Extending health maintenance organization insurance to the uninsured. A controlled measure of health care utilization.

OBJECTIVE: To investigate the utilization of health care services of previously uninsured low-income patients after becoming insured by a health maintenance organization (HMO). DESIGN: Retrospective study of utilization in a previously uninsured study group compared with an age- and sex-matched randomly selected control group of commercial HMO enrollees. SETTING: Group model HMO. PATIENTS: A study group of 346 previously uninsured low-income patients and 382 controls. MEASURES: utpatient visits for primary and specialty care, outpatient pharmacy, laboratory, and radiology use, and inpatient admissions and hospital days over a 2-year period. Self-reported health status measures were obtained to control for differences in health status. PRINCIPAL FINDINGS: There were no differences between the study and control groups in hospital admissions, hospital days, and measures of outpatient laboratory, pharmacy, and radiology use. The odds of having an outpatient visit per patient per month was 30% higher for the study group. Approximately half the increase in the odds ratio for outpatient visits was related to the worse self-perceived health status of the study group. While both groups utilized more services in the early phase of their enrollment, the intensity of this start-up effect was similar for both groups. CONCLUSIONS: Compared with a commercial group of the same age and sex, the patterns of utilization were similar and the financial costs of care were only moderately more for a previously uninsured group provided with comprehensive HMO insurance. With the growth of managed care, these data should be beneficial in the development of health care programs for the growing number of uninsured Americans.

Should nurses in Israeli primary care clinics be expected to manage streptococcal throat infections?

INTRODUCTION: Legal regulations in Israel allow nurses to perform only limited clinical procedures. OBJECTIVE: To determine the probability of streptococcal infection in adults with sore throat, as assessed clinically by standard nursing procedures. DESIGN: Using throat culture as the standard, the contribution of various clinical findings (fever, exudate, erythrocyte sedimentation rate (ESR), white blood count) to the determination of the diagnosis of streptococcal infection was assessed, using logistic regression analysis. SETTING: Israeli general practice. PATIENTS: 100 consecutive adult patients presenting with a red, sore throat. RESULTS: Six patients showed the full clinical picture of exudate, increased ESR and leukocytosis, with an 82% probability of streptococcal infection. Forty-nine patients showed none of these three findings, and only one of them (among the three patients with rhinitis) had a positive throat swab. Forty-five patients showed an intermediate clinical picture which did not provide a reliable basis for the diagnosis or exclusion of streptococcal infection. Fever alone did not significantly (P < 0.05) predict streptococcal infection. CONCLUSIONS: Nurses may safely discharge adult patients with a red, sore throat without antibiotic treatment only if they have no additional signs or symptoms. The few patients with all the clinical findings may be treated with antibiotics without a throat swab. All other patients should be referred for examination by a doctor.

[Oral contraceptive lowers serum magnesium].

The effect of an oral contraceptive on serum magnesium was assessed in a group of 32 women, mean age 24.2 years, attending a family planning clinic. The pill contained ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg. As in pregnancy and during estrogen replacement in postmenopausal women, the contraceptive pill lowered serum magnesium (from a mean of 0.82 mmol/l, to 0.61 mmol/l in 6 months). Larger studies may determine whether routine dietary magnesium supplementation is necessary in oral contraception.

Polymyalgia rheumatica and temporal arteritis in a married couple.

A husband suffering from temporal arteritis and his wife afflicted with polymyalgia rheumatica are reported. The possibility of the existence of an environmental factor rather than a genetic etiology is discussed.