摘要:

Various aspects of the demand for ambulatory services of physicians have been studied by researchers, but so far the effect of increased availability of nonwork time due to retirement on demand has not been examined. This study investigated whether discouraging early retirement (which was the intent of the 1983 Amendments to the Social Security Act) will reduce the use of medical services because persons who continue to work have less time than retirees for visits to doctors. This study found that, for men whose health does not interfere with work and who have had no in-hospital care in the study year, retirement does not increase the demand for ambulatory services when compared with being a part-time or full-time employee. However, compared with full-time self-employment, retirement increases the probability of using any physician services in the year by 14% and the number of physician visits by two visits. Although the self-employed have more control over their work time than employees, they may be more affected than employees by the loss of output and earnings associated with absence from the workplace.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Data from a 1987 survey of Maryland physicians in three specialties (internal medicine, family or general practice, and obstetrics-gynecology) were used to study the types of changes physicians have made in their practices during the last 2 years as a result of the current malpractice litigation climate. Overall, 51% reported making some type of practice change. The practice changes that physicians reported reflect both risk-reduction (e.g., increased use of tests) and risk-avoidance (e.g., cutting back high-risk patients) strategies, although riskreduction actions were reported more frequently. Raising patient fees was also reported. Specialty predicts whether or not physicians make each type of change; in particular, obstetrician-gynecologists are more likely to report practice changes of all types. Prior litigation experience does not, in general, predict practice changes. The implications of the types of changes reported for access to care and costs of care were considered.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Concerns about the increasing cost of hospital care have directed policy attention to inappropriate hospital use and, in particular, to hospital patients awaiting long-term care (LTC) placement. In 1982, pursuant to changes in federal Medicare and Medicaid law, Maine implemented changes in Medicaid reimbursement policy for subacute patients designed to reduce hospital backups and corresponding Medicaid expenditures for unnecessary hospital care. This article evaluates the impact of this change in Medicaid hospital payment policy on the volume of subacute patient days and the length of subacute stays (LOS) in Maine. Although declines in Medicaid expenditures, total subacute days, and LOS of patients awaiting LTC placement were observed in the 1st year of the policy, study findings do not show a statistically significant impact of the policy on the length of patients' subacute stays. Patient diagnosis of mental and nervous system disorders and nursing home occupancy rates in the hospital service area were both Significant predictors of subacute LOS. Study findings indicate that efforts to reduce hospital backups must address specific barriers to timely LTC placement, including shortages of institutional and noninstitutional LTC services, and the lack of financial incentives for LTC providers to accept heavier care patients.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The effects of removing propoxyphene napsylate products from the Wisconsin Medicaid drug program formulary were examined. Internal analgesic expenditures and usage data for 3-month periods before and after the removal were compared (April through June 1984 versus the same period in 1985). After adjusting for price and reimbursement changes between the two study periods, overall expenditures were slightly higher after removal of these products. Expenditures per recipient, prescription, and unit all increased, as did the number of prescriptions per recipient. Expenditures, prescriptions, and recipients increased more for propoxyphene hydrochloride products as substitutes for propoxyphene napsylate products than for products in any other category. Increases also occurred for nonsteroidal anti-inflammatory products, suggesting they may have been chosen as replacement therapy. The proportion of napsylate prescriptions converted to hydrochloride prescriptions was larger for institutional patients than for noninstitutional patients. Although program expenditures did not decrease, as intended by the formulary change, other qualitative outcomes also should be considered, such as any therapeutic advantages the replacement products may have had for the patients.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A controlled trial of a probabilistic reasoning curriculum to change test ordering behavior was conducted. Twenty-four medical interns in university, veterans, and community hospitals were randomly assigned to “probabilities” or “placebo” groups. Four months after the curriculum sessions, interns in the probabilities group wrote 16% fewer orders for “little ticket” laboratory tests than placebo group interns (P = 0.032). The probabilities group ordered fewer tests than the placebo group at all hospitals, but differences were greatest in the community hospital. Probabilities interns ordered ten of 97 tests significantly less often in the postcurriculum period than at baseline; multitest panels were particularly affected. Placebo curriculum interns ordered three of 97 tests less often in the postcurriculum period. Differences in test ordering were not explained by differences in case mix. Testing rates correlated slightly with case mix and length of stay at baseline; all three measures correlated strongly in the postcurriculum period. Teaching about probabilistic reasoning improves the efficiency of test ordering.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A principal method of studying physician practice patterns has been to examine physicians' responses to brief written cases. We have compared this method with practice patterns of the same physicians derived from chart audit. Subjects were 98 family practice residents for whom data were available in actual patient encounters for the workup of asymptomatic hypertension. Short, carefully structured case reports using four cues were designed and a checklist similar to the one used for test ordering in practice was employed. Chart reviews and billing encounter forms were used for comparison. Results indicated residents ordered fewer tests in clinical practice, due, in part, to practice constraints not represented in the written cases. Physicians tend to make the diagnosis of hypertension incrementally in practice, with no one visit adequately representing the point of diagnosis. Studies based on data bases using a patient encounter as the unit of analysis in chronic disease such as hypertension may spuriously underestimate the actual number of tests ordered for the workup. Judgment cases may better reflect the patterns of use of information in a well-defined problem. Prediction of number of tests ordered in the clinical setting has not been established in this case

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This study was undertaken to determine if a measure of severity of illness for psychiatric patients, the Psychiatric Severity of Illness Index, could produce psychiatric case mix groups that are more homogeneous with respect to resource use than the diagnosis-related groups (DRGs). Psychiatric Severity of Illness data were collected on 1,672 cases in ten hospitals of various types. Of these cases, 1,418 had enough information in the medical record to be scored using the Psychiatric Severity Index, 1,173 of which were in MDC 19 (mental diseases and disorders). We found that four Psychiatric Severity of Illness groups explained between 34% and 50% of the variation in length of stay of the combined hospital data in MDC 19, whereas nine DRGs explained between 6% and 14%. DRGs subdivided by Psychiatric Severity of Illness groups explained between 40% and 54% of the variation in length of stay. The implications of these results for cross-hospital comparisons are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Using data from the Health Insurance Experiment (HIE), this article examines use of over-the-counter drugs (OTC) in a general, nonelderly population. Families from six areas of the country were assigned to health insurance plans that varied in the amount of medical care cost sharing. Thus, the out-of-pocket prices of OTC relative to prescription drugs were experimentally varied. The sites were chosen to represent markets with differing access to physician services. Multivariate methods were used to relate OTC use (collected from biweekly health diaries) to cost sharing and demographic variables. The empirical results do not support the expectation that people assigned less generous insurance for prescription drugs substitute OTC for prescriptions. People with complete insurance coverage purchased more of both types of drugs, suggesting OTC are an adjunct to formal medical care, rather than a substitute for it. Better educated and more knowledgeable consumers used more OTC drugs and spent more of their drug budget on OTC products. That there was greater OTC drug use in HIE sites with poorer access to formal medical care suggests there was some substitution between formal care and self-care with OTC drugs. Overall, however, better financial access to formal care promotes rather than substitutes for OTC use.

ISSN:0025-7079    

出版商:OVID    

年代:1989

数据来源: OVID