Prepaid Health Care Plan Research Articles

Commentary

BirthVolume 16, Issue 3 p. 108-108 Free Access Commentary Diana Pettiti M.D., M.P.H., Diana Pettiti M.D., M.P.H. Diana Pettiti is Associate Professor of Community Medicine and Epidemiology, University of California at San Francisco.Search for more papers by this author Diana Pettiti M.D., M.P.H., Diana Pettiti M.D., M.P.H. Diana Pettiti is Associate Professor of Community Medicine and Epidemiology, University of California at San Francisco.Search for more papers by this author First published: September 1989 https://doi.org/10.1111/j.1523-536X.1989.tb00877.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Norbeck JS, Tilden VP. Life stress, social support, and emotional disequilibrium in complications of pregnancy: A prospective, multivariate study. J Health and Social Behavior 1983; 24: 30– 46. 2 Berkowitz GS, Kasl SV. The role of psychosocial factors in spontaneous preterm delivery. J Psychosom Res 1983; 27: 283– 289. 3 Eisner V, Brazie JV, Pratt MW, Hexter AC. The risk of low birthweight. Am J Public Health 1979; 69: 887– 893. 4 Greenberg RS. The impact of prenatal care in different social groups. Am J Obstet Gynecol 1983; 145: 797– 801. 5 Murray JI, Bernfield M. The differential effect of prenatal care on the incidence of low birth weight among blacks and whites in a prepaid health care plan. N Engl J Med 1988; 319: 1385– 1391. Citing Literature Volume16, Issue3September 1989Pages 108-108 ReferencesRelatedInformation

The differential effect of prenatal care on the incidence of low birth weight among blacks and whites in a prepaid health care plan.

Black infants are born with low birth weights (less than 2500 g) and very low birth weights (less than 1500 g) at twice the rate of white infants. We investigated the effect of prenatal care delivered in a health maintenance organization on the birth weights of black and white infants at normal risk for low birth weight. Using birth certificates for all children born in 1978 in the California Kaiser-Permanente hospitals, we studied data on more than 31,000 black and white newborns whose mothers' ages and levels of education were comparable. The data show that black mothers used prenatal care less extensively and had a higher incidence of infants with low birth weights (8.4 vs. 3.6 percent) and very low birth weights (2.0 vs. 0.7 percent) than white mothers. The difference in the use of prenatal care, however, accounted for less than 15 percent of the difference in the incidence of low birth weight. The rates of low birth weight, very low birth weight, and preterm birth (less than 260 days' gestation) decreased with increasing levels of prenatal care for both blacks and whites. However, increasing levels of care were associated with a greater reduction among black infants than among white infants in low birth weight, very low birth weight, and low birth weight at term (greater than or equal to 260 days' gestation). When we compared mothers who received adequate care with those who received inadequate care, the relative risk of giving birth to a very-low-birth-weight infant was reduced 3.6-fold (95 percent confidence interval, 2.0 to 6.6) for black mothers and 2.1-fold (confidence interval, 1.3 to 3.4) for white mothers; the relative risk of giving birth to a low-birth-weight infant at term was reduced 3.4-fold (95 percent confidence interval, 2.2 to 5.4) for black mothers and 1.6-fold (confidence interval, 1.1 to 2.3) for white mothers. We conclude that even in a population of women at low risk for giving birth to low-birth-weight infants, prenatal care is more beneficial for blacks than for whites.

Effect of prepaid health plans on a family practice residency.

The rapid growth of prepaid health care plans imposes clinical, financial, and educational changes on residency programs. In the study reported here, the authors examined some perceived and actual effects of such plans on a family medicine center associated with a family medicine residency training program. In the study, 37 residents and 19 faculty members completed a 5-point, 16-item survey covering the effect of the prepaid plans used at the center on the program's practice profile, cost-containment efforts, and education activities over a three-year period. Overall, the respondents agreed with the need for cost containment that accompanied participation in the prepaid plan and agreed that prepaid plans increased the number of patient visits and visits by family members. The residents and faculty members agreed that prepaid patients were more demanding and were seen more often for minor or inappropriate problems. Regarding the educational impact of the prepaid plans, the respondents agreed that they improved their clinical decision-making, and no significant concern regarding limitation of laboratory or consultations was noted. Some of the respondents' perceptions were corroborated by findings in the clinic data base that showed increased numbers of patient visits, more visits by members of the same family, and no significant change in outpatient consultation rates.

Non-contraceptive estrogen use and the risk of gallstone disease in women.

We interviewed 102 women, ages 41-74 years who underwent gallstone surgery between January 1979 and September 1980, and 98 controls selected from the membership files of a large prepaid health care plan in Western Washington, about their past use of certain medications, reproductive history, and physical and demographic characteristics. The risk of gallstone disease among women who used estrogens for at least one year prior to diagnosis of their condition, relative to that of other women, was 1.18 (95% CI: 0.65-2.13). Standardization for the effects of age, race, obesity, parity, thiazide use, and history of high blood pressure did not alter appreciably the estimate of relative risk. Among estrogen users, the duration of use was similar in cases and controls. Our findings suggest that if non-contraceptive estrogen use is a risk factor for gallstone disease (requiring surgery) in women, its effect is very small.

Multiphasic Health Checkup Evaluation: A 16-year follow-up

The Multiphasic Health Checkup Evaluation Study, a long-term clinical trial, has been completed. A study group of 5156 men and women age 35–54 at entry was urged to have annual multiphasic health checkups (MHCs) for 16 years. A control group of 5557 comparable subjects was not so urged but was followed up in a comparable fashion. The mean and median number of MHCs per person were 6.8 and 6, respectively, in the study group and 2.8 and 1, respectively, in the control group. During 16 years the study group experienced a 30% reduction ( p < 0.05) in deaths from pre-specified “potentially postponable” causes, largely associated with lower death rates from colorectal cancer and hypertension. This reduction was most pronounced in the early years of the study. The two groups did not differ to a statistically significant degree in mortality from all other causes (84% of total mortality) or in total mortality. There was no difference in self-reported disability in the overall groups. In the setting of our prepaid health care plan where MHCs were already available on a voluntary basis, a program of urging middle-aged persons to undergo regular MHCs brought about a substantial reduction in mortality from preselected diseases.

Undergraduate medical education in prepaid health care plan settings.

The authors in this article focus on prepaid health care plan (PHCP) involvement in undergraduate medical education and report the results of two surveys undertaken to determine the extent of such involvement. Additionally, the authors provide a review of published studies that have examined the costs of such training. The survey findings show that current use of PHCPs for educational purposes is distributed throughout all four years of undergraduate medical education and is apparently on the rise. In addition to 26 medical schools reporting formal educational arrangements with health maintenance organizations, 35 other schools indicated that they either planned or were seriously considering such arrangements with PHCPs had ongoing ad hoc arrangements with PHCPs, or attributed their lack of an arrangement to an absence of appropriate opportunities rather than to any conceptual reservations. Three studies represented the extent of the published research that could be identified on the costs of formal undergraduate clinical training in PHCPs. Serious inconsistencies in the methodologies employed in those studies resulted in widely varying and even contradictory findings.

The competitive approach to health care reform: implications for hospital management

A successful competitive approach to health care reform based on the development of prepaid health care plans could affect hospital management. From hospital management's point of view, affiliations with health care plans have advantages and disadvantages. Since hospitals cannot remain unaffected by health care plan development in their market areas, they must choose their affiliations to be consistent with their own institutional objectives.

Prepaid pediatric health care in a university teaching hospital: A working model for pediatric education and health care delivery

To provide a working model for the teaching and improved delivery of pediatric health care in a university teaching hospital, a pilot comprehensive prepaid health care plan was developed. House staff and fellows functioned as primary physicians to their own panel of patients. Enrollment, utilization, financial experience, and consumer satisfaction were examined in the context of the plan's educational function and its location in a university hospital. Low initial enrollment with adverse selection, high illness and specialty referral rates, low hospitalization rates, and high consumer satisfaction were found. Educational benefits identified by trainees dealt with the opportunities to learn to handle common pediatric problems, to learn about normal growth and development through longitudinal patient observation, and to receive feedback about their professional roles through continuing physician-parent and child contact.

Toward automated health services

The fragmented and disorganized nature of health care programs and services acts to impede the acceptance of the technological developments and modern business practices needed to provide comprehensive health services of high quality for every person. A national system in the U.S. to provide for a coherent and comprehensive program of medical research, development, and health care services is described as operated under the structure of a Health Maintenance Corporation. Financial support for technological developments would be provided by a National Health Insurance program and health services would be provided by a national network of group practice prepaid health care plans. The administrative, organizational, and operational arrangements of other public and private services are related to the needs of a modern health care system to suggest how to adopt and exploit technologies from those sectors.