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Objectives. The purpose of this study was to estimate the aggregate annual costs of maternal and infant health care and to describe the flow of funds that finance that care. Methods. Estimates of costs and financing based on household and provider surveys, third-party claims data, and hospital discharge data were combined into a single, best estimate. Results. The total cost of perinatal care in 1989 was $27.8 billion, or $6850 per mother-infant pair. Payments made directly by patients or third parties for this care totaled $25.4 billion, or about 7% of personal health care spending by the nonaged population. Payments were less than costs because they did not include a value for direct delivery care or for bad debt and charity care, which accounted for $2.4 billion. Private insurance accounted for about 63% of total payments, and Medicaid accounted for 17% of the total. Conclusions. National health reform would provide windfall receipts to hospitals, which would receive payment for the considerable bad debt and charity care they provide. Reform might also provide short-term gains to providers as private payment rates are substituted for those of Medicaid. (Am J Public Health. 1994;84:1473-1478), Costs of medical care can be estimated and evaluated in a number of ways. Using a more complex method, an estimate of the total cost of obstetrics, gynecology, prenatal care, hospitalization for labor and delivery and other related health services for mothers and newborns totalled about $27.8 billion in the US in 1989. This averages to $6,850 per mother and infant. The method used to calculate this estimate included more specific information than most other estimates. It was based not as much on charges assigned, but on actual payments and costs. It also used administrative records to estimate service provision, analyzed by individual occurrence as much as possible. In addition, this analysis looked at sources of payment and the results indicate that almost $2 billion in costs were paid by third party private payers, even though they were not costs to patients of private payers. This appears to be cost-shifting from non-paying or partial-paying patients. This situation may have changed after 1989, when Medicaid expanded its coverage of pregnant women and infants.

Elderly black and elderly poor Medicare patients receive a poorer quality of hospital care than do other patients in the same hospitals. A representative sample of 9,932 people over the age of 65 who were treated for either heart failure, heart attack, stroke or pneumonia was studied to determine what type of hospital they were treated in, the quality of care they received, mortality rates and the health of the patient upon discharge. Black and poor patients received worse care overall at each of the different types of hospitals considered. However, urban blacks and poor people were 1.8 times more likely to receive treatment at a teaching hospital, which is usually considered to provide a higher standard of care than other hospitals. Moreover, black or poor patients were found to be 1.4 times more likely to be discharged while some outstanding medical condition still affected them., Objective.--To analyze whether elderly patients who are black or from poor neighborhoods receive worse hospital care than other patients, taking account of hospital effects and using validated measures of quality of care. Design.--We compare quality of care provided to insured, hospitalized Medicare patients who are black or live in poor neighborhoods as compared with others, using simple and multivariable comparisons of clinically detailed measures of sickness at admission, quality, and outcomes. Setting.--Two hundred ninety-seven acute care hospitals in 30 areas within five states. Patients or Other Participants.--The sample includes a nationally representative sample of 9932 patients 65 years of age or older who lived at home prior to hospitalization for congestive heart failure, acute myocardial infarction, pneumonia, or stroke. Interventions.--This was an observational study. Main Outcome Measures.--Processes of care, length of stay, instability at discharge, discharge destination, and mortality. Results.--Within rural, urban nonteaching, and urban teaching hospitals, patients who are black or from poor neighborhoods have worse processes of care and greater instability at discharge than other patients (P

The purpose of this study is to examine self-reported marijuana and cocaine use responses from two nationally representative surveys. We compared prevalence rates across birth cohorts for multiple years of the National Household Survey of Drug Abuse (NHSDA) and also analyzed longitudinal inconsistencies in self-reported drug use between two waves of the National Longitudinal Survey Youth Cohort (NLS-Y). We found the percentages of respondents admitting use within the past month, year, and lifetime were comparable to other findings and were consistent with the declining trend in drug use in the late 1980s. A comparison of lifetime prevalence rates revealed seemingly inconsistent reports between 1985 respondents and their birth cohorts in 1990. Using the longitudinal NLS-Y data, we found that roughly one-fifth of the people who had admitted using marijuana or cocaine in their lifetime on the 1984 survey subsequently denied ever having used in 1988. The majority of these cases were people who reported having used infrequently. The subsample of women had similar patterns. In addition, we discovered that women who had been pregnant between the two surveys were more likely to inconsistently deny having ever used, while those who were currently pregnant responded more honestly about their past use. Overall, we found that although most people are willing to provide accurate accounts of their use, the researcher should be aware that under rep or complete denial does occur. Most importantly, external factors appear to contribute to the rate of inaccurate reporting., I. INTRODUCTION Researchers have gone to great lengths to ascertain the prevalence and patterns of drug use for particular target populations. Because most of the data rely on self-reports, one [...]

The quality of care given to elderly women in hospitals is probably almost as good as that given elderly men. Medical records of 11,242 patients 65 years or older in 297 hospitals in five states were used to measure the quality of care given to men and women who had suffered a heart attack or stroke, or had congestive heart failure or pneumonia. Scores were assigned to the patients to indicate the quality of the treatment they received. As a group, the women consistently had slightly lower scores than the men, although the differences were not great. The women stayed in the hospital longer and were more likely to be discharged to a nursing home. Mortality rates were the same, except for congestive heart failure; rates in men were higher than in women. When the use of various diagnostic services was examined, 82% were offered as often to women as to men. However, 15% were offered more often to men, while only 3% were offered more often to women., Objective.--To analyze whether important gender differences exist in the quality of hospital care provided to patients with four major medical conditions. Design.---Bivariate and multivariate comparisons of clinically detailed sickness at admission, quality, utilization, and outcome measures. Setting.--Acute care hospitals located in five states. Pstients or Other Participants.--A total of 11 242 patients 65 years or older who were hospitalized with one of four diseases: congestive heart failure, acute myocardial infarction, pneumonia, and cerebrovascular accident. We derived our data from the nationally representative sample used to study the quality of hospital care for Medicare patients before and after the implementation of the prospective payment system. A hierarchical (nested) cluster sampling design was used to draw disease-specific samples of patients hospitalized in 1981, 1982, 1985, or 1986 in one of 297 hospitals located in 30 areas within five states. Interventions. This was an observational study. Main Outcome Measures.Sickness at admission, process, use rates, length of stay, discharge status, discharge destination, and mortality. Results.--Sex differences in sickness at admission varied by disease. There was some evidence that women received worse process of care, but the difference was very small. We found many similarities in the process and outcomes of care for male and female patients. Conclusions.--After controlling for sickness at admission, age, and other important covariates, the in-hospital experiences of elderly men and women showed greater similarities than differences. The concern that sex bias enters into clinical decision making during hospitalization is eased, although not entirely eliminated.

Large urban teaching hospitals may provide better medical care than smaller, rural hospitals. A review of the medical records of 14,008 elderly patients in 297 hospitals in five states was compared to mortality data from the Health Care Financing Administration. Patients in rural hospitals had a slightly greater chance of dying compared to the average mortality for all the hospitals. Patients in large hospitals, hospitals in large cities and those that were teaching hospitals had a slightly smaller chance of dying compared to the average. Rural hospitals may find it hard to recruit doctors, and once there, doctors may find it hard to maintain their skills. Residents of small communities may have access to a larger hospital in a nearby community. Rural hospitals could specialize in services such as long-term care and walk-in clinics.