GP Reimbursement and Visiting Behaviour in Ireland

In Ireland, approximately 30 per cent of the population (“medical cardholders”) receive free GP services while the remainder (“non-medical cardholders”) must pay for each visit. In 1989, the manner in which GPs were reimbursed by the State for their medical cardholder patients was changed from fee-for-service to capitation while other patients continued to pay on a fee-for-service basis. Concerns about supplier-induced demand were in part responsible for this policy change. The purpose of this paper is to examine the extent to which the utilisation of GP services is influenced by the reimbursement system facing GPs, by comparing visiting rates for the two groups before and after this change. Using a difference-in-differences approach on pooled micro-data from 1987, 1995 and 2000, we find that medical card eligibility exerts a consistently positive and significant effect on the utilisation of GP services. However, the differential in visiting rates between medical cardholders and others did not narrow between 1987 and 1995 or 2000, as might have been anticipated if supplier-induced demand played a major role prior to the change in reimbursement system.GP Utilisation; Reimbursement; Supplier-Induced Demand; Difference-in-Differences

GP Reimbursement And Visiting Behaviour In Ireland. ESRI Working Paper No. 9, 2005

In Ireland, approximately 30 per cent of the population (“medical cardholders”) receive free GP services while the remainder (“non-medical cardholders”) must pay for each visit. In 1989, the manner in which GPs were reimbursed by the State for their medical cardholder patients was changed from fee-for-service to capitation while other patients continued to pay on a fee-for-service basis. Concerns about supplier-induced demand were in part responsible for this policy change. The purpose of this paper is to examine the extent to which the utilisation of GP services is influenced by the reimbursement system facing GPs, by comparing visiting rates for the two groups before and after this change. Using a difference-in-differences approach on pooled micro-data from 1987, 1995 and 2000, we find that medical card eligibility exerts a consistently positive and significant effect on the utilisation of GP services. However, the differential in visiting rates between medical cardholders and others did not narrow between 1987 and 1995 or 2000, as might have been anticipated if supplier-induced demand played a major role prior to the change in reimbursement system

Environmental factors influencing conidial release and sporulation of Paronospora manshurica

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Bibliography: leaves 42-44.Not availabl

Sunmaster: An SEP cargo vehicle for Mars missions

Options are examined for an unmanned solar powered electric propulsion cargo vehicle for Mars missions. The 6 prime areas of study include: trajectory, propulsion system, power system, supporting structure, control system, and launch consideration. Optimization of the low thrust trajectory resulted in a total round trip mission time just under 4 years. The argon propelled electrostatic ion thruster system consists of seventeen 5 N engines and uses a specific impulse of 10,300 secs. At Earth, the system uses 13 engines to produce 60 N of thrust; at Mars, five engines are used, producing 25 N thrust. The thrust of the craft is varied between 60 N at Earth and 24 N at Mars due to reduced solar power available. Solar power is collected by a Fresnel lens concentrator system using a multistacked cell. This system provides 3.5 MW to the propulsion system after losses. Control and positioning to the craft are provided by a system of three double gimballed control moment gyros. Four shuttle 'C' launches will be used to transport the unassembled vehicle in modular units to low Earth orbit where it will be assembled using the Mobile Transporter of the Space Station Freedom

Prerequisites in behavioral science and business: opportunities for dental education.

There is increasing pressure on recent dental school graduates to understand and successfully utilize patient management and business management strategies to run a productive dental office. Dental schools are faced with the dilemma to either add more credit hours in their already crowded curriculum or adjust predental school requirements. All fifty-nine U.S. dental schools were assessed online to determine admission requirements in the areas of behavioral science and business education. Results show that only 11.9 percent of the schools require prerequisite course work in behavioral science and no school requires prerequisite course work in business. However, 64.4 percent and 30.5 percent of schools encouraged or recommended prerequisite course work in behavioral science and business, respectively. We suggest that the dental education community involve key stakeholders to discuss the incorporation of prerequisite course work in behavioral science and business. Additional courses in these disciplines would provide dental students better backgrounds from which the dental curriculum could build a more advanced and applied perspective to better prepare students for practice

Performance of ICD‐10‐CM diagnosis codes for identifying children with Sickle Cell Anemia

ObjectiveTo develop, test, and validate the performance of ICD‐10‐CM claims‐based case definitions for identifying children with sickle cell anemia (SCA).Data SourcesMedicaid administrative claims (2016) for children <18 years with potential SCA (any D57x diagnosis code) and newborn screening records from Michigan and New York State.Study DesignThis study is a secondary data analysis.Data Collection/Extraction MethodsUsing specific SCA‐related (D5700, D5701, and D5702) and nonspecific (D571) diagnosis codes, 23 SCA case definitions were applied to Michigan Medicaid claims (2016) to identify children with SCA. Measures of performance (sensitivity, specificity, area under the ROC curve) were calculated using newborn screening results as the gold standard. A parallel analysis was conducted using New York State Medicaid claims and newborn screening data.Principal FindingsIn Michigan Medicaid, 1597 children had ≥1 D57x claim; 280 (18 percent) were diagnosed with SCA. Measures of performance varied, with sensitivities from 0.02 to 0.97 and specificities from 0.88 to 1.0. The case definition of ≥1 outpatient visit with a SCA‐related or D571 code had the highest area under the ROC curve, with a sensitivity of 95 percent and specificity of 92 percent. The same definition also had the highest performance in New York Medicaid (n = 2454), with a sensitivity of 94 percent and specificity of 86 percent.ConclusionsChildren with SCA can be accurately identified in administrative claims using this straightforward case definition. This methodology can be used to monitor trends and use of health services after transition to ICD‐10‐CM.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154614/1/hesr13257.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154614/2/hesr13257_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154614/3/hesr13257-sup-0001-Authormatrix.pd

Trace CO2 capture by an ultramicroporous physisorbent with low water affinity.

CO2 accumulation in confined spaces represents an increasing environmental and health problem. Trace CO2 capture remains an unmet challenge because human health risks can occur at 1000 parts per million (ppm), a level that challenges current generations of chemisorbents (high energy footprint and slow kinetics) and physisorbents (poor selectivity for CO2, especially versus water vapor, and/or poor hydrolytic stability). Here, dynamic breakthrough gas experiments conducted upon the ultramicroporous material SIFSIX-18-Ni-β reveal trace (1000 to 10,000 ppm) CO2 removal from humid air. We attribute the performance of SIFSIX-18-Ni-β to two factors that are usually mutually exclusive: a new type of strong CO2 binding site and hydrophobicity similar to ZIF-8. SIFSIX-18-Ni-β also offers fast sorption kinetics to enable selective capture of CO2 over both N2 (S CN) and H2O (S CW), making it prototypal for a previously unknown class of physisorbents that exhibit effective trace CO2 capture under both dry and humid conditions

Cyclone Hard X-Ray Observatory

In response to the recent NASA-SMEX Announcement of Opportunity, our collaboration proposed Cyclone, the Cyclotron/Nuclear Explorer. Cyclone is a broadband pointed astrophysical observatory, combining the highest spectral resolutions (E/(Delta) E approximately 30 - 300) and angular resolutions (15') achieved in the optimized hard X-ray range (10 - 200 keV). The instrument consists of 19 co-aligned rotation modulation collimator (RMC) telescopes, each with a high spectral resolution, 6-cm diameter germanium detector (GeD) covering energies from 3 keV to 600 keV. Both the optics and detectors are actively shielded with 15-mm BGO to gain low background an high sensitivity to astrophysical sources. A 550-km altitude, circular equatorial orbit also minimizes background. Building strongly upon instrumental heritage from the High-Energy Solar Spectroscopic Imager (HESSI) program, Cyclone would be ready for launch by September 2003. The instrument design and expected performance are discussed, as well as a brief overview of scientific goals

Cyclone Hard X-Ray Observatory

In response to the recent NASA-SMEX Announcement of Opportunity, our collaboration proposed Cyclone, the Cyclotron/Nuclear Explorer. Cyclone is a broadband pointed astrophysical observatory, combining the highest spectral resolutions (E/(Delta) E approximately 30 - 300) and angular resolutions (15') achieved in the optimized hard X-ray range (10 - 200 keV). The instrument consists of 19 co-aligned rotation modulation collimator (RMC) telescopes, each with a high spectral resolution, 6-cm diameter germanium detector (GeD) covering energies from 3 keV to 600 keV. Both the optics and detectors are actively shielded with 15-mm BGO to gain low background an high sensitivity to astrophysical sources. A 550-km altitude, circular equatorial orbit also minimizes background. Building strongly upon instrumental heritage from the High-Energy Solar Spectroscopic Imager (HESSI) program, Cyclone would be ready for launch by September 2003. The instrument design and expected performance are discussed, as well as a brief overview of scientific goals