Biomedical subjects
Publications and source records attributed to H S Luft.
Greater use of preventive services by enrollees of HMOs than of other health plans is often assumed to reflect differences in philosophy about "health maintenance." But organizational forms are less important than extent of insurance coverage in influencing use of preventive services. Policy options for improved health status will have to challenge ideologies of prevention and financing.
Explore the source record for details and available documents.
This paper examines the relative importance of various independent variables for predicting five separate measures of physician utilization in a rural community. The independent variables include socioeconomic, demographic, attitudinal, and health status factors. The results are comparable to those of national studies which find that health status is the primary determinant of utilization. Income, price measures, and travel time are notable for their relative unimportance in this rural area. This suggests that resources are more likely to be allocated on the basis of medical need within a given health care market than across a number of market areas.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Health care utilization studies often reach conflicting conclusions about the appropriate measures of utilization and the relationships between such measures and the explanatory variables. The purpose of this paper is to demonstrate why such ambiguities exist, provide empirical tests of different models, and suggest an appropriate analytical framework. A household survey of a rural California community was used to collect both family and individual data on utilization, "need," accessibility, attitudes, and demographics. A number of possible utilization models are presented, each containing alternative sets of dependent and independent variables. Multiple regression analysis is applied to each model, providing considerable insight into the roles of specific independent variables in explaining alternative utilization measures. The omission of certain variables, such as health status (or "need"), can result in an incorrect interpretation of the results.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We analyzed evidence on managed care plan (mostly health maintenance organization, or HMO) performance from thirty-seven recently published peer-reviewed studies. Quality-of-care evidence from fifteen studies showed an equal number of significantly better and worse HMO results, compared with non-HMO plans. However, in several instances, Medicare HMO enrollees with chronic conditions showed worse quality of care. Evidence comparing hospital and physician resource use showed no clear pattern, whereas evidence on enrollee satisfaction varied by measure and enrollee type. Although recent research provides useful findings, interpreting and generalizing from these relatively few studies is difficult. Fears that HMOs uniformly lead to worse quality of care are not supported by the evidence, although all quality data were collected prior to the recent round of cost cutting that started in 1992. Hopes that HMOs would improve overall quality also are not supported, in part because of slow clinical practice change, lack of risk-adjusted capitation rates, and inadequate quality measurement and reporting.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Case abstract data are routinely collected by hospital abstracting services, peer review organizations, and some state agencies. These data have proved invaluable in the analysis of patterns of performance across large numbers of hospitals and have shown, for example, the inverse relation between diagnosis- or procedure-specific volume and outcome. Routinely collected data also appear to be an attractive means for identifying hospitals, and perhaps physicians, with particularly good or poor outcomes for their patients. Unfortunately, problems of small numbers of patients and relatively low rates of poor outcomes make it difficult to be confident in the identification of individual performers. Recent data for cardiac catheterization patients are used to illustrate this problem.
This article lays the foundation for the other articles in this journal issue, which examine the effect of managed health care arrangements on a particular population: children. Although managed care has been used to finance and deliver health care services for decades, the meaning of this term often has been unclear to health care consumers and practitioners because new forms of managed care have evolved rapidly. The one consistent and unifying concept across all managed care arrangements is that enrollees obtain care from a network of participating health care providers who contract with the managed care organization and abide by the organization's rules. The uncertainty of what managed care is has made it difficult to measure the effect of these arrangements on health service delivery and health outcomes, especially in the pediatric population, where the development of outcome and quality measures lags behind that for adults. The incentives posed by managed care suggest both potential advantages and disadvantages to these arrangements for children. On the positive side, managed care enrollment may offer a "medical home" for primary care services to children who otherwise would obtain only episodic care; improve the coordination of health care services; and encourage more preventive health services. On the negative side, under capitated reimbursement, health plans have an incentive to enroll only healthy children with the lowest expected health care expenditures, and providers have an incentive to offer fewer services than may be appropriate. Managed care also may limit enrollees' choice of providers, particularly for specialty care. Despite the paucity of information about the effect of managed care on the delivery of pediatric health services and on child health outcomes, children are disproportionately being enrolled in managed care plans.