THIS STUDY EXAMINES THE RAPID GROWTH OF HOSPITAL WAGE RATES AND EMPLOYMENT LEVELS OVER THE PAST DECADE, WITH PARTICULAR ATTENTION TO THE PERIOD 1971-73. THE ANALYSIS SUGGESTS THE CURRENT HEW PROPOSAL FOR HOSPITAL COST CONTAINMENT WOULD SIGNIFICANTLY DECREASE THE RATE OF GROWTH OF HOSPITAL WAGES AND EMPLOYMENT.
As employers have turned to managed care to curtail the rising cost of health care benefits, the number of HMO enrollees has proliferated. Between 1984 and 1994, HMO enrollment incrased from approximately 15 million to over 49 million individuals. Although research has indicated that HMOs have been effective in limiting medical costs, there is mixed evidence in the literature on how they achieve these savings. This article uses data from the 1987 National Medical Expenditure Survey to examine one hypothesis for these patterns: that HMOs enroll a healthier population than fee-for-service plans. To test this hypothesis we examine HMO andjee-for-evice enrollees with respect to sxioeconomic variables such as age, race, sex, income, education, health status, and location. Our results indicate that HMOs tend to enroll a younger but not much healthier population than traditional fee-for-service plans, suggesting that self-selection is not a major contriutor to HMO cost savings.
Infectious hematopoietic necrosis virus (IHNV) and Flavobacterium psychrophilum are major pathogens of farmed rainbow trout. Improved control strategies are desired but the influence of on-farm environmental factors that lead to disease outbreaks remain poorly understood. Water reuse is an important environmental factor affecting disease. Prior studies have established a replicated outdoor-tank system capable of varying the exposure to reuse water by controlling water flow from commercial trout production raceways. The goal of this research was to evaluate the effect of constant or pulsed reuse water exposure on survival, pathogen prevalence, and pathogen load. Herein, we compared two commercial lines of rainbow trout, Clear Springs Food (CSF) and Troutex (Tx) that were either vaccinated against IHNV with a DNA vaccine or sham vaccinated. Over a 27-day experimental period in constant reuse water, all fish from both lines and treatments, died while mortality in control fish in spring water was <1%. Water reuse exposure, genetic line, vaccination, and the interaction between genetic line and water exposure affected survival (P<0.05). Compared to all other water sources, fish exposed to constant reuse water had 46- to 710-fold greater risk of death (P<0.0001). Tx fish had a 2.7-fold greater risk of death compared to CSF fish in constant reuse water (P <= 0.001), while risk of death did not differ in spring water (P=0.98). Sham-vaccinated fish had 2.1-fold greater risk of death compared to vaccinated fish (P=0.02). Both IHNV prevalence and load were lower in vaccinated fish compared to sham-vaccinated fish, and unexpectedly, F. psychrophilum load associated with fin/gill tissues from live-sampled fish was lower in vaccinated fish compared to sham-vaccinated fish. As a result, up to forty-five percent of unvaccinated fish were naturally co-infected with F. psychrophilum and IHNV and the coinfected fish exhibited the highest IHNV loads. Under laboratory challenge conditions, co-infection with F. psychrophilum and IHNV overwhelmed IHNV vaccine-induced protection. In summary, we demonstrate that exposure to reuse water or multi-pathogen challenge can initiate complex disease dynamics that can overwhelm both vaccination and host genetic resistance. ; National Institutes of Health EEIDUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01GM113233]; US Department of Agriculture, Agricultural Research ServiceUnited States Department of Agriculture (USDA)USDA Agricultural Research Service [1930-32000-006] ; Published version ; This work was supported by the National Institutes of Health EEID [grant number R01GM113233]; and the US Department of Agriculture, Agricultural Research Service [Project number 1930-32000-006 Integrated Research to Improve On-Farm Animal health in Salmonid Aquaculture]. The authors alone are responsible for the content and writing of this paper. ; Public domain authored by a U.S. government employee
