Biomedical subjects

M A Morrisey

Publications and source records attributed to M A Morrisey.

At least 19 recordsLinked to original sources

PubMed2001

The effect of state regulations on motor vehicle fatalities for younger and older drivers: a review and analysis.

Policymakers have had a long-standing interest in improving the motor vehicle safety of both younger and older drivers. Although younger and older drivers share the distinction of having more crashes and fatalities per mile driven than other age groups, the problems posed by these two groups stem from different origins and manifest in different ways. A number of state-level policies and regulations may affect the number of motor vehicle crashes and fatalities in these two high-risk groups. A critical review of the existing literature in regard to the risk factors and the effects of various policy measures on motor vehicle crashes in these two high-risk populations provides direction for policymakers and high-priority areas of interest for the research community.

Accidents, Traffic↗

PubMed2001

CEO perceptions of competition--and strategic response in hospital markets.

Physician-organization integration (POI) has emerged as a key issue for hospitals and health systems seeking to improve the quality and cost-effectiveness of care. Although competition and managed care are often cited as primary market drivers of the adoption of POI strategies, prior research has shown only weak associations between these market attributes and POI. This article argues that the role of key organizational decision makers has not been adequately accounted for in explaining strategic change. The study examines the role of hospital CEO perceptions of competition in predicting the adoption of five different approaches to POI. CEO perceptions of general market competition are explained by a combination of market and organizational attributes. Furthermore, when controlling for objective characteristics of the environment and organization, CEO perceptions of competition have consistent, statistically significant associations with four of five measures of POI examined.

Attitude of Health Personnel↗

PubMed2001

Competition in hospital and health insurance markets: a review and research agenda.

OBJECTIVES: To review the empirical literature on the effects of selective contracting and hospital competition on hospital prices, travel distance, services, and quality; to review the effects of managed care penetration and competition on health insurance premiums; and to identify areas for further research. PRINCIPAL FINDINGS: Selective contracting has allowed managed care plans to obtain lower prices from hospitals. This finding is generalizable beyond California and is stronger when there is more competition in the hospital market. Travel distances to hospitals of admission have not increased as a result of managed care. Evidence on the diffusion of technology in hospitals and the extent to which hospitals have specialized as a result of managed care is mixed. Little research on the effects on quality has been undertaken, but preliminary evidence suggests that hospital quality has not declined and may have improved. Actual mergers in the hospital market have not affected hospital prices. Much less research has been focused on managed care markets. Greater market penetration and greater competition among managed care plans are associated with lower managed care premiums. Greater HMO penetration appears to be much more effective than PPO penetration in leading to lower premiums. While workers are willing to change plans when faced with higher out-of-pocket premiums, there is little evidence of the willingness of employers to switch plan offerings. Preliminary evidence suggests that greater managed care penetration has led to lower overall employer premiums, but the results differ substantially between employers with and without a self-insured plan. CONCLUSIONS: Much more research is needed to examine all aspects of managed care markets. In hospital markets, particular attention should be focused on the effects on quality and technology diffusion.

California↗

PubMed1999

The effects of managed care on physician and clinical integration in hospitals.

OBJECTIVE: To empirically estimate the effects that managed care has had on physician and clinical integration in urban hospitals. DATA SOURCES: The 1993 Hospital-Physician Relationship Survey conducted for the Prospective Payment Assessment Commission, augmented with data from a variety of secondary sources. The entire 1,495 responding hospitals were used to construct measures of integration; 591 responding hospitals in urban areas were used for the managed care analysis. STUDY DESIGN: Factor analysis was used to reduce 23 integration variables into 5 physician and 3 clinical integration factors. Two-stage least-squares regression techniques were used to estimate the effects of endogenous managed care. Models were estimated for all urban hospitals and for hospital subsets based upon ownership, multi-hospital system status, and teaching. PRINCIPAL FINDINGS: Other things equal, physician involvement in hospital management and governance increased with managed care involvement; to a lesser degree, the use of physician organization arrangements and other joint ventures also increased. Practice management and support services were lower in hospitals with high managed care activity. Larger hospitals, investor owned, system, and non-teaching hospitals had larger managed care revenues. Managed care revenues were lower in more concentrated hospital markets. CONCLUSIONS: The relationship between managed care and physician and clinical integration is relatively modest. Much of the realignment under managed care has been limited to certain types of efforts. Those efforts can best be described as foundation-building rather than comprehensive or fundamental.

Data Collection↗

PubMed1999

Employer-sponsored health insurance and mandated benefit laws.

Regulations for the content of private health plans, called mandated benefit laws, are widespread and growing in the United States, at both state and federal levels. Three aspects of these laws are examined: their current scope; some economic reasons for their existence; and the theory and empirical evidence for their effects in health insurance markets. A growing body of literature suggests that society is paying a high price for enhanced coverage via mandated benefits. These laws increase insurance premiums, cause declines in wages and other fringe benefits, and lead some employers and their workers to forgo health benefits altogether. The cost of mandated benefit laws falls disproportionately on workers in small firms.

Costs and Cost Analysis↗

PubMed1999

Small group reform and insurance provision by small firms, 1989-1995.

Since 1989, states have enacted legislation to dismantle barriers facing small businesses that wish to purchase health insurance. Using data on the insurance offerings of 2,472 small firms (one to 49 employees) observed from 1989 to 1995, we assess whether state reforms encouraged more small firms to sponsor health benefits. We find that small group reforms did not spur uninsured firms to offer insurance. Firms without health insurance say that the high price of coverage is still the major barrier they face to offering a plan. Our findings suggest that the small group reforms within the 1996 Health Insurance Portability and Accountability Act are not likely to have an effect on the small group market. Most states already had implemented measures similar to those found in the act, and not much changed.

Cross-Sectional Studies↗

PubMed1998

Managed care and processes to integrate physicians/hospitals.

This article describes the extent to which hospitals use different integrative processes to assimilate physicians and assesses the extent to which their use is associated with managed care penetration and hospital characteristics. Results from a national survey of 1,495 community hospitals indicate that these integrative processes are quite prevalent. The use of integrative processes tends to be more prevalent in hospitals that are large, urban, involved in teaching, and members of hospitals systems. Use of particular integrative processes also appears to be associated with different thresholds of managed care penetration.

Delivery of Health Care, Integrated↗

PubMed1998

Physician and clinical integration among rural hospitals.

The pressures for closer alignment between physicians and hospitals in both rural and urban areas are increasing. This study empirically specifies independent dimensions of physician and clinical integration and compares the extent to which such activities are practiced between rural and urban hospitals and among rural hospitals in different organizational and market contexts. Results suggest that both rural and urban hospitals practice physician integration, although each emphasizes different types of strategies. Second, urban hospitals engage in clinical integration with greater frequency than their rural counterparts. Finally, physician integration approaches in rural hospitals are more common among larger rural hospitals, those proximate to urban facilities, those with system affiliations, and those not under public control.

Analysis of Variance↗

PubMed1998

The spread of state any willing provider laws.

OBJECTIVE: To describe the growth of any willing provider (AWP) and freedom of choice (FOC) laws applicable to managed care firms and to explore empirically the determinants of their enactment. STUDY SETTING: A 1996 compendium of state laws and state-level data from the 1991-1994 period. STUDY DESIGN: Pooled cross-section time-series logistic regression of the decision to enact various types of AWP and FOC laws. Analysis uses a public choice framework to examine enactment. Key variables include proxy measures of proponent and opponent strength and the political environment. PRINCIPAL FINDINGS: The model works well for laws affecting hospitals, but performs poorly for physician and pharmacy laws. More providers are associated with the enactment of AWP and FOC laws. More large employers are associated with a reduced likelihood of enactment of some forms of the laws but not others. Conservative states are more likely to enact laws limiting selective contracting with hospitals and physicians. States with greater interparty competition are also more likely to adopt some types of legislation. CONCLUSIONS: The empirical results generally are consistent with the view that AWP and FOC laws are often enacted as a defensive strategy on the part of providers, but additional research is needed to provide a more definitive assessment of the determinants of these laws. Suggestions for future research are provided.

Decision Support Techniques↗

PubMed1997

Death and reputation: how consumers acted upon HCFA mortality information.

From 1986 through 1992, the Health Care Financing Administration (HCFA) released information comparing patient death rates at individual hospitals. This was viewed widely as an effort to aid consumers in selecting hospitals. This study evaluates how the release of this information affected hospital utilization, as measured by discharges. It finds a very small, but statistically significant effect of the HCFA data release. A hospital with an actual death rate twice that expected by HCFA had fewer than one less discharge per week in the first year. However, press reports of single, unexpected deaths were associated with an average 9% reduction in hospital discharges within one year. HCFA was justified in eliminating its mortality report, not because it was being used by consumers to choose hospitals, but because it was not. Implications for report cards are discussed.

Attitude to Health↗

PubMed1997

Switching to managed care in the small employer market.

In 1993, only 22% of small employers offered a managed care product; by 1995, nearly 70% did. This study uses nationally representative data on small firms in 1993 and 1995 to examine the factors underlying this dramatic shift. Two explanations emerge from the regression work. Adoption of managed care by large employers appears to have served as a signal, certifying the acceptance of managed care among workers. Second, lower prices for managed care products, relative to conventional insurance, increased the adoption of managed care, particularly in 1995. There is little evidence that state insurance reforms prompted the switch, although they may have helped set the stage for it.

Consumer Behavior↗

PubMed1996

Trauma patients: an analysis of rural ambulance trip reports.

This study summarizes all 2,550 trauma-related rural ambulance trip reports filed for the period January 1 through December 31, 1991 from the 12 rural counties surrounding Augusta, Georgia. There were 13.1 trauma-related ambulance runs per 1,000 population. Nearly one third of all rural ambulance runs are trauma related. Severe trauma constituted less than 8.0% of trauma cases. Forty-one cases died at the scene and 19 additional cases died from any cause within 30 days of transport. The mean response time was 8.5 minutes and in 90% of all rural trauma runs the ambulance arrived in 17 minutes or less. Only 51.5% of runs had a rural hospital as a destination, 14.2% went directly to a trauma center, and nearly 20% to another urban hospital. Of the 71 severe trauma cases received by ambulance, rural hospitals transferred out only 13 cases, most of these to the regional trauma center. Of the 47 trauma cases transferred to the trauma center, 33 were not severe.

Adolescent↗

PubMed1996

Simplifying the assessment of rural emergency medical service trauma transport.

OBJECTIVES: The authors determine whether assessments of effects of rural emergency medical services (EMS) system characteristics on trauma outcomes using patient-level data are biased significantly if the Injury Severity Score (ISS) is not available. METHODS: Data are taken from ambulance trip reports merged with the trauma registry data for the Georgia EMS region VI trauma center hospital, located in Augusta. All 294 trauma patients for the rural counties surrounding Richmond County for the calendar year 1991 who were not dead at the scene and who were treated at the trauma center are included. A 20% random sample of trauma patients from Richmond county from May 1991 to September 1991 not dead at the scene and treated at the trauma center yielded an additional 96 cases. Excluding 43 patients with missing data yields 347 trauma cases with 18 trauma deaths. A logistic regression model for trauma mortality is estimated using the Revised Trauma Score, ISS, type of trauma, and patient age (analogous to the standard Trauma Related Injury Severity Score model). The predicted probability of patient mortality from this model is compared with the predicted probability of mortality when the logistic regression model omits ISS. Correlations between the difference in predicted probability (ie, the error in predicted probability associated with the omitted ISS variable) and EMS system characteristics are determined. RESULTS: Although ISS adds to the predictive power of the trauma outcome model, the errors in predicted probabilities associated with the omission of ISS generally are small and uncorrelated with patient or EMS system characteristics, with the exception of patient gender. CONCLUSIONS: In rural settings, where a patient's ISS generally is not available, studies of rural EMS system characteristics and trauma outcomes may use Revised Trauma Score, patient age, and type of trauma to control for expected survival. The patient's ISS does not appear to be essential, at least for the rural area analyzed in this study.

Emergency Medical Services↗

PubMed1996

Simplifying the assessment of rural emergency medical services trauma transport.

OBJECTIVES: The authors determine whether assessments of effects of rural emergency medical service (EMS) system characteristics on trauma outcomes (using patient-level data) are significantly biased if the Injury Severity Score (ISS) is not available. METHODS: The data are from ambulance trip reports merged with the trauma registry data for the Georgia EMS region VI trauma center hospital, located in Augusta. All 294 trauma patients for the rural counties surrounding Richmond County for the calendar year 1991 who were not dead at the scene and were treated at the trauma center are included. A 20% random sample of trauma patients from Richmond county from May to September 1991 not dead at the scene and treated at the trauma center yielded an additional 96 cases. Excluding 43 patients with missing data yields 347 trauma cases with 18 trauma deaths. A logistic regression model for trauma mortality is estimated using the Revised Trauma Score (RTS), ISS, type of trauma, and patient age (analogous to the standard Trauma Related Injury Severity Score model). The predicted probability of patient mortality from this model is compared with the predicted probability of mortality when the logistic regression model omits ISS. Correlations between the difference in predicted probability (i.e., the error in predicted probability associated with the omitted ISS variable) and EMS system characteristics are determined. RESULTS: Although ISS adds to the predictive power of the trauma outcome model, the errors in predicted probabilities associated with the omission of ISS generally are small and uncorrelated with patient or EMS system characteristics, with the exception of patient gender. CONCLUSIONS: In rural settings, where a patient's ISS generally is not available, studies of rural EMS system characteristics and trauma outcomes may use RTS, patient age, and type of trauma to control for expected survival. The patient's ISS does not appear to be essential, at least for the rural area analyzed in this study.

Emergency Medical Services↗

PubMed1996

Do nonprofit hospitals pay their way?

Using 1988 and 1991 data from nonprofit voluntary hospitals in California, we find that the vast majority of nonprofit hospitals provide community dividends in excess of the tax subsidies they receive. However, nearly 20 percent of nonprofit hospitals do not meet this standard. Further, those hospitals that do not meet the standard tend to not meet the standard over time. We recommend more explicit identification of the community dividends expected in return for special tax treatment and more explicit accounting on the part of nonprofit hospitals.

California↗

PubMed1996

Managed care and physician/hospital integration.

This paper examines the extent to which hospitals and physicians use new organizational structures designed to facilitate contracting with managed care firms and the extent to which this use is associated with managed care revenue. The data come from a nationally representative sample of 1,495 U.S. community hospitals responding to a 1993 survey about different organizational structures. The results indicate that only 23.3 percent of hospitals participate in at least one form. Hospitals with more than 15 percent of revenues from managed care are twice as likely to participate and favor forms that provide tighter linkages with physicians.

Delivery of Health Care, Integrated↗

PubMed1996

Hospital cost shifting, a continuing debate.

This Issue Brief examines the evidence on hospital cost shifting. It defines cost shifting, explores the incentives facing hospitals and payers, reviews and critiques the new evidence on cost shifting, and discusses the policy concerns that arise from the new learning. Cost shifting has a precise and easily understood meaning. It does not mean that some payers pay different prices than others. Different prices are commonplace throughout the economy. Rather, cost shifting exists when the prices faced by one group of payers are higher because another group pays less. To be able to cost shift, a hospital must have market power, and it must not yet have fully exercised that power. There has been a spate of recent cost-shifting studies. The better known studies focus on industrywide, revenue-to-cost margins by payer. They find that the extent of cost shifting declined in the mid-1990's. The methods underlying these studies have been criticized in the academic literature, with the strong suggestion that the studies overstate any true cost shifting. Cross-sectional studies compared measures of prices across individual hospitals. These studies have failed to find evidence of hospital cost shifting. However, they suffer from a potential inability to control for levels of service, quality, and amenities that may simultaneously have changed as well. Dynamic studies compare individual measures of hospital prices through time and allow each hospital to serve as its own control. These studies find no evidence of hospital cost shifting. As one analysis concluded: "We found no evidence to suggest that cost-shifting strategies that might protect hospital revenues in the face of financial pressure were undertaken successfully." Rather than cost shifting, the existing evidence points to hospital competition limiting the provider's ability to raise prices. Whatever market power hospitals once enjoyed is disappearing--and with it the ability to cost shift. This research suggests that Medicare reform or Medicaid restructuring will have little direct effect on the hospital prices that employers and their workers pay for health care. The author argues that cost shifting is dead. However, the increased hospital competition necessarily squeezes hospital profits. This reduces the amount of charity care they can provide. Expect to see more and more examples of hospitals unable to provide care to nonpaying patients. This also suggests that care for the indigent will become a more pronounced public issue. This is a form of "cost" shifting, one that the "system" will need to deal with.

Cost Allocation↗

PubMed1995

Rural emergency medical services: patients, destinations, times, and services.

This study sought to describe the volume of use, mix of patients, origin and destination of runs, times and distances to care, and the volume of clinical services provided in a rural emergency medical services region. This study summarizes all 6,080 rural emergency ambulance trip reports filed from April through September 1991 from the 12 rural counties surrounding Augusta, GA. Rural ambulances are regularly used and are used extensively by elderly populations. The pattern of services provided suggests that while advanced care may or may not have been indicated, it was rarely provided and that rural emergency medical service programs should consider a greater reliance on basic life support teams.

Adolescent↗