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As radiation safety surveys of x-ray equipment are the responsibility of many health physicists, actual procedures vary among facilities. In an effort to share survey methodology of a large research institution, aspects of the x-ray safety program at Los Alamos National Laboratory are described. A definition of an intentional x-ray generating device is proposed in light of the absence or inadequacy of such a definition in applicable federal law and national consensus guidance documents. Regulations and procedures are discussed, and a sample database used in managing the Los Alamos program is presented.

This paper updates previous research on physician-based measures of access to care for Medicare beneficiaries following the implementation of Medicare payment reform in 1992. Using data collected in spring 1993, the results show that the majority of physician-based access indicators did not change significantly from 1992 levels. Those indicators that did change generally offset reductions in access identified immediately after the implementation of Medicare physician payment reform.

This paper examines the impact of Medicare physician payment reform on access to care by comparing several physician-based access measures in the pre- and post-reform periods. The results suggest that the broad goals of payment reform may have been at least partially achieved: the proportion of physician revenues derived from Medicare increased for primary care physicians and decreased for nonprimary care MDs; there was little change in the absolute or relative number of visits provided to Medicare patients; and an increasing number of physicians charged no more than the Medicare payment amount. Some signs of deteriorating access were found, however. Fewer physicians were willing to treat all new Medicare patients and more physicians accepted no new Medicare patients. Furthermore, there was an increase in the proportion of physicians who reduced or stopped providing to Medicare patients certain types of services that they continued to provide to other patients.