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Biomedical subjects

R M Andersen

Publications and source records attributed to R M Andersen.

At least 73 records · Page 4Linked to original sources
PubMed1988

National Study of Internal Medicine Manpower: XIII. The financing of internal medicine residency and fellowship training, 1985 to 1986.

Hospital revenue is the most important source for residency and fellowship stipends in internal medicine. Medicare is especially important for residency programs in voluntary hospitals and hospitals not closely affiliated with a medical school. In the last decade state and local government support and federal training grant support for residency stipends declined, whereas Veterans Administration support increased. Fellowship stipend sources are much more diverse; federal training grants, professional fees, foundations, medical school funds, and research grants contribute significantly. Medicare support appears to be focused on subspecialties particularly important to the elderly, including critical care, rheumatology, cardiology, hematology, gastroenterology, and nephrology. Geriatric medicine, however, receives substantial Veterans Administration support. With growing revenue constraints and increasing concerns about excess physicians we need to monitor the impact of government regulations and other factors on funds available for training internal medicine specialists.

Economics, Hospital↗
PubMed1988

National Study of Internal Medicine Manpower. XII. The future of graduate medical education in internal medicine: what do program directors predict?

The 1985-1986 National Study of Internal Medicine Manpower asked directors of residency and fellowship programs about their plans to change the size of their programs in the near future. The vast majority (71% to 76%) of the directors expected their programs to remain about the same size for the next couple of years. For fellowship directors, this reflects a decline in the number planning to increase their program size since 1976-1977 from 32% to 18%. Directors of programs that are principal affiliates of medical schools are more likely to plan a decrease, while Veterans Administration directors are more likely to plan an increase in program size. The reason residency directors cited most frequently as important to their plans to increase program size was a perceived shortage of internists. Fellowship directors most frequently cited the need for fellows in clinical research. Stipend availability was the most important factor that influenced plans to decrease program size. Overall, residency and fellowship directors planned to increase the size of their programs around 1%. Program directors and others in the internal medicine community should consider how they can change the stipend availability, admissions criteria, and other incentives to channel trainees into the areas of greatest potential need and demand for the profession.

Education, Medical, Graduate↗
PubMed1988

Health care coalitions: continuity and change.

The purpose of this study has been to investigate how coalitions have changed during 1983-1986, to describe the current characteristics of coalitions, and to speculate about their future roles and likely evolution. Several insights emerge from the empirical findings of this study. First, the number of operational health care coalitions has greatly expanded over the last several years to the point where almost every state and metropolitan area of the country has at least one. Second, the service area of most coalitions is generally county-wide, although there has been significant growth in the number of coalitions that serve states. Third, coalitions are expanding their membership composition and including not only business members but also hospitals, physicians, insurance companies, and labor organizations. Fourth, coalitions are becoming more financially secure; most have annual cash budgets, and most rely on dues. Fifth, coalitions are increasingly hiring and using paid professional staff. Last, coalitions are expanding their agendas beyond investigating direct health care costs to examine some of the underlying issues (such as hospital and medical professional liability issues, the financing of uncompensated care, and ethical issues) and are developing programs to address them. For the near future, the extension of recent trends suggests how coalitions will look and function. Further down the road, health care coalitions may evolve into health care public/private policy forums or associations of health benefits managers and/or associations for managed care purchasers. In conclusion, the trends we documented and the projections of the future of coalitions appear to be in keeping with the summary perspective of John T. Dunlop (1987) who indicates: Coalitions provide a continuing forum in which parties become more interested and informed about health care costs, utilization and the problems and operations of the other participants. The discourse encourages a more extensive and informed development and sharing of data. Coalitions reflect and need to recognize the inevitable internal conflicts and interests of the constituent organizations. While some coalitions tend to flounder on internal conflicts and capacity to generate effective leadership; many are fruitfully addressing the hard issues of health care in a community, such as managed care, capitation payments, excess beds and capital requirements, and access to health care by the uninsured. As coalitions mature, beyond discourse and data, they are likely to concentrate on a few of the distinctive problems of their communities and the interaction within the health care environment to address these problems.

Budgets↗
PubMed1987

National Study of Internal Medicine Manpower: XI. Internal medicine residency and fellowship training in the 1980s.

The number of residents beginning training in internal medicine continued to increase slightly in 1985-86. However, the total number of residents in internal residency training decreased slightly from the previous year due to a decrease in the number of second- and third-year residents. The proportion of first-year residents who were foreign-trained physicians decreased from 21% to 20%, and the proportion of residents who finished training and went on to subspecialty training in 1985 decreased substantially to 56%. The number of physicians entering residency and fellowship training in internal medicine considerably exceeds the number projected by the Graduate Medical Education National Advisory Committee. In this article, we discuss implications of these trends for medical education and practice.

Fellowships and Scholarships↗
PubMed1987

Impact of municipal health services Medicare waiver program.

A major goal of the municipal health services program (MHSP) was improvement of health services for the elderly while containing Medicare reimbursement. A Health Care Financing Administration financed Medicare waiver program provided some additional benefits to Medicare Part B enrollees who used the MHSP clinics. Disadvantaged and sicker elderly groups were underrepresented in MHSP facilities. However, even after taking these differences between MHSP and other patients into account, analyses of Medicare records showed that participants in this program had lower reimbursement for hospital inpatient, outpatient, and emergency room services. Also, participants had higher reimbursements for physicians' ambulatory and ancillary care. The net result was total Medicare reimbursements were decreased for program participants.

Aged↗
PubMed1987

Black-white differences in health status: methods or substance?

Apparent differences in the health status of blacks and whites vary according to methods of measurement, errors in the measurement process and interpretation of the measures, and types of measures used. This article uses the literature and secondary analysis of available data to explore the impact of methods on health status comparisons by race. Methods to measure health status include records, direct observations, and self-reports. Blacks generally show the greatest health deficits based on observation and least on some types of self-reports. Major types of errors in health status estimates are random errors and biases. Random errors tend to be greater for blacks because samples used to estimate their characteristics have often been smaller than white samples. Biases include noncoverage or failure to include some types of individuals in the reporting systems at all, nonresponse or lack of complete information on some persons, and use of inaccurate information due to faulty data collection or processing. Such biases tend to be greater for black persons than for whites. Their impact often is to give the illusion that blacks may be in better health than is actually the case. The types of measures that show blacks in the poorest health status are those considered to be most objective: mortality rates and some clinical examinations and health provider records. Subjective measures of dissatisfaction with health level also show blacks to be much less healthy than whites. In contrast, self-reports of illness conditions, symptoms, and restricted-activity days show blacks, particularly children, to be relatively well off compared to whites. These self-reports may be misleading due to differential perceptions of illness and reporting biases between blacks and whites. There is no doubt that measured differences in the health status of blacks and whites often reflect substance. There are also significant methodological problems, however, in comparing health status by race, which tend to underestimate the problems experienced by the black population. This article and others in this volume stress the need to know much more about the sources and impact of these methodological problems. In the meantime, these problems need to be recognized and adjusted for, where possible, when health status measures are compared. It is particularly important to consider them when policy questions of equity and resource allocation are to be decided using indicators of health status.

Black or African American↗
PubMed1986

National Study of Internal Medicine Manpower: X. Internal medicine residency and fellowship training: 1985 update.

The number of medical school graduates entering internal medicine residency training was at an all-time high in 1984-85. Although the number of first-year residents who were foreign-trained physicians did not differ greatly from the 1983-84 census, the number of first-year residents who were U.S. medical school graduates was much higher than the previous year largely because the number of graduates from U.S. medical schools increased substantially in 1984. The number of internal medicine fellowship programs and the number of fellows in 1984-85 were also at an all-time high. Foreign-trained physicians represent 22% of those in residency training and 20% of those in fellowship training. Of every 100 who completed residency training, 61 went on to a first year of subspecialty fellowship training, a number up slightly from the previous year. The increasing numbers of residents and fellows being trained in internal medicine, combined with the preference for subspecialization and the substantial proportion of foreign-trained physicians being trained, are discussed against the background of pending legislation to reduce federal assistance for graduate medical education.

Education, Medical↗
PubMed1986

The Municipal Health Services Program. Improving access to primary care without increasing expenditures.

Under the Municipal Health Services Program (MHSP), five city governments created networks of primary care clinics with a goal of serving populations thought to have poor access to primary medical care. A major concern was fragmented care in public hospitals and other public facilities. The new MHSP clinics were expected to provide care at lower cost than the population's alternative sources of care. Medicare and Medicaid waivers were also provided. This evaluation indicates that MHSP did reach most, but not all, of the targeted groups. MHSP may have successfully replaced some outpatient department and emergency room services. However, it failed to realize the program goals of continuity and high patient satisfaction. Per capita expenditures for medical care for MHSP users were no higher than for others, but also were not significantly lower. However, for Medicare eligible MHSP users, expenditures by Medicare were significantly less.

Consumer Behavior↗
PubMed1984

The national profile of access to medical care: where do we stand?

This paper presents analyses of recent national survey data on access to medical care. In particular, information on major access indicators and special problems associated with the economic and political climate of the 1980s collected in a 1982 national telephone survey of 6,610 United States adults and children, representing some 4,802 families, is compared with previous national surveys for key population subgroups--by age, place of residence, income, race, insurance coverage, and type of regular source of care. In general, the findings show that favorable progress has been made, but some inequities continue to persist. Some traditionally disadvantaged groups are more likely to have a regular family doctor, private insurance coverage, have been to a doctor, or had certain preventive tests and procedures than was true for them in the past. On the other hand, compared to the more economically and/or socially advantaged groups in 1982, they have still not "caught up" entirely. There also is evidence that they may be hardest hit by the exacerbation of the financial barriers to care that result from unemployment, inflation, and cutbacks in health program eligibility and benefits that have characterized the decade of the 1980s.

Adolescent↗
PubMed1984

Self-care. Substitute, supplement, or stimulus for formal medical care services?

This article examines the relationship between selected self-care practices during an episode of illness and the use of formal medical care. Stimulated by conflicting evidence and assertions, the general question addressed is: "Is self-care a substitute, a supplement, or a stimulus for use of formal medical care services?" Multiple Classification Analysis was used in a secondary data analysis of a 1976 nationwide study on access to medical care. The results suggest that self-care users may visit the physician less often and stay fewer days in the hospital, and thus they are expected to have lower expenditures for hospital and physician services. Therefore, the self-care activities examined appear to be substitutes for, rather than supplements or stimuli to, health services utilization. The results must be viewed with some caution due to limitations in the data. However, the results also argue for a greater research emphasis on self-care.

Adolescent↗
PubMed1983

Uses of the 1980 census for Hispanic health services research.

The 1980 Census data provide a valuable resource for health services research on Hispanics. Hispanics are the fastest growing minority group in the United States and yet there is a paucity of large-scale empirical research on their health care and access needs. This paper describes how the census can assist in: 1) estimating the overall health care needs of this group, 2) identifying target groups within the Hispanic population who may have special health care problems (e.g., children, elderly, pregnant women, etc.); and 3) using other data sources to improve the quality of studies carried out on Hispanics. It also discusses problems in using the census for Hispanic health services research and some strategies for dealing with these problems.

Educational Status↗
PubMed1983

Exploring dimensions of access to medical care.

This paper examines the dimensions of the access concept with particular attention to the extent to which more parsimonious indicators of access can be developed. This process is especially useful to health policy makers, planners and researchers in need of cost-effective social indicators of access to monitor the need for and impact of innovative health care programs. Three stages of data reduction are used in the analysis, resulting in a reduced set of key indicators of the concept. Implication for subsequent data collection and measurement of access are discussed.

Consumer Behavior↗
PubMed1981

Potentials of local health surveys: a state-of-the-art summary.

This paper provides a state-of-the-art summary of the potentials and limitations of local surveys for assessing health problems in local areas. The information they provide may be helpful for a variety of purposes such as measuring the need for services, planning programs to address these needs, and evaluating their impact. Particular advantages of surveys are that they: provide information on the needs of people who have not sought care; permit special studies of particular target groups; provide data on variables which are only available from "asking" people; enable information to be collected on a range of correlates and indicators of health care behavior; provide an opportunity for examining relationships among variables; and permit well-timed community estimates of the impact of experimental programs. Limitations include the validity and reliability of survey data, and the costs and other problems of survey implementation.

Health Services Research↗