ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A population-based, retrospective analysis of Medicare Part A and Blue Cross hospital insurance claims data was used to determine whether hospice home care cost savings to third-party insurers are substantial and result from the substitution of less expensive home care visits for more costly hospital inpatient days. The study was carried out by comparing the third-party payments of Cuyahoga County residents who died of cancer and were served by a hospice home care program (n = 152) with the insurance payments of cancer patients who never received hospice home care (n = 1,397). The data strongly supported the research hypothesis. The relative use of hospital days decreased more than 50% and the use of home care visits increased 10-fold when dying patients shifted from conventional care to hospice home care. This change in use represented a relative savings of about 40%, ranging from $1,089 per patient during the last 2 weeks of life to $2,676 per patient during the last 12 weeks of life. These results were not accounted for by group differences in age, type of cancer, or personal preference for home care.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Hospital diversification and its impact on the operating ratio are studied for 62 New York hospitals during the period 1974-1979. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependent. Institutional diversification is found to yield better financial position, and the better operating ratio allows the institution the wherewithal to diversify. The impact of external government planning and hospital competition are also measured. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. These results should not be generalized beyond the New York State context. Restructuring of the organization, unrelated business ventures, and transactions with related organizations were not a problem in this sample. However, in 1983, many a new corporation is set up whose revenues do not become part of the hospital's and whose complex transactions conceal unallowable costs and maximize reimbursement. A number of hypotheses are advanced concerning hospital administrator's attitude toward risk.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The effect of a copayment for pharmaceutical services in a Medicaid program is presented. Data were collected from Medicaid claim files in South Carolina (experimental program) and Tennessee (control program) for a 4-year period, 1976-1979. Utilization rates and expenditures for 1 year prior to copayment and 3 years after copayment were computed from a stratified sample of 18 counties. Both the level of prescriptions per eligible recipient and the slope of the utilization function after copayment were found to have declined with the implementation of copayment in South Carolina. The level of the expenditure series after copayment also declined, but the series retained a positive trend. Subsequent analysis of prescription quantity concluded that the increasing expenditure function was attributed to the inflation in cost of ingredients rather than an increase in average prescription size. The study concluded that a small (50¢) copayment for prescription service is a successful mechanism to control the cost and assist in financing a Medicaid prescription drug program.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Results of a two-county pilot study in Iowa revealed that capitation may have significant advantages over fee-for-service (FFS) reimbursement in the Medicaid drug program. Consequently, the capitation program was expanded to 32 counties on April 1, 1981 and continued through December 31, 1981. Another 32 counties were used as part of a before: after/experimental: control design. Pharmacists were paid 80% of projected drug expenditures in advance based on the types of Medicaid eligibles who chose them as their providers. The remaining 20% was withheld in an escrow account to be used for supplemental, emergency, and bonus payments. Pharmacists who participated in this experiment were guaranteed that their gross profits on Medicaid prescriptions would remain at least equal to what they would have been if they had remained under the current FFS payment system. Major differences in drug use levels and pharmacist dispensing behavior under capitation financing were observed in the pilot study. However, no such changes associated with payment type were noted in the expanded program. Relative to these findings, a discussion of pharmacist attitudes is presented.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Four areas of cost were analyzed in the expanded capitation drug program: total program costs; drug costs, escrow account distribution, and administrative costs. Total program costs were, on average, 9% higher under capitation. Drug costs, however, were 3% lower than under fee-for-service (FFS) reimbursement. This discrepancy is probably because pharmacists were not at financial risk under the program, the capitation rates were higher than intended, there were many emergency claims, and other aspects of the research environment. Although administrative costs were large, almost two thirds of the development cost was for one-time work, which could be transferred to another state at little or no expense. One third of the total administrative costs can be attributed to complying with regulations of the Health Care Financing Administration. Significant refinement of the present capitation model may be necessary before this financing innovation is used elsewhere. Modifications might include limiting the system to nursing home patients, placing pharmacists at partial financial risk, restricting participation to pharmacies that service a large number of Medicaid eligibles, and basing capitation rates in part on the drug use behavior of cashpaying patients.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The authors evaluated three methods of referring new hypertensive patients from a large municipal hospital emergency room to an ongoing medical care system. A total of 239 patients were assigned to one of three groups. Compliance with recommendations to receive follow-up care was compared for each group. Forty-two percent of patients who received a routine referral from nurses or physicians plus a follow-up telephone call or letter complied. Thirty percent of patients who received a referral from a specially trained interviewer to the hospital's outpatient assessment area complied. These two groups were not significantly different. Compliance was significantly greater (65%, P < 0.001) for a third group of patients who received an appointment from an interviewer to the outpatient general medicine clinic. The appointment was within 3 days from the time of the emergency room visit. An early appointment intervention given to new high blood pressure patients in the emergency room is recommended to improve patient return for follow-up care, thereby improving linkage to an ongoing care system.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

To improve the geographic distribution of physician assistants and nurse practitioners in California, the Primary Care Associate Program established five community-based training sites in outlying areas while continuing to operate its core program within the San Francisco Bay Area. To evaluate this effort, the authors prospectively compared the employment locations of graduates from both groups, achieving a follow-up rate of 95%. Graduates from community sites were twice as likely to locate first practices outside the Bay Area (91% vs. 43%, P < 0.05) and in towns with less than 10,000 inhabitants (33% vs. 16%, P < 0.05). Over the decade, the percentage of graduates practicing outside the Bay Area rose from 0 to 9% for trainees both recruited from and entirely trained within the Bay Area versus 76-84 percent for trainees experiencing any element of decentralization. The slopes of these two lines represent the effect of the increasing supply of graduates on practice location away from Stanford (9%); the distance between the lines, the greater effect of decentralization (73%). Given the goal of statewide deployment of a small number of graduates, decentralization appears to have been an effective approach.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID