National health expenditures will continue to grow faster than nominal gross domestic product (GDP) in the early 21st century (Heffler et al., 2002; Heffler et al., 2005). Increased Medicaid costs have spurred research to find reliable cost-saving methodologies (Kronick et al., 1996). The Medicaid administrations of some states have chosen risk adjustment as a methodology for savings (Tollen et al., 1998; Weiner et al., 1998), since it can reduce the financial burden of health care providers and distribute medical resources more efficiently. This dissertation presents a risk-adjustment model based on two types of health condition adjusters: diagnosis-based HCC adjusters and pharmacy-based RxRisk adjusters. HCC adjusters were developed from different diagnostic categories from inpatient, outpatient and long-term care data. RxRisk adjusters included diseases inferable from prescription drug usage. The underlying assumption is that using both types of health condition adjusters, rather than relying on either diagnosis-based adjusters or pharmacy-based adjusters alone can help increase predictive power and lower Medicaid's risk of reimbursing inflated medical costs for its beneficiaries. The population in this study consisted of all disabled and aged Florida adults who were eligible for Florida's Medicaid program in state fiscal year (SFY) 2002-03 and state fiscal year 2003-04. The population was broken down into two subpopulations: disabled Medicaid beneficiaries aged 64 and under and beneficiaries aged 65 or over.The proposed regression model includes diagnostic and pharmacy-based adjusters, and this dissertation compares the proposed model with models based solely on pharmacy- or diagnosis-based adjusters.The results presented in this dissertation demonstrate the proposed model has higher predictive power than the diagnosis-based HCC model and the pharmacy-based RxRisk model for the overall population and the subpopulations in this study. Risk-adjustment models using diagnostic and prescription drug information have higher predictive power and decrease the possibility of inappropriate gaming of the Medicaid capitation payment system.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (p. [55]-60).

Orientador: Mauro Pedro Peres / Banca: Tamotsu Hirata / Banca: Silvio Silvério da Silva / Resumo: Abrir e fechar a boca é um dos movimentos biomecânicos mais importantes do ser humano, sendo um dos primeiros a ser realizado antes mesmo do nascimento. Ela é responsável pela deglutição, mastigação, respiração e a fala. Este movimento é realizado por um conjunto articular-músculo-esquelético, chamado sistema estomatognático, no qual destaca a mais complexa articulação do corpo humano, denominada de articulação temporomandibular (ATM). Sua disfunção acarreta uma série de problemas sempre acompanhada de dores, no qual grande parte da população mundial apresenta distúrbios neste sistema, necessitando a busca de tratamento. Apesar de estudos já realizados, torna-se ainda imprescindível uma abordagem específica do tema, no qual a ausência de parâmetros existentes, e mundialmente aceitos, para avaliações e diagnósticos, comprometem os objetivos do tratamento, que atualmente depende mais da experiência do terapeuta do que de evidências científicas. Desta forma este trabalho contribui para obtenções de conhecimentos, esclarecimentos e cuidados com pacientes que sofrem de Disfunção Temporo Mandibular (DTM), com o seu principal objetivo, a construção de um equipamento capaz de mensurar e diagnosticar anormalidades durante o movimento biomecânico da abertura e fechamento da boca, através de um sistema de captação de imagens. Utiliza-se de equipamentos de baixo custo e de fácil manuseio, comparado a sistemas disponíveis hoje no mercado. As imagens obtidas são processadas por um software específico para este fim, onde os dados são tratados e modelados, fornecendo o movimento no plano frontal e lateral da mandíbula, analisando sua respectiva trajetória no movimento de lateralidade, protrusão e amplitude máxima da abertura e fechamento da boca, fornecendo dados milimetricamente mensurados ...(Resumo completo, clicar acesso eletrônico abaixo). / Abstract: To open and to close the mouth are one of the more important biomechanics movements of the human being, being one of first to be carried through before the same one of the birth. It is responsible for the deglutition, chew, breath and he says it. This movement is carried through by a joint articulate-muscle-bone, call masticate system, in which detaches the most complex joint of the called human body of Joint Temporo Mandible (JTM). Its disturb causes a series of problems always followed of pains, needing the treatment search. Although some carried through studies already, a specific boarding of the subject still becomes essential, in which the absence of existing parameters, and world-wide accepted, and diagnostic, compromises the objectives of the treatment, that currently depends more on the experience of the therapist on whom of scientific evidences. Of this form this work search the attainment of knowledge, clarifications and cares with the patients who suffer DTM, having as objective to construct an equipment capable to measure and to diagnosis abnormalities during the biomechanics movement of the opening of the mouth, through a system of capitation of images. One today used of equipment of low cost, compared the available systems in the market, generating images that will be processed for a software, developed specifically for this work, for the treatment and modeling of the data of the movement in the front plain of the jaw, analyzed its respective trajectory, in the movement of lateral, supplying given measure ...(Complete abstract, click electronic address below). / Mestre

No description available.

Thesis (D.P.H.)--University of Michigan.

Dissertation (D.P.H.)--University of Michigan.

Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves [120]-123).

Made available in DSpace on 2014-06-11T19:28:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-08Bitstream added on 2014-06-13T18:57:58Z : No. of bitstreams: 1 carvalho_as_me_guara.pdf: 714165 bytes, checksum: a9b78d56635122098c45b1b30722ec8f (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / Abrir e fechar a boca é um dos movimentos biomecânicos mais importantes do ser humano, sendo um dos primeiros a ser realizado antes mesmo do nascimento. Ela é responsável pela deglutição, mastigação, respiração e a fala. Este movimento é realizado por um conjunto articular-músculo-esquelético, chamado sistema estomatognático, no qual destaca a mais complexa articulação do corpo humano, denominada de articulação temporomandibular (ATM). Sua disfunção acarreta uma série de problemas sempre acompanhada de dores, no qual grande parte da população mundial apresenta distúrbios neste sistema, necessitando a busca de tratamento. Apesar de estudos já realizados, torna-se ainda imprescindível uma abordagem específica do tema, no qual a ausência de parâmetros existentes, e mundialmente aceitos, para avaliações e diagnósticos, comprometem os objetivos do tratamento, que atualmente depende mais da experiência do terapeuta do que de evidências científicas. Desta forma este trabalho contribui para obtenções de conhecimentos, esclarecimentos e cuidados com pacientes que sofrem de Disfunção Temporo Mandibular (DTM), com o seu principal objetivo, a construção de um equipamento capaz de mensurar e diagnosticar anormalidades durante o movimento biomecânico da abertura e fechamento da boca, através de um sistema de captação de imagens. Utiliza-se de equipamentos de baixo custo e de fácil manuseio, comparado a sistemas disponíveis hoje no mercado. As imagens obtidas são processadas por um software específico para este fim, onde os dados são tratados e modelados, fornecendo o movimento no plano frontal e lateral da mandíbula, analisando sua respectiva trajetória no movimento de lateralidade, protrusão e amplitude máxima da abertura e fechamento da boca, fornecendo dados milimetricamente mensurados.... / To open and to close the mouth are one of the more important biomechanics movements of the human being, being one of first to be carried through before the same one of the birth. It is responsible for the deglutition, chew, breath and he says it. This movement is carried through by a joint articulate-muscle-bone, call masticate system, in which detaches the most complex joint of the called human body of Joint Temporo Mandible (JTM). Its disturb causes a series of problems always followed of pains, needing the treatment search. Although some carried through studies already, a specific boarding of the subject still becomes essential, in which the absence of existing parameters, and world-wide accepted, and diagnostic, compromises the objectives of the treatment, that currently depends more on the experience of the therapist on whom of scientific evidences. Of this form this work search the attainment of knowledge, clarifications and cares with the patients who suffer DTM, having as objective to construct an equipment capable to measure and to diagnosis abnormalities during the biomechanics movement of the opening of the mouth, through a system of capitation of images. One today used of equipment of low cost, compared the available systems in the market, generating images that will be processed for a software, developed specifically for this work, for the treatment and modeling of the data of the movement in the front plain of the jaw, analyzed its respective trajectory, in the movement of lateral, supplying given measure ...(Complete abstract, click electronic address below).

Objective: The objectives of the study were to determine General Practitioners' attitudes to National Health Insurance (NHI) and to capitation as a mechanism of reimbursement. The study also aimed to explore determinants of these attitudes. Design: The methodology utilised a cross-sectional survey using telephone interviews and four focus group discussions. Setting: The study area was the Cape Peninsula area in the Western Cape Province of South Africa. Participants: 174 general practitioners (GPs) were randomly sampled from a total population of 874 GPs in the Cape Peninsula area. Main outcome measures: The main outcome measures were GPs' acceptance of NHI and of capitation as a method of reimbursement. Main results: Sixty three percent of GPs (63,3%) approved of NHI. More than 81 % approved of NHI if GPs were to maintain their independent status, for example their own premises and working hours. Eighty two percent (82,3%) said NHI would be a more equitable system of health care than the system that existed at that time, 88% approved of the fact that NHI would make care by GPs more accessible and 73% said they had the capacity to treat more patients. However, 61,3% of GPs disapproved of capitation as a form of reimbursement. The most common conditions cited by GPs for support of NHI were retention of professional autonomy, fee for service reimbursement and adequate levels of reimbursement. Conclusions: Most GPs in the Cape Peninsula were amenable to some form of NHI. However, approval of NHI is to some extent conditional to details of the NHI system, such as payment mechanisms, workload, income and effects on professional autonomy. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI in South Africa requires serious consideration by policy makers. While this research demonstrates broad ideological and conceptual support for some form of NHI or SHI, further research is required to provide more detailed quantitative information on the trade-offs that GPs would be prepared to make for them to support the introduction of a new socially based insurance system. A national survey of medical practitioners is recommended.

Thesis (Ph. D.)--RAND Graduate School, 2000. / Includes bibliographical references (p. 123-131).