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Biomedical subjects

J E Kralewski

Publications and source records attributed to J E Kralewski.

50 records · Page 3Linked to original sources
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Physician perspectives on the structure and function of group practice HMOs.

This article explores physicians' perspectives regarding how their HMOs function and their satisfaction with and loyalty to HMOs. Three HMOs were studied: a mature (28-year-old) staff model, a 16-year-old staff model, and a 13-year-old group model with both HMO and fee-for-service patients. While these HMOs were found to vary somewhat in terms of emphasis on patient care versus costs, methods used to control costs and degrees of centralization of decision making, they all received high overall satisfaction and loyalty scores. The staff model HMO with a more decentralized decision making structure received the highest satisfaction/loyalty score from its physicians. The degree to which physicians perceive the HMO to be effective and supportive and the use of educational programs and peer review to influence resource use were also found to be significantly related to physician satisfaction and loyalty.

Analysis of Variance↗
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Rural health care: an American perspective.

Over the past five years, the authors have researched various aspects of health care in rural communities in the United States. Interviews were conducted with some 100 rural physicians and hospital administrators, 75 hospital governing board members, and other rural community leaders. The difficulties of maintaining reasonable access to health services in rural communities are discussed, as are the strategies for rural health care used by policy makers and hospital governing boards.

Community Health Services↗
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Employer perspectives on the preferred provider organization concept.

The goal of preferred provider organizations (PPOs) is to identify cost effective physicians, hospitals and other providers and form them into healthcare delivery systems. Widespread interest in PPOs stems from the belief that they can contain costs while offering consumers a choice of physicians and hospitals. But there is little information available about the demand by employers to offer PPOs as a health plan option. This study gathered information on employers' attitudes toward PPOs through a survey of companies in the Minneapolis metropolitan area. Most of the surveyed firms were found to be self-insured and offered a choice of healthcare plans, including HMOs. Contrary to some previous studies, healthcare costs are a major concern by all of the firms. PPOs are viewed as one part of an overall strategy to reduce those costs while maintaining quality of care and convenient access to providers. Although somewhat skeptical about potential savings and concerned over the administrative costs of offering a new health plan, most of the firms indicated support for the PPO concept. The greatest market opportunity for PPOs is to offer the plan as an alternative within the company's existing indemnity plan, wherein employees who use the preferred providers are exempt from at least a portion of the coinsurance and deductible requirements.

Cost Control↗
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Medical practice in large-scale organizations.

The traditional role of the physician as the principle resource allocator in the health care system is rapidly giving way to a shared decision-making. As more and more physicians practice in large organizational settings, an adversarial relationship is developing that affects both the quality of care and the efficiency of medical practice.

Group Practice↗
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The effects of medical group practice organizational factors on physicians' use of resources.

Few studies have systematically examined the influence of physician, patient, and practice characteristics on physician-directed use of resources within the overall environment of medical group practices and none have included the practice culture in the analysis. This study analyzes the effects of the structure and culture of medical group practices on the amount of resources used to manage uncomplicated hypertension episodes of care for enrollees in a Minneapolis/St. Paul HMO during 1990. Three findings emerged from this study: (1) resource use for a well-defined episode of care varies much more than one would expect in this highly competitive managed care environment; (2) the culture of the group practice appears to be more important than organizational structure in determining resource use for the treatment of hypertension; and (3) together the culture and structural variables only explain 8 percent of the variance in resource use. The study indicated that medical group practice organizations have less influence on physicians' practice styles than expected. The group practices studied are all located in a highly competitive managed care environment and these conditions should be causing them to create more standardized practice styles among their physicians. However, wide variations in individual physician practice styles account for most of the differences observed. Either much of the unexplained variance in resource use for this episode of care results from unobserved patient and illness characteristics, or managed healthcare is not yet causing medical group practices in Minnesota to challenge physicians' individualistic practice styles.

Cost-Benefit Analysis↗
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Constructing episodes of care from encounter and claims data: some methodological issues.

There is growing agreement that episodes of care methodology provides the most effective means of analyzing health care delivery because it organizes health care services around the condition or illness for which they were prescribed. This paper presents a computerized approach for developing episodes of care from encounter and claims data and discusses some methodological issues. We found that we could group into five generic types of episodes of care the 31 illnesses that incur the majority of expenses for a health maintenance organization. This article describes the process for developing these types and summarizes the specific criteria defining the episodes of care for the 31 illnesses.

Algorithms↗