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Biomedical subjects

B Dowd

Publications and source records attributed to B Dowd.

At least 55 records · Page 3Linked to original sources
PubMed1991

Strategies employed by HMOs to achieve hospital discounts: a case study of seven HMOs.

This article is a summary of seven health maintenance organization (HMO) case studies focusing on strategies used to obtain favorable prices for inpatient hospital services. All of the HMOs stressed that the effort should be based on the local environment and should accommodate the special circumstances of organization of physicians' practices and hospitals, as well as the structure of the HMO and its strategic plan for growth.

Health Care Coalitions↗
PubMed1990

The relationship of house staff experience to the cost and quality of inpatient care.

The inexperience of house staff has been offered as one explanation for the increased cost of care at teaching hospitals, but conclusive evidence for this has been lacking. We studied the relationship of house staff experience to the cost and quality of inpatient care in a large series of internal medicine patients at one teaching hospital. We defined house staff experience by the month of academic year during which the patient received care. Our measures of cost were length of hospital stay and total hospital charges, while our measures of quality were hospital deaths, hospital readmissions, and nursing home placement. Multiple linear regression analysis on 21,679 hospital discharges revealed increasing house staff experience to be associated with a significant decline in length of stay (95% confidence interval for b, -0.006 to -0.066 days per discharge per month of house staff experience) and total hospital charges (95% confidence interval for b, -0.002 to -0.017 log dollars per discharge per month of house staff experience). These findings constitute an estimated average decline of 0.43 days per discharge and +370 per discharge over the academic year. Logistic regression analysis found no relationship of house staff experience to hospital deaths, readmissions, or nursing home placement. These findings suggest that the process of training inexperienced physicians may represent an important source of inefficiency for teaching hospitals struggling in a competitive environment.

Costs and Cost Analysis↗
PubMed1990

Effects of HMOs on the creation of competitive markets for hospital services.

Why do health maintenance organizations (HMOs) use particular hospitals, and do they concentrate patients in hospitals where they obtain low prices? We answered these questions with a study of six HMOs in four large metropolitan areas in 1986. A two-part model was estimated for the probability that a hospital would be used and the demand for general inpatient admissions at hospitals that were used. Four staff-network plans in our study do shop for hospital services on the basis of price more than was generally believed. However, two independent practice association (IPAs) plans use more hospitals in the community and do not concentrate patients effectively at hospitals that offer the lowest prices.

Bed Occupancy↗
PubMed1989

The role of health practices in HMO selection bias: a confirmatory study.

This research examines the relation between employees' health practices and health plan selection. A previous study, limited to one firm, showed that employees choosing a health maintenance organization (HMO) and a fee-for-service (FFS) plan had similar health practices. We extend this inquiry to 17 Minneapolis employees, all of whom offer at least one FFS plan and one or more of the 6 Twin Cities HMOs. Health practices were measured by cigarette smoking, heavy drinking (or abstinence from drinking), use of seat belts, and exercise. We estimated health plan choice equations that show that employees with poor health practices do not systematically prefer FFS plans compared with independent practice associations (IPAs). Nor do they select FFS or IPA plans compared with HMOs on the basis of health habits. We suggest that HMOs do not gain long-term cost advantages by enrolling employees with favorable health practices.

Choice Behavior↗
PubMed1989

Differences in inpatient resource use by type of health plan.

Approximately 50% of the annual increase in hospital costs comes from increased resource use per hospital admission. Health maintenance organizations (HMOs), given their fixed financial resources for patient care, have an incentive to constrain their enrollees' use of hospital resources. Our analysis investigates differences in length of stay, total charges, and the ancillary to total charge ratio for hospitalized patients in network HMOs, independent practice associations (IPAs), and fee-for-service (FFS) health plans in the Twin Cities from 1982 to 1984. Network HMO patients in several diagnostic categories are found to use significantly fewer resources, once hospitalized, than patients in either IPA or FFS plans. This difference may give network HMOs a competitive advantage in the market for health plans.

Group Practice↗
PubMed1989

Health maintenance organizations: the beginning or the end?

This article describes the changes taking place in a mature HMO market that has been identified as a bellwether HMO community, the Minneapolis-St. Paul metropolitan area. We describe how this market--previously characterized by traditional HMOs and traditional fee-for-service plans--has been transformed within the past five years into a market with a variety of plans competing on the dimensions of premiums, provider choice, and coverage. Among the most significant changes are the evolution of the local Blue Cross and Blue Shield plan into a form resembling an individual practice arrangement (IPA) with broad coverage and broad provider choice, and the appearance of preferred provider plans sponsored by the HMOs. We suggest that such changes have blurred the distinction between health plan types, making traditional plan designations no longer valid for either health policy analysis or health services research. For example, studies contrasting the performance of HMOs and fee-for-service plans should concentrate instead on the various dimensions of these plans, such as coverage and openness of provider choice. The article is intended to stimulate discussion and to suggest a new framework for describing health plan competition.

Fees, Medical↗
PubMed1986

Is there a competitive market for hospital services?

This paper focuses on the price elasticity of hospital-specific demand curves. Each hospital is assumed to practice price discrimination with respect to Medicare, Medicaid, and other patients. Among the third group, patients covered by Blue Cross are analyzed separately from those who pay their own bills or are covered by commercial insurance or a health maintenance organization (HMO). We use two different methods to estimate the price elasticity of demand. First, a pricing rule is developed from which hospital-specific price elasticities may be inferred. Second, the distribution of each payer's admissions at specific hospitals is examined to determine if low-priced hospitals attract more patients. Data for the analysis are taken from 31 hospitals in the Minneapolis-St. Paul metropolitan area in 1981. Results of the first analytic method indicate that hospitals had monopoly power in their markets for Blue Cross and self pay/commercial insurance/HMO patients. These results are confirmed and extended to Medicare patients by the hospital demand analysis.

Blue Cross Blue Shield Insurance Plans↗
PubMed1986

The competitive impact of health maintenance organizations on hospital finances: an exploratory study.

In this study we explore whether HMO-induced competition has contained expenditures in Minneapolis/St. Paul hospitals. Specifically, we assessed the impact of HMOs on revenue, cost, and net income per admission in Twin Cities hospitals from 1979 to 1981. Some HMOs have obtained negotiated discounts from hospitals. We found that hospitals which gave larger discounts did not have lower costs per admission. This finding suggest that discounts do not force hospitals to operate more efficiently. In addition, hospitals with a large share of patients from HMOs or government Medicare and Medicaid programs did not have lower costs per admission than other hospitals during the years from 1979 to 1981. This finding casts doubt on the claim that discounts are justified by lower costs for HMO or government patients. Finally, neither HMO market share nor discounts had an adverse effect on hospital profits. During the three years studied, hospital profits in the Twin Cities showed an upward trend. This study concludes that if competition is to succeed it must encompass more than HMOs. HMOs may be important, but they are only one agent in the market. Thus, public policy created to induce competition must go beyond the simple stimulus of HMO growth.

Blue Cross Blue Shield Insurance Plans↗
PubMed1985

Biased selection in Twin Cities health plans.

The data in Tables 1 through 4 show significant differences in the enrollment of higher health-related financial risk individuals and their families among health plans. FFS enrollees are older and exhibit more chronic illness on average. IPAs enroll a greater proportion of females than do PGP or FFS plans. PGPs and IPAs do not differ significantly in the age and chronic illness of their enrollees, but IPAs enroll a significantly greater proportion of females than do PGPs. The age difference between FFS and prepaid plans appears to be greater for long-term enrollees. The same pattern is true of chronic illness, but the results are often not statistically significant. We do not have time-series data, however, and cannot conclude that future comparisons among long-term enrollees will remains as they are now. In any care our data do not support the hypothesis that biased selection is a short-term problem that will be corrected as the population in prepaid plans ages. Our data contain a cross-section of environments for health plans in firms: long- and short-term offerings, long- and short-term enrollees, high and low out-of-pocket premium costs, etc. Our strongest results are the simplest: across all plans and environments there are significant differences in enrollee characteristics. These differences would not be inefficient if all groups paid actuarially fair premiums. However, mandatory offering and community-rating allow prepaid plans to enroll a younger population with less chronic illness and to maintain an information asymmetry that prevents employers and employees from determining--either prior to or following enrollment--the relationship of the prepaid plan's premium to its marginal cost.

Age Factors↗
PubMed1984

Corporate benefit policies and health insurance costs.

We tested the hypothesis that health insurance premium costs per employee are lower for employee groups where multiple health plans are offered and the employer pays a level dollar amount of the chosen premium than for employee groups where these two conditions are not met. Proposed national legislation relies on these conditions to create a competitive health care market. Data on 56 employee groups in 1981 and 66 employee groups in 1982 were collected from two surveys of large employers in Minnesota. Regression analysis of premium data from both surveys rejected the hypothesis. Indemnity plans in multiplan groups were cheaper if the employer paid a level dollar contribution versus a level percent (including 100) contribution. However, groups offered only an indemnity plan had lower premiums than groups meeting the two legislative conditions. These findings apply to both individual and family coverage premiums and are not caused by systematic differences in benefit provisions, employee demographics or factors influencing loading charges. Our findings cast doubt on attempts to achieve health care competition by legislative changes in insurance options and contribution methods.

Deductibles and Coinsurance↗
PubMed1984

Effects of contract management on hospital performance.

The performance of contract-managed (CM) hospitals is compared to that of a set of internally managed hospitals matched on a variety of hospital and market area characteristics. The performance of the study hospitals was similar to that of the matches in the years before the onset of contract management. Among 12 performance indicators, only occupancy rates differed significantly in the two samples in the years before contract management. Occupancy rates were lower on average in the hospitals which later became contract managed. During the 3 years following the onset of contract management, the CM hospitals showed no improvement in productive efficiency but did show changes in the way services were priced. The ratio of gross patient revenue to total expense increased significantly in the CM hospitals relative to their matches. This increase also appears to be associated with an increase in net profits in the CM hospitals relative to their matches.

Contract Services↗
PubMed1983

The effects of competition on prescription-drug-product substitution.

Almost all states have enacted legislation, that allows pharmacists to substitute drug products when filling prescriptions. We studied the effects of competition in the drugstore service area on the use of less costly drug products and the pricing of prescriptions under the drug-product-selection law in Minnesota. In 38 drugstores in the Minneapolis-St. Paul area, rates of substitution of generic or less-costly brands and prescription prices were analyzed according to the degree of competition in the drugstore's service area, as measured by the pharmacists' perceptions and the number of competing drugstores within a 1-mile radius. Although higher levels of competition were associated with increased use of generic drugs for prescriptions written generically, competition did not appear to affect either dispensing patterns for prescriptions written for brand-name products or the retail prices of brand-name or generic products. These findings do not support the hypothesis that competition reduces prescription-drug prices through improved selection of drug products at the retail pharmacy level.

Drug Prescriptions↗
PubMed1983

A model of physicians' practice attributes determination.

This paper presents a conceptual framework for modelling physicians' styles of practice. It also develops and estimates a causal model of practice style determination. The method allows simultaneous analysis of different practice styles and their determinants. The paper provides new insights into physician decision-making and, in particular, the positive relationship between fees and the number of physicians.

Career Choice↗
PubMed1980

Glucose-6-phosphate dehydrogenase and its relationship to mental retardation.

This study involved 100 patients who were classified as mentally retarded and who were hospitalized under state care. These patients, during the course of their annual physical, were screened for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. The incidence of G-6-PD deficiency for both black and white subjects (S's) was compared to the incidence of G-6-PD deficiency to be expected in a normal population of each ethnic group. The screening and subsequent statistical analysis of the data indicates that the incidence of G-6-PD is drastically higher among Caucasian males in the atypical population than is to be expected and it is somewhat higher among the atypical Negroes. A chi-square analysis of the observed incidence as compared to the expected incidence produces a difference that is statistically significant to the .001 level for the Caucasians. It is felt that the results of the study, albeit, based on only 100 S's, indicates strongly that there may be a relationship between G-6-PD deficiency and limited mental capacity.

Anemia, Hemolytic↗