Abstract:
:The transformation to managed care is one of the most important and complex changes ever to take place in the American health system. One key aspect of this transformation is its implications for public health policy and practice. Both public and private buyers purchase managed care; increasingly, public programs that used to act as their own insurers (i.e., Medicare, Medicaid and CHAMPUS) are purchasing large quantities of managed care insurance from private companies. The transformation to managed care is altering the manner in which public health policy makers conceive of and carry out public health activities (particularly activities that involve the provision of personal health services). The degree to which managed care changes public health and in turn is altered by public health will depend in great measure on the extent to which public and private policy makers understand the implications of their choices for various aspects of public health and take steps to address them. Because both publicly and privately managed care arrangements are relatively deregulated, much of the dialogue between public health and managed care purchasers can be expected to take place within the context of the large service agreements that are negotiated between buyers and sellers of managed care products. This is particularly true for Medicaid because of the importance of Medicaid coverage, payment and access policies to public health policy makers, and because of the public nature of the Medicaid contracting process. A nationwide study of Medicaid managed care contracts offers the first detailed analysis of the content and structure of managed care service agreements and the public health issues they raise. Four major findings emerge from a review of the contracts. First, most of the agreements fail to address key issues regarding which Medicaid-covered services and benefits are the contractor's responsibility and which remain the residual responsibility of the state agency. Second, most contracts fail to address the legal and structural issues arising from the relationship between the managed care service system and the public health system, including such key matters as access to care for communicable diseases and contractors' relationship to state public health laboratories. Third, many contracts are silent on health agencies' access to data for surveillance and community health measurement purposes. Finally, many contracts may be developed with only a limited understanding of the key public health-related issues facing the community from which the members will be drawn. The CDC and state and local public health agencies must expand their activities in the area of managed care contract specifications. For several years the CDC has been involved in an ongoing effort to develop quality of care measures to be collected from all companies through the HEDIS process. As important as this effort is, it represents only an attempt to measure what managed care does rather than an a priori effort to shape the underlying policy and organizational structure of managed care itself. Integrating managed care with public health policy will require this type of affirmative effort with both Medicaid agencies as well as other managed care purchasers.
journal_name
Am J Prev Medjournal_title
American journal of preventive medicineauthors
Rosenbaum Sdoi
10.1016/s0749-3797(97)00046-9subject
Has Abstractpub_date
1998-04-01 00:00:00pages
67-71issue
3 Suppleissn
0749-3797issn
1873-2607pii
S0749-3797(97)00046-9journal_volume
14pub_type
杂志文章,评审abstract:CONTEXT:The risk of chronic kidney disease (CKD) in the U.S. is higher in individuals with low SES than in those with high SES. However, differences in these risks between African Americans and whites are unclear. EVIDENCE ACQUISITION:Studies published through August 30, 2016 in Medline and EMBASE were searched. From ...
journal_title:American journal of preventive medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.amepre.2017.06.036
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:New recommendations about the use of hemoglobin A1c (HbA1c) for diagnosing diabetes have stimulated a debate about the optimal HbA1c cutoff to identify prediabetes for preventive intervention. PURPOSE:To assess the cost effectiveness associated with the alternative HbA1c cutoffs for identifying prediabetes....
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2012.01.003
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:Underage alcohol use is a major contributor to morbidity and mortality in adolescents and young adults. This study examined drinking levels and ensuing problems among college students and factors associated with binge drinking. METHOD:The Harvard School of Public Health College Alcohol Study conducted a sel...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/s0749-3797(00)00163-x
更新日期:2000-07-01 00:00:00
abstract::After publication of certain vaccine recommendations made by the Advisory Committee on Immunization Practices, several unexpected events have occurred during implementation of these recommendations. These have included changes in recommendations following adverse events involved with a particular vaccine and the confe...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2015.06.023
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Although adults with developmental disabilities are at high risk for obesity and its sequelae, few community-based lifestyle interventions targeting those with developmental disabilities exist. DESIGN:The study was a single group, community-based demonstration project with pre-post test evaluation conducted...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2009.08.005
更新日期:2009-12-01 00:00:00
abstract:OBJECTIVES:To examine the effects of a multisite environmental prevention initiative, the "A Matter of Degree" (AMOD) program, on student heavy alcohol consumption and resultant harms at ten colleges. METHODS:A quasi-experimental longitudinal analysis of alcohol consumption and harms was employed, using repeated cross...
journal_title:American journal of preventive medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.amepre.2004.06.008
更新日期:2004-10-01 00:00:00
abstract:INTRODUCTION:The purpose of this study is to identify whether weather-related factors moderate the effect of a physical activity (PA) intervention. METHODS:Participants (N=204, 77% female, mean age 33 [SD=11] years, mean BMI 28.2 [SD=7.1]) from the Make Better Choices 1 trial, enrolled April 2005 to April 2008, were r...
journal_title:American journal of preventive medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.amepre.2018.01.025
更新日期:2018-05-01 00:00:00
abstract::Public health advocates have increasingly highlighted the importance of implementing comprehensive physical activity interventions that use an ecologic framework. Such a framework can broadly address physical activity barriers, such as the lack of opportunities, social support, policies, built environments, and commun...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2009.09.027
更新日期:2009-12-01 00:00:00
abstract:INTRODUCTION:The U.S. Surgeon General has concluded that aerosol from electronic vapor products, such as e-cigarettes, can contain harmful and potentially harmful constituents. This study assessed the prevalence and determinants of U.S. adult attitudes toward electronic vapor product use in indoor public places. METHO...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2018.08.022
更新日期:2019-01-01 00:00:00
abstract:CONTEXT:The "first 1,000 days"-conception through age 24 months-are critical for the development and prevention of childhood obesity. This study systematically reviews existing and ongoing interventions during this period, identifies gaps in current research, and discusses conceptual frameworks and opportunities for fu...
journal_title:American journal of preventive medicine
pub_type: 杂志文章,评审
doi:10.1016/j.amepre.2015.11.010
更新日期:2016-06-01 00:00:00
abstract::The United States Cycling Federation (USCF) decision in 1986 to mandate helmet use in all sponsored races marked a major initiative in cycling safety. Confirming earlier reports about the effectiveness of helmets in preventing injuries, this study also examines the attitudes of 554 USCF members toward the policy and a...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:Infant mortality rates (IMRs) are disproportionally high in the U.S. South; however, the proximate contributors that could inform regional action remain unclear. PURPOSE:To quantify the components of excess infant mortality in the U.S. South by maternal race/ethnicity, underlying cause of death, and gestati...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2013.12.006
更新日期:2014-03-01 00:00:00
abstract:INTRODUCTION:Lifestyle-related habits have a strong influence on morbidity and mortality worldwide. This study investigates the association between a multidimensional healthy lifestyle score and all-cause mortality risk, including in the score some less-studied lifestyle-related factors. METHODS:Participants (n=20,094...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2020.01.032
更新日期:2020-08-01 00:00:00
abstract:INTRODUCTION:Infant mortality rates are higher in nonmetropolitan areas versus large metropolitan areas. Variation by race/ethnicity and cause of death has not been assessed. Urban-rural infant mortality rate differences were quantified by race/ethnicity and cause of death. METHODS:National Vital Statistics System lin...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2019.09.010
更新日期:2020-02-01 00:00:00
abstract:INTRODUCTION:This study assesses the following among primary care physicians: (1) the use of evidence-based strategies to improve adult vaccination rates, (2) the number of strategies employed simultaneously, and (3) characteristics associated with assessing adult vaccinations at each visit. METHODS:An internet and ma...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2020.03.020
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Physical activity is important for children's health, and identifying factors associated with their physical activity is important for future interventions and public health programs. PURPOSE:This study sought to identify multidimensional correlates of preschool children's physical activity. METHODS:The so...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2012.04.020
更新日期:2012-08-01 00:00:00
abstract:INTRODUCTION:Sugar-sweetened beverages (SSBs) are a major contributor to children's added sugar consumption. This study examines whether children's SSB and water intakes are associated with diet quality and total energy intake. METHODS:Using data on children aged 2-18 years from the 2009-2014 National Health and Nutri...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2017.11.005
更新日期:2018-03-01 00:00:00
abstract:INTRODUCTION:The National Asthma Campaign (NAC) was formed in 1990 as a coalition of the key professional organizations concerned with asthma and its management in Australia. It has conducted multifaceted educational activities targeting health care professionals, people with asthma, and the general public. Between Nov...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:In 2012, CDC launched the first federally funded national mass media antismoking campaign. The Tips From Former Smokers (Tips) campaign resulted in a 12% relative increase in population-level quit attempts. PURPOSE:Cost-effectiveness analysis was conducted in 2013 to evaluate Tips from a funding agency's pe...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2014.10.011
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVE:To examine demographics and immunization attitudes, beliefs, and behaviors of parents who sought medical attention for a child due to an adverse event following immunization (AEFI). METHODS:A sample of households that participated in the National Immunization Survey was re-contacted during 2001. This analysi...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2006.03.017
更新日期:2006-07-01 00:00:00
abstract:INTRODUCTION:Social determinants of health are critical drivers of health status and cost, but are infrequently screened or addressed in primary care settings. Systematic approaches to identifying individuals with unmet social determinants needs could better support practice workflows and linkages of patients to servic...
journal_title:American journal of preventive medicine
pub_type: 临床试验,杂志文章
doi:10.1016/j.amepre.2018.11.009
更新日期:2019-04-01 00:00:00
abstract::A simple microcomputer system has been developed using off-the-shelf components. The system permits local access, in an acceptable time frame, to several years of New Jersey multiple cause of death data (approximately 70,000 records per calendar year). This report describes the system, including hardware, software, da...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:This study describes opportunistic smoking-cessation counseling and compares strategies used in general practice to experts' recommendations. METHODS:In this observational study we analysed 157 videotaped consultations with self-reported smokers, visiting 70 Australian general practitioners (GPs) who were r...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/s0749-3797(97)00010-x
更新日期:1998-01-01 00:00:00
abstract:INTRODUCTION:Cost sharing can deter the use of health services and act as a potential contributor to racial/ethnic disparities in cancer. The Affordable Care Act required most health plans to cover, without cost sharing, preventive services, including colorectal cancer screening. Population-based data were used to esti...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2019.09.002
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Despite substantial evidence for neighborhood characteristics correlating with walking, so far there has been limited attention to possible practical implications for neighborhood design. This study investigates to what extent design guidelines are likely to stimulate walking. METHODS:Four of the New Urbani...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2006.12.012
更新日期:2007-04-01 00:00:00
abstract::The lengthy and uncertain translation of research into clinical practice is well documented. Much of the current "gold standard" clinical research is slow, expensive, and lacks perceived relevance for practitioners and decision makers. In contrast, we summarize experiences conducting the My Own Health Report (MOHR) pr...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2014.03.007
更新日期:2014-08-01 00:00:00
abstract:CONTEXT:The discovery of the HFE gene in 1996 has introduced DNA testing as a possible tool for screening and diagnosis of hemochromatosis and increased interest in the disorder. Population screening using transferrin saturation has been advocated by experts to permit early detection and treatment with phlebotomy befor...
journal_title:American journal of preventive medicine
pub_type: 杂志文章,评审
doi:10.1016/s0749-3797(98)00141-x
更新日期:1999-02-01 00:00:00
abstract::We evaluated the efficacy of the Stanford Quit Kit, an eight-page self-administered smoking cessation program. Subjects were randomly assigned to receive the Quit Kit (n = 142) or a delayed intervention (n = 65). Confirmed abstinence (p less than .05) and reduced smoking among continuing smokers (p less than .002) wer...
journal_title:American journal of preventive medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1986-11-01 00:00:00
abstract::To decrease adolescent morbidity and mortality and improve the quality of life, a violence-prevention consultation is offered to hospitalized victims of nondomestic violence. The context is a violence-prevention team approach to patient assessment, treatment, and follow-up. Psychoeducational counseling emphasizes the ...
journal_title:American journal of preventive medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1996-09-01 00:00:00
abstract:INTRODUCTION:This study aims to quantify out-of-pocket spending associated with respiratory hospitalizations for conditions similar to those caused by coronavirus disease 2019 and to compare out-of-pocket spending differences among those enrolled in consumer-directed health plans and in traditional, low-deductible plan...
journal_title:American journal of preventive medicine
pub_type: 杂志文章
doi:10.1016/j.amepre.2020.05.008
更新日期:2020-09-01 00:00:00