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PubMed1996

National survey of hospital-based pharmacokinetic services.

The status of pharmacokinetic services in the nation's hospitals was studied. A questionnaire was mailed in February 1995 to all 252 respondents to ASHP's 1994 national survey of hospital-based pharmaceutical services who indicated the provision of pharmacokinetic services in their institution. Ninety-eight completed questionnaires were returned (40.2% response rate). The pharmacokinetic services provided required an average of 19.1 person-hours per week, tended to be provided by staff pharmacists, were managed by the pharmacy department, tended to be most focused on aminoglycosides and vancomycin, required an average of 60 notes in patient charts per month, and relied on both computers and calculators for deriving values. There was little contact with patients during the consultation process. Drug concentration measurements tended to be scheduled by service providers, but confidence in the accuracy of the timing of dose administration and blood sampling was limited. Respondents believed that the services tended to be supported by other hospital personnel and that they were successful. There was very little expectation that the workload for providing pharmacokinetic services would increase in the near future. A national survey of hospital-based pharmacokinetic services showed that it took 19 hours per week on average to provide the services, that the focus was on aminoglycosides and vancomycin, and that the services were perceived to be supported by other departments.

Drug Monitoring↗
PubMed2004

Older adults' satisfaction with integrated capitated health and long-term care.

PURPOSE: The objective of this study is to develop an instrument to evaluate satisfaction with care for older adults in capitated environments. Although satisfaction with care is now widely accepted as an important outcome measure, there are relatively few satisfaction measures developed or validated on older persons. Because many older persons are unable to respond to surveys, separate instruments were developed for individuals and for their families. DESIGN AND METHODS: There were 402 face-to-face interviews conducted at 11 PACE sites with PACE participants or their family members and a non-PACE group. Scales were constructed by use of factor analysis and were evaluated for internal-consistency reliability, validity, and ability to discriminate. RESULTS: For the participant survey, three factors were identified, but only two exhibited adequate internal consistency (Perceived Access and Perceived Interpersonal Quality). For the family survey, all four identified factors had adequate internal consistency (Perceived Access, Family Pressure, Ease of Access, and Family Involvement). The participant survey discriminated between the PACE sites and the non-PACE sites, but the family-member survey did not. IMPLICATIONS: The PACE Satisfaction Survey appears to have adequate reliability and validity for measuring the satisfaction of older persons and their family members with capitated care. The domains of satisfaction differ between individuals and family members.

Aged↗
PubMed1997

Preparing obstetricians and gynecologists for capitation.

We are indeed facing a changing paradigm in the way medical services are delivered and reimbursed. Physicians are becoming entangled in the business world. Terms such as "medical loss ratio" must be integrated within the physician's existing language. According to Green and Barnett, "No group is so large or so small as to likely survive the next decade without being involved in a capitated contract." The change is not tomorrow, it is today. Do not be lost in the changing world of medicine without becoming involved, and see if it is for you and your practice. Progress of medicine may not be what you would like but do not be passed by without making an impact. Capitation offers an opportunity to regain control of the management of care, to develop innovative and cost-effective approaches to delivery, and to enhance income and revenue in the face of declining health care budgets.

Capitation Fee↗
PubMed1986

Prospective payment for hospital capital by Medicare: issues and options.

After this year, Medicare will no longer reimburse capital-related expenses. Instead, a new approach may be implemented. Should the new capital payment scheme be prospective? Should Medicare continue to recognize return on equity? What will be the relationship between Medicare payment and health care planning? These and other questions should be asked since the answers will directly affect the health care setting.

Aged↗
PubMed1991

Factors for success: capitated primary physicians in Medicare HMOs.

Since their introduction in 1985, Medicare health maintenance organizations (HMOs) have had mixed results, and little research has been completed on what factors lead to a successful experience for capitated physicians in Medicare HMOs. The pilot study discussed in this article was conducted in early 1989 in an attempt to identify those factors. The study involved structured individual diagnostic interviews with successful capitated Medicare HMO primary physicians, revealing that they share common characteristics in practice philosophy, attitudes, and administrative control.

Attitude of Health Personnel↗
PubMed1999

Information needs in a changing health care system: capitation and the need for a population-oriented view.

Information systems needed for managing the health care of populations under at-risk (capitation) contracts must be designed differently than those used in fee-for-service practice. Under capitation, providers must deliver health care to enrollees with financial resources that are fixed in advance. Therefore, the information systems they use must enable them to understand the health status of health plan enrollees and how health care is provided. These systems should facilitate the detection of underservice and of inadequate quality of health care as well as overuse of health care resources. They should permit clinical-epidemiologic and statistical analysis; facilitate disease management and the adoption of preventive programs, and lend themselves to use by planners, group leaders, and practicing physicians.

Ambulatory Care Information Systems↗
PubMed1994

A method for adjusting capitation payments to managed care plans using multivariate patterns of health and functioning: the experience of Social/Health Maintenance Organizations.

A multivariate procedure for identifying case-mix dimensions from discrete health variables is presented. Since the dimensions are generated only from health use data and not service use data, they can be used for adjust capitation rates to provide incentives to treat persons not currently well integrated in standard health care system (e.g., very ill persons, the uninsured) or to promote specific health outcomes. The procedure is illustrated with data from Social/Health Maintenance Organizations (S/HMO) since they provide both acute and long-term care (LTC) services. Thus, case-mix measures to adjust S/HMO reimbursements have to represent both medical conditions and the degree, and type, of functional impairment. From 31 health and functioning items, six case-mix dimensions, and scores for individuals on each, were calculated. The multivariate distribution of scores in S/HMO enrollees, and in Medicare eligible, comparison samples, were examined in each site to see how their health differed. S/HMO enrollees were healthier and less frail than persons remaining in the Medicare FFS system. Such differences are important in adjusting capitation rates to provide incentive to accept clients with complex health problems.

Activities of Daily Living↗
PubMed1996

United Kingdom labour emigration and capital exports 1816-1991.

"This paper is concerned primarily with examining the nature of linkages between capital and labour emigration from the U.K. We also consider whether the primary impulses for emigration were push or pull influences--the main intent is to look at the relation between the flows rather than the determinants of either. The nature of the capital-labour link is examined qualitatively using historical argument and quantitatively using statistical tests and causality analysis. The starting time for analysis is the end of the Napoleonic Wars when useful data became available." (SUMMARY IN FRE AND SPA)

Demography↗
PubMed2003

Improving access to capital for health care infrastructure: the experience of the Southern Rural Access Program's revolving loan fund.

Lack of access to affordable capital is a formidable barrier that compromises rural health care infrastructure development in poor rural areas. Commercial lending institutions are often limited in their ability to respond to those needs due to traditional lending criteria: creditworthiness, equity, management ability, experiences, and cash flow or profits. In the Southern Rural Access Program, a development model more frequently used in other sectors has been successfully applied to health care to help clear these hurdles. This paper describes the 5 operational loan funds in Arkansas, Louisiana, Mississippi, South Carolina, and West Virginia receiving support from the Southern Rural Access Program. Two models of loan funds have evolved: those led by health agencies and those led by community development finance institutions whose mission is rural economic development. This paper outlines major distinctive features of these 2 approaches and describes major implementation challenges these loan funds face. Key accomplishments are high-lighted, including the ability to leverage additional resources from state, federal, philanthropic, and private sources through these funds. These loan fund programs provide models for other states interested in improving access to capital to help build the rural health care infrastructure while making health care more economically viable through integration with other community development initiatives.

Capital Financing↗
PubMed1975

The development of moral judgments concerning capital punishment.

Data from a 20-year longitudinal study of the development of moral judgment in American males indicate that the most mature stages evince moral condemnation of the death penalty. The authors conclude that American moral standards are evolving towards a view of execution as unjust punishment. They contend that a theory of punishment based on the highest stage of moral reasoning is more valid than lower-stage justifications for capital punishment, and that it provides a rational basis for asserting the immorality--and unconstitutionality--of capital punishment, irrespective of uncertainties as to the deterrent efficacy of the death penalty.

Adolescent↗
PubMed1998

Capitation, managed care, and chronic obstructive pulmonary disease.

Expenditure and utilization patterns of aged Medicare beneficiaries with chronic obstructive respiratory disease (COPD) (n = 42,472) were compared with all Medicare beneficiaries (n = 1,221,615) using a 5% nationally representative sample of aged Medicare beneficiaries participating in the fee-for-service program in 1992. Per capita expenditures for an aged Medicare beneficiary with COPD were 2.4 times the per capita expenditures for all Medicare beneficiaries. The most expensive 10% of Medicare beneficiaries with COPD accounted for nearly half of total expenditures for this population. Higher comorbidity, as measured by the Deyo-adapted Charlson index, was associated with higher expenditures. For Medicare Part B claims, internal medicine accounted for the largest portion of physician expenditures (14%). Per capita expenditures for pulmonologists were 7.5 times higher for beneficiaries with COPD compared with all Medicare beneficiaries. Results from this study suggest that there is a subgroup of individuals with COPD who are likely to be very expensive during the year. Additional analytic studies are needed to more specifically identify characteristics associated with these individuals. As more Medicare beneficiaries enroll in managed care and as physicians are increasingly being paid on a capitated basis this information will be useful to physicians as they monitor the care provided to patients and assess the financial risks they accept under capitation.

Aged↗
PubMed1989

Philadelphia's capitation plan for mental health services.

Dr. Sharfstein's Introduction: Prospective payment is the major economic change that is reshaping the delivery of medical care. Capitation financing for the chronic mentally ill is an innovative and promising alternative to underfunded and bureaucratically rigid public programs on the one hand and underfunded retrospective cost-based Medicaid programs on the other. This month's column describes one such capitation plan. Its impact on the target population as well as on the use of resources by persons with long-term and severe mental illnesses will require close evaluation.

Capitation Fee↗
PubMed1989

Evaluation questions for Philadelphia's capitation plan for mental health services.

Public policy should be guided by sound data emerging from quality research. A shift in the financing of medical and psychiatric care toward capitation models represents a major change, and the Philadelphia capitation experiment described in the April column is one pioneering effort. The answers to the following evaluation questions about the Philadelphia experiment will help decision makers across the country as they contemplate a policy shift from retrospective to prospective payment.

Capitation Fee↗
PubMed1993

Service utilization patterns as determinants of capitation rates.

OBJECTIVE: In a capitation payment system, the ability to project service requirements and cost is critical. The types and levels of services needed by persons with serious mental illness vary. The purpose of this study was to identify different patterns of service utilization and patient characteristics and costs associated with them. METHODS: Service use by 55 clients participating in a psychosocial-habilitation outpatient program at a hospital-based community mental health center was tracked for one year. Treatment cost for all services was calculated for each patient. RESULTS: Cluster analysis indicated that for persons with serious mental illness who enter community treatment, there appear to be four distinct patterns of service use: low, moderate, moderately high, and high. The groups were differentiated only by the presence of a disability (among the moderately high users) and a history of frequent inpatient treatment (among the high users). The two highest-use groups represented about one-third of the total sample but consumed more than three-fourths of the total resources. CONCLUSIONS: The lack of significant group differences on most clinical variables may make it difficult to develop capitation rates for subgroups of persons with serious mental illness. Service use may be determined by factors other than clinical need.

Activities of Daily Living↗
PubMed1993

Labor emigration and the accumulation and transfer of human capital.

"This article examines the processes involved in the acquisition and transfer of human capital by Filipino overseas workers.... In the four major occupational groupings (seamen, production/construction workers, domestic helpers and entertainers), little homeward transmission of human capital has been identified.... Because of the high rate of unemployment in the economy, the outflow of workers has had no observable impact on domestic wage rates."

Asia↗
PubMed1993

Hospital capital structure decisions: theory and practice.

The paper explores capitalisation decisions within the hospital sector. This is done theoretically by examining the appropriateness of capital structure theory of hospitals and also in a real world context of soliciting the views of hospital chief financial officers. The ways in which capital decisions are made is described and the relationship of practice to theoretical models discussed.

Capital Financing↗
PubMed1982

Capital cost reimbursement to community hospitals under Federal health insurance programs.

Issues in current capital cost reimbursement to community hospitals by Medicare and Medicaid are described, and options for change analyzed. Major reforms in the way the federal government pays for capital costs--in particular substitution of other methods of payment for existing depreciation reimbursement--could have significant impact on the structure of the health care system and on government expenditures. While such reforms are likely to engender substantial political opposition, they may be facilitated by broader changes in the reimbursement system.

Capital Expenditures↗