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Biomedical subjects

R W Broyles

Publications and source records attributed to R W Broyles.

At least 19 recordsLinked to original sources
PubMed2003

Break-even analysis revisited: the need to adjust for profitability, the collection rate and autonomous income.

This paper modifies traditional break-even analysis and develops a model that reflects the influence of variation in payer mix, the collection rate, profitability and autonomous income on the desired volume alternative. The augmented model indicates that a failure to adjust for uncollectibles and the net surplus results in a systematic understatement of the desired volume alternative. Conversely, a failure to adjust for autonomous income derived from the operation of cafeterias, gift shops or an organization's investment in marketable securities produces an overstatement of the desired volume. In addition, this paper uses Microsoft Excel to develop a spreadsheet that constructs a pro forma income statement, expressed in terms of the contribution margin. The spreadsheet also relies on the percentage of sales or revenue approach to prepare a balance sheet from which indicators of fiscal performance are calculated. Hence, the analysis enables the organization to perform a sensitivity analysis of potential changes in the desired volume, the operating margin, the current ratio, the debt: equity ratio and the amount of cash derived from operations that are associated with expected variation in payer mix, the collection rate, grouped by payer, the net surplus and autonomous income.

Accounts Payable and Receivable↗
PubMed2001

Factors contributing to the amount of vehicular damage resulting from collisions between four-wheel drive vehicles and passenger cars.

This study examines the vehicular damage resulting from motor vehicle crashes involving four-wheel drive vehicles and passenger cars in the state of Oklahoma. In particular, the focus of the analysis is on differences in vehicular damage to passenger cars and four-wheel drive vehicles. Results indicate that passenger cars sustain significantly greater vehicular damage than four-wheel drive vehicles. In addition, several other factors significantly influence the level of damage resulting from collisions between four-wheel drive vehicles and passenger cars. Driver behavior or unsafe acts, represented by the rate of travel prior to the collision, failure to yield, failure to obey a stoplight or a stop sign, the consumption of alcohol and the use of drugs, also contributed to the amount of vehicular damage. In addition, results also indicate that the level of damage was influenced significantly by environmental factors, represented by a reduced intensity of light, wet or slippery roadways and the type of collision. The findings reinforce the importance of a number of policy initiatives that may reduce the vehicular damage resulting from collisions involving four-wheel drive vehicles and passenger cars. For example, the study indicates a need to initiate legislation that lowers the speed limit during dark and twilight hours, commits additional resources to road maintenance to reduce unsafe road conditions, and stimulates improvements in automotive design that provide better lateral protection to vehicles.

Accidents, Traffic↗
PubMed2000

Health risks, ability to pay, and the use of primary care: is the distribution of service effective and equitable?

BACKGROUND: This study clarifies the confusion about what factors are consistent predictors of primary care service use, of which preventive services are a major component. A variety of health risk, predisposing, and enabling characteristics were assessed for their association with the use of primary care. Variable selection was guided by the use of the Andersen-Newman Behavioral Model of health service utilization. METHODS: The responses of 1,512 residents of Oklahoma to the BRFS survey were used in this study. Both probit and logistic analyses were used to assess the use of nine preventive services and a summary index of service use. RESULTS: The results indicate that those at greater risk of illness and least able to use finance services have the lowest rates of use among the nine preventive services individually and when combined as an index of overall primary care use. CONCLUSIONS: Problems persist with the adequate distribution of primary care among the medically vulnerable. Furthermore, recent welfare and health reforms may present added obstacles to their access to quality primary care services. The paper concludes with a discussion of policy options that may improve the effectiveness of primary care and redress inequities in the use of these services.

Health Behavior↗
PubMed2000

Equity concerns with the use of hospital services by the medically vulnerable.

This study assessed distributional inequities in access to care among a representative sample of adults residing in Oklahoma. Inequities were identified by comparing the medically vulnerable to the less vulnerable with respect to their use or nonuse of hospital care and, among those admitted, the number of days of care consumed. The behavioral model was employed to guide the analysis and the development of hypotheses. Controlling for need, enabling, and predisposing factors, the results indicate that the use of service by the poor, the elderly who lack supplemental insurance, and the uninsured is incongruent with their health status and that current methods of financing care may contribute to distributional inequities. The implications of these findings are discussed in the context of options that may improve access to care by the medically vulnerable.

Adult↗
PubMed1999

The costs of quality: an interactive model of appraisal, prevention and failures.

The control of spending on health care while improving or maintaining quality is one of the most difficult problems confronting policy analysts. In this paper hypothetical data and an Excel spreadsheet are used to develop a model that estimates the costs of quality management. The focus is on the interaction between appraisal costs, prevention costs and the costs of failures. This approach enables the health service organization to estimate the costs associated with each of the three components and to assess the influence of appraisal and prevention on failure costs. The article concludes with a discussion of methods that might be used to assemble the required data and the benefits that might be derived by adopting the model.

Data Interpretation, Statistical↗
PubMed1999

The medically vulnerable: their health risks, health status, and use of physician care.

Employing the Andersen/Neuman model of health behavior, this research compares the medically vulnerable (elderly, poor, and uninsured) with their less vulnerable counterparts with regard to (1) health and disability status, (2) likelihood of physician use, and (3) (among users) amount of physician use. Data were from the Oklahoma Behavioral Risk Factor Surveillance Survey and the Area Resource File. Findings indicate that the medically vulnerable are more likely to be disabled and to experience poorer health than the nonmedically vulnerable. The uninsured are less likely to have seen a physician in the past year. Among those who have seen a physician in the past year, the uninsured and Medicare recipients without supplemental insurance experienced fewer physician visits. The results point to inequalities in the distribution of physician care that may be exacerbated by federal policies that are currently under consideration.

Adult↗
PubMed1998

A practical method of adjusting for risk in the prospective costs of capitated systems.

Increasingly, providers of health services and medical groups are required to negotiate with managed care organizations and evaluate the adequacy of capitation rates. An intelligent assessment of the rate of payment requires an accurate projection of the costs per member per month that have been adjusted for the risk present in the insured population. This article develops a practical model for incorporating risk in forecasts of the full cost per member per month.

Capitation Fee↗
PubMed1998

Networks and the fiscal performance of rural hospitals in Oklahoma: are they associated?

This paper uses regression analysis to explore the relation of network membership to the financial performance of rural hospitals in Oklahoma during fiscal year 1995. After adjusting for the scope of service, as measured by the number of facilities or services offered by the hospital, indicators of fiscal status are (1) the cash receipts derived from net patient revenue; (2) the cash disbursements related to operating costs, net of interest and depreciation expense, labor costs and nonlabor costs; and (3) net cash flow, defined as the difference between cash receipts and disbursements. Controlling for the effects of the hospital's structural attributes, operating characteristics and market conditions, the results indicate that members of a network reported lower net operating costs, labor costs and nonlabor expenses per service than nonmembers. Hence, the analysis seems to suggest that the membership of rural hospitals in a network is associated with lower cash disbursements and an improved net cash flow, outcomes that may preserve their fiscal viability and the access of the population at risk to service.

Case-Control Studies↗
PubMed1996

Health care reform? An American obsession with prescriptive incrementalism.

A rounded evaluation of the national health insurance proposals that now seem to be taken seriously by political elites requires conceptual organization. This article adopts a typology that describes each major proposal as a social, mixed or a private insurance scheme depending on the source(s) of funding, method of compensating hospitals and physicians, the unit of payment, and mechanism for financing capital. Not surprisingly, the analysis suggests that the social insurance model, closely resembling the Canadian system, is more likely to control inflation and redress distributional inequities than are other approaches. Why, then, has this approach not been adopted? The answer may be found in the widespread acceptance of disjointed incrementalism as a valid description of the policy process which yields an ideological orientation that can be termed "prescriptive incrementalism." This orientation is closely related to a belief in an "American exceptionalism," a belief that is not warranted by a cross-sectional examination of the political culture infusing issues about the proper role of government in health care financing and delivery. Unfortunately for advocates, the truly exceptional factor restricting the United States' ability to effect national health reform is a quite delberately obstruction-oriented political structure.

Attitude to Health↗
PubMed1996

Roles of hospital administrators in South Carolina.

Using discriminant analyses of data on 916 returned questionnaires from a mailing to 1,650 administrators in 82 South Carolina hospitals, this study examines the allocation of interpersonal, informational, decisional, and treatment roles among executive, administrative, and clinical directors. Educational attainment, years of experience, and gender were found to influence respondents' positions. Results also indicate that executive directors assume responsibility for the organization and its relation to the environment. As expected, those in clinical and administrative positions assume more responsibility for interpersonal and treatment roles than do executive directors.

Chief Executive Officers, Hospital↗
PubMed1995

Breast cancer in Oklahoma. Unnecessary deaths.

Deaths of Oklahoma women can be prevented by early detection using mammography and clinical breast examinations. This study summarizes the responses from the Oklahoma Behavioral Risk Factor Study, and the results indicate that Oklahoma women, especially low income and less well educated women, are not receiving these screening tests in adequate numbers. Physicians have a major responsibility to correct this by recommending such tests and encouraging women to take advantage of them.

Adult↗
PubMed1995

Women smokers: the tragedy is, Oklahoma is number one.

Oklahoma leads the nation in the proportion of women who smoke, and is sixth in the proportion in the childbearing ages. Furthermore, the incidence of deaths from carcinoma of the lung in women is increasing, as is the number of low birthweight babies. Both of these conditions are associated with smoking. It is clear that Oklahoma physicians should become aggressive in encouraging women to stop smoking.

Adolescent↗
PubMed1994

Local factors affecting the tendency to bypass local hospitals for inpatient mental health care: an exploratory analysis.

Using the records of 2,171 rural residents of Illinois who received inpatient treatment for mental illness or substance abuse, this paper examines factors that influence the tendency to seek service from a distant rather than a local hospital. Results indicate that the age and insurance coverage of the individual, the per capita income of the community area, surrogates for the service orientation of the local hospital and the proximity of the patient's residence to an urban center are significant influences. With the exceptions of drug abuse requiring detoxification or other symptomatic treatment, drug abuse accompanied by comorbidity and psychosocial disorders, psychosis, and childhood disorders, the primary diagnosis of the individual failed to have a significant effect on the propensity to bypass local sources of inpatient treatment.

Adult↗
PubMed1994

Progress toward Healthy People 2000: a preliminary look at Oklahoma.

Over 10,000 Oklahomans die each year from coronary artery disease or stroke. This study examined the behavioral risk factors for these illnesses present in Oklahomans. Oklahomans are at considerably higher risk than the desirable national goals for such risk factors. For example, too many Oklahomans smoke and too few exercise. The data to support these findings are included herein, and some steps to reverse these trends are recommended.

Adolescent↗
PubMed1994

Medicaid in Oklahoma.

Medicaid expenditures in Oklahoma increased 98.2% from 1986 through 1991 while those of the United States went up 111.0%. Of this increase, 21.6% was due to inpatient care and 25.9% to nursing home care. With respect to beneficiaries, 34.9% of the increase was attributable to the aged and 31.4% to the disabled. AFDC recipients accounted for only 19.1% of the increase.

Health Expenditures↗
PubMed1992

The priorities of the health care system vs. its financing: political realities vs. financial realities.

The impact of technology and the emphasis on tertiary specialty care have no inherent limits of cost escalation. Likewise, they dislocate health care resources since general and secondary care become more expensive as the impact of the high cost emphasis of health care trickles down to the costs of primary and secondary care. The change areas will involve: the principle of regionalization of specialty care and resident training, a uniform system of costs and reimbursements for all specialized medical and hospital care, the rationing of high technology specialty care and the application of prospective systems of payment to all institutional and physician specialty services.

Cost Control↗