摘要:

The ultimate goals of providing health records to patients are to improve continuity of care, to improve patient understanding of instructions, and to encourage patients to take a more active role in maintaining their health. In the current study, four types of patient-carried health records were evaluated in a hospital-based outpatient service to determine whether records would be accepted and used, to estimate the cost of the process, and to obtain patient and provider reactions. Records were provided at moderate cost and the primary determinants in record acceptance and use were physicians' support of the process, the type of record, and the employment status of the patient. A small record which could be carried in a wallet seemed suited to most patients; other more elaborate participatory records appeared to have benefits for selected patients. More extensive use of participatory records appears to require changes in the way health care would be delivered.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Using 1980 membership data made available by the provincial nurses' association, a simple, age-specific projection model was developed that comprised two submodels: a Markovian one to monitor yearly movements from one membership state to another and a linear submodel for the infusion of new members. The model assumes that the likelihood of moving to any membership state depends only on the nurse's current age and membership state. A comparison of actual/projected data for 1981-1984 indicates a fairly high level of accuracy, despite the oscillatory pattern of the nurse labor market in the Province of British Columbia since 1982. The details of the projections of labor force over time show a particular age cohort's characteristic behavior and delineate the effect of childbearing and aging on the supply of nurses. As well as projecting future manpower, the age-specific transition matrices were used to estimate the professional life expectancy of registered nurses. This information includes the average number of continuous years of practice for each age, as well as the average total number of years of practice until being deleted from the system at the age of 75. The forecasting capability developed from this work attempts to address two questions central to manpower planning: (1) how many nurses will there be in the province in the next 5 years? and (2) what is the time-frame involved in nurses' life-cycle activity patterns?

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Mental health needs assessment has been encouraged by federal and state agencies for many years, and became a statutory requirement for some federally funded programs. There is still, however, no consensus on definitions of mental health need, methods for its assessment, or criteria to define successful needs assessment efforts. This review considers the separate components of needs assessment, together with techniques suitable for the measurement of each. Problems in defining the scope and boundaries of mental health need are reviewed, and then two general methods of assessment are described; epidemiologic surveys and social indicator analysis. Techniques, methodological issues, applications and limitations are discussed. Methods for assessment of current services which are needed to derive estimates of unmet need are reviewed. Finally, consideration is devoted to assessment of community desire for services, based on key informant interviews and surveys. In a concluding comment, the use of multiple data sources is recommended, selection of which should be determined by the goals of the particular study being conducted.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Data from the 1980 National Medical Care Utilization and Expenditure Survey are used to assess whether financial burdens incurred in obtaining medical services for children are distributed equitably among families with different incomes. When measured in absolute terms, out-of-pocket charges appear to increase in a progressive fashion with family income. However, when out-of-pocket charges are measured relative to ability to pay, a regressive pattern is demonstrated. Within the poverty population, children with continuous Medicaid coverage have much lower out-of-pocket costs than other children. Extension of Medicaid coverage to additional children below poverty is suggested as one approach toward reducing current inequities.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study utilizes data from a national survey of 159 multihospital systems in order to describe the types of governance structures currently being utilized, and to compare the policy making process for various types of decisions in systems with different approaches to governance. Survey results indicate that multihospital systems most often use one of three governance models. Fortyone percent of the systems (including 33% of system hospitals) use a parent holding company model in which there is a system-wide corporate governing board and separate governing boards for each member hospital. Twenty-two percent of systems in the sample (but 47% of all system hospitals) utilize what we have termed a modified parent holding company model in which there is one system-wide governing board, but advisory boards are substituted for governing boards at the local hospital level. Twenty-three percent of the sampled systems (including 11% of system hospitals) use a corporate model in which there is one system-wide governing board but no other governing or advisory boards at either the divisional, regional or local hospital levels. A comparison of systems using these three governance approaches found significant variation in terms of system size, ownership and the geographic proximity of member hospitals. In order to examine the relationship between alternative approaches to governance and patterns of decision-making, the three model types were compared with respect to the percentages of systems reporting that local boards, corporate management and/or system-wide corporate boards have responsibility for decision-making in a number of specific issue areas. Study results indicate that, regardless of model type, corporate boards are most likely to have responsibility for decisions regarding the transfer, pledging and sale of assets; the formation of new companies; purchase of assets greater than $100,000; changes in hospital bylaws; and the appointment of local board members. In contrast, corporate management is relatively uninvolved in these issues, again regardless of governance model type. There is substantial variation in the locus of decisionmaking responsibility by governance model type for a variety of other issues, however, including: hospital-level service additions and deletions; operating and capital budgets; medical staff privileges, hospital-level long-range planning; hospital CEO performance evaluation and the appointment of hospital CEOs. In parent holding company models these issues tend to be the perogative of the local governing board; in corporate models the system-wide board is more likely than corporate management to have responsibility for these issues. Systems using a modified holding company approach display a mixed pattern of decision-making responsibilities that seems to resemble a compromise between the parent holding company and the corporate governance structures.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study compares the characteristics of the practices and patients of recent graduates of family practice and general internal medicine residency programs. National samples of 104 family physicians and 134 general internists completed questionnaires and provided log-diary data for more than 7,500 office visits and 1,100 hospitalized patients. Family physicians and general internists were generally similar in demographic and practice characteristics, though family physicians were more likely to have entered office-based practice (90% versus 70%). Among office-based physicians, family physicians saw more patients per week in ambulatory settings (117.3 versus 74.6), whereas general internists had more patients in the hospital (6.45 versus 3.81) and provided more hospital consultations per week (2.74 versus 0.45). Family physicians practiced in smaller communities and were more likely to practice on Saturday mornings, to accept walk-in patients, and to schedule appointments for new patients within 1 week. Both specialties functioned as first-contact generalists for at least 95% of office encounters. Although pediatrics and obstetrics are practiced only by family physicians and general internists see proportionately more older patients, within specific age groups the patients of general internists and family physicians were similar in terms of their main health problems, functional status, and diagnoses.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The impact and associated costs of new urolithiasis treatment methods, including extracorporeal shock wave lithotripsy (ESWL), were examined in a series of 1781 patients treated between March 1,1983, and February 28,1985. An accounting cost methodology was used to derive estimates of direct and indirect hospital costs, as distinct from charges billed to the patient. The average hospital cost per case for ESWL was lower by 27% and significantly different (P < 0.05) than the average cost for surgically treated patients. The difference in cost between ESWL and percutaneous lithotripsy was not statistically significant. The invasiveness of the treatments studied was directly related to length of hospital stay and cost. Projecting our findings to the entire urolithiasis population of the United States, we estimate that the usage of ESWL, if applied only to patients who would otherwise receive surgery, could result in an annual hospital cost savings of $124,436,520.We conclude that although the institutional cost of acquiring ESWL is high, its application results in a significant cost savings for patients previously requiring surgery, it is no more expensive than percutaneous stone removal, and it has the advantage of being less invasive than any other treatment method.The potential national savings in health care costs may not be realized if the indications for this less invasive technology are defined more broadly than are those for open surgical procedures, as seems likely, and unless limits are placed on the number of lithotripters made available nationally.Indications for ESWL need to be clearly defined based on careful studies of risks, potential benefits, and costs.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In this paper, we estimate the risk of an individual of entering a nursing home throughout the aging process. We then estimate the expected lifetime costs of nursing home use both for an individual and for society as a whole. The model is based on double-decrement life-table analysis. Data are taken from a 1977 survey of 4,400 Medicare beneficiaries. At age 65, the upper bound for the lifetime risk of entering a nursing home is 43.1%. The risk of entering a nursing home increases with age until around age 80. At about age 85, the risk begins to decline significantly. At almost all ages, the lifetime risk of entry for females is twice that of males. The expected lifetime costs of nursing home care across all ages are between $10,500 and $13,600. These costs are distributed very unequally. Only 13% of the elderly account for 90% of all nursing home expenditures. Given current life expectancy, the expected annual cost per person over age 65 is between $532 and $760. In the year 2000, the expected annual average costs of nursing home care per elderly person will range from $450 to $650. The decline in the average annual cost per person reflects shifts in the age structure and increased life expectancy. These figures need not represent an unmanageable burden on society's resources. Figures presented here help establish the feasibility and desirability of long-term care risk-sharing arrangements among the elderly, like long-term care insurance, life care communities, and other models.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Many health care services are available in both hospital and freestanding settings. Hospital-based providers are usually much more expensive than freestanding providers. According to Medicare data, costs in hospital-based skilled nursing facilities (SNFs) are twice those of freestanding facilities. While critics charge that this is the result of inefficiency, hospitals counter that higher costs are caused by treatment of sicker patients and provision of higher-quality care. This paper analyzes the research on the case-mix differences between hospitalbased and freestanding SNFs. On the basis of this analysis, it appears that hospital-based facilities tend to serve more severely ill patients (i.e., have a more difficult case mix) than do freestanding facilities. Case-mix differences, however, appear to explain less than half of the cost differential between the two types of facilities.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID