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  1. Insurance coverage, physician recommendations, and access to emerging treatments : Growth hormone therapy for childhood short stature.

    Article - En anglais

    Context. - There is concern in both the medical community and the general public about mechanisms of medical decision making and the interplay of physician and insurer decisions in determining access to care.

    Objective

    - To examine the medical process influencing access to growth hormone (GH) therapy for childhood short stature by comparing coverage policies of US insurers with the treatment recommendations of US physicians.

    Design and Particlpants

    - lndependent national representative surveys were mailed to insurers (private, Blue Cross/Blue Shield, health maintenance organizations, programs for Children with Special Health Care Needs, and Medicaid programs, n=113), primary care physicians (n=1504), and pediatric endocrinologists (n=534) with response rates of 75%, 60%, and 81%, respectively.

    Each survey included identical case scenarios.

    Primary care physicians were asked decisions about referrals to pediatric endocrinologists.

    Endocrinologists were asked GH treatment recommendations.

    Insurers were asked coverage decisions for GH therapy.

    Main Outcome Measures

    - Insurer coverage decisions for GH in specific case scenarios were compared with the recommendations of primary care physicians and pediatric endocrinologists.

    Results

    - Physician recommendations and insurance coverage decisions differed strikingly. (...)

    Mots-clés Pascal : Assurance maladie, Médecin, Prise décision, Défaut croissance, Traitement, Chimiothérapie, Facteur croissance, Economie santé, Recommandation, Enfant, Homme, Endocrinopathie, Couverture sociale

    Mots-clés Pascal anglais : Health insurance, Physician, Decision making, Growth defect, Treatment, Chemotherapy, Growth factor, Health economy, Recommendation, Child, Human, Endocrinopathy

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0155323

    Code Inist : 002B02O. Création : 21/07/1998.