Recombinant human erythropoietin in the treatment of myelodysplastic syndromes--response patterns.

Different response patterns to recombinant human erythropoietin (rHuEpo) administration to anemic patients with myelodysplastic syndromes (MDS) are described. The biology of rHuEpo effect on erythropoiesis in patients with MDS has not been elucidated. However, until more biological information is obtained, it could be prudent to consider these response patterns as guidelines in the treatment of MDS. In the small but interesting series of nine patients with MDS only one responded to rHuEpo within the treatment period of eight weeks. Two additional patients continued the treatment on their own, and after 16 weeks a response was noted for the first time. A third patient was treated for only six weeks and a delayed response was recorded while off treatment for ten weeks. This response was also recorded 16 weeks from treatment initiation-as in the other two patients. A fourth patient with MDS developed transfusion related hemosiderosis and during iron chelation therapy the RBC transfusion rate dropped to a rate lower than the rate needed before the rHuEpo treatment. It is emphasized that in non responders, non-routine approaches should be considered.

Workers Compensation cases with traumatic brain injury: an insurance carrier's analysis of care, costs, and outcomes.

The purpose of this survey was to review the medical care, medical costs, and outcomes of 86 Workers Compensation cases involving traumatic brain injury. An analysis of ICD-9 diagnoses, Rancho Los Amigos Cognitive Levels, age, sex, accident description, management techniques, costs, outcomes, and many other factors was conducted. The total indemnity (wage loss) and medical payments amounted to $27.1 million. For example, one case with temporal lobe hematoma, due to a fall in 1972, has had $1.1 million in medical payments since the injury occurred. The current average age is 40 years with 71% still residing at home. Only 10% are currently employed and 40% are known to be receiving other benefits. The increasing frequency and severity of these cases, as well as the extension of survival due to improved care and technology, highlight the need to address the question, "Who will be the caretakers, and what will be the associated costs?" Actuarial projections into the 21st century are given. It is concluded that, while further long-term studies are needed, Workers Compensation carrier representatives and health care providers must continue to work together on the interdisciplinary rehabilitation team.

Insurance reimbursement mechanisms for rehabilitation equipment and environmental modifications.

Third party payment mechanisms are reviewed from the viewpoint of one commercial insurer. Attention is focused upon insurance coverage for rehabilitation equipment, environmental modifications, orthotics, prosthetics, and durable medical equipment. Numerous variables influence coverage decisions. Typical examples, unique in rehabilitation literature, illustrate situations related to the major types of insurance (Group Health, Miscellaneous Lines, Workers' Compensation, and Reinsurance). The importance of the rights of disabled persons and the impact of national financial estimates are discussed. Consideration is given to several approaches which might improve the benefits available. Techniques to cope with the system include prompt communication, accurate correspondence, and employer policyholder awareness.

Rehabilitation issues from an insurer's viewpoint: past, present, future.

Insurance is a contractual agreement by which one party agrees to compensate another for losses stipulated within the agreement. Coverage for services depends upon the specific contact in force. This presentation reviews the historical basis for third-party payment mechanisms from the perspective of an insurer. Current practices and problems related to the many facets of Health Care Insurance deserve emphasis. With certain fundamentals in mind, it may be easier to analyze trends. The need for quality and other controls impacts significantly upon the providers of services, those who utilize rehabilitation resources, society in general, and the fiscal reimbursement system.

The handicapped driver: an insurer's point of view.

This paper reviews the approach used by one automobile insurer to underwrite and to medically evaluate a handicapped driver. Significant factors which must be carefully developed for each application for automobile insurance are discussed. In the final analysis. The extent of any physical or mental impairment must be considered along with information verifying the capability of the handicapped person to safely operate an automobile. Cooperation in research programs among many disciplines, namely, state motor vehicle bureaus, insurers, product manufacturers, health professionals and driver educators as well as handicapped drivers, is clearly indicated.

Cancer and malpractice claims.

An analysis of 36 closed malpractice claims related to the diagnosis of cancer was conducted at a time when both subjects are receiving particular attention. Awareness of cancer statistics and the medicolegal literature is necessary. Factors related to the allegation of delay as well as the psychological aspects of cancer are presented. Suggestions for claims prevention have been delineated.