Medical loss ratio

While provider compensation methods are effective in controlling a significant proportion of managed care s costs, they cannot work alone, as there are other priority issues that continually challenge managed care s ability to deliver high quality services, yet control healthcare costs. Cost containment issues that influence business decisions in managed care include medical loss ratios (MLRs) and pharmacoeconomic and outcomes data. 

The cost of workplace injuries is enormous. In 1992 the U.S. economy lost 115.9 billion from work-related accidents 62.5 billion from wage and productivity losses, 22.0 billion from medical costs, 14.5 billion from administration expenses, 3.4 billion from motor vehicle damages, 10.2 billion from indirect employer costs, and 3.3 billion from fire losses (National Safety Council 1993). In addition to monetary losses, work injuries cause pain and suffering and frequently result in permanent disabilities that impede the normal enjoyment of life. The National Safety Council (1993) estimated that for every dollar of monetary loss accidents lower the quality of life on average by two dollars. With a two-to-one quality-of-life loss ratio the total cost of workplace accidents in 1992 was 347.7 billion, about 5.8 percent of 1992 U.S. GDP. 

As metabolic balance techniques cannot separate the contribution of malabsorption from that of endogenous loss, collaborators at the Division of Nutrition, University of Sao Paolo Medical School at Rlbeirao Preto, Brazil and I undertook to assess Sn Zn interaction using the change-in-plasma-zinc approach. Healthy volunteers received 12.5 mg of zinc as 55 mg of zinc sulfate in 100 ml of CocaCola either alone (control) or with 25, 50 or 100 mg of tin as stannous chloride to constitute 2 1, 4 1 and 8 1 Sn/Fe ratios. We measured the change in plasma zinc concentration at hourly Intervals over a 4-h period. None of the treatments produced any significant decrement in the uptake of zinc in plasma (61) (Table V). Thus, unlike the dramatic effect of even lesser ratios of Fe/Zn (above), the plasma appearance of zinc was unaffected by soluble, inorganic, divalent tin ions. 

---