ABSTRACT
This is a comparative analysis of California's "experiment" in Medi-Cal managed care. It compares managed care to fee-for-service in the area of quality. In March 1993, the California State Department of Health Services issued a State Strategic Plan for Medi-Cal Managed Care. The goal: to transfer the delivery of care for the majority of the state's Medi-Cal population from a predominantly fee-for-service payment system to capitated managed care. The state of California has steadily increased its commitment to the large-scale expansion of managed care within the Medi-Cal Program in order to improve beneficiaries' access to quality preventative and primary health care while acting as a prudent purchaser of services. This study examines one Local Initiative--Inland Empire Health Plan--created as a not-for-profit, joint powers, public entity by Riverside and San Bernardino counties, California.
Subject(s)
Fee-for-Service Plans/standards , Managed Care Programs/standards , Medicaid/organization & administration , Quality of Health Care , State Health Plans/standards , California , Case Management/standards , Credentialing/standards , Fee-for-Service Plans/economics , Health Education/standards , Health Services Accessibility/standards , Hospitals/standards , Insurance, Pharmaceutical Services/standards , Managed Care Programs/economics , Medicaid/standards , Preventive Health Services/standards , State Health Plans/economics , United StatesABSTRACT
In March 1992, a cluster of 89 persons with tuberculosis infection was identified in San Mateo County, California. Thirteen persons (15%), including 11 children, were diagnosed with active pulmonary tuberculosis. All contacts were African Americans who resided in or visited one of two houses used for crack cocaine smoking or dealing. The patient with the index case, a male infected with human immunodeficiency virus, contributed to the transmission of tuberculosis as a transient resident of several dwellings. Public health authorities applied unique intervention methods to control the outbreak, including the use of a mobile health van. Further innovative strategies will be necessary to meet the challenge of this reemerging disease.
Subject(s)
Contact Tracing/methods , Crack Cocaine , Disease Outbreaks/prevention & control , Mass Screening/methods , Population Surveillance , Substance-Related Disorders/complications , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/prevention & control , Adolescent , Adult , Aged , California/epidemiology , Child , Child, Preschool , Cluster Analysis , Disease Outbreaks/statistics & numerical data , Ill-Housed Persons , Humans , Male , Middle Aged , Mobile Health Units , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/etiologyABSTRACT
OBJECTIVES: Health departments that use passive surveillance alone cannot be sure of the level of complete and accurate reporting of acquired immunodeficiency syndrome (AIDS) cases. We sought to develop a model of active AIDS case reporting using limited county resources. METHODS: A validation study of AIDS case reporting using discharge diagnosis codes was undertaken to assess underreporting. Hospital-specific protocols for active surveillance were developed. RESULTS: The validation study revealed that 24% of AIDS cases in all hospitals were not reported through passive surveillance in 1990. In the first 3 months of 1991, active surveillance identified nine unreported cases (69% of the total cases reported) in one hospital. These underreporting estimates far exceed the 15% national underreporting rate estimated by the Centers for Disease Control. CONCLUSIONS: A method of hospital-based case finding was developed and serves as the model for implementing an ongoing program of active surveillance needed to ensure complete, accurate, and timely reporting of diagnosed AIDS cases. Application of this model may be helpful in attempts to minimize underreporting.
