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PubMed2004

Health care reforms in Poland.

This paper examines the shape of the recently reformed health care system in Poland. Until December 31,1998 everyone had access to free health care and the medical institutions were financed by the State. Since January 1, 1999, under the provisions of the Universal Health Insurance Act, hospitals became independent from the State budget and gained more financial resources for their activities. 17 regional health insurance funds contract for medical services with hospitals and individual practices. Most services provided to the insured are paid by the funds that receive premiums, but some are still financed from the State budget. The revised legislation on Medical Care Establishments intended to create a better management of health care institutions and administrative control over the quality of care. The system has been severely criticised: it is too bureaucratic, there are too many insurance funds, patients have experienced problems with access to health care, particularly to special treatment or to treatment available outside the area of the health insurance fund to which the patient belongs. The new Minister for Health suggested that the 17 funds should be replaced by 5 "health funds" that would finance health care and be closely connected to the local government answerable for their activities. This paper will deal with the scope of health care packages, the conditions of provision of health services, obligations of health care providers, patient rights, and the quality of health care.

Delivery of Health Care↗
PubMedDate not supplied

Hospitals.

Explore the source record for details and available documents.

Blue Cross Blue Shield Insurance Plans↗
PubMed1987

Commercial insurers and all-payer regulation. Evidence on hospitals' responses to financial need.

This study explores commercial insurers' claims about cost-shifting in the broader context of hospitals' responses to revenue needs. It relies on hospital survey data from 1980 and 1982, a period that pre-dates Medicare's Prospective Payment System (PPS) for hospitals. While we find that limited amounts of cost-shifting occur, evidence does not support the notion that it is a perfect safety valve to control financial status. In addition, all-payer rate-setting does not appear to be related to hospitals' ability to shift costs. Instead, inpatient rate controls cause hospitals to contain costs, seek greater outpatient revenues and accept lower margins. Are the financial 'stresses' associated with PPS sufficient enough to kick off renewed concerns about cost-shifting? Some aggregate data from the PPS-era indicates that lower growth in Medicare payments has not resulted in cost-shifting on a widespread basis.

Cost Allocation↗
PubMed1995

Race and sex differences in rates of invasive cardiac procedures in US hospitals. Data from the National Hospital Discharge Survey.

BACKGROUND: Lower rates of invasive cardiac procedures have been reported for blacks and women than for white men. However, few studies have adjusted for differences in the type of hospital of admission, insurance status, and disease severity. SETTING, DESIGN, AND PARTICIPANTS: Data from the National Hospital Discharge Survey were used to investigate race and sex differences in rates of cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass surgery among 10,348 persons hospitalized for acute myocardial infarction. RESULTS: White men consistently had the highest procedure rates, followed by white women, black men, and black women. After matching for the hospital of admission and adjusting for age, in-hospital mortality, health insurance, and hospital transfer rates (with white men as the referent), the odds ratios for cardiac catheterization were 0.67 (95% confidence interval [CI], 0.51 to 0.87) for black men, 0.72 (95% CI, 0.63 to 0.83) for white women, and 0.50 (95% CI, 0.37 to 0.68) for black women. Similar race-sex differences were noted for percutaneous transluminal coronary angioplasty and coronary artery bypass surgery. CONCLUSIONS: Race and sex differentials in the rates of invasive cardiac procedures remained despite matching for the hospital of admission and controlling for other factors that influence procedure rates, suggesting that the race and sex of the patient influence the use of these procedures.

Adult↗
PubMed2001

Health insurance, primary care, and preventable hospitalization of children in a large state.

OBJECTIVES: To analyze variations in the admission rate to hospitals of children with ambulatory care-sensitive (ACS) conditions and to test the relationship of ACS admission rates to insurance coverage, health maintenance organization (HMO) enrollment, availability of primary care, severity of illness, distance to hospital, and a number of other factors. STUDY DESIGN: Hypotheses were derived from basic considerations about demand and use of primary care and preventive services and then were tested with a weighted linear regression model of the ACS admission rate for children residing in each county. PATIENTS AND METHODS: The principal data were all hospital discharges for New York resident children admitted to hospitals in New York, Pennsylvania, New Jersey, or Connecticut in 1994. The data and methodology were noteworthy for including out-of-area hospital admissions. RESULTS: There was a substantial negative association of the ACS rate with private HMO coverage. There also were sizable negative effects of the availability of primary care services in physician offices and the distance traveled. Large differences related to racial and ethnic composition of the population were found independent of other determinants. There was a positive association with the proportion of all admissions (admissions for all conditions) covered by Medicaid or self-pay. Severity of illness and use of emergency departments were controlled. There was no independent effect of a location in New York City. CONCLUSIONS: The results are consistent with smaller-scale studies suggesting that improved health insurance for children could reduce hospital admissions. Contracting with HMOs also appears to be beneficial. Independently, programs to increase the availability of primary and preventive services could substantially reduce ACS admissions.

Ambulatory Care↗
PubMed1977

The effect of physician-controlled health insurance. U.S. v. Oregon State Medical Society.

The trial record in an antitrust case against the Oregon State Medical Society, finally decided in 1952, was examined to reconstruct the behavior of a competitive market for health insurance coverage. Health insurers, called "hospital associations," were found to have engaged individually in cost-control efforts similar to, but possibly more aggressive than, today's utilization review under professional sponsorship. The subsequent disappearance of these insurer-initiated cost controls in Oregon is traced to the medical society's organization of a competing Blue Shield plan as a model of insurer conduct and to a simultaneous boycott by physicians of the hospital associations as long as they persisted in questioning doctors' practices. Some modern parallels are noted, and the advantages of fostering privately sponsored cost-control efforts are suggested.

Hospitals↗
PubMedDate not supplied

Can hospitals and physicians shift the effects of cuts in Medicare reimbursement to private payers?

Leaders of health insurance companies, hospital systems, and physician organizations believe that when Medicare and Medicaid reduce payment rates to hospitals or physicians, these providers respond by raising prices to private insurers to offset a portion of the loss in revenue. This would mean that payment reductions in public programs contribute to increasing premiums for private insurance. But on both theoretical and empirical grounds, economists have been skeptical about the existence of this "cost shifting." I show that more realistic models of the behavior of hospitals and physicians than exist in basic economics texts provide a conceptual basis for cost shifting.

Cost Allocation↗
PubMed1995

[Legal liability of subordinate physicians, legal liability for management responsibility from the jurisprudence viewpoint].

Within the bounds of the hospitalization contract and the department's work, the hospital management is liable for compensation for its own as well as its staff's culpable faults (liability of the accomplices) by contract and by offense. For the same damage, subordinate and senior physicians are liable by offense for malpractice and organization faults. To the outside, the hospital management and the medical staff are common debtors. To the inside, the hospital management bears the consequences by itself in case of a light negligence of a staff member, the damage is divided for medium negligence, and the staff member has to bear it alone after severe negligence. Beside the hospital, the physician with an authorization for billing is the contract partner of the patient with private treatment (physician side-contract). In a general practitioner hospital, the contract partner of the patient is only the general practitioner (divided hospitalization contract) and for work with outside-patients as a sideline the physician with an authorization for billing. Usually, the hospital management insures itself and all staff members for claims on compensation occurring during hospital tasks.

Ambulatory Care↗