Social health maintenance organizations' service use and costs, 1985-89.

Presented in this article are aggregate utilization and financial data from the four social health maintenance organization (S/HMO) demonstrations that were collected and analyzed as a part of the national evaluation of the S/HMO demonstration project conducted for the Health Care Financing Administration. The S/HMOs, in offering a $6,500 to$12,000 chronic care benefit in addition to the basic HMO benefit package, had higher start up costs and financial losses over the first 5 years than expected, and controlling costs continues to be a challenge to the sites and their sponsors

Development of \u3ci\u3eOrius Insidiosus\u3c/i\u3e (Hemiptera: Anthocoridae) in Relation to Temperature

A developmental threshold of lO.3°C and a thermal constant of 307 day-degrees C were estimated for a Wisconsin population of Orius insidiosus (Say) (Hemiptera: Anthocoridae) by rearing eggs and nymphs at various constant temperatures

Trends and issues in the Medicaid 1915(c) waiver program.

Over the past 15 years, Medicaid 1915(c) home and community-based waivers have made a substantial contribution to States' efforts to transform their long-term care (LTC) systems from largely institutional to community-based systems. By 1997, every State had implemented a waiver program for at least some subgroups of individuals with disabilities, and expenditures increased from $3.8 million in 1982 to more than$8.1 billion in 1997. Emerging, as well as long-standing, policy issues related to the waiver program include concerns with access, variation in availability by disability group, State decisions related to the provision of community-based LTC, and evidence on effectiveness

Nursing home bed capacity in the States, 1978-86.

Trends in nursing home bed supply in the States show large variations in beds per population and a gradual decline in supply per aged population. A cross-sectional time-series regression analysis was used to examine some factors associated with nursing home bed supply. Variation was accounted for by economic factors, supply of alternative services, and climate. State Medicaid reimbursement rates had negative coefficients, with supply suggesting States may be increasing rates to improve access where supply is limited. Medicaid waiver policy was not found to be significant

Medicaid 1915(c) home and community-based services waivers across the states.

This article provides State-level data on the Medicaid 1915(c) home and community-based services (HCBS) waivers program. Medicaid 1915(c) waiver participants were 32 percent of the Medicaid participants in institutional care in 1997. These data document wide interstate variation in organizational oversight and program policies for the waivers. Many structural barriers to HCBS waiver growth existed. Case management services, in some form, were normative for most HCBS waiver participants, but formal mechanisms to assess client satisfaction and service quality were less common. Substantial new growth in this program may require fundamental changes in HCBS waiver policies

Converting energy from fusion into useful forms

If fusion power reactors are to be feasible, it will still be necessary to convert the energy of the nuclear reaction into usable form. The heat produced will be removed from the reactor core by a primary coolant, which might be water, helium, molten lithium-lead, molten lithium-containing salt, or CO2. The heat could then be transferred to a conventional Rankine cycle or Brayton (gas turbine) cycle. Alternatively it could be used for thermochemical processes such as producing hydrogen or other transport fuels. Fusion presents new problems because of the high energy neutrons released. These affect the selection of materials and the operating temperature, ultimately determining the choice of coolant and working cycle. The limited temperature ranges allowed by present day irradiated structural materials, combined with the large internal power demand of the plant, will limit the overall thermal efficiency. The operating conditions of the fusion power source, the materials, coolant, and energy conversion system will all need to be closely integrated.Comment: 22 pages, 4 figures, Proceedings of the Institution of Mechanical Engineers, Part A: Journal of Power and Energy December 11, 201

Variations and trends in state nursing facility capacity: 1978-93.

The demand for nursing facility (NF) beds has been growing with the aging of the population and many other factors. As the need for nursing home care grows, the Nation's capacity to provide such care is the subject of increasing concern. This article examines licensed NFs and beds, presenting data on trends from 1978-93. Measures of the adequacy of NF beds in States are examined over time, including the ratio of beds per aged population, occupancy rates, and State official's opinions of the adequacy of supply. State and regional variations are shown over time, and we speculate on the factors which may be associated with the variation

Social/health maintenance organization and fee-for-service health outcomes over time.

Evaluating the performance of long-term care (LTC) demonstrations requires longitudinal assessment of multiple outcomes where selective mortality and disenrollment, if not accounted for, can give the appearance of reduced (or enhanced) efficacy. We assessed outcomes in social/health maintenance organizations (S/HMOs) and Medicare fee-for-service (FFS) care using a multivariate model to estimate active life expectancy (ALE). S/HMO enrollees and samples of FFS clients in four sites were analyzed and outcome differences assessed for a 3-year period. Results provide insights into S/HMO performance under different conditions and, more generally, into evaluating LTC demonstrations without randomized client and control groups