摘要:

The issue of how many elderly are affected by catastrophic nursing home expenses is a major part of the debate over if and/or how to reform long-termcare financing. Currently, there is some discussion regarding the magnitude of this catastrophic event, referred to as “asset spend-down,” among the elderly. National data suggest the magnitude is small, while state-specific studies indicate it is greater. In addition, the literature regarding asset spend-down has presented two different measures of its magnitude, further confusing the issue. These two measures, each based on different denominators, have often been presented without adequate explanation. In this study, the authors review both measures and analyze reasons for the differences observed across studies. Major reasons identified include the type of sample used, the mix of payor source at admission, the length of time covered by the data, data on payor source/Medicaid eligibility, and the ability to observe multiple nursing-home stays within the data. Using the measure based on the number of persons who are private pay at admission, these studies indicate that approximately one fourth will eventually deplete assets. The second measure, based on a count of Medicaid residents at a point in time, indicates approximately one third were private pay when admitted. Study results indicate that national studies have underestimated the extent of spend-down due to national-level data limitations, while state-specific studies inevitably refect the specific state data set available and circumstances particular to each state. More state studies and a better understanding of asset transfer are needed.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Although studies of illness behavior have concentrated on utilization of formal services, recent research has highlighted the importance of lay care. In this article, patterns of self-treatment of symptoms among a sample of older people living in community settings are explored. Data were collected through personal interviews and health diaries completed by a probability sample of 667 elderly people. A majority of respondents managed most symptoms on their own. A decision to take no action was a common response to a number of symptoms. Prescription and over-the-counter medications were the most frequently reported intervention strategies. Multivariate analyses affirmed the importance of both symptom interpretation and symptom experience on lay treatment decisions. Causal attributions and prior experience with symptoms exhibited a less consistent impact on lay care strategies. Whether people ignore or treat symptoms appears to have less to do with their familiarity and causal explanation than with whether or not the symptom causes them pain or discomfort, whether it interferes with their desired activities, or whether they think it might be indicative of a serious decision.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We compare rates and days of maternity and nonmaternity hospital admission for the years 1981 through 1984 for three groups of employees and dependents from a large private employer: those continuously enrolled in a fee-forservice (FFS) plan (N=147,700), those continuously enrolled in a health maintenance organization (HMO) (N=30,957), and those switching from the FFS plan to the HMO (N=2,144). The rate of maternity admissions for plan switchers increased by 106%(P<0.001) in the post-switch year compared with the pre-switch year, while maternity rates for continuing FFS-plan enrollees declined by 12%(P<0.001) and rates for continuing HMO enrollees remained unchanged. Nonmaternity admission rates for switchers decreased by 19%(P=0.079),consistent with the expectation that HMOs reduce these rates substantially, while rates for FFS-plan stayers increased 4%(P<0.001) and those for HMO stayers remained unchanged. We conclude that employees often switch health plans when anticipating increased needs for maternity care and therefore that pre-switch rates of utilization are unreliable measures of the true magnitude of risk selection between HMOs and FFS plans.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based on insurance coverage, particularly Medicaid, and race. Segmentation based on insurance and race is related to hospital characteristics, but not the characteristics of the hospital's community. Medicaid patients are more likely to go to hospitals with lower costs and fewer service offerings. Privately insured patients go to hospitals offering more services, although cost concerns are increasing. Hispanic patients also go to low-cost hospitals, ceteris paribus. Results indicate little evidence of segmentation based on medical condition in either 1983 or 1989, suggesting that “centers of excellence” have yet to play an important role in patient choice of hospital. The authors found that distance matters, and that patients prefer nearby hospitals, moreso for some medical conditions than others, in ways consistent with economic theories of consumer choice.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Many patients attempt to stop smoking during hospitalization, but most relapse after discharge. This study developed and evaluated a brief smoking-cessation and relapse-prevention program for hospitalized smokers. All hospitalized smokers (n=1,119) were identified by questionnaire at hospital admission and then received either usual care or usual care plus a hospital-based smoking- cessation intervention regardless of interest in stopping smoking. Intervention components included a 20-minute bedside counseling session, a 12-minute videotape, a variety of self-help materials, and a follow-up telephone call. Special attention was given to techniques for preventing relapse after hospital discharge. Defining ex-smokers as those who reported no tobacco use at both 3- and 12-month follow-up assessments, and counting those lost to follow-up as smokers, the intervention increased the proportion of patients who quit smoking by one half (9.2%vs 13.5%, P<0.05). These results demonstrate the efficacy of a brief in-hospital intervention and suggest that relapse-prevention efforts are needed to convert temporary cessation during hospitalization into longterm abstinence.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study evaluated changes over the academic year in the cost and the outcome of inpatient care to investigate the effect of housestaff experience in teaching hospitals. Patients with 25 preselected discharge diagnoses, admitted between January 1,1983 and December 31,1987 to acute-care, nonfederal, nonpediatric hospitals in the Minneapolis/St. Paul metropolitan area (total number available for analysis 240,467) were examined. Level of housestaff experience was measured as the number of days (1 to 365) into the academic year when the patient was admitted. Linear and logistic regression analyses were used to evaluate the different effects of experience on patient care in teaching hospitals compared with nonteaching hospitals. For the subset of patients with internal medicine diagnoses, the expected “July Phenomenon” was observed, with significant relative declines in diagnostic and pharmaceutical charges in teaching hospitals over the academic year. In contrast, surgery patients showed an increase in length of stay and various charges over the academic year in teaching hospitals. There were no meaningful effects of housestaff experience on mortality, operative complications, or nursing home discharge. These results indicate that housestaff training is significantly related to the use of hospital resources for inpatients, but that the degree and direction of the effects differ by specialty. These findings may reflect important differences among training programs in the process of physician education and its effects on patient care.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Patients with better health status have often been shown to be more satisfied with their medical care, but the causal factors in this relation have not been determined. In this study, a longitudinal assessment of these two constructs was undertaken in which older patients in a health maintenance organization were interviewed at baseline (N=590) and again 1 year later (N=526) about their health status and satisfaction with their medical care. Structural equation modeling using LISREL procedures revealed that the predominant direction of causation went from earlier self-perceived overall health and functional ability to later levels of satisfaction. There was no evidence for causal paths going from satisfaction to later health. In addition, a test of spuriousness indicated that for self-perceived overall health, the significant longitudinal path was unlikely to be explained by unmeasured confounding variables.

ISSN:0025-7079    

出版商:OVID    

年代:1993

数据来源: OVID