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PubMed1975

A study of consumer attitudes about health care: the control, cost, and financing of health services.

The delivery of health care had emerged as one of the most important political issues of the 1970's, yet public attitudes about health issues remains a relatively unexplored subject. Little is known about the public's opinion of who should control the delivery of health care, about how the costs of health care are perceived, or about how the delivery of care should be financed. This paper relates respondent attitudes on these subjects to attitudes about criteria that determine the respondent's choice of ambulatory care facility and to socioeconomic, political, and other demographic characteristics. The data are derived from a survey (N=521) of households representative of the area of Rochester, New York.

Adolescent↗
PubMed1999

Increasing use of Medicare services by veterans with acute myocardial infarction.

OBJECTIVES: Some of the nation's 26 million veterans have two government-financed health care entitlements: Medicare and the Department of Veterans Affairs (VA). The aims of this investigation were to examine trends where Medicare-eligible VA users are initially hospitalized for acute myocardial infarction (AMI) and then to assess rates of cardiac procedure use and mortality for veterans initially admitted to each system of care. METHODS: We used VA and HCFA national databases to identify VA users (age range, > or = 65 years) who were initially admitted to a VAMC or Medicare financed hospital (Medicare hospital) with a primary diagnosis of AMI between January 1, 1992, and December 31, 1995, (n = 47,598). We examined the use of cardiac procedures (cardiac catheterization [CC], coronary artery bypass surgery [CABG], and coronary angioplasty [CA] and mortality (30-day and 1-year) by the type of initial admitting hospital within each system of care. RESULTS: Almost 70% of VA users hospitalized for AMI were initially admitted to Medicare hospitals versus VAMCs between 1992 (64%) and 1995 (72%). After adjusting for patient characteristics in logistic models, VA users initially hospitalized in Medicare hospitals were significantly more likely to undergo cardiac procedures than were VA users hospitalized in VAMCs. Differences in the odds of receiving a procedure were most significant when comparing Medicare hospitals with on-site cardiac technology to VA hospitals without on-site cardiac technology (CC: OR 4.34, 95% CI 3.98-4.73; CABG: OR 2.16, 95% CI 1.92-2.43; CA: OR 4.56, 95% CI 3.98-5.25). We found no significant differences in 30-day and 1-year adjusted mortality rates between VA users initially admitted to VAMCs or Medicare hospitals. CONCLUSIONS: Medicare-eligible VA users are increasingly hospitalized in Medicare hospitals for AMI. VA users cared for in Medicare hospitals receive more cardiac procedures but have the same survival as VA users cared for in VAMCs. These findings have policy implications for access, quality, and costs in both systems of care.

Aged↗
PubMedDate not supplied

Education financing.

Explore the source record for details and available documents.

Education, Nursing, Baccalaureate↗
PubMed1992

Public and private insurer designation of transplantation programs.

In an effort to assure quality and contain costs, several major private health insurers now restrict payment of transplantation procedures to designated programs, often referred to as centers of excellence. These insurers underwrite coverage for over 100 million people. Few transplantation programs meet the criteria set forth by insurers, thus raising concerns about patient access to care. The criteria being used by five private insurers and Medicare were obtained and reviewed. Insurers now designate kidney, heart, liver, heart-lung, pancreas, and bone marrow transplant programs based upon total annual transplant volume as well as one- and two-year patient and graft survival rates. Transplant center criteria vary according to procedure and type of recipient (i.e., pediatric vs. adult). Most insurers require hospitals to perform a minimum of at least 6, and up to 50 procedures annually. Expected one-year patient survival rates may exceed 90% and are often higher than 80%, although standards are usually lower for heart-lung and bone marrow transplantation. In addition, if centers meet the minimum volume and outcome criteria, insurers expect transplant centers to discount per procedure changes by as much as 25%. Patients are often offered incentives to use designated centers with insurers frequently paying travel costs and reducing or waiving copayment amounts. The designation of transplant programs by third-party payers has merit, although program volume requirements may have less validity than individual transplant surgeon and physician experience. Other problems are also apparent. For example, discount pricing is suspect, given the lack of data on actual transplant procedure costs. Also, some insurers intend to regionalize transplant programs, thus unnecessarily limiting patient access to care. Alternatively, the concentration of transplant activity at a smaller number of centers may enhance research opportunities. Nonetheless, transplant professionals, hospital administrators, and patient advocates remain wary of insurer objectives. There is concern that the designation of centers is simply another method by which insurers can avoid paying for transplants.

Costs and Cost Analysis↗
PubMed2005

Acknowledged funding sources in pressure ulcer literature: a systematic review.

OBJECTIVE: To identify pressure ulcer research funding sources. DESIGN: A systematic review of the acknowledgment sections of pressure ulcer literature published between 2000 and 2002. RESULTS: Sixty-four papers were identified that acknowledged funding sources. Governmental funding sources were acknowledged in 53% (n = 34) of these papers, followed by manufacturers (30%, n = 19), consumer/professional organizations (17%, n = 11), provider organizations (11%, n = 7), philanthropic organizations (11%, n = 7), and academic institutions (9%, n = 6). CONCLUSION: Although various governmental organizations fund most pressure ulcer-related projects, this systematic review found that many other sources of funding are available. Researchers are encouraged to explore multiple sources for funding clinical research.

Academic Medical Centers↗
PubMed2004

A national evaluation of school breakfast clubs: where does economics fit in?

STUDY OBJECTIVE: To describe the economics of UK school breakfast clubs, to estimate costs resulting from clubs and to investigate relationships between costs and outcomes. DESIGN: A postal survey of schools with a 1-year follow-up, a cluster randomized controlled trial, case studies, semi-structured interviews with parents and a secondary econometric analysis. SETTING: England, the UK. MAIN RESULTS: Key economic differences were identified between clubs based in primary schools and those based in secondary schools in terms of both funding levels and cost structures. However, funding levels were not a significant determinant of the observed outcomes in either type of school. CONCLUSIONS: For formal economic evaluation to succeed during implementation of a new initiative, a clearer understanding of relevant outcomes and the distinction between short- and long-term outcomes and potential individual, institutional and societal benefits are required from an early stage.

Child↗
PubMed2005

Paying for health in two Rwandan provinces: financial flows and flaws.

The study intended to analyse the financial flows in two provinces within the Rwandan health system through the review of all available documentation and through interviews with key informants, to assess the scope for improved resource allocation. In Rwanda, there exists a large deficit of available financial resources in the health sector in general, and more specifically at health centre level. To improve this situation, it is considered to cover a large proportion of the entire population by mutual health insurance schemes. The schemes are able to pool certain risks, and they definitely improve financial access to health services. Nonetheless, they are inaccessible to the 'very poor', and--due to their limited financial base--they are unable to cover a complementary health care package. It is unlikely that they will mobilize substantial additional resources for health. External long-term commitments are required to cover this gap. A reassurance and readjustment system between the various insurance schemes should be established in order to increase financial protection provided. It might link up with insurance schemes in the formal employment sector. The combination of such a support for health insurance with performance-related incentives for health staff has the potential to increase both equity and quality of health services simultaneously and substantially.

Financing, Government↗
PubMed1995

Privatization and just healthcare.

When advocates of insurance-privatization consider whether private insurance-dominated systems achieve justice at all, they tend to rely on an incomplete set of criteria for a just healthcare system. They also mistakenly assume that it is enough to show that justice is in principle achievable within a private insurance-dominated system. This essay offers a more complete set of criteria for a just healthcare system. It then argues that the motivational assumptions needed to make insurance-privatization at all plausible (on grounds of choice, efficiency, and quality of care) are inconsistent with the motivational assumptions needed to show that in practice a private insurance-dominated system will achieve justice. A private insurance-dominated system can be expected to satisfy the criteria for just healthcare only if (a) there is extensive and effective regulation to constrain the normal competitive behavior of private insurers or if (b) generous public funds are provided to fill the gaps in access left by the private insurance market. Yet the assumptions about the motivations and abilities of the public, regulators, and public officials needed to satisfy conditions (a) or (b) contradict the privatization advocate's explanations of how privatization will maximize efficiency, choice, and quality of care.

Altruism↗
PubMed2004

Subsidies and the demand for individual health insurance in California.

OBJECTIVE: To estimate the effect of changes in premiums for individual insurance on decisions to purchase individual insurance and how this price response varies among subgroups of the population. DATA SOURCE: Survey responses from the Current Population Survey (http://www.bls.census.gov/cps/cpsmain.htm), the Survey of Income and Program Participation (http://www.sipp.census.gov/sipp), the National Health Interview Survey (http://www.cdc.gov/nchs/nhis.htm), and data about premiums and plans offered in the individual insurance market in California, 1996-2001. STUDY DESIGN: A logit model was used to estimate the decisions to purchase individual insurance by families without access to group insurance. This was modeled as a function of premiums, controlling for family characteristics and other characteristics of the market. A multinomial model was used to estimate the choice between group coverage, individual coverage, and remaining uninsured for workers offered group coverage as a function of premiums for individual insurance and out-of-pocket costs of group coverage. PRINCIPAL FINDINGS: The elasticity of demand for individual insurance by those without access to group insurance is about -.2 to -.4, as has been found in earlier studies. However, there are substantial differences in price responses among subgroups with low-income, young, and self-employed families showing the greatest response. Among workers offered group insurance, a decrease in individual premiums has very small effects on the choice to purchase individual coverage versus group coverage. CONCLUSIONS: Subsidy programs may make insurance more affordable for some families, but even sizeable subsidies are unlikely to solve the problem of the uninsured. We do not find evidence that subsidies to individual insurance will produce an unraveling of the employer-based health insurance system.

Adult↗