HMOS—ANOTHER ROADBLOCK FOR ALZHEIMER'S DRUG

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. A51-A51
Author(s):  
J. F. L.
Keyword(s):  
Health Care ◽  
Health Reform ◽  
Liver Toxicity ◽  
Puget Sound ◽  
Cost Effective ◽  
Point Of View ◽  
American People ◽  
Northern California ◽  
Kaiser Permanente ◽  
Physician Visits

The first Cognex auguries are not promising. These signs of resistance come from two of the nation's largest HMOs, Northern California Kaiser Permanente and the Group Health Cooperative of Puget Sound. Northern California Kaiser has already decided to ban Cognex from its formulary... Cognex is expected to cost about $1,300 to $1,500 annually per patient, and this does not include the costs of blood tests and physician visits required to guard against side effects. Against this Kaiser argues that Cognex helps only some victims of Alzheimer's Disease; the gain is not very great in many patients; and some who take Cognex suffer liver toxicity that the HMOs would have to treat. So from an HMO's point of view, Cognex is not "cost-effective," the magic mantra of HMO health care. But for anyone who's aware of the living hell in which many Alzheimer's patients and their families live, this argument does not wash... Americans still expect their doctors to put patients' interests first. As the Cognex incident at the two major HMOs shows, that expectation need not be satisfied in HMO health care. Mr. Clinton, his health reform, and the American people can only benefit if the president takes specific measures to ensure that patients' expectations and HMO reality are congruent.

Patterns and predictors of chemotherapy and trastuzumab use for early-stage breast cancer in Kaiser Permanente Northern California, 2004-2007.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 256-256
Author(s):  
Allison W. Kurian ◽  
Daphne Lichtensztajn ◽  
Theresa H.M. Keegan ◽  
Rita W. Leung ◽  
Sarah J. Shema ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Practice Guidelines ◽  
Early Stage ◽  
Local Population ◽  
Early Stage Breast Cancer ◽  
Care Organization ◽  
Northern California ◽  
Kaiser Permanente ◽  
Oncology Practice

256 Background: Chemotherapy regimens for early-stage breast cancer have been extensively tested by randomized clinical trials, and specified by evidence based-practice guidelines. However, little is known about the translation of trial results and guidelines to oncology practice. Methods: We extracted individual-level data on chemotherapy administration from the electronic medical records of Kaiser Permanente Northern California (KPNC), a pre-paid integrated health-care delivery system serving 29% of the local population. We linked data to the California Cancer Registry, incorporating demographic and tumor factors, and performed multivariable logistic regression analyses on the receipt of specific chemotherapy regimens. Results: We identified 6,178 women diagnosed with stage I to III breast cancer at KPNC during 2004 to 2007; 2,735 (44.3%) received at least one chemotherapy infusion at KPNC within 18 months of diagnosis. Factors associated with receiving chemotherapy, and specifically receiving anthracyclines, taxanes, and/or trastuzumab, included young age, large tumor size, involved lymph nodes, hormone receptor-negative or HER2/neu-positive tumors, and high tumor grade; comorbid conditions were inversely associated with chemotherapy use (heart disease for anthracyclines, neuropathy for taxanes). We observed less chemotherapy use by unmarried women, less anthracycline and taxane use by low-socioeconomic status (SES) non-Hispanic whites, and more anthracycline use by high-SES Asian/Pacific Islanders (versus high-SES non-Hispanic whites). Concordance with relevant measures of the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) was highest among younger women with larger, higher grade tumors. Conclusions: In this health care organization with essentially equal access, we discovered that chemotherapy use was concordant with practice guidelines, yet may vary according to socio-demographic factors. These findings may inform efforts to optimize treatment, and guide studies of quality in breast cancer care.

If HMOs Want Evidence-Based Medicine, They Should Pay for Studies!

PEDIATRICS ◽  
1995 ◽  
Vol 96 (6) ◽  
pp. A40-A40
Author(s):  
J. F. L.
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Insurance Industry ◽  
Puget Sound ◽  
Experimental Medicine ◽  
Kaiser Permanente ◽  
Health Official ◽  
The Public ◽  
Based Medicine ◽  
Support Research

Some managed-care organizations are keen to support research. Kaiser-Permanente (which started life in California during the 1930s and now operates in many states) and Group Health Co-operative of Puget Sound (in Seattle) have for decades entered their patients in NIH-sponsored trials and conducted their own studies ... Several newer managed-care firms have followed suit. ... In the insurance industry, attitudes to research range from lukewarm to hostile. Lee Newcomer, medical director of United Health Care, a huge managedcare organization based in Minneapolis, says his firm would be more enthusiastic about paying for it if fewer clinical trials were "too small, too poorly designed, and too poorly organized" to answer questions about which treatments—particularly the most complex and costly—are worthwhile. William Roper, a former health official in the Reagan and Bush administrations who is now Dr Newcomer's counterpart at the Prudential Health Care System in Roseland, New Jersey, goes further. He agrees that research is important, but he also argues that researchers have been too little accountable for how they have spent the public dollars that have flowed their way. "Why," he asks, "should society be paying extra for the delivery of health care at academic institutions merely on the presumption that it is getting something of value?" Prudential's position—unless Congress decides to tax all managed-care companies to support research—is that it will not pay for experimental medicine.

Quantification of Standards for Length-of-Stay Based upon Optimal Patient Care and Standard Medical Practice

1981 ◽  
Vol 89 (1) ◽  
pp. 27-33 ◽  
Author(s):  
F. Owen Black ◽  
Jonas Johnson ◽  
Eugene N. Myers ◽  
Olga Perkun
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Medical Practice ◽  
Care Delivery ◽  
Radical Neck Dissection ◽  
Preoperative Assessment ◽  
Cost Effective ◽  
Point Of View ◽  
Increased Risk ◽  
Postoperative Length

Length-of-stay criteria are being developed by the Allegheny Professional Standards Review Organization (APSRO) in western Pennsylvania. In order to statistically document the standard of practice at the Eye and Ear Hospital of Pittsburgh, a retrospective review of patients who underwent laryngectomy with or without radical neck dissection was performed. Results demonstrated that routinely allowing only one day preoperative assessment deviates significantly from optimal medical practice and may place some patients at increased risk, especially for postoperative complications. From a cost-effective health care delivery point of view, abbreviated preoperative preparation contributes negatively to postoperative length-of-stay which was the most costly component of hospital health care for this group of patients. The development of appropriate standards of medical practice criteria using preexisting HEW mechanisms and scientifically designed prospective studies should be encouraged.

scholarly journals Economic aspects of telemedicine

2021 ◽  
Vol 7 (3) ◽  
pp. 65-72
Author(s):  
I.A. Shaderkin ◽  
◽  
Keyword(s):  
Health Care ◽  
Health Financing ◽  
Cost Effective ◽  
Point Of View ◽  
Financing System ◽  
Formative Stage ◽  
Lead Generation ◽  
Monitoring Technologies ◽  
Low Prevalence ◽  
Further Development

Introduction. For the recent years telemedicine (TM) has been actively integrated into daily life, and its growth was especially significant during COVID-19 pandemic. However, its economic component has its own specificities depending on the health financing system. The aim of this article is to analyze reasons of economical inefficiency of TM technologies in different health financing systems and to determine its further development path in economic terms. Results. It’s not justified to expect cost reduction of health care after integrating TM technologies into medical practice. In private health-care system TM technologies in the form of TM consultation aren’t cost-effective for beneficiaries. Representatives of private clinics use TM as a part of lead generation. From private clinics’ point of view, it’s cost-effective to use distant monitoring technologies integrated into programs of patients’ management. It’s economically appropriate to apply all varieties of TM including TM consultation on the voluntary health insurance (VHC) system. However, due to the low prevalence of VHC in Russia we can’t expect significant growth of TM in Russia based on using this sector. Conclusions. TM technologies require financing in its formative stage, implementation, development and further functioning phases.

For Profit Enterprise in Health Care: Can it Contribute to Health Reform?

2010 ◽  
Vol 36 (2-3) ◽  
pp. 405-435 ◽  
Author(s):  
Eleanor D. Kinney
Keyword(s):  
Health Care ◽  
Health Reform ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
American People ◽  
Health Coverage ◽  
Public Programs ◽  
For Profit ◽  
New Treatments

Since the demise of the last major health reform initiative in 1994, health coverage for the American people has deteriorated. Private insurance costs have risen, and coverage under private insurance became less comprehensive, with higher deductibles and copayments. Many new treatments for serious diseases and associated provider compensation have become more and more unaffordable, even for those with health insurance coverage. Recent reports document the challenges for cancer patients faced with the soaring cost of cancer treatment. Public programs, such as Medicare and Medicaid, have picked up some slack and have grown in numbers. But gaps remain. Approximately 16 percent of the U.S. population is uninsured. Annual U.S. spending for health care was $2 trillion in 2005, and is estimated to reach $4 trillion by 2015.

Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Health Care System ◽  
Gulf Coast ◽  
New Technology ◽  
Cost Effective ◽  
Veterans Health ◽  
Potential Benefits ◽  
Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

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