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PubMed1980

Employment status after coronary bypass operations and some cost considerations.

The occupational consequences and expenses of the bypass operation have been investigated in 100 survivors of 102 consecutive operations for coronary artery bypass grafting. There was one late death 8 months after the operation, and four patients were lost to follow-up, providing a total of 95 patients for survey. Patients were divided into four groups: I, those working before and after the operation (43); II, those working before but not after the operation (18); III, those not working before the operation who returned to work after the operation (8); IV, those not working before or after the operation (26). The four groups were analyzed for age, type of employment, severity of disease, ventricular function, incidence of perioperative infarction, graft patency, postoperative treadmill performance, and exepnses incurred. Profiles of the four groups have emerged which may have predictive value. Group I patients tend to be under age 55, self-employed in higher skill occupations, and with significant left ventricular dysfunction. Group II patients tend to be over age 55, employed in lower skill occupations, but also without significant left ventricular function. Of the 34 patients unemployed for 6 months in 24 months before the operation, 24% (eight) returned to work after the operation. The typical total bill for diagnosis and treatment was $15,000, of which insurance paid $12,000 and the patient paid $3,000.

Age Factors↗
PubMedDate not supplied

Premium elasticities of health plan choice.

We estimate out-of-pocket premium elasticities of health plan choice using panel data from five Twin Cities employers. Using simple methods and a small data set, we replicate the findings of our previous study, which was considerably more detailed, difficult, and expensive. An increase of $5 in 1984 dollars ($6.95 in 1993) in the relative out-of-pocket premium for single coverage is predicted to decrease that plan's share of the single coverage market by .112 percentage points. The corresponding elasticity is approximately -7.9. This simple analysis should be repeated by other analysts in their market areas to determine the consistency of findings across geographic areas and over time.

Economic Competition↗
PubMed1994

National health expenditures: a global analysis.

As part of the background research to the World development report 1993: investing in health, an effort was made to estimate public, private and total expenditures on health for all countries of the world. Estimates could be found for public spending for most countries, but for private expenditure in many fewer countries. Regressions were used to predict the missing values of regional and global estimates. These econometric exercises were also used to relate expenditure to measures of health status. In 1990 the world spent an estimated US$ 1.7 trillion (1.7 x 10(12) on health, or $1.9 trillion (1.9 x 10(12)) in dollars adjusted for higher purchasing power in poorer countries. This amount was about 60% public and 40% private in origin. However, as incomes rise, public health expenditure tends to displace private spending and to account for the increasing share of incomes devoted to health.

Financing, Government↗
PubMed1975

Equity in paying for health care services under a national insurance system.

The debate over the future of the health care delivery system evolves around the policy issue of what constitutes a fair distribution of the medical services which are considered essential to prolonging life, curing disease, and relieving pain. A case can be made that a socially equitable distribution implies that consumption of medical services is independent of the consumer's income and payment for them unrelated to utilization. The present paper examines to what extent the provisions for financing a national health insurance system are likely to advance or hinder the fair distribution of health care services. Almost all bills specify a mix of direct (cost-shared) and indirect (prepaid) financing. When cost-sharing is based on the quantity of services or on the level of medical expenditure, it helps divert medical care and health insurance benefits to high-income persons at the expense of their low-or moderate-income counterparts. When indirect payments or premium levels are determined by insurance risks rather than by income, they may be too high for persons with moderate means, and are likely to exclude such persons from the national insurance program. When health insurance is tied to salaried employment, it discriminates against the unemployed and the self-employed. To rectify such inequities, some NHI proposals specify separate insurance plans for the disadvantaged. Such programs, which require income-testing to determine eligibility, are likely to be plagued by administrative complications currently engulfing other means-tested social welfare programs. The present paper makes some recommendations for the purpose of avoiding these difficulties and fostering equity in health care.

Deductibles and Coinsurance↗
PubMedDate not supplied

Planning for emergency medical services in Boston.

The results of a survey of 10,200 visits to 11 Boston hospital emergency rooms during a 9-day period in March 1972 are presented. The survey was designed to provide data on emergency room use to permit more informed planning by public agencies concerned with improving areawide emergency medical services. The 11 institutions surveyed provided virtually all of the emergency medical services in the city of Boston. A majority are teaching hospitals affiliated with one or more of the three medical schools in the area. Of the 11 hospitals, 3 accounted for 60% of all emergency room visits. Survey data were extracted from emergency room log sheets and hospital medical records of individual patients. Information collected included the residence pattern of patients within the geographic area, the patient mix by degree of urgency based on presenting complaints, mode of transportation to the hospital, and age and sex of the patients. Only 15 percent of the 10,200 visits were true emergencies. Fifty-seven percent were classified as urgant and 28% nonurgent. The mix among the 11 hospitals ranged from 7 to 22 percent in the emergency category, and 11 to 61 percent in the nonurgent classification. Trauma accounted for 19 percent of all admissions, with 3 percent attributed to fractures and 4 percent to head injuries. Fifty-six percent of the emergency cases required the services of an internist or pediatrician, 38 percent a surgeon, and 1 percent an obstetrician. The highest utilization rate--27 per 1,000 population--was recorded for the under 5 age group. Although the 65 and older age group had the lowest utilization rate of 6 per 1,000, this group had the highest rate of visits classified as emergencies. Children under 5 accounted for the highest proportion of nonurgent visits. The survey revealed that 30 percent of all hospital admissions were from the emergency room. One in four emergency patients lived outside the city of Boston. A neighborhood health center and a hospital general practice unit reduced hospital emergency room workloads appreciably, even when they were open only during daytime hours. Eighty-eight percent of all patients arranged for their own transportation, usually by private automobile. Of those arriving by ambulance, only 35 percent were classified as emergencies. The survey data reinforce the conclusion that major planning efforts should be concentrated on the management of the nonemergency patient. The data also emphasize the need for a single agency to be responsible for overall planning for emergency medical services on an area wide basis.

Adolescent↗
PubMed1976

National health expenditures, fiscal year 1975.

According to preliminary estimates of the Nation's health spending in fiscal year 1975, health expenditures reached $118.5 billion, or $547 per person. Total health spending showed a 14-percent rise, significantly higher than the increase in 1974 when price controls in the health industry were in effect for most of the year. The acceleration of health spending during 1975 was accompanied by a slackening in the growth of the gross national product. Expenditures for this purpose, as a share of the GNP, thus rose significantly to 8.3 percent. Public spending grew two and one-half times as fast as private spending in 1975, mainly because of the continuing expansion of Medicare and Medicaid. Third parties financed an estimated two-thirds of all personal health care spending, with the government share 40 percent and that of private insurance 27 percent.

Aged↗
PubMed1996

Local television news coverage of President Clinton's introduction of the Health Security Act.

OBJECTIVE: To investigate how local television news reported on health system reform during the week President Clinton presented his health system reform bill. DESIGN: Retrospective content analysis of the 1342-page Health Security Act of 1993, the printed text of President Clinton's speech before Congress on September 22, 1993, and a sample of local television news stories on health system reform broadcast during the week of September 19 through 25, 1993. SETTING: The state of California. RESULTS: During the week, 316 television news stories on health system reform were aired during the 166 local news broadcasts sampled. Health system reform was the second most frequently reported topic, second to stories on violent crime. News stories on health system reform averaged 1 minute 38 seconds in length, compared with 57 seconds for violent crime. Fifty-seven percent of the local news stories focused on interest group politics. Compared with the content of the Health Security Act, local news broadcasts devoted a significantly greater portion of their stories to financing, eligibility, and preventive services. Local news stories gave significantly less attention to cost-saving mechanisms, long-term care benefits, and changes in Medicare and Medicaid, and less than 2% of stories mentioned quality assurance mechanisms, malpractice reform, or new public health initiatives. Of the 316 televised news stories, 53 reported on the president's speech, covering many of the same topics emphasized in the speech (financing, organization and administration, and eligibility) and de-emphasizing many of the same topics (Medicare and Medicaid, quality assurance, and malpractice reform). Two percent of the president's speech covered partisan politics; 45% of the local news stories on the speech featured challenges from partisan politicians. CONCLUSIONS: Although health system reform was the focus of a large number of local television news stories during the week, in-depth explanation was scarce. In general, the news stories provided superficial coverage framed largely in terms of the risks and costs of reform to specific stakeholders.

Data Collection↗
PubMed1996

The era of health care reform and the information superhighway. Implications for radiology.

Radiology is undergoing dramatic change, along with the rest of the health care system, in its mode of organization, financing, and delivery. Information technology is becoming central to health care delivery and will enable a higher degree of integration of imaging practice with the rest of the health care system. Radiology will need to address the requirements for achieving this integration to continue to be successful in the future.

Computer Communication Networks↗
PubMed1996

Use of nursing informatics in advanced nursing practice roles for building healthier populations.

Dynamic changes in health care delivery organization, financing, and role of the consumer present an unprecedented opportunity for advanced practice nurses (APNs) to provide quality care to individuals and aggregates that emphasize health promotion, disease prevention, and health care management at a reasonable cost. APNs can use nursing informatics to help build healthier populations. This article outlines the major information needs dictated by the complex changes in health care, the power of information, and the strategies for ensuring access to information by APNs to meet the goal of building healthier populations.

Databases, Factual↗
PubMedDate not supplied

Delivering health and mental health care services to children in family foster care after welfare and health care reform.

As the 20th century draws to a close, fundamental changes in the organization, financing, and delivery of health care and welfare services, principally directed at poor families, are likely to result in an increased number of children entering out-of-home care. These children typically have significant physical, mental health, and developmental problems. Whether the quality of health care services they receive will improve as a result of health care reform efforts and new approaches to service delivery remains to be seen. This article addresses some of the major changes wrought by welfare and health care reform and describes the essential features of a health care system that can meet the special needs of children in care.

Child↗