摘要:

In the early 1960's, a number of observers argued that the current method of reimbursing hospitals by third parties would be a factor contributing to increasing hospital costs. In this report, we analyze one method of reimbursing hospitals—we postulate and test a number of hypotheses about the nature of the incentives that are built into the program, and then propose an alternative way of reimbursing hospitals. It is argued that a prospective reimbursement formula be negotiated and developed that depends on two factors: 1. an agreed upon rate of general inflation, and 2. an estimated cost function which captures important aspects of the case-mix which accounts for differential costs across hospitals. The cost function is presented, and various aspects of the proposed formula are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

One year's utilization of medical and hospital services by some 3,300 Canadian steelworkers and their families who belonged to a prepaid group practice plan has been compared with utilization by the families of fellow members of the same union Local whose care was provided by independently practicing physicians. Although the group practice had no financial incentive to economize on inpatient care, its rate of hospital utilization was lower by about a quarter. On comparing the frequency of different types of service rendered under the two systems, it appeared that the group practice placed somewhat greater emphasis on health protection against the investigation and treatment of disease, but utilization of both laboratory and radiologic services was certainly higher in the population served by the group practice.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

A causal model has been developed relating patient-days per thousand population and its components, hospital admission rates and average length of stay, to demographic characteristics of New Mexico counties. Data from the U. S. Census I960, the New Mexico State Department of Business Research, and the annual Guide Issue of “Hospitals,” the Journal of the American Hospital Association, have been used to estimate parameters of this model. Analysis of the model suggests that the supply of hospital beds is a major determinant of utilization in an area. In those areas where alternative health services are lacking or inadequate, an increase in the supply of beds significantly alters both the admission rate and the average length of stay. Socioeconomic factors such as income level, educational level, and ethnic composition have surprisingly little effect on the use of hospital facilities in New Mexico, a fact that probably reflects the major changes that have occurred in financing hospitalization during the past several decades. At the same time, hospital utilization rates appear to be highly sensitive to even small changes in the age structure of the population. Urbanization also affects the use of short-term general hospitals primarily due to the increased availability of hospital services to urban populations. The findings suggest that inpatient hospital care is substituted for ambulatory care normally provided by physicians in areas where the physician-to-population ratio is low. In general, the findings of this study clearly demonstrate the value of causal models in ascertaining the effects of demographic factors on the use of health care services and in planning for future demands on the system.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The importance of the telephone in the American medical care system is only beginning to receive appropriate attention. Fast studies indicate that a significant proportion of new diseases and a significant proportion of all medical care contacts take place by phone. A study of telephone use in a prepaid group practice system is presented. Data on telephone utilization are analyzed to determine the significance of telephone utilization of the population and to identify the patterns of telephone calls within total care seeking behavior. The purpose is to determine alternative modes of dealing with problems presented by phone or at least to assure that this important aspect of care is integrated into medical care. Telephone calls represented a significant proportion of the total medical care of the study population. About 50 per cent of all phone calls to medical core personnel were concerning symptoms of disease and approximately 40 per cent concerned laboratory results or prescriptions. Factors affecting the disposition of symptom phone calls were analyzed. It was hypothesized that the relative probability of a patient being told to come to the clinic after discussing a symptom would vary inversely with the certainty of the physician in his diagnosis and directly with the seriousness of the disease as perceived by the physician. The inferences from the data generally tended to support the hypotheses. These tendencies, however, were not strong enough to accurately predict when the physician would only discuss the symptom, give a prescription, or request a patient to visit. The concepts do not yet lend themselves to operational decision models for use by personnel trained to handle these kinds of calls, because of tremendous individual variation among physicians that confounds attempts to predict the disposition of symptom phone calls using only patient, disease, and situational variables.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The purpose of this study was to discover who is making the decisions concerning publicly funded health programs and the differential effect that various types of decision-makers have on the decisions. The variations in content, administration, and funding level of eight Model Cities health programs in Michigan were studied. These programs were scaled into a composite score of the consumer vis-à-vis provider orientation of the final program. Participants were studied in terms of the amount of influence they held in the process, their role as consumers or providers, their position in the community, and their attitudes concerning the delivery of health services. Reliability of the attitudes and influence scales is discussed. The data were collected by means of content analysis of the Model Cities documents and personal interviews with the participants. Providers who represented community health agencies were more influential than consumers in every city. The attitudinal orientation of high-influence providers is highly associated with the consumer-provider orientation of the program. It is concluded that representatives of community health agencies seem to be able to determine the nature of the outcome whether they have been invited to do so or not. Consequently, a requirement for a certain provider/consumer mix on a decision-making body will not ensure a policy output that is representative of this particular mil. The study demonstrates the direction and effect of consumer and provider interests in new health care programs.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Policy actions taken in one market setting may be useful experience for planners in another. This, of course, requires similarities in market structural defects and recognition of limitations in the analogy. In this report, we consider applying a Civil Aeronautics Board-type planning model to health services. The particular application concerns residents of rural areas who have significantly less access to comprehensive health services than do persons living in more populated areas. The primary underlying cause is that physicians prefer to practice in urban areas. Additional complicating factors include difficulties in providing services on small scales, the time patients must spend in traveling to receive services, and lesser per capita incomes of rural residents. Consequently, health planners are searching for ways to provide better health service to rural areas at a reasonable cost. The CAB faced a similar problem in bringing airline services to areas other than large metropolitan centers. While the CAB is a comprehensive planning body with franchising and subsidy powers, unlike those currently available to health planning bodies, both industries share important structural similarities. These similarities include a publicly subsidized facility, resource indivisibilities, and a recognized need for regional market expansion. We discuss the results of airline planning undertaken by the CAB and suggest general principles that can effectively be transferred to health planning.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The American Dental Association has for the past few years labored over its official view of closed panel forms of practice. Somehow the Association is attempting to arrive at a solution which will satisfy both the realities of this form of practice and its reluctance to admit that traditional private practice may not be providing adequate levels of dental services to the general population.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The advent of health maintenance organizations (HMO) creates an opportunity to test the effectiveness of alternative staffing patterns within prepaid group practices. The HMO's task is to reduce illness and hospitalization (or a defined population, thereby helping to contain health costs. If it is true that preventive care and health maintenance arc the keystone to HMO success, then non-physician health workers have a major contribution to make to health maintenance organizations. This article discusses as one staffing alternative, the extensive use of nurses, especially nurse specialists, in family health maintenance. Reasons supporting increased nurse involvement and potential difficulties emerging from innovative use of personnel are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1973

数据来源: OVID