ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Use of outpatient mental health services by dependent children younger than 18 years of age enrolled in the Blue Cross and Blue Shield Federal Employees Plan (FEP) is examined in 1978 and 1983 focusing on a cut in benefits and a shift from high- to low-option plan enrollment between those years. While use rates increased from 2.13% to 2.76% by 1983, the average number of visits decreased from 18.9 to 12.8. High-option plan use exceeded low-option plan use in both years—2.26% versus 0.81% in 1978 and 3.58% versus 1.93% in 1983. In addition to benefit plan, ethnicity, parent's education, type of provider, and type of treatment setting also significantly predicted amount of use. Despite the strong evidence of the effects of benefit coverage, it is likely that need exceeded use even in this insured population of children and adolescents. Implications of the findings are discussed in the context of recent dramatic changes in mental service delivery including privatization, managed care initiatives to cut costs, and growing pressures for national health insurance.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Recent closings of rural hospitals, anecdotal evidence of rural elderly persons having difficulty gaining access to health services, and the large and growing number of elderly persons living in rural areas has renewed concern about access to care for the rural elderly. In this study, 1987 Medicare skilled nursing Facility (SNF) bills were used to examine differences in urban and rural use of the SNF benefit. Using multivariate techniques, the analysis found that Medicare enrollees living in rural and large metropolitan areas used the SNF benefit at a rate 20% and 17% higher than enrollees living in small and medium-sized metropolitan areas, respectively. However, in rural areas the swing-bed program plays a major role in assuring access to the SNF benefit. Without the swing-bed program, rural enrollees would use the SNF benefit at a rate comparable to that of enrollees in small and medium-sized metropolitan areas. The importance of the swing-bed program cannot be underscored, because relative to urban enrollees, rural enrollees disproportionately live in nursing home markets that are not amenable to serving Medicare patients.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Conversion of closed hospitals to alternative health care facilities is often suggested as a way of maintaining the availability of medical services in rural areas. This study investigates the factors that influence whether or not a closed rural hospital will convert to an alternative health care facility. The study uses primary data collected from a survey of rural hospitals in Texas that closed during the years 1985 through 1990. Regression results indicate that conversion was more likely when the local economy was healthier and when there were fewer substitute forms of health services. Ownership also played a role: government-operated hospitals that closed were less likely to convert than were private not-for-profit providers. The results of the study will be useful for evaluating programs designed to encourage alternative ways to provide health care services in rural areas

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Co-existent or comorbid diseases are appreciated as prognostic factors in studies of quality and effectiveness of care when mortality is the end point. The need to measure and adjust for comorbidity in studies of postoperative hospital complications or long-term recovery from surgery has not been documented. In this study, we determined the impact of co-existent disease on post-operative complications and 1-year health-related quality of life in patients hospitalized for a total hip replacement. The study population consisted of a cohort of 356 patients who were hospitalized in four teaching hospitals in California and Massachusetts for a total hip replacement. Patients' medical records were reviewed to collect information regarding severity of illness, co-existent disease, and postoperative complications. The kind and amount of baseline preoperative co-existent disease was measured from medical record information at admission using a four level Index of co-existent Disease (ICED). Approximately 12 months after hospital discharge, 283 (80%) of the patients were surveyed by questionnaire. The presence and amount of co-existent disease were significant predictors of postoperative complications. The complication rates ranged from 3% to 41% between the lowest and highest levels of the ICED. Patients treated at the four study hospitals differed in functional outcomes 1 year after surgery. Functional outcomes were strongly related to ICED scores: patients in Level 4 ICED scored 26.8 points lower in instrumental activities of daily living than patients in Level 1. After controlling for gender, age, education, and marital status, ICED remained a significant predictor of functional status at 1 year. Furthermore, differences among hospitals in functional outcomes disappeared when the ICED was included in the model to adjust for patient characteristics at the time of surgery. A measure of co-existent disease was crucial in explaining differences among hospitals in recovery from total hip replacement patients.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A completed series of reports on a randomized trial (N=400) indicated that, in contrast to comparison services, prenatal and infancy nurse home visitation improved a wide range of maternal and child health outcomes among poor, unmarried, and teenaged women bearing first children in a semirural county in upstate New York. Eighty-nine percent of the sample was white, and all analyses focused on this group. In this article, an analysis of the net cost of the home-visitation program from the perspective of government spending is presented. The average per-family cost of the program in 1980 dollars was $3,246 for the sample as a whole, and $3,133 for low-income families. Treatment differences in government expenditures for Aid to Families with Dependent Children, Food Stamps, Medicaid, and Child Protective Services, minus tax revenues due to maternal employment (also expressed in 1980 dollars), were conceived as government savings. By the time the children were 4 years of age, government savings were $1,772 (95% confidence interval [CI]: -$557, $4,102) for the sample as a whole, and $3,498 (95% CI: $569, $6,427) for low-income families. Within 2 years after the program ended, after discounting, the net cost of the program (program costs minus savings) for the sample as a whole was $1,582 per family. For low-income families, the cost of the program was recovered with a dividend of $180 per family.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID