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PubMed2003

A devotion to trauma.

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Emergency Service, Hospital↗
PubMed1991

The deteriorating administrative efficiency of the U.S. health care system.

BACKGROUND AND METHODS: In 1983 the proportion of health care expenditures consumed by administration in the United States was 60 percent higher than in Canada and 97 percent higher than in Britain. To assess the effects of recent health policy initiatives on the administrative efficiency of health care, we examined four components of administrative costs in the United States and Canada for 1987: insurance overhead, hospital administration, nursing home administration, and physicians' billing and overhead expenses. Most data were provided by the two nations' federal health and statistics agencies, supplemented by state and provincial data and published sources. Because data on physicians' billing costs were limited, we estimated a range for these costs by two methods that rely on different sources of data. All figures are reported in 1987 U.S. dollars. RESULTS: In 1987 health care administration cost between $96.8 billion and $120.4 billion in the United States, amounting to 19.3 to 24.1 percent of total spending on health care, or $400 to $497 per capita. In Canada, between 8.4 and 11.1 percent of health care spending ($117 to $156 per capita) was devoted to administration. Administrative costs in the United States increased 37 percent in real dollars between 1983 and 1987, whereas in Canada they declined. The proportion of health care spending consumed by administration is now at least 117 percent higher in the United States than in Canada and accounts for about half the total difference in health care spending between the two nations. If health care administration in the United States had been as efficient as in Canada, $69.0 billion to $83.2 billion would have been saved in 1987. CONCLUSIONS: The administrative structure of the U.S. health care system is increasingly inefficient as compared with that of Canada's national health program. Recent health policies with the avowed goal of improving the efficiency of care have imposed substantial new bureaucratic costs and burdens.

Canada↗
PubMed2002

The funding of private hospitals in Australia.

Private hospitals are an essential component of Australia's complex mix of public and private health funding and provision. Private hospitals account for 34.3 per cent of all hospital separations, and over half (56.2%) of all same-day separations. The revenue (funding) of the sector approached $4 billion by 1998/99, and as a result of its recent rapid growth capital expenditure in the sector was nearly $550 million in the same year. Private casemix of private hospitals is distinctive, and characterised by a high proportion of surgical procedures in general (48.1 per cent), and more than a majority of all services in such areas as rehabilitation, orthopaedics (shoulder, knee, spinal fusion, and hand surgery), alcohol disorders, same day colonoscopy and sleep disorders. This chapter synthesizes data from a multitude of sources to produce a comprehensive picture of Australia's private hospital sector and its funding. It examines the funding (revenue) sources of private hospitals, and considers how and why private hospitals approach the issue of funding from a different perspective than their public sector colleagues. To illustrate how Australian private hospitals approach revenue (funding) strategically, a series of indicative types of hospitals is explored.

Australia↗
PubMed2002

Conflicting interests in private hospital care.

This article looks at key changes impacting on private hospital care: the increasing corporate ownership of private hospitals; the Commonwealth Government's support for private health; the significant increase in health fund membership; and the contracting arrangements between health funds and private hospitals. The changes highlight the often conflicting interests of hospitals, doctors, Government, health funds and patients in the provision of private hospital care. These conflicts surfaced in the debate around allegations of 'cherry picking' by private hospitals of more profitable patients. This is also a good illustration of the increasing entanglement of the Government in the fortunes of the private health industry.

Australia↗
PubMed1995

How do Canadian hospitals do it? A comparison of utilization and costs in the United States and Canada.

In 1990 Canadian hospitals provided more services at less cost than did acute care facilities in the United States. Canadians spent $2,720 less per discharge for 48 percent longer stays. If U.S. acute care facilities had achieved an average discharge cost comparable to that in Canada, the annual savings among hospitals in the United States would have totalled $84.3 billion. In a comparative study of volumes and costs in medium-size and teaching hospitals, it was found that U.S. hospitals had greater costs for delivering services than Canadian acute care facilities did in almost every department.

Canada↗
PubMed2001

Patterns of inpatient and outpatient care for asthma in Erie and Niagara Counties, western New York State.

The prevalence of asthma, as well as the morbidity and mortality due to asthma, has increased in the United States, especially among poor minority subpopulations. The causes of these increases are complex and not well understood. Our findings from an analysis of emergency room (ER) visits and hospitalizations for Erie and Niagara Counties in western New York State for the period 1984-1991 provides important background to this problem. Of all respiratory disorders, asthma was the most frequent reason for ER visits and was second only to pneumonia as a reason for hospital admissions. In Erie County the hospitalization rates for asthma in two inner-city communities with predominantly minority populations were 1.48 and 2.09 times higher than those in the rest of the county. Furthermore, the hospitalization rates for these communities showed an increasing trend over the study period. Gender differences were also found. Boys age 0 to 9 years were hospitalized for asthma twice as often as girls. However, over 15 years of age, females had admission rates that were twice those of males. In contrast, hospitalization rates for pneumonia were equal for males and females, which would suggest gender differences particular to asthma. Hospitalizations for asthma in the western New York region cost an estimated $6,000,000 in 1990. We conclude that asthma is a major cause of morbidity in this region with excessive and increasing impact on inner-city communities.

Adolescent↗
PubMed2004

Nursing facility compliance with do-not-hospitalize orders.

PURPOSE: This study sought to determine whether nursing homes comply with residents' do-not-hospitalize (DNH) orders prohibiting inpatient hospitalization. DESIGN AND METHODS: With the use of data from the nationally representative 1996 Nursing Home Component of the Medical Expenditure Panel Survey, a multivariate logistic regression model was developed. RESULTS: Three percent of residents had DNH orders. These residents were half as likely to be hospitalized. Residents in not-for-profit or public facilities were less likely to be hospitalized than those in for-profit homes. Hospitalization was more likely among men, racial or ethnic minorities, those with more diagnosed health conditions, and those in facilities in the South compared with those in the Midwest. Hospitalized residents with DNH orders had no limitations of activities of daily living, were not located in hospital-based nursing homes, were less likely to be in a for-profit facility, and were sicker than nonhospitalized residents with DNH orders. IMPLICATIONS: Improved education regarding advance directives, particularly DNH orders, is necessary for health care practitioners and patients. More consistent and rigorous policies should be implemented in nursing facilities.

Activities of Daily Living↗
PubMed1983

Specialty hospitals: the challenge of the 1980s.

Specialty care institutions will face many concerns during the remainder of this decade. Increased intermediary and community education, establishing reliable benchmarks, understanding and dealing with a competitive marketplace, and establishing improved professional productivity are some of the major challenges.

Community Health Services↗
PubMed1998

Auto theft-related trauma.

OBJECTIVE: To determine the medical consequences and economic impact of caring for patients injured after motor vehicle crashes (MVC) involving stolen cars. METHODS: Presented is a case series of inpatients injured secondary to a MVC involving a stolen car from January of 1993 to December of 1994 and treated at a university Level I trauma center in Newark, New Jersey. During the time period of the study, 1,232 patients (either as the driver or passenger) were admitted after a MVC, 115 patients (8%) were identified as sustaining injuries secondary to a MVC involving a stolen car. Injuries after car theft represent 8% of all MVC-related admissions. Data collected included demographics, types of injuries, surgical intensive care unit and hospital lengths of stay, insurance status, hospital and physician charges, and ultimate outcome. RESULTS: Of the 84 men and 31 women, 66 were perpetrators, either as the driver (34) or passenger (32) of a stolen vehicle. Perpetrators were significantly younger and more likely to be male than victims. The overall mortality was 11%. An additional nine fatalities occurred at the scene of a MVC linked to a patient in this study. A high rate of speed and the presence of police pursuit seemed to be related to the severity of the crashes. The mean charges (hospital and physician) were over $34,000 per patient, and the aggregate charges for this cohort were greater than $3.6 million. Fifty-four percent of patients were uninsured. CONCLUSION: Injuries involving stolen cars are common in areas in which the activity has a high prevalence and can compose a significant percentage of a trauma center's MVC population. These data run contrary to the popular belief that auto theft is merely a crime against property, because the injuries sustained as a result of this criminal activity tended to be severe and were associated with a high fatality rate. Restricting police pursuit to only those instances in which other felonious activity is suspected may decrease the number of stolen car MVC. Additionally, the total amount of uncompensated care that these patients receive places another financial burden on limited health care and trauma center resources, which ultimately effects all other citizens.

Accidents, Traffic↗
PubMed1976

A study of physicians' assistants in a rural setting.

In an effort to improve the health care in a rural county in Southern Appalachia, physicians' assistants (MEDEX) have been employed in the offices of three general practitioners over a three-year period. This program was evaluated using a before-after and experimental-control (county) design, utilizing data both from physician office contracts and a continuing survey of the populations of the experimental and control counties. Results show the following: 1) utilization (average office visits per week) increased; 2) types of care (preventive versus curative) remained stable; 3) the hospitalization rate increased continuously during the three years for those physicians using physicians' assistants; and 4) the physicians' assistant functioned more as a physician substitute than as an assistant. It is concluded that although use of physicians' assistants may increase utilization rates, they may not reduce the long-range cost of medical care through providing more preventive or ambulatory (as opposed to hospital) care.

Acute Disease↗
PubMed1980

Trends in medical care costs. Do HMOs lower the rate of growth?

Total medical care expenses are generally lower for HMO enrollees than for comparable persons with other coverage. However, a rarely addressed question is whether HMO enrollees also experience a slower rate of growth in costs. This paper examines data from several sources (Federal Employees Health Benefits Program, California State Employees, and Kaiser-Oregon) to compare trends in utilization and costs for HMO enrollees and comparison groups over periods of up to twenty-five years. Total costs can be decomposed into cost per unit of service and the number of units, or utilization of services. Trends over time in cost per unit of service (e.g., per hospital patient day) in HMOs are generally comparable to national trends, as are measures of factor inputs (e.g., physician office visits per physician per year). Trends in utilization, such as hospital days per 1,000 enrollees, show slight reductions for HMO enrollees relative to persons with conventional coverage. Therefore, the rate of growth in total costs (including out-of-pocket expenses) is only slightly lower for persons in HMOs. While HMOs may offer lower costs at any point in time, they have not been able to substantially alter the national patterns of medical care inflation and increasing resource use.

Age Factors↗
PubMed1980

Use of hospital services under two prepaid plans.

This study compares the use of hospital services under two prepaid plans offered to Stanford University employees and their families. One is a Kaiser plan while under the other (Clinic plan), physician services are provided by the Palo Alto Medical Clinic, a multispecialty, largely fee-for-service group practice, and hospital services are covered by a Blue Cross policy. Using age- and sex-adjusted data, the hospital admission rate excluding deliveries is higher under the Clinic plan (44.2 admissions per 1,000 personyears compared with 38.2 under the Kaiser plan), but hospital days per 1,000 personyears are almost identical (249.8 days under the Kaiser plan, 250.7 under the Clinic plan). The difference in the admission rates is due to the higher surgical admission rate under the Clinic plan (32.4 admissions per 1,000 personyears compared to 25.0 under the Kaiser plan). However, when surgical procedures performed in the hospital on a nonadmission basis are added to surgical admissions, the surgical rates under the two plans become very close (35.7 admissions and procedures per 1,000 personyears under the Kaiser plan and 37.6 under the Clinic plan). This lends some support to the hypothesis that the lower hospital surgery rates found under prepaid group practice plans may be due as much to the group practice form of their organization as to their prepaid feature. The authors offer some possible reasons why surgeons in fee-for-service group practices may have relatively low surgery rates even though they do not have the incentive to hold down costs which surgeons in prepaid group practices have.

Ambulatory Surgical Procedures↗