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Biomedical subjects

D A Freund

Publications and source records attributed to D A Freund.

53 records · Page 3Linked to original sources
PubMed1988

Determinants of provider selection or assignment in a mandatory case management program and their implications for utilization.

Mandatory managed-care programs for Medicaid beneficiaries typically require enrollees to select the provider who will act as gatekeeper to the medical care system. A substantial number of beneficiaries, however, do not exercise this choice and are assigned a gatekeeper. Using consumer survey data from the Missouri Managed Health Care Project, we examined characteristics and use experiences of assignees compared with selectors. We found that the assignees enjoyed better health than the selectors and were less likely to have had a regular source of care prior to the program. The utilization experience was similar for both groups. We conclude that the basis for not making a choice is one of indifference.

Adult↗
PubMed1987

Competitive health plans and alternative payment arrangements for physicians in the United States: public sector examples.

The Medicaid program in the United States is moving to a competitive managed care system whereby patients no longer have freedom of choice of physicians and physicians are given incentives to provide care cost effectively. The wide variety of competitive managed care programs represents attempts to introduce rationality into the relationship between consumers and providers in a community. Early evidence, based largely on preliminary data analysis indicates that competing plans which place physicians at some financial risk and also employ administrative mechanisms, are more likely to show cost savings than health plans that do not employ these methods.

Cost Control↗
PubMed1986

Overview of Medicaid capitation and case-management initiatives.

Case-management programs have grown in number and in acceptance in the Medicaid program since 1981. In this article, we review their structure and incentives as well as what is known about their impact on cost and use. These programs also have been difficult to implement, posing myriad management challenges for prepaid program managers and State administrators. We highlight the problems in the following areas: eligibility, enrollment, rate setting, and management information systems.

Aged↗
PubMed1986

A method for constructing case-mix indexes, with application to hospital length of stay.

This article presents the methodological development of an index for case-mix adjustment of hospital data exemplified by our construction of an index for studying length of stay. We describe the development and evaluation of this index, including internal and external validation procedures, and show an example of its use in a policy-relevant context by applying it to the analysis of length-of-stay differences between investor-owned and voluntary hospitals. Some advantages of this approach to adjusting for case mix are applicability to many hospital or patient output measurements/diagnostic scheme situations; usefulness in reducing heterogeneity in other case-mix adjustments, e.g., the Diagnosis-Related Group (DRG) approach; interpretation possibilities; production of a single score for each patient/hospital; statistical approach allowing more accurate and reliable interpretation of hospital and patient output measurements, ability to deal with hospital deaths; and consideration of the complete set of secondary diagnoses. We also suggest other possible uses of this approach.

Diagnosis-Related Groups↗
PubMed1985

Factors affecting physicians' choice to practice in a fee-for-service setting versus an individual practice association.

Individual Practice Associations (IPAs) must be able to recruit physicians from the community to compete in the future. This article reports the results of a study to assess the factors that influenced physicians in the Research Triangle area of North Carolina to join a primary care network type of IPA. Results indicate that physicians with lower incomes and fewer physician visits and those who were newly established in the community were more likely to join. Peers had a strong influence on their decisions, while Blue Cross/Blue Shield marketing representatives did not.

Attitude of Health Personnel↗
PubMed1985

An evaluation of subsidized rural primary care programs: IV. Impact of the rural hospital on clinic self-sufficiency.

Subsidized rural clinics and providers have long depended on the rural hospital for the care of some of their patients; the hospital has also been a source of revenue for these providers and programs. We studied a representative national sample of 116 subsidized rural clinics, focusing on the impact on rural clinic costs and revenues of the use of the hospital by the clinics' providers. Both clinic costs and revenue are reduced by the use of the hospital by rural practice providers, but costs are lowered to a greater extent than revenues, thereby enhancing the financial self-sufficiency of the subsidized clinic. The cost savings affect all aspects of clinic operation, but especially laboratory costs, community services costs, and administrative costs. The dependence of these rural clinics on the hospital indicates that the condition of subsidized rural clinics would be worsened by decreased availability of hospital services.

Ambulatory Care Facilities↗
PubMed1984

Cost effectiveness of postoperative carcinoembryonic antigen monitoring in colorectal cancer.

Serial monitoring of carcinoembryonic antigen (CEA) has been thought to provide early indication of recurrent cancer in individuals who have undergone curative resection. The current study was designed to assess the costs associated with CEA monitoring. Costs included CEA determinations, other evaluative tests prompted by abnormal CEA values and hospital/surgical costs in patients undergoing "second-look" procedures. The authors estimated that the cost per resectable tumor was $24,779; but, under optimal circumstances, it might be as low as $10,446. The most important factors were the percentage of recurrent tumors and the proportion of these that were resectable. It proved slightly more efficient to limit the preoperative workup rather than to decrease the frequency of CEA determinations. The true benefits of CEA initiated second-look surgery in terms of prolonged survival remain unknown. More clinical experience is needed to better understand these benefits.

Carcinoembryonic Antigen↗
PubMed1984

Equality of opportunity and the demand for medical care by race.

In this article I estimate the demand for medical care for eight groups delineated by sex and marital status. I use the results to simulate what will happen to black's demand for care if they are given equality of opportunity with whites and the potential impact on their health status. The findings suggest blacks' demand (and therefore health status) may decrease with equality of opportunity because of lack of coordination in social programs.

Black or African American↗
PubMedDate not supplied

Management of osteoarthritis of the knee by primary care physicians.

BACKGROUND: Most patients with osteoarthritis (OA) are treated by primary care physicians (in this article, primary care physicians are family physicians and general internists). OBJECTIVE: To describe and compare the self-reported practice patterns of family physicians and general internists for the evaluation and management of severe OA of the knee, including factors that might influence referral for total knee replacement. DESIGN, SETTING, AND PARTICIPANTS: A survey was developed and mailed to randomly selected community family physicians and general internists practicing in Indiana. MAIN OUTCOME MEASURE: Self-reported physician practice patterns regarding OA of the knee. RESULTS: Physical examination was the most common method of evaluating OA of the knee. Family physicians were more likely to examine for crepitation, joint stability, and quadriceps muscle strength than were general internists (P<.05). Patients with OA of the knee treated by family physicians were more likely to receive nonsteroidal anti-inflammatory drugs or oral corticosteroids and were less likely to receive aspirin, acetaminophen, or narcotics compared with patients treated by general internists. Six patient characteristics were rated as positive factors favoring a referral for possible total knee replacement, 8 characteristics were rated as negative, and 5 were rated as not a factor in the decision about referral. CONCLUSIONS: Results from this study suggest that additional research is needed to determine the evaluative techniques for OA of the knee that provide the most useful information for management decisions, the management techniques that maximize patient outcomes, and the criteria that should be used to select patients who would benefit most from referral for possible total knee replacement.

Aged↗
PubMedDate not supplied

Cost per service differentials in local health departments.

An emerging issue in health care is the relative efficiency with which local health departments provide their services. The problem is complicated by the fact that many factors may contribute to variations in efficiency. We have developed a framework for analyzing such variations across departments, using cost per service (CPS) as the measure of efficiency. The approach is illustrated with data from all 82 county or district health departments in North Carolina. CPS levels can be differentially affected by selected uncontrollable characteristics of the serviced population. Thus, when used to evaluate departmental performance, or to determine reimbursement rates, the CPS must be adjusted for relevant exogenous factors. Our method of cluster analysis accounts "naturally" for these factors, thereby allowing for development of policy decisions more responsive to actual health department circumstances.

Direct Service Costs↗