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Biomedical subjects

J Hadley

Publications and source records attributed to J Hadley.

At least 91 records · Page 5Linked to original sources
PubMed1988

Medicare spending and mortality rates of the elderly.

This paper addresses the issue of Medicare expenditures and mortality rates of the elderly by examining cross-sectional area data for 1980. Econometric methods are used to determine whether age-, sex-, race-specific mortality rates for elderly population cohorts are lower in areas where Medicare expenditures per beneficiary are higher, controlling for the effects of differences in population and area characteristics. The results show that greater Medicare spending per beneficiary is associated with significantly lower mortality rates. Furthermore, the level of Medicare spending is positively related to the level of public income support for the elderly and the extent of the elderly's contact with hospitals and nursing homes.

Age Factors↗
PubMed1987

How did Medicare's prospective payment system affect hospitals?

Using data from 1982 and 1984, we examined how Medicare's prospective payment system affected hospitals. The study showed that hospitals paid through the prospective payment system had significantly lower increases in Medicare costs and greater declines in Medicare use than did other hospitals. Unlike these other hospitals, for which Medicare costs approximately equaled Medicare revenues, hospitals receiving prospective payment kept Medicare costs from rising as fast as Medicare revenues, earning the profit that the prospective payment system allowed. The opportunity to earn a profit led hospitals to slow increases in Medicare costs, regardless of the level of revenue constraint. However, the more the prospective payment system constrained hospitals' revenues, the more hospitals slowed increases in Medicare costs. In the most constrained hospitals, slower increases in Medicare costs were accompanied by slower increases in total hospital spending. The least constrained hospitals slowed Medicare cost increases the least and did not show their overall spending. These hospitals nevertheless increased their profit margins the most, since the prospective payment system's federal rate paid them the highest rates relative to base-year costs. Since federal rates produced extra profits, not extra cost containment, their appropriateness is questionable. The prospective payment system should be modified to eliminate windfalls while continuing to promote cost containment.

Cost Control↗
PubMed1987

A threat or a promise: acquisition of teaching hospitals by investor-owned chains.

In the early 1980s, acquisition of a small number of teaching hospitals by investor-owned chains raised the spectre of a for-profit takeover of teaching institutions. Drawing on experience to date, as well as interviews with affected parties, this article assesses the likely scope of such acquisitions and their impact on the education, research, and indigent care that teaching hospitals provide. Our assessment concludes that relatively few teaching hospitals are likely to satisfy the financial criteria chains apply to acquisitions; that hospitals with modest rather than extensive commitments to education and research are most likely to satisfy these criteria; and that terms of sale typically enhance, rather than undermine, these institutions' resources for research, education, and, to a lesser extent, indigent care, at least in the short run. In the long run, continuation of these activities is more likely to be a function of third-party payment policies than of proprietary versus nonprofit hospital ownership.

Education, Medical↗
PubMed1987

Seeking the just price: constructing relative value scales and fee schedules.

Many conceptual issues underlie the current policy debate over how to reform the fee-for-service method of paying physicians, including the development of a relative value scale for physicians' services and the relationship between a relative value scale and a fee schedule. We consider the relationship between fees and costs and the criteria for judging whether a fee is appropriate or right and then propose a two-step process for constructing a relative value scale. A fee schedule based on a relative value scale is the most practical way to reform the current fee-for-service system and makes the most sense from both clinical and economic viewpoints.

Costs and Cost Analysis↗
PubMed1987

Residency positions offered in three specialties.

Many believe that the changing economic environment might have dramatic effects on the quality or quantity of graduate medical training, yet the evidence is scant. This article assesses the impact of economic factors on the number of residency positions offered by teaching hospitals in surgery, in medicine, in pathology, and in the hospital as a whole. It first outlines in a nontechnical way the policy and empirical implications of an economic approach to residency training. The empirical analysis then compares results from three separate data sets, using both hospitalwide and department-specific information. The article closes by using the estimates to attempt an assessment of the likely impact of cost control and increased competition on training opportunities.

Cost Control↗
PubMed1985

The demand for residents.

This paper develops an empirical model of the demand for medical residents. Not-for-profit teaching hospitals are viewed as firms facing shadow prices that differ from market prices, and the impacts of variations in stipends in the quality of training, in the cost of teaching, and in hospitals' objectives on the shadow cost of hiring residents are made explicit. Empirical results from three data sets are shown to be consistent with a simple derived demand model, and the indirect effects of increased competition and cost control initiatives on the demand for residents are assessed.

Economics, Hospital↗
PubMed1985

Relative value scales for physicians' services.

A key element in the construction of a physician fee schedule is the underlying relative value scale (RVS). The focus in this article is on the development and comparison of RVS's based on alternative data sources and construction methods. Results suggest that medical procedures' values are preserved across alternative charge-based RVS's. Some differences are observed, however, when comparing procedures' values on scales derived from charges versus those derived from time data. The major conclusion is that the choice of a charge data base and method of constructing an RVS need not be a primary concern in the process of developing physicians' fee schedules.

Fee Schedules↗
PubMed1984

Poor people and poor hospitals: implications for public policy.

In 1980, while most hospitals were in reasonably good financial health, hospitals heavily involved in serving the poor ran a considerable risk of financial trouble. Fewer than 9 percent of the nation's hospitals accounted for 40 percent of the nation's total care to the poor. These hospitals, almost half of which were in the 100 largest cities, not only devoted more of their care to the poor than other hospitals, they also served substantially smaller proportions of privately-insured patients. The result was that one-third of these hospitals--by themselves accounting for over 15 percent of all care to the poor--ran deficits in 1980. Using data from a 1980 survey of nonfederal, nonprofit hospitals, this paper examines the fiscal situation of hospitals heavily involved in serving the poor. The analysis shows that it is insufficient revenues, not inefficiency or underuse, that creates these hospitals' financial problems. The article concludes with an assessment of several policies that could be adopted to alleviate this financial pressure and sustain care to the poor.

Costs and Cost Analysis↗