Consumer-sponsored prepaid group practice: restructuring the health care system

The traditional separation of health care delivery and financing systems is breaking down as various new types of health care facilities are established and as payment continues to be a major concern. Group Health Cooperative of Puget Sound (GHC) was organized as a prepaid group practice system responsive to consumers. Costs, methods of payment and delivery of care are interrelated and are all influenced by consumer ownership. GHC has been refining its benefit programs since 1945. Strategies for controlling use and costs focus on improved provider management and on flexibility. This article explains how the structure of GHC benefits the consumer.     

Growth behavior of the blue blowfly Calliphora vicina maggots

Fifty-three clusters of blowfly eggs of the genus Calliphora vicina were observed in the laboratory up to the hatching stage under reproducible and virtually field-like conditions. Rearing the larvae was then continued up to pupation, the larval growth in length being recorded several times a day. As the object was to study the dependence of the larvae increase in length on the temperature conditions in vitro, the substratal humidity and food supply were kept unchanged during the entire study. The temperature ranged from 6.5 degrees C to 35 degrees C, with the temperature for the individual cluster kept constant during the entire developmental process. Data on about 5500 measured larvae were statistically evaluated. The basic result established was that in the case of the blowfly of the genus Calliphora vicina in vivo, all developmental stages relevant to the entomologic determination of the time of death depend on the temperature conditions: (1) the duration of the egg stage increases with decreasing temperature; (2) the speed of larval growth is slower at lower temperatures; (3) the maximal larval length is reached earlier at higher temperatures; (4) the mean value of maximal length decreases with increasing temperature; (5) larvae under all temperature conditions decrease in size after having reached their maximal length, the decrease in length being more rapid at higher temperatures; (6) constant temperatures over 30 degrees C lead to "stunted forms" which do not pupate and die; (7) constant temperatures under approximately 16 degrees C after the peak of growth has been reached inhibit the readiness to pupate, which causes the larvae to fall into a stationary state of rest, which will be interrupted only when the temperature is raised and resumption of the metamorphosis is thus induced. To allow rapid reconstruction of the larval age in general practice, the established growth data were set out in the form of a diagram designated isomegalendiagram, which permits temperature-fluctuation-related entomologic determination of the time of death with a maximum degree of accuracy.