Biomedical subjects

W D Marder

Publications and source records attributed to W D Marder.

22 records · Page 2Linked to original sources

PubMed1982

Spending time with patients: the impact of organizational structure on medical practice.

This article assesses whether the amount of time that physicians spend overall, in the office, and in the hospital per patient visit depends upon the organizational structure of the physician's practice (i.e., does the physician practice in the fee-for-service system or in an HMO, and if in an HMO, in what type of an HMO). Data pooled from two national studies (N = 2.521) reveal several interesting patterns, including: 1) on all measures, solo physicians spend more time per patient visit than physicians in group practice; 2) overall and in the office, internists spend more time per patient visit than general practitioners; 3) overall and in the hospital, obstetricians-gynecologists spend more time per patient visit than general practitioners; 4) overall and in the office, physicians in prepaid group practices spend less time per patient visit than physicians in fee-for-service group practices; 5) overall and in the office, physicians reimbursed on a straight salary basis spend more time per patient visit than nonsalaried physicians; and, 6) in the hospital, physicians in staff model HMOs spend more time per patient visit than physicians in fee-for-service group practice. The implications of these findings for future studies of the effects of organizational structure on medical practice are discussed.

Health Maintenance Organizations↗

PubMedDate not supplied

Trends in adult visits to primary care physicians in the United States.

BACKGROUND: Although numerous changes are apparent in the US health care system, little is known about how these changes have altered the work of primary care physicians. METHODS: We analyzed a nationally representative sample of 136,233 adult office visits to general internists, general practitioners, and family physicians contained in the 1978 through 1981, 1985, and 1989 through 1994 National Ambulatory Medical Care Surveys. Annual sample sizes varied between 5662 and 19,977 visits. Measures included the characteristics of patients presenting to primary care physicians, physician activities during these visits, and the disposition of the visits to primary care physicians. RESULTS: Visits to primary care physicians have diminished as a proportion of all adult visits from 52% in 1978 to 41% in 1994. Dramatic trends in adult primary care included the growing racial or ethnic diversity of patients, the doubling (since 1985) of health maintenance organization coverage, increased provision of prevention services, changes in the most common medications, and an 18% increase in the duration of adult visits to primary care physicians. CONCLUSIONS: Trends in primary care practice reflect changes in society and in the US health care system, including demographic changes, an emphasis on prevention, and the growth of managed care. The increasing role of managed care, with its emphasis on increased productivity, appears at odds with primary care physicians' increasing responsibility for prevention and the associated increase in the duration of primary care visits.

Age Distribution↗

PubMedDate not supplied

Short-run associations between medical care expenditures and adherence to clinical practice guideline-based measures for diabetes.

OBJECTIVES: To estimate relationships between medical care expenditures in 1996 and adherence to seven guideline-based measures for diabetes. METHODS AND DATA: Nonlinear exponential regression analyses were used to estimate relationships between medical care expenditures in 1996 and adherence to guideline-based measures that year, adjusting for differences in patients' demographics, location, plan type, and severity of illness. Adherence to criteria regarding physician visits, eye exams, blood sugar tests, urinalysis, triglyceride tests, total cholesterol tests, and HDL cholesterol tests was studied for 18,403 patients in 35 health plans. RESULTS: Average total medical expenditures would be $713 higher if all patients were treated according to the guideline-based measures in 1996, compared to what expenditures would be if no patients were treated that way. Average diabetes-related expenditures would be about $322 higher. Two important exceptions to this pattern were for adherence to the suggested frequency of hemoglobin A1c blood sugar tests and ophthalmology visits for dilated eye exams. Having the recommended number of these tests was associated with significantly lower total expenditures. CONCLUSIONS: In general, adherence to clinical practice guideline-based measures was more costly than deviating from those criteria, in the short-run. Perhaps expenditures should be higher for many patients who are not treated according to guidelines. Randomized studies with more years of follow-up should be conducted to assess whether short-term investments in guideline adherence pay off with lower medical expenditures and greater levels of health in the long term.

Databases, Factual↗

PubMedDate not supplied

HMO: the concept, new evidence, implications.

HMOs have been the most controversial alternative healthcare delivery system in the US. As a first step towards understanding the concept and state of HMOs, a description is offered, including a review of basic characteristics, types, and general financial incentives and disincentives. Although the performance of HMOs has also been the subject of recent debate, there is evidence that studies of performance have been inconclusive, and while observations about the effects of HMOs appear frequently in the literature, the causes are not actually known. To provide more conclusive information on the performance of HMOs, the American Medical Association conducted several related studies during the tenure of the authors. Results and implications of these studies are presented.

Evaluation Studies as Topic↗