The American journal of managed care
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Despite the fact that the Human Genome Project was completed only recently, genetic tests already have entered the marketplace, some with few or no long-term data to support their use. Managed care organizations will face reimbursement decisions for genetic tests on a growing scale, and they should have a framework in place to evaluate the clinical and economic outcomes of this new class of diagnostics. ⋯ When evaluating a genetic test for reimbursement, these criteria can help to: (1) quantify the potential clinical benefit and economic savings; (2) assess the robustness of a cost-effectiveness analysis; and (3) clarify areas where data are deficient. These criteria should be used to inform the decision-making process in the context of ethical, legal, and social issues related to genetic testing.
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Controversy persists about the most efficient allocation of healthcare funds for cardiovascular disease prevention. Previous economic analyses have generally focused on primary or secondary prevention as discrete categories. ⋯ The economic impact of an integrated approach to prevention of cardiovascular disease has not been thoroughly explored. CORE permits realistic analysis of policy decisions involving the entire continuum of risk rather than isolated consideration of specific disease stages, and thus provides a unique tool for assessing the full implications of treatment guidelines such as those of the NCEP ATP III.
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To determine the costs associated with conducting concurrent utilization review, a utilization management strategy widely used by the managed care industry. ⋯ These figures are conservative in that they do not include the payer component of the costs, which could be as high as the hospital provider cost. Given a denial rate of < 2% and the high cost of the process, it may be beneficial to investigate alternative processes for conducting utilization review.
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Comparative Study
Variation in racial and ethnic differences in consumer assessments of health care.
Prior studies have documented significant racial and ethnic disparities in health and healthcare, but data about disparities from consumer assessments of care are inconsistent. ⋯ Significant race/ethnic differences in experience with, access to, and use of care exist in health plans. Substantial variation in racial differences suggests compromised quality of healthcare and opportunities for quality improvement.