Biomedical subjects

K Siddharthan

Publications and source records attributed to K Siddharthan.

14 recordsLinked to original sources

PubMed2000

Data envelopment analysis to determine efficiencies of health maintenance organizations.

We use Data Envelopment Analysis (DEA) to measure the relative technical efficiencies of 164 HMOs licensed to practice in the United States in 1995 with data collected from the American Association of Health Plans. Health care output measures used in the analysis are the number of commercial, Medicare and Medicaid lives covered in each plan. Inputs to the model are health care utilization measures such as the number of medical and surgical inpatient days, number of maternity and newborn stays in days, number of outpatient and emergency room visits and the number of non-invasive and invasive procedures performed on patients in an ambulatory setting. Mean efficiency of health plans was 40% (of the most efficient). We use multivariate analysis to try and explain variations in efficiency. Enrollment influences efficiency, with larger HMOs being more efficient than those with fewer enrollees. Plans with a more even distribution of Commercial, Medicare and Medicaid patients were more efficient on average than plans with heterogeneous mixes in enrollment. HMOs with Medicare patients are significantly less efficient, with efficiency decreasing with increasing Medicare participation in plan membership. Health plans in operation for longer periods of time had greater outputs with the same inputs. Health plans that had a majority of their enrollees in network or IPA type arrangements were more efficient as were for-profit plans compared to not-for-profits. Policy implications are discussed.

Chi-Square Distribution↗

PubMed2000

Causes of cost inefficiency in HMOs.

Estimates a total effects cost function using a national 1994 health maintenance organization (HMO) data set to examine and update findings related to HMO efficiency. The cost function controls for ownership characteristics (profit status and ownership), size, enrollment diversity, regional location, product diversity, model type, payment characteristics, and years of operation. While not explicitly controlling for quality or acuity, measures of plan and enrollee diversity help control for aculty and quality. Results show that most of the difference in cost efficiency between HMOs is explained by factors specific to the HMO, including efficiencies of scale and scope, lower levels of Medicare patients, and efficient levels of capital. The study also shows that for-profits are more efficient than non-profits because they rely less on withhold pools to control costs. Limitations of the study include weak controls for quality of care, and limited data related to payment characteristics.

Aged↗

PubMed1999

Managed care organizations and mammography: opportunities to serve underserved women.

Breast cancer is one of the major causes of mortality and morbidity among women. Breast cancer screening (mammography) has been shown to be an effective preventive service. Significant proportions of women for whom mammography would be an appropriate intervention, especially older, low-income, and minority women, do not receive it. A large proportion of American women (including those in the workforce or who are Medicare and Medicaid beneficiaries) is now enrolled in managed care plans and that trend is likely to continue. Analysts have identified several concerns related to access and use of preventive services by low-income and other vulnerable populations. Research related to these concerns is summarized. Many research-based interventions have been identified that increase the likelihood of women receiving mammography. These are summarized and recommendations are made for managed care organizations to implement them.

Adult↗

PubMed1999

Prenatal, intrapartum, and newborn care provided by health maintenance organizations: Medicaid versus commercial enrollees.

A large majority of states have adopted a policy of enrolling Medicaid and other low-income populations in managed care organizations. Analysts have raised several questions relating to whether these populations will achieve appropriate access and utilization of services, including prenatal, intrapartum, and newborn care. Data from a national survey of health maintenance organizations are used to compare access to these kinds of care for Medicaid and commercial enrollees. Overall, utilization of services by the two populations is comparable.

Female↗

PubMed1998

Health care utilization by the elderly in HMOs: comparing risk and cost contracts.

Data are utilized collected from the American Association of Health Plans, a trade association representing HMOs, to study differences in utilization patterns between medicare beneficiaries enrolled in Medicare risk and cost contracts with health plans. Utilization is measured by the number of ambulatory procedures performed, outpatient and emergency room visits, and acute and nonacute discharges. Compared to elders enrolled in risk plans, those in cost arrangements appear to exhibit higher inpatient and outpatient use. Members of for-profit plans experienced greater outpatient visits, accreditation did not appear to influence utilization, and IPA arrangements resulted in a decrease in outpatient utilization. Financial and policy issues are discussed.

Aged↗

PubMed1997

The impact of ownership on health care services in HMOs.

Tests the theory that owners (hospital, physician, insurance) of vertically integrated health maintenance organizations (HMOs) might substitute towards production of their own specialty goods. Uses data from various sources in the USA. Determines the impact of ownership on factors such as average physician ambulatory services per enrollee and average hospital days per enrollee. Concludes that policymakers need to encourage the development of standard publicly available quality measures to intensify competition and eliminate excess profits accruing to provider-owners who substitute towards production of their own goods.

Catchment Area, Health↗

PubMed1996

The importance of sense of community on people's perceptions of their health-care experiences.

OBJECTIVES: The authors study the relationship between people's sense of community and problems they experience with the health-care system, specifically problems related to cost, access, provider choice, and satisfaction. METHODS: Data from a 1993 Florida poll (n = 1202) was used to conduct a multinomial logit analysis to estimate people's sense of community as a function of 13 characteristics and perceptions of community. Logit analysis was used to estimate the relationship between people's sense of community and their health-care experiences, controlling for other demographic influences, including insurance coverage and self-reported health status. RESULTS: Lower sense of community was significantly associated with higher levels of choice, cost, and satisfaction problems in people's interactions with the health-care sector. CONCLUSIONS: Community quality needs to be considered in efforts to improve the functional capabilities of health-care institutions.

Adolescent↗

PubMed1996

A priority queuing model to reduce waiting times in emergency care.

Investigates the increased waiting time costs imposed on society due to inappropriate use of the emergency department by patients, seeking non-emergency or primary care. Proposes a simple economic model to illustrate the effect of this misuse at a public or not-for-profit hospital. Provides evidence that non-emergency patients contribute to lengthy delays in the ER for all classes of patients. Proposes a priority queuing model to reduce average waiting times.

Appointments and Schedules↗

PubMed1996

Inpatient utilization by undocumented immigrants without insurance.

Data collected from a large county hospital in Miami, Florida were used to study the severity of illness (using the Case Mix Severity Index) and resource use (measured by average length of stay, procedures, and/or diagnostic tests performed) of undocumented persons from Dade Country, Florida in an inpatient setting. Compared with native-born populations and those with permanent residency status (insured by Medicaid or of uninsured status) admitted to the same hospital, undocumented immigrants had a higher Case Mix Severity Index but a lower adjusted average length of stay. Undocumented immigrants and uninsured residents of the United States had a similar number of adjusted procedures/ tests performed, but less than Medicaid beneficiaries. Policy issues are discussed.

Adult↗

PubMed1993

Undocumented aliens and uncompensated care: whose responsibility?

Undocumented aliens concentrated in metropolitan areas and certain Sunbelt states can financially burden local health agencies and may interfere with access to health care for indigent populations that are legally resident. Data collected from Jackson Memorial Hospital, which provides the bulk of indigent medical services in Dade County, Florida, are used to investigate the problem of providing uncompensated care to undocumented aliens. Policy alternatives concerning immigration issues and reimbursement are discussed.

Florida↗

PubMed1991

Health insurance coverage of the immigrant elderly.

In this paper, I examine and contrast factors that contribute to whether individuals are covered by public health insurance (Medicare, Parts A and B, with and without Medicaid benefits) or private insurance. The study, based on data from a sample of foreign- and native-born elderly, employs descriptive analysis and a multivariate investigation involving logistic regression models. The results show that the immigrant population is less likely than native-born elderly to be covered by public insurance or to have private insurance. Medicare coverage for the immigrant elderly is strongly influenced by their length of stay in the United States, employment status, and country of origin, while their having private insurance coverage is affected by race, income, and employment status. For native-born elderly, race, income, and employment status are contributing factors to the type of insurance coverage retained. Policy implications are discussed.

Black or African American↗

PubMed1990

HMO enrollment by Medicare beneficiaries in heterogeneous communities.

This study examines the effect of ethnicity, race, and other socioeconomic and utilization variables on belonging to a fee-for-service or capitated plan by Medicare beneficiaries. Native-born beneficiaries cite health status, physical access to health care facilities, and income levels as affecting their choice. Immigrants, on the other hand, mention age, a lifestyle of living alone, and income as influencing their decision. Among foreign-born nationals, race appears to play an important role in choosing health care plans. A key factor affecting enrollment among immigrant populations appears to be the availability of ethnic sensitive providers of health care. While the elderly Hispanic immigrant population utilizes participating providers in prepaid plans catering to a Spanish-speaking population, the lack of similar facilities among predominantly black immigrant neighborhoods inhibits participation in HMOs by elderly immigrants from places such as Haiti and the Caribbean Basin. Policy implications are discussed.

Aged↗

PubMed1989

Elders' attitudes and access to health care: a comparison of Cuban immigrants and native-born Americans.

We report on findings of an empirical study of attitudes and access to health care by elderly Cuban immigrants and native-born Americans in Southeast Florida. Major findings based on a random sample of 1,216 respondents indicate a need for bilingual educational materials to inform consumers of health support services available and ethnic-sensitive public health services for the indigent Cuban population.

Aged↗

PubMedDate not supplied

Output efficiency of health maintenance organizations in Florida.

We use data envelopment analysis (DEA) to measure the relative technical efficiencies of 28 HMOs licensed to practice in the State of Florida in the autumn of 1994. Health care output measures used in the analysis are number of commercial, Medicare and Medicaid members enrolled in each plan. Inputs to the model are capital assets, total expenditures on the provision of medical services and administrative expenses. We find differences in HMO efficiency scores and loss ratios (defined as the ratio of expenses on the provision of medical services to the total expenses incurred by the organization) across individual plans. Differences in efficiency measures across model type (staff, IPA, combination) and ownership types (for-profit, not-for-profit) are small but significant: staff models and for-profits are more efficient. In a multivariate model, we also find that large HMOs are more efficient and HMOs with Medicaid patients are significantly less efficient than other HMOs.

Ambulatory Care↗