WorldWideScience

Sample records for state payer mandates

  1. Effects of state contraceptive insurance mandates.

    Science.gov (United States)

    Dills, Angela K; Grecu, Anca M

    2017-02-01

    Using U.S. Natality data for 1996 through 2009 and an event analysis specification, we investigate the dynamics of the effects of state insurance contraceptive mandates on births and measures of parental investment: prenatal visits, non-marital childbearing, and risky behaviors during pregnancy. We analyze outcomes separately by age, race, and ethnicity. Among young Hispanic women, we find a 4% decline in the birth rate. There is evidence of a decrease in births to single mothers, consistent with increased wantedness. We also find evidence of selection into motherhood, which could explain the lack of a significant effect on birth outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. State Mandated Benefits and Employer Provided Health Insurance

    OpenAIRE

    Jonathan Gruber

    1992-01-01

    One popular explanation for this low rate of employee coverage is the presence of numerous state regulations which mandate that group health insurance plans must include certain benefits. By raising the minimum costs of providing any health insurance coverage, these mandated benefits make it impossible for firms which would have desired to offer minimal health insurance at a low cost to do so. I use data on insurance coverage among employees in small firms to investigate whether this problem ...

  3. Assessing Early Implementation of State Autism Insurance Mandates

    Science.gov (United States)

    Baller, Julia Berlin; Barry, Colleen L.; Shea, Kathleen; Walker, Megan M.; Ouellette, Rachel; Mandell, David S.

    2016-01-01

    In the United States, health insurance coverage for autism spectrum disorder treatments has been historically limited. In response, as of 2015, 40 states and Washington, DC, have passed state autism insurance mandates requiring many health plans in the private insurance market to cover autism diagnostic and treatment services. This study examined…

  4. The state of internal audit’s regulatory mandate

    Directory of Open Access Journals (Sweden)

    Christo Ackermann

    2016-08-01

    Full Text Available The importance of an effective internal audit function in South African municipalities have been recognised insofar as internal audit functions are legally mandated to exist within municipalities. This also means that legally, internal audit has certain mandates which must be fulfilled in order to add value to management and audit committees, and ultimately, to the board of directors. Even though internal audit is sanctioned by this important legal mandate, evidence shows that internal audit does not always fulfil this mandate. This state of affairs has prompted a detailed review of the relevant laws and regulations governing the work of internal audit in South African municipalities in order to determine the extent to which key stakeholders find the regulatory work of internal audit useful in discharging their (stakeholders’ oversight responsibilities. Questionnaires were administered to audit committees. The results summarise the extent to which internal audit’s work assists audit committees in their oversight responsibilities as this ultimately affects the ability of audit committees to fulfil these responsibilities to the board of directors. The results indicate that audit committees are greatly dependent on internal audit as a provider of assurance on a variety of legally mandated variables. The results of this study can be used as a measure of best practice of the legally mandated duties performed by internal audit. It can also be used by other researchers in comparative studies and by practitioners to benchmark their work in order to better serve audit committees and ultimately, the board of directors

  5. Health Spending By State 1991-2014: Measuring Per Capita Spending By Payers And Programs.

    Science.gov (United States)

    Lassman, David; Sisko, Andrea M; Catlin, Aaron; Barron, Mary Carol; Benson, Joseph; Cuckler, Gigi A; Hartman, Micah; Martin, Anne B; Whittle, Lekha

    2017-07-01

    As the US health sector evolves and changes, it is informative to estimate and analyze health spending trends at the state level. These estimates, which provide information about consumption of health care by residents of a state, serve as a baseline for state and national-level policy discussions. This study examines per capita health spending by state of residence and per enrollee spending for the three largest payers (Medicare, Medicaid, and private health insurance) through 2014. Moreover, it discusses in detail the impacts of the Affordable Care Act implementation and the most recent economic recession and recovery on health spending at the state level. According to this analysis, these factors affected overall annual growth in state health spending and the payers and programs that paid for that care. They did not, however, substantially change state rankings based on per capita spending levels over the period. Project HOPE—The People-to-People Health Foundation, Inc.

  6. The Little State That Couldn't Could? The Politics of "Single-Payer" Health Coverage in Vermont.

    Science.gov (United States)

    Fox, Ashley M; Blanchet, Nathan J

    2015-06-01

    In May 2011, a year after the passage of the Affordable Care Act (ACA), Vermont became the first state to lay the groundwork for a single-payer health care system, known as Green Mountain Care. What can other states learn from the Vermont experience? This article summarizes the findings from interviews with nearly 120 stakeholders as part of a study to inform the design of the health reform legislation. Comparing Vermont's failed effort to adopt single-payer legislation in 1994 to present efforts, we find that Vermont faced similar challenges but greater opportunities in 2010 that enabled reform. A closely contested gubernatorial election and a progressive social movement opened a window of opportunity to advance legislation to design three comprehensive health reform options for legislative consideration. With a unified Democratic government under the leadership of a single-payer proponent, a high-profile policy proposal, and relatively weak opposition, a framework for a single-payer system was adopted by the legislature - though with many details and political battles to be fought in the future. Other states looking to reform their health systems more comprehensively than national reform can learn from Vermont's design and political strategy. Copyright © 2015 by Duke University Press.

  7. Payer and Pharmaceutical Manufacturer Considerations for Outcomes-Based Agreements in the United States.

    Science.gov (United States)

    Brown, Joshua D; Sheer, Rich; Pasquale, Margaret; Sudharshan, Lavanya; Axelsen, Kirsten; Subedi, Prasun; Wiederkehr, Daniel; Brownfield, Fred; Kamal-Bahl, Sachin

    2018-01-01

    Considerable interest exists among health care payers and pharmaceutical manufacturers in designing outcomes-based agreements (OBAs) for medications for which evidence on real-world effectiveness is limited at product launch. To build hypothetical OBA models in which both payer and manufacturer can benefit. Models were developed for a hypothetical hypercholesterolemia OBA, in which the OBA was assumed to increase market access for a newly marketed medication. Fixed inputs were drug and outcome event costs from the literature over a 1-year OBA period. Model estimates were developed using a range of inputs for medication effectiveness, medical cost offsets, and the treated population size. Positive or negative feedback to the manufacturer was incorporated on the basis of expectations of drug performance through changes in the reimbursement level. Model simulations demonstrated that parameters had the greatest impact on payer cost and manufacturer reimbursement. Models suggested that changes in the size of the population treated and drug effectiveness had the largest influence on reimbursement and costs. Despite sharing risk for potential product underperformance, manufacturer reimbursement increased relative to having no OBA, if the OBA improved market access for the new product. Although reduction in medical costs did not fully offset the cost of the medication, the payer could still save on net costs per patient relative to having no OBA by tying reimbursement to drug effectiveness. Pharmaceutical manufacturers and health care payers have demonstrated interest in OBAs, and under a certain set of assumptions both may benefit. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  8. Is State-Mandated Redesign an Effective and Sustainable Solution?

    Science.gov (United States)

    Young, Michelle D.

    2013-01-01

    There is a pervasive and ongoing perception that leadership preparation is a problem. Important questions remain about the intentions, capacity, and impact of state departments of education engaged in leadership preparation program redesign. In this essay, I take up several issues concerning this state policy work, including whether a one size…

  9. Myths and memes about single-payer health insurance in the United States: a rebuttal to conservative claims.

    Science.gov (United States)

    Geyman, John P

    2005-01-01

    Recent years have seen the rapid growth of private think tanks within the neoconservative movement that conduct "policy research" biased to their own agenda. This article provides an evidence-based rebuttal to a 2002 report by one such think tank, the Dallas-based National Center for Policy Analysis (NCPA), which was intended to discredit 20 alleged myths about single-payer national health insurance as a policy option for the United States. Eleven "myths" are rebutted under eight categories: access, cost containment, quality, efficiency, single-payer as solution, control of drug prices, ability to compete abroad (the "business case"), and public support for a single-payer system. Six memes (self-replicating ideas that are promulgated without regard to their merits) are identified in the NCPA report. Myths and memes should have no place in the national debate now underway over the future of a failing health care system, and need to be recognized as such and countered by experience and unbiased evidence.

  10. Failed State and the Mandate of Peacekeeping Operations

    OpenAIRE

    Eka Nizmi, Yusnarida

    2011-01-01

    By 1990, Somalia had become a good example of what was becoming known as a “failed state”- a people without a government strong enough to govern the country or represent it in International organizations; a country whose poverty, disorganization, refugee flows, political instability, and random warfare had the potential to spread across borders and threaten the stability of other states and the peace of the region.[1] At the end of the cold war there were several such failed states in Africa,...

  11. States Stepping up Mandates for School Safety Drills

    Science.gov (United States)

    Shah, Nirvi

    2013-01-01

    Hundreds of U.S. schools will supplement fire drills and tornado training next fall with simulations of school shootings. In response to the December shootings by an intruder at Sandy Hook Elementary School in Newtown, Connecticut, several states have enacted or are considering laws that require more and new types of school safety drills, more…

  12. Federally mandating motorcycle helmets in the United States.

    Science.gov (United States)

    Eltorai, Adam E M; Simon, Chad; Choi, Ariel; Hsia, Katie; Born, Christopher T; Daniels, Alan H

    2016-03-09

    Motorcycle helmets reduce both motorcycle-related fatalities and head injuries. Motorcycle crashes are a major public health concern which place economic stress on the U.S. healthcare system. Although statewide universal motorcycle helmet laws effectively increase helmet use, most state helmet laws do not require every motorcycle rider to wear a helmet. Herein, we propose and outline the solution of implementing federal motorcycle helmet law, while addressing potential counterarguments. The decision to ride a motorcycle without a helmet has consequences that affect more than just the motorcyclist. In an effort to prevent unnecessary healthcare costs, injuries, and deaths, public health efforts to increase helmet use through education and legislation should be strongly considered. Helmet use on motorcycles fits squarely within the purview of the federal government public health and economic considerations.

  13. The Financial Education Tool Kit: Helping Teachers Meet State- Mandated Personal Finance Requirements

    Science.gov (United States)

    St. Pierre, Eileen; Richert, Charlotte; Routh, Susan; Lockwood, Rachel; Simpson, Mickey

    2012-01-01

    States are recognizing the need for personal financial education and have begun requiring it as a condition for high school graduation. Responding to teacher requests to help them meet state-mandated financial education requirements, FCS educators in the Oklahoma Cooperative Extension Service developed a financial education tool kit. This article…

  14. The Relationship of State Funding of Education to Student Performance on State Mandated Assessments in South Dakota

    Science.gov (United States)

    Price, Joel Philip

    2012-01-01

    This study determined the relationship of state funding to student performance on state mandated assessments in South Dakota between the years of 2003-2009. A cohort group of 40 school districts between 200 ADM and 600 ADM who had not reorganized were selected. Data was collected using the Dakota STEP assessment portal on the South Dakota…

  15. Estimated Budget Impact of Adopting the Affordable Care Act's Required Smoking Cessation Coverage on United States Healthcare Payers.

    Science.gov (United States)

    Baker, Christine L; Ferrufino, Cheryl P; Bruno, Marianna; Kowal, Stacey

    2017-01-01

    Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice. This study presents current cessation patterns, real-world drug costs and plan benefit design data, and estimates the 1- to 5-year pharmacy budget impact of providing ACA-required coverage for smoking cessation products to understand the fiscal impact to a US healthcare plan. A closed cohort budget impact model was developed in Microsoft Excel ® to estimate current and projected costs for US payers (commercial, Medicare, Medicaid) covering smoking cessation medicines, with assumptions for coverage and smoking cessation product utilization based on current, real-world national and state-level trends for hypothetical commercial, Medicare, and Medicaid plans with 1 million covered lives. A Markov methodology with five health states captures quit attempt and relapse patterns. Results include the number of smokers attempting to quit, number of successful quitters, annual costs, and cost per-member per-month (PMPM). The projected PMPM cost of providing coverage for smoking cessation medications is $0.10 for commercial, $0.06 for Medicare, and $0.07 for Medicaid plans, reflecting a low incremental PMPM impact of covering two attempts ranging from $0.01 for Medicaid to $0.02 for commercial and Medicare payers. The projected PMPM impact of covering two quit attempts with access to all seven cessation medications at no patient cost share remains low. Results of this study reinforce that the impact of adopting the ACA requirements for smoking cessation coverage will have a limited near-term impact

  16. The Great Recession, insurance mandates, and the use of in vitro fertilization services in the United States.

    Science.gov (United States)

    Kiatpongsan, Sorapop; Huckman, Robert S; Hornstein, Mark D

    2015-02-01

    To investigate the relationship between economic activities, insurance mandates, and the use of in vitro fertilization (IVF) in the United States. We examined the correlation between the coincident index (a proxy for overall economic conditions) and IVF use at the national level from 2000 to 2011. We then analyzed the relationship at the state level through longitudinal regression models. The base model tested the correlation at the state level. Additional models examined whether this relationship was affected, both separately and jointly, by insurance mandates and the Great Recession. Not applicable. Not applicable. None. Direction and magnitude of the relationship between the coincident index and IVF use, and influences of insurance mandates and the Great Recession. The coincident index was positively correlated with IVF use at the national level (correlation coefficient = 0.89). At the state level, an increase of one unit in the coincident index was associated with an increase of 16 IVF cycles per 1 million women, with a significantly greater increase in IVF use in states with insurance mandates than in states without mandates (27 versus 15 IVF cycles per 1 million women). The Great Recession did not alter the relationship between the coincident index and IVF use. Our study demonstrates a positive relationship between the economy and IVF use, with greater magnitude in states with insurance mandates. This relationship was not affected by the Great Recession regardless of mandated insurance coverage. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  17. "Prefacing the Script" as an Ethical Response to State-Mandated Abortion Counseling.

    Science.gov (United States)

    Buchbinder, Mara; Lassiter, Dragana; Mercier, Rebecca; Bryant, Amy; Lyerly, Anne Drapkin

    Laws governing abortion provision are proliferating throughout the United States, yet little is known about how these laws affect providers. We investigated the experiences of abortion providers in North Carolina practicing under the 2011 Women's Right to Know Act, which mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. We focus here on a subset of the data to examine one strategy by which providers worked to minimize moral conflicts generated by the counseling procedure. Drawing on Erving Goffman's work on language and social interaction, we highlight how providers communicated moral objections and layered meanings through a practice that we call prefacing the script . We conducted semi-structured interviews with 31 physicians, nurses, physician assistants, and clinic managers who provide abortion care in North Carolina. Audio-recorded interviews were transcribed verbatim and analyzed using an inductive, iterative analytic approach, which included reading for context, interpretive memo-writing, and focused coding. Roughly half of the participants (14/31) reported that they or the clinicians who performed the counseling in their institution routinely prefaced the counseling script with qualifiers, disclaimers, and apologies that clarified their relationship to the state-mandated content. We identified three performative functions of this practice: 1) enacting a frame shift from a medical to a legal interaction, 2) distancing the speaker from the authorial voice of the counseling script, and 3) creating emotional alignment. Prefacing state-mandated abortion counseling scripts constitutes a practical strategy providers use to balance the obligation to comply with state law with personal and professional responsibilities to provide tailored care, emotional support, and serve the patient's best interests. Our findings suggest that language constitutes a powerful resource for navigating and

  18. “Prefacing the Script” as an Ethical Response to State-Mandated Abortion Counseling

    Science.gov (United States)

    Lassiter, Dragana; Mercier, Rebecca; Bryant, Amy; Lyerly, Anne Drapkin

    2016-01-01

    BACKGROUND Laws governing abortion provision are proliferating throughout the United States, yet little is known about how these laws affect providers. We investigated the experiences of abortion providers in North Carolina practicing under the 2011 Women’s Right to Know Act, which mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. We focus here on a subset of the data to examine one strategy by which providers worked to minimize moral conflicts generated by the counseling procedure. Drawing on Erving Goffman’s work on language and social interaction, we highlight how providers communicated moral objections and layered meanings through a practice that we call prefacing the script. METHODS We conducted semi-structured interviews with 31 physicians, nurses, physician assistants, and clinic managers who provide abortion care in North Carolina. Audio-recorded interviews were transcribed verbatim and analyzed using an inductive, iterative analytic approach, which included reading for context, interpretive memo-writing, and focused coding. RESULTS Roughly half of the participants (14/31) reported that they or the clinicians who performed the counseling in their institution routinely prefaced the counseling script with qualifiers, disclaimers, and apologies that clarified their relationship to the state-mandated content. We identified three performative functions of this practice: 1) enacting a frame shift from a medical to a legal interaction, 2) distancing the speaker from the authorial voice of the counseling script, and 3) creating emotional alignment. CONCLUSIONS Prefacing state-mandated abortion counseling scripts constitutes a practical strategy providers use to balance the obligation to comply with state law with personal and professional responsibilities to provide tailored care, emotional support, and serve the patient’s best interests. Our findings suggest that language constitutes a

  19. State-Mandated (Mis)Information and Women's Endorsement of Common Abortion Myths.

    Science.gov (United States)

    Berglas, Nancy F; Gould, Heather; Turok, David K; Sanders, Jessica N; Perrucci, Alissa C; Roberts, Sarah C M

    The extent that state-mandated informed consent scripts affect women's knowledge about abortion is unknown. We examine women's endorsement of common abortion myths before and after receiving state-mandated information that included accurate and inaccurate statements about abortion. In Utah, women presenting for an abortion information visit completed baseline surveys (n = 494) and follow-up interviews 3 weeks later (n = 309). Women answered five items about abortion risks, indicating which of two statements was closer to the truth (as established by prior research) or responding "don't know." We developed a continuous myth endorsement scale (range, 0-1) and, using multivariable regression models, examined predictors of myth endorsement at baseline and change in myth endorsement from baseline to follow-up. At baseline, many women reported not knowing about abortion risks (range, 36%-70% across myths). Women who were younger, non-White, and had previously given birth but not had a prior abortion reported higher myth endorsement at baseline. Overall, myth endorsement decreased after the information visit (0.37-0.31; p < .001). However, endorsement of the myth that was included in the state script-describing inaccurate risks of depression and anxiety-increased at follow-up (0.47-0.52; p < .05). Lack of knowledge about the effects of abortion is common. Knowledge of information that was accurately presented or not referenced in state-mandated scripts increased. In contrast, inaccurate information was associated with decreases in women's knowledge about abortion, violating accepted principles of informed consent. State policies that require or result in the provision of inaccurate information should be reconsidered. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  20. Hospital compliance with a state unfunded mandate: the case of California's Earthquake Safety Law.

    Science.gov (United States)

    McCue, Michael J; Thompson, Jon M

    2012-01-01

    Abstract In recent years, community hospitals have experienced heightened regulation with many unfunded mandates. The authors assessed the market, organizational, operational, and financial characteristics of general acute care hospitals in California that have a main acute care hospital building that is noncompliant with state requirements and at risk of major structural collapse from earthquakes. Using California hospital data from 2007 to 2009, and employing logistic regression analysis, the authors found that hospitals having buildings that are at the highest risk of collapse are located in larger population markets, possess smaller market share, have a higher percentage of Medicaid patients, and have less liquidity.

  1. Constraining Elementary Teachers' Work:Dilemmas and Paradoxes Created by State Mandated Testing

    Directory of Open Access Journals (Sweden)

    Sandra Mathison

    2003-09-01

    Full Text Available There are frequent reports of the challenges to teacher professionalism associated with high stakes and mandated testing (McNeil, 2000. So, we were not surprised in this year-long study of two elementary schools in upstate New York to hear teachers talk about the many ways the 4th grade tests in English Language Arts, Mathematics and Science undermine their ability to do their jobs with integrity. We came to understand in more nuanced ways the ongoing tension created by teachers' desires to be professionals, to act with integrity, and at the same time to give every child a chance to succeed. What we found in these schools is that the high stakes tests continually forced teachers to act in ways they did not think were professional and often resulted in creating instructional environments that teachers did not think were conducive to student success. The teachers at these elementary schools are not radicals. They do not seek complete autonomy, they do not eschew the need for accountability (even bureaucratic accountability, they find some virtue in state mandated tests, they are content within centralized systems that proscribe some aspects of their work. But, they also perceive themselves as professionals with both the responsibility and capability of doing their jobs well and in the best interests of their students. New York State's outcomes based bureaucratic accountability system tests their resolve, makes them angry or frustrated, and requires unnecessary compromises in their work.

  2. Billing third party payers for vaccines: state and local health department perspectives.

    Science.gov (United States)

    Quintanilla, Carlos; Duncan, Lorraine; Luther, Lydia

    2009-01-01

    The cost of adequately immunizing a child has risen steadily with recommendations of new, more expensive vaccines. The Vaccines for Children (VFC) program, a federal entitlement, has continued to fund all recommended vaccines for eligible children. The one other federal vaccine-funding source, Section 317 of the Public Health Service Act, has not kept pace with rising vaccine costs. For local health departments to immunize children not eligible for VFC, but whose families are underinsured or otherwise unable to pay for vaccines, state immunization programs have often relied on Section 317 funds. Recognizing this funding challenge and having learned that children covered by health insurance were being immunized in public clinics with publicly supplied vaccines, the Oregon Immunization Program (OIP) launched a project to expand billing of health plans by local health departments for vaccines administered to covered persons. This has resulted in significant savings of Section 317 funds, allowing the Oregon program to provide more vaccines for high-need persons.

  3. Improving coordinated responses for victims of intimate partner violence: law enforcement compliance with state-mandated intimate partner violence documentation.

    Science.gov (United States)

    Cerulli, Catherine; Edwardsen, Elizabeth A; Hall, Dale; Chan, Ko Ling; Conner, Kenneth R

    2015-07-01

    New York State law mandates specific intimate partner violence (IPV) documentation under all circumstances meeting the enumerated relationship and crime criteria at the scene of a domestic dispute. Law enforcement compliance with this mandate is unknown. We reviewed law enforcement completion rates of Domestic Violence Incident Reports (DVIRs) and assessed correlations with individual or legal factors. Law enforcement officers filed DVIRs in 54% of the cases (n = 191), more often when injury occurred (p < .01) and the defendant had prior court contact (p < .05). The discussion explores policy implications and potential means to rectify the gap between mandated processes and implementation. © The Author(s) 2015.

  4. Impact of school-entry and education mandates by states on HPV vaccination coverage: Analysis of the 2009–2013 National Immunization Survey-Teen

    OpenAIRE

    Perkins, Rebecca B.; Lin, Mengyun; Wallington, Sherrie F.; Hanchate, Amresh D.

    2016-01-01

    Objective: To determine the effectiveness of existing school entry and education mandates on HPV vaccination coverage, we compared coverage among girls residing in states and jurisdictions with and without education and school-entry mandates. Virginia and the District of Columbia enacted school entry mandates, though both laws included liberal opt-out provisions. Ten additional states had mandates requiring distribution of education to parents or provision of education within school curricula...

  5. The effect of state dependent mandate laws on the labor supply decisions of young adults.

    Science.gov (United States)

    Depew, Briggs

    2015-01-01

    Prior to the Affordable Care Act, the majority of states in the U.S. had already implemented state laws that extended the age that young adults could enroll as dependents on their parent's employer-based health insurance plans. Because of the fundamental link between health insurance and employment in the U.S., such policies may effect the labor supply decisions of young adults. Although the interaction between labor supply and health insurance has been extensively studied for other subpopulations, little is known about the role of health insurance in the labor supply decisions of young adults. I use the variation from the implementation and changes in state policies that expanded dependent health insurance coverage to examine how young adults adjusted their labor supply when they were able to be covered as a dependent on their parent's plan. I find that these state mandates led to a decrease in labor supply on the intensive margin. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Impact of school-entry and education mandates by states on HPV vaccination coverage: Analysis of the 2009-2013 National Immunization Survey-Teen.

    Science.gov (United States)

    Perkins, Rebecca B; Lin, Mengyun; Wallington, Sherrie F; Hanchate, Amresh D

    2016-06-02

    To determine the effectiveness of existing school entry and education mandates on HPV vaccination coverage, we compared coverage among girls residing in states and jurisdictions with and without education and school-entry mandates. Virginia and the District of Columbia enacted school entry mandates, though both laws included liberal opt-out provisions. Ten additional states had mandates requiring distribution of education to parents or provision of education within school curricula. Using data from the National Immunization Survey-Teen from 2009-2013, we estimated multilevel logistic regression models to compare coverage with HPV vaccines for girls ages 13-17 residing in states and jurisdictions with and without school entry and education mandates, adjusting for demographic factors, healthcare access, and provider recommendation. Girls residing in states and jurisdictions with HPV vaccine school entry mandates (DC and VA) and education mandates (LA, MI, CO, IN, IA, IL, NJ, NC, TX, and WA) did not have higher HPV vaccine series initiation or completion than those living in states without mandates for any year (2009-2013). Similar results were seen when comparing girls ages 13-14 to those ages 15-17, and after adjustment for known covariates of vaccination. States and jurisdictions with school-entry and education mandates do not currently have higher HPV vaccination coverage than states without such legislation. Liberal opt-out language in existing school entry mandates may weaken their impact. Policy-makers contemplating legislation to improve vaccination coverage should be aware of the limitations of existing mandates.

  7. State-mandated accountability as a constraint on teaching and learning science

    Science.gov (United States)

    Wood, Terry

    The purpose of this study is to examine the effect of state-mandated policy, emphasizing control through performance-based instruction and student test scores as the basis for determining school accreditation, on the teaching and learning of science. The intended consequence of instigating the rational theory of management by one state is to improve their current level of student literacy. However, some contend that the implementation of the policy has results that are not intended. The identification of the tension between the intended and unintended results of centralized policy making is the basis for examining a specific case in which the rational model is implemented. One hundred and sixty-five seventh-grade science students and four teachers are participants in the study. Qualitative analysis is the research methodology used as a means to provide detailed information about the contextual nature of the classroom processes. The intention is to identify and describe features of the behavior setting that influence the behavior of the teachers and their students. Three assertions generated during the field work were: Teachers redefine the goals of science instruction as the acquisition of facts and isolated skills, teachers alter their usual instructional behavior to implement uniform instructional procedures, and the teacher/student classroom interaction constrains students' opportunities to learn science. The implications of the study indicate that the state-mandated policy has results that are in opposition to the intended results. Instead of improving the practices of teachers, the implementation of the policy constrains and routinizes the teachers' behavior, causing them to violate their own standards of good teaching. They feel pressured to get through the materials so students will score well on tests. The classroom interaction is structured in such a way as to inhibit students from asking questions of their own. As a result, students' opportunity to

  8. STATE-MANDATED FOOD SAFETY CERTIFICATION REQUIREMENTS FOR RESTAURANTS: A 2002 REVIEW OF STATES

    OpenAIRE

    Schilling, Brian J.; O'Connor, Jack; Hendrickson, Veronica

    2003-01-01

    The Food and Drug Administration publishes a Standard Food Code which individual states either ratify, or amend and ratify, as the State Food Code. New Jersey has not adopted any revisions to the FDA Standard Food Code since 1993. Currently, the New Jersey Department of Health and Senior Services is considering the implementation of a mandatory food safety certification program for all of the state's foodservice establishments beginning in April 2003. Foodservice businesses serving "high risk...

  9. The Association of State Legal Mandates for Data Submission of Central Line-associated Blood Stream Infections in Neonatal Intensive Care Units with Process and Outcome Measures

    Science.gov (United States)

    Zachariah, Philip; Reagan, Julie; Furuya, E. Yoko; Dick, Andrew; Liu, Hangsheng; Herzig, Carolyn T.A; Pogorzelska-Maziarz, Monika; Stone, Patricia W.; Saiman, Lisa

    2014-01-01

    Objective To determine the association between state legal mandates for data submission of central line-associated blood stream infections (CLABSIs) in neonatal intensive care units (NICUs) with process/outcome measures. Design Cross-sectional study. Participants National sample of level II/III and III NICUs participating in National Healthcare Safety Network (NHSN) surveillance. Methods State mandates for data submission of CLABSIs in NICUs in place by 2011 were compiled and verified with state healthcare-associated infection coordinators. A web-based survey of infection control departments in October 2011 assessed CLABSI prevention practices i.e. compliance with checklist and bundle components (process measures) in ICUs including NICUs. Corresponding 2011 NHSN NICU CLABSI rates (outcome measures) were used to calculate Standardized Infection Ratios (SIR). The association between mandates and process/outcome measures was assessed by multivariable logistic regression. Results Among 190 study NICUs, 107 (56.3%) NICUs were located in states with mandates, with mandates in place for 3 or more years for half. More NICUs in states with mandates reported ≥95% compliance to at least one CLABSI prevention practice (52.3% – 66.4%) than NICUs in states without mandates (28.9% – 48.2%). Mandates were predictors of ≥95% compliance with all practices (OR 2.8; 95% CI 1.4–6.1). NICUs in states with mandates reported lower mean CLABSI rates in the prevention practices but not with lower CLABSI rates. PMID:25111921

  10. Increased Incidence of Spinal Abscess and Substance Abuse after Implementation of State Mandated Prescription Drug Legislation.

    Science.gov (United States)

    Nagar, Vittal R; Springer, Joe E; Salles, Sara

    2015-10-01

    To investigate the incidence of spinal abscess and substance abuse in a tertiary care hospital after state legislation titled "House Bill 1" (HB1) mandated stricter regulation of prescription drugs of abuse in Kentucky in 2012. A retrospective case series study design was used to review the incidence of spinal abscess and drug abuse diagnoses admissions from 2010 to 2014. Variances in the incidence of spinal abscess and substance abuse were plotted across this time frame. The incidence of intraspinal abscess increased 1.56-fold in 2011 (n = 26) and 2012 (n = 25) relative to 2010 (n = 16). However, in 2013, the year following implementation of HB1 legislation, the incidence of intraspinal abscess increased 2.38-fold (n = 38) and then 4.19-fold (n = 67) in 2014. The incidence of intraspinal abscess in subjects with drug abuse diagnosis remained constant between 2010 (n = 3) and 2012 (n = 3). However, it increased twofold (n = 7) in 2013 and then ninefold (n = 27) in 2014. A correlation coefficient (rSAD ) of 0.775 revealed a strong association between the increase incidence of intraspinal abscess and diagnosis of drug abuse. The results of this retrospective study demonstrate an increased incidence of intraspinal abscess associated with drug abuse after passage of HB1 legislation regulating prescriptions of controlled medications in Kentucky. This increased incidence may be related to individuals relying on nonprescription drugs of abuse due to more highly regulated access to controlled prescription medications. However, additional factors unrelated to HB1 legislation must be taken into account. Wiley Periodicals, Inc.

  11. Prospects of Single Tax Payers

    Directory of Open Access Journals (Sweden)

    Tofan Ivan M.

    2014-03-01

    Full Text Available The article speaks about problem aspects of taxation, which were set by the state for the single tax administering due to permanent and system changes in the tax legislation. It shows the necessity of search for alternative methods of administering in the process of taxation of single tax payers by fiscal services. The goal of the article is the study of prospects of further taxation of entrepreneurs – single tax payers on the basis of analysis of conditions and principles created by the state for the business. The article used methods of system analysis, comparison, forecasting and modelling. It analyses the process of evolution of the simplified taxation system, accounting and reporting from the moment of its adoption until today. The article presents the structure of the quantitative composition of single tax payers depending on the selected groups. It marks out and characterises administrative and fiscal factors that do not facilitate further development of entrepreneurship in Ukraine. In the result of the conducted studies the article outlines problem aspects of organisation of taxation of the small business and offers specific and real ways of their overcoming or partial solution.

  12. Impact of school-entry and education mandates by states on HPV vaccination coverage: Analysis of the 2009–2013 National Immunization Survey-Teen

    Science.gov (United States)

    Perkins, Rebecca B.; Lin, Mengyun; Wallington, Sherrie F.; Hanchate, Amresh D.

    2016-01-01

    ABSTRACT Objective: To determine the effectiveness of existing school entry and education mandates on HPV vaccination coverage, we compared coverage among girls residing in states and jurisdictions with and without education and school-entry mandates. Virginia and the District of Columbia enacted school entry mandates, though both laws included liberal opt-out provisions. Ten additional states had mandates requiring distribution of education to parents or provision of education within school curricula. Methods: Using data from the National Immunization Survey-Teen from 2009–2013, we estimated multilevel logistic regression models to compare coverage with HPV vaccines for girls ages 13–17 residing in states and jurisdictions with and without school entry and education mandates, adjusting for demographic factors, healthcare access, and provider recommendation. Results: Girls residing in states and jurisdictions with HPV vaccine school entry mandates (DC and VA) and education mandates (LA, MI, CO, IN, IA, IL, NJ, NC, TX, and WA) did not have higher HPV vaccine series initiation or completion than those living in states without mandates for any year (2009–2013). Similar results were seen when comparing girls ages 13–14 to those ages 15–17, and after adjustment for known covariates of vaccination. Conclusions: States and jurisdictions with school-entry and education mandates do not currently have higher HPV vaccination coverage than states without such legislation. Liberal opt-out language in existing school entry mandates may weaken their impact. Policy-makers contemplating legislation to improve vaccination coverage should be aware of the limitations of existing mandates. PMID:27152418

  13. Negotiating with payers.

    Science.gov (United States)

    Kaufman, Joel M

    2010-05-01

    Negotiating with payers for better reimbursement, contract language, support for practice enhancement, or changes in policies and procedures is a critical function that may greatly enhance a practice's success over time. This article discusses keys to successful negotiating and several specific areas beyond reimbursement that deserve the reader's attention. Copyright 2010 Elsevier Inc. All rights reserved.

  14. Do biofuel blending mandates reduce gasoline consumption? Implications of state-level renewable fuel standards for energy security

    Science.gov (United States)

    Lim, Shinling

    In an effort to keep America's addiction to oil under control, federal and state governments have implemented a variety of policy measures including those that determine the composition of motor gasoline sold at the pump. Biofuel blending mandates known as Renewable Fuel Standards (RFS) are designed to reduce the amount of foreign crude oil needed to be imported as well as to boost the local ethanol and corn industry. Yet beyond looking at changes in gasoline prices associated with increased ethanol production, there have been no empirical studies that examine effects of state-level RFS implementation on gasoline consumption. I estimate a Generalized Least Squares model for the gasoline demand for the 1993 to 2010 period with state and time fixed effects controlling for RFS. States with active RFS are Minnesota, Hawaii, Missouri, Florida, Washington, and Oregon. I find that, despite the onset of federal biofuel mandates across states in 2007 and the lower energy content of blended gasoline, being in a state that has implemented RFS is associated with 1.5% decrease in gasoline consumption (including blended gasoline). This is encouraging evidence for efforts to lessen dependence on gasoline and has positive implications for energy security.

  15. The association between state mandates of colorectal cancer screening coverage and colorectal cancer screening utilization among US adults aged 50 to 64 years with health insurance

    Directory of Open Access Journals (Sweden)

    Virgo Katherine

    2011-01-01

    Full Text Available Abstract Background Several states in the US have passed laws mandating coverage of colorectal cancer (CRC screening tests by health insurance plans. The impact of these state mandates on the use of colorectal cancer screening has not been evaluated among an age-eligible target population with access to care (i.e., health care insurance coverage. Methods We collected information on state mandates implemented by December 31, 2008 and used data on insured adults aged 50 and 64 years from the Behavioral Risk Factor Surveillance System between 2002 and 2008 to classify individual-level exposure to state mandates for at least 1 year. Multivariate logistic regression models (with state- and year- fixed effects, and patient demographic and socioeconomic characteristics were used to estimate the effect of state mandates on recent endoscopy screening (either flexible sigmoidoscopy or colonoscopy during the past year. Results From 1999-2008, twenty-two states in the US, including the District of Columbia passed comprehensive laws requiring health insurance coverage of CRC screening including endoscopy tests. Residence in states with CRC screening coverage mandates in place for at least 1 year was associated with a 1.4 percentage point increase in the probability of utilization of recent endoscopy (i.e., 17.5% screening rates in those with mandates versus 16.1% in those without, Adjusted OR = 1.10, 95% CI: 1.02 - 1.20, p = 0.02. Conclusions The findings suggest a positive, albeit small, impact of state mandates on the use of recent CRC screening endoscopy among the target eligible population with health insurance. However, more research is needed to evaluate potential effects of mandates across health insurance types while including controls for other system-level factors (e.g. endoscopy and primary care capacity. National health insurance reform should strive towards a system that expands access to recommended CRC screening tests.

  16. Parent opinion of sexuality education in a state with mandated abstinence education: does policy match parental preference?

    Science.gov (United States)

    Ito, Kristin E; Gizlice, Ziya; Owen-O'Dowd, Judy; Foust, Evelyn; Leone, Peter A; Miller, William C

    2006-11-01

    Despite public debate about the content of sexuality education in schools, state and federal policy has increasingly financed and legislated abstinence-only education over the past decade. Although public schools strive to meet the needs of parents who, as taxpayers, fund the educational system, little is known about parental desires regarding sexuality education in states with mandated abstinence education. The objective of this study was to assess parental opinion about sexuality education in public schools in North Carolina, a state with mandated abstinence education. Computer-assisted, anonymous, cross-sectional telephone surveys were conducted among 1306 parents of North Carolina public school students in grades K-12. Parental support for sexuality education in public schools and 20 sexuality education topics was measured. We defined comprehensive sexuality education as education that includes a discussion of how to use and talk about contraception with partners. Parents in North Carolina overwhelmingly support sexuality education in public schools (91%). Of these respondents, the majority (89%) support comprehensive sexuality education. Less than a quarter of parents oppose teaching any specific topic, including those typically viewed as more controversial, such as discussions about sexual orientation, oral sex, and anal sex. Parents' level of education was inversely related to support for specific sexuality education topics and comprehensive education, although these differences were small in magnitude. More than 90% of respondents felt that parents and public health professionals should determine sexuality education content and opposed the involvement of politicians. Current state-mandated abstinence sexuality education does not match parental preference for comprehensive sexuality education in North Carolina public schools.

  17. Association of State-Mandated Abstinence-only Sexuality Education with Rates of Adolescent HIV Infection and Teenage Pregnancy.

    Science.gov (United States)

    Elliot, L M; Booth, M M; Patterson, G; Althoff, M; Bush, C K; Dery, M A

    2017-01-01

    Abstinence-only sexuality education (AOSE); is required in the public school systems of many states, raising public health concerns and perpetuating health disparities through school systems. This study aimed to determine the correlations between state-mandated AOSE and the rates of adolescent HIV and teen pregnancy. Using publicly available data on all 50 United States' laws and policies on AOSE, states were ranked according to their level of abstinence emphasis on sexuality education (Level 0 - Level 3);. We calculated the relative proportion of Black students in public schools and the proportion of families below the federal poverty line then ranked them by state. We compared the states' ranks to the incidence of adolescent HIV and teen pregnancy in those states to identify associations between variables. The majority of states (~44 percent ); have legally mandated AOSE policies (Level 3); and adolescent HIV and teen pregnancy rates were highest in these Level 3 states. There were significant, positive correlations between HIV incidence rates of 13-19 year olds, HIV rates of 20-24 year olds, teen pregnancy rates, and AOSE level, with the proportion of the population that lives below the federal poverty level, and whether they attended schools that had a greater than 50 percent of an African American population. These data show a clear association between state sexuality education policies and adolescent HIV and teen pregnancy rates not previously demonstrated. Our data further show that states that have higher proportions of at-risk populations, with higher adolescent HIV and teen pregnancy rates, are more likely to also have restrictive AOSE policies. These populations may be more likely to attend public schools where AOSE is taught, increasing their risk for HIV and teen pregnancy. The World Health Organization considers fact-based Comprehensive Sexuality Education a human right, and the authors believe it is past time to end harmful, discriminatory sexuality

  18. Setting a national minimum standard for health benefits: how do state benefit mandates compare with benefits in large-group plans?

    Science.gov (United States)

    Frey, Allison; Mika, Stephanie; Nuzum, Rachel; Schoen, Cathy

    2009-06-01

    Many proposed health insurance reforms would establish a federal minimum benefit standard--a baseline set of benefits to ensure that people have adequate coverage and financial protection when they purchase insurance. Currently, benefit mandates are set at the state level; these vary greatly across states and generally target specific areas rather than set an overall standard for what qualifies as health insurance. This issue brief considers what a broad federal minimum standard might look like by comparing existing state benefit mandates with the services and providers covered under the Federal Employees Health Benefits Program (FEHBP) Blue Cross and Blue Shield standard benefit package, an example of minimum creditable coverage that reflects current standard practice among employer-sponsored health plans. With few exceptions, benefits in the FEHBP standard option either meet or exceed those that state mandates require-indicating that a broad-based national benefit standard would include most existing state benefit mandates.

  19. Stated and Revealed Preferences for Funding New High-Cost Cancer Drugs: A Critical Review of the Evidence from Patients, the Public and Payers.

    Science.gov (United States)

    MacLeod, Tatjana E; Harris, Anthony H; Mahal, Ajay

    2016-06-01

    The growing focus on patient-centred care has encouraged the inclusion of patient and public input into payer drug reimbursement decisions. Yet, little is known about patient/public priorities for funding high-cost medicines, and how they compare to payer priorities applied in public funding decisions for new cancer drugs. The aim was to identify and compare the funding preferences of cancer patients and the general public against the criteria used by payers making cancer drug funding decisions. A thorough review of the empirical, peer-reviewed English literature was conducted. Information sources were PubMed, EMBASE, MEDLINE, Web of Science, Business Source Complete, and EconLit. Eligible studies (1) assessed the cancer drug funding preferences of patients, the general public or payers, (2) had pre-defined measures of funding preference, and (3) had outcomes with attributes or measures of 'value'. The quality of included studies was evaluated using a health technology assessment-based assessment tool, followed by extraction of general study characteristics and funding preferences, which were categorized using an established WHO-based framework. Twenty-five preference studies were retrieved (11 quantitative, seven qualitative, seven mixed-methods). Most studies were published from 2005 onward, with the oldest dating back to 1997. Two studies evaluated both patient and public perspectives, giving 27 total funding perspectives (41 % payer, 33 % public, 26 % patients). Of 41 identified funding criteria, payers consider the most (35), the general public considers fewer (23), and patients consider the fewest (12). We identify four unique patient criteria: financial protection, access to medical information, autonomy in treatment decision making, and the 'value of hope'. Sixteen countries/jurisdictions were represented. Our results suggest that (1) payers prioritize efficiency (health gains per dollar), while citizens (patients and the general public) prioritize

  20. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and originates in the sacroiliac (SI) joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US). Methods A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3), an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date), and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars) were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592) per privately-insured patient (N=78,533). Among patients with lumbar spinal fusion (N=434), attributable 3-year mean costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) per patient among patients without lumbar spinal fusion (N=78,099). Overall, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. The estimated 3-year insurance payments attributable to SI joint disruption

  1. High school science teacher perceptions of the science proficiency testing as mandated by the State of Ohio Board of Education

    Science.gov (United States)

    Jeffery, Samuel Shird

    There is a correlation between the socioeconomic status of secondary schools and scores on the State of Ohio's mandated secondary science proficiency tests. In low scoring schools many reasons effectively explain the low test scores as a result of the low socioeconomics. For example, one reason may be that many students are working late hours after school to help with family finances; parents may simply be too busy providing family income to realize the consequences of the testing program. There are many other personal issues students face that may cause them to score poorly an the test. The perceptions of their teachers regarding the science proficiency test program may be one significant factor. These teacher perceptions are the topic of this study. Two sample groups ware established for this study. One group was science teachers from secondary schools scoring 85% or higher on the 12th grade proficiency test in the academic year 1998--1999. The other group consisted of science teachers from secondary schools scoring 35% or less in the same academic year. Each group of teachers responded to a survey instrument that listed several items used to determine teachers' perceptions of the secondary science proficiency test. A significant difference in the teacher' perceptions existed between the two groups. Some of the ranked items on the form include teachers' opinions of: (1) Teaching to the tests; (2) School administrators' priority placed on improving average test scores; (3) Teacher incentive for improving average test scores; (4) Teacher teaching style change as a result of the testing mandate; (5) Teacher knowledge of State curriculum model; (6) Student stress as a result of the high-stakes test; (7) Test cultural bias; (8) The tests in general.

  2. Trends in Medial Ulnar Collateral Ligament Reconstruction in the United States: A Retrospective Review of a Large Private-Payer Database From 2007 to 2011.

    Science.gov (United States)

    Erickson, Brandon J; Nwachukwu, Benedict U; Rosas, Sam; Schairer, William W; McCormick, Frank M; Bach, Bernard R; Bush-Joseph, Charles A; Romeo, Anthony A

    2015-07-01

    Overuse injuries to the elbow in the throwing athlete are common. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on both recreational and high-level athletes. There is no current literature regarding the incidence and demographic distribution of this surgical procedure in relation to patient age, location within the Unites States, and sex. To determine the current demographic distribution of UCLR within the US population included in the PearlDiver database. Descriptive epidemiology study. A retrospective analysis of the PearlDiver supercomputer database, a private-payer database, was performed to identify UCLR procedures performed between 2007 and 2011. The Current Procedural Terminology (CPT) code 24346 (reconstruction of the ulnar collateral ligament of the elbow with the use of a tendinous graft) was used. Between 2007 and 2011, a total of 790 patients underwent UCLR. The average (±SD) annual incidence was 3.96 ± 0.38 per 100,000 patients for the overall population but was 22 ± 3.4 for patients aged 15 to 19 years. The overall average annual growth was 4.2%. There were 695 males and 95 females. The 15- to 19-year-old patients accounted for significantly more procedures than any other age group (56.8%; P United States than in any other region (P < .001). The number of procedures significantly increased over time (P = .039). According to this database of a privately insured population, UCLR was performed significantly more in patients aged 15 to 19 than any other age group. The average annual incidence of UCLR per 100,000 people for patients aged 15 to 19 was 22 ± 3.4. Further, this database showed that the number of UCLR procedures is increasing over time. Further work should address risk reduction efforts in this at-risk population. © 2015 The Author(s).

  3. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2014-02-01

    Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Tim Holt,4 John Cummings5 1Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 5Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and originates in the sacroiliac (SI joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US. Methods: A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3, an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date, and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results: The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592 per privately-insured patient (N=78,533. Among patients with lumbar spinal fusion (N=434, attributable 3-year

  4. Mid-mandate reports

    CERN Multimedia

    Staff Association

    2011-01-01

    Now half way through his mandate (2009-2013), our Director-General presented on 4th July a glowing report on both the scientific and technical fronts. This gives him, his team, and all CERN staff great satisfaction. Furthermore, despite a rather worrying economic situation in most of our Member States, he has managed to obtain the approval of the 2012 budget and the medium-term plan until 2016, which will allow our social security system, pensions and health insurance, to be considerably consolidated. The mandate of the President of the Staff Association lasts one year. So, where are we at half way through the mandate? Without doubt the pensions issue in particular kept us busy during the first six months. We explained to you during the two series of public meetings in April and June that we did not agree with the Management’s proposals for the new members and beneficiaries of the Fund and we showed you our own fairer proposals. However, under the continuous pressure of the Member States, almost...

  5. From Partnership Formation to Collaboration: Developing a State Mandated University-Multidistrict Partnership to Design a PK-12 Principal Preparation Program in a Rural Service Area

    Science.gov (United States)

    Carlson, Cameron B.

    2012-01-01

    Recent state policies demand universities restructure principal preparation programs. Mandates, though unfunded, provide an opportunity for universities to engage representative stakeholders who benefit from context specific instruction. This article demonstrates how professors in one research university used collected programmatic information and…

  6. "Managed competition" for Ireland? The single versus multiple payer debate.

    LENUS (Irish Health Repository)

    Mikkers, Misja

    2014-09-01

    A persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of \\'managed competition\\' based on the recent reforms in the Netherlands, which would replace many functions of Ireland\\'s public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.

  7. The Failure of Mandated Disclosures

    Directory of Open Access Journals (Sweden)

    Omri Ben-Shahar

    2017-06-01

    Full Text Available Objective to elaborate the conceptual theoreticallegal provisions and scientific recommendations for the substantiating the inefficiency of mandated disclosure. Methods general dialectic method of cognition as well as the general scientific and specific legal methods of research based on it. Results the article explores the spectacular prevalence and failure of the single most common technique for protecting personal autonomy in modern society mandated disclosure. The article has four parts 1 a comprehensive summary of the recurring use of mandated disclosures in many forms and circumstances in the areas of consumer and borrower protection patient informed consent contract formation and constitutional rights 2 a survey of the empirical literature documenting the failure of the mandated disclosure regime in informing people and in improving their decisions 3 an account of the multitude of reasons mandated disclosures fail focusing on the political dynamics underlying the enactments of these mandates the incentives of disclosers to carry them out and most importantly on the ability of disclosees to use them and 4 an argument that mandated disclosure not only fails to achieve its stated goal but also leads to unintended consequences that often harm the very people it intends to serve. Scientific novelty the article elaborates and introduces into academic sphere the substantiation of the efficiency of mandated disclosure proves the failure of the mandated disclosure regime in informing people and in improving their decisions and reveals the unintended consequences that often harm the very people it intends to serve. Practical significance the provisions ad conclusions of the article can be used in scientific lawmaking and lawenforcement activities and in the educational process of institutions of higher education.

  8. The Failure of Mandated Disclosure

    Directory of Open Access Journals (Sweden)

    Omri Ben-Shahar

    2017-12-01

    Full Text Available Objective to elaborate the conceptual theoreticallegal provisions and scientific recommendations for the substantiating the inefficiency of mandated disclosure. Methods general dialectic method of cognition as well as the general scientific and specific legal methods of research based on it. Results the article explores the spectacular prevalence and failure of the single most common technique for protecting personal autonomy in modern society mandated disclosure. The article has four parts 1 a comprehensive summary of the recurring use of mandated disclosures in many forms and circumstances in the areas of consumer and borrower protection patient informed consent contract formation and constitutional rights 2 a survey of the empirical literature documenting the failure of the mandated disclosure regime in informing people and in improving their decisions 3 an account of the multitude of reasons mandated disclosures fail focusing on the political dynamics underlying the enactments of these mandates the incentives of disclosers to carry them out and most importantly on the ability of disclosees to use them and 4 an argument that mandated disclosure not only fails to achieve its stated goal but also leads to unintended consequences that often harm the very people it intends to serve. Scientific novelty the article elaborates and introduces into academic sphere the substantiation of the efficiency of mandated disclosure proves the failure of the mandated disclosure regime in informing people and in improving their decisions and reveals the unintended consequences that often harm the very people it intends to serve. Practical significance the provisions ad conclusions of the article can be used in scientific lawmaking and lawenforcement activities and in the educational process of institutions of higher education.

  9. Social learning in a policy-mandated collaboration: Community wildfire protection planning in the eastern United States

    Science.gov (United States)

    Rachel F. Brummel; Kristen C. Nelson; Pamela J. Jakes; Daniel R. Williams

    2010-01-01

    Policies such as the US Healthy Forests Restoration Act (HFRA) mandate collaboration in planning to create benefits such as social learning and shared understanding among partners. However, some question the ability of top-down policy to foster successful local collaboration. Through in-depth interviews and document analysis, this paper investigates social learning and...

  10. A descriptive study of the reported effects of state-mandated testing on the instructional practices and beliefs of middle school science teachers

    Science.gov (United States)

    Font-Rivera, Miriam Josefa

    The purpose of this study was to investigate the effects of state-level testing on the instructional practices and beliefs of middle school science teachers. The study addressed four questions: (a) What are the beliefs of middle school science teachers regarding the pressure to improve their students' test scores? (b) What are the beliefs of middle school science teachers about how standardized tests influence their class time? (c) What are the attitudes of middle school science teachers toward state testing? and (d) What commonalities emerge from teachers' responses about the state tests? The sample was composed of 86 middle school science teachers from states that have state mandated testing programs in the area of science. Descriptive statistics and an inductive analysis were performed to answer the research questions. Teachers reported that they and their students were under a great amount of pressure to increase test scores from central office administrators and from the school principal. Teachers reported spending considerable time on certain test preparation activities throughout the school year. Teachers reported that the three strongest influences in instructional planning were reviewing the content and skills covered on the state tests prior to the test administration, having to prepare students for state tests, and adjusting the curriculum sequence based on the content tested by the state tests. Multiple-choice items were reported to be the most often used assessment strategy. Teachers reported that state-mandated tests were not very helpful because the test results presented an inaccurate picture of student learning. The categories formed from the teachers' written comments reflected the findings of the survey questions. Comments concentrated on the negative effects of the tests in the areas of pressure, overemphasis on the test, accountability, reduction of instructional time due to test preparation, and negative uses of state-mandated tests

  11. Certification of Public Librarians in the United States. A Detailed Summary of Legally Mandated and Voluntary Certification Plans for Public Librarians Based on Information Supplied by the Various Certificating State Agencies or Other Appropriate Sources. 3rd Edition.

    Science.gov (United States)

    Coe, Mary J., Ed.

    This report contains summaries of legally mandated and voluntary certification plans for public librarians in the United States based on information supplied by the various certifying state agencies or other appropriate sources in April 1979. Each plan is identified by the descriptive terms "mandatory" (certification required by law--23 states),…

  12. The Effect of Florida Medicaid's State-Mandated Formulary Provision on Prescription Drug Use and Health Plan Costs in a Medicaid Managed Care Plan.

    Science.gov (United States)

    Munshi, Kiraat D; Mager, Douglas; Ward, Krista M; Mischel, Brian; Henderson, Rochelle R

    2018-02-01

    Formulary or preferred drug list (PDL) management is an effective strategy to ensure clinically efficient prescription drug management by managed care organizations (MCOs). Medicaid MCOs participating in Florida's Medicaid program were required to use a state-mandated PDL between May and August 2014. To examine differences in prescription drug use and plan costs between a single Florida Medicaid managed care (MMC) health plan that implemented a state-mandated PDL policy on July 1, 2014, and a comparable MMC health plan in another state without a state-mandated PDL, controlling for sociodemographic confounders. A retrospective analysis with a pre-post design was conducted using deidentified administrative claims data from a large pharmacy benefit manager. The prepolicy evaluation period was January 1 through June 30, 2014, and the postpolicy period was January 1 through June 30, 2015. Continuously eligible Florida MMC plan members were matched on sociodemographic and health characteristics to their counterparts enrolled in a comparable MMC health plan in another state without a state-mandated formulary. Outcomes were drug use, measured as the number of 30-day adjusted nonspecialty drug prescriptions per member per period, and total drug plan costs per member per period for all drugs, with separate measures for generic and brand drugs. Bivariate comparisons were conducted using t-tests. Employing a difference-in-differences (DID) analytic approach, multivariate negative binomial regression and generalized estimating equation models were used to analyze prescription drug use and costs. The final analytical sample consisted of 18,372 enrollees, evenly divided between the 2 groups. In the postpolicy evaluation period, overall and generic use declined, while brand use increased for members in the Florida health plan. Drug costs, especially for brands, significantly increased for Florida health plan members. No significant changes were observed over the same time period

  13. The impact of high-stakes, state-mandated student performance assessment on 10th grade English, mathematics, and science teachers' instructional practices

    Science.gov (United States)

    Vogler, Kenneth E.

    The purpose of this study was to determine if the public release of student results on high-stakes, state-mandated performance assessments influence instructional practices, and if so in what manner. The research focused on changes in teachers' instructional practices and factors that may have influenced such changes since the public release of high-stakes, state-mandated student performance assessment scores. The data for this study were obtained from a 54-question survey instrument given to a stratified random sample of teachers teaching at least one section of 10th grade English, mathematics, or science in an academic public high school within Massachusetts. Two hundred and fifty-seven (257) teachers, or 62% of the total sample, completed the survey instrument. An analysis of the data found that teachers are making changes in their instructional practices. The data show notable increases in the use of open-response questions, creative/critical thinking questions, problem-solving activities, use of rubrics or scoring guides, writing assignments, and inquiry/investigation. Teachers also have decreased the use of multiple-choice and true-false questions, textbook-based assignments, and lecturing. Also, the data show that teachers felt that changes made in their instructional practices were most influenced by an "interest in helping my students attain MCAS assessment scores that will allow them to graduate high school" and by an "interest in helping my school improve student (MCAS) assessment scores," Finally, mathematics teachers and teachers with 13--19 years of experience report making significantly more changes than did others. It may be interpreted from the data that the use of state-mandated student performance assessments and the high-stakes attached to this type of testing program contributed to changes in teachers' instructional practices. The changes in teachers' instructional practices have included increases in the use of instructional practices deemed

  14. Variation in Private Payer Coverage of Rheumatoid Arthritis Drugs.

    Science.gov (United States)

    Chambers, James D; Wilkinson, Colby L; Anderson, Jordan E; Chenoweth, Matthew D

    2016-10-01

    Payers in the United States issue coverage determinations to guide how their enrolled beneficiaries use prescription drugs. Because payers create their own coverage policies, how they cover drugs can vary, which in turn can affect access to care by beneficiaries. To examine how the largest private payers based on membership cover drugs indicated for rheumatoid arthritis and to determine what evidence the payers reported reviewing when formulating their coverage policies. Coverage policies issued by the 10 largest private payers that make their policies publicly available were identified for rheumatoid arthritis drugs. Each coverage determination was compared with the drug's corresponding FDA label and categorized according to the following: (a) consistent with the label, (b) more restrictive than the label, (c) less restrictive than the label, or (d) mixed (i.e., more restrictive than the label in one way but less restrictive in another). Each coverage determination was also compared with the American College of Rheumatology (ACR) 2012 treatment recommendations and categorized using the same relative restrictiveness criteria. The policies were then reviewed to identify the evidence that the payers reported reviewing. The identified evidence was divided into the following 6 categories: randomized controlled trials; other clinical studies (e.g., observational studies); health technology assessments; clinical reviews; cost-effectiveness analyses; and clinical guidelines. Sixty-nine percent of coverage determinations were more restrictive than the corresponding FDA label; 15% were consistent; 3% were less restrictive; and 13% were mixed. Thirty-four percent of coverage determinations were consistent with the ACR recommendations, 33% were more restrictive; 17% were less restrictive; and 17% were mixed. Payers most often reported reviewing randomized controlled trials for their coverage policies (an average of 2.3 per policy). The payers reported reviewing an average of

  15. The Efficiency of a Group-Specific Mandated Benefit Revisited: The Effect of Infertility Mandates

    Science.gov (United States)

    Lahey, Joanna N.

    2012-01-01

    This paper examines the labor market effects of state health insurance mandates that increase the cost of employing a demographically identifiable group. State mandates requiring that health insurance plans cover infertility treatment raise the relative cost of insuring older women of child-bearing age. Empirically, wages in this group are…

  16. Managing Mandated Educational Change

    Science.gov (United States)

    Clement, Jennifer

    2014-01-01

    This paper explores teachers' perspectives on the management of mandated educational change in order to understand how it may be managed more effectively. A case study of teachers' responses to the introduction of a quality teaching initiative in two New South Wales schools found that while some teachers described the strong negative impact of…

  17. Differences in Hospital Readmission Risk across All Payer Groups in South Carolina.

    Science.gov (United States)

    Chakraborty, Hrishikesh; Axon, Robert Neal; Brittingham, Jordan; Lyons, Genevieve Ray; Cole, Laura; Turley, Christine B

    2017-06-01

    To evaluate differences in hospital readmission risk across all payers in South Carolina (SC). South Carolina Revenue and Fiscal Affairs Office (SCRFA) statewide all payer claims database including 2,476,431 hospitalizations in SC acute care hospitals between 2008 and 2014. We compared the odds of unplanned all-cause 30-day readmission for private insurance, Medicare, Medicaid, uninsured, and other payers and examined interaction effects between payer and index admission characteristics using generalized estimating equations. SCRFA receives claims and administrative health care data from all SC health care facilities in accordance with SC state law. Odds of readmission were lower for females compared to males in private, Medicare, and Medicaid payers. African Americans had higher odds of readmission compared to whites across private insurance, Medicare, and Medicaid, but they had lower odds among the uninsured. Longer length of stay had the strongest association with readmission for private and other payers, whereas an increased number of comorbidities related to the highest readmission odds within Medicaid. Associations between index admission characteristics and readmission likelihood varied significantly with payer. Findings should guide the development of payer-specific quality improvement programs. © Health Research and Educational Trust.

  18. To what extent have high schools in California been able to implement state-mandated nutrition standards?

    Science.gov (United States)

    Samuels, Sarah E; Bullock, Sally Lawrence; Woodward-Lopez, Gail; Clark, Sarah E; Kao, Janice; Craypo, Lisa; Barry, Jay; Crawford, Patricia B

    2009-09-01

    To determine extent and factors associated with implementation of California's school nutrition standards 1 year after standards became active. Information on competitive foods and beverages available in schools was collected from a representative sample of 56 public high schools in California. Adherence to nutrition standards was calculated for each item and summarized for each school by venue. The association between schools' sociodemographic characteristics and adherence to standards was determined by multivariate analysis. The majority of schools were adhering to the required beverage standards. None of the schools selling competitive foods were 100% adherent to the food standards. Adherence to both standards tended to be highest in food service venues. In univariate analyses, percent nonwhite enrollment, population density, percent free/reduced-price (FRP) meal eligibility, and school size were significantly correlated with the beverage adherence rate. Percent nonwhite enrollment and population density remained significant in the multivariate regression model. Percent nonwhite enrollment and percent FRP meal eligibility were significantly correlated with the food adherence rate in univariate analysis, but neither remained significant in the multiple regression model. California high schools are making progress toward implementation of the state nutrition standards. Beverage standards appear easier to achieve than nutrient-based food standards. Additional support is needed to provide schools with resources to implement and monitor these policies. Simpler standards and/or a reduction in the foods and beverages sold could better enable schools to achieve and monitor adherence.

  19. The Failure of Mandated Disclosures, part 3

    Directory of Open Access Journals (Sweden)

    Omri Ben-Shahar

    2017-09-01

    Full Text Available Objective to elaborate the conceptual theoreticallegal provisions and scientific recommendations for the substantiating the inefficiency of mandated disclosure. Methods general dialectic method of cognition as well as the general scientific and specific legal methods of research based on it. Results the article explores the spectacular prevalence and failure of the single most common technique for protecting personal autonomy in modern society mandated disclosure. The article has four parts 1 a comprehensive summary of the recurring use of mandated disclosures in many forms and circumstances in the areas of consumer and borrower protection patient informed consent contract formation and constitutional rights 2 a survey of the empirical literature documenting the failure of the mandated disclosure regime in informing people and in improving their decisions 3 an account of the multitude of reasons mandated disclosures fail focusing on the political dynamics underlying the enactments of these mandates the incentives of disclosers to carry them out and most importantly on the ability of disclosees to use them and 4 an argument that mandated disclosure not only fails to achieve its stated goal but also leads to unintended consequences that often harm the very people it intends to serve. Scientific novelty the article elaborates and introduces into academic sphere the substantiation of the efficiency of mandated disclosure proves the failure of the mandated disclosure regime in informing people and in improving their decisions and reveals the unintended consequences that often harm the very people it intends to serve. Practical significance the provisions ad conclusions of the article can be used in scientific lawmaking and lawenforcement activities and in the educational process of institutions of higher education.

  20. A Study of the Impact of Transformative Professional Development on Hispanic Student Performance on State Mandated Assessments of Science in Elementary School

    Science.gov (United States)

    Johnson, Carla C.; Fargo, Jamison D.

    2014-11-01

    This paper reports the findings of a study of the impact of the transformative professional development (TPD) model on student achievement on state-mandated assessments of science in elementary school. Two schools (one intervention and one control) participated in the case study where teachers from one school received the TPD intervention across a 2-year period while teachers at the other school received no program and continued business as usual. The TPD program includes a focus on the core conceptual framework for effective professional development (Desimone in Educ Res 38:181-199, 2009) as well as an emphasis on culturally relevant pedagogy (CRP) and other effective science instructional strategies. Findings revealed that participation in TPD had a significant impact on student achievement for Burns Elementary with the percentage of proficient students growing from 25 % at baseline to 67 % at the end of the 2-year program, while the comparison school did not experience similar growth. Implications for future research and implementation of professional development programs to meet the needs of teachers in the realm of CRP in science are discussed.

  1. Adaptive Pathways: Possible Next Steps for Payers in Preparation for Their Potential Implementation

    Science.gov (United States)

    Vella Bonanno, Patricia; Ermisch, Michael; Godman, Brian; Martin, Antony P.; Van Den Bergh, Jesper; Bezmelnitsyna, Liudmila; Bucsics, Anna; Arickx, Francis; Bybau, Alexander; Bochenek, Tomasz; van de Casteele, Marc; Diogene, Eduardo; Eriksson, Irene; Fürst, Jurij; Gad, Mohamed; Greičiūtė-Kuprijanov, Ieva; van der Graaff, Martin; Gulbinovic, Jolanta; Jones, Jan; Joppi, Roberta; Kalaba, Marija; Laius, Ott; Langner, Irene; Mardare, Ileana; Markovic-Pekovic, Vanda; Magnusson, Einar; Melien, Oyvind; Meshkov, Dmitry O.; Petrova, Guenka I.; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Schuurman, Ad; Ramos, Ricardo; Rodrigues, Jorge; Zara, Corinne; Zebedin-Brandl, Eva; Haycox, Alan

    2017-01-01

    Medicines receiving a conditional marketing authorization through Medicines Adaptive Pathways to Patients (MAPPs) will be a challenge for payers. The “introduction” of MAPPs is already seen by the European Medicines Agency (EMA) as a fait accompli, with payers not consulted or involved. However, once medicines are approved through MAPPs, they will be evaluated for funding by payers through different activities. These include Health Technology Assessment (HTA) with often immature clinical data and high uncertainty, financial considerations, and negotiations through different types of agreements, which can require monitoring post launch. Payers have experience with new medicines approved through conditional approval, and the fact that MAPPs present additional challenges is a concern from their perspective. There may be some activities where payers can collaborate. The final decisions on whether to reimburse a new medicine via MAPPs will have more variation than for medicines licensed via conventional processes. This is due not only to increasing uncertainty associated with medicines authorized through MAPPs but also differences in legal frameworks between member states. Moreover, if the financial and side-effect burden from the period of conditional approval until granting full marketing authorization is shifted to the post-authorization phase, payers may have to bear such burdens. Collection of robust data during routine clinical use is challenging along with high prices for new medicines during data collection. This paper presents the concept of MAPPs and possible challenges. Concerns and potential ways forward are discussed and a number of recommendations are presented from the perspective of payers. PMID:28878667

  2. Adaptive Pathways: Possible Next Steps for Payers in Preparation for Their Potential Implementation.

    Science.gov (United States)

    Vella Bonanno, Patricia; Ermisch, Michael; Godman, Brian; Martin, Antony P; Van Den Bergh, Jesper; Bezmelnitsyna, Liudmila; Bucsics, Anna; Arickx, Francis; Bybau, Alexander; Bochenek, Tomasz; van de Casteele, Marc; Diogene, Eduardo; Eriksson, Irene; Fürst, Jurij; Gad, Mohamed; Greičiūtė-Kuprijanov, Ieva; van der Graaff, Martin; Gulbinovic, Jolanta; Jones, Jan; Joppi, Roberta; Kalaba, Marija; Laius, Ott; Langner, Irene; Mardare, Ileana; Markovic-Pekovic, Vanda; Magnusson, Einar; Melien, Oyvind; Meshkov, Dmitry O; Petrova, Guenka I; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Schuurman, Ad; Ramos, Ricardo; Rodrigues, Jorge; Zara, Corinne; Zebedin-Brandl, Eva; Haycox, Alan

    2017-01-01

    Medicines receiving a conditional marketing authorization through Medicines Adaptive Pathways to Patients (MAPPs) will be a challenge for payers. The "introduction" of MAPPs is already seen by the European Medicines Agency (EMA) as a fait accompli, with payers not consulted or involved. However, once medicines are approved through MAPPs, they will be evaluated for funding by payers through different activities. These include Health Technology Assessment (HTA) with often immature clinical data and high uncertainty, financial considerations, and negotiations through different types of agreements, which can require monitoring post launch. Payers have experience with new medicines approved through conditional approval, and the fact that MAPPs present additional challenges is a concern from their perspective. There may be some activities where payers can collaborate. The final decisions on whether to reimburse a new medicine via MAPPs will have more variation than for medicines licensed via conventional processes. This is due not only to increasing uncertainty associated with medicines authorized through MAPPs but also differences in legal frameworks between member states. Moreover, if the financial and side-effect burden from the period of conditional approval until granting full marketing authorization is shifted to the post-authorization phase, payers may have to bear such burdens. Collection of robust data during routine clinical use is challenging along with high prices for new medicines during data collection. This paper presents the concept of MAPPs and possible challenges. Concerns and potential ways forward are discussed and a number of recommendations are presented from the perspective of payers.

  3. Estimating inpatient hospital prices from state administrative data and hospital financial reports.

    Science.gov (United States)

    Levit, Katharine R; Friedman, Bernard; Wong, Herbert S

    2013-10-01

    To develop a tool for estimating hospital-specific inpatient prices for major payers. AHRQ Healthcare Cost and Utilization Project State Inpatient Databases and complete hospital financial reporting of revenues mandated in 10 states for 2006. Hospital discharge records and hospital financial information were merged to estimate revenue per stay by payer. Estimated prices were validated against other data sources. Hospital prices can be reasonably estimated for 10 geographically diverse states. All-payer price-to-charge ratios, an intermediate step in estimating prices, compare favorably to cost-to-charge ratios. Estimated prices also compare well with Medicare, MarketScan private insurance, and the Medical Expenditure Panel Survey prices for major payers, given limitations of each dataset. Public reporting of prices is a consumer resource in making decisions about health care treatment; for self-pay patients, they can provide leverage in negotiating discounts off of charges. Researchers can also use prices to increase understanding of the level and causes of price differentials among geographic areas. Prices by payer expand investigational tools available to study the interaction of inpatient hospital price setting among public and private payers--an important asset as the payer mix changes with the implementation of the Affordable Care Act. © Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

  4. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

    Directory of Open Access Journals (Sweden)

    Christine D. Jones MD, MS

    2015-08-01

    Full Text Available Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001, uninsured encounters decreased (18.4% to 6.3%, P < 0.001, and private payer encounters also decreased (14.1% to 13.3%, P = .001. The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001. In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion.

  5. Mandated Preparation Program Redesign: Kentucky Case

    Science.gov (United States)

    Browne-Ferrigno, Tricia

    2013-01-01

    This case study presents a chronicle of events spanning a decade in Kentucky that led to state policy changes for principal preparation and details the response to those mandated changes by professors at the University of Kentucky. Professors' collaborative efforts resulted in a new teacher leadership program and redesigned principal certification…

  6. Innovative payer engagement strategies: will the convergence lead to better value creation in personalized medicine?

    Science.gov (United States)

    Akhmetov, Ildar; Bubnov, Rostyslav V

    2017-12-01

    As reimbursement authorities are gaining greater power to influence the prescription behavior of physicians, it remains critical for life science companies focusing on personalized medicine to develop "tailor-made" payer engagement strategies to secure reimbursement and assure timely patient access to their innovative products. Depending on the types of such engagement, pharmaceutical and diagnostic companies may benefit by obtaining access to medical and pharmacy claims data, getting invaluable upfront inputs on evidence requirements and clinical trial design, and strengthening trust by payers, therefore avoiding uncertainties with regards to pricing, reimbursement, and research and development reinvestment. This article aims to study the evolving trend of partnering among two interdependent, yet confronting, stakeholder groups-payers and producers-as well as to identify the most promising payer engagement strategies based on cocreation of value introduced by life science companies in the past few years. We analyzed the recent case studies from both therapeutic and diagnostic realms considered as the "best practices" in payer engagement. The last 5 years were a breakout period for deals between life science companies and reimbursement authorities in the area of personalized medicine with a number of felicitous collaborative practices established already, and many more yet to emerge. We suggest that there are many ways for producers and payers to collaborate throughout the product life cycle-from data exchange and scientific counseling to research collaboration aimed at reducing healthcare costs, addressing adherence issues, and diminishing risks associated with future launches. The presented case studies provide clear insights on how successful personalized medicine companies customize their state-of-the-art payer engagement strategies to ensure closer proximity with payers and establish longer-term trust-based relationships.

  7. Child Abuse and Mandated Reporting

    Science.gov (United States)

    Woika, Shirley; Bowersox, Carissa

    2013-01-01

    Teachers and teachers-in-training are mandated reporters; they are legally required to report any suspected child abuse or neglect. This article describes: (1) How to file a report; (2) How prevalent child abuse is; (3) What abuse is; (4) What it means to be a mandated reporter; (5) When the report should be made; and (6) What to do if abuse is…

  8. Payer Negotiations in the New Healthcare Environment: How to Prepare for and Succeed in a Value-Based World.

    Science.gov (United States)

    Howrigon, Ron

    2016-01-01

    Because of their involvement with the Affordable Care exchanges, the national insurance companies have reported significant financial losses. As a result, there will soon be significant payer pressure to reduce medical expenses. To succeed in future negotiations with the payers, medical practices must understand the needs of the payers and then play to those needs. The author is a former managed care executive with more than 25 years of experience managing provider networks and implementing payer strategies for some of the largest payers in the United States. In this article, he outlines important things medical practices should be doing to prepare for the new world of value-based contracting. Medical practices that embrace this change and work hard to evolve with the future are the ones that are going to survive and succeed.

  9. Impact of the New Jersey all-payer rate-setting system: an analysis of financial ratios.

    Science.gov (United States)

    Rosko, M D

    1989-01-01

    Although prospective payment may contain costs, many analysts are concerned about the unintended consequences of rate regulation. This article presents the results of a case-study analysis of the New Jersey rate-setting programs during the period 1977-1985. Using measures of profitability, liquidity, and leverage, data for New Jersey, the Northeast, and the United States as a whole are used to contrast the impact of two forms of prospective payment. After attempting alternative cost-containment methods, the New Jersey Department of Health implemented an all-payer system in which prospective rates of compensation were established for DRGs. The new rate-setting system was designed to control costs, improve access to care, maintain quality of services, ensure financial viability of efficient providers, and limit the payment differentials associated with cost shifting. The results of this study have a number of implications for the evaluation of all-payer rate regulation. First, although the New Jersey all-payer system was more successful than the partial-payer program in restraining the rate of increase in cost per case, savings were achieved without adversely affecting the viability of regulated hospitals. Second, the large differentials among payers that were associated with the partial-payer program were reduced dramatically by the all-payer program. Third, using the financial position of inner-city hospitals relative to suburban hospitals as a measure of equity, the all-payer system appeared to be a fairer method of regulating rates.

  10. 42 CFR 411.22 - Reimbursement obligations of primary payers and entities that received payment from primary payers.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement obligations of primary payers and... Provisions § 411.22 Reimbursement obligations of primary payers and entities that received payment from... reimburse CMS for any payment if it is demonstrated that the primary payer has or had a responsibility to...

  11. Variation in provider vaccine purchase prices and payer reimbursement.

    Science.gov (United States)

    Freed, Gary L; Cowan, Anne E; Gregory, Sashi; Clark, Sarah J

    2009-12-01

    The purpose of this work was to collect data regarding vaccine prices and reimbursements in private practices. Amid reports of physicians losing money on vaccines, there are limited supporting data to show how much private practices are paying for vaccines and how much they are being reimbursed by third-party payers. We conducted a cross-sectional survey of a convenience sample of private practices in 5 states (California, Georgia, Michigan, New York, and Texas) that purchase vaccines for administration to privately insured children/adolescents. Main outcome measures included prices paid to purchase vaccines recommended for children and adolescents and reimbursement from the 3 most common, non-Medicaid payers for vaccine purchase and administration. Detailed price and reimbursement data were provided by 76 practices. There was a considerable difference between the maximum and minimum prices paid by practices, ranging from $4 to more than $30 for specific vaccines. There was also significant variation in insurance reimbursement for vaccine purchase, with maximum and minimum reimbursements for a single vaccine differing from $8 to more than $80. Mean net yield per dose (reimbursement for vaccine purchase minus price paid per dose) varied across vaccines from a low of approximately $3 to more than $24. Reimbursement for the first dose of vaccine administered ranged from $0 to more than $26, with a mean of $16.62. There is a wide range of prices paid by practices for the same vaccine product and in the reimbursement for vaccines and administration fees by payers. This variation highlights the need for individual practices to understand their own costs and reimbursements and to seek opportunities to reduce costs and increase reimbursements.

  12. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

    Science.gov (United States)

    Jones, Christine D.; Scott, Serena J.; Anoff, Debra L.; Pierce, Read G.; Glasheen, Jeffrey J.

    2015-01-01

    Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. PMID:26310500

  13. Adaptive Pathways: Possible Next Steps for Payers in Preparation for Their Potential Implementation

    Directory of Open Access Journals (Sweden)

    Patricia Vella Bonanno

    2017-08-01

    Full Text Available Medicines receiving a conditional marketing authorization through Medicines Adaptive Pathways to Patients (MAPPs will be a challenge for payers. The “introduction” of MAPPs is already seen by the European Medicines Agency (EMA as a fait accompli, with payers not consulted or involved. However, once medicines are approved through MAPPs, they will be evaluated for funding by payers through different activities. These include Health Technology Assessment (HTA with often immature clinical data and high uncertainty, financial considerations, and negotiations through different types of agreements, which can require monitoring post launch. Payers have experience with new medicines approved through conditional approval, and the fact that MAPPs present additional challenges is a concern from their perspective. There may be some activities where payers can collaborate. The final decisions on whether to reimburse a new medicine via MAPPs will have more variation than for medicines licensed via conventional processes. This is due not only to increasing uncertainty associated with medicines authorized through MAPPs but also differences in legal frameworks between member states. Moreover, if the financial and side-effect burden from the period of conditional approval until granting full marketing authorization is shifted to the post-authorization phase, payers may have to bear such burdens. Collection of robust data during routine clinical use is challenging along with high prices for new medicines during data collection. This paper presents the concept of MAPPs and possible challenges. Concerns and potential ways forward are discussed and a number of recommendations are presented from the perspective of payers.

  14. On the complaint of unconstitutionality of the Stuttgart Court decisions against non-payers and part payers of electricity bills

    International Nuclear Information System (INIS)

    Fischerhof, H.

    1980-01-01

    In a decision dated December 20, 1979, the Federal Constitutional Court refused to accept the complaint of unconstitutionality brought by the Technische Werke (Municipal Utilities) of the city of Stuttgart (TWS) against two decisions by the Stuttgart Municipal Court in favor of non-payers and part payers of electricity bills. The reasons given for the refusal to accept the complaint state that there was every indication of the Stuttgart judgements being faulty. On the basis of this finding, TWS can continue to demand payment in full of their electricity bills. The Federal Constitutional Court maintains that civil rights could not be applied to TWS as a corporation under private law, whose activities exclusively consisted in providing the public with means of existence and whose shares were held in full by an agency with rights of jurisdiction. In a footnote, the author argues that the refusal to grant protection of civil rights to TWS was in conflict with the equal rights principle. (HSCH) [de

  15. Systematic review of the effect of immunization mandates on uptake of routine childhood immunizations.

    Science.gov (United States)

    Lee, Cecilia; Robinson, Joan L

    2016-06-01

    The efficacy of immunization mandates for childcare or school entry is a long-standing controversy. The United States (US) adopted school entry immunization mandates in the 1800s, while most countries still do not have mandates. The objective of this systematic review was to analyze the evidence that immunization uptake increases with mandates. A search was conducted for studies that compared immunization uptake in a population prior to and after mandates, or in similar populations with one group having and the other not having mandates. Data were extracted and synthesized qualitatively due to the heterogeneity of study design. Eleven before-and-after studies and ten studies comparing uptake in similar populations with and without mandates were included. Studies were from the US (n = 18), France (n = 1) and Canada (n = 2). Eleven of the 21 studies looked at middle school mandates. All but two studies showed at least a trend towards increased uptake with mandates. Higher uptake was associated with a more long-standing mandate. Immunization mandates have generally led to increased short-term and long-term uptake in the group to whom the mandate applies. Many studies have centered around middle school mandates in the US and there is a paucity of studies of childcare mandates or of studies of mandates in other countries or in settings with relatively high baseline immunization uptake. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  16. Consequences of a Liquid Mandate

    DEFF Research Database (Denmark)

    Sörbom, Adrienne; Garsten, Christina

    This paper describes and answers the question how the WEF creates a strong position for itself in the global arena, without a formal and institutional mandate. Theoretically the paper builds and adds to emerging body of literature regarding partial organization, as framed by Ahrne and Brunsson (2...

  17. Cost of transfusion-dependent myelodysplastic syndrome (MDS) from a German payer?s perspective

    OpenAIRE

    2010-01-01

    Abstract No curative treatment exists for patients with myelodysplastic syndrome (MDS) besides allogeneic stem cell transplantation. Hence, palliative treatment is provided for a life time accruing high health care cost. As no study in cost of MDS exists in Germany, the objective of this study was to assess and analyze costs of transfusion-dependent low/intermediate-1-risk MDS in Germany from a payers? perspective. From seven centers, 116 low/intermediate-1-risk transfusion-depende...

  18. Does good medication adherence really save payers money?

    Science.gov (United States)

    Stuart, Bruce C; Dai, Mingliang; Xu, Jing; Loh, Feng-Hua E; S Dougherty, Julia

    2015-06-01

    Despite a growing consensus that better adherence with evidence-based medications can save payers money, assertions of cost offsets may be incomplete if they fail to consider additional drug costs and/or are biased by healthy adherer behaviors unobserved in typical medical claims-based analyses. The objective of this study was to determine whether controlling for healthy adherer bias (HAB) materially affected estimated medical cost offsets and additional drug spending associated with higher adherence. A total of 1273 Medicare beneficiaries with diabetes enrolled in Part D plans between 2006 and 2009. Using survey and claims data from the Medicare Current Beneficiary Survey, we measured medical and drug costs associated with good and poor adherence (proportion of days covered ≥ 80% and <80%, respectively) to oral antidiabetic drugs, ACE inhibitors/ARBs, and statins over 2 years. To test for HAB, we estimated pairs of regression models, one set containing variables typically controlled for in conventional claims analysis and a second set with survey-based variables selected to capture HAB effects. We found consistent evidence that controlling for HAB reduces estimated savings in medical costs from better adherence, and likewise, reduces estimates of additional adherence-related drug spending. For ACE inhibitors/ARBs we estimate that controlling for HAB reduced adherence-related medical cost offsets from $6389 to $4920 per person (P<0.05). Estimates of additional adherence-related drug costs were 26% and 14% lower in HAB-controlled models (P < 0.05). These results buttress the economic case for action by health care payers to improve medication adherence among insured persons with chronic disease. However, given the limitations of our research design, further research on larger samples with other disease states is clearly warranted.

  19. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI) joint (15%–30% of cases) is commonly treated with nonoperative care, but new minimally invasive surgery (MIS) options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication) were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier’s Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results The cumulative 3-year (base-case analysis) and 5-year (sensitivity analysis) differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS) were $14,545 and $6,137 per patient, respectively (2012 US dollars). Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality was achieved in year 1. Conclusion Cost offsets from new interventions for chronic conditions such as MIS SI joint fusion accrue over time. Higher initial procedure costs for MIS were largely offset by decreased nonoperative care costs over a 5-year time horizon. Optimizing effective resource use in both nonoperative and operative patients will facilitate cost-effective health care delivery. The impact of SI joint disruption on direct and indirect costs to commercial insurers, health

  20. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2014-05-01

    Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Karen Schneider,4 Tim Holt,5 John Cummings Jr6 1Covance Market Access Services Inc., San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc., Gaithersburg, MD, USA; 4Covance Market Access Services Inc., Sydney, Australia; 5Montgomery Spine Center, Orthopedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI joint (15%–30% of cases is commonly treated with nonoperative care, but new minimally invasive surgery (MIS options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods: An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier's Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results: The cumulative 3-year (base-case analysis and 5-year (sensitivity analysis differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS were $14,545 and $6,137 per patient, respectively (2012 US dollars. Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality

  1. Programs of Study as a State Policy Mandate: A Longitudinal Study of the South Carolina Personal Pathways to Success Initiative. Technical Appendix B

    Science.gov (United States)

    Hammond, Cathy; Drew, Sam F.; Withington, Cairen; Griffith, Cathy; Swiger, Caroline M.; Mobley, Catherine; Sharp, Julia L.; Stringfield, Samuel C.; Stipanovic, Natalie; Daugherty, Lindsay

    2013-01-01

    This Technical Appendix discusses how researchers from the National Research Center for Career and Technical Education (NRCCTE) conducted the five-year longitudinal study of South Carolina's Personal Pathway to Success initiative, which was authorized by the state's Education and Economic Development Act (EEDA) in 2005, and how they defined and…

  2. Programs of Study as a State Policy Mandate: A Longitudinal Study of the South Carolina Personal Pathways to Success Initiative. Final Technical Report: Major Findings and Implications

    Science.gov (United States)

    Hammond, Cathy; Drew, Sam F.; Withington, Cairen; Griffith, Cathy; Swiger, Caroline M.; Mobley, Catherine; Sharp, Julia L.; Stringfield, Samuel C.; Stipanovic, Natalie; Daugherty, Lindsay

    2013-01-01

    This is the final technical report from the National Research Center for Career and Technical Education's (NRCCTE's) five-year longitudinal study of South Carolina's Personal Pathway to Success initiative, which was authorized by the state's Education and Economic Development Act (EEDA) in 2005. NRCCTE-affiliated researchers at the National…

  3. Reimbursement issues facing patients, providers, and payers.

    Science.gov (United States)

    Antman, K

    1993-11-01

    Escalating costs of health care delivery and the current constraints imposed by the federal budget deficit seriously threaten to compromise patient care and innovative biomedical research. Recent third-party refusal to cover some patients treated in protocols has had considerable impact on trial research. In addition, reimbursement for conventional care sometimes has been refused if delivered as part of a study (e.g., MOPP therapy versus ABVD therapy) or for an indication that is not specifically cited on the Food and Drug Administration label. Who should cover the patient care costs of patients participating in clinical trials? One approach would have patients cover these costs themselves. A second approach is the reinstitution of patient care costs into research grants. A third possibility is that the pharmaceutical industry support patient care costs of clinical research. Historically, hospital expenses of patients participating in studies have been paid by health insurance policies. In the absence of a clinical trial, many patients would be treated with Food and Drug Administration-approved therapies despite a lack of substantial benefit. Such marginal treatments are compensated by third-party payers routinely. The current system is arbitrary and expensive, compromises research and development, and equates new treatment with no treatment. By refusing to reimburse the patient care costs of investigational therapy, third-party carriers are, in fact, making medical decisions. There is a growing and legitimate concern that the pace of clinical research will be impeded significantly at a time when many exciting developments will be ready for clinical trials. The molecular steps in carcinogenesis are being documented rapidly for common malignancies, such as colon cancer. Immunologic, biologic, and hormonal approaches, and emerging technologies, such as marrow transplant or antibody toxin conjugates, already are being studied in the clinic. Health policy legislation

  4. Payer Perspectives on Patient-Reported Outcomes in Health Care Decision Making: Oncology Examples.

    Science.gov (United States)

    Brogan, Andrew P; DeMuro, Carla; Barrett, Amy M; D'Alessio, Denise; Bal, Vasudha; Hogue, Susan L

    2017-02-01

    Health authorities and payers increasingly recognize the importance of patient perspectives and patient-reported outcomes (PROs) in health care decision making. However, given the broad variety of PRO endpoints included in clinical programs and variations in the timing of PRO data collection and country-specific needs, the role of PRO data in reimbursement decisions requires characterization. To (a) determine the effect of PRO data on market access and reimbursement decisions for oncology products in multiple markets and (b) assess the effect of PRO data collected after clinical progression on payer decision making. A 3-part assessment (targeted literature review, qualitative one-on-one interviews, and online survey) was undertaken. Published literature was identified through searches in PubMed/MEDLINE and Embase. In addition, a targeted search was conducted of health technology assessment (HTA) agency websites in the United States, the United Kingdom, France, and Germany. Qualitative one-on-one interviews were conducted with 16 payers from the RTI Health Solutions global advisory panel in 14 markets (Australia, Brazil, France, Germany, Italy, South Korea, Netherlands, Poland, Spain, Sweden, Taiwan, Turkey, the United Kingdom, and the United States [n = 3]). Of the 200 payers and payer advisors from the global advisory panel invited to participate in the online survey, 20 respondents (China, France, Germany, Spain [n = 2], Taiwan, the United Kingdom, and the United States [n = 13]) completed the survey, and 6 respondents (Australia, South Korea, and the United States [n = 4]) partially completed the survey. Reviews of the literature and publicly available HTAs and reimbursement decisions suggested that HTA bodies and payers have varying experience with and confidence in PRO data. Payers participating in the survey indicated that PRO data may be especially influential in oncology compared with other therapeutic areas. Payers surveyed offered little differentiation

  5. Print News Coverage of School-Based HPV Vaccine Mandate

    Science.gov (United States)

    Casciotti, Dana; Smith, Katherine C.; Andon, Lindsay; Vernick, Jon; Tsui, Amy; Klassen, Ann C.

    2015-01-01

    BACKGROUND In 2007, legislation was proposed in 24 states and the District of Columbia for school-based HPV vaccine mandates, and mandates were enacted in Texas, Virginia, and the District of Columbia. Media coverage of these events was extensive, and media messages both reflected and contributed to controversy surrounding these legislative activities. Messages communicated through the media are an important influence on adolescent and parent understanding of school-based vaccine mandates. METHODS We conducted structured text analysis of newspaper coverage, including quantitative analysis of 169 articles published in mandate jurisdictions from 2005-2009, and qualitative analysis of 63 articles from 2007. Our structured analysis identified topics, key stakeholders and sources, tone, and the presence of conflict. Qualitative thematic analysis identified key messages and issues. RESULTS Media coverage was often incomplete, providing little context about cervical cancer or screening. Skepticism and autonomy concerns were common. Messages reflected conflict and distrust of government activities, which could negatively impact this and other youth-focused public health initiatives. CONCLUSIONS If school health professionals are aware of the potential issues raised in media coverage of school-based health mandates, they will be more able to convey appropriate health education messages, and promote informed decision-making by parents and students. PMID:25099421

  6. Are Teachers Prepared? Predictors of Teachers' Readiness to Serve as Mandated Reporters of Child Abuse

    Science.gov (United States)

    Greytak, Emily A.

    2009-01-01

    The Child Abuse Prevention and Treatment Act (1974) requires that states receiving U.S. federal funds directed at child abuse implement mandated reporting laws. As a result, all states have adopted legislation requiring teachers and other professionals who deal with children to report suspicions of child abuse. The federal mandate for such…

  7. The Impact and Dilemma of Unfunded Mandates Confronting Local Government South Africa: A Comparative Analysis

    Directory of Open Access Journals (Sweden)

    M. Basdeo

    2012-09-01

    Full Text Available Local government has emerged from a prolonged transition to face a second generation of challenges, namely unfunded mandates. Compliance with the current financial management system is a constant challenge for local government. To complicate matters local government is challenged by the dilemma of unfunded mandates which are an extreme manifestation of the phenomenon of governing from the centre. National government through various strategies imposes national mandates on provincial and local government at the expense of the latter. The incidence of unfunded mandate reflects a power hierarchy. Unfunded mandates are generally a significant indicator of the relative weakness of national government because it is often local government occupying constitutionally and politically the weakest position in the hierarchy that is burdened with new responsibilities. In decentralised and federal government systems, provincial/state and local governments object to unfunded mandates because they shrink their policy space, limit their expenditure choices and ultimately local government’s accountability to their electorates. Further, these systems of governance establish a hierarchy of authority that creates  notions of self-rule by national government. Unfunded mandates reflect systemic weaknesses of decentralised or federal allocation of powers and functions. Although there are principled objections, unfunded mandates remain constitutional. Given the wide incidence of unfunded mandates the critical question arises as to how in a decentralised system, one level of government can impose mandates with cost implications on another. How is it constitutionally justifiable?

  8. Billing third party payers for pharmaceutical care services.

    Science.gov (United States)

    Poirier, S; Buffington, D E; Memoli, G A

    1999-01-01

    To describe the steps pharmacists must complete when seeking compensation from third party payers for pharmaceutical care services. Government publications; professional publications, including manuals and newsletters; authors' personal experience. Pharmacists in increasing numbers are meeting with success in getting reimbursed by third party payers for patient care activities. However, many pharmacists remain reluctant to seek compensation because they do not understand the steps involved. Preparatory steps include obtaining a provider/supplier number, procuring appropriate claim forms, developing data collection and documentation systems, establishing professional fees, creating a marketing plan, and developing an accounting system. To bill for specific patient care services, pharmacists need to collect the patient's insurance information, obtain a statement of medical necessity from the patient's physician, complete the appropriate claim form accurately, and submit the claim with supporting documentation to the insurer. Although many claims from pharmacists are rejected initially, pharmacists who work with third party payers to understand the reasons for denial of payment often receive compensation when claims are resubmitted. Pharmacists who follow these guidelines for billing third party payers for pharmaceutical care services should notice an increase in the number of paid claims.

  9. Did the US Infertility Health Insurance Mandates Affect the Timing of First Birth?

    NARCIS (Netherlands)

    Ohinata, A.

    2011-01-01

    From 1977-2001, 15 US states mandated health insurance providers to offer coverage for infertility treatment. Although the majority of the past literature has studied impacts on older women who are likely to seek treatment, this paper proposes that the mandates may have had a wider impact on the US

  10. Contract law: relationship between dermatologists and third-party payers.

    Science.gov (United States)

    Askanas, A V

    1993-04-01

    The relationship between third-party payers and dermatologists is generally governed by a written contract. That relationship can be more beneficial to the dermatologist, and chances of liability may be decreased, both for breach of contract and for malpractice, if the dermatologist pays close attention to the language in the contract. All contracts are generally negotiable; detrimental language in the contract often may be removed or changed. This article presents information to help prepare dermatologists to review and negotiate contracts.

  11. Payer source influence on effectiveness of lifestyle medicine programs.

    Science.gov (United States)

    Vogelgesang, Joseph; Drozek, David; Nakazawa, Masato; Shubrook, Jay H

    2015-09-01

    Many chronic diseases are responsive to interventions focused on diet and physical activity. The Complete Health Improvement Program (CHIP) is an intensive, community-based lifestyle intervention that effectively treats many chronic diseases and their risk factors. This is a pilot study examining the effect of payer source for CHIP tuition on participants' outcomes. Seventy-nine self-selected participants (73.4% female) attended 1 of 3 CHIP classes (classes 7-9) offered January through May 2013 in Athens, Ohio. Participants were categorized into 3 groups based on the source(s) of their tuition payment: self-pay, employer-pay, or scholarship. Chronic disease risk factors for each individual were assessed at the beginning and conclusion of the program. Outcome variables included percent reduction between pre- and post CHIP measures in body mass index, systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and fasting blood glucose. Results were compared between type of payer source (out of pocket vs employer and/or scholarship) and between each individual CHIP class attended. There was no statistical difference in outcomes based on payer source. Those who received funding through their employer or a scholarship experienced similar effects from a lifestyle intervention program as those who paid out of pocket. This study demonstrates that the benefit of CHIP for reducing chronic disease risk factors exists independent of payment source, and thus suggests its benefit may cross socioeconomic lines.

  12. Change of Subsidiary Mandates in Emerging Markets

    DEFF Research Database (Denmark)

    Hansen, Michael W.; Petersen, Bent; Wad, Peter

    2011-01-01

    fails to conceptualize how the specificities of emerging market business environments affect subsidiary mandate evolution. The paper develops a theoretical model for business environment change influence on subsidiary mandates, and demonstrates how the model can capture much of recent years dramatic......In recent years, the activities of Danish MNCs in India have expanded dramatically. Previously dormant subsidiaries have been transformed into integral components in the global strategies of Danish MNCs, either as crucial cash cows catering to the rapidly growing Indian markets, or as platforms...

  13. Differences in the rates of patient safety events by payer: implications for providers and policymakers.

    Science.gov (United States)

    Spencer, Christine S; Roberts, Eric T; Gaskin, Darrell J

    2015-06-01

    The reduction of adverse patient safety events and the equitable treatment of patients in hospitals are clinical and policy priorities. Health services researchers have identified disparities in the quality of care provided to patients, both by demographic characteristics and insurance status. However, less is known about the extent to which disparities reflect differences in the places where patients obtain care, versus disparities in the quality of care provided to different groups of patients in the same hospital. In this study, we examine whether the rate of adverse patient safety events differs by the insurance status of patients within the same hospital. Using discharge data from hospitals in 11 states, we compared risk-adjusted rates for 13 AHRQ Patient Safety Indicators by Medicare, Medicaid, and Private payer insurance status, within the same hospitals. We used multivariate regression to assess the relationship between insurance status and rates of adverse patient safety events within hospitals. Medicare and Medicaid patients experienced significantly more adverse safety events than private pay patients for 12 and 7 Patient Safety Indicators, respectively (at P patients had significantly lower event rates than private payers on 2 Patient Safety Indicators. Risk-adjusted Patient Safety Indicator rates varied with patients' insurance within the same hospital. More research is needed to determine the cause of differences in care quality received by patients at the same hospital, especially if quality measures are to be used for payment.

  14. Biosimilars: How Can Payers Get Long-Term Savings?

    Science.gov (United States)

    Mestre-Ferrandiz, Jorge; Towse, Adrian; Berdud, Mikel

    2016-06-01

    The term 'biosimilar' refers to an alternative similar version of an off-patent innovative originator biotechnology product (the 'reference product'). Several biosimilars have been approved in Europe, and a number of top-selling biological medicines have lost, or will lose, patent protection over the next 5 years. We look at the experience in Europe so far. The USA has finally implemented a regulatory route for biosimilar approval. We recommend that European and US governments and payers take a strategic approach to get value for money from the use of biosimilars by (1) supporting and incentivising generation of high-quality comprehensive outcomes data on the effectiveness and safety of biosimilars and originator products; and (2) ensuring that incentives are in place for budget holders to benefit from price competition. This may create greater willingness on the part of budget holders and clinicians to use biosimilar and originator products with comparable outcomes interchangeably, and may drive down prices. Other options, such as direct price cuts for originator products or substitution rules without outcomes data, are likely to discourage biosimilar entry. With such approaches, governments may achieve a one-off cut in originator prices but may put at risk the creation of a more competitive market that would, in time, produce much greater savings. It was the creation of competitive markets for chemical generic drugs-notably, in the USA, the UK and Germany-rather than price control, that enabled payers to achieve the high discounts now taken for granted.

  15. Financing care for the uninsured: the dilemma vexes New Jersey hospitals and payers.

    Science.gov (United States)

    Wells, E V

    1996-05-01

    New Jersey's diverse constituencies and special interest groups don't usually agree on a public policy issue. However, almost everyone in the public policy arena agrees that hospitals should treat people who show up in emergency departments with problems requiring medical attention. For over a decade, Garden State policymakers, payers, and providers have faced the dilemma of excess demand on hospitals that treat the uninsured. This demand has risen due to increasing health care costs, development of costly technology, state deregulation of hospital payments, and employers' reluctance to insure workers and their families coupled with a mobile workforce holding part-time and seasonal jobs. The fiscal solvency of inner-city hospitals is threatened yet the problem continues to elude resolution.

  16. Teaching to and beyond the Test: The Influence of Mandated Accountability Testing in One Social Studies Teacher's Classroom

    Science.gov (United States)

    Neumann, Jacob

    2013-01-01

    Background/Context: The nature of the impact of state-mandated accountability testing on teachers' classroom practices remains contested. While many researchers argue that teachers change their teaching in response to mandated testing, others contend that the nature and degree of the impact of testing on teaching remains unclear. The research on…

  17. An Assessment of the Unfunded Mandates Reform Act in 1997

    National Research Council Canada - National Science Library

    Gullo, Theresa

    1998-01-01

    .... At the same time, some Members of Congress and other observers question whether UMRA's definition of intergovernmental mandates is adequate and whether the legislative procedures that apply to private-sector mandates should be bolstered.

  18. The Ontario Energy Board's proposed new mandate

    International Nuclear Information System (INIS)

    Laughren, F.

    1998-01-01

    The Ontario Energy Board's proposed new mandate was reviewed. The role of the Board will be to regulate the monopoly delivery components of the electricity and natural gas industry and to smooth the transition to competition. The Board will monitor market performance and will encourage electricity and natural gas monopoly services to be compatible where possible. The Board will also assist local restructuring efforts when called upon do so and ensure that the marketplace operates efficiently and effectively. Gas marketers' licensing is scheduled to begin in early 1999. Licenses will also apply to the electric industry. The objectives of the proposed licensing, the regulatory requirements and the proposed regulatory approach are described

  19. 10 CFR 490.302 - Vehicle acquisition mandate schedule.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Vehicle acquisition mandate schedule. 490.302 Section 490... Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a) Except as provided in section 490.304 of this part, of the light duty motor vehicles newly acquired by a...

  20. Guidelines and Value-Based Decision Making: An Evolving Role for Payers.

    Science.gov (United States)

    McCauley, Janet L

    2015-01-01

    Payers use evidence-based guidelines to promote effective health diagnoses and treatments for their members and to ensure that members are not subject to harmful or wasteful care. Payer guidelines inform coverage, but the content of these guidelines relies on the same evidentiary base as clinical treatment guidelines. Recent strategies to foster value through benefit design and alternative reimbursement methodologies illustrate emerging applications for evidence-based guidelines. The current focus on cost effectiveness within health technology assessment, comparative effectiveness research in collaboration with payers, and transparency around payer evidence assessment could better align payers' interests in evidence-based care with those of other stakeholders. The move to value in health care will depend upon credible clinical evidence to enable informed decision making. ©2015 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

  1. The effects of mandated health insurance benefits for autism on out-of-pocket costs and access to treatment.

    Science.gov (United States)

    Chatterji, Pinka; Decker, Sandra L; Markowitz, Sara

    2015-01-01

    As of 2014, 37 states have passed mandates requiring many private health insurance policies to cover diagnostic and treatment services for autism spectrum disorders (ASDs). We explore whether ASD mandates are associated with out-of-pocket costs, financial burden, and cost or insurance-related problems with access to treatment among privately insured children with special health care needs (CSHCNs). We use difference-in-difference and difference-in-difference-in-difference approaches, comparing pre--post mandate changes in outcomes among CSHCN who have ASD versus CSHCN other than ASD. Data come from the 2005 to 2006 and the 2009 to 2010 waves of the National Survey of CSHCN. Based on the model used, our findings show no statistically significant association between state ASD mandates and caregivers' reports about financial burden, access to care, and unmet need for services. However, we do find some evidence that ASD mandates may have beneficial effects in states in which greater percentages of privately insured individuals are subject to the mandates. We caution that we do not study the characteristics of ASD mandates in detail, and most ASD mandates have gone into effect very recently during our study period.

  2. Estimating Nitrogen Load Resulting from Biofuel Mandates

    Science.gov (United States)

    Alshawaf, Mohammad; Douglas, Ellen; Ricciardi, Karen

    2016-01-01

    The Energy Policy Act of 2005 and the Energy Independence and Security Act (EISA) of 2007 were enacted to reduce the U.S. dependency on foreign oil by increasing the use of biofuels. The increased demand for biofuels from corn and soybeans could result in an increase of nitrogen flux if not managed properly. The objectives of this study are to estimate nitrogen flux from energy crop production and to identify the catchment areas with high nitrogen flux. The results show that biofuel production can result in an increase of nitrogen flux to the northern Gulf of Mexico from 270 to 1742 thousand metric tons. Using all cellulosic (hay) ethanol or biodiesel to meet the 2022 mandate is expected to reduce nitrogen flux; however, it requires approximately 25% more land when compared to other scenarios. Producing ethanol from switchgrass rather than hay results in three-times more nitrogen flux, but requires 43% less land. Using corn ethanol for 2022 mandates is expected to have double the nitrogen flux when compared to the EISA-specified 2022 scenario; however, it will require less land area. Shifting the U.S. energy supply from foreign oil to the Midwest cannot occur without economic and environmental impacts, which could potentially lead to more eutrophication and hypoxia. PMID:27171101

  3. The Distribution of Federal Elementary-Secondary Education Grants among the States. Final Report on the Study Mandated by Congress in P.L. 100-297, Section 6207.

    Science.gov (United States)

    Barro, Stephen M.

    In the Hawkins-Stafford Elementary and Secondary School Improvement Amendments of 1988, Congress directed the U.S. Department of Education (ED) to conduct a study of methods used to allocate federal elementary and secondary education grants among the states. This document, the final report on that study, assesses grant distribution funding…

  4. The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age.

    Science.gov (United States)

    Villelli, Nicolas W; Yan, Hong; Zou, Jian; Barbaro, Nicholas M

    2017-12-01

    OBJECTIVE Several similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors' prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US. METHODS Using the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers' compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control. RESULTS The authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and "other" categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65-84 years old, with a decrease in surgeries for those 18-44 years old. New York showed an increase in all insurance categories and all adult age groups. CONCLUSIONS After the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly

  5. Comparative analysis on the probability of being a good payer

    Science.gov (United States)

    Mihova, V.; Pavlov, V.

    2017-10-01

    Credit risk assessment is crucial for the bank industry. The current practice uses various approaches for the calculation of credit risk. The core of these approaches is the use of multiple regression models, applied in order to assess the risk associated with the approval of people applying for certain products (loans, credit cards, etc.). Based on data from the past, these models try to predict what will happen in the future. Different data requires different type of models. This work studies the causal link between the conduct of an applicant upon payment of the loan and the data that he completed at the time of application. A database of 100 borrowers from a commercial bank is used for the purposes of the study. The available data includes information from the time of application and credit history while paying off the loan. Customers are divided into two groups, based on the credit history: Good and Bad payers. Linear and logistic regression are applied in parallel to the data in order to estimate the probability of being good for new borrowers. A variable, which contains value of 1 for Good borrowers and value of 0 for Bad candidates, is modeled as a dependent variable. To decide which of the variables listed in the database should be used in the modelling process (as independent variables), a correlation analysis is made. Due to the results of it, several combinations of independent variables are tested as initial models - both with linear and logistic regression. The best linear and logistic models are obtained after initial transformation of the data and following a set of standard and robust statistical criteria. A comparative analysis between the two final models is made and scorecards are obtained from both models to assess new customers at the time of application. A cut-off level of points, bellow which to reject the applications and above it - to accept them, has been suggested for both the models, applying the strategy to keep the same Accept Rate as

  6. Negotiating with third party payers: one community pharmacy's experience.

    Science.gov (United States)

    Fridy, Kimberly; DeHart, Renee M; Monk-Tutor, Mary R

    2002-01-01

    attempts at contract negotiation between one pharmacy and nine third party payers. The difficulty of achieving successful results and the necessity of carefully considering the time and cost of contract negotiations underscore how important it is for independent pharmacists to concentrate their efforts on contracts and terms they have an opportunity to change.

  7. Charged-particle beam: a safety mandate

    International Nuclear Information System (INIS)

    Young, K.C.

    1983-01-01

    The Advanced Test Accelerator (ATA) is a recent development in the field of charged particle beam research at Lawrence Livermore National Laboratory. With this experimental apparatus, researchers will characterize intense pulses of electron beams propagated through air. Inherent with the ATA concept was the potential for exposure to hazards, such as high radiation levels and hostile breathing atmospheres. The need for a comprehensive safety program was mandated; a formal system safety program was implemented during the project's conceptual phase. A project staff position was created for a safety analyst who would act as a liaison between the project staff and the safety department. Additionally, the safety analyst would be responsible for compiling various hazards analyses reports, which formed the basis of th project's Safety Analysis Report. Recommendations for safety features from the hazards analysis reports were incorporated as necessary at appropriate phases in project development rather than adding features afterwards. The safety program established for the ATA project faciliated in controlling losses and in achieving a low-level of acceptable risk

  8. The Protos mandate a scientific novel

    CERN Document Server

    Kanas, Nick

    2014-01-01

    In the 25th Century, the effects of overpopulation and global warming on Earth have led to the formation of human colonies on the Moon, Mars and elsewhere in the Solar System, yet the limited number of viable places forces humanity to look to the stars. A crash program has been developed to send Protos 1, a giant multigenerational starship, to a newly discovered Earth-like planet orbiting a nearby star. The plan is for awake crewmembers to run the ship, and for people in suspended animation to be roused before planetfall to use their skills in exploration and colony formation. To fulfill the goals of the mission and ensure that the in-flight population does not deplete the limited resources, the Protos Mandate is set up to govern a tightly controlled social system for the duration of the journey, which will take several generations.  But problems threaten to sabotage the mission during its launch and transit, and what finally awaits the crewmembers shocks them in an unpredictable way.  This novel chronicl...

  9. A constructive Indian country response to the evidence-based program mandate.

    Science.gov (United States)

    Walker, R Dale; Bigelow, Douglas A

    2011-01-01

    Over the last 20 years governmental mandates for preferentially funding evidence-based "model" practices and programs has become doctrine in some legislative bodies, federal agencies, and state agencies. It was assumed that what works in small sample, controlled settings would work in all community settings, substantially improving safety, effectiveness, and value-for-money. The evidence-based "model" programs mandate has imposed immutable "core components," fidelity testing, alien programming and program developers, loss of familiar programs, and resource capacity requirements upon tribes, while infringing upon their tribal sovereignty and consultation rights. Tribal response in one state (Oregon) went through three phases: shock and rejection; proposing an alternative approach using criteria of cultural appropriateness, aspiring to evaluability; and adopting logic modeling. The state heard and accepted the argument that the tribal way of knowing is different and valid. Currently, a state-authorized tribal logic model and a review panel process are used to approve tribal best practices for state funding. This constructive response to the evidence-based program mandate elevates tribal practices in the funding and regulatory world, facilitates continuing quality improvement and evaluation, while ensuring that practices and programs remain based on local community context and culture. This article provides details of a model that could well serve tribes facing evidence-based model program mandates throughout the country.

  10. Does hemopericardium after chest trauma mandate sternotomy?

    Science.gov (United States)

    Thorson, Chad M; Namias, Nicholas; Van Haren, Robert M; Guarch, Gerardo A; Ginzburg, Enrique; Salerno, Tomas A; Schulman, Carl I; Livingstone, Alan S; Proctor, Kenneth G

    2012-06-01

    Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether these were rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy. Records were retrospectively reviewed for all patients at a Level I trauma center (December 1996 to November 2011) who sustained chest trauma with pericardial window (PCW, n = 377) and/or median sternotomy (n = 110). Fifty-five (15%) patients with positive PCW proceeded to sternotomy. Penetrating injury was the dominant mechanism (n = 49, 89%). Nineteen (35%) were hypotensive on arrival or during initial resuscitation. Most received surgeon-performed focused cardiac ultrasound examinations (n = 43, 78%) with positive results (n = 25, 58%). Ventricular injuries were most common, with equivalent numbers occurring on the right (n = 16, 29%) and left (n = 15, 27%). Six (11%) with positive PCW had isolated pericardial lacerations, but 21 (38%) had no repairable cardiac or great vessel injury. Those with therapeutic versus nontherapeutic sternotomies were similar with respect to age, mechanisms of injury, injury severity scores, presenting laboratory values, resuscitation fluids, and vital signs. Multiple logistic regression revealed that penetrating trauma (odds ratio: 13.3) and hemodynamic instability (odds ratio: 7.8) were independent predictors of therapeutic sternotomy. Hemopericardium per se may be overly sensitive for diagnosing cardiac or great vessel injuries after chest trauma. Some stable blunt or penetrating trauma patients without continuing intrapericardial bleeding had nontherapeutic sternotomies, suggesting that this intervention could be avoided in selected cases. Therapeutic study, level III. Copyright © 2012 by Lippincott Williams & Wilkins.

  11. The Mandate System for the Belgian Public Prosecution

    Directory of Open Access Journals (Sweden)

    Bruno BROUCKER

    2009-12-01

    Full Text Available The law of 22 December 1998 introduced the mandate system for the heads of the Public Prosecution offices, which were appointed permanent before that. Theoretically, such a system needs to enhance, within the organization, effectiveness, efficiency, responsabilisation, and goal-orientation. However, the mandate system within the Belgian Public Prosecution was introduced prematurely, for dubious reasons and in a precipitate manner. In the current situation, the position of the mandate holder is uncertain, with a bounded autonomy and a low wage increase. Moreover, it remains impossible to intervene in the policy of appointed heads of office (during their mandate, the efficiency and effectiveness is only increased in some prosecution offices and a contract containing actual management responsibilities is absent. In sum: there is a large gap between the theoretical principles of mandate systems and the way it is introduced in the Belgian Public Prosecution.

  12. Primary Payer at DX: Issues with Collection and Assessment of Data Quality.

    Science.gov (United States)

    Sherman, Recinda L; Williamson, Laura; Andrews, Patricia; Kahn, Amy

    2016-01-01

    An individual's access to health insurance influences the amount and type of health services a patient receives for prevention and treatment, and, ultimately, influences survival. The North American Association of Central Cancer Registries (NAACCR) Item #630, Primary Payer at DX, is a required field intended to document health insurance status for the purpose of supporting patterns-of-care studies and other research. However, challenges related to the uniformity of collection and availability of data needed to populate this field diminish the value of the Primary Payer at DX data. A NAACCR taskforce worked on issues surrounding the collection of Primary Payer at DX; including proposing a crosswalk between Primary Payer at DX and the new Public Health Payment Typology standard, often available in hospital discharge databases. However, there are issues with compatibility between coding systems, intent of data collection, timelines for coding insurance, and changes in insurance coverage (partly due to the Affordable Care Act) that continue to complicate the collection and use of Primary Payer at DX data.

  13. Benchmarking Insulin Treatment Persistence Among Patients with Type 2 Diabetes Across Different U.S. Payer Segments.

    Science.gov (United States)

    Wei, Wenhui; Jiang, Jenny; Lou, Youbei; Ganguli, Sohini; Matusik, Mark S

    2017-03-01

    Treatment persistence with basal insulins is crucial to achieving sustained glycemic control, which is associated with a reduced risk of microvascular disease and other complications of type 2 diabetes (T2D). However, studies suggest that persistence with basal insulin treatment is often poor. To measure and benchmark real-world basal insulin treatment persistence among patients with T2D across different payer segments in the United States. This was a retrospective observational study of data from a national pharmacy database (Walgreen Co., Deerfield, IL). The analysis included patients with T2D aged ≥ 18 years who filled ≥ 1 prescription for basal insulins between January 2013 and June 2013 (the index prescription) and who had also filled prescriptions for ≥ 1 oral antidiabetes drug in the database. Patients with claims for premixed insulin were excluded. Treatment persistence was defined as remaining on the study medication(s) during the 1-year follow-up period. Patients were stratified according to treatment history (existing basal insulin users vs. new insulin users), payer segments (commercially insured, Medicare, Medicaid, or cash-pay), type of basal insulin (insulin glargine, insulin detemir, or neutral protamine Hagedorn insulin [NPH]), and device for insulin administration (pen or vial/syringe). A total of 274,102 patients were included in this analysis, 82% of whom were existing insulin users. In terms of payer segments, 45.3% of patients were commercially insured, 47.8% had Medicare, 5.9% had Medicaid, and 1.1% were cash-pay. At the 1-year follow-up, basal insulin treatment persistence rate was 66.8% overall, 61.7% for new users, and 67.9% for existing users. In general, for both existing and new basal insulin users, higher persistence rate and duration were associated with Medicare versus cash-pay patients, use of insulin pens versus vial/syringe, and use of insulin glargine versus NPH. This large-scale study provides a benchmark of basal insulin

  14. Mandating nutrient menu labeling in restaurants: potential public health benefits.

    Science.gov (United States)

    Stran, Kimberly A; Turner, Lori W; Knol, Linda

    2013-03-01

    Many Americans have replaced home-cooked meals with fast food and restaurants meals. This contributes to increased incidences of overweight and obesity. Implementing policies that require restaurants to disclose nutrition information has the potential to improve nutrition knowledge and food behaviors. The purpose of this paper was to examine the potential health benefits of nutrient menu labeling in restaurants, the progress of this legislation and to provide results regarding the implementation of these policies. Data sources were obtained from a search of multiple databases including PubMed, Science Direct, Academic Search Premier, and Google Scholar. Study inclusion criteria were publication in the past ten years, obesity prevention, and utilization of nutrition labeling on menus in restaurants. The initial policies to provide consumers with nutrition information in restaurant settings began at the state levels in 2006. These laws demonstrated success, other states followed, and a national law was passed and is being implemented. Mandating nutrient menu disclosure has the potential to influence a large number of people; this legislation has the opportunity to impact Americans who dine at a fast food or chain restaurant. Given the growing obesity epidemic, continued research is necessary to gauge the effectiveness of this new law and its effects on the health status of the American people.

  15. Gender, Colonialism and Rabbinical Courts in Mandate Palestine

    Directory of Open Access Journals (Sweden)

    Lisa Fishbayn

    2011-11-01

    Full Text Available The distribution of powers between the state and religious groups plays an important role in shaping how controversies over multicultural toleration and women’s rights under religious law can be resolved. Some structures encourage dialogue while others make it difficult. In Israel, the presence of multiple systems of personal religious law limits the possibilities for the transformation of discriminatory religious laws. There is no civil marriage or divorce in Israel. When the modern State of Israel was created, exclusive power over family law disputes involving Jewish citizens was placed in the hands of rabbinical courts. This arrangement has been called one to retain the ‘status quo’. However, it was not a continuation of Jewish tradition or of the arrangements in place during the long period of Ottoman rule in Palestine. It reflected strengthened powers that had been given to rabbinical courts during the period of the British Mandate for Palestine. This article will trace the ways in which British policies for colonial rule and the interests of Jewish religious leaders coalesced to create a regime of religious family law that is resistant to feminist demands for change.

  16. Did the Affordable Care Act's Dependent Coverage Mandate Increase Premiums?

    OpenAIRE

    Briggs Depew; James Bailey

    2014-01-01

    We investigate the impact of the Affordable Care Act's dependent coverage mandate on insurance premiums. The expansion of dependent coverage under the ACA allows young adults to remain on their parent's private health insurance plans until the age of 26. We find that the mandate has led to a 2.5-2.8 percent increase in premiums for health insurance plans that cover children, relative to single-coverage plans. We find no evidence that the mandate caused an increase in the amount of the employe...

  17. Relative efficacy of drugs: an emerging issue between regulatory agencies and third-party payers.

    Science.gov (United States)

    Eichler, Hans-Georg; Bloechl-Daum, Brigitte; Abadie, Eric; Barnett, David; König, Franz; Pearson, Steven

    2010-04-01

    Drug regulatory agencies have traditionally assessed the quality, safety and efficacy of drugs, and the current paradigm dictates that a new drug should be licensed when the benefits outweigh the risks. By contrast, third-party payers base their reimbursement decisions predominantly on the health benefits of the drug relative to existing treatment options (termed relative efficacy; RE). Over the past decade, the role of payers has become more prominent, and time-to-market no longer means time-to-licensing but time-to-reimbursement. Companies now have to satisfy the sometimes divergent needs of both regulators and payers, and to address RE during the pre-marketing stages. This article describes the current political background to the RE debate and presents the scientific and methodological challenges as they relate to RE assessment. In addition, we explain the impact of RE on drug development, and speculate on future developments and actions that are likely to be required from key players.

  18. School Administrator Assessments of Bullying and State-Mandated Testing

    Science.gov (United States)

    Lacey, Anna; Cornell, Dewey G.

    2016-01-01

    Bully victimization is associated with lower academic performance for individual students; however, less is known about the impact of bullying on the academic performance of the school as a whole. This study examined how retrospective administrator reports of both the prevalence of teasing and bullying (PTB) and the use of evidence-based bullying…

  19. Competing values in serving older and vulnerable adults: adult protective services, mandated reporting, and domestic violence programs.

    Science.gov (United States)

    Cramer, Elizabeth P; Brady, Shane R

    2013-01-01

    State mandatory reporting statutes may directly or indirectly list domestic violence programs as among those that are mandated reporters of cases of suspected abuse, neglect, or exploitation of older individuals and those with disabilities. Domestic violence programs, however, may not consider themselves to be mandated reporters, because the responsibility of reporting abuse may be contrary to their programmatic philosophy. In the Commonwealth of Virginia, the potential conflict between domestic violence programs and Adult Protective Services about the issue of mandated reporting has created tension between these organizations as each entity continues interpreting the issues and policies of mandated reporting through its own lens. The authors draw out some of the reasons for the conflict as well as make recommendations for improving relationships between the two organizations, which will ultimately benefit vulnerable adults who are experiencing abuse.

  20. Proposal of the Physicians' Working Group for Single-Payer National Health Insurance.

    Science.gov (United States)

    Woolhandler, Steffie; Himmelstein, David U; Angell, Marcia; Young, Quentin D

    2003-08-13

    The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care--the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least 200 billion dollars annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program

  1. Provider-Payer Partnerships as an Engine for Continuous Quality Improvement.

    Science.gov (United States)

    Balfour, Margaret E; Zinn, Tylar E; Cason, Karena; Fox, Jerimya; Morales, Myra; Berdeja, Cesar; Gray, Jay

    2018-03-01

    The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers.

  2. The distributional effects of employer and individual health insurance mandates.

    Science.gov (United States)

    Holahan, J; Winterbottom, C; Zedlewski, S

    This paper assesses the impact of different kinds of employer and individual mandates on the cost to individuals, business, and government. We also examine the distribution of health care expenditures across individuals in different income groups, assuming that individuals ultimately bear the cost of employer payments through lower wages and the cost of government payments through tax contributions. A major conclusion is that net benefits to lower income individuals improve under all alternatives to the current system with relatively small increases in payments by individuals in any income group. Additionally, while employer mandates reduce individuals' direct payments, individual mandates can have lower costs to the government and better distributional outcomes. A 50% employer mandate also has many desirable features.

  3. Diagnosis and Treatment of Diminished Ovarian Reserve in ART Cycles of Women Up to Age 40 Years: The Role of Insurance Mandates

    Science.gov (United States)

    Butts, Samantha F.; Ratcliffe, Sarah; Dokras, Anuja; Seifer, David B.

    2012-01-01

    Summary Objective To explore correlates of diminished ovarian reserve (DOR) and predictors of ART treatment outcome in DOR cycles using the SART-CORS database. We hypothesized that state insurance coverage for ART is associated with the prevalence of DOR diagnosis in ART cycles and with treatment outcomes in DOR cycles. Design Cross sectional study using ART cycles between 2004–2007. Setting United States ART registry data. Patients 182,779 fresh, non-donor, initial ART cycles in women up to age 40. Interventions None. Main Outcome Measures Prevalence of DOR and elevated FSH, odds ratio of DOR and elevated FSH in ART mandated vs. non-mandated states, live birth rates. Results Compared to cycles performed in states with mandated ART coverage, cycles in states with no ART mandate were more likely to have DOR (AOR 1.43 95% CI 1.37–1.5, pcycles. Conclusions A significant association was observed between lack of mandated insurance for ART and the proportion of cycles treating DOR or elevated FSH. The presence or absence of state mandated ART coverage could impact access to care and the mix of patients that pursue and initiate ART cycles. Additional studies are needed that consider the coalescence of insurance mandates, patient and provider factors, and state level variables on the odds of specific infertility diagnoses and treatment prognosis. PMID:23102859

  4. MNE R&D Subsidiary Mandates Evolution in Emerging Economies

    DEFF Research Database (Denmark)

    Schulzmann, David; Slepniov, Dmitrij

    2017-01-01

    The aim of this paper is to present the results of a systematic literature review (SLR) on the subject of Research and Development (R&D) subsidiary mandate evolution in emerging economies and to illustrate what triggers R&D mandate upgrade. The subject of R&D mandates is of crucial importance to ...... on subsidiary evolution in general and particularly in emerging markets. From a practical perspective, a better-integrated framework can provide guidance to businesses in emerging economies on how to start and successfully upgrade their R&D activities.......The aim of this paper is to present the results of a systematic literature review (SLR) on the subject of Research and Development (R&D) subsidiary mandate evolution in emerging economies and to illustrate what triggers R&D mandate upgrade. The subject of R&D mandates is of crucial importance...... to many multinational enterprises (MNEs) striving to utilize the potential of their foreign operations towards higher-value-added activities. While developed economies have long been a destination for R&D activities, emerging economies are increasingly recognized for their innovation potential. Previous...

  5. Performance-Based Risk-Sharing Arrangements: U.S. Payer Experience.

    Science.gov (United States)

    Goble, Joseph A; Ung, Brian; van Boemmel-Wegmann, Sascha; Navarro, Robert P; Parece, Andrew

    2017-10-01

    As a result of global concern about rising drug costs, many U.S. payers and European agencies such as the National Health Service have partnered with pharmaceutical companies in performance-based risk-sharing arrangements (PBRSAs) by which manufacturers share financial risk with health care purchasing entities and authorities. However, PBRSAs present many administrative and legal challenges that have minimized successful contract experiences in the United States. To (a) identify drug and disease characteristics and contract components that contribute to successful PBRSA experiences and the primary barriers to PBRSA execution and (b) explore solutions to facilitate contract negotiation and execution. A 37-item, web-based survey instrument (Qualtrics), approximately 20 minutes in duration, was open during July and August 2016. The survey was emailed to 90 pharmacy and medical directors of various health care organizations. Statistical analysis included the Kruskal-Wallis test and chi-square tests to examine differences among payer responses. Survey responses were anonymized and data were aggregated. Twenty-seven individuals completed the survey (30% completion rate). The majority of respondents worked for regional health plans (52%, n = 14), covering at least 1 million lives (63%, n = 17), with at least 7 years of managed care experience (81%, n = 22). A total of 51 PBRSAs were active among respondents at the time of the survey. Easily obtainable and evaluable drug data and medical data were the most important drug and disease attributes for successful PBRSAs, respectively. Pharmacy claims and patient demographic data were assessed as "very easy and inexpensive" to collect. Type and amount of manufacturer payment for drug outcome performance failure, endpoint measurement, and necessary clinical data for drug performance measurement were all critical factors for successful PBRSAs. Standardized contract templates and transparent contract financial risk evaluation and

  6. 78 FR 10610 - TRICARE; Demonstration Project for Participation in Maryland Multi-Payer Patient Centered Medical...

    Science.gov (United States)

    2013-02-14

    ... National Committee on Quality Assurance Patient Centered Medical Home (PPC-PCMH) recognition criteria... quality improvements. TMA Defense Health Cost Assessment and Evaluation (DHCAPE) staff will calculate... Maryland Multi-Payer Patient Centered Medical Home Program (MMPCMHP) Demonstration AGENCY: Department of...

  7. 78 FR 75304 - Medicare Program; Medicare Secondary Payer and Certain Civil Money Penalties

    Science.gov (United States)

    2013-12-11

    ... [CMS-6061-ANPRM] RIN 0938-AR88 Medicare Program; Medicare Secondary Payer and Certain Civil Money... practices for which civil money penalties (CMPs) may or may not be imposed for failure to comply with...-3951. I. Background A. Imposition of Civil Money Penalties (CMPs) In 1981, the Congress added section...

  8. On Meeting NCLB School Improvement Mandate

    Directory of Open Access Journals (Sweden)

    Rupert Green

    2015-11-01

    Full Text Available This descriptive study used nonparametric (Kruskal–Wallis and Mann–Whitney U tests to determine the efficacy of New York City (NYC small school initiative. A sample of 369 NYC high schools was tested on various performance indicators. The results: Large schools generated statistically significant higher performance scores and were more effective at preparing students for college and careers. On the New York State (NYS English language arts (ELA test, a Mann–Whitney U found statistically significant difference between scores for small school (median = 2.62, n = 213 and large school (median = 2.81, n = 58, U = 3200.00, z = −5.63, p = .001, r = −.34. On the state’s math test, a Mann–Whitney U found statistically significant difference between scores for small school (median = 2.76, n = 213 and large school (median = 3.12, n = 58, U = 3086.00, z = −5.84, p = .000, r = −.35. On NYC Department of Education (NYCDOE–assigned college and career readiness scores (CCRS, a Mann–Whitney U found statistically significant difference between CCRS for small school (median = 3.00, n = 213 and large school (median = 3.00, n = 58, U = 4705.50, z = −2.90, p = .004, r = −.018. The evidence suggests the city reconfigured large failing schools into smaller ones, resulting in the concentration of poverty (through the placement of mostly low socioeconomic status [SES] and underperforming Black and Hispanic students in those schools. Recommendations include future studies exploring the effect of mediating and moderating factors.

  9. Multinational Subsidiary Knowledge Protection - Do Mandates and Clusters Matter?

    DEFF Research Database (Denmark)

    Sofka, Wolfgang; Shehu, Edlira; de Faria, Pedro

    2014-01-01

    knowledge protection intensity. In addition, technological cluster regions in the host country can be expected to provide opportunities for knowledge sourcing and MNC subsidiaries may be willing to protect knowledge less intensively to participate in cluster networks. We test our hypotheses using a dataset...... of knowledge protection intensity of MNC subsidiaries. We argue that knowledge protection intensity is determined by MNC subsidiary mandates and by opportunities and risks originating from the host region. We hypothesize that not just competence-creating but also competence-exploiting mandates increase...... of 694 observations of 631 MNC subsidiaries in Germany and develop recommendations for research, managers and policy makers....

  10. Maternal employment, breastfeeding, and health: evidence from maternity leave mandates.

    Science.gov (United States)

    Baker, Michael; Milligan, Kevin

    2008-07-01

    Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada. We find very large increases in mothers' time away from work post-birth and in the attainment of critical breastfeeding duration thresholds. We also look for impacts of the reform on self-reported indicators of maternal and child health captured in our data. For most indicators we find no effect.

  11. The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases.

    Science.gov (United States)

    Rocco, Philip; Kelly, Andrew S; Béland, Daniel; Kinane, Michael

    2017-02-01

    Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs' efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform. Copyright © 2017 by Duke University Press.

  12. A Review of Open Access Self-Archiving Mandate Policies

    Science.gov (United States)

    Xia, Jingfeng; Gilchrist, Sarah B.; Smith, Nathaniel X. P.; Kingery, Justin A.; Radecki, Jennifer R.; Wilhelm, Marcia L.; Harrison, Keith C.; Ashby, Michael L.; Mahn, Alyson J.

    2012-01-01

    This article reviews the history of open access (OA) policies and examines the current status of mandate policy implementations. It finds that hundreds of policies have been proposed and adopted at various organizational levels and many of them have shown a positive effect on the rate of repository content accumulation. However, it also detects…

  13. Keeping Children Safe: Afterschool Staff and Mandated Child Maltreatment Reporting

    Science.gov (United States)

    Gandarilla, Maria; O'Donnell, Julie

    2014-01-01

    With 8.4 million children in the U.S. spending an average of eight hours a week in afterschool programs, afterschool providers are an important part of the network of caring adults who can help to keep children safe. In addition, afterschool staff are "mandated reporters." Whether or not the laws specifically mention afterschool staff,…

  14. Education Policy Mediation: Principals' Work with Mandated Literacy Assessment

    Science.gov (United States)

    Comber, Barbara; Cormack, Phil

    2011-01-01

    Mandated literacy assessment is now a ubiquitous practice in many western educational systems. While educational researchers, principals, teachers and education unions continue to offer vociferous resistance in some nations, in others it is now commonplace in the educational landscape and built into the rhythms of the school year. This paper is…

  15. Wisconsin EE Mandates: The Bad News and the Good News.

    Science.gov (United States)

    Lane, Jennie; And Others

    1996-01-01

    Examines Wisconsin teachers' perceived competencies in, attitudes toward, and amount of class time devoted to teaching about the environment. Discusses the effects of Wisconsin environmental education mandates concerning preservice preparation in environmental education and K-12 environmental education curriculum plans. Identifies areas where the…

  16. A payer-provider partnership for integrated care of patients receiving dialysis.

    Science.gov (United States)

    Kindy, Justin; Roer, David; Wanovich, Robert; McMurray, Stephen

    2018-04-01

    Patients with end-stage renal disease (ESRD) are clinically complex, requiring intensive and costly care. Coordinated care may improve outcomes and reduce costs. The objective of this study was to determine the impact of a payer-provider care partnership on key clinical and economic outcomes in enrolled patients with ESRD.  Retrospective observational study. Data on patient demographics and clinical outcomes were abstracted from the electronic health records of the dialysis provider. Data on healthcare costs were collected from payer claims. Data were collected for a baseline period prior to initiation of the partnership (July 2011-June 2012) and for two 12-month periods following initiation (April 2013-March 2014 and April 2014-March 2015). Among both Medicare Advantage and commercial insurance program members, the rate of central venous catheter use for vascular access was lower following initiation of the partnership compared with the baseline period. Likewise, hospital admission rates, emergency department visit rates, and readmission rates were lower following partnership initiation. Rates of influenza and pneumococcal vaccination were higher than 95% throughout all 3 time periods. Total medical costs were lower for both cohorts of members in the second 12-month period following partnership initiation compared with the baseline period. Promising trends were observed among members participating in this payer-provider care partnership with respect to both clinical and economic outcomes. This suggests that collaborations with shared incentives may be a valuable approach for patients with ESRD.

  17. UnitedHealthcare experience illustrates how payers can enable patient engagement.

    Science.gov (United States)

    Sandy, Lewis G; Tuckson, Reed V; Stevens, Simon L

    2013-08-01

    Patient engagement is crucial to better outcomes and a high-performing health system, but efforts to support it often focus narrowly on the role of physicians and other care providers. Such efforts miss payers' unique capabilities to help patients achieve better health. Using the experience of UnitedHealthcare, a large national payer, this article demonstrates how health plans can analyze and present information to both patients and providers to help close gaps in care; share detailed quality and cost information to inform patients' choice of providers; and offer treatment decision support and value-based benefit designs to help guide choices of diagnostic tests and therapies. As an employer, UnitedHealth Group has used these strategies along with an "earn-back" program that provides positive financial incentives through reduced premiums to employees who adopt healthful habits. UnitedHealth's experience provides lessons for other payers and for Medicare and Medicaid, which have had minimal involvement with demand-side strategies and could benefit from efforts to promote activated beneficiaries.

  18. Trial of the University Assistance Program for Alcohol Use Among Mandated Students*

    Science.gov (United States)

    Amaro, Hortensia; Ahl, Marilyn; Matsumoto, Atsushi; Prado, Guillermo; Mulé, Christina; Kemmemer, Amaura; Larimer, Mary E.; Masi, Dale; Mantella, Philomena

    2009-01-01

    Objective: The aim of this study was to investigate the effectiveness of a brief intervention for mandated students in the context of the University Assistance Program, a Student Assistance Program developed and modeled after workplace Employee Assistance Programs. Method: Participants were 265 (196 males and 69 females) judicially mandated college students enrolled in a large, urban university in the northeast United States. All participants were sanctioned by the university's judicial office for an alcohol- or drug-related violation. Participants were randomized to one of two intervention conditions (the University Assistance Program or services as usual) and were assessed at baseline and 3 and 6 months after intervention. Results: Growth curve analyses showed that, relative to services as usual, the University Assistance Program was more efficacious in reducing past-90-day weekday alcohol consumption and the number of alcohol-related consequences while increasing past-90-day use of protective behaviors and coping skills. No significant differences in growth trajectories were found between the two intervention conditions on past-90-day blood alcohol concentration, total alcohol consumption, or weekend consumption. Conclusions: The University Assistance Program may have a possible advantage over services as usual for mandated students. PMID:19538912

  19. Trial of the university assistance program for alcohol use among mandated students.

    Science.gov (United States)

    Amaro, Hortensia; Ahl, Marilyn; Matsumoto, Atsushi; Prado, Guillermo; Mulé, Christina; Kemmemer, Amaura; Larimer, Mary E; Masi, Dale; Mantella, Philomena

    2009-07-01

    The aim of this study was to investigate the effectiveness of a brief intervention for mandated students in the context of the University Assistance Program, a Student Assistance Program developed and modeled after workplace Employee Assistance Programs. Participants were 265 (196 males and 69 females) judicially mandated college students enrolled in a large, urban university in the northeast United States. All participants were sanctioned by the university's judicial office for an alcohol- or drug-related violation. Participants were randomized to one of two intervention conditions (the University Assistance Program or services as usual) and were assessed at baseline and 3 and 6 months after intervention. Growth curve analyses showed that, relative to services as usual, the University Assistance Program was more efficacious in reducing past-90-day weekday alcohol consumption and the number of alcohol-related consequences while increasing past-90-day use of protective behaviors and coping skills. No significant differences in growth trajectories were found between the two intervention conditions on past-90-day blood alcohol concentration, total alcohol consumption, or weekend consumption. The University Assistance Program may have a possible advantage over services as usual for mandated students.

  20. Association between payer mix and costs, revenues and profitability: a cross-sectional study of Lebanese hospitals.

    Science.gov (United States)

    Saleh, S; Ammar, W; Natafgi, N; Mourad, Y; Dimassi, H; Harb, H

    2015-09-08

    This study aimed to examine the association between the payer mix and the financial performance of public and private hospitals in Lebanon. The sample comprised 24 hospitals, representing the variety of hospital characteristics in Lebanon. The distribution of the payer mix revealed that the main sources of revenue were public sources (61.1%), out-of-pocket (18.4%) and private insurance (18.2%). Increases in the percentage of revenue from public sources were associated with lower total costs and revenues, but not profit margins. An inverse association was noted between increased revenue from private insurance and profitability, attributed to increased costs. Increased percentage of out of- pocket payments was associated with lower costs and higher profitability. The study provides evidence that payer mix is associated with hospital costs, revenues and profitability. This should initiate/inform discussions between public and private payers and hospitals about the level of payment and its association with hospital sector financial viability.

  1. Eight reasons payer interoperability and data sharing are essential in ACOs. Interoperability standards could be a prerequisite to measuring care.

    Science.gov (United States)

    Mookencherry, Shefali

    2012-01-01

    It makes strategic and business sense for payers and providers to collaborate on how to take substantial cost out of the healthcare delivery system. Acting independently, neither medical groups, hospitals nor health plans have the optimal mix of resources and incentives to significantly reduce costs. Payers have core assets such as marketing, claims data, claims processing, reimbursement systems and capital. It would be cost prohibitive for all but the largest providers to develop these capabilities in order to compete directly with insurers. Likewise, medical groups and hospitals are positioned to foster financial interdependence among providers and coordinate the continuum of patient illnesses and care settings. Payers and providers should commit to reasonable clinical and cost goals, and share resources to minimize expenses and financial risks. It is in the interest of payers to work closely with providers on risk-management strategies because insurers need synergy with ACOs to remain cost competitive. It is in the interest of ACOs to work collaboratively with payers early on to develop reasonable and effective performance benchmarks. Hence, it is essential to have payer interoperability and data sharing integrated in an ACO model.

  2. Cost-effectiveness analysis of allopurinol versus febuxostat in chronic gout patients: a U.S. payer perspective.

    Science.gov (United States)

    Gandhi, Pranav K; Gentry, William M; Ma, Qinli; Bottorff, Michael B

    2015-02-01

    Gout is a chronic inflammatory condition associated with poor urate metabolism. Xanthine oxidase inhibitors such as allopurinol and febuxostat are recommended to reduce uric acid levels and to prevent gout attacks in adult patients. Under budget-driven constraints, health care payers are faced with the broader challenge of assessing the economic value of these agents for formulary placement. However, the economic value of allopurinol versus febuxostat has not be assessed in patients with gout over a 5-year time period in the United States. To evaluate the cost-effectiveness of allopurinol versus febuxostat in adult patients with gout over a 5-year time period from a U.S. health care payer's perspective. A Markov model was developed to compare the total direct costs and success of serum uric acid (sUA) level reduction associated with allopurinol and febuxostat. Treatment success was defined as patient achievement of a sUA level less than  6 mg/dL (0.36 mmol/L) at 6 months. Event probabilities were based on published phase III randomized clinical trials and included long-term sequelae from open-label extension studies. A hypothetical cohort of 1,000 adult gout patients with sUA levels of ≥ 8 mg/dL (0.48 mmol/L) who had received either allopurinol 300 mg or febuxostat 80 mg at model entry transitioned among the 4 health states defined by treatment success, treatment failure and switch, treatment dropout, and death. The length of each Markov cycle was 6 months. Costs were gathered from the RED BOOK, Medicare fee schedules, Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, and for a limited number of inputs, expert consultation. Direct costs included treatment drug costs, costs for prophylaxis drugs, diagnostic laboratory tests, and the treatment and management of acute gout flare. Resource utilization was based on clinical evidence and expert consultation. All costs were inflated to 2014 U.S. dollars and were discounted at 3% in the base case

  3. School Accountability and Youth Obesity: Can Physical Education Mandates Make a Difference?

    Directory of Open Access Journals (Sweden)

    Helen Schneider

    2013-01-01

    Full Text Available This paper explores the effect of accountability laws under No Child Left Behind Act (NCLB on obesity rates among school-aged children in the United States. Our results show that pressures due to school closures for poor performance, rewards for good performance, and assistance to schools that lag behind lead to lower levels of vigorous physical activity. This effect is significant for high school children only. We find no significant impact of school accountability laws on children in grades 3 through 8 after state characteristics such as state obesity rate are taken into account. We also find that state physical education mandates increase physical activity for children in grades 3 through 8 and mitigate the negative effect of accountability pressures on physical activity at the high school level where accountability pressures are most effective at decreasing physical activity and increasing obesity. The study shows that physical education mandates play an important role in promoting physical activity for all grades in our sample.

  4. Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.

    Science.gov (United States)

    Cheng, Shou-Hsia; Jin, Hyun-Hyo; Yang, Bong-Min; Blank, Robert H

    2018-05-03

    Achieving universal health coverage has been an important goal for many countries worldwide. However, the rapid growth of health expenditures has challenged all nations, both those with and without such universal coverage. Single-payer systems are considered more efficient for administrative affairs and may be more effective for containing costs than multipayer systems. However, South Korea, which has a typical single-payer scheme, has almost the highest growth rate in health expenditures among industrialized countries. The aim of the present study is to explicate this situation by comparing South Korea with Taiwan. This study analyzed statistical reports published by government departments in South Korea and Taiwan from 2001 to 2015, including population and economic statistics, health statistics, health expenditures, and social health insurance reports. Between 2001 and 2015, the per capita national health expenditure (NHE) in South Korea grew 292%, whereas the corresponding growth of per capita NHE in Taiwan was only 83%. We find that the national health insurance (NHI) global budget cap in Taiwan may have restricted the growth of health expenditures. Less comprehensive benefit coverage for essential diagnosis/treatment services under the South Korean NHI program may have contributed to the growth of out-of-pocket payments. The expansion of insurance coverage for vulnerable individuals may also contribute to higher growth in NHE in South Korea. Explicit regulation of health care resource distribution may also lead to more limited provisioning and utilization of health services in Taiwan. Under analogous single-payer systems, South Korea had a much higher growth in health spending than Taiwan. The annual budget cap for total reimbursement, more comprehensive coverage for essential diagnosis and treatment services, and the regulation of health care resource distribution are important factors associated with the growth of health expenditures. Copyright © 2018

  5. Payers' Views of the Changes Arising through the Possible Adoption of Adaptive Pathways.

    Science.gov (United States)

    Ermisch, Michael; Bucsics, Anna; Vella Bonanno, Patricia; Arickx, Francis; Bybau, Alexander; Bochenek, Tomasz; van de Casteele, Marc; Diogene, Eduardo; Fürst, Jurij; Garuolienė, Kristina; van der Graaff, Martin; Gulbinovič, Jolanta; Haycox, Alan; Jones, Jan; Joppi, Roberta; Laius, Ott; Langner, Irene; Martin, Antony P; Markovic-Pekovic, Vanda; McCullagh, Laura; Magnusson, Einar; Nilsen, Ellen; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Sauermann, Robert; Schuurman, Ad; Ramos, Ricardo; Vlahovic-Palcevski, Vera; Zara, Corinne; Godman, Brian

    2016-01-01

    Payers are a major stakeholder in any considerations and initiatives concerning adaptive licensing of new medicinal products, also referred to as Medicines Adaptive Pathways to patients (MAPPs). Firstly, the scope and necessity of MAPPs need further scrutiny, especially with regard to the definition of unmet need. Conditional approval pathways already exist for new medicines for seriously debilitating or life-threatening diseases and only a limited number of new medicines are innovative. Secondly, MAPPs will result in new medicines on the market with limited evidence about their effectiveness and safety. Additional data are to be collected after approval. Consequently, adaptive pathways may increase the risk of exposing patients to ineffective or unsafe medicines. We have already seen medicines approved conventionally that subsequently proved ineffective or unsafe amongst a wider, more co-morbid population as well as medicines that could have been considered for approval under MAPPs but subsequently proved ineffective or unsafe in Phase III trials and were never licensed. Thirdly, MAPPs also put high demands on payers. Routine collection of patient level data is difficult with high transaction costs. It is not clear who will fund these. Other challenges for payers include shifts in the risk governance framework, implications for evaluation and HTA, increased complexity of setting prices, difficulty with ensuring equity in the allocation of resources, definition of responsibility and liability and implementation of stratified use. Exit strategies also need to be agreed in advance, including price reductions, rebates, or reimbursement withdrawals when price premiums are not justified. These issues and concerns will be discussed in detail including potential ways forward.

  6. Payer leverage and hospital compliance with a benchmark: a population-based observational study

    Directory of Open Access Journals (Sweden)

    DeMonner Sonya

    2007-07-01

    Full Text Available Abstract Background Since 1976, Medicare has linked reimbursement for hospitals performing organ transplants to the attainment of certain benchmarks, including transplant volume. While Medicare is a stakeholder in all transplant services, its role in renal transplantation is likely greater, given its coverage of end-stage renal disease. Thus, Medicare's transplant experience allows us to examine the role of payer leverage in motivating hospital benchmark compliance. Methods Nationally representative discharge data for kidney (n = 29,272, liver (n = 7,988, heart (n = 3,530, and lung (n = 1,880 transplants from the Nationwide Inpatient Sample (1993 – 2003 were employed. Logistic regression techniques with robust variance estimators were used to examine the relationship between hospital volume compliance and Medicare market share; generalized estimating equations were used to explore the association between patient-level operative mortality and hospital volume compliance. Results Medicare's transplant market share varied by organ [57%, 28%, 27%, and 18% for kidney, lung, heart, and liver transplants, respectively (P P Conclusion These data highlight the influence of payer leverage–an important contextual factor in value-based purchasing initiatives. For uncommon diagnoses, these data suggest that at least 30% of a provider's patients might need to be "at risk" for an incentive to motivate compliance.

  7. WHY DO AMERICANS STILL NEED SINGLE-PAYER HEALTH CARE AFTER MAJOR HEALTH REFORM?

    Science.gov (United States)

    Chaufan, Claudia

    2015-01-01

    Many observers have considered the Affordable Care Act (ACA) the most significant health care overhaul since Medicare, in the tradition of Great Society programs. And yet, in opinion polls, Americans across the political spectrum repeatedly express their strong support for Medicare, alongside their disapproval of the ACA. This feature of American public opinion is often seen as a contradiction and often explained as "incoherence," a mere feature of Americans' "muddled mind." In this article I argue that what explains this seeming contradiction is not any peculiarity of Americans' psychology but rather the grip of the corporate class on the political process and on key social institutions (e.g., mass media, judiciary), no less extraordinary today than in the past. I also argue that ordinary Americans, like millions of their counterparts in the world, would eagerly support a single-payer national health program that speaks to their interests rather than to those of the 1 percent. I will describe the ACA, compare it to Medicare, explain the concept of single payer, and conclude that the task is not to persuade presumably recalcitrant Americans to support the ACA but rather to organize a mass movement to struggle for what is right and join the rest of the world in the road toward health justice.

  8. Law, Economics, and Culture: Theory of Mandated Benefits and Evidence from Maternity Leave Policies

    OpenAIRE

    Yehonatan Givati; Ugo Troiano

    2012-01-01

    Why do some countries mandate a long maternity leave, while others mandate only a short one? We incorporate into a standard mandated-benefit model social tolerance of gender-based discrimination, showing that the optimal length of maternity leave depends on it. The less tolerant a society is of gender-based discrimination, the longer the maternity leave it will mandate. Relying on recent research in psychology and linguistics according to which patterns in languages offer a window into their ...

  9. Loss of benefits resulting from mandated nuclear plant shutdowns

    International Nuclear Information System (INIS)

    Peerenboom, J.P.; Buehring, W.A.

    1982-01-01

    This paper identifies and discusses some of the important consequences of nuclear power plant unavailability, and quantifies a number of technical measures of loss of benefits that result from regulatory actions such as licensing delays and mandated nuclear plant outages. The loss of benefits that accompany such regulatory actions include increased costs of systems generation, increased demand for nonnuclear and often scarce fuels, and reduced system reliability. This paper is based on a series of case studies, supplemented by sensitivity studies, on hypothetical nuclear plant shutdowns. These studies were developed by Argonne in cooperation with four electric utilities

  10. Nudges or mandates? The ethics of mandatory flu vaccination.

    Science.gov (United States)

    Dubov, Alex; Phung, Connie

    2015-05-21

    According to the CDC report for the 2012-2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011-2012, to 72% in 2012-2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a "choice architecture" that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Card index of coal user-payers in the system of accounting and analysis of coal marketing

    Energy Technology Data Exchange (ETDEWEB)

    Czapka, D

    1980-01-01

    A card index of coal users-payers was formed on the basis of an existing card file of payers which functions in development of an earlier subsystem of financial accounting of coal users by means of a corresponding reorganization of the available set of data and supplementing it with new data on users. The card index performs a monitor and address function. Checked and refined data are input in subsequent technological cycles of data conversion. The structure of the card file, its functions, realization conditions with output of necessary following results are examined.

  12. Louisiana motorcycle fatalities in the wake of governmentally implemented change: a retrospective analysis of the motorcycle morbidity and mortality before, during, and after the repeal of a statewide helmet mandate.

    Science.gov (United States)

    Strom, Shane F; Ambekar, Sudheer; Madhugiri, Venkatesh S; Nanda, Anil

    2013-06-01

    On August 15, 2004, Louisiana's universal motorcycle helmet mandate was reinstated. Previous studies have shown that mortality and morbidity of motorcycle riders who crashed had increased during the 5 years the mandate was repealed. The objective of this study was to discern whether the reinstatement of the universal helmet mandate has resulted in a subsequent decrease in motorcycle-related mortality and morbidity in the state of Louisiana. A retrospective analysis was performed observing the regularity of helmet use and the associated morbidity and mortality of motorcycle traffic accidents from the time before, during, and after the universal motorcycle helmet mandate was repealed in the state of Louisiana. Fatality statistics were obtained through the National Highway Safety Traffic Association. Injury, helmet use, and collision data were obtained from the Louisiana Highway Safety Commission. Motorcycle registration data were obtained from the Federal Highway Administration. Motorcycle crash-related fatalities increased significantly when the statewide helmet mandate was repealed, and interestingly, after reinstatement, these fatality rates never returned to their previous lows. Motorcycle fatalities have increased out of proportion to the increase in motorbike registrations, even when yearly fatalities are normalized to fatalities per 10,000 registered bikes. An all-time high in fatalities was seen in 2006, a year subsequent to the mandate's reinstatement. Fatalities per collision were elevated significantly after the mandate's repeal but did not return to prerepeal lows after the mandate's reinstatement. Although helmet use after reinstatement has reached all-time highs, fatality rates have remained elevated since the original mandate repeal in 1999. Other achievable changes in state policy and law enforcement should be explored to quell this heightened risk to motorcycle enthusiasts in Louisiana, and states considering changing their own motorcycle helmet

  13. How alternative payment models in emergency medicine can benefit physicians, payers, and patients.

    Science.gov (United States)

    Harish, Nir J; Miller, Harold D; Pines, Jesse M; Zane, Richard D; Wiler, Jennifer L

    2017-06-01

    While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system. In this article, we describe a framework for the development of APMs for emergency medicine and present four examples of APMs that may be applicable in emergency medicine. A better understanding of how APMs can work in emergency medicine will help EPs develop new APMs that improve the cost and quality of care, and leverage the value that emergency care brings to the system. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. The Payer and Patient Cost Burden of Open Breast Conserving Procedures Following Percutaneous Breast Biopsy.

    Science.gov (United States)

    Kimball, Chloe C; Nichols, Christine I; Vose, Joshua G

    2018-01-01

    Percutaneous core-needle biopsy (PCNB) is the standard of care to biopsy and diagnose suspicious breast lesions. Dependent on histology, many patients require additional open procedures for definitive diagnosis and excision. This study estimated the payer and patient out-of-pocket (OOP) costs, and complication risk, among those requiring at least 1 open procedure following PCNB. This retrospective study used the Truven Commercial database (2009-2014). Women who underwent PCNB, with continuous insurance, and no history of cancer, chemotherapy, radiation, or breast surgery in the prior year were included. Open procedures were defined as open biopsy or lumpectomy. Study follow-up ended at chemotherapy, radiation, mastectomy, or 90 days-whichever occurred first. In total, 143 771 patients (mean age 48) met selection criteria; 85.1% underwent isolated PCNB, 12.4% one open procedure, and 2.5% re-excision. Incidence of complications was significantly lower among those with PCNB alone (9.2%) vs 1 open procedure (15.6%) or re-excision (25.3%, P  open procedure vs PCNB alone (US $17 125 vs US $3935, P  open procedure vs PCNB alone (US $1527 vs US $669), and US $247 greater for re-excision vs 1 procedure. A meaningful proportion of patients underwent open procedure(s) following PCNB which was associated with increased complication risk and costs to both the payer and the patient. These results suggest a need for technologies to reduce the proportion of cases requiring open surgery and, in some cases, re-excision.

  15. The U.S. biodiesel use mandate and biodiesel feedstock markets

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, Wyatt; Meyer, Seth; Green, Travis [University of Missouri, 101 Park deVille Drive, Suite E; Columbia, MO 65203 (United States)

    2010-06-15

    Studies of individual biodiesel feedstocks or broad approaches that lump animal fats and vegetable oils into a single aggregate straddle the true case of imperfect but by no means inconsequential substitution among fats and oils by different users. United States biofuel policy includes a biodiesel use mandate that rises to almost 4 hm{sup 3} by 2012, calling for biomass feedstock analysis that recognizes the complex interdependence among potential feedstocks and competition for food and industrial uses. We model biodiesel input markets to investigate the implications of the mandate for quantities and prices with and without a provision disallowing biodiesel made from soybean oil. Findings suggest a hierarchy of price effects that tends to be largest for cheaper fats and oils typically used for industrial and feed purposes and smallest for fats and oils traditionally used exclusively for direct consumption, with the cross-commodity effects and other key economic parameters playing a critical part in determining the scale in each case. Although sensitive to the exact parameters used, our results argue against overly simplifying feedstock markets by holding prices constant when considering the economics of a particular feedstock or if estimating the broader impacts of rising biodiesel production on competing uses. (author)

  16. The payers perspective on MIH-CP programs. How to make a case for funding your project.

    Science.gov (United States)

    Zavadsky, Matt

    2015-07-01

    Here are some key points to consider when engaging in conversations with potential payers for EMS-based MIH-CP programs. The realignment of fiscal incentives within the healthcare system has created an environment that encourages providers and payers to work together to right-size utilization. Providers and payers are often unaware of the true value EMS agencies can bring to their patients through proactive and innovative patient navigation services. You need to tell them--or, better yet, show them. You may need to do a small demonstration project with a handful of patients to prove you can make a difference. In order to understand the new environment, you need to become well-versed in healthcare metrics, specifically as they relate to the partners to whom you'll be proposing. Be sure you know things like readmission rates and penalties, value-based purchasing penalties, HCAHPS scores, MSPB and other motivating factors you. can use to help build the business case for your audience. For many in EMS, crafting partnerships for. payment of services not related to ambulance transport is a new and scary thing. Hopefully the examples provided here from payers paying for MIH services have demonstrated that their perspective is not much different from ours. We are all trying to do the right things for our patients, improve their experience of care and reduce the cost of the healthcare system.

  17. HIE sustainability secrets. NeHC report shares HIE success stories of alternate revenue streams and payer buy-in.

    Science.gov (United States)

    Prestigiacomo, Jennifer

    2011-11-01

    Getting effective stakeholder engagement, including that of payers, and creating innovative value-added services that provide alternate revenue streams beyond basic subscription services, are just a couple of the common traits of the flourishing health information exchanges profiled in the sustainability report released in August by the National eHealth Collaborative.

  18. Congress, courts, and commerce: upholding the individual mandate to protect the public's health.

    Science.gov (United States)

    Hodge, James G; Brown, Erin C Fuse; Orenstein, Daniel G; O'Keefe, Sarah

    2011-01-01

    Among multiple legal challenges to the Patient Protection and Affordable Care Act (PPACA) is the premise that PPACA's "individual mandate" (requiring all individuals to obtain health insurance by 2014 or face civil penalties) is inviolate of Congress' interstate commerce powers because Congress lacks the power to regulate commercial "inactivity." Several courts initially considering this argument have rejected it, but federal district courts in Virginia and Florida have concurred, leading to numerous appeals and prospective review of the United States Supreme Court. Despite creative arguments, the dispositive constitutional question is not whether Congress' interstate commerce power extends to commercial inactivity. Rather, it is whether Congress may regulate individual decisions with significant economic ramifications in the interests of protecting and promoting the public's health. This article offers a counter-interpretation of the scope of Congress' interstate commerce power to regulate in furtherance of the public's health. © 2011 American Society of Law, Medicine & Ethics, Inc.

  19. Supporting the advancement of science: Open access publishing and the role of mandates

    Directory of Open Access Journals (Sweden)

    Phelps Lisa

    2012-01-01

    Full Text Available Abstract In December 2011 the United States House of Representatives introduced a new bill, the Research Works Act (H.R.3699, which if passed could threaten the public's access to US government funded research. In a digital age when professional and lay parties alike look more and more to the online environment to keep up to date with developments in their fields, does this bill serve the best interests of the community? Those in support of the Research Works Act argue that government open access mandates undermine peer-review and take intellectual property from publishers without compensation, however journals like Journal of Translational Medicine show that this is not the case. Journal of Translational Medicine in affiliation with the Society for Immunotherapy of Cancer demonstrates how private and public organisations can work together for the advancement of science.

  20. Bariatric Surgery Coverage: a Comprehensive Budget Impact Analysis from a Payer Perspective.

    Science.gov (United States)

    Palli, Swetha R; Rizzo, John A; Heidrich, Natalie

    2018-06-01

    The objective of this study was to estimate a payer's budget impact of bariatric surgery coverage under (1) unrestricted, (2) budget-restricted ($500,000/year), and (3) quantity-restricted (100/year) medical benefit plan scenarios versus non-coverage in general and type 2 diabetes mellitus (T2DM) populations over a 10-year period. Using recently published literature and health technology assessment reports, the model evaluated a hypothetical payer population of 100,000 members under current real-world trends: BMI-defined obesity groups (31.3% normal/underweight, 33% overweight, 20.4% obese, 9% severely obese and 6.3% morbidly obese), T2DM prevalence (6.7-27.5%; 100% for the T2DM model), surgery type (LAGB, BPD/DS, VSG, and RYGB), and differential outcomes (T2DM resolution, costs, and reoperation and complications rates). Assuming a surgery election rate of 1.42% among eligible candidates with a 3% discount rate and 10% annual surgery turnover rate, the model calculated the incremental cost per-member-per-month (PMPM) by estimating the difference in total non-T2DM and T2DM-related expected costs and savings. One-way (± 25%) sensitivity analysis was performed. The impact of covering bariatric surgery under multiple scenarios for a general (or T2DM) population ranged from an additional $0.3 to $3.6 (T2DM: $0.3 to $10.5) PMPM in year 1. Incremental costs diminished over time, breaking even between years 5 and 9 (T2DM: 5-6), and by year 10, cost savings were estimated to be between $1.5 and $4.8 (T2DM: $1.2 and $31.8). Providing bariatric surgery coverage may have a modest short-term budget impact increase but would lead to long-term net cost savings in a general population model. The cost savings were much more pronounced in the T2DM model.

  1. B2, B7 or B10: Which palm-based blend mandate wise to be chosen in Malaysia?

    Science.gov (United States)

    Applanaidu, Shri-Dewi; Abidin, Norhaslinda Zainal; Ali, Anizah Md.

    2015-12-01

    The diminishing fossil energy resources, coupled with heightened interest in the abatement of greenhouse gas emissions and concerns about energy security have motivated Malaysia to produce palm-based biodiesel and it has been started to be exported since 2006. In line with this issue, the government in Malaysia launched the palm-based biodiesel blending mandate of five percent (B5) in the federal administration of Putrajaya on 1st June 2011. This was then followed by four states: Malacca on July 11, Negeri Sembilan on August 1, Kuala Lumpur on September 1 and Selangor on October 1 of the same year but it is yet to be implemented nationwide. However what is the wise blend mandate to be chosen? Thus, this paper seeks to examine the possible impact of various blend mandates implementation (B2, B7 and B10) on the palm oil industry market variables (stock and price) since the main aim of biodiesel industry in Malaysia is to reduce domestic palm oil stock to below one million tones and provide a floor price to support Crude Palm Oil (CPO) prices at RM2,000 per tonne. A structural econometric model consisting of nine structural equations and three identities was proposed in this study. The model has been estimated by two stage least squares (2SLS) method using annual data for the period 1976-2013. The study indicates that counterfactual simulation of a decrease from B5 to B2 predicts a decrease (11.2 per cent) in CPO domestic consumption for biodiesel usage, 731.02 per cent reduction in CPO stock and an increase of 27.41 percent in domestic price of CPO. However the increase in the blend mandate from B5 to B7 and B10 suggest that domestic consumption of CPO for biodiesel purpose increase 7.40 and 18.55 percent respectively. The interesting findings in this study suggest that no matter whether Malaysian government increase or decrease the blend mandate the increase in the price of CPO are the same with an increase of is 27.41 percent. Hence, this study suggests that the

  2. B2, B7 or B10: Which palm-based blend mandate wise to be chosen in Malaysia?

    International Nuclear Information System (INIS)

    Applanaidu, Shri-Dewi; Ali, Anizah Md.; Abidin, Norhaslinda Zainal

    2015-01-01

    The diminishing fossil energy resources, coupled with heightened interest in the abatement of greenhouse gas emissions and concerns about energy security have motivated Malaysia to produce palm-based biodiesel and it has been started to be exported since 2006. In line with this issue, the government in Malaysia launched the palm-based biodiesel blending mandate of five percent (B5) in the federal administration of Putrajaya on 1 st June 2011. This was then followed by four states: Malacca on July 11, Negeri Sembilan on August 1, Kuala Lumpur on September 1 and Selangor on October 1 of the same year but it is yet to be implemented nationwide. However what is the wise blend mandate to be chosen? Thus, this paper seeks to examine the possible impact of various blend mandates implementation (B2, B7 and B10) on the palm oil industry market variables (stock and price) since the main aim of biodiesel industry in Malaysia is to reduce domestic palm oil stock to below one million tones and provide a floor price to support Crude Palm Oil (CPO) prices at RM2,000 per tonne. A structural econometric model consisting of nine structural equations and three identities was proposed in this study. The model has been estimated by two stage least squares (2SLS) method using annual data for the period 1976-2013. The study indicates that counterfactual simulation of a decrease from B5 to B2 predicts a decrease (11.2 per cent) in CPO domestic consumption for biodiesel usage, 731.02 per cent reduction in CPO stock and an increase of 27.41 percent in domestic price of CPO. However the increase in the blend mandate from B5 to B7 and B10 suggest that domestic consumption of CPO for biodiesel purpose increase 7.40 and 18.55 percent respectively. The interesting findings in this study suggest that no matter whether Malaysian government increase or decrease the blend mandate the increase in the price of CPO are the same with an increase of is 27.41 percent. Hence, this study suggests that the

  3. B2, B7 or B10: Which palm-based blend mandate wise to be chosen in Malaysia?

    Energy Technology Data Exchange (ETDEWEB)

    Applanaidu, Shri-Dewi, E-mail: dewi@uum.edu.my; Ali, Anizah Md., E-mail: anizah@uum.edu.my [Department of Economics and Agribusiness, School of Economics, Finance & Banking, UUM (Malaysia); Abidin, Norhaslinda Zainal, E-mail: nhaslinda@uum.edu.my [Department of Decision Sciences, School of Quantitative Sciences, UUM (Malaysia)

    2015-12-11

    The diminishing fossil energy resources, coupled with heightened interest in the abatement of greenhouse gas emissions and concerns about energy security have motivated Malaysia to produce palm-based biodiesel and it has been started to be exported since 2006. In line with this issue, the government in Malaysia launched the palm-based biodiesel blending mandate of five percent (B5) in the federal administration of Putrajaya on 1{sup st} June 2011. This was then followed by four states: Malacca on July 11, Negeri Sembilan on August 1, Kuala Lumpur on September 1 and Selangor on October 1 of the same year but it is yet to be implemented nationwide. However what is the wise blend mandate to be chosen? Thus, this paper seeks to examine the possible impact of various blend mandates implementation (B2, B7 and B10) on the palm oil industry market variables (stock and price) since the main aim of biodiesel industry in Malaysia is to reduce domestic palm oil stock to below one million tones and provide a floor price to support Crude Palm Oil (CPO) prices at RM2,000 per tonne. A structural econometric model consisting of nine structural equations and three identities was proposed in this study. The model has been estimated by two stage least squares (2SLS) method using annual data for the period 1976-2013. The study indicates that counterfactual simulation of a decrease from B5 to B2 predicts a decrease (11.2 per cent) in CPO domestic consumption for biodiesel usage, 731.02 per cent reduction in CPO stock and an increase of 27.41 percent in domestic price of CPO. However the increase in the blend mandate from B5 to B7 and B10 suggest that domestic consumption of CPO for biodiesel purpose increase 7.40 and 18.55 percent respectively. The interesting findings in this study suggest that no matter whether Malaysian government increase or decrease the blend mandate the increase in the price of CPO are the same with an increase of is 27.41 percent. Hence, this study suggests that

  4. Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.

    Science.gov (United States)

    Coupet, Edouard; Karp, David; Wiebe, Douglas J; Kit Delgado, M

    2018-03-28

    Investment in violence prevention programs is hampered by lack of clearly identifiable stakeholders with a financial stake in prevention. We determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. We analyzed all emergency department (ED) visits from 2009 to 2014 with diagnosis codes for violent injury in the Nationwide Emergency Department Sample (NEDS). We used sample weights to estimate total charges with adjusted generalized linear models to estimate charges for the 15% of ED visits with missing charge data. We then calculated the share attributable by payer and determined the difference in proportion by payer from 2013 to 2014. Between 2009 and 2013, the uninsured accounted for 28.2-31.3% of annual charges for the acute care of violent injury, while Medicaid was responsible for a similar amount (29.0-31.0%). In 2014, there were $10.7 billion in total charges for violent injury. Medicaid assumed the greatest share, 39.8% (95% CI: 38.0-41.5%, $3.5-5.1 billion), while the uninsured accounted for 23.6% (95% CI: 22.2-24.9%, $2.0-3.0 billion), and Medicare accounted for 7.8% (95% CI: 7.7-8.0%, $0.7-1.0 billion). After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. These findings highlight the benefit to state Medicaid programs of preventing interpersonal violence. Published by Elsevier Inc.

  5. Mandated empowerment: handing antipoverty policy back to the poor?

    Science.gov (United States)

    Banerjee, Abhijit V; Duflo, Esther

    2008-01-01

    The current trend in antipoverty policy emphasizes mandated empowerment: the poor are being handed the responsibility for making things better for themselves, largely without being asked whether this is what they want. Beneficiary control is now being built into public service delivery, while microcredit and small business promotion are seen as better ways to help the poor. The clear presumption is that the poor are both able and happy to exercise these new powers. This essay uses two examples to raise questions about these strategies. The first example is about entrepreneurship among the poor. Using data from a number of countries, we argue that there is no evidence that the median poor entrepreneur is trying his best to expand his existing businesses, even if we take into account the many constraints he faces. While many poor people own businesses, this seems to be more a survival strategy than something they want to do. The second example comes from an evaluation of a program in India that aims to involve poor rural parents in improving local public schools. The data suggest that despite being informed that they now have both the right to intervene in the school and access to funds for that purpose, and despite being made aware of how little the children were learning, parents opt to not get involved. Both examples raise concerns about committing ourselves entirely to antipoverty strategies that rely on the poor doing a lot of the work.

  6. Telemental health: responding to mandates for reform in primary healthcare.

    Science.gov (United States)

    Myers, Kathleen M; Lieberman, Daniel

    2013-06-01

    Telemental health (TMH) has established a niche as a feasible, acceptable, and effective service model to improve the mental healthcare and outcomes for individuals who cannot access traditional mental health services. The Accountability Care Act has mandated reforms in the structure, functioning, and financing of primary care that provide an opportunity for TMH to move into the mainstream healthcare system. By partnering with the Integrated Behavioral Healthcare Model, TMH offers a spectrum of tools to unite primary care physicians and mental health specialist in a mind-body view of patients' healthcare needs and to activate patients in their own care. TMH tools include video-teleconferencing to telecommute mental health specialists to the primary care setting to collaborate with a team in caring for patients' mental healthcare needs and to provide direct services to patients who are not progressing optimally with this collaborative model. Asynchronous tools include online therapies that offer an efficient first step to treatment for selected disorders such as depression and anxiety. Patients activate themselves in their care through portals that provide access to their healthcare information and Web sites that offer on-demand information and communication with a healthcare team. These synchronous and asynchronous TMH tools may move the site of mental healthcare from the clinic to the home. The evolving role of social media in facilitating communication among patients or with their healthcare team deserves further consideration as a tool to activate patients and provide more personalized care.

  7. Use of Oritavancin in Moderate-to-Severe ABSSSI Patients Requiring IV Antibiotics: A U.S. Payer Budget Impact Analysis.

    Science.gov (United States)

    Jensen, Ivar S; Wu, Elizabeth; Fan, Weihong; Lodise, Thomas P; Nicolau, David P; Dufour, Scott; Cyr, Philip L; Sulham, Katherine A

    2016-06-01

    It is estimated that acute bacterial skin and skin structure infections (ABSSSI) account for nearly 10% of hospital admissions and 3.4-3.8 million emergency department visits per year in the United States. Analyses of hospital discharge records indicate 74% of ABSSSI admissions involve empiric treatment with methicillin-resistant Staphylococcus aureus (MRSA) active antibiotics. Analysis has shown that payer costs could be reduced if moderate-to-severe ABSSSI patients were treated to a greater extent in the observational unit followed by discharge to outpatient parenteral antibiotic therapy (OPAT). Oritavancin is a lipoglycopeptide antibiotic with bactericidal activity against gram-positive bacteria, including MRSA. To estimate the impact on a U.S. payer's budget of using single-dose oritavancin in ABSSSI patients with suspected MRSA involvement who are indicated for intravenous antibiotics. A decision analytic model based on current clinical practice was developed to estimate the economic value of decreased hospital resource consumption by using single-dose oritavancin over a 1-year time horizon. Use of antibiotics was informed by an analysis of the Premier Research Database. Demographic and clinical data were derived from a targeted literature review. Emergency department, observation, laboratory, and administration costs used were Medicare National Limitation amounts. Drug costs were 2014 wholesale acquisition costs. For a hypothetical U.S. payer with 1,000,000 members, it is expected that approximately 14,285 members per year will be diagnosed with ABSSSI severe enough to indicate intravenous antibiotics with MRSA activity. Based on this simulation, use of single-dose oritavancin in 26% of these patients was estimated to reduce the number of inpatient admissions, reduce length of stay for patients requiring admission, and reduce the number of days a patient needs to receive daily infusions in the OPAT clinic. The total patient days decreased from 171,125 to 133

  8. Mapping Economic Development: The South Seas Government and Sugar Production in Japan’s South Pacific Mandate, 1919–1941

    Directory of Open Access Journals (Sweden)

    Ti Ngo

    2012-03-01

    Full Text Available Japan acquired the Mariana, Caroline, and Marshall Island chains as a League of Nations mandate following World War I. Why did the local administration (the South Seas Government or Nanyōchō heavily subsidize the establishment of a sugar industry? While the South Seas Government did not explicitly state why it chose to support the sugar industry despite the wealth of oceanic resources surrounding the islands, imperial maps of the South Pacific produced by the Japanese navy and the South Seas Government provide a window into how both parties envisioned and planned for the economic future of the mandate. These maps included information regarding the available natural resources, land, and culture level of the Micronesian population. The author argues that in depicting the islands as spaces where a “primitive” nonagricultural population failed to take advantage of the islands’ resources, mapmakers and officials planned for the mass migration of Japanese labor to the mandate in order to support a newly established sugar industry.

  9. Alcohol Use Problems Mediate the Relation between Cannabis Use Frequency and College Functioning among Students Mandated to an Alcohol Diversion Program

    Science.gov (United States)

    McChargue, Dennis E.; Klanecky, Alicia K.; Anderson, Jennifer

    2012-01-01

    The present study examined the degree to which alcohol use problems explained the relationship between cannabis use frequency and college functioning. Undergraduates (N = 546) mandated to an alcohol diversion program at a Midwestern United States university completed screening questionnaires between October 2003 and April 2006. Sobel's (1982) test…

  10. "I'm Not Teaching English, I'm Teaching Something Else!": How New Teachers Create Curriculum under Mandates of Educational Reform

    Science.gov (United States)

    Costigan, Arthur

    2018-01-01

    This study presents how beginning teachers create and teach an English Language Arts (ELA) curriculum in urban schools in the context of an educational reform movement driven by mandates such as Common Core State Standards (CCSS), high stakes tests, and prescribed curricula. They serve in schools with each using unique and individual curricula due…

  11. State Policies Influence Medicare Telemedicine Utilization.

    Science.gov (United States)

    Neufeld, Jonathan D; Doarn, Charles R; Aly, Reem

    2016-01-01

    Medicare policy regarding telemedicine reimbursement has changed little since 2000. Many individual states, however, have added telemedicine reimbursement for either Medicaid and/or commercial payers over the same period. Because telemedicine programs must serve patients from all or most payers, it is likely that these state-level policy changes have significant impacts on telemedicine program viability and utilization of services from all payers, not just those services and payers affected directly by state policy. This report explores the impact of two significant state-level policy changes-one expanding Medicaid telemedicine coverage and the other introducing telemedicine parity for commercial payers-on Medicare utilization in the affected states. Medicare claims data from 2011-2013 were examined for states in the Great Lakes region. All valid claims for live interactive telemedicine professional fees were extracted and linked to their states of origin. Allowed encounters and expenditures were calculated in total and on a per 1,000 members per year basis to standardize against changes in the Medicare population by state and year. Medicare telemedicine encounters and professional fee expenditures grew sharply following changes in state Medicaid and commercial payer policy in the examined states. Medicare utilization in Illinois grew by 173% in 2012 (over 2011) following Medicaid coverage expansion, and Medicare utilization in Michigan grew by 118% in 2013 (over 2012) following adoption of telemedicine parity for commercial payers. By contrast, annual Medicare telemedicine utilization growth in surrounding states (in which there were no significant policy changes during these years) varied somewhat but showed no discernible pattern. Although Medicare telemedicine policy has changed little since its inception, changes in state policies with regard to telemedicine reimbursement appear to have significant impacts on the practical viability of telemedicine programs

  12. A roadmap for navigating voluntary and mandated programs for building energy efficiency

    International Nuclear Information System (INIS)

    Peterman, Andrew; Kourula, Arno; Levitt, Raymond

    2012-01-01

    Commercial building owners and managers often face the challenge of selecting the appropriate combination of voluntary and mandated programs for commercial building energy efficiency. Using a mixed-method, both quantitative and qualitative approach, this study finds that barriers to energy efficiency can be interpreted as strategic drivers for the emergence of five forms of voluntary and mandated program forms. We argue that the links between energy efficiency programs in commercial buildings should be conceptualized in a comprehensive manner by evaluating the strategic drivers that have ultimately led to the emergence of the principal forms of voluntary programs: economic incentives; certifications; alliances and partnerships; and internal company programs. We develop a conceptual framework that helps building owners and managers: identify the primary drivers for energy efficiency efforts; assess the efficacy and limitations of available program forms; apply each program form strategically in conjunction with a number of other program forms; and, ultimately, predict the emergence of new program forms. In addition to United States Department of Energy survey data, this study draws upon data collected through semi-structured interviews with experts at major U.S.-based corporations, federally funded laboratories, government agencies, and non-governmental organizations. - Highlights: ► Distills a complex system of energy efficiency programs into a single framework. ► Classify drivers, emerging forms, and shortcomings of each voluntary program form. ► Present survey and interview data from retail, real estate, and hospital experts. ► None of these programs alone meet organizational needs for energy efficiency. ► Entrepreneurs will play a key role by capitalizing on broken agency challenges.

  13. Compared to Canadians, U.S. physicians spend nearly four times as much money interacting with payers.

    Science.gov (United States)

    Zimmerman, Christina

    2011-11-01

    (1) In Canadian office practices, physi­cians spent 2.2 hours per week interacting with payers, nurses spent 2.5 hours, and clerical staff spent 15.9 hours. In U.S. practices, physicians spent 3.4 hours per week interacting with payers, nurses spent 20.6 hours, and clerical staff spent 53.1 hours. (2) Canadian physician practices spent $22,205 per physician per year on interactions with health plans. U.S. physician practices spent $82,975 per physician per year. (3) U.S. physician practices spend $60,770 per physician per year more (approximately four times as much) than their Canadian counterparts.

  14. Economic Evaluation of PCSK9 Inhibitors in Reducing Cardiovascular Risk from Health System and Private Payer Perspectives.

    Directory of Open Access Journals (Sweden)

    Alejandro Arrieta

    Full Text Available The introduction of Proprotein covertase subtilisin/kexin type 9 (PCSK9 inhibitors has been heralded as a major advancement in reducing low-density lipoprotein cholesterol levels by nearly 50%. However, concerns have been raised on the added value to the health care system in terms of their costs and benefits. We assess the cost-effectiveness of PCSK9 inhibitors based on a decision-analytic model with existing clinical evidence. The model compares a lipid-lowering therapy based on statin plus PCSK9 inhibitor treatment with statin treatment only (standard therapy. From health system perspective, incremental cost per quality adjusted life years (QALYs gained are presented. From a private payer perspective, return-on-investment and net present values over patient lifespan are presented. At the current annual cost of $14,000 to $15,000, PCSK9 inhibitors are not cost-effective at an incremental cost of about $350,000 per QALY. Moreover, for every dollar invested in PCSK9 inhibitors, the private payer loses $1.98. Our study suggests that the annual treatment price should be set at $4,250 at a societal willingness-to-pay of $100,000 per QALY. However, we estimate the breakeven price for private payer is only $600 per annual treatment. At current prices, our study suggests that PCSK9 inhibitors do not add value to the U.S. health system and their provision is not profitable for private payers. To be the breakthrough drug in the fight against cardiovascular disease, the current price of PCSK9 inhibitors must be reduced by more than 70%.

  15. Payer Perspectives on PCSK9 Inhibitors: A Conversation with Stephen Gorshow, MD, and James T. Kenney, RPh, MBA.

    Science.gov (United States)

    Mehr, Stanton R

    2016-02-01

    The new proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can have significant budget effects, depending on the breadth of the US Food and Drug Administration (FDA)'s approved labeling. American Health & Drug Benefits asked Stephen Gorshow, MD, Regional Medical Director, UnitedHealthcare, and James T. Kenney, RPh, MBA, Manager, Specialty and Pharmacy Contracts, Harvard Pilgrim Health Care, to participate in a teleconference to better understand how payers are approaching the management of these agents.

  16. Cost effectiveness of tenofovir disoproxil fumarate for the treatment of chronic hepatitis B from a Canadian public payer perspective.

    Science.gov (United States)

    Dakin, Helen; Sherman, Morris; Fung, Scott; Fidler, Carrie; Bentley, Anthony

    2011-12-01

    Previous research has demonstrated that tenofovir disoproxil fumarate (DF) is the most cost-effective nucleos(t)ide treatment for chronic hepatitis B (CHB) in the UK, Spain, Italy and France. However, to our knowledge, no published studies have yet evaluated the cost effectiveness of any treatments for CHB in a Canadian setting, where relative prices and management of CHB differ from those in Europe. Our objective was to determine the cost effectiveness of tenofovir DF compared with other nucleos(t)ide therapies licensed for CHB in Canada from the perspective of publicly funded healthcare payers. A Markov model was used to calculate the costs and benefits of nucleos(t)ide therapy in three groups of patients with hepatitis B e antigen (HBeAg)-positive and -negative CHB: nucleos(t)ide-naive patients without cirrhosis; nucleos(t)ide-naive patients with compensated cirrhosis; and lamivudine-resistant patients. Disease progression was modelled as annual transitions between 18 disease states. Transition probabilities, quality of life and costs were based on published studies. Health benefits were measured in QALYs. The reference year for costs was 2007 and costs and outcomes were discounted at 5% per annum. First-line tenofovir DF was the most effective nucleos(t)ide strategy for managing CHB, generating 6.85-9.39 QALYs per patient. First-line tenofovir DF was also the most cost-effective strategy in all patient subgroups investigated, costing between $Can43,758 and $Can48,015 per QALY gained compared with lamivudine then tenofovir. First-line tenofovir DF strongly dominated first-line entecavir. Giving tenofovir DF monotherapy immediately after lamivudine resistance developed was less costly and more effective than any other active treatment strategy investigated for lamivudine-resistant CHB, including second-line use of adefovir or adefovir + lamivudine. Probabilistic sensitivity analysis demonstrated 50% confidence that first-line tenofovir DF is the most cost

  17. Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.

    Science.gov (United States)

    Song, Chao; Liu, Emelline; Tackett, Scott; Shi, Lizheng; Marcus, Daniel

    2017-06-01

    This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. A time series study was conducted using the Premier Hospital Perspective ® Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective. During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective. The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities. Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases

  18. Substance use, symptom, and employment outcomes of persons with a workplace mandate for chemical dependency treatment.

    Science.gov (United States)

    Weisner, Constance; Lu, Yun; Hinman, Agatha; Monahan, John; Bonnie, Richard J; Moore, Charles D; Chi, Felicia W; Appelbaum, Paul S

    2009-05-01

    This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary least-squares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years. Overall, participants with a workplace mandate had one- and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlled for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.

  19. Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

    Science.gov (United States)

    Weisner, Constance; Lu, Yun; Hinman, Agatha; Monahan, John; Bonnie, Richard J.; Moore, Charles D.; Chi, Felicia W.; Appelbaum, Paul S.

    2010-01-01

    Objective This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. Methods The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary least-squares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years. Results Overall, participants with a workplace mandate had one- and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlled for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. Conclusions Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence. PMID:19411353

  20. An electric mandate. The EU procedure for harmonising cross-border network codes for electricity

    Energy Technology Data Exchange (ETDEWEB)

    Jevnaker, Torbjoerg

    2012-07-01

    The research question addressed in this report is why the EU procedure for developing network codes for electricity was enacted in its particular form. Passed by the EU in 2009, European organisations partly outside of the formal EU structure were given a mandate to make rules that would apply across the EU. This was puzzling given the observed resistance on part of the member states to let go of national control over energy issues. Drawing on institutionalist perspectives, the analysis shows that the procedure would not have been passed without support from and compromise among the Commission, European Parliament and the member states in Council; that parts of the procedure imitated existing practices within related policy areas; that horizontal and vertical specialization within the nation-states along with a Commission actively promoting transnational cooperation changed the feedback mechanisms, which changed the direction of European energy market regulation; and finally, that the new actors played an active role vis-a-vis EU bodies as the latter were legislating on the procedure. (Author)

  1. The views of low-income employees regarding mandated comprehensive employee benefits for the sake of health.

    Science.gov (United States)

    Adikes, Katherin A; Hull, Sara C; Danis, Marion

    2010-01-01

    Socioeconomic factors stand in the way of good health for low-income populations. We suggest that employee benefits might serve as a means of improving the health of low-wage earners. We convened groups of low-income earners to design hypothetical employee benefit packages. Qualitative analysis of group discussions regarding state-mandated benefits indicated that participants were interested in a great variety of benefits, beyond health care, that address socioeconomic determinants of health. Long-term financial and educational investments were of particular value. These results may facilitate the design of employee benefits that promote the health of low-income workers.

  2. The Views of Low-Income Employees Regarding Mandated Comprehensive Employee Benefits for the Sake of Health

    Science.gov (United States)

    Adikes, Katherin A.; Hull, Sara C.; Dams, Marion

    2013-01-01

    Socioeconomic factors stand in the way of good health for low-income populations. We suggest that employee benefits might serve as a means of improving the health of low-wage earners. We convened groups of low-income earners to design hypothetical employee benefit packages. Qualitative analysis of group discussions regarding state-mandated benefits indicated that participants were interested in a great variety of benefits, beyond health care, that address socioeconomic determinants of health. Long-term financial and educational investments were of particular value. These results may facilitate the design of employee benefits that promote the health of low-income workers. PMID:20391255

  3. Insurance denials for cancer clinical trial participation after the Affordable Care Act mandate.

    Science.gov (United States)

    Mackay, Christine B; Antonelli, Kaitlyn R; Bruinooge, Suanna S; Saint Onge, Jarron M; Ellis, Shellie D

    2017-08-01

    The Affordable Care Act (ACA) includes a mandate requiring most private health insurers to cover routine patient care costs for cancer clinical trial participation; however, the impact of this provision on cancer centers' efforts to accrue patients to clinical trials has not been well described. First, members of cancer research centers and community-based institutions (n = 252) were surveyed to assess the status of insurance denials, and then, a focused survey (n = 77) collected denial details. Univariate and multivariate analyses were used to examine associations between the receipt of denials and site characteristics. Overall, 62.7% of the initial survey respondents reported at least 1 insurance denial during 2014. Sites using a precertification process were 3.04 times more likely to experience denials (95% confidence interval, 1.55-5.99; P ≤ .001), and similar rates of denials were reported from sites located in states with preexisting clinical trial coverage laws versus states without them (82.3% vs 85.1%; χ = 50.7; P ≤ .001). Among the focused survey sites, academic centers reported denials more often than community sites (71.4% vs 46.4%). The failure of plans to cover trial participation was cited as the most common reason provided for denials (n = 33 [80.5%]), with nearly 80% of sites (n = 61) not receiving a coverage response from the insurer within 72 hours. Despite the ACA's mandate for most insurers to cover routine care costs for cancer clinical trial participation, denials and delays continue. Denials may continue because some insurers remain exempt from the law, or they may signal an implementation failure. Delays in coverage may affect patient participation in trials. Additional efforts to eliminate this barrier will be needed to achieve federal initiatives to double the pace of cancer research over the next 5 years. Future work should assess the law's effectiveness at the patient level to inform these efforts

  4. The rural utility response to Colorado's electricity mandates

    International Nuclear Information System (INIS)

    Tierney, Sean

    2011-01-01

    When Colorado voters passed Amendment 37 in 2004, it became the first state to pass a renewable portfolio standard at the ballet box, suggesting broad appeal to harness and pay for renewable energy. While large urban utilities are prepared to make this transition, smaller cities and rural areas, for various financial and scale issues are severely disadvantaged in trying to incorporate more renewable energy sources into their electricity mix. This was evident by the state's support for Amendment 37, which was passed due to strong support in the Denver metro area-representing nearly half of the state's population. Support for the bill was poor in the rest of the state. Nevertheless, in 2007, the state expanded up Amendment 37 by forcing the utilities in rural communities to diversify their electricity mix. This study surveyed the managers at the state's various rural electric cooperatives and municipal utilities in an effort to gage their attitudes concerning: carbon legislation, conservation and efficiency programs, and their plans for making the transition away from fossil fuel generation. - Highlights: → Communities served by rural utilities opposed Colorado's state-wide RPS, but were forced to adhere anyway. → Most rural utilities are very concerned about the economic impacts of trying to diversify their energy portfolios. → Many of these unregulated utilities were already pushing DSM programs to promote conservation and improve efficiency.

  5. Designing Surveillance of Healthcare-Associated Infections in the Era of Automation and Reporting Mandates

    NARCIS (Netherlands)

    van Mourik, Maaike S M; Perencevich, Eli N; Gastmeier, Petra; Bonten, Marc J M

    2018-01-01

    Surveillance and feedback of infection rates to clinicians and other stakeholders is a cornerstone of healthcare-associated infection (HAI) prevention programs. In addition, HAIs are increasingly included in public reporting and payment mandates. Conventional manual surveillance methods are resource

  6. Designing Surveillance of Healthcare-Associated Infections in the Era of Automation and Reporting Mandates.

    NARCIS (Netherlands)

    van Mourik, Maaike S M; Perencevich, Eli N; Gastmeier, Petra; Bonten, Marc J M

    2018-01-01

    Surveillance and feedback of infection rates to clinicians and other stakeholders is a cornerstone of healthcare-associated infection (HAI) prevention programs. In addition, HAIs are increasingly included in public reporting and payment mandates. Conventional manual surveillance methods are resource

  7. Health Benefits Mandates and Their Potential Impacts on Racial/Ethnic Group Disparities in Insurance Markets.

    Science.gov (United States)

    Charles, Shana Alex; Ponce, Ninez; Ritley, Dominique; Guendelman, Sylvia; Kempster, Jennifer; Lewis, John; Melnikow, Joy

    2017-08-01

    Addressing racial/ethnic group disparities in health insurance benefits through legislative mandates requires attention to the different proportions of racial/ethnic groups among insurance markets. This necessary baseline data, however, has proven difficult to measure. We applied racial/ethnic data from the 2009 California Health Interview Survey to the 2012 California Health Benefits Review Program Cost and Coverage Model to determine the racial/ethnic composition of ten health insurance market segments. We found disproportional representation of racial/ethnic groups by segment, thus affecting the health insurance impacts of benefit mandates. California's Medicaid program is disproportionately Latino (60 % in Medi-Cal, compared to 39 % for the entire population), and the individual insurance market is disproportionately non-Latino white. Gender differences also exist. Mandates could unintentionally increase insurance coverage racial/ethnic disparities. Policymakers should consider the distribution of existing racial/ethnic disparities as criteria for legislative action on benefit mandates across health insurance markets.

  8. Cost effectiveness of endometrial ablation with the NovaSure® system versus other global ablation modalities and hysterectomy for treatment of abnormal uterine bleeding: US commercial and Medicaid payer perspectives

    Directory of Open Access Journals (Sweden)

    Miller JD

    2015-01-01

    Full Text Available Jeffrey D Miller,1 Gregory M Lenhart,1 Machaon M Bonafede,1 Cindy M Basinski,2 Andrea S Lukes,3 Kathleen A Troeger4 1Truven Health Analytics, Cambridge, MA, 2Basinski, LLC, Newburgh, IN, 3Carolina Women’s Research and Wellness Center, Durham, NC, 4Hologic, Inc, Marlborough, MA, USA Objectives: Abnormal uterine bleeding (AUB interferes with physical, emotional, and social well-being, impacting the quality of life of more than 10 million women in the USA. Hysterectomy, the most common surgical treatment of AUB, has significant morbidity, low mortality, long recovery, and high associated health care costs. Global endometrial ablation (GEA provides a surgical alternative with reduced morbidity, cost, and recovery time. The NovaSure® system utilizes unique radiofrequency impedance-based GEA technology. This study evaluated cost effectiveness of AUB treatment with NovaSure ablation versus other GEA modalities and versus hysterectomy from the US commercial and Medicaid payer perspectives. Methods: A health state transition (semi-Markov model was developed using epidemiologic, clinical, and economic data from commercial and Medicaid claims database analyses, supplemented by published literature. Three hypothetical cohorts of women receiving AUB interventions were simulated over 1-, 3-, and 5-year horizons to evaluate clinical and economic outcomes for NovaSure, other GEA modalities, and hysterectomy. Results: Model analyses show lower costs for NovaSure-treated patients than for those treated with other GEA modalities or hysterectomy over all time frames under commercial payer and Medicaid perspectives. By Year 3, cost savings versus other GEA were $930 (commercial and $3,000 (Medicaid; cost savings versus hysterectomy were $6,500 (commercial and $8,900 (Medicaid. Coinciding with a 43%–71% reduction in need for re-ablation, there were 69%–88% fewer intervention/reintervention complications for NovaSure-treated patients versus other GEA modalities

  9. Budget Impact Analysis to Estimate the Cost Dynamics of Treating Refractory Gastroesophageal Reflux Disease With Radiofrequency Energy: a Payer Perspective.

    Science.gov (United States)

    Gregory, David; Scotti, Dennis J; Buck, Daniel; Triadafilopoulos, George

    2016-05-01

    A minimally invasive endoscopic treatment that utilizes radio-frequency energy (RFE) has received increased attention as an appropriate middle-ground approach in the treatment of refractory gastroesophageal reflux disease (GERD) and as an alternative to complicated and invasive surgical procedures. The objective of this study was to develop a longitudinal budget impact analysis from the payer perspective to estimate the direct medical costs of treatment for the refractory GERD patient population and to estimate the budgetary impact of further extending the RFE treatment option to other target populations. A retrospective analysis of claims designed to assess the longitudinal costs and budget impact on payer expenditures associated with managing and treating GERD surgically (Nissen fundoplication [NF]), endoscopically (RFE), or medically was performed. Both Medicare and commercially insured claims databases were interrogated for such population-level analyses. At current adoption rates (less than 1% of procedures), RFE demonstrated overall cost savings ranging from 7.3% to 50.5% in the 12-month time period following the index procedure (inclusive of procedure costs) when compared to medical management and fundoplication across the commercial and Medicare patient populations. Increasing the total number of RFE procedures to 2% of total cases performed generated per-member, per-month (PMPM) savings of $0.28 in the Medicare population and $0.37 in the commercially insured population. Further increases yielded higher PMPM savings. Adding to the clinical importance of RFE in filling the gap between medical and surgical management, this economic analysis demonstrates to payers that the adoption of RFE can create notable savings to their plans when compared to surgery or medical management.

  10. Direct and indirect costs for adverse drug events identified in medical records across care levels, and their distribution among payers.

    Science.gov (United States)

    Natanaelsson, Jennie; Hakkarainen, Katja M; Hägg, Staffan; Andersson Sundell, Karolina; Petzold, Max; Rehnberg, Clas; Jönsson, Anna K; Gyllensten, Hanna

    2017-11-01

    Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is known about costs caused by ADEs outside hospitals, effects on productivity, and how the costs are distributed among payers. To describe the direct and indirect costs caused by ADEs, and their distribution among payers. Furthermore, to describe the distribution of patient out-of-pocket costs and lost productivity caused by ADEs according to socio-economic characteristics. In a random sample of 5025 adults in a Swedish county, prevalence-based costs for ADEs were calculated. Two different methods were used: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by comparing costs among individuals with ADEs to costs among matched controls. Payers of costs caused by ADEs were identified in medical records among those with ADEs (n = 596), and costs caused to individual patients were described by socio-economic characteristics. Costs for resource use caused by ADEs were €505 per patient with ADEs (95% confidence interval €345-665), of which 38% were indirect costs. Compared to matched controls, the costs attributable to ADEs were €1631, of which €410 were indirect costs. The local health authorities paid 58% of the costs caused by ADEs. Women had higher productivity loss than men (€426 vs. €109, p = 0.018). Out-of-pocket costs displaced a larger proportion of the disposable income among low-income earners than higher income earners (0.7% vs. 0.2%-0.3%). We used two methods to identify costs for ADEs, both identifying indirect costs as an important component of the overall costs for ADEs. Although the largest payers of costs caused by ADEs were the local health authorities responsible for direct costs, employers and patients costs for lost productivity contributed substantially. Our results indicate inequalities in costs caused by ADEs, by sex and income. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Do coverage mandates affect direct-to-consumer advertising for pharmaceuticals? Evidence from parity laws.

    Science.gov (United States)

    Nathenson, Robert; Richards, Michael R

    2018-01-29

    Direct-to-consumer advertising (DTCA) for prescription drugs is a relatively unique feature of the US health care system and a source of tens of billions of dollars in annual spending. It has also garnered the attention of researchers and policymakers interested in its implications for firm and consumer behavior. However, few economic studies have explored the DTCA response to public policies, especially those mandating coverage of these products. We use detailed advertising expenditure data to assess if pharmaceutical firms increase their marketing efforts after the implementation of relevant state and federal health insurance laws. We focus on mental health parity statutes and related drug therapies-a potentially ripe setting for inducing stronger consumer demand. We find no clear indication that firms expect greater value from DTCA after these regulatory changes. DTCA appears driven by other considerations (e.g., product debut); however, it remains a possibility that firms respond to these laws through other, unobserved channels (e.g., provider detailing).

  12. Health Care Sharing Ministries and Their Exemption From the Individual Mandate of the Affordable Care Act.

    Science.gov (United States)

    Galarneau, Charlene

    2015-06-01

    The U.S. 2010 Patient Protection and Affordable Care Act (ACA) exempts members of health care sharing ministries (HCSMs) from the individual mandate to have minimum essential insurance coverage. Little is generally known about these religious organizations and even less critical attention has been brought to bear on them and their ACA exemption. Both deserve close scrutiny due to the exemption's less than clear legislative justification, their potential influence on the ACA's policy and ethical success, and their salience to current religious liberty debates surrounding the expansion of religious exemptions from ACA responsibilities for both individuals and corporations. Analyzing documents of the United States' three largest health care sharing ministries and related material, I examine these organizations and their ACA exemption with particular consideration of their ethical dimensions. Here a thick description of the nature and workings of health care sharing ministries precedes a similar account of the ACA exemption. From these empirical analyses, five ethical and policy concerns emerge: (1) the charity versus insurance status of these ministries; (2) the conflation of two ACA religious exemptions; (3) the tension between the values of religious liberty and of justice; (4) the potential undermining of ACA policy goals; and (5) the questionable compliance of health care sharing ministries with ACA exemption requirements.  An accurate and informed understanding of HCSMs is required for policymakers and others to justify the ACA exemption of health care sharing ministry members. A sufficient justification would address at least the five ethical and policy concerns raised here.

  13. The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans.

    Science.gov (United States)

    Li, Xiaoxue; Ye, Jinqi

    2017-09-01

    This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance. We exploit state-by-year variation in policy implementation in 1999-2008 and focus on a sample of veterans, who have better access to public insurance than non-veterans. Using data from the Current Population Survey, we find that the parity laws reduce employer-sponsored insurance (ESI) coverage by 2.1% points. The drop in ESI is largely offset by enrollment gains in public insurance, namely through the Veterans Affairs (VA) benefit and Medicaid/Medicare programs. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Civil rights for people with disabilities: obstacles related to the least restrictive environment mandate.

    Science.gov (United States)

    Palley, Elizabeth

    2009-01-01

    State and other social service agencies as well as service providers are governed by laws that often provide unclear guidance regarding the rights of people with disabilities. Although some standards can be, and have been, developed to protect the rights of people with disabilities, all people with disabilities are not the same and therefore, each can require very different types of accommodations. Some aspects of disability rights must be individually based, including the requirement that people with disabilities receive educational services in the least restrictive environment and care in the most inclusive setting. The current interpretation of these mandates suggests that agency decisions rely on professional judgments. Unless professionals work with their clients, this reliance can serve to disempower those whom the law was intended to protect. Though much debated, the legal definition of a person with a disability is unclear. This article examines the concept of disability and that of the least restrictive environment as well as that of the "most inclusive setting," explains to whom they apply, discusses how they have been defined both in statutes and case law, and elaborates on the role of social workers as a result of the law's reliance on professional judgment in ascertaining client rights.

  15. The estimated impact of California’s urban water conservation mandate on electricity consumption and greenhouse gas emissions

    Science.gov (United States)

    Spang, Edward S.; Holguin, Andrew J.; Loge, Frank J.

    2018-01-01

    In April 2015, the Governor of California mandated a 25% statewide reduction in water consumption (relative to 2013 levels) by urban water suppliers. The more than 400 public water agencies affected by the regulation were also required to report monthly progress towards the conservation goal to the State Water Resources Control Board. This paper uses the reported data to assess how the water utilities have responded to this mandate and to estimate the electricity savings and greenhouse gas (GHG) emissions reductions associated with reduced operation of urban water infrastructure systems. The results show that California succeeded in saving 524 000 million gallons (MG) of water (a 24.5% decrease relative to the 2013 baseline) over the mandate period, which translates into 1830 GWh total electricity savings, and a GHG emissions reduction of 521 000 metric tonnes of carbon dioxide equivalents (MT CO2e). For comparison, the total electricity savings linked to water conservation are approximately 11% greater than the savings achieved by the investor-owned electricity utilities’ efficiency programs for roughly the same time period, and the GHG savings represent the equivalent of taking about 111 000 cars off the road for a year. These indirect, large-scale electricity and GHG savings were achieved at costs that were competitive with existing programs that target electricity and GHG savings directly and independently. Finally, given the breadth of the results produced, we built a companion website, called ‘H2Open’ (https://cwee.shinyapps.io/greengov/), to this research effort that allows users to view and explore the data and results across scales, from individual water utilities to the statewide summary.

  16. Understanding modern energy policy: An evaluation of RPS mandates and behavioral nudges

    Science.gov (United States)

    Brannan, Deborah Lynn Baker

    Climate change has emerged as one of the leading policy issues of the early 21st century. In response, a variety of policies and programs have been adopted encouraging renewable energy, energy efficiency and energy conservation. My dissertation consists of three research papers which evaluate two classes of modern energy policy in the United States: renewable energy mandates and behavioral nudges. The Renewable Portfolio Standard (RPS) is the most prominent state-level renewable energy policy in the United States and has been debated several times at the federal level. Using a fixed-effects panel data model I study the existing experience of the RPS to help inform the policy debate. In contrast with the previous literature that has predominantly studied the average effect of the RPS on renewable capacity investments I explore factors resulting in the heterogeneous effect of the RPS policy. Relying on a basic understanding the electric utility industry and the electricity dispatch process I provide insight into existing experience with the RPS. Spurred by political and economic barriers to adopting renewable energy policy, interest has increased in using motivational techniques informed by behavioral science to encourage reductions in energy consumption. Existing research has predominantly addressed residential energy consumption. The remainder of my dissertation applies well-established motivational techniques to the transportation sector. Using an experimental design, I test whether real-time feedback and social norms can encourage fuel efficient driving behavior. I find that real-time feedback has a large impact on fuel economy, particularly when aggregated across the entire vehicle fleet. I also find some evidence suggesting that social norms can encourage eco-driving, but perhaps more importantly, identify key challenges associated with using social norms in a transportation setting.

  17. Forging a novel provider and payer partnership in Wisconsin to compensate pharmacists for quality-driven pharmacy and medication therapy management services.

    Science.gov (United States)

    Trapskin, Kari; Johnson, Curtis; Cory, Patrick; Sorum, Sarah; Decker, Chris

    2009-01-01

    To describe the Wisconsin Pharmacy Quality Collaborative (WPQC), a quality-based network of pharmacies and payers with the common goals of improving medication use and safety, reducing health care costs for payers and patients, and increasing professional recognition and compensation for pharmacist-provided services. Wisconsin between 2006 and 2009. Community (independent, chain, and health-system) pharmacies and private and public health care payers/purchasers with support from the McKesson Corporation. This initiative aligns incentives for pharmacies and payers through implementation of 12 quality-based pharmacy requirements as conditions of pharmacy participation in a practice-advancement pilot. Payers compensate network pharmacies that meet the quality-based requirements for two levels of pharmacy professional services (level 1, intervention-based services; level 2, comprehensive medication review and assessment services). The pilot project is designed to measure the following outcomes: medication-use quality improvements, frequency and types of services provided, drug therapy problems, patient safety, cost savings, identification of factors that facilitate pharmacist participation, and patient satisfaction. The Pharmacy Society of Wisconsin created the WPQC network, which consists of 53 pharmacies, 106 trained pharmacists, 45 student pharmacists, 6 pharmacy technicians, and 2 initial payers. A quality assurance process is followed approximately quarterly to audit the 12 network quality requirements. An evaluation of this collaboration is being conducted. This program demonstrates that collaboration among payers and pharmacists is possible and can result in the development of an incentive-aligned program that stresses quality patient care, standardized services, and professional service compensation for pharmacists. This combination of a quality-based credentialing process with a professional services reimbursement schedule is unique and has the promise to

  18. Mandates, buyouts and fuel-tax rebates: Some economic aspects of biofuel policies using the UK as an example

    International Nuclear Information System (INIS)

    Swinbank, Alan; Tranter, Richard; Jones, Philip

    2011-01-01

    Many governments mandate the blending of biofuels with fossil fuel supplies. The paper raises the possibility that some firms might choose not to respect such mandates, and cites the UK's experience, where a buyout of the obligation is possible. A simple economic framework is then used to explore some implications of mandate buyouts, including situations when buyouts and road-fuel-tax rebates are applied together. Finally, it discusses the design of buyout-mandate schemes that could release raw materials from biofuel production, following a future world food price shock. - Research Highlights: → Many governments mandate the blending of biofuels with fossil fuels. → Some allow firms to buyout the obligation. → Buyouts change the economic incentives firms face. → We use an economic framework to analyse buyouts of biofuel mandates. → Buyouts could alleviate the impact of biofuel mandates on rising food prices.

  19. Race, Medicine, and Colonial Rule in the Mandated Territory of New Guinea.

    Science.gov (United States)

    Cameron-Smith, Alexander

    2013-01-01

    Public health in the Mandated Territory of New Guinea shared characteristics with regimes in other colonial territories. The protection of European health and ensuring a supply of efficient indigenous labour were the principle aims of the public health regime. Measures to control infectious disease focused on racial segregation of urban spaces, surveillance, and control of indigenous mobility. Yet, if the mandate did not systemically encourage projects in preventive health and social medicine, wider public engagement with the international discourse of indigenous welfare and uplift surrounding it at times shaped colonial administration indirectly. One Director of Public Health in New Guinea, Raphael Cilento, invoked the terms of the mandate during acrimonious debates over nutrition in the 1920s that led to significant changes to rations included in the Native Labour Ordinance.

  20. A proposed ethical framework for vaccine mandates: competing values and the case of HPV.

    Science.gov (United States)

    Field, Robert I; Caplan, Arthur L

    2008-06-01

    Debates over vaccine mandates raise intense emotions, as reflected in the current controversy over whether to mandate the vaccine against human papilloma virus (HPV), the virus that can cause cervical cancer. Public health ethics so far has failed to facilitate meaningful dialogue between the opposing sides. When stripped of its emotional charge, the debate can be framed as a contest between competing ethical values. This framework can be conceptualized graphically as a conflict between autonomy on the one hand, which militates against government intrusion, and beneficence, utilitarianism, justice, and nonmaleficence on the other, which may lend support to intervention. When applied to the HPV vaccine, this framework would support a mandate based on utilitarianism, if certain conditions are met and if herd immunity is a realistic objective.

  1. The French biofuels mandates under cost uncertainty - an assessment based on robust optimization

    International Nuclear Information System (INIS)

    Lorne, Daphne; Tchung-Ming, Stephane

    2012-01-01

    This paper investigates the impact of primary energy and technology cost uncertainty on the achievement of renewable and especially biofuel policies - mandates and norms - in France by 2030. A robust optimization technique that allows to deal with uncertainty sets of high dimensionality is implemented in a TIMES-based long-term planning model of the French energy transport and electricity sectors. The energy system costs and potential benefits (GHG emissions abatements, diversification) of the French renewable mandates are assessed within this framework. The results of this systemic analysis highlight how setting norms and mandates allows to reduce the variability of CO 2 emissions reductions and supply mix diversification when the costs of technological progress and prices are uncertain. Beyond that, we discuss the usefulness of robust optimization in complement of other techniques to integrate uncertainty in large-scale energy models. (authors)

  2. Multi-objective regulations on transportation fuels: Comparing renewable fuel mandates and emission standards

    International Nuclear Information System (INIS)

    Rajagopal, D.; Plevin, R.; Hochman, G.; Zilberman, D.

    2015-01-01

    We compare two types of fuel market regulations — a renewable fuel mandate and a fuel emission standard — that could be employed to simultaneously achieve multiple outcomes such as reduction in fuel prices, fuel imports and greenhouse gas (GHG) emissions. We compare these two types of regulations in a global context taking into account heterogeneity in carbon content of both fossil fuels and renewable fuels. We find that although neither the ethanol mandate nor the emission standard is certain to reduce emissions relative to a business-as-usual baseline, at any given level of biofuel consumption in the policy region, a mandate, relative to an emission standard, results in higher GHG emissions, smaller expenditure on fuel imports, lower price of ethanol-blended gasoline and higher domestic fuel market surplus. This result holds over a wide range of values of model parameters. We also discuss the implications of this result to a regulation such as the US Renewable Fuel Standard given recent developments within the US such as increase in shale and tight oil production and large increase in average vehicle fuel economy of the automotive fleet. - Highlights: • Biofuel mandates and fuel GHG emission standards are analyzed from a multiple criteria perspective • An emission-standard always results in lower global emissions while requiring less biofuel relative to a biofuel mandate • An emission-standard results in higher fuel price in the home region relative to a biofuel mandate • Emission standards lead to more shuffling of both fossil fuels and biofuels between home and abroad • The relative impact of the policies on fuel imports depends on the relative cost-effectiveness of domestic & imported biofuel • Recent developments oil production and fuel economy increase the net benefits of an LCFS approach relative to RFS

  3. Postoperative outcomes in bariatric surgical patients participating in an insurance-mandated preoperative weight management program.

    Science.gov (United States)

    Schneider, Andrew; Hutcheon, Deborah A; Hale, Allyson; Ewing, Joseph A; Miller, Megan; Scott, John D

    2018-02-02

    Many insurance companies require patient participation in a medically supervised weight management program (WMP) before offering approval for bariatric surgery. Clinical data surrounding benefits of participation are limited. To evaluate the relationship between preoperative insurance-mandated WMP participation and postoperative outcomes in bariatric surgery patients. Regional referral center and teaching hospital. A retrospective review of patients who underwent vertical sleeve gastrectomy or Roux-en-Y gastric bypass between January 2014 and January 2016 was performed. Patients (N = 354) were divided into 2 cohorts and analyzed according to presence (n = 266) or absence (n = 88) of an insurance-mandated WMP requirement. Primary endpoints included rate of follow-up and percent of excess weight loss (%EWL) at postoperative months 1, 3, 6, and 12. All patients, regardless of the insurance-mandated WMP requirement, followed a program-directed preoperative diet. The majority of patients with an insurance-mandated WMP requirement had private insurance (63.9%). Both patient groups experienced a similar proportion of readmissions and reoperations, rate of follow-up, and %EWL at 1, 3, 6, and 12 months (P = NS). Median operative duration and hospital length of stay were also similar between groups. Linear regression analysis revealed no significant improvement in %EWL at 12 months in the yes-WMP group. These data show that patients who participate in an insurance-mandated WMP in addition to completing a program-directed preoperative diet experience no significant benefit to rate of readmission, reoperation, follow-up, or %EWL up to 12 months postoperation. Our findings suggest that undergoing bariatric surgery without completing an insurance-mandated WMP is safe and effective. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  4. Real-World Evidence: Useful in the Real World of US Payer Decision Making? How? When? And What Studies?

    Science.gov (United States)

    Malone, Daniel C; Brown, Mary; Hurwitz, Jason T; Peters, Loretta; Graff, Jennifer S

    2018-03-01

    To examine how real-world evidence (RWE) is currently perceived and used in managed care environments, especially to inform pharmacy and therapeutic (P&T) committee decisions, to assess which study factors (e.g., data, design, and funding source) contribute to RWE utility in decisions, and to identify barriers to consideration of RWE studies in P&T decision making. We conducted focus groups/telephone-based interviews and surveys to understand perceptions of RWE and assess awareness, quality, and relevance of two high-profile examples of published RWE studies. A purposive sample comprised 4 physicians, 15 pharmacists, and 1 researcher representing 18 US health plans and health system organizations. Participants reported that RWE was generally used, or useful, to inform safety monitoring, utilization management, and cost analysis, but less so to guide P&T decisions. Participants were not aware of the two sample RWE studies but considered both studies to be valuable. Relevant research questions and outcomes, transparent methods, study quality, and timely results contribute to the utility of published RWE. Perceived organizational barriers to the use of published RWE included lack of skill, training, and timely study results. Payers recognize the value of RWE, but use of such studies to inform P&T decisions varies from organization to organization and is limited. Relevance to payers, timeliness, and transparent methods were key concerns with RWE. Participants recognized the need for continuing education on evaluating and using RWE to better understand the study methods, findings, and applicability to their organizations. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  5. Teaching English or Producing Docility? Foucauldian Analysis of Pakistani State-Mandated English Textbooks

    Science.gov (United States)

    Channa, Liaquat Ali; Gilhooly, Daniel; Channa, Abdul Razaque; Manan, Syed Abdul

    2017-01-01

    The scholarship of language education, particularly with reference to learning and use of English, is marked by varieties of English. One may note two broad models: (1) ENL, ESL, and EFL; (2) EIL, ELF, and WEs. Although the scholarship is replete with debates, the debates seem to only construct and maintain that learning English and its use are…

  6. A Nationwide Survey of State-Mandated Evaluation Practices for Domestic Violence Agencies

    Science.gov (United States)

    Riger, Stephanie; Staggs, Susan L.

    2011-01-01

    Many agencies serving survivors of domestic violence are required to evaluate their services. Three possible evaluation strategies include: a) process measurement, which typically involves a frequency count of agency activities, such as the number of counseling hours given; b) outcome evaluation, which measures the impact of agency activities on…

  7. Teacher Job Satisfaction as Related to Student Performance on State-Mandated Testing

    Science.gov (United States)

    Crawford, James Douglas

    2017-01-01

    The growing demand placed upon educators has taken a toll on the profession (Walker, 2014). Teacher burnout, stress, and unhappiness may be predestined unless administrators recognize how to prevent these from happening (Elias, 2012). The intent of this quantitative study was to survey teachers in southwest Missouri to determine their level of job…

  8. The influences of implementing state-mandated science assessment on teacher practice

    Science.gov (United States)

    Katzmann, Jason Matthew

    Four high school Biology teachers, two novice and two experienced, participated in a year and a half case study. By utilizing a naturalistic paradigm, the four individuals were studied in their natural environment, their classrooms. Data sources included: three semi-structured interviews, classroom observation field notes, and classroom artifacts. Through cross-case analysis and a constant comparative methodology, coding nodes where combined and refined resulting in the final themes for discussion. The following research question was investigated: what is the impact of high-stakes testing on high school Biology teacher's instructional planning, instructional practices and classroom assessments? Seven final themes were realized: Assessment, CSAP, Planning, Pressure, Standards, Teaching and Time. Each theme was developed and discussed utilizing each participant's voice. Trustworthiness of this study was established via five avenues: triangulation of data sources, credibility, transferability, dependability and confirmability. A model of the influences of high-stakes testing on teacher practice was developed to describe the seven themes (Figure 5). This model serves as an illustration of the complex nature of teacher practice and the influences upon it. The four participants in this study were influenced by high-stakes assessment. It influenced their instructional decisions, assessment practices, use of time, planning decisions and decreased the amount of inquiry that occurred in the classroom. Implications of this research and future research directions are described.

  9. Survey of the Statewide Impact of Payer Source on Referral of Small Burns to Burn Centers.

    Science.gov (United States)

    Penny, Rachel; Coffey, Rebecca; Jones, Larry; Bailey, J Kevin

    It is generally agreed that patients with large burns will be referred to organized burn centers, however, the referral of patients with smaller burns is less certain. A two-part survey was conducted to identify referral patterns for burn patients that meet American Burn Association referral criteria, and any effect insurance type might have on the referral patterns. The emergency departments of our state hospital association's member hospitals were contacted seeking a referral for a fictitious patient with a third-degree scald of the dominant hand. The referral sites were contacted twice, first stating that the patient had commercial insurance, next stating that the patient had Medicaid. Data collected included wait time for an appointment or reasons for denial of an appointment. Of 218 hospitals, 46 were excluded because they did not offer emergency care, and eight because they were listed as burn centers on the American Burn Association website. Of the remaining 164, 119 (73%) would refer to a burn center, 21 (13%) to a plastic surgeon, 10 (6%) to a hand surgeon, 7 (4%) to a wound center, 7 (4%) to another nonburn physician resource. There was no difference in wait time to the first available appointment with regards to insurance type (6.56 ± 4.68 vs 6.53 ± 5.05 days). Our state's referral pattern gives us insight into the regional referral pattern. This information will be used to guide a focused education and communication program to provide better service for the burn victims of our state.

  10. Personal Consequences of Compliance and Resistance to Mandated Reforms for Teachers in Low-Performing Schools

    Science.gov (United States)

    Burke, Christopher J. F.; Adler, Martha

    2013-01-01

    This case study examines the experiences of two fifth grade teachers as they dealt with district mandates while trying to address their high-poverty urban children's learning needs. It reveals their personal struggles that led to both compliance and resistance. In this case, the act of finding the space to engage in the intellectual and…

  11. Perceptions of legally mandated public involvement processes in the U.S. Forest Service

    Science.gov (United States)

    S. Andrew Predmore; Marc J. Stern; Michael J. Mortimer; David N. Seesholtz

    2011-01-01

    Results from an agency-wide survey of U.S. Forest Service personnel indicate that respondents in our sample engage in National Environmental Policy Act (NEPA) public involvement processes primarily to accomplish two goals. The most commonly supported goal was to inform and disclose as mandated by the act. The other goal reflected interests in managing agency...

  12. Local mandate improves equity of paid sick leave coverage: Seattle’s experience

    Directory of Open Access Journals (Sweden)

    Jennifer L. Romich

    2017-01-01

    Full Text Available Abstract Background Paid sick leave allows workers to take time off work for personal or family health needs, improving health and potentially limiting infectious diseases. The U.S. has no national sick leave mandate, and many American workers - particularly those at lower income levels - have no right to paid time off for their own or family members’ health needs. This article reports on outcomes of a local mandate, the City of Seattle Paid Sick and Safe Time Ordinance, which requires certain employers to provide paid sick leave to eligible workers. Methods Survey collectors contacted a stratified random sample of Seattle employers before the Ordinance went into effect and one year later. Pre- and post- analysis draws on responses to survey items by 345 employers who were subject to the paid sick leave mandate. Results Awareness of the policy and provision of paid leave grew significantly over the year after the Ordinance was enacted. More employers offered leave to full-time workers (80.8 to 93.9%, p < .001 and part-time workers (47.1 to 66.7%, p < .001 with particularly large increases in the hospitality sector, which includes food workers (coverage of any hospitality employee: 27.5 to 85.0%, p < .001. Conclusions Absent a federal policy, local paid sick time mandates can increase paid sick leave coverage, an important social determinant of health.

  13. "You Can't Mandate What Matters": Bumping Visions against Practices

    Science.gov (United States)

    Merz, Alice H.; Swim, Terri Jo

    2011-01-01

    In this study, an American public school principal's vision of promoting growth in her teachers and students was inspired by the Reggio Emilia approach. Unlike other educational approaches, this approach did not involve a product, i.e., "to become Reggio", and it did not involve a set of rules or mandates. Instead, the principal had her…

  14. Challenges and Choices: A Multidistrict Analysis of Statewide Mandated Democratic Engagement

    Science.gov (United States)

    Marsh, Julie A.; Hall, Michelle

    2018-01-01

    This article seeks to deepen our understanding of the nature and quality of democratic participation in educational reform by examining the first-year implementation of California's Local Control Funding Formula (LCFF) mandating civic engagement in district decision-making. Drawing on democratic theory, empirical literature, and data from 10…

  15. Mandated Psychological Assessments for Suicide Risk in a College Population: A Pilot Study

    Science.gov (United States)

    Kirchner, Grace L.; Marshall, Donn; Poyner, Sunney R.

    2017-01-01

    This study was conducted to evaluate the impact of a protocol mandating psychological assessment of college students exhibiting specific signs of suicide risk and/or nonsuicidal self-harm. Thirty-seven current and former students who had been documented as at risk completed a structured interview in person or by phone. Outcomes suggest this…

  16. UN-mandated maritime arms embargo operations in Operation Unified Protector

    NARCIS (Netherlands)

    Fink, M.D.

    2011-01-01

    On the basis of UNSC Resolutions 1970 and 1973 on the situation in Libya, between March and October 2011 NATO conducted the Operation Unified Protector (OUP). An important part of this NATO-led mission was that of enforcing a UN-mandated arms embargo at sea. In this context, this article examines

  17. A College Administrator's Framework to Assess Compliance with Accreditation Mandates

    Science.gov (United States)

    Davis†, Jerry M.; Rivera, John-Juan

    2014-01-01

    A framework to assess the impact of complying with college accreditation mandates is developed based on North's (1996) concepts of transaction costs, property rights, and institutions; Clayton's (1999) Systems Alignment Model; and the educational production function described by Hanushek (2007). The framework demonstrates how sought…

  18. New Mandates and Imperatives in the Revised "ACA Code of Ethics"

    Science.gov (United States)

    Kaplan, David M.; Kocet, Michael M.; Cottone, R. Rocco; Glosoff, Harriet L.; Miranti, Judith G.; Moll, E. Christine; Bloom, John W.; Bringaze, Tammy B.; Herlihy, Barbara; Lee, Courtland C.; Tarvydas, Vilia M.

    2009-01-01

    The first major revision of the "ACA Code of Ethics" in a decade occurred in late 2005, with the updated edition containing important new mandates and imperatives. This article provides interviews with members of the Ethics Revision Task Force that flesh out seminal changes in the revised "ACA Code of Ethics" in the areas of confidentiality,…

  19. Summer Versus School-Year Alcohol Use Among Mandated College Students.

    Science.gov (United States)

    Miller, Mary Beth; Merrill, Jennifer E; Yurasek, Ali M; Mastroleo, Nadine R; Borsari, Brian

    2016-01-01

    Longitudinal research examining college students' alcohol use during the summer months, especially in at-risk individuals, is limited. The current study evaluated changes in mandated college students' alcohol use and related consequences over the summer. Participants (n = 305, 67% male) who had violated campus alcohol policy and were subsequently mandated to treatment completed follow-up assessments at 3, 6, and 9 months. For the majority of students, one of these follow-up assessments occurred over the summer. Hierarchical linear modeling was used to examine changes in alcohol use and related consequences during the school year and summer. Participants reported consuming significantly fewer drinks per occasion, reaching lower peak blood alcohol concentrations, and experiencing fewer alcohol-related consequences during the summer months. All outcomes were mediated by summer housing, indicating that summer influenced alcohol use indirectly through participants' tendency to live at home. Despite small but significant decreases in alcohol consumption and related consequences when living with a parent/guardian, mandated college students continue to exhibit risky drinking and consequences during the summer months. Given these findings, summer may be an appropriate time to implement prevention and intervention strategies with mandated and other at-risk populations.

  20. Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership.

    Science.gov (United States)

    Kerr, Christopher W; Donohue, Kathleen A; Tangeman, John C; Serehali, Amin M; Knodel, Sarah M; Grant, Pei C; Luczkiewicz, Debra L; Mylotte, Kathleen; Marien, Melanie J

    2014-12-01

    In the United States, 5% of the population is responsible for nearly half of all health care expenditures, with a large concentration of spending driven by individuals with expensive chronic conditions in their last year of life. Outpatient palliative care under the Medicare Hospice Benefit excludes a large proportion of the chronically ill and there is widespread recognition that innovative strategies must be developed to meet the needs of the seriously ill while reducing costs. This study aimed to evaluate the impact of a home-based palliative care program, implemented through a hospice-private payer partnership, on health care costs and utilization. This was a prospective, observational database study where insurance enrollment and claims data were analyzed. The study population consisted of Home Connections (HC) program patients enrolled between January 1, 2010 and December 31, 2012 who subsequently expired (n=149) and who were also Independent Health members. A control group (n=537) was derived using propensity-score matching. The primary outcome variable was overall costs within the last year of life. Costs were also examined at six months, three months, one month, and two weeks. Inpatient, outpatient, ancillary, professional, and pharmacy costs were compared between the two groups. Medical service utilization and hospice enrollment and length of stay were also evaluated. Cost savings were apparent in the last three months of life—$6,804 per member per month (PMPM) cost for palliative care participants versus $10,712 for usual care. During the last two weeks of life, total allowed PMPM was $6,674 versus $13,846 for usual care. Enhanced hospice entry (70% versus 25%) and longer length of stay in hospice (median 34 versus 9 days) were observed. Palliative care programs partnered with community hospice providers may achieve cost savings while helping provide care across the continuum.

  1. Why Hospitals and Payers are Recommending Home Care Upon Discharge Instead of SNF or Traditional Home Health Services--Alternative Payment Model Hospital Incentives Aligning with Patient Choice.

    Science.gov (United States)

    Luke, Josh

    2016-01-01

    Seniors and other hospital patients in the United States have traditionally had the option of being discharged to a skilled nursing facility (convalescent home) for post-acute services, or home with nursing and therapy services provided in the home setting. Traditionally, these home based services have been referred to as "home health." As more Americans have retired, home health services have expanded and are readily accessible. This growth put tremendous stress on the Medicare fund which pays for senior care services. However, "Home Care," which traditionally has been viewed as non-medical home based services, has also become a booming industry for the cost conscious in recent years as more Americans reach retirement age. With the passing of the Affordable Care Act in 2010, providers and payers are now finding themselves responsible for post-acute care and continuous patient health, so cost efficient solutions for post-acute care are thriving. For the first time in history, American hospitals and Insurers are recognizing Home Care as an effective model that achieves the Triple Aim of Health Care reform. Home Care, which is no longer completely non-medical services, has proven to be an integral part of the care continuum for seniors in recent years and is now becoming a viable solution for keeping patients well, while still honoring their desire to age and heal at home. This paper analyzes the benefits and risks of home care and provides a clear understanding as to why American hospitals are emphasizing SNF Avoidance and skipping home health, opting instead to refer patients directly to home care as the preferred discharge solution in a value based model.

  2. Impact of state mandatory insurance coverage on the use of diabetes preventive care

    Directory of Open Access Journals (Sweden)

    Barker Lawrence

    2010-05-01

    Full Text Available Abstract Background 46 U.S. states and the District of Columbia have passed laws and regulations mandating that health insurance plans cover diabetes treatment and preventive care. Previous research on state mandates suggested that these policies had little impact, since many health plans already covered the benefits. Here, we analyze the contents of and model the effect of state mandates. We examined how state mandates impacted the likelihood of using three types of diabetes preventive care: annual eye exams, annual foot exams, and performing daily self-monitoring of blood glucose (SMBG. Methods We collected information on diabetes benefits specified in state mandates and time the mandates were enacted. To assess impact, we used data that the Behavioral Risk Factor Surveillance System gathered between 1996 and 2000. 4,797 individuals with self-reported diabetes and covered by private insurance were included; 3,195 of these resided in the 16 states that passed state mandates between 1997 and 1999; 1,602 resided in the 8 states or the District of Columbia without state mandates by 2000. Multivariate logistic regression models (with state fixed effect, controlling for patient demographic characteristics and socio-economic status, state characteristics, and time trend were used to model the association between passing state mandates and the usage of the forms of diabetes preventive care, both individually and collectively. Results All 16 states that passed mandates between 1997 and 1999 required coverage of diabetic monitors and strips, while 15 states required coverage of diabetes self management education. Only 1 state required coverage of periodic eye and foot exams. State mandates were positively associated with a 6.3 (P = 0.04 and a 5.8 (P = 0.03 percentage point increase in the probability of privately insured diabetic patient's performing SMBG and simultaneous receiving all three preventive care, respectively; state mandates were not

  3. Adoption and implementation of mandated diabetes registries by community health centers.

    Science.gov (United States)

    Helfrich, Christian D; Savitz, Lucy A; Swiger, Kathleen D; Weiner, Bryan J

    2007-07-01

    Innovations adopted by healthcare organizations are often externally mandated. However, few studies examine how mandated innovations progress from adoption to sustained effective use. This study uses Rogers's model of organizational innovation to explore community health centers' (CHCs') mandated adoption and implementation of disease registries in the federal Health Disparities Collaborative (HDC). Case studies were conducted on six CHCs in North Carolina participating in the HDC on type 2 diabetes mellitus. Data were collected from semistructured interviews with key staff, and from site-level and individual-level surveys. Although disease registry adoption and implementation were mandated, CHCs exercised prerogative in the timing of registry adoption and the functions emphasized. Executive and medical director involvement, often directly on the HDC teams, was the single most salient influence on adoption and implementation. Staff members' personal experience with diabetes also provided context and gave registries added significance. Participants lauded HDC's technique of small-scale, rapid-cycle change, but valued even more shared problem solving and peer learning among HDC teams. However, lack of cross-training, inadequate resources, and staff turnover posed serious threats to sustainability of the registries. The present study illustrates the usefulness of Rogers's model for studying mandated innovation and highlights several key factors, including direct, personal involvement of organizational leadership, and shared problem solving and peer learning facilitated by the HDC. However, these six CHCs elected to participate early in the HDC, and may not be typical of North Carolina's remaining CHCs. Furthermore, most face important long-term challenges that threaten routinization.

  4. Economic impact of new active substance status on EU payers' budgets: example of dimethyl fumarate (Tecfidera(®)) for multiple sclerosis.

    Science.gov (United States)

    Toumi, Mondher; Jadot, Guy

    2014-01-01

    Recently, collaboration between regulators and payers was set up and was mainly focused on evidence generation along product clinical development. However, neither the regulatory path nor the new active substance status (NASs) was considered. Granting NASs will provide the product with 8 years of data protection and 2 years of market exclusivity during which no generic could enter the market. To review the economic impact (for payers) of NASs granted by the European Medicines Agency (EMA) for dimethyl fumarate (DMF), developed by Biogen and approved for multiple sclerosis (MS) as Tecfidera(®) on 3 February 2014. We reviewed the available DMF-containing products and identified their indication and price through relevant databases and official Web sites. The economic impact of Tecfidera(®) on payers' budgets was calculated assuming NASs was or was not granted. The forecast was identified in Datamonitor. Results identified four products already containing DMF as the main or unique active substance. This would have potentially prevented Tecfidera(®) from being granted NASs. The EMA Committee for Medicinal Products for Human Use (CHMP) denied Tecfidera(®) NASs and, following a company appeal, reversed its position opening as polemic. The impact of that decision has been evaluated at €7 to €10 billion over a 10-year period. NASs is a critical decision because it does have a major budget impact for payers, and it prevents generic competition. Current European Union (EU) regulations on that topic are unclear and open up too many interpretations thus distorting fair trade and affecting payers' bills. Greater clarity and more stringent rules are required to prevent mistrust of this EMA decision.

  5. Bundled payment reimbursement for anterior and posterior approaches for cervical spondylotic myelopathy: an analysis of private payer and Medicare databases.

    Science.gov (United States)

    Virk, Sohrab S; Phillips, Frank M; Khan, Safdar N

    2018-03-01

    OBJECTIVE Cervical spondylotic myelopathy (CSM) is a progressive spinal condition that often requires surgery. Studies have shown the clinical equivalency of anterior versus posterior approaches for CSM surgery. The purpose of this study was to determine the amount and type of resources used for anterior and posterior surgical treatment of CSM by using large national databases of clinical and financial information from patients. METHODS This study consists of 2 large cohorts of patients who underwent either an anterior or posterior approach for treatment of CSM. These patients were selected from the Medicare 5% National Sample Administrative Database (SAF5) and the Humana orthopedic database (HORTHO), which is a database of patients with private payer health insurance. The outcome measures were the cost of a 90-day episode of care, as well as a breakdown of the cost components for each surgical procedure between 2005 and 2014. RESULTS A total of 16,444 patients were included in this analysis. In HORTHO, there were 10,332 and 1556 patients treated with an anterior or posterior approach for CSM, respectively. In SAF5, there were 3851 and 705 patients who were treated by an anterior or posterior approach for CSM, respectively. The mean ± SD reimbursements for anterior and posterior approaches in the HORTHO database were $20,863 ± $2014 and $23,813 ± $4258, respectively (p = 0.048). The mean ± SD reimbursements for anterior and posterior approaches in the SAF5 database were $18,219 ± $1053 and $25,598 ± $1686, respectively (p reimbursements for a rehabilitation/skilled nursing facility and hospital/inpatient care for patients who underwent a posterior approach in both the private payer and Medicare databases. In all cohorts in this study, the hospital-related reimbursement was more than double the surgeon-related reimbursement. CONCLUSIONS This study provides resource utilization information for a 90-day episode of care for both anterior and posterior approaches

  6. The new regulator in town : The effect of Walmart’s sustainability mandate on supplier shareholder value

    NARCIS (Netherlands)

    Gielens, K.J.P.; Geyskens, Inge; Deleersnyder, Barbara; Nohe, Max

    Suppliers are increasingly forced by dominant retailers to clean up their supply chains. While these retailers argue that their sustainability mandates may translate into profits for suppliers, many suppliers are cynical about these mandates because the onus to undertake the required investments is

  7. Does the U.S. biofuels mandate increase the price at the pump?

    Science.gov (United States)

    Bolotin, Stephen R.

    The Renewable Fuel Standard (RFS) as amended by the Energy Independence and Security Act of 2007 created a federal mandate for blending conventional biofuels like corn-based ethanol and advanced biofuels like biodiesel and renewable gasoline into the United States transportation fuel supply. The RFS established yearly blending standards for the obligated parties--refiners and importers of petroleum products--that increase progressively until reaching a high of 36 billion gallons by 2022. Each ethanol-equivalent gallon of biofuel blended is assigned a unique Renewable Identification Number (RIN) through the Environmental Protection Agency's (EPA) Moderated Transaction System (EMTS). At year's close, obligated parties must submit their allotted RIN obligations to the EPA to demonstrate compliance. In the case of under-compliance or over-compliance, RINs can be traded between obligated parties freely through the EMTS or carried over for use in the next year. It follows, then, that a RIN carries a market value reflective of the cost of complying with RFS regulations. Indeed, most biofuels cost more than their fossil-based equivalents. When the price of a corn ethanol RIN went from 2-3 cents each in 2012 to nearly $1.50 in July of 2013 due to a perceived shortage in corn ethanol RINs, obligated parties faced the prospect of multimillion-dollar compliance cost increases. Arguing that RFS makes fuel significantly more expensive for consumers, petroleum companies have begun to advocate for the full repeal of the RFS, winning over some allies in Congress. The future of this program is uncertain. In an attempt to quantify the concerns of RFS critics, this thesis estimated the effect that RIN prices have on the wholesale cost of diesel fuel. Using daily price data from January 2011 through August of 2013 on RINs and crude oil, I specified twelve OLS regression models that predict the passthrough of the diesel RIN price to wholesale diesel price. My statistical analysis

  8. Mandated reporters' experiences with reporting child maltreatment: a meta-synthesis of qualitative studies.

    Science.gov (United States)

    McTavish, Jill R; Kimber, Melissa; Devries, Karen; Colombini, Manuela; MacGregor, Jennifer C D; Wathen, C Nadine; Agarwal, Arnav; MacMillan, Harriet L

    2017-10-16

    To systematically search for research about the effectiveness of mandatory reporting of child maltreatment and to synthesise qualitative research that explores mandated reporters' (MRs) experiences with reporting. As no studies assessing the effectiveness of mandatory reporting were retrieved from our systematic search, we conducted a meta-synthesis of retrieved qualitative research. Searches in Medline (Ovid), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Education Resources Information Center, Criminal Justice Abstracts and Cochrane Library yielded over 6000 citations, which were deduplicated and then screened by two independent reviewers. English-language, primary qualitative studies that investigated MRs' experiences with reporting of child maltreatment were included. Critical appraisal involved a modified checklist from the Critical Appraisal Skills Programme and qualitative meta-synthesis was used to combine results from the primary studies. All healthcare and social-service settings implicated by mandatory reporting laws were included. Included studies crossed nine high-income countries (USA, Australia, Sweden, Taiwan, Canada, Norway, Finland, Israel and Cyprus) and three middle-income countries (South Africa, Brazil and El Salvador). The studies represent the views of 1088 MRs. Factors that influence MRs' decision to report and MRs' views towards and experiences with mandatory reporting of child maltreatment. Forty-four articles reporting 42 studies were included. Findings indicate that MRs struggle to identify and respond to less overt forms of child maltreatment. While some articles (14%) described positive experiences MRs had with the reporting process, negative experiences were reported in 73% of articles and included accounts of harm to therapeutic relationships and child death following removal from their family of origin. The findings of this meta-synthesis suggest that there are many potentially

  9. Potential impact of legislation mandating breast density notification: benefits, harms, and cost effectiveness of supplemental ultrasound screening

    Science.gov (United States)

    Sprague, Brian L.; Stout, Natasha K.; Schechter, Clyde; van Ravesteyn, Nicolien T.; Cevik, Mucahit; Alagoz, Oguzhan; Lee, Christoph I.; van den Broek, Jeroen J.; Miglioretti, Diana L.; Mandelblatt, Jeanne S.; de Koning, Harry J.; Kerlikowske, Karla; Lehman, Constance D.; Tosteson, Anna N. A.

    2014-01-01

    Background At least nineteen states have laws that require telling women with dense breasts and a negative screening mammogram to consider supplemental screening. The most readily available supplemental screening modality is ultrasound, yet little is known about its effectiveness. Objective To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Design Comparative modeling with 3 validated simulation models. Data Sources Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; the medical literature. Target Population A contemporary cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Payer. Interventions Supplemental ultrasound screening for women with dense breasts following a negative screening mammogram. Outcome Measures Breast cancer deaths averted, quality-adjusted life years (QALYs) gained, false positive ultrasound biopsy recommendations, costs, costs per QALY gained. Results of Base-Case Analysis Supplemental ultrasound screening after a negative mammogram for women aged 50–74 with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models: 0.14–0.75), gained 1.7 QALYs (0.9–4.7), and resulted in 354 false-positive ultrasound biopsy recommendations (345–421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained ($112,000-$766,000). Restricting supplemental ultrasound screening to women with extremely dense breasts cost $246,000 per QALY gained ($74,000-$535,000). Results of Sensitivity Analysis The conclusions were not sensitive to ultrasound performance characteristics, screening frequency, or starting age. Limitations Provider costs for coordinating supplemental ultrasound were not considered. Conclusions Supplemental ultrasound screening for women with dense breasts undergoing

  10. Managed care and inpatient mortality in adults: effect of primary payer.

    Science.gov (United States)

    Hines, Anika L; Raetzman, Susan O; Barrett, Marguerite L; Moy, Ernest; Andrews, Roxanne M

    2017-02-08

    Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor. This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients. A cross-sectional design was used to examine the association between managed care and inpatient mortality for four common inpatient conditions. Data from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases for 11 states were linked to data from the American Hospital Association Annual Survey Database. Hospital discharges were categorized as managed care or fee for service. A phased approach to multivariate logistic modeling examined the likelihood of inpatient mortality when adjusting for individual patient and hospital characteristics and for county fixed effects. Results showed different effects of managed care for Medicare and privately insured patients. Privately insured patients in managed care had an advantage over their fee-for-service counterparts in inpatient mortality for acute myocardial infarction, stroke, pneumonia, and congestive heart failure; no such advantage was found for the Medicare managed care population. To the extent that the study showed a protective effect of privately insured managed care, it was driven by individuals aged 65 years and older, who had consistently better outcomes than their non-managed care counterparts. Privately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service plans

  11. Refusing to be Complicit in our Prison Nation: Teachers Rethinking Mandated Reporting

    Directory of Open Access Journals (Sweden)

    Erica Meiners

    2016-11-01

    Full Text Available Ensuring that Black Lives Matter in schools requires seismic shifts including excavating the ongoing practices and policies that reproduce heterogendered white supremacy in schools. However, what is too often erased in these movements is the key way the profession of teaching facilitates racialized surveillance and criminalization. Teachers are mandated reporters who are required by law to report suspected negligence and abuse. While on paper this charge looks neutral, this essay illustrates why teachers should rethink their roles and organize against mandated reporting laws. To teach to ensure that all Black Lives Matter requires refusing to be complicit in the mechanisms that contribute to the destruction of too many families and communities.

  12. Ethical dilemma of mandated contraception in pharmaceutical research at catholic medical institutions.

    Science.gov (United States)

    Casey, Murray Joseph; O'Brien, Richard; Rendell, Marc; Salzman, Todd

    2012-01-01

    The Catholic Church proscribes methods of birth control other than sexual abstinence. Although the U.S. Food and Drug Administration (FDA) recognizes abstinence as an acceptable method of birth control in research studies, some pharmaceutical companies mandate the use of artificial contraceptive techniques to avoid pregnancy as a condition for participation in their studies. These requirements are unacceptable at Catholic health care institutions, leading to conflicts among institutional review boards, clinical investigators, and sponsors. Subjects may feel coerced by such mandates to adopt contraceptive techniques inconsistent with their personal situation and beliefs; women committed to celibacy or who engage exclusively in non-heterosexual activities are negatively impacted. We propose principles to insure informed consent to safeguard the rights of research subjects at Catholic institutions while mitigating this ethical conflict. At the same time, our proposal respects the interests of pharmaceutical research agencies and Catholic moral precepts, and fully abides by regulatory guidance.

  13. THE COVERAGE OF THE FOLHA DE S.PAULO ON THE POSSIBLE THIRD MANDATE

    Directory of Open Access Journals (Sweden)

    Merilyn Escobar de Oliveira

    2009-08-01

    Full Text Available The possibility of a new mandate for President Lula guided the public agenda in the last quarter of 2007 and returned to the media scene in April and the first week of May 2008. This article investigates the aspects of journalistic coverage on the “thesis” of the third mandate giving emphasis to the news making, the framing and the outcome. The importance gained by the “thesis” of re-election related directly of the electoral process of 2010 and the futures expectations of the Workers’ Party (PT. This article supports the hypothesis that rhythm of the journalistic coverage, and more precisely, that the news framing was tendentious. Our corpus contemplates publications of the Folha de S. Paulo, the national newspaper of larger circulation in the country.

  14. Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data.

    Science.gov (United States)

    Kim, Hyunjee; McConnell, K John; Sun, Benjamin C

    2017-08-01

    The high rate of emergency department (ED) use by Medicaid patients is not fully understood. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid-commercial differences in ED use can be explained by observable factors in administrative data. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011-2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database. Demographics, comorbidities, health services use, and neighborhood characteristics accounted for 44% of the Medicaid-commercial difference in ED use, compared to 83% for mental health care and 75% for inpatient care. This suggests that relative to mental health and inpatient care, a large portion of ED use cannot be explained by administrative data. Models that further accounted for patient access to different primary care physicians explained an additional 8% of the Medicaid-commercial difference in ED use, suggesting that the quality of primary care may influence ED use. The remaining unexplained difference suggests that appropriately reducing ED use remains a credible target for policy makers, although success may require knowledge about patients' perceptions and behaviors as well as social determinants of health.

  15. Success under duress: policies and practices managers view as keys to profitability in five California hospitals with challenging payer mix.

    Science.gov (United States)

    Rundall, Thomas; Oberlin, Shelley; Thygesen, Brian; Janus, Katharina

    2012-01-01

    Hospitals with a challenging payer mix (CPM)-high proportions of uninsured and Medicaid patients and a low proportion of commercially insured patients-are an important source of care for low-income, uninsured people. Achieving profitability is difficult for CPM hospitals. From 2005 through 2008, only one-third of 67 CPM hospitals in California reported positive total margins. In-depth group interviews were completed with the management leadership teams of a diverse group of five profitable CPM hospitals to identify the management strategies and practices that the hospitals' leadership teams credited for their financial success. Twelve management policy and practice topics were identified. Four of the policies and practices that managers identified involve organizational actions to increase hospital revenue or operational efficiency. These factors are consistent with those identified in previous research. However, managers also identified eight factors not previously revealed in research on hospital profitability, including management policies and practices that establish the organizational culture, workforce, relationships, monitoring systems, and governance necessary to ensure that hospital employees and affiliated physicians support and successfully implement organizational actions necessary to achieve profitability.

  16. Hospital competition and patient-perceived quality of care: Evidence from a single-payer system in Taiwan.

    Science.gov (United States)

    Chen, Chi-Chen; Cheng, Shou-Hsia

    2010-11-01

    To examine the effects of market competition on patient-perceived quality of care under a single-payer system in Taiwan. Data came from two nationwide surveys conducted on discharged patients and National Health Insurance (NHI) hospital claim datasets in 2002 and 2004. Competition was measured by the Herfindahl-Hirschman Index (HHI). Quality of care was measured by patient-rated hospital performance including interpersonal skills and clinical competence domains. We used the instrumental variable approach to address the endogeneity between competition and patient-perceived quality of care. The results showed that HHI was significantly associated with a decrease in the perceived interpersonal skills (coefficient of -0.460; pcompetition. A similar association was found for the perceived clinical competence (coefficient of -0.457; p=0.001). Quality of care from the patients' perspective is sensitive to the degree of competition. By using patient-reported data, this study provides new evidence concerning competition and quality of care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  17. Encouraging tobacco control using national multisectoral ministerial mandate and priorities in Indonesia

    Directory of Open Access Journals (Sweden)

    Farrukh Qureshi

    2018-03-01

    In countries having strong tobacco industry influence, tobacco control issue needs to be brought forward within larger policy mandates of non-health sector ministries, using their national priorities. Intergovernmental organizations as well as other partners and organizations working on tobacco control should expand reach out to sectors beyond health, establish and encourage dialogue; and help develop ownership of these sectors on specific policy interventions that directly or indirectly support implementation of key policy measures for tobacco control.

  18. India's New Mandate against Economic Apartheid in Schools

    OpenAIRE

    Juneja, Nalini

    2014-01-01

    In most countries, children attend the common neighbourhood school, especially at the compulsory stage. In India however, in keeping with its highly stratified and hierarchically oriented society, schools and parents in India tend to choose each other based largely on socio-economic criteria. India’s new law on right to education attempts to put an end to this socio economic segregation by mandating the admission and free education of children from economically weaker sections in all private ...

  19. Artificial intelligence and distance learning philosophy in support of PfP mandate

    OpenAIRE

    Antoliš, Krunoslav

    2003-01-01

    Computers have long been utilised in the legal environment. The main use of computers however, has merely been to automate office tasks. More exciting is the prospect of using artificial intelligence (AI) technology to create computers that can emulate the substantive legal jobs performed by lawyers, to create computers that can autonomously reason with the law to determine legal solutions, for example: structuring and support of Partnership for Peace (PfP) mandate. Such attempts have not bee...

  20. Alcohol Interventions for Mandated College Students: A Meta-Analytic Review

    Science.gov (United States)

    Carey, Kate B.; Scott-Sheldon, Lori A. J.; Garey, Lorra; Elliott, Jennifer C.; Carey, Michael P.

    2016-01-01

    Objective When college students violate campus alcohol policies, they typically receive disciplinary sanctions that include alcohol education or counseling. This meta-analysis evaluated the efficacy of these “mandated interventions” to prevent future alcohol misuse. Methods Studies were included if they evaluated an individual- or group-level intervention, sampled students mandated to an alcohol program, used a pretest-posttest design, and assessed alcohol use as an outcome. Thirty-one studies with 68 separate interventions (N = 8,621 participants; 35% women; 85% White) were coded by independent raters with respect to sample, design, methodological features, and intervention content; the raters also calculated weighted mean effect sizes, using random-effects models. A priori predictors were examined to explain variability in effect sizes. Results In the five studies that used assessment-only control groups, mandated students reported significantly less drinking relative to controls (between-group contrasts), d+ ranged from 0.13-0.20 for quantity and intoxication outcomes. In the 31 studies that provided within-group contrasts, significant effects were observed for all outcomes in the short-term (i.e., ≤ 3 months post-intervention), with d+ ranging from 0.14-0.27; however, fewer significant effects appeared at longer follow-ups. Four commercially-available intervention protocols (i.e., BASICS, e-CHUG, Alcohol 101, and Alcohol Skills Training Program) were associated with risk reduction. Conclusions Providing mandated interventions to students who violate campus alcohol policies is an effective short-term risk reduction strategy. Continued research is needed to maintain initial gains, identify the most useful intervention components, and determine the cost-effectiveness of delivery modes. PMID:27100126

  1. THE PLIGHT OF GERMAN MISSIONS IN MANDATE CAMEROON: AN HISTORICAL ANALYSIS

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    Lang Michael Kpughe

    2017-09-01

    Full Text Available The First World War and its resultant Mandate and Trusteeship systems greatly affected the German mission enterprise in Cameroon. Apart from causing the forceful ousting of German missionaries from Cameroon, the British and the French whom the League of Nations and United Nations successively chose as administering powers within the Mandate and Trusteeship frameworks adopted hostile policies towards German missions. From the beginning of the war to the post-Second World War era, the foundation of German missions was seriously threatened. This paper critically examines the treatment of German missions in both British and French Cameroons during the Mandate and Trusteeship periods, focusing especially on the opposing attitudes of both administering powers towards the missions in their spheres of influence. The paper establishes that the administering powers’ treatment of German missions, which was underpinned by imperial and nationalist exigencies, roiled the attainment of the triple missionization agenda of planting self-supporting, self-governing and self-evangelizing churches. It thus argues that the First World War triggered the mistreatment of German missions, with some missions forced to terminate their activities while others were allowed to continue their mission work under difficult conditions.

  2. Is mandating elective single embryo transfer ethically justifiable in young women?

    Directory of Open Access Journals (Sweden)

    Kelton Tremellen

    2015-12-01

    Full Text Available Compared with natural conception, IVF is an effective form of fertility treatment associated with higher rates of obstetric complications and poorer neonatal outcomes. While some increased risk is intrinsic to the infertile population requiring treatment, the practice of multiple embryo transfer contributes to these complications and outcomes, especially concerning its role in higher order pregnancies. As a result, several jurisdictions (e.g. Sweden, Belgium, Turkey, and Quebec have legally mandated elective single-embryo transfer (eSET for young women. We accept that in very high-risk scenarios (e.g. past history of preterm delivery and poor maternal health, double-embryo transfer (DET should be prohibited due to unacceptably high risks. However, we argue that mandating eSET for all young women can be considered an unacceptable breach of patient autonomy, especially since DET offers certain women financial and social advantages. We also show that mandated eSET is inconsistent with other practices (e.g. ovulation induction and intrauterine insemination–ovulation induction that can expose women and their offspring to risks associated with multiple pregnancies. While defending the option of DET for certain women, some recommendations are offered regarding IVF practice (e.g. preimplantation genetic screening and better support of IVF and maternity leave to incentivise patients to choose eSET.

  3. Collective Security Treaty Organization: Origins of the Multidimensional Mandate and Modern Means for its Implementation

    Directory of Open Access Journals (Sweden)

    Golub K.

    2018-03-01

    Full Text Available This article examines the historically contradictory development of the Collective Security Treaty Organization (CSTO following its 15th anniversary, and evaluates its political potential from the point of view of its assigned mandate. The evolution of international stability at the beginning of the century forced the contracting parties of the CSTO to formalize their mainly declarative interactions through the creation of a valid regional security organization. This new collective security forum enriched the cooperation mandate by establishing additional areas for mutual coordination including counterterrorism activities, measures to combat illegal migration and drug trafficking, strategies to respond to natural disasters and cybersecurity. The creation of the multitasking Collective Rapid Reaction Forces was the first significant step on the way to the practical realization of the CSTO. The Collective Security Strategy for the period ending in 2025 organizes the CSTO instruments of international cooperation within the CSTO crisis management framework and thus works to reduce the fragmentary nature of the CSTO. Despite the availability of the Collective Rapid Reaction Forces and the Collective Peace-Keeping Forces, the CSTO’s crisis management approach gives priority to political approaches and negotiation. Consequently, the multifunctional mandate of the CSTO predetermines its strategic role in Eurasia and allows it to achieve its political goals related to conservation of the common military and strategic area, the creation of a constraining effect, the facilitation of cooperation among law enforcement and intelligence agencies and the ability to contribute to the settlement of regional and local conflicts.

  4. Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies.

    Science.gov (United States)

    Intrator, Orna; Grabowski, David C; Zinn, Jacqueline; Schleinitz, Mark; Feng, Zhanlian; Miller, Susan; Mor, Vince

    2007-08-01

    Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. Prospective cohort study of 570,614 older (> or =65-year-old), non-MCO (Medicare Managed Care), long-stay (> or =90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.

  5. Saving tax payers' money

    DEFF Research Database (Denmark)

    Staak, Thorsten; Günzel, Franziska

    this aim. To resolve this existing dichotomy between the motivation and the practical design of public intervention is the goal of this paper. To this end, we develop, using the Analytical Hierarchy Process, a decision tool, which incorporates the market failure theory as its foundation. With this study......, we contribute to the public policy research by introducing a new multi-attributive decision model as well as to the entrepreneurship arena by introducing the Analytical Hierarchy Process as a methodology that can be used to structure and solve complex public policy decision problems....

  6. Association of a Policy Mandating Physician-Patient Communication With Racial/Ethnic Disparities in Postmastectomy Breast Reconstruction.

    Science.gov (United States)

    Mahmoudi, Elham; Lu, Yiwen; Metz, Allan K; Momoh, Adeyiza O; Chung, Kevin C

    2017-08-01

    With the stabilization of breast cancer incidence and substantial improvement in survival, more attention has focused on postmastectomy breast reconstruction (PBR). Despite its demonstrated benefits, wide disparities in the use of PBR remain. Physician-patient communication has an important role in disparities in health care, especially for elective surgical procedures. Recognizing this, the State of New York enacted Public Health Law (NY PBH Law) 2803-o in 2011 mandating that physicians communicate about reconstructive surgery with patients undergoing mastectomy. To evaluate whether mandated physician-patient communication is associated with reduced racial/ethnic disparities in immediate PBR (IPBR). This retrospective study used state inpatient data from January 1, 2008, through December 31, 2011, in New York and California to evaluate a final sample of 42 346 women aged 20 to 70 years, including 19 364 from New York (treatment group) and 22 982 from California (comparison group). The primary hypothesis tested the effect of the New York law on racial/ethnic disparities, using California as a comparator. The National Academy of Medicine's (formerly Institute of Medicine) definition of a disparity was applied, and a difference-in-differences method (before-and-after comparison design) was used to evaluate the association of NY PBH Law 2803-o mandating physician-patient communication with disparities in IPBR. Data were analyzed from July 1, 2016, to February 24, 2017. New York PBH Law 2803-o was implemented on January 1, 2011. The preexposure period included January 1, 2008, through December 31, 2010 (3 years); the postexposure period, January 1 through December 31, 2011 (1 year). The primary outcome was use of IPBR among white, African American, Hispanic, and other minority groups before and after the implementation of NY PBH Law 2803-o. Among the 42 346 women (mean [SD] age, 53 [10] years), 65.3% (27 654) were white, 12.7% (5365) were Hispanic, 9.4% (3976

  7. Resuscitation and Obstetrical Care to Reduce Intrapartum-Related Neonatal Deaths: A MANDATE Study.

    Science.gov (United States)

    Kamath-Rayne, Beena D; Griffin, Jennifer B; Moran, Katelin; Jones, Bonnie; Downs, Allan; McClure, Elizabeth M; Goldenberg, Robert L; Rouse, Doris; Jobe, Alan H

    2015-08-01

    To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.

  8. Alcohol Use and Problems in Mandated College Students: A Randomized Clinical Trial Using Stepped Care

    Science.gov (United States)

    Borsari, Brian; Hustad, John T.P.; Mastroleo, Nadine R.; Tevyaw, Tracy O’Leary; Barnett, Nancy P.; Kahler, Christopher W.; Short, Erica Eaton; Monti, Peter M.

    2012-01-01

    Objective Over the past two decades, colleges and universities have seen a large increase in the number of students referred to the administration for alcohol policies violations. However, a substantial portion of mandated students may not require extensive treatment. Stepped care may maximize treatment efficiency and greatly reduce the demands on campus alcohol programs. Method Participants in the study (N = 598) were college students mandated to attend an alcohol program following a campus-based alcohol citation. All participants received Step 1: a 15-minute Brief Advice session that included the provision of a booklet containing advice to reduce drinking. Participants were assessed six weeks after receiving the Brief Advice, and those who continued to exhibit risky alcohol use (n = 405) were randomized to Step 2, a 60–90 minute brief motivational intervention (BMI) (n = 211) or an assessment-only control (n = 194). Follow-up assessments were conducted 3, 6, and 9 months after Step 2. Results Results indicated that the participants who received a BMI significantly reduced the number of alcohol-related problems compared to those who received assessment-only, despite no significant group differences in alcohol use. In addition, low risk drinkers (n = 102; who reported low alcohol use and related harms at 6-week follow-up and were not randomized to stepped care) showed a stable alcohol use pattern throughout the follow-up period, indicating they required no additional intervention. Conclusion Stepped care is an efficient and cost-effective method to reduce harms associated with alcohol use by mandated students. PMID:22924334

  9. Access to and use of infertility services in the United States: framing the challenges.

    Science.gov (United States)

    Adashi, Eli Y; Dean, Laura A

    2016-05-01

    An overview of access to and use of general infertility and assisted reproductive technology (ART) services in the United States (U.S.) shows a declining trend for the ever-use of infertility services. Moreover, the use of ART services lags relative to other member nations of the Organization for Economic Co-operation and Development (OECD). Access to and use of general infertility and ART services is primarily undermined by a severely constrained underwriting universe dominated by self-insured employers and by a finite number of state infertility insurance mandates. The contribution of traditional public and private payers to the underwriting of ART is limited. As compared with OECD member nations wherein the access to and underwriting of general infertility and ART services is universal, the current status quo in the U.S. can only be characterized as dismal. Further, the current state of affairs is socially unjust in that the right to build a family in the face of infertility appears to have become a function of economic prowess. Given the dominance of the self-insured employers as underwriters of general infertility and ART services, advocacy directed at this interest group is likely to prove most productive. Improving the state of underwriting of general infertility and ART services in the U.S. must be embraced as a central moral imperative and as an unwavering strategic goal of the professional societies entrusted with the reproductive health of women and men. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  10. Military Personnel: DOD's Predatory Lending Report Addressed Mandated Issues, but Support Is Limited for Some Findings and Recommendations

    National Research Council Canada - National Science Library

    Farrell, Brenda S

    2007-01-01

    ... (see the list of related GAO products at the end of this report). In conducting our review, we limited the scope of our work to the types of loans that DOD identified as being predatory in its mandated 2006 report...

  11. How does petroleum price and corn yield volatility affect ethanol markets with and without an ethanol use mandate?

    International Nuclear Information System (INIS)

    Thompson, Wyatt; Meyer, Seth; Westhoff, Pat

    2009-01-01

    The recent increase in ethanol use in the US strengthens and changes the nature of links between agricultural and energy markets. Here, we explore the interaction of market volatility and the scope for policy to affect this interaction, with a focus on how corn yields and petroleum prices affect ethanol prices. Mandates associated with new US energy legislation may intervene in these links in the medium-term future. We simulate stochastically a structural model that represents these markets, and that includes mandates, in order to assess how shocks to corn or oil markets can affect ethanol price and use. We estimate that the mandate makes ethanol producer prices more sensitive to corn yields and less sensitive to changes in petroleum prices overall. We note a discontinuity in these links that is caused by the mandate. Ethanol use can exceed the mandate if petroleum prices and corn yields are high enough, but the mandate limits downside adjustments in ethanol use to low petroleum prices or corn yields

  12. Federal Health Coverage Mandates and Health Care Utilization: The Case of the Women's Health and Cancer Rights Act and Use of Breast Reconstruction Surgery.

    Science.gov (United States)

    Xie, Yang; Tang, Yuexin; Wehby, George L

    2015-08-01

    Utilization of breast reconstruction services remains low among women who underwent mastectomy despite the improvement in quality of life associated with this treatment. The objective of this study is to identify the effect of the Women's Health and Cancer Rights Act (WHCRA)-an understudied ongoing federal law that mandated insurance coverage of breast reconstruction following mastectomy beginning in 1999-on use of reconstructive surgery after mastectomy. We use a difference-in-differences (DD) approach to identify the change in breast reconstruction utilization induced by WHCRA by comparing the pre- and post-policy changes in utilization between states that did not have existing laws mandating coverage before the WHCRA (treatment group) and those that had such state laws (control group). The data are from the Surveillance, Epidemiology, and End Results program. The main sample includes 15,737 female patients who were under the age of 64 and underwent mastectomy within 4 months of diagnosis of early stage breast cancer during 1998 and 2000. Based on the DD model, the odds of using reconstruction services in the states without preexisting laws increased after the WHCRA by 31% in 1999 and 36% in 2000 (compared with 1998 before the WHCRA). These effects are masked in a simple pre/post model for change in reconstruction across all states. Additional analyses through 2007 indicate that the WHCRA had long-term effects on utilization. Furthermore, analyses by state indicate that most states in the treatment group experienced a significance increase in utilization. The use of breast reconstruction after mastectomy significantly increased after the WHCRA. At a minimum, our estimates may be considered the lower bound of the real policy effect.

  13. Quality, quantity and distribution of medical education and care: regulation by the private sector or mandate by government?

    Science.gov (United States)

    Anlyan, W G

    1975-05-01

    The public, the federal government and most state governments have become increasingly concerned with the lack of access to primary care as well as the specialty and geographic maldistribution problems. Currently, there is a race in progress between the private sector and the federal government to devise solutions to these problems. In the federal sector, varying pieces of legislation are under active consideration to mandate the correction of specialty and geographic maldistribution; proposals include: 1) setting up federal machinery to regulate the numbers and types of residencies; 2) make obligatory the creation of Departments of Family Practice in each medical school; 3) withdraw current education support from medical schools causing tuition levels to increase substantially--federal student loans would then provide the necessary leverage to obligate the borrower to two years of service in an under-served area in exchange for loan forgiveness. In the private sector, for the first time in the history of the United States, the five major organizations involved in medical care have organized to form the Coordinating Council on Medical Education (CCME) and the Liaison Committee on Graduate Medical Education (LCGME). One of the initial major endeavors of the CCME has been to address itself to the problem of specialty maldistribution. The LCGME has been tooling up to become the accrediting group for residency training thus providing an overview of the quality and quantity of specialty training. It will be the intent of this presentation to bring the membership of the Southern Surgical Association an up-to-date report on these parallel efforts. The author's personal hope is that the private sector can move sufficiently rapidly to set up its own regulatory mechanisms and avert another federally controlled bureaucracy that will forever change the character of the medical profession in the United States.

  14. How Mandated College Students Talk About Alcohol: Peer Communication Factors Associated with Drinking

    Science.gov (United States)

    Carey, Kate B.; Lust, Sarah A.; Reid, Allecia E.; Kalichman, Seth C.; Carey, Michael P.

    2015-01-01

    Relatively little research has examined how peer communication influences alcohol consumption. In a sample of mandated college students, we differentiate conversations about drinking among from conversations about harm prevention and provide evidence for the validity of these communication constructs. Students who violated campus alcohol policies and were referred for alcohol sanctions (N = 345) reported on drinking patterns, use of protective behavioral strategies, perceived descriptive norms for close friends and serving as social leader among their friends; they also reported on the frequency of conversations about drinking, about drinking safety, and about risk reduction efforts. Predicted correlations were found among types of communication and conceptually related variables. General communication was related to consumption but not protective behavioral strategies, whereas safety/risk reduction conversations correlated positively with all protective behavioral strategies. Both types of communication were associated with social leadership. Safety communication moderated the relationship between peer descriptive norms and drinks per week; more frequent talking about safety attenuated the norms-consumption relationship. Peer communication about both drinking and safety may serve as targets for change in risk reduction interventions for mandated college students. PMID:26861808

  15. Alcohol interventions for mandated students: behavioral outcomes from a randomized controlled pilot study.

    Science.gov (United States)

    Logan, Diane E; Kilmer, Jason R; King, Kevin M; Larimer, Mary E

    2015-01-01

    This study investigated the effectiveness of three single-session interventions with high-risk mandated students while considering the influence of motivational interviewing (MI) microskills. This randomized, controlled pilot trial evaluated single-session interventions: Alcohol Skills Training Program (ASTP), Brief Alcohol Screening and Intervention for College Students (BASICS) feedback sessions, and treatment-as-usual Alcohol Diversion Program (ADP) educational groups. Participants were 61 full-time undergraduates at a southern U.S. campus sanctioned to a clinical program following violation of an on-campus alcohol policy (Mage = 19.16 years; 42.6% female). RESULTS revealed a significant effect of time for reductions in estimated blood alcohol concentration (eBAC) and number of weekly drinks but not in alcohol-related consequences. Although ASTP and BASICS participants reported significant decreases in eBAC over time, ADP participant levels did not change (with no intervention effects on quantity or consequences). MI microskills were not related to outcomes. RESULTS from this study suggest equivalent behavioral impacts for the MI-based interventions, although individual differences in outcome trajectories suggest that research is needed to further customize mandated interventions. Given the overall decrease in eBAC following the sanction, the lack of reduction in the ADP condition warrants caution when using education-only interventions.

  16. Urgent Protection versus Chronic Need: Clarifying the Dual Mandate of Child Welfare Services across Canada

    Directory of Open Access Journals (Sweden)

    Nico Trocmé

    2014-08-01

    Full Text Available This study analyzed data from the 1998, 2003 and 2008 Canadian Incidence Study of reported child abuse and neglect (CIS and compared the profile of children who were reported for an urgent protection investigation versus any other investigation or assessment. As a proportion of all investigations, urgent protection cases have dropped from 28% of all investigations in 1998, to 19% in 2003, to 15% in 2008. Results from the CIS-2008 analysis revealed that 7% of cases involved neglect of a child under four, 4% of cases involved sexual abuse, 2% of cases involved physical abuse of a child under four and 1% of cases involved children who had sustained severe enough physical harm that medical treatment was required. The other 85% of cases of investigated maltreatment involved situations where concerns appear to focus less on immediate safety and more on the long-term effects of a range of family related problems. These findings underscore the importance of considering the dual mandate of child welfare mandates across Canada: intervening to assure the urgent protection and safety of the child versus intervening to promote the development and well-being of the child.

  17. Constitutionally Mandated Funds for Financing Regional Development in Brazil: An Analysis of the Compensatory Mechanisms Used by Financial Institutions (1995-2013

    Directory of Open Access Journals (Sweden)

    Girley Vieira Damasceno

    2016-04-01

    Full Text Available This paper examines the relationship between constitutionally mandated funds for financing regional development in Brazil and the regional financial institutions that manage them. These constitutionally mandated funds apply a fraction of federal tax revenues in the productive sectors of the North, Northeast and Midwest regions of Brazil. We investigate the occurrence of soft budget constraint on these institutions, induced by compensatory mechanisms for management of the resources of these funds (administration fee and by the assumption of credit risk in lending (del credere. The concept of soft budget constraint, proposed by Hungarian economist Janos Kornai in the context of socialist economies, refers to the expectations for systematic bailout of economic organizations by governments or banks, usually associated with the paternalistic role of the state towards these organizations. Our analysis uses comparative graphics and spreadsheets. The results indicate more remuneration than administrative costs and credit risk assumed by financial institutions and confirm the hypothesis of legal parameters that induce soft budget constraint.

  18. Vaccinating health care workers against influenza: the ethical and legal rationale for a mandate.

    Science.gov (United States)

    Ottenberg, Abigale L; Wu, Joel T; Poland, Gregory A; Jacobson, Robert M; Koenig, Barbara A; Tilburt, Jon C

    2011-02-01

    Despite improvements in clinician education, symptom awareness, and respiratory precautions, influenza vaccination rates for health care workers have remained unacceptably low for more than three decades, adversely affecting patient safety. When public health is jeopardized, and a safe, low-cost, and effective method to achieve patient safety exists, health care organizations and public health authorities have a responsibility to take action and change the status quo. Mandatory influenza vaccination for health care workers is supported not only by scientific data but also by ethical principles and legal precedent. The recent influenza pandemic provides an opportunity for policymakers to reconsider the benefits of mandating influenza vaccination for health care workers, including building public trust, enhancing patient safety, and strengthening the health care workforce.

  19. Predicting treatment noncompliance among criminal justice-mandated clients: a theoretical and empirical exploration.

    Science.gov (United States)

    Sung, Hung-En; Belenko, Steven; Feng, Li; Tabachnick, Carrie

    2004-01-01

    Compliance with therapeutic regimens constitutes an important but infrequently studied precursor of treatment engagement and is a necessary condition of successful treatment. This study builds on recent treatment process research and provides a theory-driven analysis of treatment compliance. Five hypotheses are formulated to predict treatment noncompliance among criminal justice-mandated clients. These hypotheses tap different determinants of treatment progress, including physical prime, supportive social network, conventional social involvement, treatment motivation, and risk-taking propensity. Data from 150 addicted felons participating in a diversion program are analyzed to test the hypotheses. Predictors related to these hypotheses correctly identify 58% of the fully compliant clients and 55-88% of the noncompliant clients. Most hypotheses are at least partially corroborated and a few strong correlates emerge across analyses. Clients in their physical prime, those with poorer social support, and those lacking internal desires for change were found especially likely to violate treatment program rules. Clinical implications are discussed.

  20. The French press mobilization during Aoun mandate: historical considerations and French internal issues

    Directory of Open Access Journals (Sweden)

    Roy JREIJIRY

    2010-01-01

    Full Text Available The purpose of this research is to analyse, through three national daily newspapers which represent the French press, how this press is related Lebanon, during a turbulent period full of events. This period starts the week of September 19, 1988, the last week of mandate of President Amine Gemayel who appoints a transational government boycotted by the “Muslim side”. It ends on May 13, 1991, date of the signature of cooperation treaty between Lebanon and Syria. The thesis leads, on one hand, to highlighting the links between the representation of Lebanon in the press and the socio-political history of France, its diplomacy and the issues of internal policy, and on the other hand, highlighting the complexity of elaborating a coherent daily information marked by the permanent need of landmarks within a political world.

  1. The "difficult" patient reconceived: an expanded moral mandate for clinical ethics.

    Science.gov (United States)

    Fiester, Autumn

    2012-01-01

    Between 15 and 60% of patients are considered "difficult" by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed "difficult." But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as a response to problematic interactions related to health care delivery. If there are grounds to reconceive the "difficult" patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.

  2. On some aspects of the UN Security Council Mandate Application during the NATO Operation Unified Protector

    Directory of Open Access Journals (Sweden)

    Zdeněk Kříž

    2012-12-01

    Full Text Available The question of the compliance of the NATO operation Unified Protector with the international law has not become a key topic of scholarly debate yet. The prevailing attitude is such that NATO intervention was in accordance with the international law. Nevertheless, the article argues that NATO in Libya exceeded the UN Security Council mandate. Unified Protector was an operation conducted in the favour of one side, in this case, the rebels. NATO military engagement in Libya very much approached providing air support to Libyan rebelling groups in order to topple the regime. Furthermore, this conclusion is also confirmed by the fact that Western countries had provided military advisors and arms as well.

  3. Alternative sources of power generation, incentives and regulatory mandates: a theoretical approach to the Colombian case

    International Nuclear Information System (INIS)

    Zapata, Carlos M; Zuluaga Monica M; Dyner, Isaac

    2005-01-01

    Alternative Energy Generation Sources are turning relevant in several countries worldwide because of technology improvement and the environmental treatment. In this paper, the most common problems of renewable energy sources are accomplished, different incentives and regulatory mandates from several countries are exposed, and a first theoretical approach to a renewable energies incentive system in Colombia is discussed. The paper is fundamentally in theoretical aspects and international experience in renewable energies incentives to accelerate their diffusion; features are analyzed towards a special incentive system for renewable energies in Colombia. As a conclusion, in Colombia will be apply indirect incentives like low interest rate, taxes exemptions and so on. But these incentives are applied to limit the support of electricity productivity in generating organizations.

  4. The mandate and work of ICRP Committee 3 on radiological protection in medicine.

    Science.gov (United States)

    Miller, D L; Martin, C J; Rehani, M M

    2018-01-01

    The mandate of Committee 3 of the International Commission on Radiological Protection (ICRP) is concerned with the protection of persons and unborn children when ionising radiation is used in medical diagnosis, therapy, and biomedical research. Protection in veterinary medicine has been newly added to the mandate. Committee 3 develops recommendations and guidance in these areas. The most recent documents published by ICRP that relate to radiological protection in medicine are 'Radiological protection in cone beam computed tomography' (ICRP Publication 129) and 'Radiological protection in ion beam radiotherapy' (ICRP Publication 127). A report in cooperation with ICRP Committee 2 entitled 'Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances' (ICRP Publication 128) has also been published. 'Diagnostic reference levels in medical imaging' (ICRP Publication 135), published in 2017, provides specific advice on the setting and use of diagnostic reference levels for diagnostic and interventional radiology, digital imaging, computed tomography, nuclear medicine, paediatrics, and multi-modality procedures. 'Occupational radiological protection in interventional procedures' was published in March 2018 as ICRP Publication 139. A document on radiological protection in therapy with radiopharmaceuticals is likely to be published in 2018. Work is in progress on several other topics, including appropriate use of effective dose in collaboration with the other ICRP committees, guidance for occupational radiological protection in brachytherapy, justification in medical imaging, and radiation doses to patients from radiopharmaceuticals (an update to ICRP Publication 128). Committee 3 is also considering the development of guidance on radiological protection in medicine related to individual radiosusceptibility, in collaboration with ICRP Committee 1.

  5. Payers' experiences with confidential pharmaceutical price discounts: A survey of public and statutory health systems in North America, Europe, and Australasia.

    Science.gov (United States)

    Morgan, Steven G; Vogler, Sabine; Wagner, Anita K

    2017-04-01

    Institutional payers for pharmaceuticals worldwide appear to be increasingly negotiating confidential discounts off of the official list price of pharmaceuticals purchased in the community setting. We conducted an anonymous survey about experiences with and attitudes toward confidential discounts on patented pharmaceuticals in a sample of high-income countries. Confidential price discounts are now common among the ten health systems that participated in our study, though some had only recently begun to use these pricing arrangements on a routine basis. Several health systems had used a wide variety of discounting schemes in the past two years. The most frequent discount received by participating health systems was between 20% and 29% of official list prices; however, six participants reported their health system received one or more discount over the past two years that was valued at 60% or more of the list prices. On average, participants reported that confidential discounts were more common, complex, and significant for specialty pharmaceuticals than for primary care pharmaceuticals. Participants had a more favorable view of the impact of confidential discount schemes on their health systems than on the global marketplace. Overall, the frequency, complexity, and scale of confidential discounts being routinely negotiated suggest that the list prices for medicines bear limited resemblance to what many institutional payers actually pay. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  6. Hospital revenue cycle management and payer mix: do Medicare and Medicaid undermine hospitals' ability to generate and collect patient care revenue?

    Science.gov (United States)

    Rauscher, Simone; Wheeler, John R C

    2010-01-01

    The continuing efforts of government payers to contain hospital costs have raised concerns among hospital managers that serving publicly insured patients may undermine their ability to manage the revenue cycle successfully. This study uses financial information from two sources-Medicare cost reports for all US hospitals for 2002 to 2007 and audited financial statements for all bond-issuing, not-for-profit hospitals for 2000 to 2006 to examine the relationship between hospitals' shares of Medicare and Medicaid patients and the amount of patient care revenue they generate as well as the speed with which they collect their revenue. Hospital-level fixed effects regression analysis finds that hospitals with higher Medicare and Medicaid payer mix collect somewhat higher average patient care revenues than hospitals with more privately insured and self-pay patients. Hospitals with more Medicare patients also collect on this revenue faster; serving more Medicaid patients is not associated with the speed of patient revenue collection. For hospital managers, these findings may represent good news. They suggest that, despite increases in the number of publicly insured patients served, managers have frequently been able to generate adequate amounts of patient revenue and collect it in a timely fashion.

  7. Brief alcohol interventions for mandated college students: comparison of face-to-face counseling and computer-delivered interventions.

    Science.gov (United States)

    Carey, Kate B; Carey, Michael P; Henson, James M; Maisto, Stephen A; DeMartini, Kelly S

    2011-03-01

    College students who violate alcohol policies are often mandated to participate in alcohol-related interventions. This study investigated (i) whether such interventions reduced drinking beyond the sanction alone, (ii) whether a brief motivational intervention (BMI) was more efficacious than two computer-delivered interventions (CDIs) and (iii) whether intervention response differed by gender. Randomized controlled trial with four conditions [brief motivation interventions (BMI), Alcohol 101 Plus™, Alcohol Edu for Sanctions(®), delayed control] and four assessments (baseline, 1, 6 and 12 months). Private residential university in the United States. Students (n = 677; 64% male) who had violated campus alcohol policies and were sanctioned to participate in a risk reduction program. Consumption (drinks per heaviest and typical week, heavy drinking frequency, peak and typical blood alcohol concentration), alcohol problems and recidivism. Piecewise latent growth models characterized short-term (1-month) and longer-term (1-12 months) change. Female but not male students reduced drinking and problems in the control condition. Males reduced drinking and problems after all interventions relative to control, but did not maintain these gains. Females reduced drinking to a greater extent after a BMI than after either CDI, and maintained reductions relative to baseline across the follow-up year. No differences in recidivism were found. Male and female students responded differently to sanctions for alcohol violations and to risk reduction interventions. BMIs optimized outcomes for both genders. Male students improved after all interventions, but female students improved less after CDIs than after BMI. Intervention effects decayed over time, especially for males. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

  8. Separating Wheat from Chaff: How Secondary School Principals' Core Values and Beliefs Influence Decision-Making Related to Mandates

    Science.gov (United States)

    Larsen, Donald E.; Hunter, Joseph E.

    2014-01-01

    Research conducted by Larsen and Hunter (2013, February) identified a clear pattern in secondary school principals' decision-making related to mandated change: more than half of participants' decisions were based on core values and beliefs, requiring value judgments. Analysis of themes revealed that more than half of administrative decisions…

  9. An Evaluation of the Implementation and Impact of England's Mandated School-Based Mental Health Initiative in Elementary Schools

    Science.gov (United States)

    Wolpert, Miranda; Humphrey, Neil; Deighton, Jessica; Patalay, Praveetha; Fugard, Andrew J. B.; Fonagy, Peter; Belsky, Jay; Vostanis, Panos

    2015-01-01

    We report on a randomized controlled trial of Targeted Mental Health in Schools (TaMHS), which is a nationally mandated school-based mental health program in England. TaMHS aimed to improve mental health for students with, or at risk of, behavioral and emotional difficulties by providing evidence-informed interventions relating to closer working…

  10. Women Saw Large Decrease In Out-Of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing.

    Science.gov (United States)

    Becker, Nora V; Polsky, Daniel

    2015-07-01

    The Affordable Care Act mandates that private health insurance plans cover prescription contraceptives with no consumer cost sharing. The positive financial impact of this new provision on consumers who purchase contraceptives could be substantial, but it has not yet been estimated. Using a large administrative claims data set from a national insurer, we estimated out-of-pocket spending before and after the mandate. We found that mean and median per prescription out-of-pocket expenses have decreased for almost all reversible contraceptive methods on the market. The average percentages of out-of-pocket spending for oral contraceptive pill prescriptions and intrauterine device insertions by women using those methods both dropped by 20 percentage points after implementation of the ACA mandate. We estimated average out-of-pocket savings per contraceptive user to be $248 for the intrauterine device and $255 annually for the oral contraceptive pill. Our results suggest that the mandate has led to large reductions in total out-of-pocket spending on contraceptives and that these price changes are likely to be salient for women with private health insurance. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Assessing mandated credit programs: Case study of the Magna Carta in the Philippines

    Directory of Open Access Journals (Sweden)

    Ryan Jacildo

    2016-09-01

    Full Text Available We examine the effects of a mandated credit program to small and medium enterprises in the Philippines (Magna Carta Law using a panel dataset compiled from official data published by the Bangko Sentral ng Pilipinas. The final sample of 109 financial institutions represented over 90% of total finance sector assets in the Philippines. We highlight three important findings. First, although the total lending levels to micro, small, and medium enterprises (MSMEs grew slightly, the percentage shares of loans allocated to MSMEs declined drastically from a peak of 30% of total loans in 2002 to 16.4% in 2010. Second, following the upwards revision of the loan target (from 6% to 8% for smaller firms in 2008, there was a sharp increase in noncompliance especially amongst universal and commercial banks. On the other hand, total loans to medium enterprises were still more than threefold larger than the targeted 2%. Third, there is an increased heterogeneity in optimal loan portfolio across banks. Most surprisingly, the absolute level of MSME lending by rural and cooperative banks declined since 2008. Direct compliance amongst universal and commercial banks decreased beginning in the late 2007, while that of thrift banks increased to almost 100%. Abolishing the Magna Carta targets for medium-sized enterprise loans would most likely yield little adverse effects. Meanwhile, efforts to improve financial access to MSMEs should focus on alternative nondistortionary ways to increase financing supply, such as improving institutional framework for informational availability and development of equity and bond markets for MSMEs.

  12. Texas Nurse Staffing Trends Before and After Mandated Nurse Staffing Committees.

    Science.gov (United States)

    Jones, Terry; Heui Bae, Sung; Murry, Nicole; Hamilton, Patti

    2015-08-01

    This article describes the evolution of mandated nurse staffing committees in Texas from 2002 to 2009 and presents a study that analyzed nurse staffing trends in Texas using a secondary analysis of hospital staffing data (N = 313 hospitals) from 2000 to 2012 obtained from the American Hospital Association Annual Survey. Nurse staffing patterns based on three staffing variables for registered nurses (RNs), licensed vocational nurses (LVNs), and total licensed nurses were identified: full-time equivalents per 1,000 adjusted patient days, productive hours per adjusted patient day, and RN skill mix. Similar to national trends between 2000 and 2012, most Texas hospitals experienced an increase in RN and total nurse staffing, decrease in LVN staffing, and an increase in RN skill mix. The magnitude of total nurse staffing changes in Texas (5% increase) was smaller than national trends (13.6% increase). Texas's small, rural, government hospitals and those with the highest preregulation staffing levels experienced the least change in staffing between 2000 and 2012: median change of 0 to .13 full-time equivalents per 1,000 adjusted patient days and median change in productive hours per patient day of 0 to .23. The varying effects of staffing committees in different organizational contexts should be considered in future staffing legislative proposals and other policy initiatives. © The Author(s) 2015.

  13. The colonial world as mission and mandate: leprosy and empire, 1900-1940.

    Science.gov (United States)

    Worboys, M

    2000-01-01

    The history of medicine in twentieth-century empires has been dominated by studies of "imperial tropical medicine" (ITM) and its consequences. Historians have been fascinated by the work of medical scientists and doctors in the age of high imperialism, and there are many studies of medicine as a "tool of empire." This paper reviews work that explores colonial medicine as a broader enterprise than ITM in three spheres: missionary activity, modernization, and protection of the health and welfare of indigenous peoples. To illustrate the themes of mission and mandate, it discusses the development of policies to control leprosy in the tropical African and Asian colonies of Britain in the first half of this century, especially the work of the British Empire Leprosy Relief Association (BELRA). Although BELRA's efforts did little to change imperial medical and health agendas, they had an important impact locally and ideologically, and show how closely interwoven the themes of Christian caring, medical humanism, colonial development, and welfare policy had become by the outbreak of the Second World War.

  14. Mandate for the Nursing Profession to Address Climate Change Through Nursing Education.

    Science.gov (United States)

    Leffers, Jeanne; Levy, Ruth McDermott; Nicholas, Patrice K; Sweeney, Casey F

    2017-11-01

    The adverse health effects from climate change demand action from the nursing profession. This article examines the calls to action, the status of climate change in nursing education, and challenges and recommendations for nursing education related to climate change and human health. Discussion paper. The integration of climate change into nursing education is essential so that knowledge, skills, and insights critical for clinical practice in our climate-changing world are incorporated in curricula, practice, research, and policy. Our Ecological Planetary Health Model offers a framework for nursing to integrate relevant climate change education into nursing curricula and professional nursing education. Nursing education can offer a leadership role to address the mitigation, adaptation, and resilience strategies for climate change. An ecological framework is valuable for nursing education regarding climate change through its consideration of political, cultural, economic, and environmental interrelationships on human health and the health of the planet. Knowledge of climate change is important for integration into basic and advanced nursing education, as well as professional education for nurses to address adverse health impacts, climate change responses policy, and advocacy roles. For current and future nurses to provide care within a climate-changing environment, nursing education has a mandate to integrate knowledge about climate change issues across all levels of nursing education. Competence in nursing practice follows from knowledge and skill acquisition gained from integration of climate change content into nursing education. © 2017 Sigma Theta Tau International.

  15. Alcohol-related problems and life satisfaction predict motivation to change among mandated college students.

    Science.gov (United States)

    Diulio, Andrea R; Cero, Ian; Witte, Tracy K; Correia, Christopher J

    2014-04-01

    The present study investigated the role specific types of alcohol-related problems and life satisfaction play in predicting motivation to change alcohol use. Participants were 548 college students mandated to complete a brief intervention following an alcohol-related policy violation. Using hierarchical multiple regression, we tested for the presence of interaction and quadratic effects on baseline data collected prior to the intervention. A significant interaction indicated that the relationship between a respondent's personal consequences and his/her motivation to change differs depending upon the level of concurrent social consequences. Additionally quadratic effects for abuse/dependence symptoms and life satisfaction were found. The quadratic probes suggest that abuse/dependence symptoms and poor life satisfaction are both positively associated with motivation to change for a majority of the sample; however, the nature of these relationships changes for participants with more extreme scores. Results support the utility of using a multidimensional measure of alcohol related problems and assessing non-linear relationships when assessing predictors of motivation to change. The results also suggest that the best strategies for increasing motivation may vary depending on the types of alcohol-related problems and level of life satisfaction the student is experiencing and highlight potential directions for future research. Copyright © 2014. Published by Elsevier Ltd.

  16. Is There Evidence for Systematic Upcoding of ASA Physical Status Coincident with Payer Incentives? A Regression Discontinuity Analysis of the National Anesthesia Clinical Outcomes Registry.

    Science.gov (United States)

    Schonberger, Robert B; Dutton, Richard P; Dai, Feng

    2016-01-01

    Modifications in physician billing patterns have been shown to occur in response to payer incentives, but the phenomenon remains largely unexplored in billing for anesthesia services. Within the field of anesthesiology, Medicare's policy not to provide additional reimbursement for higher ASA physical status scores contrasts with the practices of most private payers, and this pattern of reimbursement introduces a change in billing incentives once patients attain Medicare eligibility. We hypothesized that, coincident with the onset of widespread Medicare eligibility at age 65 years, a discontinuity in reported ASA physical status scores would be observed after controlling for the underlying trend of increasing ASA physical status scores with age. This phenomenon would manifest as a pattern of upcoding of ASA physical status scores for patients younger than 65 years that would become less common in patients age 65 years and older. Using data on age, sex, ASA physical status scores, and type of surgery from the National Anesthesia Clinical Outcomes Registry, we used a quasi-experimental regression discontinuity design to analyze whether there was evidence for a discontinuity in reported ASA physical status scores occurring at age 65 years for the nondeferrable anesthesia services accompanying hip, femur, or lower leg fracture repair. A total of 49,850 records were analyzed. In models designed to detect regression discontinuity at 65 years of age, neither the binary variable "age ≥ 65" nor the interaction term of age × age ≥ 65 was a statistically significant predictor of the outcome of ASA physical status score. The statistical inference was unchanged when ASA physical status scores were reclassified as a binary outcome (I-II vs III-V) and when different bandwidths around age 65 years were used. To test the validity of our study design for detecting regression discontinuity, simulations of the occurrence of deliberate upcoding of ASA physical status scores

  17. The Impact of the Affordable Care Act's Dependent Coverage Mandate on Use of Dental Treatments and Preventive Services.

    Science.gov (United States)

    Shane, Dan M; Wehby, George L

    2017-09-01

    Oral health problems are the leading chronic conditions among children and younger adults. Lack of dental coverage is thought to be an important barrier to care but little empirical evidence exists on the causal effect of private dental coverage on use of dental services. We explore the relationship between dental coverage and dental services utilization with an analysis of a natural experiment of increasing private dental coverage stemming from the Affordable Care Act's (ACA)-dependent coverage mandate. To evaluate whether increased private dental insurance due to the spillover effect of the ACA-dependent coverage health insurance mandate affected utilization of dental services among a group of affected young adults. 2006-2013 Medical Expenditure Panel Surveys. We used a difference-in-difference regression approach comparing changes in dental care utilization for 25-year olds affected by the policy to unaffected 27-year olds. We evaluate effects on dental treatments and preventive services RESULTS:: Compared to 27-year olds, 25-year olds were 8 percentage points more likely to have private dental coverage in the 3 years following the mandate. We do not find compelling evidence that young adults increased their use of preventive dental services in response to gaining insurance. We do find a nearly 5 percentage point increase in the likelihood of dental treatments among 25-year olds following the mandate, an effect that appears concentrated among women. Increases in private dental coverage due to the ACA's-dependent coverage mandate do not appear to be driving significant changes in overall preventive dental services utilization but there is evidence of an increase in restorative care.

  18. Federal Aid and State Library Agencies.

    Science.gov (United States)

    Shavit, David

    1985-01-01

    Considers role of states as middlemen between federal government and local public libraries in administration of Library Services and Construction Act funds. An audit of Illinois state library agencies, 1970 federal mandates, state control of federal funds, and state library agencies' use of funds are discussed. Eight references are cited. (EJS)

  19. Storying Teacher Education Policy: Critical Counternarratives of Curricular, Pedagogical, and Activist Responses to State-Mandated Teacher Performance Assessments

    Science.gov (United States)

    Henning, Nick; Dover, Alison; Dotson, Erica K.; Agarwal-Rangath, Ruchi

    2018-01-01

    The rise of high-stakes, standardized, teacher performance assessments (TPAs) is central to the industry being created out of the regulation, policing, and evaluation of university-based teacher education In addition to reinforcing a narrow and counter-critical framework, TPAs can shift responsibility for the evaluation of teacher candidates from…

  20. A Qualitative Meta-Analysis of the Diffusion of Mandated and Subsidized Technology: United States Energy Security and Independence

    Science.gov (United States)

    Noah, Philip D., Jr.

    2013-01-01

    The purpose of this research project was to explore what the core factors are that play a role in the development of the smart-grid. This research study examined The Energy Independence and Security Act (EISA) of 2007 as it pertains to the smart-grid, the economic and security effects of the smart grid, and key factors for its success. The…

  1. Intended and Unintended Effects of State-Mandated High School Science and Mathematics Course Graduation Requirements on Educational Attainment.

    Science.gov (United States)

    Plunk, Andrew D; Tate, William F; Bierut, Laura J; Grucza, Richard A

    2014-06-01

    Mathematics and science course graduation requirement (CGR) increases in the 1980s and 1990s might have had both intended and unintended consequences. Using logistic regression with Census and American Community Survey (ACS) data ( n = 2,892,444), we modeled CGR exposure on (a) high school dropout, (b) beginning college, and (c) obtaining any college degree. Possible between-groups differences were also assessed. We found that higher CGRs were associated with higher odds to drop out of high school, but results for the college-level outcomes varied by group. Some were less likely to enroll, whereas others who began college were more likely to obtain a degree. Increased high school dropout was consistent across the population, but some potential benefit was also observed, primarily for those reporting Hispanic ethnicity.

  2. Keep Kids in School: A Collaborative Community Effort to Increase Compliance with State-Mandated Health Requirements

    Science.gov (United States)

    Rogers, Valerie; Salzeider, Christine; Holzum, Laura; Milbrandt, Tracy; Zahnd, Whitney; Puczynski, Mark

    2016-01-01

    Background: It is important that collaborative relationships exist in a community to improve access to needed services for children. Such partnerships foster preventive services, such as immunizations, and other services that protect the health and well-being of all children. Methods: A collaborative relationship in Illinois involving an academic…

  3. Attorney work product privilege trumps mandated child abuse reporting law: The case of Elijah W. v. Superior Court.

    Science.gov (United States)

    Lareau, Craig R

    2015-01-01

    Forensic psychologists and psychiatrists are licensed in their respective professions, but they perform most of their work with attorneys in the legal arena. Both attorneys and mental health professionals place high value on confidentiality of information, reflected in the ethics of their professions and codified into laws governing their work. In psychology and psychiatry, there are some well-known exceptions to confidentiality; two primary exceptions include the mandated reporting of suspected child abuse and various "Tarasoff" duty to warn or protect laws. Generally, however, the corresponding duty for attorneys to report suspected child abuse or to warn or protect intended victims of threatened harm is not as extensive. This difference in mandated reporting responsibilities can create significant difficulties when attorneys need to retain forensic psychologists and psychiatrists to evaluate their clients, especially in criminal contexts. If the retained psychologist or psychiatrist is required to report suspected abuse or threatened harm, the attorney may be harming his or her client's legal interests by using the forensic psychologist or psychiatrist to evaluate his or her client. This article will briefly review the development of mandated reporting laws for psychologists and psychiatrists and juxtapose those with the legal and ethical requirements of confidentiality for attorneys embodied in the attorney-client privilege and attorney work product privilege. The article will then discuss the California Court of Appeals case in Elijah W. v. Superior Court, where the court addressed the issue of whether retained mental health professionals must report suspected child abuse and threatened harm to others as required by law or if they do not need to report because they come under the umbrella of the attorney work product privilege. This California court ultimately concluded that retained psychologists and psychiatrists work under the attorney work product

  4. Employee designation and health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital.

    Science.gov (United States)

    Feemster, Kristen A; Prasad, Priya; Smith, Michael J; Feudtner, Chris; Caplan, Arthur; Offit, Paul; Coffin, Susan E

    2011-02-17

    Determine predictors of support of a mandatory seasonal influenza vaccine program among health care workers (HCWs). Cross-sectional anonymous survey of 2443 (out of 8093) randomly selected clinical and non-clinical HCWs at a large pediatric network after implementation of a mandatory vaccination program in 2009-10. 1388 HCWs (58.2%) completed the survey and 75.2% of respondents reported agreeing with the new mandatory policy. Most respondents (72%) believed that the policy was coercive but >90% agreed that the policy was important for protecting patients and staff and was part of professional ethical responsibility. When we adjusted for attitudes and beliefs regarding influenza and the mandate, there was no significant difference between clinical and nonclinical staff in their support of the mandate (OR 1.08, 95% C.I. 0.94, 1.26). Attitudes and beliefs regarding influenza and the mandate may transcend professional role. Targeted outreach activities can capitalize on beliefs regarding patient protection and ethical responsibility. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Grounded Theory of Barriers and Facilitators to Mandated Implementation of Mental Health Care in the Primary Care Setting

    Directory of Open Access Journals (Sweden)

    Justin K. Benzer

    2012-01-01

    Full Text Available Objective. There is limited theory regarding the real-world implementation of mental health care in the primary care setting: a type of organizational coordination intervention. The purpose of this study was to develop a theory to conceptualize the potential causes of barriers and facilitators to how local sites responded to this mandated intervention to achieve coordinated mental health care. Methods. Data from 65 primary care and mental health staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after an organizational mandate to provide integrated mental health care in the primary care setting. Results. Standardized referral procedures and communication practices between primary care and mental health were influenced by the organizational factors of resources, training, and work design, as well as provider-experienced organizational boundaries between primary care and mental health, time pressures, and staff participation. Organizational factors and provider experiences were in turn influenced by leadership. Conclusions. Our emergent theory describes how leadership, organizational factors, and provider experiences affect the implementation of a mandated mental health coordination intervention. This framework provides a nuanced understanding of the potential barriers and facilitators to implementing interventions designed to improve coordination between professional groups.

  6. Optimal Mandates and The Welfare Cost of Asymmetric Information: Evidence from The U.K. Annuity Market.

    Science.gov (United States)

    Einav, Liran; Finkelstein, Amy; Schrimpf, Paul

    2010-05-01

    Much of the extensive empirical literature on insurance markets has focused on whether adverse selection can be detected. Once detected, however, there has been little attempt to quantify its welfare cost, or to assess whether and what potential government interventions may reduce these costs. To do so, we develop a model of annuity contract choice and estimate it using data from the U.K. annuity market. The model allows for private information about mortality risk as well as heterogeneity in preferences over different contract options. We focus on the choice of length of guarantee among individuals who are required to buy annuities. The results suggest that asymmetric information along the guarantee margin reduces welfare relative to a first best symmetric information benchmark by about £127 million per year, or about 2 percent of annuitized wealth. We also find that by requiring that individuals choose the longest guarantee period allowed, mandates could achieve the first-best allocation. However, we estimate that other mandated guarantee lengths would have detrimental effects on welfare. Since determining the optimal mandate is empirically difficult, our findings suggest that achieving welfare gains through mandatory social insurance may be harder in practice than simple theory may suggest.

  7. Optimal Mandates and The Welfare Cost of Asymmetric Information: Evidence from The U.K. Annuity Market*

    Science.gov (United States)

    Einav, Liran; Finkelstein, Amy; Schrimpf, Paul

    2009-01-01

    Much of the extensive empirical literature on insurance markets has focused on whether adverse selection can be detected. Once detected, however, there has been little attempt to quantify its welfare cost, or to assess whether and what potential government interventions may reduce these costs. To do so, we develop a model of annuity contract choice and estimate it using data from the U.K. annuity market. The model allows for private information about mortality risk as well as heterogeneity in preferences over different contract options. We focus on the choice of length of guarantee among individuals who are required to buy annuities. The results suggest that asymmetric information along the guarantee margin reduces welfare relative to a first best symmetric information benchmark by about £127 million per year, or about 2 percent of annuitized wealth. We also find that by requiring that individuals choose the longest guarantee period allowed, mandates could achieve the first-best allocation. However, we estimate that other mandated guarantee lengths would have detrimental effects on welfare. Since determining the optimal mandate is empirically difficult, our findings suggest that achieving welfare gains through mandatory social insurance may be harder in practice than simple theory may suggest. PMID:20592943

  8. I strong administrative buy-in, firm mandates can push flu vaccination rates up to more than 99% among health care workers.

    Science.gov (United States)

    2014-11-01

    While flu vaccination rates are inching up among health care workers, there is still room for improvement. The Centers for Disease Control and Prevention reports that slightly more than 75% of health care workers received the flu vaccination during the 2013-14 season--an increase of roughly 3% over the 2012-13 season. However, some hospitals have been able to achieve vaccination rates in excess of 99%. The apparent key to these efforts is a firm mandate that all personnel receive a flu shot as a condition of employment. There is always pushback to such policies, but hospitals report that most personnel eventually come around. While flu vaccination rates are on the increase among health, care personnel, data from the Centers for Medicare and Medicaid Services (CMS) note that rates vary widely from state to state. For example, the vaccination rate for health care workers in New Jersey stood at just 62% last year. In contrast, more than 95% of health care workers in Maryland received the shot during the 2013-14 flu season. Both Loyola University Medical Center and Henry Ford Hospital have been able to boost flu vaccination rates among their health care workers to more than 99% with the implementation of policies that require flu shots as a condition of employment. Experts say successful flu vaccination campaigns require strong administration buy-in and physician leadership.

  9. Florida's Mandated Educational Leadership Program Redesign: The William Cecil Golden Touch

    Science.gov (United States)

    Mountford, Meredith; Acker-Hocevar, Michele A.

    2013-01-01

    In 2007, educational leadership programs in Florida were notified by Florida's Department of Education of a law requiring all programs to align with new legislation, State Rule 6A-5.081. Previously, most state-approved preparation programs were based on Florida's Leadership Preparation Standards, a version of the 1996 Interstate School Leadership…

  10. The electric car controversy. A social-constructivist interpretation of the California zero-emission vehicle mandate

    Energy Technology Data Exchange (ETDEWEB)

    Fogelberg, H.

    1998-07-01

    This study focuses the socio-technical dynamics of the attempted reintroduction of electric cars in California. The underlying question is whether or not it is possible to open up an entrenched technological area as car technology, and achieve a radical change. With the perspectives of social constructivist approaches to technological change, this study examines how a large technological controversy was initiated by regulatory action of the air agency in California, the California Air Resources Board, how this controversy developed and stabilized, and how it was ended by the air agency and the auto industry. Based on mainly secondary sources, the definitions that were established on electric cars and gasoline cars at the turn of the 20th century are highlighted, thus showing the existence of two types of automobiles: the city car and the endurance car. The city car did not survive, and was not defined as being a real car. Based on mainly primary sources, the recent electric car controversy is examined, suggesting that the air agency could not force the car industry to re-introduce the city car, and consequently the efforts were directed towards the development of more advanced batteries that could give the electric car a performance close to that of the gasoline car. It also display that electric car technology was enhanced due to the mandate. In ending the controversy, the agency, due to political forces, changed from 'command-and-control' to a 'partnership' strategy. The California Air Resources Board postponed the mandate (from 1998 to 2003), due to the fact that large volume production of advanced batteries was not expected to be in place by 1998. This regulatory relief removed the principal obstacle on behalf of auto manufacturers of not to accept mandated markets, and led General Motors to start to market their purpose built electric sports car by late 1996, and Toyota to promote electric- and electric hybrid car technologies. Thus car

  11. The electric car controversy. A social-constructivist interpretation of the California zero-emission vehicle mandate

    Energy Technology Data Exchange (ETDEWEB)

    Fogelberg, H

    1998-07-01

    This study focuses the socio-technical dynamics of the attempted reintroduction of electric cars in California. The underlying question is whether or not it is possible to open up an entrenched technological area as car technology, and achieve a radical change. With the perspectives of social constructivist approaches to technological change, this study examines how a large technological controversy was initiated by regulatory action of the air agency in California, the California Air Resources Board, how this controversy developed and stabilized, and how it was ended by the air agency and the auto industry. Based on mainly secondary sources, the definitions that were established on electric cars and gasoline cars at the turn of the 20th century are highlighted, thus showing the existence of two types of automobiles: the city car and the endurance car. The city car did not survive, and was not defined as being a real car. Based on mainly primary sources, the recent electric car controversy is examined, suggesting that the air agency could not force the car industry to re-introduce the city car, and consequently the efforts were directed towards the development of more advanced batteries that could give the electric car a performance close to that of the gasoline car. It also display that electric car technology was enhanced due to the mandate. In ending the controversy, the agency, due to political forces, changed from 'command-and-control' to a 'partnership' strategy. The California Air Resources Board postponed the mandate (from 1998 to 2003), due to the fact that large volume production of advanced batteries was not expected to be in place by 1998. This regulatory relief removed the principal obstacle on behalf of auto manufacturers of not to accept mandated markets, and led General Motors to start to market their purpose built electric sports car by late 1996, and Toyota to promote electric- and electric hybrid car technologies. Thus car technology was re-opened.

  12. Mandated college students' response to sequentially administered alcohol interventions in a randomized clinical trial using stepped care.

    Science.gov (United States)

    Borsari, Brian; Magill, Molly; Mastroleo, Nadine R; Hustad, John T P; Tevyaw, Tracy O'Leary; Barnett, Nancy P; Kahler, Christopher W; Eaton, Erica; Monti, Peter M

    2016-02-01

    Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to 2 interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-min brief advice (BA) session (Step 1) and a 60- to 90-min brief motivational intervention (BMI) delivered by trained interventionists (Step 2). Analyses were completed in 2 stages. First, 3 types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) 6 weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content compared with assessment only (AO) control over the 3-, 6-, and 9-month follow-ups. Participants reporting lower scores on the Alcohol Use Disorders Identification Test, more benefits to changing alcohol use, and those who fit the "Bad Incident" profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that Bad Incident students who received the BMI reported more HED at 9-month follow-up than those who received AO. Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity. (c) 2016 APA, all rights reserved).

  13. Aviation security : preliminary observations on TSA's progress and challenges in meeting the statutory mandate for screening air cargo on passenger aircraft.

    Science.gov (United States)

    2009-03-01

    The Implementing : Recommendations of the 9/11 : Commission Act of 2007 mandates : the Department of Homeland : Security (DHS) to establish a : system to physically screen 50 : percent of cargo transported on : passenger aircraft by February : 2009 a...

  14. Le professeur Llewellyn Smith achève son mandat de Directeur général

    CERN Multimedia

    CERN Press Office. Geneva

    1998-01-01

    Speakers representing the world community of particle physics praised the outstanding achievements of Prof. Christopher Llewellyn Smith during his five-year mandate as Director General of CERN. The significance of his achievements whilst Director General are difficult to over-estimate. The approval of the construction of the Large Hadron Collider (LHC) in 1994 and the subsequent decision in 1996 to build the accelerator in a single stage, in a period of great economic difficulty, was in large part due to the leadership and tenacity of the Director General.

  15. Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark: A Nationwide Survey.

    Science.gov (United States)

    Malta Hansen, Carolina; Zinckernagel, Line; Ersbøll, Annette Kjær; Tjørnhøj-Thomsen, Tine; Wissenberg, Mads; Lippert, Freddy Knudsen; Weeke, Peter; Gislason, Gunnar Hilmar; Køber, Lars; Torp-Pedersen, Christian; Folke, Fredrik

    2017-03-14

    School cardiopulmonary resuscitation (CPR) training has become mandatory in many countries, but whether legislation has translated into implementation of CPR training is largely unknown. We assessed CPR training of students following 8 years of legislative mandates in Denmark. A nationwide cross-sectional survey of Danish school leadership (n=1240) and ninth-grade homeroom teachers (n=1381) was carried out for school year 2013-2014. Qualitative interviews and the Theory of Planned Behavior were used to construct the survey. Logistic regression models were employed to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR and automated external defibrillator training, respectively. Among leadership, 60.2% (95% CI 56.2% to 64.1%) reported CPR training had occurred during the 3 years prior to the survey. Factors associated with completed CPR training included believing other schools were conducting training (odds ratio [OR] 9.68 [95% CI 4.65-20.1]), awareness of mandating legislation (OR 4.19 [95% CI 2.65-6.62]), presence of a school CPR training coordinator (OR 3.01 [95% CI 1.84-4.92]), teacher feeling competent to conduct training (OR 2.78 [95% CI 1.74-4.45]), and having easy access to training material (OR 2.08 [95% CI 1.57-2.76]). Despite mandating legislation, school CPR training has not been successfully implemented. Completed CPR training was associated with believing other schools were conducting training, awareness of mandating legislation, presence of a school CPR training coordinator, teachers teacher feeling competent to conduct training, and having easy access to training material. Facilitating these factors may increase rates of school CPR training. © 2017 The Authors. Published on behalf of the

  16. The dynamic model on the impact of biodiesel blend mandate (B5) on Malaysian palm oil domestic demand: A preliminary finding

    Science.gov (United States)

    Abidin, Norhaslinda Zainal; Applanaidu, Shri-Dewi; Sapiri, Hasimah

    2014-12-01

    Over the last ten years, world biofuels production has increased dramatically. The biodiesel demand is driven by the increases in fossil fuel prices, government policy mandates, income from gross domestic product and population growth. In the European Union, biofuel consumption is mostly driven by blending mandates in both France and Germany. In the case of Malaysia, biodiesel has started to be exported since 2006. The B5 of 5% blend of palm oil based biodiesel into diesel in all government vehicles was implemented in February 2009 and it is expected to be implemented nationwide in the nearest time. How will the blend mandate will project growth in the domestic demand of palm oil in Malaysia? To analyze this issue, a system dynamics model was constructed to evaluate the impact of blend mandate implementation on the palm oil domestic demand influence. The base run of simulation analysis indicates that the trend of domestic demand will increase until 2030 in parallel with the implementation of 5 percent of biodiesel mandate. Finally, this study depicts that system dynamics is a useful tool to gain insight and to experiment with the impact of changes in blend mandate implementation on the future growth of Malaysian palm oil domestic demand sector.

  17. From Policy to Practice: Parent Perceptions of the 2010 Federal School Lunch Mandate

    Science.gov (United States)

    Golembiewski, Elizabeth H.; Askelson, Natoshia M.; Elchert, Daniel M.; Leicht, Erika A.; Scheidel, Carrie A.; Delger, Patti J.

    2015-01-01

    Purpose/Objectives: The purpose of this study was to investigate parent awareness and perceptions of changes to the National School Lunch Program (NSLP) implemented as a result of the Healthy, Hunger-Free Kids Act (HHKA) of 2010. Methods: An online survey of parents of school age (K-12) children in a Midwestern state was conducted (n = 2,189). The…

  18. National Mandates and Statewide Enactments: Inquiry in/to Large-Scale Reform

    Science.gov (United States)

    Hines, Mary Beth; Conner, Jenny; Campano, Gerald; Damico, James; Enoch, Melissa; Nam, Daehyeon

    2007-01-01

    Since the inauguration of the No Child Left Behind Act of 2001 (NCLB) in the United States, with a billion-dollar budget to induce educational reform, American schools have been under the microscope for meeting accountability standards for students. The performance pressures have intensified as the consequences for not achieving academic…

  19. Constitutional Mandate for Free and Compulsory Education: New Light on the Intention of the "Founding Fathers"

    Science.gov (United States)

    Juneja, Nalini

    2015-01-01

    The original constitutional provision for free and compulsory education, granted under Article 45 stated that it was to be available for "all children until they complete the age of fourteen years", but it did not specify the lower age limit nor the stage of education (whether elementary or primary) that would be free and compulsory.…

  20. Which strengths-based practice? Reconciling strengths-based practice and mandated authority in child protection work.

    Science.gov (United States)

    Oliver, Carolyn; Charles, Grant

    2015-04-01

    The recent application of strengths-based practice in child protection settings has been accompanied by evidence of inconsistent implementation and concerns that the approach is incompatible with statutory work. Few studies have moved beyond asking whether child protection workers are implementing strengths-based practice to explore why the approach is enacted as it is. This article describes a mixed methods study using an online survey and interviews to elicit from 225 statutory child protection workers in a large Canadian agency how they applied strengths-based ideas and why they did what they did. The authors found that although strengths-based practice was popular, 70 percent of participants believed that it was not always applicable to child protection work. Participants described five distinct versions of the approach, only one of which was fully congruent with their mandated role. The study suggests that the common conflation of strengths-based and solution-focused approaches ignores important differences in the conceptualization of practitioner authority and leaves practitioners attempting to implement versions ofstrengths-based practice that do not fit statutory child protection work. Only when practitioners choose solution-focused models that support their use of mandated authority is consistent implementation a reasonable expectation.

  1. The Interactive Effects of Antisocial Personality Disorder and Court-Mandated Status on Substance Abuse Treatment Dropout

    Science.gov (United States)

    Daughters, Stacey B.; Stipelman, Brooke A.; Sargeant, Marsha N.; Schuster, Randi; Bornovalova, Marina A.; Lejuez, C.W.

    2013-01-01

    The present study sought to examine the interactive effects of court-mandated (CM) treatment and antisocial personality disorder (ASPD) on treatment dropout among 236 inner-city male substance users receiving residential substance abuse treatment through a pretrial release to treatment program. Of the 236 participants, 39.4% (n = 93) met criteria for ASPD and 72.5 % (n = 171) were mandated to treatment by the court system. Results indicated a significant interaction between ASPD and CM status, such that ASPD patients voluntarily receiving treatment were significantly more likely to drop out of treatment than each of the other groups. Subsequent discrete-time survival analyses to predict days until dropout using Cox proportional hazards regression indicated similar findings, with ASPD patients voluntarily receiving treatment completing fewer days of treatment than each of the other groups. These findings suggest the effectiveness of the court system in retaining ASPD patients, as well as the role of ASPD in predicting treatment dropout for individuals who are voluntarily in treatment. Implications are discussed including the potential value of early implementation of specialized interventions aimed at improving adherence for ASPD patients who are receiving treatment voluntarily. PMID:17869050

  2. Conflicted Identification in the Sex Education Classroom: Balancing Professional Values With Organizational Mandates.

    Science.gov (United States)

    Williams, Elizabeth A; Jensen, Robin E

    2016-09-01

    Despite enormous resources spent on sex education, the United States faces an epidemic of unplanned pregnancy and sexually transmitted infections among young people. Little research has examined the role sex educators play in alleviating or exacerbating this problem. In this study, we interviewed 50 sex educators employed by public schools throughout a Midwestern, U.S. state about their experiences in the sex education classroom. Twenty-two interviewees communicated feelings of conflicted identification and provided examples of the ways in which they experienced this subjectivity in the context of their employment. We find these interviews shed light on the as-yet-understudied communicative experience of conflicted identification by delineating key sources of such conflict and discursive strategies used in its negotiation. Our results suggest that those who experience conflicted identification and who have a sense of multiple or nested identifications within their overarching professional identity may be safeguarded to some extent from eventual organizational disidentification. © The Author(s) 2015.

  3. Impact of a private health insurance mandate on public sector autism service use in Pennsylvania.

    Science.gov (United States)

    Stein, Bradley D; Sorbero, Mark J; Goswami, Upasna; Schuster, James; Leslie, Douglas L

    2012-08-01

    Many states have implemented regulations (commonly referred to as waivers) to increase access to publicly insured services for autism spectrum disorders (ASD). In recent years, several states have passed legislation requiring improved coverage for ASD services by private insurers. This study examines the impact of such legislation on use of Medicaid-funded ASD services. We used Medicaid claims data from July 1, 2006, through June 30, 2010, to identify children with ASD and to assess their use of behavioral health services and psychotropic medications. Service and medication use were examined in four consecutive 12-month periods: the 2 years preceding passage of the legislation, the year after passage but before implementation, and the year after implementation. We examined differences in use of services and medications, and used growth rates from nonwaiver children to estimate the impact of the legislation on Medicaid spending for waiver-eligible children with ASD. The number of children with ASD receiving Medicaid services increased 20% from 2006-2007 to 2009-2010. The growth rate among children affected by the legislation was comparable to that of other groups before passage of the legislation but decreased after the legislation's passage. We project that, without the legislation, growth in this population would have been 46% greater in 2009-2010 than observed, associated with spending of more than $8 million in 2009-2010. Passage of legislation increasing private insurance coverage of ASD services may decrease the number of families seeking eligibility to obtain Medicaid-funded services, with an associated substantial decrease in Medicaid expenditures. Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  4. Relationships Between Shame, Restrictiveness, Authoritativeness, and Coercive Control in Men Mandated to a Domestic Violence Offenders Program.

    Science.gov (United States)

    Kaplenko, Hannah; Loveland, Jennifer E; Raghavan, Chitra

    2018-04-01

    Coercive control, a key element of intimate partner violence (IPV), is defined as an abuse dynamic that intends to strip the target of autonomy and liberty. While coercive control is gaining popularity in the research world, little is known about its correlates and causes. This study sought to examine how shame and men's need for dominance, measured by two trait indexes of dominance, restrictiveness and the need for authority, influence coercive control. The present study used a diverse sample of men (n = 134) who were mandated to attend a domestic violence offenders program. Findings suggest that shame plays a role in the commission of coercively controlling behavior both directly and partially through its influence on authority but not through restrictiveness. Implications for understanding IPV in a domestic violence offenders program are discussed.

  5. Is there evidence for mandating electrocardiogram as part of the pre-participation examination?

    Science.gov (United States)

    Borjesson, Mats; Dellborg, Mikael

    2011-01-01

    The risk of sudden cardiac death may be increased up to 2.8 times in competitive athletes compared with nonathletes. The majority of sudden cardiac death cases are caused by an underlying abnormality that potentially may be identified on cardiovascular screening, depending on the specific abnormality and the content of the cardiovascular screening applied. Indeed, today, cardiac screening is universally recommended by the cardiac societies [European Society of Cardiology (ESC) and American Heart Association (AHA)] and required by the sporting bodies [Fédération Internationale de Football Association (FIFA) and Union of European Football Associations (UEFA)]. Pre-participation examination is by consensus understood to include personal history and physical examination; controversy exists regarding the usefulness and appropriateness of screening using resting 12-lead electrocardiogram (ECG), with an apparent transatlantic difference. The ESC recommends screening consisting of personal history, physical examination, and 12-lead resting ECG, whereas recommendations from the AHA includes only personal history and physical examination. There is firm scientific ground to state that the sensitivity of screening with ECG is vastly superior to, and the cost-effectiveness significantly better than, screening without ECG. Cardiac screening of elite athletes with personal history, physical examination, and ECG is cost-effective also in comparison with other well-accepted procedures of modern health care, such as dialysis and implantable cardiac defibrillators. Newly published recommendations for the interpretation of the ECG in athletes (ESC) and future studies on ECGs in athletes of different ethnicity, gender, and age may further increase the specificity of ECG in cardiac screening, refining the screening procedure and lowering the costs for additional follow-up testing. Cardiac screening without ECG is not cost-effective and may be only marginally better than no screening

  6. Estimated burden of cardiovascular disease and value-based price range for evolocumab in a high-risk, secondary-prevention population in the US payer context.

    Science.gov (United States)

    Toth, Peter P; Danese, Mark; Villa, Guillermo; Qian, Yi; Beaubrun, Anne; Lira, Armando; Jansen, Jeroen P

    2017-06-01

    that, accounting for uncertainties, the expected value-based price for evolocumab is higher than its current annual cost, as long as the payer discount off list price is greater than 20%.

  7. Access to Posthospitalization Acute Care Facilities is Associated with Payer Status for Open Abdominal Aortic Repair and Open Lower Extremity Revascularization in the Vascular Quality Initiative.

    Science.gov (United States)

    Ulloa, Jesus G; Woo, Karen; Tseng, Chi-Hong; Maggard-Gibbons, Melinda; Rigberg, David

    2017-07-01

    Uninsured patients may not have access to postacute care facilities that play an important role in clinical recovery, and functional outcomes after vascular surgery. We sought to determine whether discharge disposition is associated with insurance status. We retrospectively reviewed data from the Vascular Quality Initiative ® for patients who underwent open abdominal aortic repair, infrainguinal bypass, or suprainguinal bypass (SB) between January 2012 and July 2015. Mixed-effects logistic regression analysis with clustering at the surgeon and facility level was used to calculate 95% confidence intervals for discharge disposition to home, skilled nursing facility (SNF) or rehabilitation (Rehab) facility by payer status (Medicare, Medicaid, Commercial, Military/Veterans Affairs, Non-US Insurance, or Self-pay), with adjustment for patient, operative, and postoperative characteristics. The study cohort comprised 18,478 procedures (open abdominal aortic repair = 2,817; infrainguinal bypass = 11,572; suprainguinal bypass = 4,089) after we excluded procedures with missing data and in-hospital deaths. Twenty-four percent of the cohort was discharged to an SNF or Rehab site. On univariate analysis, the odds ratio (OR) of discharge home was 4.38 (95% CI: 3.33-5.77) for self-pay as compared to Medicare. On mixed-effects analysis, the adjusted odds of discharge home for self-pay as compared to Medicare remained high (OR = 3.09; 95% CI: 2.23-4.26), after adjustment for age, gender, race/ethnicity, preoperative ambulatory status, number of comorbidities, case urgency, total operative time, presence of a postoperative complication, procedure type, and length of stay. Adjusted odds for discharge to SNF (OR = 0.26; 95% CI: 0.15-0.46) and Rehab (OR = 0.50; 95% CI: 0.35-0.72) were lowest for self-pay status. Access to postacute care facilities is associated with insurance status. Self-pay (uninsured) patients are less likely to have access to discharge services that may

  8. Association of mandated language access programming and quality of care provided by mental health agencies.

    Science.gov (United States)

    McClellan, Sean R; Snowden, Lonnie

    2015-01-01

    This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

  9. Collaborations between the State and Local Colleges: Sleeping with the Enemy?

    Science.gov (United States)

    Brand, Elizabeth Cox

    2014-01-01

    This chapter describes the characteristics of successful partnerships between a state-level department and local community colleges. Particular focus is paid to the lack of mandated collaboration between the entities and the elements necessary for motivation and sustainability.

  10. Mandating the offer of HIV testing in New York: simulating the epidemic impact and resource needs.

    Science.gov (United States)

    Martin, Erika G; MacDonald, Roderick H; Smith, Lou C; Gordon, Daniel E; Tesoriero, James M; Laufer, Franklin N; Leung, Shu-Yin J; Rowe, Kirsten A; OʼConnell, Daniel A

    2015-01-01

    A 2010 New York law requires that patients aged 13-64 years be offered HIV testing in routine medical care settings. Past studies report the clinical outcomes, cost-effectiveness, and budget impact of expanded HIV testing nationally and within clinics but have not examined how state policies affect resource needs and epidemic outcomes. A system dynamics model of HIV testing and care was developed, where disease progression and transmission differ by awareness of HIV status, engagement in care, and disease stage. Data sources include HIV surveillance, Medicaid claims, and literature. The model projected how alternate implementation scenarios would change new infections, diagnoses, linkage to care, and living HIV cases over 10 years. Without the law, the model projects declining new infections, newly diagnosed cases, individuals newly linked to care, and fraction of undiagnosed cases (reductions of 62.8%, 59.7%, 54.1%, and 57.8%) and a slight increase in living diagnosed cases and individuals in care (2.2% and 6.1%). The law will further reduce new infections, diagnosed AIDS cases, and the fraction undiagnosed and initially increase and then decrease newly diagnosed cases. Outcomes were consistent across scenarios with different testing offer frequencies and implementation times but differed according to the level of implementation. A mandatory offer of HIV testing may increase diagnoses and avert infections but will not eliminate the epidemic. Despite declines in new infections, previously diagnosed cases will continue to need access to antiretroviral therapy, highlighting the importance of continued funding for HIV care.

  11. Private sector risk-sharing agreements in the United States: trends, barriers, and prospects.

    Science.gov (United States)

    Garrison, Louis P; Carlson, Josh J; Bajaj, Preeti S; Towse, Adrian; Neumann, Peter J; Sullivan, Sean D; Westrich, Kimberly; Dubois, Robert W

    2015-09-01

    Risk-sharing agreements (RSAs) between drug manufacturers and payers link coverage and reimbursement to real-world performance or utilization of medical products. These arrangements have garnered considerable attention in recent years. However, greater use outside the United States raises questions as to why their use has been limited in the US private sector, and whether their use might increase in the evolving US healthcare system. To understand current trends, success factors, and challenges in the use of RSAs, we conducted a review of RSAs, interviews, and a survey to understand key stakeholders' experiences and expectations for RSAs in the US private sector. Trends in the numbers of RSAs were assessed using a database of RSAs. We also conducted in-depth interviews with stakeholders from pharmaceutical companies, payer organizations, and industry experts in the United States and European Union. In addition, we administered an online survey with a broader audience to identify perceptions of the future of RSAs in the United States. Most manufacturers and payers expressed interest in RSAs and see potential value in their use. Due to numerous barriers associated with outcomes-based agreements, stakeholders were more optimistic about financial-based RSAs. In the US private sector, however, there remains considerable interest--improved data systems and shifting incentives (via health reform and accountable care organizations) may generate more action. In the US commercial payer markets, there is continued interest among some manufacturers and payers in outcomes-based RSAs. Despite continued discussion and activity, the number of new agreements is still small.

  12. Alternative U.S. biofuel mandates and global GHG emissions: The role of land use change, crop management and yield growth

    International Nuclear Information System (INIS)

    Mosnier, A.; Havlík, P.; Valin, H.; Baker, J.; Murray, B.; Feng, S.; Obersteiner, M.; McCarl, B.A.; Rose, S.K.; Schneider, U.A.

    2013-01-01

    We investigate the impacts of the U.S. renewable fuel standard (RFS2) and several alternative biofuel policy designs on global GHG emissions from land use change and agriculture over the 2010–2030 horizon. Analysis of the scenarios relies on GLOBIOM, a global, multi-sectoral economic model based on a detailed representation of land use. Our results reveal that RFS2 would substantially increase the portion of agricultural land needed for biofuel feedstock production. U.S. exports of most agricultural products would decrease as long as the biofuel target would increase leading to higher land conversion and nitrogen use globally. In fact, higher levels of the mandate mean lower net emissions within the U.S. but when the emissions from the rest of the world are considered, the US biofuel policy results in almost no change on GHG emissions for the RFS2 level and higher global GHG emissions for higher levels of the mandate or higher share of conventional corn-ethanol in the mandate. Finally, we show that if the projected crop productivity would be lower globally, the imbalance between domestic U.S. GHG savings and additional GHG emissions in the rest of the world would increase, thus deteriorating the net global impact of U.S. biofuel policies. - Highlights: ► We model the impact of the U.S. renewable fuel standard (RFS2). ► RFS2 would require more agricultural land and nitrogen globally. ► Increasing the mandates reduce GHG emissions within the U.S. ► Increasing the mandates increase GHG emissions in the rest of the world. ► Total GHG emissions increase with higher levels of mandate; higher share of corn-ethanol; lower productivity growth

  13. A 360 degrees evaluation of a night-float system for general surgery: a response to mandated work-hours reduction.

    Science.gov (United States)

    Goldstein, Michael J; Kim, Eugene; Widmann, Warren D; Hardy, Mark A

    2004-01-01

    New York State Code 405 and societal/political pressure have led the RRC and ACGME to mandate strict limitations on resident work hours. In an attempt to meet these limitations, we have switched from the previous Q3 call schedule to a specialized night float (NF) system, the continuity-care system (CCS). The purpose of this CCS is to maximize resident duty time spent on direct patient care, operative experience, and outpatient clinics, while reducing duty hours spent on performing routine tasks and call coverage. The implementation of the CCS is the fundamental step in the restructuring of our residency program. In addition to a change in the call system, we added physician assistants to aid in performing some service tasks. We performed a 360 degrees evaluation of this work in progress. In May 2002, the standard Q3 call system was abolished on the general surgery services at the New York Presbyterian Hospital, Columbia campus. Two dedicated teams were created to provide day and night coverage, a day continuity-care team (DCT) and a night continuity-care team (NCT). The DCTs, consisting of PGY1-5 residents, provide daily in-house coverage from 6 AM to 5 PM with no regular weekday night-call responsibilities. The DCT residents provide Friday night, Saturday, and daytime Sunday call coverage 3 to 4 days per month. The NCT, consisting of 5 PGY1-5 residents, provides nightly continuous care, 5 PM to 6 AM, Sunday through Thursday, with no other weekend call responsibilities. This system creates a schedule with less than 80 duty hours per week, on average, with one 24-hour period off a week, one complete weekend off per month, and no more than 24 hours of consecutive duty time. After 1 year of use, the system was evaluated by a 360 degrees method in which residents, residents' spouses, nurses, and faculty were surveyed using a Likert-type scale. Statistical significance was calculated using the Student t-test. Patient satisfaction was measured both by internal review of

  14. 13 CFR 120.1892 - What happens if an SISMBD does not use SISMBD Loan funds for a statutorily mandated purpose?

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What happens if an SISMBD does not use SISMBD Loan funds for a statutorily mandated purpose? 120.1892 Section 120.1892 Business Credit... the Small Business Act or Pools of such loans, the Administrator shall: (a) Demand immediate repayment...

  15. State Teacher Evaluation and Teacher Education

    Science.gov (United States)

    Marchant, Gregory J.; David, Kristine A.; Rodgers, Deborah; German, Rachel L.

    2015-01-01

    Current accountability trends suggest an increasing role in state mandates regarding teacher evaluation. With various evaluation models and components serving as the basis for quality teaching, teacher education programs need to recognize the role teacher evaluation plays and incorporate aspects where appropriate. This article makes that case and…

  16. Initial mandate concerning the problem of fluctuating gasoline prices and their effect on the Quebec economy : Final report

    International Nuclear Information System (INIS)

    Guillot, R.; Ford, N. ed.

    2002-06-01

    Over a three-year period covering May 1998 to May 2001, the average price of gasoline in Quebec slowly increased from 57.1 cent per litre to 82.6 cent per litre. This 45 per cent increase in the price of gasoline worried consumers and had an effect on commercial and industrial operations throughout the province. This situation prompted the Commission de l'economie et du travail (Commission on Labour and the Economy) to initiate a mandate to examine the problem. In October 2001, experts representing energy and taxation sectors were consulted and presentations made by 17 people and organizations. The Ministre des Ressources Naturelles (Minister of Natural Resources) and the President de la Regie de l'Energie were heard in a public consultation forum. In the first part of the document, the authors explained the mechanism by which the price of gasoline and its various components are determined, identified the elements responsible for the increases in prices, and compare the prices in the different parts of the province. In part two, the responsibilities and powers of the Ministry of Natural Resources and the Regie de l'Energie with regard to petroleum products were examined. Part three described the opinions expressed and proposed recommendations obtained during the public consultation process and they were grouped under four headings: taxation, competition, consumer information, and energy savings. The final part of the document presented the recommendations of the Commission on Labour and the Economy. 15 refs., 5 tabs

  17. Outcome Evaluation of a Policy-Mandated Lifestyle and Environmental Modification Program in a National Job Training Center.

    Science.gov (United States)

    Jimenez, Elizabeth Yakes; Harris, Amanda; Luna, Donald; Velasquez, Daniel; Slovik, Jonathan; Kong, Alberta

    2017-06-01

    Excess weight gain is common when adolescents become young adults, but there are no obesity prevention or weight management interventions that have been tested for emerging adults who follow non-traditional post-secondary paths, such as enrolling in job training programs. We evaluated Healthy Eating & Active Lifestyles (HEALs), a policy-mandated lifestyle education/environmental modification program, at a job training center for low-income 16-24 year olds. We examined average change in body mass index (BMI) z-score from baseline to 6 months for emerging adults (aged 16-24 years) in pre-HEALs implementation (n = 125) and post-HEALs implementation (n = 126) cohorts living at the job training center, by baseline weight status. In both cohorts, average BMI z-score significantly increased from baseline to 6 months for students with BMI < 25. Average BMI z-score significantly decreased for the overweight (BMI 25 to <30; -0.11, p = .03) and obese (BMI ≥ 30; -0.11, p = .001) students only within the post-HEALs cohort; changes within the pre-HEALs cohort and between cohorts were not significant. HEALs may promote positive weight-related trends for overweight/obese students, but prevention efforts for non-overweight/obese students need to be improved.

  18. Paying for the Orphan Drug System: break or bend? Is it time for a new evaluation system for payers in Europe to take account of new rare disease treatments?

    Directory of Open Access Journals (Sweden)

    Hughes-Wilson Wills

    2012-09-01

    specificities of orphan drugs given that the higher price-points claimed by orphan drugs are unlikely to meet current cost-effectiveness thresholds. The authors propose the development of a new assessment system based on several evaluation criteria, which would serve as a tool for Member State governments to evaluate each new orphan drug at the time of pricing and reimbursement. These should include rarity, disease severity, the availability of other alternatives (level of unmet medical need, the level of impact on the condition that the new treatment offers, whether the product can be used in one or more indications, the level of research undertaken by the developer, together with other factors, such as manufacturing complexity and follow-up measures required by regulatory or other authorities. This will allow governments to value an orphan drug that fulfilled all the criteria very differently from one that only met some of them. An individual country could determine the (monetary value that it places on each of the different criteria, according to societal preferences, the national healthcare system and the resources at its disposal – each individual government deciding on the weighting attributed to each of the criteria in question, based on what each individual society values most. Such a systematic and transparent system will help frame a more structured dialogue between manufacturers and payers, with the involvement of the treating physicians and the patients; and foster a more certain environment to stimulate continued investment in the field. A new approach could also offer pricing and reimbursement decision-makers a tool to handle the different characteristics amongst new orphan drugs and to redistribute the national budgets in accordance with the outcome of a differentiated assessment. The authors believe that this could, therefore, facilitate the approach for all stakeholders.

  19. The Budget Impact of Including Necitumumab on the Formulary for First-Line Treatment of Metastatic Squamous Non-Small Cell Lung Cancer: U.S. Commercial Payer and Medicare Perspectives.

    Science.gov (United States)

    Bly, Christopher A; Molife, Cliff; Brown, Jacqueline; Tawney, Mahesh K; Carter, Gebra Cuyun; Cinfio, Frank N; Klein, Robert W

    2018-06-01

    Necitumumab (Neci) was the first biologic approved by the FDA for use in combination with gemcitabine and cisplatin (Neci + GCis) in first-line treatment of metastatic squamous non-small cell lung cancer (msqNSCLC). The potential financial impact on a health plan of adding Neci + GCis to drug formularies may be important to value-based decision makers in the United States, given ever-tightening budget constraints. To estimate the budget impact of introducing Neci + GCis for first-line treatment of msqNSCLC from U.S. commercial and Medicare payer perspectives. The budget impact model estimates the costs of msqNSCLC before and after adoption of Neci + GCis in hypothetical U.S. commercial and Medicare health plans over a 3-year time horizon. The eligible patient population was estimated from U.S. epidemiology statistics. Clinical data were obtained from randomized clinical trials, U.S. prescribing information, and clinical guidelines. Market share projections were based on market research data. Cost data were obtained from online sources and published literature. The incremental aggregate annual health plan, per-patient-per-year (PPPY), and per-member-per-month (PMPM) costs were estimated in 2015 U.S. dollars. One-way sensitivity analyses were conducted to assess the effect of model parameters on results. In a hypothetical 1,000,000-member commercial health plan with an estimated population of 30 msqNSCLC patients receiving first-line chemotherapy, the introduction of Neci + GCis at an initial market share of approximately 5% had an overall year 1 incremental budget impact of $88,394 ($3,177 PPPY, $0.007 PMPM), representing a 2.9% cost increase and reaching $304,079 ($10,397 PPPY, $0.025 PMPM) or a 7.4% cost increase at a market share of 14.7% in year 3. This increase in total costs was largely attributable to Neci drug costs and, in part, due to longer survival and treatment duration for patients treated with Neci+GCis. Overall, treatment costs increased by $81

  20. The Supply of Medical Radioisotopes. Final Report of the Third Mandate of the High-level Group on the Security of Supply of Medical Radioisotopes (2013-2015)

    International Nuclear Information System (INIS)

    Charlton, Kevin; )

    2016-07-01

    At the request of its member countries, the Organisation for Economic Co-operation and Development (OECD) Nuclear Energy Agency (NEA) became involved in global efforts to ensure a secure supply of molybdenum-99 ( 99 Mo)/technetium-99m ( 99m Tc). In April 2009, the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) was created and received an initial, two-year mandate from the NEA Steering Committee for Nuclear Energy to examine the causes of supply shortages of 99 Mo/ 99m Tc and develop a policy approach to address them. In its first mandate, the HLG-MR conducted a comprehensive economic study of the 99 Mo/ 99m Tc supply chain, which identified the key areas of vulnerability and major issues to be addressed. The HLG-MR released a policy approach, including six principles (Appendix 1) and supporting recommendations to help resolve the issues in the 99 Mo/ 99m Tc market. In the second mandate (2011-2013), the HLG-MR worked to encourage the implementation of the six policy principles and promoted an industry transition away from the use of highly enriched uranium (HEU) targets for 99 Mo production. Projects were undertaken by the NEA that resulted in the publication of documents and reports to assist in implementing the HLG-MR policy approach. The second mandate showed that, while commendable progress had occurred in many areas, there were still major issues in the 99 Mo/ 99m Tc market, with some continued government subsidisation, insufficient ORC and inadequate reimbursement for 99 mTc. Potential future periods of supply shortage were identified, particularly concerning the likely loss of significant capacity around 2016. In the third mandate, the HLG-MR continued its efforts to help ensure the global security of supply of 99 Mo/ 99m Tc through implementation of the six policy principles. The NEA undertook a further self-assessment review of the 99 Mo/ 99m Tc supply chain, focusing again on progress with implementing FCR and paid ORC and

  1. The Reach and Limitation of the ADA and its Integration Mandate: Implications for the Successful Reentry of Individuals with Mental Disabilities in a Correctional Population.

    Science.gov (United States)

    Dlugacz, Henry A; Droubi, Luna

    2017-03-01

    This article argues that the ADA and its integration mandate, informed by international standards, should extend to incarcerated individuals with mental disabilities who reenter society, as they are at highly elevated risk for unnecessary segregation in institutions such as homeless shelters or hospitals or through reincarceration. An understanding of the precise services needed to prevent these strongly related but distinct variants of institutionalization requires a robust and continuing research agenda. In discussing the breadth of the ADA, we explore its history, interpretations of its application in a variety of contexts with respect to vulnerable populations and integration, and enforcement. We also turn to international approaches to integration mandates as they apply to reentry. By interpreting the domestic and international principles that create the context for integration we hope to have provided a resource for future application of the ADA integration in the context of prisoner reentry. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  2. Mandating influenza vaccinations for health care workers: analysing opportunities for policy change using Kingdon's agenda setting framework.

    Science.gov (United States)

    Jackson-Lee, Angela; Barr, Neil G; Randall, Glen E

    2016-09-29

    The consequences of annual influenza outbreaks are often underestimated by the general public. Influenza poses a serious public health threat around the world, particularly for the most vulnerable populations. Fortunately, vaccination can mitigate the negative effects of this common infectious disease. Although inoculating frontline health care workers (HCWs) helps minimize disease transmission, some HCWs continue to resist participating in voluntary immunization programs. A potential solution to this problem is government-mandated vaccination for HCWs; however, in practice, there are substantial barriers to the adoption of such policies. The purpose of this paper is to identify the likelihood of adopting a policy for mandatory immunization of HCWs in Ontario based on a historical review of barriers to the agenda setting process. Documents from secondary data sources were analysed using Kingdon's agenda setting framework of three converging streams leading to windows of opportunity for possible policy adoption. The problems, politics, and policies streams of Kingdon's framework have converged and diverged repeatedly over an extended period (policy windows have opened and closed several times). In each instance, a technically feasible solution was available. However, despite the evidence supporting the value of HCW immunization, alignment of the three agenda setting streams occurred for very short periods of time, during which, opposition lobby groups reacted, making the proposed solution less politically acceptable. Prior to the adoption of any new policies, issues must reach a government's decision agenda. Based on Kingdon's agenda setting framework, this only occurs when there is alignment of the problems, politics, and policies streams. Understanding this process makes it easier to predict the likelihood of a policy being adopted, and ultimately implemented. Such learning may be applied to policy issues in other jurisdictions. In the case of mandatory influenza

  3. Inequity between male and female coverage in state infertility laws.

    Science.gov (United States)

    Dupree, James M; Dickey, Ryan M; Lipshultz, Larry I

    2016-06-01

    To analyze state insurance laws mandating coverage for male factor infertility and identify possible inequities between male and female coverage in state insurance laws. We identified states with laws or codes related to infertility insurance coverage using the National Conference of States Legislatures' and the National Infertility Association's websites. We performed a primary, systematic analysis of the laws or codes to specifically identify coverage for male factor infertility services. Not applicable. Not applicable. Not applicable. The presence or absence of language in state insurance laws mandating coverage for male factor infertility care. There are 15 states with laws mandating insurance coverage for female factor infertility. Only eight of those states (California, Connecticut, Massachusetts, Montana, New Jersey, New York, Ohio, and West Virginia) have mandates for male factor infertility evaluation or treatment. Insurance coverage for male factor infertility is most specific in Massachusetts, New Jersey, and New York, yet significant differences exist in the male factor policies in all eight states. Three states (Massachusetts, New Jersey, and New York) exempt coverage for vasectomy reversal. Despite national recommendations that male and female partners begin infertility evaluations together, only 8 of 15 states with laws mandating infertility coverage include coverage for the male partner. Excluding men from infertility coverage places an undue burden on female partners and risks missing opportunities to diagnose serious male health conditions, correct reversible causes of infertility, and provide cost-effective treatments that can downgrade the intensity of intervention required to achieve a pregnancy. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. A Comprehensive Analysis of High School Genetics Standards: Are States Keeping Pace with Modern Genetics?

    Science.gov (United States)

    Dougherty, M. J.; Pleasants, C.; Solow, L.; Wong, A.; Zhang, H.

    2011-01-01

    Science education in the United States will increasingly be driven by testing and accountability requirements, such as those mandated by the No Child Left Behind Act, which rely heavily on learning outcomes, or "standards," that are currently developed on a state-by-state basis. Those standards, in turn, drive curriculum and instruction.…

  5. Mandated Local Health Networks across the province of Québec: a better collaboration with primary care working in the communities?

    Science.gov (United States)

    Breton, Mylaine; Maillet, Lara; Haggerty, Jeannie; Vedel, Isabelle

    2014-01-01

    Background In 2004, the Québec government implemented an important reform of the healthcare system. The reform was based on the creation of new organisations called Health Services and Social Centres (HSSC), which were formed by merging several healthcare organisations. Upon their creation, each HSSC received the legal mandate to establish and lead a Local Health Network (LHN) with different partners within their territory. This mandate promotes a 'population-based approach' based to the responsibility for the population of a local territory. Objective The aim of this paper is to illustrate and discuss how primary healthcare organisations (PHC) are involved in mandated LHNs in Québec. For illustration, we describe four examples that facilitate a better understanding of these integrated relationships. Results The development of the LHNs and the different collaboration relationships are described through four examples: (1) improving PHC services within the LHN - an example of new PHC models; (2) improving access to specialists and diagnostic tests for family physicians working in the community - an example of centralised access to specialists services; (3) improving chronic-disease-related services for the population of the LHN - an example of a Diabetes Centre; and (4) improving access to family physicians for the population of the LHN - an example of the centralised waiting list for unattached patients. Conclusion From these examples, we can see that the implementation of large-scale reform involves incorporating actors at all levels in the system, and facilitates collaboration between healthcare organisations, family physicians and the community. These examples suggest that the reform provided room for multiple innovations. The planning and organisation of health services became more focused on the population of a local territory. The LHN allows a territorial vision of these planning and organisational processes to develop. LHN also seems a valuable lever when

  6. The Implications of State Fiscal Policies for Community Colleges

    Science.gov (United States)

    Dowd, Alicia C.; Shieh, Linda Taing

    2014-01-01

    A variety of policies and practices, including those developed by local boards and administrations, as well as those mandated by state and federal governments, affect budgets and finances at community colleges. Examples include tuition policies, fee structures, performance-based funding, and personnel policies. This chapter explores some of the…

  7. Direct healthcare costs and cost-effectiveness of acute coronary syndrome secondary prevention with ticagrelor compared to clopidogrel: economic evaluation from the public payer's perspective in Poland based on the PLATO trial results.

    Science.gov (United States)

    Pawęska, Justyna; Macioch, Tomasz; Perkowski, Piotr; Budaj, Andrzej; Niewada, Maciej

    2014-01-01

    Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist designed to reduce clinical thrombotic events in patients with acute coronary syndrome (ACS). Compared to clopidogrel, ticagrelor has been proven to significantly reduce the rate of death from vascular causes, myocardial infarction (MI), or stroke without an increase in the rate of overall major bleeding in patients who have an ACS with or without ST-segment elevation (STEMI and NSTEMI) or unstable angina (UA). To evaluate the cost-effectiveness and healthcare costs associated with secondary prevention of ACS using ticagrelor or clopidogrel in patients after STEMI, NSTEMI and UA. An economic model based on results from the PLATO trial was used to evaluate the cost-effectiveness of one-year therapy with ticagrelor or clopidogrel. The structure of the model consisted of two parts, i.e. the decision tree with one-year PLATO results and the Markov model with lifelong estimations, which exceeded PLATO follow-up data. The model was adjusted to Polish settings with country-specific data on death rates in the general population and direct medical costs calculated from the public payer's perspective. Costs were derived from the National Health Fund (NHF) and the Ministry of Health and presented in PLN 2013 values. Annual mean costs of second and subsequent years after stroke or MI were obtained from the literature. Uncertainty of assumed parameters was tested in scenarios and probabilistic sensitivity analyses. The adopted model allowed the estimation of an incremental cost-effectiveness ratio for life years gained (LYG) and an incremental cost-utility ratio for quality adjusted life years (QALY). Total direct medical costs to the public payer at a one year horizon were 2,905 PLN higher with ticagrelor than with clopidogrel. However, mean healthcare costs at a one year horizon (excluding drug costs and concomitant drugs) were 690 PLN higher for patients treated with clopidogrel. In a lifetime horizon

  8. Reinventing primary care: lessons from Canada for the United States.

    Science.gov (United States)

    Starfield, Barbara

    2010-05-01

    Canada is, in many respects, culturally and economically similar to the United States, and until relatively recently, the two countries had similar health systems. However, since passage of the Canada Health Act in the 1970s, that nation's health statistics have become increasingly superior. Although the costs of Canada's health system are high by international standards, they are much lower than U.S. costs. This paper describes several factors likely to be responsible for Canada's better health at lower cost: universal financial coverage through a so-called single payer; features conducive to a strong primary care infrastructure; and provincial autonomy under general principles set by national law.

  9. The Historic Urban Core of Antakya under the Influence of the French Mandate, and Turkish Republican Urban Conservation and Development Activities

    Directory of Open Access Journals (Sweden)

    Mert Nezih RİFAİOĞLU

    2014-12-01

    Full Text Available Antakya, known as Antioch during the ancient period, is significant among Turkey’s historical urban contexts. It is located in the south-east of Turkey, near the Syrian border and is the capital of Hatay province. Called the ‘Queen of the East’ at one time, it is an important city historically since it was an early center of Christianity and one of the capital cities of the Roman Empire. As a result of its importance, the city has been formed/re-formed over time by different empires, and many structures from various periods are still persist in the current urban form. The aim of this paper is to examine the French Mandate and Turkish Republican Period urban conservation and development strategies in Antakya in order to better understand their influences and effects on its historical urban core. The paper thus begins with an introduction and brief outline of the historical development of the core of Antakya. The second part focuses on the French Mandate and Turkish Republican Period urban conservation and development plan strategies. The final part discusses the effects of different urban development strategies on the historic core of the city.

  10. United States Holocaust Museums: Pathos, Possession, Patriotism

    OpenAIRE

    Baum, Rob

    2011-01-01

    This article examines the role of United States holocaust museums in directing (American) knowledge and memory of World War II, and demonstrates how signifiers of race, colour and Jewishness are played out and theatricalised. Erected in two principal U.S. cities of Los Angeles and Washington, D.C., the Holocaust Museum and Museum of Tolerance uphold very different mandates: the first dedicated to revealing European civilian tragedies during WWII; the latter dealing with Jewish persecution and...

  11. The costs of heart failure in Poland from the public payer's perspective. Polish programme assessing diagnostic procedures, treatment and costs in patients with heart failure in randomly selected outpatient clinics and hospitals at different levels of care: POLKARD.

    Science.gov (United States)

    Czech, Marcin; Opolski, Grzegorz; Zdrojewski, Tomasz; Dubiel, Jacek S; Wizner, Barbara; Bolisęga, Dorota; Fedyk-Łukasik, Małgorzata; Grodzicki, Tomasz

    2013-01-01

    Heart failure (HF) is a chronic disease of great clinical and economic significance for both the healthcare system and patients themselves. To determine the consumption of medical resources for treatment and care of HF patients and to estimate the related costs. The study involved 400 primary care practices and 396 specialist outpatient clinics, as well as 259 hospitals at all reference levels. The sample was representative and supplemented with patient interview data. Based on the consumption of particular resources and the unit costs of services in 2011, costs of care for HF patients in Poland were estimated. Separate analyses were conducted depending on the stage of the disease (according to NYHA classification I-IV). The public payer's perspective and a one year time horizon were adopted. Direct annual costs of an HF patient's treatment in Poland may range between PLN 3,373.23 and 7,739.49 (2011), the main cost item being hospitalisation. The total costs for the healthcare system could be as high as PLN 1,703 million, which is 3.16% of the National Health Fund's budget (Ex. rate from 05.03.2012: 1 EUR = 4.14 PLN). The costs of treating heart failure in Poland are high; proper allocation of resources to diagnostic procedures and treatment may contribute to rationalisation of the relevant expenditure.

  12. The Role of District Office Leaders in the Adoption and Implementation of the Common Core State Standards in Elementary Schools

    Science.gov (United States)

    Durand, Francesca T.; Lawson, Hal A.; Wilcox, Kristen Campbell; Schiller, Kathryn S.

    2016-01-01

    Purpose: This multiple case study investigated district leaders' orientations and strategies as their elementary schools proceeded with state-mandated implementation of the Common Core State Standards (CCSS). We identified differences between schools achieving above-predicted outcomes on state CCSS assessments ("odds-beaters") and…

  13. Health economic analysis of human papillomavirus vaccines in women of Chile: perspective of the health care payer using a Markov model.

    Science.gov (United States)

    Gomez, Jorge Alberto; Lepetic, Alejandro; Demarteau, Nadia

    2014-11-26

    In Chile, significant reductions in cervical cancer incidence and mortality have been observed due to implementation of a well-organized screening program. However, it has been suggested that the inclusion of human papillomavirus (HPV) vaccination for young adolescent women may be the best prospect to further reduce the burden of cervical cancer. This cost-effectiveness study comparing two available HPV vaccines in Chile was performed to support decision making on the implementation of universal HPV vaccination. The present analysis used an existing static Markov model to assess the effect of screening and vaccination. This analysis includes the epidemiology of low-risk HPV types allowing for the comparison between the two vaccines (HPV-16/18 AS04-adjuvanted vaccine and the HPV-6/11/16/18 vaccine), latest cross-protection data on HPV vaccines, treatment costs for cervical cancer, vaccine costs and 6% discounting per the health economic guideline for Chile. Projected incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICERs) for the HPV-16/18 AS04-adjuvanted vaccine was 116 United States (US) dollars per quality-adjusted life years (QALY) gained or 147 US dollars per life-years (LY) saved, while the projected ICUR/ICER for the HPV-6/11/16/18 vaccine was 541 US dollars per QALY gained or 726 US dollars per LY saved. Introduction of any HPV vaccine to the present cervical cancer prevention program of Chile is estimated to be highly cost-effective (below 1X gross domestic product [GDP] per capita, 14278 US dollars). In Chile, the addition of HPV-16/18 AS04-adjuvanted vaccine to the existing screening program dominated the addition of HPV-6/11/16/18 vaccine. In the probabilistic sensitivity analysis results show that the HPV-16/18 AS04-adjuvanted vaccine is expected to be dominant and cost-saving in 69.3% and 77.6% of the replicates respectively. The findings indicate that the addition of any HPV vaccine to the current cervical screening

  14. The economic burden of dry eye disease in the United States: a decision tree analysis.

    Science.gov (United States)

    Yu, Junhua; Asche, Carl V; Fairchild, Carol J

    2011-04-01

    The aim of this study was to estimate both the direct and indirect annual cost of managing dry eye disease (DED) in the United States from a societal and a payer's perspective. A decision analytic model was developed to estimate the annual cost for managing a cohort of patients with dry eye with differing severity of symptoms and treatment. The direct costs included ocular lubricants, cyclosporine, punctal plugs, physician visits, and nutritional supplements. The indirect costs were measured as the productivity loss because of absenteeism and presenteeism. The model was populated with data that were obtained from surveys that were completed by dry eye sufferers who were recruited from online databases. Sensitivity analyses were employed to evaluate the impact of changes in parameters on the estimation of costs. All costs were converted to 2008 US dollars. Survey data were collected from 2171 respondents with DED. Our analysis indicated that the average annual cost of managing a patient with dry eye at $783 (variation, $757-$809) from the payers' perspective. When adjusted to the prevalence of DED nationwide, the overall burden of DED for the US healthcare system would be $3.84 billion. From a societal perspective, the average cost of managing DED was estimated to be $11,302 per patient and $55.4 billion to the US society overall. DED poses a substantial economic burden on the payer and on the society. These findings may provide valuable information for health plans or employers regarding budget estimation.

  15. The OSHA Communication Standard and State Right-to-Know Laws.

    Science.gov (United States)

    Roll, Michalene H.

    1990-01-01

    As a result of a 1988 federal appellate court mandate, schools and colleges in 24 states and 2 territories with OSHA-approved state plans must inform their employees about hazardous chemicals to which they may be exposed. School administrators should implement a responsible program meeting regulatory compliance, tort liability, and public…

  16. 77 FR 24139 - State Community Development Block Grant Program: Administrative Rule Changes

    Science.gov (United States)

    2012-04-23

    ... their regulatory actions on state, local, and tribal governments and the private sector. This final rule does not impose a federal mandate on any state, local, or tribal government, or the private sector... additional burden on the already heavy CDBG administrative workload. Another commenter suggested that the...

  17. A Study of State Social Studies Standards for American Indian Education

    Science.gov (United States)

    Warner, Connor K.

    2015-01-01

    In this study the author surveys social studies standards from 14 U.S. states seeking to answer: (a) what social studies knowledge about American Indians is deemed essential by those states mandating the development of American Indian Education curricula for all public K-12 students? and (b) at what grade levels is this social studies content…

  18. Implications of State Policy Changes on Mental Health Service Models for Students with Disabilities

    Science.gov (United States)

    Lawson, Janelle E.; Cmar, Jennifer L.

    2016-01-01

    For over 25 years, students with disabilities in California received educationally related mental health services through interagency collaboration between school districts and county mental health agencies. After a major change in state policy that eliminated state-mandated interagency collaboration, school districts in California are now solely…

  19. Alliance Helps States Map New Terrain in Educator Evaluation. REL West Research Digest

    Science.gov (United States)

    Regional Educational Laboratory West, 2014

    2014-01-01

    About five years ago, states across the country took on the huge, complex task of developing and implementing new systems to evaluate teacher and principal performance in public schools. In response to a federal mandate aimed at improving student achievement, especially in the lowest performing schools, state boards of education drafted high-level…

  20. Comparison of Outcomes before and after Ohio's Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Ushma D Upadhyay

    2016-08-01

    Full Text Available In February 2011, an Ohio law took effect mandating use of the United States Food and Drug Administration (FDA-approved protocol for mifepristone, which is used with misoprostol for medication abortion. Other state legislatures have passed or enacted similar laws requiring use of the FDA-approved protocol for medication abortion. The objective of this study is to examine the association of this legal change with medication abortion outcomes and utilization.We used a retrospective cohort design, comparing outcomes of medication abortion patients in the prelaw period to those in the postlaw period. Sociodemographic and clinical chart data were abstracted from all medication abortion patients from 1 y prior to the law's implementation (January 2010-January 2011 to 3 y post implementation (February 2011-October 2014 at four abortion-providing health care facilities in Ohio. Outcome data were analyzed for all women undergoing abortion at ≤49 d gestation during the study period. The main outcomes were as follows: need for additional intervention following medication abortion (such as aspiration, repeat misoprostol, and blood transfusion, frequency of continuing pregnancy, reports of side effects, and the proportion of abortions that were medication abortions (versus other abortion procedures. Among the 2,783 medication abortions ≤49 d gestation, 4.9% (95% CI: 3.7%-6.2% in the prelaw and 14.3% (95% CI: 12.6%-16.0% in the postlaw period required one or more additional interventions. Women obtaining a medication abortion in the postlaw period had three times the odds of requiring an additional intervention as women in the prelaw period (adjusted odds ratio [AOR] = 3.11, 95% CI: 2.27-4.27. In a mixed effects multivariable model that uses facility-months as the unit of analysis to account for lack of independence by site, we found that the law change was associated with a 9.4% (95% CI: 4.0%-18.4% absolute increase in the rate of requiring an additional

  1. Clinicians' awareness of the Affordable Care Act mandate to provide comprehensive tobacco cessation treatment for pregnant women covered by Medicaid

    Directory of Open Access Journals (Sweden)

    Van T. Tong

    2015-01-01

    Full Text Available The Affordable Care Act (ACA requires states to provide tobacco-cessation services without cost-sharing for pregnant traditional Medicaid-beneficiaries effective October 2010. It is unknown the extent to which obstetricians–gynecologists are aware of the Medicaid tobacco-cessation benefit. We sought to examine the awareness of the Medicaid tobacco-cessation benefit in a national sample of obstetricians–gynecologists and assessed whether reimbursement would influence their tobacco cessation practice. In 2012, a survey was administered to a national stratified-random sample of obstetricians–gynecologists (n = 252 regarding awareness of the Medicaid tobacco-cessation benefit. Results were stratified by the percentage of pregnant Medicaid patients. Chi-squared tests (p < 0.05 were used to assess significant associations. Analyses were conducted in 2014. Eighty-three percent of respondents were unaware of the benefit. Lack of awareness increased as the percentage of pregnant Medicaid patients in their practices decreased (range = 71.9%–96.8%; P = 0.02. One-third (36.1% of respondents serving pregnant Medicaid patients reported that reimbursement would influence them to increase their cessation services. Four out of five obstetricians–gynecologists surveyed in 2012 were unaware of the ACA provision that required states to provide tobacco cessation coverage for pregnant traditional Medicaid beneficiaries as of October 2010. Broad promotion of the Medicaid tobacco-cessation benefit could reduce treatment barriers.

  2. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

    OpenAIRE

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2014-01-01

    Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Karen Schneider,4 Tim Holt,5 John Cummings Jr6 1Covance Market Access Services Inc., San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc., Gaithersburg, MD, USA; 4Covance Market Access Services Inc., Sydney, Australia; 5Montgomery Spine Center, Orthopedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low ba...

  3. Continental Illinois National Bank v. Washington: does the contract clause mandate the completion of nuclear power plants at all costs

    International Nuclear Information System (INIS)

    Snowden, E.A.

    1984-01-01

    Although the Washington Public Power Supply System (WPPSS)/Bonneville Power Administration (BPA) contracts were substantially impaired, the reasoning by which the Ninth Circuit court found the WPPSS/bondholders contracts to be unconstitutionally impaired is flawed. Because none of the cases before or since United States Trust have found legislation unconstitutional without a showing of a substantial impairment, the case should be limited to its facts and not used as a precedent. The relative burdens imposed on the bondholders by stopping construction are small compared to the cost to the ratepayers of completing unneeded plants. The court should have upheld the cost study requirement of Initiative 394 even if it believed the voter approval requirement was unjustified. The cost study requirement's impairment of the contracts was negligible or nonexistant. 130 references

  4. Morality and Intimate Partner Violence: Do Men in Court-Mandated Psychological Treatment Hold a Sacred Moral Vision of the World and Themselves?

    Science.gov (United States)

    Vecina, María L; Chacón, José C

    2016-01-01

    This article examines the characterization of men in a court-mandated treatment for violence against their partners as holding a sacred vision of the 5 moral foundations and of their own morality. This characterization is compatible with the assumption that a sacred moral world is easily threatened by reality and that may be associated to violent defensive actions. The results from latent class analyses reveal (a) a 4-class distribution depending exclusively on the intensity with which all participants (violent and nonviolent) tend to sacralize the actions proposed in the Moral Foundations Sacredness Scale and (b) a greater prevalence of the violent participants among the classes that are more prone to sacralize. They also show that they hold an inflated moral vision of themselves: They think they are much more moral than intelligent than others who have never been charged with criminal behavior (Muhammad Ali effect).

  5. Impact assessment of WHO TobReg proposals for mandated lowering of selected mainstream cigarette smoke toxicants.

    Science.gov (United States)

    Eldridge, Alison C; McAdam, Kevin G; Betson, Tatiana R; Gama, Marcos V; Proctor, Christopher J

    2017-06-01

    The WHO Tobacco Product Regulation Study Group (TobReg) has proposed three regulatory models for cigarettes, each creating mandatory limits for emissions of nine smoke toxicants. One approach proposes country-specific limits, using median or 1.25× median toxicant/nicotine emission ratios. A second model provides fixed toxicant-ratio limits. The third model limits were three times the lowest toxicant emission on a market. Currently, the practical implications of these models are largely unknown. An impact assessment was conducted using cigarette data from 79 countries to identify four diverse test markets. We sampled all products from each market but limited product availability led to incomplete (80-97%) sourcing. Analysis showed that the country-specific model led to diverse (up to threefold) toxicant limits across the four markets. 70%-80% of products were non-compliant, rising to 100% in some countries with the second and the third models. With each regulatory model the main drivers of non-compliance were the tobacco-specific nitrosamines, the simultaneous application of limits for nine poorly correlated smoke toxicants, and analytical variability. Use of nicotine ratios led to compliance of some high toxicant emission products due to high nicotine emissions. Our findings suggest that these proposals would have greater impact on global markets than TobReg's stated aims. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  6. Expanding mandate and corporate social responsibility in the management of National Parks and protected areas in Nigeria

    Directory of Open Access Journals (Sweden)

    James Oshuo Ewak

    2011-11-01

    Full Text Available Park’s objectives in Nigeria have evolved and been added over time. Four main phases are evident: Establishment of reserves to protect game, fauna; preservation of spectacular landscapes including cultural and scientific sites for the benefit, enjoyment and education of the public (Roosevolt 1929; Conservation of biological diversity from genes to ecosystem and evolutionary processes (Decree 11 (1985 and decree 35 (1991. The last and most recent phase places increasing emphasis on the challenges of land and resource alienation on indigenous populations that answers to protected areas. The first three phases have been largely achieved through establishment of fortress conservation called National parks, reserves and Protected areas. The State’s seeming failure to meet the challenges of the fourth and recent phase has exposed the poverty of fortress conservation and threatened the integrity of protected areas. This paper posits that to sustain conservation in Nigeria and beyond, the State should establish Conservation Agency that will collaborate with conservation partners, encourage community participation and seek partnership with other stakeholders to promote rural development and capacity building amongst indigenous populations within protected areas.

  7. Bilateral communication and information exchange, an attempt relating to mandate 8 of the Dutch-German commission (NDKK)

    International Nuclear Information System (INIS)

    Salfeld, H.Ch.; Hable, K.; Kok, Y.S.; Reinen, H.A.J.M.

    2003-01-01

    Full text: According to a memorandum of understanding between Germany and the Netherlands, the NDKK has to review the existing communication methods. Proceeding from this review proposals have to be developed to improve the bilateral communication and data exchange in case of events near the German-Dutch border and more generally for every event involving nuclear facilities. The NDKK has established a working group for reviewing and working out the proposals. Members of the working group are federal institutions resp. state institutions. Within their scope of duties are emergency management and communication, data collection and communication and expert advice to stakeholders. On the Dutch side the National Institute for Public Health and the Environment (RIVM) takes part, on the German side, the Federal Office for Radiation Protection (BfS) and the Lower Saxony State Agency for Ecology (NLOE) are involved. At international level, the ECURIE (European Community Urgent Radiological Information Exchange, system of the EU) and EMERCON (Emergency Convention, system of the IAEA) are used for early notification and subsequent messaging. The designated contact points and competent authorities are VROM (Ministry of Housing, Spatial Planning and the Environment) and BMU (German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety). According to a bilateral agreement, there is an additional direct communication for emergency notification between BMU and VROM. For the exchange of radiological measurement data the EURDEP standard (European Radiological Data Exchange Platform) is applied. In addition to the multinational procedure, it has been decided to exchange data directly in order to make the exchange faster and redundant. Presently, data are exchanged on a weekly basis by ftp, using EURDEP 2.0 format. The only NPP located near the Dutch-German border is the German NPP Emsland (KKE) close to the town of Lingen. Other nuclear facilities in this area

  8. Effect of the Affordable Care Act Medicaid Expansion on Emergency Department Visits: Evidence From State-Level Emergency Department Databases.

    Science.gov (United States)

    Nikpay, Sayeh; Freedman, Seth; Levy, Helen; Buchmueller, Tom

    2017-08-01

    We assess whether the expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) results in changes in emergency department (ED) visits or ED payer mix. We also test whether the size of the change in ED visits depends on the change in the size of the Medicaid population. Using all-capture, longitudinal, state data from the Agency for Healthcare Research and Quality's Fast Stats program, we implemented a difference-in-difference analysis, which compared changes in ED visits per capita and the share of ED visits by payer (Medicaid, uninsured, and private insurance) in 14 states that did and 11 states that did not expand Medicaid in 2014. Analyses controlled for state-level demographic and economic characteristics. We found that total ED use per 1,000 population increased by 2.5 visits more in Medicaid expansion states than in nonexpansion states after 2014 (95% confidence interval [CI] 1.1 to 3.9). Among the visit types that could be measured, increases in ED visits were largest for injury-related visits and for states with the largest changes in Medicaid enrollment. Compared with nonexpansion states, in expansion states the share of ED visits covered by Medicaid increased 8.8 percentage points (95% CI 5.0 to 12.6), whereas the uninsured share decreased by 5.3 percentage points (95% CI -1.7 to -8.9). The ACA's Medicaid expansion has resulted in changes in payer mix. Contrary to other studies of the ACA's effect on ED visits, our study found that the expansion also increased use of the ED, consistent with polls of emergency physicians. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  9. THE TAX ADVANTAGES OF INCOME TAX PAYERS

    Directory of Open Access Journals (Sweden)

    SUCIU GHEORGHE

    2015-04-01

    Full Text Available The paper analyzes the cost of financing through financial and operational leasing due to the deductibility of depreciation and interest. The shareholders of any company aim to obtain profit and to increase their ownership equity. In order for this to happen, the company must have profit, for which a corporate tax must be paid. A good management translates into choosing the most advantageous means of financing, which will lead to paying a lower corporate tax. Leasing and the non-taxation of reinvested profits are two means through which companies can obtain significant fiscal advantages, by increasing the deductible expenses, or by paying lower taxes.

  10. Diabetes benefit management: evolving strategies for payers.

    Science.gov (United States)

    Tzeel, Albert L

    2011-11-01

    Over the next quarter century, the burden of type 2 diabetes mellitus (T2DM) is expected to at least double. Currently, 1 in every 10 healthcare dollars is spent on diabetes management; by 2050, it has been projected that the annual costs of managing T2DM will rise to $336 billion. Without substantial, systemic changes, T2DM management costs will lead to a potentially untenable strain on the healthcare system. However, the appropriate management of diabetes can reduce associated mortality and delay comorbidities. In addition, adequate glycemic control can improve patient outcomes and significantly reduce diabetes-related complications. This article provides an overview of key concepts associated with a value-based insurance design (VBID) approach to T2DM coverage. By promoting the use of services or treatments that provide high benefits relative to cost, and by alternatively discouraging patients from utilizing services whose benefits do not justify their cost, VBID improves the quality of healthcare while simultaneously reining in spending. VBID initiatives tend to focus on chronic disease management and generally target prescription drug use. However, some programs have expanded their scope by incorporating services traditionally offered by wellness and disease management programs. The concept of VBID is growing, and it is increasingly being implemented by a diverse and growing number of public and private entities, including pharmacy benefit managers, health plans, and employers. This article provides key background on VBID strategies, with a focus on T2DM management. It also provides a road map for health plans seeking to implement VBID as part of their programs.

  11. Transforming the tobacco market: why the supply of cigarettes should be transferred from for-profit corporations to non-profit enterprises with a public health mandate.

    Science.gov (United States)

    Callard, C; Thompson, D; Collishaw, N

    2005-08-01

    Current tobacco control strategies seek primarily to decrease the demand for cigarettes through measures that encourage individuals to adopt healthier behaviours. These measures are impeded and undermined by tobacco corporations, whose profit drive compels them to seek to maintain and expand cigarette sales. Tobacco corporations seek to expand cigarette sales because they are for-profit business corporations and are obliged under law to maximise profits, even when this results in harm to others. It is not legally possible for a for-profit corporation to relinquish its responsibility to make profits or for it to temper this obligation with responsibilities to support health. Tobacco could be supplied through other non-profit enterprises. The elimination of profit driven behaviour from the supply of tobacco would enhance the ability of public health authorities to reduce tobacco use. Future tobacco control strategies can seek to transform the tobacco market from one occupied by for-profit corporations to one where tobacco is supplied by institutions that share a health mandate and will help to reduce smoking and smoking related disease and death.

  12. When states regulate emergency contraceptives like abortion, what should guide disclosure?

    Science.gov (United States)

    Flynn, Cameron O'Brien; Wilson, Robin Fretwell

    2015-01-01

    State laws dictating "informed consent" about surgical and chemical abortions sometimes ensnare emergency contraceptives (EC), as the science surrounding EC shows. Courts evaluating mandated disclosures gravitate to professional norms rather than the information most women would value: basic factual information about EC so that they can decide for themselves whether to use these drugs. © 2015 American Society of Law, Medicine & Ethics, Inc.

  13. Existing and Proposed Child Find Initiatives in One State's Part C Program

    Science.gov (United States)

    Edwards, Nicole Megan; Gallagher, Peggy A.; Green, Katherine B.

    2013-01-01

    Despite a Child Find mandate in IDEA, early detection and screening of infants and toddlers with special needs continues to remain an area in need of improvement. The authors sought to better understand existing and proposed outreach initiatives in one state's Part C Early Intervention (EI) program that ranks among the lowest nationally in the…

  14. Teacher Compliance and Accuracy in State Assessment of Student Motor Skill Performance

    Science.gov (United States)

    Hall, Tina J.; Hicklin, Lori K.; French, Karen E.

    2015-01-01

    Purpose: The purpose of this study was to investigate teacher compliance with state mandated assessment protocols and teacher accuracy in assessing student motor skill performance. Method: Middle school teachers (N = 116) submitted eighth grade student motor skill performance data from 318 physical education classes to a trained monitoring…

  15. La implementación de programas de educación en medios: el caso Ontario Implementing Mandates in Media Education: The Ontario Experience

    Directory of Open Access Journals (Sweden)

    Barry Duncan

    2009-03-01

    Full Text Available Este artículo expone un informe sobre la educación en alfabetización mediática en Ontario. Brinda una visión general del plan de estudios para la alfabetización mediática propuesta por el gobierno regional. Específicamente, describe varias aproximaciones para la enseñanza acerca de los medios, así como la teoría que apuntala los documentos del plan de estudios y las prácticas en el aula. También describe el trabajo de organizaciones y asociaciones clave que ayudaron a priorizar la educación en alfabetización mediática, y ofrece sugerencias para el desarrollo exitoso y la implementación de programas de alfabetización mediática. La conclusión discute los retos y el curso futuro de la alfabetización mediática más allá del caso Ontario, centrándose en nueve tesis clave para el éxito en su implementación en todo el mundo. This analysis presents a report on media literacy education in Ontario. It provides an overview of the curriculum for media literacy that is mandated by the provincial government. Specifically, it describes various approaches for teaching about the media as well as the theory that underpins curriculum documents and classroom practices. The analysis also describes the work of key organizations and partnerships that helped prioritize media literacy education, and offers suggestions for the successful development and implementation of media literacy programs. The conclusion discusses the challenges and future directions for media literacy beyond the Ontario case, focusing on nine key tenets for success in its implementation worldwide.

  16. Cost analysis of LEED certified United States navy buildings

    OpenAIRE

    Kirar, Carl V.

    2011-01-01

    CIVINS (Civilian Institutions) Thesis document A study was completed at UW-Madison in 2010 that reviewed the energy consumption of US Navy buildings which earned Leadership in Energy and Environmental Design (LEED) certification by the United States Green Building Council (USGBC). The research compared LEED certified buildings to a commercial counterpart within the US Navy inventory against Executive Order (EO) 13423. The EO mandated that all federal agencies meet a 30 percent reduction of...

  17. Is the swiss health care system a model for the United States?

    Science.gov (United States)

    Chaufan, Claudia

    2014-01-01

    Both supporters and critics of the Patient Protection and Affordable Care Act (ACA) have argued that it is similar to Switzerland's Federal Law on Health Insurance (LAMal), which currently governs Swiss health care, and have either praised or condemned the ACA on the basis of this alleged similarity. I challenge these observers on the grounds that they overlook critical problems with the Swiss model, such as its inequities in access, and critical differences between it and the ACA, such as the roots in, and continuing commitment to, social insurance of the Swiss model. Indeed, the daunting challenge of attempting to impose the tightly regulated model of operation of the Swiss model on mega-corporations like UnitedHealth, WellPoint, or Aetna is likely to trigger no less ferocious resistance than a fully public, single-payer system would. I also conclude that the ACA might unravel in ways unintended or even opposed by its designers and supporters, as employers, confronted with ever-rising costs, retreat from sponsoring insurance, and workers react in outrage as they confront the unaffordable underinsurance mandated by the ACA. A new political and ideological landscape may then ensue that finally ushers in a truly national health program.

  18. A Case Study of the Alignment between Curriculum and Assessment in the New York State Earth Science Standards-Based System

    Science.gov (United States)

    Contino, Julie

    2013-01-01

    In a standards-based system, it is important for all components of the system to align in order to achieve the intended goals. No Child Left Behind law mandates that assessments be fully aligned with state standards, be valid, reliable and fair, be reported to all stakeholders, and provide evidence that all students in the state are meeting the…

  19. Moving beyond Compliance: Promoting Research-Based Professional Discretion in the Implementation of the Common Core State Standards in English Language Arts

    Science.gov (United States)

    Woodard, Rebecca; Kline, Sonia

    2015-01-01

    State- and local-level mandates are currently being implemented to ensure strict compliance to the new national Common Core State Standards for English Language Arts (CCSS for ELA) and related assessments. These standards provide many potential opportunities to improve literacy education nationally and locally. However, the CCSS for ELA will…

  20. Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence.

    Science.gov (United States)

    Jiwani, Aliya; Himmelstein, David; Woolhandler, Steffie; Kahn, James G

    2014-11-13

    The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375

  1. Analysis of the feasibility of inclusion of decentralised renewable electricity systems into a mandated market share mechanism for China. Executive summary

    International Nuclear Information System (INIS)

    Van der Linden, N.H.; Junfeng, L.; Keyun, D.; Martens, J.W.; Ramani, K.V.; Sicheng, W.; Shutian, W.; Tak, C. van der

    2003-09-01

    The World Bank and the Global Environment Facility provide assistance to the Government of China with the implementation of the renewable energy programme during the 10th and 11th Five Year Plans. To this end, the China Renewable Energy Scale-up Programme (CRESP) was set up. CRESP is managed by the Project Management Office (PMO), which is institutionally placed in the National Development and Planning Commission (NDRC). One of the first activities initiated by CRESP is the development of the institutional framework within which the Mandated Market System (MMS) policy for renewable energy can be introduced. An MMS policy is based on the requirement that a set amount (or proportion) of the electricity supply is produced from renewable energy sources. The obligation is placed at some point in the supply chain, which could range from production, through transmission to supply or consumption. Monitoring procedures are put in place to ensure that the obligation will be met. Environmental considerations are the main reason behind the intention to introduce an MMS in China but the government has also recognised the importance of (renewable) energy to achieving poverty objectives. Decentralised renewable electricity systems (DRES) have special relevance for rural poor communities that are unserved or underserved by centralised fossil fuel networks or utility electricity grids. DRES may offer a promising solution to meet demand for energy services of these communities in remote location, which cannot be reach by the electricity grid. The analysis in this study focused on mini-hydro (less than 10 kW), solar home systems and stand-alone wind turbines. The principal objective of the study is to analyse the feasibility of inclusion of DRES into the proposed MMS for China. Because DRES are often used in remote areas, which are difficult to reach, the costs of verifying these systems are prohibitive if the procedures are not sufficiently simple and efficient. Therefore

  2. Analysis of the feasibility of inclusion of decentralised renewable electricity systems into a mandated market share mechanism for China. Final Report

    International Nuclear Information System (INIS)

    Van der Linden, N.H.; Junfeng, L.; Keyun, D.; Martens, J.W.; Ramani, K.V.; Sicheng, W.; Shutian, W.; Tak, C. van der

    2003-10-01

    The World Bank and the Global Environment Facility provide assistance to the Government of China with the implementation of the renewable energy programme during the 10th and 11th Five Year Plans. To this end, the China Renewable Energy Scale-up Programme (CRESP) was set up. CRESP is managed by the Project Management Office (PMO), which is institutionally placed in the National Development and Planning Commission (NDRC). One of the first activities initiated by CRESP is the development of the institutional framework within which the Mandated Market System (MMS) policy for renewable energy can be introduced. An MMS policy is based on the requirement that a set amount (or proportion) of the electricity supply is produced from renewable energy sources. The obligation is placed at some point in the supply chain, which could range from production, through transmission to supply or consumption. Monitoring procedures are put in place to ensure that the obligation will be met. Environmental considerations are the main reason behind the intention to introduce an MMS in China but the government has also recognised the importance of (renewable) energy to achieving poverty objectives. Decentralised renewable electricity systems (DRES) have special relevance for rural poor communities that are unserved or underserved by centralised fossil fuel networks or utility electricity grids. DRES may offer a promising solution to meet demand for energy services of these communities in remote location, which cannot be reach by the electricity grid. The analysis in this study focused on mini-hydro (less than 10 kW), solar home systems and stand-alone wind turbines. The principal objective of the study is to analyse the feasibility of inclusion of DRES into the proposed MMS for China. Because DRES are often used in remote areas, which are difficult to reach, the costs of verifying these systems are prohibitive if the procedures are not sufficiently simple and efficient. Therefore

  3. Regional growth management policies: Toward reducing global warming at state and local levels

    International Nuclear Information System (INIS)

    Purdie, J.

    1995-01-01

    State and local governments in the United States are accepting mandates to coordinate legislated land use and growth management planning with vigorous environmental protection and resource conservation. These mandates, implemented or planned in states with populations totaling over 100 million, will directly impact growth patterns and ultimately affect the level of atmospheric gases and particulates generated within their borders. This paper addresses the issues of growth management and land use planning at the local, state and regional levels and identifies areas impacting global warming. A review of existing systems will be presented, and recommendations will be made to improve monitoring of growth management mechanisms and organizational structures with the goal of global atmospheric improvement. The issues discussed include urban sprawl, transportation, and growth patterns as managed by policies also designed to protect environments and provide for sustainable growth. Areas for improved coordination between jurisdictions to ease global warming will also be examined

  4. Colonial Guilt and the Recycling of Oppression: The Merit of Unofficial History in Transforming the State's Narrative

    Science.gov (United States)

    Habashi, Janette

    2012-01-01

    This article juxtaposes colonial guilt with selective historical memory of Palestinian narratives as presented in the Israeli state-mandated history textbooks. The advancement of colonial guilt imposes a particular subjective truth of oppressed groups' historical memories. The purpose of colonial guilt is to keep the power structure intact by…

  5. Nutrition Education Needs Assessment for Licensed Group Day Care Centers in the State of Utah

    OpenAIRE

    Barksdale, Almina

    1980-01-01

    In November 1977 Congress established the Nutrition Education and Training Program (NETP) with the passage of Public Law 95-166. Section 227.37 of the NETP Regulations (1978) mandates that each state establish a plan of action for the use of any federally appropriated funds earmarked for "nutrition education" , and further, the plan should contain a proposal to instruct all students in the state about the nutritional value of foods as well as the relationship between food , nutrition, and hea...

  6. Evaluating U.S. States climate change initiatives

    Energy Technology Data Exchange (ETDEWEB)

    Silva, P

    2004-07-01

    This paper evaluates sub-federal efforts to mitigate climate change in the United States through a range of climate-relevant initiatives, identifying principal trends and detailing climate-relevant initiatives in several states. These strategies include renewable electricity mandates, State and regional greenhouse gas emissions inventories, mandatory greenhouse gas emissions reporting, State greenhouse gas emissions caps, greenhouse gas emissions reductions from motor vehicles, and greenhouse gas emissions cap-and-trade programs for electric generation in several States. Many municipalities in the United States are also pursuing a range of climate-relevant initiatives, those actions are beyond the scope of this paper, but it should be noted they also influence state and national consideration of climate-relevant initiatives in the United States. (author)

  7. Evaluating U.S. States climate change initiatives

    International Nuclear Information System (INIS)

    Silva, P.

    2004-01-01

    This paper evaluates sub-federal efforts to mitigate climate change in the United States through a range of climate-relevant initiatives, identifying principal trends and detailing climate-relevant initiatives in several states. These strategies include renewable electricity mandates, State and regional greenhouse gas emissions inventories, mandatory greenhouse gas emissions reporting, State greenhouse gas emissions caps, greenhouse gas emissions reductions from motor vehicles, and greenhouse gas emissions cap-and-trade programs for electric generation in several States. Many municipalities in the United States are also pursuing a range of climate-relevant initiatives, those actions are beyond the scope of this paper, but it should be noted they also influence state and national consideration of climate-relevant initiatives in the United States. (author)

  8. State of the States

    Science.gov (United States)

    Journal of Education Finance, 2017

    2017-01-01

    In 2016, a group of school finance scholars and public school practitioners gathered in Jacksonville, Florida, for the National Education Finance Academy's annual conference to discuss, among an array of topics, the state of P-20 finance in all 50 states. At the roundtable discussion, 36 states were represented, and scholars representing 30 states…

  9. Midwife-attended births in the United States, 1990-2012: results from revised birth certificate data.

    Science.gov (United States)

    Declercq, Eugene

    2015-01-01

    Data on attendance at birth by midwives in the United States have been available on the national level since 1989, allowing for the documentation of long-term trends. New items on payer source and prepregnancy body mass index (BMI) from a 2003 revision of the birth certificate provide an opportunity to examine additional aspects of US midwifery practice. The data in this report are based on records on birth attendant gathered as part of the US National Standard Certificate of Live Birth from a public use Web site, Vital Stats (http://www.cdc.gov/nchs/VitalStats.htm), which allows users to create and download specialized tables. Analysis of new items on prepregnancy BMI and birth payer source are limited to the 38 states (86% of US births) that adopted the revised birth certificate by 2012. Between 1989 and 2012, the proportion of all births attended by certified nurse-midwives (CNMs) increased from 3.3% to 7.9%. The proportion of vaginal births attended by CNMs reached an all-time high of 11.9%. Births attended by "other midwives" (typically certified professional midwives) rose to a peak of 28,343, or 0.7% of all US births. The distribution of payer source for CNM-attended births (44% Medicaid; 44% private insurance; 6% self-pay) is very similar to the national distribution, whereas the majority (53%) of births attended by other midwives are self-pay. Women whose births are attended by other midwives are less likely (13%) to have a prepregnancy BMI in the obese range than women attended by CNMs (19%) or overall (24%). The total number of births attended by CNMs and other midwives has remained steady or grown at a time when total US births have declined, resulting in the largest proportions of midwife-attended births in the quarter century that such data have been collected. © 2015 by the American College of Nurse-Midwives.

  10. Medical Device Regulation: A Comparison of the United States and the European Union.

    Science.gov (United States)

    Maak, Travis G; Wylie, James D

    2016-08-01

    Medical device regulation is a controversial topic in both the United States and the European Union. Many physicians and innovators in the United States cite a restrictive US FDA regulatory process as the reason for earlier and more rapid clinical advances in Europe. The FDA approval process mandates that a device be proved efficacious compared with a control or be substantially equivalent to a predicate device, whereas the European Union approval process mandates that the device perform its intended function. Stringent, peer-reviewed safety data have not been reported. However, after recent high-profile device failures, political pressure in both the United States and the European Union has favored more restrictive approval processes. Substantial reforms of the European Union process within the next 5 to 10 years will result in a more stringent approach to device regulation, similar to that of the FDA. Changes in the FDA regulatory process have been suggested but are not imminent.

  11. Independence and interdependence predict health and wellbeing: divergent patterns in the United States and Japan

    Directory of Open Access Journals (Sweden)

    Shinobu Kitayama

    2010-12-01

    Full Text Available A cross-cultural survey was used to examine two hypotheses designed to link culture to well-being and health. The first hypothesis states that people are motivated toward prevalent cultural mandates of either independence (personal control in the United States or interdependence (relational harmony in Japan. As predicted, Americans with compromised personal control and Japanese with strained relationships reported high perceived constraint. The second hypothesis holds that people achieve well-being and health through actualizing the respective cultural mandates in their modes of being. As predicted, the strongest predictor of well-being and health was personal control in the United States, but the absence of relational strain in Japan. All analyses controlled for age, gender, and personality traits. The overall pattern of findings underscores culturally distinct pathways (independent versus interdependent in achieving these positive life outcomes.

  12. State oil companies have diverse strategies

    International Nuclear Information System (INIS)

    Anon.

    1994-01-01

    The Journal's series on state-owned oil companies continues with profiles on seven more companies which already are, or could be, important players in the international oil industry. The first part of this series appeared last August. It featured the world's producing giants. This installment shows that national oil companies are definitely not cut from the same mold and that they have diverse mandates from their countries or have developed unusual niches in the oil world. The objective of these profiles is not to fully cover the plans and performance of such companies. That is done regularly in weekly editions of OGJ. Rather, these articles are written by a team of experienced Journal editors to characterize the individual companies, describe their mandates and organization, and present some professional background information, when available, on those in top management with the hope of getting some insight into the corporate cultures. The companies covered come from Brazil, China, Finland, Japan, Norway, Oman, and Vietnam. In addition the article profiles Borealis Holding A/S, created from the merger of two state companies from Norway and Finland

  13. The value of atorvastatin over the product life cycle in the United States.

    Science.gov (United States)

    Grabner, Michael; Johnson, Wallace; Abdulhalim, Abdulla M; Kuznik, Andreas; Mullins, C Daniel

    2011-10-01

    US health care reform mandates the reduction of wasteful health care spending while maintaining quality of care. Introducing new drugs into crowded therapeutic classes may be viewed as offering "me-too" (new drugs with a similar mechanism of action compared to existing drugs) drugs without incremental benefit. This article presents an analysis of the incremental costs and benefits of atorvastatin, a lipid-lowering agent. This analysis models the cost-effectiveness of atorvastatin over the product life cycle. The yearly cost-effectiveness of atorvastatin compared to simvastatin was modeled from 1997 to 2030 from the point of view of a US third-party payer. Estimates for incremental costs (in US $) and effects (in quality-adjusted life-years [QALYs]) for the primary and secondary prevention of cardiovascular events were taken from previously published literature and adjusted for changes in drug prices over time. Estimates of total statin use were derived using the National Health and Nutrition Examination Survey. Sensitivity analyses were conducted to examine variations in study parameters, including drug prices, indications, and discount rates. Assuming increasing statin use over time (with a mean of 1.07 million new users per year) and a 3% discount rate, the cumulative incremental cost-effectiveness ratio (ICER) of atorvastatin versus simvastatin ranged from cost-savings at release to a maximum of $45,066/QALY after 6 years of generic simvastatin use in 2012. Over the full modeled life cycle (1997-2030), the cumulative ICER of atorvastatin was $20,331/QALY. The incremental value of atorvastatin to US payers (after subtracting costs) was estimated at $44.57 to $194.78 billion, depending on willingness to pay. Findings from the sensitivity analyses were similar. A hypothetical situation in which atorvastatin did not exist was associated with a reduction in total expenditures but also a loss of QALYs gained. The cumulative ICER of atorvastatin varied across the

  14. Reporting of Sepsis Cases for Performance Measurement Versus for Reimbursement in New York State.

    Science.gov (United States)

    Prescott, Hallie C; Cope, Tara M; Gesten, Foster C; Ledneva, Tatiana A; Friedrich, Marcus E; Iwashyna, Theodore J; Osborn, Tiffany M; Seymour, Christopher W; Levy, Mitchell M

    2018-05-01

    Under "Rory's Regulations," New York State Article 28 acute care hospitals were mandated to implement sepsis protocols and report patient-level data. This study sought to determine how well cases reported under state mandate align with discharge records in a statewide administrative database. Observational cohort study. First 27 months of mandated sepsis reporting (April 1, 2014, to June 30, 2016). Hospitalizations with sepsis at New York State Article 28 acute care hospitals. Sepsis regulations with mandated reporting. We compared cases reported to the New York State Department of Health Sepsis Clinical Database with discharge records in the Statewide Planning and Research Cooperative System database. We classified discharges as 1) "coded sepsis discharges"-a diagnosis code for severe sepsis or septic shock and 2) "possible sepsis discharges," using Dombrovskiy and Angus criteria. Of 111,816 sepsis cases reported to the New York State Department of Health Sepsis Clinical Database, 105,722 (94.5%) were matched to discharge records in Statewide Planning and Research Cooperative System. The percentage of coded sepsis discharges reported increased from 67.5% in the first quarter to 81.3% in the final quarter of the study period (mean, 77.7%). Accounting for unmatched cases, as many as 82.7% of coded sepsis discharges were potentially reported, whereas at least 17.3% were unreported. Compared with unreported discharges, reported discharges had higher rates of acute organ dysfunction (e.g., cardiovascular dysfunction 63.0% vs 51.8%; p New York State Department of Health Sepsis Clinical Database. Incomplete reporting appears to be driven more by underrecognition than attempts to game the system, with minimal bias to risk-adjusted hospital performance measurement.

  15. State insurance parity legislation for autism services and family financial burden.

    Science.gov (United States)

    Parish, Susan; Thomas, Kathleen; Rose, Roderick; Kilany, Mona; McConville, Robert

    2012-06-01

    We examined the association between states' legislative mandates that private insurance cover autism services and the health care-related financial burden reported by families of children with autism. Child and family data were drawn from the National Survey of Children with Special Health Care Needs (N  =  2,082 children with autism). State policy characteristics were taken from public sources. The 3 outcomes were whether a family had any out-of-pocket health care expenditures during the past year for their child with autism, the expenditure amount, and expenditures as a proportion of family income. We modeled the association between states' autism service mandates and families' financial burden, adjusting for child-, family-, and state-level characteristics. Overall, 78% of families with a child with autism reported having any health care expenditures for their child for the prior 12 months. Among these families, 54% reported expenditures of more than $500, with 34% spending more than 3% of their income. Families living in states that enacted legislation mandating coverage of autism services were 28% less likely to report spending more than $500 for their children's health care costs, net of child and family characteristics. Families living in states that enacted parity legislation mandating coverage of autism services were 29% less likely to report spending more than $500 for their children's health care costs, net of child and family characteristics. This study offers preliminary evidence in support of advocates' arguments that requiring private insurers to cover autism services will reduce families' financial burdens associated with their children's health care expenses.

  16. A Consideration of What Educational Faculty Need to Know and Be Able to Do: Federal and State Policies and Best Practices for Collaborative Preparation Programs

    Science.gov (United States)

    Grenot-Scheyer, Marquita; Coots, Jennifer J.; Bishop-Smith, Kathryn

    2004-01-01

    This article addresses how teacher preparation programs can best respond to the broad, complex calls for reform in ways that are locally meaningful and honor academic integrity, but that are also true to the intent of the reform mandates. The authors begin with an overview of some of the federal and state initiatives that are presenting challenges…

  17. Patient access to new cancer drugs in the United States and Australia.

    Science.gov (United States)

    Wilson, Andrew; Cohen, Joshua

    2011-01-01

    In light of the current debate on the use value and potential impact of comparative effectiveness research on patient access, it may prove insightful to compare a health-care system that systematically bases its reimbursement decisions on comparative effectiveness evidence with the United States (US) system that hitherto has only been informed by such evidence on an ad hoc basis. For a set of 2000-2009 approved new molecular entities and biologics indicated for cancer, we compared patient access between US Medicare and Australian Pharmaceutical Benefits Scheme (PBS) beneficiaries. Here, access is defined in terms of marketing availability, payer coverage, and patient out-of-pocket costs. Although 34 drugs and biologics were approved for cancer in the US, just more than one-third (35%) were ultimately covered by the Australian PBS. The PBS also placed more restrictions on use. On the other hand, prices and patient out-of-pocket costs were greater for the US Medicare population. Our analysis points to a possible trade-off in market access to oncology drugs. Although more oncology drugs are available in the US and a higher percentage of available drugs are covered, the evidence-based approach adopted by Australia has contributed to reduced prices, thereby improving affordability for payers and patients for those medications deemed cost-effective by the reimbursement authority. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  18. State funding for local public health: observations from six case studies.

    Science.gov (United States)

    Potter, Margaret A; Fitzpatrick, Tiffany

    2007-01-01

    The purpose of this study is to describe state funding of local public health within the context of state public health system types. These types are based on administrative relationships, legal structures, and relative proportion of state funding in local public health budgets. We selected six states representing various types and geographic regions. A case study for each state summarized available information and was validated by state public health officials. An analysis of the case studies reveals that the variability of state public health systems--even within a given type--is matched by variability in approaches to funding local public health. Nevertheless, some meaningful associations appear. For example, higher proportions of state funding occur along with higher levels of state oversight and the existence of local service mandates in state law. These associations suggest topics for future research on public health financing in relation to local accountability, local input to state priority-setting, mandated local services, and the absence of state funds for public health services in some local jurisdictions.

  19. Evaluation of the Impact of Mandating Health Care Providers to Offer Hepatitis C Virus Screening to All Persons Born During 1945-1965 - New York, 2014.

    Science.gov (United States)

    Flanigan, Colleen A; Leung, Shu-Yin J; Rowe, Kirsten A; Levey, Wendy K; King, Andrea; Sommer, Jamie N; Morne, Johanne E; Zucker, Howard A

    2017-09-29

    Approximately 75% of all hepatitis C virus (HCV) infections in the United States and 73% of HCV-associated mortality occur in persons born during 1945-1965, placing this birth cohort at increased risk for liver cancer and other HCV-related liver disease (1). In the United States, an estimated 2.7 million persons are living with HCV infection, and it is estimated that up to 75% of these persons do not know their status. Since 2012, CDC has recommended that persons born during 1945-1965 receive one-time HCV testing. To increase the number of persons tested for HCV and to ensure timely diagnosis and linkage to care, in 2014, New York enacted a hepatitis C testing law that requires health care providers to offer HCV antibody screening to all persons born during 1945-1965 who are receiving services in primary care settings or as hospital inpatients, and to refer persons with positive HCV antibody tests for follow-up health care, including an HCV diagnostic test (i.e., HCV RNA).* The New York State Department of Health (NYSDOH) used survey data from clinical laboratories and Medicaid claims and encounter data, and state and New York City (NYC) HCV surveillance data to assess the number of persons tested for HCV and number of persons with newly diagnosed HCV infections who were linked to care. During the first year of the HCV law implementation, there was a 51% increase in specimens submitted for HCV testing to surveyed clinical laboratories; testing rates among active Medicaid clients increased 52%, and linkage to care among persons with newly diagnosed HCV infection increased approximately 40% in New York and 11% in NYC. These findings highlight the potential for state laws to promote HCV testing and the utility of HCV surveillance and Medicaid claims data to monitor the quality of HCV testing and linkage to care for HCV-infected persons.

  20. An Evaluation of the Cybersecurity Policies for the United States Health & Human Services Department: Criteria, Regulations, and Improvements

    OpenAIRE

    Derek Mohammed; Ronda Mariani

    2014-01-01

    This paper examines the criteria necessary for the evaluation of the cybersecurity policies for the United States Health and Human Services Department of the Federal Government. The overall purpose of cybersecurity policies and procedures is supported through compliance with Federal mandated regulation and standards, which serve to protect the organizational services and goals of the United States Health and Human Services Department, and to promote the best possible security practices in the...

  1. The Integration of Mexico into NAFTA: Neoliberal Restructuring and the Crisis of the Party/State System

    OpenAIRE

    Marcel Cuijpers; Alex Fernández Jilberto

    1995-01-01

    The incorporation of Mexico into NAFTA is considered a determining reference between two ways of understanding the economic structures and political models of the State. The identification between State and single party, and a certain idea of protectionism, sustained by the premise “industrialization sustituting imports” (ISI) went into crisis beginning with the neoliberal reforms introduced by President Miguel de la Madrid and was continued throughout the mandate of Carlos Salinas de Gortari...

  2. The Supply of Medical Radioisotopes. Progress and Future Challenges in Implementing the HLG-MR Policy Principles: Final Report of the Second Mandate of the HLG-MR (2011-2013)

    International Nuclear Information System (INIS)

    Peykov, Pavel; Cameron, Ron

    2013-09-01

    At the request of its member countries, the Organisation of Economic Co-operation and Development (OECD) Nuclear Energy Agency (NEA) became involved in global efforts to ensure a secure supply of molybdenum-99 ( 99 Mo)/technetium-99m (' 99m Tc). In April 2009, the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) was created and received an initial, two-year mandate from the NEA Steering Committee for Nuclear Energy to examine the causes of supply shortages of 99 Mo/' 99m Tc and develop a policy approach to address those causes. In its second mandate (2011-2013), the HLG-MR has given priority to the implementation by supply chain participants of the first two policy principles - on full-cost recovery and outage reserve capacity for 99 Mo production, in a timely and globally consistent manner. To that end, the NEA, in co-operation with key stakeholders, has created methodologies for calculating full costs and valuing and paying for outage reserve capacity. It issued reports on these methodologies and their implementation, which are particularly useful to the upstream segment of the industry (reactor operators and processors), where the most changes need to occur for long-term market sustainability (Sections 2 and 3 of this report). The NEA has also worked with key stakeholders to ensure that the methodologies are applied in a consistent manner. Additionally, in its second mandate, the HLG-MR has focused on working with governments to accelerate the withdrawal of public funds to support reactors and processors, thus helping drive the process towards full-cost recovery and the provision of outage reserve capacity. To better understand the transition from highly enriched uranium (HEU) to LEU targets for 99 Mo production, the HLG-MR requested that the NEA undertake a project to study the impacts on the 99 Mo/' 99m Tc supply chain and propose actions to support this transition. This work resulted in the release of two reports - one on the

  3. DOE states reheat nuclear waste debate

    International Nuclear Information System (INIS)

    Crawford, M.

    1985-01-01

    After decades of struggling with the issue, Congress in late 1982 established a firm plan for burying growing volumes of nuclear reactor wastes. But 2 l/2 years later the waste disposal debate is as hot as ever. Utility companies, environmentalists, federal officials, and state governments are again clashing - this time over the way the program is proceeding. The Nuclear Waste Policy Act calls for the Department of Energy to start accepting wastes in 1998 at the first of two planned repositories. Selection of this first repository site was mandated for early 1987, but program delays at DOE have pushed the decision back to March 1991. Despite this postponement and other schedule slips, the Department still aims to meet Congress's 1998 deadline. But states, Indian tribes, and environmentalists fear the site selection process will be compromised and want the start up date rolled back

  4. Estimates of state-level health-care expenditures associated with disability.

    Science.gov (United States)

    Anderson, Wayne L; Armour, Brian S; Finkelstein, Eric A; Wiener, Joshua M

    2010-01-01

    We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

  5. A Comparison of African American Students' Self-Perceptions of School Competence with Their Performance on State-Mandated Achievement Tests and Normed Tests of Oral and Written Language and Reading

    Science.gov (United States)

    Gordon Pershey, Monica

    2011-01-01

    This study measured self-perceptions of school competence among 263 4th- and 6th-grade African American students who attended an academically challenged school district. Self-perceptions of school competence are defined as self-perceptions of ability, confidence, and school satisfaction. Results indicated that 4th-grade students had lesser…

  6. A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program.

    Science.gov (United States)

    Gomez, Marta; Reddy, Amanda L; Dixon, Sherry L; Wilson, Jonathan; Jacobs, David E

    Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311. Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for

  7. Annual Report on the State of the DOE National Laboratories

    Energy Technology Data Exchange (ETDEWEB)

    None

    2017-01-01

    This first Annual Report to Congress on the State of the DOE National Laboratories provides a comprehensive overview of the Lab system, covering S&T programs, management and strategic planning. The Department committed to prepare this report in response to recommendations from the Congressionally mandated Commission to Review the Effectiveness of the National Energy Laboratories (CRENEL) that the Department should better communicate the value that the Laboratories provide to the Nation. We expect that future annual reports will be much more compact, building on the extensive description of the Laboratories and of the governance structures that are part of this first report.

  8. Self-archiving to Institutional Repositories Is Improved by Assisted and Mandated Deposit; Disciplinary Culture is not a Factor. A Review of: Xia, Jingfeng. “Assessment of Self-Archiving in Institutional Repositories: Across Disciplines.” The Journal of Academic Librarianship 33.6 (Dec. 2007: 647-54.

    Directory of Open Access Journals (Sweden)

    Gaby Haddow

    2008-06-01

    QUT, where deposit into the IR is mandatory, self-archiving rates are high for the three disciplines for which findings are reported. The self-archiving rate for chemistry was 68.3%, sociology 46.3%, and physics 42.9%. A librarian was responsible for the majority of the remaining deposits. Conclusion – This research tested the proposition that disciplines familiar with subject-based open access repositories, such as physics and economics, are more likely to contribute to IRs. Its findings did not support this view. Instead, the study found no particular pattern of deposit rate across the four disciplines of chemistry, physics, economics and sociology in the seven IRs. Operational aspects of IRs, such as assisted and mandated deposit, appear to have a more significant effect on deposit rates. Assisted deposit, either through departmental administrative staff or librarians, accounted for relatively high deposit rates for economics in the Queensland and Melbourne IRs. Deposit date information in the Queensland IR suggests administrative staff of theeconomics department deposit to the IR on an ongoing basis. Students showed a high rate of self-archiving for theses and dissertations. It might be speculated that a mandate policy at Queensland University of Technology is responsible for the high self-archiving rates seen for economics, chemistry and sociology. However, librarians have assisted in the process, depositing over half the items for physics and sociology. The author recognises the value of both assisted and mandated deposit, but raises questions about how this will affect faculty use of IRs. For example, in cases where faculty have no role in contributing to an IR and therefore no familiarity with it, will they in fact use it? Another important consideration is the policy approach taken to temporary faculty and a mobile academic workforce. In conclusion, the author states,“Institutional repositories need a mandate policy to ensure success”.

  9. Local health care initiatives--ERISA preemption of State Health Care Reform-Health Insurance-Fair Share Act. Golden Gate Restaurant Association v. City and County of San Francisco, 512 F.3d 1112 (9th Cir. 2008).

    Science.gov (United States)

    2009-01-01

    A state or local ordinance is not preempted by ERISA if it does not bind plan administrators to structure plans in a certain way or mandate that they provide specific benefits to employees. A local law could be preempted if it contains specific provisions relating to ERISA, or the operation of the law itself depends upon ERISA.

  10. Getting the job done: Resolving state-federal conflicts in Superfund

    Energy Technology Data Exchange (ETDEWEB)

    Smith, R.; Silver, D.

    1998-12-31

    The American system of federalism creates frequent opportunities for clashes between state and federal environmental regulators.State and federal environmental laws overlap but are not easily reconciled. Most federal environmental law provides no clear answer as to how to reconcile differing mandates of state and federal environmental regulators. In this article, they will examine these state-federal conflicts as they played out in 1994 in the cleanup of contaminated sites in the state of Washington. This article describes the way a regional office of the Environmental Protection Agency and the state`s Department of Ecology developed a novel approach to managing the essential tension between overlapping state and federal cleanup laws.

  11. FAILED STATE

    African Journals Online (AJOL)

    Dr. Miles R. Cone

    The state and society are mutual symbionts as far as their political, economic and social relationships .... consequences have played a role in the African state's deviation from the 'strong state' ideal. .... International Olympic Committee (IOC).

  12. TRENDS IN THE DEVELOPMENT OF INDIRECT TAXES IN THE MEMBER STATES OF THE EUROPEAN UNION

    Directory of Open Access Journals (Sweden)

    MARIA FELICIA CHIRCULESCU

    2015-10-01

    Full Text Available In this paper it is showed the trends in the evolution of indirect taxes of the Member States of the European Union, using for this purpose, statistical series, because this category of taxes can be successfully used by the economic situation. As these taxes are placed on transactions, the yield of these taxes is influenced by developments in the tax bases of economic transactions volume, price and level of rates. The importance of the work is based on the fact that there are countries in the single market with different degrees of development and different living standards and fiscal policy through the transition from direct to indirect taxes. This creates a tax base budget by shifting the tax burden from operators for the whole population, consumption being heavily taxed. The consumer society is the company of the tax payer of the consumer society.

  13. Financial Performance of Health Insurers: State-Run Versus Federal-Run Exchanges.

    Science.gov (United States)

    Hall, Mark A; McCue, Michael J; Palazzolo, Jennifer R

    2018-06-01

    Many insurers incurred financial losses in individual markets for health insurance during 2014, the first year of Affordable Care Act mandated changes. This analysis looks at key financial ratios of insurers to compare profitability in 2014 and 2013, identify factors driving financial performance, and contrast the financial performance of health insurers operating in state-run exchanges versus the federal exchange. Overall, the median loss of sampled insurers was -3.9%, no greater than their loss in 2013. Reduced administrative costs offset increases in medical losses. Insurers performed better in states with state-run exchanges than insurers in states using the federal exchange in 2014. Medical loss ratios are the underlying driver more than administrative costs in the difference in performance between states with federal versus state-run exchanges. Policy makers looking to improve the financial performance of the individual market should focus on features that differentiate the markets associated with state-run versus federal exchanges.

  14. Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005-2014.

    Science.gov (United States)

    Admon, Lindsay K; Winkelman, Tyler N A; Moniz, Michelle H; Davis, Matthew M; Heisler, Michele; Dalton, Vanessa K

    2017-12-01

    To estimate trends in the prevalence and socioeconomic distribution of chronic conditions among women hospitalized for obstetric delivery in the United States. A retrospective, serial cross-sectional analysis was conducted using 2005-2014 data from the National Inpatient Sample. We estimated the prevalence of eight common, chronic conditions, each associated with obstetric morbidity and mortality, among all childbearing women and then across socioeconomic predictors of obstetric outcomes. Differences over time were measured and compared across rural and urban residence, income, and payer subgroups for each condition. We identified 8,193,707 delivery hospitalizations, representing 39,273,417 delivery hospitalizations occurring nationally between 2005 and 2014. Identification of at least one chronic condition increased significantly between 2005-2006 and 2013-2014 (66.9 per 1,000 delivery hospitalizations in 2005-2006 compared with 91.8 per 1,000 delivery hospitalizations in 2013-2014). The prevalence of multiple chronic conditions also increased during the study period, from 4.7 (95% CI 4.2-5.2) to 8.1 (95% CI 7.8-8.4) per 1,000 delivery hospitalizations between 2005-2006 and 2013-2014. Chronic respiratory disease, chronic hypertension, substance use disorders, and pre-existing diabetes were the disorders with the greatest increases in prevalence over time. Increasing disparities over time were identified across all socioeconomic subgroups analyzed including rural compared with urban residence, income, and payer. Key areas of concern include the rate at which substance use disorders rose among rural women and the disproportionate burden of each condition among women from the lowest income communities and among women with Medicaid as their primary payer. Between 2005-2006 and 2013-2014, the prevalence of chronic conditions increased across all segments of the childbearing population. Widening disparities were identified over time with key areas of concern including

  15. As estratégias de retórica na disputa pela Prefeitura de São Paulo em 2004: PT, mandatário, versus PSDB, desafiante

    Directory of Open Access Journals (Sweden)

    Luciana Fernandes Veiga

    2007-06-01

    Full Text Available A experiência do PT no governo (nos âmbitos nacional e local suscitou a curiosidade sobre possíveis alterações no seu discurso eleitoral na disputa pela Prefeitura de São Paulo. O foco desta análise está nas continuidades e rupturas das estratégias retóricas elaboradas a partir dos eixos ideológico (esquerda e direita e pragmático (mandatário e desafiante. A preocupação central é o discurso do PT, e a análise da comunicação apresentada pelo PSDB tem um caráter complementar. Todos os programas e spots veiculados pelas campanhas do PT e do PSDB em São Paulo foram analisados a partir de métodos qualitativos e quantitativos.The experience of the Worker's Party at the Brazilian national and local governments has estimuladted the curiosity about changings in its electoral discourse at the elections for the São Paulo Mayor. This article focuses on the changes and continuities of rethorical strategieand the analysis is based on campaign 'spots' veiculated by the Worker's Party and the Brazilian Social Democratic Party.

  16. Incremental Effect of the Addition of Prescriber Restrictions on a State Medicaid's Pharmacy-Only Patient Review and Restriction Program.

    Science.gov (United States)

    Keast, Shellie L; Pham, Timothy; Teel, Ashley; Nesser, Nancy J

    2017-08-01

    Patient review and restriction programs (PRRPs), used by state Medicaid programs to limit potential abuse and misuse of opioids and related controlled medications, often restrict members to a single pharmacy for controlled medications. While most states use a restricted pharmacy access model, not all states include restricted prescriber access. Oklahoma Medicaid (MOK) added a restricted prescriber access feature to its PRRP in July 2014. To evaluate the incremental effect that the addition of a prescriber restriction to MOK's pharmacy-only PRRP had on the pharmacy and resource utilization of the enrolled members. MOK members with at least 6 months of enrollment in the pharmacy-only PRRP were restricted to a maximum of 3 prescribers for controlled substances in July 2014 and were identified as "cases." Using a propensity score method, cases were matched to controls from the MOK non-PRRP enrolled population based on demographics and baseline health care utilization. Data from January 1, 2014, through December 31, 2014, were evaluated. Each member's monthly health care resource utilization, defined in terms of medical and pharmacy costs, prescription counts, and opioid use per member per month (PMPM), was analyzed. A difference-indifferences (DID) regression estimated the change in resource utilization following the July 2014 policy change. This study included 378 controls and 126 cases after propensity matching. No differences were noted for daily morphine equivalents, benzodiazepine prescriptions, or maintenance prescriptions. There were decreases in mean PMPM use for both groups for short-acting opioid (SAO) claims (P evidence that overall opioid claims were affected, the addition of prescriber restrictions may have resulted in an incremental change to SAO, prescriber, and pharmacy use in the PRPP population. Use of PRRPs may be an effective tool in reducing inappropriate use of prescription opioids within payer systems. The question remains whether these changes

  17. Reporting transparency: making the ethical mandate explicit.

    Science.gov (United States)

    Nicholls, Stuart G; Langan, Sinéad M; Benchimol, Eric I; Moher, David

    2016-03-16

    Improving the transparency and quality of reporting in biomedical research is considered ethically important; yet, this is often based on practical reasons such as the facilitation of peer review. Surprisingly, there has been little explicit discussion regarding the ethical obligations that underpin reporting guidelines. In this commentary, we suggest a number of ethical drivers for the improved reporting of research. These ethical drivers relate to researcher integrity as well as to the benefits derived from improved reporting such as the fair use of resources, minimizing risk of harms, and maximizing benefits. Despite their undoubted benefit to reporting completeness, questions remain regarding the extent to which reporting guidelines can influence processes beyond publication, including researcher integrity or the uptake of scientific research findings into policy or practice. Thus, we consider investigation on the effects of reporting guidelines an important step in providing evidence of their benefits.

  18. Counter - Drug: Mandate for the Army.

    Science.gov (United States)

    1991-03-01

    this comprehensive review will provide a basis for responding to new missions assigned...observations for determining the short-, mid-, and long-term direction of Army support to the national counter-drug effort. Also, this comprehensive review will provide...and long-term direction of Army support to the national counter-drug effort. Also, this comprehensive review will provide a basis for responding

  19. Think like a payer when patients are uninsured.

    Science.gov (United States)

    2012-04-01

    Hospitals need to develop a detailed policy of when and how they'll provide post-acute financial assistance for uninsured or under-insured patients. The policy should allow staff to get real time decisions about what will be covered. Staff should apply the policy consistently to all patients in all situations. A policy frees up case managers to coordinate care for all their patients rather than spending hours at a time trying to line up post-acute care for unfunded patients.

  20. An interactive, all-payer, multidomain primary care performance dashboard.

    Science.gov (United States)

    Ward, Charlotte E; Morella, Lisa; Ashburner, Jeffrey M; Atlas, Steven J

    2014-01-01

    Engaging physicians and practice leaders through regular performance reporting is a key goal of patient-centered medical home improvement efforts. We developed and implemented an interactive, Web-based performance dashboard for primary care practices with input from provider focus groups. Adapting a business software application, individual physician and practice-level reports included information on visit-based and panel productivity, patient panel demographics, and outcome measures (quality of care, patient experience of care, and resource utilization). User training occurred prior to dissemination. Over 2 rounds of reporting, 69% to 77% of users viewed their report within 30 days and 79% of users found the report informative.

  1. State shipment fees as a supplement to federal financial assistance under section 180(c) of the nuclear waste policy act

    International Nuclear Information System (INIS)

    Janairo, L.R.

    2009-01-01

    In Section 180(c) of the Nuclear Waste Policy Act (NWPA), Congress requires the Secretary of Energy to provide financial and technical assistance to states and tribes that will be affected by shipments of spent nuclear fuel and high-level radioactive waste (HLW) to a national repository or other NWPA-mandated facility. Although Section 180(c) assistance may be an important source of revenue for some states, two major limitations will reduce its effectiveness in preparing state and local personnel along shipping routes for their oversight and emergency response roles in connection with shipments to a national repository. First, Section 180(c) applies only to shipments to facilities mandated by the NWPA, therefore unless Congress amends the NWPA, the Secretary has no obligation to provide assistance to states and tribes that are affected by shipments to private facilities or to other federal storage locations. Second, the U.S. Department of Energy (DOE) has interpreted Section 180(c) assistance as solely intended 'for training', not for actually carrying out activities such as inspecting or escorting shipments. No mechanism or mandate currently exists for DOE to provide states with assistance in connection with operations - related activities. This paper looks at state shipment fees as a supplement to or a substitute for the federal financial assistance that is available through Section 180(c) specifically with regard to states. Using DOE' s data on projected shipment numbers, representative routes, and affected population, and following the department's proposed formula for allocating Section 180(c) assistance, the author examined the potential revenues states could reap through a standard fee as opposed to the NWPA-mandated assistance . The analysis shows that, while more states would likely derive greater benefit from Section 180(c) grants than they would from fees, the states with the highest projected shipment numbers would appear to gain by foregoing Section

  2. Payment - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment measures – state data. This data set includes state-level data for the payment measures associated with an episode of care for heart attack, heart failure,...

  3. Title 16 united states code §55 and its implications for management of concession facilities in Yosemite National Park

    Science.gov (United States)

    Lemons, John

    1987-08-01

    Yosemite National Park is one of the nation's most scenic and ecologically/geologically important parks. Unfortunately, the park is subject to extensive development of concession facilities and associated high levels of visitor use. Those concerned with preservation of the park's resources have attempted to limit the types and extent of such facilities to reduce adverse impacts. Strictly speaking, resolution of the preservation versus use controversy must be based on whether the National Park Service is adhering to its legislative mandate to regulate development and use in the parks. The common interpretation of legislative mandates for national parks, including Yosemite, is that they call for a difficult balancing between the conflicting goals of preservation and use. Accordingly, although concession developments cause significant impacts, they usually have been interpreted to be within the legal discretion allowed the secretary of the interior. However, the usual interpretations of the meanings of legislative mandates for Yosemite National Park have not considered Title 16 United States Code §55, which is a very restrictive statute limiting concession facilities. Many of the limitations imposed on concession facilities by the plain language of the statute have been exceeded. If it can be shown that 16 United States Code §55 is a valid statute, the policy implications for park management in Yosemite National Park would be considerable — namely, that significant reductions in concession facilities could be required. This article examines whether the statute can reasonably be thought to be valid and encourages others to conduct further examination of this question.

  4. Supersqueezed states from squeezed states

    International Nuclear Information System (INIS)

    Nieto, M.M.

    1992-01-01

    Using super-Baker-Campbell-Hausdorff relations on the elements of the supergroup OSP(2/2), we derive the supersqueeze operator and the supersqueezed states, which are the supersymmetric generalization of the squeezed states of the harmonic oscillator

  5. Cost of managing an episode of relapse in multiple sclerosis in the United States

    Directory of Open Access Journals (Sweden)

    Ward Alexandra J

    2003-09-01

    Full Text Available Abstract Background The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. Methods Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. Results Average cost per person for high management level was $12,870, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female. Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was $1,847 and mild episode $243. Conclusions Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses.

  6. Federal and state public health authority and mandatory vaccination: is Jacobson v Massachusetts still valid?

    Science.gov (United States)

    Marshall, Lewis W; Marshall, Brenda L; Valladares, Glenn

    2010-01-01

    Novel H1N1 influenza virus infected more than 43,000 people, killed 353 and spread to more than 122 countries within a few months. The World Health Organization declared a stage 6 worldwide pandemic. Healthcare workers and hospitals prepared for the worst. Federal and State regulations provided the legal framework to allow for the preparation and planning for a pandemic. One State had mandated both seasonal and Novel H1N1 vaccination of all healthcare workers in an effort to reduce transmission of influenza in healthcare facilities. The US Supreme Court decided in 1905 that the police power of the State permitted a State Department of Health the leeway to mandate vaccination in the face of a contagious disease. Law suits were filed, and a temporary injunction barring mandatory vaccination was entered by the court. While awaiting a court hearing, the mandatory vaccination regulation was rescinded because of the shortage of both seasonal and H1N1 vaccine. Based on the current state of the pandemic and the shortage of vaccination, it is possible that the US Supreme Court would uphold mandatory vaccination in a pandemic.

  7. Agile Data Curation at a State Geological Survey

    Science.gov (United States)

    Hills, D. J.

    2015-12-01

    State agencies, including geological surveys, are often the gatekeepers for myriad data products essential for scientific research and economic development. For example, the Geological Survey of Alabama (GSA) is mandated to explore for, characterize, and report Alabama's mineral, energy, water, and biological resources in support of economic development, conservation, management, and public policy for the betterment of Alabama's citizens, communities, and businesses. As part of that mandate, the GSA has increasingly been called upon to make our data more accessible to stakeholders. Even as demand for greater data accessibility grows, budgets for such efforts are often small, meaning that agencies must do more for less. Agile software development has yielded efficient, effective products, most often at lower cost and in shorter time. Taking guidance from the agile software development model, the GSA is working towards more agile data management and curation. To date, the GSA's work has been focused primarily on data rescue. By using workflows that maximize clear communication while encouraging simplicity (e.g., maximizing the amount of work not done or that can be automated), the GSA is bringing decades of dark data into the light. Regular checks by the data rescuer with the data provider (or their proxy) provides quality control without adding an overt burden on either party. Moving forward, these workflows will also allow for more efficient and effective data management.

  8. Excited states

    CERN Document Server

    Lim, Edward C

    1974-01-01

    Excited States, Volume I reviews radiationless transitions, phosphorescence microwave double resonance through optical spectra in molecular solids, dipole moments in excited states, luminescence of polar molecules, and the problem of interstate interaction in aromatic carbonyl compounds. The book discusses the molecular electronic radiationless transitions; the double resonance techniques and the relaxation mechanisms involving the lowest triplet state of aromatic compounds; as well as the optical spectra and relaxation in molecular solids. The text also describes dipole moments and polarizab

  9. Waste of energy and public funds as a consequence of the interdependence of the State and power industry

    International Nuclear Information System (INIS)

    1980-01-01

    The consequence resulting from the monopoly of the state and power industry and from the special position in competition law, are investigated. In doing so, the question is posed whether the central structure, existing at that time in the power industry, particularly with the power-supply network, which is still up-to-date and suitable, are justifiable and reasonable for the economy, for the tax-payer and for the consumer. The investigation is based on the main report of the Monopolies' Commission between 1973-75 on concentration in the power industry. Going from this, the situation on the energy market is investigated and the themes of energy-policy, energy conservation and nuclear energy discussed. (UA) [de

  10. A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation

    Science.gov (United States)

    Rieckmann, Traci; Abraham, Amanda; Zwick, Janet; Rasplica, Caitlin; McCarty, Dennis

    2015-01-01

    Objective To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT). Data Sources/Study Setting Primary data collected from representatives of 50 states and the District of Columbia’s Single State Authorities from 2007 to 2009. Study Design/Data Collection The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs. Principal Findings Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged. Conclusions Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act. PMID:25532616

  11. Planning and Implementing Immunization Billing Programs at State and Local Health Departments: Barriers and Possible Solutions.

    Science.gov (United States)

    Corriero, Rosemary; Redmon, Ginger

    Before participating in a project funded by the Centers for Disease Control and Prevention, most state and local health departments (LHDs) were not seeking reimbursement or being fully reimbursed by insurance plans for the cost of immunization services (including vaccine costs and administration fees) they provided to insured patients. Centers for Disease Control and Prevention's Billables Project was designed to enable state and LHDs to bill public and private insurance plans for immunization services provided to insured patients. Identify and describe key barriers state and LHDs may encounter while planning and implementing a billing program, as well as possible solutions for overcoming those barriers. This study used reports from Billables Project participants to explore barriers they encountered when planning and implementing a billing program and steps taken to address those barriers. Thirty-eight state immunization programs. Based on project participants' reports, barriers were noted in 7 categories: (1) funding and costs, (2) staff, (3) health department characteristics, (4) third-party payers and insurance plans, (5) software, (6) patient insurance status, and (7) other barriers. Possible solutions for overcoming those barriers included hiring or seeking external help, creating billing guides and training modules, streamlining workflows, and modifying existing software systems. Overcoming barriers during planning and implementation of a billing program can be challenging for state and LHDs, but the experiences and suggestions of past Billables Project participants can help guide future billing program efforts.

  12. New York State interim waste management cost evaluation

    International Nuclear Information System (INIS)

    Ma, M.S.; Watts, R.J.; Jorgensen, J.R.; Rochester Gas and Electric Corp., NY)

    1985-01-01

    The purpose of this study is to investigate and quantify the comparative costs associated with including or excluding Class A utility wastes at a centralized interim waste management facility in New York State. The objective of the study is to assess the unit costs and total statewide costs associated with two distinct scenarios: (1) the case where non-utility Class A LLRW is received, incinerated and stored at the centralized interim facility, and utility Class A wastes are held without incineration at respective nuclear power plant interim onsite facilities without incineration; and (2) the alternative case where both utility and non-utility Class A wastes are accepted, incinerated and stored at the centralized facility. Unit costs to waste generators are estimated for each of the two cases described. This is followed by an estimation of the statewide cost impact to the public. The cost impact represents the cost differential resulting from the exclusion of utility Class A waste from the centralized NYS interim waste management facility. The principal factors comprising the cost differential include (1) higher unit disposal fees charged to non-utility waste generators, which are passed along in the costs of products and services; and (2) costs to utilities due to construction of additional onsite storage capacity, which in turn are charged to electric rate payers

  13. Multiquark states

    International Nuclear Information System (INIS)

    Wang, F.; Ping, J.L.; Quing, D.; Goldman, T.

    2005-01-01

    The pentaquark state recently discovered has been discussed based on various quark model calculations. Odd parity for the state cannot be ruled out theoretically because the contributions related to nontrivial color structures have not been studied completely. Other multiquark states, especially dibaryons, have been discussed also. A strangeness -3 NΩ dibaryons, have been shown to have a width as small as 12-22 keV and should be detectable in Ω-high-productivity reactions such as at RHIC, COMPAS, and the planned JHF and FAIR projects [ru

  14. A systematic review of factors influencing human papillomavirus vaccination among immigrant parents in the United States.

    Science.gov (United States)

    Kim, Kyounghae; LeClaire, Anna-Rae

    2017-11-21

    To critically appraise factors influencing human papillomavirus (HPV) vaccination among immigrant parents in the United States, a comprehensive search of electronic databases and reference lists was conducted. The findings from 22 articles were ordered based on a socioecological model. About 30% of children initiated and 14% completed a three-dose series. Correlates of HPV vaccine initiation rates included lack of information, concerns about vaccine safety and promiscuity, providers' recommendations, school mandates, financial issues, immigration laws, and living in disadvantaged neighborhoods. Upstream initiatives embracing cultural descriptors could facilitate HPV vaccination, reducing HPV-related disparities in cancer among immigrants in the US.

  15. Feasibility of Producing and Using Biomass-Based Diesel and Jet Fuel in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Milbrandt, A. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Kinchin, C. [National Renewable Energy Lab. (NREL), Golden, CO (United States); McCormick, R. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-12-01

    The study summarizes the best available public data on the production, capacity, cost, market demand, and feedstock availability for the production of biomass-based diesel and jet fuel. It includes an overview of the current conversion processes and current state-of-development for the production of biomass-based jet and diesel fuel, as well as the key companies pursuing this effort. Thediscussion analyzes all this information in the context of meeting the RFS mandate, highlights uncertainties for the future industry development, and key business opportunities.

  16. Integrating industry nuclear codes and standards into United States Department of Energy facilities

    Energy Technology Data Exchange (ETDEWEB)

    Jacox, J.

    1995-02-01

    Recently the United States Department of Energy (DOE) has mandated facilities under their jurisdiction use various industry Codes and Standards developed for civilian power reactors that operate under U.S. Nuclear Regulatory Commission License. While this is a major step forward in putting all our nuclear facilities under common technical standards there are always problems associated with implementing such advances. This paper will discuss some of the advantages and problems experienced to date. These include the universal challenge of educating new users of any technical documents, repeating errors made by the NRC licensed facilities over the years and some unique problems specific to DOE facilities.

  17. Altered States

    International Development Research Centre (IDRC) Digital Library (Canada)

    But as members of the international community, we can take advantage of .... The connections and their effects, between people and states, are not just more ...... children's IQs and are linked to attention disorders, aggression, and delinquency.

  18. State Climatologist

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Quarterly newsletter published by the American Association of State Climatologists. Library includes volumes 1 through 21, for the years 1977-1997.

  19. State Averages

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of a variety of averages for each state or territory as well as the national average, including each quality measure, staffing, fine amount and number of...

  20. HCAHPS - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of the state averages for the HCAHPS survey responses. HCAHPS is a national, standardized survey of hospital patients about their experiences during a recent...

  1. Administrative waste in the U.S. health care system in 2003: the cost to the nation, the states, and the District of Columbia, with state-specific estimates of potential savings.

    Science.gov (United States)

    Himmelstein, David U; Woolhandler, Steffie; Wolfe, Sidney M

    2004-01-01

    This report provides nationwide and state-specific estimates of U.S. health care administration spending and potential savings in 2003 were the United States to institute a Canadian-style national health insurance system. The United States wastes more on health care bureaucracy than it would cost to provide health care to all its uninsured. Administrative expenses will consume at least dollar 399.4 billion of a total health expenditure of dollar 1,660.5 billion in 2003. Streamlining administrative overhead to Canadian levels would save approximately dollar 286.0 billion in 2003, dollar 6,940 for each of the 41.2 million Americans who were uninsured as of 2001. This is substantially more than would be needed to provide full insurance coverage. The cost of excess health bureaucracy in individual states is equally striking. For example, Massachusetts, with 560,000 uninsured state residents, could save about dollar 8,556 million in 2003 (dollar 16,453 per uninsured resident of that state) if it streamlined administration to Canadian levels. New Mexico, with 373,000 uninsured, could save dollar 1,500 million on health bureaucracy (dollar 4,022 per uninsured resident). Only a single-payer national health insurance system could garner these massive administrative savings, allowing universal coverage without any increase in total health spending. Because incremental reforms necessarily preserve the current fragmented and duplicative payment structure, they cannot achieve significant bureaucratic savings.

  2. Rydberg states

    International Nuclear Information System (INIS)

    Brouillard, F.

    1983-01-01

    This chapter considers the formation of Rydberg atoms; their radiative decay; their behavior in electric and electromagnetic fields; and their collisions with atoms and ions. Discusses electron capture into high excited states; laser excitation of Rydberg states; Stark shift and Stark mixing; field ionization; ionization in oscillating fields; thermal collisions of Rydberg atoms; fast collisions of Rydberg atoms; n-changing collisions; and charge exchange. Points out that a large amount of experimental work has been done on collisions of Rydberg atoms with neutral perturbers at thermal energies, and most of it concerns the destruction of Rydberg alkali atoms in collisions with rare gases

  3. Costs, Staffing, and Services of Assisted Living in the United States: A Literature Review.

    Science.gov (United States)

    Kisling-Rundgren, Amy; Paul, David P; Coustasse, Alberto

    2016-01-01

    Assisted-living facilities (ALFs), which provide a community for residents who require assistance throughout their day, are an important part of the long-term-care system in the United States. The costs of ALFs are paid either out of pocket, by Medicaid, or by long-term-care insurance. Monthly costs of ALFs have increased over the past 5 years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the United States to determine the impact of health care on costs. The methodology for this study was a literature review, and a total of 32 sources were referenced. Trends in monthly costs of ALFs have increased from 2004 to 2014. Within the past 5 years, there has been an increase on average of 4.1% in assisted-living costs. Medicaid is one payer for residents of ALFs, whereas another alternative is the use of long-term-care insurance. Unfortunately, Medicare does not pay for ALFs. Staffing concerns in ALFs are limited because of each state having different rules and regulations. Turnover and retention rates of nurses in ALFs are suggested to be high, whereas vacancy rate for nurses is suggested to be lower. The baby-boomer generation can be one contribution to the increase in costs. Over the years, there has been an increase in Alzheimer disease, which has had also an effect on cost in ALFs.

  4. State Treasure

    Science.gov (United States)

    Olson, Cathy Applefeld

    2013-01-01

    When a music teacher is named Teacher of the Year for an entire state, one just know a special story awaits. The narrative of Heidi Welch, director of music at Hillsboro-Deering High School in New Hampshire, does not disappoint. Welch, who grew up in abject poverty and was often homeless, developed her love of music through memorizing and singing…

  5. FAILED STATE

    African Journals Online (AJOL)

    Dr. Miles R. Cone

    colonial history is the 'artificial nature' of Africa's state borders and the notion that statehood ..... Source: Central Intelligence Agency, 2003b. Scientia .... As a virtue of the lack of faith in the country's banking system, this move had the opposite ...

  6. RIVER STATE

    African Journals Online (AJOL)

    principals randomly selected from one hundred secondary schools in Cross River State. The data collected ... There was no siyriificant influerlce of gender on principals' leadership styles effectiveness. ... result of the cultural stereotyping of males and females by .... schools were single sex boys, another 10 were single sex ...

  7. Assisted Reproductive Technology Surveillance - United States, 2015.

    Science.gov (United States)

    Sunderam, Saswati; Kissin, Dmitry M; Crawford, Sara B; Folger, Suzanne G; Boulet, Sheree L; Warner, Lee; Barfield, Wanda D

    2018-02-16

    Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to deliver multiple-birth infants. Multiple births pose substantial risks for both mothers and infants, including obstetric complications, preterm delivery (state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2015 and compares birth outcomes that occurred in 2015 (resulting from ART procedures performed in 2014 and 2015) with outcomes for all infants born in the United States in 2015. 2015. In 1995, CDC began collecting data on ART procedures performed in fertility clinics in the United States as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493 [October 24, 1992]). Data are collected through the National ART Surveillance System, a web-based data collection system developed by CDC. This report includes data from 52 reporting areas (the 50 states, the District of Columbia, and Puerto Rico). In 2015, a total of 182,111 ART procedures (range: 135 in Alaska to 23,198 in California) with the intent to transfer at least one embryo were performed in 464 U.S. fertility clinics and reported to CDC. These procedures resulted in 59,334 live-birth deliveries (range: 55 in Wyoming to 7,802 in California) and 71,152 infants born (range: 68 in Wyoming to 9,176 in California). Nationally, the number of ART procedures performed per 1 million women of reproductive age (15-44 years), a proxy measure of the ART utilization rate, was

  8. Immunity and Impunity: Corruption in the State-Pharma Nexus

    Directory of Open Access Journals (Sweden)

    Paddy Rawlinson

    2017-11-01

    Full Text Available Critical criminology repeatedly has drawn attention to the state-corporate nexus as a site of corruption and other forms of criminality, a scenario exacerbated by the intensification of neoliberalism in areas such as health. The state-pharmaceutical relationship, which increasingly influences health policy, is no exception. That is especially so when pharmaceutical products such as vaccines, a burgeoning sector of the industry, are mandated in direct violation of the principle of informed consent. Such policies have provoked suspicion and dissent as critics question the integrity of the state-pharma alliance and its impact on vaccine safety. However, rather than encouraging open debate, draconian modes of governance have been implemented to repress and silence any form of criticism, thereby protecting the activities of the state and pharmaceutical industry from independent scrutiny. The article examines this relationship in the context of recent legislation in Australia to intensify its mandatory regime around vaccines. It argues that attempts to undermine freedom of speech, and to systematically excoriate those who criticise or dissent from mandatory vaccine programs, function as a corrupting process and, by extension, serve to provoke the notion that corruption does indeed exist within the state-pharma alliance.

  9. Financing cures in the United States.

    Science.gov (United States)

    Basu, Anirban

    2015-02-01

    True cures in health care are rare but likely not for long. The high price tag that accompanies a cure along with its rapid uptake create challenges in the financing of cures by public and private payers. In the US, the disaggregated nature of health insurance system adds to this challenge as patients frequently churn across multiple health plans. This creates a 'free-rider' problem, where no one health plan has the incentive to invest in cure since the returns will be scattered over many health plans. Here, a new health currency is proposed as a generalized version of a social impact bond that has the potential to solve this free-rider problem, as it can be traded not only between public and private payers but also within the private sector. An ensuing debate as to whether and how to develop such a currency can serve the US health care system well.

  10. State of the States 2016: Arts Education State Policy Summary

    Science.gov (United States)

    Aragon, Stephanie

    2016-01-01

    The "State of the States 2016" summarizes state policies for arts education identified in statute or administrative code for all 50 states and the District of Columbia. Information is based on a comprehensive search of state education statute and codes on each state's relevant websites. Complete results from this review are available in…

  11. United States Holocaust Museums: Pathos, Possession, Patriotism

    Directory of Open Access Journals (Sweden)

    Rob Baum

    2011-12-01

    Full Text Available This article examines the role of United States holocaust museums in directing (American knowledge and memory of World War II, and demonstrates how signifiers of race, colour and Jewishness are played out and theatricalised. Erected in two principal U.S. cities of Los Angeles and Washington, D.C., the Holocaust Museum and Museum of Tolerance uphold very different mandates: the first dedicated to revealing European civilian tragedies during WWII; the latter dealing with Jewish persecution and the L.A. Riots of 1991, with references to other cultural catastrophes. While these projects are different, they are not opposed; both museums locate the American perspective of events and their meanings at the forefront. American holocaust museums seem to challenge spaces between memory and its direction, vision and revision. Within the gruesome context of holocaust portrayal, interrogate the valences of memory’s play and expose American holocaust museums as theatres of pornographic memory. The seduction of feeling does not invite change so much as purgation, what Aristotle identified as catharsis — an emotional and physical release, unfortunately replicating the seductive techniques used by Goebbels for the glorification of Hitler. Through manipulation of viewers as automatic audiences, these museums function as centres for pathos I question the policy and polity of presenting genocide as an entertainment leading to catharsis, recognizing that the final act of purgation is all too easily negation.

  12. Suicide Prevention Training: Policies for Health Care Professionals Across the United States as of October 2017.

    Science.gov (United States)

    Graves, Janessa M; Mackelprang, Jessica L; Van Natta, Sara E; Holliday, Carrie

    2018-06-01

    To identify and compare state policies for suicide prevention training among health care professionals across the United States and benchmark state plan updates against national recommendations set by the surgeon general and the National Action Alliance for Suicide Prevention in 2012. We searched state legislation databases to identify policies, which we described and characterized by date of adoption, target audience, and duration and frequency of the training. We used descriptive statistics to summarize state-by-state variation in suicide education policies. In the United States, as of October 9, 2017, 10 (20%) states had passed legislation mandating health care professionals complete suicide prevention training, and 7 (14%) had policies encouraging training. The content and scope of policies varied substantially. Most states (n = 43) had a state suicide prevention plan that had been revised since 2012, but 7 lacked an updated plan. Considerable variation in suicide prevention training for health care professionals exists across the United States. There is a need for consistent polices in suicide prevention training across the nation to better equip health care providers to address the needs of patients who may be at risk for suicide.

  13. State perspectives

    International Nuclear Information System (INIS)

    Neill, R.H.

    1985-01-01

    Expectations by States in fulfilling their responsibilities in the disposal of radioactive wastes as defined in the Nuclear Waste Policy Act are discussed. Specific areas include informational needs, participation in the process of site selection and characterization, access to technical data in a timely manner, and development of consultation and cooperation agreements. Experiences in New Mexico over the past seven years in conducting an independent technical review of the WIPP Project are described. A discussion is included of avoidable factors that contribute to public concern of radioactive waste disposal on relative risk, voluntary versus involuntary risk, technological needs, changes in disposal practices, public health concerns and enforcement of regulations

  14. A three-state kinetic agent-based model to analyze tax evasion dynamics

    Science.gov (United States)

    Crokidakis, Nuno

    2014-11-01

    In this work we study the problem of tax evasion on a fully-connected population. For this purpose, we consider that the agents may be in three different states, namely honest tax payers, tax evaders and undecided, that are individuals in an intermediate class among honests and evaders. Every individual can change his/her state following a kinetic exchange opinion dynamics, where the agents interact by pairs with competitive negative (with probability q) and positive (with probability 1-q) couplings, representing agreement/disagreement between pairs of agents. In addition, we consider the punishment rules of the Zaklan econophysics model, for which there is a probability pa of an audit each agent is subject to in every period and a length of time k detected tax evaders remain honest. Our results suggest that below the critical point qc=1/4 of the opinion dynamics the compliance is high, and the punishment rules have a small effect in the population. On the other hand, for q>qc the tax evasion can be considerably reduced by the enforcement mechanism. We also discuss the impact of the presence of the undecided agents in the evolution of the system.

  15. Environmental monitoring at Hanford by the state of Washington

    International Nuclear Information System (INIS)

    Conklin, A.W.; Mooney, R.R.; Erickson, J.L.

    1990-01-01

    The Department of Social and Health Services' Office of Radiation Protection (ORP), Washington State's radiation control agency, has a mandate to protect the public from radiation. In 1985, ORP was instructed by the legislature to establish a statewide environmental radiological base line, beginning with Hanford, to verify federal environmental programs, and to enforce federal and state Clean Air Acts. The primary mission of the agency is to protect public health by active involvement in Hanford monitoring and oversight. The state's program was designed not to duplicate but to supplement existing programs and to identify any sampling gaps or problems. Split, side-by-side, and independent samples are collected, with analysis performed by the state's own laboratory. Media sampled have included surface and drinking water, seep and ground water, fruits and vegetables, milk, soils, and air particulates; ambient radiation levels have been determined. Special activities have included split sampling of river seeps with multiple agencies, preliminary dose assessment of early Hanford releases, investigations of 129 I in the environment and in Franklin County drinking water, verification of U.S. Department of Energy (DOE) data on erroneous alarms at the Hanford Plutonium Uranium Extraction Plant, split sampling with a DOE headquarters survey, and participation in several General Accounting Office investigations and a National Academy of Sciences review. The independence of ORP programs guarantees that the public has access to environmental data on the activities of DOE and its contractors. We will describe the interrelationship of ORP and Hanford programs and present results of ORP activities

  16. State of the States, 2012: Arts Education State Policy Summary

    Science.gov (United States)

    Arts Education Partnership (NJ1), 2012

    2012-01-01

    The "State of the States 2012" summarizes state policies for arts education identified in statute or code for all 50 states and the District of Columbia. Information is based primarily on results from the AEP Arts Education State Policy Survey conducted in 2010-11, and updated in April 2012.

  17. Continuing education requirements among State Occupational Therapy Regulatory Boards in the United States of America

    Directory of Open Access Journals (Sweden)

    Savannah R. Hall

    2016-10-01

    Full Text Available Purpose The purpose of this study is to compare and contrast the contents of each state’s occupational therapy (OT regulatory board requirements regarding licensees’ acquisition of continuing education units in the United States of America. Methods Data related to continuing education requirements from each OT regulatory board of all 50 states and the District of Columbia in the United States were reviewed and categorized by two reviewers. Analysis was conducted based on the categorization of the continuing education requirements and activities required, allowed, and not allowed/not mentioned for continuing education units. Results Findings revealed non-uniformity and inconsistency of continuing education requirements for licensure renewal between OT regulatory boards and was coupled with lack of specific criteria for various continuing education activities. Continuing education requirements were not tailored to meet the needs of individual licensee’s current and anticipated professional role and job responsibilities, with a negative bias towards presentation and publication allowed for continuing education units. Few boards mandated continuing education topics on ethics related to OT practice within each renewal cycle. Conclusion OT regulatory boards should move towards unifying the reporting format of continuing education requirements across all states to reduce ambiguity and to ensure licensees are equipped to provide ethical and competent practice. Efforts could be made to enact continuing education requirements specific to the primary role of a particular licensee. Finally, assigning the amount of continuing education credits to be awarded for different activities should be based on research evidence rather than arbitrary determination.

  18. When renewable energy met sustainable growth. Regulation, cost reduction, and the rise of renewable energy in the United States

    International Nuclear Information System (INIS)

    Stephens, Samantha

    2016-01-01

    Historically and famously fossil-fuel dependent, the U.S. energy and electricity mixes are evolving quickly as costs fall for renewables, regulations mandate their implementation, and fiscal policy incentivizes their installation. The investment and production tax credits (ITC and PTC) as well as power purchase agreements (PPAs) are well-known for their contributions to the development of solar and wind capacity, and the recent extensions of these credits has led to a positive outlook for continued growth in installations and generation. In addition, the green power market is experiencing record participation, as tracking the positive environmental externalities of renewable power has become important to meet renewable portfolio standards, which mandate implementation of renewable energy by state. Cost reduction is further taking place globally due to technological advances and economies of scale, which serves as another key driver for development. Of course, challenges are still present, particularly due to a plentiful and inexpensive domestic fossil fuel supply, uneven application of regulation and incentives state-by-state, and the uncertainty of continued political support. Even so, a progressive lowering of traditional barriers is leading to the potential for widespread deployment of renewables across the American landscape. (author)

  19. Financial Barriers and Lapses in Treatment and Care of HIV-Infected Adults in a Southern State in the United States.

    Science.gov (United States)

    Wohl, David A; Kuwahara, Rita K; Javadi, Kamran; Kirby, Christine; Rosen, David L; Napravnik, Sonia; Farel, Claire

    2017-11-01

    Antiretroviral (ARV) adherence has largely been considered from the perspective of an individual's behavior with less attention given to potential structural causes for lapses in treatment, such as the cost of medications and care. HIV medication expense is typically covered by third party payers. However, private insurance premiums and deductibles may rise, or policies terminated such as with a change in employment. Likewise, a patient's eligibility for publicly funded coverage like state AIDS Drug Assistance Programs (ADAP) or Medicaid can also be lost. We conducted a one-time survey of a sample of 300 patients receiving HIV care at a single large academic center in the south of United States to examine lapses in HIV therapy due to financial reasons. We found that during the prior year, financial issues including medication cost or coverage led to a lapse in ARVs in 10% (n = 31) of participants. However, of the 42% (n = 125) participants who had been enrolled in ADAP at any time during the prior year, 21% (n = 26) reported an ARV lapse due to problems with ADAP or medication cost. Respondents cited ADAP's required semi-annual renewal process and other administrative issues as the cause of ARV lapses. The median duration of missed ARVs was 2 weeks (range of financial burdens to care by respondents. In conclusion, although conducted at a single medical center and one state, this study suggests that a significant minority of HIV-infected patients encounter financial barriers to ARV access, and this is paradoxically more common among those enrolled in the state ADAP. Streamlining, supporting, and simplifying ADAP renewal procedures will likely reduce lapses in ARV adherence and persistence.

  20. Cost-effectiveness of Tyrosine Kinase Inhibitor Treatment Strategies for Chronic Myeloid Leukemia in Chronic Phase After Generic Entry of Imatinib in the United States.

    Science.gov (United States)

    Padula, William V; Larson, Richard A; Dusetzina, Stacie B; Apperley, Jane F; Hehlmann, Rudiger; Baccarani, Michele; Eigendorff, Ekkehard; Guilhot, Joelle; Guilhot, Francois; Hehlmann, Rudiger; Mahon, Francois-Xavier; Martinelli, Giovanni; Mayer, Jiri; Müller, Martin C; Niederwieser, Dietger; Saussele, Susanne; Schiffer, Charles A; Silver, Richard T; Simonsson, Bengt; Conti, Rena M

    2016-07-01

    We analyzed the cost-effectiveness of treating incident chronic myeloid leukemia in chronic phase (CML-CP) with generic imatinib when it becomes available in United States in 2016. In the year following generic entry, imatinib's price is expected to drop 70% to 90%. We hypothesized that initiating treatment with generic imatinib in these patients and then switching to the other tyrosine-kinase inhibitors (TKIs), dasatinib or nilotinib, because of intolerance or lack of effectiveness ("imatinib-first") would be cost-effective compared with the current standard of care: "physicians' choice" of initiating treatment with any one of the three TKIs. We constructed Markov models to compare the five-year cost-effectiveness of imatinib-first vs physician's choice from a US commercial payer perspective, assuming 3% annual discounting ($US 2013). The models' clinical endpoint was five-year overall survival taken from a systematic review of clinical trial results. Per-person spending on incident CML-CP treatment overall care components was estimated using Truven's MarketScan claims data. The main outcome of the models was cost per quality-adjusted life-year (QALY). We interpreted outcomes based on a willingness-to-pay threshold of $100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct. Both strategies met the threshold. Imatinib-first ($277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of $88 343 over five years to payers compared with physician's choice ($365 744, 3.97 QALYs). The imatinib-first incremental cost-effectiveness ratio was approximately $883 730/QALY. The results were robust to multiple sensitivity analyses. When imatinib loses patent protection and its price declines, its use will be the cost-effective initial treatment strategy for CML-CP. © The Author 2016. Published by Oxford University Press.

  1. Fostering member state implementation of the IAEA's transport regulations

    International Nuclear Information System (INIS)

    Brittinger, M.T.M.; Wangler, M.E.

    2004-01-01

    Based on a 1959 mandate from the United Nations Economic and Social Council, international safety requirements are embodied in the ''Regulations for the Safe Transport of Radioactive Material'' that were first published by the International Atomic Energy Agency in 1961 and revised in 1967, 1973, 1985 and 1996 to keep them abreast of scientific and technical developments. The requirements are incorporated into the regulatory documents of the International Civil Aviation Organization for air transport, and the International Maritime Organization for marine transport. As the requirements of the latter documents are legally-binding for the member states of the corresponding organizations, the IAEA safety requirements thus also become mandatory in those countries. The same situation applies for the surface modes in Europe, by means of the regulatory documents of the European Community for rail, road and inland waterways. Nevertheless, the IAEA has not relaxed its efforts to ensure that its Transport Regulations stay abreast of scientific and technical developments; on the contrary, it has been undertaking a regular and vigorous review of its safety requirements, and continues to do so with the assistance of Member States and relevant international organizations. Beyond providing the regulatory basis for the safe transport of radioactive material, however, the IAEA also offers a work programme under which it assists Member States in complying with the regulatory requirements. This assistance comes in the form of providing training on the safety requirements, and publishing documents that facilitate the exchange of information

  2. Poison politics: a contentious history of consumer protection against dangerous household chemicals in the United States.

    Science.gov (United States)

    Jones, Marian Moser; Benrubi, Isidore Daniel

    2013-05-01

    The history of consumer protection against household poisons presents a key case study of the uniquely American struggle to balance public health and safety with the interests of business. By the late 19th century, package designs, warning labels, and state statutes had formed an uneven patchwork of protective mechanisms against accidental poisonings. As household chemicals proliferated in the early 20th century, physicians concerned with childhood poisonings pressured the federal government to enact legislation mandating warning labels on packaging for these substances. Manufacturers of household chemicals agreed to labeling requirements for caustic poisons but resisted broader regulation. Accidental poisonings of children continued to increase until the enactment of broad labeling and packaging legislation in the 1960s and 1970s. This history suggests that voluntary agreements between government agencies and manufacturers are inadequate to protect consumers against household poisonings and that, in the United States, protective household chemical regulation proceeds in a reactive rather than a precautionary manner.

  3. Quick overview of the General State of Play of UNFCCC negotiations after Poznan

    International Nuclear Information System (INIS)

    Guerin, E.

    2008-01-01

    Very few concrete results were expected to come out of Poznan, given the intermediary nature of this Conference (a year after Bali, and a year before the final deal in Copenhagen), and given the political context in the United States (the current Bush administration was still at the negotiating table, but with no mandate to negotiate). The cornerstone of Poznan was to find an agreement on the 2009 work programme, especially on two issues: the mandate given to the incoming AWG-LCA Chair, Mr. Michael Zammit Cutajar (Malta), to write his two first negotiating texts, and the possibility to organize an additional session. Agreement on these two issues was found quite easily during informal consultations. In fact, one might even argue that agreement on these issues was found too quickly, leaving Ministers with nothing to negotiate, except for two very tricky issues: the share of proceeds and the Adaptation Fund (see point 3). Nevertheless this agreement, especially on the two first negotiating texts, successfully paves the way for the entrance of the Parties into full negotiating mode in 2009. (author)

  4. Impacts of a United States' biofuel policy on New Zealand's agricultural sector

    International Nuclear Information System (INIS)

    Saunders, Caroline; Kaye-Blake, William; Marshall, Liz; Greenhalgh, Suzie; De Aragao Pereira, Mariana

    2009-01-01

    The rise in oil prices has spurred interest in biofuels. Policies in the United States like the renewable fuel standard (RFS) have led to an expansion of ethanol production, while the New Zealand government has mandated a minimum level of biofuel sales. The research used a partial equilibrium model of international trade to quantify the price and farmgate income effects of the US RFS policy. The goal was to examine the competition between food and biofuel production and to quantify the impact of the policy on the agricultural sector in New Zealand. The RFS policy has a significant impact on corn prices, but a small effect on livestock prices and production. There thus appears to be little conflict between food and fuel uses for corn at the level of the RFS mandate. New Zealand's pasture-based livestock sector benefits from the use of corn for ethanol production: it receives better prices for its products, but does not face the same input cost increases as competitors. The results suggest that New Zealand faces an interesting decision: it could support investment in biofuels research, or benefit from the biofuels boom through the indirect impacts on demand and prices for meat and milk. (author)

  5. Quantum States Transfer by Analogous Bell States

    International Nuclear Information System (INIS)

    Mei Di; Li Chong; Yang Guohui; Song Heshan

    2008-01-01

    Transmitting quantum states by channels of analogous Bell states is studied in this paper. We analyze the transmitting process, constructed the probabilitic unitary operator, and gain the largest successful transfer quantum state probability.

  6. Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

    Science.gov (United States)

    Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

    2014-09-01

    In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers

  7. Assessment of energy research, development, and demonstration priorities for New York State. Interim report. Volume I

    Energy Technology Data Exchange (ETDEWEB)

    Allentuck, J; Appleman, J; Carroll, T O; Palmedo, P F; Nathans, R

    1977-11-01

    In compliance with its mandate to accelerate the development and use of energy technologies in furtherance of the state's economic growth and the best interests of its population, the New York State Energy Research and Development Authority (NYSERDA) initiated, in March 1977, an assessment of energy research and development priorities. This report presents a view of the energy supply-demand future of the state, and the ways in which this future can be affected by external contingencies and concerted policies. That view takes into consideration energy supplies that may be available to the state as well as energy demands as they are affected by demographic and economic changes within the state. Also included are the effects of national energy policies and technological developments as they modify both supplies and demands in New York State. Finally, this report proceeds to identify those general technological areas in which the Authority's program can be of greatest potential benefit to the state's social and economic well being. This effort aims at a cost/benefit analysis determination of RD and D priorities. The preliminary analysis thus far indicates these areas as being of highest priority: energy conservation in buildings (promotion and execution of RD and D) and industry; district heating; fuel cell demonstration;solar heating and cooling (analysis, demonstration, and information dissemination); energy-environment interaction (analysis); energy information services; and, in general, the attraction of Federal RD and D programs to the state.

  8. The hydroelectric power market in the United States

    International Nuclear Information System (INIS)

    2002-01-01

    The second-largest producer of hydroelectric power in the world is the United States, right after Canada. In the United States, 7.1 per cent of net electricity generation was attributed to hydroelectric power in 2000, which totalled 269 terawatt hours (TWh). Aging facilities, outdated technology in some facilities, a cumbersome licensing process, and increasing environmental demands from interest groups for the preservation of river systems and surrounding wildlife challenge the industry. Pacific Coast states, especially California, were faced with electric power shortages during the summer of 2001, due to low market prices, high power usage among consumers and drought. The problems with the deregulation of the electricity market were brought to light by these shortages. Legislation to restructure the electric power industry in 25 states had not been enacted as of January 2002. The purchase of more power from both Canada and the Mexico is being considered by the government of the United States, as is the creation of a national power grid to allow for power transmission throughout the country. The Canada-United States energy trade might be affected by such a move, and result in project construction opportunities for Canadian companies. Renewable energy sources must be responsible for the generation of 10 per cent of power generation levels by 2020, on a gradual basis as mandated by law. By 2005, New York City must purchase 10 per cent of its power from renewable energy sources, reaching 20 per cent by 2010. The repair and replacement of aging dam equipment, the development of advanced turbine technology to protect fish stocks and water quality, dam removal, the construction of power lines are all opportunities open to Canadian companies. 60 refs., 5 tabs

  9. Complications of cesarean deliveries among HIV-infected women in the United States

    Science.gov (United States)

    Kourtis, Athena P.; Ellington, Sascha; Pazol, Karen; Flowers, Lisa; Haddad, Lisa; Jamieson, Denise J.

    2015-01-01

    Objective To compare rates of complications associated with cesarean delivery in HIV-infected and HIV-uninfected women in the United States and to investigate trends in such complications across four study cycles spanning the implementation of HAART in the United States (1995–1996, 2000–2001, 2005–2006, 2010–2011). Design The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project is the largest all-payer hospital inpatient care database in the United States; when weighted to account for the complex sampling design, nationally representative estimates are derived. After restricting the study sample to women aged 15–49 years, our study sample consisted of approximately 1 090 000 cesarean delivery hospitalizations annually. Methods Complications associated with cesarean deliveries were categorized as infection, hemorrhage, or surgical trauma, based on groups of specific International Classification of Diseases 9th revision codes. Length of hospitalization, hospital charges, and in-hospital deaths were also examined. Results The rate of complications significantly decreased during the study periods for HIV-infected and HIV-uninfected women. However, rates of infectious complications and surgical trauma associated with cesarean deliveries remained higher among HIV-infected, compared with HIV-uninfected women in 2010–2011, as did prolonged hospital stay and in-hospital deaths. Length of hospitalization decreased over time for cesarean deliveries of HIV-infected women to a greater extent compared with HIV-uninfected women. Conclusion In the United States, rates of cesarean delivery complications decreased from 1995 to 2011. However, rates of infection, surgical trauma, hospital deaths, and prolonged hospitalization are still higher among HIV-infected women. Clinicians should remain alert to this persistently increased risk of cesarean delivery complications among HIV-infected women. PMID:25574961

  10. Utilizing GIS to Examine the Relationship Between State Renewable Portfolio Standards and the Adoption of Renewable Energy Technologies

    Directory of Open Access Journals (Sweden)

    Chelsea Schelly

    2013-12-01

    Full Text Available In the United States, there is no comprehensive energy policy at the federal level. To address issues as diverse as climate change, energy security, and economic development, individual states have increasingly implemented Renewable Portfolio Standards (RPSs, which mandate that utility providers include a specified amount of electricity from renewable energy sources in their total energy portfolios. Some states have included incentives for individual energy technologies in their RPS, such as solar electric (also called photovoltaic or PV technology. Here, we use GIS to visualize adoption of RPSs and electricity generation from renewable energy sources in the US and examine changes in renewable electricity and solar electric generation over time with the goal of informing future policies aimed at promoting the adoption of renewable energy technologies.

  11. An Evaluation of the Cybersecurity Policies for the United States Health & Human Services Department: Criteria, Regulations, and Improvements

    Directory of Open Access Journals (Sweden)

    Derek Mohammed

    2014-04-01

    Full Text Available This paper examines the criteria necessary for the evaluation of the cybersecurity policies for the United States Health and Human Services Department of the Federal Government. The overall purpose of cybersecurity policies and procedures is supported through compliance with Federal mandated regulation and standards, which serve to protect the organizational services and goals of the United States Health and Human Services Department, and to promote the best possible security practices in the protection of information systems from unauthorized actors and cyber-threats. The criteria of the cybersecurity evaluation is identified and analyzed for quality, strengths, weaknesses, and future applicability. Topics within the criteria include organizational operation, regulations and industrial standards compliance, service delivery to national customers, and the prevention and mitigation of IT system and security failure. This analysis determines the strengths and weaknesses, and makes recommendations for revising the cybersecurity policies within the United States Health and Human Services Department.

  12. Where Do Freestanding Emergency Departments Choose to Locate? A National Inventory and Geographic Analysis in Three States.

    Science.gov (United States)

    Schuur, Jeremiah D; Baker, Olesya; Freshman, Jaclyn; Wilson, Michael; Cutler, David M

    2017-04-01

    We determine the number and location of freestanding emergency departments (EDs) across the United States and determine the population characteristics of areas where freestanding EDs are located. We conducted a systematic inventory of US freestanding EDs. For the 3 states with the highest number of freestanding EDs, we linked demographic, insurance, and health services data, using the 5-digit ZIP code corresponding to the freestanding ED's location. To create a comparison nonfreestanding ED group, we matched 187 freestanding EDs to 1,048 nonfreestanding ED ZIP codes on land and population within state. We compared differences in demographic, insurance, and health services factors between matched ZIP codes with and without freestanding EDs, using univariate regressions with weights. We identified 360 freestanding EDs located in 30 states; 54.2% of freestanding EDs were hospital satellites, 36.6% were independent, and 9.2% were not classifiable. The 3 states with the highest number of freestanding EDs accounted for 66% of all freestanding EDs: Texas (181), Ohio (34), and Colorado (24). Across all 3 states, freestanding EDs were located in ZIP codes that had higher incomes and a lower proportion of the population with Medicaid. In Texas and Ohio, freestanding EDs were located in ZIP codes with a higher proportion of the population with private insurance. In Texas, freestanding EDs were located in ZIP codes that had fewer Hispanics, had a greater number of hospital-based EDs and physician offices, and had more physician visits and medical spending per year than ZIP codes without a freestanding ED. In Ohio, freestanding EDs were located in ZIP codes with fewer hospital-based EDs. In Texas, Ohio, and Colorado, freestanding EDs were located in areas with a better payer mix. The location of freestanding EDs in relation to other health care facilities and use and spending on health care varied between states. Copyright © 2016 American College of Emergency Physicians

  13. Employee, State of Alaska

    Science.gov (United States)

    Business Resources Division of Corporations, Business & Professional Licensing Dept. of Commerce Benefits Resources State Employee Directory State Calendar State Training: LearnAlaska State Travel Manager) Web Mail (Outlook) Login Who to Call Health Insurance Insurance Benefits Health and Optional

  14. Building and Benefiting from Member State Laboratory Capacities

    International Nuclear Information System (INIS)

    2014-01-01

    The Department of Nuclear Sciences and Applications implement a number of activities that are designed to enhance and capitalize upon the capacities of Member States’ laboratories worldwide. The Nuclear Sciences and Applications (NA) laboratories strengthen Member States’ analytical capacities through activities such as proficiency tests and inter-laboratory comparisons, and share the capacities of Member States’ laboratories with other Member States through the coordination of relevant networks and participation in the IAEA Collaborating Centre scheme. An example of these activities is the collaborative work carried out by the Terrestrial Environment Laboratory (TEL). The TEL cooperates with the IAEA Environment Laboratories in Monaco to distribute 92 types of reference materials for characterizing radionuclides, stable isotopes, trace elements or organic contaminants. These materials serve as international standards for establishing and evaluating the reliability and accuracy of analytical measurements. This collaborative work between NA laboratories, Member States and laboratories around the globe contribute to the IAEA’s mandate of fostering scientific and technical exchanges for the peaceful use of nuclear science and technology throughout the world

  15. Evaluation of the state water-resources research institutes

    Science.gov (United States)

    Ertel, M.O.

    1988-01-01

    Water resources research institutes, as authorized by the Water Resources Research Act of 1984 (Public Law 98-242), are located in each state and in the District of Columbia, Guam, Puerto Rico , and the Virgin Islands. Public Law 98-242 mandated an onsite evaluation of each of these institutes to determine whether ' . . .the quality and relevance of its water resources research and its effectiveness as an institution for planning, conducting, and arranging for research warrant its continued support in the national interest. ' The results of these evaluations, which were conducted between September 1985 and June 1987, are summarized. The evaluation teams found that all 54 institutes are meeting the basic objectives of the authorizing legislation in that they: (1) use the grant funds to support research that addresses water problems of state and regional concern; (2) provide opportunities for training of water scientists through student involvement on research projects; and (3) promote the application of research results through preparation of technical reports and contributions to the technical literature. The differences among institutes relate primarily to degrees of effectiveness, and most often are determined by the financial, political, and geographical contexts in which the institutes function and by the quality of their leadership. (Lantz-PTT)

  16. Digital control for the Penn State Breazeale reactor

    International Nuclear Information System (INIS)

    Raiskums, G.A.

    1991-01-01

    Digital control has been an integral part of Canada deuterium uranium (CANDU) nuclear power reactor technology since the 1960s. Much of the high CANDU production reliability can be attributed to the fault-tolerant and flexible control algorithms achievable with digital control. Atomic Energy of Canada Limited (AECL) has now transported this technology to research reactors, using industrial-grade microcomputers to solve equipment aging and spares obsolescence problems so prevalent at older installations. The open architecture of the Intel 8086-based computers provides for wide availability and reasonably priced, quality hardware from numerous sources. AECL recently supplied the Pennsylvania State University Breazeale Reactor (PSBR) with a new console containing a digital control and monitoring system. The reactor safety system (RSS) was also replaced with hardwired relay logic and truly analog state-of-the-art wide range nuclear instrumentation supplied by AECL's subcontractor, Gamma-Metrics. Retaining analog hardware for the mandated RSS functions was key to minimizing licensing efforts and the extensive verification and validation that would be required for safety system software. This paper elaborates on the digital control and monitoring portion of the PSBR console replacement, with emphasis on the key system objectives

  17. Optimal resource states for local state discrimination

    Science.gov (United States)

    Bandyopadhyay, Somshubhro; Halder, Saronath; Nathanson, Michael

    2018-02-01

    We study the problem of locally distinguishing pure quantum states using shared entanglement as a resource. For a given set of locally indistinguishable states, we define a resource state to be useful if it can enhance local distinguishability and optimal if it can distinguish the states as well as global measurements and is also minimal with respect to a partial ordering defined by entanglement and dimension. We present examples of useful resources and show that an entangled state need not be useful for distinguishing a given set of states. We obtain optimal resources with explicit local protocols to distinguish multipartite Greenberger-Horne-Zeilinger and graph states and also show that a maximally entangled state is an optimal resource under one-way local operations and classical communication to distinguish any bipartite orthonormal basis which contains at least one entangled state of full Schmidt rank.

  18. Sweeping the State Space

    DEFF Research Database (Denmark)

    Mailund, Thomas

    The thesis describes the sweep-line method, a newly developed reduction method for alleviating the state explosion problem inherent in explicit-state state space exploration. The basic idea underlying the sweep-line method is, when calculating the state space, to recognise and delete states...... that are not reachable from the currently unprocessed states. Intuitively we drag a sweep-line through the state space with the invariant that all states behind the sweep-line have been processed and are unreachable from the states in front of the sweep-line. When calculating the state space of a system we iteratively...

  19. Is scorpion antivenom cost-effective as marketed in the United States?

    Science.gov (United States)

    Armstrong, Edward P; Bakall, Maja; Skrepnek, Grant H; Boyer, Leslie V

    2013-12-15

    The purpose of this study was to analyze the cost-effectiveness of scorpion antivenom compared to no antivenom, in the United States, using a decision analysis framework. A decision analytic model was created to assess patient course with and without antivenom. Costs were determined from the perspective of a health care payer. Cost data used in the model were extracted from Arizona Medicaid. The probability of clinical events occurring with and without antivenom was obtained from the published literature, medical claims obtained from Arizona Medicaid, and results of recent clinical trials. Patients that became so ill that mechanical ventilator support was necessary were considered treatment failures. A Monte Carlo simulation was run 1000 times and sampled simultaneously across all variable distributions in the model. The mean success rate was 99.87% (95% CI 99.64%-99.98%) with scorpion antivenom and 94.31% (95% CI 91.10%-96.61%) without scorpion antivenom. The mean cost using scorpion antivenom was $10,708 (95% CI $10,556 - $11,010) and the mean cost without scorpion antivenom was $3178 (95% CI $1627 - $5184). Since the 95% CIs do not overlap for either the success or cost, use of the scorpion antivenom was significantly more effective and significantly more expensive than no antivenom. Cost-effectiveness analysis found that the scorpion antivenom was not cost-effective at its current price as marketed in the United States. The scorpion antivenom marketed in the United States is extremely effective, but too costly to justify its use in most clinical situations. Formulary committees should restrict the use of this antivenom to only the most severe scorpion envenomations. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Amending the Oil Pollution Act of 1990 for state implementation of program elements

    Energy Technology Data Exchange (ETDEWEB)

    Pearson, L. [Alaska Dept. of Environmental Conservation, Juneau, AK (United States)

    1997-10-01

    A legal argument was made in favour of amending the Oil Pollution Act (OPA) of 1990 to allow state implementation of a portion or portions of the law. As it now stands the OPA does not have language for delegating program elements to the states. A review of the legislation indicated that a number of program elements may be more effectively carried out by the State of Alaska, while others should continue to be administered by both the federal and state governments. The review and approval of industry contingency plans for manned and unmanned vessels/barges carrying oil as a primary cargo is one example where efficiencies may be gained. Such plans are currently submitted to Coast Guard headquarters in Washington and retained there. In effect, there is no `local` federal knowledge of the vessel response plans approved for operation in the State of Alaska, nor do Alaskans have the opportunity to review or comment on the adequacy of these plans. Components where efficiencies would be gained include: local review of industry contingency/ response plans, inventory of existing rural above-ground tank farms, coordination of vessel and facility inspections, area contingency plan development and access to federal clean up funds. Past experience clearly indicates that delegation to the states is a workable proposition. There is no apparent justification for not extending this provision to the OPA, not as a mandate, but as an option for reducing cost and improving efficiency. 28 refs.

  1. Amending the Oil Pollution Act of 1990 for state implementation of program elements

    International Nuclear Information System (INIS)

    Pearson, L.

    1997-01-01

    A legal argument was made in favour of amending the Oil Pollution Act (OPA) of 1990 to allow state implementation of a portion or portions of the law. As it now stands the OPA does not have language for delegating program elements to the states. A review of the legislation indicated that a number of program elements may be more effectively carried out by the State of Alaska, while others should continue to be administered by both the federal and state governments. The review and approval of industry contingency plans for manned and unmanned vessels/barges carrying oil as a primary cargo is one example where efficiencies may be gained. Such plans are currently submitted to Coast Guard headquarters in Washington and retained there. In effect, there is no 'local' federal knowledge of the vessel response plans approved for operation in the State of Alaska, nor do Alaskans have the opportunity to review or comment on the adequacy of these plans. Components where efficiencies would be gained include: local review of industry contingency/ response plans, inventory of existing rural above-ground tank farms, coordination of vessel and facility inspections, area contingency plan development and access to federal clean up funds. Past experience clearly indicates that delegation to the states is a workable proposition. There is no apparent justification for not extending this provision to the OPA, not as a mandate, but as an option for reducing cost and improving efficiency. 28 refs

  2. State-Funded Activism: Lessons from Civil Society Organizations in Ireland

    Directory of Open Access Journals (Sweden)

    Anna Visser

    2016-03-01

    Full Text Available Civil society organizations (CSOs in Ireland receive significant state funding and institutional support according to the logic that they are important contributors to democratic governance, with the effect that the CSO sector has expanded and become more embedded in formal decision-making processes over the past several decades. At the same time, dependency on government funding exposes CSOs to three important challenges: to stay true to activist mandates in the face of pressure from state funders to focus on service provision; to maintain accountability to constituents while also satisfying the vertically oriented accountability requirements of the state; and to nurture collaboration among CSOs in a context of competition for state funding. University-based activists, who are also reliant on (increasingly scarce government funding, face similar challenges, and therefore should pay more attention to debates regarding state funding in the CSO sphere. By working together to overcome common challenges associated with state funding, activists in both spheres can more effectively contribute to progressive social change.

  3. State focus on health care-associated infection prevention in nursing homes.

    Science.gov (United States)

    Cohen, Catherine C; Herzig, Carolyn T A; Carter, Eileen J; Pogorzelska-Maziarz, Monika; Larson, Elaine L; Stone, Patricia W

    2014-04-01

    Despite increased focus on health care-associated infections (HAI), between 1.6 and 3.8 million HAI occur annually among the vulnerable population residing in US nursing homes (NH). This study characterized state department of health (DOH) activities and policies intended to improve quality and reduce HAI in NH. We created a 17-item standardized data collection tool informed by 20 state DOH Web sites, reviewed by experts in the field and piloted by 2 independent reviewers (Cohen's κ .45-.73). The tool and corresponding protocol were used to systematically evaluate state DOH Web sites and related links. Three categories of data were abstracted: (1) consumer-directed information intended to increase accountability of and competition between NH, including mandatory HAI reporting and NH inspection reports; (2) surveyor training for federally-mandated NH inspections; and (3) guidance for NH providers to prevent HAI and monitor incidence. Only 5 states included HAI reporting in NH with differing HAI types and reporting requirements. State DOH information and activities focused on NH quality and reducing HAI were inconsistent. Systematically characterizing state DOH efforts to reduce HAI in NH is important to interpret the effects of these activities. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  4. The anatomy of health care in the United States.

    Science.gov (United States)

    Moses, Hamilton; Matheson, David H M; Dorsey, E Ray; George, Benjamin P; Sadoff, David; Yoshimura, Satoshi

    2013-11-13

    Health care in the United States includes a vast array of complex interrelationships among those who receive, provide, and finance care. In this article, publicly available data were used to identify trends in health care, principally from 1980 to 2011, in the source and use of funds ("economic anatomy"), the people receiving and organizations providing care, and the resulting value created and health outcomes. In 2011, US health care employed 15.7% of the workforce, with expenditures of $2.7 trillion, doubling since 1980 as a percentage of US gross domestic product (GDP) to 17.9%. Yearly growth has decreased since 1970, especially since 2002, but, at 3% per year, exceeds any other industry and GDP overall. Government funding increased from 31.1% in 1980 to 42.3% in 2011. Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the United States trailing peer nations. The findings from this analysis contradict several common assumptions. Since 2000, (1) price (especially of hospital charges [+4.2%/y], professional services [3.6%/y], drugs and devices [+4.0%/y], and administrative costs [+5.6%/y]), not demand for services or aging of the population, produced 91% of cost increases; (2) personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%; and (3) chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly. Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources

  5. The US Opioid Crisis: Current Federal and State Legal Issues.

    Science.gov (United States)

    Soelberg, Cobin D; Brown, Raeford E; Du Vivier, Derick; Meyer, John E; Ramachandran, Banu K

    2017-11-01

    The United States is in the midst of a devastating opioid misuse epidemic leading to over 33,000 deaths per year from both prescription and illegal opioids. Roughly half of these deaths are attributable to prescription opioids. Federal and state governments have only recently begun to grasp the magnitude of this public health crisis. In 2016, the Centers for Disease Control and Prevention released their Guidelines for Prescribing Opioids for Chronic Pain. While not comprehensive in scope, these guidelines attempt to control and regulate opioid prescribing. Other federal agencies involved with the federal regulatory effort include the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), and the Department of Justice. Each federal agency has a unique role in helping to stem the burgeoning opioid misuse epidemic. The DEA, working with the Department of Justice, has enforcement power to prosecute pill mills and physicians for illegal prescribing. The DEA could also implement use of prescription drug monitoring programs (PDMPs), currently administered at the state level, and use of electronic prescribing for schedule II and III medications. The FDA has authority to approve new and safer formulations of immediate- and long-acting opioid medications. More importantly, the FDA can also ask pharmaceutical companies to cease manufacturing a drug. Additionally, state agencies play a critical role in reducing overdose deaths, protecting the public safety, and promoting the medically appropriate treatment of pain. One of the states' primary roles is the regulation of practice of medicine and the insurance industry within their borders. Utilizing this authority, states can both educate physicians about the dangers of opioids and make physician licensure dependent on registering and using PDMPs when prescribing controlled substances. Almost every state has implemented a PDMP to some degree; however, in addition to mandating their use, increased interstate

  6. Hazardous waste landfill research: U. S. E. P. A. (United States Environmental Protection Agency) Program

    Energy Technology Data Exchange (ETDEWEB)

    Schomaker, N.B.

    1984-06-01

    The hazardous waste land disposal research program is collecting data necessary to support implementation of disposal guidelines mandated by the 'Resource Conservation and Recovery Act of 1976' (RCRA) PL 94-580. This program relating to the categorical areas of landfills, surface impoundments, and underground mines encompasses state-of-the-art documents, laboratory analysis, economic assessment, bench and pilot studies, and full-scale field verification studies. Over the next five years the research will be reported as Technical Resource Documents in support of the RCRA Guidance Documents. These documents will be used to provide guidance for conducting the review and evaluation of land disposal permit applications. This paper will present an overview of this program and will report the current status of the work.

  7. A Cross-cultural Comparison of Objectivity in Childhood Games: Iran and the United States.

    Science.gov (United States)

    Rastegarpour, Ali

    2011-07-01

    Games have been introduced as a means for studying cross-cultural differences and societies. This paper presents a case study in analogous games played by children in two different countries with two different cultures - Iran and the United States. Four examples are presented to demonstrate that games played by Iranian children are subject to less objectivity in their rules. Therefore, nonobjectivity may be a phenomenon that has roots in the society and the many differences between the two societies may very well be the results of this fundamental difference. If the presence of objectivity in childhood game rules could be, in actuality, indicative of objectivity in social and civil interactions in the everyday lives of the people, the direction of causality remains to be established. In other words, it remains unclear whether the games influence the culture or are influenced by the mandates of the society.

  8. AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for United States Coast Guard Headquarters

    Energy Technology Data Exchange (ETDEWEB)

    Schey, Stephen [Idaho National Lab. (INL), Idaho Falls, ID (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-05-01

    Federal agencies are mandated to purchase alternative fuel vehicles, increase consumption of alternative fuels, and reduce petroleum consumption. Available plug-in electric vehicles (PEVs) provide an attractive option in the selection of alternative fuel vehicles. PEVs, which consist of both battery electric vehicles (BEVs) and plug-in hybrid electric vehicles (PHEVs), have significant advantages over internal combustion engine (ICE) vehicles in terms of energy efficiency, reduced petroleum consumption, and reduced production of greenhouse gas (GHG) emissions, and they provide performance benefits with quieter, smoother operation. This study intended to evaluate the extent to which the United States Coast Guard Headquarters (USCG HQ) could convert part or all of their fleet of vehicles from petroleum-fueled vehicles to PEVs.

  9. Progress report and preliminary 1981-83 agenda of the United States Radiation Policy Council

    International Nuclear Information System (INIS)

    1980-09-01

    The U.S. Radiation Policy Council is responsible for coordinating the formulation and implementation of Federal Policy relating to radiation protection. In carrying out this very broad and basic mandate, the RPC has been directed to: Advise on the formulation of broad radiation protection policies; monitor the implementation of Federal policies; Help resolve conflicts in jurisdiction among Federal agencies; Recommend corrective legislation, if needed; ensure effective liaison with the States and the Congress; and Serve as a forum for public participation and comment. The RPC was established by Executive Order Number 12194 in February 1980. The Council was created to coordinate the formulation and implementation of Federal policies relating to radiation protection. This report summarizes the first 7 months the Council has been in operation, its activities, and decisions through September 1980

  10. State of Data Guidance in Journal Policies: A Case Study in Oncology

    Directory of Open Access Journals (Sweden)

    Deborah H. Charbonneau

    2015-06-01

    Full Text Available This article reports the results of a study examining the state of data guidance provided to authors by 50 oncology journals. The purpose of the study was the identification of data practices addressed in the journals’ policies. While a number of studies have examined data sharing practices among researchers, little is known about how journals address data sharing. Thus, what was discovered through this study has practical implications for journal publishers, editors, and researchers. The findings indicate that journal publishers should provide more meaningful and comprehensive data guidance to prospective authors. More specifically, journal policies requiring data sharing, should direct researchers to relevant data repositories, and offer better metadata consultation to strengthen existing journal policies. By providing adequate guidance for authors, and helping investigators to meet data sharing mandates, scholarly journal publishers can play a vital role in advancing access to research data.

  11. Alaska State Trails Program

    Science.gov (United States)

    Recreation Search DNR State of Alaska Home Menu Parks Home Alaska State Trails Boating Safety Design and Home / Alaska State Trails Alaska State Trails Program Trails in the Spotlight Glacier Lake and Saddle Trails in Kachemak State Park Glacier Lake A Popular route joins the Saddle and Glacier Lake Trails. The

  12. The changing world of climate change: Oregon leads the states

    International Nuclear Information System (INIS)

    Carver, P.H.; Sadler, S.; Kosloff, L.H.; Trexler, M.C.

    1997-01-01

    Following on the heels of recent national and international developments in climate change policy, Oregon's open-quote best-of-batch close-quote proceeding has validated the use of CO 2 offsets as a cost-effective means of advancing climate change mitigation goals. The proceeding was a first in several respects and represents a record commitment of funds to CO 2 mitigation by a private entity. In December 1995, the Intergovernmental Panel on Climate Change (IPCC), issued its Second Assessment Report. The IPCC's conclusion that open-quotes[t]he balance of evidence suggests a discernible human influence on global climateclose quotes fundamentally changed the tenor of the policy debate regarding potential threats associated with global climate change. At the Climate Change Convention's Conference of the Parties (COP) in Geneva in July 1996, most countries, including the United States, advocated adopting the IPCC report as the basis for swift policy movement toward binding international emissions targets. The next COP, in December 1997, is scheduled to be the venue for the signing of a treaty protocol incorporating such targets. Binding targets would have major consequences for power plant operators in the US and around the world. Recent developments in the state of Oregon show the kinds of measures that may become commonplace at the state level in addressing climate change mitigation. First, Oregon recently completed the first administrative proceeding in the US aimed at offsetting the greenhouse gas emissions of a new power plant. Second, a legislatively mandated energy facility siting task force recently recommended that Oregon adopt a carbon dioxide (CO 2 ) standard for new power plant construction and drop use of the open-quotes need for powerclose quotes standard. This article reviews these two policy milestones and their implications for climate change mitigation in the United States

  13. Going Tobacco-Free: Predictors of Clinician Reactions and Outcomes of the NY State OASAS Tobacco-Free Regulation

    Science.gov (United States)

    de Tormes Eby, Lillian Turner; George, Kerrin; Brown, B. Lindsay

    2012-01-01

    In an effort to reduce patient tobacco dependence and create healthier work environments, New York State (NYS) mandated 100% tobacco-free addiction treatment programs for state funded or certified facilities in 2008. We present the results of a longitudinal study examining how local implementation features shape clinician reactions to the regulation and influence post-regulation clinician behavior and strain. A cohort of 147 clinicians associated with 13 treatment organizations throughout NYS completed a survey prior to the passage of the regulation and again approximately 1 year post-regulation. Findings reveal that local implementation features of clinician participation in the planning for change, the provision of change-related information, and perceived organizational support predicted perceptions of change management fairness, which in turn predicted clinical practice behaviors to support smoking cessation, as well as psychological and behavioral strain. In contrast, self-efficacy for change was neither related to local implementation or clinician outcomes. Practical implications are discussed. PMID:22959978

  14. Impact of a State Law on Physician Practice in Sports-Related Concussions.

    Science.gov (United States)

    Flaherty, Michael R; Raybould, Toby; Jamal-Allial, Aziza; Kaafarani, Haytham M A; Lee, Jarone; Gervasini, Alice; Ginsburg, Richard; Mandell, Mark; Donelan, Karen; Masiakos, Peter T

    2016-11-01

    To determine physician-reported adherence to and support of the 2010 Massachusetts youth concussion law, as well as barriers to care and clinical practice in the context of legislation. Primary care physicians (n = 272) in a large pediatric network were eligible for a cross-sectional survey in 2014. Survey questions addressed key policy and practice provisions: concussion knowledge, state regulations and training, practice patterns, referrals, patient characteristics, and barriers to care. Analyses explored relationships between practice and policy, adjusting for physician demographic and practice characteristics. The survey response rate was 64% among all responders (173 of 272). A total of 146 respondents who had evaluated, treated, or referred patients with a suspected sports-related concussion in the previous year were eligible for analysis. The vast majority (90%) of providers agreed that the current Massachusetts laws regarding sports concussions are necessary and support the major provisions. Three-quarters (74%) had taken a required clinician training course on concussions. Those who took training courses were significantly more likely to develop individualized treatment plans (OR, 3.6; 95% CI, 1.1-11.0). Physician training did not improve screening of youth with concussion for depression or substance use. Most physicians (77%) advised patients to refrain from computer, telephone, or television for various time periods. Physicians reported limited communication with schools. Primary care physicians report being comfortable with the diagnosis and management of concussions, and support statewide regulations; however, adherence to mandated training and specific legal requirements varied. Broader and more frequent training may be necessary to align current best evidence with clinical care and state-mandated practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. State Traffic Safety Information

    Data.gov (United States)

    Department of Transportation — The State Traffic Safety Information (STSI) portal is part of the larger Fatality Analysis Reporting System (FARS) Encyclopedia. STSI provides state-by-state traffic...

  16. State Transportation Statistics 2014

    Science.gov (United States)

    2014-12-15

    The Bureau of Transportation Statistics (BTS) presents State Transportation Statistics 2014, a statistical profile of transportation in the 50 states and the District of Columbia. This is the 12th annual edition of State Transportation Statistics, a ...

  17. State Park Trails

    Data.gov (United States)

    Minnesota Department of Natural Resources — This data set is a collection of ArcView shapefiles (by park) of trails within statutory boundaries of individual MN State Parks, State Recreation Areas and State...

  18. State Park Statutory Boundaries

    Data.gov (United States)

    Minnesota Department of Natural Resources — Legislative statutory boundaries for sixty six state parks, six state recreation areas, and eight state waysides. These data are derived principally from DNR's...

  19. Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending.

    Science.gov (United States)

    Wouters, Olivier J; Kanavos, Panos G; McKEE, Martin

    2017-09-01

    Policy Points: Our study indicates that there are opportunities for cost savings in generic drug markets in Europe and the United States. Regulators should make it easier for generic drugs to reach the market. Regulators and payers should apply measures to stimulate price competition among generic drugmakers and to increase generic drug use. To meaningfully evaluate policy options, it is important to analyze historical context and understand why similar initiatives failed previously. Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. We compared generic drug prices and market shares in 13 European countries, using data from 2013, to assess the amount of variation that exists between countries. To place these results in context, we reviewed evidence from recent studies on the prices and use of generics in Europe and the United States. We also surveyed peer-reviewed studies, gray literature, and books published since 2000 to (1) outline existing generic drug policies in European countries and the United States; (2) identify ways to increase generic drug use and to promote price competition among generic drug companies; and (3) explore barriers to implementing reform of generic drug policies, using a historical example from the United States as a case study. The prices and market shares of generics vary widely across Europe. For example, prices charged by manufacturers in Switzerland are, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. The proportion of prescriptions filled with generics ranges from 17% in Switzerland to 83% in the United Kingdom. By comparison, the United States has historically had low generic drug prices and high rates of generic drug use (84% in 2013), but has in recent years experienced sharp price increases for some off-patent products. There are policy

  20. Minimally conscious state or cortically mediated state?

    Science.gov (United States)

    Naccache, Lionel

    2018-04-01

    Durable impairments of consciousness are currently classified in three main neurological categories: comatose state, vegetative state (also recently coined unresponsive wakefulness syndrome) and minimally conscious state. While the introduction of minimally conscious state, in 2002, was a major progress to help clinicians recognize complex non-reflexive behaviours in the absence of functional communication, it raises several problems. The most important issue related to minimally conscious state lies in its criteria: while behavioural definition of minimally conscious state lacks any direct evidence of patient's conscious content or conscious state, it includes the adjective 'conscious'. I discuss this major problem in this review and propose a novel interpretation of minimally conscious state: its criteria do not inform us about the potential residual consciousness of patients, but they do inform us with certainty about the presence of a cortically mediated state. Based on this constructive criticism review, I suggest three proposals aiming at improving the way we describe the subjective and cognitive state of non-communicating patients. In particular, I present a tentative new classification of impairments of consciousness that combines behavioural evidence with functional brain imaging data, in order to probe directly and univocally residual conscious processes.

  1. A Study of the State of Budgetary Financial Reporting in Navy Medicine

    National Research Council Canada - National Science Library

    Smith, Glenn

    1998-01-01

    .... BUMED must comply with financial reporting reform mandates from Congress and other federal agencies, while simultaneously optimizing the use of its financial systems to improve financial management processes...

  2. Job Patterns for Minorities and Women in State and Local Government, 2015 EEO-4Data Table: US by State Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  3. Job Patterns for Minorities and Women in State and Local Government, 2009 EEO-4 Data Table: State by Function Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  4. Job Patterns for Minorities and Women in State and Local Government, 2009 EEO-4Data Table: US by State Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  5. Job Patterns for Minorities and Women in State and Local Government, 2011 EEO-4 Data Table: State by Function Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  6. Job Patterns for Minorities and Women in State and Local Government, 2011 EEO-4Data Table: US by State Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  7. Job Patterns for Minorities and Women in State and Local Government, 2015 EEO-4 Data Table: State by Function Report

    Data.gov (United States)

    US Equal Employment Opportunity Commission — As part of its mandate under Title VII of the Civil Rights Act of 1964, as amended, the Equal Employment Opportunity Commission requires periodic reports from public...

  8. State nuclear initiatives in the United States

    International Nuclear Information System (INIS)

    Strauss, P.L.; Stoiber, C.R.

    1977-01-01

    The paper deals with State nuclear initiatives regarding the role of nuclear power in the energy future of the United States. The question of whether and under what circumstances nuclear facilities should be used to generate electricity was put to the popular vote in several States in 1976. Some general principles of Federal-State relations are discussed with specific reference to nuclear regulations. The initiative mechanism itself is described as well as its legal form and background. The parallel developments in the State and Federal legislative consideration of nuclear issues is reviewed and the suggested reasons for the defeat of the proposals in the seven States concerned are discussed. Finally, the author draws some conclusions on the effects of the 1976 initiatives on future decision-making in the US on energy policy in general and nuclear power in particular. (NEA) [fr

  9. Legal Policy Of Corruption Eradication At State-Owned Enterprises Sector In Indonesia

    Directory of Open Access Journals (Sweden)

    Zulkipli

    2015-08-01

    Full Text Available A mandate of the constitution of the Republic of Indonesia as the highest law is the creation of Indonesia people that is just and prosperous and then the development in all sectors becomes a necessity for achieving that goal. To achieve continuity and development success the enforcement of law supremacy in the form of prevention and eradication of corruption is a necessary condition condition sine qua non. Type of legal research conducted is normative. This research was carried out by discussion of concepts doctrine and theory principles as well as legislation which is correlated to the philosophical construction on state finances. The results of the research indicated that law enforcement of corruption against the management of limited state-owned enterprises during this that damage SEOs state is one of the important parts in the form of control the management of SOEs whose responsible and integrity. Though on the other hand the debate over the use of the criminal instruments in resolving the problems that occurred in the transaction of SOEs state that damage will continue to occur but against the actor of state-owned companies still put forward the principle of prudence in running the business because in some judicial practice has been expandingconstructing carelessness be a part of unlawful action in corruption crime.

  10. State laws and the provision of family planning and abortion services in 1985.

    Science.gov (United States)

    Sollom, T; Donovan, P

    1985-01-01

    65 laws relating to fertility were enacted by the 49 state legislatures that held sessions in 1985. This was the largest enacted since 1973, and the 2nd largest total since. Some of the 1985 abortion laws are designed to protect abortion rights. Several states in the US took action to severely punish the perpetrators of violence against abortion clinics. Lesislation dealing with the delivery of family planning services was subjected to public funding restrictions in 1985. Attempts have been made recently on the federal level to prevent Title X recipients from being provided with information on abortion in their pregnancy counseling sessions. These actions are similar to some of the state laws attempting to reach the same end. Many states included funds for family planning in general appropriations bills. Differences among legislators regarding the right of minors to consent to reproductive health care have led to 2 patterns of response: 1) affirmation of the right of minors to receive family planning services on their own consent; or 2) laws mandating parental involvement in a minor's abortion decision. The most troubling aspect of the fertility related legislation endated in 1985 is the effort by a number of legislatures to attach restrictions on abortion counseling and referral to family planning appropriations bills. In 1985, state laws were enacted to regulate the disposal of fetal remains, to prohibit the use of fetal remains for commercial purposes and to impose criminal sanctions for causing the miscarriage of a fetus during a felony.

  11. Devolution's policy impact on non-emergency medical transportation in State Children's Health Insurance Programs.

    Science.gov (United States)

    Borders, Stephen; Blakely, Craig; Ponder, Linda; Raphael, David

    2011-01-01

    Proponents of devolution often maintain that the transfer of power and authority of programs enables local officials to craft policy solutions that better align with the needs of their constituents. This article provides one of the first empirical evaluations of this assumption as it relates to non-emergency medical transportation (NEMT) in the State Children's Health Insurance Program (SCHIP). NEMT programs meet a critical need in the areas in which they serve, directly targeting this single key access barrier to care. Yet states have great latitude in making such services available. The authors utilize data from 32 states to provide a preliminary assessment of devolution's consequences and policy impact on transportation-related access to care. Their findings provide mixed evidence on devolution's impact on policy outcomes. Proponents of devolution can find solace in the fact that several states have gone beyond federally mandated minimum requirements to offer innovative programs to remove transportation barriers to care. Detractors of devolution will find continued pause on several key issues, as a number of states do not offer NEMT to their SCHIP populations while cutting services and leaving over $7 billion in federal matching funding unspent.

  12. Analytical approaches used in stream benthic macroinvertebrate biomonitoring programs of State agencies in the United States

    Science.gov (United States)

    Carter, James L.; Resh, Vincent H.

    2013-01-01

    Biomonitoring programs based on benthic macroinvertebrates are well-established worldwide. Their value, however, depends on the appropriateness of the analytical techniques used. All United States State, benthic macroinvertebrate biomonitoring programs were surveyed regarding the purposes of their programs, quality-assurance and quality-control procedures used, habitat and water-chemistry data collected, treatment of macroinvertebrate data prior to analysis, statistical methods used, and data-storage considerations. State regulatory mandates (59 percent of programs), biotic index development (17 percent), and Federal requirements (15 percent) were the most frequently reported purposes of State programs, with the specific tasks of satisfying the requirements for 305b/303d reports (89 percent), establishment and monitoring of total maximum daily loads, and developing biocriteria being the purposes most often mentioned. Most states establish reference sites (81 percent), but classify them using State-specific methods. The most often used technique for determining the appropriateness of a reference site was Best Professional Judgment (86 percent of these states). Macroinvertebrate samples are almost always collected by using a D-frame net, and duplicate samples are collected from approximately 10 percent of sites for quality assurance and quality control purposes. Most programs have macroinvertebrate samples processed by contractors (53 percent) and have identifications confirmed by a second taxonomist (85 percent). All States collect habitat data, with most using the Rapid Bioassessment Protocol visual-assessment approach, which requires ~1 h/site. Dissolved oxygen, pH, and conductivity are measured in more than 90 percent of programs. Wide variation exists in which taxa are excluded from analyses and the level of taxonomic resolution used. Species traits, such as functional feeding groups, are commonly used (96 percent), as are tolerance values for organic pollution

  13. Transcriptome States Reflect Imaging of Aging States.

    Science.gov (United States)

    Eckley, D Mark; Coletta, Christopher E; Orlov, Nikita V; Wilson, Mark A; Iser, Wendy; Bastian, Paul; Lehrmann, Elin; Zhang, Yonqing; Becker, Kevin G; Goldberg, Ilya G

    2018-06-14

    In this study, we describe a morphological biomarker that detects multiple discrete subpopulations (or "age-states") at several chronological ages in a population of nematodes (Caenorhabditis elegans). We determined the frequencies of three healthy adult states and the timing of the transitions between them across the lifespan. We used short-lived and long-lived strains to confirm the general applicability of the state classifier and to monitor state progression. This exploration revealed healthy and unhealthy states, the former being favored in long-lived strains and the latter showing delayed onset. Short-lived strains rapidly transitioned through the putative healthy state. We previously found that age-matched animals in different age-states have distinct transcriptome profiles. We isolated animals at the beginning and end of each identified state and performed microarray analysis (principal component analysis, relative sample to sample distance measurements, and gene set enrichment analysis). In some comparisons, chronologically identical individuals were farther apart than morphologically identical individuals isolated on different days. The age-state biomarker allowed assessment of aging in a novel manner, complementary to chronological age progression. We found hsp70 and some small heat shock protein genes are expressed later in adulthood, consistent with the proteostasis collapse model.

  14. Rates and Outcomes of Parathyroidectomy for Secondary Hyperparathyroidism in the United States.

    Science.gov (United States)

    Kim, Sun Moon; Long, Jin; Montez-Rath, Maria E; Leonard, Mary B; Norton, Jeffrey A; Chertow, Glenn M

    2016-07-07

    Secondary hyperparathyroidism is common among patients with ESRD. Although medical therapy for secondary hyperparathyroidism has changed dramatically over the last decade, rates of parathyroidectomy for secondary hyperparathyroidism across the United States population are unknown. We examined temporal trends in rates of parathyroidectomy, in-hospital mortality, length of hospital stay, and costs of hospitalization. Using the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, a representative national database on hospital stay regardless of age and payer in the United States, we identified parathyroidectomies for secondary hyperparathyroidism from 2002 to 2011. Data from the US Renal Data System reports were used to calculate the rate of parathyroidectomy. We identified 32,971 parathyroidectomies for secondary hyperparathyroidism between 2002 and 2011. The overall rate of parathyroidectomy was approximately 5.4/1000 patients (95% confidence interval [95% CI], 5.0/1000 to 6.0/1000). The rate decreased from 2003 (7.9/1000 patients; 95% CI, 6.2/1000 to 9.6/1000), reached a nadir in 2005 (3.3/1000 patients; 95% CI, 2.6/1000 to 4.0/1000), increased again through 2006 (5.4/1000 patients; 95% CI, 4.4/1000 to 6.4/1000), and remained stable since that time. Rates of in-hospital mortality decreased from 1.7% (95% CI, 0.8% to 2.6%) in 2002 to 0.8% (95% CI, 0.1% to 1.6%) in 2011 (P for trend secondary hyperparathyroidism have not declined in recent years. Copyright © 2016 by the American Society of Nephrology.

  15. Ecological effects assessment: requirements vs state-of-the-art

    International Nuclear Information System (INIS)

    McKenzie, D.H.; Thomas, J.M.; Eberhardt, L.L.

    1981-05-01

    Concerns for environmental quality, the ecologist's understanding of ecosystems, and the ability to quantitatively sample and evaluate hypotheses have contributed to current requirements and the state-of-the-art in ecological effects assessments in refard to nuclear power plants. The current cooling system approaches, data collection programs, and ecological effects assessments reflect these contributions. Over a decade of experience provides the basis for a timely review and evaluation of current proactice. The magnitude of economic and environmental resources being committed to cooling system alternatives mandates that the decision-making process result in as many optimal choices as possible. In addition, the resources being devoted to environmental data collection and integration provide considerable motivation for providing meaningful input to the decision-making process. It is maintained that the input should be as quantitative and as free from subjective content as is reasonably possible. An alternative viewpoint suggests that the past several decades of experience be considered but a first step, and the current task to be one of designing a second step

  16. The water needs for LDV transportation in the United States

    International Nuclear Information System (INIS)

    King, Carey W.; Webber, Michael E.; Duncan, Ian J.

    2010-01-01

    Concern over increased demand for petroleum, reliable fuel supply, and global climate change has resulted in the US government passing new Corporate Average Fuel Economy standards and a Renewable Fuels Standard. Consequently, the fuel mix for light duty vehicle (LDV) travel in the United States will change over the coming years. This paper explores the embodied water consumption and withdrawal associated with two projections for future fuel use in the US LDV sector. This analysis encompasses conventional and unconventional fossil fuels, corn ethanol, cellulosic ethanol, soy biodiesel, electricity, and hydrogen. The existing mandate in the US to blend ethanol into gasoline had effectively committed 3300 billion liters of irrigation water in 2005 (approximately 2.4% of US 2005 fresh water consumption) for producing fuel for LDVs. With current irrigation practices, fuel processing, and electricity generation, it is estimated that by 2030, approximately 14,000 billion liters of water per year will be consumed and 23,000-27,000 billion liters withdrawn to produce fuels used in LDVs. Irrigation for biofuels dominates projected water usage for LDV travel, but other fuels (coal to liquids, oil shale, and electricity via plug-in hybrid vehicles) will also contribute appreciably to future water consumption and withdrawal, especially on a regional basis. (author)

  17. Current and future state of FDA-CMS parallel reviews.

    Science.gov (United States)

    Messner, D A; Tunis, S R

    2012-03-01

    The US Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS) recently proposed a partial alignment of their respective review processes for new medical products. The proposed "parallel review" not only offers an opportunity for some products to reach the market with Medicare coverage more quickly but may also create new incentives for product developers to conduct studies designed to address simultaneously the information needs of regulators, payers, patients, and clinicians.

  18. Tomography of nonclassical states

    NARCIS (Netherlands)

    Bazrafkan, MR; Man'ko, [No Value

    2003-01-01

    A review of the symplectic tomography method is presented. Superpositions of different types of photon states are considered within the framework of the tomography approach. Such nonclassical photon states as even and odd coherent states, crystallized Schrodinger cat states, and other superposition

  19. Catalogue of generic plant states leading to core melt in PWRs: includes appendix 1: detailed description of sequences leading to core melt

    International Nuclear Information System (INIS)

    1996-11-01

    The Task Group on thermal-hydraulic system behaviour was given a mandate from PWG 2 on Coolant System-Behaviour with the approval of CSNI to deal with the topic of Accident Management. A writing group was set up to identify generic plant states leading to core melt for pressurized water reactors (PWR) and find 'possible approaches to accident management measures' (AM-Measures) for dealing with them. From a matrix of 15 initiating events and 12 system failures (i.e. from 180 possibilities), 32 event sequences have been identified as leading to core melt. Each sequence has been divided into characteristic plant state intervals according to safety function challenges. For each of the 141 defined characteristic plant state intervals, the members of the Writing Group made proposals for AM-Measures

  20. The State and Corporatism

    DEFF Research Database (Denmark)

    Kaspersen, Lars Bo; Schmidt-Hansen, Ulrich

    in corporatist theory. In particular, we draw upon a conceptualization of the state developed by Michael Mann and Eric Nordlinger's different forms of state autonomy. We propose a state-centered theoretical focus enabling us to grasp the role of the state in the dynamics of the corporatist system. In the second...... to the development of the `Danish model', but that these actors were often orchestrated by the state. At crucial moments the direction of these different actors was even determined by the state. In the first part of the article, it is argued that the state has been under-theorized and to some extent neglected...