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Biomedical subjects

D A Conrad

Publications and source records attributed to D A Conrad.

At least 55 records · Page 3Linked to original sources
PubMed1987

Dental care demand among children with dental insurance.

As the number of families with dental insurance and expenditures for dental care has increased over the past two decades, so has interest in determining cost-sharing effects on dental demand among insureds. Using a representative sample of Pennsylvania Blue Shield children insureds during 1980, we estimate cost-sharing effects on dental demand for basic (diagnostic, preventive, restorative, endodontic, and extraction services) and orthodontic care. Results indicate that cost-sharing has little influence on the probability of using any dental services and basic expenditures. However, the probability of using orthodontic services decreases 2.1 percent when the proportion of orthodontic expenditures paid by the parent increases 10 percent. By reducing the cost of care, cost-sharing reduces social class differences in dental demand common in unisured populations, likely producing public oral health benefits.

Child↗
PubMed1987

Dental care demand: insurance effects and plan design.

This study concentrates on an important health policy question: the impact of dental insurance on the demand of adults for dental services. Demand equations for individuals are estimated from a systematic random sample of 4,173 families with complete information on their dental claims (insured through Pennsylvania Blue Shield) and survey data. The principal contributions of the research are twofold: (1) to provide rigorous, large-sample estimates of the demand for dental services of insured individuals--providing a complementary set of "natural" experiment results to the randomized experiment results of the RAND Health Insurance Experiment--and (2) to estimate the incremental effects on dental care demand of certain factors related to adverse selection. The study is a companion to a previously published study of children by the same authors. Generally, the analysis shows relatively small money price elasticities of dental care demand among this insured adult population (ranging from -.01 to -.266 across specific types of service). Given a finding that total expenditures for Basic services are 37 percent and 90 percent higher, respectively, for community-rated (versus experience-rated) primary subscribers and insureds, we conclude that differential adverse selection between community- and experience-rated groups accounts for significant differences in dental demand.

Adult↗
PubMed1986

Coinsurance effects on dental prices.

For many Americans the cost of dental services represents a barrier to receiving regular dental care and maintaining proper oral health. The recent growth of the dental insurance industry, however, may partly offset this price barrier among insureds. Our purpose is to examine the relationship between coinsurance and dental prices for 16 dental services among a sample of Pennsylvania Blue Shield (PBS) adult insureds. The dependent price measure is the annual average gross price paid for 16 specific preventive, restorative, periodontic, endodontic, prosthodontic, and surgical dental services. Independent variables in the price model include the insured's age, education, coinsurance rates, time costs, market area, non-wage income, oral health status, area dentist-population ratio and usual source of care. Data sources are 1980 PBS claims and coinsurance rate data and a mail survey of sampled insureds. OLS regression analysis reveals that the model's independent variables explain little dental price variation. No variable is consistently significant across services, but market area, coinsurance rates, and time costs alternately dominate across equations. These results suggest that, among adult insureds, coinsurance and time costs influence dental fees in a minority of dental services. Insurance reduces the patient's sensitivity to money price, and non-price factors correspondingly seem to become more important in patient search.

Adolescent↗
PubMed1986

Rapid estimation of hospitalization charges from a brief medical record review. Evaluation of a multivariate prediction model.

In settings where an itemized hospital bill is not generated, estimation of hospitalization charges for research or administrative purposes can be a laborious task. This article examines the extent to which the number of hospital days spent outside an intensive care unit (ICU), number of days in an ICU, number of laboratory tests performed, number of x-rays, and number of surgeries can be used in a multiple regression equation to impute inpatient charges for a sample of 103 hospitalizations at a Veterans Administration hospital. These predictor variables, all of which are readily ascertained in a brief medical record review, accounted for about 97% of the variance in imputed hospital charges. The bootstrap method was applied for validation of the prediction equation. Application of the method described here may be of value to researchers concerned with hospital charge estimation in non-fee-for-service settings.

Aged↗
PubMed1985

Bacterial arthritis.

Explore the source record for details and available documents.

Anti-Bacterial Agents↗
PubMed1985

In vitro activity of BMY-28142 against pediatric pathogens, including isolates from cystic fibrosis sputum.

The antibacterial activity of BMY-28142, a new aminothiazole cephalosporin, was measured by standardized broth microdilution and agar dilution methods against 450 gram-positive and gram-negative bacteria isolated from pediatric infections, including acute pulmonary exacerbations of cystic fibrosis. BMY-28142 activity was compared with that of aminoglycosides, beta-lactams, chloramphenicol, trimethoprim-sulfamethoxazole, vancomycin, and clindamycin. The activity of BMY-28142 in combination with other antimicrobial agents against Pseudomonas aeruginosa was also determined. Furthermore, the effects of inoculum and pH on BMY-28142 activity were evaluated. BMY-21842 was active against most of the gram-positive and gram-negative isolates, with the exception of methicillin-resistant Staphylococcus aureus and Pseudomonas cepacia. The combination of BMY-28142 with tobramycin was often synergistic, and combinations of BMY-28142 with either polymyxin B or imipenem were usually antagonistic. BMY-28142 antibacterial activity could be adversely affected at extremes of medium pH and by high inoculum densities.

Bacteria↗
PubMed1985

A theory of organizational response to hospital regulation: a reply to Smith and Mick.

Smith and Mick identify four basic problems with the theory the present writers developed to explain organizational responses (in this case the behavior of hospitals) to regulation. They challenge the basic assumption regarding autonomy, disagree with the implied cause and effect relations between organizational response and regulation, criticize the omission of goals, and claim that the theory has only limited generality. In so doing they state that their primary concern is with "improving our understanding of the limitations and benefits of the theory." Each of the four topics they raise for consideration will receive comment.

Certificate of Need↗
PubMed1985

Economic regulation and hospital behavior: the effects on medical staff organization and hospital-physician relationships.

New forms of payment, growing competition, the continued evolution of multiunit hospital systems, and associated forces are redefining the fundamental relationship between hospitals and physicians. As part of a larger theory of organizational response to the environment, the effects of these external forces on hospital-medical staff organization were examined using both cross-sectional data and data collected at two points in time. Findings suggest that regulation and competition, at least up to 1982, have had relatively little direct effect on hospital medical staff organization. Rather, changes in medical staff organization are more strongly associated with hospital case mix and with structural characteristics involving membership in a multiunit system, size, ownership, and location. The pervasive effect of case mix and the consistent effect of multiunit system involvement support the need for policymakers to give these factors particular attention in considering how hospitals and their medical staffs might respond to future regulatory and/or competitive approaches.

Certificate of Need↗
PubMed1984

Hospital rate review. A theory and an empirical review.

This paper presents a theory of the effects of rate review on hospital operations and organization. Its purpose is to explain the way in which hospitals have responded to regulation. In the development of this theory, the hospital product was viewed as a bundle of services, rate review was looked upon as a ceiling on the value of the bundle. The ceiling creates an incentive to remove elements from the bundle, i.e., to reduce 'quality'. When quality is variable, the effect on utilization becomes indeterminate. The model argues, among other things, that the hospital will change its service complement and its contractural arrangements with physicians and other hospitals. An extension of the organizational theory literature leads to implications concerning the ordering of hospital responses to regulation. The growing body of empirical literature on the effects of hospital rate review is used as an initial test of the major thrusts of the theory. A suggested agenda for further empirical work also is presented.

Cost Control↗
PubMed1984

Insurance plan effects on dental provider treatment patterns for elderly patients. An experimental economics approach.

Three hundred forty-six dentists, randomly selected from the population of Washington State Dental Association members, volunteered to participate in a controlled experiment of treatment planning for elderly patients. Experimental oral health problems were designed that conform to the prevailing actual distribution of dental and related systemic disease among the elderly population of the United States. Each volunteer dentist constructed two treatment plans for the presenting dental problem: 1) a treatment plan to optimize oral health, ignoring the hypothetical patient's financial status and insurance coverage; and 2) a treatment plan given the particular dental insurance plan and patient financial status incorporated in the case. Results suggest that increasingly comprehensive insurance coverage does not necessarily lead to uniform, monotonic increases in total dental expenditures. Rather, the incremental substitution of different services for one another appears to be the dominant effect of increased coverage, with the singular exception of coverage for fixed prosthodontia . The key implication of these findings is that careful design of improved insurance benefit plans for the elderly could widen the range of dental services provided without necessarily increasing total treatment cost.

Aged↗
PubMed1984

Returns on equity to not-for-profit hospitals: theory and implementation.

It is argued that not-for-profit hospitals can be assumed to generate a return on equity capital due, in principle, to competition in the final product market for hospital services and in the capital market. Practical difficulties in identifying claimants to the net income of the firm, as well as the incentive problems of cost-based reimbursement, suggest that a competitive pricing approach is likely to be the appropriate means to provide a reasonable return on equity for the not-for-profit and the for-profit hospital. Implications of the analysis for the correct discount rate in investment decisions are outlined.

Capital Financing↗
PubMed1983

A theory of organizational response to regulation: the case of hospitals.

This paper presents a general theory of organizational response to regulation, a theory that integrates adaptation and mutual selection perspectives. Two major forms of regulation in the hospital industry, certificate of need and rate review, are examined. Hypotheses are derived concerning the nature and timing of the various adjustments hospitals make both in internal organizational arrangements and in patterns of interorganizational activity in the face of regulatory constraints. Suggestions and data sources for testing the theory are presented.

Certificate of Need↗
PubMed1983

Dental care demand: age-specific estimates for the population 65 years of age and over.

This paper derives estimates of the demand for dental care among the U.S. population 65 years of age and over. The analysis is unique in that it focuses on a segment of the population with particular relevance to future policy regarding dental insurance coverage and distinguishes determinants of dental care demand by type of service. The empirical estimates suggest that the use of dental service by elderly persons does respond to price changes and that price-elasticity of demand varies significantly among different dental procedures.

Aged↗