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Biomedical subjects

C E Begley

Publications and source records attributed to C E Begley.

36 records · Page 2Linked to original sources
PubMed1989

Evaluation of a primary health care program for the poor.

This paper examines the success in implementing a major program involving a partnership between public and private providers to deliver primary health care services to the poor. In 1985, the 69th Texas Legislature passed the Primary Health Care Services Act, authorizing the Texas Department of Health to contract for or directly provide primary health care services in those parts of the state that are medically underserved and have large numbers of people in poverty. This paper evaluates the potential impact of the projects with respect to access and cost. The study revealed that the basic concept of allowing local public and private providers to develop projects reflecting their community's unique needs and resources was successful. The approach lead to a wide variety of different types of projects, but the basic goals and activities of the projects are consistent with the legislation. The evaluation identified three major program areas that could be improved: (1) patient monitoring and follow-up to ensure the accessibility of the priority primary care services, (2) the need for the development of projects in other high need areas of the state, and (3) greater efficiency in service delivery.

Health Resources↗
PubMed1989

A cost-effectiveness evaluation of primary health care projects for the poor.

A cost-effectiveness analysis was conducted to determine the relative efficacy of nine primary health care projects serving low income persons in urban and rural areas of Texas. The projects were created as part of a government program to provide services in medically underserved areas of the state by contracting with local public and private providers. While they vary widely in terms of sponsoring organizations, service strategy, and scope of services, the projects share a similar goal of providing an array of basic medical and preventive care services to the poor. This study compares the average cost per encounter for diagnosis/treatment, emergency, family planning, and preventive health screening services provided by the various projects during the first year of operation. After adjusting for differences in input prices and patient volume, the cost differences are examined and related to organizational model and personnel mix. Those projects with the highest ratio of nonphysician to physician practitioners proved more cost-effective, as did those projects following the public clinic model of service delivery.

Community Health Centers↗
PubMed1989

Health care spending in Texas: 1980-1986.

This paper reports health care spending and payment patterns for Texas by category of service. Various methods and sources are used to generate annual estimates of total spending, state government spending, and spending per person. The basic approach is similar to that used by the US Health Care Financing Administration in estimating national health care spending. Comparisons between spending in Texas and the nation are made and various reasons for differences are discussed.

Health Expenditures↗
PubMed1987

Prospective payment and medical ethics.

This article considers the ethical implications of prospective payment from the perspective of physicians and other health care practitioners. It focuses on the argument that prospective payment creates ethical conflict by giving physicians an economic incentive to do less for their patients. This argument is criticized in two respects. First, available evidence is reviewed which suggests that the incentives actually created by different prospective payment schemes and their effect on "optimal" patterns of practice is uncertain. Further, it is pointed out that ethical conflict originates in the dual role of physicians as agents and suppliers of service. Recognizing that such conflict exists under any payment mechanism, a better focus for the ethical evaluation of prospective payment is suggested that considers whether the incentive to do less is likely to have adverse effects on physician decisions, relative to decisions made under other payment mechanisms.

Cost Control↗
PubMed1985

Some problems with pro-competition reforms.

As the search for effective cost-containment policies continues, health care reform along pro-competition lines has gained considerable backing in the United States. By offering market competition to achieve allocational efficiency and vouchers and tax credits to achieve distributional equity, pro-competition reforms appear to satisfy what many believed were incommensurable goals. A critical review of this strategy reveals two practical difficulties, however. The first concerns the ambiguity arising from the proposals' reliance on the concept of equal access to some basic level of health care as its distributional objective and the second concerns the ethical dilemma arising from the proposals' reliance on physicians as rationers of health care. In considering the distributional goal of guaranteeing access to a basic minimum of health care, we argue that, despite its theoretical attractiveness, there exists no acceptable way of determining or justifying its content, and without a clear definition of the basic minimum there is no guarantee that any equity objective will be achieved under the pro-competition strategy. With regard to the use of physicians and other providers as society's gatekeepers, we point out that this role is in direct conflict with traditional responsibilities that patients expect providers to assume. Requiring doctors to ration services in response to market incentives may further erode the trust relationship between physicians and patients, and clearly puts the more seriously ill at a disadvantage.

Cost Control↗
PubMed1985

Are DRGs fair?

Explore the source record for details and available documents.

Diagnosis-Related Groups↗
PubMed1983

The effects of implementation problems on certificate of need decisions in Illinois.

There has been a lack of appreciation of the complexities of implementing certificate of need (CON) programs and, further, the effects of those implementation problems on the program's effectiveness. This study describes implementation problems and presents some evidence of their impact on approval rates in one state. Start-up phase problems included non-reviewable projects, exempted projects and pre-emptive actions by the hospitals to avoid the regulations. It is estimated that these problems raised the program's approval rate by 12 percent and resulted in approximately +310 million of capital costs and an unknown increase in operating costs. Two problems of continuing implementation are identified. The first concerns the availability and specification of the standards and criteria for project review. The second problem is the lack of significant compliance mechanisms. The Reagan administration has made massive cuts in support for health planning and CON programs. The rationale for these cuts is based on the belief that CON has not been effective in reducing the escalation of hospital costs. This article indicates some of the reasons for its impotence.

Certificate of Need↗
PubMed1982

Factors that may explain interstate differences in certificate-of-need decisions.

A major difficulty in conducting studies of the impact of certificate-of-need programs is in accounting for interstate differences in program characteristics. This paper addresses this problem by examining the empirical relationship between various characteristics of certificate-of-need programs and program decisions, measured in terms of the approvals of hospital capital projects. Aggregate data on capital expenditure approvals and net bed change approvals for 28 States are correlated with an index of each State's regulatory characteristics that was developed in an earlier study. In addition, a multivariate model of certificate-of-need approvals is estimated in which certain measures associated with the need for hospital capital in a State are introduced, along with the indices of regulatory characteristics, to explain interstate differences in regulatory characteristics, to explain interstate differences in program decisions. The results of this analysis indicate that although regulatory characteristics are significantly correlated with the relative number of new beds approved, they have little correlation with total capital expenditure approvals. Moreover, variables reflecting the need for new hospital capital in a State, such as past population growth and existing hospital capacity, appear to be more important than regulatory characteristics in explaining the relative amount of capital approvals.

Capital Expenditures↗
PubMedDate not supplied

The incremental cost of screening, diagnosis, and treatment of gonorrhea and chlamydia in a family planning clinic.

A standard cost-finding methodology was used to estimate the incremental expenses associated with the provision of screening, diagnostic and treatment services for N. gonorrhoeae and Chlamydia trachomatis in a family planning clinic serving high risk adolescents. The study included both the personnel and nonpersonnel costs accrued in administering screening and diagnostic tests, contacting patients with infection, treating patients with infection, and administering tests of cure. The cost per screening test averaged $9.74 when part of a routine family planning visit. Diagnostic tests provided to drop-ins with symptoms averaged $19.92. Treatment-related costs per visit averaged $24.97. The total incremental cost of providing STD screening, diagnosis, and treatment services in the clinic represented 14% of the clinic's overall budget during the study period.

Adolescent↗
PubMedDate not supplied

Cost of epilepsy in the United States: a model based on incidence and prognosis.

A model of the clinical course of epilepsy from onset until remission or death has been developed for six prognostic groups, including survival, use and cost of medical care, and time lost from work and housekeeping. The model has been used to generate preliminary estimates of the lifetime cost of epilepsy for a cohort of persons diagnosed in 1990 in the United States. The distribution of incident cases among prognostic groups is derived from epidemiologic studies of prognosis in epilepsy. Direct cost is estimated by multiplying nationally representative unit costs by the expected type and frequency of medical care use. The latter were derived by an expert panel, based on inferences from existing literature and on their own clinical experiences. Indirect cost is estimated based on lost earnings associated with projections of restricted activity days, excess unemployment, and excess mortality. Total lifetime cost in 1990 dollars of all persons with epilepsy onset in 1990 was estimated at $3.0 billion, with indirect cost accounting for 62% of the total. Cost per patient ranged from $4,272 for persons with remission after initial diagnosis and treatment to $138,602 for persons with intractable and frequent seizures. Antiepileptic drug (AED) treatment is the most costly category of service. Different assumptions about the amount and type of drug administration cause major changes in overall cost estimates.

Adolescent↗
PubMedDate not supplied

Cost-benefit analysis of safety belts in Texas school buses.

Although safety belts have been shown to reduce the risk of serious injury or death in automobile crashes, evidence of their effectiveness in school buses is uncertain. In this paper, the potential costs and benefits of mandatory safety belts in Texas school buses are estimated, based on the assumption that their effectiveness is less than or equal to rear seatbelt effectiveness in autos. Costs are based on both retrofitting old buses with belts and installing them in new buses. Benefits include the direct and indirect (forgone earnings) cost-savings from preventable injuries and fatalities. Results indicate that a law mandating safety belts in Texas school buses would not be cost-beneficial. Annual benefits would exceed the annual costs of installing belts in new school buses. However, the benefits would not be large enough to compensate for the five-year costs associated with retrofitting old buses.

Adolescent↗