Quality and Employers' Choice of Health Plan

We seek to understand the relationship between employer decisions regarding which health plans firms choose to offer to their employees and the performance of those plans. We measure performance using data from the Health Plan Employer Data Information Set (HEDIS) and the Consumer Assessment of Health Plan Survey (CAHPS). We use a unique data set that lists the Health Maintenance Organizations (HMOs) available to, and offered by, large employers across markets in the year 2000, and examine the relationship between plan offerings, performance measures and other plan characteristics. We estimate two sets of specifications that differ in whether they model plan choice as a function of absolute plan performance or plan performance relative to competitors. We find that employers are more likely to offer plans with strong absolute and relative HEDIS and CAHPS performance measures. Our results are consistent with the view that large employers are responsive to the interests of their employees.

Long‐Term Health Spending Persistence among the Privately Insured in the US

There is little current information regarding the long‐term persistence of health spending in the United States, in particular among the population aged under 65 (pre‐Medicare eligibility). We describe and model the extent of persistence over a six‐year period (2003–08) using medical and pharmacy claims for over 3 million employees, retirees and dependants derived from the Truven Health MarketScan database. Overall, substantial persistence in spending exists, particularly at the extremes of the distribution and for pharmaceutical spending. Error components models are estimated to separate transient from persistent variation in spending, and dynamic probit models are estimated to assess the predictive power of demographic and co‐morbid conditions and prior high spending in determining the likelihood of future high spending. A better understanding of the persistence of health spending can inform the selection and evaluation of appropriate interventions to address high costs, and can help forecast the likelihood and severity of adverse selection in public and private programmes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134842/1/fisc12120_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134842/2/fisc12120.pd

The imprints of the Galactic Bar on the Thick Disk with RAVE

We study the kinematics of a local sample of stars, located within a cylinder of 500 pc radius centered on the Sun, in the RAVE data set. We find clear asymmetries in the v R v∞ velocity distributions of thin and thick disk stars: there are more stars moving radially outward for low azimuthal velocities and more radially inward for high azimuthal velocities. Such asymmetries have been previously reported for the thin disk as being due to the Galactic bar, but this is the first time that the same type of structures are seen in the thick disk. Our findings imply that the velocities of thick-disk stars should no longer be described by Schwarzschilds, multivariate Gaussian or purely axisymmetric distributions. Furthermore, the nature of previously reported substructures in the thick disk needs to be revisited as these could be associated with dynamical resonances rather than to accretion events. It is clear that dynamical models of the Galaxy must fit the 3D velocity distributions of the disks, rather than the projected 1D, if we are to understand the Galaxy fully

Verbal extensions in Sheng: an examination of variation in form and function

This paper investigates verbal extensions in Sheng, a youth language originating in Nairobi, Kenya. Sheng has received scholarly attention since the 1980s, primarily with a focus on its sociolinguistic traits. Our study aims to advance the linguistic description of Sheng and its morphosyntax by investigating verbal extensions in Sheng. Specifically, we look at the causative, applicative, reciprocal, and passive suffixes, as they are applied to coined and metathesized verbs and verbs which have their origins in Swahili, English, or Gikuyu. We present examples from speakers in Kibera and Umoja neighbourhoods of Nairobi. We find that, while many of the extensions can be applied to elicited verbs, such examples were often considered odd by speakers. In some cases, our consultants suggested alternative strategies, typically employing the use of periphrastic constructions or different verb forms. The use of verbal extensions sometimes resulted in changes in interpretation, requiring us to re-consider the function of these extensions in Sheng more broadly

Re-Alinhando Visão: Correntes Alternativas no Desenho Sul-Americano

Re-Alinhando Visão: Correntes Alternativas no Desenho Sul-Americano - Exposição na Galeria Hungton da Universidade de Austin no Texas, 1997. Curadoria Mari Carmen Ramíre

Mortality Rate in Veterans with Multiple Chronic Conditions

Background: Among patients with multiple chronic conditions, there is increasing appreciation of the complex interrelatedness of diseases. Previous studies have focused on the prevalence and economic burden associated with multiple chronic conditions, much less is known about the mortality rate associated with specific combinations of multiple diseases. Objective: Measure the mortality rate in combinations of 11 chronic conditions. Design: Cohort study of veteran health care users. Participants Veterans between 55 and 64 years that used Veterans Health Administration health care services between October 1999 and September 2000. Measurements: Patients were identified as having one or more of the following: COPD, diabetes, hypertension, rheumatoid arthritis, osteoarthritis, asthma, depression, ischemic heart disease, dementia, stroke, and cancer. Mutually exclusive combinations of disease based on these conditions were created, and 5-year mortality rates were determined. Results: There were 741,847 persons included. The number in each group by a count of conditions was: none = 217,944 (29.34%); 1 = 221,111 (29.8%); 2 = 175,228 (23.6%); 3 = 86,447 (11.7%); and 4+ = 41,117 (5.5%). The 5-year mortality rate by the number of conditions was: none = 4.1%; 1 = 6.0%; 2 = 7.8%; 3 = 11.2%; 4+ = 16.7%. Among combinations with the same number of conditions, there was significant variability in mortality rates. Conclusions: Patients with multiple chronic conditions have higher mortality rates. Because there was significant variation in mortality across clusters with the same number of conditions, when studying patients with multiple coexisting illnesses, it is important to understand not only that several conditions may be present but that specific conditions can differentially impact the risk of mortality

What Are the Total Costs of Surgical Treatment for Uterine Fibroids?

Abstract Objective: To investigate the direct and indirect costs of uterine fibroid (UF) surgery. Methods: Data were obtained from the MarketScan Commercial Claims and Encounters databases for 1999–2004. Our sample included 22,860 women with insurance coverage who were treated surgically for UF and 14,214 women who were treated nonsurgically for UF. Medical care costs and missed workdays were divided into baseline (1 year prior to surgery) and postoperative (1 year after surgery) periods. For a subsample of women, we calculated average annual costs 3 years before and after their surgery. Results: Of patients electing surgery, 85.9% underwent hysterectomy, 7.6% myomectomy, 4.9% endometrial ablation, and 1.6% uterine artery embolization (UAE). Women undergoing UAE incurred the highest medical care costs in the operative year ($16,430 unadjusted,$20,634 adjusted for confounders), followed by hysterectomy ($15,180 unadjusted,$17,390 adjusted), myomectomy ($14,726 unadjusted,$18,674 adjusted), and endometrial ablation ($12,096 unadjusted,$13,019 adjusted). Women treated nonsurgically incurred costs of $7,460 unadjusted and$8,257 adjusted during the year after they were diagnosed with UF. Three years after surgery, patients treated with hysterectomy had the lowest annual costs. Missed workdays in the year after surgery were high, resulting in significant losses to employers in the magnitude of $6,670–$25,229, depending on treatment, values assigned to missed workdays, and whether the analyses adjusted for confounders. Conclusions: UF surgical treatment costs were high. Absenteeism and disability were important components of the cost burden of UF treatment for women, their employers, and the healthcare system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63391/1/jwh.2008.0456.pd

Antimicrobial and antioxidant linen via laccase-assisted grafting

A laccase from Ascomycetemyceliophthora thermophila was used to assist the binding of chitosan and catechin onto a previous enzymatically oxidized linen surface. The process consists of the pre-treatment of the linen with laccase followed by the application of chitosan in a first step and catechin plus laccase in a second step. The results presented here support the conclusion that laccase is able to oxidize phenols naturally existing in flax fibres, and that the o-quinones formed promote the attachment of chitosan or/and catechin. The pre-treatment of linen with laccase is therefore the key factor for the success of catechin and chitosan grafting. A multifunctional linen product with both antioxidant and antibacterial properties was obtained with an acceptable level of durability in terms of end user requirements.Carla Silva would like to acknowledge the Portuguese Fundacao para a Ciencia e a Tecnologia (FCT) for funding under the scholarship SFRH/BPD/46515/2008