The effects of managed care on the quality of dental hygiene care.

PURPOSE: This study examined whether patients insured by a managed dental care plan receive lower quality dental hygiene care than those not enrolled in a managed dental care plan. METHODS: Questionnaire data were gathered from 193 dental hygienists in the Chicago, Illinois area. Managed care was measured by a questionnaire item that assessed the proportion of managed care patients treated by the subject; quality of dental hygiene care was measured by items that assessed the extent to which the subject performed each of 23 dental hygiene tasks. RESULTS: A factor analysis of the 23 items assessing the quality of dental hygiene care indicated four meaningful factors named: periodontal procedures, appointment time, visual examinations, and oral examinations. Measures based on these factors were the dependent variables in regression analysis that included managed care as the primary independent variable and demographic characteristics of the subjects and their practices as control variables. Managed care had a significant (p < .05) negative relationship with appointment time, but did not have a significant relationship with periodontal procedures, visual examinations, or oral examinations. CONCLUSION: This study suggests that managed dental care program patients may have inadequate appointment time with a dental hygienist, which may affect whether they receive important services, such as oral health education. Dental hygienists in managed-care environments should be certain they are making effective use of the scheduled appointment time and procedures to ensure managed-care patients receive adequate time for dental hygiene care.

Physician reimbursement reform and family physicians.

In the final hours of the 1989 session, Congress passed the Omnibus Budget Reconciliation Act (OBRA) of 1989, which included the most important change in physician reimbursement policy since the introduction of Medicare. The new payment system will base physician Medicare reimbursement on a fee schedule, establish uniform percentage limits on balance billing, and set targets for total Part B physician expenditures. Medicare payments to family physicians will increase substantially under the new system. This will enhance the status and attractiveness of the specialty. The new system will decrease physician autonomy in some respects, and it is not clear that it will successfully control spending. However, on balance it offers significant advantages for family physicians.

Managing health care costs: strategies available to small businesses.

Although health care costs continue to rise at an alarming rate, small businesses can take steps to help moderate these costs. First, business firms must restructure benefits so that needless surgery is eliminated and inpatient hospital care is minimized. Next, small firms should investigate the feasibility of partial self-insurance options such as risk pooling and purchasing preferred premium plans. Finally, small firms should investigate the cost savings that can be realized through the use of alternative health care delivery systems such as HMOs and PPOs. Today, competition is reshaping the health care industry by creating more options and rewarding efficiency. The prospect of steadily rising prices and more choices makes it essential that small employers become prudent purchasers of employee health benefits. For American businesses, the issue is crucial. Unless firms can control health care costs, they will have to keep boosting the prices of their goods and services and thus become less competitive in the global marketplace. In that event, many workers will face a prospect even more grim than rising medical premiums: losing their jobs.

Rural health, family practice, and area health education centers: a national study.

The National Area Health Education Center (AHEC) Program and the family practice specialty were both created around 1970, in part to help meet the health care needs of medically underserved populations. Because these two entities share the common goal of alleviating physician shortages in rural areas, a study was conducted to determine the nature and extent of their interaction. Questionnaires were mailed to all AHEC projects and all nonmilitary family practice residency programs. Response rates were 100% and 79%, respectively. Elective rural rotations (usually preceptorships) are offered by 135 (49%) residencies, but only 84 (31%) require them. Fourteen (64%) AHEC projects interact with family practice residencies; however, only 9% (15/167) of the programs in those states utilize AHEC resources. The authors conclude that additional rural rotations could be offered to family practice residents by taking advantage of under-utilized resources of the National AHEC Program.

Competitive reform and nonprice competition: implications for the hospital industry.

This article examines the current status of cost containment, the nature of health care competition, the characteristics of the market for medical services that influence competition, and the implications of these factors for the hospital industry.

Hospital planning: administrators create the future.

Hospital planning has evolved from a response to external regulation into an integrated part of management function. Planning offers distinct advantages to administrators who wish to enhance their facility in a time of constrained resources and increased competition. Planning failure is most frequently related to inadequate administrative support or failure to appreciate the need for change. As hospitals face an increasingly complex business environment, the need for planned change is likely to increase.

Characteristics of the frequent visitor to the industrial medical department and implications for health promotion.

The number of visits to an in-house industrial medical clinic, of absences in three categories, and of late arrivals found in 1,505 employees of an automobile assembly plant were compared with respect to the age, sex, race, department, and shift characteristics of the employees. Less than 16% of the work force was found to account for over 50% of the medical visits. Those 235 frequent visitors were found to have significantly more absences and more tardiness compared with the rest of the plant population. The frequent visitors who completed a health risk appraisal had significantly greater health risks compared with a responding sample of nonfrequent visitors.

Managed care and vertical integration: implications for the hospital industry.

Efforts to control health care costs are encouraging vertical integration in the health services industry. This restructuring is uniting the financing and delivery of health services into one organizational structure. Current trends in health insurance suggest that the principal insurance products of vertically integrated systems will be carefully managed to reduce unnecessary utilization. As integrated health systems come to dominate the markets of health insurance and medical services, the hospital industry will be dramatically affected. Hospitals will be the principal cost centers while insurance products will be the principal sources of revenue in integrated systems. Accordingly, management will face incentives to minimize hospital utilization and sell or convert excess hospital assets. This article discusses specific changes that hospitals may face if current trends continue.

Financing reform and structural change in the health services industry.

This paper reviews the major trends in financing reform, emphasizing their impact on those characteristics of the market for health services that economists have viewed as monopolistic, and discusses the implications of structural change for the allied health professions. Hopefully, by understanding the fundamental forces of change and responding to uncertainty with flexibility and imagination, the allied health professions can capitalize on the opportunities afforded by structural change. Overall, these trends should result in the long-term outlook for use of allied health services to increase at an average annual rate of 9% to 10%. Allied health professionals may also witness an increase in independent practice opportunities. Finally, redistribution of jobs will likely occur in favor of outpatient facilities, home health agencies, and nontraditional settings. This in turn will have an impact on allied health education, which will need to adapt to these types of reforms.

The economic transformation of American health insurance: implications for the hospital industry.

The economics of cost containment, growing competition, and the introduction of new technology are forcing major changes on the health insurance industry. This transformation will impact the hospital industry in significant ways, hastening its evolution from a cottage industry to a modern corporate structure.

Smoking behavior and the tobacco crop.

The purpose of the study was to measure the influence of the physical and economic presence of the tobacco crop on the smoking behavior and related attitudes of adolescents in tobacco raising regions. A stratified random sample of all grades five-12 from the schools in four Kentucky counties yielded a sample size of 1,322 students. A variable called Tobacco Crop Intensity (TCI), based on pounds of tobacco sold per population and land area, was defined. It was determined that the counties were polarized on this variable; two counties have a much more significant crop. Students from the pairs of counties were surveyed and compared. Results indicate that young people living in the counties with high intensity tobacco production or whose parents grow tobacco were twice as likely to smoke cigarettes; some of their attitudes and beliefs indicate a greater predisposition to cigarette smoking. Implications for government agricultural and educational policy are discussed.

A comparison of smoking related attitudes and behaviors among Kentucky public school children whose families are and are not involved in tobacco production.

School health education has an important role to play in discouraging teenage smoking. However, it is likely that government, the general public and students themselves will be less favorable toward smoking education in major tobacco-producing states. To determine whether students whose families are involved in tobacco production hold more favorable attitudes toward smoking and smoke more than children whose families are not involved, 1,322 Kentucky public school students in grades five-12 were surveyed regarding smoking attitudes and behavior. Twenty-one percent (276) of the students reported that their families were involved in tobacco production. Tobacco family students held more favorable attitudes toward smoking and a larger percentage of these children smoked and smoked more than their nontobacco family peers. These differences were statistically significant at the 0.05 level. Tobacco family children appear to be at high risk for smoking-related disease and may prove resistant to some antismoking messages. Developing effective smoking education programs in major tobacco states in an important challenge for school health education.