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At least 19 recordsLinked to original sources
PubMed1992

Will Medicare beneficiaries switch physicians? A test of economic competition.

We assess the potential of increased economic competition by examining whether Medicare beneficiaries are willing to switch to physicians who agree to accept all services on assignment. Data come from a survey of Medicare beneficiaries conducted in November 1988. Our principal finding is that beneficiaries are not sensitive to price when making decisions about whether or not to switch physicians. Less than one-half of 1 percent of the sample had switched physicians for economic reasons in the year prior to the survey. Furthermore, willingness to switch was not correlated with ability to pay. We conclude that policies aimed at altering consumer demand may not be the most effective way to control Medicare costs.

Aged↗
PubMed1978

Rx for health care economics: competition, not rigid NHI.

While competition may serve consumers well in the production of many goods and services, it does not function equally well in all of the nation's economic sectors. And the health services sector does not fit the competitive model at all well. The market for medical care services might be restructured, however, so competition might yield more of the benefits it yields in other markets.

Capitation Fee↗
PubMed1975

Ethanol fermentation and potential.

Ethyl alcohol is one of the United States and world's major chemicals. Beverage alcohol in the United States must be prepared from cereal grains or other natural products. The U.S. industrial alcohol market has remained relatively stable for several years at approximately 300 million gallons annually. Most of this has been produced synthetically from petroleum raw material (gas and oil). These raw materials are experiencing major price increases and are in short supply. The production of ethyl alcohol from cereal grains and cellulosic raw materials by fermentation is technically feasible and has been proven. Alcohol produced from all such materials is equal to synthetic alcohol in quality and performance. Competitive economics have controlled the basic raw materials used. The major potential new ethyl alcohol market is as a component of automobile fuels. A 10% alcohol-gasoline blend in the United States would annually require over 10 billion gallons of anhydrous alcohol. Use of alcohol for this purpose is technically feasible. However, alcohol has not been economically competitive to date.

Cellulose↗
PubMed1990

Choledochoscopy. A cost-minimization analysis.

Although choledochoscopy for the prevention of retained bile duct stones has been postulated as cost effective, no economic evaluation exists to substantiate this claim. We performed a cost-minimization analysis on 287 patients who underwent choledochoscopy during operations for biliary tract calculi between 1981 and 1987 to assess the economic impact of choledochoscopy versus noncholedochoscopic alternatives in obtaining a stone-free duct. Common duct exploration was positive for calculi in 75% of patients. Choledochoscopy-detected residual stones after duct exploration in 10% of patients. Residual stones were more frequent after positive (12.5%) than negative (2.7%) duct explorations. retained stones occurred in 4.5% of patients after operation. Sensitivity, specificity, and negative predictive values of choledochoscopy were 67%, 100%, and 95%, respectively. Cost-minimization analysis showed that total cost of either selective ($75,250) or routine ($110,450) choledochoscopy significantly exceeded the total cost of obtaining a stone-free duct for patients with retained stones via either extraction through a T-tube tract ($17,545) or by endoscopic papillotomy ($45,675). Because choledochoscopy was not economically competitive with noncholedochoscopic, nonoperative alternatives, reduction of choledochoscopy fees was implemented to economically justify continued use of choledochoscopy. We conclude that choledochoscopy is clinically efficacious in obtaining a stone-free duct, but endorsement of either routine or selective choledochoscopy by cost-minimization analysis requires careful assessment of fee structure to make choledochoscopy competitive economically.

Aged↗
PubMed1978

[The desire to have children (author's transl)].

During the past fourtytwo years the birth statistics of Bavaria show that the percentage of intramarital first children increased from 1/3 to 1/2 of all children born within marriages. The percentage of the marital second born children increased relatively less from 25% in 1935 to around 30% in 1977. During the same time the percentage of third and fourth children decreased from 38,8% to 19,2% by approxiamately 1/2. For some time now close correlation exists between economic competition and achievement stress and social, sexual, and generative behaviour. Not the modern contraceptives are responsible for the random and sensitive characteristics of the desire for children in couples since contraceptives only increase the planning of children but the vagaries of the future expectations in a dubious economic and social system are responsible.

Birth Rate↗
PubMed1989

Economics of practice and inpatient care.

The nature and structure of inpatient psychiatric services are rapidly evolving. This article identifies and explores how these changes are being influenced by four interrelated areas: rapid growth in general and private hospital psychiatric practice; increased connections of public, private, and voluntary sectors of care; the emergence and quick acceptance of capitated and managed care programs; and dramatic change and growth in the insurance industry. These four interrelated areas further the development of a two-tier system in psychiatry: one for those with insurance, and one of the poor and the severely disabled. The changes in these four areas have also led to greater demand for increased economic competition among services, and new alliances and innovations in the delivery of treatment. This article discusses how the four areas have combined to support a two-tier system and how they are likely to affect the future evolution of general and private hospital inpatient psychiatric practice.

Cost Control↗
PubMed1991

The reaction of private physicians to price deregulation in France.

French private physicians are paid on a fee-for-service basis and nearly all of them are under contract to the Social Security, which refunds part of the medical fee to the whole population. Previously the prices of medical services were fixed, but since 1980, a new option has been possible: a doctor can choose to fix the price of his services freely, provided he pays a higher social insurance contribution. But the amount refunded by Social Security does not vary, so that the consumer has to bear the extra charge. Our purpose here is to identify the factors that influence the physician's option. In Section 2, we define a model of the private physician's economic behaviour, of the classic income-leisure type. In Section 3, empirical tests are performed on a sample of observations in 95 'départements', gathering information about private GPs on the one hand, and the whole population on the other. According to our results, GPs' decisions depend on characteristics of both supply of and demand for GPs' services. One of our conclusions is that GPs seem to make up for low activity levels with higher prices, on condition the income of their practice allows it.

Choice Behavior↗
PubMed1989

Working for which patients and at what cost?

The Government's white-paper Working for Patients proposes introducing a system in which publicly financed resources for hospital and community health services will be distributed to districts and general practitioners with practice budgets for them to choose between competing providers from both the public and private sectors. The NHS Management Board in 1986 observed that such a system would be costly and impractical and would require careful pilot work in situations where its benefits are likely to outweight its costs. This paper shows that there is no reason for changing that judgement.

Adult↗
PubMed1991

Extraction of mercury from groundwater using immobilized algae.

Bio-Recovery Systems, Inc. conducted a project under the Emerging Technology portion of the United States Environmental Protection Agency's (EPAs) Superfund Innovative Technology Evaluation (SITE) Program to evaluate the ability of immobilized algae to adsorb mercury from contaminated groundwater in laboratory studies and pilot-scale field tests. Algal biomass was incorporated in a permeable polymeric matrix. The product, AlgaSORB, packed into adsorption columns, exhibited excellent flow characteristics, and functioned as a "biological" ion exchange resin. A sequence of eleven laboratory tests demonstrated the ability of this product to adsorb mercury from groundwater that contained high levels of total dissolved solids and hard water components. However, use of a single AlgaSORB preparation yielded nonrepeatable results with samples collected at different times of the year. The strategy of sequentially extracting the groundwater through two columns containing different preparations of AlgaSORB was developed and proved successful in laboratory and pilot-scale field tests. Field test results indicate that AlgaSORB could be economically competitive with ion exchange resins for removal of mercury, with the advantage that hardness and other dissolved solids do not appear to compete with heavy metals for binding capacity.

Absorption↗