Employees’ choice of health benefits and its effect on utilization and third-party payments

Despite the popularity of Preferred-Provider Organizations (PPOs) in the employer-sponsored market, it is still unclear from the literature whether the adoption of the PPO cost-containment design is able to reduce employer coverage costs and efficiently manage employees' health services utilization relative to other plan designs. The objective of this research is to examine the effect of three PPO benefit designs on health services use and third-party payments compared to an Indemnity design, controlling for non-random selection. A by product of examining benefit design is observing predictors of health plan selection. All four plans in this study offered the exact same provider network and only differed in their out-of-pocket (OOP) cost-sharing requirements. To address the potential bias resulting from the endogenous health insurance choice, a two-stage residual inclusion equation is applied which allows for a consistent estimate of the effect of the PPOs. Of the four plans available, the PPO Standard was the most frequently selected plan (60%), followed by the PPO Plus (14%), PPO Basic (4%), and Indemnity (12%). Regression results showed the PPOs with the highest-cost sharing requirements, Standard ($3,032) and Basic ($2,862), had lower predicted total third-party payments than the Indemnity ($3,955) plan (p<0.05). The differences in the PPOs' predicted total third-party payments compared to the Indemnity's payment total was consistent across family health statuses and dependent coverage type. Also, inpatient and office utilization totals were greater in the Plus and Indemnity plans compared to the Basic and Standard plans' utilization totals (p<0.05). The Basic and Standard plans' effect on third-party payments demonstrates that the higher cost-sharing PPOs are likely to produce more employer cost savings than an Indemnity plan with similarly high, cost-sharing requirements. The higher utilization totals in the low cost-sharing plans, and the lower utilization totals in the high cost-sharing plans, suggest that members' price sensitivity to the cost-sharing requirements is likely influencing their level of health services use. This finding is consistent with previous insurance literature showing that the type of health plan cost-sharing arrangement has a positive effect on the use of services and total expenditures

Stepwise determination of multicompartment disposition and absorption parameters from extravascular concentration-time data. Application to mesoridazine, flurbiprofen, flunarizine, labetalol, and diazepam

When disposition is monoexponential, extravascular concentrationtime (C, t) data yield both disposition and absorption parameters, the latter via the Wagner-Nelson method or deconvolution which are equivalent. Classically, when disposition is multiexponential, disposition parameters are obtained from intravenous administration and absorption data are obtained from extravascular C, t data via the Loo-Riegelman or Exact Loo-Riegelman methods or via deconvolution. Thus, in multiexponential disposition one assumes no intrasubject variation in disposition, a hypothesis that has not been proven for most drugs. Based on the classical two and threecompartment open models with central compartment elimination, and using postabsorptive extravascular C, t data only, we have developed four equations to estimate k 10 when disposition is biexponential and two other equations to estimate k 10 when disposition is triexponential. The other disposition rate constants are readily obtained without intravenous data. We have analyzed extravascular data of flurbiprofen (12 sets), mesoridazine (20 sets), flunarizine (5 sets), labetalol (9 sets), and diazepam (4 sets). In the case of diazepam intravenous C, t data were also available for analysis. After disposition parameters had been estimated from the extravascular data the Exact Loo-Riegelman method with the Proost modification was applied to the absorptive extravascular data to obtain A T /V p as a function of time. These latter data for each subject and each drug studied were found to befitted by a function indicating either simple firstorder absorption, two consecutive firstorder processes, or zero order absorption. After absorption and disposition parameters had been estimated, for each set of extravascular data analyzed, a reconstruction trend line through the original C, t data was made. The new methods allow testing of the hypothesis of constancy of disposition with any given drug. There is also a need for new methods of analysis since the majority of drugs have no marketed intravenous formulation, hence the classical methods cannot be applied .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45040/1/10928_2005_Article_BF01061665.pd

Epidemiology and Outcome of Klebsiella Species Bloodstream Infection: A Population-Based Study

OBJECTIVE: To determine incidence rate, seasonal variation, and short- and long-term outcomes of Klebsiella species bloodstream infection (BSI) in a population-based setting