摘要:

State regulation of health care costs has been increasing at the same time as criticism of governmental regulation in other sectors of the economy has been increasing.The authors examine major system elements necessary to effect cost control in health care, present normative models of value preferences which underlie alternative state cost control systems, and indicate control foci and intervention strategies for state government under the alternative models.The authors conclude that state governments should assume responsibility for controlling health care costs. Presently, state regulatory agencies should emphasize development of adequate information systems, strengthening of state regulatory capability, and implementation of experimental reimbursement programs rather than comprehensive and detailed rate setting.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The implementation in Connecticut of Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a program of comprehensive medical care for needy children, illustrates the complexities engendered by federally mandated state-administered health programs. The EPSDT amendments to Title V and Title XIX (Medicaid) were ambiguous on four major issues: administrative responsibility, costs, eligibility, and scope of services. The problems experienced by federal, regional, state, and local administrators in resolving these issues illustrate the weaknesses inherent in federal-state relations, and the contrasting roles health and welfare agencies under Medicaid have played in the development of health policy.Connecticut may represent maximum limits to state performance in carrying out EPSDT because it is a rich state, ranking high in medical resources and in the provision of Medicaid services. During the first year of implementation of EPSDT, the program had little impact: less than 5 per cent of eligible children were served. State policies, which contravened federal policy, precluded effective resolution of the legislative ambiguities; no new services were added, the organization of health services remained unchanged and fragmented; and the State Health Department played only a limited role.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Providers for California's Medicaid program were interviewed to determine their reaction to the copayment experiment. Private physicians, pharmacists, and nursing homes routinely collected the copayments and thought it was not a particular hardship on the patients. Hospital outpatient departments often did not collect. Physicians both in hospitals and in private practice generally did not know which patients were copayers and hence copayment had no effect on their practice. Pharmacists reported some delay and some selectivity on the part of patients in the filling of their prescriptions. All providers felt much more harassment and interference from the concurrent prior authorization requirements. This effect may have swamped copayment effects.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The attitude of the public toward physicians and medical services is an issue of current concern and debate. To address this problem, an instrument was developed using Thurstone scaling methods in conjunction with a Likert format and a modified scoring technique. Following pretesting of the instrument among both patient and population samples, a survey was conducted among the residents of a probability sample of households in a city of 200,000 people. The attitude questionnaire was completed by 1,713 adults in 1,112 households. Overall, attitudes were favorable toward the professional competency and the personal qualities of physicians. Accessibility, including costs and convenience, were less highly regarded. Men were less satisfied than women and blacks less satisfied than whites. Particularly negative attitudes were expressed toward the personal qualities of physicians by young blacks, whereas among blacks over 60 the negative effect was toward costs and convenience.Having a regular physician and long attendance with that physician were correlated with positive attitudes. The most negative sentiment was expressed by women without a regular source of care.Medical services are being sought and obtained by a large segment of society, but problems of costs and acceptability for the elderly, low social class persons, members of large families, and for blacks still remain.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The delivery of health care has emerged as one of the most important political issues of the 1970's, yet public attitudes about health issues remains a relatively unexplored subject. Little is known about the public's opinion of who should control the delivery of health care, about how the costs of health care are perceived, or about how the delivery of care should be financed. This paper relates respondent attitudes on these subjects to attitudes about criteria that determine the respondent's choice of ambulatory care facility and to socioeconomic, political, and other demographic characteristics. The data are derived from a survey (N = 521) of households representative of the area of Rochester, New York.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The factor analytic development and validation of numerous index scores to measure patient attitudes regarding characteristics of doctors and medical care services is described. Index scores meeting factor analytic criteria and found to be reliable were used to study the nature and number of attitudinal dimensions underlying patient satisfaction. The use of index scores which have met logical and empirical criteria is in contrast to the common practice of using individual questionnaire items as the unit of analysis. Four major dimensions of patient attitudes were identified and described, including attitudes toward doctor conduct (humanness and quality) and such enabling components as availability of services, continuity/convenience of care and access mechanisms (cost, payment mechanisms, and case of emergency care). Measures of attitudes toward caring (humanness) and curing (quality/competence) aspects of doctor conduct appear to reflect the same underlying attitudinal dimension. Findings are discussed in relation to concepts and measures mentioned in the published literature and suggestions are offered for future research.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Consumer evaluation research is defined and analyzed as an experimental model for establishing a link between social science research and public policy. The paper reports the results of an 18-month longitudinal study of an experimental citizen evaluation group. Participant observation was the method used to organize the data.The impact of the model on methodological issues, such as objectivity, researcher autonomy, and control over research decision-making are discussed. Implications of the consumer evaluation model for integrating social research and health policy formulation are analyzed and principles of citizen evaluation research are presented.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID