Health maintenance organizations (HMOs) : analysis and summary :need for legislative overview /

"June 12, 1984."

Hospitals and HMOs : an overview of hospital sponsorship of health maintenance organizations /

Mode of access: Internet.

Metabolism of host-derived carbohydrates by Bifidobacterium breve UCC2003

Bifidobacteria are Gram positive, anaerobic, typically Y-shaped bacteria which are naturally found in the digestive tract of certain mammals, birds and insects. Bifidobacterium breve strains are numerically prevalent among the gut microbiota of many healthy breast-fed infants. The prototypical B. breve strain UCC2003 has previously been shown to utilise numerous carbohydrates of plant origin. Various aspects of host-derived carbohydrate metabolism occurring in this bacterium will be described in this thesis. Chapter II describes B. breve UCC2003 utilisation of sialic acid, a nine-carbon monosaccharide, which is found in human milk oligosaccharides (HMOs) and the mucin glycoprotein. B. breve UCC2003 was also shown to cross-feed on sialic acid released from 3’ sialyllactose, a prominent HMO, by the extracellular sialidase activity of Bifidobacterium bifidum PRL2010. Chapter III reports on the transcriptional regulation of sialic acid metabolism in B. breve UCC2003 by a transcriptional repressor encoded by the nanR gene. NanR belongs to the GntR-family of transcriptional regulators and represents the first bifidobacterial member of this family to be characterised. Chapter IV investigates B. breve UCC2003 utilisation of mucin. B. breve UCC2003 was shown to be incapable of degrading mucin; however when grown in co-culture with B. bifidum PRL2010 it exhibits enhanced growth and survival properties. A number of methods were used to investigate and identify the mucin components supporting this enhanced growth/viability phenotype. Chapter V describes the characterisation of two sulfatase-encoding gene clusters from B. breve UCC2003. The transcriptional regulation of both sulfatase-encoding gene clusters was also investigated. The work presented in this thesis represents new information on the metabolism of host-derived carbohydrates in bifidobacteria, thus increasing our understanding of how these gut commensals are able to colonise and persist in the gastrointestinal tract.

Análise do desempenho econômico-financeiro de operadoras de planos de saúde no mercado de saúde suplementar brasileiro

O mercado privado de planos de saúde tem sido marcado por aumento dos custos da assistência médica, ampliação da cobertura de procedimentos, restrições nos reajustes dos planos e aumento das garantias de solvência exigidas pela Agência Nacional de Saúde Suplementar (ANS), impactando o desempenho econômico-financeiro das operadoras de planos de saúde. A presente dissertação tem como objetivo analisar o desempenho econômico-financeiro de operadoras das modalidades autogestão, cooperativa médica, medicina de grupo e seguradora no período de 2001 a 2012. Foi utilizada uma base de dados operacionais e contábeis disponível na página eletrônica da ANS, com 5.775 observações, avaliando-se o desempenho econômico-financeiro por meio de cinco indicadores: Retorno sobre Ativos, Retorno Operacional sobre Ativos, Retorno sobre o Patrimônio Líquido, Liquidez Corrente e Sinistralidade. Dois modelos hierárquicos foram adotados para estimar os efeitos operadora, modalidade e porte no desempenho. Dentre estes, a pesquisa identificou que o efeito operadora é responsável pela maior parte da variabilidade explicada do desempenho. A investigação permitiu identificar as operadoras que apresentaram melhor desempenho no período, direcionando a realização futura de estudos qualitativos visando conhecer os principais fatores que explicam o desempenho superior.

Einfluss prebiotischer Oligosaccharide und probiotischer Bakterien auf den Phänotyp und die Funktion dendritischer Zellen

Neben der Therapie allergischer Erkrankungen, wie dem allergischen Asthma oder der atopischen Dermatitis, nehmen präventive Maßnahmen zur Vermeidung einer Sensibilisierung einen immer höheren Stellenwert ein. Hierbei scheint der Einsatz von Pre- und Probiotika vielversprechend zu sein. rnrnIm Rahmen dieser Dissertation wurde der Einfluss von Pre- und Probiotika auf den Phänotyp und die Funktion von DCs untersucht. Hierzu wurden unreife DCs aus Vorläuferzellen im Knochenmark von Mäusen differenziert (BM-DCs). Nach Behandlung der Kulturen während der Differenzierung der BM-DCs mit neutrale Humanmilch-analoge Oligosaccharide-enthaltenden Präparationen (NOS-Präparationen) konnte ein Einfluss auf die Zellen nachgewiesen werden; die NOS-Präparationen sind in der Lage, die durch LPS induzierte Ausreifung der BM-DCs zu supprimieren. Weiterhin konnte gezeigt werden, dass die primärstimulatorische Kapazität LPS-stimulierter BM-DCs, die in Anwesenheit von NOS-Präparationen differenziert wurden, sowohl für allogene als auch für syngene T-Zellen signifikant vermindert war. Die Charakterisierung dieser T-Zellen ergab zwar eine verstärkte Expression des für regulatorische T-Zellen charakteristischen Transkriptionsfaktors FoxP3, auf funktioneller Ebene konnte jedoch keine Induktion von regulatorischen T-Zellen beobachtet werden; allerdings wurde in diesen T-Zellen eine Anergie induziert. Der Befund, dass verschiedene NOS-Präparationen unterschiedliche Wirkungen auf die Differenzierung von BM-DCs aufweisen, muss weitergehend untersucht werden. rnrnWeiterhin wurden im Rahmen dieser Arbeit die Auswirkungen einer Kultivierung der BM-DCs mit den beiden probiotischen Bakterien Lactobacillus rhamnosus GG (LGG) und Lactobacillus fermentum analysiert. Hier induzierte ein Kontakt unreifer BM-DCs mit den Bakterien eine Maturierung der Zellen. Das Potential zur Produktion von IL-10 konnte dabei nicht erhöht werden. Im Gegensatz dazu induzierte eine Supplementierung der Kulturen während der Differenzierungsphase der DCs konträre Effekte; die LGG-Gabe resultierte hier in einer unvollständigen Ausreifung der DCs nach LPS-Stimulus. Dies konnte auch auf funktioneller Ebene als stark vermindertes Potential zur T-Zellstimulation bestätigt werden. Inwieweit die Supplementierung mit LGG in tolerogenen DCs resultiert, welche Tregs induzieren können, muss weiter analysiert werden.

The effect of the shift from HMO to PPO plans on the prevalence of hospital bad debt in the insured population: A case study in two Houston-area hospitals

In spite of the dramatic increase and general concern with U.S. hospital bad debt expense (AMNews, January 12, 2004; Philadelphia Business Journal, April 30, 2004; WSJ, July 23, 2004), there appears to be little available analysis of the precise sources and causes of its growth. This is particularly true in terms of the potential contribution of insured patients to bad debt expense in light of the recent shift in managed care from health maintenance organization (HMO) plans to preferred provider organization (PPO) plans (Kaiser Annual Survey Report, 2003). This study examines and attempts to explain the recent dramatic growth in bad debt expense by focusing on and analyzing data from two Houston-area hospital providers within one healthcare system. In contrast to prior studies in which self-pay was found to be the primary source of hospital bad debt expense (Saywell, R. M., et al., 1989; Zollinger, T. W., 1991; Weissman, Joel S., et al., 1999), this study hypothesizes that the growing hospital bad debt expense is mainly due to the shifting trend away from HMOs to PPOs as a conscious decision by employers to share costs with employees. Compared to HMO plans, the structure of PPOs includes higher co-pays, coinsurance, and deductibles for the patient-pay portion of medical bills, creating the potential for an increase in bad debt for hospital providers (from a case study). This bad debt expense has a greater impact in the community hospital than in the Texas Medical Center hospital. ^

Campaign contributions to congressional candidates by the healthcare sector from 1990 to 2008

Stakeholder groups with special interests as donors to finance congressional campaigns have been a controversial issue in the United Sates. While previous studies concentrated on whether a connection existed between the campaign contributions provided by stakeholder groups and the voting behavior of congressional members, there is little evidence to show the trend of allocation of their campaign contributions to their favorite candidates during the elections. This issue has become increasingly important in the health sector since the health care reform bill was passed in early 2010.^ This study examined the long-term trend of campaign contributions offered by various top healthcare stakeholder groups to particular political parties (i.e. Democrat and Republican). The main focus of this paper was to observe and describe the financial donations provided by these healthcare stakeholder groups in the congressional election cycles from 1990 to 2008 in order to obtain an overview of their patterns of campaign contributions. Their contributing behaviors were characterized based on the campaign finance data collected by the Center for Responsive Politics (CRP). Specifically, I answered the questions: (1) to which political party did specific healthcare stakeholder groups give money and (2) what was the pattern of their campaign contributions from 1990 to 2008?^ The findings of my study revealed that the healthcare stakeholder groups had different political party preferences and partisanship orientations regarding the Democratic or Republican Party. These differences were obvious throughout the election cycles from 1990 to 2008 and their distinct patterns of financial contribution were evident across industries in the health sector as well. Among all the healthcare stakeholder groups in this study, physicians were the top contributors in the congressional election. The pharmaceutical industry was the only group where the majority of contribution funds were allocated to Republicans in every election period studied. This study found that no interest group has succeeded in electing the preferred congressional candidate by giving the majority of its financial support to the winning party in every election. Chiropractors, hospitals/nursing homes, and health services/HMOs performed better than other healthcare stakeholder groups by supporting the electoral winner 8 out of 9 election cycles.^

HEALTH MAINTENANCE ORGANIZATION ENVIRONMENT: AN EMPIRICAL STUDY OF THE RELATIONSHIP OF EXTERNAL CONTEXT AND PERFORMANCE

The research project is an extension of a series of administrative science and health care research projects evaluating the influence of external context, organizational strategy, and organizational structure upon organizational success or performance. The research will rely on the assumption that there is not one single best approach to the management of organizations (the contingency theory). As organizational effectiveness is dependent on an appropriate mix of factors, organizations may be equally effective based on differing combinations of factors. The external context of the organization is expected to influence internal organizational strategy and structure and in turn the internal measures affect performance (discriminant theory). The research considers the relationship of external context and organization performance.^ The unit of study for the research will be the health maintenance organization (HMO); an organization the accepts in exchange for a fixed, advance capitation payment, contractual responsibility to assure the delivery of a stated range of health sevices to a voluntary enrolled population. With the current Federal resurgence of interest in the Health Maintenance Organization (HMO) as a major component in the health care system, attention must be directed at maximizing development of HMOs from the limited resources available. Increased skills are needed in both Federal and private evaluation of HMO feasibility in order to prevent resource investment and in projects that will fail while concurrently identifying potentially successful projects that will not be considered using current standards.^ The research considers 192 factors measuring contextual milieu (social, educational, economic, legal, demographic, health and technological factors). Through intercorrelation and principle components data reduction techniques this was reduced to 12 variables. Two measures of HMO performance were identified, they are (1) HMO status (operational or defunct), and (2) a principle components factor score considering eight measures of performance. The relationship between HMO context and performance was analysed using correlation and stepwise multiple regression methods. In each case it has been concluded that the external contextual variables are not predictive of success or failure of study Health Maintenance Organizations. This suggests that performance of an HMO may rely on internal organizational factors. These findings have policy implications as contextual measures are used as a major determinant in HMO feasibility analysis, and as a factor in the allocation of limited Federal funds. ^

146th Annual Report of the Insurance Division, August 2016

Annual report on the insurance industry. Statistical tables reflect in detail the financial condition of all insurance companies licensed to do business in Iowa, based on their sworn annual statements covering the twelve-month period beginning January 1, 2015, and ending December 31, 2015, filed with the Division.

145th Annual Report of the Insurance Division, August 2015

Annual report on the insurance industry. Preliminary material outlines Insurance Division activities generally. The statistical tables reflect in detail the financial condition of all insurance companies licensed to do business in Iowa, based on their sworn annual statements covering the twelve-month period beginning January 1, 2014, and ending December 31, 2014, filed with the Division.

Know Your Rights, June 24, 2016

In Iowa, the Managed Care Ombudsman Program was established to advocate for the rights and wishes of Medicaid managed care members who receive care in a health care facility, assisted living program or elder group home, as well as members enrolled in one of the following seven home and community-based services (HCBS) waiver programs.

Bifidobacterium breve UCC2003 metabolises the human milk oligosaccharides lacto-N-tetraose and lacto-N-neo-tetraose through overlapping, yet distinct pathways

In this study, we demonstrate that the prototype B. breve strain UCC2003 possesses specific metabolic pathways for the utilisation of lacto-N-tetraose (LNT) and lacto-N-neotetraose (LNnT), which represent the central moieties of Type I and Type II human milk oligosaccharides (HMOs), respectively. Using a combination of experimental approaches, the enzymatic machinery involved in the metabolism of LNT and LNnT was identified and characterised. Homologs of the key genetic loci involved in the utilisation of these HMO substrates were identified in B. breve, B. bifidum, B. longum subsp. infantis and B. longum subsp. longum using bioinformatic analyses, and were shown to be variably present among other members of the Bifidobacterium genus, with a distinct pattern of conservation among human-associated bifidobacterial species.