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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 2000年第5期131卷 597-605页

作者： Dennison, JB Straffon, LH Smith, RC Univ Michigan Sch Dent Dept Cariol Restorat Sci & Endodont Ann Arbor MI 48109 USA Univ Michigan Sch Dent Dept Orthodont & Pediat Dent Ann Arbor MI 48109 USA Delta Dent Plan Michigan Lansing MI USA

Background, The authors analyzed an insurance claim database to evaluate the use and effectiveness of placing sealants on first and second permanent molars of children in private dental practices. Methods. A retrospective study was conducted using an insured population with sealant coverage at 70 percent of the usual fee in a preferred provider organization plan that limited reapplication to once every three years. Children were selected who were eligible for sealant benefits from July 1, 1990, to June 30, 1991. Two groups were selected for analysis;based on age, as determined by permanent molar eruption dates. Children who received sealants were compared with those who did not to determine post-sealant restorative outcomes after five years. Results, During the full year of coverage, sealants were used in only 16.3 percent of first permanent molars and 11.6 percent of second permanent molars. The five-year incidence of an occlusal restoration having been placed was 13.7 percent and 20.8 percent, respectively, on nonsealed first and second molars and 6.5 percent and 10.4 percent, respectively, on sealed first and second molars. From years three to five, sealant placement provided only nominal additional preventive effect. Conclusions, In the population selected, both the incidence of occlusal caries and the use of sealants were lower than expected for both age groups. However, within these groups, molar occlusal surfaces were only half as likely to have been restored in sealed teeth than in nonsealed teeth after five years. Clinical Implications. Based on the live-year data from a population with a low incidence of caries, the authors found that 15 sealed first permanent molars or 10 sealed second permanent molars prevented placement of one occlusal.. restoration. Therefore, sealants are more effective when placed in patients with risk factors for occlusal caries.

关键词：龋齿/预防和控制牙列恒按诊疗收费计划/统计学和数值数据保险索赔审核/统计学和数值数据保险牙科/统计学和数值数据密执安磨牙窝沟封闭剂/治疗应用回顾性研究时间因素青少年儿童儿童学龄前人类

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Dental services: Use, expenditures and sources of payment, 1987

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第4期130卷 500-508页

作者： Manski, RJ Moeller, JF Maas, WR Univ Maryland Sch Dent Dept Oral Hlth Care Delivery Baltimore MD 21201 USA

Background This article pro rides per capita estimates of dental care utilization, expenditures mix of services and sources of payment for each of several socioeconomic and demographic categories. Methods. The focus of the analyses presented here is on dental cafe utilization by the U.S, population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. Results. During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. Conclusions. These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. Practice Implications. Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses. practitioners will be better positioned to meet the dental needs of all Americans.

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Survival and treatment for colorectal cancer medicare patients in two group staff health maintenance organizations and the fee-for-service setting

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MEDICAL CARE RESEARCH AND REVIEW 1999年第2期56卷 177-196页

作者： Merrill, RM Brown, ML Potosky, AL Riley, G Taplin, SH Barlow, W Fireman, BH Brigham Young Univ Provo UT 84602 USA NCI Bethesda MD 20892 USA US Hlth Care Financing Adm Baltimore MD 21207 USA

The current study compares treatment use and long-term survival in colorectal cancer patients between Medicare beneficiaries enrolled in two large prepaid group/study health maintenance organizations (HMOs) and the fee-for-service (FFS) setting. The study is based on 15,352 colorectal cancer cases diagnosed between 1985 and 1992 and followed through 1995. Survival differences between the HMO and FFS cases were assessed using Cox regression. Treatment differences were evaluated using logistic regression. HMO cases had a lower overall mortality than did FFS cases but not a significantly lower colorectal cancer-specific mortality. Use of surgical resection was similar between HMO and FFS cases. However, rectal cancer cases in the HMOs were more likely to receive postsurgical radiation therapy than FFS cases. Superior overall survival in the HMOs may be the result of increased colorectal cancer screening, greater use of adjuvant therapies, and selection of healthier individuals.

关键词：队列研究结直肠肿瘤/死亡率结直肠肿瘤/治疗数据说明统计按诊疗收费计划/统计学和数值数据联合开业预付费/统计学和数值数据健康维护组织/统计学和数值数据卫生服务研究保险选择偏倚 Logistic模型 Medicare 医师诊疗模式/统计学和数值数据卫生保健质量旧金山/流行病学存活率分析美国华盛顿/流行病学老年人女(雌)性人类男(雄)性

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Involuntary health plan switching: Case study of a corporate health benefits program

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MEDICAL CARE RESEARCH AND REVIEW 1996年第2期53卷 225-239页

作者： Robinson, JC Gardner, LB UNIV CALIF BERKELEY BERKELEYCA 94720 USA

This study examined the extent of health plan switching in one large corporation due to changes in employment, compared it with the extent of voluntary switching among continuously employed individuals, and evaluated the risk mix of health plan stayers, voluntary switchers, and involuntary switchers. Of 14,791 workers enrolled in the firm's fee-for-service plan in 1987, only 5,320 remained in 1990. Of the 11,494 employees enrolled in the large health maintenance organization (HMO) and the 7,677 enrolled in the small HMOs in 1987, only 5,299 and 3,026, respectively, remained in their HMOs and insured by the firm in 1990. These large enrollment losses were offset by large enrollment gains from new employees. Health plan leavers were at a lower risk of using medical services than were health plan stayers. The lowest expected annual expenditures were among newly hired health plan joiners.

关键词：保险统计分析加利福尼亚用户参与/统计学和数值数据就业按诊疗收费计划/统计学和数值数据按诊疗收费计划/利用保健福利计划雇员/统计学和数值数据保健福利计划雇员/利用卫生经费支出健康维护组织/统计学和数值数据健康维护组织/利用工业模型统计学危险因素

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Vulnerable populations and health insurance

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MEDICAL CARE RESEARCH AND REVIEW 2000年第1期57卷 110-134页

作者： Shi, LY Johns Hopkins Univ Sch Publ Hlth & Hyg Dept Hlth Policy & Management Baltimore MD 21205 USA

This study provided a national profile of health insurance of certain vulnerable populations including children, racial/ethnic minorities, low-income families, non-metropolitan statistical area (MSA) residents, and those with poor health status. The study shows an increase in the proportion of uninsured nonelderly population. While public insurance helped reduce the employment- and health-related disparities in private coverage, it has not overcome other disparities related to vulnerable characteristics including race/ethnicity, wages, education, and area of residence. Comparison between health maintenance organization (HMO) and fee-for-service insurance indicates that younger although not much healthier people, racial/ethnic minorities, MSA residents, and those residing in the West and Northeast regions were more likely to have HMO coverage. To reduce significant disparities in health insurance coverage, policy makers will have to consider expanding public insurance coverage, targeting vulnerable groups, partiallarly those with multiple vulnerable characteristics rather than merely the economically distressed. Expecting managed care to achieve cost containment for services provided to vulnerable populations may be unrealistic.

关键词：费用控制按诊疗收费计划/统计学和数值数据卫生服务研究健康状况保险健康/统计学和数值数据 Logistic模型管理医疗规划/统计学和数值数据未参加医疗保险者/统计学和数值数据少数民族/统计学和数值数据模型经济计量学贫困/统计学和数值数据问卷调查美国青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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