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At least 1,009 records · Page 56Linked to original sources
PubMed2001

Competition in hospital and health insurance markets: a review and research agenda.

OBJECTIVES: To review the empirical literature on the effects of selective contracting and hospital competition on hospital prices, travel distance, services, and quality; to review the effects of managed care penetration and competition on health insurance premiums; and to identify areas for further research. PRINCIPAL FINDINGS: Selective contracting has allowed managed care plans to obtain lower prices from hospitals. This finding is generalizable beyond California and is stronger when there is more competition in the hospital market. Travel distances to hospitals of admission have not increased as a result of managed care. Evidence on the diffusion of technology in hospitals and the extent to which hospitals have specialized as a result of managed care is mixed. Little research on the effects on quality has been undertaken, but preliminary evidence suggests that hospital quality has not declined and may have improved. Actual mergers in the hospital market have not affected hospital prices. Much less research has been focused on managed care markets. Greater market penetration and greater competition among managed care plans are associated with lower managed care premiums. Greater HMO penetration appears to be much more effective than PPO penetration in leading to lower premiums. While workers are willing to change plans when faced with higher out-of-pocket premiums, there is little evidence of the willingness of employers to switch plan offerings. Preliminary evidence suggests that greater managed care penetration has led to lower overall employer premiums, but the results differ substantially between employers with and without a self-insured plan. CONCLUSIONS: Much more research is needed to examine all aspects of managed care markets. In hospital markets, particular attention should be focused on the effects on quality and technology diffusion.

California↗
PubMed2004

[Roles of the hospital pharmacist and the cooperation between hospital pharmacy and insurance pharmacy in the introduction of home parenteral nutrition].

In the introduction of home parenteral nutrition (HPN), roles of the pharmacist are important from the viewpoint of drug therapy. In our hospital, patients are to be shifted to home medical care under the adequate guidance and proper adjustment by the cooperation between the clinical pharmacists and home medical care pharmacists. We are also enhancing the cooperation with the pharmacists in insurance pharmacies. At present, however, there are few insurance pharmacies that can concoct the injection of medicine, resulting in our insufficient responses to the needs of the patients. It is necessary and quite important to increase the number of insurance pharmacies that are allowed to manage the patient's medication as well as the concoction of injecting medicine. The cooperation between hospital pharmacy and insurance pharmacy (Yaku-Yaku Renkei in Japanese) is indispensable in order to promote home medical care; especially "the sharing of information" is most required between the two pharmacy groups.

Community Networks↗
PubMed1984

Falling through the cracks: poverty, insurance coverage, and hospital care for the poor, 1980 and 1982.

About one-third of the nation's poor lack insurance--public or private--against the costs of illness. Data from 1980 and 1982 show that a patchwork of state and local government charitable grants, and the disparate efforts of hospitals to provide free care, cannot mend the national "safety net." A prudent short-run approach to modifying charity care is advanced, although the long-run necessity for insuring the uninsured is inevitable.

Charities↗
PubMed1999

Severe and fatal complications after diagnostic and therapeutic ERCP: a prospective series of claims to insurance covering public hospitals.

BACKGROUND AND STUDY AIMS: Increasing numbers of patients are undergoing endoscopic retrograde cholangiopancreatography (ERCP) prior to laparoscopic cholecystectomy, and more departments and doctors are performing ERCP, while new data from large prospective series have documented the risks of both diagnostic and therapeutic ERCP. The establishment in Denmark of a Patient Insurance Association, which has covered injury caused during investigation and treatment in public hospitals since July 1992, has made it possible to collect and analyze a large prospective series of ERCP complications for which compensation has been claimed. PATIENTS AND METHODS: Thirty-nine consecutive claims for compensation due to complications after ERCP occurring between 1 July 1992 and 31 December 1996 were investigated. Case notes were reviewed, along with laboratory reports and radiographs. The complications were classified according to the international consensus. RESULTS: Claims for compensation were made in 39 cases from 25 hospitals. The indication for ERCP was appropriate in 31. Precut papillotomy for access had been performed in seven. The severity of the complications was mild in one patient, moderate in three patients, severe in 24, and fatal in nine; in two cases, the severity was not classifiable. The complications were: pancreatitis in 23 patients (seven cases fatal, one of which had involved a precut procedure), bleeding in two, perforation in nine (six had a precut procedure, one died), and other reasons in five (including one fatal case). Among the nine fatal cases, cannulation had not been achieved in two and the endoscopic retrograde cholangiogram was normal in four, one of whom underwent a sphincterotomy. One patient with a previous adenoma had an endoprosthesis removed, developed gangrenous cholecystitis afterward, and died. Thirty patients were eligible for compensation. The rejected cases included mild and moderate pancreatitis, a case of fatal hemorrhagic pancreatitis in which the patient had refused blood transfusion, and one patient who had pancreatitis prior to ERCP. CONCLUSIONS: ERCP, even for diagnostic purposes, may be associated with very serious and even fatal complications. The use of the precut procedure for access should still be considered dangerous. Other means of investigating the bile ducts should be developed. If endoscopic ultrasonography and magnetic resonance cholangiography prove to have the same diagnostic value as ERCP, which must be considered the gold standard for visualizing the ducts today, they might replace ERCP as the primary investigation in patients with an intermediate or low risk of bile duct stones; this would reduce the numbers of patients exposed to the risks of ERCP.

Adult↗
PubMed1999

Tracking the State Children's Health Insurance Program with hospital data: national baselines, state variations, and some cautions.

State and federal agencies are concerned with the impact of the State Children's Health Insurance Program (CHIP) on the health care of enrolled children. As part of a broad program evaluation, and at relatively low cost, analysts can track data on hospital admissions for ambulatory care sensitive (ACS) conditions. This article uses hospital data for 19 states to calculate baseline ACS rates and to discuss trends and cross-state variations just prior to the start of the CHIPs. A few cautions and limitations are discussed. An unexpected result in the exploration was a substantial increase in the rate of ACS admissions for self-pay and Medicaid-enrolled children during the period of 1990-1995. During that same period, the admission rate for other insured children fell by more than a third. The comparisons across states are meant to be illustrative; they do reveal a relationship between the rate of asthma admissions and the proportion of self-pay plus Medicaid-enrolled cases.

Adolescent↗