Medicaid HMO enrollees in the emergency room: use of nonemergency care

Medicaid managed care is generally acknowledged to reduce the use of emergency departments (EDs). Yet some studies of Medicaid managed care have shown no change in ED use, and others show wide variation across plans. Because emergency departments may not be the best place to deliver nonemergency care, it is useful to understand the characteristics of enrollees associated with a lower likelihood of ED use for nonurgent conditions. A recent study of Medicaid enrollees in a large Colorado health maintenance organization (HMO) revealed several sociological and psychological factors associated with nonemergency ED visits. The study found that nonemergency visits by people who are female, older, more satisfied with the HMO and their doctor, and enrolled longer in the HMO are less likely to visit the ED, whereas visits on weekends and those by people who live farther from their physicians and people who have more inpatient hospital admissions are more likely to be to the ED.

State policy issues in nonprofit conversions

The increasing number of nonprofit hospitals and health plans converting to for-profit enterprises, public concern, and media attention have brought conversions to the top of state policy agendas. Conversions raise public policy issues because nonprofit corporations' legal status obligates them to operate in the public interest, their tax subsidies should not inure to the benefit of private interests, and they often represent unique community resources providing valuable services. This paper describes legal authority that states can use to oversee conversions and outlines several policy issues facing state regulators that could be addressed by new legislation.

Reversible cataracts in diabetes mellitus

BACKGROUND

True diabetic cataracts are rare and have been infrequently reported in the literature. They often have a rapid onset, appear as white punctate or stellate opacities, and can resolve without treatment. The following case report describes reversible cataracts as a complication of diabetes mellitus with photodocumentation.

METHODS

A fifty-two-year-old white male was examined 5 days following the initiation of insulin therapy for severe hyperglycemia. The patient complained of sudden onset visual disability and extreme glare. He was given a complete ophthalmic examination and was monitored for 3 months.

RESULTS

The patient was diagnosed with acute posterior subcapsular cataracts secondary to diabetes mellitus. Within the following 7 weeks the lens opacities resolved without intervention. During this time period, the patient also exhibited a transient hyperopic refractive change.

CONCLUSIONS

The transient nature of the diabetic cataract is related to changes in lens hydration. Biochemical changes that occur as a result of rapid changes in blood sugar cause the lens fibers to swell, forming a cataract. The same mechanism is responsible for the hyperopic refractive change. Patients presenting with this condition have been shown to stabilize within 3 months.

Prolongation of platelet survival in hypercholesterolaemic rabbits by CGS 12970 (3-methyl-2-(3-pyridyl)-1 indoleoctanoic acid) and dazoxiben

In rabbits receiving a normal laboratory diet the platelet half-life was 40.4 +/- 2.5h (mean +/- S.D., n = 35). In animals fed the cholesterol-enriched diet for 12 weeks the platelet half-life was reduced to 31.6 +/- 3.6h (mean +/- S.D., n = 35). Treatment of cholesterol-fed animals with a single daily dose of CGS 12970 (a long acting inhibitor of thromboxane synthase) normalised the platelet half-life. Single daily doses of the relatively shorter acting thromboxane synthase inhibitors (CGS 13080 and dazoxiben) failed to correct the reduced platelet survival. However, twice daily dosing with dazoxiben was effective. The cyclooxygenase inhibitors, aspirin and sulphinpyrazone, failed to correct the reduced platelet survival.