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Biomedical subjects

D R Wholey

Publications and source records attributed to D R Wholey.

28 records · Page 2Linked to original sources
PubMed1991

Differences in access and quality of care across HMO types.

This paper investigates differences between various HMO types (eg, staff model, group model, IPA model) in their access and quality of care outcomes. Several sources of evidence are analyzed, including research findings reported in the health administration literature, survey data from a random sample of 42 HMOs, and accreditation data gathered from 26 HMOs in four states. Consistent with previous research, both the random sample survey data and the accreditation data indicate that group and staff model HMOs score more favorably than IPA models in terms of the level of services provided, preventive care, and various quality of care outcomes. Data from the random sample survey indicate that IPA models score more favorably on measures of patient satisfaction and access outcomes. These findings are consistent with speculation that IPAs trade off utilization and quality controls for patient access and physician autonomy. Contrary to speculation, the effect of HMO type on access and quality may be independent of the degree to which physicians are financially and organizationally tied to the HMO.

Attitude of Health Personnel↗
PubMed1991

The effects of regulatory tools on organizational populations.

One of the main activities of regulation is the control of market development by influencing the number of firms in an industry, their entry into an industry, and their exit from an industry. Population ecology is used as a framework for explaining both the direct and indirect effects of regulatory activity on entry, exit, and market structure. This framework is then used to derive specific propositions about regulatory effects on entry, exit, and market structure in the health maintenance organization industry.

Economic Competition↗
PubMed1991

Convenience and independence: do physicians strike a balance in admitting decisions?

This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions. Results are interpreted in light of recent changes in the profession of medicine and physician-hospital relationships.

Consultants↗
PubMed1989

Physician use of hospitals: effects of physician, patient, and hospital characteristics.

This paper examines the determinants of hospital utilisation in one county. In contrast to previous studies, the paper examines the physician rather than the patient as the key decision-maker. Specifically, the paper assesses the impact of several physician, patient, and hospital characteristics on the probability of admitting to a hospital, the volume of the physician's admissions at the hospital, and the concentration of the physician's admissions at the hospital. Distance from the physician's office to the hospital exerts the strongest and most consistent effects. The results are interpreted in light of several theoretical and research perspectives on physician behaviour.

Age Factors↗
PubMedDate not supplied

Managed care, market stages, and integrated delivery systems: is there a relationship?

This DataWatch evaluates four-stage models of market evolution developed initially by the University HealthSystem Consortium (UHC). Such models suggest that increasing health maintenance organization (HMO) penetration is linked with increases in hospital consolidation and vertical integration between physicians and hospitals. These claims are tested using national data for 1992-1995. Results suggest that such models accurately classify the markets of UHC member hospitals according to their levels of HMO penetration only. Moreover, they do not discern evolutionary stages of market development and may not be generalizable to the markets of non-UHC member hospitals. Researchers and policymakers should exercise caution in applying such models.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

HMO market structure and performance: 1985-1995.

This paper estimates the effect of market structure on hospital days and ambulatory visits in independent practice associations (IPAs) and group-model health maintenance organizations (HMOs) where market structure is measured by HMO penetration and the number of HMOs operating in a market. There was a steady decline in inpatient use in HMOs during the study period and a steady increase in use of ambulatory care. In multivariate analyses, inpatient use is significantly higher in IPAs, but there is no difference in ambulatory use. As HMO penetration increases and the number of HMOs increases, group-model HMOs have lower hospital use and greater ambulatory use. In contrast, use of both inpatient and ambulatory care decreases in IPAs but only at high levels of penetration and numbers of competitors.

Ambulatory Care↗
PubMedDate not supplied

HMO consolidations: how national mergers affect local markets.

The health maintenance organization (HMO) industry has undergone a wave of national consolidations in recent years. The most notable among these were between United HealthCare and MetraHealth (1995), PacifiCare Health Systems and FHP International (1996), Aetna Life and Casualty and U.S. Healthcare (1996), and Aetna and Prudential's health care unit (1999). This paper examines HMO consolidation from 1994 to 1997, looking first at concentration at the national level and then at the consequences of national consolidations for local markets. Whereas earlier mergers may have caused only a small increase in the type of local market concentration that may increase prices, later and currently proposed mergers may be motivated by considerations of increasing local market concentration. However, the concentration-increasing effect of national mergers was offset by the concentration-decreasing effect of HMO entry and growth. The analyses suggest that antitrust policy still has a role to play in ensuring that HMO markets remain open to new entry and in evaluating the effect of national mergers on local market concentration.

Antitrust Laws↗