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At least 1,189 records · Page 66Linked to original sources
PubMed1998

Insurance type and choice of hospital for coronary artery bypass graft surgery.

OBJECTIVE: To examine the effect of insurance type on the relationship between hospital attributes and patient flows, with particular attention to whether HMO enrollees are more or less likely than other patients to receive care at high-quality hospitals and whether HMO enrollees travel farther to receive care. DATA SOURCES/STUDY SETTING: Data on patient flows, taken from discharge abstracts compiled by the California Office of Statewide Health Planning and Development. Our sample consists of patients undergoing coronary artery bypass graft surgery (CABG) in 1991 who resided in three California markets. Only patients under the age of 65 and insured by HMOs, Blue Cross/Blue Shield, or other commercial insurance were included. Hospital quality is based on hospital-specific measures of excess mortality from CABG. Other hospital attributes were taken from American Hospital Association survey data. STUDY DESIGN: Conditional-choice models were used to estimate the probability that patients would receive care at any given hospital as a function of their insurance type and the hospital's attributes. PRINCIPAL FINDINGS: Patients were more likely to receive care from hospitals closer to their residence. However, HMO patient flows were less sensitive to proximity. In general, the likelihood that an HMO enrollee received care at a given hospital was positively related to hospital quality. Moreover, quality had a greater effect on patient flows for HMO enrollees than for non-HMO enrollees. However, the evidence suggests that the effect of quality on patient flows is neither uniform across markets nor across HMOs. CONCLUSIONS: HMOs do not appear to direct patients to low-quality hospitals. However, heterogeneity among HMOs and across markets suggests that buyers must recognize that choosing an HMO involves greater scrutiny than simply picking a plan labeled "HMO."

California↗
PubMed2000

A preliminary study on the knowledge and attitudes of physicians at two university hospitals towards the medical insurance system of Japan.

In this preliminary study, we surveyed the physicians at two academic hospitals on their knowledge of and attitudes toward the medical insurance system in Japan. Most of the physicians had not read the "Ministerial Ordinance on Insurance Medical Institutions' and Insurance Medical Doctors' Medical Treatment under Health Insurance." Of the 433 physicians who filled out the questionnaire completely, 34% had either not read or rarely read the "Medical Fee Point List." Most (89.1%) of the physicians knew that there is a stepwise reduction in the hospitalization fee as the length of a patient's hospital stay increases. However, approximately 30% did not know the stipulation of obtaining an informed consent from the patient prior to blood transfusion. As for the right of patients to see their medical care remuneration statements, which was decided by the government in 1997, 26.8% of the physicians did not know this rule. Physicians who had read the "Ministerial Ordinance on Medical Treatment," were more likely to read the "Medical Fee Point List" frequently; were more likely to know the stipulation about diminishing hospitalization fee; were more likely to know that an informed consent must be obtained prior to blood transfusion; and were more likely to know that patients had a right to see their medical care remuneration statements. The longer the clinical experience of the physician, the more likely that the physician had read the "Ministerial Ordinance on Medical Treatment" and know the other stipulations well. In these two academic hospitals, it is important to establish educational seminars for physicians on the guidelines of the medical insurance system so that physicians will become familiar with the medical insurance system quickly.

Attitude of Health Personnel↗
PubMedDate not supplied

Understanding diagnostic related groups (DRGs) and inpatient hospital reimbursement.

Knowing insurance plan regulations and complying precisely with requirements is critical for hospital reimbursement of care provided. Diagnostic related groups provide guidelines widely used in the United States to determine hospital reimbursement by Medicare, Medicaid, and many insurance providers. Because hospitals are the largest employers of nurses, nurses have a responsibility and interest in contributing to the stability of their hospital's financial status to protect incomes and job security. This article provides an overview of diagnostic related groups and demonstrates how nurses can contribute to more accurate documentation outcomes that determine hospital reimbursement.

Cost Control↗
PubMed2003

The effect of increased private health insurance coverage on Victorian public hospitals.

It was anticipated that the recent reforms to private health insurance arrangements would reduce the demand pressures on Australian public hospitals. However, this has not been demonstrated by trends in elective surgery waiting lists in Victorian public hospitals. Moreover, it appears that the increased caseload assumed by Victorian private hospitals since the reforms took effect mainly reflects an increase in low cost same day episodes.

Elective Surgical Procedures↗
PubMed2001

Breast cancer: a socioeconomic and racial comparison in northwest Louisiana.

A tumor registry data review on breast cancer populations seen at two hospitals in North Louisiana was completed in order to determine if race is independent of socioeconomic status (SES) factors related to breast cancer stage at diagnosis. The North Louisiana tumor registry identified 1183 patients diagnosed with breast cancer between 1987 and 1991, 304 patients from Louisiana State University Health Science Center (LSUHSC), a state supported hospital providing predominantly indigent care, and 879 patients from a private hospital (PH) serving predominantly insured patients. Hospital site was used as a proxy for SES (LSUHSC low, PH high). The patient populations differed significantly by age, racial makeup, and stage at presentation. Both white and African-American patients seen at PH had more stage 0 disease compared with LSUHSC (9.2% and 2.7%). White patients seen at PH had more stage I cancer as compared to white patients at LSUHSC (31.3% and 19.2%) or African-American patients at either PH or LSUHSC (19.4% and 19.9%). The frequency of stage III/IV cancer was higher in African-American patients at both LSUHSC (30.1%) and PH (29.0%) and white patients at LSUHSC (24.0%) as compared to white patients at PH (14.7%). Two hundred and nine patients were available for individual interview and specific definition of SES. LSUHSC patients were predominantly indigent (83% indigent and without insurance), while only 10% of PH patients lacked insurance. This study provides further support that the SES of white patients influences breast cancer stage at presentation. African-American patients, however, presented with more advanced breast cancer stages regardless of SES. Factors influencing African-American patient's disease stage are not limited to defined SES factors. Further studies are needed to define barriers and develop intervention strategies.

Breast Neoplasms↗
PubMed1984

Hospital costs of surgical complications.

Fifteen patients who had a general or gynecologic abdominal operation were operated on a second time for a complication of the first operation. There were three deaths. Extra costs attributable to the complications amounted to +211,503, of which one third was uncollectible. One half of the extra hospital days for surviving patients were spent in the intensive care unit.

Abdomen↗
PubMed1979

Where do cancer patients die? A review of cancer deaths in Cuyahoga County, Ohio, 1957--1974.

The great concern over the status and care of the dying cancer patient requires the understanding of current trends in care. An 18-year review of 55,288 death certificates of patients with cancer in Cuyahoga County, Ohio (1957--1974) revealed that 35,381 patients (65%) died in acute and chronic care hospitals, 8,251 patients (15%) died in nursing homes, and 11,242 patients (20%) died at home. Trends over the 18-year period demonstrated a shift from patients dying at home to patients dying in nursing homes. The hospital care of dying cancer patients remained unchanged during the study period. An analysis of 33 consecutive patients dying of cancer over a six-month period in an acute care hospital in Cuyahoga County showed an average length of stay of 20.1 +/- 15.7 days, during which only palliative care was provided. The cost benefit of home care/hospice programs is related to the final hospital stay of the dying cancer patient.

Adult↗
PubMed1996

Payment source and the cost of hospital care: evidence from a multiproduct cost function with multiple payers.

This study investigates the capacity of hospitals to vary the intensity of their services based on patients' expected sources of payment. While the concept of price discrimination by hospitals based on payer generosity ("cost-shifting") has been discussed extensively, the notion that hospitals can adjust payer-specific marginal costs to reflect differences in reimbursement policies has not been studied in depth. To examine this issue. this analysis employs a multiproduct cost function with hospital outputs defined as admissions by payment source, controlling for the distribution and severity of illness ("casemix") for each payer. Marginal costs of casemix-adjusted discharges are obtained and compared for Medicare, Medicaid, Private Payers, and a residual category that includes uncompensated care. We find that indeed, payer-specific marginal costs generally reflect payer generosity.

Cost Allocation↗
PubMed1991

Hospital utilization for AIDS: are all hospital days necessary?

This study examined hospital utilization and, specifically, unnecessary hospital days for patients with acquired immunodeficiency syndrome (AIDS) in a Midwest regional referral center as of June 1987. In 1990 a follow-up study was conducted to measure changes in length of stay (LOS) and unnecessary days. Results show a mean LOS consistent with other studies and a pattern of unnecessary days comprising 14% to 18% respectively of the mean LOS. Admissions in which the patient died and those considered outliers (LOS greater than 36 days) had a trend toward a higher percentage of unnecessary days. Hospital utilization and unnecessary days for patients with AIDS should be an ongoing quality indicator for hospitals experiencing a high volume of persons with AIDS admissions.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Length of hospital stay and cost of Staphylococcus and Streptococcus infections among hospitalized patients.

BACKGROUND: Staphylococcus (Staph) and Streptococcus (Strep) infections are important causes of morbidity and mortality worldwide. The economic burden of these infections is also significant, especially among hospitalized patients. OBJECTIVE: The aim of this study was to estimate length of hospital stay (LOS) and total payments for hospital admissions for patients with Staph or Strep infection as a first (primary) or second or higher (comorbid) diagnosis. METHODS: From the 1994-1997 MarketScan inpatient database, admissions with Staph (n = 2,042) or Strep (n = 1,401) infection (905 as primary and 2,538 as comorbid diagnosis) and 89,899 control admissions without a diagnosis of gram-positive infection were identified. Crude and category-specific mean LOS and anti-log mean total payments were compared between admissions with Staph or Strep infection and admissions without a diagnosis of any gram-positive infection within major diagnostic categories and principal surgical procedures (SPs). RESULTS: For admissions with Staph or Strep infection as first (primary) diagnosis (n = 905), the mean LOS was 4.68 days (95% CI, 4.44-4.93) and 4.78 days (95% CI, 4.35-5.26), respectively. The mean total payments were $6,445 (95% CI, $6,045-$6,870) and $6,821 (95% CI, $6,149-$7,566), respectively. In contrast, the average LOS and total payment for the control group were 2.99 days (95% CI, 2.98-3.01) and $6,325 (95% CI, $6,284-$6,365). For admissions with infection as the comorbid diagnosis (n = 2,538), mean LOS and total payment were 4 days longer and $6,000 higher for Staph infections and 1.2 days longer and $1,200 higher for Strep infections than the control group. Within each SP, LOS and total payments were substantially higher for patients with Staph and Strep infections. CONCLUSIONS: The results of this study indicate that infections with the pathogens Staph and Strep substantially increase LOS and total payments among hospitalized patients.

Adolescent↗