Private cost containment. The effects of utilization review programs on health care use and expenditures

Utilization review has been regarded as one of the most promising approaches to the containment of health care costs. We analyzed insurance claims data on 222 groups of employees and dependents for 1984 and 1985 to evaluate the effects of utilization review programs instituted by a large private insurance carrier. The utilization review programs we studied were compulsory; patients who did not follow established utilization review procedures were subject to financial penalties. Controlling for employee characteristics, health care market area factors, and benefit-plan features, we found that utilization review reduced admissions by 12.3 percent, inpatient days by 8.0 percent, hospital expenditures by 11.9 percent, and total medical expenditures by 8.3 percent. When only groups that had relatively high admission rates before adopting utilization review were analyzed, it was found that they had a 34 percent reduction in patient days and a 30 percent reduction in hospital expenditures. The savings-to-cost ratio of utilization review for groups overall was highly favorable--approximately 8 to 1. Private utilization review programs of the type we studied appear to be effective in reducing hospital use and decreasing medical expenditures. This study did not address the possible effects of such programs on the health status of patients.     

Temperament as a moderator of children's stressful experiences

Data on 158 children, six and nine years old, are analyzed for the relationship between stress and behavior. Undesirable life events and intense "hassles" were particularly correlated with behavioral symptoms. Statistically, temperament appears to moderate this influence but, lacking appreciable variance of symptoms in the models including these interaction effects, the more parsimonious main-effects concept may be more useful.     

The relation between good communication skills on the part of the physician and patient satisfaction in a military setting

OBJECTIVE: The objective of this study was to assess the correlation between patients' view of the consultation and the assessment of an auditing physician on the same consultation. METHODS: A prospective study in military clinics was conducted. A board-certified family physician made a real-time semistructured assessment of the medical consultation. At the end of it, the patient was asked to fill in the Consultation Satisfaction Questionnaire. The degree of correlation between patients' satisfaction from consultation and the scores given by the auditing physician was evaluated. RESULTS: Twelve primary care physicians were evaluated. A total of 117 (76.5%) of 153 patients returned their questionnaires. A positive correlation was found between physician's communication skills and general satisfaction (r = 0.614), professional care (r = 0.367), and depth of relationship (r = 0.275) calculated from the Consultation Satisfaction Questionnaire. No correlation was found between patient satisfaction and other consultation skills. CONCLUSIONS: Good communication skills may enhance patient satisfaction. It may be advisable to investigate whether a training program to enhance the physician's communication skills can improve patient satisfaction.     

A reasonable mechanism for visible light-induced skin rejuvenation

In recent years, much research has been done in the field of non-ablative skin rejuvenation. This comes as a response to the continuous demand for a simple method of treating rhytides, UV exposure, and acne scars. Numerous researches involve visible light-pulsed systems (20–30 J/cm²). The mechanism of action is believed to be a selective heat-induced denaturalization of dermal collagen that leads to subsequent reactive synthesis (Bitter Jr., Dermatol. Surg., 26:836–843, 2000; Fitzpatrick et al., Arch. Dermatol., 132:395–402, 1996; Kauvar and Geronemus, Dermatol. Clin., 15:459–467, 1997; Negishi et al., Lasers Surg. Med., 30:298–305, 2002; Goldberg and Cutler, Lasers Surg. Med., 26:196–200, 2000; Hernandez-Perez and Ibeitt, Dermatol. Surg., 28:651–655, 2002). In this study, we suggest a different mechanism for photorejuvenation based on light-induced reactive oxygen species (ROS) formation. We irradiated collagen in vitro with a broadband of visible light (400–800 nm, 24–72 J/cm²) and used the spin trapping coupled with electron paramagnetic resonance spectroscopy to detect ROS. Irradiated collagen resulted in hydroxyl radicals formation. We propose, as a new concept, that visible light at the energy doses used for skin rejuvenation (20–30 J/cm²) produces high amounts of ROS, which destroy old collagen fibers, encouraging the formation of new ones. On the other hand, at inner depths of the skin, where the light intensity is much weaker, low amounts of ROS are formed, which are well known to stimulate fibroblast proliferation.