Search PubMed⌕ Search

Biomedical subjects

J H Sunshine

Publications and source records attributed to J H Sunshine.

89 records · Page 5Linked to original sources
PubMed1991

Expenditures and sources of funds for mental health organizations: United States and each state, 1988.

Expenditures. Expenditures by the 8 types of mental health organizations covered in this report totaled $23.1 billion in 1988 in the United States and territories. Three States (California, New York, and Pennsylvania) accounted for 30 percent of this total. Nationally, State and county mental hospitals (hereafter called State mental hospitals) accounted for the largest proportion of all expenditures (30 percent, down from 34 percent in 1986). Private psychiatric hospitals and multiservice mental health organizations had the next largest expenditures, each accounting for 20 percent of the total, followed by the separate psychiatric services of non-Federal general hospitals at 16 percent. Department of Veterans Affairs (VA) mental health services, residential treatment centers (RTCs) for emotionally disturbed children, freestanding psychiatric outpatient clinics, and freestanding psychiatric partial care organizations accounted for 6 percent, 6 percent, 3 percent, and less than one-half percent of total expenditures, respectively. State mental hospitals represented the largest expenditures of any single type of mental health organization in 23 States; expenditures of private psychiatric hospitals were largest in 12 States; and expenditures of multiservice mental health organizations were the largest in 10 States. The $23.1 billion total for 1988 represented a 25 percent increase over the 1986 figure but, when adjusted for inflation, the estimated increase (expressed in constant dollars) was only 10 percent overall and 8 percent on a per capita basis. Constant dollar expenditures of most types of mental health organizations increased between 1986 and 1988, with the largest increase occurring among private psychiatric hospitals (54 percent). In contrast, constant dollar expenditures decreased for State mental hospitals and VA mental health services. Sources of Funds In 1988, the funds received by mental health organizations totaled $23.4 billion. Of this total, $8.8 billion (38 percent) was provided directly by State governments, predominantly by State mental health agencies. Direct Federal funds, plus Medicare and Medicaid (including the State and local share of Medicaid), provided $6.5 billion (28 percent) of total funding. Fees from clients (including private insurance) provided $5.2 billion (22 percent); direct local government funds provided 7 percent; and all other sources, 5 percent. State governments provided 77 percent of the funds received by State mental hospitals and were also the largest single source of funds for multiservice mental health organizations (51 percent) and freestanding psychiatric partial care organizations (44 percent). VA mental health services were funded by the Federal government, while 62 percent of funding for private psychiatric hospitals came from client fees (including private insurance).(ABSTRACT TRUNCATED AT 400 WORDS)

Community Mental Health Services↗
PubMed1991

Mental health services of the Veterans Administration, United States, 1986.

The mental health services of the Veterans Administration (VA) form an important component of the organized mental health care delivery system in the United States. The 140 VA organizations delivering mental health care represented 3 percent of all mental health organizations in the U.S. in 1986, but accounted for approximately 11 percent of the average daily inpatient mental health census and 8 percent of outpatient mental health visits in organized settings. Their 33,000 full-time equivalent (FTE) staff and $1.4 billion in expenditures devoted to mental health care were approximately 7 percent of the respective totals for all mental health organizations. Between 1983 and 1986, the number of VA organizations offering mental health care increased by only 1, but inpatient mental health additions increased by 22 percent. Average length-of-stay for these inpatients declined by almost as much. Outpatient mental health additions increased by 30 percent, and FTE staff in VA mental health services grew by 10 percent. Mental health services were provided by VA organizations in all States except Alaska, Hawaii, Montana, and North Dakota in 1986. (Veterans are free to make use of programs outside their State of residence.) The largest numbers of mental health services, additions, and episodes were found in States with very large populations, such as California, New York, and Texas. However, the highest rates of additions and episodes per 100,000 civilian population were generally in States with small populations, and often in rural States. For example, Maine, South Dakota, Wyoming, and West Virginia were among the States with the highest rates of additions and episodes. Reflecting the composition of the total population in VA facilities, of 315,630 in VA mental health services, over 95 percent were male, a relatively large percentage (17 percent) were 65 or over, and very few were under 18 years old. About two-thirds were white, non-Hispanic; one-fourth were black, non-Hispanic; and 8 percent were Hispanic. About one-sixth were suffering primarily from drug or alcohol abuse; almost all the rest suffered primarily from mental illness. In November 1986, approximately 36,000 staff persons worked in VA mental health services. About 84 percent of these worked full-time; 9 percent, part-time; and 7 percent, as trainees. The staff included approximately 2,800 psychiatrists, 700 other physicians, 1,600 psychologists, 1,800 social workers, and 7,200 nurses. Three-fourths of the expenditures for VA mental health services went for staff, with other operating expenses consuming most of the remainder.

Adolescent↗
PubMed1991

Residential treatment centers and other organized mental health care for children and youth: United States, 1988.

Residential treatment centers (RTCs) for emotionally disturbed children are an important component of the mental health services delivery system in the United States. The 440 RTCs operating in 1988 represented 9 percent of all mental health organizations in the U.S. in that year. They served approximately 10 percent of the patients who received inpatient and residential treatment care and approximately 2 percent of outpatient psychiatric visits in organized settings. Their 39,000 full-time equivalent (FTE) staff and $1.3 billion expenditures were, respectively, 7 percent and 6 percent of the total for all mental health organizations. Between 1986 and 1988, the number of RTCs increased slightly, while the volume of residential treatment care changed little. However, partial care and outpatient care expanded in RTCs, with the number of visits in these categories increasing by 75 percent and 42 percent, respectively. FTE staff grew by 13 percent, and expenditures increased by 33 percent between 1986 and 1988. In 1988, RTCs were located in all States except North Dakota. The largest number were found in California (48), Massachusetts (38), and New York (28). By definition, all RTCs provided residential treatment care. About one-third of them also provided partial care and one-third provided outpatient care. The highest rates of additions to residential treatment care in RTCs per 100,000 civilian population were found in Minnesota and Colorado. Reflecting the role of RTCs as providers of care to children and youth, 94 percent of residential treatment patients in RTCs were under age 18. Seventy percent of residential treatment patients were male; 28 percent, black; and 10 percent, Hispanic. Approximately 94 percent had mental illness as their principal disability. In December 1988, 43,000 staff worked in RTCs; 14 percent were employed part-time, and 3 percent were trainees. Among others, the staff included approximately 900 psychiatrists, 300 other physicians, 1,700 psychologists, 4,800 social workers, and 1,000 nurses. Nationally, expenditures by RTCs averaged $5 per capita, but the highest per capita spending was $20 in Massachusetts and $14 in Arizona. The principal sources of funds for RTCs were local governments (the source of 33 percent of total funds available to RTCs), State mental health agencies (15 percent of funds), and other State government sources (21 percent of funds). RTCs focus their care on children and youth more than do any other type of mental health organization. At year-end in 1988, 64 percent of all the patients on the rolls of all types of programs in RTCs were under age 18.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

The volume and cost of radiologic services in the United States in 1990.

Knowing the total number of radiologic services provided in the United States and their cost is important. This information can, for example, indicate the opportunities available to a radiology practice considering opening a new office or show whether high-technology radiology is, as is widely assumed, an important factor in United States health costs. However, neither the total number of procedures nor their cost is known. We developed two largely independent estimates of each total (one based principally on surveys of radiologists, the other on Medicare data) to cross-validate the estimates and provide an indication of their uncertainty. We estimate that 260-330 million radiologic procedures were performed in the United States in 1990 (including both diagnostic and therapeutic procedures and radiologic procedures performed by nonradiologists) and that payments for these services totaled $19 to $22 billion (including payments for technical components in the hospital setting). This total was approximately 3.5% of national spending on personal health care; high-technology radiology totaled less than half of this amount. The procedures numbered 1.0-1.3 per capita annually, an increase of some 10-40% since 1980. Of the spending total, $10 to $12 billion was paid to physician practices, with a substantial portion of this amount going ultimately to practice expenses, particularly in the office setting. Our results suggest that spending on high-technology radiology is too small to be a major explanation for the current level of health costs in the United States.

Costs and Cost Analysis↗
PubMed1991

Physician payment reform: issues for Canadian radiologists.

Policy decisions taken by the US Congress in the 1980s to restrain health care costs included the designation of diagnostic-related groups, the creation of scales of relative value and legislation to introduce free-for-service payment to physicians in 1992; discrepancies in the system are to be corrected by 1996. Under federal contract a system of resource-based relative-value scales was created for all medical disciplines except radiology, which by special legislation prepared its own experience-based relative-value scale. The scales are based on magnitude estimation of the work of physicians and analyses of actual costs. Codes for medical services have been published, which include a weighting for each service in relation to all others. Multiplication by a conversion factor establishes the fee to be paid by the carriers acting for the Health Care Financing Administration. The relative values will be updated every 5 years. Publication of this information for US Medicare patients (the disabled, the elderly and those with end-stage renal disease) will likely have a profound effect on the physician payment system in Canada. Under the reformed system the lifetime earnings of all physicians will become more similar. Four problem areas are discussed in the paper: self-referral, administrative complexity, malpractice and the plight of those without medical coverage. Resolution of these problems is being actively sought.

Canada↗
PubMed1990

Frequency and costs of diagnostic imaging in office practice--a comparison of self-referring and radiologist-referring physicians.

BACKGROUND: To assess possible differences in physicians' practices with respect to diagnostic imaging, we compared the frequency and costs of imaging examinations as performed by primary physicians who used imaging equipment in their offices (self-referring) and as ordered by physicians who always referred patients to radiologists (radiologist-referring). METHODS: Using a large, private insurance-claims data base, we analyzed 65,517 episodes of outpatient care by 6419 physicians for acute upper respiratory symptoms, pregnancy, low back pain, or (in men) difficulty urinating. The respective imaging procedures studied were chest radiography, obstetrical ultrasonography, radiography of the lumbar spine, and excretory urography, cystography, or ultrasonography. RESULTS: For all four clinical presentations, the self-referring physicians obtained imaging examinations 4.0 to 4.5 times more often than the radiologist-referring physicians (P less than 0.0001 for all four). For chest radiography, obstetrical ultrasonography, and lumbar spine radiography, the self-referring physicians charged significantly more than the radiologists for imaging examinations of similar complexity (P less than 0.0001 for all three). The combination of more frequent imaging and higher charges resulted in mean imaging charges per episode of care that were 4.4 to 7.5 times higher for the self-referring physicians (P less than 0.0001). These results were confirmed in a separate analysis that controlled for the specialty of the physician. CONCLUSIONS: Physicians who do not refer their patients to radiologists for medical imaging use imaging examinations more frequently than do physicians who refer their patients to radiologists, and the charges are usually higher when the imaging is done by the self-referring physician. From our results it is not possible to determine which group of physicians uses imaging more appropriately.

Ambulatory Care↗
PubMed1990

Expenditures and sources of funds for mental health organizations: United States and each state, 1986.

EXPENDITURES: Expenditures by the 8 types of mental health organizations covered in this report totaled $18.5 billion in 1986, for the United States and the Territories. Three States (California, New York, and Pennsylvania) accounted for one-third of this total. Nationally, the largest proportion of total expenditures were the expenses of State and county mental hospitals (34 percent, down from 38 percent in 1983) and those of multiservice mental health organizations (20 percent). In all but 19 States, State and county mental hospitals (hereafter called State mental hospitals) had the largest expenditures of any type of mental health organization; in 10 of the remaining 19 states, expenditures of multiservice mental health organizations were largest. Nationally, separate psychiatric services of non-Federal general hospitals, private psychiatric hospitals, and VA psychiatric organizations ranked next, with 16, 14, and 7 percent of total mental health expenditures, respectively. At the other extreme, residential treatment centers (RTCs) for emotionally disturbed children, freestanding psychiatric outpatient clinics, and freestanding psychiatric partial care organizations accounted for 5 percent, 3 percent, and less than 1 percent of national total expenditures, respectively. The $18.5 billion expenditure in 1986 was a 28 percent increase over the 1983 figure, but when adjusted for inflation, the estimated increase was only 5 percent overall and 3 percent on a per capita basis. Constant dollar expenditures (1983 = 100) of most types of mental health organizations increased between 1983 and 1986, but those of freestanding psychiatric outpatient clinics were virtually unchanged, and those of State mental hospitals and VA psychiatric organizations actually decreased. SOURCES OF FUNDS: In 1986, the funds received by mental health organizations totaled $19.0 billion. Of this total, $7.9 billion (41 percent) was provided directly by State governments, predominantly by the State mental health agencies. Direct Federal funds plus Medicare and Medicaid (including the State and local share of Medicaid) provided $4.8 billion, or one-fourth, of total funding. Fees from clients (including private insurance) provided $4 billion, or 21 percent, of total funding; direct local government funds provided 8 percent and all other sources 5 percent. State governments provided 78 percent of the funds received by State mental hospitals and were also the largest single source of funds, although not so dominant, for multiservice mental health organizations, freestanding psychiatric partial care organizations, and freestanding psychiatric outpatient clinics. VA medical centers were funded by the Federal Government, while two-thirds of funding for private psychiatric hospitals came from client fees...

Costs and Cost Analysis↗
PubMed1990

Determinants of total family charges for health care: United States, 1980.

This report addresses a question of importance for policymakers: "What are the determinants of the total charges for health care that U.S. families face?" Policymakers' concerns about this question have two main grounds. First, U.S. health care costs are large and growing rapidly. They now exceed 11 percent of the gross national product, and the answer to the question can shed some light on their troubling growth. Second, total family charges for health care reflect the quantity of health care received by families, and it is important to know whether the determinants of total charges are principally the need for health care, or involve other factors less related to need. In this report, the determinants of total charges and their importance are identified principally through multiple regression analysis. Total charges are defined as the full amount charged for all types of health care for all family members regardless of whether these amounts are paid out of pocket, paid by insurance (or public health care coverage programs), or go unpaid. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on the approximately 5,000 multiple-person families interviewed in this year-long longitudinal survey. The report provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple-person families with a member 65 years of age or over); (2) younger, lower income families (all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better off families (all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65). Multiple regression analysis was used to investigate the effect on total family charges of family demographic and sociocultural characteristics, family illnesses, special health events (such as births, deaths, and hospitalizations of family members), general family health status, family income, family health insurance characteristics, and family geographic and urbanization characteristics. Regressions were run separately for each of the three socio-economic family populations, with total family charges as the dependent variable and approximately 45 variables measuring these family characteristics as independent variables. Because of the large number of independent variables involved, a multiple-step regression process (described in appendix I) was used.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

Determinants of financially burdensome family health expenses: United States, 1980.

This report focuses on two questions of current interest to policymakers. First, "What percent of U.S. families experience financially burdensome health expenses?" and, second, "What are the determinants of financially burdensome health expenses among U.S. families?" The first question is addressed by examining how the distribution in the United States of families with financially burdensome health expenses is affected by six different possible measures of financial burden. The second question is addressed by using multiple regression techniques on one of the measures selected as a preferred measure. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on approximately 5,000 multiple-person families interviewed in this longitudinal survey. It provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple-person families with a member 65 years of age or over); (2) younger, lower-income families (defined as all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better-off families (defined as all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65 years of age). Two general conceptual approaches have been used in the literature to assess financially burdensome health expenses. The first approach measures financial burden by the size of a family's health bill in dollars. The second approach focuses on a family's ability to pay its health bill, and it measures financial burden as a ratio of health expenses to family income. There is no agreement on which of the two approaches is preferable and also no agreement on which of several operational measures in each category is the most appropriate. In order to shed light on this controversy, this report compares six potentially useful operational measures of financially burdensome health expenses. Three are dollar measures and three are ratio measures. The three dollar measures are (1) total charges for health care (irrespective of who pays the bill or whether or not the bill is paid), (2) out-of-pocket expenses for health care services (family-paid premiums for health insurance are not included), and (3) total out-of-pocket expenses for health (the previous measure plus out-of-pocket premiums).(ABSTRACT TRUNCATED AT 400 WORDS)

Data Collection↗
PubMed1987

Family use of health care: United States, 1980.

Information on families' use of health care in 1980 is presented in this report. The data discussed here were gathered in the national household sample of the National Medical Care Utilization and Expenditure Survey. In this sample, information was collected on health problems, health care received, expenditures for care, health insurance, and related topics throughout calendar year 1980 from approximately 6,800 families in the U.S. civilian noninstitutionalized population. (The report entirely excludes families with military heads, even if they have civilian members.) For this report, a family was initially defined as (1) two or more persons living together who were related by either blood, marriage, adoption, or a formal foster care relationship or (2) a single person living outside such relationships. But because these data were collected across an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of the use of health services are calculated in annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals. Data on both multiple-person families (families that averaged 1.5 persons or more during the year) and one-person families (families that averaged less than 1.5 persons during the year) are presented in this report. Only findings for multiple-person families, however, are addressed in this section. It is multiple-person families that are usually referred to in discussions of families by both the general public and professional social scientists.

Data Collection↗
PubMed1987

Total family expenditures for health care: United States, 1980.

Information on total family expenditures for health care in 1980 is presented in this report. Total expenditures are the total amounts billed (either actual or imputed) to families whether these amounts are paid out-of-pocket by the family, paid by private health insurance or a public health care coverage program, or remain unpaid. The data discussed here were gathered in the national household sample of the National Medical Care Utilization and Expenditure Survey (NMCUES). In this sample, information was collected on health problems, health care received, expenditures for care, health insurance, and related topics throughout calendar year 1980 from approximately 6,800 families in the civilian noninstitutionalized population of the United States. The survey excluded all individuals who were in institutions or in the military. This report also entirely excludes families with military heads, even if they had some civilian members. For this report, a family was initially defined as (1) two or more persons living together who were related by either blood, marriage, adoption, or a formal foster care relationship or (2) a single person living outside such relationships. Because data on these families were collected across an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of expenditures for care are calculated in annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals. This report deals with total expenditures for health care as reported by a sample of consumers of health care. These types of data are limited by the knowledge the respondent has as to the amount of the total bill. For various reasons, which are discussed in detail in the text, the respondent often doesn't know the amount of the total bill. Therefore, the statistics in this report should be regarded as having more limitations than the statistics in two previous family reports: "Family Use of Health Care: United States, 1980" (Dicker and Sunshine, 1987) and "Family Out-of-Pocket Expenditures for Health Care: United States, 1980" (Sunshine and Dicker, 1987).

Age Factors↗
PubMed1987

Family out-of-pocket expenditures for health care: United States, 1980.

Information on out-of-pocket health care expenditures for families in 1980 is presented in this report. The data discussed here were gathered through the national household sample of the National Medical Care Utilization and Expenditure Survey (NMCUES). Information for the year 1980 was collected on health problems, health care received, expenditures for care, health insurance, and related topics from approximately 6,800 families in the U.S. civilian, noninstitutionalized population. All individuals who are in institutions or in the military are excluded from this analysis as are all families with military heads of family, even if they have civilian members. For this report, a family was initially defined as: two or more persons living together who were related either by blood, marriage, adoption, or a formal foster care relationship; or as a single person living outside such relationships. Because these data were collected throughout an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time, and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of health care expenditures are calculated in terms of annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals.

Adult↗