摘要:

The case loads of 11 teaching and 20 nonteaching hospitals are compared, using the original 383 diagnosis-related groups (DRGs) to analyze the extent to which case-mix differences contribute to differences in average cost per case. Case-mix differences are concentrated in a small proportion of DRGs. Teaching hospitals have relatively more surgery cases and neoplasms, and nonteaching hospitals have more cases with heart conditions and infectious diseases. Most nonteaching hospitals have a similar case mix, but among the teaching hospitals, there are two distinct case-mix types, one with which only teaching hospitals are correlated, one that correlates with both teaching and nonteaching hospitals. The average cost per case is more than 60% more expensive in teaching hospitals. Only approximately one quarter of this higher cost is accounted for by case-mix differences. The rest results from the fact that patients in the same DRGs cost more, on average, in teaching than in nonteaching hospitals.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This study developed a case-mix patient classification system for long-term care. Patient assessment and resource consumption data, collected for 1,151 patients within 23 hospital-based and freestanding long-term care facilities in California, were used to develop a patient classification system made up of 13 homogeneous patient groups. The 13 groups, formed on the basis of nine patient assessment variables, explained 68.5% of the overall variance in resource use. The relatively high variance reduction achieved in the creation of a limited number of groups demonstrates the feasibility of developing measures of case mix based on patient resource use for long-term care. Case-mix classification may provide a useful tool for long-term care reimbursement reform.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This study considers the correlates of the incidence of self-reported disability. Because the data base used followed individuals for a number of years, simultaneity bias is avoided. A great number ol regressors are considered. Holding a hazardous job, being recently divorced or widowed, smoking cigarettes, experiencing unemployment, and frequently working overtime are positively associated with becoming disabled, while education and risk preference are negatively associated. Moreover, the findings suggest that some of the reasons for the strong association between health and schooling in prior studies include the association between schooling and access to a safe job, less chance of unemployment, fewer cigarettes smoked, and risk preferences.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This article presents a multivariate analysis of the career preferences of 923 Mexican interns. Such preferences were operationalized along two dimensions: type of activity (general/family practice, primary specialties, or subspecialties) and type of institution (public assistance, social security, or private). There were six independent variables: father's occupation, father's education, type of medical school, place of internship, assimilation to the internship hospital, and perception of the medical labor market. The appearance in recent years of unemployment and underemployment among Mexican physicians made labor market issues particularly salient. Thus the study offered an appropriate occasion to test the relative strengths of alternative explanations of career choice that are based on social mobility, professional socialization, or responses to labor market signals. Results obtained through multiple regression revealed that the most important variable in the determination of activity preference was medical school, although the two social origin variables retained the important role of directing students into different schools. With regard to institution preference, the most important factor was shown to be place of internship, as it interacted with the level of assimilation to the hospital. Although perception of the medical labor market was a significant predictor of both dimensions of career preference, the greater importance of the other variables indicated that, even under extreme conditions of medical unemployment, explanations of career choice must go beyond simple models of rational decisionmaking to include the experiences that socialize future physicians into dominant paradigms about medical practice.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Data From the 1977 National Nursing Home Survey show that more than one fourth of admissions are discharged back to the community. Weighted logistical regression analysis was used to assess the impacts of patient, facility, and contextual characteristics on discharge status. Many facility characteristics appear to have little effect on discharge status. The important exception is the proportion of the home's patients supported publicly, especially by Medicaid. Patients in homes that are heavily Medicaid supported have a significantly reduced chance of community discharge. Profit versus nonprofit status of the facility does not prove to be significant, nor does chain membership. Important patient characteristics are marital status, age, diagnosis, physical dependency, mental disorders, and source of payment for charges. Climate is significant, while occupancy rate is not.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

It has been hypothesized that there is more demand creation by doctors in high physician density areas. Empirical tests of actual utilization have had difficulties accounting for potential confounders, particularly possible differences in the health status of diverse populations. To eliminate that problem, physicians were presented with identical, hypothetical medical cases. Actual physician density was significantly and positively correlated with the aggressiveness of proposed treatment, holding constant other physician characteristics. This result lends support for the hypothesis of demand-inducement.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The purpose of this article is to examine children's use of ambulatory physician services in relation to three dimensions of family life: maternal employment, single-parent versus two-parent households, and the presence of a nuclear or extended family. Data from the National Medical Care Expenditure Survey show that maternal employment has no relationship to children's experience of disability days, and although children of mothers employed full-time are less likely to have a physician contact than are other children, this is attributable to a lower probability of seeing a doctor for children in good health (i.e., no disability days). Multivariate analysis confirms that although maternal employment decreases the likelihood of an ambulatory physician visit (among children with no disability days), it does not affect the total number of ambulatory physician visits or the likelihood of a telephone consultation with the child's physician. Children in single-parent families are more likely to see a physician when they have no disability days, than are children in families with two parents present. Children in nuclear rather than extended families do not differ in patterns of use, even when the mother works. Aside from other characteristics that might be expected to affect use (e.g., age, health status, insurance coverage, a usual source of care), there is a clear relationship between likelihood and volume of use by mothers and children.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Previous studies using multivariate models of physician visits by the general population and by older people have failed to take into account the interaction between health, functional impairment, and economic status. Further, they have not inquired fully into effects of psychologic distress and social support on the use of services. Based on the analysis of data from a statewide crosssectional survey of noninstitutionalized older people (N = 2,146), it was discovered that: 1) economic deprivation had a negative main effect and a negative interaction effect (with medical conditions) on the number of self-reported physician visits; 2) both psychosomatic and emotional distress had independent positive effects; 3) the number and self-perceived severity of medical conditions, along with psychosomatic symptoms, were important predictors of the number of visits for older people without ADL impairments, but these factors were nonsignificant among functionally impaired respondents; and 4) social support and emotional distress were the major factors accounting for visits among the severely functionally impaired. The findings point to the importance of integrating concepts from illness-behavior studies into multivariate models of health service use and considering access to medical care within the total context of long-term care services.

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1985

数据来源: OVID