Managed care in workers' compensation plans.

Workers' compensation plans have lagged behind most public and private health care plans in the adoption of managed care techniques. This is largely attributable to the underlying differences between workers' compensation and group health plans. Managed care techniques were developed within group health plans with the objective of health at the lowest cost. In workers' compensation, managed care must address a different objective-restoring a worker to health and productivity at the lowest cost. It is this fundamental difference that makes the application of managed care techniques to workers' compensation plans contentious and at times inappropriate. Research on the impact of managed care on the health and welfare of injured workers is sparse, and important questions remain about the appropriateness of care delivered under workers' compensation managed care plans. In this paper, we discuss the application of managed care to workers' compensation, and highlight the barriers to effective implementation.

Effect of different recruitment sources on the composition of a bipolar disorder case registry.

BACKGROUND: Conducting research on low-prevalence conditions presents an ongoing challenge for clinical and services researchers. Recruitment through health professionals versus other forms of self-referral may affect study group composition. METHODS: We compared members of a voluntary case registry for bipolar disorder who were recruited through a variety of sources including health professionals, support groups, an Internet website, and mailings, brochures, and other general public relations activities. We also compared the cost of recruitment methods. We hypothesized that self-referred registry members would be of higher socioeconomic status and less likely to be in treatment compared to members recruited through health professionals. RESULTS: Registrants referred through the Internet and patient support groups were better educated and more likely to be married than other registrants. However, Internet registrants were younger, had fewer lifetime hospitalizations and were more likely to be working. Nearly all registrants were in treatment with a psychiatrist. Local registrants were predominantly recruited through health professionals and public presentations. Registrants outside of the local region most often learned about the registry from patient support groups and the Internet. Local registrants were less likely to be using non-lithium mood stabilizers. Recruitment through public relations efforts was the most expensive method of recruitment, and the Internet website was the cheapest. CONCLUSIONS: Diverse recruitment methods can expand the population available for clinical trials. For services research, the Internet and patient support groups are less expensive ways to identify persons served in diverse settings and health plans, but these recruitment methods yield a sample that is better educated than the remainder of the population. It remains a difficult task to identify minorities and persons not in treatment.

Employer-sponsored health insurance: are employers good agents for their employees?

Employers in the United States provide many welfare-type benefits, such as life insurance, disability insurance, health insurance, and pensions, to their employees. Employers can be viewed as performing an agency role in purchasing pension, health, and other welfare benefits for their employees. An exploration of their competence in this role as agents for their employees indicates that large employers are very helpful to their employees in this arena. They seem to contribute to individual employees' welfare by providing them with valued services in purchasing health insurance.

Benefit limits in managed behavioral health care: do they matter?

More than half of Americans with insurance coverage for mental health services are enrolled in plans that carve out behavioral health care services with a vendor specializing in the management of these services. However, utilization management has not taken the place of benefit limitations. Do benefit limits matter? This article reports the percentage of enrollees in managed behavioral health care carve-out plans that encounter benefit limits. Estimates are provided on the impact and savings of imposing benefit limits on enrollees in unrestricted plans. Costs to eliminate benefit limits are estimated to be very small. This study finds that benefit limits do matter but only to a very small number of plan enrollees. Furthermore, the results of this study show that for inpatient limits, children are especially vulnerable. These issues have important implications for discussions about the impact of managed care in mental health and for discussions concerning parity legislation.

Evaluating welfare losses in the health care market.

According to traditional welfare analysis, consumers facing a price increase forego consumption of the least valued units of a commodity. Studies, such as the Rand HIE, show that patients decrease their consumption of all types of health care when faced with a price increase for health care. From this observation, Thomas Rice (1992) concludes that traditional welfare analysis is inadequate for evaluating insurance-related welfare losses in health care. In this note, I argue that it is not traditional welfare analysis which is inadequate, but the method of assigning marginal valuations to units of health care.

A new technique for interpreting the BAER in cochlear disease.

We found, by studying 20 normal ears and 34 ears with cochlear disease, that the brainstem auditory evoked response (BAER) wave I latency was a good predictor of the I-V interval (r = -0.67, p less than 0.001), whereas hearing loss had little predictive value. The normal and hearing-loss groups generated regression lines (wave I latency vs I-V latency) that did not differ significantly from each other. A normal range of I-V intervals can be established for any wave I latency, increasing the sensitivity of the BAER.