Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Capitalism”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed2000

The effect of capitated financing on mental health services for children and youth: the Colorado experience.

OBJECTIVES: This study tested 2 propositions concerning the effect of capitated financing on mental health services for Medicaid-eligible children and youth in Colorado. The first is that capitation reduces costs. The second is that shifting providers from fee-for-service to capitated financing will increase their efforts to prevent illness. METHODS: Interrupted time-series designs were applied to a naturally occurring quasi experiment occasioned by the state of Colorado's reorganization of mental health services financing. RESULTS: The cost of services was significantly lower in counties with capitated services compared with counties with fee-for-service financing. Findings also suggested that economic incentives may lead to greater efforts at secondary and tertiary prevention. CONCLUSIONS: Policymakers and the public can expect that capitation will reduce the costs of children's mental health services below those likely with fee-for-service financing. Capitation per se, however, may not increase prevention as surely or swiftly as it lowers costs.

Adolescent↗
PubMed1991

Prospective payment for Medicare hospital capital: implications of the research.

The special characteristics of capital have an important effect on the cross-section variation in hospitals' capital costs. Variables reflecting capital age and financing differences perform as expected and add substantial explanatory power to capital cost models. However, even with the inclusion of these variables, the capital-cost models perform poorly compared with total-cost models. The empirical findings of this article support using the total-cost models to develop a common set of adjustment factors for capital and operating payment amounts in the Medicare prospective payment system.

Capital Expenditures↗
PubMedDate not supplied

The myth of Japan's low-cost capital.

The low rate at which U.S. companies are investing in manufacturing and the resulting decline in America's competitive position has been a topic of grave concern for more than a decade. During that time, critics have offered many excuses for this shortsighted investment behavior. Yet one excuse has steadily gained adherents and is becoming something of an article of faith--that is, that capital in the United States is more expensive than in other countries, particularly Japan. It is both a popular and appealing argument. Yet authors W. Carl Kester and Timothy A. Luehrman, professors at the Harvard Business School, warn that this argument is not only false but also dangerous. They assert that the empirical evidence does not support the claim that the U.S. manufacturing sector has persistently faced significantly higher average capital costs than the Japanese manufacturing sector. The authors argue that differences in capital costs have been isolated and temporary, not broad and persistent. To prove their point, Kester and Luehrman critically dissect both the common wisdom and the academic studies on the topic. They conclude that in the new global economy, all companies--Japanese, American, European, and others--must compete for the same capital. Some will succeed in obtaining it on temporarily favorable terms, not because they are Japanese but because they are efficiently organized and governed. But as long as an alleged international cost-of-capital gap is their excuse, U.S. managers run the risk of retaliating counterproductively against U.S. trading partners or doing nothing at all inside corporations. In short, managers should stop complaining about how much capital costs and worry more about how to manage it after it's been raised.

Capital Financing↗
PubMed1998

Dialogue. Prescription for problems? Capitating mental health drugs--the great debate.

With the issue of physician capitation far from being resolved, mental health drug capitation is understandably up for debate. Those who deem it essential point to the rising cost of mental health drugs and urge management techniques which they believe can hold the delicate balance between a plan's budgetary limitations and a patient's appropriate care. They suggest that with an objectively calculated capitation rate, based not on expenditure alone, but on a defined population and their care needs, providers will not have to choose between profitability and optimal care. But others, responding to increasing quality concerns under capitation, worry that the increasing use of formularies will preclude patients and their providers from ready access to newer, more effective medications. With advocates still striving for nationwide parity for mental health benefits, capitating medications is not likely to assuage their concerns. Driving the debate is the fact that new technology drugs are expensive and most health plans are unable to anticipate the funding of breakthrough pharmaceuticals. With the advent of marketing to consumers directly through television and print media, plans and providers are increasingly pressured to provide these medications. The recent clamor for Viagra is an excellent example of how quickly the word can spread. New mental health medications may be even more expensive and offer patients and their families greater effectiveness with far fewer side effects. Plans, providers, and patients are caught in the middle, each holding their distinct view of the problems and solutions. This issue's dialogue brings our readers a discussion of capitation of pharmaceuticals as a primary answer to the sharp rise in mental health drugs. Three points of view lay out the viability and cautions of developing formularies and systems that could keep costs under control while still providing patient access. Without question, the debate will continue as legislative and consumer pressure continues to focus on managed care's techniques for cost savings and patient management. More sophisticated systems, designed for increasingly integrated and complex treatment plans, are certain to be required in the future. However, decisions about how to develop practice guidelines and integrate formularies with expensive new pharmaceutical technology, must begin to take shape now.

Budgets↗
PubMed1981

Capital maintenance and equity erosion in the nursing home industry: a study in one state.

Federal contingencies charge states to regulate the reimbursement of the nursing home industry such that government reimbursement is at a minimal cost that reflects efficient operations, yet at amounts great enough to allow viability and ability to attract and maintain the investment of capital. This study discusses the regulation of the nursing home industry in terms of the significance and costs of financial capital, and the constraints imposed upon states as regulators of capital reimbursement policies. Descriptive financial profiles of nursing homes are provided in one state where the industry alleges inadequacies in the capital reimbursement formula. These financial profiles suggest that the nursing homes investigated have not been able to provide for capital maintenance; instead, the industry may be suffering from equity erosion. Also, the descriptive profiles of capital structure in the nursing home industry differ across three major segments--county, not-for-profit and proprietary homes.

Capital Financing↗
PubMed1987

Grandfathering: is it a fair capital payment transition approach?

The concept of grandfathering capital obligations was discussed in last year's Congressional debate over capital payment methods for the Medicare prospective payment system (PPS). Under grandfathering, hospitals would continue to receive cost-based capital payments for expenditures obligated prior to a threshold date, over a predetermined period of time. While grandfathering protects hospitals that recently invested in major capital projects, it is concluded that grandfathering is an inequitable approach for paying for capital under PPS. It provides payments in excess of cash needs to hospitals that recently invested, at the expense of hospitals that need to invest. An alternative capital payment method based on a straight-line transition, all other things being equal, provides greater protection to a larger number of hospitals.

Capital Financing↗
PubMed1989

Allocating capital systemwide. Who gets how much and why.

The maturing of multi-institutional healthcare systems has created a need for systemwide approaches to managing investment in capital expenditures. Historically, hospitals have allocated capital using traditional capital budgeting techniques, including discounted cash flow, net present value, and internal rate of return methodologies. Now systems can use a multifactored model to allocate capital among member hospitals. This approach uses historical and projected financial and statistical information to quantify the risks member hospitals face. At the system level, capital allocation decisions should start with the strategic and financial planning processes. Catholic systems face an additional caveat: The system's mission statement drives the planning processes. Conceptually, the capital allocation plan is an attempt to value each hospital as a going, or viable, concern. From this perspective, value is understood as a function of expected return, the certainty of the return, and the return offered by similar investments in other hospital markets. Despite the many determinants of business and financial risk, much of the variance in asset market value can be explained through five assessment criteria: market demographics, position within the market, historical and projected financial performance, historical utilization, and third-party reimbursement mix.

Capital Expenditures↗
PubMedDate not supplied

Capitation among Medicare beneficiaries.

CONTEXT: The Medicare program has promoted capitation as a way to contain costs. About 15% of Medicare beneficiaries nationwide are currently under capitation, but tremendous regional variation exists. PRACTICE PATTERN EXAMINED: The proportion of Medicare beneficiaries who have enrolled in risk-contract plans in individual states and in the 25 largest metropolitan areas in the United States. DATA SOURCE: Health Care Financing Administration data files. RESULTS: Medicare beneficiaries are most likely to be under capitation in Arizona (38%) and California (37%). Eight other states have capitation rates greater than 20%: Colorado, Florida, Rhode Island, Oregon, Washington, Pennsylvania, Massachusetts, and Nevada. Thirty states, largely in the Great Plains area and the southern United States, have capitation rates less than 10%. Four major metropolitan areas have market penetration rates greater than 40%: San Bernardino, California; San Diego, California; Phoenix, Arizona; and Miami, Florida. Little penetration exists outside of metropolitan areas. CONCLUSION: Capitation in Medicare is a regional and predominantly an urban phenomenon.

Capitation Fee↗
PubMedDate not supplied

Administrative competencies for physician organizations with capitation.

In California, it is common for HMOs to capitate physician organizations (e.g., independent practice organizations and multispecialty medical groups) for all professional and outpatient ancillary services (and to share risk for inpatient care) under professional risk capitation contracts. This arrangement exports most of the financial risk from the HMO to the physician organization. When HMOs and physician organizations contract under these arrangements, HMOs delegate many of their administrative functions to physician organizations--giving the physician organization authority to make the decisions needed to manage capitated risk. As a result, administrators of physician organizations must be competent in such areas as provider network development, financial forecasting, utilization and quality management, contract negotiation, and establishing systems for claims, reporting, authorizations, and the like. In this study four HMO and 22 physician organization administrators were interviewed concerning key administrative competencies for managing capitation contracts. The competencies were assessed as key administrative work activities that required specific knowledge, skill, or ability to perform. Identifying these competencies is important for physician organizations preparing for capitated risk and will be essential for organizations preparing for HMO or Medicare capitation.

Administrative Personnel↗
PubMed1999

Providing capital for physician group practices: new opportunities for hospitals.

As physician group practices grow and consolidate, they have an increasing interest in developing close capital partnerships to ensure access to capital. Yet as many healthcare organizations have sought to divest poorly performing acquired physician practices, physicians have seen their pool of potential capital partners shrink. Under these conditions, hospitals have a new opportunity to present themselves to physician group practices as attractive capital partners. To understand the nature of this opportunity, one needs to know why group practices seek capital, how groups approach their investment strategies, and what criteria they use to compare prospective capital partners. To build stronger relationships with physicians, hospitals should focus on turning around their poorly performing acquired physician practices and pursue strategies such as collaborating with physician practice management companies and developing new models for partnering with physicians (e.g., special purchase agreements and more advanced management services organizations).

Capital Financing↗
PubMed1988

Physician satisfaction with capitation patients in an academic family medicine clinic.

Physician work satisfaction may play an important role in the management and quality of health care, yet cost-containment measures may compromise levels of physician satisfaction. This article reports an evaluation of physician attitudes toward aspects of capitation plans that may place the physician in conflict with the physician's traditional role. The literature was reviewed in an effort to generate a list of constructs that would be relevant to physician work satisfaction. By using constructs that focus on both physician work satisfaction and capitation, a survey instrument was developed and serially administered to physicians involved directly in a capitation program. Among the five dimensions studied, providers rated capitation patients more favorably in only one area: interpersonal relationships. Providers indicated a preference for noncapitation patients in the dimensions of autonomy, intellectual stimulation, time restraints, and structural variables. Furthermore, physicians' satisfaction levels with capitation patients tended to decrease the longer they cared for them. These findings are consistent with expectations, and lend support to the hypothesis that organizational constraints may have an adverse effect on physician attitudes toward selected aspects of caring for capitation patients.

Academic Medical Centers↗
PubMed2003

Effects of child abuse and neglect: does social capital really matter?

OBJECTIVE: To explore whether social capital and social support moderate the relationship between child maltreatment and emotional and behavioral outcomes such as depression-anxiety and aggression in 6-year-old children. DESIGN: Data from Longitudinal Studies of Child Abuse and Neglect were used. Data were collected through interviews and questionnaires at the child's birth and at the age of 6 years. SETTING: General community. PARTICIPANTS: Two hundred fifteen maternal caregivers of children at high risk for child abuse and neglect were included in this study. MAIN OUTCOME MEASURES: Depression-anxiety and aggression were measured through the Child Behavior Checklist. RESULTS: Among 5 potential effect modifiers (3 social capital constructs and 2 measures of social support), only 1 (instrumental support) significantly modified the relationship between maltreatment and child aggression. CONCLUSIONS: Social capital did not modify the relationship between child maltreatment and either aggression or depression-anxiety. This might be related to the fact that many previous studies looked at social capital ecologically, whereas this study uses individuals as the unit of analysis. The results of this study might also indicate that previous studies of social capital and health outcomes might actually be using social capital as a proxy for social support.

Aggression↗
PubMed1997

An empirical test of the identity capital model.

In a previous issue of this journal, the identity capital model was presented as part of an effort to better understand the relationship between social context and identity formation (Côté, 1996a). The present paper provides an empirical test of that model as it applies to the late-adolescent passage of university students toward adulthood. A series of research questions are explored which reveal the following: (1) concepts used in the model can be reliably measured; (2) significant relationships exist among certain measures of identity capital resources; (3) these resources have significant associations with measures of identity capital acquisition; (4) over 2 years of university, identity capital increases overall for female students (on a measure of adult identity resolution) and for those of lower social class background (on a measure of community identity resolution); and (5) certain resources acquired before attending university are predictors of identity capital acquisition after 2 years of attendance, net of the identity capital with which students begin university.

Achievement↗
PubMed2001

Individual-level relationships between social capital and self-rated health in a bilingual community.

BACKGROUND: Previous register studies have shown that mortality rates and disability pension statistics favor Swedish-speakers when compared to their Finnish-speaking neighbors in the same bilingual region in Finland. The purpose of the present questionnaire survey was to determine whether the Swedish-speaking community has more social capital and if the social capital is associated with health at the individual level. METHODS: The study population consisted of randomly selected samples of Finnish-speakers (N 1,000, response rate 66%) and Swedish-speakers (N 1,000, response rate 63%) representing all adults living in bilingual Ostrobothnian municipalities (75,000 Finnish-speakers and 78,000 Swedish-speakers). To inquire into social capital and health indicators, a bilingual questionnaire was composed to cover variables and indicators of sociodemography, health status, health behavior, and social capital (interpersonal trust and civic engagement). Data were analyzed with multiple logistic regression for two binary outcome variables: language group (Finnish vs Swedish) and self-rated health (good vs almost good/fair/poor/bad). RESULTS: When health-related variables (urban residence, migration, age, BMI, household income, smoking, singing in a choir, membership in any voluntary association, participation in community events, and long-term diseases) were controlled for, the Finnish-speakers were more often migrated (P = 0.0001) and mistrusting (P = 0.0001) and less active in community events (P = 0.0016) and in singing in a choir (P = 0.02) than the Swedish-speakers. After controlling for language and the above-mentioned health-related variables, the number of auxiliary (willing to help) friends (P = 0.001), mistrust (P = 0.037), and membership in any religious association (P = 0.0096) were significantly and independently associated with good self-rated health in the whole sample. CONCLUSIONS: The Swedish-speaking community seems to hold a fair quantity of social capital, which is associated with good health. Since the ecological and socioeconomic circumstances are equal for both language communities, a great deal of health inequality can be explained by differences in social capital.

Adult↗
PubMed2005

Depressive symptoms in mothers of pre-school children--effects of deprivation, social support, stress and neighbourhood social capital.

BACKGROUND: Depressive symptoms in mothers of young children can have serious consequences for the health of the child. In particular, children whose mothers are experiencing depressive symptoms are at significantly greater risk of poisoning and accidental injury. A mother's risk of developing depressive symptoms has been shown to be related to socio-economic disadvantage, high levels of stress and a perceived lack of social support. Residents who perceive their neighbourhoods to be of low social capital are more likely to report poor mental health. The aim of this study was to investigate the relationship between maternal depressive symptoms, deprivation, social support, stress and neighbourhood social capital in a group of mothers living in deprived areas of Nottingham, United Kingdom (UK). DESIGN AND SETTING: A postal questionnaire at entry to a randomised controlled trial (RCT) assessed socio-demographic characteristics and a second questionnaire, 21 months later, assessed depressive symptoms, perceived lack of social support, self-reported stress and individual-level assessment of neighbourhood social capital. PARTICIPANTS: A total of 846 mothers of young children living in deprived areas in Nottingham, UK, enrolled in the control group of an RCT. RESULTS: One-third of mothers reported high levels of depressive symptoms. Neighbourhood-level deprivation and receiving means-tested benefits were independently associated with maternal depressive symptoms. A lack of social support and high levels of self-reported stress were also strongly associated with depressive symptoms. Individual-level assessment of neighbourhood social capital was not associated with depressive symptoms amongst mothers after adjusting for self-reported stress. CONCLUSIONS: Neighbourhood- and individual-level variables of deprivation and psychological distress are more important than mother's assessment of the social capital of the neighbourhood in which she lives in determining the risk of depressive symptoms. Interventions aimed at supporting mothers of young children may be more effective at reducing the risks of depressive symptoms and consequent risks to the child's health than interventions aimed at improving a neighbourhood's social capital.

Adult↗
PubMed2004

Further development of an Australian-based measure of social capital in a US sample.

Social capital is an increasingly popular construct in research examining social and behavioral determinants of health and well-being. Yet, comparing the results of social capital research is inhibited by inconsistencies in labeling, different definitions and subsequent disagreement on level of analysis, and limited evaluation of the psychometric properties of measures of social capital. This study examined the psychometric properties of the Social Capital Questionnaire (Journal of Applied Behavioral Science 36(1) (2000) 23). In the current study, the original Australian-based instrument was modified for telephone administration with a US sample. Exploratory factor analysis revealed a similar factor structure to that found during initial survey development. These findings lend support to the notion of social capital as a meaningful construct and suggest the Onyx and Bullen instrument deserves further attention as a practical tool for health researchers and community agencies interested in social capital.

Adult↗
PubMed2004

Social capital in working life and the health of employees.

It is commonly assumed that social capital influences health, but only few studies have examined this hypothesis in the context of the workplace. The present prospective cohort study of 6028 public sector employees in Finland investigated social capital as a workplace characteristic which potentially affects employee health. The two indicators of social capital were trust in the labour market, measured by security of the employment contract, and trust in co-worker support. Self-rated health status and psychological distress were used as indicators of health. The combination of subsidised job contract and low co-worker support (i.e. the lowest category of social capital) was associated with poorer health prospects than the combination of permanent employment and high support (the highest social capital category) in an age-adjusted model, but this association disappeared in logistic regression analysis adjusted by sociodemographic background factors and baseline health. Fixed-term employment predicted better self-rated health and less psychological distress when compared with permanent employment. Co-worker support was most common in permanent and least common in subsidised employees and it was associated with better self-rated health in women. Our findings suggest only partial support for the hypothesis of work-related social capital as a health resource.

Adult↗
PubMed2005

Social capital, geography and health: a small-area analysis for England.

There has recently been much debate about the influence of social capital on health outcomes. In particular it has been suggested that levels of social capital vary from place to place and that such variations may account for previously unexplained between-place variations in health outcomes. As yet few studies exist of the influence of small-area variations in social capital on health outcomes. One reason for this is the difficulty of obtaining indicators for small areas such as electoral wards in England, and we describe a method used to derive what we term 'synthetic estimates' of aspects of social capital by linking coefficients produced from multi-level analyses of national survey datasets to census data. We produce estimates for electoral wards in England and apply these in multi-level models of our response variable, the probability of survival of individuals surveyed in the Health and Lifestyle Survey of England. We report various combinations of models incorporating individual attributes, health-related behaviours, area measures of deprivation, and area measures of social capital. Our overall conclusion is that we find little support, at this spatial scale, for the proposition that area measures of social capital exert a beneficial effect on health outcomes.

Censuses↗