The Use of Technology Assessment by Hospitals, Health Maintenance Organizations, and Third-Party Payers in the United States

1995 ◽  
Vol 11 (1) ◽  
pp. 79-92 ◽  
Author(s):  
Bryan R. Luce ◽  
Ruth E. Brown
Keyword(s):  
Technology Assessment ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Assessment System ◽  
Third Party ◽  
Assessment Process ◽  
Health Maintenance ◽  
Use Of Technology ◽  
Controversial Technologies ◽  
Third Party Payers

AbstractA case study design was used to determine the reliance on technology assessment of decisionmakers in hospitals, health maintenance organizations (HMOs), and third-party payers. Thirty different organizations were contacted and semistructured interviews conducted. The study found that hospitals, HMOs, and insurers are conducting technology assessments, but the form and sophistication of these analyses range widely. Hospitals are particularly focused on traditional financial analyses (“prudent purchasing”) with the exception of pharmacy committees, which generally conduct more sophisticated socio-economic analyses. HMOs and insurers conduct outcome assessments for coverage of expensive or controversial technologies but exclude economics. Technology assessment will become increasingly important in resource allocation decision making and it is in the interest of technology providers to foster better information, a more comprehensive assessment process, and a more efficient assessment system.

Response to Dr Stone

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 850-851
Author(s):  
Howard A. Pearson
Keyword(s):  
Nurse Practitioners ◽  
Cost Effective ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Quality Health Care ◽  
Quality Cost ◽  
Health Maintenance ◽  
Effective Care ◽  
Quality Health

Dr Elsa Stone, in her usual organized and lucid fashion, has presented the case for inclusion of pediatric nurse practitioners (PNPs) in private pediatric practices. She bases her conclusions on her nearly 10 years of positive experience with a PNP in her own practice in Connecticut. Dr Stone describes the PNP population and demography, describes the training curriculum of PNPs, and discusses the scope of work of these individuals. She concludes that "there is substantial evidence that PNPs provide quality health care and that collaborative teams of pediatricians and PNPs can provide high-quality, cost-effective care to a broader spectrum of children than can be served by either profession alone." The American Academy of Pediatrics (AAP) has insisted for several years that there is a shortage of pediatricians to meet the expanding needs of the children of the United States. Furthermore, pediatricians—because of system changes—will be expected increasingly to provide a variety of time-intensive services. Dr Stone believes that many of these services can be well provided by PNPs. Within the AAP, there have been some concerns about the role of PNPs. Of particular worry seems to be the possibility that PNPs might decide to practice independently, leading to a lower quality of care for their patients. Less often stated, but clearly an issue, is that PNPs are viewed by some pediatricians as potential competitors. Dr Stone's demographic analysis of what PNPs are currently doing is relevant to these concerns. One third of PNPs work in private pediatric practices or health maintenance organizations.

Ethics Case Consultation in Primary Care: Contextual Challenges for Clinical Ethicists

2009 ◽  
Vol 18 (4) ◽  
pp. 397-405 ◽  
Author(s):  
ANNE SLOWTHER
Keyword(s):  
Primary Care ◽  
Clinical Ethics ◽  
Western Europe ◽  
Ethics Consultation ◽  
Ethics Committees ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Ethics Committee ◽  
Health Maintenance ◽  
Case Consultation

The development of ethics case consultation over the past 30 years, initially in North America and recently in Western Europe, has primarily taken place in the secondary or tertiary healthcare settings. The predominant model for ethics consultation, in some countries overwhelmingly so, is a hospital-based clinical ethics committee. In the United States, accreditation boards suggest the ethics committee model as a way of meeting the ethics component of the accreditation requirement for payment by Health Maintenance Organizations (HMOs), and in some European countries, there are legislatory requirements or government recommendations for hospitals to have clinical ethics committees. There is no corresponding pressure for primary care services to have ethics committees or ethics consultants to advise clinicians, patients, and families on the difficult ethical decisions that arise in clinical practice.

scholarly journals Infrastructure for e-testing

2005 ◽  
Vol 18 (2) ◽  
pp. 181-204 ◽  
Author(s):  
Goce Armenski ◽  
Marjan Gusev
Keyword(s):  
Higher Education ◽  
Everyday Life ◽  
Assessment System ◽  
Assessment Process ◽  
It Use ◽  
Student Knowledge ◽  
Software Packages ◽  
Use Of Technology ◽  
Testing Tool ◽  
New Challenges

The characteristics of the society in which we live, where knowledge and the ways of its use are the most important in everyday life, brings new challenges for higher education. The extensive use of technology in learning and working is forcing its use in the assessment process. A lot of software packages exist in the market to realize automated assessment. In this article we analyze different methods used for testing and present new frontiers, especially in cases where the number of students is very big (several hundreds), and in cases in which students can take exams every month. Using the results from this analysis we have designed and developed a new assessment system. We also give a report of the results from using e-testing tool for assessment of student knowledge, concentrating on the effectiveness of it use for assessment purposes.

Status of Insurance Coverage for Organ Transplants in the United States: A Review of Recent Surveys

1986 ◽  
Vol 2 (3) ◽  
pp. 563-570
Author(s):  
Fred J. Hellinger
Keyword(s):  
Organ Transplantation ◽  
New Technologies ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Heart Transplants ◽  
Health Maintenance ◽  
Blue Cross Blue Shield ◽  
Lung Transplants ◽  
Blue Shield ◽  
Health Insurers

The economic, political, ethical, and medical issues surrounding organ transplantation are complex, and coverage policies for it vary considerably among insurers. Some insurers cover virtually all transplants, while others cover few or none (Wyoming Medicaid does not cover any transplants) (3;4;5;6;7). In the past, insurers have followed Medicare's lead regarding coverage of new technologies. This has not been the case with organ transplantation. Although Medicare does not cover heart transplants, almost all Blue Cross/Blue Shield plans and commercial health insurers, as well as one-half of the state Medicaid plans and one-third of the Health Maintenance Organizations (HMOs), do cover heart transplants. (See note, p. 570.) In addition, although Medicare does not cover heart–lung transplants, a substantial proportion of Blue Cross/Blue Shield plans, commercial health insurers, state Medicaid plans, and HMOs cover it. At present, Medicare covers kidney and cornea transplants, selected pediatric liver transplants, and selected bone marrow transplants.

Kaiser-Permanente: A Model American Health Maintenance Organization

1974 ◽  
Vol 4 (4) ◽  
pp. 599-615 ◽  
Author(s):  
Judith Carnoy ◽  
Linda Koo
Keyword(s):  
Cost Reduction ◽  
Health Maintenance Organization ◽  
Care Program ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Kaiser Permanente ◽  
Health Maintenance ◽  
For Profit ◽  
Use Of Services ◽  
Private Corporations

The Kaiser-Permanente medical care program, a prepaid group practice that has been operating in California for over 30 years, is one of the most successful Health Maintenance Organizations (HMOs) in the United States. Kaiser's membership in California, Portland, Hawaii, Denver, and Cleveland exceeds 2.5 million. The main success that HMOs can claim is cost reduction. Kaiser can provide a package of services at lower cost than identical services would cost in “mainstream” medicine. The way in which an HMO reduces cost is by lowering the use of services by its members. Kaiser members spend half as many days in the hospital as a similar population of Blue Cross/Blue Shield subscribers. But Kaiser also tends to lower the availability of services that are not presently performed in excess. Ambulatory care is not easily accessible-large numbers of patients complain of waiting several weeks for appointments, of receiving rushed impersonal treatment, and of being unable to find and keep a personal physician. Thus Kaiser cost reduction goes hand-in-hand with a general inaccessibility of services. The reason for this is the working of the profit motive. Whether for-profit or technically “nonprofit,” private corporations have always committed themselves to maximizing their income, reducing their expenditures, and using the surplus for expansion. The profit incentive leads private HMOs to limit services by hiring an inadequate number of physicians and other personnel so that patients will be discouraged from seeking care. In this way, expenses go down and surplus goes up. This is a revision of an article, “Kaiser Plan,” that appeared in the Health-PAC Bulletin, No. 55, pp. 1-18, November 1973.

A Review of Data on the Health Sector of the United States January 2002

2002 ◽  
Vol 32 (3) ◽  
pp. 579-599 ◽  
Author(s):  
Ida Hellander
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Health Care Systems ◽  
Health Sector ◽  
The United States ◽  
Health Maintenance Organizations ◽  
The State ◽  
Health Maintenance ◽  
Care Systems

This report presents data on the state of U.S. health care at the end of 2001. It provides information on access to health care, inequalities in incomes and medical care, the increasing costs of health care and health insurance, and the role of corporate money in the provision of health care and the development, marketing, and patenting of pharmaceuticals. The author also looks at the state of health maintenance organizations, the results of some recent surveys on physicians' and public opinion on managed care, and news about the nursing professions. Also provided is an update on Congressional activity on health care legislation, the role of health care industry money in politics, and some developments in health care systems elsewhere in the world.

Interpreting for California’s Insured Deaf or Hard of Hearing Population

2011 ◽  
Vol 22 (3) ◽  
pp. 170-178 ◽  
Author(s):  
Christopher J. Moreland ◽  
Dominique Ritley ◽  
Patrick S. Romano
Keyword(s):  
Hard Of Hearing ◽  
Access To Health Care ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Health Maintenance ◽  
Signed Language ◽  
Language Interpretation ◽  
Access To Health ◽  
Survey Responses

Deaf or hard of hearing (DHOH) people experience significant health disparities in the United States; signed language interpretation services may increase their access to health care via health insurance plans. The authors’ objective is to describe signed language interpretation (SLI) services provided by California’s health maintenance organizations (HMOs) to their DHOH members. They conducted a descriptive review of an annual state-administered survey of California HMOs from 2003 through 2008 via retrospective analysis of annual or biennial survey responses to questions regarding SLI services and DHOH members. From 2003 through 2008, California HMOs increased efforts to inform DHOH members of SLI services while using more formal methods to assess the quality of those services. DHOH members were increasingly discouraged from using family members for medical SLI. California’s HMOs have improved efforts to promote and evaluate SLI services for the DHOH community.

scholarly journals Initial Public Offerings: The Case Of Health Maintenance Organizations (HMOs)

2011 ◽  
Vol 1 (6) ◽  
Author(s):  
Martha Strange ◽  
John R. Ezzell ◽  
Aref N. Dajani
Keyword(s):  
Initial Public Offerings ◽  
Stock Prices ◽  
Composite Index ◽  
Abnormal Returns ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Accounting Data ◽  
Health Maintenance ◽  
Public Offerings ◽  
Long Run

Objective: To determine whether the returns of initial public offerings (IPOs) of HMOs in the days following issue are similar to the return behavior of IPOs in previous studies.Data Source: The Center for Research in Security Prices (CRSP) tapes compiled by the Graduate School of Business at the University of Chicago provides daily stock prices, holding period returns, and other data pertinent to research in traded securities.Study Design: The hypothesis to be tested is whether the mean excess return surrounding the offer date is equal to zero. To adjust the initial returns of the IPOs for overall market movements, Standard & Poors Composite Index (S&P 500) was selected as the proxy for the market in general. We compute the long-run performance for the HMOs and compare that return to the S&P 500 and the CRSP AMEX/NYSE equally-weighted and value-weighted indices.Data Collection/Extraction Method: We matched for-profit HMOs listed in the National Directory of Managed & Integrated Care Organizations to the commitment offerings reported by Securities Data Corporation to the same firms on the daily CRSP tapes. This left 49 firms that went public between 1971 through 1997. The Wharton Research and Data Services External (WRDSX) was used for data extraction and SAS was used for statistical analysis.Principal Findings: IPOs of HMOs are underpriced and demonstrate abnormal returns. The average initial return on these IPOs is less than that of the average in the United States. On a long-run performance basis, they performed better than the broad market indices.Conclusions: Returns follow a similar pattern as do IPOs in general except for the long-run performance. This needs further research as well as a comparison of performance before and after going public in cases where accounting data is available.

Primary, Secondary, and Tertiary Prevention Capabilities of Selected HMOs: Findings of an Employer Survey

1997 ◽  
Vol 12 (2) ◽  
pp. 102-109 ◽  
Author(s):  
Larry S. Chapman ◽  
Lou Nelson ◽  
Beverly Sloan ◽  
Robert Plankenhorn
Keyword(s):  
Response Rate ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Tertiary Prevention ◽  
Average Score ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Health Maintenance ◽  
Prevention Activity ◽  
Managed Care Organizations

Purpose. To survey Health Maintenance Organizations (HMOs) of a major employer regarding the extent of their health promotion and disease prevention capabilities. Design. A one-time cross-sectional survey. Setting. The setting involved in this study was managed care organizations. Subjects. The subjects were 22 HMOs located in the western part of the United States. Measures. The study involved completion of a survey grid on a fairly comprehensive range of primary, secondary, and tertiary prevention activities. Results. Twenty-two HMOs were surveyed and 20 responded, providing a response rate of 90.9%. Analysis of distribution of responses and simple means were used. If a “perfect score” included addressing all 52 prevention targets across all 13 intervention modalities (minus inappropriate combinations) and that represented a score of 100%, the highest scoring HMO indicated that it provided or addressed 36.8% of all possible modalities and prevention target combinations. The composite average score for all three areas of prevention for all responding HMOs was slightly less than 13%. Additionally, five of the HMO respondents provided approximately 59% of all the prevention activity reported in the survey. Nonrepresentativeness of the HMOs in the sample represents the most significant study limitation. Conclusions. Results suggest that prevention capabilities among the HMOs surveyed are unevenly distributed and somewhat concentrated.

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