摘要:

Objectives.Universal coverage will trigger an increase in health-care spending, because the uninsured will use more services after they are insured. The effect of insurance status on expenditures is estimated here from a multivariate statistical model.Methods.The model is estimated with data from the 1987 National Medical Expenditure Survey, aged to 1994 using population projections from the US Bureau of the Census and expenditure projections from the Health Care Financing Administration.Results.Expenditures for the full-year uninsured increase by approximately $700 per person in 1994 as a result of universal coverage. Nearly half of the increase is because of a substantial increase in the likelihood of hospitalization.Conclusions.If the uninsured are enrolled in plans similar to those offered by employers currently, personal health-care spending increases by approximately $20 billion in 1994. There are other costs associated with universal coverage that are not included in this figure.

ISSN:0025-7079    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objectives.Medicare hospitalizations involve both facility and physician services. Although several studies analyze hospital-level variations in Medicare inpatient facility and inpatient physician services per admission, few studies directly explore the relationshipbetweenthese services. Theoretically, inpatient facility and physician services may be complements or substitutes. That is, an increase in facility services may lead to an increase or decrease in physician services and vice versa. This article contributes to the existing literature by exploring directly the relationship between facility and physician services.Methods.Medicare physician claims were linked to inpatient hospital stays using data from the Medicare hospital cost reports, the Medicare Patient Analysis and Review file, and the Medicare National Claims History System.Results.In multivariate regression analyses, the (partial) correlations between facility and physician services were positive, which is consistent with complementarity. Standardized regression coefficients indicate that physician services are the single most important determinant of facility services; however, facility services are a less important determinant of physician services. A 10% increase in physician services is associated with at least a 3.0% increase in facility services.Conclusions.Proposals that reduce inpatient physician expenditures also would reduce facility expenditures in the long-run.

ISSN:0025-7079    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objectives.This study examines the association between the regional availability of cardiac technology and outcomes of care for patients admitted to Department of Veterans Affairs (VA) hospitals. Patients using the VA regional medical system initially are admitted to a hospital with or without the on-site availability of technology-intensive cardiac services.Methods.The authors identified male veterans (n = 24,229) discharged from VA hospitals with a primary diagnosis of acute myocardial infarction (AMI) from January 1, 1988 through December 31, 1990. Analyses of mortality up to 2 years after AMI and the use of cardiac procedures were stratified by the type of VA hospitals to which patients initially were admitted. Logistic regression models adjusted for age, race, marital status, hospitalization in previous year, comorbidities, cardiac complications coded, and year of AMI.Results.Adjusted mortality was significantly higher for patients initially admitted to hospitals without on-site cardiac technology at: 2 days (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.62-0.81), 90 days (OR 0.78; 95% CI 0.73-0.85); 1 year (OR 0.87, 95% CI 0.81-0.93); and 2 years (OR 0.86, 95% CI 0.81-0.92) compared with hospitals with on-site cardiac technology (ie, coronary angioplasty and cardiac surgery facilities). Patients initially admitted to hospitals without on-site cardiac technology also were less likely to undergo cardiac procedures than patients admitted to hospitals with on-site cardiac technology.Conclusions.The regional distribution of cardiac technology may restrict patient access to technology-intensive services and to "equally good medical care." Policies that promote regionalization of medical services should consider carefully the distribution of benefits and burdens to patients.

ISSN:0025-7079    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objectives.This article describes Medicaid participation among office-based primary care physicians in cities and examines its determinants.Methods.Data used in this study were collected through the 1993 and 1994 American Medical Association Socioeconomic Monitoring System telephone surveys. The sample includes 1,300 primary care physicians. Our multivariate model includes a variety of personal, practice, community, and policy factors thought to influence participation. Logistic regression was used to examine determinants of accepting any Medicaid patients and ordinary least square regression was used to examine determinants of the extent of participation among participants.Results.The authors found that 19% of respondents did not participate in Medicaid and 62% had practices with 9% or fewer Medicaid patients. Multivariate analyses indicated that Medicaid payment levels were not associated with observed patterns of Medicaid participation. Community sociode-mographic characteristics and demand from Medicaid-eligibles, by contrast, play a significant role in influencing observed levels of participation.Conclusions.Strategies other than raising Medicaid payment levels will be needed to achieve equitable access to office-based primary care for the poor residing in cities.

ISSN:0025-7079    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objectives.According to some studies, women with heart disease receive fewer procedures and have higher in-hospital death rates than men. These studies vary by data source (hospital discharge abstract versus detailed clinical information) and severity measurement methods. The authors examined whether evaluations of gender differences for acute myocardial infarction patients vary by data source and severity measure.Methods.The authors considered 10 severity measures: four using clinical medical record data and six using discharge abstracts (diagnosis and procedure codes). The authors studied all 14,083 patients admitted in 1991 for acute myocardial infarction to 100 hospitals nationwide, examining in-hospital death and use of coronary angiography, coronary artery bypass graft surgery (CABG), and percutaneous transluminal coronary angioplasty (PTCA). Logistic regression was used to calculate odds ratios for death and procedure use for women compared with men, controlling for age and each of the severity scores.Results.After adjusting only for age, women were significantly more likely than men to die and less likely to receive CABG and coronary angiography. Severity measures provided different assessments of whether women were sicker than men; for all cases, clinical data-based MedisGroups rated women's severity compared with men's, whereas four code-based severity measures viewed women as sicker. After adjusting for severity and age, women were significantly more likely than men to die in-hospital and less likely to receive coronary angiography and CABG; women and men had relatively equal adjusted odds ratios of receiving PTCA. Odds ratios reflecting gender differences in procedure use and death rates were similar across severity measures.Conclusions.Comparisons of severity-adjusted in-hospital death rates and invasive procedure use between men and women yielded similar findings regardless of data source and severity measure.

ISSN:0025-7079    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objectives.The authors examine 58,441 obstetric deliveries in New York State outside New York City to test for the existence of defensive medicine in obstetrics.Methods.The data consist of merged vital statistics and hospital discharge records from the New York State Department of Health, together with other merged variables. Physician fear of malpractice is proxied by cumulative obstetric malpractice suits by county for 1975 through 1986. A generalized probit analysis is used.Results.Malpractice exposure is shown to influence slightly the use of the electronic fetal monitor (EFM), a major diagnostic tool. Use of the EFM is shown to influence the diagnosis of fetal distress; fear of malpractice influences this diagnosis both directly and through the EFM. The diagnosis of fetal distress significantly affects the choice of cesarean section (c-section) as a method of delivery; hence, fear of malpractice influences the choice of a c-section both directly and through the diagnosis of fetal distress. Failure to include indirect effects via diagnostic procedures and diagnosis would result in an underestimate of the effect of fear of malpractice. Of an overall c-section rate of 27.6% in the data set, fear of malpractice accounts for an estimated 6.6 percentage points, of which 4.4 percentage points reflect a direct effect, and the remaining 2.2 percentage points reflect the effect of malpractice exposure on the use of the EFM and, directly and indirectly, the diagnosis of fetal distress.Conclusions.The results appear to confirm the existence of defensive medicine in obstetrics. Whether this is a desirable or undesirable effect remains ambiguous, but it is costly.

ISSN:0025-7079    

出版商:OVID    

年代:1997

数据来源: OVID