Health Maintenance Organization (HMO) "risk contracts," under which HMOs cover Medicare-eligible individuals, are explained; and the costs, benefits, and coverage are compared with those of other managed care options. Employers with retiree medical plans are encouraged to consider using HMO risk contracts for both short- and long-term…

Emergency department charts of 186 suspected preadolescent victims of sexual abuse (SSA) were compared with 623 patients evaluated for upper limb fracture. Hospital costs of SSA patients were more often and to a greater degree underwritten by the hospital itself because of lower reimbursement and a higher percentage of uninsured and publicly…

Increases in costs to colleges and universities for employee health insurance have risen as much as 20 to 30 percent annually, requiring adjustments to control costs, a new philosophy of sharing costs with employees, increased proportions of payroll (now 6.1 percent) going for health care costs, and reductions in work force size. (DB)

Increasingly, colleges are finding it hypocritical to have nondiscrimination policies protecting gay faculty and staff but deny benefits available to married employees. Institutions have adopted different criteria to determine who qualifies as a "spousal equivalent." The standards may face legal challenges from unmarried heterosexual couples. (MSE)

Health care reform needs to assure coverage to all children regardless of income level or illnesses; address benefits, financing, administration, and delivery systems; provide substantial subsidies to low-income families; be equitable for all people; provide better monitoring of child health; protect and strengthen health providers who assist…

Examines how health care reform might be structured to provide support for a package of primary care services for children of all socioeconomic strata. An insurance-like financing system, such as the special Medicaid payment system adopted by New York State for public and nonprofit primary health care programs, may be useful as a model for a…

Discusses the implications of the Medicare program's rate setting system on health care reform and considers whether such a procedure could be applied to a health insurance system that included children. Examines desirable characteristics of a provider payment system, special health needs of children, and hospital and physician payment issues.…

Examines the claimed advantages and potential disadvantages of managed care plans for children and pregnant women. Although available research does not support most claims that such plans reduce costs and improve care, managed care plans are growing and changing rapidly. Therefore, past experience with managed care may not be a good guide to…

Discusses the advantages and disadvantages of an employer-based health insurance system and the effects of such a system on children. Examines employer decisions regarding coverage, financial limitations, insurer and health plan practices that affect the availability and continuity of coverage, and several new models for providing health insurance…

This article reviews court litigation to prevent school systems from drawing on a family's health insurance or other family resources to pay for required educational benefits such as physical and occupational therapy. Parents are encouraged to withhold insurance information from schools and get help from advocacy organizations. (DB)

Recent developments have led agencies serving young children with disabilities to obtain third-party reimbursement (Medicaid, private insurance, etc.) for services. An examination of the legal and policy implications of increased third-party billing reveals serious drawbacks including loss of confidentiality, burdens on informed consent, hidden…

Data were collected retrospectively from insurance information forms and histories of 111 patients (ages 14-84) referred to physical therapy for evaluation of back and/or neck pain. Analysis indicated that patients with compensable (work-related or motor vehicle accident) injuries infrequently acknowledged prior episodes of back or neck pain. (JDD)

This article explains why college faculty benefit by taking large portions of their compensation in fringe benefits, presents data showing trends in the provision of fringe benefits to college and university employees, and suggests that academic supply and demand conditions during the 1990s may lead to resumption of the upward trend in…

Discusses the impact of health care reform on child-care centers and child-care employees. Topics covered include requirements to provide health insurance for all employees; subsidies for businesses with fewer than 50 employees; subsidies for low income employees; family coverage; health are costs for 2 working parents; and costs to day-care…

Information available so far indicates that children in managed care arrangements are less likely to be seen by pediatric specialists and that families and providers are less satisfied under managed care. In spite of these drawbacks, the managed care approach, modified appropriately, offers new opportunities to provide high-quality medical care…