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PubMed1998

Changes in charges and costs associated with hospitalization of patients with mandibular fractures between 1991 and 1993.

PURPOSE: The purpose of the study was to examine the changes in costs, charges, and income related to hospitalization of patients with mandibular fractures treated over a 3-year period. PATIENTS AND METHODS: The study involved retrospective analysis of data on 97 patients treated by the Department of Oral and Maxillofacial Surgery between 1991 and 1993. Biographical data were obtained from the Trauma Registry, and the financial data were obtained from the Financial Services Administration. The study examined the changes in costs and charges of hospitalization, insurance status, reimbursement, total revenue, and income losses from hospitalization of patients admitted with a primary diagnosis of mandibular fracture. In addition, the study examined the changes in costs of major items involved in treatment. Possible variables such as age, gender, and cause of fracture were also recorded. RESULTS: Twenty-nine patients were admitted in 1991, 35 in 1992, and 33 in 1993. These patients were predominantly young males. The average cost of treatment decreased by 2% in 1992 and increased by 58% in 1993. The average charge increased by 12.9% in 1992 and by 76.8% in 1993. The total reimbursement increased by 11.2% in 1992 and by 47.7% in 1993. The average payment per patient to the institution by third-party payers decreased by 7.8% in 1992 and increased by 56.6% in 1993. The loss of income to the institution (cost minus reimbursement) increased by 105.9% in 1992 and by 58% in 1993. The average institution income loss from the care for each patient increased by 70.6% in 1992 and by 67.8% in 1993. CONCLUSIONS: This study showed that there was a continued increase in costs, charges, and income loss for hospitalization of mandibular fracture patients during the years 1991 to 1993, whereas the reimbursement rate decreased from 65% to 47% of the charges. The increase in cost of supplies and use of rigid fixation, the increase in the number of uninsured patients, and the pricing practices of the institution were possible causes of these changes.

Academic Medical Centers↗
PubMed1990

Liability for medical record disclosure is real but rare.

The most recent public concern for patient confidentiality has centered on the medical records of AIDS patients. However, a new confidentiality concern is the liability of the self-insured hospital that reviews medical claims internally. Also, the sometimes conflicting demands of protecting patient confidentiality and being reimbursed in a timely fashion are setting off sparks between the medical records department and the business office.

Confidentiality↗
PubMedDate not supplied

Evidence from the National Survey of Family Growth. Work during pregnancy and subsequent hospitalization of mothers and infants.

Large and increasing proportions of women work late into pregnancy and resume work soon after delivery. If work in those periods injures their health or that of their infants, this trend would be of public health concern. Data on ever-married primaparas from the National Survey of Family Growth conducted by the National Center for Health Statistics were used to investigate the relationship between working in the last trimester of pregnancy and two indicators of illness--hospitalization of women for complications of pregnancy and hospitalization of their infants during the first year of life. Hospitalization of the mother or child occurred for 15.0 percent of the primaparas. For primaparas who worked in the last trimester of pregnancy, the percentage was slightly higher--17.1 percent. In two groups, black women and women without hospital insurance for delivery, the percentage of mothers or infants hospitalized was much higher among the mothers who worked in the third trimester than among those who did not. The association of working late in pregnancy with higher rates of hospitalization does not mean, necessarily, that working is a cause of hospitalization. It does indicate, however, the need for epidemiologic and medical research on the relationship.

Adolescent↗
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↗
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↗
PubMed1986

Actuarial status of the HI and SMI Trust Funds.

This article is adapted from the 1986 annual reports of the Medicare Board of Trustees. It presents a summary of the current financial and actuarial status of the Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) Trust Funds. The Board found that the present financing schedule for the HI program is barely sufficient to ensure the payment of benefits through the late 1990's if the intermediate (II-A and II-B) assumptions underlying the estimates are realized. Although steps have been undertaken to reduce the rate of growth in payments to hospitals, the Board urges Congress to take remedial measures to bring future HI program costs and financing into balance. The Board found the SMI program to be actuarially sound but recommends that Congress take action to curtail the rapid growth in that part of Medicare.

Actuarial Analysis↗
PubMed1993

Cost-effective health care: the Rochester experience.

Rochester, New York, has been cited repeatedly for having achieved one of the most cost-effective and efficient health care systems in the country. The determinants of the success of this system include a long history of comprehensive health planning; innovative hospital reimbursement programs; community-rated health insurance; and high levels of mutual cooperation among business, insurers, hospitals, and physicians. The Rochester system promotes the goals of access, quality, affordability, and provider satisfaction through a balanced approach to regulation and competition.

Cost-Benefit Analysis↗
PubMed1980

Hospital pharmacy in Canada.

The status of Canadian hospital pharmacy and the impact of national hospital insurance on its development are discussed. The provision of health care services for Canadians is shared by the federal and provincial governments. The federal government enacts protective and regulatory legislation, compiles health statistics, promotes research, and provides direct health care for those citizens for whom it is directly responsible. Each province is responsible for hospitals, the education and training of health care professionals, public health, and the financing and administration of health insurance for all its citizens. Largely because of line-item budget allocations and a bureaucratic tendency to equalize services for the whole population, funds for existing pharmaceutical services have been assured but the introduction of upgraded or innovative programs has been difficult to achieve. The result has been an even quality of health care services, including pharmacy, throughout the country and a deficiency in clinical pharmacy programs and the trained personnel to run them. The last decade has brought advances, however, as allocation methods have changed and both hospital and insurance administrators have recognized the patient benefits and cost effectiveness of many of the newer pharmacy programs. The main challenges facing Canadian hospital pharmacy are to upgrade clinical services and education and to improve managerial and bureaucratic competence among department directors.

Canada↗
PubMed1996

Measuring hospital outcomes from a buyer's perspective.

This study reports lessons learned from a project to develop a flexible, generalizable, and valid method for corporate buyers of hospital care that would permit them to use available secondary data to rate the outcomes quality of all hospitals in a local market area. As hospitalization insurance has moved from coverage that applied equally to all licensed hospitals to arrangements which selected a certain preferred hospital or hospitals and rejected others, the need to determine the quality of different hospitals (as well as what they would cost the insurer or buyer) has become apparent. The product of this project was the development and demonstration of a set of rating methods that build on the strengths available in large hospital discharge data bases, such as (but by no means limited to) that of the Pennsylvania Health Care Cost Containment Council (PHC4). These measures, or others developed using these methods, deal with uncertainty in the data--its diagnosis and treatment--in a conceptually valid and practically useful way, illustrate a process that might be used in the general development of quality measures, and provide a useful critique of some other measures.

Commerce↗