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Biomedical subjects

B Dowd

Publications and source records attributed to B Dowd.

58 records · Page 4Linked to original sources
PubMedDate not supplied

Call nights and patients care: effects on inpatients at one teaching hospital.

OBJECTIVE: To determine whether the timing and number of patients admitted by internal medicine housestaff under a traditional call schedule affect the resource utilization and outcome of care for those patients. DESIGN: Retrospective cohort study, using existing computerized records. SETTING: University-affiliated 340-bed city/county teaching hospital. PATIENTS/PARTICIPANTS: 22,112 patients discharged from the internal medicine service who had been admitted by an on-call first-year resident between January 1, 1980, and December 31, 1987. MEASUREMENTS AND MAIN RESULTS: Admission after 5:00 PM was associated with decreased hospital length of stay (8.1%, p less than 0.0001), but increased total charges (3.1%, p = 0.007). The relative risk of inpatient mortality for patients admitted at night was 1.21 (p = 0.03). Patients of busier housestaff, as indicated by a larger number of on-call admissions, had lower total charges (1.7% decreased per admission) and no change in risk of inpatient mortality. While no linear relation was found between number of admissions and length of stay, analysis of nonlinear effects revealed that length of stay first rises, then falls as interns receive more on-call admissions. CONCLUSIONS: The number and timing of admissions by on-call internal medicine housestaff are significantly related to length of hospital stay, total charges, and likelihood of inpatient mortality at one teaching hospital. These variations should be considered in planning the reform of residency training programs.

Adult↗
PubMedDate not supplied

A tale of four cities: Medicare reform and competitive pricing.

The current payment system for Medicare + Choice (M + C) plans is based on prices calculated from administrative records. This system has been criticized as arbitrary, inefficient, and unfair. Most Medicare reform proposals would replace the current payment system with some form of competitive pricing. However, efforts over the past five years to demonstrate competitive pricing for M + C plans have been blocked repeatedly by Congress, even when the demonstrations were directly responsive to a congressional mandate. In the absence of political support, a demonstration of competitive pricing may be infeasible, and Congress could be forced to take the risky step of implementing broad Medicare reforms with very little information about their effects.

Arizona↗
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↗