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At least 757 records · Page 42Linked to original sources
PubMed1976

Survival, hospitalization charges and follow-up results in critically ill patients.

In 226 consecutive critically ill primarily postoperative patients, we determined survival and quality of life, hospitalization charges, and consumption of blood and blood products. The patients were physiologically unstable and required intensive physician and nursing care. By one month, 123 patients had died (54 per cent), 70 were still hospitalized, and 31 were home; only one of 103 survivors had fully recovered. By 12 months, 164 patients (73 per cent) had died, 10 were still hospitalized, and 51 were home. Twenty-seven of 62 survivors had fully recovered. Hospitalization charges averaged $14,304 per patient. The total charge for blood and blood fractions was $617,710--21 per cent of the total hospitalization charge; $515,711 (83 per cent) of the blood charge went to 164 nonsurvivors, whereas $101,939 (17 per cent) went to the 62 survivors. These data document the use of increasingly limited resources in the management of critically ill patients. The medical profession must make difficult decisions to allocate these resources effectively.

Age Factors↗
PubMed1977

Relation between the race and economic status of patients and who performs their surgery.

We evaluated the relation between race and economic status of surgical patients and their likelihood of being treated by a surgeon in training rather than by a staff surgeon. Blacks were 2.2 to 4.3 times more likely than whites to be under the care of surgeons in training (P less than 0.001). This relation has remained unchanged over the past two decades. It remained when the method of payment was via self-payment or private insurance, but disappeared when patients being paid for by Medicaid were considered. In addition, black emergency patients were more likely than white emergency patients to be cared for by surgeons in training.

Black or African American↗
PubMed1978

The social and economic costs of end-stage renal disease. A patient's perspective.

The soical and economic effects of end-stage renal disease are enormous. This case history of our experience with dialysis and transplantation details our life with these two modes of treatment. Despite the common notion that Medicare covers most of the expenses, the detailed records of our financial experience show that Medicare paid only 53 per cent of our total costs; the remainder came from a mixture of private and public sources. In seeking alternative financial support, we encountered many problems, including complex and constraining requirements for aid, invasion of privacy, high insurance and bank-interest rates and termination of employment. Even those in middle-income brackets find it difficult to maintain their independence under such circumstances. New legislation extending Medicare coverage of home dialysis and transplantation should help to alleviate these problems in the future.

Adult↗
PubMed1979

A rationale for continued federal support of medical education.

Changing circumstances and shifting public attitudes are forcing policy makers and educators to reconsider the rationale for a continuing federal role in support of medical education. Federal institutional support programs are criticized as being inappropriate to current and future needs, socially inequitable and subject to abuse by a coercive governmental apparatus. A rationale for federal support can be advanced, but such support must be designed to avoid unwarranted subsidies and to encourage maximum reliance upon private-sector resources, and should be confined to functions for which the federal government in uniquely suited. The appropriate federal role is conceived as being the ultimate guarantor of financial access to the medical-education system by otherwise qualified students, perfecting the market for human-capital investment.

Budgets↗
PubMed1980

Duplicated hospital facilities: How much can we save by consolidating them?

One strategy for controlling the costs of health care is to eliminate duplicative hospital facilities so that the current volume of services can be delivered more efficiently. We evaluated the potential saving from consolidating hospital facilities according to the guidelines recently established by the Department of Health and Human Services (HHS) Eliminating duplication in four categories (computerized axial-tomographic scanners, open-heart surgery and cardiac-catheterization units, megavoltage-radiation units, and general hospital beds) would yield a potential theoretical saving of about $1 billion a year. However, the resulting indirect costs, such as those incurred by certificate-of-need programs and by moving patients from one facility to another, would reduce or possibly eradicate this gain. Overall, the expected saving falls far short of HHS goals. We conclude that only by reducing the demand for services will substantial savings be realized.

Cardiac Catheterization↗
PubMed1987

Payment restrictions for prescription drugs under Medicaid. Effects on therapy, cost, and equity.

In an attempt to contain costs, 27 Medicaid programs have implemented patient-level payment limits for medications, but the effects of these restrictions on quality of care, costs, and health status remain largely unknown. We measured the effect of one state's limit of three paid prescriptions per month and its replacement a year later by a $1 copayment. Using data on 48 months of claims in the study state (New Hampshire) and a comparison state (New Jersey), we employed time-series analysis to evaluate patient-level changes in the number of prescriptions filled for 16 drugs that varied in their clinical importance and cost. Among 10,734 continuously enrolled patients, the limit of three paid prescriptions per month caused a sudden, sustained drop of 30 percent in the number of prescriptions filled (from 1.10 to 0.77 prescriptions per patient per month); no change was observed in the comparison state. The 860 recipients of multiple drugs, who were predominantly female and elderly or disabled, were most severely affected; the number of prescriptions per month dropped from 5.2 to 2.8 (46 percent). The decrease was greatest for "ineffective drugs" (58 percent), but large drops were also observed for "essential" medications, such as insulin (28 percent), thiazides (28 percent), and furosemide (30 percent). Reductions in Medicaid prescriptions were minimally offset by increases in the size of the prescription or in out-of-pocket payments. When a $1 copayment replaced the three-prescription cap, prescriptions for most medications increased to just below precap levels. Medicaid's savings on drug costs resulting from both policies were comparable ($0.4 to $0.8 million annually), but the copayment policy had less effect on patients receiving multiple drugs. Because the clinical consequences of such policies cannot be assessed from prescription data alone, further study is needed to determine the effects of cost-containment strategies on health status and the use of other services among poor populations.

Cost Control↗