Managed Care’s Crimea: Medical Necessity, Therapeutic Benefit, and the Goals of Administrative Process in Health Insurance

En brotyp som är vanlig bland brokonstruktioner är plattrambron. Denna brotyp byggs både med slak- och spännarmering. Det är dock vanligare att bygga med slakarmering än spännarmering, vilket övervägs särskilt då spännvidderna är ungefär 25- 30 meter eller mer. Inledningsvis har en noggrann litteraturstudie genomförts tillsammans med en intervju av en kunnig brokonstruktör för att säkerställa en interaktion mellan teori och aktuell praxis. Detta arbete har haft ett huvudmål, vilket är att ur ett struktur- och kostnadsperspektiv jämföra och utvärdera hur behovet av slakarmering varierar i en plattrambros farbana då spännvidder varieras och betongtvärsnitt ändras. Arbetet har utförts med hjälp av finita elementprogrammet ”Brigade Standard”, vilket erbjuder en tre-dimensionell strukturanalys. Fyra olika tvärsnitt för spännvidder mellan 10-20 meter analyseras. Dimensioner på brodelar bestäms med hjälp av tumregler samt generella råd från intervjuperson; höjd i fält enligt L/20, L/25, L/30 samt L/35, där L är spännvidden. Resultatet visar främst att för ökade spännvidder mot 20 meter ökar lasteffekten på grund av egentyngd drastiskt och då särskilt det tvärsnitt som är störst, det vill säga L/20. Vidare visas även att slankare tvärsnitt resulterar i aningen högre armeringsmängd. Dock påverkas betongkostnaden i större utsträckning av slankare tvärsnitt och särskilt större spännvidder. Även om större spännvidd och slankare tvärsnitt föranleder ett större armeringsbehov, fås en lägre totalkostnad. Det bör noteras att priset på betong och stål är starkt beroende av konjunktur och tillgång till material. Denna studie kan bli ännu intressantare då priset varierar kraftigt för stål och föranleder att betongpriset blir mindre dominerande än vad det är idag. Huvudprodukten från detta arbete är att med hjälp av tabeller och nya priser kunna beräkna en preliminär totalkostnad för plattrambrons farbana för olika spännvidder och hur olika tvärsnittsalternativ påverkar denna kostnad

Managed Care’s Crimea: Medical Necessity, Therapeutic Benefit, and the Goals of Administrative Process in Health Insurance

This Essay explores the concept of medical necessity as it has evolved in the judicial and administrative oversight of managed care. The goals of the Essay are to illustrate the range of plausible rationales for establishing administrative procedures to govern medical necessity disputes, and to demonstrate the difficulty of incorporating into those procedures the most important professional and social responsibilities of managed care in today’s health care system. Part I of the Essay explains the ideological and practical significance of medical necessity as managed care has evolved. Part II examines medical necessity as a legal problem, and questions whether current independent review programs match social needs. Part III offers an alternative perspective on oversight of decisionmaking in managed care that emphasizes therapeutic effect rather than contractual enforcement. Part IV describes improvements in both independent review and overall medical necessity policy that would better serve therapeutic objectives. Among other things, the Essay suggests that independent review procedures should be different for insured individuals who are severely or chronically ill than for those who are only occasional users of health care services

Double Secret Protection: Bridging Federal and State Law To Protect Privacy Rights for Telemental and Mobile Health Users

Mental health care in the United States is plagued by stigma, cost, and access issues that prevent many people from seeking and continuing treatment for mental health conditions. Emergent technology, however, may offer a solution. Through telemental health, patients can connect with providers remotely—avoiding stigmatizing situations that can arise from traditional healthcare delivery, receiving more affordable care, and reaching providers across geographic boundaries. And with mobile health technology, people can use smart phone applications both to self-monitor their mental health and to communicate with their doctors. But people do not want to take advantage of telemental and mobile health unless their privacy is protected. After evaluating the applicability of current health information privacy law to these new forms of treatment, this Note proposes changes to the federal regime to protect privacy rights for telemental and mobile health users

Double Secret Protection: Bridging Federal and State Law To Protect Privacy Rights for Telemental and Mobile Health Users

Mental health care in the United States is plagued by stigma, cost, and access issues that prevent many people from seeking and continuing treatment for mental health conditions. Emergent technology, however, may offer a solution. Through telemental health, patients can connect with providers remotely—avoiding stigmatizing situations that can arise from traditional healthcare delivery, receiving more affordable care, and reaching providers across geographic boundaries. And with mobile health technology, people can use smart phone applications both to self-monitor their mental health and to communicate with their doctors. But people do not want to take advantage of telemental and mobile health unless their privacy is protected. After evaluating the applicability of current health information privacy law to these new forms of treatment, this Note proposes changes to the federal regime to protect privacy rights for telemental and mobile health users

Rerouting Technique for Faster Restoration of Preempted Calls

In a communication network where resources are shared between instantaneous request (IR) and book-ahead (BA) connections, activation of future BA connections causes preemption of many on-going IR connections upon resource scarcity. A solution to this problem is to reroute the preempted calls via alternative feasible paths, which often does not ensure acceptably low disruption of service. In this paper, a new rerouting strategy is proposed that uses the destination node to initiate the rerouting and thereby reduces the rerouting time, which ultimately improves the service disruption time. Simulations on a widely used network topology suggest that the proposed rerouting scheme achieves more successful rerouting rate with lower service disruption time, while not compromising other network performance metrics like utilization and call blocking rate

A New Vision for Health Care: A Leadership Role for Business

This report urges employers, along with government, not only to stay the course but to actively lead in implementing specific changes in private and public policies that could produce a health care system that works for all Americans. Since the publication of this report, CED has reversed its health care policy recommendations

Exact and suboptimal reactive strategies for resource-constrained project scheduling with uncertain resource availabilities.

In order to cope with the uncertainty inherent in practical project management, proactive and/or reactive strategies can be used. Proactive strategies try to anticipate future disruptions by incorporating slack time or excess resource availability into the schedule, whereas reactive strategies react after a disruption happened and try to revert to a feasible schedule. Traditionally, reactive approaches have focused on obtaining a good schedule with respect to the original objective function or a schedule that deviates as little as possible from the baseline schedule. In this paper, we present various approaches, exact as well as heuristic, for optimizing the latter objective and thus encouraging schedule stability. Furthermore, in contrast to traditional rescheduling algorithms, we present a new heuristic that also takes future uncertainty into account when repairing the schedule. We consider a variant of the resource- constrained project scheduling problem in which the uncertainty is modeled by means of unexpected resource breakdowns. The results of an extensive computational experiment are given to compare the performance of the proposed strategies.Schedule stability; Stability; Algorithms; Heuristic; Uncertainty; Project scheduling; Scheduling; Performance; Strategy; Order; Project management; Management; Time;