OBJECTIVE To compare the rates and patterns of children's specialty referrals in the United States (US) and the United Kingdom (UK). DESIGN Retrospective cohort analysis of health care claims/encounter data obtained in 1996 (US) and 1997 (UK). SETTING Children in the US were selected from 5 managed health plans that used primary care physicians as gatekeepers: 2 health maintenance organizat...

The Research Services Branch plans and coordinates new facilities for the Institute, operates and maintains existing facilities and provides other support functions including centralized glassware and media preparation; instrumentation development and maintenance; arts, graphics and photography; space management; security; landscaping and grounds maintenance and janitorial. Facilities NIEHS is ...

Growing public interest in the operations of managed care plans has fueled a variety of activities to collect and analyze their performance. These activities include studies of financial performance, analysis of enrollment decisions, and, more recently, the development of systems for measuring healthcare quality to improve accountability to consumers. In this study, the authors focus on the act...

INTRODUCTION Although tobacco control activity in the United States during the past several years has increased dramatically, tobacco use continues to have devastating consequences among all age cohorts. METHODS In November 2003, a survey of tobacco control practices and policies in health insurance plans was conducted by America's Health Insurance Plans' national technical assistance office....

This paper analyzes the transformation of the central organization in the managed care system: the multiproduct, multimarket health plan. It examines vertical disintegration, the shift from ownership to contractual linkages between plans and provider organizations, and horizontal integration--the consolidation of erstwhile indemnity carriers, Blue Cross plans, health maintenance organizations (...

Enrollment of rural beneficiaries into Medicare Advantage (MA) plans has more than quadrupled since the inception of the MA program at the beginning of 2006 and increased 35% in the last year. However, as a percent of all beneficiaries, the enrollment rate in rural areas (11.8%) remains well below the national enrollment rate (21.8%) (Tables 1 and 2). The tremendous growth in rural MA plans ove...

Maintenance strategies are typically implemented by optimizing only the cost whilst the reliability of facility performance is neglected. This study proposes a novel algorithm using multi-objective particle swarm optimization (MOPSO) technique to evaluate the cost-reliability tradeoff in a flexible maintenance strategy based on non-dominant solutions. Moreover, a probabilistic model for regress...