Insurance coverage and outcomes of in vitro fertilization. (57/592)

BACKGROUND: Although most insurance companies in the United States do not cover in vitro fertilization, a few states mandate such coverage. METHODS: We used 1998 data reported to the Centers for Disease Control and Prevention by 360 fertility clinics in the United States and 2000 U.S. Census data to determine utilization and outcomes of in vitro fertilization services according to the status of insurance coverage. RESULTS: Of the states in which in vitro fertilization services were available, 3 states (31 clinics) required complete insurance coverage, 5 states (27 clinics) required partial coverage, and 37 states plus Puerto Rico and the District of Columbia (302 clinics) required no coverage. Clinics in states that required complete coverage performed more in vitro fertilization cycles than clinics in states that required partial or no coverage (3.35 vs. 1.46 and 1.21 transfers per 1000 women of reproductive age, respectively; P<0.001) and more transfers of frozen embryos (0.43 vs. 0.30 and 0.20 per 1000 women of reproductive age, respectively; P<0.001). The percentage of cycles that resulted in live births was higher in states that did not require any coverage than in states that required partial or complete coverage (25.7 percent vs. 22.2 percent and 22.7 percent, respectively; P<0.001), but the percentage of pregnancies with three or more fetuses was also higher (11.2 percent vs. 8.9 percent and 9.7 percent, respectively; P=0.007). The number of fresh embryos transferred per cycle was lower in states that required complete coverage than in states that required partial or no coverage (P=0.001 and P<0.001, respectively). CONCLUSIONS: State-mandated insurance coverage for in vitro fertilization services is associated with increased utilization of these services but with decreases in the number of embryos transferred per cycle, the percentage of cycles resulting in pregnancy, and the percentage of pregnancies with three or more fetuses.  (+info)

Mental health and substance abuse emergency response criteria. Final rule. (58/592)

Section 3102 of the Children's Health Act of 2000, Pub. L. 106-310, amends section 501 of the Public Health Service (PHS) Act (42 U.S.C. 290aa) to add a new subsection (m) entitled "Emergency Response." This newly enacted subsection 501(m) authorizes the Secretary to use up to, but no more than, 2.5% of all amounts appropriated under Title V of the PHS Act, other than those appropriated under Part C, in each fiscal year to make "noncompetitive grants, contracts or cooperative agreements to public entities to enable such entities to address emergency substance abuse or mental health needs in local communities." Because Congress believed the Secretary needed the ability to respond to emergencies, it exempted any grants, contracts, or cooperative agreements authorized under this section from the peer review process. See section 501(m)(1) of the PHS Act. Instead, the Secretary is to use an objective review process by establishing objective criteria to review applications for funds under this authority.  (+info)

Racial and ethnic identification practices in public health data systems in New England. (59/592)

OBJECTIVE: Efforts are underway to standardize "racial" and "ethnic" identification in public health data systems under the Revised Minimum Standards for the Classification of Federal Data on Race and Ethnicity issued in 1997. This study analyzed the racial and ethnic constructs and labels used in public health data systems maintained by the six New England states in light of these standards. METHODS: The authors surveyed public health officials responsible for ongoing individual-level data systems and reviewed relevant documents. RESULTS: Information was obtained on 169 of 170 identified data systems. Ninety-one systems (54%) conformed to the federal standard in having separate "race" and "ethnicity" fields, yet many of these did not conform to the standard in other respects. Fifty-five systems had only a race field; of these, 20 included no identifiers corresponding to Hispanic and/or Latino ethnicity. Three systems used only an ethnicity field. The systems used various lists of racial and/or ethnic categories, and overlapping but not fully comparable labels. Few systems allowed for identification of ancestry groups not included in the revised federal guidelines but with large populations in New England, such as Brazilians. Some definitions and coding instructions seemed inconsistent with social and geographic reality. CONCLUSIONS: These public health data systems used inconsistent methods for classifying people by race and ethnicity. Standardization according to federal standards would improve comparability, but would limit options for defining and including some ethnic groups while forcing other groups to be aggregated in single race categories, perhaps inappropriately. Fundamental reconsideration of racial and ethnic categorization is called for.  (+info)

Medicare program; supplementary medical insurance premium surcharge agreements. Final rule. (60/592)

This final rule implements legislation contained in section 1839(e) of the Social Security Act (the Act). That statute authorizes a Medicare premium payment arrangement whereby State and local government agencies can enter into an agreement with the Secretary to make periodic lump sum payments for the Supplementary Medical Insurance (SMI) late enrollment premium surcharge amounts due for a designated group of eligible enrollees. Under this rule, we define and set out the basic rules for the new SMI premium surcharge billing agreement. In order to give States additional time for implementation of the provisions of this final rule, we are delaying the rule's effective date to six months from the date of its publication in the Federal Register.  (+info)

State Children's Health Insurance Program; eligibility for prenatal care and other health services for unborn children. Final rule. (61/592)

In order to provide prenatal care and other health services, this final rule revises the definition of "child" under the State Children's Health Insurance Program (SCHIP) to clarify that an unborn child may be considered a "targeted low-income child" by the State and therefore eligible for SCHIP if other applicable State eligibility requirements are met. Under this definition, the State may elect to extend eligibility to unborn children for health benefits coverage, including prenatal care and delivery, consistent with SCHIP requirements.  (+info)

State expenditures for tobacco-control programs and the tobacco settlement. (62/592)

BACKGROUND: Despite controversy surrounding the use of funds arising from settlement agreements with the tobacco industry, little is known about the role of these funds in expenditures for state tobacco-control programs. METHODS: We evaluated state expenditures for tobacco-control programs in fiscal year 2001 in the context of the amount of tobacco-settlement funds received and allocated to tobacco-control programs and in the context of other state-level economic and health data. RESULTS: In 2001 the average state received $28.35 per capita from the tobacco settlement but allocated approximately 6 percent of these funds to tobacco-control programs. The average state dedicated $3.49 per capita (range, $0.10 to $15.47) to tobacco-control programs. The proportion of settlement funds allocated to tobacco-control programs varied from 0 to 100 percent and was strongly related to levels of tobacco-control funding (P<0.001). States with higher smoking rates tended to invest less per capita in tobacco-control programs (P=0.007), as did tobacco-producing states (the mean per capita expenditure was $1.20, as compared with $3.81 in non-tobacco-producing states; P<0.008). In a multivariate analysis, the proportion of the settlement revenue allocated to tobacco-control programs was the primary determinant of the level of total funding; the state tobacco-related health burden was unrelated to program funding. CONCLUSIONS: State health needs appear to have little effect on the funding of state tobacco-control programs. Because only a very small proportion of the tobacco settlement is being used for tobacco-control programs, the settlement represents an unrealized opportunity to reduce morbidity and mortality from smoking.  (+info)

The impact of government policies and neighborhood characteristics on teenage sexual activity and contraceptive use. (63/592)

OBJECTIVES: This study sought to examine the effects of government policies and neighborhood characteristics on adolescent female sexual behavior to better inform future public policy decisions. METHODS: Using a bivariate probit model and National Survey of Family Growth data on women aged 15 through 19 years, we estimated the probabilities of their being sexually active and, if sexually active, of their using contraceptives. RESULTS: Variables measuring the cost of obtaining an abortion are not good predictors of sexual activity or contraceptive use. However, the relationship between family planning availability and contraceptive use is statistically significant at conventional levels. CONCLUSIONS: Policymakers seem to have little leverage with regard to influencing the decision to become sexually active, although increased access to family planning services may encourage responsible contraceptive behavior. Neighborhood context is an important determinant of adolescent female sexual behavior.  (+info)

The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997. (64/592)

OBJECTIVES: This study developed national estimates of the burden of selected infectious diseases among correctional inmates and releases during 1997. METHODS: Data from surveys, surveillance, and other reports were synthesized to develop these estimates. RESULTS: During 1997, 20% to 26% of all people living with HIV in the United States, 29% to 43% of all those infected with the hepatitis C virus, and 40% of all those who had tuberculosis disease in that year passed through a correctional facility. CONCLUSIONS: Correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for infectious diseases. Such interventions stand to benefit not only inmates, their families, and partners, but also the public health of the communities to which inmates return.  (+info)