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Background. In 2005, an innovative system of hospital-community, on-line medical records (OFEK) was introduced in Clalit Health Services (CHS). Goals. To examine OFEK's use and impact on quality indicators and medical-service utilisation in CHS primary-care clinics. Methods. Examining the frequency of OFEK's use with its own track-log data; comparing ''before'' and ''after'' quality indicators and service utilisation of experimental versus control clinics. Results. Use of OFEK increased by hundreds of percent between 2005 and 2006, continued rising at a slower rate in 2007 and decreased slightly in 2008. At clinics in catchment areas of hospitals using OFEK extensively, OFEK reduced the number of imaging tests and, to a lesser extent, laboratory testing and improved several quality measures. An examination of all clinics in the catchment areas and in the study revealed a much weaker impact. Conclusions. OFEK's introduction affected a number of outcome measures -- some, significantly -- in medical and financial terms. Its increased use at additional clinics may exert a stronger impact there, too. The study contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of Health Information Technology (HIT) systems. [ABSTRACT FROM AUTHOR]

Small group health insurance statutes of 48 states and the District of Columbia, as of 1999, were reviewed. Reform provisions judged to have some relevance for the market are catalogued and total 74 distinct regulations. Judgment of market relevance was based on actuarial experience at a leading health insurance company. The regulations are categorized under: (I) Access improvement; (2) Pricing and Rating Reforms; (3) Improving stability of coverage; and (4) Improving valued features of plans. The nuances and variety of these regulations, adopted in various combinations by the states, are discussed. The complexity of the reform scenario suggests the need for impact studies that take into account the totality of reform. Past studies have evaluated the impact of selected major reforms in isolation, and, thus, have been inadequate to provide definitive conclusions on the reforms' impact. [ABSTRACT FROM AUTHOR]

The role of the newly created brazilian regulatory agency for the health plans market is a work in progress. In this paper, the author describes the brazilian healthcare system structure and evolution, in order to put in context the reasons that eventually determined the creation of such organ. The stakeholder theory is utilized as a framework to analyze the reactions to the creation of the agency. It is postulated that the agency has established itself as a player in the market, in spite of initial doubts about its legitimacy. [ABSTRACT FROM AUTHOR]