Gastrointestinal illness in managed care: healthcare utilization and costs.

Identification of inefficiencies is a first step to improving the quality of gastrointestinal (GI) care at the most reasonable cost. This analysis used administrative data to examine the healthcare utilization and associated costs of the management of GI illnesses in a 2.5 million-member private managed care plan containing many benefit designs. An overall incidence of 10% was found for GI conditions, with a preponderance in adults (patients older than 40 years) and women. The most frequently occurring conditions were abdominal pain, nonulcer peptic diseases, lower GI tract diseases, and other GI tract problems. These conditions, along with gallbladder/biliary tract disease, were also the most costly. Claims submitted for care during GI episodes averaged $17 per member per month. Increasing severity of condition was associated with substantial increases in utilization and costs (except for medication use). For most GI conditions, approximately 40% of charges were for professional services (procedures, tests, and visits) and 40% of charges were for facility admissions. The prescription utilization analysis indicated areas where utilization patterns may not match accepted guidelines, such as the low use of anti-Helicobacter pylori therapy, the possible concomitant use of nonsteroidal anti-inflammatory drugs in patients with upper GI diseases, and the use of narcotics in treating patients with lower GI disease and abdominal pain. Also, there was no clear relationship between medication utilization and disease severity. Thus, this analysis indicated that GI disease is a significant economic burden to managed care, and identified usage patterns that potentially could be modified to improve quality of care.

Bridging cultures. Arab American women and their birth experiences.

PIP: Estimates from Arab consulates indicate that 2-3 million Arab immigrants are now living in the U.S., most of these from Palestine, Lebanon, Egypt, Iraq, and Yemen. The unique cultural outlook and culturally determined social behavior of Arab American women may cause communication problems when they enter the American health care system. The following aspects of Arab/Islamic behavior lead to the greatest misunderstandings: 1) involvement of the Arab male in all aspects of health care for his wife and children; 2) the incorporation of children into all aspects of life; 3) female modesty; 4) the lack of planning as a value; 5) the subordinate status of women; 6) low threshold reactions to pain; and 7) the strong emphasis on the traditional female role and on production of male heirs. Health care workers who deal with Arab American women must seek to understand their cultural background and resultant behavior.^ieng