Search PubMed⌕ Search

Biomedical subjects

S M Davidson

Publications and source records attributed to S M Davidson.

At least 37 records · Page 2Linked to original sources
PubMed1986

Medicaid myths: trends in Medicaid expenditures and the prospects for reform.

Medicaid expenditures, which had reached more than +32 billion by 1981, have grown substantially throughout the program's history. As a result, the conventional wisdom is that Medicaid expenditures represent a significant public-policy problem. Using other measures, however, it can be shown that the program is much less of a problem than it appears to be. By 1981, spending for Medicaid represented only 12.7 percent of total state spending and had contributed only 14.2 percent to the overall growth in state expenditures since 1965. Moreover, considering only the funds which states raise from in-state sources, the median share of state budgets accounted for by Medicaid was just 5.6 percent, and only 7 states spent as much as 9 percent of their own money on the program. These figures suggest that the marginal reductions in Medicaid expenditures which would result from typical program changes are likely to be so small that rational state officials might be unwilling to incur the political opposition of powerful provider groups or the resistance of large state bureaucracies by proposing substantial reforms. The major exceptions are the few states with very large programs where even small proportional savings would amount to millions of dollars. We conclude that, given its present federal-state form and the current distribution of expenditures, it is unlikely that major reforms will be enacted because the stakes are too small for most states and the federal interest is too diffused.

Health Expenditures↗
PubMed1985

The extent of physician participation in Medicaid: a comparison of physician estimates and aggregated patient records.

This article compares two measures of the extent of physician participation in Medicaid programs. The first, which has been used in most research to date on the subject, is based on physician estimates of the proportion of their patients who are Medicaid patients. The second derives from encounter forms for a sample of visits to the interviewed physicians. The comparison shows that physicians in the sample tended to overestimate by 40 percent the extent of their Medicaid participation. Because the two measures are highly correlated, the analysis of the determinants of Medicaid participation was not affected by the measure used. However, since physicians tended to overstate the proportion of Medicaid patients in their practices, interview data should not be used to measure the amount of physician participation or to calculate elasticities for the effects of policy changes on the extent of participation.

Data Collection↗
PubMed1984

Teaching dialysis kinetics with a minicomputer.

The quantitative aspects of dialysis kinetics are poorly understood by the majority of nephrology fellows in training. For this reason, we have developed three teaching programs for use on the Apple II computer. The programs, based on the dialysis equations of Gotch et al. [1] and Gotch [2], allow the student to alter each of the dialysis variables independently, and to graphically display the resulting dialysis curves, so that the effects of changing variables can be visually compared. The three teaching programs describe intradialysis kinetics, dialysis kinetics during a single intradialytic and interdialytic period, and dialysis kinetics during a 2-week interval.

Computer-Assisted Instruction↗
PubMed1984

The Medical Care Advisory Committee for state Medicaid programs: current status and trends.

Each State Medicaid program is required by Federal Regulations to have a Medical Care Advisory Committee ( MCAC ) which includes provider, consumer, and government representatives and which participates in policy development and program administration. Data are presented about the composition of these committees, their structure, the administrative and financial support they receive, and the nature of their activities. It is argued that they can play an important role in policy formulation and implementation, but that they need to be reformed in order to exploit that potential.

Health Planning Councils↗
PubMed1983

Full and limited medicaid participation among pediatricians.

Participation in Medicaid by pediatricians is an important element in the access of low income children to health care. Factors that influence whether participating pediatricians choose to participate fully in the program or to limit their acceptance of Medicaid patients are identified and analyzed. Data were derived from interviews conducted with 814 pediatricians in 13 states. A multivariate analysis examining physician, practice, service area, and Medicaid policy characteristics indicates that policy factors are most influential in the physician's decision whether to participate fully in medicaid programs. Factors found to foster the willingness of pediatricians to participate fully in state Medicaid programs included more competitive levels of reimbursement, minimal delays in reimbursement, and eligibility and benefit policies that minimize interference with the exercise of medical judgment.

Fees and Charges↗
PubMed1982

Medicaid reform.

Explore the source record for details and available documents.

Aid to Families with Dependent Children↗
PubMed1982

National health line.

Explore the source record for details and available documents.

Deductibles and Coinsurance↗
PubMed1982

Physician participation in Medicaid: background and issues.

Most Americans gain entry into the medical care system through office-based primary care physicians. The Medicaid program was created in 1965 in part to increase the access of low-income people to medical services in that mainstream. But, over the years, office-based physicians have reduced their treatment of Medicaid patients, and many have withdrawn from the program altogether. The result is not only that the original programmatic goal has not been fully achieved, but also that the costs of the program are higher than they would be otherwise. In this article, the importance of Medicaid participation by office-based primary care physicians is described, and a number of obstacles to their participation are identified. The obstacles include state policies regarding eligibility, coverage, and provider compensation. The article recommends actions pertaining to these policies that might increase participation.

Eligibility Determination↗
PubMed1982

Nonphysician health care providers in pediatrics.

This paper has identified nurse practitioners, physician's assistants and, potentially, nurse-midwives, as nonphysician health care providers who might have a significant impact on physician manpower requirements in pediatrics in the United States. These providers are capable of providing well child care, as well as care for minor illnesses. Patient acceptance and the quality of care rendered by these providers appear to be high. Physician acceptance is also high, especially when the physician has actually employed a nonphysician provider. State legislation and reimbursement procedures may interfere with the full utilization of nonphysician providers, but when nurse practitioners and physician assistants are employed in pediatric care, they deliver a wide range of services efficiently and economically. There are estimated to be a total of approximately 5,500 nonphysician providers specializing in pediatric care, but other nonphysician providers who may also care for children are discussed. The total number of these providers for 1980 is estimated at 7,232 and for 1990, at 15,512.

Clinical Competence↗
PubMed1979

Hypertension continuation adherence: natural history and role as an indicator condition.

We analyzed a random sample of general medicine clinic patients to determine the natural history of newly treated hypertensive (NH) patients: discontinuation patterns, critical intervention periods, and hypertension's (HBP) utility as an indicator condition. The NH patients exhibited a 48% dropout rate in the first year and better continuation adherence than new nonhypertensive (NNH) patients. Patients with HBP and other chronic diseases had better continuation adherence than those with HBP alone, although no predictive patterns emerged. New patients displayed rapid early discontinuation, with further linear decline by four months for NNH and by eight months for NH patients. All patients showed similar subsequent falloff: linear annual decline at 13% to 36%. We conclude that discontinuation rates are unacceptably high, that interventions must be continued throughout treatment, and that HBP has limited utility as an indicator chronic disease.

Adult↗
PubMed1979

The status of aid to the medically needy.

Medical indigence, as incorporated in Medicaid legislation, is official recognition that medical expenses are frequently large and often unpredictable, and that the consequences of not using needed services because of their cost can be serious. Under the law, states may make eligible for medical vendor payments people whose incomes, while sufficient for the normal expenses of living, are not large enough to cover the costs of medical care. States which choose to do so may enroll people for Medicaid benefits whose incomes are as much as 133 1/3 percent of the eligibility level for cash grants to families of comparable size under the state's program of Aid to Families with Dependent Children (AFDC). Of fifty jurisdictions with Medicaid programs, twenty-one have decided not to include the medically indigent. Of the remaining twenty-nine, ten have set eligibility at levels less than the figure at which an AFDC family would begin to receive cash income maintenance grants, and twenty-two have set them below the maximum permitted by federal law. Similar figures are presented for the aged showing that twenty states have set eligibility levels below that for the Supplemental Security Income program. Thus, the concept of medical indigence has been eroded by eligibility decisions in more than half of the states, although it remains important, especially for the elderly with large expenses for long-term care.

Eligibility Determination↗
PubMed1979

A general medicine clinic: the dilemma and teaching implications.

An academic general medicine clinic (GMC) was studied to determine current patterns, shortcomings, and potential solutions. Retrospective medical record review of 349 randomly selected GMC patients from 1975 permitted profile generation. Only 11.5% of the patients had first visits in the study year. Almost 75% of the study group used the university hospital as their major source of care. Over two years only 58% continued in active care, while 5% died, 8% needed no further follow-up, and 29% were lost from care. The prevalence of hypertensive cardiovascular disease was disproportionately high. Patients exhibited chronic disease exclusively in 91% of return visits. The authors conclude that the GMC offers insufficient variety of patient presentations for optimal postgraduate medical education and inadequate accessibility for comprehensive medical care. Potential improvements include expanding the patient base, extending availability, and employing nonphysician clinicians.

Cardiovascular Diseases↗
PubMed1978

Understanding the growth of emergency department utilization.

Much research on utilization of hospital emergency departments has been published over the past 10 to 15 years. It has failed to yield a coherent view of why the volume of use has increased, however, because most of it has focused on users of one or more ERs, ignoring the nonusers, and has provided insufficient detail about the local context in which the ER operates. The result has been large quantities of data which, when compared, produce inconsistencies which cannot be resolved without additional data from different studies. Yet, a tentative explanation of ER growth can be presented if the question of why people use ERs, which is usually thought of as being similar to the question of why people use medical care services, is restated as, why do people who want to use medical care choose the ER as the site of care? That question can best be answered by paying greater attention to enabling and illness factors than to the predisposing demographic factors upon which much research has focused. A tentative explanation of the growth of ER utilization is offered. Then, the support from the literature for it is presented and the remaining questions are identified for future research.

Ambulatory Care↗
PubMed1978

Variations in state Medicaid programs.

Many federal laws permit the states considerable latitude in determining the important characteristics of programs created under them. Yet, frequently, this aspect is overlooked in the analyses of differences in state-level programs. The purpose of this paper is to present a measure to aid in the analysis of one such program, Medicaid, and to illustrate some of the ways it can be useful. The Medicaid Program Index (MPI) differentiates among state Medicaid programs according to four important characteristics: inclusion of the medically indigent, the optional services covered, limitations on the provision of the basic services, and arrangements for paying providers. Data are presented to show that, in fact, the states do vary considerably on these factors, which can be analyzed in the aggregate (i.e., as the MPI) or separately. In addition, several uses for the MPI are discussed. They include: (1) identifying variations in state programs; (2) accounting for those differences by comparing them to promising explanatory variables; (3) identifying trends in program characteristics over time: and (4) developing hypotheses to account for those trends. Finally, it was suggested that similar measures can be developed to facilitate analyses of other federal/state programs.

Humans↗