The Distribution of the Burden of US Health Care Financing

The complex financing system that supports health care spending in the US makes estimation of the incidence of financing both daunting and important. A significant portion of financing is embedded in the tax system at all levels of government, while tax expenditures that subsidize private purchases implicitly transfer a large share of financing from private to public revenue sources. We compute and describe the final incidence of financing health care by major component and in total. We use the Kakwani measure of progressivity and find the overall incidence of US health care financing to be regressive although less so than in earlier years. This change is due in part to an increased federal role. We provide detail as to our methods and assumptions for benchmarking and assessment of the equity implications of financing health care in the future

Mathematical predictive models for cooling ponds and lakes. Part B, User's manual and applications of MITEMP. Part C. A transient analytical model for shallow cooling ponds

"Also published as R.M. Parsons Laboratory Technical Report No. 262."In Part B a computer code, '"MITEMP: M.I.T. Transient Temperature Prediction Model for Natural Reservoirs and Cooling Impoundments," is presented as a feasible and efficient tool for the prediction of transient performance of man-made impoundments. Particular emphasis is placed on waste heat dissipation from steam-electric power stations. The code allows the simulation of the physical regime (temperature and flow patterns) of impoundments as a function of design and for long time periods. The code contains the following elements: (1) Natural Deep Lake and Reservoir Model, (2) Deep Stratified Cooling Pond Model, (3) Shallow Vertically Mixed Dispersive Cooling Pond Model, and (4) Shallow, Vertically Mixed Recirculating Cooling Pond Model. The physical and mathematical basis for the present computer code is developed in an earlier report entitled, "Mathematical Predictive Models for Cooling Ponds and Lakes, Part A: Model Development and Design Considerations," by G. Jirka, M. Watanabe, K.H. Octavio, C. Cerco and D.R.F. Harleman, R.M. Parsons Laboratory for Water Resources and Hydrodynamics, Technical Report No. 238, December 1978. The user's manual presented herein gives a detailed description of the computational structure of MITEMP and discusses input and output requirements. The application to several case studies is presented. A complete code listing is given in the appendix, as are some sample computations. In Part C, an analytical model is developed to predict the transient performance of shallow, vertically mixed cooling ponds. This model is suggested as an aid in the initial design or screening process, eliminating the need for repeated use of MITEMP for long term simulations. When a candidate design(s) is selected, its long term performance can be analyzed with the more precise MITEMP.Prepared under the support of: Commonwealth Edison Company, Chicago, Illinois; NUS Corporation, Rockville, Maryland; Environmental Control Technology Division, U.S. Department of Energy; and Electric Power Research Institute, Palo Alto, Californi

Pregnancy and Delivery Costs in Georgia Medicaid: PCCM Versus Fee-for-Service Enrollees

This study examines the enrollment, resource utilization, and prenatal care cost patterns among pregnant black and white women in Georgia’s PCCM program, Georgia Better Health Care (GBHC), compared with those acquiring pregnancy and delivery services through Georgia’s Fee for Service (FFS) sector. Birth certificate data from 1998 were linked with Medicaid enrollment and claims data from 1997 and 1998 to construct a retrospective pregnancy history for each Medicaid woman giving birth in Georgia hospitals in 1998. Total payments for pregnancy and delivery services and on the total number of prenatal care visits were derived for each woman in the sample. Multivariate logistic analyses were employed to assess the role of PCCM versus FFS in determining total payments and the likelihood of a prenatal hospitalization, length of hospital stay longer than 2 days following delivery, and cesarean section delivery. While prenatal pregnancy services and delivery costs were higher for those in PCCM than FFS, PCCM women had fewer prenatal care visits and were less likely to have delivery stays longer than 2 days postpartum compared with FFS women. The higher costs under PCCM are apparently related to the finding that this delivery system was highly associated with having more prenatal hospitalizations compared with FFS. In similar analyses conducted separately for white and black pregnant women, black women served by PCCM followed these overall results across delivery systems while there were no differences in the likelihood of a prenatal hospitalization or total prenatal care visits for whites served by PCCM versus FFS. In light of Georgia’s turn toward full capitation under its new managed care initiative, many issues regarding pregnancy services and delivery such as earlier program enrollment, coordination of care, payment policies and capitation rates will need to be addressed

The Relationship between Narcotic Administration and Emergency Department Recidivism

The present study investigated the impact of narcotic administration on quantity and frequency of recidivism by patients presenting to the Emergency Department (ED) with a primary complaint of chronic pain. This study explored the relationship between narcotic administration, gender, prescribing physician and subsequent ED visits. We analyzed the data from the twelve months of medical records for 80 patients (278 visits) who presented at the ED of a general medical center in a rural area. Results indicated that the number of visits by those who received narcotics was significantly higher than for those who did not receive narcotics. There was also a significant difference in prescribing patterns, with females being more likely than males to receive a narcotic. Observable differences were found between the frequency of days between visits for those who received narcotics vs. those who did not, and the differential pattern of narcotic administration between providers. These findings raise the question that the receipt of a narcotic may reinforce visits to the ED. This study concluded that an established protocol for treating patients with chronic pain who present in the ED may be useful

Smoking Policies and Birth Outcomes: Estimates From a New Era

Smoking during pregnancy has been shown to have significant adverse health effects for new born babies. Smoking is the leading preventable cause of low birth weight of infants who in turn, need more resources at delivery and are more likely to have related health problems in infancy and beyond. Despite these outcomes, many women still smoke during pregnancy. The main question for policy makers is whether tobacco control policies can influence maternal smoking and reduce adverse birth outcomes. We examine this question using data from the Pregnancy Risk Assessment Monitoring System data from 2000 to 2005. This is a time period during which states significantly changed their tobacco control policies by raising excise taxes and imposing strong restrictions on indoor smoking. We estimate reduced form models of birth weight and gestational weeks, focusing on the effects of taxes and workplace restrictions on smoking as the policies of interest. We also estimate demand equations for the probability of smoking during the third trimester. Results show that the smoking policies are effective, but limited to babies born to mothers of certain age groups. For babies born to teenage mothers, higher cigarette taxes are associated with small increases in birth weight and gestational weeks. For babies born to mothers ages 25-34, restrictions on smoking in the workplace are associated with small increases in gestational weeks.

The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in Georgia: Women Covered and Medicaid Costs in 2003

The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) provided states with an optional Medicaid eligibility category for uninsured women with breast and/or cervical cancers. The BCCPTA is the first and only such effort to use a population-based public health screening program, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to provide a pathway to publicly funded health insurance for otherwise uninsured low-income women. Georgia was one of the first states to adopt the BCCPTA and was one of only twelve states that provided Medicaid eligibility to women screened by non-NBCCEDP providers. We use 2003 Georgia Medicaid claims and enrollment data to investigate the scope of the state’s BCCPTA enrollment and enrollees’ costs as well as demographic characteristics of breast and cervical cancer patients in Georgia’s BCCPTA and other Medicaid eligibility categories. Georgia’s Medicaid coverage of women with breast and/or cervical cancer under BCCPTA accounted for over one-third of all women with these cancers covered by the state in 2003 alone. Those newly eligible under BCCPTA were more likely to have breast, as opposed to cervical, cancer and to be older than those women with breast/cervical cancers enrolled in Georgia Medicaid due to low-income, pregnancy or disability status. Georgia’s Medicaid program spent over $29 million on BCCPTA enrollees in 2003 at a cost of over$12,000 per enrollee. BCCPTA enrollee costs were more similar to those for disabled women with these cancers, about $19,500, than to costs for low-income/pregnant women which equaled about$7,500. By expanding Medicaid coverage, BCCPTA can potentially bring women in at earlier stages of their cancer and provide needed coverage/treatment. Future research should examine the potential effect of BCCPTA on reduced morbidity and mortality among these low-income women

Adherence to the updated guidelines for the prevention of perinatal Group B streptococcal disease

In 2010, the Centers for Disease Control and Prevention updated the Guidelines for the Prevention of Perinatal Group B Streptococcal (GBS) Disease. Previous studies of adherence to GBS guidelines have focused on the treatment of carriers of GBS. Our objective was to determine whether there was any difference in adherence to the guidelines for screening and treatment of women who delivered at our institution between the beginning of 2011 and the end of 2011 as the revised guidelines were published in November 2010. Our secondary outcome was to determine whether any differences in adherence occurred between prenatal provider types (OB/Gyn, Certified Nurse Midwives, and Family Practice)

Characterization of subsurface media from locations up- and down-gradient of a uranium-contaminated aquifer.

The processing of sediment to accurately characterize the spatially-resolved depth profiles of geophysical and geochemical properties along with signatures of microbial density and activity remains a challenge especially in complex contaminated areas. This study processed cores from two sediment boreholes from background and contaminated core sediments and surrounding groundwater. Fresh core sediments were compared by depth to capture the changes in sediment structure, sediment minerals, biomass, and pore water geochemistry in terms of major and trace elements including pollutants, cations, anions, and organic acids. Soil porewater samples were matched to groundwater level, flow rate, and preferential flows and compared to homogenized groundwater-only samples from neighboring monitoring wells. Groundwater analysis of nearby wells only revealed high sulfate and nitrate concentrations while the same analysis using sediment pore water samples with depth was able to suggest areas high in sulfate- and nitrate-reducing bacteria based on their decreased concentration and production of reduced by-products that could not be seen in the groundwater samples. Positive correlations among porewater content, total organic carbon, trace metals and clay minerals revealed a more complicated relationship among contaminant, sediment texture, groundwater table, and biomass. The fluctuating capillary interface had high concentrations of Fe and Mn-oxides combined with trace elements including U, Th, Sr, Ba, Cu, and Co. This suggests the mobility of potentially hazardous elements, sediment structure, and biogeochemical factors are all linked together to impact microbial communities, emphasizing that solid interfaces play an important role in determining the abundance of bacteria in the sediments

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS‐like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo‐controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS‐specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149751/1/nmo13607.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149751/2/nmo13607_am.pd

Circumstellar Structure around Evolved Stars in the Cygnus-X Star Formation Region

We present observations of newly discovered 24 micron circumstellar structures detected with the Multiband Imaging Photometer for Spitzer (MIPS) around three evolved stars in the Cygnus-X star forming region. One of the objects, BD+43 3710, has a bipolar nebula, possibly due to an outflow or a torus of material. A second, HBHA 4202-22, a Wolf-Rayet candidate, shows a circular shell of 24 micron emission suggestive of either a limb-brightened shell or disk seen face-on. No diffuse emission was detected around either of these two objects in the Spitzer 3.6-8 micron Infrared Array Camera (IRAC) bands. The third object is the luminous blue variable candidate G79.29+0.46. We resolved the previously known inner ring in all four IRAC bands. The 24 micron emission from the inner ring extends ~1.2 arcmin beyond the shorter wavelength emission, well beyond what can be attributed to the difference in resolutions between MIPS and IRAC. Additionally, we have discovered an outer ring of 24 micron emission, possibly due to an earlier episode of mass loss. For the two shell stars, we present the results of radiative transfer models, constraining the stellar and dust shell parameters. The shells are composed of amorphous carbon grains, plus polycyclic aromatic hydrocarbons in the case of G79.29+0.46. Both G79.29+0.46 and HBHA 4202-22 lie behind the main Cygnus-X cloud. Although G79.29+0.46 may simply be on the far side of the cloud, HBHA 4202-22 is unrelated to the Cygnus-X star formation region.Comment: Accepted by A