Simulating the impact of medical savings accounts on small business. (25/1460)

OBJECTIVE: To simulate whether allowing small businesses to offer employer-funded medical savings accounts (MSAs) would change the amount or type of insurance coverage. STUDY SETTING: Economic policy evaluation using a national probability sample of nonelderly non-institutionalized Americans from the 1993 Current Population Survey (CPS). STUDY DESIGN: We used a behavioral simulation model to predict the effect of MSAs on the insurance choices of employees of small businesses (and their families). The model predicts spending by each family in a FFS plan, an HMO plan, an MSA, and no insurance. These predictions allow us to compute community-rated premiums for each plan, but with firm-specific load fees. Within each firm, employees then evaluate each option, and the firm decides whether to offer insurance-and what type-based on these evaluations. If firms offer insurance, we consider two scenarios: (1) all workers elect coverage; and (2) workers can decline the coverage in return for a wage increase. PRINCIPAL FINDINGS: In the long run, under simulated conditions, tax-advantaged MSAs could attract 56 percent of all employees offered a plan by small businesses. However, the fraction of small-business employees offered insurance increases only from 41 percent to 43 percent when MSAs become an option. Many employees now signing up for a FFS plan would switch to MSAs if they were universally available. CONCLUSIONS: Our simulations suggest that MSAs will provide a limited impetus to businesses that do not currently cover insurance. However, MSAs could be desirable to workers in firms that already offer HMOs or standard FFS plans. As a result, expanding MSA availability could make it a major form of insurance for covered workers in small businesses. Overall welfare would increase slightly.  (+info)

Impact of diabetes on crash risks of truck-permit holders and commercial drivers. (26/1460)

OBJECTIVE: The U.S. and some Canadian government agencies have waived commercial license restrictions for some insulin-using diabetic drivers. However, the U.S. Federal Highway Administration is no longer giving waivers. Scientific evidence to support such regulations has been sparse. This article presents detailed analyses of crash risks for users and nonusers of insulin among diabetic truck-permit holders in Quebec, Canada. RESEARCH DESIGN AND METHODS: Diabetic truck-permit holders were group-matched by age to a random sample of healthy permit holders. Data on permits, medical conditions, and crashes involving 13,453 permit holder-years in 1987-1990 were extracted from the files of the public insurer for automobile injuries in Quebec. Additional health status data were obtained from the provincial public health insurer. A telephone survey was conducted to collect data on driving patterns and exposure. Risk ratios were estimated using negative binomial regression models. RESULTS: Risk ratios for crashes vary by category of diabetes. Permit holders for single-unit trucks (STs) who are diabetic without complications and not using insulin have an increased crash risk of 1.68 when compared with healthy permit holders of the same permit class. When controlling for risk exposure, commercial drivers with an ST permit and the same diabetic condition have an increased risk of 1.76. Insulin use is not associated with higher crash risk. CONCLUSIONS: The increased crash risk for the group with uncomplicated diabetes not using insulin is a new finding. The lack of consistent increases in crash risks among diabetic commercial drivers with complications or who use insulin may be a "healthy worker effect" masking the real risk, because these licensees have a lower participation rate as professional drivers.  (+info)

Global trade and health: key linkages and future challenges. (27/1460)

Globalization of trade, marketing and investment has important implications for public health, both negative and positive. This article considers the implications of the single package of World Trade Organization (WTO) agreements for public health research and policy, focusing on three themes: commodities, intellectual property rights, and health services. The main aims of the analysis are as follows: to identify how trade issues are associated with the transnationalization of health risks and possible benefits; to identify key areas of research; and to suggest policy-relevant advice and interventions on trade and health issues. The next wave of international trade law will need to take more account of global public health issues. However, to become more engaged in global trade debates, the public health community must gain an understanding of the health effects of global trade agreements. It must also ensure that its own facts are correct, so that public health is not blindly used for political ends, such as justifying unwarranted economic protectionism. "Healthy trade" policies, based on firm empirical evidence and designed to improve health status, are an important step towards reaching a more sustainable form of trade liberalization.  (+info)

Commercial predictive testing: the desirability of one overseeing body. (28/1460)

In Europe a process of harmonisation of standards and regulations on genetic testing has started. Public discussion and consultation are recommended, but it is not clear in every European country how the decision making process as regards the further introduction of genetic testing services should be formed. In this paper the usefulness and importance of an overseeing body for genetic screening and testing is founded on four lines of reasoning: (1) analysis of the role of value judgments in the use of the concept of (genetic) abnormality; (2) a balancing of potential benefits for all parties involved; (3) a balancing of potential disadvantages, and (4) the greater availability of commercial genetic tests in the future. It is further argued that such an overseeing body has advantages for all the interested parties.  (+info)

Dehydration, stress, and water consumption of horses during long-distance commercial transport. (29/1460)

The aim of this study was to characterize progressive dehydration, stress responses, and water consumption patterns of horses transported long distances in hot weather and to estimate recovery time after 30 h of transport. Thirty adult mares and geldings were deprived of access to feed and water for 6 h, blocked by age, sex, breed, and body condition score, and assigned to one of the following treatments: penned, offered water (Penned/Watered, n = 5); penned, no water (Penned, n = 5); transported, offered water (Transported/Watered, two groups of n = 5); or transported, no water (Transported, two groups of n = 5). None of the horses had access to feed while on treatment. A commercial, single-deck, open-top, 15.8-m-long trailer was divided into four compartments to accommodate the two Transported/Watered and two Transported groups at 1.77 m2 per horse. At 8, 17, 22, 27, 30, and 33 h after initiation of transport, the truck returned and stopped for 1 h to allow for data collection and to give the Transported/Watered and Penned/Watered horses 10 min of access to water in individual buckets. Treatments for the non-watered horses (Penned and Transported) were terminated after 30 h due to dehydration and fatigue, whereas the watered horses (Penned/Watered and Transported/Watered) could continue for another 2 h. Mean weight loss after 30 h was greater in the Penned (57.1 kg, 12.8%) and Transported (52.2 kg, 10.3%) groups than in the Transported/Watered (20.7 kg, 4.0%) and Penned/Watered (17 kg, 3.5%) groups (P < 0.0001). Respiration, heart rate, sodium, chloride, total protein, and osmolality were significantly elevated in the non-watered horses (P < 0.0001), and sodium, chloride, total protein, and osmolality greatly exceeded normal reference ranges, indicating severe dehydration. Although not statistically significant, the horses penned in full sun, with or without water, had a dehydration response that was slightly greater than that of the transported horses. Plasma cortisol concentrations had a significant time x treatment interaction (P < 0.0001), in which the Penned/Watered and Transported/Watered horses remained relatively consistent, whereas the Transported, and especially the Penned, horses' plasma cortisol concentrations greatly increased. Transporting healthy horses for more than 24 h during hot weather and without water will cause severe dehydration; transport for more than 28 h even with periodic access to water will likely be harmful due to increasing fatigue.  (+info)

Metaphors, models and organisational ethics in health care. (30/1460)

Crucial to discussions in organisational ethics is an evaluation of the metaphors and models we use to understand the organisations we are discussing. I briefly defend this contention and evaluate three possible models: the current corporate model, an orchestrator model which puts hospitals in the same class as malls and airports, and a community model. I argue that the corporate and orchestrator model push to the background some important organisational ethics issues and bias us inappropriately towards certain solutions. Furthermore, I argue that the community model allows these to be more easily brought up. I also respond to the likely challenge that hospitals really are corporations by arguing that this is not relevant to evaluations of the appropriateness of the corporate model.  (+info)

Soft drink "pouring rights": marketing empty calories to children. (31/1460)

Healthy People 2010 objectives call for meals and snacks served in schools to contribute to overall diets that meet federal dietary guidelines. Sales in schools of foods and drinks high in calories and low in nutrients undermine this health objective, as well as participation in the more nutritious, federally sponsored, school lunch programs. Competitive foods also undermine nutrition information taught in the classroom. Lucrative contracts between school districts and soft drink companies for exclusive rights to sell one brand are the latest development in the increasing commercialization of school food. These contracts, intended to elicit brand loyalty among young children who have a lifetime of purchases ahead of them, are especially questionable because they place schools in the position of "pushing" soft drink consumption. "Pouring rights" contracts deserve attention from public health professionals concerned about the nutritional quality of children's diets.  (+info)

Lessons learned from the tobacco industry's efforts to prevent the passage of a workplace smoking regulation. (32/1460)

OBJECTIVES: This study assessed the implementation of tobacco industry strategies to prevent a workplace smoking regulation. METHODS: Tobacco industry internal documents were identified; hearing transcripts for the affiliations, arguments, and positions regarding the regulation of testifiers were coded; and media coverage was analyzed. RESULTS: Tobacco industry strategies sought to increase business participation and economic discussions at public hearings and to promote unfavorable media coverage of the regulation. The percentage of business representatives opposing the regulation grew from 18% (5 to 28) to 57% (13 of 23) between the hearings. Economic arguments opposing the regulation rose from 25% (7 of 28) to 70% (16 of 23). Press coverage was neutral and did not increase during the period of the regulatory hearings. CONCLUSIONS: The tobacco industry was successful in implementing 2 of its 3 strategies but was not able to prevent passage of the comprehensive workplace regulation.  (+info)