摘要:

Prospective payment for inpatient hospital care is based on the ideal that hospitals that produce similar outputs, as measured by the types of cases the hospital treats, should be paid similar prices. However, similar output is a multidimensional concept. Thus operationalization of this ideal will ultimately require a more complex framework for determining hospital payment rates than currently employed at either the federal or state level. This article illustrates a multidimensional approach to achieve this objective. This technique, called Grade of Membership, is used to generate a unique type of hospital group and to characterize individual hospitals in terms of their degree of similarity to these groups. In addition, a new concept of grouping is described, a variable set based on hospitals' internal cost structure is developed and used, and ordinary least squares regression is employed to compute prices for these groups. With the use of simulation analysis, these groups are compared with more conventional groups.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The costs of postgraduate medical education remain a relevant topic for educators and managers as well as for the payors of medical care. Historically, the pervasive problem has been that of identifying education costs in a program that jointly produces patient services and research as well as training. This problem is often approached by an accounting “allocation” of program costs to education. The previous literature on calculating the costs of medical education is reviewed in this paper and the theory related to joint product costing presented as an alternative to the accounting approach. A discussion of the issue centered around an example selected from a teaching hospital outpatient practice is presented.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The cost-effectiveness of quality assurance programs is often poorly documented, especially for innovative approaches. The authors analyzed the economic effects of an experimental educational outreach program designed to reduce inappropriate drug prescribing, based on a four-state randomized controlled trial (N = 435 physicians). Primary care physicians randomized into the face-to-face group were offered two individualized educational sessions with clinical pharmacists, lasting an average of 18 minutes each, concerning optimal use of three drug groups that are often used inappropriately. After the program, expenditures for target drugs prescribed by these physicians to Medicaid patients decreased by 13%, compared with controls (P = 0.002); this effect was stable over three quarters. Implementation of this program for 10,000 physicians would lead to projected drug savings (to Medicaid only) of $2,050,000, compared with resource costs of $940,000. Net savings remain high, even after adjustment for use of substitution medications. Although there was a ninefold difference in average preintervention prescribing levels between the highest and lowest thirds of the sample, all groups reduced target drug expenditures at the same rate. Targeting of higher-volume prescribers would thus further raise the observed benefit-to-cost ratio from approximately 1.8 to at least 3.0. Net benefits would also increase further if non-Medicaid savings were added, or if the analysis included quality-of-care considerations. Although print materials alone may be marginally cost-effective, print plus face-to-face approaches offer greater net benefits. The authors conclude that a program of brief, face-to-face “detailing” visits conducted by academic rather than commercial sources can be a highly cost-effective method for improving drug therapy decisions. Such an approach makes possible the enhancement of physicians' clinical expertise without relying on restriction of drug choices.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The effectiveness of sharing medical records in improving physician-older patient communication was evaluated in 203 ambulatory chronically ill older patients (mean age, 70.1 years) by a randomized controlled trial. Ninety-five experimental group patients received copies of their physicians' progress notes 1 week after their last office visit, and 108 control patients did not. After 1-2 weeks, knowledge of health problems, medication, and nonmedication treatments was assessed by interview. Experimental group patients knew 74.1% of their health problems, compared with 64.1% in the control groups (P < 0.05). There was no difference in knowledge of medications or adherence to medication regimens. Experimental group patients displayed higher treatment knowledge scores than control group patients (P < 0.01). Less-educated patients showed greater adherence to nonmedication treatments. Shared medical records can enhance physician-older patient communication about health problems and nonmedication treatments, but they do little to enhance medication knowledge or adherence to medication regimens.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Previous research has neglected to delineate pediatric nurse practitioner (PNP) roles in tertiary care settings (TCS). New PNP roles have developed as TCS seek cost-effective solutions to providing quality patient care and to meeting new demands for outpatient care. The authors evaluated the roles of 11 PNPs in eight specialty clinics in a large university TCS. Data were collected from various sources, including interviews, typical day information, and on-site information. Content analysis was used to analyze aspects of the PNP role that are different from other PNP clinic settings that potentially contribute to greater continuity of patient care. TCS PNPs spent less time in direct patient care and more time providing care by telephone, teaching health professionals, consulting, comforting, and counseling. PNPs performed more in-depth counseling (situational crises) and administrative tasks (follow-up, record review) and fewer primary care tasks (physical examinations) than expected. The type of clinic, average patient age, case load, and physician availability modified the PNP role. It was concluded that PNPs have a viable TCS role and contribute to patient care by performing a wide range of functions vital to a multispecialty setting.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The authors demonstrate a large-scale, computerized simulation model to estimate the economic impacts of the regional health services industry on a seven-county region in Northeast Minnesota, known as the Arrowhead Region. The model, known as SIMLAB, was developed at the University of Minnesota. SIMLAB is designed to simulate the economic performance of a subnational region. Three scenarios were developed: one to illustrate a regional economy functioning normally, one to show how the area's economy would operate in the absence of its entire health services industry, and one to show the regional economic impacts of the closing of a single major hospital within the region. The first two scenarios were compared, with the differences between them representing the impact estimates for the region. The findings give a graphic demonstration of how vitally important health services are to the region. Without the health sector, the region's total gross output for all industries- is estimated to fall by more than $1 billion by 1990. A comparison of the first and third scenarios demonstrates the sensitivity of SIMLAB to smaller but still significant economic dislocations, such as the closing of a single major health care facility.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Because of demographic, economic, and social pressures, it is likely that public programs benefitting the elderly population will be subject to much public debate and calls for the reform in the next few years. This paper presents an analysis of two prototypical reforms that are based on alternative views of government's role in caring for the elderly. One view focuses on means-testing as a method for restricting the role of government to caring for the poor. The second view focuses on universal standards of care for the poor. The purpose of the analysis is to assess the implications of these two alternative views of the role of government as the basis for altering public support for the elderly. The authors show that either view of government results in a redistribution of public resources so that basic medical care, long-term care, and food and shelter needs of all poor elderly are met. The redistribution, however, involves a large reduction of public support for healthy, non-poor elderly.

ISSN:0025-7079    

出版商:OVID    

年代:1986

数据来源: OVID