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Biomedical subjects

K M Langwell

Publications and source records attributed to K M Langwell.

At least 19 recordsLinked to original sources
PubMed1990

Structure and performance of health maintenance organizations: a review.

During the past decade, the number of and enrollment in health maintenance organizations (HMOs) have grown dramatically. In 1980, 236 HMOs served 9 million members. By 1989, there were 591 HMOs with over 34 million enrollees. New HMOs are very different in organizational structure and arrangements than the HMOs that were operating in the 1970s, and the health care markets they serve also have changed substantially with the increasing supply of physicians and declining hospital admissions. Consequently, the accepted research findings on HMO performance in the 1970s may have only limited usefulness in understanding the role of HMOs and their effect on today's market for health services. This is of particular concern as the Health Care Financing Administration considers the further expansion of managed care options available to Medicare and Medicaid beneficiaries. In this article, the author reviews evidence on the relationship between HMO organizational arrangements and performance, and the trends within the HMO industry toward new organizational structures. The implications for Medicare and Medicaid risk contracting are also examined.

Health Maintenance Organizations↗
PubMed1989

Evaluation of the Medicare competition demonstrations.

A summary of findings from the Evaluation of the Medicare Competition Demonstrations is presented in this article. The purpose of this evaluation was to examine the implementation and operational experiences of the 26 health maintenance organizations that operated as demonstrations from 1983 to 1985, their experiences in marketing their plans, the factors that affected beneficiaries' decisions to join or not join a plan, the extent to which beneficiaries were satisfied with their choice of plans, the quality of care provided by the plans, and the impact of the demonstrations on Medicare beneficiaries' use and cost of services.

Aged↗
PubMed1986

Capitation and the Medicare program: history, issues, and evidence.

This article reviews the history of capitation in the Medicare program and examines issues and research findings related to Medicare capitation. Specific capitation issues and related research findings reviewed include: the feasibility and extent of health maintenance organization participation in Medicare; plan marketing; beneficiary choice behavior; quality of care; and the use and cost of services. In addition, areas requiring further study are noted, and the potential for extensions of capitation under Medicare are explored.

Aged↗
PubMed1983

Research on competition in the market for health services: problems and prospects.

The dramatic and continuing rise in price levels and aggregate expenditures for health services has led many researchers to conclude that, for a variety of reasons, there are insufficient competitive forces present to permit this market to function properly. One solution under consideration is the introduction of stronger competitive forces into the market for health services to restore appropriate incentives to consumers and providers. This paper identifies research needs and develops recommendations for critical research that would provide indications to policy makers of the potential effects and possible consequences of implementing various procompetitive approaches under consideration.

Ambulatory Care↗
PubMed1982

Identification of physical therapist shortage areas: a study of thirteen states.

Establishing the adequacy or inadequacy of the supply of physical therapists, nationally and across geographic areas, has important policy implications for federal support of education and training of physical therapists. This article summarizes research that was undertaken to determine 1) whether physical therapists are in short supply nationally, or are geographically maldistributed in the United States, and 2) if there is an uneven distribution, whether it is possible to identify areas lacking physical therapists. The supply of physical therapists at the county level is examined in relation to factors presumed to indicate need for physical therapy services. Next, the distribution of physical therapists is examined in selected groups of counties to determine why some areas are relatively better supplied than others and whether any obvious set of criteria accurately and consistently identifies those areas appearing underserved. The major conclusion is there may be a maldistribution of physical therapist. Criteria for identifying shortages are recommended.

Health Services Accessibility↗
PubMed1982

Differences by sex in economic returns associated with physician specialization.

Women comprised only 8.8 percent of active physicians in the United States in 1977. However, recent trends in the sex composition of medical school classes indicate that women will make up at least one-fourth of total physician supply in the future. Consequently, the effect of sex-composition changes on the supply of physicians' services is of importance, especially since much current federal policy is based upon assumptions about physician behavior drawn from observation of the current stock of physicians. This article explores the issue of differences by sex in lifetime earnings associated with alternative specialty choices. Economic incentives to specialize rather than enter general/family practice are examined initially. Then the incentives influencing the decision to specialize in either primary care or non-primary care fields are considered. Findings are reviewed and implications for future trends in specialty distribution of physicians, as well as implications for current and future federal policy affecting physicians' specialty decisions, are discussed.

Adult↗
PubMed1981

Professional liability environment and physicians' responses: a regional examination.

This article examines the relationship between measures of severity of the professional liability "crisis" and physicians' responses, which may affect both costs of medical care and availability of care. Data from the American Medical Association's Periodic Surveys of Physicians are stratified by Census Region and specialty category. Claim frequencies, premiums and increases in premiums are calculated as indicators of the professional liability environment. Responses of physicians in each Region to questions on refusal cases, additional testing and fee increases due to liability considerations are then examined and compared with the liability environment to determine if there appears to be an association between liability environment severity factors and physicians' responses.

Economics, Medical↗
PubMed1981

Geographic distribution of occupational therapists.

This paper reports the findings of a recent study conducted to determine whether there is an appropriate distribution of occupational therapists in the United States. A method for an analysis of requirements for occupational therapists was developed to assess whether, given requirements indicators in each county, the current distribution is appropriate. As a final stage of the analysis, three groups of counties were singled out for special attention: 1. those with no occupational therapists; 2. those with low levels of relative supply of occupational therapists; and 3. those with high levels of relative supply of occupational therapists. These groups were compared in order to determine whether differences exist in demographic characteristics and health status indicators that might be associated with differences in the supply of occupational therapists in each group of countries. Conclusions and discussion of potential policy implications were drawn from the descriptive and analytic findings.

Health Services Needs and Demand↗
PubMed1980

Career paths of first-year resident physicians: a seven-year study.

Much policy formulation and research on physician manpower supply and demand are based upon historical data on physicians or on medical students' attitudes toward career choices and expectations about future career plans. Neither of these sources provides the kind of information about specialty and location choices or recent graduates that planner require to design and evaluate effective policy. In order to obtain information on career decisions of young physicians, all 1968 first-year resident physicians were identified and their career were followed through the seven-year period from 1968 through 1975. The career decisions of this cohort were compared with the activity, specialty, and geographic distribution of all physicians in 1975 in an attempt to discern changes, or trends, in these decisions. Results of this evaluation indicate that young physicians are attracted to nonprimary-care specialties in greater numbers than were physicians in the past and are continuing the trend away from rural practice locations. Increasing numbers of women physicians are affecting these trends, and changes in the sex-composition of the physician stock must be taken into account in future forecasting efforts and in policy formulation activity.

Adult↗
PubMed1980

Economic incentives in health manpower policy.

Policymakers have evidenced continued concern with the issue of maldistribution of physicians among specialties and locations. Many of the recent policy proposals in this area have involved increasing the financial rewards to primary care specialization and to location of practice in underserved areas. This article examines the evidence on current economic incentives to specialize and to locate, including income and the hours of work needed to produce income. Findings suggest that current distributions of physicians among locations and specialties are more consistent with a decision to minimize hours worked, rather than an income maximization rule. Policy implications are discussed with respect to potentially perverse results which may occur if consideration is not given to this aspect of career decisions.

Health Policy↗
PubMed1980

Regional variations in the determinants of professional liability claims.

The problem of professional liability claims and impact on the medical care market has become increasingly important in recent years. Professional liability insurance premiums, and the practice of defensive medicine by physicians in response to potential professional liability claims, have been cited as partly responsible for the increasing costs of medical care. This study is an analysis of factors which influence the probability of a professional liability claim occurring for physicians in each of the four Census Regions. The data analyzed are from the Eleventh Periodic Survey of Physicians conducted by the American Medical Association in 1977, in which respondents indicated whether they had a professional liability claim filed against them. A logit analysis suggests that variations across Census Regions in population characteristics, availability of medical resources and supply of legal services are determinants of the occurrence of claims.

Catchment Area, Health↗
PubMed1979

An evaluation of income incentives and board-certification trends.

In this paper the author examines income differentials between board-certified and non-board-certified physicians to determine whether the trend toward board certification is consistent with economic incentives. Although simple income comparisons indicate substantial differentials by certification status, after adjustments are made for specialty-mix, age distribution, and hours worked, the remaining differential is small. However, results by specialty indicate that physicians are most likely to become certified in specialties with the largest income differentials.

Adult↗