Preferred provider org. (PPO) are more prevalent than other types of health plans, but, in 2003, only 6 PPOs contracted to serve Medicare beneficiaries (BE) in Medicare+Choice. The Centers for Medicare & Medicaid Services (CMS) initiated 2 demonstrations that include a total of 34 PPOs. This study: (1) describes how CMS used its statutory authority to conduct the 2 demo's., (2) assessed the extent to which demo. PPOs (DP) expanded access to Medicare health plans & attracted enrollees, (3) compared CMS's est. of out-of-pocket costs that BE incurred in DP with those of other types of coverage, incl. fee-for-service Medicare, M+C plans, & Medigap policies, & (4) determined the effects of DP on Medicare spending. Charts & tables.
This book is first of its kind exclusively dedicated to plant polyphenol oxidases (PPOs), highlighting their importance in the food processing industry. By reviewing the scientific developments of the past several decades, it offers a comprehensive overview of various aspects of plant PPOs, including chemistry, structure, functions, regulation, genetics/genomics and molecular aspects. PPOs are copper-containing proteins found in several plant species that catalyze the hydroxylation of o-monophenols to o-diphenols and oxidation of the o-dihydroxyphenols to o-quinones. Further, the quonines undergo self-polymerization or react with amines/thiol groups to produce brown/dark coloration of products. All the PPOs contain two Cu-binding sites (CuA and CuB) as their central domain, these interact with phenolic substrates and molecular oxygen. Several of the plant PPOs contain an N-terminal transit peptide (~80-100 amino acids ) necessary for plastid import. The PPOs occur in latent form that are activated by various treatments including acid and base shock, exposure to detergents or proteolytic degradation. The pH optimum of PPOs varies widely depending upon different plant species but is usually ~4.0 – 8.0. Similarly, the optimum temperature also varies as per the source and substrate involved ranging from 30 to 45 °C. Multiple PPO isoforms have been reported in several plant species, and the chromosomal location of PPOs has also been studied in some species. The physiological role (s) of PPOs is not entirely understood, but they could be involved in defense-related functions in plants. From an applied perspective, PPOs are implicated in enzymatic browning/darkening of cereal products, vegetables and fruits. Interestingly, browning is preferred in some instances like the processing of black tea, cocoa, and coffee as it enhances their quality by forming flavorful products. There have b een initiatives to specifically breed and develop cultivars with reasonably low PPO levels in the mature grain or fruit. Further, several types of inhibitors that reduce the PPO activity have also been identified. Despite their commercial/economic importance and the availability of literature on different aspects of PPOs in different plant species, this is the first book to provide basic information regarding PPOs. It is a valuable resource for researchers involved in quality-related research specifically in crops, vegetables and fruits. Further, as PPOs are also implicated in defense- or stress-related functions, the book is also useful to breeders, pathologists, molecular biologists, physiologists and entomologists.
The potential geographic distribution of preferred provider organizations (PPOs) differs greatly from that of health maintenance organizations (HMOs). We explain this theoretically by the natural ordering of insurance types according to the degree of consumer choice of provider. We examine the issue empirically, employing a unique data set based on California hospital discharges in 1998, a time when PPO and HMO insurance types were coded separately. Because HMOs are more restrictive than PPOs in the provider networks allowed, we find that they require urban areas with many physicians to form viable networks. PPOs are less restrictive in the provider networks, which we find allows PPOs to thrive outside of urban areas where HMOs cannot. We find that indemnity-type plans, also known as fee-for-service plans, can survive anywhere because they do not impose restrictions on provider choice. These findings have real world implications for Medicare modernization efforts aimed at increasing the proportion of seniors enrolled in Medicare managed care plans. Regional PPOs established under the Medicare Modernization Act of 2003 are likely to thrive, extending the geographic coverage of managed care service options to all seniors.
The American health care industry has undergone such dizzying transformations since the 1960s that many patients have lost confidence in a system they find too impersonal and ineffectual. Is their distrust justified and can confidence be restored? David Dranove, a leading health care economist, tackles these and other key questions in the first major economic and historical investigation of the field. Focusing on the doctor-patient relationship, he begins with the era of the independently practicing physician--epitomized by Marcus Welby, the beloved father figure/doctor in the 1960s television show of the same name--who disappeared with the growth of managed care. Dranove guides consumers in understanding the rapid developments of the health care industry and offers timely policy recommendations for reforming managed care as well as advice for patients making health care decisions. The book covers everything from start-up troubles with the first managed care organizations to attempts at government regulation to the mergers and quality control issues facing MCOs today. It also reflects on how difficult it is for patients to shop for medical care. Up until the 1970s, patients looked to autonomous physicians for recommendations on procedures and hospitals--a process that relied more on the patient's trust of the physician than on facts, and resulted in skyrocketing medical costs. Newly emerging MCOs have tried to solve the shopping problem by tracking the performance of care providers while obtaining discounts for their clients. Many observers accuse MCOs of caring more about cost than quality, and argue for government regulation. Dranove, however, believes that market forces can eventually achieve quality care and cost control. But first, MCOs must improve their ways of measuring provider performance, medical records must be made more complete and accessible (a task that need not compromise patient confidentiality), and patients must be willing to seek and act on information about the best care available. Dranove argues that patients can regain confidence in the medical system, and even come to trust MCOs, but they will need to rely on both their individual doctors and their own consumer awareness.
This book serves 3 types of readers. The first type of reader is one who is going to read this book as study material for the PPO Qualified Manager Exam. As such, the content was based on the Exam Outline for PPOs. For the second type of reader, this book serves are those considering opening a security company or those who are managing a company and who want a guide on the current industry standards. This book will explore the basic fundamentals of owning and operating a security company in California. The third type of reader is that of the attorney who is investigating or prosecuting a negligence case involving a private security company. The intent of this book is to serve as one of the primary legal treatises on private security standards. Although the book contains practice questions, the reader must understand these questions are not the same questions on the state exam. Neither the same or exact content in the state exam. Remember, no particular author or entity has legal access to the BSIS questions.
This issue discusses the concerns of skin disease in the United States and the national clinical dermatology research priorities – the article topics also closely follow the plan set out by the recent dermatology needs assessment of the UK. Articles include Health Care Disparities, The Burden of Skin Disease in the United States, as well as specific conditions such as psoriasis, acne, and melanoma. There is also an article devoted to dermatologic surgery needs assessment.
