RESUMEN
This paper reports on The Hospital of the University of Pennsylvania's experience and concerns as a participating primary care site in a Medicaid managed care program (HealthPASS), which was established in 1986. Enrollment is mandatory for approximately half of Philadelphia's medical assistance population. Participating primary care sites receive monthly capitation for enrollees and serve as "gatekeepers" for specialty and inpatient services. The report discusses why the academic medical center chose to participate in the program and how existing activities were modified to meet both increased demand for primary care and increased administrative requirements. It also identifies characteristics of the HealthPASS program and of the medical center that have impeded effective case management of care for the urban poor population that the program serves. Improving the quality of care for the medically indigent while controlling costs is essential, but political realities and the special needs of the Medicaid population must be acknowledged. Increased attention must be given to the impact that political compromises have on the design and effectiveness of a managed care program.
Asunto(s)
Centros Médicos Académicos/organización & administración , Programas Controlados de Atención en Salud/organización & administración , Medicaid , Indigencia Médica/economía , Atención Primaria de Salud/métodos , Centros Médicos Académicos/economía , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Capitación , Control de Costos , Femenino , Humanos , Programas Controlados de Atención en Salud/economía , Medicaid/economía , Pennsylvania , Política , Atención Primaria de Salud/economía , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud/economía , Estados Unidos , Salud UrbanaRESUMEN
Cost-effectiveness analysis compared four treatments of end-stage renal disease in Brazil: continuous ambulatory peritoneal dialysis (CAPD), in-center hemodialysis (HD), cadaver donor transplantation (CD-Tx), and living related donor transplantation (LR-Tx). After 2 years, the costs per year of survival were CAPD, $12,134; HD, $10,065; CD-Tx, $6,978; and LR-Tx, $3,022. The HD cost was lower than CAPD partially because of the reuse of hemodialyzers in Brazil. Although less cost-effective, both dialysis treatments yielded more years of survival after 2 years. This analysis reveals a trade-off between cost per year of survival and years of survival.
Asunto(s)
Fallo Renal Crónico/economía , Trasplante de Riñón/economía , Diálisis Peritoneal Ambulatoria Continua/economía , Diálisis Renal/economía , Adolescente , Adulto , Brasil , Análisis Costo-Beneficio , Humanos , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Persona de Mediana Edad , Tasa de SupervivenciaRESUMEN
CSP #221 is a randomized multiinstitutional clinical trial to assess the efficacy of 10 d of perioperative total parenteral nutrition (TPN) in reducing morbidity and mortality in malnourished patients undergoing intraperitoneal and/or intrathoracic operations. In this paper a detailed protocol for the clinical efficacy trial is presented primarily as a reference document for use in interpretation of the results of the clinical trial. It is also anticipated, however, that review of this protocol may be useful to other investigators planning future clinical nutrition intervention trials.