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At least 19 recordsLinked to original sources
PubMed2005

Health care restructuring and family physician care for those who died of cancer.

BACKGROUND: During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992) to 30% (1998). These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP) visits to advanced cancer patients in Nova Scotia (NS) during the years of health care restructuring. METHODS: Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics), the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000). SUBJECTS: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212). Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department), time of day (regular hours, after hours), total length of inpatient hospital stay and number of hospital admissions during the last six months of life. RESULTS: In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED), 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP visits over time compared to 1992-93 levels (for 1997-98, adjusted RR = 0.88, 95%CI = 0.81-0.95) and an increase in FP ED visits (for 1997-98, adjusted RR = 1.18, 95%CI = 1.05-1.34). CONCLUSION: Despite hospital downsizing and fewer deaths occurring in hospitals, FP ambulatory visits (except for ED visits) did not rise correspondingly. Although such restructuring resulted in more people dying out of hospital, it does not appear FPs responded by providing more medical care to them in the community.

Adolescent↗
PubMed1977

Private health insurance in 1975: coverage, enrollment, and financial experience.

More improvement in the scope than in the quality of private health insurance coverage took place during 1975. Four-fifths of the population under age 65 was covered for hospital and surgical care, and nearly that proportion was protected against the costs of physicians' in-hospital visits, X-ray and laboratory examinations, and prescribed out-of-hospital drugs. The $33.6 billion in premiums paid by consumers resulted in the return of only $28.9 billion in benefits, which covered just 44% of their total personal health care expenditures. Major-medical insurance, held by an estimated 43% of the population, helped to overcome some of the deficiencies of private insurance--dollar limitations on health care services, ceilings on the duration of hospital stays, and exclusions for some types of care. It also provided economic protection against catastrophic expenses. Premiums and subscription income rose faster than benefits as private insurers attempted to keep their coverage in line with rising health care costs. The overall underwriting gain was due largely to a $952.4 million gain in group business by the insurance companies.

Adult↗
PubMed2004

Access to physician services: does supplemental insurance matter? evidence from France.

In France, public health insurance is universal but incomplete, with private payments accounting for roughly 25% of all spending. As a result, most people have supplemental private health insurance. We investigate the effects of such insurance on the utilization of physician services using data from the 1998 Enquête sur la santé et la protection sociale, a nationally representative survey of the non-institutionalized French population. Our results indicate that insurance has a strong and significant effect on the utilization of physician services. Individuals with supplemental coverage have substantially more physician visits than those without. While French patients have greater freedom than patients in other countries to choose to see a specialist rather than a general practitioner, we find no evidence that supplemental insurance affects this decision.

Adult↗
PubMed1983

The use of physician services under a national health insurance scheme. An examination of the Canada Health Survey.

In this paper the individual is employed as the unit of analysis to examine the extent to which the use of physician care by beneficiaries insured under the Canadian Medicare program is determined by medical needs and sociodemographic characteristics as opposed to economic considerations. The data were derived from the Canada Health Survey, which is a stratified, multistaged sample of the entire population. The results of the discriminant and weighted multiple regression analysis indicate that the use or nonuse of service and the volume of physician care consumed is determined by medical needs and sociodemographic characteristics rather than by economic status. Accordingly, the findings of this study are consistent with the contention that the Medicare program has resulted in an equitable distribution of physician service.

Adolescent↗
PubMedDate not supplied

Billing basics for physician assistants and nurse practitioners.

In recent years, physicians have increasingly looked to nonphysician practitioners (NPPs) as a resource for delivering care to patients. While historically more prevalent in primary care groups, nonphysician practitioners have expanded their presence within medical subspecialty and surgical groups as well. Along with planning for appointment scheduling, credentialing, and introducing the nonphysician provider to patients and referring physicians, the savvy practice will thoroughly review how services for a nonphysician can and should be billed. In this article, we focus our attention on basic Medicare billing parameters for physician assistants and nurse practitioners, two types of nonphysician practitioners.

Aged↗
PubMed1981

Copayments and consumer search: increasing competition in Medicare and other insured medical markets.

Between 1950 and 1980, the physician fee component of the Consumer Price Index (CPI) rose 488 percent. In contrast, an index of physician fees adjusted for 1) overall inflation, and 2) the declining proportion which is paid out-of-pocket by the patient, declined over the same 30-year period. This last observation, pointing to the erosion of the market, is important for structuring price competition for physician services. For insured patients, out-of-pocket payments arise from deductibles, coinsurance and limits, each of which is briefly discussed in this article. Following a review of Medicare Part B physician reimbursement, the paper shows that limits can be used to strengthen the incentive which insured patients have to search for less expensive medical care.

Community Participation↗
PubMed1992

Workable competition in health care: prospects for the Dutch design.

Since 1989 a gradual restructuring of the Dutch health care system is taking place to realize a multiple choice social health insurance system with workable competition among insurers and among health care providers. This paper investigates whether the structural change will induce the intended competition. An examination of the characteristics of the market for health insurance, physician services and hospital services in the Netherlands points out that the scope for competition is limited. If competition is to work, rather extensive government regulation to monitor the conduct of both providers and insurers is needed. Without an effective antitrust policy a high degree of concentration and collusion is likely.

Antitrust Laws↗
PubMed1994

Policy issues in physician reimbursement.

As physicians become increasingly involved in home care, the issue of their reimbursement arises with increasing frequency and intensity. Currently most physician services for home care are not reimbursable; HCFA, however, is reconsidering.

Centers for Medicare and Medicaid Services, U.S.↗