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Biomedical subjects

D R Lairson

Publications and source records attributed to D R Lairson.

35 records · Page 2Linked to original sources
PubMed1985

A cost-effectiveness analysis of prenatal care delivery.

This cost-effectiveness analysis (CEA) was conducted to evaluate the relative efficiency of three alternative prenatal care programs in rural, low-income areas of Texas. The study compared both the actual cost per visit and the predicted capacity cost per visit, the latter determining which model type has potential to be most efficient. The same clinic model proved to have the lowest cost per visit when using both actual and adjusted capacity data. After considering specific criteria, cost per visit differences were attributed primarily to the mix of medical personnel. Specifically, the use of certified nurse midwives in conjunction with physician backup proved more cost-effective than salaried MDs. Relative efficiency is quantified and reasons for cost differences are identified.

Cost-Benefit Analysis↗
PubMed1985

Economic evaluation of occupation-based programs: conflicting criteria and the case for government subsidy.

Differences in the economic criteria for evaluating the efficiency of occupation-based intervention programs vs public (nonprofit) rehabilitation programs are highlighted and the consequences of these differences are discussed. It is shown that if the development of such programs is determined strictly by the employer's criteria, they will not produce the full benefits for society that they are capable of. The incentive therefore exists for government to encourage the development and proliferation of quality programs. It is proposed that this can be accomplished by altering the employer's incentives (through subsidies or tax credits), thus making the private and public economic criteria for program evaluation more consistent.

Alcoholism↗
PubMed1985

Patient characteristics and the demand for care in two freestanding emergency centers.

Because freestanding emergency centers (FECs) represent a new approach to the delivery of health care services, little is known about them and their patient populations. This article reports on a study of 551 systematically sampled users of two commonly owned FECs. It describes the patient population and develops an economic demand model to compare the patients' use of the FECs with their use of other sources of ambulatory care. The typical FEC patient is a 27-year-old white male with at least a high school education. Age, education, and affiliation with a regular source of care most influenced FEC use, whereas health status and affiliation with a regular source best predicted the use of other sources of ambulatory care.

Adult↗
PubMed1984

Agreement of self-reported and physiologically estimated fitness status in a symptom-free population.

A population of 204 symptom-free clerical and white-collar employees who volunteered for a corporate-based health promotion program was studied to determine agreement between self-reported and physiologically determined fitness status. Physiologic fitness was estimated using exercise treadmill performance. There were statistically significant differences between self-reported and treadmill-estimated fitness status. The study population rated their fitness substantially higher than that estimated by treadmill performance. Self-reported fitness was found to be poorly correlated with physiologic fitness, indicating independent distributions. These relationships persisted across gender. The results question the use of self-reported estimates of physical health in health services research.

Adult↗
PubMed1982

Catastrophic health insurance and HMO's.

The catastrophic health insurance bills introduced during the 96th U.S. Congress failed to consider the current role that Health Maintenance Organizations (HMO's) play in providing catastrophic protection and the potential negative impact such legislation may have on their competitive position. This article demonstrates that HMO's are providing this coverage by using the simulated health care expenditures for families in one HMO. The estimated proportion of families that incur catastrophic expenditures varies from 0.3 to 14.4% depending on the definition used for catastrophic. The paper closes with a discussion of the potential adverse impact that the legislation would have had on HMO's.

Adolescent↗
PubMed1980

Do-not-admit versus inpatient surgery in an HMO: determinants of choice and the implications for medical care costs.

We develop a model for investigating the implications of policies that have encouraged a shift from inpatient to do-not-admit (DNA) surgery. We use discriminant function analysis on date for two surgical procedures from the Kaiser Permanente Medical Care Program of Portland, Oregon. Case attributes found to be significantly associated with the choice of surgery mode are surgeons' rate of inpatient surgery, number of chronic conditions per patient, time in surgery, number of procedures performed, and type of anesthesia used. Our estimates of cost savings provide support on economic grounds for the use of DNA surgery, for the types of surgery investigated. Our results also suggest that simple evaluation methods, based on the mean length of stay and on extrapolation of proportion of DNA cases from the base year to the current year, may overestimate the cost savings derived from the shift to DNA surgery.

Ambulatory Surgical Procedures↗
PubMed1979

Prospective economic evaluation of lead poisoning prevention programs.

This paper illustrates an economic methodology for the prospective evaluation of individual lead poisoning screening and prevention programs. A method is presented for prospectively estimating the prevalence and expected health consequences of lead poisoning in an urban population. The economic costs of these consequences are calculated and cost-benefit analysis is used to complete the evaluation. A case study is developed to illustrate the potential utility of the model as a framework for the prospective evaluation of programs under funding consideration.

Child, Preschool↗
PubMed1979

Estimates of preventive versus nonpreventive medical care demand in an HMO.

Multiple regression analysis is used to investigate whether medical services in a large HMO are distributed primarily on the basis of need and predisposing factors (such as health status, age and sex) or according to enabling characteristics (such as coinsurance and income) of the population. Equations are formulated to estimate the likelihood and volume of preventive visit demand, nonpreventive visit demand and hospital admissions for a sample of 3,892 individuals enrolled in the Kaiser Foundation Health Plan of Portland, Oregon. The results indicate that predisposing and need factors are the main determinants of nonpreventive visits and hospital utilization, while enabling characteristics are important determinants (along with age and education) of preventive utilization. There are marked differences in the impact of explanatory factors on utilization by dependents (children) versus nondependents (adults).

Adult↗
PubMed1978

A multivariate analysis of the likelihood and volume of preventive visit demand in a prepaid group practice.

An economic framework for the investigation of the demand for preventive medical care services is suggested and empirical models for the likelihood and volume of preventive physician visits are specified. These are tested using data on 3,892 individuals enrolled in the Kaiser Foundation Prepaid Health Plan of Portland, Oregon. Preventive visits, delineated by the Kaiser Clinical Behavioral Classification System, included general medical examinations, eye examinations, well-child care and immunization services. Multiple regression is used to estimate the likelihood of preventive visits for all persons and the volume of preventive visits for users. Income and coinsurance were the most significant economic variables in the likelihood equation, possessing the expected positive and negative signs, respectively. The usual findings of a positive education effect and negative family size effect were supported by the results. The economic variables were less significant in the volume equations than in the likelihood equations, suggesting that system and physician effects may neutralize these factors. Females were more likely to make a preventive visit than were males and the relatively young and old were the heaviest age-group users of preventive care. Perceived helath status did not appear to significantly affect preventive care demand.

Adult↗
PubMedDate not supplied

Cost of epilepsy in the United States: a model based on incidence and prognosis.

A model of the clinical course of epilepsy from onset until remission or death has been developed for six prognostic groups, including survival, use and cost of medical care, and time lost from work and housekeeping. The model has been used to generate preliminary estimates of the lifetime cost of epilepsy for a cohort of persons diagnosed in 1990 in the United States. The distribution of incident cases among prognostic groups is derived from epidemiologic studies of prognosis in epilepsy. Direct cost is estimated by multiplying nationally representative unit costs by the expected type and frequency of medical care use. The latter were derived by an expert panel, based on inferences from existing literature and on their own clinical experiences. Indirect cost is estimated based on lost earnings associated with projections of restricted activity days, excess unemployment, and excess mortality. Total lifetime cost in 1990 dollars of all persons with epilepsy onset in 1990 was estimated at $3.0 billion, with indirect cost accounting for 62% of the total. Cost per patient ranged from $4,272 for persons with remission after initial diagnosis and treatment to $138,602 for persons with intractable and frequent seizures. Antiepileptic drug (AED) treatment is the most costly category of service. Different assumptions about the amount and type of drug administration cause major changes in overall cost estimates.

Adolescent↗
PubMedDate not supplied

Pregnancy and medical cost outcomes of a self-help prenatal smoking cessation program in a HMO.

The results of a randomized clinical trial of a prenatal self-help smoking cessation program are reported in terms of the pregnancy and cost outcomes. The study population were the socioeconomically and ethnically diverse members of a large health maintenance organization (HMO) who reported that they were smoking at the time of their first prenatal visit. The intervention consisted predominantly of printed materials received through the mail. Compared with the usual care control group, women assigned to the self-help program were more likely to achieve cessation for the majority of their pregnancy (22.2 percent versus 8.6 percent), gave birth to infants weighing on average 57 grams more, and were 45 percent less likely to deliver a low birth weight infant. An economic evaluation of the self-help program was conducted from the perspective of the sponsoring HMO. Based upon the expenditures associated with the neonates' initial hospital episode, the intervention had a benefit-cost ratio of 2.8:1. These findings provide strong evidence to support widespread incorporation of smoking cessation interventions as a standard component of prenatal care.

Cost-Benefit Analysis↗
PubMedDate not supplied

Patterns of preventive dental behavior.

Preventive dental behavior was examined using data from the National Health and Nutrition Examination Survey of 1971-75 conducted by the National Center for Health Statistics. Most research to date has dealt with the use of all types of dental services, with relatively few studies focusing on utilization of dental services for preventive purposes or on preventive dental behavior. Economic theory on the demand for health services and the Andersen model of health services utilization were applied to examine predisposing, enabling, and need characteristics which may influence use of preventive dental health services and preventive dental behavior. The associations between each of three measures of preventive dental behavior and the three sets of characteristics from Andersen's model were analyzed using multiple regression analysis. The enabling factors (income and a regular source of care) were the most important determinants of use of preventive dental services. Need characteristics, measured by self-evaluated condition of teeth, were also significant determinants of use, while the predisposing variables were the least important of the three types. In contrast, for the home care measure, frequency of brushing, the predisposing variables were the most important, with gender and education ranking highest. Consideration of these results may be useful to health educators and to those who formulate policies affecting the distribution of preventive dental services and dental insurance coverage.

Adult↗