In this prospective study, conducted in China where providers have traditionally been paid fee-for-service, and where drug spending is high and irrational drug prescribing common, township health centers in two counties were assigned to two groups: in one fee-for-service was replaced by a capitated global budget (CGB); in the other by a mix of CGB and pay-for-performance. In the latter, 20% of ...

A new species of biting midge (Diptera: Ceratopogonidae), Culicoides hildebrandoi sp. n., is described and illustrated based on female and male specimens from the states of Amazonas and Rondônia, Brazil. This new species belongs to the reticulatus species group and differs from the 24 other species of this group by the elongate slightly swollen 3(rd) palpal segment with scattered capitate sensi...

For a very impaired population needing multiple interrelated services, the case management approach used by On Lok Senior Health Services in San Francisco, California, produces a responsive, flexible service system. Case management in On Lok's consolidated model has three key characteristics: (1) a true multidisciplinary team of medical as well as nonmedical personnel who separately assess, the...

In 1994 Tennessee moved virtually its entire Medicaid population and new eligibles into fully capitated managed care (TennCare). We analyze Tennessee's strategy, given limited existing managed care; and health plans' development of managed care infrastructure. We find signs of progress and developing infrastructure, but these are threatened by concerns over TennCare's financial viability and th...

We report 2 new cases of isolated fracture of the capitate. The diagnosis and follow-up were made with MRI. Conventional radiographs initially failed to reveal the fracture. Both fractures were treated conservatively; one healed completely; the other went on to a well-tolerated nonunion.

Clinical care pathways and case management are strategies utilized by increasing numbers of hospitals to meet the challenges of capitated reimbursement and managed care. A clinical pathway is an outcome-focused tool used to define a multidisciplinary plan of care. A case manager coordinates patient care across an episode of illness or hospitalization. These tools and systems have great potentia...

Soft tissue ganglion cysts are the most common benign tumours of the wrist; their pathogenesis remains controversial. We prospectively screened the radiographic appearance of the wrists of 51 patients presenting to a single surgeon with dorsal wrist ganglions during a one-year period. Postero-anterior and lateral radiographs were systematically performed looking for possible associated intraoss...

Primary bone healing fails to occur in 5-15 % of scaphoid bones that undergo fracture fixation. Untreated, occult fractures result in nonunion up to 12 % of the time. Conventional bone grafting is the accepted management in the treatment algorithm of scaphoid nonunion if the proximal pole is vascularized. Osteonecrosis of the proximal scaphoid pole intuitively suggests a need for transfer of th...

Traditionally, many medical groups have compensated physicians based on “productivity.” Productivity meant the more that physicians billed and collected, the higher their compensation. This approach worked well enough as long as insurance companies and Medicare were paying on a feefor-service basis. In a capitated, managed care world, however, the same compensation formula could prove disastrou...

Pavania setiformis Loghmani & Hajiqanbar sp. nov. (Acari: Heterostigmatina: Dolichocybidae) associated with Onthophagus (Palaeonthophagus) vitulus (Fabricius) (Coleoptera: Scarabaeidae) is described from northeastern Iran. This remarkable new species represents a new setiformis species group characterized by seta-like sc(1), instead of capitate trichobothria. The genus Pavania is thus divided i...