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PubMedDate not supplied

Hysterectomy charges: geographic variations United States, 1994.

During 1994 Metropolitan Life Insurance Company claims by group health insureds and their dependents for a vaginal hysterectomy averaged $10,500, for an abdominal hysterectomy (laparotomy), $12,440, and for a laparoscopically assisted vaginal hysterectomy (LAVH), $13,840. The distributions of the three surgeries varied by geographic area and state. The East South Central states had the lowest average total charge for each procedure whereas the highest charge for a laparotomy was reported in the Middle Atlantic states; the highest vaginal hysterectomy charge was in the Pacific area, and LAVH average total charge was the highest in New England. Of the three surgeries, the vaginal hysterectomy charges varied the most by state-the average charge in Florida was almost twice that in Oklahoma. Laparotomy charges differed by 59 percent between California and Tennessee, where they were 30 percent above and 19 percent below the U.S. norm, respectively. The total charge for the LAVHs varied by 42 percent and was the highest in California and lowest in North Carolina. Three study states, California, Florida and Illinois, were among the four states with the highest average total charges for each form of hysterectomy. Physicians' fees accounted for 41 percent of vaginal hysterectomy charges, 37 percent of the laparotomy total charges, and 34 percent of the LAVH charges. Of the laparotomies, the physicians' fees differed by 132 percent between the highest in New York and the lowest in Tennessee. For the country as a whole, the average length of stay was 2.17 days for the LAVHs, 2.54 days for a vaginal hysterectomy and 3.43 days for an abdominal hysterectomy.

Adult↗
PubMed2004

[Surgical practice under the recent health insurance system of Japan].

Candidates for surgeon have been declining in number for a long time because the labor conditions for surgeon are worse than those for other specialists, especially for internists. In this symposium, we will examine how to improve the present status of surgeons under the totally controlled health insurance system by discussing regarding what is a surgeon, what is a surgeon's work, what is a rational surgical fee, the necessity for surgeon's fees, etc. for the sake of the future development of both clinical surgical practice and research.

General Surgery↗
PubMed2006

Analysis of surgical errors in closed malpractice claims at 4 liability insurers.

BACKGROUND: The relative importance of the different factors that cause surgical error is unknown. Malpractice claim file analysis may help to identify leading causes of surgical error and identify opportunities for prevention. METHODS: We retrospectively reviewed 444 closed malpractice claims, from 4 malpractice liability insurers, in which patients alleged a surgical error. Surgeon-reviewers examined the litigation file and medical record to determine whether an injury attributable to surgical error had occurred and, if so, what factors contributed. Detailed descriptive information concerning etiology and outcome was recorded. RESULTS: Reviewers identified surgical errors that resulted in patient injury in 258 of the 444 (58%) claims. Sixty-five percent of these cases involved significant or major injury; 23% involved death. In most cases (75%), errors occurred in intraoperative care; 25% in preoperative care; 35% in postoperative care. Thirty-one percent of the cases had errors occurring during multiple phases of care; in 62%, more than 1 clinician played a contributory role. Systems factors contributed to error in 82% of cases. The leading system factors were inexperience/lack of technical competence (41%) and communication breakdown (24%). Cases with technical errors (54%) were more likely than those without technical errors to involve errors in multiple phases of care (36% vs 24%, P = .03), multiple personnel (83% vs 63%, P < .001), lack of technical competence/knowledge (51% vs 29%, P < .001) and patient-related factors (54% vs 33%, P = .001). CONCLUSIONS: Systems factors play a critical role in most surgical errors, including technical errors. Closed claims analysis can help to identify priority areas for intervening to reduce errors.

Adolescent↗
PubMed1979

Private health insurance plans in 1977: coverage, enrollment, and financial experience.

The private health insurance industry collected $47.1 billion in premiums in 1977 and returned $41.6 billion in benefits to their subscribers. Premiums rose 16.3 percent as a direct consequence of rapid claims growth in 1976. After operating expenses were deducted, the industry showed a small, $.4 billion underwriting loss. About 78 percent of the population were insured for hospital care, and about 76 percent for surgical services. Smaller percentages had coverage for other types of care. An estimated 61.8 percent of the aged bought private hospital insurance, and 47.1 percent bought surgical insurance, mostly to supplement Medicare benefits. About 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid.

Data Collection↗
PubMed2005

Effects of a professional liability crisis on residents' practice decisions.

OBJECTIVE: Pennsylvania, like many states, is in a professional liability crisis characterized by escalating cost and decreasing availability of liability insurance. Medical and surgical specialists have experienced especially large increases in insurance premiums. The objective of this study was to estimate the impact of liability concerns during a professional liability crisis on Pennsylvania residents' decisions regarding their future practice. It was hypothesized that liability concerns would negatively affect Pennsylvania residents' propensity to practice in the state following residency. METHODS: Statewide mail surveys were completed in 2003 by 68 Pennsylvania residency program directors and 360 residents nearing the end of their training in anesthesiology, general surgery, emergency medicine, obstetrics and gynecology, orthopedics, and radiology residencies. RESULTS: One third of residents in their final or next-to-last year of residency planned to leave Pennsylvania because of the lack of availability of affordable malpractice coverage. Although, in general, residents' geographic decisions are influenced by a range of factors, those who are about to leave Pennsylvania named malpractice costs as the primary reason 3 times more often than any other factor. Seventy-one percent of residency program directors reported a decrease in retention of residents in the state since the onset of the professional liability crisis. For some programs the decreases were very large. CONCLUSION: An environment of mounting liability costs in Pennsylvania appears to have dissuaded substantial numbers of residents in high-risk specialties from locating their clinical practices in the state. The impact of decreased resident retention on the future availability of specialist services in high-cost states merits close monitoring.

Adult↗
PubMed1993

Comparing surgical efficiency in independent practice association HMOS and traditional insurance programs.

This study examines the effect of Independent Practice Association (IPA) HMO membership on hospital total charges, ancillary charges and length of stay (LOS) for surgical patients. Intrahospital comparisons of IPA and traditional insurance patients are made after adjusting for surgical procedure, admission severity of illness, age, sex and year of admission. Our multiple regression model indicates that IPA patients undergoing 12 frequently occurring surgical procedures have lower resource use. Eight (80%) of the 10 study hospitals exhibit a negative IPA beta coefficient for total charges, ancillary charges and LOS. Five (50%) hospitals have statistically significant (p < 0.05) negative coefficients for total charges, while one (10%) hospital has a significant positive coefficient. IPA patients exhibit adjusted total charges that are 6% lower than traditional insurance, ancillary charges that are 4.3% lower, and LOS that is 10% shorter.

Efficiency↗
PubMed2005

Colorectal cancer surgical care and survival: do private health insurance, socioeconomic and locational status make a difference?

BACKGROUND: The purpose of the present paper was to examine patterns of surgical care and the likelihood of death within 5 years after a diagnosis of colorectal cancer, including the effects of demographic, locational and socioeconomic disadvantage and the possession of private health insurance. METHODS: The Western Australian Data Linkage System was used to extract all hospital morbidity, cancer and death records for people with a diagnosis of colorectal cancer from 1982 to 2001. Demographic, hospital and private health insurance information was available for all years and measures of socioeconomic and locational disadvantage from 1991. A logistic regression model estimated the probability of receiving colorectal surgery. A Cox regression model estimated the likelihood of death from any cause within 5 years of diagnosis. RESULTS: People were more likely to undergo colorectal surgery if they were younger, had less comorbidity and were married/defacto or divorced. People with a first admission to a private hospital (odds ratio (OR) 1.31, 95% confidence interval (CI): 1.16-1.48) or with private health insurance (OR 1.27, 95% CI: 1.14-1.42) were more likely to undergo surgery. Living in a rural or remote area made little difference, but a first admission to a rural hospital reduced the likelihood of surgery (OR 0.76, 95% CI: 0.66-0.87). Residency in lower socioeconomic areas also made no difference to the likelihood of having surgical treatment. The likelihood of death from any cause was lower in those who were younger, had less comorbidity, were elective admissions and underwent surgery. Residency in lower socioeconomic status and rural areas, admission to a rural hospital or a private hospital and possession of private health insurance had no effect on the likelihood of death. CONCLUSIONS: The present study demonstrates that socioeconomic and locational status and access to private health care had no significant effects on surgical patterns of care in people with colorectal cancer. However, despite the higher rates of surgery in the private hospitals and among those with private health insurance, their survival was no better.

Age Factors↗
PubMed1995

The need for accurate risk-adjusted measures of outcome in surgery. Lessons learned through coronary artery bypass.

OBJECTIVE: The authors review the Pennsylvania Health Care Cost Containment Council reports on coronary artery surgery and compare this reporting structure to others, including the Society for Thoracic Surgeons database, currently used by their own program. The authors review the growing likelihood of a need for outcome measures for all of the surgical subspecialties. SUMMARY AND BACKGROUND DATA: Pressure from consumers and insurers will require surgical specialties to be graded by objective outcome measures. Practitioners must be prepared and become involved in the process. METHODS: The authors reviewed the data, which grades all of Pennsylvania's hospitals at which coronary artery bypass is performed. Apparently, the major risk factors commonly employed in most other risk adjustment schemes for cardiac surgery have been deleted, and the practitioners might be judged unfairly. The Pennsylvania system appears to be insurance driven to reward low-cost providers who operate on patients with the lowest risk. RESULTS: Review of data suggests that the Pennsylvania Health Care Cost Containment Council's annual publication, A Consumer's Guide for Coronary Artery Bypass Surgery, misrepresents fair risk adjustment in favor of lower-risk patients, thereby encouraging better score cards for those institutions with patients who are less ill. Data regarding charges for the procedure have not been risk adjusted or related to a regional economic index. CONCLUSIONS: Surgeons must prepare to better understand relevant models that evaluate outcome. Cardiothoracic surgery is one of the first specialties to feel the pressures of mandated evaluations, and the lessons learned in Pennsylvania should be applicable to other states and their practitioners.

Coronary Artery Bypass↗
PubMed1976

Surgical rates in the Canadian provinces, 1968 to 1972.

Canadian and provincial rates for eight elective and seven nonelective operations were determined from 1968 through 1972. Of the elective procedures considered, the Canadian tonsillectomy rate decreased substantially and rates for hysterectomy and cholecystectomy showed large increases. The provinces reflected national trends for these three operations. Except for coletomy, which increased 36%, rates for the nonelective procedures showed little change. Correlations between the numbers of surgical personnel and the elective surgery rates in the provinces were demonstrated in 3 of the 5 years; these are best shown at the extremes. Newfoundland had the fewest surgeons, a bed: population ratio below the national average and the lowest combined elective surgical rate; Alberta ranked high in all three categories. In the seven other provinces, there was less variation in the number of surgeons, hospital beds and elective surgical rates. Provinces with extensive insurance coverage prior to universal medical insurance reduced their combined elective surgery rate, while provinces where fewer people were insured showed increases. In the absence of different methods of payment for surgical services and marginal changes in the number of hospital beds and the number of surgeons, more insured persons produced more elective surgery.

Canada↗
PubMed2001

Racial and economic demographics of couples seeking infertility treatment.

OBJECTIVE: We characterized new infertility patients on the basis of race and economic factors. STUDY DESIGN: A retrospective chart review was performed of all patients seeking infertility evaluation from 1998 to 1999 at two infertility centers in Cincinnati, Ohio. Patients were categorized by race (white, black, or other). Statistics were analyzed by chi2 and logistic regression. RESULTS: Of 756 patients, 85.2% were white, 10.2% were black, and 4.4% were other. Infertility diagnoses were placed into the following 7 categories: ovarian, salpingitis, surgical sterilization, male factor, endometriosis, unexplained, and other. Black women had significantly more salpingitis than did nonblack women (P <.001) regardless of insurance status. However, surgical sterilization was more prevalent in patients without insurance regardless of race (P <.001). CONCLUSIONS: Our findings are consistent with previous studies showing that black women have more risk factors for salpingitis. Surgical sterilization risk factors were concordant with those of the National Center for Health Statistics.

Black or African American↗
PubMed1986

[Reasonableness of surgical interventions and compliance responsibilities in various insurance fields and under the social compensation law].

According to the German Social Legal Code I (I. Sozialgesetzbuch, SGB I) the recipient of social benefits is under obligation to submit to medical treatment if such treatment would result in an improvement of his/her condition or in the prevention of further deterioration (section 63 SGB I). In certain situations, lack of cooperation may result in total or partial refusalor withdrawal of benefits (section 66 SGB I). This social law parallels the civil law which can recognize, in the area of private liability, co-delinquency in cases of refusal of reasonable treatment (section 157. section 242 and 254 GBG). In private liability insurance, the acceptance of reasonable medical treatments is contractually anchored. - In practice, the underwriter is generally unable to enforce surgical interventions. In the administration of social benefits surgical measures are exempt from the obligation of cooperation through administrative rules and guidelines of the regional state departments. The entitlement to pensions for the visually handicapped ("Blindengeld"), based on the Federal Social Benefit Law (BSHG), is regulated at the state level through state organizations. The corresponding state laws do not provide for the termination of support in cases of refusal of reasonable and prognostically promising operations. The recipients of pensions for the blind are not addressed in SGB I. Benefit recipients are therefore not penalized for refusing reasonable medical measures. - In legal accident insurance and legal social security insurance there exist, under certain conditions, obligations to cooperate in line with SGB I.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethics, Medical↗
PubMed2004

Race, ethnicity, insurance coverage, and preoperative status of hip and knee surgical patients.

Our objective was to examine the association between race/ethnicity and insurance type and the preoperative status of patients undergoing joint arthroplasty surgery. Quality of life and WOMAC measures were collected preoperatively in a consecutive series of patients undergoing primary hip or knee arthroplasties (n = 573). Non-Hispanic whites had lower preoperative pain and WOMAC scores and higher Quality Well Being Index and SF-36 scores compared with other racial/ethnic subgroups. Patients with Medicare/private insurance had better preoperative scores relative to patients with Medicaid or no insurance. Racial/ethnic status was generally more strongly associated with preoperative status than was insurance type. Hispanics, blacks, and patients without Medicare or private health insurance reach arthroplasty surgery with lower preoperative functional and health status.

Arthroplasty, Replacement, Hip↗