ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Medicare's Prospective Payment System (PPS) created incentives to reduce the application of technology to hospitalized Medicare beneficiaries. Using data from 501 hospitals from 1980 and 1983-85, this study assesses changes in use of intensive care units and use of nonsurgical procedures before versus after implementation of PPS. The percent of hospitalized patients, both Medicare and non-Medicare, admitted to intensive care units increased post-PPS. Also, stays within such units remained constant. However, the percent of inpatients to whom several nonsurgical procedures were administered was lower post-PPS. For some (e.g., CAT scanning), the percentage of inpatients having the procedure continued to increase after PPS but at a much slower rate. For others, the percent of inpatients with the procedure declined at a faster rate (e.g., intravenous pyelogram). Still others showed utilization increases during 1980–83 followed by declines thereafter (e.g., occupational and physical therapy). Before 1983, there was almost no change in the number of routine tests per inpatient (e.g., serology and blood chemistry). Afterwards, there were major decreases. PPS has influenced the in hospital use of many nonsurgical procedures by both Medicare and non-Medicare patients.

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study is a secondary analysis of the Harris Survey of Aging Veterans (SAV) and is designed to identify variables that may be associated with older veterans' future use of the Veterans Administration (VA) health care system. Using regression and discriminant analysis techniques, the study identifies variables that may predispose older veterans to use the VA health care system in the next 10 years. The results indicate that older veterans may elect to use their health care benefits on objective criteria consistent with their health and financial resources, e.g., past use of veterans benefits, expected health status, and private insurance coverage. These variables suggest that the VA's recently enacted means test and the removal of automatic age eligibility will disenfranchise few older veterans

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Whether the functional capacities of older Americans enable them to remain in the work force longer, is a significant consideration in appraising proposals to advance the normal eligibility age for Medicare benefits. This article analyzes the durations of work capability and work disablement of a representative panel of 5000 white and black men in their sixties and early seventies. The analysis shows that these men and succeeding cohorts of men are expected to function capably for long enough periods to meet the conditions necessary for raising the age of Medicare eligibility

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

As a crisis event and major life transition, bereavement is believed to precipitate or exacerbate physical and psychologic dysfunction. Yet, despite an evergrowing body of research, the causal relationship between bereavement and subsequent morbidity remains unsettled. Using a large sample, prospective measurements, and multivariate analyses, a literature-based model of the determinants of clinical depression after bereavement was tested. Results show that consanguinity, patient age, poor prior physical and mental health, family tension, and survivor dissatisfaction with their caretaking abilities during the terminal phase were the most important determinants of risk of depression after bereavement. Among spouses, bereavement depression was significantly associated with poor prior physical and mental health and dissatisfaction with caretaking abilities. Analyses of the consequences of bereavement in terms of health-care utilization found strong effects of depression on physician utilization. In light of the aging of the United States population, and thus the growth of the bereaved population, the results suggest the importance of preventive medicine to avert the costs to the health-care system of depression-related somatization following bereavement

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Protocol systems are a mechanism that some have contended will maintain high quality of patient care and will result in improved delivery of care, more efficient management of care, and in lower costs. Cost savings reported from protocol care generally are based on average costs. This article reports on an analysis of the cost effects of a pediatric protocol system. The impact of the system on both average and marginal costs was considered. The study results indicated that care adhering to the protocols, when compared to nonadherent care, resulted in a substantial savings measured against average costs. However, only a very small decrease in the marginal cost of care occurred. Ancillary department costs were found to be fixed in most cases and not subject to variation without substantial changes in the volume of services ordered. None of the volume changes attributable to the protocols were sufficiently large to result in the reallocation of labor resources or the reconfiguration of departmental equipment. Although protocol systems still may be of great value in generating more appropriate care, their ability to reduce costs is apparently less than was supposed

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Because fluoridation effectively reduces dental caries among children, it may also reduce their demand for dental care. The authors tested this proposition among 985 insureds aged 9 to 14 in Washington State using dental claims from 1982 to 1985. In the sample almost two thirds of the children with continuous fluoridation exposure lived in markets with the smallest number of persons per dentist. Relative to other children, these children received more diagnostic and preventive services and had the highest probability of receiving restorative care. Among children who received restorations, children in this group had the fewest restorations. While the last result reflects expected reductions in caries due to fluoridation, the others may reflect providers' response to less tooth decay and increased competition for patients

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1988

数据来源: OVID