIDEMIOLOGY OF CANCER AND MENTAL ILLNESS IN RURAL AREAS Principal Investigator & Institution: Doebbeling, Caroline C. Psychiatry; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2006 Summary: In this application for a Mentored-Patient Oriented Research Career Development Award, the candidate will obtain expertise in epidemiology, biostatistics, and health management & policy so that she may conduct population-based epidemiological studies to evaluate the association between psychiatric disorders and physical disorders. She will use the findings to support the development and implementation of clinical interventions designed to prevent or modify comorbidity. The candidate proposes a multi-disciplinary training and research program at a university with a long-standing history of excellence in psychiatric epidemiology research. She will capitalize on resources including the availability of two populationbased data sets (Wellmark Blue Cross/Blue Shield Claims Data Files and the SEER Iowa Cancer Registry), mentors with significant experience in epidemiology, biostatistics, and health services research, and a supportive research environment offered through a college of medicine and a college of public health. The educational program will be integrated with the proposed research and mentorship to study: 1) the longitudinal relationship between mental disorders and physical disorders (specifically cancer) in an insured, rural population; 2) patient and provider factors that influence the interaction between mental and physical disorders and 3) the utilization of health resources and the delivery of clinical preventive services to persons with psychiatric disorders. Based on the epidemiological findings, the candidate will develop a clinical preventive intervention directed at the primary and secondary prevention of comorbidity. The candidate's proposed research will provide a paradigm for the future study of the association of mental disorders and physical disorders such as cardiovascular diseases. This award will provide the candidate with the necessary background to develop future studies directed at the understanding and prevention of comorbidity. She will develop
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the additional skills necessary in the design and analysis of large-scale epidemiological studies and an understanding of health services that will prepare her for the development of research proposals leading to an independent research career. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ESSAYS ON SPOUSAL INSURANCE AND HEALTH CARE DEMANDS Principal Investigator & Institution: Zimmer, David Michael. Economics; Indiana University Bloomington P.O. Box 1847 Bloomington, IN 47402 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (provided by the applicant): This study attempts to simultaneously model family insurance arrangement decisions and family health care demand among the married population. Spouses may choose to enroll with the same insurance policy, or they may join different plans. The main focus of this study is to determine if enrollment on different insurance plans significantly affects either spouse's health care demand. Data come from the Medical Expenditure Panel Survey. The sample consists of 2429 married couples. Parametric models are developed, and simulated maximum likelihood techniques are used to estimate parameters in a simultaneous equations model with a probit specification of insurance arrangement choice and negative binomial specifications of each spouse's health care demand. Family insurance arrangement choices and spousal health care demands are assumed to have common unobserved heterogeneity that captures the effect of self-selection into enrollment on different insurance plans. In addition, each spouse's utilization is assumed to have common unobserved family heterogeneity. Several different forms of health care utilization are considered: office-based physician visits, office-based non-physician visits, outpatient department provider visits, emergency room visits, and nights spent in a hospital. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ETHNIC DISPARITIES IN PERINATAL OUTCOMES Principal Investigator & Institution: Fuentes-Afflick, Elena; Associate Professor; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EVALUATING IMPACT OF A RESOURCE CENTER FOR DRUG USERS Principal Investigator & Institution: Kral, Alexander H. Family and Community Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2006 Summary: (provided by applicant): This study will evaluate the impact of an innovative integrated resource center for homeless and marginally housed drug users in San Francisco. Homeless and marginally housed drug users are at high risk for severe physical and mental health problems that are exacerbated because they are isolated, uninsured, and underserved. In light of the myriad of barriers to health care utilization, it is critical to the public health agenda that new and innovative interventions attempt to alleviate these barriers and their health consequences. It is equally critical that these
Studies 39
innovative interventions undergo rigorous scientific evaluation. The past decade has seen the emergence of integrated resource centers serving drug users, which provide a variety of services under one roof. The Mission Neighborhood Resource Center (MNRC) is opening in May, 2002, and will integrate primary care, mental health care, substance abuse counseling, dental care, vocational training, housing advocacy, peer counseling, and basic personal services (including showers, lockers, voicemail, and storage). The aims of this study are (1) to assess whether MNRC participants are more likely than those in a comparison group to reduce their HIV risk behaviors, (2) to assess whether MNRC participants are more likely than those in a comparison group to access drug treatment, (3) to assess whether MNRC participants are more likely than those in a comparison group to report an increase in quality of physical and mental health, and (4) to assess whether MNRC participants are more likely than those in a comparison group to increase utilization of primary health care and reduce emergency room utilization. To accomplish these aims, six serial cohorts of 80 injection drug users (IDUs) and crack cocaine smokers (CCSs) will be recruited and followed for six months (n=480). Each cohort will consist of 40 MNRC intervention participants and 40 comparison subjects from a nearby neighborhood. We will investigate Specific Aims 1, 3 and 4 by examining if MNRC clients are more likely than those in the comparison group to report changes in HIV risk behavior, physical and mental health, and primary health care utilization. We will investigate Specific Aim 2 by comparing entry to drug treatment among MNRC clients to the comparison group. Qualitative interviews will also be conducted with clients (N=30) and staff (N=6), to gain a richer contextual understanding of the impacts of the MNRC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EVOLUTION OF PSYCHOPATHOLOGY IN THE POPULATION Principal Investigator & Institution: Eaton, William W. Professor; Mental Hygiene; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 01-APR-1992; Project End 30-JUN-2002 Summary: In 1981 the Epidemiologic Catchment Area (ECA) survey completed interviews with 3481 respondents from a probability sample of East Baltimore, as part of a national, five site effort. By 1996, 846 of these respondents had died (24%). In 19931996, the Baltimore ECA follow up completed interviews with 1914 respondents who were interviewed in 1981 (73% of the survivors). By the end of the funding period, analyses will have been completed, and papers submitted for publication, on all five specific aims of the Follow up award. Over 50 papers have been published or accepted for publication, and more than 15 submitted, as of the date of the application. The ECA surveys were the first on this continent to obtain data on specific mental disorders, and Baltimore is the only site following the entire wave 1 sample. The data include age of onset and most recent occurrence at the level of symptoms, syndromes, and disorders, and have unusual potential to describe the complex evolution of psychopathology over the course of adult life, regardless of whether treatment is sought or received. This request is for funds to support three additional analytic aims: (1) the evolution of comorbidity and syndrome structures, including the overlap between physical and psychiatric disorders; (2) the process of seeking and obtaining treatment, including the study of its long-term consequences; and (3) the consequences of psychopathology, including disability, marriage breakup, occupational careers, social networks, and mortality. Investigators include a multi disciplinary team with a history of successful collaboration. In addition to analysis of available data, we propose to track the sample, and gather some new data, without face to face contact. Tracking will include yearly
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mailing of the rich data, including: longitudinal latent variable models; threshold analyses; adaptations of the case-crossover design; a generalization of the life table; and an integration of growth and survival approaches. Results will provide clinicians and other a more comprehensive longitudinal picture of psychopathology; demonstrate the importance of psychopathology for general health; show the impact of psychopathology on use of general health services; provide information for policy decisions regarding mental health care and health insurance; and help integrate the ideologies of general and mental health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EYE DISEASE IN CUBAN-AMERICAN AND PUERTO RICAN ADULTS Principal Investigator & Institution: Scott, Ingrid U. Ophthalmology; University of Miami Box 016159 Miami, FL 33101 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Hispanics represent the fastest-growing minority group in the United States. While population-based data exist on the magnitude and causes of visual impairment and ocular disease in non-Hispanic Whites and AfricanAmericans in the U.S., data among Hispanics remain limited. Further, virtually all of this research has focused on Mexican-Americans. Although Hispanics share a common language, Hispanic subgroups vary with respect to genetics, sociodemographics, acculturation, health behaviors, and access to health care. The objective of this planning grant is to investigate the feasibility of a large-scale, population-based epidemiologic survey to determine the cause-specific prevalence rates of visual impairment and ocular disease among community-residing adults aged 40 years and older among CubanAmericans in Miami-Dade County , Florida and Puerto Ricans in Puerto Rico. Specific aims of this planning grant are to: 1) obtain a population-based sample of 200 community-residing Hispanics in Miami from a predominantly Cuban census tract and study the response rates to an in-person household interview and an ophthalmologic examination at Bascom Palmer Eye Institute, and to assess the quality of data collected (e.g. gradability of fundus photographs); 2) enroll a convenience sample of 100 Puerto Ricans in San Juan to assess the quality of data collected from in-person interviews and ophthalmologic examinations at the University of Puerto Rico; 3) establish partnerships with community leaders to maximize support for the large-scale study; and 4) develop a Manual of Procedures for the large-scale survey. Data will be collected in a fashion similar to the Los Angeles Latino Eye Study, the ongoing population-based study of visual impairment and ocular disease among Mexican-Americans funded by the NEI. The household interview will include health service use, general health, ocular history, health insurance, tobacco and alcohol use, acculturation and socioeconomic status. Each subject will also undergo a complete dilated ophthalmologic examination and a clinic interview assessing health- and vision-related quality of life (e.g. NEI-VFQ 25) and eye service use. Subjects who refuse will be questioned as to reason(s) for refusal. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: FIRM HEALTH INSURANCE PLANS Principal Investigator & Institution: Wise, David A. John F. Stambaugh Professor of Political; National Bureau of Economic Research Cambridge, MA 02138 Timing: Fiscal Year 2001
Studies 41
Summary: Health insurance expenditures in the United States have increased enormously over the last 50 years. Understanding why expenditures are rising and the potential for different kinds of insurance reforms to limit expenditures have become crucial policy issues. The provisions of employer plans-which cover almost two thirds of Americans under 65--vary a great deal from firm to firm and so do the costs of medical care under these plans. Thus firms provide a unique opportunity to understand the relationship between plan provisions and expenditures for health care. A unique file of claims data makes this possible. The core aim of this sub-project is to determine the effect of employer-provided insurance plan provisions on medical expenditures. The goals are: (1) To describe and quantify the sources of the differences in health care expenditures among firms. (2) To understand the determinants of employee plan choices. (3) To isolate the effects of plan incentives from the effects of self-selection of plans, and thus to evaluate the potential for plan provisions to influence medical care use and expenditures. (4) To understand the implications for medical expenditures of various health insurance reforms, including HMO plans, other managed-care options, and medical savings accounts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GENETIC UNDERWRITING
INFORMATION
AND
LIFE
INSURANCE
Principal Investigator & Institution: Rothstein, Mark A. Professor; Inst/Bioethics/Hlth Policy/Law; University of Louisville University of Louisville Louisville, KY 40292 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2003 Summary: (Applicant's Abstract) The proposed research will study whether there should be any limits placed on life insurers' use of predictive genetic information in risk classification or medical underwriting. The research will focus on the following issues: 1) the current state of the science on the use of predictive genetic information in mortality risk calculations; 2) the statutory and case law addressing actuarial fairness in life insurance; 3) existing and proposed legislative activity regulating life insurers' use of genetic information (including life insurers' ability to request or require genetic testing); 4) the case law allowing individuals to challenge their denial of life insurance coverage or premium rates under Title III of the Americans with Disabilities Act; 5) antitrust and other legal constraints on cooperation among life insurance companies with regard to their use of predictive medical information in underwriting; 6) consumer attitudes toward life insurance and genetic information, including consumer perceptions of adverse selection pressures based on predictive genetic information; 7) comparative law perspectives on genetics and life insurance; 8) the moral mission and social function of life insurance; and 9) the development of policy options and possible legislative and regulatory strategies. The research design will consist of traditional legal, medical science, social science, and bioethics research and analysis. A detailed, national consumer survey instrument will be prepared and administered by a specially selected contractor. Leading experts in the fields of life insurance, economics, genetics, insurance law, comparative law, and philosophy will research and write a chapter on their respective topics in advance of a conference in Houston, Texas. Additional invited guests at the conference will be other experts as well as representatives of the insurance industry, consumers, elected officials, and regulatory bodies. The conference will focus on building consensus and advancing understanding in areas of disagreement. The chapters, as well as the positions developed at the conference, will form the basis of a book to be published Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENETICS & DISABILITY INSURANCE--ETHICS, LAW & POLICY Principal Investigator & Institution: Kahn, Jeffrey S. Director; Center for Biomedical Ethics; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, MN 554552070 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2003 Summary: (Adapted from the Investigator's Abstract): Issues of genetic testing and the potential for discrimination by insurance providers have received considerable scholarly attention during the past decade. This work has not directly addressed disability insurance, which is an important part of the social safety net and has features that are clearly different from either health or life insurance. Similarly, a small fraction of the states prohibiting genetic discrimination in insurance have included disability insurance. The University of Minnesota Center for Bioethics and the University's Joint Degree Program in Law, Health & the Life Sciences plan to complete a comprehensive investigation of the ethical, legal, and policy issues in the use of genetic information in private and public disability insurance and to recommend policies based on our findings. To achieve the goals of this project, the center and Joint degree Program will convene an interdisciplinary working group comprised of some of the best U.S. scholars and experts working on ethical, legal, and social issues raised by genetics, insurance, and disability. The group will include members from the field of ethics, policy and law, social science, medical science, people who live with disabilities, and the insurance industry. The Working Group will convene four times during a two-year period. In conjunction with the group's third meeting, the Center and Joint Degree Program will host an invitational national conference on the ethical, legal, and policy issues raised by genetic testing and disability insurance. Through these efforts the investigators will clarify the issues; develop a consensus about effective responses; author a consensus paper with their recommendations; and produce the first comprehensive collection of articles on the issues to be published as a journal symposium. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENETICS LEGISLATION--SYNTAX, SCIENCE AND POLICY Principal Investigator & Institution: Gostin, Lawrence O. Professor of Law; None; Georgetown University Washington, DC 20057 Timing: Fiscal Year 2000; Project Start 30-SEP-1998; Project End 30-JUN-2004 Summary: Emerging genetic technology continues to yield valuable clinical and societal benefits, yet the information it produces poses potential threats to civil liberties. With surprising speed, legislators have begun to draft and enact laws intended to protect privacy, confidentiality, and autonomy interests related to genetics and genetic information. In such a rapidly evolving and technically complex area, however, legislators face many challenges. Although scholars have offered valuable policy recommendations, lawmakers lack a source of comprehensive, clear, and unbiased research concerning the ethical, technical, and legal issues that influence genetics legislation. This project is intended to provide legislators with objective and comprehensive information from a nonpartisan source so they can draft genetics-related legislation that accurately conveys the legislative intent; is clearly understood by lay people, scientists, and industry; and avoids unintended adverse effects. To achieve this goal, the project will analyze legislation and the legislative process to identify trends difficulties, lack of uniformity of approaches, and inconsistencies with legislative intent, sound science, and ethical principles. Specifically, the project will track and collect proposed and existing genetics legislation in the nation s 50 states, including that related
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to the health-care and public health systems, insurance, employment, research, criminal justice, paternity, adoption, and any other legislation, regulations, or case law that significantly relate to human genetics. In addition, the project will survey and interview legislators who draft genetics legislation. Moreover, to inform legislators of relevant scholarly literature, the project will gather, analyze and disseminate current literature on genetics and genetics- related law, ethics, and public-policy issues. Finally, the project will provide a forum for state legislators to discuss genetics law and related policy issues to encourage a more consistent and uniform approach to regulation of genetic information and technologies. The overall objective of the project is to educate legislators about genetics-science, law, and ethics-through reports, articles, a website homepage, and a National Conference. These educational means should give legislators the tools to craft genetics-related statues that: 1) achieve intended legislative and policy goals; 2) are scientifically and ethically sound; 3) protect privacy interests and prevent discrimination; 4) are comprehensible to the lay, scientific, and commercial communities; and 5) avoid unintended burdens on research, medical treatment, and human rights. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEALTH AND RETIREMENT STUDY Principal Investigator & Institution: Willis, Robert J. Senior Research Scientist; Survey Research Center; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2001; Project Start 25-SEP-1990; Project End 31-DEC-2003 Summary: This application is to design and field the Health and Retirement Study (HRS) and the study of Asset and Health Dynamics Among the Oldest Old (AHEAD) for a six-year period (2000-2005). In 1998, the HRS and AHEAD studies were merged and added two new birth cohorts. The combined study is referred to as the Health and Retirement Study. The HRS was designed to provide a uniquely rich longitudinal dataset for the community of scientific and policy researchers who study the health, economics and demography of aging. The design and execution of the survey has involved the active participation of a large number of scientists from a broad array of disciplines. HRS has evolved considerably from its inception, guided by input from its Steering and Data Monitoring Committees, the broader research community, and scientific review panels that have evaluated earlier proposals. HRS is currently comprised o four birth cohorts: persons born in 1931-41 and their spouses (HRS original cohort); persons born before 1924 and their spouses (AHEAD cohort); and, persons born in 1942-47 ("War Babies") and 1924-30 ("Children of the Depression") and their spouses who were not already included in the original HRS or AHEAD cohorts. We plan to add a new 6-year cohort of Americans entering their 50's in 2004, and every sixth year thereafter. Respondents are followed longitudinally at two-year intervals until they die. In addition to the core biennial interviews, we plan to continue the development of complementary data sources from employer pension plans and from linked administrative data, including Social Security and Medicare records. We will also explore possible linkages associated with geocoding, and employer and nursing home characteristics, as associated with our sample members. In sum, our goals for this period are: l) Continue data collection on the original HRS and AHEAD cohorts; 2) Collect longitudinal data on the new cohorts introduced in 1998; 3) Begin baseline data collection on the "Early Boomer" cohort of 1948-53 in 2004; 4) Continue developing complementary data sources; 5) Enhance data quality; 6) Enhance data distribution and
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dissemination; 7) Expand outreach activities; and, 8) Continue to innovate content and survey methodology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEALTH CARE ACCESS QUALITY AND INSURANCE FOR CSHCN Principal Investigator & Institution: Swigonski, Nancy L. Pediatrics; Indiana UnivPurdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, IN 462025167 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-MAR-2003 Summary: Indiana's Children's Health Insurance Program (ICHIP) has enormous potential benefit for Children with Special Health Care Needs (CSHCN) who are uninsured. Indiana opted for a combination of a Medicaid managed care expansion (Phase I) and a separate State Insurance Program (Phase II). Phase I of ICHIP expands Medicaid coverage for children birth to age 18 up to 150 percent FPL. Phase II, effective January 1, 2000, serves children 150-200 percent FPL with a basic plan that includes primary, preventive and acute care. Additional services, not provided under the State Insurance Program, will be accessed through other resources for CSHCN, such as the First Steps Early Intervention (IDEA, Part C) and Children's Special Health Care Services (CSHCS, Title V). Little is known about the impact of differing health care delivery systems on children with special health care needs (CSHCN). We will assess enrollee impact for CSHCN, using a 2 X 2 quasi-experimental design. Indicators of access and quality of care will be compared within and between health care delivery systems: Phase I (comprehensive package of services), Phase II (relying on "wrap around" services from other state programs), Risk-Based Managed Care (RBMC) and Primary Care Case Management(PCCM). Specific Aims are to: 1) Describe the structural, organizational and implementation features of Phase I and Phase II of CHIP that facilitate coordination and collaboration of services for optimal outcomes of CSHCN. 2) Evaluate, within and between, program comparisons of outcomes for CSHCN including: (1) access to care; (2) utilization of services; (3) quality of care; (4) satisfaction with care; (5) expenditures for care, evidence of "crowd out"; (6) health outcomes; and (7) family impact by comparing: pre- and post- enrollment outcomes for CSHCN; CSHCN who receive services through the managed care model of RBMC to those enrolled in PCCM; and CSHCN enrolled in a comprehensive package of benefits under EPSDT (Phase I) to CSHCN with a basic service plan and "wrap-around" services (Phase II). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HEALTH CARE MARKETS AND VULNERABLE POPULATIONS Principal Investigator & Institution: Escarce, Jose J.; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2005 Summary: The proposed Program Project, entitled "Impact of Changing Health Care Markets on Vulnerable Populations and Their Providers," consists of a series of interrelated research projects that will address questions regarding the effect of health care market structure an the growth of managed care on a variety of vulnerable populations in the United States. The research plan under the program project is intended to contribute toward the fulfillment of the following long range goals: * Increase understanding of the changes and trends in health care markets and how they influence vulnerable populations and their providers. * Increase understanding of how health care market structure affects access to health insurance; access, utilization and
Studies 45
quality of medial care; and economic and clinical outcomes form members of vulnerable populations. The Program Project will include five component projects, as well as an Administrative Core and a Data, Measures, in Synthesis Core. Each project and core will contribute to the goals and theme of the Program Project, as follows: Project 1 will assess the effects of health care market structure on the quality of care provided by hospitals, focusing on potential differential effects for safety net and on-safety net hospitals. Project 2 will assess effects of health care market structure on safety net and non-safety net hospitals with regard to participation in hospital systems and managed care networks, financial performance, service offerings, and provision of charity care. Project 3 will examine the effects of market structure on access to employer-sponsored health insurance for two vulnerable populations: workers in low wage businesses and the workers employed in rural areas. Project 4 will determine how the structure of the Medicare managed care market affects economic and clinical outcomes, including insurance choice, health status, and out-of- pocket expenses for chronically ill elderly persons. Project 5 will examine the effects of health care Data, Measures, and Synthesis Core will serve as the intellectual center for the program project, and will provide the main locus for conceptual and methodological integration of the five component projects. In addition, the Core will create a library of contextual, market-level data on health care market structure and the safety net, and will produce reports and manuscripts that summarize and synthesize the findings of the Program Project. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEALTH OUTCOMES FOR UNINSURED OLDER ADULTS-II Principal Investigator & Institution: Baker, David W. Chief, Division of General Internal Medi; Medicine; Northwestern University Office of Sponsored Programs Chicago, IL 60611 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: Aims: 1) To determine whether the continuously uninsured (?92-?98) are at increased risk of developing a major decline in overall health and/or a new physical difficulty from ?92-?00, and whether the relative risks for these outcomes change over time. 2) To determine whether people who are intermittently uninsured are at increased risk of these same adverse outcomes for a) periods during which they were uninsured (i.e., concurrent effects), and b) periods after an episode without insurance (i.e., lagged effects from having been uninsured). 3) To determine whether individuals who were uninsured > 1 times from ?92-?98 were at increased risk of a) death and b) death/major decline in health. 4) To determine the degree to which lower rates of insurance explain socioeconomic and racial/ethnic differences in health outcomes. Methods: This project will conduct a series of prospective cohort studies using data files from the Health and Retirement study, which consists of a national sample of US adults 51-61 years old beginning in 1992 with follow-up interviews every 2 years. Deaths were determined through contacts and the National Death Index. Insurance coverage (private or public), health status, socioeconomic status, chronic diseases, and health behaviors will be determined at the time of each interview. Health outcomes will include 1) a major decline in overall health, defined as either a decline from excellent, very good, or good health at time 1 to fair or poor health at time 2, or a decline from fair health to poor health; 2) development of a new difficulty walking or climbing stairs (mobility) or a new difficulty with activities of daily living; 3) death. Based on, insurance coverage, we will construct cohorts of individuals who were continuously insured (private or public), continuously uninsured, lost insurance (transitioned from insured to uninsured), and gained insurance. Multivariate logistic regression and Cox proportional hazards
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survival analyses will be used to examine the relationship between patterns of insurance coverage and the risk of adverse health outcomes. Significance: This will be the first study to assess whether being uninsured has only contemporaneous adverse effects or whether lack of insurance has cumulative and lagged effects. Many Americans are intermittently uninsured. If this group has an increased risk of adverse outcomes, this would suggest that we monitor the number of people who are continuously or intermittently uninsured to estimate the number of Americans vulnerable to the effects of being uninsured. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INCENTIVES
HEALTH
PLAN
ADVERTISING
STRATEGIES
&
MARKET
Principal Investigator & Institution: Dudley, R Adams.; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001 Summary: We hypothesize, first, that health plans will develop advertising campaigns based on their perceptions of the incentives they face in local markets and, second, that the recent and growing emphasis on quality of care will lead to changes in advertising. The project addresses topic area 1, Provider and Health Plan Behavior, by exploring the nature of plan advertising over time, with an emphasis on the extent to which plans try to influence selection in health insurance markets through their advertising strategies. Since we also explore the degree to which plans use ads to exclude or discourage minority enrollment, our study is also related to topic area 3, Minority Access. While we cannot fully test the first hypothesis, we will be able to determine whether plan advertising from 1970-2000 follows patterns consistent with it by assessing whether plans increased their use of ads that might result in risk selections as the incentives to do so rose. To assess the second hypotheses, we will determine whether increasing purchaser interests in quality measurement to quality-based payment is associated with changes in plan advertising. We will also evaluate different methods of monitoring advertising. The specific aims of this project are: (1) to investigate the association between changes in the frequency of risk selection behaviors manifest in health plan newspaper advertising and changes in HMO market share in the same locations from 1970-2000; (2) to compare in each MSA the percentage of models in ads who are minorities to the local racial/ethnic mix and to assess whether competitiveness in local markets changes the probability that plans use minority models; (3) to calculate the rate of use in ads of themes and descriptions of benefits designed to attract healthy individuals/exclude the ill before and after the introduction of risk adjustment or as purchaser emphasis on quality increases in 2000-2004; and, finally, (4) to compare the frequency of risk selection behaviors in ads in major local newspapers to the frequency of such behaviors in ads in specialty local newspapers (e.g., Spanish-language papers) and on TV. The time period from which the ads are collected, the media studied, and the techniques of data analysis will vary with each specific aim. For aim 1, ads will come from the Duke Advertising Archives, while ads for aims 2 and 3 will be collected for this project by media monitoring companies. For all aims, we will employ content analysis to evaluate the message strategy of advertisements. We will create indices of risk selection behaviors to measure the extent to which plans use ads to select risk and record the frequency with which minorities are represented. These dependent variables will be regressed on local HMO market share for aim 1 and on more sophisticated measures of market competition for aims 2 and 3. We will control for the percentage of local
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populations who are minorities for aim 2 and for purchaser initiatives to risk adjust or improve quality for aim 3. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEALTH PLAN CHOICE: IMPLICATIONS FOR CONSUMERS & PURCHA Principal Investigator & Institution: Bundorf, Mary K. Health Research and Policy; Stanford University Stanford, CA 94305 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2006 Summary: The long-term goal of the candidate's research agenda is to determine how choice among competing health plans within group purchasing arrangements can most effectively be designed to provide access to and deliver high quality, high-value health care to consumers. In this research career award application, the candidate identifies short-term (5-year) career development and research objectives leading toward that goal and describes an integrated career development and research plan that will enable her to achieve these objectives. Career development activities include formal training in three new methodological areas, formal career development mentoring, and research collaborations with senior investigators. The research agenda has the following three specific aims: 1) to analyze how individuals choose among alternative health plans, focusing on how characteristics of managed care plans influence the choices of different types of consumers; 2) to examine the effects of group purchasing strategies relying on choice among competing plans on cost and access to health insurance for consumers and purchasers, and to determine how the mix of individuals within a purchasing group affects these outcomes; and 3) to determine how differences between public and private purchasers in their objectives and the composition of their covered populations affect the feasibility and optimal design of group health insurance purchasing arrangements. To analyze individual choice among health plans, the candidate will conduct econometric studies of individual choice behavior, focusing on the elderly and nearelderly. She will also use an alternative, complementary methodology, contingent valuation, to determine the value individuals place on health plan characteristics. The applicant will explore the implications of group purchasing strategies by developing a simulation model of health insurance purchasing groups and estimating empirical models of the determinants of employer purchasing strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HEALTH PLAN RESPONSES TO MEDICARE HMO PREMIUM PAYMENTS Principal Investigator & Institution: Ellis, Randall P. Professor; Economics; Boston University Charles River Campus 881 Commonwealth Avenue Boston, MA 02215 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2003 Summary: This project will examine how Medical Health Maintenance Organizations (HMOs) have reacted to the new Medicare formula being used to set HMO capitation rates in 1998 and 1999. In 1998, 45 HMOs canceled their Medicare contracts, while 54 others reduced the market areas in which they offer services. At the same time, more than 30 new plans applied to enter; many plans lowered premiums and changed benefits; and overall Medicare HMO enrollment grew by eight percent. This study will take advantage of this setting to study HMO behavior and its differential response to Medicare payment policy. Empirical specifications will be based on an analytical model of HMO and consumer behavior. Three types of HMO decisions will be examined:
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HMO selection of counties to enroll Medicare beneficiaries in; the choice of the enrollee premiums; and HMO selection of optional benefits to offer beyond the minimum required levels. One consumer choice will be modeled, aggregate and plan-level Medicare HMO enrollment, in response to plan premiums and benefit features. The project will use rich information from the Health Care Finance Administration, the Area Resource File, and Interstudy. A series of statistical models of HMO behavior and consumer enrollment decisions identify the plan and market factors that explain the dramatic changes that have occurred in Medicare markets. The relationship between commercial and Medicare HMO activities will be explored. Results will contribute to the recent academic research about how health plans compete. Results will also be useful to policy makers in understanding how recent Medicare reforms have altered HMO premiums, competition, benefit features and the resulting Medicare enrollments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEALTH, HUMAN CAPITAL AND THE LABOR MARKET Principal Investigator & Institution: Thomas, Duncan; Senior Economist; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001; Project Start 01-MAR-2001; Project End 28-FEB-2002 Summary: This project will examine labor outcomes over the life course of men and women in Indonesia and Malaysia using retrospective life history data collected in three waves of the Malaysian Family Life Survey (MFLS) and two waves of the Indonesian Family Life Survey (IFLS). In addition to distinguishing life-cycle from cohort effects over the last quarter- to half-century in these rapidly developing countries, particular attention will be paid to how economic and social change affects the lives of different socio-economic groups and also to changes in the importance of inter-generational mobility. Specially collected data from the IFLS provide a unique opportunity to carefully evaluate long-term retrospective histories on wages and labor supply in a dynamic setting. In addition to informing our research, the results of that sub-study will be of general methodological interest in and of themselves. A key factor affecting the well-being of a population is health. The richness of health status measures in the MFLS and IFLS will be exploited to examine the relationship between labor market success and a broader array of health indicators than has hitherto been possible using survey data. Both sets of surveys contain information on multiple family members and, in the MFLS, health status is reported for the same individual early in life along with health status of family members across three generations. Regression models will use all this information to control for individual-and family-specific health "endowments" and to examine the influence of early childhood health on labor market outcomes later in life. By exploiting the panel dimension of the IFLS, we will examine the impact on labor market outcomes of not only current health but also previous health and changes in health status, neither of which has been studied in this context. Recognizing that health may be endogenous, an instrumental variables approach will be explored with the instruments being drawn from specially collected community-level survey data on prices, health services and infrastructure. Changes in the health insurance market in Indonesia will also be explored. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HEALTHCARE ACCESS FOR CHILDREN OF THE WORKING POOR Principal Investigator & Institution: Guendelman, Sylvia; Health Policy and Management; University of California Berkeley Berkeley, CA 94720
Studies 49
Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2003 Summary: (provided by applicant): Working poor families, who earn less than 200% of the federal poverty level, have long been overlooked by researchers and policy makers. Despite their low earnings, adults in these families have not relied on public assistance and historically have not qualified for means-tested insurance programs such as Medicaid. As a result, working poor families, many of whom do not receive health insurance benefits through their employer, have had difficulties accessing healthcare and meeting their healthcare needs. With welfare reform setting short lifetime limits on the receipt of welfare and imposing work requirements, more families are transitioning into the ranks of the working poor. Even though California is the most expensive state to reside in, its working poor families (18% of the state population) have the lowest average income in the nation. In California, a large proportion of working poor families are immigrants. Evidence suggests that immigrant working poor children experience even greater difficulties in access to care. In an effort to minimize these disparities, California has recently expanded health insurance coverage for eligible working poor children and their parents. Yet there has been no population-based study to monitor the impact of these expansions. The proposed study will analyze data from the 2001 California Health Interview Survey (CHIS) in an aim to fill gaps in knowledge of the extent to which children of the working poor access and utilize health services. Specifically, it will 1) compare access and utilization of healthcare among working poor children with children in other socioeconomic strata; 2) explore the differences in access and utilization of healthcare between immigrant and native born children of the working poor; and 3) assess the extent to which expansions in health coverage for working poor parents can improve access and use of health services for their children. CHIS, the largest cross-sectional state health survey of the civilian population ever conducted in the US, offers an excellent opportunity to examine healthcare access for working poor families. The sampling frame, language capabilities, and 70% response rate for adults indicate that the data are likely to be representative of the California population. Because this is the first large-scale data collection effort since California expanded health insurance access for the working poor, CHIS data will allow this study to monitor the extent to which these policies have affected access to and use of healthcare and the extent to which, by expanding insurance coverage for parents, children's access to care may also improve. Further, it will allow for an assessment of the extent to which legal status influences access to and use of health services for working poor immigrants in California. This study will help policy makers understand the determinants of access to care and use of health services as a first step towards assessing the quality of care for children of the working poor. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEALTHCARE NEEDS OF ADDICTED CRIMINAL OFFENDERS Principal Investigator & Institution: Goldstein, Paul J. Professor; Epidemiology and Biostatistics; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 31-AUG-2003 Summary: (Applicant's Abstract) Health care issues involving substance users have taken on increased significance with the advent of managed care in our current costconscious era. The war on drugs has led to arrest of increasing numbers of substance users, adding salience to the role of the criminal justice system as a "trouser" of drug users, and as a conduit to the drug treatment system. The termination of the addiction disability within the SSI program presents the possibility that many substance users will lose, or have already lost, Medicaid benefits that covered health care and
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pharmaceutical costs. The goal of this study is to gain a detailed understanding of the health care needs and service utilization of a sample of chemically dependent criminal offenders taking into account their current chemical dependency status, co-occurring psychiatric disorders, baseline medical conditions including HIV status, and significant mediating factors such as participation in drug treatment, utilization of medical services within incarcerate and community settings, age, and injection drug use. The study will employ a prospective, longitudinal, repeated measures design with a sample of 600 predominantly African-American male felony offenders and 200 predominantly African-American female felony offenders, screened for lifetime chemical dependency. The study has four aims: 1) Identify and assess a sample of addicted criminal offenders for their baseline chemical dependency status, psychiatric status, health status, utilization of health care services, and perceived barriers to utilization of health services; 2) Validate participants' self-reported baseline health status through physician administered medical examinations; 3) Develop a multivariate statistical model of the interrelationship over a three-year follow-up period between chemical dependency status, psychiatric status, health status, barriers to service utilization, and actual utilization of health care services controlling for baseline health status, participation in drug treatment, age, injection drug use, and health insurance coverage; 4) Determine the relative impact of medical conditions and injuries related to violent victimization on the utilization of medical services through collection of detailed information on violent victimization of study participants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HELPING ELDERS INCLUDE QUALITY IN HEALTH PLAN CHOICE Principal Investigator & Institution: Harris-Kojetin, Lauren D.; Research Triangle Institute Box 12194, 3040 Cornwallis Rd Research Triangle Park, NC 27709 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-AUG-2003 Summary: Every year about 200,000 persons aging into Medicare face a health care market too complex for many of them to make informed health plan choices without assistance. Because they are vulnerable to potentially serious health and financial consequences of an uninformed plan choice, prospective Medicare beneficiaries would benefit from considering comparative quality information in their plan choice. Considerable research had focused on measuring and presenting health plan quality information to consumers. However, no research has examined how best to develop a system to integrate comparative quality, cost, and benefit information with motivational, educational and decision support in a way that works for aging persons with limited education. This study will develop and evaluate this integrated information and decision support strategy for use by employee benefits staff in counseling employees aged 60-64 about their Medicare plan options. The specific aims are to: 1) identify counseling practices and materials benefits counselors use to assist employees with Medicare plan choices; 2) understand the challenges benefits staff face when educating employees about Medicare health plan choices and the use of quality, and determine how best to address these challenges from the benefits counselors' perspective; 3) develop, test, and evaluate print materials that, a) help benefits counselors do a better job in helping 60-64 year old employees make good Medicare decisions, b) integrate quality measures, costs, and benefits in a way that employees will include these factors in their choice, and c) address the needs of less educated employees who may have limited access to decision support resources outside their workplace; and 4) assess the feasibility of an innovative computer-based prototype as an alternative to paper guide dissemination. The research methods investigators will use to
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achieve these aims are case studies, plan choice, material design, cognitive testing, a laboratory experiment, a small- scale demonstration and evaluation, and a computer feasibility sub-study. Findings will further the consumer health information field and inform policy decisions regarding effective plan choice information and assistance dissemination strategies, especially for less educated consumers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EMPLOYMENT
HIGHLY
ACTIVE
ANTIRETROVIRAL
THERAPY
AND
Principal Investigator & Institution: Bernell, Stephanie L. Public Health; Oregon State University Corvallis, OR 973391086 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JAN-2004 Summary: (PROVIDED BY APPLICANT): The objective of this research is to examine the employment consequences of HIV, focusing on the labor market behavior of HIV positive individuals who use and who do not use highly active antiretroviral therapy (HAART). Like all workers, HIV positive individuals leave the state of employment and unemployment for very different reasons. This study examines the causes of job loss and job acquisition, concentrating primarily on the contribution of HAART and secondarily on the effect of mental health and substance abuse problems. This study uses data from the HIV Cost and Services Utilization Study (HCSUS) and employs discrete choice models of analysis. The specific aims of this research are to (1) examine the effect of HAART on the probability of leaving employment, (2) assess the effect of HAART on the probability of leaving unemployment, and (3) identify whether persons dually diagnosed as HIV positive and having mental health and/or substance abuse problems have differential labor market outcomes than those without mental health or substance abuse problems. Understanding the influence of HAART on the labor market behavior of HIV positive individuals is of fundamental significance to pubic sector policymakers as well as employers in all parts of the economy. On an individual level, it is likely that many people with HIV are still denied opportunities in the workplace due to their HIV status. On a national level, if HAART results in better employment outcomes, it is likely that individuals will remain privately insured for a longer period of time and will be less reliant on federal and state programs (SSI, Medicaid, Medicare, etc,). Furthermore, by having a clearer understanding of the employment outcomes of those who are dually diagnosed with HIV and mental health and/or substance abuse problems, this project will provide new information on the effects of recent policy revisions, including employment-based mental health insurance parity mandates. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIV, RACE AND SURVIVAL IN THE HIGHLY ACTIVE THERAPY ERA Principal Investigator & Institution: Giordano, Thomas P. Pediatrics; Baylor College of Medicine 1 Baylor Plaza Houston, TX 77030 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2007 Summary: (provided by applicant): Highly active antiretroviral therapy (HAART) has reduced mortality in patients with HIV. Crude CDC data demonstrate that, though they had the same mortality in the pre-HAART era, mortality in 2000 was >15% higher for Hispanics with AIDS and >50% higher for African Americans with AIDS, compared to whites. The effectiveness of HAART has not been assessed in a nationally distributed population with HIV, and the factors contributing the mortality discrepancy are not well
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known. The goals of this proposal are to assess the magnitude of the HAART-era mortality discrepancy by race/ethnicity, and identify potentially modifiable factors responsible for that discrepancy. The research is based on a model of care that outlines crucial Steps of HIV Care, which in turn determine the overall effectiveness of HAART in clinical practice. These steps are: a) access outpatient care, b) utilize care services, and c) adhere to care. Past studies and preliminary data indicate that minorities may have difficulty with all 3 steps, but the relative influence that patient and process of care factors have on these Steps and the effect that the Steps have on survival are unknown. The specific aims for this proposal are: Specific Aim 1: To determine if the mortality rates of patients with HIV in routine clinical practice differed by race/ethnicity in the pre-HAART and HAART eras; Specific Aim 2: To evaluate the relationship between the Steps of HIV Care, patient factors, and mortality; Specific Aim 3: To develop an instrument to assess newly diagnosed HIV-infected patients' attitudes and beliefs about HIV disease and care; Specific Aim 4: To evaluate the relationship between patients' attitudes and beliefs about HIV disease and care and patients' success in following the Steps of HIV Care. The first 2 Aims will be accomplished with retrospective cohort studies using a unique, national, Veteran's Health Administration HIV registry; the 3rd Aim with focus group and pilot studies of persons with HIV; and the last Aim with a prospective cohort study of patients newly diagnosed with HIV during hospitalization. This research will expand upon the principle investigator's current skills and past work by taking advantage of an outstanding research and mentoring environment, allowing him to acquire new and refine existing skills in the design and performance of patientoriented clinical research, so that he will be an independent researcher improving the health of people with HIV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HOSPITAL FINANCES AND THE QUALITY OF HOSPITAL CARE Principal Investigator & Institution: Bazzoli, Gloria J. Research Associate Professor; Health Administration; Virginia Commonwealth University Richmond, VA 232980568 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 30-SEP-2004 Summary: (based on application?s abstract): The hospital industry in the United States is facing unparalleled financial pressures. Unlike the 1980s, hospitals do not have private payer surpluses to offset constrained payments from Medicare or Medicaid. Nor can they rely on steady growth in Medicare payments to offset reductions in private payer surpluses. As a result, some hospitals may be making tough choices about investments in hospital operations and processes that support high quality patient care, including providing sufficient staff with adequate training to meet patient needs, replacing antiquated equipment, investing in new technology, and providing adequate management and support structures. This study will examine the relationship between hospital financial condition and the quality of care delivered by U.S. hospitals through 5 specific research questions: Research Question 1: How does a hospital?s underlying financial position affect its decisions about resources and processes that are likely to affect the provision of high quality hospital care? Research Question 2: How do these decisions about resources and processes combine with patient characteristics and other factors to influence patient health care quality, including rates of mortality and complication from hospital care? Research Question 3: How do hospital decisions about resources and processes combine with market conditions and other factors to affect the annual financial performance of hospitals? Research Question 4: For hospitals that face limited competition, either due to geography or patient immobility, can more pronounced effects of financial pressures be observed on investments in quality-related
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resources and processes relative to hospitals in more competitive markets? Research Question 5: How does public policy that affects hospital payments, especially the 1997 Balanced Budget Act and its revisions, influence hospital decisions about quality-related resources and processes and the care their patients receive? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HUMAN SUBJECTS RESEARCH ENHANCEMENTS PROGRAM AT MUSC Principal Investigator & Institution: Raymond, John R. Dci Professor of Medicine; Medicine; Medical University of South Carolina 171 Ashley Ave Charleston, SC 29425 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2003 Summary: In this application, the Medical University of South Carolina (MUSC) focuses on performance enhancements of its system for protecting human subjects in research, including three IRBs that carry a caseload of more than 1,300 active protocols. Funds are requested for technical services, hardware and software to construct, test and implement an array of databases for use as a decision support system by the IRB and related MUSC activities (biosafety, academic compliance [education, audits], conflict of interest). Our specific aims are to: 1. Develop and implement a secure, Health Insurance Portability and Accountability Act (HIPAA)-compliant, Web-based IRB database system that increases the quality and efficiency of all interactions with human research teams and the review of research protocols (new, continuing, amendments), adverse events, recruitment practices and progress, protocol deviations and violations, and outcomes of corrective action plans resulting from protocol audits. 2. Develop and implement a set of secure, HIPAA-compliant parallel databases for other university activities contributing to human subjects protection. Parallel databases for university biosafety, academic compliance [education, audits], and conflict of interest activities will be linked to the new IRB database, creating an array of relational databases that can be queried to answer specific questions about oversight system activity. 3. Evaluate the effectiveness of the relational database array as an IRB decision support system in: (a) identifying areas of protection of human subjects that need improvement, and (b) facilitating the development, implementation and evaluation of action plans designed to make those improvements. The objective is to increase the quality and efficiency of procedures to protect human subjects in research protocols.The database array will enable identification of areas that need improvement, facilitate evaluation of action plans designed to effect those improvements, and provide data that can be used locally (with distribution to PIs, IRB members, university administration) and nationally in conjunction with other institutions to enhance the protection of human subjects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HUMAN SUBJECTS RESEARCH PROTECTION IMPROVEMENT PLAN Principal Investigator & Institution: Abramson, Ruth G. Professor; Medicine; Mount Sinai School of Medicine of Nyu of New York University New York, NY 10029 Timing: Fiscal Year 2003; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: The goals of this continuation proposal are 1) to expand the computer based system that was proposed last year to encompass components beyond those previously included and 2) to collaborate with four institutions that conduct human subjects research, none of which were previously funded by the S 07 program. In addition to serving as an instrument for an investigator's development and submission of
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applications to the IRB, IRB office management and tracking of all appli cations, adverse events, and advert isements, a tool for monitoring the education of IRB members, staff and investigators and a means for preparing agendas and minutes, the expanded system will incorporate the following additional components that are highly relevant to the protection of hum an research subjects: a) conflicts of interest; b) the new requirements of the Health Insurance Portability and Accountability Act (HIPAA); c) biosafety considerations; and d) pharmacy information required for all drugs utilized in protocols that include human subjects. Furthermore, access to the computer based system will be expanded beyond the investigators, IRB members and staff to incorporate access to staff of the Grants and Contracts Offices and access to relevant components of the IRB application by designated individuals in the General Clinic al Research Center (GCRC) incl uding the Research Subject Advocate (RSA), the MSSM Conflicts of Interest in Research Committee, the Bios afety Officer and Biosafety Committee, the Research Pharmacy and the MSSM Compliance Officer. The collaboration with the external institutions will include integrating the needs of those institutions relative to human subjects research into the computer system and sharing the product that is devel oped with these institutions. The collaborating institutions will include Elmhurst Hospital Center, Queens Medical Center (both part of the Health and Hospital Corporation of New York City), the Jewish Home and Hospital of New York and the Bronx Veteran's Administration Medical Center. The expanded access to the computer system and the unique, rapidly available searchable system for adverse events that will be provided to the MSSM GCRC RSA and Biosafety Committee are considered particularly important elements of the proposed software that will greatly enhance the ability of the MSSM IRB and its collaborating instituti ons to protect human research subjects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMPACT OF CULTURE ON CANCER SCREENING IN CHINESE WOMEN Principal Investigator & Institution: Liang, Wenchi; V T Lombardi Cancer Res Center; Georgetown University Washington, DC 20057 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Asian American and Pacific Islanders (AAH's) are the fastest growing U.S. minority group. The Chinese represent the single largest group of AAPI's. Despite the availability of early detection for breast, cervical, and colorectal cancers, Chinese women screened at significantly lower rates than Whites and other ethnic minorities. Cultural views (and acculturation) are likely to contribute to the under-utilization of screening in Chinese populations. The overall goals of this research project are to use the PRECEDE/PROCEED conceptual framework to (1) describe factors related to older Chinese women's screening behaviors; (2) refine culturally- and stage-tailored Chinese language educational materials designed to improve screening use this population; and (3) conduct a preliminary randomized trial to evaluate the feasibility, acceptability, and potential effectiveness of these culturally sensitive educational materials. A prospective longitudinal design will be used to recruit 250 Chinese American women ages 50 and older from community-based sites in the metro D.C. area for this two-phase project. In the first phase, participants will be interviewed at baseline and be followed-up for another telephone interview 18 months later. Crosssectional analyses of baseline data will be used for refinement of educational materials tailored to stages of screening adoption. Baseline data will also be used to predict screening behaviors noted on the follow-up survey to confirm cross-sectional results and temporality of effects. In the second phase, participants will be randomized after
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completing the follow-up survey into two groups: receipt of standard vs. culturally- and stage- tailored Chinese language educational print materials. Women will be contacted by phone 1-2 weeks after mailing of materials to evaluate feasibility, acceptability, and effects of tailored materials on intentions to receive screening. This research program will broaden and deepen the Principle Investigator's knowledge and experiences in socio-cultural aspects of cancer control in an under-studied population, and set the stage for a larger randomized trial to assess long-term behavioral change. The training program will complement this research project by strengthening the P.I.'s background in cancer epidemiology and aging, behavioral and socio-cultural research, and health services research. With the full support of a nurturing research institution and intellectual interactions with cancer control researchers, this award will allow the P.I. to develop critical research skills to become an independent cancer control researcher. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMPACT OF DRUG BENEFIT DESIGN ON UTILIZATION AND COST Principal Investigator & Institution: Joyce, Geoffrey F.; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: (provided by applicant): Spending on outpatient prescription drugs in the U.S. has increased at double-digit rates for the past decade and is now the third largest component of health care expenses. With drug spending rising so rapidly, many employers and insurers have adopted benefit designs to encourage less and lower cost pharmaceutical use. While some evidence suggests these measures reduce total drug spending, their impact on patterns of drug use, medication compliance and utilization of other medical services is largely unknown. Without this knowledge, health plans and their sponsors could be designing prescription benefits that reduce the costs of pharmaceuticals but increase overall medical costs. We link medical and pharmacy claims data for a wide array of employers across multiple years to the benefit designs for each employee. These data provide a unique opportunity to assess the impact of increased patient cost-sharing and recent innovations in drug benefit design on the patterns of drug use, medication compliance and medical care utilization and costs. The proposed project has four specific aims:1. To assess the impact of drug benefit design on disease-specific patterns of use.2. To examine how medication compliance varies by drug benefit plans and the extent to which these effects differ across disease conditions and level of health status.3. To estimate the impact of poor compliance on hospitalization rates, emergency room use, physician office visits, and overall medical care costs.4. To estimate how novel drug benefits and cost-sharing arrangements affect non-pharmaceutical spending. These questions are highly relevant to health plans, employers and policymakers seeking to design drug benefits that induce more rationale consumption of pharmaceuticals without restricting use of appropriate. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: IMPACT OF MEDICARE POLICIES ON UTILIZATION AND OUTCOMES. Principal Investigator & Institution: Fitzgerald, John D. Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2002; Project Start 16-JUL-2002; Project End 30-JUN-2006 Summary: (provided by applicant): The candidate is a board-certified rheumatologist interested in applying the methodology of health economics to study fiscal policies that
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impact the care of patients suffering from arthritis and other rheumatic diseases. He is seeking external funding support so that he might have the protected time to avail himself of formal course studies, research time on the proposed project, and access to his mentors. He has a business background and is currently enrolled in the UCLA School of Public Health, Health Services Ph.D. degree program, with an emphasis on Health Economics. UCLA provides an excellent environment for the development of his career. The Department of Medicine provides formal support for its young investigators through the Scientific Training and Advanced Research program. UCLA has excellent health service researchers and health economists in the Schools of Public Health and Medicine. UCLA has a close working relationship with RAND and the RAND Graduate School. During the award, the candidate will take classes required to complete his Ph.D. degree. A portion of the proposed research will serve as his dissertation. He has enlisted a team of health economists, health service researchers, a rheumatologist and a statistician to teach him the skills he needs to complete the proposed research and to develop his career as an independent researcher with health economic and arthritis expertise. He has proposed to study the impact of the Balanced Budget Act expenditure cuts on post-acute care utilization and clinical outcomes on a 100% sample of Medicare patients who have undergone elective joint replacement surgery or surgical management of hip fracture. He has also proposed to examine managed care costshifting to the fee for service sector by studying managed care disenrollment prior to planned surgery (elective joint replacement) and disenrollment prior to unplanned surgery (hip fracture). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMPACT OF OR. HLTH PLN ON TANF LEAVERS' ABILITY TO CARE Principal Investigator & Institution: Seccombe, Karen; Sociology; Portland State University Box 751 Portland, OR 97207 Timing: Fiscal Year 2001; Project Start 05-SEP-2001; Project End 31-AUG-2004 Summary: This proposal requests funds to examine the effects of welfare reform on the access to health insurance and use of health services among former welfare recipients and their children in the state of Oregon, a state with a unique health care financing system. Specifically it will aim to determine how families leaving welfare for employment plan for and cope with the expiration of their one-year transitional OHP/Medicaid coverage, and what happens to them after losing their eligibility for the single year of transitional coverage. The research has two main aims, requiring both quantitative and qualitative strategies: (1) An assessment of the ways in which welfare reform has impacted the health and well-being of Temporary Assistance for Needy Families (TANF) leavers, including (a) access and barriers they face in securing health care; (b) ways in which they utilize the health care system; (c) how these patterns vary by urban and rural residence, and race/ethnicity; and (d) how the Oregon Health Plan (OHP) influences these outcomes. (2) An appraisal of the ways in which families leaving welfare for employment plan for and cope with the expiration of their one-year transitional OHP/Medicaid coverage, including (a) respondents' knowledge, expectations, and planning process for securing health insurance; (b) their worries and coping strategies; (c) an elaboration of the ways in which welfare reform has impacted their health and well-being, the access and barriers they face in securing health care, and the ways they utilize the health care system; and (d) the ways that residential location and race/ethnicity may influence their access and use of services. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: IMPACT OF PUBLICLY FUNDED PROGRAMS ON CHILD SAFETY NETS Principal Investigator & Institution: Budetti, Peter P. None; Northwestern University 633 Clark St Evanston, IL 60208 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-MAR-2003 Summary: Expansion of Medicaid managed care (MMC), a decline in Medicaid enrollment, and an increase in the number of uninsured children appears to be threatening the stability of pediatric safety net hospitals and Federally Qualified Health Centers (FQHC). Implementation of the State Children's Health Insurance Program (SCHIP) may play a key role in their survival. The impact of these health care-related changes on community safety nets for children has not been studied. SPECIFIC AIMS The study will (1)describe relationship between characteristics of publicly funded programs and survival/financial viability of pediatric safety net providers (PSNP), (2) determine differential effects of MMC and S-CHIP for PSNPs relative to pediatric FQHCs, (3) investigate institutional and organizational factors among PSNPs that are precipitating change as a result of evolving Medicaid and S-CHIP programs, and (4)examine how successes and failures that PSNPs have experienced in confronting changes have affected their communities. STUDY DESIGN The unit of analysis is the individual pediatric safety net institution and the study period is 1996 through 1999. Safety net hospitals will be identified from the American Hospital Association's (AHA) Annual Survey of Hospitals and the Medicare Cost Report. FQHCs will be identified from the Uniform Data System (UDS). All hospitals with a high burden of uncompensated care (UC) and/or a large proportion of Medicaid revenues and all FQHCs will be included. Pediatric safety net hospitals and FQHCs will be selected by service mix (AHA data) and telephone survey to gather pediatric UC and Medicaid revenues for each hospital and by service mix and patient characteristics on the UDS, respectively. Key informant interviews will be conducted in MSAs with significant changes MMC and S-CHIP and in MSAs with significant negative, positive, or no changes in financial status of pediatric safety nets. Five case studies of MSAs with substantial change in MMC and S-CHIP and financial safety net success or failure will be conducted. ANALYSIS A logistic regression model will estimate the impact of hospital, market, and policy factors on closure. The model will indicate the extent to which baseline factors as well as changes in state Medicaid and S-CHIP policies affected the probability of closure over time. The hospital's cost, revenue, and profit equations will be modeled using a fixed effects regression model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: IMPROVING DISPUTE RESOLUTION IN HEALTH CARE Principal Investigator & Institution: Studdert, David M. Health Policy and Management; Harvard University (Sch of Public Hlth) Public Health Campus Boston, MA 02460 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-AUG-2004 Summary: My training in law and health services research has led to interests in health law, health policy and medical ethics. Research to date has focused on medical malpractice. More recently, however, my interests have gravitated toward legal issues in medical error and Disputes in health care. The agenda outlined in this proposal relates to the latter. It is premised on the overarching hypothesis that advancement of knowledge about disputes in health care-in particular, information about why they arise, how they are resolved, and the identity of the disputants- will help guide policy and practice toward three positive outcomes: (1) improved quality of care; (2) greater
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procedural justice and fairness for managed care enrollees; and (3) reduced costs. Two projects will occupy the majority of my time over the next four years. The first, a study of coverage decision-making in managed care organizations, began in October, 1999. Its goal is to describe and analyze denials of insurance coverage within a managed care population, with a particular focus on how vulnerable enrollees (e.g. the poor, minorities, those lacking physician support for their claim) fare in appealing coverage decisions. Data for the project come from two large health plans and two medical groups in California. The second study has training similar goals but is centered on external review of coverage appeals, specifically among Medicare beneficiaries in managed care. With collaborators at the Center for Health Dispute Resolution, the largest external reviewer in the country, we are currently developing a proposal. As well as providing opportunities to pursue a range of exciting normative and descriptive research questions related to the above studies, the proposed award would allow me the time and flexibility to develop my career in several key areas: (1) quantitative and qualitative skills relevant to empirical research in health law; (2) grant-writing experience; (3) capacity to pursue policy-relevant analyses from existing data sources; and (4) successful transition into a new, little-studied area of health policy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMPROVING OUTCOMES IN US LATINO CHILDREN Principal Investigator & Institution: Lara, Marielena; Pediatrics; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2005 Summary: I am applying for this 5-year K08 Mentored Clinical Scientist Development Award to support and facilitate my development as a health services researcher and speed my transition to an independent investigator. This award will allow me to complete my training in health services methods and provide me with the protected time to assure my publication and grant-making productivity during a pivotal period. I have begun to establish myself as a minority researcher concerned with disparities in health care delivery and outcomes in children through work in 3 areas: 1) analyzing access and quality of care barriers associated with higher asthma morbidity in poor and minority children with asthma; (2) improving survey methods for evaluating morbidity and risk factors associated with asthma, paying particular attention to challenges posed by English/Spanish bilingualism and by the need to incorporate perspectives of both parents and child, and (3) reviewing the existing literature regarding differences in asthma morbidity among Latino children with asthma. Founded on this work and with the guidance of my mentors, Dr. Robert Brook and Dr. Harold Morgenstern, I will continue to develop a research career whose long-term goal is to improve health outcomes and quality of life in Latino children with asthma through evidence-based health care and community- based interventions. The short-term objectives of this 5-year career development award are to: 1) obtain additional formal training in quality of care, statistical, study design, and epidemiological methods, 2) complete a period of supervised experience in analyses of existing datasets to enhance my analytic skills and increase my publication record, 3) submit at least 2 R01 applications to carry out the next phase of my investigations, and 4) continue to develop the community-based and research infrastructure necessary for my research. The specific aims of my intended R01 funded research include to: 1) develop and evaluate a combined health care and school community-based intervention to ensure access to high-quality primary care for Latino and other children with asthma, and 2) identify the factors, such as differences in primary care health care use and socio-demographic risks, that are associated with
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variations in asthma prevalence and morbidity among US children of Puerto Rican, Mexican, Cuban, and other Latino heritage. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INAPPROPRIATE ANTIBIOTIC USE--A COMMUNITY APPROACH Principal Investigator & Institution: Hart, Ann M. None; University of Colorado Hlth Sciences Ctr Uchsc at Fitzsimons Aurora, CO 800450508 Timing: Fiscal Year 2001; Project Start 01-APR-2001 Summary: Widespread inappropriate antibiotic use for upper respiratory infections (URI) is a leading cause for antibiotic resistance, with studies indicating that one-half of all antibiotics prescribed for URIs are unwarranted. The purpose of this study is to evaluate the effectiveness of a community- based antibiotic educational program to reduce inappropriate antibiotic use in a rural western county. The specific aims are to: 1) Describe antibiotic prescribing patterns for URIs in Albany County, WY; 2) determine the predisposing, reinforcing, and enabling constructs that lead to inappropriate use of antibiotics for URIs in Albany County; 3) develop and implement community-based educational interventions to discourage inappropriate antibiotic use for URIs in Albany County; and 4) evaluate the effectiveness of these interventions on the knowledge, attitudes, and behavior of the residents and health care providers of Albany County. Using the steps and phases outlined in Green and Kreuter PRECEDE- PROCEED model, a quasi-experimental design is proposed that employs repeated measures with an historical control and a community-wide educational intervention. Albany County, WY will serve as the community of study. Observations will be made prior to, immediately after, and one year after the implementation of the six month intervention phase, using data obtained from lay-public and health care provider questionnaires, as well as antibiotic prescribing information obtained from computerized Wyoming State Medicaid and private health insurance records. Additionally, formal, semi-structured personal and focus, group interviews, informed by grounded theory, will be conducted and analyzed to help plan for an guide the questionnaire development and the educational intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INAPPROPRIATE PRESCRIBING AND RISK FACTORS IN ELDERLY Principal Investigator & Institution: Liu, Gordon G. Pharmaceutical Policy & Evaluation Sciences; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 30-JUN-2003 Summary: This research proposes to conduct a national population-based pilot study using explicit criteria to assess both individual and organizational system factors that affect inappropriate use of prescriptions in the elderly. The proposed research has three specific aims: To develop a comprehensive population-based panel database on prescribed medication use for a nationally representative elderly sample derived from the Medical Expenditure Panel Survey (MEPS). The database will be a result of matching and augmenting the MEPS medication sample with additional descriptive drug information from the National Drug Code Directory database. To document the most recent national patterns and time trend of inappropriate prescriptions in the elderly, for both general and disease- specific cohorts. The inappropriateness of prescriptions for the elderly will be assessed by the most recently updated explicit criteria developed by Bears (1997). To analyze how individual and organizational
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characteristics affect the probability as well as the quantity of inappropriate prescriptions by the elderly in the context of a two-part model framework controlling for patient characteristics and disease conditions. Organizational structures will include pharmacy sources of care for medical and pharmacy services, insurance type, and medical care organizational features. This study design is warranted on three major grounds. First, inappropriate predescribing contributes to substantial adverse drug events (ADEs), which account for a majority of medical adverse events. Second, elderly are at much higher risk for ADEs than younger people. Third, existing research has not satisfactorily distinguished how individual and organizational features contribute differently to the likelihood vs. The quantity of inappropriate predescribing in the elderly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INCOME AND EMPLOYMENT EFFECTS ON CHILDREN AND FAMILIES Principal Investigator & Institution: Huston, Aletha C. Professor; Human Ecology; University of Texas Austin 101 E. 27Th/Po Box 7726 Austin, TX 78712 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-DEC-2002 Summary: The long-term consequences of economic policies for children's development and healthy families have both theoretical and practical import. Almost all extant studies testing income effects on children and families are non-experimental; therefore, they are subject to the criticism that unmeasured correlates of income may account for all or part of the effects observed. This is a proposal to assess the impact on family functioning and child well-being of the New Hope Project, a 3-year random-assignment experiment designed to test the effectiveness of a multifaceted employment-based antipoverty program for families who are economically poor. Because its goal is reduction of poverty, New Hope rests on different assumptions than many interventions designed to reduce welfare dependence. It provides job-search assistance, wage supplements that raise income above the poverty threshold, and subsidies for health insurance and child care in a rigorous random assignment experimental design; hence, it represents a strong test of the causal effects of income, benefits, and employment on family functioning and child development. Because control group members are also affected by changes brought about by the 1996 Personal Responsibility and Work Opportunities Act, this project offers information that is especially pertinent to public policy affecting the working and nonworking poor. An extensive survey, funded by the MacArthur Foundation, is currently being completed 24 months after the point of random assignment to families with one or more children ages 3 through 12. Information is collected on parents' income, employment, use of child care, health care, psychological well-being, and parenting practices. Children's educational progress, aspirations, school motivation, well-being, and social behavior is assessed using information collected from parents, children, and teachers. This proposal seeks funding to: (i) complete the 24month analysis; (ii) collect and analyze ethnographic data from 40 experimental and 20 control families between 24 and 60 months after random assignment; (iv) collect and analyze data from a survey administered to sample families 60 months after the point of random assignment. The primary analytic questions are the extent to which: (i) the likely increase in maternal labor supply alter family schedules to the benefit or detriment of children; (ii) the higher incomes occasioned by the wage supplements translate into resources for children; (iii) social-psychological changes in adults' stress or self-esteem are affected, and (iv) how all of these changes in turn affect family life and
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children's well-being, educational progress, and social development in early childhood through early adolescence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INFORMATION NEEDS OF AFRICAN AMERICAN CANCER PATIENTS Principal Investigator & Institution: Matthews, Alicia K. Psychiatry; University of Chicago 5801 S Ellis Ave Chicago, IL 60637 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JUL-2002 Summary: A study is proposed to explore information seeking, patient- provider communication, participation in treatment decision making, and emotional adjustment of a random sample of 250 African American and 250 White cancer patients and their families. Subjects will be identified from hospital tumor registries. The study partially replicates and expands a previous study exploring information seeking and treatment participation of White cancer patients (Manfredi, Czaja, Price, Ruis, and Jansizewski, 1993a). The proposed study expands previous work by exploring racial, economic, and psychosocial predictors of information seeking. African American and White samples will be matched on patient characteristics: age, gender, cancer site (breast, colon, prostate), time since diagnosis, and size of hospital where the patient was first diagnosed or treated. Data will be collected through telephone interviews of the patients to determine: 1) the information needs and information-seeking activities of the patients and their families at the time of diagnosis and sine then; 2) patient-provider communication about care decisions; 3) participation in treatment decision making; 4) the extent to which the three items above are influenced by sociopsychological characteristics of the patient, including SES (education and type of employment), type of insurance coverage, disease related factors, and coping style and resources; 5) whether the patient sought and received a second opinion or consultation or was offered or participated in a clinical trial; and 6) the patient's adjustment to the disease. The specific goals of the study are to: 1. To revise, expand and pretest the questionnaire used in the previous study of information seeking with White cancer patients (Manfredi, et al., 1993). Expansion will include adding validated psychometric instruments assessing psychosocial factors thought to affect patient information seeking and new items to assess the potential impact of race on variables such a patient-provider communication. 2. To identify and interview a random sample of 250 African American and 250 White cancer patients, stratified by cancer site (breast, prostate, colon-rectum), and matched on months since diagnosis (3-6, 7-10, 11-14), age group (less than or equal to 50, 51-64, greater than or equal to 65), gender, and size of hospital at diagnosis. 3. To analyze the above data. The main focus of the analysis will be to: a) describe the coping styles, patient-provider communication patterns, informational needs, information-seeking activities, participation in treatment decision-making, and emotional adjustment to their disease of African-American cancer patients; b) compare these characteristics with those of White cancer patients; c) explore patterns of interactions among these variables, how they are influenced by demographic and illness characteristics; and how these patterns are affected by race; d) develop a theoretical model that predicts information-seeking, participation in treatment decision making process, and emotional adjustment among individuals facing a diagnosis of cancer, based on predisposing, enabling, and reinforcing socio-psychological factors taking into consideration the effect of demographic and illness variables; and e) assess the potential effect of race and related mediating factors on the above model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INSURANCE EFFECTS ON PRIMARY CARE FOR DEPRESSED PATIENTS Principal Investigator & Institution: Post, Edward P. Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2006 Summary: (Provided by applicant): This application's primary purpose is to provide the candidate with the means and mentorship to achieve the following goals: 1) Immediate goal: to characterize the effect of healthcare financing structure on utilization and quality of primary care services for patients with depression. 2) Long-term goals: to become an independent health services researcher, investigating policy-relevant questions about the effects of insurance structure on care for the chronically ill. The candidate will further develop and utilize research skills in health economics and psychiatric outcomes assessment; develop facility in techniques to analyze the effects of financial and organizational incentives; and acquire advanced training in quality of care measurement. He will master disease-specific skills in mental health services research by working on a multidisciplinary team studying a patient-oriented mental health intervention in a primary care setting. The career development program will incorporate formal coursework; tutorials and workshops with experts in specific methodological issues; site visits to major venues studying mental health services; and attendance and research presentations at local and national conferences. The major goal of the proposed research program is to characterize the effect of insurance structure on utilization and quality of primary care services for patients with depression. This goal will be accomplished through the planning, conduct, and analysis of a research project using data from a study that focuses on treatment for geriatric patients with depression. This study, a five-year multi-site NIMH-funded clinical intervention trial (Charles F. Reynolds, III, P.I., Prevention of Suicide in Older Primary Care: Patients [PROSPECT], is investigating strategies to improve depression treatment in primary care settings. The proposed K23 research will describe the effects of insurance structure on: individual patients' ambulatory service utilization, and the quality of care for depression. In addition, the research will assess the effect of insurance on the intervention to improve depression treatment in a primary care setting. Furthermore, this study will implement, collect, and predictably validate quality of care performance measures for several domains of depression management. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INSURANCE FINANCING OF INTEGRATIVE MEDICINE Principal Investigator & Institution: Lafferty, William E. Health Services; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2001; Project Start 17-SEP-2001; Project End 31-MAY-2004 Summary: (Provided by applicant): CAM accounts for a substantial proportion of United States healthcare expenditures. Its integration into healthcare financing, although relatively new, is expected to increase. Washington State is one of the few states with a comprehensive legal mandate related to CAM integration. The law, initiated by the legislature in 1995, is unique - based on coverage of all provider types, rather than on a specification of precise benefits. After a series of court challenges, full implementation of the mandate was ordered for January 1, 2000. With 53 categories of licensed healthcare providers, Washington State currently licenses more CAM providers that most other states in the country. Thus, insurance claims data from Washington State provide a unique opportunity for studying one method integrating CAM into traditional
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mechanisms for healthcare finance. The health insurance carriers included in the study cover over 75% of the commercially insured lives in the state and sell products that vary in the richness of their benefit packages and the case mix of their enrollees. These factors will be considered in describing and building predictive models of CAM utilization and cost. Claims from 1996 will provide baseline information on CAM coverage prior to implementation of the Washington legislative mandate; claims from 2000 will provide information reflecting the first full year of post-mandate integration. The study will measure the extent to which the legislation requiring coverage of every category of health care provider has increased the integration of CAM into conventional health care financing. Analysis of insurance claims data will quantify CAM use for specific conditions for which CAM has proven efficacy and will assess the extent to which efficacy studies have been translated into real-world settings within an integrated model of financing. Analyses will describe to what extent and for what conditions integrative medicine is now funded by insurance and whether the intent of the Washington State legislation, which was to promote more cost-effective options by reducing barriers to the use of integrative medicine, has been fulfilled. The study will calculate CAM cost offsets for individual insurance carriers, both for their total enrollments and for specific populations within their enrollments. This will explore the question of whether CAM use is "complementary" (in addition to) or "alternative" (instead of) in its relationship to traditional healthcare. By looking at medical conditions for which CAM has demonstrated efficacy, the study will compare reimbursements for enrollees with and without CAM use, thus allowing an indirect measure of cost-effectiveness to be calculated. The study will assess provider behaviors of CAM and conventional practitioners through a consideration of the percentage of CAM practitioners in Washington State who participate in insurance coverage, and of the types of conventional practitioners who make CAM referrals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INSURING UNINSURED CHILDREN Principal Investigator & Institution: Flores, Glenn; Associate Professor and Associate Direct; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, MA 02118 Timing: Fiscal Year 2001; Project Start 18-SEP-2000; Project End 31-JUL-2002 Summary: The long-term career goal of the candidate, Glenn Flores, MD, is to become a recognized leader in child health services research through outstanding contributions as an investigator, clinician, mentor, and advocate. He has endeavored to conduct research that has the potential to have an immediate impact on children's health, particularly those who are minority, poor, and under- served by the health care system. Dr. Flores considers his publications, research funding, track record as a mentor, and national recognition as a speaker and consultant to be strong evidence of his success as an investigator and potential to make future contributions to the field. The candidate's career development plan includes: 1) refining research skills in conducting focus groups and randomized trials; 2) regular meetings with a senior advisory team; 3) completing a course on the responsible conduct of research; 4) mentoring minority health services researchers; and 5) developing and using collaborative policy links. The institutional environment provides excellent resources, including departmental commitment to protect 80 percent of Dr. Flores's effort for the proposed research, a senior advisory team of renown pediatric health services researchers, and needed support staff and equipment. The aims of the proposed research are to 1) use focus groups to identify the reasons why parents are unable to obtain health insurance for their uninsured children,
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with an emphasis on Latinos; and 2) conduct a randomized trial to evaluate whether case managers are more effective than traditional methods in insuring uninsured children. Eleven million children are uninsured in the US, and the number grows yearly, despite the Children's Health Insurance Programs (CHIP). States are having difficulty identifying and enrolling uninsured children, and unused CHIP fiends are in danger of being lost. We will conduct 6 focus groups on obstacles to insuring children in the communities identified by pilot work to have particularly high proportions of uninsured children. Focus group data will be used to train case managers to assist families with insurance eligibility, applications, and maintaining coverage. Uninsured children (N = 300) will be recruited and randomized to trained case managers, or a control group with access only to traditional methods of insurance enrollment. Outcomes examined will include: the proportion of children obtaining health insurance coverage, the time from study enrollment to obtaining coverage, the proportion of children with episodic coverage, and parental satisfaction with the process of obtaining coverage. Subjects in both groups will receive participation incentives and be contacted monthly to monitor outcomes for 1-2 years (depending on time of enrollment); intervention subjects also will be contacted monthly for ongoing assistance by case managers. Pilot work has identified several communities with high proportions of uninsured children that are willing to participate in research. The proposed project is timely because it rigorously evaluates the effectiveness of a specific, reproducible approach in a high-risk population. If successful, the intervention could serve as a national model for insuring uninsured children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INTERACTIVE CD-ROM FOR COPING WITH DEPRESSION Principal Investigator & Institution: Levin, Will; Mpower Llc 261 E 12Th Ave Eugene, OR 07401 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 28-FEB-2003 Summary: This project further develops and evaluates an instructional CD-ROM product, the Attitude mPowerment Workshop, for teaching coping skills for managing depression. The product extends the demonstrated promise of the Phase I prototype by broadening the content and enhancing the interactivity and multimedia components. The prevalence and impact of depressive illness demonstrates the need for low cost, accessible interventions. Digital technology makes possible efficient mass distribution of an individualized, engaging and effective learning experience. The Attitude mPowerment Workshop, based on the Coping With Depression intervention developed by Dr. Peter Lewinsohn and his Associates, has been empirically validated as effective in alleviating depression. A new module, Physical Activity, will be added in response to the demonstrated efficacy of physical activity for improving mood. The product will be suitable for mass distribution through health and mental health care institutions, health maintenance organizations, health insurance companies and employee assistance programs. In addition, multimedia training materials will be developed to provide instruction to professionals who prescribe the product to end-users. The efficacy of the product will be studied by measuring its added value over a one year period to a "usual care" depression intervention provided in primary health care settings. PROPOSED COMMERCIAL APPLICATION: The research will evaluate the efficacy of an interactive CD-ROM product that can potentially assist tens of millions of people in the United States who suffer from depression or depressive symptoms. The product will be appropriate for distribution through established mental health and health care
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institutions, including health maintenance organizations, primary care clinics, employee assistance programs and health insurance organizations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LABOR MARKET OUTCOMES OF LONG TERM CANCER SURVIVORS Principal Investigator & Institution: Bradley, Cathy J. Associate Professor; Medicine; Michigan State University 301 Administration Bldg East Lansing, MI 48824 Timing: Fiscal Year 2001; Project Start 09-MAY-2001; Project End 31-MAR-2005 Summary: We propose a longitudinal study of cancer patients' and their spouses' abilities to remain in the work force after a cancer diagnosis. Very little is known about the abilities of these individuals to restore their lives after they mounted an initial effort to survive treatment. We will collect data from patients at four time points: diagnosis, 46 months after diagnosis, and 12 and 18 months post-diagnosis. By labor market decisions, we mean changes in patients' and spouses' employment status, decisions to remain in jobs, and changes in hours worked. We will compare our study groups' labor market decisions and outcomes to a cohort of similar individuals in the Current Population Survey (CPS) to ensure that the changes we observe in the labor market decisions in the cancer population are not due to changes in the economy or changes attributable to aging. Specifically, our aims are to: 1) Determine if patients diagnosed with cancer increase or decrease labor market participation; 2) For patients who are married, examine if their spouses increase or decrease their labor market participation; 3) Determine if changes in employment status lead to consequences such as changes in income and health insurance coverage; and 4) Estimate the productivity costs of cancer and its treatment for patients and their spouses that can be used in future studies of cost-effectiveness comparing various cancer therapies. We address the labor market effects of cancer and its treatment in an important way -- we hypothesize that the demand for health insurance is a primary motivator to remain in the work force. Our study will provide a unique, rich data set that models the labor market experience of patients and their spouses. These data will be the most comprehensive data available on the employment and economic experience of survivors and their spouses and can 1) be used to inform public policy and 2) provide estimates of productivity losses for future studies of cost-effectiveness of screening and treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: LARGE DATABASE RESEARCH FOR CANCER PREVENTION & CONTROL Principal Investigator & Institution: Cooper, Gregory S. Associate Professor; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, OH 44106 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: The Candidate, a gastroenterologist/health services researcher has developed a focused research program in cancer prevention and control, primarily through the use of large population-based databases. In addition, he has mentored several trainees and junior faculty at different levels of training. However, because of time and budgetary restraints, his ability to provide data and methodological support to junior researchers is increasingly limited. In addition, he has been unable to expand his research focus to different cancer sites and other content areas, including pharmacoepidemiology. The proposed Established Investigator Award in Cancer Prevention, Control Behavioral and Population Research will assist the Candidate in
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fulfilling his long-term career goals. These include to evaluate the effectiveness of commonly performed screening, treatment and surveillance procedures in routine clinical practice; determine the accuracy, completeness and appropriateness of alternative methods to measure cancer screening, surveillance, and therapy; and develop a critical mass of cancer prevention and control researchers. The proposal will enable the Candidate to use data sources with which has considerable experience to study other clinically relevant issues. He will investigate the recognition of premalignant conditions of the esophagus and its impact on patient outcome, as well as the frequency of use and clinical impact of endoscopic ultrasonography on the diagnosis and treatment of patients with gastrointestinal cancer. In addition, we will develop expertise in the use of pharmacy databases to study the protective effects of nonsteroidal anti-inflammatory drugs on colorectal cancer incidence. The resources of this award will also enable aim to develop an infrastructure that will provide the necessary data and research support to train junior investigators in the use of large databases to conduct cancer related health services research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LINKING MOTHER AND CHILD ACCESS TO DENTAL CARE Principal Investigator & Institution: Grembowski, David E. Professor; Health Services; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by investigator): Background. Healthy People 2010 and the U.S. Surgeon General's report, Oral Health in America, indicate that caries is a severe oral health problem among low-income, minority preschool children that is compounded by low access to dental care. Potential solutions to this problem may exist in the linkage between mother and child access to dental care. If low-income mothers have a regular source of dental care (RSDC), oral health benefits may accrue to both mother and child through biological and dental care mechanisms, but little is known about these associations. Aims. Among children aged three-to-six years old and enrolled in Medicaid dental insurance in Washington state (N=115,853), study aims are: 1) to measure the percentage of mothers with a RSDC and identify the determinants of mothers having a RSDC; 2) among mothers, to determine whether having a RSDC is associated with greater dental knowledge, oral health behaviors, dental satisfaction, better self-reported oral health, and less reparative treatment and work loss due to dental care; 3) among children, to determine whether having a mother with a RSDC is associated with greater utilization of dental care and better oral health; and 4) among children, to determine whether children with mothers losing dental coverage have less dental utilization than other children. Methods. Aims will be achieved through a prospective cohort study design composed of a baseline survey of mothers and one-year follow-up of children's dental utilization from Medicaid dental claims. Disproportionate stratified random sampling will select Medicaid households with children aged three-tosix years in four racial/ethnic strata (White non-Hispanic (n=3,050), Hispanic (n=4,511), African-American (n=6,100), and other race/ethnic groups (n=4,518). At least 780 sampled mothers will complete a baseline telephone or mail survey. One year later, Medicaid dental claims for one-year pre/post-survey will be extracted for sampled children. Separate regression analyses will be conducted for each racial/ethnic stratum. Aim 1 analyses will identify factors associated with mothers having a RSDC. Aim 2 analyses of mothers will determine the association between having a RSDC and knowledge and attitudes about dental care, oral health behaviors, and dental utilization. Aim 3 analyses of children will determine whether having a mother with a RSDC is
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associated with greater dental utilization in the prospective year. Aim 4 analyses of children will determine whether mothers' loss of dental insurance results in fewer children dental utilization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LONGEVITY AND ELDERLY HEALTH CARE EXPENDITURES Principal Investigator & Institution: Norton, Edward C. Associate Professor; Health Policy & Administration; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2001; Project Start 15-APR-2000; Project End 31-MAR-2003 Summary: (Adapted from the Applicant's Abstract): Rapid aging by the United States population over the next several decades is expected to have profound effects on aggregate health care costs. Health care costs are expected to increase because babyboomers will swell the number of elderly, health care expenditures generally increase with age, the elderly are living longer, and technological change will increase the cost of medicine if it continues to increase at historical rates. However, four factors may mitigate the problem. Health care expenditures depend in part on time until death, with higher expenditures prior to death, so increased longevity may merely push expenditures further into the future. A growing percentage of Medicare beneficiaries are enrolling in Medicare managed care, which may slow the growth of expenditures. Male longevity has increased faster than female longevity, meaning that fewer elderly are widowed, which is a major risk factor for expensive long-term care. Finally, disability rates have been declining over at least the last decade. In the first part of the study the investigators will analyze per person annual health care expenditures as a function of age, time until death, their interaction, insurance (FFS vs. HMO), functional status (ADLs and IADLs), and demographics using seven years of the Medicare Current Beneficiary Survey. The analysis will focus on total health care expenditures by all payers for elderly Medicare beneficiaries, for both standard fee-for-service and HMO beneficiaries. They will also look at three specific types of expenditures: inpatient hospital care, home health, and nursing home. Payer types include Medicare, Medicaid, out-of-pocket, and other payers. In the second part of the study they will simulate future health care expenditures by combining our empirical results with available estimates of changes in the key parameters--mortality, functional status, other demographics, insurance, and technological change. The MCBS panel data will enable them to use their own estimates of the increase in managed care coverage and the decrease in disability rates, as well as other sources. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MANAGED CARE & QUALITY: CHILDREN WITH CHRONIC CONDITIONS Principal Investigator & Institution: Connell, Frederick A. Associate Dean for Academic Affairs; Health Services; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2002 Summary: The purpose of this observational study is to identify and measure how the structural characteristics, incentives, and quality assurance efforts of managed care organizations affect quality of care among children with chronic conditions in western Washington state, specifically children with asthma, diabetes mellitus, low birthweight, and cerebral palsy. The intent of this study is to look "inside the black box of managed care" at specific features which are likely to affect the care of children with chronic
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conditions. We will enlist the major health plans operating in western Washington state --who cover approximately 610,000 children -- to assure the maximum variability of plan features. Features of managed care plans/products will be measured through structured interviews and document review. In this study we will define and describe these features in specific terms and develop approaches for measuring their presence and intensity. We estimate that approximately 22,000 children will be identified from health insurance claims files: 18,000 with clinically significant asthma, 1,500 with diabetes, 1,200 with cerebral palsy, and 1,780 low- birthweight infants. Claims data will be used to compute a large array of both non-categorical and condition-specific indicators of quality of care and adverse health outcomes. Because patient characteristics, disease severity, provider characteristics, and self- (or non-random) selection into plans/products or providers are likely confounders, we will collect data on these factors and test for confounding in our analyses. For this project, we will build upon our existing relationships with private health plans, Medicaid, the state's low-income health insurance plan (Basic Health Plan), and consumer groups to create a consortium/advisory board to collaborate in this study. The goal of this effort is not to identify or label any specific plan/product as either good or bad; rather our intention is to work with the plans to identify best managed care features and practices -- with the expectations that they will use this information to improve the quality of care and health outcomes for children in Washington state. We also expect that the indicators developed and used in this study will have wide interest and applicability in other settings. Furthermore, we hope that this study will help generate a greater interest in using and improving existing claims- based data systems to enhance health care monitoring and quality improvement for children with chronic conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MANAGED CARE AND HEALTH CARE MARKETS Principal Investigator & Institution: Baker, Laurence C. Professor and Director for Clinical Rese; Medicine; Stanford University Stanford, CA 94305 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 29-SEP-2004 Summary: This project addresses concerns about quality of health care prompted by the growth of managed care. It proposes to do so by developing the largest and most advanced collection of managed care measures in the country and then by using these measures in two important applications. The project thus has three parts: (1) improving the measurement of managed care activity in markets by compiling new measures and applying new techniques to construct more precise measures of managed care, (2) examining the impact of the growth of managed care on the performance of health care markets, including study of specific measures of care for patients and outcomes, and (3) assessing the impact of legislative and regulatory determinants of managed care growth. The project will advance the state of managed care measurement and will produce specific, quantitative evidence about the effects of managed care on health care markets and about the effects of specific policies on managed care. Doing so will help policymakers, public and private purchasers, managers, and other health care leaders to assess managed care policy options. Our aims include: 1. To compile and evaluate a wide range of measures of managed care activity. These will include data on the prevalence and market share of various plan types, data on the specific cost-reducing activities of plans like restrictions on provider choice, capitation, and utilization management, and data on competition between plans. 2. To synthesize existing measures to develop new, more precise, measures of HMO activity specifically, and managed care activity more broadly. We will specifically focus on developing measures that are valid over time. 3.
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To examine the effects of growth in managed care and competition among health plans on treatments, costs, and health outcomes for patients, including both those enrolled in managed care plans and those not enrolled. 4. To study the factors that determine the growth of managed care, particularly managed care regulations, including any willing provider laws, freedom of choice laws, mandated benefits, grievance procedure laws, liability laws that expand the rights of patients to sue managed care plans, and medical necessity definitions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MATERNAL HEALTH STATUS AND ADVERSE BIRTH OUTCOMES Principal Investigator & Institution: Haas, Jennifer S. Assistant Professor; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2002 Summary: (Adapted from the applicant's abstract): The rates of maternal and neonatal mortality remain significantly above the objectives for the new millennium. The proposed research will examine whether a woman's pre-pregnancy health status explains, in part, the persistent racial disparities in adverse perinatal outcomes in the United States. A multi-ethnic cohort of 2,400 women in the San Francisco Bay Area will be followed throughout pregnancy until they are three months post-partum. We will recruit women who will deliver at one of three sites: an academic health center, a public hospital, and a large group model HMO. We will collect standardized, self-reported information on pre-pregnancy health status and objective clinical data from medical records to examine whether a legacy of chronic health problems and poor health status are related to an increased risk of adverse perinatal outcomes. Our research is based on the hypothesis that the prenatal period is too late to address the legacy of chronic health problems and poor health status of African-American and disadvantaged women. Cohort characteristics will be grouped into three broad categories: (1) race and other sociodemographic characteristics, (2) pre-pregnancy factors, and (3) current pregnancy factors. Data will be analyzed to examine whether disparities in adverse outcome are explained by pre-pregnancy maternal health status. We will examine two primary outcomes variables: (1) an aggregate indicator of adverse neonatal outcome, and (2) an aggregate indicator of adverse maternal outcome. These data could have significant health policy impact. While all states provide insurance coverage for prenatal care for poor pregnant women through Medicaid, only Hawaii extends coverage to eligible women regardless of pregnancy. These data may address whether more continuous coverage for reproductive age women is appropriate. The long-term goal of this investigation is to inform public policy so that discrete interventions can be designed and implemented to reduce the health risks of women prior to pregnancy. Such interventions should begin from the premise that improved maternal and infant outcomes can only come from improved maternal health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MEASURING THE QUALITY OF CARE FOR HIGH RISK INFANTS Principal Investigator & Institution: Rogowski, Jeannette A.; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 29-SEP-2003 Summary: This project will develop new methods for measuring the quality of care for a vulnerable population: very low birth weight infants, defined as those infants who weigh 1500 grams or less at birth. These infants are vulnerable in many ways. First, one
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in four infants born with a birth weight of 1500 grams or less will not survive to the end of the first year of life. While they account for only 1 percent of births, very low birth weight infants account for 46 percent of infant deaths. Second, infants with birth weights 1500 grams or less have high rates of disability. In fact, birth weight under 1200 grams is a qualifying condition for the Supplemental Security Income (SSI) Program, which provides income support and health insurance coverage for disabled children. Third, very low birth weight infants are disproportionately born in black, low-income families, with Medicaid being the largest single payer for their medical care. Little is known about the quality of care for this patient population because of methodological challenges and the lack of available data. In this project we will: Develop methods to measure the quality of care for high-risk infants that overcome the problems of small sample sizes, bias from patient mix, and the multidimensionality of quality. Use these methods to create "filtered" estimates of the quality of care which extract the quality "signal" from the noise observed in the data. Apply similar methods to measuring economic performance and to quantify the relation between hospital characteristics, such as volume and NICU level, on the quality of care provided to very low birth weight infants. To overcome the data problems, we will use a unique source of data, the Vermont Oxford Network (VON) database, which contains 40 percent of NICUs in the United States and includes half of all very low birthweight births in the county each year. The quality measures developed will be implemented by the Network within two years of the initiation of this project, thus having the potential to rapidly influence the care received by a large number of these fragile infants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICAID ALTERNATIVES
VS.
PREMIUM
SUBSIDY:
OREGON'S
CHIP
Principal Investigator & Institution: Mitchell, Janet B. President; Center for Health Economics Research 411 Waverly Oaks Rd, Ste 330 Waltham, MA 02452 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 29-SEP-2003 Summary: Oregon provides a unique laboratory to study how CHIP has improved access to health insurance and medical care for low-income children. Oregon has chosen to offer two very different CHIP health insurance options: (1) a Medicaid "lookalike" program; and (2) a premium subsidy program. Eligibility requirements are identical under both programs (up to 170 percent of FPL). The Medicaid CHIP program is virtually indistinguishable from Oregon's regular Medicaid program. The premium subsidy CHIP program is run by a separate state agency and assists low-income children in buying insurance either through their parent's employer or through the individual market. Unlike the Medicaid CHIP program, however, the premium subsidy program does require some modest cost-sharing. This study will identify the factors leading parents to seek publicly subsidized health insurance, which insurance option they choose, and the cumulative impacts of these decisions on children's access to medical care, with a special emphasis on Hispanic children. The cross-sectional component of this study will consist of a telephone survey of the parents of three groups of children (with an oversample of Hispanic children): children enrolled in the Medicaid look-alike program, children enrolled in the premium subsidy program, and uninsured children. The survey will focus on insurance-seeking behavior, usual source of care, access and utilization, and satisfaction. The longitudinal component will follow children over time using secondary data to examine turn-over in CHIP eligibility. A postcard survey will be conducted of all children who do not re-apply for CHIP coverage when their eligibility period expires. Understanding the perceived benefits and liabilities of
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the two CHIP options will assist policymakers in making programmatic changes to help increase enrollment. This study will also shed light on whether one of the two CHIP programs is more successful than the other in attracting Hispanic children and securing access to medical care for them. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICAL CONTRACTING
GROUP
RESPONSES
TO
HMO
SELECTIVE
Principal Investigator & Institution: Ketcham, Johnathan; Health Care Systems; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 30-NOV-2002 Summary: (provided by applicant): The purpose of this dissertation is to develop an understanding of how managed care insurers? presence, market power, and use of selective contracting affect physician groups, and how state Any Willing Provider (AWP) and Freedom of Choice (FOC) laws moderate the effects by limiting selective contracting. The approach lies on the premise that different market structures have different implications for medical groups, and that these markets stimulate medical groups? responses in different ways. This research can help interpret theoretically the conventional wisdom that managed care has caused consolidation in the medical group market and that groups have grown larger. The proposed work will then empirically test this belief and measure the consequences for group costs, revenues, and efficiency. Medical groups and managed care insurers (MCOs) engage each other in a variety of market structures, ranging from strong competition in both markets to monopoly power in both markets. The approach taken in this proposal is that MCOs in many markets are able to increase the price elasticity of demand for medical services, thereby altering the size of the medical group that optimizes member-physician utility. In some markets, however, the relationship can be described better as monopoly-monopsonist bargaining. A proposed bargaining model describes the size and investment decisions that medical groups make in response to insurer monopsony power and selective contracting. The combination of state-level variation in the ability of MCOs to exclude providers with the variation in managed care penetration in different geographical markets allows research on how these differences affect medical groups. The empirical analysis considers both the direct effects that HMOs might have on the costs and prices of physician services and the indirect effects through medical groups? responses. Panel data from the Medical Group Management Association (MGMA) on medical group costs and outputs are used to achieve these ends. The first empirical work will use random effects to determine whether different levels in managed care?s presence in the market contribute to differences in either group size or investment, due to either the goal of increased efficiency or the objective of increased bargaining power, or simply the change in elasticity of demand. Group responses to the level of managed care in a market will be ascribed to efficiency, whereas responses to HMO concentration conditional on efficiency will be interpreted as driven by bargaining motives. The next step will use quasi-translog functions to find the relationship between group size and average cost and revenues, and whether HMO monopsony or selective contracting influences this relationship either directly or indirectly via group responses. Technical efficiency and its determinants are then measured using cost and revenue functions in stochastic frontier analysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MEDICAL IMAGE/DATE SECURITY ASSURANCE - DIGITAL ENVELOPE Principal Investigator & Institution: Huang, H K. Professor of Radiology and Biomedical En; Children's Hospital Los Angeles 4650 Sunset Blvd Los Angeles, CA 90027 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 30-JUN-2003 Summary: (provided by applicant): Health Data security, characterized in terms of data privacy, authenticity, and integrity, is a vital issue when digital images and other patient information are transmitted through public networks in teleradiology and other telehealth applications. Mandates for ensuring health data security have been issued by the federal government (e.g. HIPAA [Health Insurance Portability and Accountability Act]), and guidelines such as DICOM (Digital Imaging and Communication in Medicine) standard continue to be published by organizing bodies in healthcare (e.g. American College of Radiology); however, there has not been a systematic research and development effort within the medical imaging community to address this critical matter. Over the past six years, members in the Image Processing and Informatics Laboratory/Children's Hospital Los Angeles/University of Southern California (PI/CHLA/USC) has actively researched image security issues related to PACS (Picture Archiving and Communication System) and telehealth with very encouraging results. This application represents an organized and rigorous approach to further research on this topic based on this experience. The proposal outlines the systematic development of the digital envelope (DE) concept to assure data integrity, authenticity, and privacy during image/data transmission through public networks. The DE includes the digital signature (DS) of the image as well as encrypted patient information from the DICOM image header. The proposal delineates eight specific tasks, including review and selection of digital security technologies suitable for medical imaging applications, revamping our existing DE security algorithm based on these new selections, designing the DE to be DICOM compliant, and performing a three-phase evaluation from the laboratory, to intra-hospital, and finally inter-hospital environments. The three-year research plan will culminate in the delivery of a portable, self-contained, and evolving DE package available for the medical image community to use in telemedicine and teleradiology applications. For telemedicine and teleradiology, since data cannot be limited within a private local area network protected by a firewall, the DE package offers the most useful security assurance. This method also provides additional image/data assurance to conventional network security protections. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MEDICAL PROCEDURES
OUTCOMES
IN
THE
PRICING
OF
HOSPITAL
Principal Investigator & Institution: Dor, Avi; National Bureau of Economic Research Cambridge, MA 02138 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 29-SEP-2004 Summary: This proposal utilizes economic models of pricing behavior to assess the effects of hospital quality on the prices of major medical hospital procedures. Hospital quality is defined in terms of medical outcomes, i.e., less-than-expected in-hospital mortality rates. We will focus on cardiac procedures such as CABG and PTCA. These are relatively expensive but common procedures that are also characterized by significant in-hospital mortality. The empirical specification of the price equation will be derived from a Nash-bargaining model that describes the hospital-insurer interaction. While this model had been recently used to describe appendectomy pricing, we
Studies 73
undertake further extension to incorporate product quality. The empirical strategy will be based on instrumental variable (IV) techniques, subject to appropriate specification tests. Other than quality, prices will depend on variables representing hospital bargaining power (Herfindahl index, ownership, system affiliation), insurer bargaining power (HMO penetration, market share, type of plan) and patient and clinical traits that account for technical variations within a given procedure. Statistical identification of the model will be attained by instrumenting quality on hospital size (beds, days, etc.), procedure specific volume, and propensity to perform these procedures (teaching intensity, acute and intensive care days). Following earlier literature, hospital volume is expected to improve outcomes. Given our focus on price-informed institutional players, the main hypothesis to be tested states that higher prices reflect higher quality, holding market structure constant. We will further examine whether differences between managed care plans, such as PPOs, EPOs, and point-of-service HMOs, also lead to varying degrees of price discounting. Since emergency care is more likely to occur outside an insurer s network we will distinguish between procedure done on an emergent or elective basis. Finally, regional price variation will also be examined. The core data will be drawn from the inpatient component of the MarketScan claims database for 1995-1996, together with a complementary file with matching hospital level and patient level mortality rates. These data will be merged with data elements from MEDPAR, the AHA Annual Survey of Hospitals, and the Area Resource File. Data prior to 1995 will not be used because MarketScan had not yet included a detailed description of insurance plans. However, based on 1994 frequencies, final samples are expected to range from 900 to 2,400 per year, depending on the procedure and elective/emergency setting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICARE EDUCATION AND DECISION SUPPORT TOOLS Principal Investigator & Institution: Mcarthur, Lynne; Johnson, Bassin and Shaw, Inc. 8630 Fenton St, 12Th Floor Silver Spring, MD 20910 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JAN-2004 Summary: (provided by applicant): Who will care for aging baby boomers? They will likely have to do it themselves. The need to educate boomers about the extent of the problems they will face in obtaining affordable health insurance and assisted-living services is abundantly clear. To date, boomers have tended to "turn a blind eye" to these issues, partly out of ignorance and partly out of denial that they will ever need these services. Medicare, Medigap, M+C, Medicaid, and private health insurance eligibility, enrollment, dis-enrollments, coverage, and costs have become a maze of complexity. Government sources of information are inadequate and often not sought until a crisis occurs. Our firm, JBS, runs the Centers for Medicare and Medicaid Services' national resource center in support of all state health insurance and counseling programs We believe that the private sector can develop some informational products that will better enable boomers to plan for and use long-term health insurance options. The proposed products are CD-based interactive software, a "Medicare Game," a Dummies-type book that would make Medicare understandable, a toolkit for retirement planners and human resources professionals, and a Web site. Our SBIR goals are to develop prototype products, assess interest of likely distributors, and evaluate commercial viability. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MEDICARE POLICY AND AGING IN THE U.S. AND CANADA Principal Investigator & Institution: Decker, Sandra L. Senior Research Analyst; International Longevity Center-Usa 60 E 86Th St New York, NY 10028 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-FEB-2004 Summary: (provided by applicant): We investigate the effect of universal health insurance coverage on health outcomes and the use of health services by exploiting a natural experiment that changes the insurance status of most Americans at age 65, that is, eligibility for the U S Medicare program Since instance status is not randomly assigned, correctly identifying a causal relationship between insurance status and health is notoriously difficult This study will employ panel data from the Health and Retirement Study in the U S to estimate the effect of turning 65 and becoming Medicare eligible on health status and the user of health services The Clinton Administration's 1998 introduction of legislation seeking to expand Medicare coverage to many individuals in the 55-to-64 year age group (a group often referred to as the "near elderly") has since spawned considerable interest among policy analysts who have sought to document the insurance, health and employment status of this age group The enclosed study explores the possible benefits of such a proposal by examining the effect of obtaining Medicare coverage on the health of previously uninsured individuals in the near elderly group Many researchers both in the U S and abroad have documented that socioeconomic differences in health tend to be largest in middle age (prior to age 65), and decline at older ages The proposed study will also fill a large gap in this literature on converging socioeconomic inequalities in health over the lifecycle by exploring the role of universal health I insurance coverage in producing these patterns In particular, we will compare differences in health just before and after the age of 65 in the U S to differences between comparable ages in Canada, where Medicare is a universal program and eligibility is not conditioned on age. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MENTAL DISORDERS, PRIVATE INSURANCE, AND SSDI BENEFITS Principal Investigator & Institution: Salkever, David S. Professor; Health Policy and Management; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2004 Summary: This project will specify and estimate econometric models of transitions from private, long-term disability (LTD) benefits to Social Security Disability insurance (SSDI) benefits by employees who are on LTD as a result of a mental disorder. Using data from individual LTD claims, the probability of transitioning to SSDI benefits will be modeled as function of: 1) individual employee, employer, and disability characteristics; 2) LTD policy provisions; 3) mental health coverage provided by the employer; 4) availability of mental health treatment resources; 5) employers' disability management efforts; and 6) interstate differences in availability of SSDI and other compensation programs. Data on SSDI costs will also be aggregated over individual claims to the employer-year level for estimating models of SSDI costs per employee (covered by LTD insurance) per year. Data for the project will pertain to approximately 1,400 employers and their 500,00 employees covered by LTD insurance. Administrative data, claims data, data from public sources, and survey data on 278 of these 1,400 employers will be analyzed. Econometric methods will include hazard (duration) regressions as well as multiple hazard models (where return to work and transition to SSDI benefits are the competing risks). Estimation of employer-level costs will use the methods for modeling health
Studies 75
expenditures recently proposed by Manning and Mullahy. Several approaches for estimation with missing data will also be tested as strategies for combining our employer survey data with information for all 1,400 employers in the study. The empirical estimates obtained in the study will provide information on the possible implications of changes in mental health benefits and changes in benefit and compensation programs for the continuing rapid rise in SSDI costs for beneficiaries with mental disorders. Estimates will be derived of the impacts, on SSDI receipt and costs, or increased managed care/carve-out coverage, of increased geographic availability of mental health specialty care, and of employers' disability management efforts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MENTAL HEALTH AND LABOR MARKET OUTCOMES Principal Investigator & Institution: Sturm, Roland; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2005 Summary: (provided by applicant): This project investigates the relationship between mental health disorders and an individual's labor market outcomes, such as labor force participation, job turnover, hours worked, and earnings, using both cross-sectional and panel data techniques. The project will pay special attention to low income populations and the effect of mental health status on participation in welfare, disability, and other public assistance programs. This project builds on data from a new national survey, Healthcare for Communities (HCC), which is unique in its broad coverage of both mental health and economic measures. Its policy relevance stems from the ability to study recent market and policy effects and to trace the consequences from labor market outcomes through the mediating effects of insurance status and income to access to care and utilization for individuals with mental disorders. Achieving a better understanding of the cross-sectional and dynamic relationships between mental health and labor market outcomes is of central importance to policy makers in the mental health field. In the employment-based US private health insurance system, labor market outcomes and income affect access to care and treatment through their effect on insurance and income. In addition, labor market outcomes are central functional outcomes in themselves. By providing better information on the complex relationship between mental illness and labor market outcomes using the most recent data, this project will provide new insights on the consequences of recent and ongoing policy and market changes, including employment-based mental health parity mandates and social welfare policy for low income populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MH AND ADVERSE SELECTION IN MANAGED CARE Principal Investigator & Institution: Mcguire, Thomas G. Professor of Health Economics; Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2001; Project Start 15-AUG-1999; Project End 30-JUN-2004 Summary: Many believe that underprovision of mental health services will be one strategy managed care plans will adopt to discourage loser enrollees because of the correlation of mental health costs with costs of other services, but this contention has never been subject to empirical scrutiny. Are mental health services any more likely to be under-provided in managed care than treatments for other conditions? The proposed research would address this question by identifying the conditions whose treatments
76 Health Insurance
are most affected by selection incentives in managed care. We are particularly interested in mental health, but we consider the incentives to provide care for mental health in relation to the incentives for other services. This proposal introduces a new approach, based on economic theory, to derive a measure of plan strictness in rationing of services. We show how this measure can be used as a computationally straightforward index of incentives to over and under-provide services for various conditions. We intend to empirically implement this concept in this research, and based on the results, make concrete recommendations for policies of risk adjustment and "carve outs" for dealing with selection-related incentives in markers for managed care plans. Service distortions generated by selection-related incentives affect the plan choices of enrollees. Carve out programs may attenuate such incentives by removing the mental health care from the competitive strategy of health plans. We test the empirical importance of this effect. Adverse selection is a enduring threat to the efficiency of provision of mental health care in insurance markets. Understanding how adverse selection works in managed care and what can be done about it should be a very high priority for research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MINORITY PREDOCTORAL FELLOWSHIP PROGRAM Principal Investigator & Institution: Mojica, Cynthia M. None; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 01-MAR-2001 Summary: Though there has been some progress in the fight against cancer, minority populations as a whole continue to suffer high rates of cancer morbidity and mortality. Low socio-economic status, education, income, lack of insurance, cultural and linguistic barriers, all play a role in preventing individuals from receiving accessible, affordable, quality health care. Our challenge as public health professionals, will be to reduce, if not eliminate, these racial and ethnic disparities in health status. My goal, therefore, will be to focus on issues of health care access, health insurance coverage, and quality of care with respect to cancer prevention, early detection and treatment as they pertain to socioeconomically, disadvantaged communities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MODELING OVARIAN CANCER SCREENING FOR CEA Principal Investigator & Institution: Urban, Nicole D. Member; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, WA 98109 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: (provided by applicant): Interest in screening for ovarian cancer is growing. Five-year survival in women diagnosed with ovarian cancer is 50% overall, but in women with cancer confined to the ovaries, it is 95%. Only 25% of ovarian cancer is diagnosed in this early stage, however, suggesting that there is an opportunity for significant improvement through early detection. Our goal is to improve the accuracy of a previously developed microsimulation model of ovarian cancer screening by accounting for heterogeneity in the disease and in the population screened, in order to evaluate the cost-effectiveness of using a marker panel longitudinally to detect developing disease. We will expand the scope of the model to accommodate use of 1) a panel of serum markers for screening, and 2) risk-based screening. We will also incorporate QOL effects of both screening and disease, and update the model with respect to screening and treatment costs. These efforts will enable us to identify the potentially most efficient strategies for ovarian cancer screening and to report their cost-
Studies 77
effectiveness. The specific aims of this study are twofold: one, to develop a state-of-theart microsimulation model of ovarian cancer screening and two, to use the model to explore the cost-effectiveness of alternative strategies for ovarian cancer screening. There are two components to aim 2: to identify potentially cost-effective strategies for ovarian cancer screening using a panel of serum markers and imaging and to estimate the cost-effectiveness of the strategies in various populations defined by risk level. Two randomized controlled trials (RCT) of ovarian cancer screening are underway, one in the U.S. and one in the U.K., but results will not be available for several more years. Regardless of the outcomes of the RCTs, questions about cost-effectiveness, the efficacy of more frequent screening, and innovative use of multiple markers and imaging will remain. Molecular discoveries are likely soon to yield a panel of markers that can be used together as a first-line screen in a multimodal strategy involving imaging. Because it would be prohibitively expensive to conduct new RCT to test each potentially better screening strategy, an accurate simulation model will be necessary to develop sensible health care policy as well as to direct future research at both the basic and applied level. To improve the accuracy of the model's predictions, we will refine it to account for heterogeneity in the disease (histology, grade) and heterogeneity in the population screened (risk level). In addition, we will refine the detection component of the model to better represent imaging, and update the cost estimates used in the model, using insurance claims data from Regence Blue Cross of Washington State and Medicare. Extensive validation will be undertaken to assess the consistency of the model's predictions with estimates obtained from trials. Ultimately, an enhanced microsimulation model that incorporates new developments, innovations of the future as well as those we recognize today, will help guide policy and research investment decisions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MOTIVATING PARENTS OF KIDS WITH ASTHMA TO QUIT SMOKING Principal Investigator & Institution: Borrelli, Belinda; Associate Professor; Miriam Hospital Providence, RI 02906 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JUL-2003 Summary: (adapted from investigator's abstract): This application will contrast the efficacy of two theoretically-based smoking cessation interventions for parents of children with asthma, and compare key mechanisms of behavior change. Implementing effective smoking cessation for this population has the potential to effect changes in health outcomes for both the adult smoker and child with asthma. Smokers will be recruited into an in- home, individualized asthma education program, which is part of their health insurance carrier's standard of care. They will be randomized to one of two treatment conditions employing constructs from a larger social cognitive theoretical framework. The first, Behavioral Action Model (BAM), is based on AHCRP guidelines and emphasizes goal-setting and problem-solving skills to enhance self-efficacy to quit smoking. The second, Precaution Adoption Model (PAM), is tailored to the smokers's degree of readiness to quit, and incorporates specific biomarker feedback (level of environmental tobacco smoke in the home, and carbon monoxide and cotinine testing) to increase perception of risk of smoke exposure. All smokers will receive the nicotine patch if they are ready to quit, and all intervention components will be delivered by respiratory therapists in the home. Analyses will examine: 1) quit rates, level of environmental tobacco smoke in the home, and motivation to quit between treatment groups throughout the 12 months post-treatment; 2) strength of mediators of behavior
78 Health Insurance
change between and within each condition; and 3) relations between smoking outcomes and asthma morbidity variables in children post-treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MULTIMEDIA LONG-TERM CARE RESOURCE Principal Investigator & Institution: Lantz, Penelope A.; Health Media Lab, Inc. 2734 Cortland Pl Nw Washington, DC 20008 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 31-OCT-2003 Summary: (provided by investigator): The long-term goal of this project is to develop and evaluate through focus group discussions and questionnaire survey data, a multimedia resource designed to help individuals and caregivers of individuals navigate through the maze of intricacies associated with long-term care planning, and to help them make informed decisions about long-term care options including, type of care, source of care, and how to pay for care. This resource will include a CD-ROM with tutorials, worksheets, common applications, and legal forms; a toll-free telephone helpline staffed by experienced long-term care counselors; and Website resources from Health Media Lab's long-term care Website section, plus links to other Internet resources. We envision the information provided by each of these media as overlapping, although each has its own advantages. For instance, the telephone helpline will offer personalized, one-on-one help. The Website will have tutorials, printable worksheets, links to other resources, and will be updated frequently. The CD-ROM can have much of the same information and tools as the Website, but may be easier to use for people without high speed Internet access. This multimedia resource will be for use by individuals and couples who want to plan for their long-term care, adult children of elderly parents who are caregivers or who monitor care, and spouses, friends, relatives and others who provide care to elders. It will also be useful for professionals, including employee benefits coordinators, public health, medical and nursing personnel, elder care lawyers and others who provide legal assistance, insurance companies, social workers and other senior service providers, and elder care volunteers who assist in educating caregivers about long-term care options. It will help users understand and utilize (or help others to utilize) health insurance, health care, legal and financial issues, medicare and medicaid, and other long-term care issues for seniors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NCCU-WFU BIOMEDICAL SCIENCES BRIDGE PARTNERSHIP Principal Investigator & Institution: Howlett, Allyn C. Director of Neuroscience/Drug Abuse Rese; None; North Carolina Central University 160 Alexander-Dunn Bidg. Durham, NC 27707 Timing: Fiscal Year 2002; Project Start 10-JUL-2002; Project End 30-JUN-2005 Summary: (provided by the applicant): The NCCU-WFU Biomedical Sciences Bridge Partnership is a Bridges to the Future initiative for the training of M.S. students in the Department of Biology at North Carolina Central University (NCCU) to continue in their Ph.D. training at the Department of Physiology and Pharmacology at Wake Forest University (WFU). Our goal to create and maintain a "research environment" at NCCU will be achieved by maintaining strong research programs through NCCU's J.L. Chambers Biomedical/ Biotechnology Research Institute (JLC-BBRI), by increasing awareness of the NCCU-WFU Bridge Partnership program among Ph.D.-directed candidates, selecting graduate students with potential for success, and nurturing them through laboratory research and research-related activities. Our goal to foster the
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"research thinking process" among graduate students will be achieved by promoting level Ill cognitive skills into coursework. Our goal to bridge students into an advanced position when entering the Ph.D. phase of their training, yet diminishing the social disadvantage, will be implemented by developing faculty research collaborations between institutions so that students can work on aspects of the project at both institutions, and by fostering joint programs between students at NCCU and WFU. The NCCU-WFU Biomedical Sciences Bridge Partnership proposes to take advantage of the unique research environment of the JLC-BBRI on the NCCU campus by making available to underrepresented minority students the dual environments of an active biomedical research facility and the HBCU community. To achieve these goals, we are requesting support for 3 graduate assistantships, tuition, health insurance, computers and travel to an annual scientific meeting for 3 M.S. students in year one, to increase to 6 students in year three. We are also requesting 3 years of support for a program administrator and office assistant at 25% effort each, and support supplies and travel cost related to the administration of this program. Support of students via the NCCUWFU Biomedical Sciences Bridge Partnership will solidify the existing effective interinstitutional partnership between NCCU and WFU that will improve the quantity, but more importantly, the quality, of the next generation of underrepresented minority scientists in the U.S. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: NEW YORK'S SCHIP: WHAT WORKS FOR VULNERABLE CHILDREN Principal Investigator & Institution: Szilagyi, Peter G. Professor of Pediatrics Professor and As; Pediatrics; University of Rochester Orpa - Rc Box 270140 Rochester, NY 14627 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 29-SEP-2002 Summary: This study evaluates the degree to which features of a mature SCHIP program, New York State's Child Health Plus (CHPlus), affect access and quality of care for low-income children. Our specific aims are to measure 1) SCHIP enrollee's experience with access, utilization, and quality, by (a) structural health care features (insurance plan type, provider factors, geography), and (b) patient characteristics (minority status, age, special need); 2) SCHIP selection effects by comparing patient characteristics at enrollment across plan types; 3) continuity of insurance by describing enrollment patterns of CHPlus enrollees and by measuring crowd-out of commercial insurance; and 4) two aspects of community impact: changes in hospital uncompensated care in New York State (NYS), and CHPlus penetration in New York City [NYC] areas. Key comparisons are by CHPlus plan type (for-profit IPA; and not-for-profit IPA, center based, staff model), geographic region (NYC, NYC environs, upstate urban or rural), age (adolescent, school-age, preschool), minority status (white, black, Hispanic), and presence of a special health need--asthma. The study design is a prospective T1/T2 interview of parents of CHPlus enrollees (N=1890) and adolescent enrollees (N=780). The T1 interview at CHPlus enrollment will evaluate baseline characteristics and preCHPlus experience. The T2 interview, 1 year after enrollment, will evaluate CHPlus experience and pre-post changes. A baseline interview for a control group (N=400) who enrolled 1 year later (T2) will test for secular trends. Study group subjects will be selected by stratified sampling from the 4 CHPlus plan types, 4 geographic regions, 3 age groups, and 3 racial/ethnic groups. 350 children with asthma will be studied. Plan performance will be compared using standard HEDIS and NYS managed care quality indicators and interview data. Enrollment patterns and hospital uncompensated care will be evaluated using statewide databases. Crowd-out will be assessed by the CHPlus
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enrollee interview and a statewide enrollment questionnaire. Bivariate and multivariate analyses will compare outcomes by CHPlus plan types, geographic regions, and patient subgroups (age, minority status, and asthma diagnosis). The NYS SCHIP Evaluation Team comprises researchers from the University of Rochester, Montefiore Medical Center, Columbia University, the AAP, and the National Opinion Research Center (NORC). These evaluations will assess how well different health care insurance delivery systems work for vulnerable subgroups of low-income children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: FIBRILLATION
OPTIMAL
ANTITHROMBOTIC
THERAPY
IN
ATRIAL
Principal Investigator & Institution: Gage, Brian F.; Barnes-Jewish Hospital Ms 90-94-212 St. Louis, MO 63110 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2003 Summary: Although clinical trials demonstrated that antithrombotic therapy can reduce the risk of stroke in carefully selected patients with atrial fibrillation (AF), many patients were excluded from these trials because of their advanced age, comorbid conditions, or both. Exclusion of the very elderly has led to uncertainty about the effectiveness and safety of stroke prophylaxis for patients older than 75 years. To address the shortcoming of available data, we will compare outcomes in a cohort of 3600 Medicare beneficiaries with AF who were prescribed warfarin, aspirin, or neither upon hospital discharge. In collaboration with 5 Peer Review Organizations (PROs) we will use Medicare Part A claims data to determine how prescribing antithrombotic therapy affects the rates of death, stroke, and hemorrhage. The broad, long-term objective of the proposed study is to decrease the mortality and improve the quality of life of patients who have AF. In pursuit of this dual objective, the study has 3 specific aims: (l) to determine the effectiveness of prescribing antithrombotic therapy in very elderly patients with AF; (2) to determine the safety of prescribing antithrombotic therapy in very elderly patients with AF; and (3) to conduct a formal cost-benefit analysis of prescribing antithrombotic therapy in very elderly patients with AF. To assess effectiveness, we will determine how antithrombotic therapy affects the rate of death or nonfatal stroke. To assess safety, we will determine how antithrombotic therapy affects the rate of major hemorrhage. To perform the cost-benefit analysis we will use the observed rates of death, stroke, and hemorrhage in a decision model to estimate the effect of antithrombotic therapy on quality- adjusted survival and costs. Results from our pilot study, in combination with other literature, demonstrate that the proposed project has potential to save lives, prevent strokes, and reduce health care expenditure. In our pilot study we found that the absolute reduction in death and nonfatal stroke attributable to antithrombotic therapy may be greatest in patients older than 75. If the proposed project confirms the results of the pilot study, it will clarify the risks and benefits of prescribing antithrombotic therapy to the very elderly and elucidate the optimal stroke prophylaxis for this growing population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MINORITIES
OUTCOME
OF
SYSTEMIC
LUPUS
ERYTHEMATOSUS
IN
Principal Investigator & Institution: Alarcon, Graciela S. Professor & Jane Knight Lowe Chair of Me; Medicine; University of Alabama at Birmingham Uab Station Birmingham, AL 35294
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Timing: Fiscal Year 2001; Project Start 30-SEP-1993; Project End 31-AUG-2003 Summary: (Taken from the application) Both genetic and nongenetic factors contribute to the predisposition, course and outcome of systemic lupus erythematosus (SLE). We have constituted a cohort of 229 SLE patients from three ethnic groups (Hispanics, African-Americans and Caucasians) at two geographic locations (Alabama and Texas) in order to examine the relative importance of socioeconomic-demographic, behavioralcultural and immunogenetic features in the clinical manifestations of SLE over time. At disease onset, we found that immunogenetic and ethnic factors primarily accounted for disease activity and specific organ manifestations of SLE (renal, neuropsychiatric and cardiac). At study entry, Hispanics and African-Americans exhibited higher levels of disease activity. Lack of private insurance, abrupt disease onset, anti-Ro antibodies, lack of HLA-DR3 and abnormal illness behaviors, also predicted greater disease activity. Two years into a study, helplessness, poor social support and lack of health insurance predicted persistent disease activity over the study duration. As expected, persistent disease activity as a single factor best predicted disease damage. As more time passes, we are noticing a differential rate of damage accrual in the three ethnic groups, with non-Caucasians having more disease related consequences, although the differences are not yet statistically significant. Despite this, self-perceived functioning was similar in the three groups. Of particular note was that ethnicity per se, independent of genetic factors measured thus far, and socioeconomic-demographic and behavioral-cultural factors, predicted both persistent disease activity and damage, suggesting that other genetic factors are affecting the course of SLE. In this submission, we propose: 1) to continue following the present cohort: 2) to enlarge the present cohort from 229 to 450 patients in order to increase our ability to detect meaningful differences between the three ethnic groups; 3) to examine additional MHC-and non-MHC genes that have also been associated with SLE (TNF, MBP, IL1-RA, Bcl-2); 4) to refine the assessment of those clinical, behavioral-cultural factors found to be important predictors of disease activity, damage and self-perceived functioning thus far; 5) to study the relationship among disease activity, disease damage and self-perceived functioning in these patients as the disease progresses and the factors that predict them. With longer follow-up we expect the impact of the disease will be significantly different among the three ethnic groups and with the addition of new patient recruits we expect to have the power to detect the socioeconomic-demographic, clinical, immunogenetic and behavioral-cultural factors contributing to these differences. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OVERCOMING BARRIERS TO EARLY PHASE CLINICAL TRIALS Principal Investigator & Institution: Fracasso, Paula M. Associate Professor of Medicine; Internal Medicine; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant) Patient accrual is a longstanding obstacle to clinical research. Despite widespread importance placed on clinical trials of all phases, research estimates that less than 5% of new cancer patients are enrolled on clinical trials of all phases and types. The barriers to clinical trials enrollment are multi-faceted, with physician, patient, and system components. Similar barriers seem to affect the entire country and, specifically, all NCI-designated Cancer Centers. This is particularly the case in early phase clinical trials, where therapeutic effectiveness is less definitive than in later phase studies. This application proposes to explore four major barriers to early phase clinical trials - lack of insurance coverage, communication issues, physician time constraints, and trust/understanding issues - utilizing simple and reproducible models
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that, if effective, could be easily translated in other Cancer Centers, or in other disease areas. The specific aims of this proposal are: 1) To determine if there is a significant difference in treatment cost for patients treated on early phase clinical trials versus an alternative commercially available chemotherapeutic agent(s) or best supportive care, and to assess the effectiveness of using the resulting data in overcoming insurance coverage barriers to accrual, 2) To evaluate the extent to which new communication models/technologies can bolster early phase clinical trials accrual, 3) To assess the ability of a new staffing model to overcome the barrier of physician and staff time constraints and to increase accrual to early phase clinical trials, and 4) To test whether a coaching intervention engenders trust and communication in minority patients thereby enhancing accrual to early phase clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PARENTAL HELP SEEKING FOR DENTAL CARE Principal Investigator & Institution: Binkley, Catherine J. Surigical & Hosptial Dentistry; University of Louisville University of Louisville Louisville, KY 40292 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): This Developmental/Exploratory study will use theoretical models that have been used in medicine to promote access and improve outcomes as the point of departure for examining why low-income and socially disadvantaged Hispanic, African American, and Caucasian parents do not obtain dental care for their children. The short goal of this proposal is to determine the psychosocial, structural and cultural factors that impact parental help seeking and to refine and evaluate an intervention to enhance parental dental care seeking behavior. The longterm goal of this pilot research is to test a community, family, and practice approach to improve access to care in an R01 multi-site efficacy trial. The pilot research will be accomplished in two phases. In Phase I we will use focus groups to develop a family and community based intervention and measures that will be used in Phase II. In Phase II the intervention will be pilot tested using a randomized controlled repeated measures design in which families will be assigned to an intervention group and a control group. Data will be collected from all participating parents by telephone interview at three assessment periods prior to and immediately after the family intervention implementation. Data will be collected for a third time from a subsample of parents in the intervention group who visit the dental office and all parents in the control group. Analysis of Covariates and logic regression procedures will be used to analyze the direct effects of the intervention. Evaluation of the intervention processes will also be conducted. The results of this pilot project are needed to directly support implementation of an R01 multi-site intervention efficacy trial that will (1) empirically cross validate the measures used in the pilot study and refine the intervention model, and (2) test the direct and indirect effects of the interventions. The proposed research addresses the NIDCR's Health Disparities Plan that recognizes the need for patientoriented research to understand the bases of health disparities: specifically, the sociological, anthropological and political underpinnings of health-care seeking behavior. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PARTNERSHIP IN SURVEILLANCE AND PREVENTION Principal Investigator & Institution: Mccauley, Linda A. Professor; None; Oregon Health & Science University Portland, OR 972393098
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Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2003 Summary: This proposal addresses the NORA designated priority area of Surveillance Research Methodology and is based on a collaboration between the Center for Research on Occupational and Environmental Toxicology (CROET) at Oregon Health Sciences University (OHSU), the Environmental, Occupational and Injury Epidemiology Section of the Oregon Health Division (OHD), and major insurers for Workers' Compensation (WC) in Oregon. This collaboration brings together experts in epidemiology, surveillance, WC, and insurance plans for industry to advance the knowledge of worker injury and illness surveillance. Specifically we will address the disparities in data available in the state-mandated WC system and those available in the databases held by private insurers and self- insured companies. We will also provide for insurers that collaborate in this project evidence of the utility of surveillance data in understanding how the employers they insure compare with other employers in the state and the nature of their occupational injuries and illnesses. A research plan has been developed which will assess the feasibility and potential utility of WC claims data from multiple insurers into a common database for monitoring all types of WC claims. This transformation of claims data from multiple insurers will provide a broad view across insurers, will indicate any need for taxonomy development and standardization to facilitate the merging of data, and will provide the mechanism to compare illness and injury claims in relation to key variables. Upon successful merging of data from multiple insurers, this project will determine differences in the disabling and "medical-only" claims among different insurers according to type of injury/illness, age and gender of claimants, type of industry, and occupation. Comparisons will be made in the profile of occupational injury and illness available in state WC databases and the profile available in data from insurers. This project will demonstrate the utility of complete insurer databases in monitoring clusters of illness and injury, trends and patterns of claims and identifying new intervention opportunities as they emerge. The information generated from this surveillance can then be used to communicate to insurers the benefit of the surveillance for their loss prevention and the ultimate goal of improving worker safety and health and decreasing WC claims costs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PATHFINDERS--ACCESS AND EARLY CANCER DETECTION FOR THE UNDERSERVED Principal Investigator & Institution: Otero-Sabogal, Regina; Northern California Cancer Center 32960 Alvarado-Niles Rd, Ste 600 Union City, CA 94587 Timing: Fiscal Year 2001 Summary: Strategies to improve survival from breast and cervical cancer have not successfully addressed the needs of low-income and ethnically diverse women. The goal of this project is to improve initial breast and cervical cancer screening and maintenance of interval screening under conditions of shifting access to medical care in low-income, multi-ethnic sample of women in Alameda County, California. The specific aims of this study are: 1) in a randomized controlled trial, to develop and test the impact of a phased, access-oriented intervention, individually tailored in both content and intensity, "managed outreach"; 2) to evaluate the cost- effectiveness of the intervention; 3) to prospectively assess the association between cost of outreach and women's characteristics (including insurance status, positive/negative perceptions toward screening); 4) to identify and measure positive/negative perceptions in an under-served, multi-ethnic population. The proposed intervention, informed by a conceptual framework anchored in the Trans-theoretical Model and Precede-Proceed, is designed to
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achieve maximum impact at a minimum cost in an effort to make the intervention affordable to agencies serve low- income communities. A cohort of 1,500 ethnically diverse women, ages 45- 74, will be recruited from low-income census tracts, randomized to intervention of control group, and followed over 3 years. Throughout the intervention, women will be linked with resources from provider systems and insurance plans. The phases have been designed such that a costly, but effective, lay health work component is combined with less expensive but complementary activities. Computergenerated tailored letters, along with audio tapes for women of low literacy, will be sent every 6 months throughout the intervention based on data from follow-up surveys, insurance plans, and providers. Phase I combines letters and telephone counseling by Lay Wealth Workers (LHWs), or in-person support if needed. In Phase II, to reduce the cost and intensity of the intervention yet still make language-appropriate information and support available, LHWs will be phased out and women will be encouraged to use a multi-lingual telephone help-line for screening and access assistance. For the final 6 months of the intervention, the help-line will be phased out and women will be referred to existing community resources. We expect that this phased intervention will result in significant improvements in consumer skills and maintenance screening. The innovations of this study are to provide women tailored outreach at the lowest possible cost, and to associate outreach cost with individual pros/cons for screening. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PATIENT PREFERENCES FOR DISCLOSURE: A NATIONAL SURVEY Principal Investigator & Institution: Levinson, Wendy; Chief, General Internal Medicine; National Opinion Research Center 1155 E 60Th St Chicago, IL 60637 Timing: Fiscal Year 2001; Project Start 15-SEP-1999; Project End 31-AUG-2003 Summary: In the changing health care environment, important decisions previously made by patients and their physicians are now strongly influenced by third parties such as health plans and insurers whose intrusion has led many patients to question whether their physicians are truly acting in their best interest. Physicians report that they are challenged in knowing how to communicate effectively with patients about third-party restrictions while simultaneously building trust and maintaining patient satisfaction. This study proposes to answer this question by eliciting patient opinions on how and when they should be informed about third-party policies, particularly referralrestrictions and conflicts of interest. Through a national survey based on a representative sample of the US population, respondents will be exposed to different communication strategies used by physicians to disclose referral restrictions and financial conflicts of interest. These statements will reflect the highest standards of professional conduct and will be based on the assumption that physicians act within ethical parameters. The specific objectives of this research proposal are as follows: (1) develop communication strategies for disclosure of third-party restrictions by physicians and evaluate their authenticity and acceptability; (2) pilot test a survey instrument (containing audiotaped statements of disclosure of third-party restrictions) among patients from high and low penetration managed care markets; (3) experimentally evaluate public preferences on how information regarding third-party restrictions should be implemented through the nationally representative General Social Survey (GSS) administered by the National Opinion Research Center (NORC); (4) Evaluate how disclosure of third-party restrictions affects outcomes of patient trust, satisfaction, and intent to disenroll from health plan; and (5) evaluate how disclosure outcomes vary based on patients' experience with third-party restrictions, health status, and other demographic characteristics. The results will provide the basis for policy
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decisions for both legislative bodies and health care organizations responsible for disclosure to patients and the public at large. The study will form the basis of broadly disseminated educational interventions for physicians helping them to disclose information about third-party restrictions in manner that reinforces the therapeutic patient-physician relationship. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PATTERNS OF INDIVIDUAL HEALTH PLAN COVERAGE AMONG RURAL Principal Investigator & Institution: Mcbride, Timothy D. Professor and Associate Dean; None; University of Southern Maine 96 Falmouth St, P O Box 9300 Portland, ME 04103 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2003 Summary: Individually purchased health plans have become an increasingly important source of coverage for many Americans, especially as employer-based coverage rates have declined. Studies have shown that these plans are more prevalent among rural than urban residents. There are still many unaddressed questions, however, concerning how and why rural consumers use the individual insurance market. This study will use the 1993 panel of the Survey of Income and Program Participation (SIPP), to address two broad research goals: (1) to identify and compare the characteristics of rural and urban residents in individual plans, and (2) to investigate the patterns of individual plan coverage, including the duration of individual insurance spells and the paths of entrance and exit into individual insurance spells. The study will use descriptive analyses to explore the characteristics of rural and urban persons with individual insurance, comparing these people to those with other forms of insurance, or to the uninsured. Using the sample of people who have any spell of individual insurance coverage, we will employ survival analysis techniques to estimate the duration of their individual insurance spells. A variety of multivariate techniques will be used to test the hypotheses that 1) rural purchasers of individual insurance differ significantly from their urban counterparts in terms of socio-demographic, employment and health statuses and 2) there are rural-urban differences in the patterns of individual coverage. We will employ separate multivariate techniques to explore each of these general areas of inquiry. Both sets of analyses will explore the characteristics of persons holding individual insurance, as compared to others, while also comparing rural to urban residents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PATTERNS OF REHABILITATION USE FOLLOWING STROKE Principal Investigator & Institution: Harada, Nancy D. Adjunct Associate Professor; None; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2003 Summary: Stroke is the leading cause of disability and the third leading cause of death in the United States. After suffering a stroke, the pattern of acute and postacute rehabilitation is often determined by the physician with consideration of the patient's clinical status and the health care delivery system. As a result, the types of acute and postacute services received by stroke patients may vary substantially. This study focuses on the movement of patients from the acute hospital to postacute (skilled nursing facility (SNF) and/or freestanding rehabilitation hospital) settings. The specific aims are to: (1) compare and contrast the demographic, clinical, and organizational characteristics
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of stroke patients who receive six different patterns of rehabilitation use: acute hospital rehabilitation only; acute hospital and SNF rehabilitation; acute hospital and freestanding rehabilitation hospital care; SNF rehabilitation only; freestanding rehabilitation hospital care only; and no rehabilitation; (2) to compare and contrast facility length of stay by rehabilitation use pattern and identify characteristics associated with length of stay; (3) to compare and contrast total episode days of care by rehabilitation use pattern and identify characteristics associated with total episode days of care; and (4) to compare and contrast discharge destination by rehabilitation use pattern and identify characteristics associated with discharge destination. To accomplish these aims, we will conduct a cross-sectional, secondary analysis of Fiscal Year 1995 administrative data obtained from the Health Care Financing Administration. Several datasets will be merged to develop an analytical file that contains demographic, clinical, facility, and resource use variables. The specific data sets to be merged are: the Medicare Provider Analysis and Review File, Provider Specific File, Hospital Cost Report Information System Minimum Data Set, and SNF Minimum Data Set. Data will be analyzed using multivariate techniques. The findings of this study will contribute towards our current knowledge of how patterns of rehabilitation utilization throughout an episode of care influence clinical outcomes of care. The findings have implications for the development of an integrated payment system for postacute services. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PERSONS WITH MENTAL DISORDERS IN THE LABOR MARKET Principal Investigator & Institution: Baldwin, Marjorie L. Sch of Health Admin & Policy; Arizona State University P.O. Box 873503 Tempe, AZ 852873503 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 31-JAN-2005 Summary: (provided by investigator): The purpose of this research is to develop and assess amodel of mental illness and work disability, with a specific focus on identifying the types of mental disorders associated with poor work outcomes, and the extent to which persons with mental disorders are subject to discrimination in the labor market. Previous research shows that discrimination contributes to the low wages and employment rates of persons with disabilities, and that the extent of discrimination is weakly correlated with the intensity of prejudice against different types of impairments. Persons with mental disorders may be subject to intense prejudice, but there are no studies of labor market discrimination specifically focused on mental illness. In part, this is because the data have not been available to support such a study. The information is now available on the MEPS and the NHIS Disability Survey, and the two data sets can be linked. The proposed project will use this rich data source to provide the first rigorous economic analysis of the impactof mental disorders on outcomes in the labor market. The specific goals of the project are: (1) To compare the relative wages and employment rates of persons with serious mental disorders to persons with physical impairments and non-disabled persons; and to estimate the extent to which the low wages of persons with mental disorders can be attributed to labor market discrimination. (2) To compare the health care and work loss costs of persons with different types of mental disorders and analyze the extent to which expectations regarding expenditures may explain observed wage and employment differentials. (3)To identify job characteristics that enable persons with mental disorders to participate in the labor market (e.g., occupation, health insurance coverage, part-time employment). (4) To analyze the extent to which self-reports of job-related discrimination coincide with measures of discriminatory wage and employment differentials across different types of mental disorders. The proposed project is timely
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because recent advances in medications for serious mental disorders now enable many persons with these illnesses to participate in the labor market. Yet discrimination may still prevent them from achieving their full potential. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PHILIPPINE CHILD HEALTH AND POLICY EXPERIMENT Principal Investigator & Institution: Peabody, John W. Epidemiology and Biostatistics; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2003; Project Start 15-JUL-2003; Project End 30-APR-2008 Summary: (provided by applicant): The long-term consequences of poverty on child health, including cognitive development, are one of the world's great tragedies. In the Philippines, diarrhea, acute lower respiratory infections, and the attendant problems of malnutrition, are the leading causes of childhood illness. The Philippine government plans to launch a broad national Health Sector Reform Agenda (HSRA) that will address the problems of poverty and illness in children. The introduction of these reforms provides an exceptional opportunity to conduct a social experiment. Four institutions, already involved in the design and implementation of the HSRA, plus leading experts in international health, government, and health measurement will collaborate on this project to collect longitudinal data and measure the impact of HSRA reforms on child health outcomes in a population. We will measure the health impacts of two experimental interventions: (1) expansion of health insurance coverage, and (2) capitation of providers. Our research will measure the impact of health reforms on the physical and cognitive health outcomes of children age 0-4. We will use a block design of 21 sites throughout the Philippines: seven for each of the two interventions, and seven matched controls. We will measure the quality of clinical practice using vignettes and will measure health outcomes using objective clinical tests. We will also use an advanced sampling strategy and panel data to link clinical practice with population health outcomes. This unparalleled research opportunity will yield significant insights about specific, unanswered questions of tremendous importance: Does health care serve as a social intervention that ameliorates the effects of morbidity and malnutrition on cognitive development? How effective are government policies at creating incentives to improve the quality of clinical practice? Do financial and organizational policies actually lead to better health and developmental outcomes? The results from this study will provide insights into the linkages between increased access, high quality care, and health outcomes in children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PRESCHOOL VISION SCREENING IN PRIMARY CARE SETTINGS Principal Investigator & Institution: Kemper, Alex R. Pediatrics & Communicable Dis; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Visual impairment in young children is common, affecting between 5% and 10% of children 5 years of age and younger. Preschool vision screening is therefore recommended as a standard component of well-child care. Unfortunately, the rate of vision screening by primary care practitioners is less than 30%. The overarching goals of this proposed project are to improve vision care for preschool-aged children and to prepare the candidate for a career as an expert and independent investigator in the delivery of vision related services for children. These
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goals will be achieved through career development activities and research activities organized in three phases of research: (1) Identification of the barriers to the delivery of vision-related services; (2) Measurement of utilization of vision-related services under public and private insurance; and, (3) Development and pilot testing of educational material based to improve the delivery of vision-related services in the primary care practice setting. Research methods for Phase One of the research will include surveys of primary care practitioners, eye care specialists, and the parents of preschool-aged children. Phase Two will be based on analysis of administrative claims databases from private and public insurers. In Phase Three, the educational intervention will be developed and pilot tested in 10 primary care practices. Career development activities during these phases of research will include formal training in vision science and the treatment of visual impairment, survey research methodology, and healthcare economics. Three dedicated and expert mentors will guide these career development activities. By the completion of this proposed project, the candidate will be an expert in vision care for children, and he will submit an independent investigator-initiated grant proposal to continue his goal of improving the delivery of vision services for children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PREVENTIVE ASTHMA CARE UTILIZATION AMONG BLACK CHILDREN Principal Investigator & Institution: Ireland, Andrea M. Maternal and Child Health; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2002; Project Start 01-APR-2002 Summary: Epidemiological data suggests increased morbidity, prevalence and mortality associated with asthma among African-American children. This population tends to over-utilize the emergency department for asthma care although preventive asthma care within the primary care setting is more optimal to control and manage asthmaassociated morbidity. Previous studies have suggested that racial differences in the rates of preventive asthma care utilization can be attributed to several factors, including the disparity in health insurance coverage between racial groups, social, financial and system barriers to preventive asthma care, and divergent health care seeking beliefs among African-American women. For my dissertation research, I plan to investigate how "race" when defined explicitly as social class, culturally derived health beliefs, and exposure to structural forces such as racism mediates my outcome of interest, utilization of preventive asthma care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PRIVATE AND SOCIAL COST OF SMOKING Principal Investigator & Institution: Sloan, Frank A. J. Alexander Mcmahon Professor; Ctr/Hlth Policy Law & Mgmt; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 01-MAY-1999; Project End 31-DEC-2002 Summary: Gaining a comprehensive understanding of the cost and consequences of smoking commands a high policy priority. The proposed study will take advantage of several existing data bases to estimate the private cost to families and social cost of smoking to those age 25+, including the near elderly and the elderly. Individual contributions to private health insurance, Medicare, Medicaid, Social Security, private pensions, disability insurance, sick leave and other transfer programs will be compared according to smoking status of family members. Our econometric analysis will account
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for endogeneity of the smoking decision and for factors other than smoking plausibly affecting health services use. A simulation of how age structure and underlying primary causes of death would change under varied societal smoking cessation rates will performed by extending an existing smoking intervention model developed by a study investigator. Several data bases will be used: 1994 National Health interview Survey for persons 25-50; Health and Retirement Study for persons 51-64; Asset and Health Dynamics of the Oldest Old and National Long-Term Care Survey merged with Medicare claims for those 65+. These data will be used to document contributions and outlays from public and private programs by smoking status and to estimate cost of smoking-related diseases, e.g., lung cancer. Survival analysis based on the American Cancer Society's Center Prevention Study data set will be used for the analysis of age structure and mortality and to estimate the lifetime cost of smoking. We will examine implications of our empirical analysis for tort claims brought against tobacco companies and the evolution of legal theories underlying tobacco tort litigation in a law review article. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PROVIDER PARTICIPATION AND ACCESS IN ALABAMA AND GEORGIA Principal Investigator & Institution: Bronstein, Janet M. Health Care Organization & Pol; University of Alabama at Birmingham Uab Station Birmingham, AL 35294 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 29-SEP-2003 Summary: This project takes advantage of a 'natural experiment' occurring in Alabama and Georgia, states which have many similarities but which have taken different approaches to providing health insurance coverage for low income children. This project examines 1) changes in provider availability across communities in the two states and 2) changes over time and differences across plans in children's utilization of appropriate care. Provider availability is examined with longitudinal panel studies of claims data covering two periods, the introduction of pccm into the Medicaid programs and the expansion of the number of children covered by CHIP programs. Zip codes are the unit of analysis, and the number of participating providers in both plans, the extent of their participation and the concentration of patients across providers are the measures of provider availability. A longitudinal panel study of claims generated by Medicaid enrolled children will be used to examine the impact of primary care case management and provider availability, on several measures of access to care. Three annual cross sectional studies of Medicaid and CHIP enrollees during 1999-2001 will examine the impact of provider availability and insurance plan features on access measures. Both studies of children will include sub-studies of African American children (about 50 percent of the enrollees in both states) and of children with special health care needs (as identified by diagnoses and eligibility categories). These studies will be complemented by enrollee surveys of the Medicaid and CHIP enrollees in the two states to examine perceived ease of access to and quality of care. In addition, providers, CHIP and Medicaid enrollees in six varied communities in each state will participate in focus groups exploring the impact of insurance coverage and other delivery system factors on use and provision of health care to low income children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PURCHASER/PROVIDER EVALUATION: HOSPITAL QUALITY DATA, TN Principal Investigator & Institution: Braun, Barbara L.; Park Nicollet Institute 3800 Park Nicollet Blvd Minneapolis, MN 55416 Timing: Fiscal Year 2002; Project Start 15-JUN-2002; Project End 31-JAN-2004 Summary: Public reporting of comparative health care performance information is a central strategy for improving quality of care. This strategy, however, has not been applied to the Leapfrog Group?s three hospital patient safety measures. The Leapfrog Group is sponsored by the National Business Coalition on Health, a coalition of Fortune 500 companies dedicated to mobilizing purchasing power to initiate health care quality improvements and overall health care value. The 3 measures are: 1) computerized physician order entry; 2) staffing the Intensive Care Unit with physicians trained ,as intensivists; 3) evidence-based hospital referral standards linked to patient outcomes and the volume of procedures done. In October 2001, HealthCare 21, a business coalition of health care purchasers and providers in Tennessee, included these hospital patient safety measures in its annual comparative hospital report. Our specific aims are: 1. To compare and contrast the perceptions of health care purchasers and hospital administrators regarding the relative importance of each hospital quality measure and the salience of hospital differences. 2. To determine how health care purchasers use the comparative reports of hospital performance among their employees and for negotiating health coverage. 3. To determine the response of hospital administrators to the report data. We propose a single wave, qualitative evaluation of the novel HealthCare 21 comparative report of hospital performance. To obtain detailed information about how purchasers use the hospital quality information and how and to what extent purchasers distribute the report to their employees, we will interview 30 key purchaser members using telephone interviews. To determine the reaction and response of hospital administrators to the comparative report, we will conduct in-person interviews of 2 senior administrators at each of the 24 hospitals described in the report card. Findings from this evaluation will answer key policy questions about the impact and utility of public disclosure of hospital patient safety measures on purchasers/employers and hospital administrators, the possible pathways for improving hospital performance, and how to increase the impact of future hospital comparative reports. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: QUALITY MEASURES AND MANAGED CARE MARKETS Principal Investigator & Institution: Luft, Harold S. Institute for Health Policy Studies; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001; Project Start 15-JUL-2000; Project End 30-JUN-2005 Summary: As the second decade of managed care's transformation of the US healthcare system comes to an end, consumers the policy and health professional communities, state and federal regulatory, the media, and health plans have begun to shift their attention increasingly to concerns about quality of care. The goal of our proposed program project grant is to understand how marketplace behavior affects quality and how the increased focus on quality in turn affects the various participants in the health care system. We see this system as an interconnected set of markets. One is the market for health care services. Another is the marker for health insurance plans. Since many individuals purchase their insurance through their employer, a third is the market for labor. Behavior and competition in each of these markers will influence outcomes elsewhere in the health care system. This project is designed to understand how these
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various markets interrelate and how measures of quality can refocus market forces away from a simple concentration on cost minimization to value maximization. Specifically, we will examine: 1) Decisions by large employers in choosing among health plans, 2) how these decisions influence health plan quality in markers with varying degrees of health plan competition, 3) advertising strategies used by plans to attract various types of enrollees, and 4) the implications of behaviors in these different markets for consumers, with a focus on racial and ethnic minority groups. We draw upon preexisting, large national surveys but will also use data not previously available for research. This includes information about the health plans offered by more than 60 large employers with beneficiaries in over 250 markets, measures of quality from every HMO that has sought NCQA accreditation, a new, market-specific index of provider overlap among plans, and previously untapped sources of health plan advertising data for a panoramic view of the issues under study. We will also use data from in-depth case studies of selected communities to provide detailed portraits of these behaviors in welldescribed settings, both to assist in understanding the broad data sets, and to facilitate communications of our findings beyond the research community. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: QUALITY OF LIFE OF AFRICAN AMERICAN CANCER SURVIVORS Principal Investigator & Institution: Ferrans, Carol E. Medical-Surgical Nursing; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2001; Project Start 28-SEP-2001; Project End 31-AUG-2005 Summary: The purpose of this study is to determine the prevalence of long-term effects of cancer and describe their impact on the quality of life and cancer screening behaviors of African Americans. Issues specific to cancer survivorship for African Americans will be examined. Comparisons will be made with African Americans who have not had cancer to identify the differential impact of cancer on African Americans lives. The study will examine quality of life issues for survivors who have been treated for a variety of cancers: leukemia, Hodgkin's disease, colon, breast, and prostate cancer, which will make possible the identification of survivorship issues that are similar across groups, as well as those unique to each. In addition, this study will explore whether there are differences between African American cancer survivors who have participated in clinical trials and those who have not. Specific aims: the primary objective of this study is (1) To identify differences in quality of life between African American cancer survivors and African Americans who have not had cancer, who are similar in terms of age, gender, health insurance status, and education, to determine the prevalence of cancer-related problems and their effects on quality of life and cancer screening behaviors. The secondary objectives are (2) To examine differences in cancer- related problems and quality of life among survivors of different cancers; and to examine the effect of gender on these differences; and (3) To describe the physical, psychological, social, and economic differences between African American cancer survivors who participated in clinical trials and those who did not. This descriptive study has a casecontrol design. The cancer survivor sample (n = 500) will be drawn from completed CALGB clinical trials and cancer registries of selected CALGB institutions with large African American populations. Non-cancer controls (n = 500) will be African Americans who are selected via random digit dialing from the areas in which the cancer survivors reside. The controls as a group will be matched to the survivor group on age, gender, health insurance, status, and education level. Data will be collected by telephone interview and from medical records. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: RACIAL AND NEIGHBORHOOD DISPARITIES IN INFANT HEALTH Principal Investigator & Institution: Elo, Irma T. Assistant Professor; Sociology; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2003 Summary: In this project, we construct a unique data set for Philadelphia, which merges information from vital statistics records with Medicaid claims records and individuallevel data from publicly funded health centers. We then merge the individual-level data with a rich set of contextual information from multiple sources to create various measures of neighborhood quality, including housing and environmental quality, economic distress, social disorganization, health and service availability. We examine the influence of individual and contextual factors on racial and neighborhood variations on birth outcomes using rigorous statistical techniques suited for analyses of multilevel data. We will examine social class differences within race as well as the racial disparity itself. A second set of analyses addresses the effectiveness of publicly funded health services on prenatal care use, infant health, and costs for low-income women. We will compare the content of prenatal care and birth outcomes of women who received Medicaid services in a managed care setting versus women who received services from fee-for-service provides who accepted Medicaid patients in 1989-1992. Another set of analyses will focus specifically on women using city-funded health centers for prenatal care in 1993-1996. To complement the above analyses we will undertake an in-depth longitudinal study of low-income women. We propose to follow approximately 1,900 women from their first prenatal care visit through their baby s first birthday. This study will enable us to examine the effects of factors present in our conceptual framework that are not available from vital statistics data, including the mother s social support networks, living arrangements, housing stability, psychosocial factors, the wantedness of her pregnancy and risk-taking behaviors. The sample will consist of white, African American, Hispanic and Asian women. The sample composition will permit us to address explicitly the role of race in infant health, and to examine whether factors contributing to infant health are similar for low income women in all racial/ethnic groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: RACIAL DIFFERENCES IN THE TREATMENT OF HEART DISEASE Principal Investigator & Institution: Heidenreich, Paul A. Medicine; Stanford University Stanford, CA 94305 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: Acute myocardial infarction and heart failure result are a common cause of morbidity and mortality for elderly patients in the United States. Numerous studies have documented that ethnic minority populations receive less intensive cardiac care than non-Hispanic whites in a variety of clinical settings. These studies have focused on major procedures such as coronary artery bypass grafting using both large administrative and small clinically detailed databases. Whether these differences are increasing, or decreasing is unclear. The reasons for racial and gender differences are also unclear. Several studies have documented that age, severity of illness, and insurance status can explain part, but not all of the observed differences in treatment. Whether physician, hospital and regional characteristics affect treatment differences remains unknown. In addition, little is known about differences between racial groups in less invasive interventions such as medication use or smoking cessation counseling.
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The degree to which these treatment differences explain differences in survival is also not known. The aim of this proposal is to further examine racial differences in treatment of acute myocardial infarction and heart failure among elderly patients in the United States. Using multiple national datasets from the Health Care Financing Administration (Medicare) already available to the investigators, we will examine trends in racial differences in treatment and outcome for elderly patients from 1985 through 1997. Detailed clinical data from Medicare and the National Registry of Myocardial Infarction will be used to examine racial differences in the appropriateness of care for acute myocardial infarction (aspirin, beta-blockers, reperfusion, angiotensin converting enzyme inhibitors, smoking cessation counseling and angiography) and heart failure (angiotensin converting enzyme inhibitors, measures of left ventricular function). Several potential causes of treatment differences will be examined by linking patient data to procedure refusal (Cooperative Cardiovascular Project) physician (American Medical Association Physician Master File), hospital (American Hospital Association data) and regional data (Census bureau statistics at the level of zip code). Examining the physician, hospital and regional variation in treatment differences are necessary if systematic strategies are to be implemented to reduce gender and racial disparities in the treatment of elderly patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RACIAL DISPARITIES IN RECTAL CANCER Principal Investigator & Institution: Sandler, Robert S. Professor of Medicine; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2001 Summary: There are substantial racial disparities in rectal cancer. Between 1973 and 1995 the incidence of rectal cancer decreased 20.2% in whites but only 2.0% in blacks. The five year relative survival is currently 63.0% in whites but only 52.5% in blacks. Surprisingly, there have been few studies that have investigated the racial differences in rectal cancer. The primary goal of the proposed research is to examine possible exposure, susceptibility, and health care factors that might explain diverging incidence and mortality trends in blacks and whites. The proposed proj4ect is a population-based case-control study in a 33-county area of North Carolina with the following aims: (1) To evaluate factors that might account for the higher rectal cancer mortality among blacks including income/poverty, insurance, transportation, access to care, attitudes about the medical care system and diagnostic delay. (2) To identify environmental and lifestyle may be related to rectal cancer including: personal characteristics, family history, physical activity, aspirin/non-steroidal use, and dietary supplements, with special emphasis on exposures that are amenable to intervention (e.g. moderate physical activity, diet, vitamin supplements). Cases will be identified using the rapid ascertainment program of the North Carolina Central Cancer Registry. Controls under age 65 will be drawn from data tapes from the North Carolina Department of Motor Vehicles and those 65 and older from HCFA. Cases and controls will be interviewed by telephone about a range of dietary and lifestyle factors. A major strength of the proposed study is the fact that it builds upon the infrastructure created for an ongoing population-based study of colon cancer. The proposed study of rectal cancer will extend this research to provide insight into risk factors and health access in a mixed-mice, mixed urban-rural-suburban population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SAFETY AND FINANCIAL RAMIFICATIONS OF ED COPAYMENTS Principal Investigator & Institution: Hsu, John; Physician Scientist; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, CA 94612 Timing: Fiscal Year 2001; Project Start 15-JUL-2001; Project End 30-JUN-2003 Summary: Copayments are a commonly used patient level incentive for modulating the demand for services. Prior studies have demonstrated that copayments and other forms of cost sharing lead to decreased utilization, but none have had sufficient sample sizes to evaluate effects on patient outcomes. The dearth of information on outcomes is particularly concerning given data suggesting that the lack of insurance is associated with poor outcomes. Furthermore, questions remain about whether copayments result in higher downstream treatment costs. To address these issues, we propose to evaluate the effects of the size of a copayment for emergency department (ED) use on patient outcomes and treatment costs within the Kaiser Permanente- Northern California (KP) health system, using a quasi-experimental pre- post design, with concurrent controls. KP is in the midst of a natural experiment, with nearly half of the 2.7 million member population experiencing a sizable increase in ED copayment level on January 1, 2000; 47 percent of members now face a 25-35 dollars ED copayment. The size of the ED copayment will be the main predictor; and the main outcomes of interest are population rates of hospital admissions, ICU admissions, mortality, and the mean costs of hospital care (treatment costs). We will investigate these rates by the level of copayment within the Total Population (KP), as well as within select Vulnerable Populations. We also will investigate the adverse outcome rates and treatment costs for select Sentinel ED Diagnoses. We will use the Cox proportional hazard model to test the hypotheses that the copayment size is related to rates of adverse outcomes. To test our hypothesis relating copayment size to treatment costs, we will use a two-part model. We also will make adjustments in our analyses for relevant patient and organizational factors, such as SES (census block group characteristics, employer type), case-mix, medical center, and use of a primary care physician. These factors may influence ED use independently or modify the association of ED copayment and patients' decisions to access ED care. Given the sample size, our study will have the ability to detect small changes in relatively rare adverse outcomes, e.g. 95 percent power to detect a difference of 2 deaths/10,000 person- years (baseline rate = 56 deaths/ 10,000py); also, the assignment of copayments at the employer level (rather than the patient level) reduces concerns of confounding by self-selection in this natural experiment. In short, the issue of the safety of copayments is of tremendous and increasing importance as the use of financial incentives becomes more common, and concerns about patient safety and choice increase among patients, providers, and policy makers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SAN JUAN MB COMMUNITY CLINICAL ONCOLOGY PROGRAM Principal Investigator & Institution: Baez, Luis; Chief of Hematology/Oncology; San Juan City Hospital Apartado Br, Rio Piedras San Juan, PR 00928 Timing: Fiscal Year 2003; Project Start 30-SEP-1990; Project End 31-MAY-2008 Summary: (provided by applicant): Puerto Rico is an island of 100 miles long by 35 miles wide. The population based on the 2000 census revealed a 3.8 million inhabitants with 1.9 million women and 1.8 million male. Our island cancer registry expects to show close to 11,300 new cancer cases for 2002 year. Although our cancer risk is less than that of US mainland, there is a real trend towards parity in the next few decades. Despite this, our population do show an excess incidence in cervical, endometrial and tobacco-
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related cancers. Equally important, our death rate is higher than mainland USA for selected sites such as lung, liver, stomach and esophageal cancer. The health care delivery system in the island has dramatically changed during the past decade. In 1994, there were 1,950,000 privately medically-insured citizens and 1,600,000 uninsured population. Most of the latter were cared by the government sector. A private health insurance (PR Health Care Reform) has since then been established and works through a capitation system that utilizes private insurance companies as intermediates between the government and the public sector. Currently for year 2002, 1,729,511 medically indigent are covered by the reform system. The San Juan Minority-Based Community Clinical Oncology Program (MBCCOP) was established in 1990 at the San Juan Hospital. The goals of the MBCCOP are to expand and strengthen quality cancer control and treatment research in a changing medical environment in our own communities; to provide access to state of the art cancer control and treatment; to involve a wide sector of health care professionals into the NIH/National Cancer Institute network; to provide educational and informational activities to professionals in their own communities. In 1990, the San Juan MBCCOP started within the PR Medical Center facilities. Since then, the Program has been extended to include satellite centers in Ponce, Bayamon and Manati. It has also included an active group of primary care physicians in their own offices. The Program currently works with several research bases in USA mainland such as National Surgical Adjuvant Breast and Bowel Project, Eastern Cooperative Oncology Group, MD Anderson Cancer Center, and the University of Michigan. Through our participation, a significant number of hispanic subjects have entered in NCI-sponsored trials. Our final goal is to offer the benefits of the NCI Program to the entire island population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SOCIAL AND ECONOMIC FACTORS IN LATE-LIFE DEPRESSION Principal Investigator & Institution: Harman, Jeffrey S. Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 18-SEP-2001; Project End 30-JUN-2006 Summary: (provided by applicant): Although health care for older persons is a major policy concern and the impact of depression on social and physical functioning, quality of life, and health care costs for elderly persons is severe, and effective treatments for depression exist, under-treatment and non-treatment is common. More needs to be known about the factors associated with the use of mental health services by elderly persons, yet there are very few researchers examining these issues. In addition, the data that are currently available for analyses were not designed for geriatric mental health services research, and all have significant limitations for this type of research. The applicant has a strong background of academic and research training in health economics, statistics, econometrics, health policy, and utilization of mental health services, but needs further training to become an effective geriatric mental health services researcher. The applicant is requesting. five years of funding through the Mentored Career Development Award (KO 1) program to improve his knowledge of geriatric psychiatry and medical sociology and obtain methodological skills in survey design and administration to become a geriatric mental health services researcher. These activities will take place within the NIMH supported Intervention Research Center for Late-Life Mood Disorders at the University of Pittsburgh, with Charles F. Reynolds serving as mentor, and Linda George, Martha Bruce, Herbert C. Schulberg, Judy Lage, Richard Schulz, and Scott Beach serving as consultants. The applicant will then use this training to create a pilot database, combining survey and claims data, that can be used
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to examine the relative role of social and economic factors on the utilization of mental health services for the treatment of late-life depression. By determining the relative role of social and economic factors on the use of mental health services by elderly persons, health policy and other interventions can be designed that can improve rates of recognition and treatment of depression in this population. The research plan for this award involves the collection of pilot survey data that will be linked to Medicare HMO encounter data. The survey will collect information on economic and social factors related to the use of mental health services, as well as information on mental and physical health status, physical functioning, and medical and psychiatric history. This survey data will then be linked to respondents' HMO encounter data. Information from this pilot database, such as reliability and validity of measures, response rates, and effect sizes, will be used to develop an RO1 application to create a large, longitudinal, and comprehensive database that can be used for geriatric mental health services research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SOCIAL PSYCHOLOGICAL PATHWAYS IN HEALTH AND COGNITION Principal Investigator & Institution: Schnittker, Jason S. Sociology; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2004 Summary: Scholars have been increasingly concerned with the linkages between health and cognition in elderly populations, in part because health problems may help to explain cognitive differences between socioeconomic groups To date, however, this explanation not been extensively tested Using the combined Health and Retirement Survey (HRS) and Asset and Health Dynamics (AHEAD) data, I propose to investigate the longitudinal relationship between six common diseases and cognition There are three specific goals (1) assess socioeconomic differences in dimensions of cognitive functioning, (2) assess the extent to which any observed differences can be explained by the higher prevalence of health problems among socioeconomically disadvantaged groups, (3) assess the extent to which the relationship between health and cognition varies by features of socioeconomic status, including job characteristics and treatment and insurance status By examining these issues, I hope to better understand the dynamics of health and cognition in old age and lay the groundwork for a larger project. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SOCIODEMOGRAPHICS AND HRQL: MAPPING THE SF-12 AND EQ-5D Principal Investigator & Institution: Lubetkin, Erica I. Community Hlth & Social Med; City College of New York 138Th St and Convent Ave New York, NY 10031 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2004 Summary: (Provided by Applicant): Background: Subjective measures of health status and health-related quality of life (HRQL) hold great promise because they realign how the health care community evaluates its programs and services and assess outcomes that are likely to be of most relevance to patients and populations. Few studies, however, have examined the performance of these measures in the U.S. general population and even less is known about their performance in racially heterogeneous, socioeconomically diverse populations. In 2000 MRS administered both the SF-12 (a health profile) and the EQ-5D (a preference-weighted health index) to a large nationally representative sample of the U.S. general population. The inclusion of both
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questionnaires in the same survey enables an exploration of (1) how each measure captures the effect of sociodemographic factors on HRQL and, (2) how well the SF12 can be mapped onto the EQ-5D in this representative sample. Such a mapping may allow the SF-12, an instrument known to be useful in assessing clinical outcomes in groups of patients, also to be used in cost-effectiveness studies. Specific Aims: Aim 1: (a) To examine the scores on the SF-12 and EQ-5D index and visual analogue scale (VAS) with regard to specific sociodemographic variables, including income and education, age, gender, race/ethnicity, and health insurance coverage; (b) to summarize the population decrement in HRQL (health status burden) associated with income and education, gender, race/ethnicity, and health insurance status. Aim 2: To examine the degree to which the SF-12 can predict scores on the EQ-5D index and EQ VAS. Methods: The first aim will be accomplished through a series of ordinary linear least squares regression analyses. The four dependent variables for each regression analysis will be the PCS-12, MCS-12, EQ-5D index, and EQ VAS. The independent variables will be the sociodemographic characteristics of interest. The second aim will be accomplished through regressing the EQ5D index and EQ VAS onto the MCS-12 and PCS-12 in separate regressions. We initially will use the main effects of the MCS-12 and PCS-12 together with polynomials. The validity of the predicted scores will be examined through the bootstrap approach and use of data from both low-income primary care patients and the York Population Health Laboratory project. Conclusions: The EQ-5D primarily was designed for use in economic analyses while the SF-12 was designed for measurement of clinical health status. Understanding how sociodemographic factors affect HRQL for each measure provides valuable information with which to inform both quality of care and cost-effectiveness analyses (CEA). In addition, understanding the relationship between the two measures could allow data from studies initially undertaken for one purpose (i.e. clinical trials, quality assessment) to be used for the other (i.e. CEA). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SURVIVAL
SOCIO-ECONOMIC
DETERMINANTS
OF
KIDNEY
GRAFT
Principal Investigator & Institution: Woodward, Robert S. Associate Professor; Health Management and Policy; University of New Hampshire Service Building Durham, NH 038243585 Timing: Fiscal Year 2002; Project Start 05-JUL-2002; Project End 31-MAY-2004 Summary: (provided by applicant): Objective: This study proposes to expand the understanding of how insurance coverage, recipient incomes, immunosuppression prices, Medicaid, and state-specific support programs interact to significantly affect long-term kidney transplantation graft survival. Specific Aims: Elsewhere, we have demonstrated that in the absence of Medicare's immunosuppressive medication coverage, low-income recipients had significantly greater graft loss. Here we ask: 1) whether recipient income and immunosuppression insurance affect graft survival among black recipients differently than white; 2) whether differences in state Medicaid regulations and state programs such as the Missouri Kidney Program have ameliorated the importance of insurance as a determinant of graft survival among low income recipients; and 3) whether the cost of the immunosuppressive regimen correlates with graft survival. Methods: The project merges a) patient-level USRDS-provided data about the patient, transplant, immunosuppressive medications, graft survival, and cost; b) ZIP-code-level Census data socio-economic characteristics (Income, Education, and state-level data with details about Medicaid programs relevant to kidney
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transplantation and state-kidney-specific support programs. The project will illustrate the importance of each of these variables on graft survival using Kaplan-Meier plots of graft survival. The project will estimate each variable's importance in multivariate Cox Proportional Hazards model. Importance: The results of this project will provide some guidance to both Medicare and state policy-makers responsible for determining the length of immunosuppression coverage. Specifically, it will identify those patient characteristics for which insurance had the greatest historical impact. The results will also guide physicians in selecting among immunosuppressive medications with widely variable prices by identifying those patient groups for whom out-of-pocket price was an important determinant of long-term graft survival. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SOUTHERN COMMUNITY COHORT STUDY Principal Investigator & Institution: Blot, William J. Chief Executive Officer; Medicine; Vanderbilt University 3319 West End Ave. Nashville, TN 372036917 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: The current body of knowledge regarding the etiology and prevention of cancer draws substantially from prospective epidemiologic studies, among which African-Americans have been greatly underrepresented. Meanwhile, African-Americans experience a disproportionate incidence of and/or mortality from many major cancers and other chronic diseases for reasons that remain unknown. Our objective is to initiate a long-term prospective cohort study comprised of 90,000 African-American and 45,000 non African-American residents of southeastern US states. Comprehensive baseline information will be collected about dietary, lifestyle, medical, occupational and other factors, and a large biospecimen repository will be established that can be used to test future hypotheses involving individual susceptibility to environmental carcinogens. Seventy thousand of the cohort members will be recruited from southern community health centers, providing health services to primarily low-income residents without health insurance. Here participants will be offered an in-person assisted interview using a structured questionnaire and the collection of buccal cell and blood specimens in a practical and convenient setting. The remaining 65,000 will be recruited from the general populations (identified from drivers license, voter registration and Medicare files) of the southern states via mail and telephone contact. For these individuals a portion of the interview will be conducted by phone, with the remainder of the questionnaire (mostly the dietary section) mailed to be self administered. The general population sample will also be mailed a buccal cell collection kit and return mail envelope. The cohort will then be followed actively via periodic repeat contact to ascertain health status and exposure changes since entry, and passively via linkage with state mortality and cancer registries and the National Death Index. The cohort was designed to be large enough to begin analyses of specific risk factors for common cancers (prostate, lung, breast, colorectal) within the 5-year study period. Furthermore, the large study size will enable the assessment of less common cancers afflicting blacks more than other racial groups shortly thereafter, and the biospecimen repository will provide an invaluable resource for the evaluation of biomarkers of cancer risk. Pilot testing in Tennessee, Mississippi and Florida has indicated that the proposed research approach is feasible. The resultant study should help answer questions regarding the etiology of certain cancers, elucidate causes of the disparities in cancer incidence and mortality across racial groups, and lead to the development of measures aimed at the prevention of cancer and other diseases, especially among African-Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: STATE AND FEDERAL POLICY AND OUTCOMES FOR HIV+ ADULTS Principal Investigator & Institution: Goldman, Dana P. Senior Economist; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 30-APR-2003 Summary: Treating HIV and AIDS poses tremendous challenges to health policymakers. To date, policymakers have lacked information about the interaction among employment, costs, ands treatment to adequately assess the efficacy of policy choices. Our proposed research will use a nationally representative population of patients receiving care for HIV to assess the links among government policy, treatment, insurance, and the labor market outcomes of HIV. The specific aims are: (1) Estimate the extent to which public and private insurance protects HIV patients against deteriorating health status; (2) Assess the longitudinal relationships among medical costs, labor market outcomes, insurance coverage and health status of HIV patients; and (3) Develop and estimate a dynamic model of health status, insurance, employment, receipt of therapy, and medical costs; and use this model to stimulate the effects of innovative state and federal policy changes. The integrated model to be developed as part of the final aim can be used to stimulate how broad changes in Medicare, Medicaid, and other programs will affect insurance coverage, treatment, and labor market outcomes in a dynamic setting. The model will be an invaluable tool for assessing the likely consequences of policy changes such as the Work Incentives Improvement Act, which extends Medicare coverage to the working disabled. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: STATE MENTAL HEALTH POLICY-MAKING UNDER MANAGED CARE Principal Investigator & Institution: Erb, Christopher T. None; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, IL 61820 Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 25-SEP-2008 Summary: This project will explore the state mental health policymaking process in the context of managed care. Research suggests that as many as 20 to 29 percent of Americans will have a mental disorder during any given year (Regier, 1998). Despite recent advances in the diagnosis and treatment of mental illness (Norquist, 1999), significant disparities in health coverage remain for people with mental illness, due largely to limited knowledge about mental diseases, stigma, and inadequacies in insurance coverage (Mechanic, 2002). It is this last category that recent public policy initiatives in mental health have focused on most strongly. In particular, "parity" of coverage of mental health has been the central thrust of both federal and state health insurance legislation. There is a need, however, to examine the extent to which parity laws can and do accomplish the goal of reducing mental health disparities, and to identify the factors that exist that encourage or hinder their effective implementation. This research uses a case study design the accomplish the following specific aims: 1) Describe the states' mental health policy "packages," including the major programs, services, laws, and regulations that constitute the state policy response to the needs of people with mental illness; 2) Examine the political and legislative process in states that causes policymakers to choose one policy vehicle over another in general and with respect to mental health parity laws in particular; 3) Assess whether the content of state mental health packages is different in states that have passed mental health parity laws, and whether passing a mental health parity law significantly changes the mental health
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policy package in that particular state. A variety of methodological techniques will be used to guide these case studies, including survey questionnaires of legislators and other stakeholders, personal interviews of State Mental Health Program Directors, and comprehensive review of legislative records and policy reports. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STRUCTURING SERVICE/COSTS
HOSPITAL
MARKETS--EFFECTS
ON
Principal Investigator & Institution: Ma, Albert; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2001 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STUDY OF A NEW PAYMENT SYSTEM FOR MEDICAID Principal Investigator & Institution: Eklund, Stephen A. Professor; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2005 Summary: (Provided by the applicant): This study will monitor utilization of dental care in Michigan children, in order to evaluate the effectiveness of recent and future SCHIP (State Children?s Health Insurance Program) and Medicaid initiatives in reducing disparities in access to and utilization of dental care. Evidence from many sources demonstrates a wide disparity in utilization of dental care that is associated with the socioeconomic status of children. Disparities exist as measured by both visits for care as well as untreated oral disease. Dental insurance claims data will be used to demonstrate historical patterns of utilization and the disparities between privately insured and Medicaid-eligible children. Future data from both the privately-insured child in Michigan and from the newly-implemented private-insurance based SCHIP and Medicaid programs in Michigan will then be monitored for the next several years to assess the ability of these methods of payment and administration to reduce the historical disparities in dental care utilization. Specific null hypotheses to be tested are: 1) Payment for dental care at market rates will result in no difference in the percent of children with at least one dental visit per year, between children with Medicaid, SCHIP, or private insurance coverage, 2) Payment for dental care at market rates will result in no difference in the mix of services received, between children with Medicaid, SCHIP, or private insurance coverage, and 3) Payment for dental care at market rates will result in no difference in the distance traveled to receive care, between children with Medicaid, SCHIP, or private insurance coverage. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TAILORED COMMUNICATIONS FOR COLORECTAL CANCER SCREENING Principal Investigator & Institution: Basch, Charles E. Professor and Chair; Health & Behavior Studies; Columbia University Teachers College Teachers College New York, NY 10027 Timing: Fiscal Year 2001; Project Start 26-JUL-1999; Project End 29-FEB-2004 Summary: Recent health communications research using tailored messages, computer applications and interactive telephone outreach indicates that these approaches can
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effectively influence health-related behaviors, but very little research has attempted to apply these innovations to colorectal cancer (CRC) screening. Virtually no research of this type has been reported in minority populations. Screening for CRC has been shown to reduce CRC mortality, and current NCI guidelines recommend regular CRC screening for people aged 50 to 80 years. Yet the prevalence of CRC screening remains low, particularly in low-income and minority populations. The goal of the proposed study is to evaluate tailored health communications as a strategy for promoting CRC screening in a predominantly low-income minority population. The intervention, which will be delivered in Spanish as well as English, will be directed at a predominantly black and Hispanic population of men and women between 50-80 years of age who have not had CRC screening in at least the past two years. Participants will be sampled from the 1199 National Benefit Fund, the self-administered and self-insured health insurance and retirement benefit fund of the largest health care workers union in the U.S. The intervention comprises outreach and health communications provided through tailored telephone counseling coupled with computer-based decision support and tailored follow-up print communications. The proposed intervention strategy is a logical extension of recent research by Columbia University investigators and others, showing tailored health communications delivered by telephone to be an effective means of promoting screening behavior in low-income and minority populations. The study is designed as a randomized controlled trial with blinded ascertainment of medically documented CRC screening as the outcome. A total of 1,204 men and women will be randomized and followed to assess rates of fecal occult blood testing or flexible sigmoidoscopy within six months of randomization. This sample size will provide adequate statistical power to test the effect of the intervention separately in men and in women. Measures of mediating variables, including knowledge and beliefs, will be collected and used to formulate models predicting which subgroups are most and least likely to respond to the intervention. This proposal addresses the need for research assessing tailored communications to increase CRC screening in minority groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TESTING EBP AND ORGANIZATION EFFECTS IN RURAL APPALACHIA Principal Investigator & Institution: Glisson, Charles A. Professor and Director; None; University of Tennessee Knoxville Knoxville, TN 37996 Timing: Fiscal Year 2003; Project Start 03-JUL-2003; Project End 31-MAR-2008 Summary: (provided by applicant): The proposed study examines a two-level strategy for overcoming barriers to the implementation of effective mental health treatments for youth in very rural, deeply impoverished communities. The two-level strategy includes (1) the implementation of an evidence-based practice (EBP) delivered in the homes of referred youth by therapists organized to provide treatment over large, rural, geographical areas and (2) an organizational-community intervention (entitled ARC) that changes the social context in which the service is provided and supports therapists' efforts to serve children in widely-dispersed, isolated communities. The study will be conducted in eight of the poorest, least populated counties in the rural Appalachian Mountains of East Tennessee. The sample will include 720 children referred to juvenile courts in those counties as a result of antisocial behavior. Half of the children selected in each county will receive an EBP, Multisystemic Therapy (MST), and half will receive the usual care provided to children referred to juvenile courts in the eight counties. In addition, an organizational-community intervention (ARC) will be administered in half (four) of the counties by change agents (Ph.D. industrial-organizational psychologists
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trained in organizational and community development). The change agents will work with treatment teams, judges, school administrators, and other community opinion leaders to address the barriers to mental health care in rural Appalachia and develop community and organizational support for the implementation of the EBP. Multisystemic Therapy (MST) will be provided by Youth Villages, the state's largest private children's mental health service organization. MST services will be funded by the Bureau of TennCare, the state's Medicaid-waiver health insurance program that covers children eligible for Medicaid as well as the children of the working poor who are ineligible for Medicaid. The services are being structured and funded in a way that will ensure they can be sustained in each county, if successful, after the completion of the study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE ECONOMIC CONSEQUENCES OF CANCER SURVIVAL Principal Investigator & Institution: Short, Pamela F. Professor; None; Pennsylvania State University-Univ Park 201 Old Main University Park, PA 16802 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-JUL-2004 Summary: This study is designed to answer the following research questions: (1) What changes in employment, earnings, and health insurance do cancer patients experience shortly after diagnosis and treatment?; (2) What is the effect of cancer survival on trajectories of employment, earnings, and health insurance over the long term?; (3) How do the economic effects of cancer vary by type of cancer, patient characteristics, and prediagnosis employment and insurance?; (4) What adjustments in the employment and health insurance of spouses are made to accommodate changes in the health employment, and health insurance of married cancer survivors?; and (5) What are the implications of these economic adjustments for the psycho-social well-being and quality of life of cancer survivors? We will identify a cohort of cancer survivors from four tumor registries in the Mid-Atlantic region, which together draw patients from inner-city, small urban, suburban, and rural areas. We will conduct a computer-assisted telephone interview with the subjects one to three years after diagnosis and re-interview them annually (a total of four times) until about half have survived to five years. The first interview will include retrospective questions about employment, insurance, and health just prior to cancer diagnosis. Each cancer patient's employment and insurance will be compared pre- and post-diagnosis and treatment, identifying factors that differentially protect or expose cancer survivors to economic changes. We also will compare cancer cohort experiences to those of a comparison group without cancer, drawn from either or both of two national panel surveys covering the same time period (the Health and Retirement Survey and the Survey of Income and Program Participation). By emphasizing hazard modeling as our main analytic approach, we will estimate and project both short-term and long-term effects of cancer on survivors' economic wellbeing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THE ECONOMIC COST OF JOINT RETIREMENT Principal Investigator & Institution: Maestas, Nicole; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Empirically, we observe that husbands and wives tend to retire around the same time. But because women tend to marry older men, the
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joint retirement of married couples implies that married women retire at younger ages than their husbands do. This study investigates the opportunity costs of married women's relatively young retirement. Unless married couples compensate in other ways for foregone opportunities to increase retirement annuities, save, and minimize health insurance costs, women's younger retirement will result in lower retirement income and thus may contribute to poverty among elderly widows. The specific aims of the project are: (1) Compare the age-earnings profiles of married men and women between the ages of 55-65, and test whether the slope is greater for women than for men of the same age; (2) Simulate married women's counterfactual retirement age in the absence of joint retirement using a structural model; (3) Calculate the value of foregone earnings, pension accruals, active saving, and employer health insurance subsidies by comparing the observed and counterfactual retirement ages of married women; and (4) Explore the implications for poverty among elderly widows. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE ECONOMICS OF INFORMATION IN THE HEALTH CARE MARKET Principal Investigator & Institution: Johnson, Tricia J. Economics; Arizona State University P.O. Box 873503 Tempe, AZ 852873503 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2003 Summary: (provided by applicant): The purpose of this research is to examine provider behavior from a theoretical and empirical perspective and to develop a method of quantifying and predicting provider responses to legislative and market-based incentives. The proposed study examines provider behavior in response to proposed legislation and policy intended to improve the quality of care and health outcomes. With increased attention on the need for more provider autonomy and patient involvement in the provision of health care services, little attention has been given to the issue of whether these changes will result in an increase in the quality of care or simply in an increase in utilization without an improvement in quality. The goals of the research are: (1) to assess the efficiency and social welfare under common health insurance contracts including various market-based and regulatory practice incentives and extend the model to workers? compensation insurance; (2) to develop a model of the optimal contracting relationship between the patient, health care provider, and payer when the provider is the "expert" in the diagnosis and treatment of the patient; (3) to develop an analytical framework for examining provider behavior in response to legislative, regulatory and market-based changes to practice incentives; and (4) to predict the effect of relaxing utilization constraints on provider practice patterns, including quantity and mix of health care services and to quantify the effect on health care expenditures. The proposed study will provide policy makers, health insurers and workers? compensation insurers with information needed to assess the effects of relaxing utilization constraints on provider behavior. This study will examine the changes in utilization attributed to "demand inducement" versus quality of care and will quantify the changes in services and associated costs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THE ECONOMICS OF VIATICAL SETTLEMENTS Principal Investigator & Institution: Bhattacharya, Jay; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2001; Project Start 01-MAR-2001; Project End 28-FEB-2002
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Summary: (adapted from the applicant's abstract): A viatical settlement is the sale of a life insurance policy, typically to a third party, for immediate cash payment. The market emerged in 1989 in response to the AIDS crisis, but since then has diversified to the elderly and to other terminal ill patients. Despite the growing importance of this industry, no economic studies have been done. States have begun adopting regulation of the market despite little empirical information. The primary reason for the lack of scholarly attention is the absence of data - for example, neither the Health and Retirement (HRS) nor the Asset and Health Dynamics Among the Oldest Old (AHEAD) surveys contain questions regarding the use of viatical settlements. The purpose of this project is to investigate the economics of the viatical settlement market using a nationally representative sample of HIV infected adults. The specific aims of this research project are as follows: 1. Empirically investigate the demographic, economic, and medical factors correlated with the decision to viaticate. 2. Compare outcomes in the viatical settlements market across states with differing regulatory structures. 3. Model and test for the presence of adverse selection in the viatical settlements market. 4. Suggest questionnaire items on viatical settlements for inclusion in the HRS and AHEAD surveys. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE EFFECT OF PUBLIC INSURANCE ON DENTAL HEALTH OUTCOMES Principal Investigator & Institution: Hughes, Tegwyn L. Dental Ecology; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 30-JUN-2002 Summary: Numerous barriers threaten access to oral health services for young children. Enacted policies regarding the coverage of oral health services do not necessarily translate into realized access for children. Low levels of provider participation and reimbursement rates in publicly funded programs are key factors in this unrealized access to oral health services. In addition, children enrolled in these public programs are from lower socioeconomic families and tend to face multiple barriers to accessing health care. North Carolina's SCHIP program, or Health Choice (NCHC) program, provides health services, including dental through NC Blue Cross/ Blue Shield's private insurance program. The other public health insurance program is the state Medicaid program. This investigation represents an in-depth comparison of children's dental health status and their receipt of dental services through the NC Medicaid Program versus the NC Health Choice Program. This analysis will link children, ages 1-5, enrolled in Medicaid or NCHC to their dental claims file from July 1999 through June 2000, creating person-level data on the utilization of dental services. In addition the NC surveillance of dental caries in Kindergarten aged children for the 1999-2000 school year will be merged with procedure claims creating person-level data on clinical status and use of dental services for a representative sample of young children who were defined by Medicaid and NCHC enrollment. The first part of the investigation compares the use of dental services between Medicaid and NCHC for children 1 to 5 years of age. The second part of the investigation examines differences in specified process measures of plan performance between the two insurance programs. The third part of the investigation compares the dental health status and untreated dental disease of kindergarten aged children enrolled in either public dental program. This project represents an in-depth comparison of the utilization of dental services, effectiveness of established pediatric oral health performance measures, and dental services, effectiveness of established pediatric oral health performance measures, and dental
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health status for children enrolled in either the NC Medicaid program or NCHC. This study provides an opportunity to determine the benefits of public dental insurance for low income children when structured similar to private insurance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE PERIODONTITIS
EFFECTIVENESS
OF
TREATMENT
FOR
ADULT
Principal Investigator & Institution: Hujoel, Philippe P. Associate Professor; Dental Public Health Sciences; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2007 Summary: BACKGROUND: Adult periodontitis is a destructive disease that may lead to tooth loss and decreased quality of life. Currently, little is known regarding the impact of surgical periodontal therapy on tooth loss and oral-specific health- related quality of life (OQOL). GOAL: The aim of this R01 proposal is to initiate a periodontal outcomes study among the members of Washington Dental Service (WDS), a not for-profit dental insurance plan. AIMS: Primary aim: To determine the impact common periodontal procedures on tooth loss and OQOL in a population of 1561 WDS patients with periodontitis using a prospective cohort design. Secondary aims: (i) Relate OQOL to tooth loss, periodontal treatment history, and periodontal disease characteristics. (ii) Investigate subgroups, dose- response relationships, site-specific relationships between periodontal treatments and tooth loss, and specific treatments such as osseous grafts and site-specific anti-microbial treatments. (iii) Study the impact of patient characteristics (e.g., smoking, diabetes) on the therapeutic response. (iv) Estimate the association between non-surgical periodontal therapy and tooth loss and OQOL. (v) Assess the feasibility of conducting randomized trials of simple periodontal treatments among an insured population. PROPOSED STUDY: Study Design: A prospective cohort study (n=1,561;starting date: January 2002), with a retrospective component (n=20,275 patients starting in 1993). Patient clinical characteristics, outcomes, procedure data, and OQOL will be obtained from patient-survey data (mail and telephone) and the WDS data warehouse. Generalized estimating equation models, with time dependent covariates, will be used to relate tooth loss and OQOL to the periodontal treatment history and patient characteristics. PRELIMINARY DATA: The feasibility and design of this study were determined by a periodontal outcome study in Kaiser Permanente Dental Plan, a mail survey of WDS patients regarding patient risk factors for periodontitis, a retrospective analysis of WDS data, and a pre-testing of the OQOL instrument. SIGNIFICANCE: Information will be obtained regarding the tooth loss and OQOL that is associated with real-world clinical decisions, in a broad range of periodontitis patients, in specialist practice settings. This information can help determine in what area of periodontal research definitive clinical trials may offer the greatest contribution. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TREATMENT UTILIZATION FOR ALCOHOL-RELATED PROBLEMS Principal Investigator & Institution: Wu, Li-Tzy T.; Research Triangle Institute Box 12194, 3040 Cornwallis Rd Research Triangle Park, NC 27709 Timing: Fiscal Year 2001; Project Start 28-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): This R01 proposal is in response to PA-00-100, Secondary Analysis of Existing Health Services Data Sets. This application to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) proposes 2 years of
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support for research on national trends, determinants, barriers, and outcomes of treatment utilization for alcohol-related problems in nationally representative samples of household residents in the United States. The proposed research requires no new and costly data gathering. Secondary data analysis will be performed on data files from the 1991 to 1998 National Household Surveys on Drug Abuse (NESDAS) and the National Comorbidity Survey (NCS). Alcohol abuse and/or dependence is one the most prevalent psychiatric disorders among adults in the United States, and it tends to cooccur with other psychiatric disorders. However, there is extremely low prevalence of alcohol abuse treatment utilization among those having an alcohol disorder in the past year. The combination of a high prevalence of alcohol use disorders with a relatively low prevalence of alcohol abuse treatment utilization represents an important public health problem. The specific aims of the proposed study are as follows: (1) provide population estimates of the national trend in alcohol abuse treatment utilization and examine its relationship with demographics, insurance coverage/benefits, and type of treatment settings; (2) determine factors affecting the utilization of different types of alcohol abuse treatment and factors related to unmet needs for treatment; (3) examine the time lag between the onset of alcohol-related problems and first treatment use and factors predicting the delay in seeking treatment; and (4) understand drinking outcomes of prior treatment status and factors that may moderate the relationship between prior treatment status and later drinking outcomes. Findings from the proposed analysis have significant implications. They will (a) provide population estimates on national trends and the magnitude of met and unmet needs for alcohol abuse treatment; (b) specify under served subgroups who can then be targeted to improve their access to treatment; identify determinants of and barriers to treatment service utilization that suggest directions for future research, the planning of treatment service delivery, and policy making; and (d) provide vital information for predicting the potential future burden of alcohol-related problems by subgroups and for guiding future efforts to improve the quality of alcohol-related care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: UNDERSTANDING HOW INSURANCE AFFECTS PERSONS WITH MULTIP* Principal Investigator & Institution: Solomon, Matthew D.; Rand Corporation 1700 Main St Santa Monica, CA 90401 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2004 Summary: (provided by the applicant): Prescription drugs have become an indispensable tool to treat and manage chronic disease, and the utilization and cost of drugs have dramatically increased in the past decade. As drug costs have grown, access to drugs has decreased for both the insured and uninsured. For the uninsured, paying one hundred percent of the cost of drugs has made adhering to drug regimens difficult. Similarly, the insured have suffered reductions in benefits from insurers trying to control spiraling costs. Because drug therapy is the standard treatment for many chronic illnesses, the interruption or lack of drug therapy can have serious health consequences. Thus, the chronically ill may be particularly vulnerable to changes in utilization mediated by insurance. While some research has measured the effect of insurance status and benefits on the use and cost of drug regimens for the chronically ill, virtually no research has examined these same effects for persons with multiple chronic illnesses. This project aims to compare how insurance status, insurance benefits, and the price of disease-specific medications affect the drug treatment regimens for persons with two chronic conditions relative to persons with only one of the two conditions. To
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accomplish these aims, this study will utilize a large claims database of privatelyinsured individuals and the Medical Expenditure Panel Survey. Analysis will include multi-variate regression techniques to estimate: 1) how the use and duration of diseasespecific medications are affected by insurance status and benefits design for persons with a single chronic condition and with multiple conditions; and 2) how price-sensitive these populations are to different disease-specific drug classes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: USE ENVIRONMENT
OF
CANCER
SCREENING
IN
A
MANAGED
CARE
Principal Investigator & Institution: Phillips, Katheryn A. Associate Professor of Health Economics; Dean's Office; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001; Project Start 01-FEB-2000; Project End 31-JAN-2003 Summary: The growth of managed care has important implications for cancer screening utilization. Previous studies demonstrated that the type of insurance coverage is an important predictor of the use of cancer screening, yet these studies were conducted using data from the early 1990's before the proliferation of new types of managed care plans. It is therefore important to examine recent data on screening utilization that reflects today's health care environment, and to explore what features of health plans and the managed care environment influence screening. This study will examine whether specific characteristics of health insurance plans and the managed care environment influence utilization of breast, cervical, and prostate cancer screening. Rather than only comparing utilization in "managed care" vs. fee-for-service plans, we will analyze specific characteristics across types of plans such as the benefits provided, use of primary care gatekeepers, and the extent of enrollees' provider choice. These characteristics, rather than whether a plan is labeled "managed care", are most likely to influence screening utilization. We will use data from the Medical Expenditure Panel Survey, a nationally representative survey conducted by the Agency for Health Care Policy and Research. The MEPS obtains data not only from individual patients but also from their insurers, which expands and validates individuals' reports of coverage. Furthermore, by linking MEPS data with our own database of environmental characteristics, we will be able to examine whether characteristics of the managed care environment such as HMO market share, competition, and other measures of HMO activity influence utilization. We will also examine patterns of cancer screening utilization in the current managed care context; develop a conceptual framework; examine the relative influence of patient, provider, plan, and environmental factors; and conduct a study of the accuracy of self-reported prostate cancer screening in collaboration with Kaiser Permanente. Examining the factors that influence utilization is important for understanding the impact of the current managed care environment on access, outcomes, and quality of care. The findings will therefore have implications not only for the types of screening examined in this study but also for other health care services. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: USING INCENTIVES TO DRIVE LEAPS IN PATIENT SAFETY Principal Investigator & Institution: Delbanco, Suzanne F.; Leapfrog Group 1801 K St Nw, Ste 701-L Washington, DC 20006 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2003
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Summary: This project would entail a multi-stakeholder effort to design and implement financial incentives and rewards to speed the adoption of The Leapfrog Group's recommended hospital patient safety practices: computerized physician order entry; evidence-based hospital referrals for select high-risk conditions and procedures; and staffing intensive care units with trained specialists. The Leapfrog Group is a consortium of more than 110 large private and public health care purchasers who buy health benefits for approximately 32 million Americans. Building on volunteer work during 2002 by Leapfrog's incentives and rewards work group consisting of hospital, health plan, physician, consumer and purchaser representatives, as well as actuarial support from Towers Perrin, and project management and health benefits contracting guidance from General Electric Company, Leapfrog would devise a plan for implementing financial incentive or reward pilots in approximately three U.S. healthcare markets where purchasers are making a concerted effort to implement Leapfrog's patient safety initiatives. Leapfrog members are committed to rewarding hospitals for their efforts, however most purchasers need significant help with making high-level design plans operational before they can begin. This planning project would build multi-stakeholder collaboration, further the design of incentive and reward concepts to test at the regional level, and set the stage for an evaluation to test the effectiveness of incentives or rewards in actual health care markets. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: USUAL CARE VS. CHOICE OF ALTERNATIVE RX: LOW BACK PAIN Principal Investigator & Institution: Eisenberg, David M. Instructor in Medicine; Beth Israel Deaconess Medical Center St 1005 Boston, MA 02215 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2002 Summary: This study, which implements procedures used in a completed pilot study (n=60), compares two approaches to the management of acute low back pain: usual care (standard benefit) vs. the choice of: usual care, chiropractic, acupuncture or massage therapy (expanded benefit). 480 subjects will be recruited from a health maintenance organization, Harvard Pilgrim Health Care/Harvard Vanguard Medical Associates. Patients with uncomplicated, acute low back pain will be randomized to either usual care (n=160) or choice of expanded benefits (n=320). Patients' preferences for individual therapies and expectations of improvement will be measured at baseline and throughout the study. Subjects randomized to the expanded benefits arm who choose chiropractic, acupuncture or massage will receive up to 10 treatments over a five-week period. Additional treatments will be available after the fifth week but will require a copayment. Treatments will be provided by licensed providers who have met strict credentialing criteria. Chiropractic, acupuncture or massage treatments will begin within 48 hours. Chiropractic, acupuncture and massage therapy scope of practice guidelines for the treatment of acute low back pain have been developed as have detailed data tracking procedures to be used at each patient visit. Symptom relief, functional status, restricted activity days, use of health care, and patient and provider satisfaction will be assessed at 2, 5,12, 26 and 52 weeks after initiation of treatment. Primary outcomes will include: 1) change in symptoms; 2) change in functional status; 3) patient satisfaction; and 4) total utilization of services associated with care for low back pain. Medical records and the HMO's cost management information system will identify use of services. All procedures have been successfully incorporated in an ongoing pilot (feasibility) study. It is hypothesized that patients offered their choice of expanded benefits will experience a more rapid improvement in symptoms, a faster return to baseline functional status, a decrease in utilization of conventional medical services, and
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will be more satisfied with their care. The study is a direct examination of the effectiveness of an insurance eligibility intervention, not a test of the efficacy of specific, non-allopathic treatment regimens. The results of this study will provide valuable information to clinicians, patients and third party payers on the relative benefits and costs of an "expanded benefits" treatment option which incorporates chiropractic, acupuncture and massage services for low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: UTILITY AND CHOICE OF DENTAL TREATMENTS Principal Investigator & Institution: Ismail, Amid I. Professor; Cariology/Restor Sci/Endod; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2003 Summary: This proposal responds to PA-98-031 that called for research in the field of "Methodology and Measurement in the Behavioral and Social Sciences". Specifically, the proposed study will test the feasibility and construct validity of two methods of measuring utility of dentin regeneration, tooth extraction, and root canal therapy (Healthy Time Equivalent [HTE] and Willingness to Pay [WTP]). The HTE and WTP methods will be used, in the proposed population-based study in Southeast Michigan (population of 4.5 million), to evaluate the potential impact that dentin regeneration, a new technology under development, may have on the oral health status of uninsured Americans and to test hypotheses to validate a model of determinants of utility and choice of dental treatments. This project will sample 461 adults without dental insurance and 415 adults with dental insurance. This sample was computed to provide 90 percent power for detecting differences in average HTE scores between insured and uninsured adults and between adults with low and high education status. The sample size will also be powerful for testing hypotheses to validate the model of determinants of utility (preferences) and choice that was developed for this project. Sampling will be carried out using a list-assisted random digit dialing. Adults who meet the eligibility criteria (age between 18 and 69 years and have at least one natural tooth) will be invited to participate in a home interview that will assess utilities using the standard gamble approach. Respondents will also be invited to answer a questionnaire that measures WTP, dental anxiety, toothache, quality of life and general health status, quality of oral health, previous dental experiences and satisfaction with dental care. The questionnaire will also ask for information on gender, race/ethnicity, income, employment and education status. Sampling and telephone interviewing will be conducted by the Institute for Social Research (ISR). Home interviews, assessment of utilities, and administering the personal questionnaire will be carried out by staff hired for the project and trained by ISR. This project is the first to test a model for adoption or choice of dental treatments. This new field of research will be needed in the 21st century where demands for cost containment and the rapid development of new technology and treatments will pressure health care providers and policy makers to choose among competing health outcomes. This project will validate two measures of utilities of dental treatments that could be applied to evaluate the potential outcomes of dental and nondental interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: VIEWS OF PRIVACY OF GENETIC INFORMATION Principal Investigator & Institution: Klitzman, Robert; New York State Psychiatric Institute 1051 Riverside Dr New York, NY 10032
110 Health Insurance
Timing: Fiscal Year 2002; Project Start 08-FEB-2002; Project End 31-JAN-2006 Summary: The increasing availability of genetic information on individuals raises a series of critical questions concerning privacy and confidentiality that have not been fully explored. The rise of computers, the Internet, and managed care all threaten the privacy of individuals' health information; and the sequencing of the human genome makes these issues particularly acute. Sharing genetic information may lead to stigma, discrimination, and threats to jobs and life and health insurance. Former President Clinton released privacy regulations, and some states have genetic privacy laws, yet numerous questions and controversies remain. The implementation of such safeguards remains unclear, and patient advocates feel further policies are needed. It is also unclear how privacy concerns and such regulations may affect behavior (e.g., participation in genetic testing) and to what degree new safeguards will allay patient concerns. It is critical to understand patients' underlying conceptions, views and approaches to privacy, and to policy and threats to privacy, and factors involved in these views. Yet no published research has investigated in-depth the perspectives and experiences of individuals confronting genetic diseases, concerning these issues. The aims of this study are thus 1) to explore views of privacy issues among individuals who are at risk of or have genetic disorders concerning privacy of genetic and other health information, threats to privacy, possible policies, and tradeoffs between privacy and benefits that might accrue from sharing genetic information (e.g., for research); 2) to explore the experiences of these individuals concerning privacy and disclosure - to whom they have disclosed that they confront a genetic disease (e.g., to health care professionals, family members, co-workers, employers, and insurance companies); when, why and what they disclosed; what reactions (e.g., stigma and discrimination) they have encountered; and how they view and make these privacy and disclosure decisions; 3) to explore the relationship of these views of privacy to health behaviors (e.g., delaying or avoiding diagnostic tests or treatment); and 4) to assess how type of genetic or other illness, or other factors may affect these views and experiences. We will conduct in-depth semistructured interviews with 160 individuals -40 each who confront Huntington's Disease, genetically-linked breast cancer, alpha 1 antitrypsin deficiency, and, as a comparison group, coronary artery disease. We have chosen the first 3 of these disorders because our pilot work suggests that critical privacy concerns arise with all 3 of these genetic diseases, but are related to different aspects of these conditions. The findings of this study can enhance further policy, professional and public education, and future research in this area. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: WORKPLACE HEALTH BENEFITS AND EMPLOYEE HEALTH Principal Investigator & Institution: Losasso, Anthony T. Research Associate Professor; None; Northwestern University 633 Clark St Evanston, IL 60208 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 31-AUG-2005 Summary: Most adults in the United States spend well over a third of their waking hours in the workplace. There is little doubt that workplace issues directly affect the health of employees, While employers are often not obligated to offer certain benefits to employees, clearly there exists a symbiotic relationship between employer and employee. The central focus of this proposed Independent Scientist Award application is to study the critical role, both currently realized and in potential, that employers play in the health of their employees. This K02 award would provide an unparalleled opportunity to develop abroad-based research frame in a coherent and unified manner that ties several lines of research together, instead of the piecemeal approach that would
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otherwise be necessary. The central goal is to leverage the support from this award to explore three broad aspects of employer provided health benefits. The first area of research proposes to explore the interaction between local health care market factors, particularly the local health care safety net, and the employer's decision to offer health insurance and the employee's subsequent decision to accept insurance when it is offered. The second area proposes to examine firm behavior with respect to the provision of health care benefits at a national level by specifically looking at responsible health care purchasing behavior by firms. The third area proposes to extend ongoing collaborative relationships to examine several specific disease areas and conditions that employers may affect, such as mental illness, substance abuse, arid leave policies to care for elderly parents. By elucidating the processes by which the majority of Americans receive their health benefits and the characteristics of the benefits in general and for specific conditions, it will be possible to achieve a greater understanding of the means by which coverage and health can be improved for all. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: YOUNG BREAST CANCER SURVIVORS--POPULATION BASED COHORT Principal Investigator & Institution: Bloom, Joan R. Professor; Health Policy and Management; University of California Berkeley Berkeley, CA 94720 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 31-JUL-2002 Summary: We propose to investigate the 5-year effects of breast cancer and its treatment in a cohort of women diagnosed at age 50 or younger who where originally identified through the SEER tumor registry in the San Francisco Bay Area. In Phase I, we will resurvey eligible women from the original cohort of 336 (80 percent response) to assess change in social, emotional and physical concerns and functioning. These findings will inform our proposed Phase II eight session psychoeducation group intervention. We anticipate a sample of 434 women to be randomly assigned to intervention or control. In the intervention arm, participants in each of the 22 groups will learn the latest scientific information about topical issues of relevance to breast cancer. As part of this strategy, the woman will learn (or be re-exposed) to coping skills training and have opportunities to practice these skills. The effect of the intervention will be evaluated using a pre-posttest design. Pre-test in-person interviews will assess health behaviors, physical and mental health, and improved mood; post-test interviews will be conducted by telephone. Because the two samples for the proposed study are population-based, they are representative not only of younger breast cancer survivors, but also the multi-ethnic population of this region of the country. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and 3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age.
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unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “health insurance” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for health insurance in the PubMed Central database: •
More Americans have health insurance. by Sibbald B. 2000 Nov 14; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=80348
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Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study. by Murray SF. 2000 Dec 16; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27552
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US health workers losing their health insurance. by Korcok M. 2002 Jul 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=117106
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with health insurance, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “health insurance” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for health insurance (hyperlinks lead to article summaries): •
A better way to pay. Health insurance should be replaced with an integrated, allinclusive approach to coverage. Author(s): Herzlinger R. Source: Modern Healthcare. 2000 December 11; 30(51): 32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11140017&dopt=Abstract
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A call to action: growing health insurance problem threatens vitality of Georgia hospitals. Author(s): Parker JA. Source: J Med Assoc Ga. 2000 Spring; 89(1): 36-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10820975&dopt=Abstract
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The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A case for no-fault health insurance: from the “worried well” to the “guilty ill.”. Author(s): Terry PE. Source: Am J Health Promot. 1994 January-February; 8(3): 165-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10146852&dopt=Abstract
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A combination approach to children's health insurance. Author(s): Mann C. Source: Health Aff (Millwood). 1998 March-April; 17(2): 229-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9558803&dopt=Abstract
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A comparison of the socioeconomic and health status characteristics of uninsured, state Children's health insurance program-eligible children in the united states with those of other groups of insured children: implications for policy. Author(s): Byck GR. Source: Pediatrics. 2000 July; 106(1 Pt 1): 14-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10878143&dopt=Abstract
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A cross-sectional audit of student health insurance waiver forms: an assessment of reliability and compliance. Author(s): Molnar J. Source: Journal of American College Health : J of Ach. 2002 January; 50(4): 187-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910953&dopt=Abstract
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A different kind of 'new federalism'? The Health Insurance Portability and Accountability Act of 1996. Author(s): Nichols LM, Blumberg LJ. Source: Health Aff (Millwood). 1998 May-June; 17(3): 25-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9637965&dopt=Abstract
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A flexible benefits tax credit for health insurance and more. Author(s): Etheredge L. Source: Health Aff (Millwood). 2002; Suppl: W1-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11911320&dopt=Abstract
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A health insurance scheme for hospital care in Bwamanda District, Zaire: lessons and questions after 10 years of functioning. Author(s): Criel B, Kegels G. Source: Tropical Medicine & International Health : Tm & Ih. 1997 July; 2(7): 654-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9270733&dopt=Abstract
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A health insurance tax credit for uninsured workers. Author(s): Zelenak L. Source: Inquiry. 2001 Summer; 38(2): 106-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11529509&dopt=Abstract
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A national study of commercial health insurance and medicaid definitions of medical necessity: what do they mean for children? Author(s): Fox HB, McManus MA. Source: Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association. 2001 January-February; 1(1): 16-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11888367&dopt=Abstract
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A national study of medical care expenditures for musculoskeletal conditions: the impact of health insurance and managed care. Author(s): Yelin E, Herrndorf A, Trupin L, Sonneborn D. Source: Arthritis and Rheumatism. 2001 May; 44(5): 1160-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11352250&dopt=Abstract
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A non-single payor plan for universal health insurance for Maryland. Author(s): Goodman N. Source: Md Med. 2003 Spring; 4(2): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847823&dopt=Abstract
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A payment method for health insurance purchasing cooperatives. Author(s): Robinson JC. Source: Health Aff (Millwood). 1993; 12 Suppl: 65-75. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8477944&dopt=Abstract
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A prospective cohort study on National Health Insurance beneficiaries in Ohsaki, Miyagi Prefecture, Japan: study design, profiles of the subjects and medical cost during the first year. Author(s): Tsuji I, Nishino Y, Ohkubo T, Kuwahara A, Ogawa K, Watanabe Y, Tsubono Y, Bando T, Kanemura S, Izumi Y, Sasaki A, Fukao A, Nishikori M, Hisamichi S. Source: J Epidemiol. 1998 December; 8(5): 258-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9884474&dopt=Abstract
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A reappraisal of private employers' role in providing health insurance. Author(s): Carrasquillo O, Himmelstein DU, Woolhandler S, Bor DH. Source: The New England Journal of Medicine. 1999 January 14; 340(2): 109-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9887163&dopt=Abstract
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A shifting picture of health insurance coverage. Author(s): Holahan J, Winterbottom C, Rajan S. Source: Health Aff (Millwood). 1995 Winter; 14(4): 253-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8690351&dopt=Abstract
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A study of influenza and influenza-related complications among children in a large US health insurance plan database. Author(s): Loughlin J, Poulios N, Napalkov P, Wegmuller Y, Monto AS. Source: Pharmacoeconomics. 2003; 21(4): 273-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12600222&dopt=Abstract
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A study of Minnesota's high-risk health insurance pool. Author(s): Zellner BB, Haugen DK, Dowd B. Source: Inquiry. 1993 Summer; 30(2): 170-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8314605&dopt=Abstract
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A tale of two visions: the changing fortunes of Social Health Insurance in South Africa. Author(s): McIntyre D, Doherty J, Gilson L. Source: Health Policy and Planning. 2003 March; 18(1): 47-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12582107&dopt=Abstract
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A total of 58 million Americans lack health insurance. Author(s): Marwick C. Source: Bmj (Clinical Research Ed.). 2002 September 28; 325(7366): 678. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358013&dopt=Abstract
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A vote of confidence: attitudes toward employer sponsored health insurance. Author(s): Schoen C, Stumpf E, Davis K. Source: Issue Brief (Commonw Fund). 2000 January; (363): 1-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11584830&dopt=Abstract
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ABC of mandatory health insurance. Author(s): van der Linde I. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1995 August; 85(8): 719, 722, 725. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8553134&dopt=Abstract
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ABCs of health insurance benefits: a practical guide. Author(s): Leyden CG. Source: Pediatric Nursing. 1997 May-June; 23(3): 276-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9220803&dopt=Abstract
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Abortion services under national health insurance: the examples of England and France. Author(s): Henshaw SK. Source: Family Planning Perspectives. 1994 March-April; 26(2): 87-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8033984&dopt=Abstract
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Absence of health insurance is associated with decreased life expectancy in patients with cystic fibrosis. Author(s): Curtis JR, Burke W, Kassner AW, Aitken ML. Source: American Journal of Respiratory and Critical Care Medicine. 1997 June; 155(6): 1921-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9196096&dopt=Abstract
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Acceptability to general practitioners of national health insurance and capitation as a reimbursement mechanism. Author(s): Blecher MS, Bachmann MO, McIntyre D. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1995 September; 85(9): 847-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8545741&dopt=Abstract
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Access for low-income children: is health insurance enough? Author(s): Rosenbach ML, Irvin C, Coulam RF. Source: Pediatrics. 1999 June; 103(6 Pt 1): 1167-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10353924&dopt=Abstract
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Access to family planning services and health insurance among low-income women in Arizona. Author(s): Kirkman-Liff B, Kronenfeld JJ. Source: American Journal of Public Health. 1994 June; 84(6): 1010-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8203666&dopt=Abstract
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Access to health care: health insurance considerations for young adults with special health care needs/disabilities. Author(s): White PH. Source: Pediatrics. 2002 December; 110(6 Pt 2): 1328-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456953&dopt=Abstract
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Addressing challenges, creating opportunities: fostering consumer participation in Medicaid and Children's Health Insurance managed care Programs. Author(s): Molnar C. Source: The Journal of Ambulatory Care Management. 2001 July; 24(3): 61-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11433557&dopt=Abstract
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Addressing the Health Insurance Portability and Accountability Act. Part III--A strategy for achieving compliance: transaction code sets, privacy and security. Author(s): Norman H, Burroughs VJ. Source: Journal of the National Medical Association. 2002 October; 94(10): 861-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408689&dopt=Abstract
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Adolescent health insurance coverage: recent changes and access to care. Author(s): Newacheck PW, Brindis CD, Cart CU, Marchi K, Irwin CE. Source: Pediatrics. 1999 August; 104(2 Pt 1): 195-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10428994&dopt=Abstract
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Adolescents' knowledge of their health insurance coverage. Author(s): Ryan SA, Millstein SG, Kang M, Ensminger ME, Starfield B, Irwin CE Jr. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1998 April; 22(4): 293-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9561461&dopt=Abstract
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Adults without health insurance: do state policies matter? Author(s): Spillman BC. Source: Health Aff (Millwood). 2000 July-August; 19(4): 178-87. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10916972&dopt=Abstract
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Adverse selection and price sensitivity when low-income people have subsidies to purchase health insurance in the private market. Author(s): Swartz K, Garnick DW. Source: Inquiry. 2000 Spring; 37(1): 45-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10892357&dopt=Abstract
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Advisory Council on Health Promotion of the life and health insurance industry: a short history, a large legacy. Author(s): Karson SG. Source: Am J Health Promot. 1993 July-August; 7(6): 416-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10146253&dopt=Abstract
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Affordable health insurance for all is possible by means of a pragmatic approach. Author(s): Tooker J. Source: American Journal of Public Health. 2003 January; 93(1): 106-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511396&dopt=Abstract
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AHIMA provides testimony on coding/classification issues pertaining to HIPAA (Health Insurance Portability and Accountability Act of 1996) implementation. Author(s): Prophet S. Source: J Ahima. 1997 July-August; 68(7): 52-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10168983&dopt=Abstract
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Alternative health insurance schemes: a welfare comparison. Author(s): Hansen BO, Keiding H. Source: Journal of Health Economics. 2002 September; 21(5): 739-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12349880&dopt=Abstract
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American Academy of Pediatrics: Implementation principles and strategies for the State Children's Health Insurance Program. Author(s): Committee on Child Health Financing. Source: Pediatrics. 2001 May; 107(5): 1214-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11331712&dopt=Abstract
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An analysis of private health insurance purchasing decisions with national health insurance in Taiwan. Author(s): Liu TC, Chen CS. Source: Social Science & Medicine (1982). 2002 September; 55(5): 755-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190269&dopt=Abstract
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An epidemiological framework for the formulation of health insurance policy. Author(s): Loue S. Source: The Journal of Legal Medicine. 1993 December; 14(4): 523-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8308449&dopt=Abstract
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An evaluation of universal health insurance in the elderly: burden of disease, utilization, and costs in the Republic of Korea. Author(s): Peabody JW, Robalino DA, Kim JH. Source: Journal of Aging and Health. 2002 May; 14(2): 286-309. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11995744&dopt=Abstract
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An examination of the decline in employment-based health insurance between 1988 and 1993. Author(s): Fronstin P, Snider SC. Source: Inquiry. 1996-97 Winter; 33(4): 317-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9031648&dopt=Abstract
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An investigation of the effects of lifestyle on care-seeking behavior using data from health insurance claims. Author(s): Tarumi K, Hagihara A, Morimoto K. Source: Nippon Eiseigaku Zasshi. 1995 February; 49(6): 984-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7723182&dopt=Abstract
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An outline for HIPAA compliance. Health Insurance Portability and Accountability Act. Author(s): Lax JR. Source: Optometry. 2002 November; 73(11): 711-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12516801&dopt=Abstract
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Analysis of emergency department utilization by elderly patients under National Health Insurance. Author(s): Huang JA, Weng RH, Tsai WC, Hu WH, Yang DY. Source: Kaohsiung J Med Sci. 2003 March; 19(3): 113-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12751871&dopt=Abstract
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Analysis of health insurance cover for reproductive immunology. Author(s): Engemann KJ, Beer AE, Kwak JY, Gruber L. Source: Human Reproduction (Oxford, England). 1996 January; 11(1): 72-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8671161&dopt=Abstract
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Analysis of private health insurance premium growth rates: 1985-1992. Author(s): Feldstein PJ, Wickizer TM. Source: Medical Care. 1995 October; 33(10): 1035-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7475402&dopt=Abstract
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Antibiotic usage in primary care units in Taiwan after the institution of national health insurance. Author(s): Chang SC, Shiu MN, Chen TJ. Source: Diagnostic Microbiology and Infectious Disease. 2001 July; 40(3): 137-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11502383&dopt=Abstract
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Antibiotic use in public hospitals in Taiwan after the implementation of National Health Insurance. Author(s): Chang SC, Chen YC, Hu OY. Source: J Formos Med Assoc. 2001 March; 100(3): 155-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11393108&dopt=Abstract
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Appeal board denies public health insurance coverage to immigrants on Minister's Permits. Author(s): Elliott R. Source: Can Hiv Aids Policy Law Newsl. 1999 Fall-1999 Winter; 5(1): 14-6, 15-7. English, French. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11868551&dopt=Abstract
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Appraising the financial reform in Bulgarian public health care sector: the Health Insurance Act of 1998. Author(s): Pavlova M, Groot W, van Merode F. Source: Health Policy (Amsterdam, Netherlands). 2000 October; 53(3): 185-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10996066&dopt=Abstract
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Are Americans closer than we think to national health insurance? Author(s): Oberlander J. Source: Health Aff (Millwood). 2002 July-August; 21(4): 103-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12117120&dopt=Abstract
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Are prescribed and over-the-counter medicines economic substitutes? A study of the effects of health insurance on medicine choices by the elderly. Author(s): Stuart B, Grana J. Source: Medical Care. 1995 May; 33(5): 487-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7739273&dopt=Abstract
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Arguments for a single-payer national health insurance program. Author(s): Newcomb P. Source: The Nurse Practitioner. 2000 November; 25(11): 8, 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11107602&dopt=Abstract
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Association between health insurance and antibiotics prescribing in four counties in rural China. Author(s): Dong H, Bogg L, Rehnberg C, Diwan V. Source: Health Policy (Amsterdam, Netherlands). 1999 July; 48(1): 29-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10539584&dopt=Abstract
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Association between health insurance coverage of office visit and cancer screening among women. Author(s): Friedman C, Ahmed F, Franks A, Weatherup T, Manning M, Vance A, Thompson BL. Source: Medical Care. 2002 November; 40(11): 1060-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12409851&dopt=Abstract
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Asymmetric information in health insurance: evidence from the National Medical Expenditure Survey. Author(s): Cardon JH, Hendel I. Source: The Rand Journal of Economics. 2001 Autumn; 32(3): 408-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11800005&dopt=Abstract
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Australian health insurance reforms face collapse. Author(s): Zinn C. Source: Bmj (Clinical Research Ed.). 1995 May 20; 310(6990): 1287. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7773037&dopt=Abstract
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Availability of retiree health insurance important factor as near-elderly consider leaving work force. Author(s): Alteras TT. Source: Find Brief. 1999 November; 3(2): 1-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12138920&dopt=Abstract
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Avoiding health insurance crowd-out: evidence from the Medicare as secondary payer legislation. Author(s): Glied S, Stabile M. Source: Journal of Health Economics. 2001 March; 20(2): 239-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11252372&dopt=Abstract
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Barriers to enrollment in a state child health insurance program. Author(s): Kempe A, Renfrew BL, Barrow J, Cherry D, Jones JS, Steiner JF. Source: Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association. 2001 May-June; 1(3): 169-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11888395&dopt=Abstract
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Black and white middle class children who have private health insurance in the United States. Author(s): Weitzman M, Byrd RS, Auinger P. Source: Pediatrics. 1999 July; 104(1 Pt 2): 151-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10390282&dopt=Abstract
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Body MR imaging and CT volume: variations and trends based on an analysis of medicare and fee-for-service health insurance databases. Author(s): Mitchell DG, Parker L, Sunshine JH, Levin DC. Source: Ajr. American Journal of Roentgenology. 2002 July; 179(1): 27-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12076898&dopt=Abstract
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Bradley vs. Gore: how media covered proposals for health insurance reform in the context of the 2000 presidential campaign. Author(s): Mebane F. Source: Journal of Health Communication. 2003 May-June; 8(3): 283-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12857656&dopt=Abstract
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Business associate agreements: a key requirement under the HIPAA privacy regulations. Health Insurance Portability and Accountability Act. Author(s): Sfikas PM. Source: The Journal of the American Dental Association. 2003 January; 134(1): 114-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555967&dopt=Abstract
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California's new Assembly and Senate districts: geographic disparities in health insurance coverage. Author(s): Mendez CA, Wallace SP, Yu H, Meng YY, Chia J, Brown ER. Source: Policy Brief Ucla Cent Health Policy Res. 2003 May; (Pb2003-3): 1-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756982&dopt=Abstract
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Can adverse selection be avoided in a market for individual health insurance? Author(s): Swartz K, Garnick DW. Source: Medical Care Research and Review : Mcrr. 1999 September; 56(3): 373-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10510609&dopt=Abstract
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Can an employer-based health insurance system be just? Author(s): Jecker NS. Source: Journal of Health Politics, Policy and Law. 1993 Fall; 18(3 Pt 2): 657-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8282993&dopt=Abstract
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Can defined contribution health insurance reduce cost growth? Author(s): Nichols LM. Source: Ebri Issue Brief. 2002 June; (246): 1-15. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12098959&dopt=Abstract
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Caroliance. North Carolina's health insurance cooperative for small businesses needs a doctor. Author(s): Lawlor JS, Hall MA. Source: N C Med J. 2000 November-December; 61(6): 352-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11103612&dopt=Abstract
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Carrots and sticks--the fall and fall of private health insurance in Australia. Author(s): Hall J, De Abreu Lourenco R, Viney R. Source: Health Economics. 1999 December; 8(8): 653-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10590468&dopt=Abstract
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Cervical cancer screening in rural NSW: Health Insurance Commission data compared to self-report. Author(s): Hancock L, Sanson-Fisher R, Kentish L. Source: Aust N Z J Public Health. 1998; 22(3 Suppl): 307-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9629814&dopt=Abstract
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Challenges and options for increasing the number of Americans with health insurance. Author(s): Glied SA. Source: Inquiry. 2001 Summer; 38(2): 90-105. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11529519&dopt=Abstract
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Changes in access to care, 1977-1996: the role of health insurance. Author(s): Zuvekas SH, Weinick RM. Source: Health Services Research. 1999 April; 34(1 Pt 2): 271-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10199674&dopt=Abstract
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Changes in drug economy in Israel's health maintenance organizations in the wake of the National Health Insurance Law. Author(s): Sax P. Source: Isr Med Assoc J. 2001 August; 3(8): 605-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11519388&dopt=Abstract
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Changes in health insurance and payment for substance use treatment. Author(s): Oggins J. Source: The American Journal of Drug and Alcohol Abuse. 2003; 29(1): 55-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12731681&dopt=Abstract
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Changes in health insurance coverage within rural and urban environments--1977 to 1987. Author(s): Duncan RP, Seccombe K, Amey C. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 1995 Summer; 11(3): 16976. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10151308&dopt=Abstract
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Changes in reported health status and unmet need for children enrolling in the Kansas Children's Health Insurance Program. Author(s): Fox MH, Moore J, Davis R, Heintzelman R. Source: American Journal of Public Health. 2003 April; 93(4): 579-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12660200&dopt=Abstract
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Changes in the 1995 Current Population Survey and estimates of health insurance coverage. Author(s): Swartz K. Source: Inquiry. 1997 Spring; 34(1): 70-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9146509&dopt=Abstract
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Changes in use of health insurance and food assistance programs in medically underserved communities in the era of welfare reform: an urban study. Author(s): Pati S, Romero D, Chavkin W. Source: American Journal of Public Health. 2002 September; 92(9): 1441-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197970&dopt=Abstract
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Changes in utilization and cost sharing within the Danish National Health Insurance dental program, 1975-90. Author(s): Schwarz E. Source: Acta Odontologica Scandinavica. 1996 February; 54(1): 29-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8669238&dopt=Abstract
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Changing nature of public and private health insurance. Author(s): Goody B, Mentnech R, Riley G. Source: Health Care Financing Review. 2002 Spring; 23(3): 1-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500345&dopt=Abstract
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Characteristics of the nonelderly with selected sources of health insurance and lengths of uninsured spells. Author(s): Copeland C. Source: Ebri Issue Brief. 1998 June; (198): 1-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10179854&dopt=Abstract
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Child health benefits packages: lessons from Minnesota for State Children's Health Insurance Programs. Author(s): Petersen DJ. Source: Maternal and Child Health Journal. 1998 March; 2(1): 55-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10728259&dopt=Abstract
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Child health insurance outreach through the emergency department: a pilot study. Author(s): Gordon JA, Dupuie TA. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2001 November; 8(11): 1088-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11691673&dopt=Abstract
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Child health insurance update. a message from president-elect, Linda Wolfe. Author(s): Wolfe L. Source: Nasnewsletter. 2000 November; 15(5): 9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987334&dopt=Abstract
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Children and health insurance: an overview of recent trends. Author(s): Newacheck PW, Hughes DC, Cisternas M. Source: Health Aff (Millwood). 1995 Spring; 14(1): 244-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7657210&dopt=Abstract
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Children at risk: their health insurance status by state. Author(s): Yudkowsky BK, Tang SF. Source: Pediatrics. 1997 May; 99(5): E2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9113959&dopt=Abstract
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Children first: expanding health insurance coverage for children. Author(s): Havens DM, Hannan C. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1997 March-April; 11(2): 85-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9155354&dopt=Abstract
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Children without health insurance: an analysis of the increase of uninsured children between 1992 and 1993. Author(s): Fronstin P. Source: Inquiry. 1995 Fall; 32(3): 353-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7591048&dopt=Abstract
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Children's health insurance coverage and family structure, 1977-1996. Author(s): Weinick RM, Monheit AC. Source: Medical Care Research and Review : Mcrr. 1999 March; 56(1): 55-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10189777&dopt=Abstract
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Children's Health Insurance Program, (CHIP), North Dakota Healthy Steps. Author(s): Rose W. Source: Prairie Rose. 1998 June-August; 67(2): 11. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12025595&dopt=Abstract
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Children's health insurance program--an opportunity for improvement. Author(s): Lowe M, Havens DH. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1998 September-October; 12(5): 273-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9987261&dopt=Abstract
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Children's health insurance programs: beware of hidden risks. Author(s): Meerschaert JD. Source: Medical Group Management Journal / Mgma. 1999 January-February; 46(1): 10, 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10351681&dopt=Abstract
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Children's health insurance programs: strategies for outreach and enrollment. Author(s): Rissman C. Source: States Health. 1998 December; 8(7): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11503891&dopt=Abstract
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Children's health insurance status and emergency department utilization in the United States. Author(s): Luo X, Liu G, Frush K, Hey LA. Source: Pediatrics. 2003 August; 112(2): 314-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897280&dopt=Abstract
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Children's health insurance, access to care, and health status: new findings. Author(s): Weinick RM, Weigers ME, Cohen JW. Source: Health Aff (Millwood). 1998 March-April; 17(2): 127-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9558790&dopt=Abstract
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Children's health insurance: the difference policy choices make. Author(s): Holahan J, Uccello C, Feder J, Kim J. Source: Inquiry. 2000 Spring; 37(1): 7-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10892354&dopt=Abstract
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China in transition: the new health insurance scheme for the urban employed. Author(s): Hindle D. Source: Aust Health Rev. 2000; 23(3): 122-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11186044&dopt=Abstract
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CHIP: Child Health Insurance Plan Part II. Author(s): Reid D. Source: Kans Nurse. 1998 January; 73(1): 8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9573988&dopt=Abstract
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CHIP: Child Health Insurance Program. Author(s): Reid DL. Source: Kans Nurse. 1997 October; 72(9): 8-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9384124&dopt=Abstract
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Choice of health insurance by families of the mentally ill. Author(s): Deb P, Wilcox-Gok V, Holmes A, Rubin J. Source: Health Economics. 1996 January-February; 5(1): 61-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8653192&dopt=Abstract
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Chronic Illness and health insurance-related job lock. Author(s): Stroupe KT, Kinney ED, Kniesner JJ. Source: Journal of Policy Analysis and Management : [the Journal of the Association for Public Policy Analysis and Management]. 2001 June; 20(3): 525-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12693417&dopt=Abstract
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Citizens' views on health insurance in Croatia. Author(s): Mastilica M, Babic-Bosanac S. Source: Croatian Medical Journal. 2002 August; 43(4): 417-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12187519&dopt=Abstract
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Clients without health insurance at publicly funded HIV counseling and testing sites: implications for early intervention. Author(s): Valdiserri RO, Gerber AR, Dillon BA, Campbell CH Jr. Source: Public Health Reports (Washington, D.C. : 1974). 1995 January-February; 110(1): 47-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7838943&dopt=Abstract
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Clinical research and future improvement in clinical care: the Health Insurance Portability and Accountability Act (HIPAA) and future difficulties but optimism for the way forward. Author(s): Willerson JT, Kereiakes DJ. Source: Circulation. 2003 August 26; 108(8): 919-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12939242&dopt=Abstract
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Clinton signs Kassebaum-Kennedy bill--reduces barriers to health insurance. Author(s): Owens MB. Source: Update Natl Minor Aids Counc. 1996 October-November; : 6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11367430&dopt=Abstract
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Coding for change: the power of the human genome to transform the American Health Insurance System. Author(s): Geetter JS. Source: American Journal of Law & Medicine. 2002; 28(1): 1-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12025537&dopt=Abstract
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Cognition and utilization of Papanicolaou testing after the implementation of National Health Insurance in rural Taiwan. Author(s): Huang CP, Chi LY, Chang HJ, Chou P. Source: J Formos Med Assoc. 1999 January; 98(1): 19-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10063269&dopt=Abstract
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Combining mandatory health insurance and medical savings accounts. Author(s): Zivaljevic N, Kiel JM, Gollatz J, Imbriglia JE. Source: Manag Care Interface. 2002 April; 15(4): 63-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11979708&dopt=Abstract
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Comment: Serving the patient, or self-serving? Nesseim v. Mail Handlers Benefit Plan and health insurance plan interpretation. Author(s): Rembold M. Source: J Health Hosp Law. 1994 May; 27(5): 141-4, 160. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10184209&dopt=Abstract
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Commentary on Canadian health insurance: lessons for the United States. Author(s): Marmor TR. Source: International Journal of Health Services : Planning, Administration, Evaluation. 1993; 23(1): 45-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8425788&dopt=Abstract
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Commentary on IOM report: health insurance is a family matter. Author(s): Fairbrother G. Source: Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association. 2003 March-April; 3(2): 66-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643776&dopt=Abstract
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Commentary: monitoring expanded health insurance for children: challenges and opportunities. Author(s): Newacheck PW, Halfon N, Inkelas M. Source: Pediatrics. 2000 April; 105(4 Pt 2): 1004-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10742363&dopt=Abstract
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Common sense, common ground, and a common language: the Health Insurance Portability and Accountability Act privacy rule. Author(s): Hanson L. Source: Northwest Dent. 2003 January-February; 82(1): 37-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12640777&dopt=Abstract
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Communication with cancer patients. The influence of age, gender, education, and health insurance status. Author(s): Sen M. Source: Annals of the New York Academy of Sciences. 1997 February 20; 809: 514-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9103602&dopt=Abstract
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Communities play key role in extending public health insurance to children. Author(s): Felland L, Benoit AM. Source: Issue Brief Cent Stud Health Syst Change. 2001 October; (44): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11800004&dopt=Abstract
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Community mental health services in Israel: current status and future trends in light of the Netanyahu Commission recommendations and the National Health Insurance Law. Author(s): Hershko S, Ophir M. Source: The Israel Journal of Psychiatry and Related Sciences. 1993; 30(3): 142-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8225931&dopt=Abstract
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Community rating and choice between traditional health insurance and managed care. Author(s): Kifmann M. Source: Health Economics. 1999 November; 8(7): 563-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10544324&dopt=Abstract
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Community rating in health insurance and different benefit packages. Author(s): Kifmann M. Source: Journal of Health Economics. 2002 September; 21(5): 719-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12349879&dopt=Abstract
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Community-based health insurance schemes in India: a review. Author(s): Ranson MK. Source: Natl Med J India. 2003 March-April; 16(2): 79-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816186&dopt=Abstract
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Community-based health insurance. Author(s): Tang SL. Source: World Health Forum. 1997; 18(1): 63-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9233071&dopt=Abstract
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Competition in health insurance--is there such a thing in Iowa? Author(s): Stephenson L. Source: Iowa Med. 2002 January-February; 92(1): 20-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11852844&dopt=Abstract
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Competition still illusive in Iowa's concentrated health insurance market. Author(s): Stephenson LL. Source: Iowa Med. 2003 March-April; 93(2): 18-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728606&dopt=Abstract
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Complying with Health Insurance Portability and Accountability Act: what it means to dietetics practitioners. Author(s): Michael P, Pritchett E. Source: Journal of the American Dietetic Association. 2002 October; 102(10): 1402-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396155&dopt=Abstract
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Complying with the Health Insurance Portability and Accountability Act. Privacy standards. Author(s): Shuren AW, Livsey K. Source: Aaohn Journal : Official Journal of the American Association of Occupational Health Nurses. 2001 November; 49(11): 501-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11760704&dopt=Abstract
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Compulsory health insurance databases. Author(s): Svoljsak J, Dovzan I. Source: Studies in Health Technology and Informatics. 1999; 68: 89-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10725026&dopt=Abstract
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Computerized system for the networking of health services (Proposed solution for the informational support of the health insurance law in Romania). Author(s): Teseleanu M, Afteni V, Sucholotiuc M, Stefan L, Dobre I. Source: Studies in Health Technology and Informatics. 1999; 68: 247-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10724880&dopt=Abstract
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Confidentiality and health insurance fraud. Author(s): Farber NJ, Berger MS, Davis EB, Weiner J, Boyer EG, Ubel PA. Source: Archives of Internal Medicine. 1997 March 10; 157(5): 501-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9066453&dopt=Abstract
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Conflicting aims. Voluntary health insurance and contemporary medical practice. Author(s): Siu AL. Source: Archives of Internal Medicine. 1993 February 22; 153(4): 457-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8435025&dopt=Abstract
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Coping with the Health Insurance Portability and Accountability Act of 1996. Author(s): Coile RC, Blonski E, Trusko B. Source: Russ Coile's Health Trends. 2000 February; 12(4): 1, 3-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10788152&dopt=Abstract
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Cost and performance: a comparison of the individual and group health insurance markets. Author(s): Pauly MV, Percy AM. Source: Journal of Health Politics, Policy and Law. 2000 February; 25(1): 9-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10804471&dopt=Abstract
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Cost effectiveness of ramipril in patients with non-diabetic nephropathy and hypertension: economic evaluation of Ramipril Efficacy in Nephropathy (REIN) Study for Germany from the perspective of statutory health insurance. Author(s): Schadlich PK, Brecht JG, Brunetti M, Pagano E, Rangoonwala B, Huppertz E. Source: Pharmacoeconomics. 2001; 19(5 Pt 1): 497-512. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11465309&dopt=Abstract
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Cost sharing in health insurance--a reexamination. Author(s): Rasell ME. Source: The New England Journal of Medicine. 1995 April 27; 332(17): 1164-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7700293&dopt=Abstract
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Cost-benefit analysis of a new health insurance card and electronic prescription in Germany. Author(s): Lux A. Source: Journal of Telemedicine and Telecare. 2002; 8 Suppl 2: 54-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12217136&dopt=Abstract
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Cost-effectiveness analysis of ramipril in heart failure after myocardial infarction. Economic evaluation of the Acute Infarction Ramipril Efficacy (AIRE) study for Germany from the perspective of Statutory Health Insurance. Author(s): Schadlich PK, Huppertz E, Brecht JG. Source: Pharmacoeconomics. 1998 December; 14(6): 653-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10346417&dopt=Abstract
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Cover yourself. It's getting easier to find affordable health insurance online. Here's how. Author(s): Chatzky J. Source: Time. 2003 April 21; 161(16): 80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747171&dopt=Abstract
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Cross-subsidization in the market for employment-related health insurance. Author(s): Monheit AC, Selden TM. Source: Health Economics. 2000 December; 9(8): 699-714. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11137951&dopt=Abstract
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Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery. Author(s): Kuerer HM, Hwang ES, Anthony JP, Dudley RA, Crawford B, Aubry WM, Esserman LJ. Source: Annals of Surgical Oncology : the Official Journal of the Society of Surgical Oncology. 2000 June; 7(5): 325-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10864338&dopt=Abstract
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Current national health insurance policies for thyroid cancer prophylactic surgery in the United States. Author(s): Dackiw AP, Kuerer HM, Clark OH. Source: World Journal of Surgery. 2002 August; 26(8): 903-6. Epub 2002 June 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12045864&dopt=Abstract
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Data field standards and the Health Insurance Portability and Accountability Act. Author(s): Braithwaite WR. Source: Statistics in Medicine. 2001 May 15-30; 20(9-10): 1323-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11343353&dopt=Abstract
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Data mining approach to policy analysis in a health insurance domain. Author(s): Chae YM, Ho SH, Cho KW, Lee DH, Ji SH. Source: International Journal of Medical Informatics. 2001 July; 62(2-3): 103-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11470613&dopt=Abstract
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Datapoints: mental health parity and employer-sponsored health insurance in 19992000: II. Copayments and coinsurance. Author(s): Pacula RL, Sturm R. Source: Psychiatric Services (Washington, D.C.). 2000 December; 51(12): 1487. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11097639&dopt=Abstract
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Deductibles in health insurance: can the actuarially fair premium reduction exceed the deductible? Author(s): Bakker FM, van Vliet RC, van de Ven WP. Source: Health Policy (Amsterdam, Netherlands). 2000 September; 53(2): 123-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10958993&dopt=Abstract
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Defined-contribution health insurance products: development and prospects. Author(s): Christianson JB, Parente ST, Taylor R. Source: Health Aff (Millwood). 2002 January-February; 21(1): 49-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11900095&dopt=Abstract
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Defining the risk in health insurance. Author(s): Kent P. Source: Nature Medicine. 1995 August; 1(8): 720. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7585160&dopt=Abstract
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Denial of health insurance due to preexisting conditions: how well does one high-risk pool work? Author(s): Sumner B, Dowd B, Pheley AM, Lurie N. Source: Medical Care Research and Review : Mcrr. 1997 September; 54(3): 357-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9437172&dopt=Abstract
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Dental care and health insurance. 1938. Author(s): Swanish PT. Source: Cds Rev. 2000 March; 93(2): 38-40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11276590&dopt=Abstract
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Dentistry in Taiwan, Republic of China: national health insurance reforms, illegal dentistry and plans for peer review quality control. Author(s): Moore R, Shiau YY. Source: Int Dent J. 1999 April; 49(2): 76-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858736&dopt=Abstract
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Design of health insurance purchasing cooperatives. Author(s): Starr P. Source: Health Aff (Millwood). 1993; 12 Suppl: 58-64. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8477943&dopt=Abstract
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Developing a quality improvement database using health insurance data: a guided tour with application to Medicare's National Claims History file. Author(s): Parente ST, Weiner JP, Garnick DW, Richards TM, Fowles J, Lawthers AG, Chandler P, Palmer RH. Source: American Journal of Medical Quality : the Official Journal of the American College of Medical Quality. 1995 Winter; 10(4): 162-76. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8547795&dopt=Abstract
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Developing health insurance in transitional Asia. Author(s): Ensor T. Source: Social Science & Medicine (1982). 1999 April; 48(7): 871-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10192555&dopt=Abstract
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Development of State Health Insurance System in Georgia. Author(s): Kalandadze T, Bregvadze I, Takaishvili R, Archvadze A, Moroshkina N. Source: Croatian Medical Journal. 1999 June; 40(2): 216-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10234065&dopt=Abstract
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Diabetes in employer-sponsored health insurance. Author(s): Peele PB, Lave JR, Songer TJ. Source: Diabetes Care. 2002 November; 25(11): 1964-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401740&dopt=Abstract
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Diabetes prevalence from health insurance data: evaluation of estimates by comparison with a population-based diabetes register. Author(s): Von Ferber L, Salzsieder E, Hauner H, Thoelke H, Koster I, Jutzi E, Michaelis D, Fischer U. Source: Diabete Metab. 1993; 19(1 Pt 2): 89-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8314433&dopt=Abstract
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Diabetes, health insurance, and health-care reform. Author(s): Herman WH, Dasbach EJ. Source: Diabetes Care. 1994 June; 17(6): 611-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8082536&dopt=Abstract
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Differences in health insurance and health service utilization among Asian Americans: method for using the NHIS to identify unique patterns between ethnic groups. Author(s): Ruy H, Young WB, Kwak H. Source: The International Journal of Health Planning and Management. 2002 JanuaryMarch; 17(1): 55-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11963444&dopt=Abstract
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Differences in private health insurance coverage for working male Hispanics. Author(s): Fronstin P, Goldberg LG, Robins PK. Source: Inquiry. 1997 Summer; 34(2): 171-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9256821&dopt=Abstract
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Differences in the effect of patients' socioeconomic status on the use of invasive cardiovascular procedures across health insurance categories. Author(s): Carlisle DM, Leake BD. Source: American Journal of Public Health. 1998 July; 88(7): 1089-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9663160&dopt=Abstract
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Dipping into the HIPAA question box. Health Insurance Portability and Accountability Act's. Author(s): Lax JR. Source: Optometry. 2002 August; 73(8): 516-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12365676&dopt=Abstract
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Direct contracts, data sharing and employee risk selection: new stakes for patient privacy in tomorrow's health insurance markets. Author(s): Studdert DM. Source: American Journal of Law & Medicine. 1999; 25(2-3): 233-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10476330&dopt=Abstract
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Discrepancies in employer-sponsored health insurance among Hispanics, blacks, and whites: the effects of sociodemographic and employment factors. Author(s): Seccombe K, Clarke LL, Coward RT. Source: Inquiry. 1994 Summer; 31(2): 221-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8021027&dopt=Abstract
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Do enrollees in 'look-alike' Medicaid and SCHIP programs really look alike? State Children's Health Insurance Program. Author(s): Edwards JN, Bronstein J, Rein DB. Source: Health Aff (Millwood). 2002 May-June; 21(3): 240-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12025990&dopt=Abstract
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Does chronic illness affect the adequacy of health insurance coverage? Author(s): Stroupe KT, Kinney ED, Kniesner TJ. Source: Journal of Health Politics, Policy and Law. 2000 April; 25(2): 309-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10946382&dopt=Abstract
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Does employment-related health insurance inhibit job mobility? Author(s): Cooper PF, Monheit AC. Source: Inquiry. 1993 Winter; 30(4): 400-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8288403&dopt=Abstract
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Does type of health insurance affect cancer care, diagnosis? Author(s): Jones J. Source: Journal of the National Cancer Institute. 2001 June 6; 93(11): 807-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11390528&dopt=Abstract
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Does type of health insurance affect health care use and assessments of care among the privately insured? Author(s): Reschovsky JD, Kemper P, Tu H. Source: Health Services Research. 2000 April; 35(1 Pt 2): 219-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10778811&dopt=Abstract
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Does universal health insurance make health care unaffordable? Lessons from Taiwan. Author(s): Lu JF, Hsiao WC. Source: Health Aff (Millwood). 2003 May-June; 22(3): 77-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757274&dopt=Abstract
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Donor and the health insurance card. Author(s): Posega A, Dusica PR. Source: Studies in Health Technology and Informatics. 1999; 68: 858-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10725019&dopt=Abstract
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Dynamics of people without health insurance. Don't let the numbers fool you. Author(s): Swartz K. Source: Jama : the Journal of the American Medical Association. 1994 January 5; 271(1): 64-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8258891&dopt=Abstract
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Early experience with 'new federalism' in health insurance regulation. Author(s): Pollitz K, Tapay N, Hadley E, Specht J. Source: Health Aff (Millwood). 2000 July-August; 19(4): 7-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10916957&dopt=Abstract
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Eating disorders and health insurance understanding and overcoming obstacles to treatment. Author(s): Silber TJ, Robb AS. Source: Child Adolesc Psychiatr Clin N Am. 2002 April; 11(2): 419-28, Xii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12109329&dopt=Abstract
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Eating disorders and health insurance. Author(s): Silber TJ. Source: Archives of Pediatrics & Adolescent Medicine. 1994 August; 148(8): 785-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8044253&dopt=Abstract
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Economic change and health benefits: structural trends in employer-based health insurance. Author(s): Cubbins LA, Parmer P. Source: Journal of Health and Social Behavior. 2001 March; 42(1): 45-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11357718&dopt=Abstract
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Educational level, voluntary private health insurance and opportunistic cancer screening among women in Catalonia (Spain). Author(s): Borras JM, Guillen M, Sanchez V, Junca S, Vicente R. Source: European Journal of Cancer Prevention : the Official Journal of the European Cancer Prevention Organisation (Ecp). 1999 October; 8(5): 427-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10548398&dopt=Abstract
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Effect of Child Health Insurance Plan enrollment on the utilization of health care services by children using a public safety net system. Author(s): Eisert S, Gabow P. Source: Pediatrics. 2002 November; 110(5): 940-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415034&dopt=Abstract
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Effect of private health insurance on health care access and health status of diabetic patients covered by Medicare. Author(s): Harris MI. Source: Diabetes Care. 2002 February; 25(2): 405-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11815524&dopt=Abstract
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Effect of the North Carolina State Children's Health Insurance Program on Beneficiary Access to Care. Author(s): Slifkin RT, Freeman VA, Silberman P. Source: Archives of Pediatrics & Adolescent Medicine. 2002 December; 156(12): 1223-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444834&dopt=Abstract
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Effect of utilization review in a fee-for-service health insurance plan. Author(s): Rosenberg SN, Allen DR, Handte JS, Jackson TC, Leto L, Rodstein BM, Stratton SD, Westfall G, Yasser R. Source: The New England Journal of Medicine. 1995 November 16; 333(20): 1326-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7566025&dopt=Abstract
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Effects of “second generation” small group health insurance market reforms, 1993 to 1997. Author(s): Marquis MS, Long SH. Source: Inquiry. 2001-2002 Winter; 38(4): 365-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887955&dopt=Abstract
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Effects of health insurance and race on breast carcinoma treatments and outcomes. Author(s): Roetzheim RG, Gonzalez EC, Ferrante JM, Pal N, Van Durme DJ, Krischer JP. Source: Cancer. 2000 December 1; 89(11): 2202-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11147590&dopt=Abstract
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Effects of health insurance and race on colorectal cancer treatments and outcomes. Author(s): Roetzheim RG, Pal N, Gonzalez EC, Ferrante JM, Van Durme DJ, Krischer JP. Source: American Journal of Public Health. 2000 November; 90(11): 1746-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11076244&dopt=Abstract
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Effects of health insurance and race on early detection of cancer. Author(s): Roetzheim RG, Pal N, Tennant C, Voti L, Ayanian JZ, Schwabe A, Krischer JP. Source: Journal of the National Cancer Institute. 1999 August 18; 91(16): 1409-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10451447&dopt=Abstract
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Effects of state reforms on health insurance coverage of adults. Author(s): Sloan FA, Conover CJ. Source: Inquiry. 1998 Fall; 35(3): 280-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9809056&dopt=Abstract
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Effects of the Health Insurance Portability and Accountability Act of 1996. Author(s): Mathews B. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 1997 April; 51(4): 91-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10166284&dopt=Abstract
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EJPH Policy Forum: risk adjustment strategies in three social health insurance countries. Author(s): Saltman RB. Source: European Journal of Public Health. 2001 June; 11(2): 121. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11420795&dopt=Abstract
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Eligibility under State Children's Health Insurance Programs. Author(s): Ullman F, Hill I. Source: American Journal of Public Health. 2001 September; 91(9): 1449-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11527780&dopt=Abstract
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Employee demand for health insurance and employer health plan choices. Author(s): Bundorf MK. Source: Journal of Health Economics. 2002 January; 21(1): 65-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11845926&dopt=Abstract
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Employer health insurance plans and the ADA: new EEOC guidelines will cause collision. Author(s): Lorber LZ, Kirk JR, Robinson S. Source: Healthspan. 1993 September; 10(8): 3-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10171702&dopt=Abstract
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Employer health insurance premium subsidies unlikely to enhance coverage significantly. Author(s): Reschovsky JD, Hadley J. Source: Issue Brief Cent Stud Health Syst Change. 2001 December; (46): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11865904&dopt=Abstract
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Employer-based health insurance and seniors: the case of Bermuda. Author(s): Chappell NL, Penning MJ. Source: The Gerontologist. 1996 February; 36(1): 63-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8932411&dopt=Abstract
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Employer-based health insurance in a changing work force. Author(s): Chollet D. Source: Health Aff (Millwood). 1994 Spring; 13(1): 315-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8188151&dopt=Abstract
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Employer-based health insurance: a balance sheet. Author(s): Reinhardt UE. Source: Health Aff (Millwood). 1999 November-December; 18(6): 124-32. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10650694&dopt=Abstract
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Employers' benefits from workers' health insurance. Author(s): O'Brien E. Source: The Milbank Quarterly. 2003; 81(1): 5-43, Table of Contents. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12669650&dopt=Abstract
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Employer-sponsored health insurance and mandated benefit laws. Author(s): Jensen GA, Morrisey MA. Source: The Milbank Quarterly. 1999; 77(4): 425-59. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10656028&dopt=Abstract
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Employer-sponsored health insurance: are employers good agents for their employees? Author(s): Peele PB, Lave JR, Black JT, Evans JH 3rd. Source: The Milbank Quarterly. 2000; 78(1): 5-21, I. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10834079&dopt=Abstract
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Employment-based health insurance for children: why did coverage increase in the mid-1990s? Author(s): Fronstin P. Source: Health Aff (Millwood). 1999 September-October; 18(5): 131-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10495600&dopt=Abstract
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Employment-based health insurance: implications of the sampling unit for policy analysis. Author(s): Zarkin GA, Garfinkel SA, Potter FJ, McNeill JJ. Source: Inquiry. 1995 Fall; 32(3): 310-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7591044&dopt=Abstract
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Employment-related health insurance: federal agencies' roles in meeting data needs. Author(s): Wiatrowski W, Harvey H, Levit KR. Source: Health Care Financing Review. 2002 Spring; 23(3): 115-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500352&dopt=Abstract
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Enrollment in the State Child Health Insurance Program: a conceptual framework for evaluation and continuous quality improvement. Author(s): Halfon N, Inkelas M, Newacheck PW. Source: The Milbank Quarterly. 1999; 77(2): 181-204, 173. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10392161&dopt=Abstract
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Ensuring protection from genetic discrimination in health insurance. Author(s): Slaughter L. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 1997 June; 1(3): 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9271952&dopt=Abstract
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Equity in health care access to: assessing the urban health insurance reform in China. Author(s): Liu GG, Zhao Z, Cai R, Yamada T, Yamada T. Source: Social Science & Medicine (1982). 2002 November; 55(10): 1779-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12383462&dopt=Abstract
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Erosion of employer-sponsored health insurance coverage and quality. Author(s): Schoen C, Davis K. Source: Issue Brief (Commonw Fund). 1998 September; (297): 1-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11583041&dopt=Abstract
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Ethics and the drafting of the “National Health Insurance Bill”. Author(s): Phaosavasdi S, Tannirandorn Y, Kullavanijaya P, Taneepanichskul S, Karnjanapitak A. Source: J Med Assoc Thai. 2002 August; 85(8): 949-52. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12403219&dopt=Abstract
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Evaluating Child Health Plus in upstate New York: how much does providing health insurance to uninsured children increase health care costs? Author(s): Zwanziger J, Mukamel DB, Szilagyi PG, Trafton S, Dick AW, Holl JL, Rodewald LE, Shone LP, Jarrell L, Raubertas RF. Source: Pediatrics. 2000 March; 105(3 Suppl E): 728-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10699151&dopt=Abstract
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Evaluating the State Children's Health Insurance Program: critical considerations. Author(s): Starfield B. Source: Annual Review of Public Health. 2000; 21: 569-85. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10884965&dopt=Abstract
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Evaluation of a state health insurance program for low-income children: implications for state child health insurance programs. Author(s): Szilagyi PG, Zwanziger J, Rodewald LE, Holl JL, Mukamel DB, Trafton S, Shone LP, Dick AW, Jarrell L, Raubertas RF. Source: Pediatrics. 2000 February; 105(2): 363-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10654957&dopt=Abstract
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Evaluation of children's health insurance: from New York State's CHild Health Plus to SCHIP. Author(s): Szilagyi PG, Holl JL, Rodewald LE, Shone LP, Zwanziger J, Mukamel DB, Trafton S, Dick AW, Raubertas RF. Source: Pediatrics. 2000 March; 105(3 Suppl E): 687-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10699145&dopt=Abstract
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Evidence-based health policy-making, hospital funding and health insurance. Author(s): Palmer GR. Source: The Medical Journal of Australia. 2000 February 7; 172(3): 130-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10735025&dopt=Abstract
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Evolution of a children's health insurance program: lessons from New York State's Child Health Plus. Author(s): Trafton S, Shone LP, Zwanziger J, Mukamel DB, Dick AW, Holl JL, Rodewald LE, Raubertas RF, Szilagyi PG. Source: Pediatrics. 2000 March; 105(3 Suppl E): 692-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10699146&dopt=Abstract
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Evolution of the American Nurses Association's position on health insurance for the aged: 1933-1965. Author(s): Woods CQ. Source: Nursing Research. 1996 September-October; 45(5): 304-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8831658&dopt=Abstract
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Examining the links between retirement and health insurance: implications for Medicare eligibility. Author(s): Jones NS. Source: Issue Brief Natl Health Policy Forum. 1999 March 24; (733): 1-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10558401&dopt=Abstract
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Expanding health insurance coverage for smoking cessation treatments: experience of the Pacific Business Group on Health. Author(s): Harris JR, Schauffler HH, Milstein A, Powers P, Hopkins DP. Source: Am J Health Promot. 2001 May-June; 15(5): 350-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11502016&dopt=Abstract
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Expanding health insurance coverage for uninsured children: the next step in health care reform? Author(s): Markus AR, DeGraw C. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1997 September-October; 10(5): 363-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9297662&dopt=Abstract
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Expanding health insurance for children: examining the alternatives. Author(s): Fronstin P, Pierron B. Source: Ebri Issue Brief. 1997 July; (187): 1-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10169788&dopt=Abstract
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Expanding individual health insurance coverage: are high-risk pools the answer? Author(s): Chollet D. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W349-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703590&dopt=Abstract
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Experiences of families that applied for government-sponsored child health insurance: report of a follow-up study in New York City. Author(s): Boslaugh S, Fairbrother G, Dutton M, Hyson DM, Lobach KS. Source: Journal of Urban Health : Bulletin of the New York Academy of Medicine. 1999 September; 76(3): 335-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607900&dopt=Abstract
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Experiences of working-age adults in the individual insurance market: findings from The Commonwealth Fund 2001 Health Insurance Survey. Author(s): Duchon L, Schoen C. Source: Issue Brief (Commonw Fund). 2001 December; (514): 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11958229&dopt=Abstract
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Explaining the decline in health insurance coverage among young men. Author(s): Glied S, Stabile M. Source: Inquiry. 2000 Fall; 37(3): 295-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11111286&dopt=Abstract
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Explaining the decline in health insurance coverage, 1979-1995. Author(s): Kronick R, Gilmer T. Source: Health Aff (Millwood). 1999 March-April; 18(2): 30-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10091430&dopt=Abstract
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Explaining trends in health insurance coverage between 1988 and 1991. Author(s): Acs G. Source: Inquiry. 1995 Spring; 32(1): 102-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7713610&dopt=Abstract
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Extended applications with smart cards for integration of health care and health insurance services. Author(s): Sucholotiuc M, Stefan L, Dobre I, Teseleanu M. Source: Studies in Health Technology and Informatics. 2000; 77: 1010-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11187474&dopt=Abstract
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Factors related to dissatisfaction with the National Health Insurance among primary care physicians in Taiwan. Author(s): Lin HC, Chang WY, Tung YC. Source: Chang Gung Med J. 2003 February; 26(2): 81-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12718384&dopt=Abstract
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Family income and health insurance coverage for women in California. Author(s): Wyn R, Pourat N. Source: Policy Brief Ucla Cent Health Policy Res. 1997 June; (Pb 97-4): 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11475520&dopt=Abstract
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Family income and the impact of a children's health insurance program on reported need for health services and unmet health need. Author(s): Feinberg E, Swartz K, Zaslavsky A, Gardner J, Walker DK. Source: Pediatrics. 2002 February; 109(2): E29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11826239&dopt=Abstract
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Family, work, and access to health insurance among mature women. Author(s): Meyer MH, Pavalko EK. Source: Journal of Health and Social Behavior. 1996 December; 37(4): 311-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8997887&dopt=Abstract
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Federal regulation comes to private health care financing: the group health insurance provisions of the Health Insurance Portability and Accountability Act of 1996. Author(s): Rovner JA. Source: Ann Health Law. 1998; 7: 183-215. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10187379&dopt=Abstract
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Federally sponsored insurance programs for children: the State Children's Health Insurance Program. Author(s): Velsor-Friedrich B. Source: Journal of Pediatric Nursing. 2003 April; 18(2): 134-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12720210&dopt=Abstract
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Finance issue brief: the Health Insurance Portability and Accountability Act of 1996. Author(s): Plaza CI. Source: Issue Brief Health Policy Track Serv. 2000 July 3; : 1-11. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11073436&dopt=Abstract
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Findings of anthropometric and laboratory data from adult health screening under the National Health Insurance plan in Taiwan. Author(s): Huang YG, Tseng HM, Luo JC. Source: Chang Gung Med J. 2002 January; 25(1): 29-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926584&dopt=Abstract
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First, do no harm: developing health insurance market reform packages. Author(s): Blumberg LJ, Nichols LM. Source: Health Aff (Millwood). 1996 Fall; 15(3): 35-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8854507&dopt=Abstract
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Forces promoting health insurance coverage of homebirth: a case study in Washington State. Author(s): Hartley H, Gasbarro C. Source: Women Health. 2002; 36(3): 13-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12539790&dopt=Abstract
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France faces radical health insurance reforms. Author(s): Dorozynski A. Source: Bmj (Clinical Research Ed.). 1995 November 25; 311(7017): 1386. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8520264&dopt=Abstract
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France gears up to fight health insurance debts. Author(s): Dorozynski A. Source: Bmj (Clinical Research Ed.). 1995 October 14; 311(7011): 967-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7580629&dopt=Abstract
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Fraud and abuse provisions in the Health Insurance Portability and Accountability Act: a guide to the new act for physicians. Author(s): McCampbell RG. Source: J Okla State Med Assoc. 1997 April; 90(4): 139-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9143159&dopt=Abstract
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Frequency of 'obesity' in medical records and utilization of out-patient health care by 'obese' subjects in Germany. An analysis of health insurance data. Author(s): Hauner H, Koster I, von Ferber L. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 1996 September; 20(9): 820-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8880348&dopt=Abstract
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Future prospects of voluntary health insurance in Thailand. Author(s): Supakankunti S. Source: Health Policy and Planning. 2000 March; 15(1): 85-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10731239&dopt=Abstract
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Gaining and losing health insurance: strengthening the evidence for effects on access to care and health outcomes. Author(s): Kasper JD, Giovannini TA, Hoffman C. Source: Medical Care Research and Review : Mcrr. 2000 September; 57(3): 298-318; Discussion 319-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10981187&dopt=Abstract
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Gaps and transitions in health insurance: what are the concerns of women? Author(s): Short PF. Source: Journal of Women's Health / the Official Publication of the Society for the Advancement of Women's Health Research. 1998 August; 7(6): 725-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9718541&dopt=Abstract
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Gender impacts on health insurance coverage: findings for unmarried full-time employees. Author(s): Dewar DM. Source: Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health. 2000 September-October; 10(5): 268-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10980444&dopt=Abstract
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General practitioners and national health insurance--results of a national survey. Author(s): Blecher MS, Jacobs T, McIntyre D. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1999 May; 89(5): 534-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10416457&dopt=Abstract
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Generation vexed: age-cohort differences in employer-sponsored health insurance coverage. Author(s): Glied S, Stabile M. Source: Health Aff (Millwood). 2001 January-February; 20(1): 184-91. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11194840&dopt=Abstract
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Genetic discrimination and health insurance: a call for legislative action. Author(s): Rothenberg KH. Source: J Am Med Womens Assoc. 1997 Winter; 52(1): 43-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9033173&dopt=Abstract
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Genetic discrimination and health insurance: an urgent need for reform. Author(s): Hudson KL, Rothenberg KH, Andrews LB, Kahn MJ, Collins FS. Source: Science. 1995 October 20; 270(5235): 391-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7569991&dopt=Abstract
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Genetic discrimination in health insurance. Author(s): Egan LE. Source: Spec Law Dig Health Care Law. 1999 May; (242): 9-19. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10537645&dopt=Abstract
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Genetic discrimination in health insurance: an overview and analysis of the issues. Author(s): Roth MT, Painter RB. Source: Nurs Clin North Am. 2000 September; 35(3): 731-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10957687&dopt=Abstract
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Genetic information and health insurance: state legislative approaches. Author(s): Rothenberg KH. Source: The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics. 1995 Winter; 23(4): 312-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8715051&dopt=Abstract
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Genetic predispositions, prophylactic treatments and private health insurance: nothing is better than a good pair of genes. Author(s): Glazier AK. Source: American Journal of Law & Medicine. 1997; 23(1): 45-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9199732&dopt=Abstract
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Genetic testing and health insurance practices: an industry perspective. Author(s): Volpe LC. Source: Genetic Testing. 1998; 2(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10464592&dopt=Abstract
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Genetic testing when there is a mix of compulsory and voluntary health insurance. Author(s): Hoel M, Iversen T. Source: Journal of Health Economics. 2002 March; 21(2): 253-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11939241&dopt=Abstract
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Genetic testing: issues related to privacy, employment, and health insurance. Author(s): Carnovale BV, Clanton MS. Source: Cancer Practice. 2002 March-April; 10(2): 102-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903275&dopt=Abstract
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Going bare: trends in health insurance coverage, 1989 through 1996. Author(s): Carrasquillo O, Himmelstein DU, Woolhandler S, Bor DH. Source: American Journal of Public Health. 1999 January; 89(1): 36-42. Erratum In: Am J Public Health 1999 February; 89(2): 256. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9987462&dopt=Abstract
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Good managed care needs universal health insurance. Author(s): Light DW. Source: Annals of Internal Medicine. 1999 April 20; 130(8): 686-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10215566&dopt=Abstract
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Government as reinsurer for very-high-cost persons in nongroup health insurance markets. Author(s): Swartz K. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W380-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703597&dopt=Abstract
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Government policymaking, private health insurance and hospital-efficiency issues. Author(s): Palmer GR. Source: The Medical Journal of Australia. 2000 May 1; 172(9): 413-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10870530&dopt=Abstract
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Graduate students' health insurance status and preferences. Author(s): Smith DG. Source: Journal of American College Health : J of Ach. 1995 January; 43(4): 163-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7860872&dopt=Abstract
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Guaranteed renewability and the problem of risk variation in individual health insurance markets. Author(s): Patel V, Pauly MV. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W280-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703584&dopt=Abstract
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Has the increase in private health insurance uptake affected the Victorian public hospital surgical waiting list? Author(s): Hanning B. Source: Aust Health Rev. 2002; 25(6): 64-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12536864&dopt=Abstract
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Health and health insurance. Author(s): Addy BF. Source: Archives of Internal Medicine. 2001 January 8; 161(1): 128. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11146714&dopt=Abstract
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Health care workers' unions and health insurance: the 1199 story. Author(s): Berliner HS, Gibson G, Devine-Perez C. Source: International Journal of Health Services : Planning, Administration, Evaluation. 2001; 31(2): 279-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11407171&dopt=Abstract
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Health insurance and access to care for symptomatic conditions. Author(s): Baker DW, Shapiro MF, Schur CL. Source: Archives of Internal Medicine. 2000 May 8; 160(9): 1269-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10809029&dopt=Abstract
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Health insurance and discrimination concerns and BRCA1/2 testing in a clinic population. Author(s): Peterson EA, Milliron KJ, Lewis KE, Goold SD, Merajver SD. Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 2002 January; 11(1): 79-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11815404&dopt=Abstract
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Health insurance and family structure: the case of adolescents in skipped-generation families. Author(s): Kirby JB, Kaneda T. Source: Medical Care Research and Review : Mcrr. 2002 June; 59(2): 146-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12053820&dopt=Abstract
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Health insurance and female labor supply in Taiwan. Author(s): Chou YJ, Staiger D. Source: Journal of Health Economics. 2001 March; 20(2): 187-211. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11252370&dopt=Abstract
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Health insurance and health access. Reengineering local safety nets. Author(s): Bovbjerg RR, Ullman FC. Source: The Journal of Legal Medicine. 2001 June; 22(2): 247-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11467035&dopt=Abstract
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Health insurance and health services utilization in Ireland. Author(s): Harmon C, Nolan B. Source: Health Economics. 2001 March; 10(2): 135-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11252044&dopt=Abstract
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Health insurance and hospitalisation in urban China: bending to the wind of change. Author(s): Gao J, Tang S. Source: World Hosp Health Serv. 2000; 36(3): 23-6, 36, 38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11276940&dopt=Abstract
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Health insurance and mammography: would a Medicare buy-in take us to universal screening? Author(s): Taylor DH Jr, Van Scoyoc L, Hawley ST. Source: Health Services Research. 2002 December; 37(6): 1469-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12546282&dopt=Abstract
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Health insurance and retirement behavior: evidence from the health and retirement survey. Author(s): Rogowski J, Karoly L. Source: Journal of Health Economics. 2000 July; 19(4): 529-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11010239&dopt=Abstract
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Health insurance and the poor in low income countries. Author(s): Grant K, Grant R. Source: World Hosp Health Serv. 2003; 39(1): 19-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12743884&dopt=Abstract
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Health insurance coverage after welfare. Author(s): Garrett B, Holahan J. Source: Health Aff (Millwood). 2000 January-February; 19(1): 175-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10645085&dopt=Abstract
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Health insurance coverage and the job market in California. Author(s): Fronstin P. Source: Ebri Issue Brief. 2000 September; Spec No 36: 1-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11184547&dopt=Abstract
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Health insurance coverage for oral diseases. Toward a more sophisticated model. Author(s): Weiss HS, Hecht L, Friedland B. Source: The Journal of Legal Medicine. 2003 June; 24(2): 175-98. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775407&dopt=Abstract
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Health insurance coverage of adoption costs. Author(s): Grossman RA. Source: J Reprod Med. 2000 October; 45(10): 863-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11077644&dopt=Abstract
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Health insurance coverage of Californians improved in 1999--but 6.8 million remained uninsured. Author(s): Brown ER, Kincheloe J, Yu H. Source: Policy Brief Ucla Cent Health Policy Res. 2001 February; (Pb2001-1): 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11665702&dopt=Abstract
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Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin. Author(s): Carrasquillo O, Carrasquillo AI, Shea S. Source: American Journal of Public Health. 2000 June; 90(6): 917-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10846509&dopt=Abstract
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Health insurance coverage-enrollment and adequacy of prenatal care utilization. Author(s): Cokkinides V; American Cancer Society. Source: Journal of Health Care for the Poor and Underserved. 2001 November; 12(4): 461-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11688196&dopt=Abstract
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Health insurance expansion through states in a pluralistic system. Author(s): Gold MR, Mittler J, Aizer A, Lyons B, Schoen C. Source: Journal of Health Politics, Policy and Law. 2001 June; 26(3): 581-615. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11430253&dopt=Abstract
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Health insurance expansions for working families: a comparison of targeting strategies. Author(s): Ferry DH, Garrett B, Glled S, Greenman EK, Nichols LM. Source: Health Aff (Millwood). 2002 July-August; 21(4): 246-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12117137&dopt=Abstract
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Health Insurance family style: public approaches to reaching the uninsured. Author(s): Ryan JM. Source: Issue Brief Natl Health Policy Forum. 2001 September 24; (767): 1-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11678148&dopt=Abstract
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Health insurance flexibility and accountability initiative: opportunities and issues for states. Author(s): Engquist G, Burns P. Source: State Coverage Initiat Issue Brief. 2002 August; 3(2): 1-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211258&dopt=Abstract
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Health insurance for all. Author(s): Cormier LF, Thomson C. Source: School Nurse News. 2003 January; 20(1): 18-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616764&dopt=Abstract
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Health insurance for Americans approaching age sixty-five: an analysis of options for incremental reform. Author(s): Short PF, Shea DG, Powell MP. Source: Journal of Health Politics, Policy and Law. 2003 February; 28(1): 41-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705417&dopt=Abstract
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Health insurance for children: a new federal initiative and opportunity. Author(s): Waldman HB, Swerdloff M. Source: Asdc J Dent Child. 1999 March-April; 66(2): 136-9, 85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10431625&dopt=Abstract
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Health insurance for unemployed workers. Author(s): Rowland D, Garfield R. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2002 February 15; 4(1): 5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11965207&dopt=Abstract
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Health insurance for workers who lose jobs: implications for various subsidy schemes. Author(s): Kapur K, Marquis MS. Source: Health Aff (Millwood). 2003 May-June; 22(3): 203-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757286&dopt=Abstract
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Health insurance in India. Author(s): Ranson MK. Source: Lancet. 2001 November 3; 358(9292): 1555-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11705612&dopt=Abstract
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Health insurance in rural America. Author(s): Pol L. Source: Rural Policy Brief. 2000 August; 5(11(Pb2000-11)): 1-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11688507&dopt=Abstract
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Health insurance in South Africa: an empirical analysis of trends in risk-pooling and efficiency following deregulation. Author(s): Soderlund N, Hansl B. Source: Health Policy and Planning. 2000 December; 15(4): 378-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11124240&dopt=Abstract
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Health insurance in the Philippines: bold policies and socio-economic realities. Author(s): Hindle D, Acuin L, Valera M. Source: Aust Health Rev. 2001; 24(2): 96-111. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11496478&dopt=Abstract
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Health insurance knowledge among Medicare beneficiaries. Author(s): McCormack LA, Garfinkel SA, Hibbard JH, Keller SD, Kilpatrick KE, Kosiak B. Source: Health Services Research. 2002 February; 37(1): 43-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11949925&dopt=Abstract
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Health insurance markets and income inequality: findings from an international health policy survey. Author(s): Schoen C, Davis K, DesRoches C, Donelan K, Blendon R. Source: Health Policy (Amsterdam, Netherlands). 2000 March; 51(2): 67-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10699676&dopt=Abstract
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Health insurance may be improving--but not for individuals with mental illness. Author(s): Sturm R, Wells K. Source: Health Services Research. 2000 April; 35(1 Pt 2): 253-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10778813&dopt=Abstract
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Health Insurance Portability and Accountability Act (HIPAA). Implications for dental practice. Author(s): Pai SS, Zimmerman JL. Source: Dent Today. 2002 October; 21(10): 106-11; Quiz 111, 178. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12382499&dopt=Abstract
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Health Insurance Portability and Accountability Act (HIPAA): must there be a tradeoff between privacy and quality of health care, or can we advance both? Author(s): Califf RM, Muhlbaier LH. Source: Circulation. 2003 August 26; 108(8): 915-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12939241&dopt=Abstract
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Health Insurance Portability and Accountability Act is here: what price privacy? Author(s): Fleisher LD, Cole LJ. Source: Genetics in Medicine : Official Journal of the American College of Medical Genetics. 2001 July-August; 3(4): 286-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11478528&dopt=Abstract
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Health Insurance Portability and Accountability Act of 1996 (HIPAA): a provider's overview of new privacy regulations. Author(s): Blechner B, Butera A. Source: Conn Med. 2002 February; 66(2): 91-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11908191&dopt=Abstract
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Health Insurance Portability and Accountability Act of 1996: lessons from the States. Author(s): Hing E, Jensen GA. Source: Medical Care. 1999 July; 37(7): 692-705. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10424640&dopt=Abstract
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Health Insurance Portability and Accountability Act of 1996: new national medical privacy standards. Author(s): Boyle BA, Bradley T, Bradley H. Source: Aids Read. 2003 June; 13(6): 261-2, 265-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846170&dopt=Abstract
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Health Insurance Portability and Accountability Act protects privacy of medical records. Author(s): Gomez E. Source: Ons News / Oncology Nursing Society. 2003 January; 18(1): 13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12599864&dopt=Abstract
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Health Insurance Portability and Accountability Act: administrative simplification to understand the revised proposed privacy standards--a policy update. Author(s): Rocchiccioli J. Source: The Journal of the Association of Nurses in Aids Care : Janac. 2003 March-April; 14(2): 63-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698767&dopt=Abstract
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Health insurance problems are not going away. Author(s): Swartz K. Source: Inquiry. 2000 Fall; 37(3): 231-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11111281&dopt=Abstract
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Health insurance programs for children. Author(s): Douglas CY. Source: Journal of Pediatric Nursing. 2001 February; 16(1): 63-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11247526&dopt=Abstract
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Health insurance purchasing cooperatives. Author(s): Wicks EK. Source: Issue Brief (Commonw Fund). 2002 November; (567): 1-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12463200&dopt=Abstract
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Health insurance rebates in sports medicine should consider scientific evidence. Author(s): Orchard J. Source: J Sci Med Sport. 2002 December; 5(4): V-Viii. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585610&dopt=Abstract
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Health insurance record: an additional educational tool in teaching health insurance. Author(s): Vozikis A, Georgiakodis F. Source: Studies in Health Technology and Informatics. 2000; 57: 238-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10947661&dopt=Abstract
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Health insurance reform. Author(s): Jameson MG, Smoot-Haselnus C, Bielenson P. Source: Md Med. 2003 Winter; 4(1): 11-5, 21. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12652854&dopt=Abstract
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Health insurance reform: modifications to electronic data transaction standards and code sets. Final rule. Author(s): Office of the Secretary, HHS. Source: Federal Register. 2003 February 20; 68(34): 8381-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596713&dopt=Abstract
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Health insurance reform: security standards. Final rule. Author(s): Centers for Medicare & Medicaid Services (CSM), HHS. Source: Federal Register. 2003 February 20; 68(34): 8334-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596712&dopt=Abstract
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Health insurance reform: standard unique employer indentifier. Final rule. Author(s): Centers for Medicare and Medicaid Services (CMS), HHS. Source: Federal Register. 2002 May 31; 67(105): 38009-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12049095&dopt=Abstract
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Health insurance reimbursement legislation. Author(s): James JS. Source: Aids Treat News. 2000 August 18; (349): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12170992&dopt=Abstract
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Health insurance scams: how government is responding and what further steps are needed. Author(s): Kofman M, Lucia K, Bangit E. Source: Issue Brief (Commonw Fund). 2003 August; (665): 1-12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953703&dopt=Abstract
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Health insurance shock may prompt changes. Author(s): Johnson DE. Source: Health Care Strateg Manage. 2001 November; 19(11): 1, 18-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11729599&dopt=Abstract
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Health insurance status and mood during pregnancy and following birth: a longitudinal study of multiparous women. Author(s): Kermode M, Fisher J, Jolley D. Source: The Australian and New Zealand Journal of Psychiatry. 2000 August; 34(4): 66470. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10954399&dopt=Abstract
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Health insurance status of recent US immigrants. Author(s): LaPorta RF. Source: Jama : the Journal of the American Medical Association. 2001 January 24-31; 285(4): 410-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11242419&dopt=Abstract
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Health insurance system promotes disparities. Author(s): Krimgold BK. Source: Health Aff (Millwood). 2003 January-February; 22(1): 279; Author Reply 280. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528862&dopt=Abstract
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Health insurance tax credits for workers: an efficient and effective administrative system. Author(s): Etheredge L. Source: Res Agenda Brief. 2001 September; (9): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856673&dopt=Abstract
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Health insurance, health reform, and outpatient mental health treatment: who benefits? Author(s): Zuvekas SH. Source: Inquiry. 1999 Summer; 36(2): 127-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10459369&dopt=Abstract
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Health insurance, primary care, and preventable hospitalization of children in a large state. Author(s): Friedman B, Basu J. Source: Am J Manag Care. 2001 May; 7(5): 473-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11388127&dopt=Abstract
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Health insurance, the quantity and quality of prenatal care, and infant health. Author(s): Kaestner R. Source: Inquiry. 1999 Summer; 36(2): 162-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10459371&dopt=Abstract
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Health insurance. Author(s): VonderHaar WP. Source: J Ky Med Assoc. 2001 September; 99(9): 385. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11573307&dopt=Abstract
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Health insurance: the influence of the Beveridge Report. Author(s): Musgrove P. Source: Bulletin of the World Health Organization. 2000; 78(6): 845-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10916921&dopt=Abstract
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Health insurance: tradeoffs revisited. Author(s): Manning WG, Marquis MS. Source: Journal of Health Economics. 2001 March; 20(2): 289-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11252376&dopt=Abstract
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Health reform for children: the Egyptian experience with school health insurance. Author(s): Nandakumar AK, Reich MR, Chawla M, Berman P, Yip W. Source: Health Policy (Amsterdam, Netherlands). 2000 January; 50(3): 155-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10827306&dopt=Abstract
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Healthcare utilization patterns and risk adjustment under Taiwan's National Health Insurance system. Author(s): Chang RE, Lin W, Hsieh CJ, Chiang TL. Source: J Formos Med Assoc. 2002 January; 101(1): 52-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11911039&dopt=Abstract
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HealthMarts, HIPCs (health insurance purchasing cooperatives), MEWAs (multiple employee welfare arrangements), and AHPs (association health plans): a guide for the perplexed. Author(s): Hall MA, Wicks EK, Lawlor JS. Source: Health Aff (Millwood). 2001 January-February; 20(1): 142-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11194835&dopt=Abstract
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Hidden assets: health insurance reform in New Jersey. Author(s): Swartz K, Garnick DW. Source: Health Aff (Millwood). 1999 July-August; 18(4): 180-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10425855&dopt=Abstract
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HIPAA privacy regulations: new requirements for protecting patients' health information. Health Insurance Portability and Accountability Act. Author(s): Sfikas PM. Source: The Journal of the American Dental Association. 2002 December; 133(12): 1692-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12512671&dopt=Abstract
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HIPAA. Health Insurance Portability and Accountability Act of 1996. Author(s): Caplan RM. Source: Dental Assistant (Chicago, Ill. : 1994). 2003 March-April; 72(2): 6-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12723336&dopt=Abstract
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Hitting a moving target: income-related health insurance subsidies for the uninsured. Author(s): Short PF. Source: Journal of Policy Analysis and Management : [the Journal of the Association for Public Policy Analysis and Management]. 2000 Summer; 19(3): 383-405. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11067704&dopt=Abstract
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HMOs, health insurance: more problems. Author(s): James JS. Source: Aids Treat News. 2000 October 20; (353): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12173557&dopt=Abstract
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Hope for the uninsured? HHS proposes a series of initiatives to expand coverage, broaden access for the 41 million Americans without health insurance. Author(s): Tieman J. Source: Modern Healthcare. 2003 February 17; 33(7): 6-7, 16, 1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12688079&dopt=Abstract
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How a changing workforce affects employer-sponsored health insurance. Author(s): Acs G, Blumberg LJ. Source: Health Aff (Millwood). 2001 January-February; 20(1): 178-83. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11194839&dopt=Abstract
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How and why the health insurance system will collapse. Author(s): Taylor H. Source: Health Aff (Millwood). 2002 November-December; 21(6): 195-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442855&dopt=Abstract
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How comprehensive are the basic packages of health services? An international comparison of six health insurance systems. Author(s): Polikowski M, Santos-Eggimann B. Source: Journal of Health Services Research & Policy. 2002 July; 7(3): 133-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171743&dopt=Abstract
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How long will businesses have to wait? Small businesses seek health insurance rating reform. Author(s): Haran ME. Source: Mich Health Hosp. 2003 March-April; 39(2): 32-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685364&dopt=Abstract
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How well have practices followed guidelines in prescribing antihypertensive drugs: the role of health insurance. Author(s): Guo JD, Liu GG, Christensen DB, Fu AZ. Source: Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research. 2003 January-February; 6(1): 18-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12535235&dopt=Abstract
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Impact of a children's health insurance program on newly enrolled children. Author(s): Lave JR, Keane CR, Lin CJ, Ricci EM, Amersbach G, LaVallee CP. Source: Jama : the Journal of the American Medical Association. 1998 June 10; 279(22): 1820-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9628715&dopt=Abstract
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Impact of employment-based health insurance on home attendants. Author(s): Weitzman BC, Berry CA. Source: Journal of Health Care for the Poor and Underserved. 1993; 4(4): 374-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8260571&dopt=Abstract
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Impact of family health insurance and other environmental factors on universal hearing screen program effectiveness. Author(s): Vohr BR, Moore PE, Tucker RJ. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2002 July-August; 22(5): 380-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12082473&dopt=Abstract
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Impact of smoking habit on medical care use and its costs: a prospective observation of National Health Insurance beneficiaries in Japan. Author(s): Izumi Y, Tsuji I, Ohkubo T, Kuwahara A, Nishino Y, Hisamichi S. Source: International Journal of Epidemiology. 2001 June; 30(3): 616-21; Discussion 6223. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11416093&dopt=Abstract
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Impact of the Health Insurance Portability and Accountability Act on electronic processing. Author(s): Reece RS. Source: Patient Acc. 1997 April; 20(4): 2-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10166533&dopt=Abstract
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Implementation of the State Children's Health Insurance Program in rural areas. Author(s): Dunbar JL, Sloane HI, Mueller CD. Source: Policy Anal Brief W Ser. 1999 November; 2(5): 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11764815&dopt=Abstract
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In 1999, the number of children (and adults) without health insurance decreased, but. Author(s): Waldman HB, Perlman SP. Source: Asdc J Dent Child. 2001 May-June; 68(3): 211-4, 152. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11693016&dopt=Abstract
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Inadequate health insurance: costs and consequences. Author(s): Donelan K, DesRoches CM, Schoen C. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2000 August 11; : E37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11104483&dopt=Abstract
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Income, social stratification, class, and private health insurance: a study of the Baltimore metropolitan area. Author(s): Muntaner C, Parsons PE. Source: International Journal of Health Services : Planning, Administration, Evaluation. 1996; 26(4): 655-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8906444&dopt=Abstract
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Income-related cost sharing in health insurance. Author(s): Rice T, Thorpe KE. Source: Health Aff (Millwood). 1993 Spring; 12(1): 21-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8509025&dopt=Abstract
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Incorporating expanded school mental health programs in state children's health insurance program plans. Author(s): Nabors LA, Mettrick JE. Source: The Journal of School Health. 2001 February; 71(2): 73-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11247383&dopt=Abstract
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Incorporating school mental health programs in SCHIP plans. State Children's Health Insurance Program. Author(s): Nabors LA, Weist MD, Mettrick J. Source: Psychiatric Services (Washington, D.C.). 2002 July; 53(7): 902. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12096185&dopt=Abstract
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Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China. Author(s): Cai WW, Marks JS, Chen CH, Zhuang YX, Morris L, Harris JR. Source: American Journal of Public Health. 1998 May; 88(5): 777-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9585744&dopt=Abstract
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Increasing health insurance coverage through an extended Federal Employees Health Benefits Program. Author(s): Fuchs BC. Source: Inquiry. 2001 Summer; 38(2): 177-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11529514&dopt=Abstract
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Incremental health insurance reform proposals to improve access. Author(s): Young WB. Source: The Journal of Nursing Administration. 1997 September; 27(9): 8-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9300009&dopt=Abstract
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Incremental strategies for providing health insurance for the uninsured. Projected federal costs and number of newly insured. Author(s): Thorpe KE. Source: Jama : the Journal of the American Medical Association. 1997 July 23-30; 278(4): 329-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9228441&dopt=Abstract
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Individual versus job-based health insurance: weighing the pros and cons. Author(s): Pauly M, Percy A, Herring B. Source: Health Aff (Millwood). 1999 November-December; 18(6): 28-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10650686&dopt=Abstract
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Inequality in health insurance reform: are the elderly more at risk? Author(s): Phillips CR, Schuler DK, Jacobs EW. Source: Journal of Health Care Marketing. 1994 Winter; 14(4): 14-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10154632&dopt=Abstract
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Inner-city African American women who failed to receive cancer screening following a culturally-appropriate intervention: the role of health insurance. Author(s): Sung JF, Alema-Mensah E, Blumenthal DS. Source: Cancer Detection and Prevention. 2002; 26(1): 28-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12088200&dopt=Abstract
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Innovation, public choice and public control in the market for health insurance. Author(s): Fields JA, Sutton-Bell N. Source: Benefits Q. 1998 4Th Quarter; 14(4): 54-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10387155&dopt=Abstract
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Inside the sausage factory: improving estimates of the effects of health insurance expansion proposals. Author(s): Glied S, Remler DK, Zivin JG. Source: The Milbank Quarterly. 2002; 80(4): 603-35, Iii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12532642&dopt=Abstract
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Insurance agents: ignored players in health insurance reform. Author(s): Garnick DW, Swartz K, Skwara KC. Source: Health Aff (Millwood). 1998 March-April; 17(2): 137-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9558791&dopt=Abstract
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Insurance for sickness (health insurance?) Author(s): Johnson EW. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1993 August; 72(4): 183. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8363810&dopt=Abstract
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Integrated databases--the foundation for the information linking of the actors in the national health care and health insurance systems. Author(s): Marcun T, Kosir F. Source: Studies in Health Technology and Informatics. 1999; 68: 83-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10725013&dopt=Abstract
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Integration of economic appraisal and health care policy in a health insurance system; the Dutch case. Author(s): Rutten F, van der Linden JW. Source: Social Science & Medicine (1982). 1994 June; 38(12): 1609-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8047918&dopt=Abstract
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Intermittent lack of health insurance coverage and use of preventive services. Author(s): Sudano JJ Jr, Baker DW. Source: American Journal of Public Health. 2003 January; 93(1): 130-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511402&dopt=Abstract
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Introducing cards into Slovenian health insurance and health care. Author(s): Suselj M, Cuber S, Zevnik M. Source: Studies in Health Technology and Informatics. 1997; 43 Pt A: 232-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10179544&dopt=Abstract
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Introduction to special issue on the economics of health insurance in low and middleincome countries. Author(s): Carrin G, De Graeve D, Deville L. Source: Social Science & Medicine (1982). 1999 April; 48(7): 859-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10192553&dopt=Abstract
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Is desflurane a better inhalational anesthetic for our health insurance? Author(s): Wong CS. Source: Acta Anaesthesiol Sin. 1997 June; 35(2): I-Ii. No Abstract Available. Erratum In: Acta Anaesthesiol Sin 1997 September; 35(3): 191. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9293644&dopt=Abstract
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Is private health insurance in trouble? Author(s): Sackville T. Source: World Hosp Health Serv. 2000; 36(2): 1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11214450&dopt=Abstract
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Is the lack of health insurance the major barrier to early prenatal care at an inner-city hospital? Author(s): Parchment W, Weiss G, Passannante MR. Source: Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health. 1996 March-April; 6(2): 97-105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8932463&dopt=Abstract
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Israel introduces national health insurance system. Author(s): Siegelitzkovich J. Source: Bmj (Clinical Research Ed.). 1995 January 28; 310(6974): 212-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7866119&dopt=Abstract
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Israelis evaluate their health care system before and after the introduction of the national health insurance law. Author(s): Shmueli A. Source: Health Policy (Amsterdam, Netherlands). 2003 March; 63(3): 279-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12595127&dopt=Abstract
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Job-based health insurance in 2000: premiums rise sharply while coverage grows. Author(s): Gabel J, Levitt L, Pickreign J, Whitmore H, Holve E, Hawkins S, Miller N. Source: Health Aff (Millwood). 2000 September-October; 19(5): 144-51. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10992662&dopt=Abstract
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Job-based health insurance in 2001: inflation hits double digits, managed care retreats. Author(s): Gabel J, Levitt L, Pickreign J, Whitmore H, Holve E, Rowland D, Dhont K, Hawkins S. Source: Health Aff (Millwood). 2001 September-October; 20(5): 180-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11558701&dopt=Abstract
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Job-based health insurance, 1977-1998: the accidental system under scrutiny. Author(s): Gabel JR. Source: Health Aff (Millwood). 1999 November-December; 18(6): 62-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10650689&dopt=Abstract
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John's $12 tonic: press coverage of the government's selling of a private health insurance rebate. Author(s): Carter S, Chapman S. Source: Aust N Z J Public Health. 2001 June; 25(3): 265-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11494998&dopt=Abstract
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Justifying government as the backstop in health insurance markets. Author(s): Swartz K. Source: Yale J Health Policy Law Ethics. 2001 Autumn; 2(1): 89-108. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664938&dopt=Abstract
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Keeping competition fair for health insurance: how the Irish beat back risk-rated policies. Author(s): Light DW. Source: American Journal of Public Health. 1998 May; 88(5): 745-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9585738&dopt=Abstract
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Knowledge of health insurance coverage by adolescents and young adults attending a hospital-based clinic. Author(s): Robertson LM, Middleman AB. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1998 June; 22(6): 439-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9627813&dopt=Abstract
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Korean American health insurance and health services utilization. Author(s): Ryu H, Young WB, Park C. Source: Research in Nursing & Health. 2001 December; 24(6): 494-505. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11746078&dopt=Abstract
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Labor market responses to rising health insurance costs: evidence on hours worked. Author(s): Cutler DM, Madrian BC. Source: The Rand Journal of Economics. 1998 Fall; 29(3): 509-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10342942&dopt=Abstract
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Lack of health insurance and decline in overall health in late middle age. Author(s): Baker DW, Sudano JJ, Albert JM, Borawski EA, Dor A. Source: The New England Journal of Medicine. 2001 October 11; 345(15): 1106-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11596591&dopt=Abstract
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Lack of health insurance and overall health. Author(s): Harrison DJ, Biddle AK. Source: The New England Journal of Medicine. 2002 February 21; 346(8): 626-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11856806&dopt=Abstract
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Lack of health insurance costs up to 130bn dollars in illness and premature death. Author(s): Marwick C. Source: Bmj (Clinical Research Ed.). 2003 June 28; 326(7404): 1418. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12829548&dopt=Abstract
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Language proficiency and the enrollment of Medicaid-eligible children in publicly funded health insurance programs. Author(s): Feinberg E, Swartz K, Zaslavsky AM, Gardner J, Walker DK. Source: Maternal and Child Health Journal. 2002 March; 6(1): 5-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926255&dopt=Abstract
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Latino adults' health insurance coverage: an examination of Mexican and Puerto Rican subgroup differences. Author(s): Vitullo MW, Taylor AK. Source: Journal of Health Care for the Poor and Underserved. 2002 November; 13(4): 504-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407965&dopt=Abstract
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Life and health insurance behaviour of individuals having undergone a predictive genetic testing programme for hereditary non-polyposis colorectal cancer. Author(s): Aktan-Collan K, Haukkala A, Kaariainen H. Source: Community Genetics. 2002 June; 4(4): 219-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12751485&dopt=Abstract
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Life transitions and health insurance coverage of the near elderly. Author(s): Sloan FA, Conover CJ. Source: Medical Care. 1998 February; 36(2): 110-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9475467&dopt=Abstract
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Long-term determinants of patterns of health insurance coverage in the Medicare population. Author(s): Lillard L, Rogowski J, Kington R. Source: The Gerontologist. 1997 June; 37(3): 314-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9203755&dopt=Abstract
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Losing and acquiring health insurance: consequences for health care. Author(s): Comer J, Mueller K, Blankenau J. Source: J Health Soc Policy. 2000; 11(3): 1-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10557889&dopt=Abstract
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Loss of health insurance and the risk for a decline in self-reported health and physical functioning. Author(s): Baker DW, Sudano JJ, Albert JM, Borawski EA, Dor A. Source: Medical Care. 2002 November; 40(11): 1126-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12409857&dopt=Abstract
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Low demand for substitutive voluntary health insurance in Germany. Author(s): Thomson S, Busse R, Mossialos E. Source: Croatian Medical Journal. 2002 August; 43(4): 425-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12187520&dopt=Abstract
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Low-income Californians' experiences with health insurance and managed care. Author(s): Backus LI, Bindman AB. Source: Journal of Health Care for the Poor and Underserved. 2001 November; 12(4): 446-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11688195&dopt=Abstract
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Low-wage workers and health insurance coverage: can policymakers target them through their employers? Author(s): Long SH, Marquis MS. Source: Inquiry. 2001 Fall; 38(3): 331-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11761361&dopt=Abstract
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Maintaining health insurance during a recession: likely COBRA eligibility. Author(s): Doty MM, Schoen C. Source: Issue Brief (Commonw Fund). 2001 December; (513): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12465619&dopt=Abstract
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Making the Health Insurance Flexibility and Accountability (HIFA) waiver work through collaborative governance. Author(s): Zabawa BJ. Source: Ann Health Law. 2003 Summer; 12(2): 367-410, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856464&dopt=Abstract
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Managed care and the implementation of the State Children's Health Insurance Program. Author(s): Back K. Source: Manag Care Interface. 2000 January; 13(1): 73-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10747695&dopt=Abstract
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Managed care vs universal health insurance: whose whips are gentler? Author(s): Greengold RH. Source: Archives of Internal Medicine. 2000 June 12; 160(11): 1704-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10847273&dopt=Abstract
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Managed competition and consumer price sensitivity in social health insurance. Author(s): Schut FT, Hassink WH. Source: Journal of Health Economics. 2002 November; 21(6): 1009-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12475123&dopt=Abstract
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Management of otitis media among children in a large health insurance plan. Author(s): Thompson D, Oster G, McGarry LJ, Klein JO. Source: The Pediatric Infectious Disease Journal. 1999 March; 18(3): 239-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10093944&dopt=Abstract
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Managing HIPAA business associate compliance efforts. Health Insurance Portability and Accountability Act. Author(s): Bryant M, Zerbi DG. Source: Journal of the National Medical Association. 2002 May; 94(5): 290-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12069207&dopt=Abstract
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Managing the behavior of the medically insured in Germany: the acceptance of costsharing and risk premiums by members of the statutory health insurance. Author(s): Ullrich CG. Source: J Health Soc Policy. 2002; 15(1): 31-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12212931&dopt=Abstract
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Mandated child health insurance: an approach whose time has come? Author(s): Berman S. Source: Pediatrics. 2003 April; 111(4 Pt 1): 893-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671129&dopt=Abstract
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Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market. Author(s): Van Barneveld EM, Lamers LM, van Vliet RC, van de Ven WP. Source: Social Science & Medicine (1982). 1998 July; 47(2): 223-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9720641&dopt=Abstract
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Marital status, spousal coverage, and the gender gap in employer-sponsored health insurance. Author(s): Buchmueller TC. Source: Inquiry. 1996-97 Winter; 33(4): 308-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9031647&dopt=Abstract
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Markets for individual health insurance: can we make them work with incentives to purchase insurance? Author(s): Swartz K. Source: Inquiry. 2001 Summer; 38(2): 133-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11529511&dopt=Abstract
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Maternal health insurance coverage as a determinant of obstetrical anesthesia care. Author(s): Obst TE, Nauenberg E, Buck GM. Source: Journal of Health Care for the Poor and Underserved. 2001 May; 12(2): 177-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11370186&dopt=Abstract
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McGann offspring: employers may retroactively limit health insurance, says 11th Circuit. Owens v. Storehouse, Inc. Author(s): Margolis RE. Source: Healthspan. 1993 April; 10(4): 25-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10183931&dopt=Abstract
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Measuring the impact of health insurance with a correction for selection bias--a case study of Ecuador. Author(s): Waters HR. Source: Health Economics. 1999 August; 8(5): 473-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10470552&dopt=Abstract
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Medicaid and indigent care issue brief: state response to children's health insurance programs. Author(s): Johnson P. Source: Issue Brief Health Policy Track Serv. 2000 July 1; : 1-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11073442&dopt=Abstract
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Medicaid expansions and the crowding out of private health insurance among children. Author(s): Yazici EY, Kaestner R. Source: Inquiry. 2000 Spring; 37(1): 23-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10892355&dopt=Abstract
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Medical care use and selection in a social health insurance with an equalization fund: evidence from Colombia. Author(s): Trujillo AJ. Source: Health Economics. 2003 March; 12(3): 231-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12605467&dopt=Abstract
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Medical cost for disability: a longitudinal observation of national health insurance beneficiaries in Japan. Author(s): Tsuji I, Kuwahara A, Nishino Y, Ohkubo T, Sasaki A, Hisamichi S. Source: Journal of the American Geriatrics Society. 1999 April; 47(4): 470-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10203124&dopt=Abstract
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Medicare and employer-sponsored health insurance. Author(s): Gottlich V. Source: Issue Brief Cent Medicare Educ. 2000; 1(9): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11817419&dopt=Abstract
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Meeting information needs: lessons learned from New Jersey's Individual Health Insurance Reform Program. Author(s): Garnick DW, Swartz K. Source: Medical Care Research and Review : Mcrr. 1999 December; 56(4): 456-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10589204&dopt=Abstract
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Men, women, and health insurance. Author(s): Miles S, Parker K. Source: The New England Journal of Medicine. 1997 January 16; 336(3): 218-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8988905&dopt=Abstract
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Mental health and choice between managed care and indemnity health insurance. Author(s): Perneger TV, Allaz AF, Etter JF, Rougemont A. Source: The American Journal of Psychiatry. 1995 July; 152(7): 1020-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7793437&dopt=Abstract
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Mental health insurance claims among spouses of frequent business travellers. Author(s): Dimberg LA, Striker J, Nordanlycke-Yoo C, Nagy L, Mundt KA, Sulsky SI. Source: Occupational and Environmental Medicine. 2002 March; 59(3): 175-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11886948&dopt=Abstract
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Mental health insurance in the 1990s: are employers offering less to more? Author(s): Jensen GA, Rost K, Burton RP, Bulycheva M. Source: Health Aff (Millwood). 1998 May-June; 17(3): 201-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9637976&dopt=Abstract
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Mental health parity and employer-sponsored health insurance in 1999-2000: I. limits. Author(s): Sturm R, Pacula RL. Source: Psychiatric Services (Washington, D.C.). 2000 November; 51(11): 1361. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11058178&dopt=Abstract
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Mental health services in the context of health insurance reform. Author(s): Mechanic D. Source: The Milbank Quarterly. 1993; 71(3): 349-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8413066&dopt=Abstract
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Millions of mothers lack health insurance coverage in the United States. Most uninsured mothers lack access both to employer-based coverage and to publicly subsidized health insurance. Author(s): Guyer J, Broaddus M, Dude A. Source: International Journal of Health Services : Planning, Administration, Evaluation. 2002; 32(1): 89-106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11913859&dopt=Abstract
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Morbidity of allergic rhinitis based on the National Health Insurance records of Japan. Author(s): Miyao M, Furuta M, Ozawa K, Kondo TA, Sakakibara H, Ishihara S, Yamanaka K. Source: The Tohoku Journal of Experimental Medicine. 1993 April; 169(4): 345-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8248923&dopt=Abstract
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More comments on health insurance. Author(s): Feaga WP. Source: J Am Vet Med Assoc. 1994 December 1; 205(11): 1511. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7730112&dopt=Abstract
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More offers, fewer takers for employment-based health insurance: 1987 and 1996. Author(s): Cooper PF, Schone BS. Source: Health Aff (Millwood). 1997 November-December; 16(6): 142-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9444821&dopt=Abstract
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Mortality in the uninsured compared with that in persons with public and private health insurance. Author(s): Sorlie PD, Johnson NJ, Backlund E, Bradham DD. Source: Archives of Internal Medicine. 1994 November 14; 154(21): 2409-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7979836&dopt=Abstract
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Mortality, morbidity, length and cost of hospitalization in very-low-birth-weight infants in the era of National Health Insurance in Taiwan: a medical center's experience. Author(s): Chang SC, Lin CH, Lin YJ, Yeh TF. Source: Acta Paediatr Taiwan. 2000 November-December; 41(6): 308-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11198936&dopt=Abstract
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Moving to Medicare: trends in the health insurance status of near-elderly workers, 1987-1996. Author(s): Monheit AC, Vistnes JP, Eisenberg JM. Source: Health Aff (Millwood). 2001 March-April; 20(2): 204-13. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11260945&dopt=Abstract
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MSV health insurance. How the physicians' plan evolved. Author(s): Blanchard LE 3rd. Source: Va Med Q. 1994 Spring; 121(2): 79-81. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8199212&dopt=Abstract
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Mutual health organizations in Africa and social health insurance systems: will European history repeat itself? Author(s): Criel B, Van Dormael M. Source: Tropical Medicine & International Health : Tm & Ih. 1999 March; 4(3): 155-9. English, French. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10223209&dopt=Abstract
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National health information privacy: regulations under the Health Insurance Portability and Accountability Act. Author(s): Gostin LO. Source: Jama : the Journal of the American Medical Association. 2001 June 20; 285(23): 3015-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11410101&dopt=Abstract
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National Health Insurance and the antenatal care use: a case in Taiwan. Author(s): Chen CS, Liu TC, Chen LM. Source: Health Policy (Amsterdam, Netherlands). 2003 April; 64(1): 99-112. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12644332&dopt=Abstract
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National health insurance consumption and chronic symptoms following mild neck sprain injuries in car collisions. Author(s): Borchgrevink GE, Lereim I, Royneland L, Bjorndal A, Haraldseth O. Source: Scand J Soc Med. 1996 December; 24(4): 264-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8983098&dopt=Abstract
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National health insurance expenditure for adult beneficiaries in Taiwan in their last year of life. Author(s): Liu CN, Yang MC. Source: J Formos Med Assoc. 2002 August; 101(8): 552-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12440085&dopt=Abstract
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National health insurance or incremental reform: aim high, or at our feet? Author(s): Himmelstein DU, Woolhandler S. Source: American Journal of Public Health. 2003 January; 93(1): 102-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511395&dopt=Abstract
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National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan. Author(s): Tsai YW, Hu TW. Source: American Journal of Public Health. 2002 September; 92(9): 1514-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197985&dopt=Abstract
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National health insurance. Author(s): Soltys SM. Source: Mo Med. 1993 February; 90(2): 76-84. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8492792&dopt=Abstract
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National health insurance: is this the answer for the poor and underserved? Author(s): McBarnette LM. Source: Journal of Health Care for the Poor and Underserved. 1993; 4(3): 163-9; Discussion 170-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8353208&dopt=Abstract
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National health insurance: lessons from the United States experiment. Author(s): Derrick FW, Scott CE. Source: Health Care Management Review. 1995 Summer; 20(3): 55-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7591752&dopt=Abstract
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National health insurance: liberal benefits, conservative spending. Author(s): Woolhandler S, Himmelstein DU. Source: Archives of Internal Medicine. 2002 May 13; 162(9): 973-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11996604&dopt=Abstract
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Nationalizing health insurance. Author(s): England LE. Source: J Miss State Med Assoc. 1998 March; 39(3): 93. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9538593&dopt=Abstract
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Nearly one-fifth of urban Americans lack health insurance. Author(s): Levan R, Brown ER, Lara L, Wyn R. Source: Policy Brief Ucla Cent Health Policy Res. 1998 February; (Pb 98-5): 1-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11475512&dopt=Abstract
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Need mor mo' on the Child Health Insurance bill. Author(s): Feeg VD. Source: Pediatric Nursing. 1997 May-June; 23(3): 232, 251. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9220797&dopt=Abstract
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Needs for further improvement: risk adjustment in the German health insurance system. Author(s): Buchner F, Wasem J. Source: Health Policy (Amsterdam, Netherlands). 2003 July; 65(1): 21-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818743&dopt=Abstract
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New child health insurance: Florida KidCare. Author(s): Sherraden S, Marmion A. Source: The Florida Nurse. 1998 December; 46(8): 25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11995509&dopt=Abstract
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Next steps in incremental health insurance expansions: who is most deserving? Author(s): Cunningham PJ. Source: Issue Brief Cent Stud Health Syst Change. 1998 April; (12): 1-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10539728&dopt=Abstract
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NGOs in community health insurance schemes: examples from Guatemala and the Philippines. Author(s): Ron A. Source: Social Science & Medicine (1982). 1999 April; 48(7): 939-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10192560&dopt=Abstract
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NMAC supports Kassebaum/Kennedy Health Insurance Reform Act of 1996 and the Jeffords Amendment. National Minority AIDS Council. Author(s): Owens MB. Source: Update Natl Minor Aids Counc. 1996 April-May; : 3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11367397&dopt=Abstract
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No care for the caregivers: declining health insurance coverage for health care personnel and their children, 1988-1998. Author(s): Case BG, Himmelstein DU, Woolhandler S. Source: American Journal of Public Health. 2002 March; 92(3): 404-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11867320&dopt=Abstract
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No health insurance, no problem. Author(s): Busalacchi S. Source: Wmj. 2000 January-February; 99(1): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10752372&dopt=Abstract
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Nosocomial infection in a neonatal intensive care unit--from a viewpoint of national health insurance. Author(s): Lin IJ, Chen CH, Chen PY, Wang TM, Chi CS. Source: Acta Paediatr Taiwan. 2000 May-June; 41(3): 123-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10920543&dopt=Abstract
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Obstetric intervention among private and public patients in Australia. Women must have full information when choosing private health insurance for pregnancy. Author(s): Shorten A. Source: Bmj (Clinical Research Ed.). 2001 February 17; 322(7283): 431. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11179177&dopt=Abstract
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OMB estimates indicate that 900,000 children will lose health insurance due to reductions in federal SCHIP funding. Author(s): Park E, Ku L, Broaddus M. Source: International Journal of Health Services : Planning, Administration, Evaluation. 2003; 33(2): 369-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800893&dopt=Abstract
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On the edge: low-wage workers and their health insurance coverage. Findings from the Commonwealth Fund 2001 Health Insurance Survey. Author(s): Collins SR, Schoen C, Colasanto D, Downey DA. Source: Issue Brief (Commonw Fund). 2003 March; (626): 1-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641093&dopt=Abstract
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One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low-income countries? Author(s): Barnighausen T, Sauerborn R. Source: Social Science & Medicine (1982). 2002 May; 54(10): 1559-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12061488&dopt=Abstract
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One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. Author(s): Striegel-Moore RH, Leslie D, Petrill SA, Garvin V, Rosenheck RA. Source: The International Journal of Eating Disorders. 2000 May; 27(4): 381-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10744844&dopt=Abstract
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Optimal health insurance: the case of observable, severe illness. Author(s): Chernew ME, Encinosa WE, Hirth RA. Source: Journal of Health Economics. 2000 September; 19(5): 585-609. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11184795&dopt=Abstract
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Optimal social health insurance with supplementary private insurance. Author(s): Petretto A. Source: Journal of Health Economics. 1999 December; 18(6): 727-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10847932&dopt=Abstract
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Options and opportunities for individuals and families in the private health insurance market. Author(s): Trautwein JS. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W387-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703599&dopt=Abstract
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Options for expanding health insurance for people with chronic conditions. Author(s): Tu HT, Reed MC. Source: Issue Brief Cent Stud Health Syst Change. 2002 February; (50): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11865910&dopt=Abstract
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Outpatient costs of osteoporosis in a national health insurance population. Author(s): Krappweis J, Rentsch A, Schwarz UI, Krobot KJ, Kirch W. Source: Clinical Therapeutics. 1999 November; 21(11): 2001-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10890269&dopt=Abstract
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Outreach and the State Children's Health Insurance Program. Author(s): Mayer R, Kavanagh LD, Carpenter MB. Source: Maternal and Child Health Journal. 1998 June; 2(2): 127-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10728269&dopt=Abstract
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Ovarian cancer. an institutional review of patterns of care, health insurance and prognosis. Author(s): Balli S, Fey MF, Hanggi W, Zwahlen D, Berclaz G, Dreher E, Aebi S. Source: European Journal of Cancer (Oxford, England : 1990). 2000 October; 36(16): 20618. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11044642&dopt=Abstract
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Parental employment and health insurance coverage among school-aged children with special health care needs. Author(s): Heck KE, Makuc DM. Source: American Journal of Public Health. 2000 December; 90(12): 1856-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11111256&dopt=Abstract
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Parental employment, family structure, and child's health insurance. Author(s): Rolett A, Parker JD, Heck KE, Makuc DM. Source: Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association. 2001 November-December; 1(6): 306-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11888420&dopt=Abstract
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Participation of plans and providers in Medicaid and SCHIP managed care. State Children's Health Insurance Program. Author(s): Gold M, Mittler J, Draper D, Rousseau D. Source: Health Aff (Millwood). 2003 January-February; 22(1): 230-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528855&dopt=Abstract
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Pathways to access: health insurance, the health care delivery system, and racial/ethnic disparities, 1996-1999. Author(s): Zuvekas SH, Taliaferro GS. Source: Health Aff (Millwood). 2003 March-April; 22(2): 139-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674417&dopt=Abstract
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Patient choice of physician: do health insurance and physician characteristics matter? Author(s): Cooper PF, Nichols LM, Taylor AK. Source: Inquiry. 1996 Fall; 33(3): 237-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8883458&dopt=Abstract
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Pattern recognition in health insurance claims databases. Author(s): Walker AM. Source: Pharmacoepidemiology and Drug Safety. 2001 August-September; 10(5): 393-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11802583&dopt=Abstract
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Patterns of health insurance coverage among rural and urban children. Author(s): Coburn AF, McBride TD, Ziller EC. Source: Medical Care Research and Review : Mcrr. 2002 September; 59(3): 272-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12205829&dopt=Abstract
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Paying for national health insurance--and not getting it. Author(s): Woolhandler S, Himmelstein DU. Source: Health Aff (Millwood). 2002 July-August; 21(4): 88-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12117155&dopt=Abstract
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Paying for the NHS. People covered by private health insurance will not reduce consumption of NHS services. Author(s): Hennell T. Source: Bmj (Clinical Research Ed.). 2000 October 7; 321(7265): 898-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11021889&dopt=Abstract
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Paying medical bills in the United States. Why health insurance isn't enough. Author(s): Blendon RJ, Donelan K, Hill CA, Carter W, Beatrice D, Altman D. Source: Jama : the Journal of the American Medical Association. 1994 March 23-30; 271(12): 949-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8120967&dopt=Abstract
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Pediatric dentistry and national health insurance: a more than favorable opportunity. Author(s): Waldman HB. Source: Asdc J Dent Child. 1994 September-December; 61(5-6): 361-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7897007&dopt=Abstract
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Percent of adults without health insurance in Ingham County, Michigan, 1994. Author(s): Cheatham M. Source: Journal of Public Health Management and Practice : Jphmp. 1999 March; 5(2): 53-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10537825&dopt=Abstract
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Periodic screening for breast cancer: the HIP Randomized Controlled Trial. Health Insurance Plan. Author(s): Shapiro S. Source: J Natl Cancer Inst Monogr. 1997; (22): 27-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9709271&dopt=Abstract
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Personal characteristics and spells without health insurance. Author(s): Swartz K, Marcotte J, McBride TD. Source: Inquiry. 1993 Spring; 30(1): 64-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8454317&dopt=Abstract
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Personal choices on private health insurance. Author(s): Coote B, Cox E, Duckett S, Lawrence C, Lees M, Margetts D, Nelson B. Source: Aust Health Rev. 1999; 22(1): 7-17. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10387907&dopt=Abstract
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Perspectives. Facing SCHIP's (State Children's Health Insurance Program) acid test: getting kids care once they're covered. Author(s): Williams S. Source: Med Health. 1998 November 9; 52(44): Suppl 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10187177&dopt=Abstract
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Perspectives. SCHIP's (State Children's Health Insurance Program) success inspires incrementalists to pursue ideas for expanding coverage; tax-based proposals draw fresh interest. Author(s): Cunningham R. Source: Med Health. 1999 March 8; 53(10): Suppl 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10351436&dopt=Abstract
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Physicians' experiences with patient-initiated health insurance fraud. Author(s): Farber NJ, Berger MS, Davis EB, Weiner J, Boyer EG, Ubel PA. Source: Del Med J. 1998 July; 70(7): 329-34. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9707803&dopt=Abstract
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Physicians who report health insurance fraud and their practice type: health maintenance organization vs fee-for-service. Author(s): Salom IL. Source: Archives of Internal Medicine. 1997 October 27; 157(19): 2270. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9343004&dopt=Abstract
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Pitching plans to the uninsured. Insurers increasingly see viable market in growing pool of middle-class workers who don't have health insurance. Author(s): Benko LB. Source: Modern Healthcare. 2003 February 24; 33(8): 8-9, 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12632855&dopt=Abstract
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Playing by the rules and losing: health insurance and the working poor. Author(s): Seccombe K, Amey C. Source: Journal of Health and Social Behavior. 1995 June; 36(2): 168-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9113141&dopt=Abstract
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Policy change and private health insurance: did the cheapest policy do the trick? Author(s): Butler JR. Source: Aust Health Rev. 2002; 25(6): 33-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12536860&dopt=Abstract
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Poverty, health insurance, and use of health services. Author(s): Waldman HB. Source: Focus Ohio Dent. 1993 Fall-Winter; 67(2): 1-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9543844&dopt=Abstract
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Practicing allergy with universal health insurance: the Hawaii experience. Author(s): McDonnell JT, Ando RE. Source: Ann Allergy. 1994 August; 73(2): 85-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8067601&dopt=Abstract
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Predicting response to regulatory change in the small group health insurance market: the case of association health plans and HealthMarts. Author(s): Baumgardner JR, Hagen SA. Source: Inquiry. 2001-2002 Winter; 38(4): 351-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887954&dopt=Abstract
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Predicting the receipt of employer-sponsored health insurance: the role of residence and other personal and workplace characteristics. Author(s): Coward RT, Clarke LL, Seccombe K. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 1993 Fall; 9(4): 281-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10131305&dopt=Abstract
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Preference diversity and the breadth of employee health insurance options. Author(s): Moran JR, Chernew ME, Hirth RA. Source: Health Services Research. 2001 October; 36(5): 911-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11666110&dopt=Abstract
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Preliminary findings of adult health screening under national health insurance in Taiwan. Author(s): Huang L, Tseng HM. Source: Methods of Information in Medicine. 2002; 41(3): 196-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12162142&dopt=Abstract
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Premium subsidies for health insurance: excessive coverage vs. adverse selection. Author(s): Selden TM. Source: Journal of Health Economics. 1999 December; 18(6): 709-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10847931&dopt=Abstract
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Prescribing outside the limits of marketing authorizations and reimbursement by the French universal health insurance system. Author(s): Avouac B. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 December; 69(6): 534-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12537259&dopt=Abstract
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Pretax allotments for health insurance premiums. Final rule. Author(s): Office of Personnel Management. Source: Federal Register. 2001 September 26; 66(187): 49085-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11758590&dopt=Abstract
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Prevalence of antilipemic drug use in Taiwan: analysis of a sampling cohort within the national health insurance. Author(s): Chen TJ, Lin SJ, Chen LK, Hwang SJ, Chou LF. Source: J Chin Med Assoc. 2003 January; 66(1): 39-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728973&dopt=Abstract
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Prevalence of diabetes mellitus among insured of a health insurance company in Puerto Rico: 1997-1998. Author(s): Perez-Perdomo R, Perez-Cardona C, Rodriguez-Lugo L. Source: P R Health Sci J. 2001 June; 20(2): 131-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11561472&dopt=Abstract
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Prevalence of selected employer health insurance purchasing strategies in 1997. Author(s): Marquis MS, Long SH. Source: Health Aff (Millwood). 2001 July-August; 20(4): 220-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11463079&dopt=Abstract
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Private employer-sponsored health insurance: new estimates by state. Author(s): Branscome JM, Cooper PF, Sommers J, Vistnes JP. Source: Health Aff (Millwood). 2000 January-February; 19(1): 139-47. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10645080&dopt=Abstract
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Private employment-based health insurance in ten states. Author(s): Cantor JC, Long SH, Marquis MS. Source: Health Aff (Millwood). 1995 Summer; 14(2): 199-211. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7657241&dopt=Abstract
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Private entry into health insurance: what does it mean for India? Author(s): Mahal A. Source: Natl Med J India. 2000 January-February; 13(1): 3-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10743367&dopt=Abstract
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Private health insurance and a healthy personality: new risk factors for obstetric intervention? Author(s): Fisher J, Smith A, Astbury J. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 1995 March; 16(1): 1-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7787952&dopt=Abstract
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Private health insurance and veterans use of Veterans Affairs care. RATE Project Committee. Rate Alternative Technical Evaluation. Author(s): Kashner TM, Muller A, Richter E, Hendricks A, Lukas CV, Stubblefield DR. Source: Medical Care. 1998 July; 36(7): 1085-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9674625&dopt=Abstract
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Private health insurance coverage and disability among older Americans. Author(s): Landerman LR, Fillenbaum GG, Pieper CF, Maddox GL, Gold DT, Guralnik JM. Source: The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences. 1998 September; 53(5): S258-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9750574&dopt=Abstract
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Private health insurance for adolescents: is it adequate? Author(s): Fox HB, McManus MA, Reichman MB. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 2003 June; 32(6 Suppl): 12-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782441&dopt=Abstract
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Private health insurance in Ireland. Author(s): Houghton F. Source: American Journal of Public Health. 1999 March; 89(3): 418. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10076500&dopt=Abstract
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Private health insurance uptake and the impact on normal birth and costs: a hypothetical model. Author(s): Homer CS. Source: Aust Health Rev. 2002; 25(2): 32-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12046152&dopt=Abstract
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Private health insurance: should you join? Author(s): Harulow S. Source: Australian Nursing Journal (July 1993). 2000 March; 7(8): 18-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11894234&dopt=Abstract
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Private or national health insurance for adult vaccination in developed countries? Author(s): Hannoun C. Source: Vaccine. 1999 July 30; 17 Suppl 1: S99-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10471191&dopt=Abstract
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Problems of transition from tax-based system of health care finance to mandatory health insurance model in Russia. Author(s): Shishkin S. Source: Croatian Medical Journal. 1999 June; 40(2): 195-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10234062&dopt=Abstract
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Promoting private health insurance in Australia. Author(s): Willcox S. Source: Health Aff (Millwood). 2001 May-June; 20(3): 152-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11585162&dopt=Abstract
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Properties of actuarially fair and pay-as-you-go health insurance schemes for the elderly. An OLG model approach. Author(s): Johansson PO. Source: Journal of Health Economics. 2000 July; 19(4): 477-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11010236&dopt=Abstract
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Proposal to reimburse occupational medicine disease and injury claims through third party health insurance. Author(s): Ramsey S, Rosenstock L. Source: American Journal of Industrial Medicine. 1994 August; 26(2): 147-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7977392&dopt=Abstract
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Prospects for expanding health insurance coverage. Author(s): Schroeder SA. Source: The New England Journal of Medicine. 2001 March 15; 344(11): 847-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11248165&dopt=Abstract
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Protecting patients' health information: overview of the Health Insurance Portability and Accountability Act. Author(s): Fain JA. Source: Diabetes Educ. 2003 March-April; 29(2): 186. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728749&dopt=Abstract
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Providing health insurance to the short-term unemployed. Author(s): Baumgardner JR. Source: Inquiry. 1998 Fall; 35(3): 266-79. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9809055&dopt=Abstract
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Psychiatric care and health insurance reform. Author(s): Sharfstein SS, Stoline AM, Goldman HH. Source: The American Journal of Psychiatry. 1993 January; 150(1): 7-18. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8417583&dopt=Abstract
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Psychosocial consequences of inadequate health insurance for patients with cancer. Author(s): Glajchen M. Source: Cancer Practice. 1994 March-April; 2(2): 115-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8055013&dopt=Abstract
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Public and private health insurance of US foreign-born residents: implications of the 1996 welfare reform law. Author(s): Thamer M, Rinehart C. Source: Ethnicity & Health. 1998 February-May; 3(1-2): 19-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9673460&dopt=Abstract
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Public hospitals: who's looking after you? The difficulties in encouraging patients to use their private health insurance in public hospitals. Author(s): Sullivan N, Redpath R, O'Donnell A. Source: Aust Health Rev. 2002; 25(3): 6-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12136566&dopt=Abstract
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Publicly subsidized health insurance: a typology of state approaches. Author(s): Rajan S. Source: Health Aff (Millwood). 1998 May-June; 17(3): 101-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9637969&dopt=Abstract
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Qualified medical child support orders--California health insurance coverage assignment orders--national medical support notices: what's a plan administrator to do? Author(s): Coleman JB, Storke CA. Source: Employee Benefits Journal. 2000 June; 25(2): 25-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10947309&dopt=Abstract
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Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance. Author(s): Ranson MK, John KR. Source: Reproductive Health Matters. 2002 November; 10(20): 70-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557644&dopt=Abstract
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Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance. Author(s): Ranson MK, John KR. Source: Health Policy and Planning. 2001 December; 16(4): 395-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11739364&dopt=Abstract
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Quantitative evaluation of prostatectomy for benign prostatic hypertrophy under a national health insurance law: a multi-centre study. Author(s): Pilpel D, Porath A, Peleg A. Source: Journal of Evaluation in Clinical Practice. 2002 February; 8(1): 9-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11882097&dopt=Abstract
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Questions and answers on health insurance benefit issues. Author(s): McDonnell K. Source: Ebri Issue Brief. 1995 August; (164): 1-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10144836&dopt=Abstract
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Race/ethnicity and health insurance status: 1987 and 1996. Author(s): Monheit AC, Vistnes JP. Source: Medical Care Research and Review : Mcrr. 2000; 57 Suppl 1: 11-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11092156&dopt=Abstract
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Racial and ethnic differences in health insurance coverage for adults with diabetes. Author(s): Harris MI. Source: Diabetes Care. 1999 October; 22(10): 1679-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10526734&dopt=Abstract
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Racial and ethnic differences in health insurance for the near elderly. Author(s): Pol LG, Mueller KJ, Adidam PT. Source: Journal of Health Care for the Poor and Underserved. 2002 May; 13(2): 229-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12017912&dopt=Abstract
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Racial and ethnic disparities in the purchase of nongroup health insurance: the roles of community and family-level factors. Author(s): Saver BG, Doescher MP, Symons JM, Wright GE, Andrilla CH. Source: Health Services Research. 2003 February; 38(1 Pt 1): 211-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650389&dopt=Abstract
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Racial and ethnic disparities in the use of cardiovascular procedures: associations with type of health insurance. Author(s): Carlisle DM, Leake BD, Shapiro MF. Source: American Journal of Public Health. 1997 February; 87(2): 263-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9103107&dopt=Abstract
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Raising awareness of consumers' options in the individual health insurance market. Author(s): Patel V. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W367-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703594&dopt=Abstract
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Rate of health insurance reimbursement and adherence to anti-hypertensive treatment among Japanese patients. Author(s): Hagihara A, Murakami M, Chishaki A, Nabeshima F, Nobutomo K. Source: Health Policy (Amsterdam, Netherlands). 2001 December; 58(3): 231-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11641001&dopt=Abstract
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Recent developments in health insurance and life insurance case law. Author(s): Hasman JJ, Chittenden WA 3rd, Engel DA, Smith JL, Martin CA, Metz LR. Source: Tort Insur Law J. 1998 Winter; 33(2): 489-527. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10182487&dopt=Abstract
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Recent developments in health insurance, life insurance, and disability insurance case law. Author(s): Hasman JJ, Chittenden WA 3rd, Doolin EG, Wall JF. Source: Tort Trial Insur Pract Law J. 2003 Winter; 38(2): 405-45. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12807115&dopt=Abstract
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Recent developments in health insurance, life insurance, and disability insurance case law. Author(s): Hasman JJ, Chittenden WA 3rd, Doolin EG. Source: Tort Insur Law J. 2002 Winter; 37(2): 471-520. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11917929&dopt=Abstract
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Recent developments in health insurance, life insurance, and disability insurance case law. Author(s): Hasman JJ, Chittenden WA 3rd, Doolin EG, Derouin LA. Source: Tort Insur Law J. 2001 Winter; 36(2): 359-409. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11939223&dopt=Abstract
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Recent developments in health insurance, life insurance, and disability insurance case law. Author(s): Hasman JJ, Chittenden WA 3rd. Source: Tort Insur Law J. 2000 Winter; 35(2): 369-414. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11067686&dopt=Abstract
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Recent trends in children's health insurance coverage: no gains for low-income children. Author(s): Cunningham PJ, Park MH. Source: Issue Brief Cent Stud Health Syst Change. 2000 April; (29): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11010711&dopt=Abstract
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Redefining the terms of health insurance to accommodate varying consumer risk preferences. Author(s): Ellman IM, Hall MA. Source: American Journal of Law & Medicine. 1994; 20(1-2): 187-201. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7801977&dopt=Abstract
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Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Author(s): Ranson MK. Source: Bulletin of the World Health Organization. 2002; 80(8): 613-21. Epub 2002 August 27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12219151&dopt=Abstract
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Reform of health insurance in Croatia. Author(s): Turek S. Source: Croatian Medical Journal. 1999 June; 40(2): 143-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10234055&dopt=Abstract
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Reform of health insurance in the Federation of Bosnia and Herzegovina. Author(s): Ljubic B, Hrabac B, Rebac Z. Source: Croatian Medical Journal. 1999 June; 40(2): 160-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10234057&dopt=Abstract
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Reforming China's urban health insurance system. Author(s): Liu Y. Source: Health Policy (Amsterdam, Netherlands). 2002 May; 60(2): 133-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11897373&dopt=Abstract
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Reforming health insurance in Argentina and Chile. Author(s): Barrientos A, Lloyd-Sherlock P. Source: Health Policy and Planning. 2000 December; 15(4): 417-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11124245&dopt=Abstract
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Reinsurance of health insurance for the informal sector. Author(s): Dror DM. Source: Bulletin of the World Health Organization. 2001; 79(7): 672-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11477971&dopt=Abstract
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Reinventing health insurance. Author(s): Halamandaris VJ. Source: Caring. 2001 April; 20(4): 40, 39. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11301971&dopt=Abstract
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Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study. Author(s): Murray SF. Source: Bmj (Clinical Research Ed.). 2000 December 16; 321(7275): 1501-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11118176&dopt=Abstract
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Relation of gender and health insurance to cardiovascular procedure use in persons with progression of chronic renal disease. Author(s): Daumit GL, Hermann JA, Powe NR. Source: Medical Care. 2000 April; 38(4): 354-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10752967&dopt=Abstract
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Relationship between procedures and health insurance for critically ill patients with Pneumocystis carinii pneumonia. Author(s): Horner RD, Bennett CL, Rodriguez D, Weinstein RA, Kessler HA, Dickinson GM, Johnson JL, Cohn SE, George WL, Gilman SC, et al. Source: American Journal of Respiratory and Critical Care Medicine. 1995 November; 152(5 Pt 1): 1435-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7582274&dopt=Abstract
Studies 191
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Relationship between type of health insurance and time to inpatient rehabilitation placement for surgical subspecialty patients. Author(s): Gerszten PC, Witham TF, Clyde BL, Welch WC. Source: American Journal of Medical Quality : the Official Journal of the American College of Medical Quality. 2001 November-December; 16(6): 212-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11816852&dopt=Abstract
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Relationship of health services to medical expenses for the national health insurance and certification rate for long-term care insurance services in municipalities. Author(s): Hioki A. Source: J Epidemiol. 2002 March; 12(2): 136-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12033524&dopt=Abstract
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Relationships between welfare status, health insurance status, and health and medical care among children with asthma. Author(s): Wood PR, Smith LA, Romero D, Bradshaw P, Wise PH, Chavkin W. Source: American Journal of Public Health. 2002 September; 92(9): 1446-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197971&dopt=Abstract
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Renewed emphasis on consumer cost sharing in health insurance benefit design. Author(s): Robinson JC. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W139-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703570&dopt=Abstract
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Report of the AAN Task Force on access to health care: the effect of no personal health insurance on health care for people with neurologic disorders. Task Force on Access to Health Care of the American Academy of Neurology. Author(s): Earnest MP, Norris JM, Eberhardt MS, Sands GH. Source: Neurology. 1996 May; 46(5): 1471-80. Erratum In: Neurology 1996 September; 47(3): 855. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8628506&dopt=Abstract
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Reproductive and sexual health benefits in private health insurance plans in Washington State. Author(s): Kurth A, Bielinski L, Graap K, Conniff J, Connell FA. Source: Family Planning Perspectives. 2001 July-August; 33(4): 153-60, 179. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11496932&dopt=Abstract
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Reproductive health services for adolescents under the State Children's Health Insurance Program. Author(s): Gold RB, Sonfield A. Source: Family Planning Perspectives. 2001 March-April; 33(2): 81-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11330855&dopt=Abstract
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Response to health insurance by previously uninsured rural children. Author(s): Tilford JM, Robbins JM, Shema SJ, Farmer FL. Source: Health Services Research. 1999 August; 34(3): 761-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10445901&dopt=Abstract
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Retiree health insurance and pension coverage: variations by firm characteristics. Author(s): Clark RL, Ghent LS, Headen AE Jr. Source: J Gerontol. 1994 March; 49(2): S53-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8126364&dopt=Abstract
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Retiree health insurance: recent trends and tomorrow's prospects. Author(s): McCormack LA, Gabel JR, Berkman ND, Whitmore H, Hutchison K, Anderson WL, Pickreign J, West N. Source: Health Care Financing Review. 2002 Spring; 23(3): 17-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500347&dopt=Abstract
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Review of universal health insurance: should we try it? Author(s): Collins B. Source: Md Med J. 1997 September; 46(8): 427-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9294951&dopt=Abstract
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Risk factors for psychosocial dysfunction among enrollees in the State Children's Health Insurance Program. Author(s): Brickman AL, Garrity CP, Shaw JA. Source: Psychiatric Services (Washington, D.C.). 2002 May; 53(5): 614-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986513&dopt=Abstract
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Risk structure compensation in Germany's statutory health insurance. Author(s): Busse R. Source: European Journal of Public Health. 2001 June; 11(2): 174-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11420805&dopt=Abstract
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Risks associated with genetic testing: health insurance discrimination or simply business as usual? Author(s): Steinberg KK. Source: J Am Med Womens Assoc. 2000 Summer; 55(4): 241-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10935360&dopt=Abstract
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Ryan White CARE Title II funding: Louisiana's potential cost savings in providing health insurance continuation coverage. Author(s): Elkins WL, Pena J, Odem S, Scalco B. Source: J La State Med Soc. 2001 September; 153(9): 465-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11686261&dopt=Abstract
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SCHIP: a far-reaching health insurance program for children--and adults. Author(s): Levant B. Source: Jaapa. 2002 March; 15(3): 19-22. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11949541&dopt=Abstract
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SCHIP: State Children's Health Insurance Program. Author(s): Bruflat C. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 1999 October-November; 3(5): 21-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10827579&dopt=Abstract
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Schur, C.L., et al., Health insurance coverage of persons with HIV-related illness: data from the ACSUS Screener. AIDS Cost and Services Utilization Survey (ACSUS) Report No. 2. AHCPR Pub. No. 94-0009 Rockville, MD: Agency for Health Care Policy and Research, 1994. Author(s): Schur CL, Berk ML. Source: Pediatr Aids Hiv Infect. 1994 December; 5(6): 362-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11361379&dopt=Abstract
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Self-funding health insurance for small employers: is it the right way to go? Author(s): Halterman SL. Source: Employee Benefits Journal. 2000 September; 25(3): 3-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11116646&dopt=Abstract
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Self-selection and moral hazard in Chilean health insurance. Author(s): Sapelli C, Vial B. Source: Journal of Health Economics. 2003 May; 22(3): 459-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683962&dopt=Abstract
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Sex, lies, and health insurance: employer-provided health insurance coverage of abortion and infertility services and the ADA. Author(s): Millsap D. Source: American Journal of Law & Medicine. 1996; 22(1): 51-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8819596&dopt=Abstract
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Shifting health insurance coverage, 1997-1999. Author(s): Zuckerman S, Kenney GM, Dubay L, Haley J, Holahan J. Source: Health Aff (Millwood). 2001 January-February; 20(1): 169-77. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11194838&dopt=Abstract
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Should employer-sponsored health insurance benefits be made public? Author(s): Jeffress J, Azziz R, Adamson D, Rebar RW. Source: Fertility and Sterility. 2002 February; 77(2): 216-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11821073&dopt=Abstract
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Should health insurance cover IVF? Issues and options. Author(s): Neumann PJ. Source: Journal of Health Politics, Policy and Law. 1997 October; 22(5): 1215-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9394246&dopt=Abstract
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Sicker and poorer--the consequences of being uninsured: a review of the research on the relationship between health insurance, medical care use, health, work, and income. Author(s): Hadley J. Source: Medical Care Research and Review : Mcrr. 2003 June; 60(2 Suppl): 3S-75S; Discussion 76S-112S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800687&dopt=Abstract
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Simple fairness: ending discrimination in health insurance coverage of addiction treatment. Author(s): Starr SB. Source: Yale Law J. 2002 June; 111(8): 2321-65. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12041536&dopt=Abstract
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Single mothers in California: understanding their health insurance coverage. Author(s): Wyn R, Ojeda VD. Source: Policy Brief Ucla Cent Health Policy Res. 2002 May; (Pb2002-1): 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12049098&dopt=Abstract
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Situational analysis of the health insurance market and related educational needs in the era of health care reform in Thailand. Author(s): Sriratanaban J, Supapong S, Kamolratanakul P, Tatiyakawee K, Srithamrongsawat S. Source: J Med Assoc Thai. 2000 December; 83(12): 1492-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11253889&dopt=Abstract
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Sliding-scale premium health insurance programs: four states' experiences. Author(s): Ku L, Coughlin TA. Source: Inquiry. 1999-00 Winter; 36(4): 471-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10711321&dopt=Abstract
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Slovenian experience on health insurance (re)introduction. Author(s): Markota M, Albreht T. Source: Croatian Medical Journal. 2001 February; 42(1): 18-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11172651&dopt=Abstract
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Slovenian national health insurance card: the next step. Author(s): Kalin T, Kandus G, Trcek D, Zupan B. Source: Studies in Health Technology and Informatics. 1999; 68: 156-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10724859&dopt=Abstract
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Small businesses, information, and the decision to offer health insurance. Author(s): Mulkey MR, Yegian JM. Source: Health Aff (Millwood). 2001 September-October; 20(5): 278-82. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11558713&dopt=Abstract
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Small firms' demand for health insurance: the decision to offer insurance. Author(s): Hadley J, Reschovsky JD. Source: Inquiry. 2002 Summer; 39(2): 118-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371567&dopt=Abstract
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Smoking cessation services offered by health insurance plans for Wisconsin state employees. Author(s): Aakko E, Piasecki TM, Remington P, Fiore MC. Source: Wmj. 1999 January-February; 98(1): 14-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10050148&dopt=Abstract
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Social class inequalities in the use of and access to health services in Catalonia, Spain: what is the influence of supplemental private health insurance? Author(s): Borrell C, Fernandez E, Schiaffino A, Benach J, Rajmil L, Villalbi JR, Segura A. Source: International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care / Isqua. 2001 April; 13(2): 117-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11430661&dopt=Abstract
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Social health insurance and tax-based funding of health. Author(s): Shisana O. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2001 December; 91(12): 1048-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11845602&dopt=Abstract
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Social health insurance options. Author(s): Jones JS. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1998 January; 88(1): 20, 22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9539928&dopt=Abstract
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Social inequality in the utilization of in- and outpatient treatment of nonpsychotic/non-organic disorders: a study with health insurance data. Author(s): Geyer S, Haltenhof H, Peter R. Source: Social Psychiatry and Psychiatric Epidemiology. 2001 August; 36(8): 373-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11766967&dopt=Abstract
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Social movements and health insurance: a critical evaluation of voluntary, non-profit insurance schemes with case studies from Ghana and Cameroon. Author(s): Atim C. Source: Social Science & Medicine (1982). 1999 April; 48(7): 881-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10192556&dopt=Abstract
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Socioeconomic differences in children's and adolescents' hospital admissions in Germany: a report based on health insurance data on selected diagnostic categories. Author(s): Geyer S, Peter R, Siegrist J. Source: Journal of Epidemiology and Community Health. 2002 February; 56(2): 109-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11812809&dopt=Abstract
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Socio-economic differences in general practitioner and outpatient specialist care in The Netherlands: a matter of health insurance? Author(s): Bongers IM, van der Meer JB, van den Bos J, Mackenbach JP. Source: Social Science & Medicine (1982). 1997 April; 44(8): 1161-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9131740&dopt=Abstract
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Solving Tennessee's health insurance dilemma: shooting for the moon? Author(s): Williams B. Source: Tenn Med. 2002 August; 95(8): 315-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12174752&dopt=Abstract
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Some pitfalls in making cost estimates of state health insurance coverage expansions. Author(s): Long SH, Marquis MS. Source: Inquiry. 1996 Spring; 33(1): 85-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8774377&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured. Analysis of the March 1992 Current Population Survey. Author(s): Foley J, Snider S, Boyce S. Source: Ebri Issue Brief. 1993 January; (133): 1-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10129611&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured. Analysis of the March 1993 Current Population Survey. Author(s): Snider S, Boyce S. Source: Ebri Issue Brief. 1994 January; (145): 1-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10131472&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured. Analysis of the March 1996 Current Population Survey. Author(s): Fronstin P. Source: Ebri Issue Brief. 1996 November; (179): 1-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10162946&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured: analysis of the March 1994 Current Population Survey. Author(s): Snider S, Fronstin P. Source: Ebri Issue Brief. 1995 February; (158): 1-44, 47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10140737&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured: analysis of the March 1997 Current Population Survey. Author(s): Fronstin P. Source: Ebri Issue Brief. 1997 December; (192): 1-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10175505&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured: analysis of the March 1998 Current Population Survey. Author(s): Fronstin P. Source: Ebri Issue Brief. 1998 December; (204): 1-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10345791&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured: analysis of the March 1999 Current Population Survey. Author(s): Fronstin P. Source: Ebri Issue Brief. 2000 January; (217): 1-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11010394&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured: analysis of the March 2000 Current Population Survey. Author(s): Fronstin P. Source: Ebri Issue Brief. 2000 December; (228): 1-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11191096&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured: analysis of the March 2001 Current Population Survey. Author(s): Fronstin P. Source: Ebri Issue Brief. 2001 December; (240): 1-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11828592&dopt=Abstract
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Sources of health insurance and characteristics of the uninsured: analysis of the March 2002 Current Population Survey. Author(s): Fronstin P. Source: Ebri Issue Brief. 2002 December; (252): 1-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596432&dopt=Abstract
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Sources of health insurance for the self employed: does differential taxation make a difference? Author(s): Monheit AC, Harvey PH. Source: Inquiry. 1993 Fall; 30(3): 293-305. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8406786&dopt=Abstract
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Sources of health insurance in the U.S.: analysis of state-level data and implications for public health programs. Author(s): Chattopadhyay SK, Hall HI, Wolf RB, Custer WS. Source: Journal of Public Health Management and Practice : Jphmp. 1999 May; 5(3): 3546. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10537605&dopt=Abstract
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South African GPs consider health insurance. Author(s): Sidley P. Source: Bmj (Clinical Research Ed.). 1995 June 24; 310(6995): 1627. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7795445&dopt=Abstract
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Spells without health insurance: the distribution of durations when left-censored spells are included. Author(s): Swartz K, Marcotte J, McBride TD. Source: Inquiry. 1993 Spring; 30(1): 77-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8454318&dopt=Abstract
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Stability and change in health insurance among older Mexican Americans: longitudinal evidence from the Hispanic established populations for epidemiologic study of the elderly. Author(s): Angel RJ, Angel JL, Markides KS. Source: American Journal of Public Health. 2002 August; 92(8): 1264-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12144982&dopt=Abstract
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Stability and variation in employment-based health insurance coverage, 1993-1997. Author(s): Long SH, Marquis MS. Source: Health Aff (Millwood). 1999 November-December; 18(6): 133-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10650695&dopt=Abstract
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Stakeholder health insurance. Commentary is disappointing. Author(s): Enthoven AC. Source: Bmj (Clinical Research Ed.). 2001 July 14; 323(7304): 107-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11480407&dopt=Abstract
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Stakeholder health insurance. Time for evidence based policy analysis. Author(s): Green DG. Source: Bmj (Clinical Research Ed.). 2001 July 14; 323(7304): 107; Author Reply 107-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11480408&dopt=Abstract
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Stakeholder health insurance: empowering the poorest patients. Author(s): Green DG. Source: Bmj (Clinical Research Ed.). 2001 March 31; 322(7289): 786-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11282871&dopt=Abstract
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Stand-alone health insurance tax credits aren't enough. Author(s): Jackson L, Trude S. Source: Issue Brief Cent Stud Health Syst Change. 2001 July; (41): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11603402&dopt=Abstract
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State child health; revisions to the regulations implementing the State Children's Health Insurance Program. Interim final rule with comment period; revisions, delay of effective date, and technical amendments to final rule. Author(s): Health Care Financing Administration (HCFA), HHS. Source: Federal Register. 2001 June 25; 66(122): 33810-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11724064&dopt=Abstract
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State Children's Health Insurance Program. Author(s): Murphy SG, Brandt EN Jr. Source: J Okla State Med Assoc. 2002 February; 95(2): 81-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11845677&dopt=Abstract
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State children's health insurance program. Author(s): Rhodes AM. Source: Mcn. the American Journal of Maternal Child Nursing. 1998 January-February; 23(1): 51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9470361&dopt=Abstract
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State Children's Health Insurance Program. Making it work for your patients. Author(s): Howse JL. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 1997 December; 1(6): 27-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9468986&dopt=Abstract
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State Children's Health Insurance Program; eligibility for prenatal care and other health services for unborn children. Final rule. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2002 October 2; 67(191): 61955-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361063&dopt=Abstract
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State mandates, self-insurance, and employer demand for substance abuse and mental health insurance coverage. Author(s): Morrisey MA, Jensen GA. Source: Adv Health Econ Health Serv Res. 1993; 14: 209-24. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10172900&dopt=Abstract
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State must close health insurance gap. Author(s): Toal R. Source: J Med Assoc Ga. 2000 Spring; 89(1): 39-41. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10820976&dopt=Abstract
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State regulation of private health insurance: prescription drug benefits, experimental treatments, and consumer protection. Author(s): Bolin JN, Buchanan RJ, Smith SR. Source: Am J Manag Care. 2002 November; 8(11): 977-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437312&dopt=Abstract
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State welfare reform policies and declines in health insurance. Author(s): Chavkin W, Romero D, Wise PH. Source: American Journal of Public Health. 2000 June; 90(6): 900-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10846507&dopt=Abstract
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Strategies to increase enrollment in children's health insurance programs: a report of the New York Academy of Medicine. Author(s): Andrulis DP, Bauer TA, Hopkins S. Source: Journal of Urban Health : Bulletin of the New York Academy of Medicine. 1999 June; 76(2): 247-79. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10924034&dopt=Abstract
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Structural incentives and adoption of medical technologies in HMO and fee-forservice health insurance plans. Author(s): Ramsey SD, Pauly MV. Source: Inquiry. 1997 Fall; 34(3): 228-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9349247&dopt=Abstract
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Study of referral process between general practitioners and specialists in health insurance clinics in Alexandria. Author(s): Abdel Kader HZ, Shehata AI, Guirguis WW, Abdel Fattah M el-A, Saleh HS, Schacke G. Source: J Egypt Public Health Assoc. 1994; 69(1-2): 89-113. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7775897&dopt=Abstract
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Study of workload of general medicine specialists working in the health insurance clinics. Author(s): Abdel Kader HZ, Shehata AI, Guirguis WW, Abdel Fattah M el-A, Saleh HM, Schacke G. Source: J Egypt Public Health Assoc. 1993; 68(5-6): 507-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7775878&dopt=Abstract
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Sugar daddy. Most Americans know Medicare as the health insurance program for the elderly, but to providers, it's a jobs program, a capital financier and a safety net. Author(s): Hallam K, Gardner J. Source: Modern Healthcare. 1999 November 8; 29(45): 80-2, 84, 92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10623271&dopt=Abstract
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Supplemental health insurance for Medicare beneficiaries. Author(s): Rice T, Bernstein J. Source: Medicare Brief. 1999 November; (6): 1-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11125909&dopt=Abstract
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Supplemental health insurance ownership in Israel: an empirical analysis and some implications. Author(s): Shmueli A. Source: Social Science & Medicine (1982). 1998 April; 46(7): 821-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9541068&dopt=Abstract
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Supplemental health insurance: did Croatia miss an opportunity? Author(s): Langenbrunner JC. Source: Croatian Medical Journal. 2002 August; 43(4): 403-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12187517&dopt=Abstract
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Surgical training in a statutory health insurance system: Belgian experience. Author(s): Hubens A, van Hee R. Source: World Journal of Surgery. 1994 September-October; 18(5): 667-70; Discussion 666. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7975679&dopt=Abstract
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Survival time of Class II molar restorations in relation to patient and dental health insurance costs for treatment. Author(s): Sjogren P, Halling A. Source: Swed Dent J. 2002; 26(2): 59-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12462873&dopt=Abstract
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Swiss opt for compulsory health insurance. Author(s): Dorozynski A. Source: Bmj (Clinical Research Ed.). 1995 January 7; 310(6971): 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7827543&dopt=Abstract
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Switching Swiss enrollees from indemnity health insurance to managed care: the effect on health status and stisfaction with care. Author(s): Perneger TV, Etter JF, Rougemont A. Source: American Journal of Public Health. 1996 March; 86(3): 388-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8604765&dopt=Abstract
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Taiwan's new national health insurance program: genesis and experience so far. Author(s): Cheng TM. Source: Health Aff (Millwood). 2003 May-June; 22(3): 61-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757273&dopt=Abstract
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Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance. Author(s): Yip W, Berman P. Source: Health Economics. 2001 April; 10(3): 207-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11288187&dopt=Abstract
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Tax credits and the affordability of individual health insurance. Author(s): Hadley J, Reschovsky JD. Source: Issue Brief Cent Stud Health Syst Change. 2002 July; (53): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12152636&dopt=Abstract
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Tax subsidies for health insurance: costs and benefits. Author(s): Gruber J, Levitt L. Source: Health Aff (Millwood). 2000 January-February; 19(1): 72-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10645074&dopt=Abstract
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Tensions in private health insurance regulation. Author(s): Willcox S. Source: J Law Med. 2003 February; 10(3): 325-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650003&dopt=Abstract
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The American health care system. Health insurance coverage. Author(s): Kuttner R. Source: The New England Journal of Medicine. 1999 January 14; 340(2): 163-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9887170&dopt=Abstract
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The anatomy of the job-generation issue and its impact on health insurance policy. Author(s): Hirschberg D. Source: International Journal of Health Services : Planning, Administration, Evaluation. 2002; 32(1): 107-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11913852&dopt=Abstract
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The association between socioeconomic status, health insurance coverage, and quality of life in men with prostate cancer. Author(s): Penson DF, Stoddard ML, Pasta DJ, Lubeck DP, Flanders SC, Litwin MS. Source: Journal of Clinical Epidemiology. 2001 April; 54(4): 350-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11297885&dopt=Abstract
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The business associate brain teaser: a look at problems involving the business associate regulations under the Health Insurance Portability and Accountability Act of 1996. Author(s): Heitzman R. Source: Ann Health Law. 2002; 11: 159-94, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12430387&dopt=Abstract
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The Children's Health Insurance Program: expanding the framework to evaluate state goals and performance. Author(s): Shi L, Oliver TR, Huang V. Source: The Milbank Quarterly. 2000; 78(3): 403-46, 340-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11028190&dopt=Abstract
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The convergence of vulnerable characteristics and health insurance in the US. Author(s): Shi L. Source: Social Science & Medicine (1982). 2001 August; 53(4): 519-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11459401&dopt=Abstract
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The cost to the New Zealand Government of providing 'free' primary medical care: an estimate based upon the Rand Health Insurance Experiment. Author(s): Robinson T. Source: N Z Med J. 2003 May 2; 116(1173): U419. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12740613&dopt=Abstract
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The development of health insurance. Author(s): Cha S. Source: Medicine and Health, Rhode Island. 2000 September; 83(9): 269-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11002663&dopt=Abstract
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The difference between health insurance and health assurance. Author(s): Johnson S. Source: Mich Health Hosp. 2003 March-April; 39(2): 46. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685368&dopt=Abstract
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The economics of health insurance plan design. Author(s): Wrobel KJ. Source: Managed Care Quarterly. 2001 Summer; 9(3): 66-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11556057&dopt=Abstract
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The effect of methodological differences in two survey's estimates of the percentage of employers sponsoring health insurance. Author(s): Hing E, Poe G, Euller R. Source: Inquiry. 1999 Summer; 36(2): 212-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10459375&dopt=Abstract
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The effect of report cards on consumer choice in the health insurance market. Author(s): Wedig GJ, Tai-Seale M. Source: Journal of Health Economics. 2002 November; 21(6): 1031-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12475124&dopt=Abstract
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The effect of variable health insurance deductibles on the demand for physician visits. Author(s): Schellhorn M. Source: Health Economics. 2001 July; 10(5): 441-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11466805&dopt=Abstract
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The effects of economic reform on health insurance and the financial burden for urban workers in China. Author(s): Hu TW, Ong M, Lin ZH, Li E. Source: Health Economics. 1999 June; 8(4): 309-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10398524&dopt=Abstract
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The effects of SCHIP on children's health insurance coverage: early evidence from the community tracking study. Author(s): Cunningham PJ, Hadley J, Reschovsky J. Source: Medical Care Research and Review : Mcrr. 2002 December; 59(4): 359-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12508701&dopt=Abstract
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The enactment of national health insurance: a Boolean analysis of twenty advanced industrial countries. Author(s): Blake CH, Adolino JR. Source: Journal of Health Politics, Policy and Law. 2001 August; 26(4): 679-708. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11523957&dopt=Abstract
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The erosion of employer-based health coverage and the threat to workers' health care: findings from The Commonwealth Fund 2002 Workplace Health Insurance Survey. Author(s): Edwards JN, Doty MM, Schoen C. Source: Issue Brief (Commonw Fund). 2002 August; (559): 1-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12216578&dopt=Abstract
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The first 2 years of a state child health insurance plan: whom are we reaching? Author(s): Kempe A, Renfrew B, Barrow J, Cherry D, Levinson A, Steiner JF. Source: Pediatrics. 2003 April; 111(4 Pt 1): 735-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671105&dopt=Abstract
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The geography of health insurance regulation. Author(s): Hall MA. Source: Health Aff (Millwood). 2000 March-April; 19(2): 173-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10718031&dopt=Abstract
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The health care system under French national health insurance: lessons for health reform in the United States. Author(s): Rodwin VG. Source: American Journal of Public Health. 2003 January; 93(1): 31-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511380&dopt=Abstract
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The health insurance blues. Medicare doesn't cover spouses, or costly drugs, so some put off retiring. Author(s): Brink S. Source: U.S. News & World Report. 2003 June 2; 134(19): 62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800333&dopt=Abstract
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The Health Insurance Flexibility and Accountability (HIFA) Demonstration program. A new initiative to cover the uninsured. Author(s): Benjamin GC. Source: Physician Executive. 2001 November-December; 27(6): 74-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11769175&dopt=Abstract
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The Health Insurance Plan of California: the first five years. Author(s): Yegian JM, Buchmueller TC, Smith MD, Monroe AF. Source: Health Aff (Millwood). 2000 September-October; 19(5): 158-65. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10992664&dopt=Abstract
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The Health Insurance Portability and Accountability Act (HIPAA) and physician compliance. Author(s): Elliott B. Source: Del Med J. 2001 July; 73(7): 261-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11487986&dopt=Abstract
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The Health Insurance Portability and Accountability Act and adolescents. Author(s): Maradiegue A. Source: Pediatric Nursing. 2002 July-August; 28(4): 417-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12226966&dopt=Abstract
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The Health Insurance Portability and Accountability Act: implications for the dental profession. Author(s): Walker R. Source: Dent Clin North Am. 2002 July; 46(3): 553-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12222097&dopt=Abstract
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The Health Insurance Portability and Accountability Act: practice of dentistry in the United States: privacy and confidentiality. Author(s): Chasteen JE, Murphy G, Forrey A, Heid D. Source: The Journal of Contemporary Dental Practice [electronic Resource]. 2003 February 15; 4(1): 59-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12595934&dopt=Abstract
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The Health Insurance Portability and Accountability Act: security and privacy requirements. Author(s): Tribble DA. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2001 May 1; 58(9): 763-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11351916&dopt=Abstract
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The HIPAA privacy rule: its effect on diabetes treatment. Health Insurance Portability and Accountability Act. Author(s): Lebowitz PH; Health Care Services Practice Group. Source: Diabetes Technology & Therapeutics. 2001 Summer; 3(2): 285-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11478337&dopt=Abstract
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The history of employment-based health insurance: the role of managed care. Author(s): Fronstin P. Source: Benefits Q. 2001; 17(2): 7-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11372476&dopt=Abstract
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The impact of a state children's health insurance program on access to dental care. Author(s): Mofidi M, Slifkin R, Freeman V, Silberman P. Source: The Journal of the American Dental Association. 2002 June; 133(6): 707-14; Quiz 767-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12083646&dopt=Abstract
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The impact of health insurance plan type on satisfaction with health care. Author(s): Dellana SA, Glascoff DW. Source: Health Care Management Review. 2001 Spring; 26(2): 33-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11293009&dopt=Abstract
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The impact of health insurance status on emergency room services. Author(s): Jackson P. Source: J Health Soc Policy. 2001; 14(1): 61-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11374298&dopt=Abstract
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The impact of National Health Insurance on neonatal care use and childhood vaccination in Taiwan. Author(s): Liu TC, Chen CS, Chen LM. Source: Health Policy and Planning. 2002 December; 17(4): 384-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424210&dopt=Abstract
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The impact of national health insurance on the notification of tuberculosis in Taiwan. Author(s): Chiang CY, Enarson DA, Yang SL, Suo J, Lin TP. Source: The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union against Tuberculosis and Lung Disease. 2002 November; 6(11): 974-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12475143&dopt=Abstract
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The impact of national health insurance on the utilization of health care services by pregnant women: the case in Taiwan. Author(s): Chen LM, Wen SW, Li CY. Source: Maternal and Child Health Journal. 2001 March; 5(1): 35-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11341718&dopt=Abstract
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The impact of public voluntary health insurance on private health expenditures in Vietnam. Author(s): Jowett M, Contoyannis P, Vinh ND. Source: Social Science & Medicine (1982). 2003 January; 56(2): 333-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12473318&dopt=Abstract
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The impact of school enrollment-based health insurance on the State Children's Health Insurance Program (SCHIP). Author(s): Romund CM, Farmer FL. Source: The Journal of School Health. 2000 November; 70(9): 381-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11127001&dopt=Abstract
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The importance of health insurance as a determinant of cancer screening: evidence from the Women's Health Initiative. Author(s): Hsia J, Kemper E, Kiefe C, Zapka J, Sofaer S, Pettinger M, Bowen D, Limacher M, Lillington L, Mason E. Source: Preventive Medicine. 2000 September; 31(3): 261-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10964640&dopt=Abstract
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The income transfer effect, the access value of insurance and the Rand health insurance experiment. Author(s): Nyman JA. Source: Journal of Health Economics. 2001 March; 20(2): 295-8; Discussion 299. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11252377&dopt=Abstract
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The influence of health insurance on outcomes of related-donor hematopoietic stem cell transplantation for AML and CML. Author(s): Selby GB, Ali LI, Carter TH, Veseley S, Roy V. Source: Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation. 2001; 7(10): 576. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11760090&dopt=Abstract
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The lore about private health insurance and pressure on public hospitals. Author(s): Cromwell D. Source: Aust Health Rev. 2002; 25(6): 72-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12536865&dopt=Abstract
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The Medicare mix: efficient and inefficient combinations of social and private health insurance for U.S. elderly. Author(s): Pauly MV. Source: Journal of Health Care Finance. 2000 Spring; 26(3): 26-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10728483&dopt=Abstract
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The Medicare prescription drug proposals and health insurance risk. Author(s): Gencarelli DM. Source: Nhpf Issue Brief. 2003 September 4; (793): 1-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12964574&dopt=Abstract
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The modified HIPAA Privacy Rule. Health Insurance Portability and Accountability Act. Author(s): Lax JR. Source: Optometry. 2002 October; 73(10): 635-45. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408550&dopt=Abstract
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The movement for universal health insurance: finding common ground. Author(s): Bodenheimer T. Source: American Journal of Public Health. 2003 January; 93(1): 112-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511398&dopt=Abstract
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The new health insurance rebate. Author(s): Wright GW. Source: The Medical Journal of Australia. 2001 March 5; 174(5): 257-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11280701&dopt=Abstract
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The new health insurance rebate: an inefficient way of assisting public hospitals. Author(s): Duckett SJ, Jackson TJ. Source: The Medical Journal of Australia. 2000 May 1; 172(9): 439-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10870538&dopt=Abstract
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The new health insurance rebate: an inefficient way of funding public hospitals. Author(s): Woodhouse PD. Source: The Medical Journal of Australia. 2000 August 21; 173(4): 218. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11008597&dopt=Abstract
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The new HIPAA (Health Insurance Portability and Accountability Act of 1996) Medical Privacy Rule: help or hindrance for clinical research? Author(s): Kulynych J, Korn D. Source: Circulation. 2003 August 26; 108(8): 912-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12939240&dopt=Abstract
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The nongroup health insurance market: short on facts, long on opinions and policy disputes. Author(s): Pauly MV, Nichols LM. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W325-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703588&dopt=Abstract
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The number of Americans without health insurance rose in 2001 and continued to rise in 2002. Author(s): Ku L. Source: International Journal of Health Services : Planning, Administration, Evaluation. 2003; 33(2): 359-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800892&dopt=Abstract
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The Pregnancy Discrimination Act: employer health insurance plans must cover prescription contraceptives. Author(s): Kurtz JM, Mehoves C. Source: Employee Benefits Journal. 2001 September; 26(3): 29-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11534218&dopt=Abstract
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The relationship between the stages of change for exercise and health insurance costs. Author(s): Dunnagan T, Haynes G, Smith V. Source: American Journal of Health Behavior. 2001 September-October; 25(5): 447-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11518339&dopt=Abstract
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The relationship of health insurance to the diagnosis and management of asthma and respiratory problems in children in a predominantly Hispanic urban community. Author(s): Freeman NC, Schneider D, McGarvey P. Source: American Journal of Public Health. 2003 August; 93(8): 1316-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893621&dopt=Abstract
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The relationship of HMOs, health insurance, and delivery systems to breast cancer outcomes. Author(s): Lee-Feldstein A, Feldstein PJ, Buchmueller T, Katterhagen G. Source: Medical Care. 2000 July; 38(7): 705-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10901354&dopt=Abstract
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The role of cost-effectiveness analysis and health insurance in diabetes care. Author(s): Songer TJ. Source: Diabetes Research and Clinical Practice. 2001 November; 54 Suppl 1: S7-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11580963&dopt=Abstract
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The role of health insurance brokers: providing small employers with a helping hand. Author(s): Conwell LJ. Source: Issue Brief Cent Stud Health Syst Change. 2002 October; (57): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12387276&dopt=Abstract
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The role of independent agents in the success of health insurance market reforms. Author(s): Hall MA. Source: The Milbank Quarterly. 2000; 78(1): 23-45, I-Ii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10834080&dopt=Abstract
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The skeptic's guide to a movement for universal health insurance. Author(s): Nathanson CA. Source: Journal of Health Politics, Policy and Law. 2003 April-June; 28(2-3): 443-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836893&dopt=Abstract
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The state Children's Health Insurance Program (CHIP). Author(s): Jenkins J, Faulkner T. Source: Journal of the American Academy of Nurse Practitioners. 2002 October; 14(10): 438-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12426800&dopt=Abstract
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The State Children's Health Insurance Program: effective but vulnerable. Author(s): Wise PH. Source: Archives of Pediatrics & Adolescent Medicine. 2002 December; 156(12): 1175-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444823&dopt=Abstract
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The structure and enforcement of health insurance rating reforms. Author(s): Hall MA. Source: Inquiry. 2000-01 Winter; 37(4): 376-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11252447&dopt=Abstract
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Time to revive the issue of national health insurance? Author(s): Fryhofer SA, Richter D, Reardon TR. Source: Hospitals & Health Networks / Aha. 2000 August; 74(8): 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11001621&dopt=Abstract
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To buy, or not to buy: factors associated with the purchase of nongroup, private health insurance. Author(s): Saver BG, Doescher MP. Source: Medical Care. 2000 February; 38(2): 141-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10659688&dopt=Abstract
Studies 213
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Toward better access to health insurance coverage for U.S. retirees in Mexico. Author(s): Warner DC, Jahnke LR. Source: Salud P'ublica De M'exico. 2001 January-February; 43(1): 59-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11270286&dopt=Abstract
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Transitional subsidies for health insurance coverage. Author(s): Gruber J. Source: Inquiry. 2001 Summer; 38(2): 225-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11529518&dopt=Abstract
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Travel health insurance: indicator of serious travel health risks. Author(s): Somer Kniestedt RA, Steffen R. Source: Journal of Travel Medicine : Official Publication of the International Society of Travel Medicine and the Asia Pacific Travel Health Association. 2003 May-June; 10(3): 185-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757694&dopt=Abstract
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Trends and patterns in health insurance coverage, 1991-2000. Author(s): Buechner JS. Source: Medicine and Health, Rhode Island. 2001 February; 84(2): 67-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11272665&dopt=Abstract
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Trends in health insurance coverage: a look at early 2001 data. Author(s): Fronstin P. Source: Health Aff (Millwood). 2002 January-February; 21(1): 188-93. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11900076&dopt=Abstract
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Trends in mental health insurance benefits and out-of-pocket spending. Author(s): McKusick DR, Mark TL, King EC, Coffey RM, Genuardi J. Source: The Journal of Mental Health Policy and Economics. 2002 June; 5(2): 71-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12529560&dopt=Abstract
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Two cheers for employment-based health insurance. Author(s): Hyman DA, Hall M. Source: Yale J Health Policy Law Ethics. 2001 Autumn; 2(1): 23-57. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664936&dopt=Abstract
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Two ophthalmology departments financed by compulsory health insurance: what is it that makes a difference in costs and clinical effectiveness? Author(s): Nasic M, Oreskovic S. Source: Croatian Medical Journal. 2002 August; 43(4): 433-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12187521&dopt=Abstract
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Type 2 diabetes mellitus among beneficiaries of the french national health insurance for self-employed workers (AMPI): comparison of the management of craftsmen or tradesmen with professionals patients. Author(s): Auleley GR, Dematons MN, Berchery P, Raynal-Minville F, Suarez F, HeulsBernin B, Blum-Boisgard C. Source: Diabetes & Metabolism. 2002 December; 28(6 Pt 1): 491-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12522330&dopt=Abstract
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Type of health insurance and the quality of primary care experience. Author(s): Shi L. Source: American Journal of Public Health. 2000 December; 90(12): 1848-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11111255&dopt=Abstract
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U.S. public school enrollment-based health insurance initiatives and America's uninsured. Author(s): Romund CM, Farmer FL, Tilford JM. Source: The Journal of School Health. 1997 December; 67(10): 422-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9503348&dopt=Abstract
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Understanding HIPAA: the Health Insurance Portability and Accountability Act. Author(s): McLellan TS. Source: J Mich Dent Assoc. 2002 March; 84(3): 38-42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11928581&dopt=Abstract
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Uniform health insurance identification cards becoming a trend. Author(s): Jebson LR, Donato S. Source: Patient Acc. 2003 March; 26(3): 2-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690833&dopt=Abstract
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Universal health insurance in the United States: reflections on the past, the present, and the future. Author(s): Vladeck B. Source: American Journal of Public Health. 2003 January; 93(1): 16-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511377&dopt=Abstract
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Urban and rural differences in health insurance and access to care. Author(s): Hartley D, Quam L, Lurie N. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 1994 Spring; 10(2): 98-108. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10134718&dopt=Abstract
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Urban-rural differences in employer-based health insurance coverage of workers. Author(s): Coburn AF, Kilbreth EH, Long SH, Marquis MS. Source: Medical Care Research and Review : Mcrr. 1998 December; 55(4): 484-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9844352&dopt=Abstract
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US report warns that lack of health insurance affects overall service provision. Author(s): Marwick C. Source: Bmj (Clinical Research Ed.). 2003 March 15; 326(7389): 570. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12637396&dopt=Abstract
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Use of consumer ratings for quality improvement in behavioral health insurance plans. Author(s): Shaul JA, Eisen SV, Stringfellow VL, Clarridge BR, Hermann RC, Nelson D, Anderson E, Kubrin AI, Leff HS, Cleary PD. Source: Jt Comm J Qual Improv. 2001 April; 27(4): 216-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11293838&dopt=Abstract
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Use of health insurance in county-funded clinics: issues for health care reform. Author(s): Rocha CJ. Source: Health & Social Work. 1996 February; 21(1): 16-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8626153&dopt=Abstract
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Use of the ED as a regular source of care: associated factors beyond lack of health insurance. Author(s): O'Brien GM, Stein MD, Zierler S, Shapiro M, O'Sullivan P, Woolard R. Source: Annals of Emergency Medicine. 1997 September; 30(3): 286-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9287889&dopt=Abstract
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Using health insurance claims data to analyze substance abuse charges and utilization. Author(s): Garnick DW, Horgan CM, Hendricks AM, Comstock C. Source: Medical Care Research and Review : Mcrr. 1996 September; 53(3): 350-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10172725&dopt=Abstract
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Using social health insurance to meet policy goals. Author(s): Normand C. Source: Social Science & Medicine (1982). 1999 April; 48(7): 865-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10192554&dopt=Abstract
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Using tax credits and state high-risk pools to expand health insurance coverage. Author(s): Abbe B. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W345-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703589&dopt=Abstract
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Utilization of clinical preventive services among Rhode Island adults with and without health insurance coverage, 1999. Author(s): Hesser JE. Source: Medicine and Health, Rhode Island. 2001 March; 84(3): 98-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11280140&dopt=Abstract
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Utilization of dental care after the introduction of the Swedish dental health insurance. Author(s): Osterberg T, Sundh W, Gustafsson G, Grondahl HG. Source: Acta Odontologica Scandinavica. 1995 December; 53(6): 349-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8849867&dopt=Abstract
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Utilization under children's health insurance programs: children with vs. without chronic conditions. Author(s): Lin CJ, Lave JR. Source: J Health Soc Policy. 2000; 11(4): 1-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10620863&dopt=Abstract
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Variations in risk-adjusted cesarean delivery rates according to race and health insurance. Author(s): Aron DC, Gordon HS, DiGiuseppe DL, Harper DL, Rosenthal GE. Source: Medical Care. 2000 January; 38(1): 35-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10630718&dopt=Abstract
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Visionary leadership for behavioral healthcare. The Child Health Insurance Program-some lessons for the future. Author(s): Ross EC. Source: Behav Healthc Tomorrow. 1998 February; 7(1): 54-6, 48. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10177773&dopt=Abstract
Studies 217
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Voluntary health insurance in Bwamanda, Democratic Republic of Congo. An exploration of its meanings to the community. Author(s): Criel B, Van Dormael M, Lefevre P, Menase U, Van Lerberghe W. Source: Tropical Medicine & International Health : Tm & Ih. 1998 August; 3(8): 640-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9735934&dopt=Abstract
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Voluntary public health insurance for low-income families: the decision to enroll. Author(s): Madden CW, Cheadle A, Diehr P, Martin DP, Patrick DL, Skillman SM. Source: Journal of Health Politics, Policy and Law. 1995 Winter; 20(4): 955-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8770759&dopt=Abstract
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Volunteerism and children's health insurance: expand coverage. Author(s): Swartz K. Source: Inquiry. 1997 Summer; 34(2): 103-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9256815&dopt=Abstract
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Vulnerable populations and health insurance. Author(s): Shi L. Source: Medical Care Research and Review : Mcrr. 2000 March; 57(1): 110-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10705705&dopt=Abstract
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Waiting in the wings: eligibility and enrollment in the State Children's Health Insurance Program. Author(s): Selden TM, Banthin JS, Cohen JW. Source: Health Aff (Millwood). 1999 March-April; 18(2): 126-33. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10091439&dopt=Abstract
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Welfare reform: unanticipated but inevitable consequences for health insurance coverage for the poor. Author(s): Darnell J, Rosenbaum S. Source: Nutrition (Burbank, Los Angeles County, Calif.). 1997 May; 13(5): 490-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9225352&dopt=Abstract
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What drove private health insurance spending on mental health and substance abuse care, 1992-1999? Author(s): Mark TL, Coffey RM. Source: Health Aff (Millwood). 2003 January-February; 22(1): 165-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528848&dopt=Abstract
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What health services researchers need to know about the Health Insurance Portability and Accountability Act. Author(s): Iezzoni LI. Source: Medical Care. 1997 October; 35(10): 993-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9338525&dopt=Abstract
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What is the method to their “madness?” Experimental treatment exclusions in health insurance policies. Author(s): Lahr JG. Source: J Contemp Health Law Policy. 1997 Spring; 13(2): 613-36. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9212532&dopt=Abstract
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What money can't buy: the bad policy of substituting fixed payments for employersponsored health insurance. Author(s): Swartz K. Source: Inquiry. 1999-00 Winter; 36(4): 371-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10711311&dopt=Abstract
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What other programs can teach us: increasing participation in health insurance programs. Author(s): Remler DK, Glied SA. Source: American Journal of Public Health. 2003 January; 93(1): 67-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511389&dopt=Abstract
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What people really know about their health insurance: a comparison of information obtained from individuals and their insurers. Author(s): Nelson DE, Thompson BL, Davenport NJ, Penaloza LJ. Source: American Journal of Public Health. 2000 June; 90(6): 924-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10846510&dopt=Abstract
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What's ahead for health insurance in the United States? Author(s): Fuchs VR. Source: The New England Journal of Medicine. 2002 June 6; 346(23): 1822-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12050346&dopt=Abstract
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What's driving up health insurance cost now? Author(s): Batterson RE. Source: Tex Dent J. 2003 March; 120(3): 288-91. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12723113&dopt=Abstract
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When employees can't afford health insurance: the self-funding approach. Author(s): Higham AM. Source: Caring. 1997 July; 16(7): 66-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10169887&dopt=Abstract
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When should preventive treatment be paid for by health insurance? Author(s): Annas GJ. Source: The New England Journal of Medicine. 1994 October 13; 331(15): 1027-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8084353&dopt=Abstract
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Where is efficiency leading our system of health insurance? Author(s): Swartz K. Source: Inquiry. 1997 Fall; 34(3): 193-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9349243&dopt=Abstract
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Whither private health insurance? Author(s): Stacey BG. Source: Aust N Z J Public Health. 1997 June; 21(3): 347-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9270171&dopt=Abstract
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Whither private health insurance? Author(s): Hall J, Viney R, de Abreu Lourenco R. Source: Aust N Z J Public Health. 1997 April; 21(2): 119-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9161064&dopt=Abstract
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Who declines employer-sponsored health insurance and is uninsured? Author(s): Cunningham PJ, Schaefer E, Hogan C. Source: Issue Brief Cent Stud Health Syst Change. 1999 October; (22): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10915428&dopt=Abstract
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Who helps employers design their health insurance benefits? Author(s): Marquis MS, Long SH. Source: Health Aff (Millwood). 2000 January-February; 19(1): 133-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10645079&dopt=Abstract
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Who pays for employer-sponsored health insurance? Author(s): Blumberg LJ. Source: Health Aff (Millwood). 1999 November-December; 18(6): 58-61. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10650688&dopt=Abstract
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Why are workers uninsured? Employer-sponsored health insurance in 1997. Author(s): Thorpe KE, Florence CS. Source: Health Aff (Millwood). 1999 March-April; 18(2): 213-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10091450&dopt=Abstract
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Why don't the uninsured have health insurance? Author(s): Mirvis DM. Source: Tenn Med. 2002 April; 95(4): 149-51. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11941908&dopt=Abstract
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Why not private health insurance? 1. Insurance made easy. Author(s): Deber R, Gildiner A, Baranek P. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1999 September 7; 161(5): 539-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10497613&dopt=Abstract
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Why we should keep the employment-based health insurance system. Author(s): Custer WS, Kahn CN 3rd, Wildsmith TF 4th. Source: Health Aff (Millwood). 1999 November-December; 18(6): 115-23. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10650693&dopt=Abstract
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Will uninsured people volunteer for voluntary health insurance? Experience from Washington State. Author(s): Diehr P, Madden CW, Cheadle A, Martin DP, Patrick DL, Skillman S. Source: American Journal of Public Health. 1996 April; 86(4): 529-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8604784&dopt=Abstract
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Will universal health insurance assure universal access to ongoing primary care for adults? Author(s): Cykert S, Layson RT. Source: Archives of Family Medicine. 1993 November; 2(11): 1153-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8124490&dopt=Abstract
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Withering on the vine: the decline of indemnity health insurance. Author(s): Gabel JR, Ginsburg PB, Whitmore HH, Pickreign JD. Source: Health Aff (Millwood). 2000 September-October; 19(5): 152-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10992663&dopt=Abstract
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Within-state geographic patterns of health insurance coverage and health risk factors in the United States. Author(s): Pickle LW, Su Y. Source: American Journal of Preventive Medicine. 2002 February; 22(2): 75-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818175&dopt=Abstract
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Women's choice? The impact of private health insurance on episiotomy rates in Australian hospitals. Author(s): Shorten A, Shorten B. Source: Midwifery. 2000 September; 16(3): 204-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10970754&dopt=Abstract
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Workers' decisions to take-up offered health insurance coverage: assessing the importance of out-of-pocket premium costs. Author(s): Cooper PF, Vistnes J. Source: Medical Care. 2003 July; 41(7 Suppl): Iii35-Iii43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12865725&dopt=Abstract
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Working families' health insurance coverage, 1997-2001. Author(s): Strunk BC, Reschovsky JD. Source: Track Rep. 2002 August; (4): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12532969&dopt=Abstract
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Working with employers to increase SCHIP (State Children's Health Insurance Program) enrollment. Author(s): Gugenhelm AM, Shapiro LD. Source: Health Aff (Millwood). 2001 January-February; 20(1): 287-90. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11194853&dopt=Abstract
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You can't buy insurance when the house is on fire. Community rating kills health insurance. Author(s): Hartnedy JA. Source: Postgraduate Medicine. 1994 May 15; 95(7): 75-8,81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8197058&dopt=Abstract
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CHAPTER 2. NUTRITION AND HEALTH INSURANCE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and health insurance.
Finding Nutrition Studies on Health Insurance The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “health insurance” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7
Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following is a typical result when searching for recently indexed consumer information on health insurance: •
Racial and ethnic differences in health insurance coverage for adults with diabetes. Author(s): National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
[email protected] Source: Harris, M I Diabetes-Care. 1999 October; 22(10): 1679-82 0149-5992
The following information is typical of that found when using the “Full IBIDS Database” to search for “health insurance” (or a synonym): •
A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance funds in Switzerland. Author(s): University of Basel, Health Economics and Social Policy Research Unit, Switzerland. Source: Sommer, J H Burgi, M Theiss, R Complement-Ther-Med. 1999 June; 7(2): 54-61 0965-2299
•
Commentary on Sommer et al. 'A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance. Author(s): University of Bern, Kollegiale Instanz fur Komplementarmedizin KIKOM, Inselspital, Switzerland. Source: Heusser, P Complement-Ther-Med. 2000 March; 8(1): 50-3 0965-2299
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMD®Health: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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CHAPTER 3. ALTERNATIVE MEDICINE AND HEALTH INSURANCE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to health insurance. At the conclusion of this chapter, we will provide additional sources.
The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “health insurance” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •
White House Commission on Complementary and Alternative Medicine Policy: Meeting on the Access to, and Delivery of, Complementary and Alternative Medicine Services (editorial) Source: Journal of Alternative and Complementary Medicine. 7(1): 109-110. February 2001. Summary: This journal article summarizes proceedings from the meeting on Access and Delivery of Complementary and Alternative Medicine (CAM) Services, held December 4-5, 2000, by the White House Commission on CAM Policy. During the 2-day meeting, expert witnesses made written and verbal presentations and preregistered members of the public had an opportunity to comment. According to this author, some familiar disputes and long-standing tensions were aired, but the mood was positive. Therapists expressed the view that physicians are dominating the movement to integrate.
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However, some physicians were sensitive to the CAM therapists' concerns and eager to work with them on an assumption of parity. Public testimonials emphasized consumers' desire for choice, clear and impartial information, access to research results, and a role in health care decision making. Health insurance and managed care organizations, aware of public pressure, presented examples of coverage schemes to study as prototypes for future policy directions. accessibility, affordability, and accountability issues also were discussed.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to health insurance and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “health insurance” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to health insurance: •
“Gotcha covered”. Puzzling out the mysteries of health insurance benefits coverage. Author(s): Bruder P. Source: Hospital Topics. 1993 Fall; 71(4): 8-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10131262&dopt=Abstract
•
“Other” medicine enters the managed care mainstream. Author(s): Campbell S. Source: Health Care Strateg Manage. 1997 January; 15(1): 1, 20-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10163880&dopt=Abstract
•
“You can't get there from here,” Zeno says. Author(s): Czap A. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2000 August; 5(4): 289. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10956376&dopt=Abstract
•
A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance funds in Switzerland. Author(s): Sommer JH, Burgi M, Theiss R. Source: Complementary Therapies in Medicine. 1999 June; 7(2): 54-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10444908&dopt=Abstract
•
A regional survey of health insurance coverage for complementary and alternative medicine: current status and future ramifications. Author(s): Cleary-Guida MB, Okvat HA, Oz MC, Ting W.
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Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 2001 June; 7(3): 269-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11439848&dopt=Abstract •
Commentary on Sommer et al. 'A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance. Author(s): Heusser P. Source: Complementary Therapies in Medicine. 2000 March; 8(1): 50-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10812762&dopt=Abstract
•
Comments on the value of pet health insurance. Author(s): Stephens JL. Source: J Am Vet Med Assoc. 2001 March 15; 218(6): 856-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11294307&dopt=Abstract
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Employer-sponsored health insurance for chiropractic services. Author(s): Jensen GA, Roychoudhury C, Cherkin DC. Source: Medical Care. 1998 April; 36(4): 544-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9544594&dopt=Abstract
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Unconventional medicine in Central Europe: a misuse of public health insurance? Author(s): Falkenbach A, Herold M. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 1999 October; 5(5): 479-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10537248&dopt=Abstract
•
Utilization of hepatoprotectants within the National Health Insurance in Taiwan. Author(s): Chen TJ, Chou LF, Hwang SJ. Source: Journal of Gastroenterology and Hepatology. 2003 July; 18(7): 868-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12795761&dopt=Abstract
•
Who should rightfully decide whether a medical treatment necessarily incurred should be excluded from coverage under a health insurance policy provision which excludes from coverage “experimental” medical treatments? Author(s): Fisfis BA. Source: Duquesne Law Rev. 1993 Summer; 31(4): 777-800. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11652669&dopt=Abstract
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMD®Health: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to health insurance; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
Alternative Therapy Aromatherapy Source: Integrative Medicine Communications; www.drkoop.com Biofeedback Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,675,00.html Chiropractic Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,681,00.html Naturopathy Source: Integrative Medicine Communications; www.drkoop.com Naturopathy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,722,00.html Relaxation Techniques Source: Integrative Medicine Communications; www.drkoop.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. DISSERTATIONS ON HEALTH INSURANCE Overview In this chapter, we will give you a bibliography on recent dissertations relating to health insurance. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “health insurance” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on health insurance, we have not necessarily excluded non-medical dissertations in this bibliography.
Dissertations on Health Insurance ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to health insurance. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •
A Comparative Study of Two Health Insurance Benefits: a Case Study of Methodological Issues in Evaluative Research by Moroney, Robert M., Phd from Brandeis University, 1971, 250 pages http://wwwlib.umi.com/dissertations/fullcit/7122691
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A Contingent Claims Valuation of Indemnified Health Insurance Plans by Dumpe, David Albert, Phd from Kent State University, 1996, 59 pages http://wwwlib.umi.com/dissertations/fullcit/9830318
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A Sociohistorical Analysis of the Role of Interest Groups in Shaping National Health Insurance Reform by Kelly, Shawn Patrick, Phd from University of Missouri Columbia, 1998, 447 pages http://wwwlib.umi.com/dissertations/fullcit/9901246
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A Sociological Assessment of Consumers' Perceptions about a Health Care Crisis in America and Their Acceptance of the Kennedy National Health Insurance Proposal.
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by Juarez, Rumaldo Zapata, Phd from The Pennsylvania State University, 1976, 189 pages http://wwwlib.umi.com/dissertations/fullcit/7710668 •
A Study of Profitability in the United States Health Insurance Industry by Woodward, Albert Mesquita, Phd from The American University, 1982, 188 pages http://wwwlib.umi.com/dissertations/fullcit/8224516
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A Theoretical Analysis of the Impact of National Health Insurance on Consumer Behavior in the Health Care Market. by Blair, Dudley Wayne, Phd from Texas A&m University, 1975, 100 pages http://wwwlib.umi.com/dissertations/fullcit/7617340
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Access to Free Care for the Uninsured and Its Effect on Private Health Insurance Coverage by Herring, Bradley James; Phd from University of Pennsylvania, 2000, 125 pages http://wwwlib.umi.com/dissertations/fullcit/9989601
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Access to Health Insurance among the Poor: Determinants and Policy Implications (uninsured) by Jeon, Jiwon, Phd from The University of Wisconsin - Madison, 1992, 159 pages http://wwwlib.umi.com/dissertations/fullcit/9224158
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Access to Health Insurance and Health Care: an Economic Analysis of the Uninsured by Spillman, Brenda Charlene, Phd from Syracuse University, 1989, 211 pages http://wwwlib.umi.com/dissertations/fullcit/9013497
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Adverse Selection and Government Intervention in Life and Health Insurance Markets by Finkelstein, Amy Nadya; Phd from Massachusetts Institute of Technology, 2001 http://wwwlib.umi.com/dissertations/fullcit/f1025089
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Alleviating Poverty in the United States and Canada (job Training, National Health Insurance) by Hanratty, Maria Joan, Phd from Harvard University, 1991, 176 pages http://wwwlib.umi.com/dissertations/fullcit/9211687
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An Analysis of the Reasons National Health Insurance Failed to Become Policy in the United States (health Insurance) by Grant, Vicki Cain, Phd from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1992, 201 pages http://wwwlib.umi.com/dissertations/fullcit/9227593
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An Economic Analysis of Employer-related Health Insurance Coverage and Job Mobility in the United States by Slade, Eric Phillip, Phd from Brown University, 1997, 152 pages http://wwwlib.umi.com/dissertations/fullcit/9738624
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An Economic Analysis of Health Insurance, with Special Reference to Blue Cross by Hill, Daniel Bruce, Phd from Purdue University, 1971, 183 pages http://wwwlib.umi.com/dissertations/fullcit/7120471
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An Empirical Analysis of the Provision of Employer-sponsored Health Insurance by Gavin, Norma Irene, Phd from Duke University, 1994, 140 pages http://wwwlib.umi.com/dissertations/fullcit/9500518
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An Examination of the Client-professional Service Provider Relationship Maintenance from the Clients' Perspective (professional Service Provider, Health Insurance) by Suh, Munshik, Phd from Georgia State University, 1994, 262 pages http://wwwlib.umi.com/dissertations/fullcit/9422810
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An Implementation Study of the Boston Health Plan: Managed Care for the Urban Poor, What Made It So Hard? (community Health Services, Health Maintenance Organizations, Health Insurance, Health Services Administration, Policy Sciences) by Lurie, James M., Phd from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1986, 278 pages http://wwwlib.umi.com/dissertations/fullcit/8622403
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An Investigation into Health Insurance Benefits, Ambulatory Mental Health Provisions and Degree of Consumer Preference in a Changing Environment by White, Gail, Phd from University of Pittsburgh, 1989, 162 pages http://wwwlib.umi.com/dissertations/fullcit/9021467
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An Investigation of the Market for Employer-provided Group Health Insurance in the United States by Marton, James Henry; Phd from Washington University, 2002, 91 pages http://wwwlib.umi.com/dissertations/fullcit/3065073
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Analysis of Optimal Non-linear Health Insurance Schedule by Chen, Gongwei; Phd from Washington State University, 2001, 98 pages http://wwwlib.umi.com/dissertations/fullcit/3023570
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Body Fat As a Marker for Cardiovascular Risk Factors, Health Insurance Claims, and Sick Leave Costs by Brizzolara, Jeffrey Anthony, Phd from Texas A&m University, 1994, 101 pages http://wwwlib.umi.com/dissertations/fullcit/9432649
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Business and Health Reform: Worker's Compensation and Health Insurance in the Progressive Era by Abramovitz, Miriam G., Dsw from Columbia University, 1981, 663 pages http://wwwlib.umi.com/dissertations/fullcit/8125232
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Changes in the Structure of Employer-provided Health Insurance (preferred Provider Organization, Health Insurance) by Gruber, Jonathan Holmes, Phd from Harvard University, 1992, 208 pages http://wwwlib.umi.com/dissertations/fullcit/9228203
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Choice among Discrete Health Insurance Alternatives: a Theoretical and Empirical Analysis by Glenn, Darrell Eugene, Phd from University of Kentucky, 1987, 181 pages http://wwwlib.umi.com/dissertations/fullcit/8806544
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Choice of Health Insurance and Models of Decision-making under Uncertainty (medicare) by Banthin, Jessica Sherman, Phd from University of Maryland College Park, 1992, 175 pages http://wwwlib.umi.com/dissertations/fullcit/9234518
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Choice of Health Insurance Plans by Enrollees of a State High-risk Pool by Chen, Meimei, Phd from University of Minnesota, 1995, 238 pages http://wwwlib.umi.com/dissertations/fullcit/9607863
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Choice, Information and Quality of Employer-sponsored Health Insurance by Vanness, David John; Phd from The University of Wisconsin - Madison, 2000, 196 pages http://wwwlib.umi.com/dissertations/fullcit/9960350
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Chronic Illness and Health Services Use: a before - after Study of Canadian National Health Insurance. by Weiss, David Maurice, Phd from University of Pittsburgh, 1976, 257 pages http://wwwlib.umi.com/dissertations/fullcit/7723552
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Colorado Health Insurance: a Study of Markets and Hierarchies by Paulson, Kristin Mary, Phd from University of Colorado at Boulder, 1987, 288 pages http://wwwlib.umi.com/dissertations/fullcit/8716281
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Commitment and the Design of Optimal Agreements: Evidence from Employmentbased Health Insurance Contracts by Moran, John R., Phd from The Pennsylvania State University, 1997, 111 pages http://wwwlib.umi.com/dissertations/fullcit/9732337
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Community Rating and Regulatory Reform in Health Insurance Markets by Percy, Allison Marie; Phd from University of Pennsylvania, 2000, 151 pages http://wwwlib.umi.com/dissertations/fullcit/9989636
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Compensating Wage Differentials in the Presence of Employer-provided Health Insurance: an Empirical Inquiry by Morlock, Robert James; Phd from Wayne State University, 2000, 125 pages http://wwwlib.umi.com/dissertations/fullcit/9992244
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Compensation Crisis: the Value and Meaning of Work-related Injuries and Illnesses in the United States, 1842-1932 (health Insurance, Class Conflict, Torts) by Bale, Anthony Frederick, Phd from Brandeis University, 1987, 787 pages http://wwwlib.umi.com/dissertations/fullcit/8705769
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Conceptualizing the Implementation Process: National Health Insurance in South Korea (health Insurance) by Rhyu, Ji-sung, Dpa from Arizona State University, 1991, 232 pages http://wwwlib.umi.com/dissertations/fullcit/9210419
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Consumer Choice of Health Insurance: a Preferred Provider Organization (california) by Wouters, Annemarie Verena, Phd from Boston University, 1987, 236 pages http://wwwlib.umi.com/dissertations/fullcit/8707078
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Consumer Participation in a Health Care Organization: the Case of the Health Insurance Plan of Greater New York. by Steinberg, Marcia K., Phd from City University of New York, 1977, 265 pages http://wwwlib.umi.com/dissertations/fullcit/7714590
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Demand for Maternal Health Care Services in Ecuador: the Role of Health Insurance by Gordillo-tobar, Amparo Elena; Phd from Tulane University, 2003, 116 pages http://wwwlib.umi.com/dissertations/fullcit/3084113
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Determinant Attribute Analysis of Enrollment Decisions in a University-sponsored Preferred Provider Organization: a Comparison of Methods (health Insurance, Benefits, Satisfaction) by Rupp, Michael Thomas, Phd from The Ohio State University, 1986, 234 pages http://wwwlib.umi.com/dissertations/fullcit/8703610
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Differences in the Health Insurance Status and Health Care Services Utilization among Hispanics in the United States by Calderas, Onell Jesus; Ms from Southern Connecticut State University, 2002, 32 pages http://wwwlib.umi.com/dissertations/fullcit/1408472
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Differential Organizational Patterns of Blue Cross - Blue Shield and Commercial Insurers for Competition in the Market for Group Health Insurance by Hays, Robert David, Phd from Vanderbilt University, 1981, 205 pages http://wwwlib.umi.com/dissertations/fullcit/8206108
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Distributional Effects of the Canadian National Health Insurance Program, a Long Run Locational Approach by Honda, Steven Takao, Phd from University of California, Los Angeles, 1981, 115 pages http://wwwlib.umi.com/dissertations/fullcit/8201105
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Does Health Insurance Matter? an Analysis of How the Type of Health Insurance Affects Medical Procedure Use during Pregnancy and Birth by Turcotte, Leo Robert; Phd from State University of New York at Binghamton, 2000, 552 pages http://wwwlib.umi.com/dissertations/fullcit/9958502
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Effects of a Medicare, Medicaid and Private Health Insurance Program on Knowledge, Attitudes, and Practices of Elderly Citizens by Williams, Deloris Green, Phd from University of Illinois at Urbana-champaign, 1986, 325 pages http://wwwlib.umi.com/dissertations/fullcit/8623440
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Emergency Department Utilization Patterns for a Sample with Employer-based Health Insurance by Qureshi, Kristine Ann; Dnsc from Columbia University, 2003, 119 pages http://wwwlib.umi.com/dissertations/fullcit/3080832
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Employee Affective Responses to Health Insurance Benefits (benefits) by Lucero, Margaret Ann, Phd from University of Houston, 1991, 125 pages http://wwwlib.umi.com/dissertations/fullcit/9129268
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Employee Demand for Health Insurance and Employer Health Benefit Choices by Bundorf, Mary Kate; Phd from University of Pennsylvania, 2000, 190 pages http://wwwlib.umi.com/dissertations/fullcit/9965452
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Employer Choice of Health Insurance Benefits (fringe Benefits, Compensation, Taxes) by Jensen, Gail Ann, Phd from University of Minnesota, 1986, 156 pages http://wwwlib.umi.com/dissertations/fullcit/8622601
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Employer-provided Health Insurance and the Job Choice Decision (insurance Benefits) by Buchmueller, Thomas Carl, Phd from The University of Wisconsin Madison, 1992, 233 pages http://wwwlib.umi.com/dissertations/fullcit/9306392
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Employer-provided Health Insurance: Mobility, Welfare, and Labor Market Equilibrium by Dey, Matthew Scott; Phd from New York University, 2000, 119 pages http://wwwlib.umi.com/dissertations/fullcit/3009298
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Employer-sponsored Health Insurance: Costs, Coverage and Contributions by Levy, Helen Gardner, Phd from Princeton University, 1998, 228 pages http://wwwlib.umi.com/dissertations/fullcit/9901814
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Employment, Wages, and Health Insurance Coverage for Low- and High-skilled Workers by Wolaver, Amy Margaret, Phd from The University of Wisconsin - Madison, 1998, 243 pages http://wwwlib.umi.com/dissertations/fullcit/9839366
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Employment-based State Medical Insurance and Job Selection in China: a Switching Simultaneous Equation Model by Li, Zhiming, Phd from The University of North Carolina at Chapel Hill, 1994, 203 pages http://wwwlib.umi.com/dissertations/fullcit/9523071
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Employment-related Health Insurance, Disability, and Labor Supply by Davidson, Vada Agnes; Phd from The Johns Hopkins University, 2000, 147 pages http://wwwlib.umi.com/dissertations/fullcit/9964083
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Essays on Health Insurance Markets: Asymmetric Information and Multiple Periods by Frick, Kevin David, Phd from University of Michigan, 1996, 170 pages http://wwwlib.umi.com/dissertations/fullcit/9635520
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Essays on the Economics of Health Insurance by Mcknight, Robin Lynn; Phd from Massachusetts Institute of Technology, 2002 http://wwwlib.umi.com/dissertations/fullcit/f419601
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Essays on the Economics of Health Insurance by Tsui, Flora Hsiu-chen, Phd from The Johns Hopkins University, 1996, 131 pages http://wwwlib.umi.com/dissertations/fullcit/9617611
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Essays on the Impact of Changes in Health and Social Policy in Taiwan: 1. Social Health Insurance and Saving in Taiwan. 2. Health Insurance Availability and Female Labor Supply. 3. Fertility and the Cost of Having a Child: Can the Government Influence Fer by Chou, Yiing-jenq, Phd from Harvard University, 1997, 128 pages http://wwwlib.umi.com/dissertations/fullcit/9733260
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Evaluating the Effect of Medicaid and State Children's Health Insurance Program Expansions by Davis, Jason R. Phd from Michigan State University, 2002, 117 pages http://wwwlib.umi.com/dissertations/fullcit/3064218
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Evidence of Adverse Selection in the Individual Health Insurance Market by Browne, Mark Joseph, Phd from University of Pennsylvania, 1989, 143 pages http://wwwlib.umi.com/dissertations/fullcit/9004770
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Exits, Recidivism, and Caseload Growth: the Effect of Private Health Insurance Markets on the Demand for Medicaid by Perreira, Krista Marlyn; Phd from University of California, Berkeley, 1999, 173 pages http://wwwlib.umi.com/dissertations/fullcit/9966520
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Explaining Differences in Welfare State Development: a Comparative Study of Health Insurance in Canada and the United States by Maioni, Antonia, Phd from Northwestern University, 1992, 400 pages http://wwwlib.umi.com/dissertations/fullcit/9309413
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Factors Associated with Hospital Financial Performance in Taiwan Following Implementation of National Health Insurance by Chiang, Jiunn-chiou; Phd from University of South Carolina, 2002, 177 pages http://wwwlib.umi.com/dissertations/fullcit/3059425
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Financial Analysis of the Life and Health Insurance Industry: a Disaggregated and Clustered Approach (life Insurance) by Baranoff, Esther Zippora, Phd from The University of Texas at Austin, 1993, 319 pages http://wwwlib.umi.com/dissertations/fullcit/9323325
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Firm Characteristics and the Propensity to Offer Retiree Health Insurance by Ghent, Linda Shumaker, Phd from North Carolina State University, 1994, 351 pages http://wwwlib.umi.com/dissertations/fullcit/9500467
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Fringe Benefits, Job Quality, and Labor Mobility: Pension and Health Insurance Effects on Job-change Decisions by Spaulding, James Wallace, Phd from The University of Wisconsin - Madison, 1997, 218 pages http://wwwlib.umi.com/dissertations/fullcit/9735855
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From Authoritarianism to Statism: the Politics of National Health Insurance in Taiwan by Lin, Kuo-ming, Phd from Yale University, 1997, 547 pages http://wwwlib.umi.com/dissertations/fullcit/9731019
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From Sickness to Health: the Twentieth-century Development of the Demand for Health Insurance by Thomasson, Melissa Anne, Phd from The University of Arizona, 1998, 174 pages http://wwwlib.umi.com/dissertations/fullcit/9901709
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Genetic Screening and Its Impact on Health Insurance Availability by Imperato, Pamela R. Lee, Phd from The University of Nebraska - Lincoln, 1997, 277 pages http://wwwlib.umi.com/dissertations/fullcit/9812356
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Health Insurance Alternatives for Illinois School Districts by Dunn, Robert Wesley, Phd from Southern Illinois University at Carbondale, 1983, 92 pages http://wwwlib.umi.com/dissertations/fullcit/8321425
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Health Insurance and Price Distortions. by Bennett, Max Dial, Phd from The Johns Hopkins University, 1973, 248 pages http://wwwlib.umi.com/dissertations/fullcit/7608563
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Health Insurance and the Demand for Outpatient Mental Health Treatment: Will Health Reform Help Those Most in Need? by Zuvekas, Samuel Holt, Phd from The University of Wisconsin - Madison, 1996, 282 pages http://wwwlib.umi.com/dissertations/fullcit/9631843
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Health Insurance and the Making of the American Welfare State, 1915-1920 by Hoffman, Beatrix Rebecca, Phd from Rutgers the State University of New Jersey - New Brunswick, 1996, 276 pages http://wwwlib.umi.com/dissertations/fullcit/9711063
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Health Insurance Contracts and Information Costs by Li, Chu-shiu, Phd from The Claremont Graduate University, 1997, 101 pages http://wwwlib.umi.com/dissertations/fullcit/9707268
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Health Insurance Costs in Indiana Public School Corporations from 1985 to 1990 and an Analysis of Alternatives by Stroud, Roy L., Phd from Indiana State University, 1991, 121 pages http://wwwlib.umi.com/dissertations/fullcit/9206042
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Health Insurance Coverage for Persons Leaving Welfare by Brown, Margaret Elizabeth; Phd from University of Minnesota, 2002, 148 pages http://wwwlib.umi.com/dissertations/fullcit/3058628
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Health Insurance Coverage in America: Are Immigrants Different? by Bass, Elizabeth Anne; Phd from University of Illinois at Chicago, 2003, 132 pages http://wwwlib.umi.com/dissertations/fullcit/3083848
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Health Insurance Effects on the Adoption and Utilization of New Medical Technologies (insurance) by Ramsey, Scott David, Phd from University of Pennsylvania, 1994, 104 pages http://wwwlib.umi.com/dissertations/fullcit/9427602
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Health Insurance for the Bracero: a Study of Its Development and Implementation under Public Law 78 by Wiest, Grace Leona, Phd from The Claremont Graduate University, 1966, 305 pages http://wwwlib.umi.com/dissertations/fullcit/6709535
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Health Insurance in Rural Areas by Jensen, Helen Hannay, Phd from The University of Wisconsin - Madison, 1980, 199 pages http://wwwlib.umi.com/dissertations/fullcit/8011377
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Health Insurance Markets and Public Policy by Drennan, Ronald, Phd from Rutgers the State University of New Jersey - New Brunswick, 1998, 157 pages http://wwwlib.umi.com/dissertations/fullcit/9915433
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Health Insurance Program Procedures and Practices of School Districts and Selected Businesses in Missouri by Jackson, Donald E., Edd from University of Missouri Columbia, 1988, 152 pages http://wwwlib.umi.com/dissertations/fullcit/8915286
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Health Insurance, Competition and Information by Calcott, Paul Edwin, Phd from University of California, Los Angeles, 1994, 126 pages http://wwwlib.umi.com/dissertations/fullcit/9517757
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Health Insurance, Habits and Health Outcomes: a Dynamic Stochastic Model of Investment in Health by Khwaja, Ahmed Wali; Phd from University of Minnesota, 2001, 118 pages http://wwwlib.umi.com/dissertations/fullcit/3020594
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Health Insurance, Socioeconomic Status, and Government Regulation: an Empirical Analysis by Arrieta, Geralyn E. Phd from University of California, Irvine, 2000, 172 pages http://wwwlib.umi.com/dissertations/fullcit/9963040
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Household Structure and Employment Related Health Insurance Dynamics by Zhou, Zhiyuan, Phd from Wayne State University, 1993, 94 pages http://wwwlib.umi.com/dissertations/fullcit/9321828
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Identifying and Measuring Institutional Inefficiency in the Korean National Health Insurance System: a Stochastic Frontier Approach (korea) by Yoo, Tae-kyun, Phd from University of California, Berkeley, 1995, 141 pages http://wwwlib.umi.com/dissertations/fullcit/9621436
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Impact of State Children's Health Insurance Program (schip) on Children's Access to Primary Care in South Carolina: a Study of Hospitalizations with Ambulatory Care Sensitive Conditions (acsc) by Han, Whiejong Matthew; Phd from University of South Carolina, 2003, 98 pages http://wwwlib.umi.com/dissertations/fullcit/3084788
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Imperfect Information in Health Insurance Markets: Reconciling Theory and Observation (adverse Selection) by Schur, Claudia Laiken, Phd from University of Maryland College Park, 1985, 139 pages http://wwwlib.umi.com/dissertations/fullcit/8608858
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Implications of National Health Insurance for University Student Counseling Services. by Lindeman, Janet Claire, Phd from Washington State University, 1977, 130 pages http://wwwlib.umi.com/dissertations/fullcit/7800312
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Inadequate Media and the Failure of the National Health Insurance Proposal in the Late 1940's by Allen, Donna, Phd from Howard University, 1971, 276 pages http://wwwlib.umi.com/dissertations/fullcit/7214028
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Income and Health Insurance: the Financial Barrier to Health Care under Relatively Comprehensive Coverage by Young, Robert Charles, Phd from Indiana University, 1969, 191 pages http://wwwlib.umi.com/dissertations/fullcit/7007523
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Indemnities Versus Deductibles in Health Insurance: Relative Efficiency in Deterring Low-benefit Medical Treatments by Graboyes, Robert Francis; Phd from Columbia University, 2000, 148 pages http://wwwlib.umi.com/dissertations/fullcit/9970199
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Industrial Organization of Markets for Health Insurance and Medical Services by Richardson, Hugh Stanley, Phd from University of Washington, 1997, 102 pages http://wwwlib.umi.com/dissertations/fullcit/9736367
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Inequalities in the Utilization of Health Services in Chile? Analysis of the Effects of Individual Income and Health Insurance Coverage in Timely Receipt Health Care Services by Nunez, Marco Antonio; Phd from The Johns Hopkins University, 2002, 107 pages http://wwwlib.umi.com/dissertations/fullcit/3046524
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Informal Health Insurance Mechanisms: Do Pakistani Migrants Protect Parent Households against Consumption Losses after Illness? by Saleh, Karima S. Phd from The Johns Hopkins University, 2002, 210 pages http://wwwlib.umi.com/dissertations/fullcit/3046554
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Information Asymmetries, Adverse Selection, and the Individual Health Insurance Market: Alternative Mechanisms for Managing the Cost of Private Information by Thatcher, Matt Eric, Phd from University of Pennsylvania, 1998, 208 pages http://wwwlib.umi.com/dissertations/fullcit/9913527
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Institutional Legacies and State Power: the First State Health Insurance Movements in Great Britain, the United States, and Korea by Park, Chan-ung, Phd from The University of Chicago, 1997, 471 pages http://wwwlib.umi.com/dissertations/fullcit/9729858
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Insuring the Uninsured: an Analysis of the Degree of Risk Aversion and the Demand for Health Insurance in the State of Minnesota by Jonk, Yvonne Catharina Maria; Phd from University of Minnesota, 2000, 149 pages http://wwwlib.umi.com/dissertations/fullcit/9983581
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Labor Force Participation and Employer Provided Health Insurance by Sheu, Shengjang; Phd from Texas A&m University, 2002, 95 pages http://wwwlib.umi.com/dissertations/fullcit/3060892
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Labor Market Effects of Employment-based Health Insurance by Madrian, Brigitte Condie, Phd from Massachusetts Institute of Technology, 1993 http://wwwlib.umi.com/dissertations/fullcit/f74500
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Labor Market Implications of Employer-provided Health Insurance by Kapur, Kanika, Phd from Northwestern University, 1997, 205 pages http://wwwlib.umi.com/dissertations/fullcit/9814239
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Managed Care As a Public Cost Containment Mechanism (health Insurance) by Goldman, Dana P., Phd from Stanford University, 1994, 132 pages http://wwwlib.umi.com/dissertations/fullcit/9429927
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Managed Health Care: Right Idea--wrong Rules (health Insurance) by Simmons, Kennett Lynn, Phd from The University of Texas at Austin, 1992, 576 pages http://wwwlib.umi.com/dissertations/fullcit/9239350
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Measurement of the Effect of Health Insurance on the Demand for Medical Care by Huang, Lien-fu, Phd from The University of Rochester, 1971, 95 pages http://wwwlib.umi.com/dissertations/fullcit/7122296
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Medicaid and Health Insurance for Children: Essays in Empirical Economics by Shore-sheppard, Lara Dawn, Phd from Princeton University, 1996, 158 pages http://wwwlib.umi.com/dissertations/fullcit/9701249
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Medical Expenditures and Major Risk Health Insurance by Eichner, Matthew Jason, Phd from Massachusetts Institute of Technology, 1997 http://wwwlib.umi.com/dissertations/fullcit/f1464946
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Medical Student Attitudes toward Paramedical Personnel and National Health Insurance: a Sociological Analysis by Roberts, Diane Chrzanowski, Phd from The George Washington University, 1981, 163 pages http://wwwlib.umi.com/dissertations/fullcit/8112397
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Medicare and the American State: the Politics of Federal Health Insurance, 1965-1995 (health Policy, Elderly) by Oberlander, Jonathan Bruce, Phd from Yale University, 1995, 284 pages http://wwwlib.umi.com/dissertations/fullcit/9615462
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Multiple Employer Trusts in Health Insurance: an Empirical Evaluation by Oberstein, Samuel Gershon, Phd from University of Minnesota, 1988, 181 pages http://wwwlib.umi.com/dissertations/fullcit/8826479
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National Health Insurance and the American Dream: Cultural Influences and Public Opinion by Schlereth, Stephen Paul, Phd from The University of Oklahoma, 1997, 101 pages http://wwwlib.umi.com/dissertations/fullcit/9817713
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National Health Insurance As an Issue in Political Economy: the Implications of the Kennedy Health Security Act for Developing a Strategy to Effect Major Reorganization of Health Care Delivery in America. by Windham, Susan R., Phd from Brandeis University, 1977, 259 pages http://wwwlib.umi.com/dissertations/fullcit/7715274
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National Health Insurance, Social Politics and Medical Practice in Britain, 1913-1939 by Eder, Norman Richard, Phd from University of Illinois at Chicago, 1980, 380 pages http://wwwlib.umi.com/dissertations/fullcit/8023239
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National Health Insurance: Revelations in Congressional Testimony (hearings, Health Care, Values, Ama, Procompetition) by Machado, Arthur Franco, Phd from The University of Nebraska - Lincoln, 1985, 306 pages http://wwwlib.umi.com/dissertations/fullcit/8606965
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New York State Hospital Readiness to Implement Certain Patient Privacy Provisions of the Health Insurance Portability and Accountability Act by Silsbee, Donna Lou; Phd from State University of New York at Albany, 2002, 254 pages http://wwwlib.umi.com/dissertations/fullcit/3068763
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Ownership Profiles of Supplemental Health Insurance and Medical Utilization by Medicare Elderly (health Insurance) by Hu, Yu-whuei Debbie, Phd from The University of Wisconsin - Madison, 1996, 160 pages http://wwwlib.umi.com/dissertations/fullcit/9622506
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Physicians' Compliance with a Universal Health Insurance Plan an Explanatory Study in a Canadian City by Globerman, Judith Gita; Phd from University of Toronto (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL39762
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Physicians' Participation and Price Decisions When Facing Public Health Insurance Programs (medicare, Discount Programs) by Zhang, Mingliang, Phd from Vanderbilt University, 1991, 213 pages http://wwwlib.umi.com/dissertations/fullcit/9203351
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Planning the National Health Insurance Policy: an Application of the Analytic Hierarchy Process in Health Policy Evaluation and Planning by Odynocki, Boris, Phd from University of Pennsylvania, 1979, 198 pages http://wwwlib.umi.com/dissertations/fullcit/8018595
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Political Institutions and the Democratic Class Struggle: the Politics of National Health Insurance in the United States, Canada and Australia by Behan, Pamela; Phd from University of Colorado at Boulder, 2000, 275 pages http://wwwlib.umi.com/dissertations/fullcit/9969343
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Premium Cross-subsidization and Choice in the Group Health Insurance Market by Ma, Yu-luen; Phd from The University of Wisconsin - Madison, 1999, 185 pages http://wwwlib.umi.com/dissertations/fullcit/9934888
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Reform of the Tax Preference for Employer-provided Health Insurance: an Econometric Analysis by Zabinski, Daniel Joseph, Phd from University of Virginia, 1994, 127 pages http://wwwlib.umi.com/dissertations/fullcit/9402645
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Reported Acceptability of a Self-funded Health Insurance Plan for Public School Employees in the State of Iowa by Post, Harold Jay, Edd from University of South Dakota, 1986, 163 pages http://wwwlib.umi.com/dissertations/fullcit/8625519
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Risk Reduction, Income Redistribution, and the Financing of National Health Insurance: an Examination of the Taiwanese Case by Tsay, Jen-huoy, Phd from Columbia University, 1998, 133 pages http://wwwlib.umi.com/dissertations/fullcit/9834392
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Selection by Health Status and Medical Care Use in a Social Health Insurance with an Equalization Fund: the Colombian Case by Trujillo, Antonio J. Phd from The University of North Carolina at Chapel Hill, 2000, 170 pages http://wwwlib.umi.com/dissertations/fullcit/9993390
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Social Policy and Health Insurance in South Korea and Taiwan: a Comparative Historical Approach (china) by Son, Annette H. K. Phd from Uppsala Universitet (sweden), 2003, 171 pages http://wwwlib.umi.com/dissertations/fullcit/f56609
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State Government Adoptions of Small Group Health Insurance Market Reforms: 1990-1996 by Stream, Christopher Craven, Phd from The Florida State University, 1997, 129 pages http://wwwlib.umi.com/dissertations/fullcit/9735824
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Substitution in Public Spending: the Budgetary Incidence of Canadian National Health Insurance. by Zycher, Benjamin, Phd from University of California, Los Angeles, 1979, 102 pages http://wwwlib.umi.com/dissertations/fullcit/7926079
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Tax Policy and Employer-provided Health Insurance by Stabile, Mark Bernard; Phd from Columbia University, 1999, 146 pages http://wwwlib.umi.com/dissertations/fullcit/9949039
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The American Medical Association and Compulsory National Health Insurance: the Molding of Public Opinion, 1920-1965. by Walker, Harold Lloyd, Phd from The University of Texas at Austin, 1978, 138 pages http://wwwlib.umi.com/dissertations/fullcit/7817725
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The Attitudes of Social Workers toward National Health Insurance. by Becker, Ross Miles, Dsw from University of Denver, 1976, 231 pages http://wwwlib.umi.com/dissertations/fullcit/7624412
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The Beginning and End of Health Insurance in the United States by Bownds, Lynne Marie, Phd from The University of Tennessee, 1998, 342 pages http://wwwlib.umi.com/dissertations/fullcit/9903893
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The Cost of Providing Health Insurance to Uninsured Children: an Analysis of New York State's Child Health Plus Program by Jarrell, Lynne Davidson; Phd from The University of Rochester, 2001, 113 pages http://wwwlib.umi.com/dissertations/fullcit/9999620
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The Demand for and Use of Private Health Insurance in the Uk and the Costs of Nhs Waiting Lists (insurance) by Propper, Carol, Phd from University of York (united Kingdom), 1988, 330 pages http://wwwlib.umi.com/dissertations/fullcit/DX87155
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The Demand for Health Insurance Beyond Medicare by Liu, Tsai-ching, Phd from The University of North Carolina at Chapel Hill, 1993, 143 pages http://wwwlib.umi.com/dissertations/fullcit/9402165
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The Development of a Wellness Instrument to Predict the Use of Accident and Health Insurance by Hess, Dixie Lee Cooley, Phd from University of North Texas, 1982, 80 pages http://wwwlib.umi.com/dissertations/fullcit/8228041
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The Diffusion of New Medical Technology in the Presence of Health Insurance: the Cases of Renal Dialysis and Home Total Parenteral Nutrition by De Lissovoy, Gregory V., Phd from The University of North Carolina at Chapel Hill, 1987, 244 pages http://wwwlib.umi.com/dissertations/fullcit/8722284
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The Economic Effects of the Combined Non-income-tested Transfers for Families with Children: Child Support Assurance, Children's Allowance, and National Health Insurance by Kim, Yeun Hee, Phd from The University of Wisconsin - Madison, 1993, 289 pages http://wwwlib.umi.com/dissertations/fullcit/9408568
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The Economics of Expanding Health Insurance Benefits: Direct Reimbursement to Social Workers for Psychotherapy by Fairbank, Alan W. H., Phd from Boston University, 1987, 387 pages http://wwwlib.umi.com/dissertations/fullcit/8707063
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The Effect of Employee Choice on Stacking Health Insurance by Cassidy, Steven Mark, Phd from The Florida State University, 1988, 280 pages http://wwwlib.umi.com/dissertations/fullcit/8906214
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The Effect of Employer-provided Health Insurance on Labor Market Participation by Bhargavan, Mythreyi; Phd from Rutgers the State University of New Jersey - New Brunswick, 2000, 78 pages http://wwwlib.umi.com/dissertations/fullcit/9991859
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The Effect of Health Insurance on the Demand for Medical Care (adverse Selection) by Lee, Hyehoon, Phd from University of California, Los Angeles, 1993, 131 pages http://wwwlib.umi.com/dissertations/fullcit/9418859
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The Effect of Retiree Health Insurance on Early Retirement by Opcin, Selen Ayse; Phd from Stanford University, 2002, 106 pages http://wwwlib.umi.com/dissertations/fullcit/3040050
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The Effect of the Tax Subsidy on Risk Pooling in the Employment-based Health Insurance Market by Ketsche, Patricia Gregory; Phd from Georgia State University, 2000, 201 pages http://wwwlib.umi.com/dissertations/fullcit/9999486
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The Elusive Reform: the Politics of National Health Insurance, 1915-1991 (medicare) by Laham, Nicholas George, Phd from The Claremont Graduate University, 1992, 509 pages http://wwwlib.umi.com/dissertations/fullcit/9209519
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The Existence of Underwriting Cycles in United States Health Insurance Markets and Effects of External Factors on Health Insurance Market Performance by Taylor, Sharon Lee, Phd from Georgia State University, 1994, 129 pages http://wwwlib.umi.com/dissertations/fullcit/9526900
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The Feminist Underpinnings of the Welfare State: Women and the Establishment of National Health Insurance in Britain by Noll, Franklin Clemens; Phd from University of Maryland College Park, 2001, 297 pages http://wwwlib.umi.com/dissertations/fullcit/3009044
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The Health Insurance and Medical Care Marketplace: Structure, Competition, and Implications for Public Policy by Abraham, Jean Marie; Phd from Carnegie Mellon University, 2001, 146 pages http://wwwlib.umi.com/dissertations/fullcit/3089095
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The Health Insurance Cost Crisis Experienced by Indiana School Corporations by Tydgat, David Ronald, Edd from Indiana University, 1990, 122 pages http://wwwlib.umi.com/dissertations/fullcit/9119452
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The Health Policy Gap: Income, Health Insurance and Source of Care Effects on Utilization of and Access to Dental, Physician and Hospital Services by Oregon Households by Fitzgerald, Constance Hall, Phd from Portland State University, 1983, 159 pages http://wwwlib.umi.com/dissertations/fullcit/8326965
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The Impact of Health Insurance Coverage on the Lives of Low-income Adults: a Study of the Effectiveness of the Vermont Health Access Plan by Hamilton, Catherine Howland; Phd from New York University, 2001, 458 pages http://wwwlib.umi.com/dissertations/fullcit/3003034
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The Impact of Health Insurance Type on the Use of Preventive Care by Wang, Yize , Phd from University of Pennsylvania, 1999, 127 pages http://wwwlib.umi.com/dissertations/fullcit/9926213
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The Impact of Mandated Employer Provision of Health Insurance Benefits: Evidence from Hawaii by Dick, Andrew W., Phd from Stanford University, 1995, 105 pages http://wwwlib.umi.com/dissertations/fullcit/9516815
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The Impact of Market Forces and Public Health Insurance on Inpatient Care by Dafny, Leemore Sharon; Phd from Massachusetts Institute of Technology, 2001 http://wwwlib.umi.com/dissertations/fullcit/f1025073
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The Impact of Public Policy on Taiwan's Health Care System after Implementing National Health Insurance by Chien, Tein-cheng; Phd from University of South Carolina, 2002, 169 pages http://wwwlib.umi.com/dissertations/fullcit/3076755
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The Impact of Small-group Health Insurance Reform by Simon, Kosali Ilayperuma; Phd from University of Maryland College Park, 1999, 143 pages http://wwwlib.umi.com/dissertations/fullcit/9957203
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The Impact of the Personal Income Tax on Household Health Insurance Coverage (taxation, Health Insurance) by Olson, Terry Lynn, Phd from University of Illinois at Urbana-champaign, 1992, 282 pages http://wwwlib.umi.com/dissertations/fullcit/9236558
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The Impact of the Pregnancy Discrimination Act of 1978 on Employee Health Insurance Benefit Levels (compensation, Fringe Benefits) by Burgstahler, Janet Witte, Phd from The University of Iowa, 1984, 178 pages http://wwwlib.umi.com/dissertations/fullcit/8423542
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The Income Redistributive Effects of National Health Insurance Program by Park, Tae Kyu, Phd from Indiana University, 1980, 165 pages http://wwwlib.umi.com/dissertations/fullcit/8020247
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The Massachusetts Universal Health Insurance Law: a Case Study of Making Health Care Policy by Byrnes, Pamela Joy, Phd from The University of Connecticut, 1993, 375 pages http://wwwlib.umi.com/dissertations/fullcit/9406049
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The Mediating Effect of Morbidity on Price and Benefits in the Context of Consumer Health Insurance Choice by Griffiths, Stephen Jon; Phd from University of Minnesota, 2002, 140 pages http://wwwlib.umi.com/dissertations/fullcit/3056319
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The National Health Insurance in Korea: Excess Demand and Nonprice Rationing (health Insurance) by Hong, Jeongkee, Phd from University of California, Santa Barbara, 1993, 152 pages http://wwwlib.umi.com/dissertations/fullcit/9321665
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The Political Construction of Interests: National Health Insurance Politics in Sweden, France and Switzerland, 1930-1970 by Immergut, Ellen Margaretha, Phd from Harvard University, 1987, 410 pages http://wwwlib.umi.com/dissertations/fullcit/8806094
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The Reform of the Military Health Care System of the Republic of Korea: the Impact of Health Insurance on the Choice of Military Versus Civilian Providers by Song, Sejin; Phd from University of Maryland Baltimore County, 2002, 570 pages http://wwwlib.umi.com/dissertations/fullcit/3038714
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The Regulation of Health Insurance. by Frech, Harry Edward, Iii, Phd from University of California, Los Angeles, 1974, 150 pages http://wwwlib.umi.com/dissertations/fullcit/7505699
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The Role of Organized Labor in the Quest for Compulsory Health Insurance, 19121965 by Mckinney, T. Charles, Phd from The University of Wisconsin - Madison, 1969, 260 pages http://wwwlib.umi.com/dissertations/fullcit/6912396
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The Transplant Trap: Are Recipients Doomed to Dependence? an Exploratory Study of the Relationship between Concern for Health Insurance and Employment Status
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Following Renal Transplantation by Raiz, Lisa Robin, Phd from The Ohio State University, 1995, 137 pages http://wwwlib.umi.com/dissertations/fullcit/9526077 •
The Truman Administration and National Health Insurance by Poen, Monte Mac, Phd from University of Missouri - Columbia, 1967, 338 pages http://wwwlib.umi.com/dissertations/fullcit/6713889
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The United Auto Workers and the Campaign for National Health Insurance: a Case Study of Labor in Politics by Jacobs, David Carroll, Phd from Cornell University, 1983, 140 pages http://wwwlib.umi.com/dissertations/fullcit/8328708
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The Use of Physicians' Services by Low-income Children: the Role of Medicaid and Other Factors (health Insurance) by Rosenbach, Margo L., Phd from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1985, 290 pages http://wwwlib.umi.com/dissertations/fullcit/8518900
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The Uses of the Sociology of Health: with a Case Study of Social Science Use in the Health Insurance Policy Debate. by Salter, Vera, Phd from University of Pittsburgh, 1976, 242 pages http://wwwlib.umi.com/dissertations/fullcit/7703036
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Variations in Physician Practice Patterns for Eye Care under the National Health Insurance of Taiwan (china, Taiwan) by Yu Chang, Joanna Chih I; Phd from University of Southern California, 2000, 148 pages http://wwwlib.umi.com/dissertations/fullcit/3041549
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Virginia State Government Models to Increase Health Insurance Coverage for Small Business Workers and Their Families by Oglesby, Herbert Wills, Dpa from Virginia Commonwealth University, 1991, 208 pages http://wwwlib.umi.com/dissertations/fullcit/9214069
Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
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CHAPTER 5. PATENTS ON HEALTH INSURANCE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “health insurance” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on health insurance, we have not necessarily excluded nonmedical patents in this bibliography.
Patents on Health Insurance By performing a patent search focusing on health insurance, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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The following is an example of the type of information that you can expect to obtain from a patent search on health insurance: •
Automated system and method for providing real-time verification of health insurance eligibility Inventor(s): Rieker; Edward C. (Decatur, GA), Mansfield; Daniel K. (Duluth, GA) Assignee(s): Envoy Corporation (Nashville, TN) Patent Number: 5,832,447 Date filed: May 24, 1994 Abstract: Data from a health care provider computer system is used to automatically request real-time electronic insurance eligibility verification information from health care insurance payors. A patient health insurance verification computer system is operatively connected to a patient registration computer system. The verification computer system obtains a data output stream such as a print image from the registration computer system. This data output stream is captured and broken down into separate data fields. The insurance carrier is determined, and the verification computer system determines which electronic data source to request patient eligibility data from. The verification computer system reformats the captured data to fit the data format required by the data source, establishes a communications link to the data source, and sends the reformatted data to the data source. The data source sends responsive patient specific eligibility data which the verification computer system uses to automatically verify insurance coverage. Health insurance verification becomes much more reliable since no human intervention is required to carry on the automatic verification process. Additionally, automatic verification can be performed conveniently without double data entry even in environments with preexisting admissions systems that cannot be easily modified. Excerpt(s): The present invention relates to automatic insurance eligibility determination, and more specifically, to method and apparatus for automatically determining in real-time whether a patient at a health care facility has health insurance coverage. Currently, hospitals and health care providers have a real problem determining whether patients are eligible for health insurance coverage. When a patient seeks health care at a hospital, the admitting staff usually asks the patient whether the patient has health insurance. Often, the admitting staff will ask the patient for evidence of health insurance eligibility (e.g., a medical insurance card or the like). Information corresponding to the health insurance coverage the patient says he has is inputted into the hospital's computerized patient admissions system. However, there is no easy, reliable way to verify this coverage at the time the patient is admitted. Health insurance coverage, such as Medicaid and Medicare, is often determined on a periodic basis (e.g., weekly or monthly) so that the insurance rolls are constantly changing. For this reason, it is important for hospitals and other health care providers to obtain timely, accurate and complete health insurance eligibility information for each incoming patient. The admissions clerk could pick up a telephone and dial the telephone number of an information service or the patient's asserted health care provider to obtain a verbal response verifying insurance coverage. Alternatively, many hospitals and other health care providers have "POS" ("point of sale") terminals and/or personal computers that can link electronically over telephone lines with "information providers" sometimes called "clearinghouses" that verify health insurance coverage eligibility. However, these techniques require the admitting clerk to decide to check health insurance eligibility, and then take additional steps necessary to verify. Thus, these techniques suffer from
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the drawback that verifying insurance eligibility is not automatic. If the admissions clerk is busy, he or she may not have sufficient time to verify the eligibility of some or all incoming patients. Thus, many problems arise later on when the hospital's billing department tries to collect from the insurance company, and in the worst case, can cause the hospital to lose the ability to recover costs and fees for health care. Web site: http://www.delphion.com/details?pn=US05832447__ •
Health insurance management system Inventor(s): Sackler; Arthur F. (Brooklyn, NY), Levin; Marshall (Lawrenceville, NJ) Assignee(s): P. B. Toau and Company, Ltd. (New York, NY) Patent Number: 5,235,507 Date filed: January 16, 1990 Abstract: Data processing for a health insurance management system verifies the insurance status of the claimant, identifies the appropriate insurance policy, calculates the amount to be paid to the health care provider, pays the provider, calculates the payment required by the claimant, if any, and debits the account of the claimant in the amount required. A claim may be processed under more than one policy where appropriate. The system can handle both individual and family insurance policies. Excerpt(s): This invention relates to a health insurance management system, and more particularly to a method and apparatus for processing health insurance claims using a computer program. In the past, health insurance was almost exclusively the province of insurance companies which would issue a traditional reimbursement for services under a single set of master policy criteria. Recently, rising health care costs have driven many employers to become self-insured, leading to a proliferation of policy types, multiple coverage (accelerated by dual wage earner families) and wide variations in reimbursement and payment practices. However, self-insurers who are not in the insurance business are burdened by the administrative tasks associated with the processing of health insurance claims. This has caused the birth of a new industry devoted to assisting self-insurers in insurance-related administrative tasks. In addition to management companies specializing in this area, the insurance companies themselves have begun administering self-insurance plans for clients on a fee basis. Presently, more than half of all claims adjudicated by insurance companies (over $30 billion) were processed as the administrator of self-insured plans on a fee basis. Management and insurance companies devoted to servicing a number of self-insurers must keep track of the different policies in effect at each client self-insurer company, the insured parties for each self-insurer, the claims filed for each individual within each client company, etc., so that when a claim is filed it can be processed correctly and efficiently. The greater the efficiency of the processing system, the greater will be the cost-effectiveness of the management company; greater cost-effectiveness in turn makes self-insurance administration more competitive relative to the services traditionally offered by the insurance companies. Web site: http://www.delphion.com/details?pn=US05235507__
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Patent Applications on Health Insurance As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to health insurance: •
Children's income protection and benefit health insurance policy and method of underwriting the same Inventor(s): Newman, Jeffrey Marc; (Coral Springs, FL) Correspondence: STEINBERG & RASKIN, P.C. 1140 AVENUE OF THE AMERICAS, 15th FLOOR; NEW YORK; NY; 10036-5803; US Patent Application Number: 20020072936 Date filed: August 8, 2001 Abstract: An individual health insurance policy providing benefits for children who become disabled and a method for underwriting the same, providing monetary benefits to cover the expenses associated with a disabling injury suffered by a child including care, supervision, schooling, incidental expense benefits, supplemental benefits, which include long term care and home tutoring benefits, and other benefits for a disabling event. Excerpt(s): Wage-earning adults are in most cases their own primary source of monetary support. They use the wages they earn to provide themselves the necessities of life, including food, clothing, shelter, education, entertainment, and health care. Many wageearning adults not only provide support for themselves, but also provide support, either partially or totally, for dependents including children, spouses and other family members. A problem for wage-earning adults has been how to maintain the ability to support themselves and their dependents should they become disabled. Disabilities can leave wage-earners either no longer able to work and earn a living or unable to work at a pre-disability level, resulting in their only being able to work at a diminished wageearning capacity. Not only do disabilities undermine the ability to earn a living and provide for life's necessities, they often create large added expenses. Disabilities almost always require medical attention and sometimes major medical attention, resulting in large medical expenses. Further, certain disabilities may require the attention of an individual caregiver, either professional or a friend or family member. Beyond the obvious physical and mental hardships a disability may cause, it can be economically catastrophic to the wage-earner and his or her dependents. To alleviate the economic problems associated with disability, as well as engage in a profitable business, insurance companies have underwritten policies for wage-earners who become disabled. Such policies provide payments for wages lost due to a disabling injury. They also provide payments for the health care requirements of the disabled. In doing so, such policies provide money to defray or cover the costs of a disability. These costs often include those that affect not only the actual disabled person, but those that affect the dependents of the disabled person, primly families, including spouses and children. Such policies do not cover the costs of a disabling injury suffered by a non-wage-earning member of a household, such as a minor child. Traditionally, if a family wage-earner became disabled, disability insurance 1) replaced the income no longer generated by the wage earner and 2) covered the added expenses which accompany a disabling injury,
9
This has been a common practice outside the United States prior to December 2000.
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including major medical costs, rehabilitation costs and the costs associated with professional caregivers. If a non-wage-earning family member, such as a minor child, became disabled, it was assumed that the wage-earning family members would provide for the expenses of the disabling injury. It was also assumed that other family members, often a non-wage earning parent, would act as caregivers to the disabled family member. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Medical insurance system Inventor(s): Ishii, Hikaru; (Tokyo, JP) Correspondence: Samuels, Gauthier & Stevens LLP; Suite 3300; 225 Franklin Street; Boston; MA; 02110; US Patent Application Number: 20010056360 Date filed: April 24, 2001 Abstract: A medical insurance system wherein disclosure of preexisting conditions is appropriately performed upon the creation of an insurance contract. A party wishing to purchase insurance from an insurance company 10 agrees that personal medical data obtained from a database 16 of a medical facility 14, possibly including data from a physical examination conducted at the medical facility 14 or a prior diagnosis of illness, is stored in a database 12 of the insurance company 10. The parties agree that in this manner disclosure of preexisting conditions is regarded as being complete. Disclosure of preexisting conditions is easily and accurately performed. Excerpt(s): The present invention generally relates to an improved medical insurance system in which prescribed benefits are paid for sickness or bodily injury. Today there exists a vast number of insurance plans and systems wherein prescribed benefits are paid to an insured party for illness or bodily injury encountered during daily life or while traveling. Generally, to obtain this type of insurance protection, an applicant enters into an insurance contract with an insurance company which offers such insurance so that the costs for their medical treatment will be covered in case of unexpected illness or injury. Under the insurance contract, insurance benefits for unexpected sickness or bodily injury is paid to an insured and some portion of the insured's medical expenses are covered. This type of insurance scheme is what is referred to as a "medical insurance system" in the following description. For conventional medical insurance systems as described above, the insurance company offering the insurance often requires that the applicant disclose his or her preexisting conditions to the insurance company before the company will offer insurance. However, problems often arise because many applicants are unable to disclose their preexisting conditions in an appropriate manner because of their insufficient medical knowledge. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method and apparatus for processing health insurance applications over a network Inventor(s): Gibbs, Samuel C. III; (Portola Valley, CA), Patel, Nitin M. (Glendale, AZ), Howell, Eric J. (Folsom, CA) Correspondence: James H. Salter; BLAKELY, SOKOLOFF, TAYLOR & ZAFMAN LLP; Seventh Floor; 12400 Wilshire Boulevard; Los Angeles; CA; 90025-1026; US Patent Application Number: 20030083906 Date filed: October 29, 2001 Abstract: An apparatus and method of processing health insurance applications over a network are described. In one embodiment, a user interface is presented to an applicant over a network. The user interface prompts the applicant for application data such as applicant identification, medical history, or other information required to process the health insurance application. When the application data specified by the user is received, the application data is transformed into a secure digital file, such as a portable document format (PDF) file. The secure digital file is then delivered to a health insurance carrier via the network. Excerpt(s): The present invention relates generally to the field of e-commerce and, more specifically, to processing health insurance applications over a network. Millions of Americans today live without health insurance. Their plight is only exacerbated by the difficulty they face trying to obtain it. There are thousands of health insurance plans to choose from, varying forms to fill out for each plan, and long waiting periods while the paperwork is shuffled from desk to desk for weeks on end. In an attempt to make obtaining health insurance more efficient, some health insurance service providers (e.g., health insurance carriers, brokers, etc.) have turned to the Internet attempting to provide a direct sales or brokerage service that benefits from a paperless network to expedite the process. However, the current approach has only slightly improved the process. For instance, these service providers have provided an online framework that allows health insurance customers to obtain quotes for the available plans, review the benefits associated with the plans, and input their own personal, financial and health related data necessary to complete the application selected by the customer. However, once the applicant has selected a plan and the service provider has collected the applicant's data, such service provider must use the applicant's data to complete the carrier-approved application, print out the application and send the application to the applicant for a signature. Then, the applicant must return the paper contract back to the service provider, with a signature and a form of payment. Then, the application data is manually entered into a carrier's underwriting system in order to make a decision on whether to issue a policy. Finally, the service provider will make several telephone calls or use another form of communication to pass information back to the customer or to request additional information from the customer. Thus, the online process still leads to a very time consuming paper chase. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with health insurance, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued
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Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “health insurance” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on health insurance. You can also use this procedure to view pending patent applications concerning health insurance. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 6. BOOKS ON HEALTH INSURANCE Overview This chapter provides bibliographic book references relating to health insurance. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on health insurance include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “health insurance” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on health insurance: •
AIDS Case Management: What Health Insurance Companies Are Doing Contact: Health Insurance Association of America, PO Box 41455, Washington, DC, 20018, (202) 828-0111, http://www.hiaa.org. Summary: This monograph describes Acquired immunodeficiency syndrome (AIDS) case management with regard to health insurance companies. It illustrates a cost containment technique proposed by health insurance companies for keeping down the costs of AIDS while still providing adequate health care.
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Health Insurance Source: AIDS and the Law. Contact: John Wiley and Sons, Incorporated, 605 3rd Ave 10th Fl, New York, NY, 10158, (800) 225-5945.
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Summary: Health insurers are reacting to fears of AIDS infection and new legislation regarding AIDS discrimination in a number of ways, including mandatory testing of policy holders and denial of health insurance in areas of high incidence of infection. •
Inside Information on Health Insurance Source: Princeton, NJ: Novo Nordisk Pharmaceuticals, Inc. 1991. 19 p. Contact: Available from Novo Nordisk Pharmaceuticals, Inc. 100 Overlook Center, Suite 200, Princeton, NJ 08450-7810. (800) 727-6500. PRICE: Single copy free. Summary: This brochure for people with diabetes reviews the topic of health insurance. Topics include an overview of health insurance, how to get the most from health insurance coverage, how to work in cooperation with an insurance company, how to buy health insurance, and where to go for information. A glossary of terms and general guidelines for physician letters are appended.
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Health insurance is a family matter Source: Washington, DC: National Academies Press. 2002. 278 pp. Contact: Available from National Academies Press, 2101 Constitution Avenue, N.W., Lockbox 285, Washington, DC 20002. Telephone: (202) 334-3313 or (888) 624-8422 / fax: (202) 334-2451 / e-mail:
[email protected] / Web site: http://www.nap.edu. $29.00, plus shipping and handling. Summary: This book analyzes the effects being uninsured can have on the health, finances, and general well-being of the family. It also examines the health of uninsured children and pregnant women to see whether they also receive less care and suffer worse health outcomes than those who are insured. Chapter topics include a discussion of what constitutes a family; how families obtain health insurance; how insurance transitions over the family life cycle; financial characteristics and behavior of uninsured families; family well-being and health insurance coverage and health-related outcomes for children, pregnant women, and newborns. The appendices include: (1) a conceptual framework for evaluating the consequences of uninsurance for families; (2) an overview of public health insurance programs; and (3) a review of research on access, utilization, and outcomes for children, pregnant women, and infants. An executive summary, conclusion section, and references are also provided.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “health insurance” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “health insurance” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “health insurance” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
...And the Pursuit of National Health.The Incremental Strategy Toward National Health Insurance in the United States of America.(Amsterdam Monographs in
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American Studies 8) by I. Kooijman, Jaap Kooijman (1999); ISBN: 9042007664; http://www.amazon.com/exec/obidos/ASIN/9042007664/icongroupinterna •
1997 Insurance Directory: Largest Nationwide Health Insurance Billing Directory by Tricia Hodges (Editor), Medicode; ISBN: 156337191X; http://www.amazon.com/exec/obidos/ASIN/156337191X/icongroupinterna
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A Guide to Health Insurance Billing by Marie A. Moisio; ISBN: 0766812073; http://www.amazon.com/exec/obidos/ASIN/0766812073/icongroupinterna
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Accounting and Financial Reporting in Life and Health Insurance Companies by Elizabeth A. Mulligan (1997); ISBN: 0939921855; http://www.amazon.com/exec/obidos/ASIN/0939921855/icongroupinterna
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Accounting in Life & Health Insurance Companies by Judy B. Rich (1987); ISBN: 0915322862; http://www.amazon.com/exec/obidos/ASIN/0915322862/icongroupinterna
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America's Children: Health Insurance and Access to Care by Margaret Edmunds (Editor), et al (1998); ISBN: 0309065607; http://www.amazon.com/exec/obidos/ASIN/0309065607/icongroupinterna
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Belgium Private Health Insurance [DOWNLOAD: PDF] by Datamonitor (Author); ISBN: B00008R459; http://www.amazon.com/exec/obidos/ASIN/B00008R459/icongroupinterna
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Binational Collaboration in Health Insurance Services between the United States and Mexico: Issues and Innovations for the Texas Health Insurance Industry by Jeffrey John Stys; ISBN: 0899409032; http://www.amazon.com/exec/obidos/ASIN/0899409032/icongroupinterna
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Bonus Options in Health Insurance (Developments in Health Economics and Public Policy, Vol 2) by Peter Zweifel, Otto Waser (1992); ISBN: 079231722X; http://www.amazon.com/exec/obidos/ASIN/079231722X/icongroupinterna
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California: Life and Health Insurance: Principles and Practice by Dearborn Financial Institute (1998); ISBN: 0793123704; http://www.amazon.com/exec/obidos/ASIN/0793123704/icongroupinterna
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Checkbooks Guide to Health Insurance Plans for Federal Employees by 521000466; ISBN: 9990598479; http://www.amazon.com/exec/obidos/ASIN/9990598479/icongroupinterna
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Chile Health Insurance Issues: Old Age and Catastrophic Health Costs (World Bank Country Study) by World Bank (2000); ISBN: 0821348787; http://www.amazon.com/exec/obidos/ASIN/0821348787/icongroupinterna
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CliffsNotes Understanding Health Insurance [DOWNLOAD: ADOBE READER] by Darlene Brill (2001); ISBN: B00006CXNG; http://www.amazon.com/exec/obidos/ASIN/B00006CXNG/icongroupinterna
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Compulsory Health Insurance by Ronald L. Numbers (Author) (1982); ISBN: 0313234361; http://www.amazon.com/exec/obidos/ASIN/0313234361/icongroupinterna
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Cutting Taxes for Insuring: Options and Effects of Tax Credits for Health Insurance (Aei Studies on Tax Reform) by Mark V. Pauly, et al (2002); ISBN: 0844771600; http://www.amazon.com/exec/obidos/ASIN/0844771600/icongroupinterna
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Data Cleaning Procedures for the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey by Roald Euller, et al (1997); ISBN: 0833025228; http://www.amazon.com/exec/obidos/ASIN/0833025228/icongroupinterna
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Data Cleaning Procedures for the 1993 Robert Wood Johnson Foundation Family Health Insurance Survey by Linda M. Andrews, et al (1997); ISBN: 0833025236; http://www.amazon.com/exec/obidos/ASIN/0833025236/icongroupinterna
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Delmar's Medical Assisting Video Series Tape 4: Medical Insurance/Reimbursement by Delmar Publishers, et al; ISBN: 0827383088; http://www.amazon.com/exec/obidos/ASIN/0827383088/icongroupinterna
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Direct Life, Health & Medical Insurance Carriers in the US [DOWNLOAD: PDF] by IBISWorld (Author); ISBN: B00008DAVJ; http://www.amazon.com/exec/obidos/ASIN/B00008DAVJ/icongroupinterna
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Employment Screening Medical Examinations Health Insurance & the Americans With Disabilities Act (Ada Practice Ser.)) by Marjorie E. Karowe (1994); ISBN: 0685728234; http://www.amazon.com/exec/obidos/ASIN/0685728234/icongroupinterna
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Essentials of Life and Health Insurance by Marshall Reavis; ISBN: 0884626253; http://www.amazon.com/exec/obidos/ASIN/0884626253/icongroupinterna
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Expanding the Employer-Provided Health Insurance System: Effects on Workers and Their Employers (Urban Institute Report 91-3) by Sheila R. Zedlewski (1991); ISBN: 0877665095; http://www.amazon.com/exec/obidos/ASIN/0877665095/icongroupinterna
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Falling Through the Safety Net: Americans Without Health Insurance by John, MD Geyman, M. D. Geyman (2003); ISBN: 1567512550; http://www.amazon.com/exec/obidos/ASIN/1567512550/icongroupinterna
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Fight Back and Win: How to Get Hmo's and Health Insurance to Pay Up by William M. Shernoff (1999); ISBN: 0887231721; http://www.amazon.com/exec/obidos/ASIN/0887231721/icongroupinterna
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Free for All?: Lessons from the Rand Health Insurance Experiment by Joseph P. Newhouse (1996); ISBN: 0674319141; http://www.amazon.com/exec/obidos/ASIN/0674319141/icongroupinterna
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Fundamentals of Health Insurance, Part B by Various Chapter Authors; ISBN: 1879143380; http://www.amazon.com/exec/obidos/ASIN/1879143380/icongroupinterna
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Germany Private Health Insurance [DOWNLOAD: PDF] by Datamonitor (Author); ISBN: B00008R48A; http://www.amazon.com/exec/obidos/ASIN/B00008R48A/icongroupinterna
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Germany Private Medical Insurance 2001 [DOWNLOAD: PDF] by Snapshots International Ltd (Author); ISBN: B00006FCEA; http://www.amazon.com/exec/obidos/ASIN/B00006FCEA/icongroupinterna
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Glencoe Medical Insurance Coding Workbook, Student Workbook by Cynthia Newby; ISBN: 0028048830; http://www.amazon.com/exec/obidos/ASIN/0028048830/icongroupinterna
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Glencoe Medical Insurance, Student Textbook by Nenna L. Bayes, et al; ISBN: 0028048792; http://www.amazon.com/exec/obidos/ASIN/0028048792/icongroupinterna
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Group Health Insurance by Burton T. Beam (1995); ISBN: 0943590760; http://www.amazon.com/exec/obidos/ASIN/0943590760/icongroupinterna
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Hassle-Free Health Coverage: How to Buy the Right Medical Insurance Cheaply and Effectively (How to Insure Series) by The Silver Lake Editors (Editor), et al (1999); ISBN: 1563431602; http://www.amazon.com/exec/obidos/ASIN/1563431602/icongroupinterna
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Health Benefits at Work: An Economic and Political Analysis of Employment-Based Health Insurance by Mark V. Pauly (1999); ISBN: 0472086448; http://www.amazon.com/exec/obidos/ASIN/0472086448/icongroupinterna
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Health Care for the Wongs: Health Insurance, Choosing a Doctor (Consumer Education, No 2) by Marilyn Thypin, et al; ISBN: 0884365131; http://www.amazon.com/exec/obidos/ASIN/0884365131/icongroupinterna
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Health Care in America: The Political Economy of Hospitals and Health Insurance by H.E. Frech (Editor); ISBN: 0936488190; http://www.amazon.com/exec/obidos/ASIN/0936488190/icongroupinterna
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Health Cents: Isn't It Time Your Health Insurance Wrote You a Check by Jeff Taragano, Jeffrey Taragano (2001); ISBN: 0595200303; http://www.amazon.com/exec/obidos/ASIN/0595200303/icongroupinterna
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Health Insurance by Silver Lake (Editor), Made E-Z; ISBN: 1563825120; http://www.amazon.com/exec/obidos/ASIN/1563825120/icongroupinterna
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Health Insurance Among Children of Unemployed Parents by Jacob Alex Klerman (1997); ISBN: 0833025201; http://www.amazon.com/exec/obidos/ASIN/0833025201/icongroupinterna
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Health Insurance and Canadian Public Policy (1988); ISBN: 0773503072; http://www.amazon.com/exec/obidos/ASIN/0773503072/icongroupinterna
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Health Insurance Answer Book by John C. Garner (2001); ISBN: 0735514690; http://www.amazon.com/exec/obidos/ASIN/0735514690/icongroupinterna
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Health insurance answer book by John D. Reynolds; ISBN: 0916592936; http://www.amazon.com/exec/obidos/ASIN/0916592936/icongroupinterna
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Health Insurance Answer Book 2003 by John C. Garner, Aspen Publishers (2002); ISBN: 073553196X; http://www.amazon.com/exec/obidos/ASIN/073553196X/icongroupinterna
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Health Insurance Carrier Directory 2003: A Comprehensive Guide to Insurance Carriers & Claims Processing by Pmic (2003); ISBN: 1570662495; http://www.amazon.com/exec/obidos/ASIN/1570662495/icongroupinterna
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Health Insurance in Australia [DOWNLOAD: PDF] by IBISWorld (Author); ISBN: B00009XGCV; http://www.amazon.com/exec/obidos/ASIN/B00009XGCV/icongroupinterna
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Health Insurance in Practice: International Variations in Financing, Benefits, and Problems (The Jossey-Bass Health Series) by William A. Glaser; ISBN: 1555423736; http://www.amazon.com/exec/obidos/ASIN/1555423736/icongroupinterna
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Health Insurance Is a Family Matter by Institute of Medicine Committee on the Consequences of Uninsura, et al (2002); ISBN: 0309085187; http://www.amazon.com/exec/obidos/ASIN/0309085187/icongroupinterna
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Health Insurance Made Easy.Finally: How to Understand Your Health Insurance So You Start Saving Your Money and Stop Wasting Your Time by Sharon L. Stark; ISBN: 0962293601; http://www.amazon.com/exec/obidos/ASIN/0962293601/icongroupinterna
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Health Insurance Nuts and Bolts by Terry R. Lowe (Editor); ISBN: 1879143518; http://www.amazon.com/exec/obidos/ASIN/1879143518/icongroupinterna
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Health Insurance on the Polish, Russian and Romanian Markets in the US [DOWNLOAD: PDF] by Global Advertising Strategies Inc. (Author); ISBN: B00006RGVO; http://www.amazon.com/exec/obidos/ASIN/B00006RGVO/icongroupinterna
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Health Insurance Plan of New York: BusIntell Report [DOWNLOAD: PDF] by Knowledge Source Inc. (Author); ISBN: B000060M6L; http://www.amazon.com/exec/obidos/ASIN/B000060M6L/icongroupinterna
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Health Insurance Primer: Werbel's Sickness & Accident by Raymond A. D'Amico, et al (1998); ISBN: 1884803024; http://www.amazon.com/exec/obidos/ASIN/1884803024/icongroupinterna
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Health insurance terminology : a glossary; ISBN: 1879143135; http://www.amazon.com/exec/obidos/ASIN/1879143135/icongroupinterna
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Health Insurance: How to Get It, Keep It, or Improve What You'Ve Got by Robert Enteen; ISBN: 1557785112; http://www.amazon.com/exec/obidos/ASIN/1557785112/icongroupinterna
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Health Insurance: Understanding It, and Medicare by Wayne C. Lackner (1992); ISBN: 0962953806; http://www.amazon.com/exec/obidos/ASIN/0962953806/icongroupinterna
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Hospital Costs and Health Insurance by Martin S. Feldstein (1981); ISBN: 0674406753; http://www.amazon.com/exec/obidos/ASIN/0674406753/icongroupinterna
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How to Administer Health Insurance Tax Credits for Working Families [DOWNLOAD: PDF] by Lynn Etheredge (Author); ISBN: B00006397V; http://www.amazon.com/exec/obidos/ASIN/B00006397V/icongroupinterna
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How to Deal with Public Concerns About Health Insurance [DOWNLOAD: PDF] by Carrie J. Gavora (Author); ISBN: B000062XVW; http://www.amazon.com/exec/obidos/ASIN/B000062XVW/icongroupinterna
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Insurance Directory 1998: Largest Nationwide Health Insurance Billing Directory (9th Ed) by Medicode Publications; ISBN: 1563372215; http://www.amazon.com/exec/obidos/ASIN/1563372215/icongroupinterna
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Life and Health Insurance (13th Edition) by Harold D. Skipper (Author), Kenneth Black (Author); ISBN: 0138912505; http://www.amazon.com/exec/obidos/ASIN/0138912505/icongroupinterna
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Life and Health Insurance (Book and Supplement) by William F. Meyer (1972); ISBN: 0685598705; http://www.amazon.com/exec/obidos/ASIN/0685598705/icongroupinterna
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Life and Health Insurance Law by William T. Beadles, Muriel L. Crawford (1988); ISBN: 0256071217; http://www.amazon.com/exec/obidos/ASIN/0256071217/icongroupinterna
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Life and Health Insurance Marketing by Mary C. Bickley, et al (2003); ISBN: 157974172X; http://www.amazon.com/exec/obidos/ASIN/157974172X/icongroupinterna
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Life and health insurance marketing by Dennis W. Goodwin; ISBN: 0939921030; http://www.amazon.com/exec/obidos/ASIN/0939921030/icongroupinterna
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Making Them Pay: How to Get the Most from Health Insurance and Managed Care by Rhonda D. Orin (2001); ISBN: 0312267606; http://www.amazon.com/exec/obidos/ASIN/0312267606/icongroupinterna
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Managing for Solvency and Profitability in Life and Health Insurance Companies by Susan Conant (1996); ISBN: 0939921804; http://www.amazon.com/exec/obidos/ASIN/0939921804/icongroupinterna
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Maryland Guide to Life and Accident and Health Insurance Law (2002); ISBN: 079316107X; http://www.amazon.com/exec/obidos/ASIN/079316107X/icongroupinterna
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Medicaid : lessons for national health insurance; ISBN: 0912862106; http://www.amazon.com/exec/obidos/ASIN/0912862106/icongroupinterna
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Medical Care, Medical Costs: The Search for a Health Insurance Policy by Rashi Fein (1999); ISBN: 1583483101; http://www.amazon.com/exec/obidos/ASIN/1583483101/icongroupinterna
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Medical Insurance Billling and Coding: An Essentials Worktext by Linda L. French, Marilyn Takahashi Fordney (2003); ISBN: 0721695167; http://www.amazon.com/exec/obidos/ASIN/0721695167/icongroupinterna
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Medical Insurance Made Easy: A Worktext by Jill L. Brown; ISBN: 0721691870; http://www.amazon.com/exec/obidos/ASIN/0721691870/icongroupinterna
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Medical Insurance Online, Home Education by Marilyn T. Fordney, Janet I. Beik (2003); ISBN: 072160238X; http://www.amazon.com/exec/obidos/ASIN/072160238X/icongroupinterna
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National Health Insurance (Public Documents Series) by Tyrus G. Fain; ISBN: 0835209601; http://www.amazon.com/exec/obidos/ASIN/0835209601/icongroupinterna
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National Health Insurance and Health Resources: The European Experience by Jan Blanpain, et al (2000); ISBN: 1583481273; http://www.amazon.com/exec/obidos/ASIN/1583481273/icongroupinterna
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National Health Insurance: Benefits, Costs, and Consequences by Karen Davis (1976); ISBN: 0815717598; http://www.amazon.com/exec/obidos/ASIN/0815717598/icongroupinterna
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National Health Insurance: Can We Learn from Canada by Spyros Andreopoulos; ISBN: 0898743478; http://www.amazon.com/exec/obidos/ASIN/0898743478/icongroupinterna
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National Health Insurance: Conflicting Goals and Policy Choices by Judith M. Feder; ISBN: 0877662711; http://www.amazon.com/exec/obidos/ASIN/0877662711/icongroupinterna
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Negotiating Health Insurance in the Workplace: A Basic Guide by Suzanne S. Taylor; ISBN: 0871797313; http://www.amazon.com/exec/obidos/ASIN/0871797313/icongroupinterna
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New Estimates of the Effect of Kassebaum-Kennedy's Group-To-Individual Conversion Provision on Premiums for Individual Health Insurance by Jacob Alex Klerman (1996); ISBN: 0833023942; http://www.amazon.com/exec/obidos/ASIN/0833023942/icongroupinterna
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NEW YORK LAW ADDENDUM LIFE & HEALTH INSURANCE by Steven Kleinman (1998); ISBN: 1884803040; http://www.amazon.com/exec/obidos/ASIN/1884803040/icongroupinterna
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Operations of Life and Health Insurance Companies by Kenneth Huggins; ISBN: 0915322781; http://www.amazon.com/exec/obidos/ASIN/0915322781/icongroupinterna
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Operations of Life and Health Insurance Companies: Student Guide (Wkbk edition) by Nicholas Desoutter, Jane Cheek; ISBN: 0939921421; http://www.amazon.com/exec/obidos/ASIN/0939921421/icongroupinterna
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Passtrak Health Insurance: License Exam Manual by Dearborn Financial Service (Editor), Dearborn Financial Services (2002); ISBN: 0793153530; http://www.amazon.com/exec/obidos/ASIN/0793153530/icongroupinterna
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Passtrak Life and Health Insurance: Questions and Answers by Dearborn Financial Institute (2001); ISBN: 0793148510; http://www.amazon.com/exec/obidos/ASIN/0793148510/icongroupinterna
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Passtrak: Life and Health Insurance by Dearborn Financial Institute (2001); ISBN: 0793144752; http://www.amazon.com/exec/obidos/ASIN/0793144752/icongroupinterna
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Pooling Health Insurance Risks by Mark V. Pauly, Bradley Herring (1999); ISBN: 0844741205; http://www.amazon.com/exec/obidos/ASIN/0844741205/icongroupinterna
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Potential for Discrimination in Health Insurance Based on Predictive Genetic Tests: Hearing Before the Committee on Energy and Commerce, U.S. House of Representatives by Cliff Stearns (Editor) (2003); ISBN: 0756726824; http://www.amazon.com/exec/obidos/ASIN/0756726824/icongroupinterna
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Prep pak for FLMI 371 : managing for solvency and profitability in life and health insurance companies by Sean Schaeffer Gilley; ISBN: 0939921847; http://www.amazon.com/exec/obidos/ASIN/0939921847/icongroupinterna
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Private Medical Insurance [DOWNLOAD: PDF] by Mintel International Group Ltd. (Author); ISBN: B00005RC01; http://www.amazon.com/exec/obidos/ASIN/B00005RC01/icongroupinterna
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Private Practice, Public Payment: Canadian Medicine and the Politics of Health Insurance, 1911-1966 by C. David Naylor (1986); ISBN: 0773505571; http://www.amazon.com/exec/obidos/ASIN/0773505571/icongroupinterna
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Psychology and national health insurance : a sourcebook; ISBN: 091270411X; http://www.amazon.com/exec/obidos/ASIN/091270411X/icongroupinterna
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Psychotherapy and National Health Insurance: Issues and Evidence by Thomas, McGuire; ISBN: 0884107116; http://www.amazon.com/exec/obidos/ASIN/0884107116/icongroupinterna
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Q & A for Life and Health Insurance Licensing by Dearborn Financial Institute, Dearborn-R & R Newkirk; ISBN: 0793111110; http://www.amazon.com/exec/obidos/ASIN/0793111110/icongroupinterna
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Responsible Tax Creidts for Health Insurance by Mark V. Pauly, John S. Hoff (2002); ISBN: 0844771619; http://www.amazon.com/exec/obidos/ASIN/0844771619/icongroupinterna
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Ria's Complete Analysis of the Small Business, Health Insurance & Welfare Reform Acts of 1966 (1996); ISBN: 0781101441; http://www.amazon.com/exec/obidos/ASIN/0781101441/icongroupinterna
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Source Bk Health Insurance 35e by Insurance Assoccamerica Health, America Insurance Assoc (1996); ISBN: 1879143313; http://www.amazon.com/exec/obidos/ASIN/1879143313/icongroupinterna
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Source Book of Health Insurance Data 1993 by Health Insurance Association O (1994); ISBN: 1879143240; http://www.amazon.com/exec/obidos/ASIN/1879143240/icongroupinterna
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Sourcebook Health Insurance by Insurance Association Health (1995); ISBN: 1879143259; http://www.amazon.com/exec/obidos/ASIN/1879143259/icongroupinterna
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Supplemental Health Insurance by Health Insurance Association Of America, Various chapter authors (1998); ISBN: 1879143429; http://www.amazon.com/exec/obidos/ASIN/1879143429/icongroupinterna
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Tax Facts 1 2000: Life and Health Insurance, Annuities, Employee Plans, Estates and Trusts, Business Continuation (Tax Facts on Life Insurance, 2000); ISBN: 0872182568; http://www.amazon.com/exec/obidos/ASIN/0872182568/icongroupinterna
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Tax Facts 1 2001: Life & Health Insurance, Annuities, Employee Plans, Estates & Trusts, Business Continuation (Tax Facts 1, 2001); ISBN: 0872182738; http://www.amazon.com/exec/obidos/ASIN/0872182738/icongroupinterna
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Tax Facts 1: Life & Health Insurance, Annuities, Employee Plans, Estates & Trusts, Business Continuation (Tax Facts 1, 2003) (2003); ISBN: 0872186237; http://www.amazon.com/exec/obidos/ASIN/0872186237/icongroupinterna
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The Complete Guide to Health Insurance: How to Beat the High Cost of Being Sick by Kathleen Hogue, et al; ISBN: 0380707853; http://www.amazon.com/exec/obidos/ASIN/0380707853/icongroupinterna
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The Complete Small Group Health Insurance Handbook by William Y. Wilson; ISBN: 0963190547; http://www.amazon.com/exec/obidos/ASIN/0963190547/icongroupinterna
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The Fight Back! Guide to: Health Insurance by David Horowitz, Dana Shilling (Contributor); ISBN: 0440211778; http://www.amazon.com/exec/obidos/ASIN/0440211778/icongroupinterna
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The foundations of life and health insurance by William T. Hold; ISBN: 0877550689; http://www.amazon.com/exec/obidos/ASIN/0877550689/icongroupinterna
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The Professional Psychologist Today: [New Developments in Law, Health Insurance, and Health Practice] by Herbert. D”Orken (1976); ISBN: 087589271X; http://www.amazon.com/exec/obidos/ASIN/087589271X/icongroupinterna
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The Role of Health Insurance in the Health Services Sector: A Conference of the Universities--National Bureau Committee for Economic Research by Nat; ISBN: 0870142720; http://www.amazon.com/exec/obidos/ASIN/0870142720/icongroupinterna
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The Theory of Demand for Health Insurance by John A. Nyman (2002); ISBN: 0804744882; http://www.amazon.com/exec/obidos/ASIN/0804744882/icongroupinterna
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The Wages of Sickness: The Politics of Health Insurance in Progressive America (Studies in Social Medicine) by Beatrix Hoffman (2001); ISBN: 0807849022; http://www.amazon.com/exec/obidos/ASIN/0807849022/icongroupinterna
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Time for Bipartisan Action to Help Families Without Health Insurance [DOWNLOAD: PDF] by Stuart M. Butler Ph.D. (Author); ISBN: B000066CZ5; http://www.amazon.com/exec/obidos/ASIN/B000066CZ5/icongroupinterna
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Top Ten Ways To Fix America's Health Insurance Market And Expand Coverage [DOWNLOAD: PDF] by James Frogue (Author); ISBN: B000063950; http://www.amazon.com/exec/obidos/ASIN/B000063950/icongroupinterna
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UK Health Insurance 2002 [DOWNLOAD: PDF] by Datamonitor (Author); ISBN: B00008R3X4; http://www.amazon.com/exec/obidos/ASIN/B00008R3X4/icongroupinterna
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UK Private Medical Insurance 2001 [DOWNLOAD: PDF] by Snapshots International Ltd (Author); ISBN: B00006FCHJ; http://www.amazon.com/exec/obidos/ASIN/B00006FCHJ/icongroupinterna
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UK Private Medical Insurance Report 2002 [DOWNLOAD: PDF] by Snapshots International Ltd (Author); ISBN: B00006FCCL; http://www.amazon.com/exec/obidos/ASIN/B00006FCCL/icongroupinterna
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Understanding Health Insurance by Ruth M. Burke, et al (2004); ISBN: 1401884350; http://www.amazon.com/exec/obidos/ASIN/1401884350/icongroupinterna
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Understanding Health Insurance by N, A (2002); ISBN: 076687043X; http://www.amazon.com/exec/obidos/ASIN/076687043X/icongroupinterna
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Understanding Health Insurance - IML by Rowell (1998); ISBN: 0827384092; http://www.amazon.com/exec/obidos/ASIN/0827384092/icongroupinterna
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Understanding Health Insurance: A Guide to Professional Billing by Jo Ann C. Rowell, et al; ISBN: 1401837913; http://www.amazon.com/exec/obidos/ASIN/1401837913/icongroupinterna
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Understanding Medical Insurance: A Step-By-Step Guide by Jo Ann C. Rowell, Joann C. Rowell; ISBN: 0827349661; http://www.amazon.com/exec/obidos/ASIN/0827349661/icongroupinterna
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Uninsured Rates Rise Dramatically in States with Strictest Health Insurance Regulations [DOWNLOAD: PDF] by Melinda L. Schriver (Author); ISBN: B000062XW8; http://www.amazon.com/exec/obidos/ASIN/B000062XW8/icongroupinterna
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Weiss Rating's Guide to Hmos and Health Insurers Fall 2000: A Quarterly Compilation of Health Insurance Company Ratings and Analysis (Weiss Ratings' Guide to Hmo's and Health Insurers) (2000); ISBN: 1889499986; http://www.amazon.com/exec/obidos/ASIN/1889499986/icongroupinterna
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Weiss Ratings' HMO and Health Insurance Directory: A Guide to Health Insurers with Their Safety Ratings Including Blue Cross/Blue Shield Plans by Ted Brownstein (Editor) (1996); ISBN: 1889499021; http://www.amazon.com/exec/obidos/ASIN/1889499021/icongroupinterna
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Why the United States Lacks a National Health Insurance Program by Nicholas Laham (Author) (1993); ISBN: 0313287457; http://www.amazon.com/exec/obidos/ASIN/0313287457/icongroupinterna
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Workbook to Accompany Understanding Health Insurance: A Guide to Professional Billing by Joann C. Rowell, et al; ISBN: 0766832074; http://www.amazon.com/exec/obidos/ASIN/0766832074/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “health insurance” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •
CHIP shots: association between the State Children's Health Insurance Programs and immunization coverage and delivery Author: Joyce, Theodore J.; Year: 2003; Cambridge, MA: National Bureau of Economic Research, c2003
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Fulfilling the promise of genetics research: ensuring nondiscrimination in health insurance and employment: hearing of the Committee on Health, Education, Labor, and Pensions, United States Senate, One Hundred Seventh Congress, first session on S.318 to prohibit discrimination on the basis of genetic information with respect to health insurance, July 25, 2001. Author: United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions.; Year: 2003; Washington: U.S. G.P.O., 2001
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Health insurance: current issues and background Author: Stevens, William S.; Year: 2003; New York: Nova Science Publishers, c2003; ISBN: 1590336879 http://www.amazon.com/exec/obidos/ASIN/1590336879/icongroupinterna
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Health insurance premiums and cost-sharing: findings from the research on lowincome populations Author: Hudman, Julie.; Year: 2002; Washington, D.C.: Henry J. Kaiser Family Foundation, [2003]
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Health insurance resource manual: a guide for people with chronic disease and disability Author: Northrop, Dorothy E.,; Year: 2002; New York: Demos Medical Pub., c2003; ISBN: 1888799692 http://www.amazon.com/exec/obidos/ASIN/1888799692/icongroupinterna
Chapters on Health Insurance In order to find chapters that specifically relate to health insurance, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search 10
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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to book chapters and health insurance using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “health insurance” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on health insurance: •
Health Insurance Issues and Inflammatory Bowel Disease Source: in Targan, S.R., and Shanahan, F. Inflammatory Bowel Disease: From Bench to Bedside. Baltimore, MD: Williams and Wilkins. 1994. p. 457-460. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4000. Fax (410) 528-4414. PRICE: $120 (as of 1995). ISBN: 0683081101. Summary: This chapter, from a textbook on inflammatory bowel disease (IBD), was written to sensitize physicians and other health professionals to the financial pressures faced by patients with IBD, in addition to the burdens imposed by illness. The chapter addresses the recent changes in the medical and health insurance systems; cost sharing and its impact on patients with IBD; results of a recent health insurance survey of a sampling of Americans with chronic disabling conditions, including IBD; shared risk; the failure of alternatives to traditional health insurance; and suggestions for solutions. 17 references. (AA-M).
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Health Insurance and Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 591-600. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail:
[email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This chapter on health insurance and diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Among all adults with diabetes, 92 percent have some form of health insurance. However, about 640,000 people with diabetes do not have any form of health care coverage. Among individuals with diabetes, age 18 to 64 years, 10.3 percent are covered by Medicare, 69.3 percent by private health insurance, 5.5 percent through military benefits, and 14.1 percent through Medicaid or other public assistance programs. Among those 65 years of age and older, 94.7 percent are covered by Medicare, 69.2 percent by private health insurance, 4.9 percent through military benefits, and 15.4 percent through Medicaid or other public assistance programs. Government-funded programs are responsible for health care coverage for 57.4 percent of adults with diabetes, including 26.4 percent of those age 18 to 64 years and 96 percent of those age 65 or older. There is little difference by type of diabetes (IDDM or NIDDM) in the proportion of individuals covered by each health insurance mechanism. At age 18 to 64 years, males compared with females have higher rates of coverage for each insurance type except Medicaid and other public programs; a higher proportion of blacks and Hispanics compared with all whites are covered by Medicare and Medicaid; and whites are more frequently covered by private health insurance. Virtually all persons with diabetes covered by Medicare or private
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health insurance have coverage for hospital care and physician or surgeon bills. Coverage for prescription medicines occurs for 62.9 percent of adults with diabetes. There are only small differences between people with diabetes and those without diabetes in the proportion covered and the types of health care coverage. 10 figures. 5 tables. 14 references. (AA-M).
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to health insurance have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:11 •
State programs for providing children's health insurance: A resource notebook Source: Washington, DC: Forum for State Health Policy Leadership, National Conference of State Legislatures. 1997. ca. 200 pp. Contact: Available from Forum for State Health Policy Leadership, National Conference of State Legislatures, 444 North Capitol Street, N.W., Suite 515, Washington, DC 20001. Telephone: (202) 624-5400 / fax: (202) 737-1069 / Web site: http://www.ncsl.org/healthforum. $40.00. Summary: This directory provides a list and description of state child health insurance programs and is designed to provide practical information for state legislators, officials, and other organizations studying options for expanding health insurance for children. Each program description starts with a cover page that includes contact information, sponsoring agency, eligibility and benefits, enrollment, and funding. Also included is authorizing legislation or regulations, where relevant, and brochures or fact sheets supplied by the programs themselves. It includes descriptions of at least one of every model currently in existence, and every program that is large and well-established.
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You will need to limit your search to “Directory” and “health insurance” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “health insurance” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.
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CHAPTER 7. MULTIMEDIA ON HEALTH INSURANCE Overview In this chapter, we show you how to keep current on multimedia sources of information on health insurance. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on health insurance is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “health insurance” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “health insurance” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on health insurance: •
Who Pays for AIDS? Contact: Public Broadcasting Service, PBS Video, 1320 Braddock Pl, Alexandria, VA, 22314-1698, (703) 739-5380. Summary: This videorecording examines the financial needs of Persons with AIDS (PWA's), and who will ultimately pay for their health care needs. It explores the facts that many individuals who become ill are unable to work, lose their health insurance, and then are unable to pay for their medical treatment. Using examples of individuals across the United States, it looks at problems facing uninsured individuals and the steps that are necessary qualify for Medicaid. It outlines the dilemmas facing overburdened hospitals, clinics, and AIDS service organizations as they struggle to meet increasing demands on their services with decreasing revenue sources.
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Families in Crisis: Legal Responses and Alternatives Source: Bozeman, MT: Montana Alzheimer's Demonstration Project. 1997. (videocassette). Contact: Montana Aging Services, Division of Senior and Long-term Care. PO Box 4210, Helena, MT 59604. (406) 444-4077; (406) 444-7743. PRICE: Call for price information. Summary: This videotape presents a forum on legal issues for families of people with Alzheimer's disease and families of people with disabilities. Rick Bartos, legal counsel from the Montana State Department of Aging, and Andre Larose, from the Montana Advocacy Program, discuss the issues involved in one family's case, and answer questions from participants. The older son, Ben, is interviewed in four chronological segments. At the beginning of the story, his father has Alzheimer's disease (AD), his mother is the main caregiver, and his younger adult brother has Down's syndrome. Over the course of a year, Ben has to deal with legal, emotional, and caregiver issues involving his father (who has died by the last segment), his mother (who becomes debilitated from caring for her husband), and his brother. The forum's experts explain available options, including power of attorney, guardianship, and Montana's self sufficiency trust fund. Although the forum discusses Montana's specific laws, it focuses on the universal issues most caregivers experience: reluctance to accept the inevitable decline and death of a loved one from AD; frustration in finding needed help; legal paperwork; health insurance issues; despair, grief, and other emotions. The forum also examines the financial planning issues involved in providing for an adult child with (mental) disabilities and explains options for enhancing independent living and a secure future.
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Who Pays for Mom and Dad? Source: Boston, MA: WGBH-Television, Frontline. 1991. (videocassette). Contact: Available from PBS Video. 1320 Braddock Place, Alexandria, VA 22314-1698. (703) 739-5380, (800) 344-3337, or (800) 424-7963. PRICE: $200.00 (purchase), $95.00 (rental); add $20.00 for 3/4 in format. Summary: This video, produced as part of the PBS television series FRONTLINE, examines the personal side of the spiraling cost of financing long term nursing home care for the elderly. This film also profiles a new breed of elder law experts who help find loopholes in Medicaid laws. Viewers learn about the personal and national economic problems facing the elderly, including estimates that nursing home care in the United States cost nearly $50 billion in 1989; that the average American faces total impoverishment after only 13 weeks in a nursing home; and that personal health insurance, Medicare, and Federal health insurance plans often do not pay for nursing home care.
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Coping With Alzheimer's: The Houston Connection Source: Houston, TX: Baylor College of Medicine. 1990. (videocassette). Contact: Available from Media Productions. Baylor College of Medicine, One Baylor Plaza, Room 336A, Houston, TX 77030. (713) 798-4939. PRICE: $17.50 for VHS, $33.50 for U-Matic. Also available from Baylor College of Medicine, Alzheimer's Disease Center. Department of Neurology, 6550 Fannin, Suite 1801, Houston, TX 77030. (713) 789-6660. Avalaible for loan; contact by phone and send a self-addressed stamped envelope.
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Summary: The purpose of this video is to provide information about caring for individuals with Alzheimer's disease. Family caregivers and health professionals discuss problems and concerns associated with caring for loved ones with Alzheimer's disease and how the Greater Houston Chapter of the Alzheimer's Association addresses those concerns. The video program is divided into four sections: community resources, legal and financial planning, finacial aid, and research. Community resources include family support groups, respite care, day care, companions/sitters, home health aids, and nursing homes. Legal and financial planning is necessary as soon as possible after diagnosis to prevent additional burdens for family members later when the patient is unable to make his or her own decisions. Legal steps include having both a will and a living will, naming both a legal and health care power of attorney, and legal planning for the caregiver. Types of financial aid for Alzheimer's care include disability insurance, social security, supplemental security income, private health insurance, medicare and medicaid, social services, and Veterans Administration benefits. Clinical research consists of testing experimental treatments on persons who meet study criteria. Basic science research indicates that abnormalities in certain neurons in the brain, particularly an accumulation of amyloid proteins, occurs in the majority of patients with Alzheimer's disease, suggesting possible avenues for further research and treatment. •
Challenge of Serving Adults with Neurogenic Communication Disorders Source: Tucson, AZ: National Center for Neurogenic Communication Disorders, University of Arizona. 1999. (videocassette). Contact: Available from National Center for Neurogenic Communication Disorders, University of Arizona. P.O. Box 210071, Tucson, AZ 85721-0071. (520) 621-1472. Fax (520) 621-2226. PRICE: $25.00 plus shipping and handling. Order Number TR-49. Summary: This videotape program, which is part of the Telerounds videoconference series from the National Center for Neurogenic Communication Disorders at the University of Arizona (funded partly by NIDCD), focuses on the problems caused by reduced coverage by Medicare and other health insurance providers for treatment of communication disorders. Medicare has changed from a retrospective payment system to a prospective payment system. An assessment instrument known as the minimum data set (MDS) is used to provide information about patient functioning, and the MDS is used to place patients in resource utilization groups (RUGS). The amount of rehabilitation that patients receive is based on their RUGS classification. The speakers discuss the ways in which speech language pathologists are dealing with these changes in reimbursement for their services and explain how these professionals can advocate for increased services. The speakers also provide treatment scenarios for people admitted to subacute and long term care facilities. The program concludes by answering questions asked by the host and phoned in by the teleconference audience and by providing information about joining Centernet, the online forum operated by the Center.
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School based health centers: Bringing health care to kids Source: Denver, CO: National Conference of State Legislatures. 1997. 12 pp. Contact: Available from National Conference of State Legislatures, 1560 Broadway, Suite 700, Denver, CO 80202-5140. Telephone: (303) 830-2200 / fax: (303) 863-8003. $30.00. Summary: This videotape and booklet look at school based health centers as an option for states to expand the provider network to care for children under the State Childrens Health Insurance Program (SCHIP).
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Health care financing options for adolescents entering adult care Source: Iowa City, IA: University of Iowa. 1990. 1 videotape. Contact: Available from Thomas S. Hulme, University of Iowa Hospitals and Clinics, Iowa Child Health Specialty Clinics, 239 University Hospital School, Iowa City, IA 52242. Telephone: (319) 356-1455. $15 for parent groups and families, $20 for professionals and organizations; loans available (borrower pays return postage). Summary: This videotape addresses some of the potential health concerns of young adults with chronic illness or disabilities as they change from family-centered health insurance to self-directed medical care. The film highlights some of the myths and problems regarding insurance coverage, provides practical information on obtaining and keeping coverage, and reviews the impact of recent legislation. The video also lists resources that families can use in seeking both information and assistance. [Funded by the Maternal and Child Health Bureau].
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Public/private partnerships: A working model for children's health care Source: Pittsburgh, PA: Western Pennsylvania Caring Foundation. n.d. 1 videotape (VHS 1/2 inch). Contact: Available from Western Pennsylvania Caring Foundation, 500 Wood Street, Suite 600, Pittsburgh, PA 15222. Telephone: (800) KIDS-105. Summary: This videotape describes the Caring Program for Children and the Children's Health Insurance Program (Blue Cross/Blue Shield's BlueCHIP program) in Pennsylvania. It depicts the health care needs of children living in poverty and children of the uninsured working poor who do not qualify for Medicaid assistance, and explains the unique funding of this collaborative program. Appearances by Fred Rogers of 'Mr. Rogers' Neighborhood' and by local medical and government officials underscore the need for this type of program, the reasons for its success, and the ways that public and private resources can join together to help ensure access to primary health care for children. The videotape concludes with a television clip describing the program on NBC's 'America Close Up.' [Funded by the Maternal and Child Health Bureau].
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “health insurance” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on health insurance: •
Policy Implications Preventing and Treating AIDS: Part B Contact: Convention Cassettes, 1-550 Eclectic St, Ste C-140, Palm Desert, CA, 92260, (415) 776-5454. Summary: This sound recording covers a session on the effects of Human immunodeficiency virus (HIV) prevention and treatment programs on policy development at the Public Health 1990 Conference in California. The first speaker, Dr.
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Robert Hyatt, describes a study (Archives of Internal Medicine, vol. 150, April 1, 1990) analyzing the medical care costs of Persons with AIDS (PWA's) on the Kaiser Health plan in Northern California. Utilization data presented covers survival time, life time, inpatient hospitalizations, hospital days, average length of stay, and outpatient clinic visits, whereas cost analysis data includes drugs and services. Other issues addressed are additional components of future programs such as counseling and education for behavior modification, increase in infant PWA's, increase in hospital days, inadequate funding, health insurance issues covering attendant care for patients at home, and experimental drugs status. Beverly Bradlee, a San Francisco school district supervisor of health education and health services, talks about teaching Acquired immunodeficiency syndrome (AIDS) in school, in particular the development of HIV prevention programs. She explains what she has learned from the process, and what schools could and need to do about providing sex and AIDS education. •
Serving Individuals with Diabetes who are Blind or Visually Impaired: A Resource Guide for Vocational Rehabilitation Counselors Source: Mississippi State, MS: Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University. 1997. 227 p. Contact: Available from Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University. Publications Manager, P.O. Drawer 6189, Mississippi State, MS 39762. (601) 325-2001 or (601) 325-8693. Fax (601) 325-8989. TDD (601) 325-8693. PRICE: $25.00 in any format. Summary: This resource guide is designed to help counselors better serve individuals with diabetes who are blind or visually impaired. The guide refers readers to a large collection of resources on various diabetes publications, medications, and appliances. Five sections cover an introduction to diabetes; self management; current medical issues; employment issues; and emotional aspects of diabetes. Topics include myths about diabetes; diabetic eye disease; new nutrition guidelines for diabetes management; oral diabetes medications; diabetes and medications; insulin and measurement devices and systems; maintaining the proper temperature of insulin; blood glucose control; 'talking' blood glucose monitoring systems; and noninvasive glucose monitors. The authors also discuss diabetes and the feet; kidney failure, dialysis, and transplantation; pancreas transplantation; arthritis and diabetes; diabetes and yeast infections; hypoglycemia; diabetic peripheral neuropathy; diabetes and men's sexual health; cardiovascular health; diabetic ketoacidosis; diabetic dermopathy; diabetes and the Individualized Written Rehabilitation Program (IWRP); the use of Braille; health insurance; and scleral shells. The book's appendix includes lists of diabetes-related organizations, publications, listservs, and World Wide Web sites; sources of low-sugar products and products for the blind; and diabetes equipment and supplies, including insulin syringe magnifiers. The resource guide is available in large print, Braille, audiocassette, and computer diskette.
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Unmet needs and special issues in children's health programs Source: Washington, DC: Forum for State Health Policy Leadership, National Conference of State Legislatures. 1998. 1 audiotape guide (21 pp.), 1 audiotape (30:28 minutes). Contact: Available from National Conference of State Legislatures, 1560 Broadway, Suite 700, Denver, CO 80202-5140. Telephone: (303) 830-2200 / fax: (303) 863-8003. $20.00. Summary: This audiotape and accompanying guide lay the ground work to provide legislators and legislative staff an understanding of special populations and services for
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children with special health care needs, oral health, and mental health and substance abuse as related to their eligibility in the implementation of the State Children's Health Insurance Program. This audiotape is an edited recording of one session of a March 1998 meeting of legislative staff, state agency officials, and national experts in Nashville, Tennessee entitled 'Children's Unmet Needs and Special Issues.' It gave experts on these three issues the opportunity to answer questions such as how many of these children are there and what conditions do they have?. •
National Conference of State Legislatures [Annual meeting] Source: [Denver, CO]: National Conference of State Legislatures. 1996. 16 audiocassettes. Contact: Available from National Conference of State Legislatures, 1560 Broadway, Suite 700, Denver, CO 80202-5140. Telephone: (303) 830-2200 / fax: (303) 863-8003. Summary: These tapes are about legislative topics including welfare waivers, health insurance reform, federalism and the Supreme Court, Federal welfare reform and Congressional human services action, juvenile justice reform, devolution and block grants, managed care, child care, management of social services, work programs, and child protection.
Bibliography: Multimedia on Health Insurance The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in health insurance (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on health insurance (for more information, follow the hyperlink indicated): •
Health insurance: what should be the federal role [videorecording] Source: American Enterprise Institute for Public Policy Research; Year: 1975; Format: Videorecording; [Washington]: The Institute; [Rockville, Md.: for sale by BNA Communications, 1975]
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National health insurance [videorecording] Source: Dept. of Medicine, Emory University, School of Medicine; Year: 1979; Format: Videorecording; Atlanta: Emory Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library], 1979
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CHAPTER 8. PERIODICALS AND NEWS ON HEALTH INSURANCE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover health insurance.
News Services and Press Releases One of the simplest ways of tracking press releases on health insurance is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “health insurance” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to health insurance. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “health insurance” (or synonyms). The following was recently listed in this archive for health insurance: •
Census Report: More in U.S. lack health insurance Source: Reuters Medical News Date: September 30, 2003 http://www.reutershealth.com/archive/2003/09/30/professional/links/20030930man c001.html
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California senate OKs bill to extend health insurance Source: Reuters Industry Breifing Date: September 15, 2003
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Phony health insurance plans on rise in US - study Source: Reuters Industry Breifing Date: August 28, 2003
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U.S. doctors call for universal health insurance Source: Reuters Medical News Date: August 12, 2003
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U.S. Senate approves extending health insurance to military reserves Source: Reuters Industry Breifing Date: May 20, 2003
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Report says U.S. health insurance gap overstated Source: Reuters Industry Breifing Date: May 13, 2003
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German public health insurance still in red after latest cost-cut package Source: Reuters Industry Breifing Date: May 06, 2003
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Bill would reduce health insurance costs for self-employed Source: Reuters Industry Breifing Date: April 30, 2003
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Policy experts offer plan for expanding health insurance Source: Reuters Industry Breifing Date: April 23, 2003
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Outlook is stable for health insurance ratings Source: Reuters Industry Breifing Date: April 16, 2003
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Analysts make pitch for universal health insurance Source: Reuters Medical News Date: March 18, 2003
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Analysts argue for universal health insurance in US Source: Reuters Industry Breifing Date: March 18, 2003
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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “health insurance” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “health insurance” (or synonyms). If you know the name of a company that is relevant to health insurance, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “health insurance” (or synonyms).
Newsletters on Health Insurance Find newsletters on health insurance using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the
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following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “health insurance.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “health insurance” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •
Sign them up Source: Washington, DC: Children's Defense Fund. 2000-. quarterly. Contact: Available from Children's Defense Fund, 25 E Street, N.W, Washington, DC 20001. Telephone: (202) 628-8787 / fax: (202) 662-3510 / e-mail:
[email protected] / Web site: http://www.childrensdefense.org. Summary: This quarterly newsletter presents current information on children's health insurance programs to professional health service providers, interested citizens and families. The newsletter covers the issues as they occur nationally and in individual states.
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Increased risk of adverse outcomes in newborns in the Greater San Francisco Bay area Source: Berkeley, CA: California Policy Seminar. 1991. 6 pp. Contact: Available from California Policy Seminar, 2020 Milvia Street, Suite 412, Berkeley, CA 94704. Telephone: (510) 642-5514. Available at no charge. Summary: This newsletter summarizes the article, Lack of Health Insurance and Adverse Hospital Outcomes in an Eight-County Area of California, 1982 to 1986, published in the 'New England Journal of Medicine' on August 24, 1989. The article sought to correlate the lack of insurance and adverse neonatal health outcomes in the region around San Francisco. The adverse outcomes included prolonged hospital stays exceeding six days, the transfer to an acute care hospital or a long-term care facility, or death. The study analyzed data from 1982, 1984 and 1986, and it found that risks for uninsured infants appeared higher than for privately insured infants and that the magnitude of risk increased over time. There was also a higher risk if the newborn was black or Latino. Implications for setting health policies in response to these findings are discussed.
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CHP+ family newsletter Source: Denver, CO: Colorado Child Health Plan Plus. 1998-. frequency unknown. Contact: Available from Colorado Child Health Plan, P.O. Box 469022, Glendale, CO 80246. Telephone: (800) 359-1991 or (303) 692-2960 / fax: (303) 266-9723 / Web site: http://www.cchp.org. Available at no charge. Summary: This newsletter provides information about Colorado's Childrens Health Insurance Program called Child Health Plan Plus. It provides details about the plan's benefits as well as general health education information.
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the
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search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “health insurance” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on health insurance: •
Alzheimer's Disease Source: ABA Communique. [Newsletter] p. 2. July 1991. Contact: Available from American Bankers Association. 1120 Connecticut Avenue, NW, Washington, DC 20036. (202) 663-5000. PRICE: Call for price information. Summary: This newsletter article provides a brief description of Alzheimer's disease. Currently about 3 million people in the United States have Alzheimer's disease. Alzheimer's disease is a gradual, irreversible deterioration of cognitive thinking. Because the disease is irreversible, diagnosis following investigation for other possible causes which may be treatable is important. Most types of health insurance do not cover chronic disease care, so family members often seek community resources. Family members can receive support in an Alzheimer's disease support group and may explore alternatives to care including nursing home placement. Information about support groups is available through the local Alzheimer's Associations.
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Treating Psoriasis: A to Z Hits the Airwaves in April Source: National Psoriasis Foundation Bulletin. 27(2):1,3; March/April 1996. Contact: National Psoriasis Foundation, 6600 SW 92nd Avenue, Suite 300, Portland, OR 97223. Summary: This newsletter article for health professionals, the general public, and individuals with psoriasis discusses the television debut of a show on psoriasis. The show explains the symptoms of psoriasis, discusses the therapies available to treat psoriasis, and provides guidelines for referring patients to psoriasis specialists. It also features patient interviews and information on the mission and services of the National Psoriasis Foundation ( NPF ). A tape of this program will be available to managed care health insurance organizations, physicians, and NPF members.
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Lose the Job, Keep the Insurance Source: Diabetes Advisor. 7(5): 8. September-October 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article provides people who have diabetes with information on keeping their health insurance if they are unemployed or waiting for a new employer's plan to start coverage. The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 and the Health Insurance Portability and Accountability Act of 1996 both provide for health insurance coverage for certain groups of people. The article explains who is covered and what the coverage is under these laws. The article presents other health plan options, including conversion of a group plan to an individual policy after leaving the plan, employer plans, state laws, and spouse health plans. In addition, the article offers tips for avoiding health insurance problems.
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How Can Medicare Work For You? Source: Quality Care. 15(1): 2. Winter 1997. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800)-BLADDER or (864) 579-7900. Fax (864) 579-7902. Web site: http://www.nafc.org. Summary: This brief newsletter article describes how Medicare works and how it can help pay for home medical supplies, including bladder control products. Medicare is the health insurance program administered by the Federal Government. It provides insurance benefits for people 65 years or older, and for persons of all ages who are disabled or for those who have kidney failure. Medicare Part B coverage can help patients save money on supplies. Readers are advised to ask if Medicare assignment is accepted on any product before they purchase it. If a dealer 'accepts assignment' he or she agrees to accept Medicare's 'allowable' amount for the item being purchased. The allowable amount is the price that Medicare has determined is reasonable to pay for an item. This means the dealer will bill Medicare for 80 percent of the bill and the patient needs to pay the other 20 percent. It is important to know which products are covered and which are not, and to talk with one's health care provider about all of the product options. For example, absorbent products are usually not covered, but external devices like condom catheters usually are covered. The article concludes with the toll free telephone number of the Social Security Administration (800-772-1213). (AA-M).
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Living a Full Life on Dialysis Source: Renal Rehabilitation Report. 5(5): 1, 7, 8. September-October 1997. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email:
[email protected]. Summary: This article presents an introduction to a special issue on vocational rehabilitation and employment for dialysis patients. The author notes that, for most working-age Americans, being productive means, in part, being employed. There are, however, various factors that can make employment a challenge for dialysis patients. The article first reviews the symptoms of end-stage renal disease (ESRD) that may interfere with employment. Factors that are considered to be prerequisites to renal rehabilitation include anemia control, appropriate access management, dialysis adequacy, and optimum nutrition. The article then outlines and dispels five common misconceptions about the employment of people on dialysis. These are: patients with ESRD do not want to work; dialysis patients use too many sick days and are not as productive; hiring a dialysis patient will cause the employer's health insurance premiums to increase; dialysis patients require expensive employment accommodations; and dialysis patients who work automatically lose disability payments. The article concludes by offering strategies by which dialysis team members can play a role in combating the myths about ESRD and employment and helping patients manage the symptoms of ESRD. 4 references. (AA-M).
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Dental Insurance is Essential, But Not Enough Source: Closing the Gap. p. 4-5. July 1999. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472.
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Summary: This article reviews the lack of dental insurance and some additional strategies to address the problem of lack of access to dental services in the U.S., particularly among lower income persons. Topics include the amount of money spent on dental services, dental Medicaid, the lack of services for low income children (despite apparent coverage by dental Medicaid), the reasons that dentists do not participate in Medicaid services, the Children's Health Insurance Program (CHIP), dental services in CHIP, other public health initiatives, barriers to dental care for some cultural and linguistic minorities. The author concludes with recommendations for addressing these issues, including: make oral health a much higher priority on the local, state, and national levels; upgrade and expand the dental components of Medicaid and CHIP programs; promote and implement special initiatives for vulnerable and high risk populations to improve access to dental care; and fluoridate all community water supplies. 2 tables.
Academic Periodicals covering Health Insurance Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to health insurance. In addition to these sources, you can search for articles covering health insurance that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
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These publications are typically written by one or more of the various NIH Institutes.
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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database
A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “health insurance” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “health insurance” (or synonyms) into the “For these words:” box. The following is a sample result: •
Returning to Work With HIV/AIDS: Making Decisions About Employment, Benefits and Health Insurance Contact: Mobilizing Talents and Skills, 38 E 29th St 9th Fl, New York, NY, 10016, (212) 679-8234. Summary: This handbook provides information on employment, health insurance eligibility, and other employee benefits for HIV/AIDS patients who decide to return to the workforce. The first chapter defines some of the terms and programs commonly used in the employment and health benefit arena, including the AIDS Drug Assistance Program, food stamps, Medicaid and Medicare, scattered-site housing, and Social Security Disability. The following chapters explain how returning to work affects eligibility for benefits and how working affects medical insurance. The appendix contains resource lists and worksheets for calculating changes in Social Security Insurance, transitional Medicaid, public assistance, and food stamps.
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AIDS and Health Insurance: Take Charge of Your Health! Contact: Commonwealth of Massachusetts, Division of Insurance, 1 South Station, Boston, MA, 02110, (617) 521-7794, http://www.state.ma.us/doi. Summary: This monograph details medical insurance guidelines for persons with Human immunodeficiency virus (HIV) infection or Acquired immunodeficiency syndrome (AIDS) who live in Massachusetts. It tells them how to deal with the insurance system and explains the different types of private health coverage. Three chapters address how to get insurance, how to use it, and how to keep it. The monograph then explains programs for the needy, including Medicaid, CommonHealth, Medicare, and Hospital Free Care. It also tells readers about the HIV Drug Reimbursement Program, HIV-antibody tests and early treatment programs, and how to cash in life insurance policies. Readers also learn they may be eligible for financial assistance, food, and other benefits.
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Health Insurance: Risk Pools for the Medically Uninsurable Contact: US General Accounting Office, Document Distribution Center, 700 4th St NW Rm 1100, Washington, DC, 20548, (202) 512-6000, http://www.gao.gov. Summary: This report to the United States Senate Commitee on Labor and Human Resources responds to a request for information about State-administered health insurance risk pool programs. The report presents the results of a study to determine the programs' characteristics, enrollment, and financial status; characteristics of insured persons; and their success. The study focused on programs in Connecticut, Florida, Indiana, Minnesota, North Dakota, and Wisconsin. The report explains that risk pool programs provide health insurance to individuals who cannot obtain private insurance because of their health conditions. Costs are relatively high because of large deductibles and premiums that are usually 25 to 50 percent higher. However, in spite of the higher premiums, these programs require State subsidies as they operate at a loss. Report data indicate that risk pool individuals are most often treated for heart conditions, cancer, and diabetes; officials believe they can also finance the cost of treating persons with Human immunodeficiency virus (HIV) infection.
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Children falling through the health insurance cracks: Early observations and promising strategies for keeping low-income children covered by Medi-Cal and Healthy Families Source: Oakland, CA: The 100 Percent Campaign. 2003. 51 pp. Contact: Available from 100 Percent Campaign, 1212 Broadway, Fifth Floor, Oakland, CA 94612. Telephone: (510) 763-2444 / fax: (510) 763-1974 / Web site: http://www.100percentcampaign.org. Available at no charge; also available from the Web site at no charge. Summary: This report describes an examination of whether and why children fall through the cracks of health insurance after enrollment and what promising strategies exist for keeping children covered in California. Section topics include how Medi-Cal and Healthy Families work in California; what is known about children losing coverage; and recommendations for keeping children covered. The appendices provide information on the report methodology and flowcharts on program processes for continuing coverage. Also included are an executive summary, conclusions, and endnotes.
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The strengths and weaknesses of private health insurance coverage for children with special health care needs Source: Washington, DC: MCH Policy Research Center. 2002. 62 pp. Contact: Available from MCH Policy Research Center, Fox Health Policy Consultants, 750 17th Street, N.W., Suite 1205, Washington, DC 20006. Telephone: (202) 223-1500 / Web site: http://www.mchpolicy.org. Available at no charge; also available from the Web site at no charge. Summary: This report is intended to provide an in-depth picture of the health insurance coverage commonly available to children through their parents' place of employment. Specifically, the study investigated the extent of coverage for children with special health care needs (CSHCN). The report includes three major sections: (1) an analysis of the coverage potentially available to six hypothetical children with special health care needs; (2) a review of the benefit amounts, cost-sharing requirements, access restrictions and protections, and differences between health maintenance organizations (HMOs)
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and preferred provider organizations (PPOs) for 22 services important to CSHCN; and (3) a review of policy options that might be considered to address the limitations in private health insurance coverage. The report also includes an executive summary, an introduction and many tables. •
The impact of the State Children's Health Insurance Program (SCHIP) on community health centers Source: Washington, DC: Center for Health Services Research and Policy, George Washington University. 2002. 130 pp. Contact: Available from George Washington University, Center for Health Services Research and Policy, 2021 K Street, N.W., Suite 800, Washington, DC 20006. Telephone: (202) 296-6922 / fax: (202) 296-0025 / e-mail:
[email protected] / Web site: http://www.gwhealthpolicy.org. Contact for cost information. Summary: This report, funded by the Health Resources and Services Administration (HRSA), gives results of a study of the State Children's Health Insurance Program's impact on the insurance status of children served by selected HRSA programs, as well as its impact on HRSA grantee organizations. The study focused on the experiences of community health centers (CHCs), and examined three groups of children: (1) children who continue using the HRSA site after enrolling in SCHIP; (2) children who are new to the HRSA sites; and (3) children who were previous users but are no longer visiting the HRSA site. The report is divided into sections including methods; background on study state and sites; findings; conclusions and implications; and recommendations. An extensive section of tables provides details of statistical data collected in the study. The three appendices include a demographic profile of study participants; data methods and limitations; and study sites.
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The state of health insurance in California, 1996 Source: Los Angeles, CA: UCLA Center for Health Policy Research, University of California at Los Angeles; Berkeley, CA: School of Public Health, University of California at Berkeley. 1997. exec. summ. (6 pp.). Contact: Available from UCLA Center for Health Policy Research, 650 Charles E. Young Drive, South Room 21-293 CHS, Los Angeles, CA 90095-1772. Telephone: (310) 825-5491 / fax: (310) 825-5960 / e-mail:
[email protected] / Web site: http://www.healthpolicy.ucla.edu. Single copies available at no charge. $15.00 for full report; prepayment required; make checks payable to The Regents of the University of California. Summary: This summary report focuses on the status of the health insurance industry in California. It considers the residents' access to health insurance if they are uninsured or employed, reviews the practices and experiences of employers in providing health benefits, analyzes managed care practices, and discusses the role of employer purchasing cooperatives in cost containment, improving benefits and quality, and expanding access to health insurance. The summary briefly considers recent reforms and recommends further reforms to state policies regulating health insurance. This report summarizes a fuller version of the publication which has the same title.
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A Report on Medical Insurance and AIDS in Hawaii: A Survey of Existing Coverage and Recommendations for the Future Contact: Hawaii Governor's Committee on HIV/AIDS, PO Box 3378, Honolulu, HI, 96801, (808) 586-8110. Summary: This report examines Hawaii's public and private health insurance programs and finds significant gaps in coverage for people infected with the Human immunodeficiency virus (HIV). In particular, it finds deficiencies in drug insurance, post-employment health insurance coverage, coverage for uninsured people with HIV infection, and in methods of developing insurance ratings for small firms. The report recommends expanding drug insurance coverage, subsidizing existing insurance coverage, reforming insurance related to HIV, and mandating company ratings for small groups. The main bulk of the report provides background information on the effect of the Acquired immunodeficiency syndrome (AIDS) epidemic on Hawaii and projects case totals for the 1990s. It details average medical costs for a Person with AIDS (PWA) in Hawaii and on the mainland, as well as average medical care costs for symptomatic people in Hawaii. It then turns to an overview of health insurance providers in Hawaii and studies Hawaii's Prepaid Health Care Act. The report examines COBRA options, the State Health Insurance Program, and State programs targeted to PWA's.
The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “health insurance” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 86947 5143 85 1318 396 93889
HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quick15 16
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.
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reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “health insurance” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
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The HSTAT URL is http://hstat.nlm.nih.gov/.
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Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 20 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 21
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on health insurance can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to health insurance. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to health insurance. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “health insurance”:
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Guides on health insurance Health Insurance http://www.nlm.nih.gov/medlineplus/healthinsurance.html
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Other guides Financial Assistance http://www.nlm.nih.gov/medlineplus/financialassistance.html Home Care Services http://www.nlm.nih.gov/medlineplus/homecareservices.html Medicaid http://www.nlm.nih.gov/medlineplus/medicaid.html Medicare http://www.nlm.nih.gov/medlineplus/medicare.html
Within the health topic page dedicated to health insurance, the following was listed: •
General/Overviews Guide to Health Insurance Source: Health Insurance Association of America http://www.hiaa.org/consumer/guidehi.cfm Understanding Your Insurance Coverage Source: American Academy of Family Physicians http://familydoctor.org/handouts/733.html
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Specific Conditions/Aspects Emergency Care: Know What Your Health Plan Covers http://www.acep.org/library/pdf/EmergencySafety.pdf Evaluating Access to Emergency Care through Your Health Plan: A Checklist for Consumers Source: American College of Emergency Physicians http://www.acep.org/1%2C4300%2C0.html Financial Assistance for Cancer Care Source: National Cancer Institute http://cis.nci.nih.gov/fact/8_3.htm Financial Information: Paying for Long Term Care Source: National Center for Assisted Living http://www.longtermcareliving.com/financial_information/howtopay1.htm Financing a Transplant Source: United Network for Organ Sharing http://www.transplantliving.org/transplant101/financingATransplant.asp Guide to Long-Term Care Insurance http://membership.hiaa.org/pdfs/2002LTCGuide.pdf
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Guide to Medical Savings Account(MSA)/High Deductible Health Plans Source: Health Insurance Association of America http://www.hiaa.org/consumer/msaguidel.cfm Health Care Costs and Your Insurance Premium http://membership.hiaa.org/pdfs/InsPremBrochure.pdf How Your Bills Get Paid Source: Centers for Medicare and Medicaid Services http://www.medicare.gov/medigap/bills.asp Insurance (Dental Benefits) Source: American Dental Association http://www.ada.org/public/manage/insurance/index.asp Insurance, Legal Issues and Advance Directives Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=11084 Medigap Coverage Source: Centers for Medicare and Medicaid Services http://www.medicare.gov/medigap/coverage.asp Medigap Policy Basics Source: Centers for Medicare and Medicaid Services http://www.medicare.gov/medigap/default.asp Pension and Health Care Coverage: Questions and Answers for Dislocated Workers Source: Dept. of Labor http://www.dol.gov/ebsa/publications/dislocated_workers_brochure.html Switching Medigap Policies Source: Centers for Medicare and Medicaid Services http://www.medicare.gov/medigap/switching.asp Understanding Long Term Care Insurance Source: National Center for Assisted Living http://www.longtermcareliving.com/financial_information/insurance1.htm Understanding Your Health Plan's Rules Source: American Academy of Family Physicians http://familydoctor.org/handouts/734.html Understanding Your Mental Health Insurance Source: American Academy of Child and Adolescent Psychiatry http://www.aacap.org/publications/factsfam/insuranc.htm •
Children HHS Issues New Report Showing More American Children Received Health Insurance in Early 2002 Source: National Center for Health Statistics http://www.cdc.gov/nchs/releases/02news/release200212.htm Insure Kids Now: Find Your State Source: Dept. of Health and Human Services http://www.insurekidsnow.gov/states.htm
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Insure Kids Now: Questions and Answers Source: Dept. of Health and Human Services http://www.insurekidsnow.gov/questions.htm State Children's Health Insurance Program (SCHIP) Source: Dept. of Health and Human Services http://www.hhs.gov/news/press/2002pres/schip.html •
Latest News Lack of Health Insurance on the Rise Source: 09/29/2003, New York Times Syndicate http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14131 .html Minorities Feel Cheated in Health Care Source: 09/22/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14053 .html
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Law and Policy Health Benefits under the Consolidated Omnibus Reconciliation Act (COBRA) http://www.dol.gov/ebsa/pdf/cobra99.pdf Health Insurance Portability and Accountability Act (HIPAA) Insurance Reform Source: Centers for Medicare and Medicaid Services http://cms.hhs.gov/hipaa/hipaa1/content/cons.asp HHS Allows States to Provide SCHIP Coverage for Prenatal Care Source: Dept. of Health and Human Services http://www.hhs.gov/news/press/2002pres/20020131.html Issues in Genetics and Health Source: National Human Genome Research Institute http://www.genome.gov/page.cfm?pageID=10001740 Medigap Coverage of Pre-Existing Conditions Source: Centers for Medicare and Medicaid Services http://www.medicare.gov/medigap/prex.asp Mental Health Parity Act Source: Centers for Medicare and Medicaid Services http://cms.hhs.gov/hipaa/hipaa1/content/mhpa.asp Newborns' and Mothers' Health Protection Act Source: Centers for Medicare and Medicaid Services http://cms.hhs.gov/hipaa/hipaa1/content/nmhpa.asp Women's Health and Cancer Rights Act Source: Centers for Medicare and Medicaid Services http://cms.hhs.gov/hipaa/hipaa1/content/whcra.asp
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Organizations Centers for Medicare & Medicaid Services Source: Centers for Medicare and Medicaid Services http://cms.hhs.gov/ Dept. of Labor http://www.dol.gov/ Health Insurance Association of America http://www.hiaa.org/
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Research Opinions about Doctors Deceiving Insurance Companies to Obtain Health Services for Their Patients Source: American College of Physicians http://www.annals.org/cgi/content/full/138/6/I-62
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Statistics Data Provide Details on Characteristics of Health Insurance of U.S. Workers Source: Agency for Healthcare Research and Quality http://www.ahrq.gov/news/press/pr2003/mepswork.htm Early Release of Health Insurance Coverage Estimates: New Data from Quarter 3 of the 2001 National Health Interview Survey Source: National Center for Health Statistics http://www.cdc.gov/nchs/about/major/nhis/released200203.htm FASTATS: Health Insurance Coverage Source: Centers for Disease Control and Prevention http://www.cdc.gov/nchs/fastats/hinsure.htm Health Insurance Coverage: 2001 http://www.census.gov/prod/2002pubs/p60-220.pdf Health Insurance Premiums Rose More Than 30 Percent Between 1996 and 2000 Source: Agency for Healthcare Research and Quality http://www.ahrq.gov/news/press/pr2002/insprepr.htm Low Income Uninsured Children by State [1999-2001] Source: Bureau of the Census http://www.census.gov/hhes/hlthins/liuc01.html Medical Expenditure Panel Survey (MEPS): Insurance Component Source: Agency for Healthcare Research and Quality http://www.meps.ahrq.gov/MEPSNet/IC/mepsnetic.asp National Employer Health Insurance Survey Data Highlights: Selected Charts Source: National Center for Health Statistics http://www.cdc.gov/nchs/about/major/nehis/selected_charts.htm Nearly 1 Out of 3 Non-Elderly Americans Were Uninsured for All or Part of 20012002 Source: Robert Wood Johnson Foundation http://www.rwjf.org/news/releaseDetail.jsp?id=1046708993087&contentGroup=r wjfrelease
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Number and Percent of Persons Without Health Insurance Coverage, By Age Group: United States, 1997 - 2002 Source: National Center for Health Statistics http://www.cdc.gov/nchs/about/major/nhis/released200212/table01_1.htm Percent of Persons of All Ages Without Health Insurance Coverage: United States, 1997 - 2002 Source: National Center for Health Statistics http://www.cdc.gov/nchs/about/major/nhis/released200212/figure01_1.htm Percent of Persons Who Failed to Obtain Needed Medical Care during the Past 12 Months Due to Financial Barriers: United States, 1997-2002 Source: National Center for Health Statistics http://www.cdc.gov/nchs/about/major/nhis/released200212/figures03_13_3.htm Trends in Health Insurance Coverage by Poverty Status among Persons under 65 Years of Age: United States, 1997-2002 Source: National Center for Health Statistics http://www.cdc.gov/nchs/products/pubs/pubd/hestats/insurance.htm Trends in Health Insurance Coverage by Race/Ethnicity among Persons under 65 Years of Age: United States, 1997-2001 Source: National Center for Health Statistics http://www.cdc.gov/nchs/products/pubs/pubd/hestats/healthinsur.htm WISEWOMAN: Improving the Health of Uninsured Women Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/nccdphp/aag/aag_wisewoman.htm You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on health insurance. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
HIV/AIDS and Health insurance Contact: CDC Business and Labor Resource Service, PO Box 6003, Rockville, MD, 208496003, (301) 562-1098, http://www.brta-lrta.org. Summary: This brochure discusses issues concerning the coverage of corporate insurance programs for employees with the human immunodeficiency virus
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(HIV)/acquired immune deficiency syndrome (AIDS). The brochure recommends that the reader review the company insurance policy to become acquainted with the coverage offered, managed care issues, and costs for persons with HIV/AIDS. It provides sample situations that relate directly to insurance coverage and costs for employees with HIV/AIDS. These situations cover the hiring of HIV-positive employees, discovering the seropositive status of a worker, insurance costs under different types of plans, and HIV-positive employees who are too ill to work. •
Health Insurance Options for Persons With Hemophilia and HIV/ARC/AIDS Contact: Great Lakes Hemophilia Foundation, PO Box 704, Milwaukee, WI, 53201-0704, (414) 257-0200, http://www.glhf.org. Summary: This brochure provides insurance information to hemophiliacs, particularly those infected with HIV/AIDS. Health-insurance options and assistance programs that may provide health benefits are listed and briefly described.
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Weight Management and Health Insurance: Setting the Wheels in Motion Source: Washington, DC: American Obesity Association. 1998. 16 p. Contact: Available from American Obesity Association. 1250 24th Street, NW, Suite 300, Washington, DC 20037. (800) 986-2373. Website: www.obesity.org. Summary: This brochure addresses the issue of insurance reimbursement for weightloss treatment. It begins by explaining how to determine whether a person is obese and focuses on the use of the body mass index to check for obesity. The brochure continues by identifying the health risks associated with being overweight and stresses the importance of losing a modest amount of weight to reduce these risks. It highlights the reasons why a health insurance company might be reluctant to pay for weight-loss treatment and offers suggestions on communicating with a health insurance company about reimbursement for such treatment. In addition, the brochure outlines steps that people can take if their request for reimbursement is turned down and concludes with information on the American Obesity Association. 1 figure. 14 references.
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Weight management and health insurance Source: American Obesity Association. Contact: American Obesity Association, 1250 24th Street NW, Suite 300, Washington, DC 20037. 1-800-98OBESE. Summary: Most health insurance plans will only pay for the costs of weight-related health problems after they develop. Weight-loss treatments that prevent these problems in the first place and reduce their severity are often not reimbursable. This brochure offers basic information about obesity-how it is diagnosed, its complications and costs and benefits of treatment; valuable tips on how to request reimbursement for weightloss treatment from your health insurance company or employer, and contact information for the American Obesity Association (AOA), which can provide additional support.
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Serving children with special health care needs in the community: Child Health Insurance Program Source: Rockville, MD: Division of Services for Children with Special Health Care Needs, U.S. Maternal and Child Health Bureau. [2000]. 1 v.
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Contact: Available from Merle McPherson, U.S. Maternal and Child Health Bureau, Division of Services for Children with Special Health Needs, 5600 Fishers Lane, Room 18A-27, Rockville, MD 20857. Telephone: (301) 443- 2350 / fax: (301) 443-1728. Contact for cost information. Summary: This report discusses the 2000 revised national agenda and call for action for children with special health care needs (CSHCN) and the Child Health Insurance Program (CHIP). The materials enclosed outline 7 action steps to guarantee children have access to quality health care, providers are appropriately trained, financing issues are equitably addressed, and that families play a pivotal role in how services are provided to their children. The report contains 4 sections: a revised National Agenda for Children with Special Health Care Needs; an eight step process for actions; information on related initiatives such as Family Voices, Medical Home, and Communities Can; and support materials containing papers, newsletters, fact sheets, issue briefs, tables, outlines of group meetings, and a compendium of federal funded projects on managed care and CSHCN. Two additional brochures are included: evaluating managed care plans for CSHCN, purchaser's tool; and data from 1997 on managed care and vulnerable Americans from the Alliance for Health Reform. [Funded by the Maternal and Child Health Bureau]. •
Insuring children's health: A community guide to enrolling children in free and lowcost health insurance programs Source: Washington, DC: Children's Defense Fund. 1999. 22 items. Contact: Available from Children's Defense Fund, 25 E Street, N.W, Washington, DC 20001. Telephone: (202) 628-8787 / fax: (202) 662-3510 / e-mail:
[email protected] / Web site: http://www.childrensdefense.org. Summary: This information package offers step-by-step instructions on how to organize strong, local outreach and enrollment campaigns for the Children's Health Insurance Program (CHIP). It includes suggestions for simple ways to engage schools, congregations, small businesses, and other community members in the effort and has a list of key contacts for CHIP and Medicaid in each state.
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PIC briefing book: Title XXI, State Childrens Health Insurance Program Source: Arlington, VA: National Center for Education in Maternal and Child Health. 1998. ca. 300 pp. Contact: Available from Librarian, National Center for Education in Maternal and Child Health, 2000 15th Street, North, Suite 701, Arlington, VA 22201-2617. Telephone: (703) 524-7802 / fax: (703) 524- 9335 / e-mail:
[email protected] / Web site: http://www.ncemch.org. Available for loan. Summary: This loose-leaf binder is a collection of articles and reports on Title XXI, the State Childrens Health Insurance Program (SCHIP) prepared for a January, 1998 meeting of the MCH Partnership for Information and Communication (PIC) Interorganizational Work Group. The background materials focus on SCHIP. Sections concentrate on an overview of the legislation, federal guidance on implementation, perspectives on implementation, state activities, outreach and enrollment, children with special health care needs, monitoring and assurance, access, systems of care, and crowd out. A bibliography on the topic contains citations and abstracts of materials from the Reference Collection of the National Center for Education in Maternal and Child Health
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as well as resources from the Internet and electronic publications. [Funded by the Maternal and Child Health Bureau]. •
Children's Health Insurance Program (CHIP) outreach resource packet Source: Washington, DC: Association of State and Territorial Health Officials. 1998. 8 items. Contact: Available from Brent Ewig, Association of State and Territorial Health Officials, 1275 K Street, N.W., Suite 800, Washington, DC 20005. Telephone: (202) 371-9090 / email:
[email protected] / Web site: http://www.astho.org. Available from the Web site at no charge. Summary: This information packet offers a range of resources designed to assist states in planning and implementing the outreach components of expanded children's health insurance programs. The materials address outreach provisions of Title XXI, eligibility worker out-stationing, welfare stigma, and school-linked programs.
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Free and low-cost health insurance: Children you know are missing out Source: Washington, DC: Center on Budget and Policy Priorities. 1998. 158 pp., 1 English poster, 1 Spanish poster, 23 instruction cards. Contact: Available from Publications Service, Center on Budget and Policy Priorities, 820 First Street N.E., Suite 510, Washington, DC 20002. Telephone: (202) 408-1080 / fax: (202) 408-1056 / e-mail:
[email protected]. / Web site: http://www.cbpp.org. $7.50. Summary: This outreach kit is part of the Start Healthy, Stay Healthy outreach campaign to enlist national, state, and community-based organizations in efforts to identify children who may be eligible for Medicaid or other public health insurance programs for children and to help them become enrolled. The kit includes a handbook on ways to develop creative, effective outreach strategies (with examples from states and communities), posters and flyers to use in the community, and an eligibility screening tool for determining eligibility for Medicaid or state child health insurance programs.
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Health insurance coverage and access to care among African Americans Source: Menlo Park, CA: Henry J. Kaiser Family Foundation. 2000. 2 pp. Contact: Available from Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, CA 94025. Telephone: (650) 854-9400 or (800) 656-4533 / fax: (650) 854-4800 / e-mail:
[email protected] / Web site: http://www.kff.org. Available from the Web site at no charge. Summary: This fact sheet discusses disparities between African Americans and whites in access to health insurance coverage and health care and summarizes the policy implications. Graphs and tables present statistical data on health insurance, sources of care, and visits to physicians.
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Health insurance coverage and access to care among American Indians and Alaska Natives Source: Menlo Park, CA: Henry J. Kaiser Family Foundation. 2000. 2 pp.
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Contact: Available from Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, CA 94025. Telephone: (650) 854-9400 or (800) 656-4533 / fax: (650) 854-4800 / e-mail:
[email protected] / Web site: http://www.kff.org. Available from the Web site at no charge. Summary: This fact sheet discusses disparities between Native Americans, Alaska Natives, and whites in access to health insurance coverage and health care and summarizes the policy implications. Graphs and tables present statistical data on health insurance, sources of care, and visits to physicians. •
Health insurance coverage and access to care among Asian Americans and Pacific Islanders Source: Menlo Park, CA: Henry J. Kaiser Family Foundation. 2000. 2 pp. Contact: Available from Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, CA 94025. Telephone: (650) 854-9400 or (800) 656-4533 / fax: (650) 854-4800 / e-mail:
[email protected] / Web site: http://www.kff.org. Available from the Web site at no charge. Summary: This fact sheet discusses disparities between Asian Americans, Pacific Islanders, and whites in access to health insurance coverage and health care and summarizes the policy implications. Graphs and tables present statistical data on health insurance, sources of care, and visits to physicians.
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Health insurance coverage and access to care among Latinos Source: Menlo Park, CA: Henry J. Kaiser Family Foundation. 2000. 2 pp. Contact: Available from Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, CA 94025. Telephone: (650) 854-9400 or (800) 656-4533 / fax: (650) 854-4800 / e-mail:
[email protected] / Web site: http://www.kff.org. Available from the Web site at no charge. Summary: This fact sheet discusses disparities between Latinos and whites in access to health insurance coverage and health care and summarizes the policy implications. Graphs and tables present statistical data on health insurance, sources of care, and visits to physicians.
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Oral health services in the Child Health Insurance Program (CHIP) Source: Washington, DC: Children's Dental Health Project. 1998. 13 pp. Contact: Available from National Maternal and Child Health Clearinghouse, 2070 Chain Bridge Road, Suite 450, Vienna, VA 22182-2536. Telephone: (703) 356-1964 or (888) 4344MCH / fax: (703) 821-2098 / e-mail:
[email protected] / Web site: http://www.nmchc.org. Available at no charge. Summary: This fact sheet on children's dental care in the Children's Health Insurance Program (CHIP) discusses what CHIP is, what state options and current responsibilities there are, who is covered, what benefits are covered, whether dental services are covered by CHIP, what the intent of Congress regarding dental coverage was, why it is important to provide dental benefits to CHIP children, how much of the CHIP program should be devoted to dental care, what dental services should be covered, cost sharing prohibitions, and what's going on now. A list of talking points on CHIP is provided as well. The appendix contains the Health Care Financing Administration report on state CHIP submissions. [Funded by the Maternal and Child Health Bureau].
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Dental health and the Children's Health Insurance Program Source: Denver, CO: National Conference of State Legislatures. 1998. 2 pp. Contact: Available from National Conference of State Legislatures, 1560 Broadway, Suite 700, Denver, CO 80202. Telephone: (303) 830-2200 or (303) 830-2054 book order line / fax: (303) 863-8003 / e-mail:
[email protected] / Web site: http://www.ncsl.org. $3.50; any four briefs $5.00. Summary: This fact sheet presents information about tooth decay among children in underserved populations and includes a review of federal legislation and state actions to provide dental care to these children. Selected references are included.
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State Childrens Health Insurance Program Source: Washington, DC: Kaiser Commission on the Future of Medicaid. 1997. 2 pp. Contact: Available from Kaiser Commission on the Future of Medicaid, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347- 5270 / fax: (202) 347-5274. Available at no charge. Summary: This fact sheet reviews the new child health legislation enacted as part of the Balanced Budget Act of 1997.
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Children's health insurance Source: Denver, CO: National Conference of State Legislatures. 1997. 2 pp. Contact: Available from National Conference of State Legislatures, 1560 Broadway, Suite 700, Denver, CO 80202-5140. Telephone: (303) 830-2200 / fax: (303) 863-8003. Summary: This fact sheet gives information about the the lack of health insurance for 10 million American children and the reasons for this lack. Information is given about Federal, state, and private plans to increase health insurance coverage for uninsured children. Contacts for more information are given.
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The new children's health insurance program: Should states expand Medicaid? Source: Washington, DC: Urban Institute. 1997. 8 pp. Contact: Available from Urban Institute, 2100 M Street, N.W, Washington, DC 20037. Telephone: (202) 261-5709 / fax: (202) 429-0687 / e-mail:
[email protected] / Web site: http://www.urban.org. Available at no charge. Summary: This fact sheet lists the changes in funding sources for states to provide health insurance for low income children in the Balanced Budget Act of 1997, which creates the State Children's Health Insurance Program (S-CHIP), enacted as Title XXI of the Social Security Act. It describes issues for the states, such as using the program funds to expand Medicaid or to establish a new program. The fact sheet provides an overview of the new program and discusses options for the states, operational considerations, and political considerations.
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Health insurance coverage of women in California Source: Los Angeles, CA: UCLA Center for Health Policy Research, University of California at Los Angeles. 1996. 4 pp. Contact: Available from UCLA Center for Health Policy Research, 650 Charles E. Young Drive, South Room 21-293 CHS, Los Angeles, CA 90095-1772. Telephone: (310) 825-5491
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/ fax: (310) 825-5960 / e-mail:
[email protected] / Web site: http://www.healthpolicy.ucla.edu. Available at no charge. Summary: This fact sheet contains statistical information on women's ability to obtain insurance in California. It covers these aspects of the subject: non elderly uninsured women, uninsured women and their families, income levels, race and ethnic components, decreases in job-based coverage, coverage by Medi-Cal, and women's access to other coverage. The fact sheet also discusses the implications of the erosion of job-based coverage and proposed reductions in Medicaid for women's insurance coverage and their access to care. •
The facts about obesity and health insurance Source: American Obesity Association. Contact: American Obesity Association, 1250 24th Street, N.W., Suite 300, Washington, DC 20037. 1-800-98-OBESE. Summary: Many insurance plans do not provide reimbursement for weight loss treatment. The countless number of available insurance plans and ever changing policies have made it difficult to assess the extent to which obesity treatment and prevention services are covered by third party insurers. This fact sheet discusses the need for more data and better tracking to determine the health needs of persons with obesity. Healthfinder™
Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •
A Consumer Guide for Getting and Keeping Health Insurance (50 States and District of Columbia) Summary: With a grant from the Robert Wood Johnson Foundation, the Georgetown University Institute for Health Care Research and Policy has written A CONSUMER GUIDE FOR GETTING AND KEEPING HEALTH INSURANCE for Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3535
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Checkup on Health Insurance Choices Summary: You may be buying health insurance for the first time, or you may already have health insurance but want to consider changing plans. Source: Agency for Healthcare Research and Quality http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=804
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Denali KidCare Web Site Summary: This health insurance program was designed by the Alaska Department of Health and Social Services to ensure coverage for children and teens through age 18, and for pregnant women who meet income Source: Alaska Department of Health and Social Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4927
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Express Lane Eligibility: Toolkit for Action Summary: This resource is designed to provide advocates, community leaders, and policymakers with the tools they need to provide health insurance to more than 4 million uninsured children enrolled in such Source: Children's Partnership http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7112
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FAQ - HIPAA Administrative Simplification Compliance Act (ASCA) Summary: Administrative Simplification (AS) provisions were passed into law as part of Public Law 104-191 by the signing of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which amended Source: Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1221
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Financial Help for Diabetes Care Summary: An overview of financial resources that may be helpful in diabetes care: Medicaid, Medicare, managed care, health insurance. Includes suggestions for obtaining help from local resources. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6505
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Guide to Health Insurance For People With Medicare: Choosing a Medigap Policy Summary: A guide to help beneficiaries with purchasing Medigap supplemental insurance, using Medigap supplemental insurance and other kinds of health insurance. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=610
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Health Insurance Glossary of Terms Summary: A list of terms with their definitions that are commonly used in the service and administration of health insurance and related products and services. Source: National Association of Health Underwriters http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6154
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Health Insurance Portability and Accountability Act (HIPAA) --- Administrative Simplification Summary: The Administrative Simplification (AS) provisions of the Health Insurance Portability and Accountability Act (HIPAA) are intended to reduce the costs and administrative burdens of health care by Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1183
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Health Insurance Portability and Accountability Act (HIPAA) Consumer Information Summary: The purpose of this on-line information is to give you an overview of how you may be affected by health insurance coverage changes found in four federal laws: The Health Insurance Portability and Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3084
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Health Insurance Statistics - U.S. Census Bureau Summary: Statistical data on health insurance coverage in the United States. Source: U.S. Census Bureau http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1349
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Health Policy Information Web site Summary: Resources and links related to health policy and administration -- access to health care; children health insurance issues; managed care; public health; supplemental insurance; and more. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4145
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healthfinder® just for you: People with Disabilities Summary: healthfinder®'s just for you: People with Disabilities section features topics such as health insurance, long-term care, and rehabilitation. Source: U.S. Department of Health and Human Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7025
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Insurance Guides for Consumers Summary: Links to insurance guides on disability, health insurance, long term care, medical savings accounts, and general insurance information. Source: Health Insurance Association of America, Public Affairs Department http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4772
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Insure Kids Now: Your State's Children's Health Insurance Program Source: Health Resources and Services Administration, U.S. Department of Health and Human Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4033
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Medicare Health Insurance Source: National Asian Pacific Center on Aging http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7527
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Medicare Premium Amounts for 2003 Summary: A statement of Medicare hospital and medical insurance deductibles, coinsurance, and premiums. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=469
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Office for Civil Rights - HIPAA: Medical Privacy Summary: This page chronicles the development and implementation of the Standards for Privacy of Individually Identifiable Health Information applicable to entities covered by the Health Insurance Portability Source: Office for Civil Rights, U.S. Department of Health and Human Services http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6292
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Questions & Answers About the State Children's Health Insurance Program Summary: A series of answers given in response to questions raised by states, providers, consumers, and others about the State Children's Health Insurance Program (CHIP). Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1218
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State Children's Health Insurance Program Summary: Materials of interest to various audiences -- policy makers, insurers and families -- regarding the recent passage of the State Children's Health Insurance Program (CHIP), also known as Title XXI. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1187
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What is Medicare? Summary: The Centers for Medicare and Medicaid Services administer Medicare, the Nation's largest health insurance program, which covers 37 million Americans. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2141 The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to health insurance. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources
A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMD®Health: http://my.webmd.com/health_topics
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Associations and Health Insurance The following is a list of associations that provide information on and resources relating to health insurance: •
American Amputee Foundation Telephone: (501) 666-2523 Toll-free: TTY: Fax: (501) 666-8367 Background: The American Amputee Foundation (AAF) is a not-for-profit organization dedicated to researching and gathering information on amputation including studies, product information, services, self-help publications, and hundreds of articles that have been written in this area of study. Established in 1975, AAF responds to over 5,000 inquiries for both direct and indirect assistance each year. During the past years, AAF has helped with insurance claims, justification letters to payers, testimony, and life-care planning; direct financial aid for prosthetic devices and home modifications; technical assistance in developing self-help programs; hospital visitations; and counseling services. In addition, the Foundation deals with thousands of telephone inquiries and referrals each year. AAF consists of chapters in various states around the country that are self-supporting and provide a variety of peer support programs. The Foundation also maintains a list of amputee support groups and provides the 'National Resource Directory' for consumers and professionals.
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Association of Community Cancer Centers Telephone: (301) 984-9496 Fax: (301) 770-1949 Web Site: http://www.accc-cancer.org Background: The Association of Community Cancer Centers (ACCC) is a not-for-profit organization dedicated to promoting the continuum of quality cancer care (research, prevention, screening, early detection, diagnosis, treatment, psychosocial services, rehabilitation, and hospice) for individuals with cancer and the community. Established in 1974, ACCC consists of 6,000 members and 14 sub-groups. ACCC s educational materials include a brochure entitled 'Cancer Treatments Your Insurance Should Cover,' reports, and a directory. Program activities include advocacy and lobbying.
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Blood and Marrow Transplant Information Network Telephone: (847) 433-3313 Toll-free: (888) 597-7674 Fax: (847) 433-4599 Email:
[email protected] Web Site: http://www.bmtinfonet.org Background: Blood and Marrow Transplant Information Network (BMT InfoNet), formerly BMT Newsletter, is a not-for-proit organization established in 1990. It provides patient-friendly handbooks and a quarterly newsletter about bone marrow/peripheral stem cell and cord blood transplantation (BMT/PSCT). This is a medical procedure that may be used to treat certain diseases such as cancer, aplastic anemia, immune deficiency diseases, inborn errors of metabolism, and some brain tumors. Readership includes BMT/PSCT patients and survivors, their families and friends, patient support and information groups, medical personnel at BMT cancer centers, and insurance review
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personnel who handle such cases. In addition to publications, BMT InfoNet links patients with survivors who can provide emotional support, maintains an online Directory of Transplant Centers in the US and Canada, an online Directory of Drugs used during transplant, and an online Resource Directory. They offer attorney referrals for patients who have insurance disputes and have a comprehensive website. Publications include a quarterly newsletter, and books entitled 'Autologous Stem Cell Transplants: A Handbook for Patients' and 'Bone Marrow and Blood Stem Cell Transplants: A Guide for Patients'. These books are updated from an earlier version: 'Bone Marrow Transplants: A Book of Basics for Patients'. •
Catastrophic Illness in Children Relief Fund (NJ) Telephone: (609) 292-0600 Toll-free: (800) 335-3863 Fax: (609) 633-2947 Email: None. Web Site: www.state.nj.us/humanservices/catill/cicrfl.hotmail Background: The Catastrophic Illness in Children Relief Fund (CICRF) was established in 1988 to assist in preserving the financial integrity of New Jersey (NJ) families and their ability to cope with the responsibilities that accompany significant health problems in children. The purpose of the Fund is to serve as a financial safety net for NJ families who, due to their children's illnesses or conditions, have incurred medical expenses that are not otherwise covered by insurance, Federal or State programs, or other sources such as fundraising. The Fund, which is a dedicated, revolving, non-lapsing trust fund, is collected from an annual assessment of one dollar per employee levied on all employers who are subject to the New Jersey Unemployment Compensation Law. The CICRF Commission was established to administer the Fund and to implement a program by which the public may have access to this financial resource. The Commission makes all final decisions on eligibility and the amount of assistance. Since the Fund was originally established, more than 2,000 families have been assisted. In the CICRF Program, any illness may be defined as 'catastrophic' based on uncovered eligible expenses and the family's income in a prior 12-month period. A catastrophic illness is any illness or condition for which expenses are incurred that are not fully covered by insurance, State or Federal programs, or other sources and that exceed the program's eligibility threshold. There are no specific exclusions by diagnosis. Incurred expenses that will be considered and may be eligible for payment/reimbursement if found reasonable include but are not limited to the following: specialized pediatric ambulatory care, acute or specialized hospital care (both inpatient and outpatient), physician care in all settings, addictions/mental health services, medical equipment or disposable medical supplies, pharmaceuticals, home health care, medically related home modifications and medical transportation, and/or experimental medical treatment or pharmaceuticals following special review.
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Children's Craniofacial Association Telephone: (214) 570-9099 Toll-free: (800) 535-3643 Fax: (214) 570-8811 Email:
[email protected] Web Site: http://www.ccakids.com
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Background: The Children's Craniofacial Association (CCA) is a not-for-profit organization dedicated to improving the quality of life for individuals with craniofacial disorders and their families. Established in 1989, CCA is devoted to addressing the medical, financial, psychosocial, emotional, and educational concerns relating to craniofacial conditions. In addition, the association advocates on behalf of affected individuals and promotes public awareness of craniofacial disorders. Through the combined efforts of its medical and parental advisory boards, CCA provides referral services and a support network for affected children and their families. The organization also provides financial assistance; sponsors workshops to help educate parents about psychosocial, medical, and insurance issues related to their children's care; and refers patients to appropriate support groups and outreach programs. The group engages in patient advocacy to ensure quality care and appropriate health care standards and offers an annual weekend retreat for affected individuals and their families. The Children's Craniofacial Association also provides a variety of educational materials including a regular newsletter, brochures, and a booklet series on a variety of craniofacial conditions. •
Cystic Fibrosis Foundation Telephone: (301) 951-4422 Toll-free: (800) 344-4823 Fax: (301) 951-6378 Email:
[email protected] Web Site: http://www.cff.org Background: The Cystic Fibrosis Foundation (CFF) is a voluntary, not-for-profit organization dedicated to raising funds for research to find a cure for cystic fibrosis (CF) and improving the quality of life for individuals with the disease. Cystic fibrosis is a rare inherited disorder that affects many exocrine ('outward-secreting') glands of the body including the sweat glands, salivary glands, and those within the pancreas and respiratory system. Established in 1955 and currently consisting of more than 70 chapters and branch offices across the country, the Cystic Fibrosis Foundation funds its own network of CF research centers at leading universities and medical schools throughout North America. It provides a variety of grants to scientists to fund CF research and finances over 100 CF care centers nationwide. The organization supports clinical trials at its care centers to test new drug therapies for CF and works closely with Congress, the Food and Drug Administration, and pharmaceutical companies to speed the development of new drugs to treat CF. The Foundation offers affected individuals, family members, health care professionals, and the public a variety of informational materials including research updates, regular newsletters, and brochures on several topics such as health insurance and financial assistance programs.
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Diabetes UK Telephone: 020 7424 1000 Fax: 020 7424 1001 Email:
[email protected] Web Site: http://www.diabetes.org.uk Background: Diabetes UK is a voluntary organization in the United Kingdom that was founded in 1934. Diabetes UK is dedicated to helping and caring for individuals with diabetes and family members, representing and campaigning for their interests, and
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funding research. There are different forms of diabetes, including diabetes insipidus and diabetes mellitus. Diabetes insipidus is a condition in which deficient production or secretion of antidiuretic hormone results in excessive thirst (polydipsia) and excessive excretion of urine (polyuria). Diabetes mellitus is characterized by impaired fat, protein, and carbohydrate metabolism due to deficient secretion of insulin. Diabetes UK has five regional offices across the United Kingdom and a network of over 450 local groups and branches that are run by people living with diabetes. Diabetes UK offers a confidential service that provides information and support on all aspects of diabetes to affected individuals and family members. The service handles inquiries concerning such issues as employment, pregnancy, insurance, driving, diet, and many other areas. The Youth and Family Services department provides services and support to children and young people affected by diabetes, parents, teachers, career officers, and others. The department provides Youth Packs and School Packs; distributes a quarterly newsletter; offers a wide range of holiday events in the UK for affected children and adolescents from six to 18 years of age; holds regional days and annual family weekends; and conducts the Youth Diabetes Project to provide a strong voice for affected individuals from 18 to 30 years of age. In addition, the Tadpole Club is for all children with diabetes and their siblings and friends. Diabetes UK also typically funds approximately 140 to 160 ongoing research projects to investigate the causes, prevention, and treatment of diabetes; provides educational materials for affected individuals and family members; and maintains a web site on the Internet. •
Disabled Children's Relief Fund Telephone: (516) 377-1605 Toll-free: TTY: Fax: (516) 377-3978 Background: The Disabled Children s Relief Fund (DCRF) is a national not-for-profit organization dedicated to acting as an advocate for the rights and needs of children with disabilities. Founded in 1990, DCRF provides cash grants for disabled children, with preference given to families who do not have health insurance. Grants are provided for assistive devices, equipment, and rehabilitative services, as well as for innovative arts and humanitarian services for children with disabilities. DCRF publishes a regular newsletter entitled 'The Challenger.'.
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Hemangioma Newsline Telephone: (419) 425-1593 Fax: (419) 425-1593 Email:
[email protected] Web Site: http://www.hnline.org Background: The Hemangioma Newsline is a not-for-profit voluntary organization dedicated to aiding patients and their families by providing information on the diagnosis and treatment of hemangioma and vascular malformations. It also provides resource materials to medical professionals to assist them in management of patient care. Hemangioma is the most common benign tumor of infants and children. Vascular malformations are abnormally developed blood vessels. Established in 1996 and incorporated in 1997, the Hemangioma Newsline serves patients and family members, the general public, health professionals, and other professionals such as educators, with programs and activities that include free medical conferences, support groups, patient networking, education, referrals, audio-visual aids, brochures, web-site and a
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newsletter. The organization also assists with insurance claims and coordinates efforts for free transportation to medical appointments. •
Hemophilia Federation of America Telephone: (337) 991-0067 Toll-free: (800) 203-9797 Fax: (337) 991-0087 Email:
[email protected] Web Site: www.hemophiliafed.org Background: The Hemophilia Federation of America exists for the sole purpose of serving its constituents as a patient advocate for, but not limited to, product safety, treatment, insurance, and quality of life issues in a positive and proactive manner. It serves all people with coagulation disorders and complications of treatment, including HIV.
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Ileostomy and Internal Pouch Support Group (UK) Telephone: 4724-721601 Toll-free: 0800 018 Fax: 01724-721601 Email:
[email protected] Web Site: http://ww.ileostomypouch.demon.co.uk Background: The Ileostomy and Internal Pouch Support Group is a registered charity in the United Kingdom dedicated to helping individuals who have undergone surgical removal of the colon (colectomy) and creation of an ileostomy or an ileo-anal pouch. In individuals who receive an ileostomy, an opening is established between the lower region of the small intestine (ileum) and the abdominal wall and the body's waste material is collected in an externally attached bag. In individuals with an internal pouch, a reservoir is constructed from a section of the ileum. The Ileostomy and Internal Pouch Support Group was founded in 1956 by a group of people who had ileostomies and by some members of the medical profession. The organization currently includes over 60 local groups throughout Great Britain and Ireland. The Group is committed to helping affected individuals return to fully active lives as soon as possible; assisting them with all aspects of their rehabilitation including social activities and relationships with family members, friends, employers, and others; and working in close cooperation with medical authorities as part of a team whose primary aim is the complete rehabilitation of every individual who has received an ileostomy or internal pouch. The Ileostomy and Internal Pouch Support Group is also dedicated to improving knowledge about the management of ileostomies or pouches; encouraging development of new ostomy equipment and skin care preparations; and promoting and coordinating research concerning the diseases that may lead to such surgical procedures and ways to improve the quality of life with an ileostomy or an internal pouch. The Group works to fulfill its mission and objectives by providing hospital and home visits; conducting member meetings throughout the UK; offering advisory services on matters such as employment, housing, insurance, pensions, pregnancy, marriage, financial difficulties, and personal relationships; and conducting lectures and demonstrations for physicians, surgeons, and nurses. The Ileostomy and Internal Pouch Support Group also has a web site on the Internet and publishes the 'ia Journal,' a handbook based on articles published in the Journal, and several books.
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Inherited High Cholesterol Foundation Telephone: (801) 581-8720 Toll-free: (888) 244-2465 TTY: Fax: (801) 581-5402 Background: The Inherited High Cholesterol Foundation (IHCF) is a not-for-profit organization dedicated to promoting the early diagnosis and treatment of inherited cholesterol disorders by assisting in the identification of family members who may be predisposed to such disorders. Established in 1995 and currently consisting of approximately 5,400 members, the Foundation works in association with the MEDPED (Make Early Diagnoses and Prevent Early Deaths in Medical Pedigrees) program, an international collaboration consisting of research centers around the world dedicated to developing and implementing programs to identify affected individuals and their relatives. The Inherited High Cholesterol Foundation educates members of high risk families, health care providers, insurance companies, appropriate medical institutions and agencies, and the general public about inherited cholesterol disorders such as familial hypercholesterolemia, familial defective apoB, polygenic hypercholesterolemia, and familial combined hyperlipidemia. Individuals with such inherited conditions may be prone to highly elevated levels of cholesterol and an associated risk of early heart attack. The Inherited High Cholesterol Foundation also offers local support to affected individuals and family members and provides a variety of educational materials including pamphlets, brochures, leaflets, and newsletters.
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Jeffrey Modell Foundation Telephone: (212) 819-0200 Toll-free: (800) 533-3844 Fax: (212) 764-4180 Email:
[email protected] Web Site: http://www.jmfworld.org Background: The Jeffrey Modell Foundation (JMF) is a national not-for-profit research foundation dedicated to helping individuals and family members affected by primary immune deficiency disorders. The Foundation is active in four main areas: research, physician and patient education, patient support, and public awareness of primary immune deficiency. The Foundation provides funding of research fellowships and laboratory facilities; sponsors physician symposia in the United States, Canada, and Europe as well as grand rounds, seminars, and other educational activities for physicians; offers publications for both the lay and medical communities; and provides affected individuals with access to leading medical centers with departments of clinical immunology. The JMF also sponsors K.I.D.'s (Kids with Immunodeficiency) Days for affected children and their families; has insurance reimbursement workshops for affected individuals and family members; is engaged in ongoing education campaigns to promote awareness of primary immune deficiency (PID) in the general public; conducts advocacy on behalf of affected individuals by lobbying the U.S. Congress; and is committed to ongoing biomedical research into primary immune deficiency at the National Institutes of Health. The JMF also publishes a regular newsletter for affected individuals and family members, physicians, and researchers; offers general materials on the primary immune deficiency disorders as well as materials on specific PID disorders for lay and medical audiences; and has a 24-hour JMF Hotline at (800) Jeff-844, which has assisted thousands of families throughout the United States.
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Kidney Cancer Association Telephone: (847) 332-1051 Toll-free: (800) 850-9132 Fax: (847) 332-2978 Email:
[email protected] Web Site: http://curekidneycancer.org Background: The Kidney Cancer Association is a national non-profit organization comprised of people who have been affected by kidney cancer, their families and friends, physicians, and researchers. The Association is dedicated to improving the quality of care and increasing survival of individuals affected by kidney cancer. Established in 1990, the Association works toward three primary goals: to provide information to affected individuals and physicians; to sponsor and conduct research on kidney cancer; and to act as an advocate on a federal level and with insurance companies and employers on behalf of affected individuals and their families. Comprised of more than 15,000 constituents, the organization publishes 'Kidney Cancer News,' an electronic newsletter, as well as several informational brochures including 'We Have Kidney Cancer,' 'Interleukin-2 Therapy: What You Should Know,' and 'Kidney Cancer: Emotional vs. Rational.' The Association holds support group meetings several times a year in various cities so that individuals who have kidney cancer can learn how others have dealt with their disease. In addition, the Association conducts a yearly national convention that brings individuals together with leading physicians and researchers in the field of kidney cancer.
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Kniest Syndrome Group Telephone: (612) 922-6184 Fax: (612) 922-8732 Email:
[email protected] Background: The Kniest Syndrome Group (KSG) is an international voluntary organization dedicated to providing financial, educational, and emotional support to individuals and families affected by Kniest Syndrome. Kniest Syndrome is a form of dwarfism characterized by short stature and unusually short, malformed arms and legs (short-limbed dwarfism); a short, 'barrel-shaped' chest; swelling and stiffness of joints; abnormal sideways curvature of the spine (scoliosis); an abnormally flat face with protruding eyes and low nasal bridge; visual and/or hearing impairment; and/or other abnormalities. Established in 1997 and consisting of approximately 50 members, the Kniest Syndrome Group is committed to providing networking services to individuals and families affected by Kniest Syndrome; financial support for medical needs (i.e., for items not covered by many insurance companies such as glasses, hearing aids, etc.); college funds for affected children; and current, complete medical information on Kniest Syndrome. The organization also engages in professional education, offers support services, and provides a variety of materials including pamphlets, brochures, reports, a directory, and a regular newsletter.
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Medicare Rights Center Telephone: (212) 869-3850 Fax: (212) 869-3532 Email:
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Web Site: www.medicarerights.org Background: Medicare Rights Center (MRC) is a national, not-for-profit organization exclusively dedicated to ensuring that seniors and people with disabilities on Medicare have access to quality, affordable health care. Through direct services, education and public policy programs, Medicare Rights Center empowers people on Medicare to make informed choices regarding their health care benefits-for example, choosing a Medicare Supplemental Insurance policy, learning about HMOs, or understanding how Medicare works in conjunction with an employer's health plan. •
Myalgic Encephalomyelitis Association Telephone: 01375 361013 Fax: 01375 360256 Email:
[email protected] Web Site: http://www.cix.co.uk/~deepings/ Background: The Myalgic Encephalomyelitis Association is a nonprofit organization in the United Kingdom dedicated to providing information, support, and resources to individuals affected by myalgic encephalomyelitis, their family members, and health care professionals. Myalgic encephalomyelitis (ME) is a condition that is known as chronic fatigue syndrome in the United States. ME is characterized by persistent, disabling fatigue accompanied by some combination of impaired concentration or memory, muscle pain, low fever, sore throat, and headaches, with such symptoms not being attributable to any other known underlying cause. Symptoms may vary from case to case, and the cause of the condition is unknown. The ME Association was established in 1976 and currently has a national office, regional offices in Northern Ireland and Scotland, and a network of approximately 400 self-help groups throughout the UK. The Association's Information Line provides information on the management of ME, available services, benefits, insurance, research, and other areas. Its 'Listening Ear Service' offers confidential assistance and counseling with trained volunteers and publishes informational materials. The national ME Association also funds research into the cause and treatment of ME.
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National Ataxia Foundation Telephone: (763) 553-0020 Fax: (763) 553-0167 Email:
[email protected] Web Site: http://www.ataxia.org/ Background: The National Ataxia Foundation is a national not-for-profit organization that seeks to identify people with hereditary ataxia and to improve the physical and emotional well-being of affected individuals and their families. Hereditary ataxia is a group of progressive, chronic neurological disorders that affect coordination. Established in 1957, the National Ataxia Foundation encourages and supports research efforts into identifying the causes and mechanisms of the hereditary ataxias, improving diagnosis, and developing treatment models; locates families affected by ataxia or at risk for ataxia in order to offer information and education; identifies needs and services for purposes of referral; creates and makes available educational programs for ataxia families, health care professionals, and the general public; and increases public awareness of hereditary ataxia. In addition, the National Ataxia Foundation provides
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informational materials, counseling, referrals, and avenues to support groups and is responsive to the needs of its membership by achieving an acceptable balance among the funding of the various programs of education/awareness, patient services, research, administration, and fund-raising. The organization produces informational materials including brochures on hereditary ataxia, financial planning, and health insurance issues. The VHS video tape entitled 'Together. There is Hope' and a newsletter entitled 'Generations' are also distributed by the National Ataxia Foundation. There are currently 49 affiliated chapters and support groups of the National Ataxia Foundation is the United States and Canada. •
National Eye Care Project Telephone: Toll-free: (800) 222-3937 Fax: (415) 561-8567 Email:
[email protected] Web Site: http://www.eyenet.org Background: The National Eye Care Project, which was established in 1986, is a not-forprofit organization dedicated to providing medical and surgical eye care to the financially disadvantaged elderly who cannot afford care. The program is designed so that volunteer ophthalmologists provide eye care at no out-of-pocket cost to the individual, regardless of insurance coverage (or lack thereof). In order to qualify for this program, the patient must be at least 65 years of age, have citizenship or legal residency in the United States, and must demonstrate a need for financial aid, and must have no access to an ophthalmologist or an alternative method of receiving care (e.g., HMO, Veteran s Hospital). The purpose of the NECP is to provide a unique program that enables senior citizens to receive the proper eye care treatment that they need, as well as encourage the public to recognize the need for more affordable medical care in the United States, particularly in the elderly community. Program activities include patient advocacy, patient and general education, brochures and pamphlets, and referrals.
•
National Foundation For Transplants Telephone: (901) 684-1697 Toll-free: (800) 489-3863 Fax: (901) 684-1128 Email:
[email protected] Web Site: http://www.transplants.org Background: The National Foundation for Transplants (NFT), formerly the Organ Transplant Fund, Inc., is a national not-for-profit organization dedicated to helping individuals who are in need of organ or bone marrow transplants through financial assistance, advocacy, and emotional support. The National Foundation for Transplants was established in 1983 in Memphis, TN as the Liver Organ Transplant Fund to assist an individual in the local area who was in critical need of a liver transplant, but unable to afford the procedure. The small group of volunteers who founded NFT went to work to raise philanthropic contributions to pay for the transplant and related expenses. Hearing of the success of this first effort, other candidates for liver and other types of transplants turned to the new organization for assistance in raising the funds needed to help pay for their transplants. What began as a local limited endeavor evolved into an organization that is helping hundreds of organ and tissue transplant candidates and recipients nationwide. NFT provides candidates with fund-raising training and advice that can
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enable a patient campaign to raise the money needed for transplant and related expenses. The assistance provided by NFT ranges from helping to organize the volunteer fund-raising efforts, to counseling on the use of various fund-raising techniques and approaches, to acknowledging the charitable donations to the campaigns. In assisting with the patient campaigns, NFT also helps with publicity, negotiates bills, and processes payments to hospitals, physicians, pharmacies, and other providers of transplant-related services. Another NFT program is the 'Celebration of Life' Campaigns that focus on the ongoing financial needs to transplant recipients, whose transplant-related expenses (e.g., life-sustaining immunosuppressant medication costs) pose continuing monetary obstacles. 'Celebration of Life' Campaigns are created as mini- models of the patient campaigns and are implemented on a long-term basis, through the sustained efforts of transplant recipients and their volunteers. Additionally, emergency funds and short-terms assistance are available to assist with airfare, lodging, insurance premiums, home health care, and other transplant services and/or equipment. The National Foundation for Transplants also publishes 'Reaching Out To Help,' a quarterly newsletter and maintains a site on the World Wide Web at http:// www.transplants.org. •
Ovarian Cancer National Alliance Telephone: (202) 331-1332 Fax: (202) 293-1990 Email:
[email protected] Web Site: http://www.ovariancancer.org Background: The Ovarian Cancer National Alliance is a voluntary not-for-profit umbrella organization uniting ovarian cancer survivors, women's health activists, and health care professionals in a coordinated effort to focus national attention on ovarian cancer. The symptoms of ovarian cancer are often subtle and may be easily confused with symptoms associated with other disorders. Such symptoms commonly include pressure or bloating in the abdomen, constant and progressive changes in bladder or bowel patterns, persistent digestive problems, ongoing excessive fatigue, abnormal bleeding, and pain during intercourse. The Ovarian Cancer National Alliance, which was established in 1997, works to fight ovarian cancer by focusing on four key areas: expanding women's and health care providers' awareness about the disease; advocating for increased funding for research, sound genetic-testing policies, and insurance coverage of therapies; furthering the scientific understanding of ovarian cancer to improve screening and detection tools and to discover a cure; and coordinating efforts in the fight against ovarian cancer by developing networks among ovarian cancer groups and activists and other health advocates. The Alliance's activities include providing expert testimony before government committees, serving as consumer representatives on federal panels that set priorities for ovarian cancer research, working closely with the Society of Gynecologic Oncologists to strengthen ovarian cancer resources, and conducting national advocacy conferences for the ovarian cancer community. The Alliance also has a web site on the Internet and provides a variety of educational materials including brochures, the 'Ovarian Cancer National Resource List,' 'Facts about Ovarian Cancer,' and a regular newsletter.
•
Pituitary Network Association (PNA) Telephone: (805) 499-9973
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Fax: (805) 480-0633 Email:
[email protected] Web Site: http://www.pituitary.org, www.acromegaly.org Background: The Pituitary Network Association (PNA) is a support organization dedicated to promoting, supporting, and, where possible, funding research on pituitary tumors in a sustained effort to find a cure for these illnesses. Established in 1992 by four pituitary patients undergoing experimental treatment, the Association is now the world s largest pituitary support network. Its members include affected individuals, physicians, and pharmaceutical companies. The Association disseminates information to affected families, the medical community, and the public concerning early detection, symptoms, treatments, and resources available to pituitary patients. The Pituitary Network Association publishes a regular newsletter and a comprehensive resource guide. The guide, entitled 'The Pituitary Patient Resource Guide,' assists affected individuals to locate a variety of medical, surgical, insurance, occupational, lifestyle, and health maintenance services. It also helps primary-care physicians and other medical personnel to determine where to call for advice and consultation, where to send patients for specialized treatment and surgery, and what other medical specialties should be involved in treatment. •
Special Needs Advocate for Parents Telephone: (310) 201-9614 Toll-free: (888) 310-9889 Fax: (310) 201-9889 Email:
[email protected] Web Site: http://www.snapinfo.org Background: Special Needs Advocate for Parents (SNAP) is a not-for-profit organization dedicated to providing information, offering referrals, and assisting families of children of any age with special needs and disabilities. Established in 1993, SNAP is committed to helping affected families find direction and achieve peace of mind when it comes to caring and planning for their children. SNAP offers educational seminars on subjects ranging from special needs estate planning to medical insurance advocacy; engages in a problem-solving process with parents directed toward resolution of medical insurance problems; and provides referrals to special needs planning professionals, educational advocates, support groups, and related organizations. SNAP also has a national speakers bureau and provides information through its web site and quarterly newsletter.
•
TMJ Association, Ltd Telephone: (414) 259-3223 Fax: (414) 259-8122 Email:
[email protected] Web Site: http://www.tmj.org Background: The TMJ (Temporomandibular Joint) Association, Ltd. is a national not-forprofit voluntary organization that promotes awareness of temporomandibular joint disorders and provides information and support for people with TMJ disorders and their families through the development of a national network of members. In addition, the Association promotes research into the causes of TMJ and the development of safe
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and effective treatments. Established in 1986, the Association has provided testimony to a special National Institute of Dental Research panel and played an instrumental role in NIH s utilization of a multi-institute approach to basic research of temporomandibular joint disorders. Additional testimony before the Senate Appropriations Committee played a vital role in the creation of an intensive educational program for medical professionals and the public and the stimulation of controlled scientific research into the nature of the disorder. In addition, the Association was instrumental in notifying the national media about the Vitek implant recall and creating a TMJ implant registry. The Association publishes a quarterly newsletter that keeps readers updated on current research and medical, legal, legislative, and insurance issues; the newsletter also provides a forum for sharing ideas and asking questions. In addition, the TMJ Association provides informational brochures and pamphlets. •
Vascular Birthmarks Foundation Telephone: (518) 782-9637 Fax: (518) 782-9637 Email:
[email protected] Web Site: http://www.birthmark.org Background: The Hemangioma and Vascular Birthmarks Foundation is a nonprofit organization consisting of parents and professionals dedicated to providing information, assistance, and support to those affected by hemangiomas or other vascular birthmarks or tumors. Hemangiomas, the most common benign tumor affecting infants, are bluish or reddish flat or raised areas that are usually apparent at or within weeks after birth. Hemangiomas typically continue to grow for approximately one to two years and then begin a slow regression cycle. Vascular malformations are benign vascular lesions that are present at birth; however, in some cases, they may not become apparent for days, weeks, or even years after birth. Vascular malformations typically grow slowly and steadily throughout life with no regression cycle. The Hemangioma and Vascular Birthmarks Foundation is dedicated to educating physicians and other health care providers in the diagnosis and management of all vascular birthmarks; providing support, information, and referrals for all affected individuals; developing research projects concerning vascular birthmarks; and working toward the establishment of a uniform protocol for the diagnosis and treatment of vascular birthmarks. The Foundation provides understandable indepth information on hemangiomas and vascular malformations; coordinates services for affected families; provides information to families concerning reimbursement issues for treatment of vascular birthmarks; publishes a regular newsletter; and maintains a web site on the Internet. The Foundation s web site provides indepth information on vascular birthmarks, treatment options, insurance, and other related topics and offers dynamic linkage to additional sources of information and assistance on the Internet.
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to health insurance. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with health insurance.
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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about health insurance. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “health insurance” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “health insurance”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “health insurance” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “health insurance” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
23
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
•
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
•
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
•
California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
•
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
•
California: Gateway Health Library (Sutter Gould Medical Foundation)
•
California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
•
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
•
California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
•
California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
•
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
•
California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
•
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
•
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
•
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
24
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 329
•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
•
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
•
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
•
Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
•
Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
•
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
•
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
•
Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
•
Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
•
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
•
Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
•
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
•
Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
•
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
•
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
•
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
•
Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
•
Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
•
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
•
Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
•
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
•
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
•
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
•
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
•
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
•
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
•
Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
•
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
•
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
•
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
•
Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
•
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
•
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
•
National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries 331
•
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
•
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
•
New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
•
New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
•
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
•
Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
•
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
•
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
•
Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
•
Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
•
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
•
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
•
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
•
Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
•
Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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•
South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
•
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
•
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
•
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
•
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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HEALTH INSURANCE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Acculturation: Process of cultural change in which one group or members of a group assimilates various cultural patterns from another. [NIH] ACE: Angiotensin-coverting enzyme. A drug used to decrease pressure inside blood vessels. [NIH]
Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adolescent Behavior: Any observable response or action of an adolescent. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH]
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Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [NIH]
Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH]
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Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Anti-Anxiety Agents: Agents that alleviate anxiety, tension, and neurotic symptoms, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. Some are also effective as anticonvulsants, muscle relaxants, or anesthesia adjuvants. Adrenergic beta-antagonists are commonly used in the symptomatic treatment of anxiety but are not included here. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antidepressive Agents: Mood-stimulating drugs used primarily in the treatment of affective disorders and related conditions. Several monoamine oxidase inhibitors are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents also appear to act through brain catecholamine systems. A third group (antidepressive agents, secondgeneration) is a diverse group of drugs including some that act specifically on serotonergic systems. [NIH] Antidiuretic: Suppressing the rate of urine formation. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH]
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Aorta: The main trunk of the systemic arteries. [NIH] Aplastic anemia: A condition in which the bone marrow is unable to produce blood cells. [NIH]
Appendectomy: An operation to remove the appendix. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autologous bone marrow transplantation: A procedure in which bone marrow is removed from a person, stored, and then given back to the person after intensive treatment. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or
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bacillary, and spiral or spirochetal. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Birthmark: A circumscribed area of pigmentation or vascularization, usually in the form of a congenital benign neoplasm occurring in the skin or in various ocular tissues. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH]
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Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breakdown: A physical, metal, or nervous collapse. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Caesarean section: A surgical incision through the abdominal and uterine walls in order to deliver a baby. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capital Financing: Institutional funding for facilities and for equipment which becomes a part of the assets of the institution. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Catastrophic Illness: An acute or prolonged illness usually considered to be life-threatening or with the threat of serious residual disability. Treatment may be radical and is frequently costly. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH]
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Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell Transplantation: Transference of cells within an individual, between individuals of the same species, or between individuals of different species. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Check-up: A general physical examination. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Child Care: Care of children in the home or institution. [NIH]
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Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Child Health Services: Organized services to provide health care for children. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Choice Behavior: The act of making a selection among two or more alternatives, usually after a period of deliberation. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Fatigue Syndrome: Fatigue caused by the combined effects of different types of prolonged fatigue. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the
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amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cohort Effect: Variation in health status arising from different causal factors to which each birth cohort in a population is exposed as environment and society change. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colitis: Inflammation of the colon. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Communication Barriers: Those factors, such as language or sociocultural relationships, which interfere in the meaningful interpretation and transmission of ideas between individuals or groups. [NIH] Communication Disorders: Disorders of verbal and nonverbal communication caused by receptive or expressive language disorders, cognitive dysfunction (e.g., mental retardation), psychiatric conditions, and hearing disorders. [NIH] Community Health Centers: Facilities which administer the delivery of health care services to people living in a community or neighborhood. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols
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C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computer Literacy: General learning, knowledge, and fluency with computer terms; also, becoming familiar with how computers operate and how they are programmed. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Conflict of Interest: A situation in which an individual might benefit personally from official or professional actions. It includes a conflict between a person's private interests and official responsibilities in a position of trust. The term is not restricted to government officials. The concept refers both to actual conflict of interest and the appearance or perception of conflict. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH]
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Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumer Participation: Community or individual involvement in the decision-making process. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]
Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cost-benefit: A quantitative technique of economic analysis which, when applied to radiation practice, compares the health detriment from the radiation doses concerned with the cost of radiation dose reduction in that practice. [NIH] Cost-Benefit Analysis: A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors
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that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results. [NIH] Cotinine: 1-Methyl-5-(3-pyridyl)-2-pyrrolidinone antidepressant. Synonym: Scotine. [NIH]
fumarate.
Stimulant
proposed
as
Crack Cocaine: The purified, alkaloidal, extra-potent form of cocaine. It is smoked (freebased), injected intravenously, and orally ingested. Use of crack results in alterations in function of the cardiovascular system, the autonomic nervous system, the central nervous system, and the gastrointestinal system. The slang term "crack" was derived from the crackling sound made upon igniting of this form of cocaine for smoking. [NIH] Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Crowding: Behavior with respect to an excessive number of individuals, human or animal, in relation to available space. [NIH] Cutaneous: Having to do with the skin. [NIH] Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Day Care: Institutional health care of patients during the day. The patients return home at night. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Dehydration: The condition that results from excessive loss of body water. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Demography: Statistical interpretation and description of a population with reference to distribution, composition, or structure. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Anxiety: Abnormal fear or dread of visiting the dentist for preventive care or therapy and unwarranted anxiety over dental procedures. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Care for Children: The giving of attention to the special dental needs of children, including the prevention of tooth diseases and instruction in dental hygiene and dental health. The dental care may include the services provided by dental specialists. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If
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left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]
Dentists: Individuals licensed to practice dentistry. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diagnostic Services: Organized services for the purpose of providing diagnosis to promote and maintain health. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietetics: The study and regulation of the diet. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disabled Persons: Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations. [NIH]
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Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Drug Costs: The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (fees, pharmaceutical or prescription fees). [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dwarfism: The condition of being undersized as a result of premature arrest of skeletal growth. It may be caused by insufficient secretion of growth hormone (pituitary dwarfism). [NIH]
Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]
Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolytes: Substances that break up into ions (electrically charged particles) when they are dissolved in body fluids or water. Some examples are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells, and the movement of wastes out of cells. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Eligibility Determination: Criteria to determine eligibility of patients for medical care programs and services. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH]
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Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalomyelitis: A general term indicating inflammation of the brain and spinal cord, often used to indicate an infectious process, but also applicable to a variety of autoimmune and toxic-metabolic conditions. There is significant overlap regarding the usage of this term and encephalitis in the literature. [NIH] Endodontics: A dental specialty concerned with the maintenance of the dental pulp in a state of health and the treatment of the pulp cavity (pulp chamber and pulp canal). [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]
Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Environmental tobacco smoke: ETS. Smoke that comes from the burning of a tobacco product and smoke that is exhaled by smokers (second-hand smoke). Inhaling ETS is called involuntary or passive smoking. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH]
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Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Episiotomy: An incision of the posterior vaginal wall and a portion of the pudenda which enlarges the vaginal introitus to facilitate delivery and prevent lacerations. [NIH] Episode of Care: An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided. [NIH] Equalization: The reduction of frequency and/or phase distortion, or modification of gain and or phase versus frequency characteristics of a transducer, by the use of attenuation circuits whose loss or delay is a function of frequency. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] ERV: The expiratory reserve volume is the largest volume of gas that can be expired from the end-expiratory level. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Excrete: To get rid of waste from the body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expert Testimony: Presentation of pertinent data by one with special skill or knowledge representing mastery of a particular subject. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common
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abbreviation is ERV. [NIH] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]
Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Family Characteristics: Size and composition of the family. [NIH] Family Health: The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members. [NIH]
Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fathers: Male parents, human or animal. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fecal occult blood test: A test to check for blood in stool. (Fecal refers to stool; occult means hidden.) [NIH] Fees, Pharmaceutical: Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Formularies: Lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from pharmacopoeias in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy. [NIH] Formulary: A book containing a list of pharmaceutical products with their formulas and means of preparation. [NIH] Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH]
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Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Geographic Locations: All of the continents and every country situated within, the United States and each of the constituent states arranged by region, Canada and each of its provinces, Australia and each of its states, the major bodies of water and major islands on both hemispheres, and selected major cities. Although the geographic locations are not printed in index medicus as main headings, in indexing they are significant in epidemiologic studies and historical articles and for locating administrative units in education and the delivery of health care. [NIH] Geriatric Psychiatry: A subspecialty of psychiatry concerned with the mental health of the aged. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH]
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Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Survival: The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Group Practice: Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Hallucinogens: Drugs capable of inducing illusions, hallucinations, delusions, paranoid ideations, and other alterations of mood and thinking. Despite the name, the feature that distinguishes these agents from other classes of drugs is their capacity to induce states of altered perception, thought, and feeling that are not experienced otherwise. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Hay Fever: A seasonal variety of allergic rhinitis, marked by acute conjunctivitis with lacrimation and itching, regarded as an allergic condition triggered by specific allergens. [NIH]
Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Care Reform: Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH]
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Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Resources: Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Hearing aid: A miniature, portable sound amplifier for persons with impaired hearing, consisting of a microphone, audio amplifier, earphone, and battery. [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematopoietic Stem Cell Transplantation: The transference of stem cells from one animal or human to another (allogeneic), or within the same individual (autologous). The source for the stem cells may be the bone marrow or peripheral blood. Stem cell transplantation has been used as an alternative to autologous bone marrow transplantation in the treatment of a variety of neoplasms. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they
Dictionary 355
are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Histology: The study of tissues and cells under a microscope. [NIH] Home Care Services: Community health and nursing services providing coordinated multiple service home care to the patient. It includes home-offered services provided by a visiting nurse, home health agencies, hospitals, or organized community groups using professional staff for care delivery. It differs from home nursing which is provided by nonprofessionals. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Hospital Administrators: Managerial personnel responsible for implementing policy and directing the activities of hospitals. [NIH] Hospital Mortality: A vital statistic measuring or recording the rate of death from any cause in hospitalized populations. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hypercholesterolemia, Familial: A familial disorder characterized by increased plasma concentration of cholesterol carried in low density lipoproteins (LDL) and by a deficiency in a cell surface receptor which regulates LDL degradation and cholesterol synthesis. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hysterectomy: Excision of the uterus. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH]
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Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]
Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incidental: 1. Small and relatively unimportant, minor; 2. Accompanying, but not a major part of something; 3. (To something) Liable to occur because of something or in connection with something (said of risks, responsibilities, .) [EU] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical
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signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]
Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insurance Benefits: Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed. [NIH] Insurance Carriers: Organizations which assume the financial responsibility for the risks of policyholders. [NIH] Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading. [NIH] Insurance, Life: Insurance providing for payment of a stipulated sum to a designated beneficiary upon death of the insured. [NIH] Insurance, Long-Term Care: Health insurance to provide full or partial coverage for longterm home care services or for long-term nursing care provided in a residential facility such as a nursing home. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]
Intensive Care Units: Hospital units providing continuous surveillance and care to acutely ill patients. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH]
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Intracellular: Inside a cell. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU]
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Lacerations: Torn, ragged, mangled wounds. [NIH] Lag: The time elapsing between application of a stimulus and the resulting reaction. [NIH] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]
Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Living will: A health care directive that tells others how a person would like to be treated if they lose their capacity to make decisions about health care; it contains instructions about the person's choices of medical treatment and it is prepared in advance. [NIH] Local Government: Smallest political subdivisions within a country at which general governmental functions are carried-out. [NIH]
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Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]
Mammary: Pertaining to the mamma, or breast. [EU] Mammography: Radiographic examination of the breast. [NIH] Mandatory Testing: Testing or screening required by federal, state, or local law or other agencies for the diagnosis of specified conditions. It is usually limited to specific populations such as categories of health care providers, members of the military, and prisoners or to
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specific situations such as premarital examinations or donor screening. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Savings Accounts: Tax-exempt trusts or custodial accounts established by individuals with financial institutions for saving money for future medical expenses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Health Services: Organized services to provide mental health care. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]
Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU]
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Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Motility: The ability to move spontaneously. [EU] Multiparous: 1. Having had two or more pregnancies which resulted in viable fetuses. 2. Producing several ova or offspring at one time. [EU] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH] Myalgia: Pain in a muscle or muscles. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH]
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Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occult Blood: Chemical, spectroscopic, or microscopic detection of extremely small amounts of blood. [NIH] Occupational Health: The promotion and maintenance of physical and mental health in the work environment. [NIH] Occupational Medicine: Medical specialty concerned with the promotion and maintenance of the physical and mental health of employees in occupational settings. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Office Management: Planning, organizing, and administering activities in an office. [NIH] Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH]
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On-line: A sexually-reproducing population derived from a common parentage. [NIH] Operating Rooms: Facilities equipped for performing surgery. [NIH] Ophthalmologic: Pertaining to ophthalmology (= the branch of medicine dealing with the eye). [EU] Ophthalmologist: A medical doctor specializing in the diagnosis and medical or surgical treatment of visual disorders and eye disease. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Ownership: The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreas Transplant: A surgical procedure that involves replacing the pancreas of a person who has diabetes with a healthy pancreas that can make insulin. The healthy pancreas comes from a donor who has just died or from a living relative. A person can donate half a pancreas and still live normally. [NIH]
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Pancreas Transplantation: The transference of a pancreas from one human or animal to another. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Paternity: Establishing the father relationship of a man and a child. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Admission: The process of accepting patients. The concept includes patients accepted for medical and nursing care in a hospital or other health care institution. [NIH] Patient Advocacy: Promotion and protection of the rights of patients, frequently through a legal process. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pensions: Fixed sums paid regularly to individuals. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]
Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]
Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral
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sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacopoeias: Authoritative treatises on drugs and preparations, their description, formulation, analytic composition, physical constants, main chemical properties used in identification, standards for strength, purity, and dosage, chemical tests for determining identity and purity, etc. They are usually published under governmental jurisdiction (e.g., USP, the United States Pharmacopoeia; BP, British Pharmacopoeia; P. Helv., the Swiss Pharmacopoeia). They differ from formularies in that they are far more complete: formularies tend to be mere listings of formulas and prescriptions. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Pigmentation: Coloration or discoloration of a part by a pigment. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes insipidus. [EU] Polyposis: The development of numerous polyps (growths that protrude from a mucous
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membrane). [NIH] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [NIH] Population Characteristics: Qualities and characterization of various types of populations within a social or geographic group, with emphasis on demography, health status, and socioeconomic factors. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Practice Management: Business management of medical and dental practices that may include capital financing, utilization management, and arrangement of capitation agreements with other parties. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Preferred Provider Organizations: Arrangements negotiated between a third-party payer (often a self-insured company or union trust fund) and a group of health-care providers (hospitals and physicians) who furnish services at lower than usual fees, and, in return, receive prompt payment and an expectation of an increased volume of patients. [NIH] Prejudice: A preconceived judgment made without adequate evidence and not easily alterable by presentation of contrary evidence. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Prescription Fees: The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Preventive Medicine: A medical specialty primarily concerned with prevention of disease and the promotion and preservation of health in the individual. [NIH] Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests. [NIH] Privatization: Process of shifting publicly controlled services and/or facilities to the private sector. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH]
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Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective Payment System: A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity.
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[NIH]
Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Psychotropic Drugs: A loosely defined grouping of drugs that have effects on psychological function. Here the psychotropic agents include the antidepressive agents, hallucinogens, and tranquilizing agents (including the antipsychotics and anti-anxiety agents). [NIH] Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Public Sector: The area of a nation's economy that is tax-supported and under government control. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to
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separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]
Rehabilitative: Instruction of incapacitated individuals or of those affected with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH]
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Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]
Renal Dialysis: Removal of certain elements from the blood based on the difference in their rates of diffusion through a semipermeable membrane. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Research Support: Financial support of research activities. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Respite Care: Patient care provided in the home or institution intermittently in order to provide temporary relief to the family home care giver. [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Rheumatic Diseases: Disorders of connective tissue, especially the joints and related structures, characterized by inflammation, degeneration, or metabolic derangement. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested
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as possible causes. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk-Taking: Undertaking a task involving a challenge for achievement or a desirable goal in which there is a lack of certainty or a fear of failure. It may also include the exhibiting of certain behaviors whose outcomes may present a risk to the individual or to those associated with him or her. [NIH] Root Canal Therapy: A treatment modality in endodontics concerned with the therapy of diseases of the dental pulp. For preparatory procedures, root canal preparation is available. [NIH]
Rural Population: The inhabitants of rural areas or of small towns classified as rural. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Satellite: Applied to a vein which closely accompanies an artery for some distance; in cytogenetics, a chromosomal agent separated by a secondary constriction from the main body of the chromosome. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Scoliosis: A lateral curvature of the spine. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secular trends: A relatively long-term trend in a community or country. [NIH] Selection Bias: The introduction of error due to systematic differences in the characteristics between those selected and those not selected for a given study. In sampling bias, error is the result of failure to ensure that all members of the reference population have a known chance of selection in the sample. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Self-Help Groups: Organizations which provide an environment encouraging social interactions through group activities or individual relationships especially for the purpose of rehabilitating or supporting patients, individuals with common health problems, or the
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elderly. They include therapeutic social clubs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Social Behavior: Any behavior caused by or affecting another individual, usually of the same species. [NIH] Social Change: Social process whereby the values, attitudes, or institutions of society, such as education, family, religion, and industry become modified. It includes both the natural process and action programs initiated by members of the community. [NIH] Social Class: A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income. [NIH]
Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH]
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Social Security: Government sponsored social insurance programs. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Welfare: Organized institutions which provide services to ameliorate conditions of need or social pathology in the community. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Sports Medicine: The field of medicine concerned with physical fitness and the diagnosis and treatment of injuries sustained in sports activities. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become
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specialized and take the place of those that die or are lost. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Substrate: A substance upon which an enzyme acts. [EU] Suburban Population: The inhabitants of peripheral or adjacent areas of a city or town. [NIH]
Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of
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homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tear Gases: Gases that irritate the eyes, throat, or skin. Severe lacrimation develops upon irritation of the eyes. [NIH] Telecommunications: Transmission of information over distances via electronic means. [NIH]
Telemedicine: Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. [NIH] Teleradiology: A technique used to send medical X-rays over short distances, such as across a town. [NIH] Testimonials: Information provided by individuals who claim to have been helped or cured by a particular product. The information provided lacks the necessary elements to be evaluated in a rigorous and scientific manner and is not used in the scientific literature. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone,
Dictionary 377
which helps regulate growth and metabolism. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tooth Loss: The failure to retain teeth as a result of disease or injury. [NIH] Toothache: Pain in the adjacent areas of the teeth. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Tranquilizing Agents: A traditional grouping of drugs said to have a soothing or calming effect on mood, thought, or behavior. Included here are the anti-anxiety agents (minor tranquilizers), antimanic agents, and the antipsychotic agents (major tranquilizers). These drugs act by different mechanisms and are used for different therapeutic purposes. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH]
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Transurethral: Performed through the urethra. [EU] Transurethral resection: Surgery performed with a special instrument inserted through the urethra. Also called TUR. [NIH] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Uncompensated Care: Medical services for which no payment is received. Uncompensated care includes charity care and bad debts. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urban Health: The status of health in urban populations. [NIH] Urban Population: The inhabitants of a city or town, including metropolitan areas and suburban areas. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Utilization Review: An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH]
Dictionary 379
Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]
Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vision Screening: Application of tests and examinations to identify visual defects or vision disorders occurring in specific populations, as in school children, the elderly, etc. It is differentiated from vision tests, which are given to evaluate/measure individual visual performance not related to a specific population. [NIH] Vital Statistics: Used for general articles concerning statistics of births, deaths, marriages, etc. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] War: Hostile conflict between organized groups of people. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
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Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH]
381
INDEX A Abdomen, 322, 335, 339, 340, 343, 350, 355, 357, 359, 365, 375, 376 Abdominal, 317, 335, 340, 341, 364 Abortion, 116, 194, 335 Acculturation, 11, 40, 54, 335 ACE, 335 Acidity, 335, 366 Acidosis, 335, 347 Activities of Daily Living, 11, 45, 335, 347 Adjustment, 12, 46, 61, 76, 139, 159, 175, 335 Adolescence, 61, 335, 342 Adolescent Behavior, 23, 335 Adverse Effect, 42, 46, 335, 373 Age Groups, 79, 335 Age of Onset, 39, 335 Aged, 80 and Over, 335 Agonist, 335, 362, 363 Algorithms, 6, 335, 339 Alkaloid, 335, 342, 363 Allergic Rhinitis, 172, 336, 353 Allogeneic, 336, 354 Alternative medicine, 224, 228, 229, 279, 336 Ambulatory Care, 117, 240, 314, 336 Ameliorated, 97, 336 Amino acid, 336, 337, 365, 368, 372, 373, 375, 377, 378 Amino Acid Sequence, 336, 337 Ammonia, 336, 375, 378 Ampulla, 336, 349 Amputation, 313, 336 Amyloid, 273, 336 Anal, 21, 39, 58, 60, 102, 161, 243, 317, 336, 350, 351, 360, 366 Anaphylatoxins, 336, 344 Anatomical, 336, 338, 342, 349, 356 Anemia, 282, 336 Anesthesia, 170, 336, 337 Angiography, 93, 336 Angiotensin converting enzyme inhibitor, 93, 337 Anti-Anxiety Agents, 337, 369, 377 Antibiotic, 59, 119, 120, 337 Antibodies, 81, 337, 356, 366 Antibody, 290, 337, 343, 356, 361 Anticoagulant, 337, 379 Antidepressant, 33, 337, 346 Antidepressive Agents, 337, 369 Antidiuretic, 316, 337 Antigen, 337, 344, 355, 356, 361
Antigen-Antibody Complex, 337, 344 Antihypertensive, 160, 337 Anti-inflammatory, 66, 337, 338 Anti-Inflammatory Agents, 337, 338 Antithrombotic, 80, 337 Anuria, 337, 358 Anus, 336, 337, 343, 357, 370 Anxiety, 8, 337, 346 Aorta, 338, 345, 379 Aplastic anemia, 313, 338 Appendectomy, 72, 338 Appendicitis, 12, 338 Applicability, 68, 338 Aqueous, 338, 339 Arterial, 338, 355, 368, 376 Arteries, 338, 339, 345, 361, 362 Arterioles, 338, 339 Artery, 110, 338, 339, 345, 348, 349, 369, 371, 372, 379 Articular, 48, 338 Aspirin, 80, 93, 338 Ataxia, 320, 338, 376 Atrial, 80, 338, 379 Atrial Fibrillation, 80, 338, 379 Atrium, 338, 379 Attenuation, 338, 350 Autologous, 314, 338, 354 Autologous bone marrow transplantation, 338, 354 Autonomic, 338, 346, 365, 374 Autonomic Nervous System, 338, 346, 365 B Back Pain, 108, 338 Bacteria, 337, 338, 347, 348, 349, 361, 379 Basal Ganglia, 338, 339 Basal Ganglia Diseases, 338, 339 Base, 26, 339, 346, 358 Benign, 187, 316, 324, 339, 353, 362 Beta-pleated, 336, 339 Bile, 339, 351, 359 Biochemical, 339, 358, 373 Biomarkers, 98, 150, 339 Biotechnology, 78, 111, 112, 267, 279, 289, 339 Birthmark, 324, 339 Bladder, 282, 322, 339, 344, 351, 368, 371, 378 Bloating, 322, 339 Blood Glucose, 275, 339, 354, 357 Blood Platelets, 339, 373 Blood pressure, 337, 339, 340, 355, 362, 374
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Blood vessel, 316, 335, 336, 337, 339, 340, 341, 342, 349, 358, 366, 374, 375, 376, 379 Body Fluids, 339, 348, 374, 378 Body Mass Index, 303, 339, 364 Bone Marrow, 313, 321, 338, 340, 354, 356, 360 Bowel, 95, 268, 322, 336, 340, 347, 357, 375 Branch, 315, 331, 340, 346, 348, 352, 364, 365, 369, 374 Breakdown, 340, 347, 351 Buccal, 98, 340, 360 C Caesarean section, 112, 190, 340 Calcium, 340, 344, 348 Capital Financing, 340, 367 Carbohydrate, 316, 340 Carcinogenic, 340, 357 Carcinogens, 98, 340, 362 Carcinoma, 139, 340 Cardiac, 72, 81, 92, 338, 340, 362 Cardiovascular, 5, 24, 37, 93, 135, 188, 190, 235, 275, 340, 346, 373 Cardiovascular disease, 5, 24, 37, 340 Cardiovascular System, 340, 346 Catastrophic Illness, 314, 340 Catheters, 282, 340 Cathode, 341 Cations, 54, 341, 358 Cauda Equina, 341, 372 Causal, 32, 60, 74, 341, 343, 350 Cause of Death, 85, 341 Cell, 98, 313, 335, 336, 338, 339, 341, 342, 344, 346, 349, 351, 354, 355, 356, 357, 358, 364, 366, 370, 371, 376, 379 Cell Division, 338, 341, 346, 366 Cell Transplantation, 341, 354 Cellulose, 341, 366 Central Nervous System, 338, 341, 342, 346, 353, 373 Cerebellar, 338, 341, 370 Cerebral, 67, 338, 339, 341 Cerebral Cortex, 338, 341 Cerebral Palsy, 67, 341 Cerebrovascular, 339, 340, 341, 376 Cerebrum, 341 Cervical, 6, 20, 54, 83, 94, 107, 123, 341 Cervix, 335, 341 Cesarean Section, 162, 341 Check-up, 26, 341 Chemotactic Factors, 341, 344 Chemotherapeutic agent, 82, 341 Chest Pain, 12, 341 Child Care, 18, 31, 60, 87, 276, 341 Child Development, 60, 342
Child Health Services, 63, 342 Chin, 183, 342, 361 Chiropractic, 108, 229, 230, 342 Choice Behavior, 47, 342 Cholesterol, 318, 339, 342, 345, 355 Cholinergic, 342, 363 Chromosomal, 342, 372 Chromosome, 342, 353, 359, 372 Chronic Disease, 20, 45, 98, 106, 267, 281, 302, 342 Chronic Fatigue Syndrome, 320, 342 Chronic renal, 190, 342 CIS, 298, 342, 371 Clinical trial, 4, 12, 14, 22, 61, 80, 81, 91, 97, 105, 289, 315, 342, 345, 368, 369, 370 Cloning, 339, 342 Coagulation, 317, 339, 340, 342, 354, 376, 379 Cocaine, 342, 346 Cofactor, 343, 368 Cognition, 96, 128, 343 Cohort Effect, 48, 343 Cohort Studies, 5, 45, 52, 343, 350 Colectomy, 317, 343 Colitis, 343, 357 Collapse, 121, 160, 340, 343 Colon, 13, 29, 61, 91, 93, 317, 343, 357, 359, 373 Colorectal, 15, 20, 25, 54, 66, 98, 101, 139, 167, 343 Colorectal Cancer, 15, 20, 25, 54, 66, 101, 139, 167, 343 Communication Barriers, 21, 343 Communication Disorders, 273, 288, 343 Community Health Centers, 5, 98, 292, 343 Comorbidity, 30, 37, 39, 106, 343 Complement, 55, 92, 224, 336, 343, 344 Complementary and alternative medicine, 227, 228, 231, 344 Complementary medicine, 228, 344 Compliance, 7, 53, 54, 55, 113, 117, 119, 169, 207, 242, 309, 344 Computational Biology, 289, 344 Computer Literacy, 21, 344 Conception, 335, 344, 351, 375 Conflict of Interest, 53, 344 Confounding, 25, 68, 94, 344 Conjunctiva, 344, 357 Connective Tissue, 340, 344, 345, 347, 351, 360, 371, 376 Constriction, 345, 358, 372 Consultation, 61, 323, 345 Consumer Participation, 117, 236, 345 Consumption, 55, 174, 179, 241, 345, 347, 371 Continuum, 313, 345
Index 383
Contraindications, ii, 345 Contrast medium, 336, 345 Control group, 60, 64, 79, 82, 84, 345, 369 Conventional therapy, 22, 345 Conventional treatment, 22, 345 Coordination, 7, 11, 44, 320, 345 Coronary, 92, 110, 340, 345, 361, 362 Coronary Artery Bypass, 92, 345 Coronary heart disease, 340, 345 Coronary Thrombosis, 345, 361, 362 Cost Savings, 193, 345 Cost-benefit, 80, 132, 345 Cost-Benefit Analysis, 80, 345 Cotinine, 77, 346 Crack Cocaine, 39, 346 Credentialing, 108, 346 Cross-Sectional Studies, 346, 350 Crowding, 36, 171, 346 Cutaneous, 346, 358, 360 Cytogenetics, 346, 372 D Data Collection, 5, 6, 14, 15, 21, 23, 43, 49, 346, 351 Day Care, 273, 346 Decision Making, 14, 20, 61, 228, 346 Dehydration, 31, 346 Delivery of Health Care, 343, 346, 352, 353 Demography, 43, 346, 367 Dendrites, 346, 363 Density, 339, 346, 355 Dental Anxiety, 109, 346 Dental Care, 26, 39, 66, 82, 100, 109, 208, 216, 283, 306, 307, 346 Dental Care for Children, 26, 346 Dental Caries, 104, 346 Dentists, 283, 347 Dermis, 347, 375 Developed Countries, 185, 347 Developing Countries, 48, 347 Diabetes Insipidus, 316, 347, 366 Diabetes Mellitus, 67, 183, 214, 316, 347, 352, 354, 366 Diabetic Ketoacidosis, 275, 347 Diagnostic procedure, 249, 279, 347 Diagnostic Services, 347, 376 Diarrhea, 87, 347 Diastolic, 347, 355 Dietetics, 130, 347 Digestion, 339, 340, 347, 357, 359, 375 Digestive system, 347, 352 Digestive tract, 347, 373 Dilatation, 335, 347 Diploid, 347, 366
Direct, iii, 13, 22, 63, 71, 77, 82, 109, 136, 244, 254, 260, 313, 320, 347, 370 Disabled Persons, 86, 347 Discrete, 51, 69, 235, 348, 360 Discrimination, 42, 43, 86, 110, 141, 147, 148, 150, 193, 194, 211, 246, 258, 264, 267, 348 Disparity, 29, 88, 92, 100, 348 Distal, 345, 348, 366 Drug Costs, 33, 106, 348 Duct, 336, 348, 350, 364, 372, 375 Duodenum, 339, 348, 349, 375 Dwarfism, 319, 348 Dyes, 336, 348 E Ectopic, 12, 348 Ectopic Pregnancy, 12, 348 Effector, 343, 348 Efficacy, 13, 63, 64, 77, 82, 99, 109, 132, 348 Elasticity, 71, 348 Elective, 56, 73, 348 Electrocoagulation, 342, 348 Electrolysis, 341, 348 Electrolytes, 339, 348, 358 Electrophysiological, 348, 379 Eligibility Determination, 250, 348 Emboli, 348, 349, 379 Embolism, 349, 369, 379 Embolization, 349, 379 Embolus, 349, 356 Embryo, 335, 349 Empirical, 21, 30, 32, 33, 35, 36, 47, 58, 67, 71, 72, 75, 89, 103, 104, 154, 202, 234, 235, 236, 240, 242, 349 Enamel, 346, 349 Encephalitis, 349 Encephalomyelitis, 320, 349 Endodontics, 349, 372 Endogenous, 17, 34, 48, 349 Endometrial, 94, 349 Endometrium, 349 Endoscope, 349 Endoscopic, 66, 349, 373 Endotoxins, 344, 349 End-stage renal, 282, 342, 349 Environmental Health, 288, 290, 349 Environmental tobacco smoke, 4, 77, 349 Enzymatic, 336, 340, 344, 346, 349, 371 Enzyme, 93, 335, 348, 349, 361, 368, 369, 375, 379 Enzyme Inhibitors, 93, 349 Epidemic, 293, 350 Epidemiologic Studies, 98, 350, 352 Epidemiological, 37, 58, 88, 118, 350 Epigastric, 350, 364
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Episiotomy, 221, 350 Episode of Care, 86, 350 Equalization, 171, 243, 350 Equipment and Supplies, 275, 350 ERV, 23, 350, 351 Erythrocytes, 336, 340, 350 Esophageal, 95, 350 Esophagus, 66, 347, 350, 366, 375 Estrogens, 350, 352 Ethnic Groups, 11, 20, 28, 66, 79, 81, 92, 135, 350 Excrete, 337, 350, 358 Exocrine, 315, 350, 364 Exogenous, 17, 349, 350 Expert Testimony, 322, 350 Expiration, 56, 350, 371 Expiratory, 350 Expiratory Reserve Volume, 350 Extensor, 351, 368 Extracellular, 336, 344, 345, 351, 374 Extraction, 109, 341, 351 F Family Characteristics, 18, 34, 351 Family Health, 38, 161, 260, 351 Family Planning, 116, 191, 192, 289, 351 Fat, 235, 316, 340, 345, 348, 349, 351, 358, 359, 364, 371, 374 Fathers, 18, 351 Fatigue, 320, 322, 342, 351, 354 Fatty acids, 347, 351 Fecal occult blood test, 20, 101, 351 Fees, Pharmaceutical, 348, 351 Fetus, 335, 341, 351, 367, 378 Fibrosis, 116, 315, 351 Focus Groups, 63, 82, 89, 351 Formularies, 33, 351, 366 Formulary, 33, 351 Fraud, 131, 146, 181, 351 Fundus, 40, 351 G Gallbladder, 335, 347, 351 Gas, 336, 350, 351, 352, 355, 362, 369, 371, 379 Gas exchange, 352, 371 Gastrin, 352, 355 Gastroenterologist, 65, 352 Gastrointestinal, 66, 346, 352, 373, 375, 378 Gastrointestinal tract, 352, 373, 375, 378 Gene, 267, 339, 352 General practitioner, 116, 147, 196, 201, 352 Genetic testing, 41, 42, 110, 148, 167, 193, 352 Genetics, 40, 41, 42, 155, 167, 267, 300, 346, 352 Geographic Locations, 81, 352
Geriatric Psychiatry, 95, 352 Gestation, 352, 365 Gland, 352, 360, 364, 368, 372, 375, 376 Glucose, 275, 339, 341, 347, 352, 354, 357 Glucose Intolerance, 347, 352 Gonadotropin, 22, 352 Governing Board, 352, 367 Grade, 19, 77, 352 Graft, 97, 353, 355 Graft Survival, 97, 353 Grafting, 92, 345, 353 Gravidity, 353, 365 Group Practice, 14, 15, 21, 353 H Haemorrhage, 335, 353 Hallucinogens, 353, 369 Haploid, 353, 366 Hay Fever, 336, 353 Headache, 353, 357 Health Behavior, 26, 40, 45, 66, 110, 111, 211, 353 Health Care Costs, 67, 95, 142, 251, 299, 353, 354 Health Care Reform, 95, 143, 195, 215, 353 Health Education, 16, 275, 280, 353 Health Expenditures, 75, 209, 353, 354 Health Resources, iv, 4, 24, 37, 263, 292, 311, 354 Hearing aid, 319, 354 Hearing Disorders, 343, 354 Heart attack, 318, 340, 354 Heart failure, 92, 132, 354 Hematopoietic Stem Cell Transplantation, 209, 354 Hemodialysis, 354, 358 Hemoglobin, 336, 350, 354 Hemorrhage, 80, 348, 353, 354, 375 Hemostasis, 354, 373 Hereditary, 167, 320, 354 Heredity, 352, 354 Heterogeneity, 38, 76, 354 Histology, 77, 355 Home Care Services, 298, 355, 357 Homogeneous, 345, 355 Hormone, 316, 348, 352, 355, 357, 371, 376 Hospice, 16, 313, 355 Hospital Administrators, 90, 355 Hospital Mortality, 72, 355 Host, 42, 273, 353, 355, 356, 378 Hydrogen, 335, 339, 340, 355, 362, 364, 366 Hypercholesterolemia, 318, 355 Hypercholesterolemia, Familial, 318, 355 Hyperglycemia, 31, 355 Hyperlipidemia, 318, 355
Index 385
Hypersensitivity, 355, 371 Hypertension, 132, 340, 353, 355, 377 Hypertrophy, 187, 355 Hypoglycemia, 31, 275, 355 Hysterectomy, 187, 355 Hysterotomy, 341, 355 I Id, 225, 230, 301, 312, 330, 332, 355 Ileostomy, 317, 355 Ileum, 317, 355 Immune response, 337, 356, 375, 378, 379 Immune Sera, 356 Immune system, 356, 379 Immunization, 267, 356 Immunodeficiency, 257, 275, 290, 291, 293, 302, 318, 356 Immunodeficiency syndrome, 257, 275, 290, 293, 356 Immunologic, 341, 356 Immunology, 119, 318, 356 Immunosuppressant, 322, 356 Immunosuppressive, 97, 356 Impairment, 15, 34, 40, 87, 319, 338, 356, 357, 361 In vitro, 22, 356 In vivo, 356 Incidental, 252, 356 Incision, 340, 343, 350, 355, 356, 358, 368 Indicative, 6, 258, 356, 365, 379 Infant, Newborn, 335, 356 Infarction, 93, 132, 356, 371 Infection, 19, 31, 176, 258, 290, 291, 293, 341, 349, 356, 357, 360, 363, 371, 375, 379 Infertility, 22, 194, 356 Inflammation, 336, 337, 338, 343, 349, 351, 356, 357, 358, 364, 365, 366, 371, 376 Inflammatory bowel disease, 268, 357 Influenza, 115, 357 Initiation, 27, 70, 108, 357 Insight, 93, 357 Insulin, 275, 316, 347, 357, 358, 364 Insulin-dependent diabetes mellitus, 357 Insurance Benefits, 17, 49, 106, 116, 194, 213, 219, 228, 233, 235, 237, 244, 245, 253, 282, 357 Insurance Carriers, 22, 63, 254, 260, 261, 357 Insurance, Health, 7, 74, 78, 158, 235, 357 Insurance, Life, 188, 189, 357 Insurance, Long-Term Care, 310, 357 Intensive Care, 73, 90, 108, 176, 357 Intensive Care Units, 108, 357 Intermittent, 164, 357, 360 Intervertebral, 27, 357, 360, 372
Intervertebral Disk Displacement, 357, 360, 372 Intestinal, 12, 357 Intestinal Obstruction, 12, 357 Intestine, 340, 343, 357, 359 Intracellular, 356, 358, 370 Invasive, 92, 135, 358 Involuntary, 339, 349, 358, 362 Ions, 335, 339, 348, 355, 358 Irritants, 30, 358 Ischemia, 358, 371 J Joint, 42, 56, 79, 103, 182, 323, 338, 358, 374, 375, 376 K Kb, 288, 358 Keratolytic, 347, 358 Ketone Bodies, 347, 358 Ketosis, 347, 358 Kidney Failure, 275, 282, 349, 358 Kidney Failure, Acute, 358 Kidney Failure, Chronic, 358 Kidney Transplantation, 97, 358 L Labile, 343, 358 Lacerations, 350, 359 Lag, 106, 359 Language Disorders, 343, 359 Large Intestine, 343, 347, 357, 359, 370, 373 Latent, 40, 359, 367 Least-Squares Analysis, 359, 370 Length of Stay, 86, 275, 359 Leukemia, 91, 359 Leukocytes, 340, 341, 359 Library Services, 330, 359 Life cycle, 258, 359 Life Expectancy, 27, 116, 359 Ligament, 359, 368, 374 Likelihood Functions, 359, 370 Linear Models, 359, 370 Linkage, 5, 6, 9, 31, 66, 98, 324, 359 Lipid, 357, 359 Liver, 95, 321, 335, 339, 347, 351, 359, 369, 378 Living will, 273, 359 Local Government, 359, 369 Localized, 346, 356, 360, 366 Locomotion, 360, 366 Logistic Models, 4, 360, 370 Longitudinal study, 65, 92, 157, 360 Long-Term Care, 37, 63, 66, 67, 78, 89, 191, 280, 298, 360 Low Back Pain, 27, 108, 360 Lumbar, 338, 341, 357, 360
386 Health Insurance
Lupus, 360, 376 Lymph, 341, 360 Lymph node, 341, 360 Lymphatic, 356, 360, 376 Lymphocytes, 337, 356, 359, 360, 376, 379 Lymphoid, 337, 360 M Malignant, 66, 360, 362 Malnutrition, 87, 360 Mammary, 345, 360 Mammography, 20, 29, 151, 360 Mandatory Testing, 258, 360 Manifest, 46, 361 Medial, 45, 361 Mediate, 28, 361 Mediator, 361, 373 Medical Records, 5, 12, 16, 19, 69, 91, 146, 155, 361 Medical Savings Accounts, 41, 128, 311, 361 MEDLINE, 289, 361 Membrane, 336, 344, 361, 362, 365, 366, 367, 371 Memory, 320, 361 Mental, iv, 4, 7, 17, 23, 24, 25, 30, 32, 33, 37, 38, 39, 51, 62, 64, 74, 75, 86, 95, 99, 101, 111, 129, 133, 154, 158, 162, 172, 200, 213, 217, 235, 239, 252, 272, 276, 288, 294, 299, 300, 314, 341, 342, 343, 347, 351, 352, 361, 363, 368, 369, 370, 378 Mental Disorders, 23, 37, 39, 75, 86, 361, 368 Mental Health Services, iv, 4, 18, 33, 62, 75, 95, 129, 294, 314, 361 Mental Processes, 361, 368 Mental Retardation, 343, 361 Mentors, 13, 35, 37, 56, 58, 88, 361 Metabolic disorder, 347, 361 Metabolite, 361, 367, 369 MI, 10, 43, 65, 87, 100, 109, 138, 187, 333, 361 Micro-organism, 347, 361 Minority Groups, 8, 9, 91, 101, 361 Mobility, 14, 15, 45, 48, 136, 234, 237, 238, 361 Modeling, 7, 34, 74, 102, 362 Modification, 275, 336, 350, 362, 369 Molecular, 77, 289, 294, 339, 344, 346, 362, 370 Molecule, 337, 339, 344, 348, 362, 364, 370 Monitor, 24, 29, 46, 49, 64, 78, 100, 362 Motility, 362, 373 Multiparous, 157, 362 Mustard Gas, 358, 362 Myalgia, 357, 362 Myocardial infarction, 12, 92, 132, 345, 361, 362, 379
Myocardium, 361, 362 N Naloxone, 362 Naltrexone, 10, 362 Narcotic, 362 Nasal Mucosa, 357, 362 NCI, 1, 81, 95, 101, 287, 298, 342, 362 Neonatal, 31, 69, 141, 176, 193, 200, 208, 280, 362 Neonatal period, 31, 362 Neoplasm, 339, 362 Nephropathy, 132, 363 Nerve, 336, 338, 341, 342, 346, 361, 363, 366, 372, 374, 375, 377 Nervous System, 338, 341, 361, 363, 365, 376 Networks, 39, 45, 72, 92, 212, 322, 363 Neurologic, 191, 337, 363 Neurons, 273, 343, 346, 363, 374, 375 Neuropathy, 363, 366, 372 Nicotine, 77, 363 Nonverbal Communication, 343, 363 Nursing Care, 357, 363, 365 O Observational study, 67, 363 Occult, 351, 363 Occult Blood, 363 Occupational Health, 16, 131, 363 Occupational Medicine, 185, 363 Ocular, 40, 339, 363 Odds Ratio, 363, 370 Office Management, 54, 363 Office Visits, 55, 363 Oliguria, 358, 363 On-line, 31, 310, 333, 364 Operating Rooms, 12, 364 Ophthalmologic, 40, 364 Ophthalmologist, 321, 364 Ophthalmology, 40, 214, 364 Oral Health, 66, 104, 109, 276, 283, 364 Osteoporosis, 178, 364 Ostomy, 317, 364 Otitis, 169, 364 Otitis Media, 169, 364 Outpatient, 19, 36, 38, 52, 55, 158, 177, 178, 196, 239, 275, 314, 350, 364 Ovaries, 76, 364, 373 Overweight, 224, 303, 364 Ovulation, 22, 364 Ovum, 352, 359, 364 Ownership, 35, 73, 202, 242, 364 Oxidation, 347, 364 P Palsy, 68, 364
Index 387
Pancreas, 275, 315, 335, 339, 347, 357, 364, 365, 378 Pancreas Transplant, 275, 364, 365 Pancreas Transplantation, 275, 365 Parity, 10, 26, 34, 51, 75, 94, 99, 133, 172, 228, 300, 365 Patch, 77, 365 Paternity, 43, 365 Pathologic, 335, 345, 355, 365, 368 Patient Admission, 250, 365 Patient Advocacy, 315, 321, 365 Patient Education, 302, 318, 328, 330, 333, 365 Patient Satisfaction, 84, 108, 365 Pelvic, 19, 365, 368 Pelvic inflammatory disease, 19, 365 Pelvis, 335, 360, 364, 365, 378 Pensions, 88, 267, 317, 365 Peptide, 336, 365, 368 Perception, 77, 344, 353, 354, 365 Pericardium, 365, 376 Perinatal, 69, 161, 365 Periodontal disease, 105, 365 Periodontitis, 105, 365 Peripheral blood, 354, 365 Peripheral Nervous System, 364, 365, 375 Peripheral Neuropathy, 275, 366 PH, 116, 191, 198, 201, 207, 212, 292, 308, 366 Pharmacologic, 336, 366, 377 Pharmacopoeias, 351, 366 Pharynx, 357, 366 Phospholipids, 351, 366 Photocoagulation, 342, 366 Physical Examination, 253, 341, 366 Physical Fitness, 366, 374 Pigmentation, 339, 366 Pilot study, 59, 80, 82, 108, 125, 366 Pitch, 278, 366 Plants, 13, 335, 342, 352, 366, 377 Plasma, 337, 352, 354, 355, 358, 366, 373 Plasma cells, 337, 366 Pneumonia, 190, 345, 366 Policy Making, 106, 366 Polydipsia, 316, 366 Polyposis, 167, 343, 366 Polyuria, 316, 367 Population Characteristics, 23, 367 Posterior, 336, 338, 350, 364, 367, 372 Postmenopausal, 364, 367 Practice Guidelines, 108, 294, 367 Practice Management, 6, 367 Predisposition, 81, 367 Preferred Provider Organizations, 9, 292, 367
Prejudice, 86, 367 Prenatal, 69, 92, 152, 158, 165, 200, 300, 349, 367 Prenatal Care, 69, 92, 152, 158, 165, 200, 300, 367 Prescription Fees, 348, 367 Prevalence, 11, 40, 59, 64, 68, 88, 91, 96, 101, 106, 135, 183, 363, 367 Preventive Medicine, 13, 209, 221, 329, 367 Private Sector, 17, 73, 367 Privatization, 35, 367 Prodrug, 367, 369 Prognostic factor, 367, 375 Progression, 8, 190, 368 Progressive, 235, 266, 320, 322, 342, 353, 358, 368 Prone, 318, 368 Prophylaxis, 80, 368, 378, 379 Proportional, 45, 94, 98, 368 Prospective Payment System, 273, 368 Prospective study, 360, 368 Prostate, 13, 29, 61, 91, 98, 107, 204, 339, 368, 378 Prostatectomy, 187, 368 Protein S, 267, 339, 368, 372 Proteins, 273, 336, 337, 343, 362, 365, 366, 368, 370, 373, 377 Proteolytic, 344, 368 Protocol, 6, 53, 324, 368 Psoriasis, 281, 362, 368 Psychiatric, 30, 37, 39, 50, 62, 96, 106, 109, 133, 162, 172, 186, 192, 196, 343, 361, 368 Psychiatry, 37, 61, 95, 129, 157, 172, 186, 196, 299, 352, 368 Psychic, 361, 368 Psychology, 14, 264, 368 Psychopathology, 39, 368 Psychopharmacology, 33, 368 Psychotropic, 32, 369 Psychotropic Drugs, 32, 369 Public Assistance, 49, 75, 268, 290, 369 Public Policy, 8, 53, 60, 65, 69, 99, 127, 159, 240, 245, 246, 259, 261, 276, 289, 320, 369 Public Sector, 95, 369 Pulmonary, 339, 345, 358, 369, 371, 379 Pulmonary Edema, 358, 369 Pulmonary Embolism, 369, 379 Pulmonary Ventilation, 369, 371 Pulse, 362, 369 Q Quality of Life, 19, 28, 40, 58, 80, 91, 95, 96, 102, 105, 109, 204, 315, 317, 369, 375
388 Health Insurance
R Race, 15, 28, 29, 52, 56, 61, 66, 69, 88, 92, 97, 109, 139, 187, 216, 302, 308, 369 Radiation, 345, 369 Ramipril, 132, 369 Random Allocation, 369 Randomization, 101, 369 Randomized, 19, 20, 22, 54, 63, 77, 82, 83, 101, 105, 108, 180, 224, 228, 229, 348, 369, 370 Randomized clinical trial, 19, 369 Randomized Controlled Trials, 77, 370 Receptor, 337, 355, 370, 373 Receptors, Serotonin, 370, 373 Rectal, 93, 370 Rectum, 61, 337, 343, 347, 351, 357, 359, 368, 370 Red Nucleus, 338, 370 Refer, 1, 340, 343, 360, 370 Regeneration, 109, 370 Regimen, 97, 348, 370 Registries, 6, 61, 91, 98, 102, 370 Regression Analysis, 29, 97, 370 Rehabilitative, 316, 370 Relative risk, 45, 370 Reliability, 96, 113, 371 Renal Dialysis, 27, 244, 371 Reperfusion, 93, 371 Reperfusion Injury, 371 Research Design, 7, 15, 21, 28, 41, 371 Research Support, 66, 371 Respiration, 362, 371 Respiratory System, 315, 371 Respite Care, 273, 371 Response rate, 10, 40, 49, 96, 371 Retinal, 348, 371 Retropubic, 368, 371 Retrospective, 16, 20, 37, 48, 52, 102, 105, 273, 371 Rheumatic Diseases, 56, 371 Rheumatism, 19, 114, 371 Rheumatoid, 19, 371 Rheumatoid arthritis, 19, 371 Ribosome, 372, 377 Rigidity, 366, 372 Risk factor, 4, 58, 67, 93, 98, 105, 184, 192, 221, 350, 360, 368, 370, 372 Risk-Taking, 6, 92, 372 Root Canal Therapy, 109, 372 Rural Population, 37, 372 S Saliva, 372 Salivary, 315, 347, 372 Salivary glands, 315, 347, 372
Saphenous, 345, 372 Saphenous Vein, 345, 372 Satellite, 95, 372 Sciatica, 27, 372 Scoliosis, 319, 372 Sebaceous, 347, 358, 372 Sebaceous gland, 347, 358, 372 Secretion, 316, 348, 357, 372, 373 Secular trends, 79, 372 Selection Bias, 170, 372 Self Care, 335, 372 Self-Help Groups, 320, 372 Semen, 368, 373 Senile, 364, 373 Sequencing, 110, 373 Serotonin, 33, 370, 373, 378 Serum, 76, 336, 343, 352, 356, 358, 373 Sex Characteristics, 335, 350, 373 Shock, 157, 373, 378 Side effect, 335, 373, 375, 377 Sigmoid, 373 Sigmoidoscopy, 29, 101, 373 Skeletal, 348, 373 Skeleton, 358, 373 Small intestine, 317, 348, 355, 357, 373 Smoking Cessation, 77, 89, 92, 143, 373 Social Behavior, 60, 138, 145, 181, 373 Social Change, 48, 373 Social Class, 88, 92, 373 Social Environment, 369, 373 Social Security, 43, 74, 88, 273, 282, 290, 307, 370, 374 Social Support, 81, 92, 374 Social Welfare, 75, 103, 374 Social Work, 78, 215, 244, 374 Socioeconomic Factors, 11, 367, 374 Sodium, 348, 374, 375 Soft tissue, 340, 373, 374 Somatic, 335, 365, 366, 374 Specialist, 105, 196, 325, 374 Species, 336, 341, 369, 373, 374, 377 Spinal cord, 341, 342, 349, 363, 365, 374 Spinal Nerve Roots, 372, 374 Sports Medicine, 156, 328, 374 Sprains and Strains, 360, 374 Statistically significant, 81, 374 Stem Cells, 354, 374 Stent, 364, 375 Sterility, 194, 356, 375 Stimulus, 359, 375, 376 Stoma, 364, 375 Stomach, 95, 335, 347, 350, 351, 352, 355, 358, 366, 373, 375 Stool, 343, 351, 359, 375
Index 389
Stress, 37, 60, 338, 367, 371, 375 Stroke, 80, 85, 288, 340, 375 Subacute, 273, 356, 375 Subclinical, 356, 375 Substance P, 361, 372, 375 Substrate, 349, 375 Suburban Population, 93, 375 Support group, 273, 281, 313, 315, 316, 319, 321, 323, 375 Supportive care, 82, 375 Survival Analysis, 85, 375 Sweat, 315, 347, 375 Sweat Glands, 315, 347, 375 Symphysis, 342, 368, 375 Symptomatic, 150, 293, 337, 375 Synaptic, 363, 375, 376 Synaptic Transmission, 363, 376 Systemic, 81, 338, 339, 356, 376, 377, 379 Systemic lupus erythematosus, 81, 376 Systolic, 355, 376 T Tear Gases, 358, 376 Telecommunications, 376 Telemedicine, 72, 132, 376 Teleradiology, 72, 376 Testimonials, 228, 376 Thalamic, 338, 376 Thalamic Diseases, 338, 376 Thoracic, 338, 376, 380 Thorax, 335, 360, 376 Threshold, 40, 60, 314, 355, 376 Thrombosis, 368, 375, 376 Thrombus, 345, 356, 376, 379 Thymus, 356, 360, 376 Thyroid, 133, 376 Tin, 366, 377 Tinnitus, 364, 377 Tone, 377 Tonic, 166, 377 Tooth Loss, 105, 377 Toothache, 109, 377 Topical, 111, 377 Torsion, 356, 377 Toxic, iv, 349, 363, 377 Toxicology, 83, 290, 377 Toxins, 337, 349, 356, 377 Trachea, 366, 376, 377 Tranquilizing Agents, 369, 377 Transfection, 339, 377 Transfer Factor, 356, 377
Translation, 33, 336, 377 Transplantation, 27, 98, 209, 247, 275, 313, 342, 356, 377 Transurethral, 368, 378 Transurethral resection, 368, 378 Transurethral Resection of Prostate, 368, 378 Trauma, 12, 339, 353, 376, 377, 378 Tryptophan, 373, 378 Tumor marker, 339, 378 U Ultrasonography, 66, 378 Uncompensated Care, 57, 79, 378 Unconscious, 355, 378 Urban Health, 142, 144, 190, 201, 378 Urban Population, 378 Urea, 358, 375, 378 Uremia, 358, 378 Urethra, 368, 378 Urinary, 363, 367, 368, 371, 378 Urine, 316, 337, 339, 347, 358, 363, 367, 378 Uterine Contraction, 335, 378 Uterus, 335, 341, 348, 349, 351, 355, 364, 378 Utilization Review, 138, 378 V Vaccination, 185, 208, 378 Vaccine, 185, 368, 379 Vaginal, 350, 379 Vascular, 316, 324, 347, 356, 376, 379 VE, 184, 379 Vein, 372, 379 Venous, 368, 379 Venous Thrombosis, 379 Ventricle, 369, 376, 379 Ventricular, 93, 379 Ventricular Function, 93, 379 Venules, 339, 379 Vertebrae, 357, 374, 379 Vertigo, 364, 379 Veterinary Medicine, 289, 379 Viral, 349, 357, 379 Virus, 275, 290, 291, 293, 302, 379 Vision Screening, 87, 379 Vital Statistics, 92, 379 Vitro, 379 W War, 43, 49, 362, 379 Warfarin, 80, 379 White blood cell, 337, 359, 360, 366, 379 Windpipe, 366, 376, 380
390 Health Insurance
Index 391
392 Health Insurance
