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At least 181 records · Page 10Linked to original sources
PubMed1997

The impact of China's health sector reform on county hospitals.

The article describes the impact of China's health sector reform on relatively small hospitals in rural counties. It uses one county hospital to illustrate how pressures to increase revenue, combined with distortionary pricing policies, have led to cost increases. It argues that the introduction of hospital insurance could accelerate the cost increases unless measures are taken to control costs. These measures will include improvements to hospital management and changes to mechanisms of payment for hospital services. Government will have to play an active role to ensure that county hospitals serve the needs of rural people.

China↗
PubMed1978

Temporal patterns in the use of health services leading to cholecystectomy: a process evaluation using insurance records.

Data from Saskatchewan's public medical and hospital insurance programs are used to estimate a multivariate model of health services utilization among cholecystectomy patients. A methodology is developed which partitions the care process into an assessment period, a waiting period, and a hospitalization period. The general hypothesis is that presurgical and surgical decisions of physicians are influenced by extra-medical factors, including the social condition of the patient and the availability of health resources. This hypothesis is only weakly supported by the data.

Adult↗
PubMed1988

Ball Memorial Hospital: Section 2 Sherman Act analysis in the alternative health care delivery market.

In 1986, the Seventh Circuit Court of Appeals in Ball Memorial Hospital v. Mutual Hospital Insurance denied an injunction sought under the antitrust laws by the plaintiffs, eighty acute care hospitals, which would have precluded Blue Cross and Blue Shield of Indiana from implementing a Preferred Provider Organization. The Ball court used a conservative economic analysis to deny the injunction and failed to consider many industry-specific factors. This Note examines these factors and challenges the Ball court's position by arguing that antitrust scrutiny of alternative health care delivery markets must go beyond the court's narrow approach.

Blue Cross Blue Shield Insurance Plans↗
PubMed1987

Medicare use and cost of short-stay hospital services by enrollees with cataract, 1984.

In this article, we present data on aged and disabled Medicare hospital insurance enrollees discharged with the principal diagnosis of cataract from short-stay hospitals. Medical technology has reduced the risk of cataract surgery and the time needed to perform the surgery. As a result, the number of enrollees undergoing cataract surgery has increased. Also, such surgery has been shifted from inpatient hospitals to outpatient facilities. However, outpatient reimbursement for cataract surgery often equals or exceeds inpatient payments. To address this inequity, Congress legislated payment limits for cataract surgery.

Aged↗
PubMed1994

[Towards a sociology of hospitalized populations: Resorting to the hospital in Germany in the early nineteenth century].

Based on a sociological analysis of the populations which were hospitalized in the German academic hospitals during the first half of the 19th century, the purpose of this article is to put into perspective the equivalence which has often been established between penury and hospitalization. Indeed during this period the use of hospitals had not yet spread to all social classes; but numerous signs (such as the rate of activity, the age or the sex of the patients, their geographical origin, the duration of their stay and above all the development of the hospital insurances) shows that the German hospital was in no way only the refuge of indigent and marginal people but an answer to a demand springing from the popular classes as a whole.

Germany↗
PubMed2002

Public hospitals: who's looking after you? The difficulties in encouraging patients to use their private health insurance in public hospitals.

Private health insurance (PHI) is an important part of the Australian health system. During the introduction of the recent PHI reforms it was argued that, without the reforms, the public hospital system would undoubtedly collapse under the increased demand for public health services. The increase in PHI coverage might also have been expected to result in an increase in the revenue earned by public hospitals as a result of treating privately insured patients. However, the decline in numbers of privately insured patients using their PHI in public hospitals has continued, with adverse impacts on public hospital budgets in some states. This article addresses the complex interactions between various policy instruments and their impact on public hospitals, and reports the results of a study conducted at the Austin & Repatriation Medical Centre (A&RMC) which examined the reasons for privately insured patients electing not to use their insurance in public hospitals, and methods by which they might be overcome.

Budgets↗
PubMed1980

Utilization of publicly insured health services in Saskatchewan before, during and after copayment.

This study examines the effects both of introducing and of removing copayment charges under a universal public medical care and hospital insurance program. For a period between 1968 and 1971, the Province of Saskatchewan imposed user charges of approximately 33 per cent and 6 per cent on medical and hospital services, respectively. The effects of these charges are analyzed using pooled cross-section samples of families and using both multivariate methods and experimental/control groups designs. Diagnostic- and procedure-specific analysis is also performed on the hospital data using the individual as the unit of observation. The findings of the study indicate a copayment effect of 5.6 per cent for physicians' services. No evidence could be adduced that would support the conclusion of a copayment effect for hospital services.

Deductibles and Coinsurance↗
PubMed1989

Treatment modality and quality differences for black and white breast-cancer patients treated in community hospitals.

This study assessed the relationship of race and patterns of care, defined by an expert NCI-appointed committee, for 7,781 patients with breast cancer treated in 107 hospitals in 45 communities between 1982 and 1985. After control for age and stage of disease, black patients had significantly different care from white patients for four of the ten patterns examined. They were less likely to have a progesterone receptor assay or to be referred for postmastectomy rehabilitation, two patterns deemed desirable for all patients. Black patients were also more likely to receive liver scans and radiation therapy in situations in which these procedures were labeled "less appropriate (as defined in the text)." Black patients differed significantly from whites on their health insurance, hospital, and physician characteristics; these factors were also significantly associated with the patterns of care. However, after controlling for these variables, the association between race and care persisted for three patterns. The patterns that showed racial differences were not the most clinically significant of the ten studied. Different treatment for black and white patients may help to explain differences in survival rates of black and white women with breast cancer.

Adult↗
PubMed1984

Hospice home care cost savings to third-party insurers.

A population-based, retrospective analysis of Medicare Part A and Blue Cross hospital insurance claims data was used to determine whether hospice home care cost savings to third-party insurers are substantial and result from the substitution of less expensive home care visits for more costly hospital inpatient days. The study was carried out by comparing the third-party payments of Cuyahoga County residents who died of cancer and were served by a hospice home care program (n = 152) with the insurance payments of cancer patients who never received hospice home care (n = 1,397). The data strongly supported the research hypothesis. The relative use of hospital days decreased more than 50% and the use of home care visits increased 10-fold when dying patients shifted from conventional care to hospice home care. This change in use represented a relative savings of about 40%, ranging from $1,089 per patient during the last 2 weeks of life to $2,676 per patient during the last 12 weeks of life. These results were not accounted for by group differences in age, type of cancer, or personal preference for home care.

Age Factors↗
PubMed1988

Medicare's fiscal problems: an imperative for reform.

Many observers have noted that Medicare expenditures will significantly outstrip projected revenues over the course of the next 25 years. This paper examines the economic and demographic assumptions behind forecasts of Medicare hospital insurance and supplementary medical insurance expenditures and revenues and analyzes various strategies for closing the impending gap. It is argued that the present forecasts already assume considerable success in controlling hospital costs and physician payments, making substantial further savings unlikely. Shifting more of the burden onto the elderly through increased cost sharing or higher premiums also will not solve the program's fiscal problems over the long term. The remaining alternative--imposing higher income or payroll taxes on the under-65 population--is also unlikely to be a welcome solution. The authors argue that, eventually, the nation must choose between some form of a two-tier system of benefits or a Canadian-style national health insurance system.

Aged↗
PubMed1994

Health care for black and poor hospitalized Medicare patients.

OBJECTIVE: To analyze whether elderly patients who are black or from poor neighborhoods receive worse hospital care than other patients, taking account of hospital effects and using validated measures of quality of care. DESIGN: We compare quality of care provided to insured, hospitalized Medicare patients who are black or live in poor neighborhoods as compared with others, using simple and multivariable comparisons of clinically detailed measures of sickness at admission, quality, and outcomes. SETTING: Two hundred ninety-seven acute care hospitals in 30 areas within five states. PATIENTS OR OTHER PARTICIPANTS: The sample includes a nationally representative sample of 9932 patients 65 years of age or older who lived at home prior to hospitalization for congestive heart failure, acute myocardial infarction, pneumonia, or stroke. INTERVENTIONS: This was an observational study. MAIN OUTCOME MEASURES: Processes of care, length of stay, instability at discharge, discharge destination, and mortality. RESULTS: Within rural, urban nonteaching, and urban teaching hospitals, patients who are black or from poor neighborhoods have worse processes of care and greater instability at discharge than other patients (P < .05). However, this worse quality is offset by patients who are black or from poor neighborhoods being 1.8 times more likely to receive care in urban teaching hospitals that have been shown to provide better quality of care (P < .001). Because these patients receive more of their care in better-quality hospitals, there are no overall differences in quality by race and poverty status. Death rates did not vary by race or poverty status. CONCLUSIONS: Quality of hospital care for insured Medicare patients in influenced both by the patient's race and financial characteristics and by the hospital type in which the patient receives care.

Black or African American↗
PubMed2001

Paying for Medicare: benefits, budgets, and Wilbur Mills's policy legacy.

Medicare features an unusually complex financing design. The Hospital Insurance Trust Fund pays for Part A of Medicare (hospital stays), while the Supplementary Medical Insurance Trust Fund finances Part B (doctor visits, outpatient care, and certain home health services). At a time when Medicare policy is generating debate, this article takes a new analytical look at the origins and consequences of the program's peculiar bifurcated structure. Addressing historians of the U.S. welfare state as well as contemporary health policy reformers, the article focuses on the crucial role of legendary Ways and Means Committee chair Wilbur Mills in Medicare's enactment in 1965. The central theme of the article is that fiscal conservatism and a commitment to budgetary restraint constitute important elements of Medicare's original political understanding. Contrary to analysts who argue that Medicare's financing design has produced "perverse" effects, we argue that it has served a valuable social function by encouraging policy makers to confront periodically the costs of one of the largest and fastest-growing federal programs. An argument can be made that Medicare's original division requires modification in order to integrate health care delivery changes of the past few decades. It is crucial, however, for reformers not to lose sight of the policy goals, including fiscal rectitude, that motivated the adoption of Medicare's bifurcated structure in the first place.

Aged↗