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Biomedical subjects

S M Davidson

Publications and source records attributed to S M Davidson.

14 recordsLinked to original sources
PubMed1992

Prepayment with office-based physicians in publicly funded programs: results from the Children's Medicaid Program.

This paper is a report of the results of a demonstration designed to provide empirical evidence regarding the effects of alternative approaches to paying physicians for serving children in the Medicaid program: (1) visit fees set at twice regular Medicaid fees in return for physician agreement to manage utilization and (2) capitation and financial risk-sharing along with the same physician agreement to manage utilization. Participating physicians were assigned randomly to either of the two payment groups. Comparisons of utilization and expenditures were made between these two plans and the regular Medicaid program (fee-for-service, low fees). Results showed no adverse effect of capitation payments on primary care visits to office-based physicians. Capitation physician referrals to specialists decreased relative to all other groups studied, consistent with the theory that the financial incentives in capitation will lead primary care physicians to reduce referrals to specialists.

Child↗
PubMed1990

Access to office-based physicians under capitation reimbursement and Medicaid case management. Findings from the Children's Medicaid Program.

This study reports the effects of a voluntary Medicaid case-management demonstration on the primary care provided to young children by office-based physicians. The MDs who participated were reimbursed at rates higher than the regular Medicaid fee schedule, either through augmented fees for specific services or through monthly capitation payments. Using the Medicaid Management Information System (MMIS) claims data, we compared the rates at which children in the experimental program and children in the regular Medicaid program were seen by a physician during a one-year period. The majority of experimental children received regular and frequent care from primary care physicians during the demonstration. After controlling for race and prior utilization differences, we found that augmented fee-for-service children received more primary care from office-based physicians than children in the regular Medicaid program. Capitation children received at least the same amount of primary care as children in the regular Medicaid program. We interpret our data to mean that capitation payment, untied to the delivery of services, does not necessarily reduce access to primary care and that higher fees for physicians who treat children may, in fact, increase access.

Capitation Fee↗
PubMed1988

Surgical aspects of international drug smuggling.

The internal concealment of cocaine and other drugs in packets by "body packers"--those who swallow packets of drugs or hide them in their vagina or rectum--to avoid detection by customs officials has been increasing in both the United States and Europe. The types of package and how they are concealed are changing as the traffickers become more sophisticated in their methods. The latest parcels are less likely to burst, but obstruction of the bowel may occur. Awareness of the problem is important for staff of emergency medical services near international ports of arrival.

Adult↗
PubMed1986

Medicaid myths: trends in Medicaid expenditures and the prospects for reform.

Medicaid expenditures, which had reached more than +32 billion by 1981, have grown substantially throughout the program's history. As a result, the conventional wisdom is that Medicaid expenditures represent a significant public-policy problem. Using other measures, however, it can be shown that the program is much less of a problem than it appears to be. By 1981, spending for Medicaid represented only 12.7 percent of total state spending and had contributed only 14.2 percent to the overall growth in state expenditures since 1965. Moreover, considering only the funds which states raise from in-state sources, the median share of state budgets accounted for by Medicaid was just 5.6 percent, and only 7 states spent as much as 9 percent of their own money on the program. These figures suggest that the marginal reductions in Medicaid expenditures which would result from typical program changes are likely to be so small that rational state officials might be unwilling to incur the political opposition of powerful provider groups or the resistance of large state bureaucracies by proposing substantial reforms. The major exceptions are the few states with very large programs where even small proportional savings would amount to millions of dollars. We conclude that, given its present federal-state form and the current distribution of expenditures, it is unlikely that major reforms will be enacted because the stakes are too small for most states and the federal interest is too diffused.

Health Expenditures↗
PubMed1985

The extent of physician participation in Medicaid: a comparison of physician estimates and aggregated patient records.

This article compares two measures of the extent of physician participation in Medicaid programs. The first, which has been used in most research to date on the subject, is based on physician estimates of the proportion of their patients who are Medicaid patients. The second derives from encounter forms for a sample of visits to the interviewed physicians. The comparison shows that physicians in the sample tended to overestimate by 40 percent the extent of their Medicaid participation. Because the two measures are highly correlated, the analysis of the determinants of Medicaid participation was not affected by the measure used. However, since physicians tended to overstate the proportion of Medicaid patients in their practices, interview data should not be used to measure the amount of physician participation or to calculate elasticities for the effects of policy changes on the extent of participation.

Data Collection↗
PubMed1979

Hypertension continuation adherence: natural history and role as an indicator condition.

We analyzed a random sample of general medicine clinic patients to determine the natural history of newly treated hypertensive (NH) patients: discontinuation patterns, critical intervention periods, and hypertension's (HBP) utility as an indicator condition. The NH patients exhibited a 48% dropout rate in the first year and better continuation adherence than new nonhypertensive (NNH) patients. Patients with HBP and other chronic diseases had better continuation adherence than those with HBP alone, although no predictive patterns emerged. New patients displayed rapid early discontinuation, with further linear decline by four months for NNH and by eight months for NH patients. All patients showed similar subsequent falloff: linear annual decline at 13% to 36%. We conclude that discontinuation rates are unacceptably high, that interventions must be continued throughout treatment, and that HBP has limited utility as an indicator chronic disease.

Adult↗
PubMed1979

A general medicine clinic: the dilemma and teaching implications.

An academic general medicine clinic (GMC) was studied to determine current patterns, shortcomings, and potential solutions. Retrospective medical record review of 349 randomly selected GMC patients from 1975 permitted profile generation. Only 11.5% of the patients had first visits in the study year. Almost 75% of the study group used the university hospital as their major source of care. Over two years only 58% continued in active care, while 5% died, 8% needed no further follow-up, and 29% were lost from care. The prevalence of hypertensive cardiovascular disease was disproportionately high. Patients exhibited chronic disease exclusively in 91% of return visits. The authors conclude that the GMC offers insufficient variety of patient presentations for optimal postgraduate medical education and inadequate accessibility for comprehensive medical care. Potential improvements include expanding the patient base, extending availability, and employing nonphysician clinicians.

Cardiovascular Diseases↗
PubMed1978

Understanding the growth of emergency department utilization.

Much research on utilization of hospital emergency departments has been published over the past 10 to 15 years. It has failed to yield a coherent view of why the volume of use has increased, however, because most of it has focused on users of one or more ERs, ignoring the nonusers, and has provided insufficient detail about the local context in which the ER operates. The result has been large quantities of data which, when compared, produce inconsistencies which cannot be resolved without additional data from different studies. Yet, a tentative explanation of ER growth can be presented if the question of why people use ERs, which is usually thought of as being similar to the question of why people use medical care services, is restated as, why do people who want to use medical care choose the ER as the site of care? That question can best be answered by paying greater attention to enabling and illness factors than to the predisposing demographic factors upon which much research has focused. A tentative explanation of the growth of ER utilization is offered. Then, the support from the literature for it is presented and the remaining questions are identified for future research.

Ambulatory Care↗
PubMed1978

Variations in state Medicaid programs.

Many federal laws permit the states considerable latitude in determining the important characteristics of programs created under them. Yet, frequently, this aspect is overlooked in the analyses of differences in state-level programs. The purpose of this paper is to present a measure to aid in the analysis of one such program, Medicaid, and to illustrate some of the ways it can be useful. The Medicaid Program Index (MPI) differentiates among state Medicaid programs according to four important characteristics: inclusion of the medically indigent, the optional services covered, limitations on the provision of the basic services, and arrangements for paying providers. Data are presented to show that, in fact, the states do vary considerably on these factors, which can be analyzed in the aggregate (i.e., as the MPI) or separately. In addition, several uses for the MPI are discussed. They include: (1) identifying variations in state programs; (2) accounting for those differences by comparing them to promising explanatory variables; (3) identifying trends in program characteristics over time: and (4) developing hypotheses to account for those trends. Finally, it was suggested that similar measures can be developed to facilitate analyses of other federal/state programs.

Humans↗
PubMed1977

Mode of payment and length of stay in the hospital: more work for PSROs?

The Professional Standards Review Organizations (PSROs) mandated by the Social Security Act aim to monitor and control hospital utilization by publicly funded patients, particularly those whose care is paid for by Medicare and Medicaid. One question to ask is, if PSROs prove successful in reducing suspected overutilization by public patients, would the principal private third parties, Blue Cross and commericial insurance plans, benefit by applying those techniques to their patients, as well. Data are presented from the Chicago Hospital Discharge Study, which was conducted in February, 1970, before PSRO activities were undertaken. They show that average length of stay for Medicaid patients is not consistently different from that for patients who pay by other means. Therefore, it is argued that, if it proves successful as applied to Medicaid patients, private third parties might benefit by using the PSRO mechanism to try to monitor and control the stays of their patients, as well.

Blue Cross Blue Shield Insurance Plans↗