Effect of utilization review in a fee-for-service health insurance plan
Reviews of enrollee's health services by health insurance companies may reduce the number of procedures people have which require second opinions. Utilization review, as the process is known, is carried out by insurers to determine if all procedure they are being billed for are actually necessary, and is done as a cost containment measure. Among the enrollees in a fee-for-service health insurance plan, 3,702 had their medical services reviewed for approval and 3,743 had a sham review of their services. The people in the sham review group were required to call the insurance company for approval, but the services were approved without an actual review. During a one-year study period, the people in the sham review group had 110 more procedures that required second opinions, such as cataract, hernia, breast, and gallbladder surgery. During the following year, the sham review group had 14 fewer procedures, indicating that review did not result in a delay of services. There were no significant differences between the groups in average number of hospital days, rates of home care, and rates of admission to substance-abuse, psychiatric, or medical-surgical facilities. The average insurance expenditure was $7,355 per person in the review group and $6,858 per person in the sham review group.
Publication Name: The New England Journal of Medicine
Health Economic Benefits and Quality of Life During Improved Glycemic Control in Patients With Type 2 Diabetes Mellitus: A Randomized, Controlled, Double-Blind Trial
Lowering blood glucose levels in patients with type 2 diabetes can substantially improve their health, functioning, quality of life, and productivity. Researchers compared dietary control of diabetes with diet and sustained-release glipizide in 569 diabetic volunteers. After 12 weeks of treatment, patients taking glipizide had glycosylated hemoglobin (HbA1c) levels averaging 7.5%, compared to 9.3% in patients following dietary guidelines alone. A normal level is below 6%. Drug-treated patients reported higher cognitive function, better health, and greater emotional health, and patients taking glipizide missed fewer work days.
Publication Name: JAMA, The Journal of the American Medical Association
- Abstracts: Audit of nutrition screening in patients with acute illness. View from the independent acute health-care sector
- Abstracts: Researching communication approaches to heart disease prevention. Qualitative research and the gingerbread man
- Abstracts: Getting tough on safety. BSE: existing guidance and future plans
- Abstracts: Helping refugees to stay healthy. Let us join forces. Refugees: a challenge to humanity
- Abstracts: Intentional injury surveillance in a primary care pediatric setting. Mortality from intentional and unintentional injury among infants of young mothers in Colorado, 1986 to 1992