2,688 results on '"Insurance, Hospitalization"'
Search Results
2. Public hospitals: who's looking after you? The difficulties in encouraging patients to use their private health insurance in public hospitals
- Author
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Sullivan, N, Redpath, R, and O'Donnell, A
- Published
- 2002
3. Early Hospital Compliance With Federal Requirements for Price Transparency
- Author
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Suhas Gondi, Adam L. Beckman, Philip Hinkes, J. Michael McWilliams, and Avery A. Ofoje
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business.industry ,010102 general mathematics ,Accounting ,Disclosure ,01 natural sciences ,Transparency (behavior) ,Insurance, Hospitalization ,United States ,Compliance (psychology) ,Access to Information ,03 medical and health sciences ,0302 clinical medicine ,Insurance carriers ,Internal Medicine ,Research Letter ,Government Regulation ,Medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Ethics, Business ,Health Expenditures ,Hospital Costs ,business - Abstract
This cross-sectional study assesses compliance within a random sample of hospitals with a federal rule requiring hospitals to disclose the prices they negotiate with insurers.
- Published
- 2021
4. Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges
- Author
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Ranson Michael Kent
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Health expenditures ,Insurance, Health/utilization ,Insurance, Health/trends ,Insurance, Health, Reimbursement ,Insurance, Hospitalization ,Insurance claim review ,Women, Working ,Consumer participation ,Poverty ,India ,Public aspects of medicine ,RA1-1270 - Abstract
OBJECTIVE: To assess the Self Employed Women's Association's Medical Insurance Fund in Gujarat in terms of insurance coverage according to income groups, protection of claimants from costs of hospitalization, time between discharge and reimbursement, and frequency of use. METHODS: One thousand nine hundred and thirty claims submitted over six years were analysed. FINDINGS: Two hundred and fifteen (11%) of 1927 claims were rejected. The mean household income of claimants was significantly lower than that of the general population. The percentage of households below the poverty line was similar for claimants and the general population. One thousand seven hundred and twelve (1712) claims were reimbursed: 805 (47%) fully and 907 (53%) at a mean reimbursement rate of 55.6%. Reimbursement more than halved the percentage of catastrophic hospitalizations (>10% of annual household income) and hospitalizations resulting in impoverishment. The average time between discharge and reimbursement was four months. The frequency of submission of claims was low (18.0/1000 members per year: 22-37% of the estimated frequency of hospitalization). CONCLUSIONS: The findings have implications for community-based health insurance schemes in India and elsewhere. Such schemes can protect poor households against the uncertain risk of medical expenses. They can be implemented in areas where institutional capacity is too weak to organize nationwide risk-pooling. Such schemes can cover poor people, including people and households below the poverty line. A trade off exists between maintaining the scheme's financial viability and protecting members against catastrophic expenditures. To facilitate reimbursement, administration, particularly processing of claims, should happen near claimants. Fine-tuning the design of a scheme is an ongoing process - a system of monitoring and evaluation is vital.
- Published
- 2002
5. Length of stay by uncomplicated diabetes bariatric surgery patients: A laparoscopic adjustable banding versus laparoscopic sleeve gastrectomy
- Author
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Jim Goes, Seth K.A. Baffoe, and James E. Rohrer
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Adult ,Male ,medicine.medical_specialty ,Bariatric Surgery ,Comorbidity ,Logistic regression ,Insurance, Hospitalization ,Body Mass Index ,Odds ,03 medical and health sciences ,Sex Factors ,Gastrectomy ,Patient age ,Diabetes mellitus ,Diabetes Mellitus ,Humans ,Medicine ,Laparoscopic sleeve gastrectomy ,business.industry ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Odds ratio ,Length of Stay ,Middle Aged ,medicine.disease ,Hospitals ,United States ,Obesity, Morbid ,Surgery ,Third party insurance ,Costs and Cost Analysis ,Female ,Laparoscopy ,0305 other medical science ,business ,Laparoscopic adjustable gastric banding - Abstract
RATIONALE, AIMS, AND OBJECTIVE Bariatric surgery is an effective procedure for morbidly obese patients when all else fails. The purpose of this study was to compare the hospital length of stay (LOS) for two surgical procedures, laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG). METHODS This study was a retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who received bariatric surgery as indicated by International Classification of Diseases, Ninth Revision (ICD-9) procedure codes were selected (N = 4001). Cases were limited to uncomplicated diabetic patients. Differences in the odds of long vs short (2< and ≥2) stay for a patient receiving LSG were compared with LAGB while adjusting for hospital volume, hospital size, patient age, gender, ethnicity, season, and year using logistic regression analysis. RESULTS The odds for LSG (odds ratio [OR] = 0.100, 0.066-0.150, P
- Published
- 2018
6. Health care purchasing in Kenya: Experiences of health care providers with capitation and fee‐for‐service provider payment mechanisms
- Author
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Jacob Kazungu, Melvin Obadha, Jane Chuma, and Edwine Barasa
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Health Knowledge, Attitudes, Practice ,fee‐for‐service ,media_common.quotation_subject ,Health Personnel ,Insurance, Hospitalization ,Interviews as Topic ,Reimbursement Mechanisms ,03 medical and health sciences ,provider payment mechanisms ,Universal Health Insurance ,Health care ,Revenue ,Humans ,Fee-for-service ,Research Articles ,Qualitative Research ,media_common ,capitation ,Capitation ,Actuarial science ,business.industry ,030503 health policy & services ,Health Policy ,1. No poverty ,Fee-for-Service Plans ,Payment ,Kenya ,Purchasing ,3. Good health ,Incentive ,Cross-Sectional Studies ,Business ,Attributes ,Capitation Fee ,Health Expenditures ,0305 other medical science ,Qualitative research ,Research Article - Abstract
Summary Background Provider payment mechanisms (PPMs) play a critical role in universal health coverage due to the incentives they create for health care providers to deliver needed services, quality, and efficiency. We set out to explore public, private, and faith‐based providers' experiences with capitation and fee‐for‐service in Kenya and identified attributes of PPMs that providers considered important. Methods We conducted a qualitative study in two counties in Kenya. Data were collected using semistructured interviews with 29 management team members in six health providers accredited by the National Hospital Insurance Fund (NHIF). Results Capitation and fee‐for‐service payments from the NHIF and private insurers were reported as good revenue sources as they contributed to providers' overall income. The expected fee‐for‐service payment amounts from NHIF and private insurers were predictable while capitation funds from NHIF were not because providers did not have information on the number of enrolees in their capitation pool. Moreover, capitation payment rates were perceived as inadequate. Capitation and fee‐for‐service payments from NHIF and private insurers were disbursed late. Finally, public providers had lost their autonomy to access and utilise capitation and fee‐for‐service payments from the NHIF. Conclusion Through their experiences, health care providers revealed characteristics of PPMs that they considered important.
- Published
- 2018
7. A ten-year analysis of the reasons for death following ambulatory surgery: Nine closed claims declared to the SHAM insurance
- Author
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Frédéric Fuz, Alexandre Theissen, Melanie Autran, Mohammed Bouregba, and Marc Beaussier
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,030230 surgery ,Critical Care and Intensive Care Medicine ,Insurance, Hospitalization ,Care provision ,Time-to-Treatment ,Insurance Claim Review ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Cause of Death ,Intensive care ,Emergency medical services ,medicine ,Humans ,Anesthesia ,Postoperative Period ,Hemoperitoneum ,Laparoscopy ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,General Medicine ,Emergency department ,Middle Aged ,medicine.disease ,Patient Discharge ,Surgery ,Inguinal hernia ,Anesthesiology and Pain Medicine ,Ambulatory Surgical Procedures ,Child, Preschool ,Ambulatory ,Female ,medicine.symptom ,business - Abstract
Introduction The constant development of ambulatory surgery (AS) raises the problem of monitoring patients after discharge and the risk of death in the case of delays in the management of a serious complication. Patients and methods The aim of this retrospective study was to describe the deaths observed within the 30-day period following AS declared to the SHAM insurance (Societe hospitaliere d’assurance mutuelle) over the last 10 years. Results During the study period 33,962 claims were surgery-related and 11 were for deaths after AS. Two of the death claims were excluded from our study because they occurred after the first month. The surgeries concerned were tonsilectomy (3), cataract (2), inguinal hernia (2), varicose vein stripping (1) and laparoscopy (1). Death occurred on average 5.4 days after the AS, in intensive care (3), during hospitalisation (2), with emergency medical services (1), in an emergency department (1) or at home (2). Anaesthesia was directly implicated in 3 cases: anaphylactic shock (Diamox), pneumoperitoneum (gastric swelling) and hemoperitoneum (mismanagement of anticoagulants). 1 case was due to a pulmonary embolism and 5 to a surgical cause. Discussion–conclusion There was only one case where the complication was aggravated due to the delay of care provision and this was because of a lack of information on the complications requiring an emergency return (abdominal pain after laparoscopy). In all the other cases, death would also probably have occurred during conventional hospitalisation, either because it was unavoidable or because the patient was too far from the surgery.
- Published
- 2018
8. Effects of ACA Expansion of Dependent Coverage on Hospital-Based Care of Young Adults With Early Psychosis
- Author
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Susan H. Busch, Ellen Meara, Ezra Golberstein, Howard H. Goldman, Christine F. Loveridge, and Robert E. Drake
- Subjects
Adult ,Male ,Psychosis ,medicine.medical_specialty ,Insurance, Hospitalization ,Insurance Coverage ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Outcome Assessment, Health Care ,Health insurance ,Medicine ,Humans ,030212 general & internal medicine ,Young adult ,Psychiatry ,Medically Uninsured ,business.industry ,Early psychosis ,Patient Protection and Affordable Care Act ,Hospital based ,medicine.disease ,United States ,030227 psychiatry ,Hospitalization ,Psychiatry and Mental health ,Psychotic Disorders ,Schizophrenia ,Linear Models ,Female ,business ,Emergency Service, Hospital - Abstract
OBJECTIVE: Since 2010, the Affordable Care Act has required private health plans to extend dependent coverage to adults up to age 26. Because psychosis often begins in young adulthood, expanded private insurance benefits may affect early psychosis treatment. The authors examined changes in insurance coverage and hospital-based service use among young adults with psychosis before and after this change. METHODS: The study included a national sample (2006–2013) of discharges and emergency department visits. Using a difference-in-differences study design, the authors compared changes in insurance coverage (measured as payer source), per capita admissions, and 30-day readmissions for psychosis before and after ACA dependent coverage expansion among targeted individuals (ages 20–25) and a comparison group (ages 27–29). RESULTS: After dependent coverage expansion, hospitalization for psychosis among young adults was 5.8 percentage points more likely to be reimbursed by private insurance among the targeted age group (ages 20–25), compared with the slightly older age group (ages 27–29). Dependent coverage expansion was not associated with changes in overall insurance coverage, per capita admissions, or 30-day readmission for psychosis. CONCLUSIONS: Although dependent coverage expansion was unrelated to changes in use of hospital-based treatments for psychosis among young adults, care was more likely to be covered by private insurance, and coverage of these hospitalizations by public insurance decreased. This shift from public to private insurance may reduce public spending on young-adult treatments for early-episode psychosis but may leave young adults without coverage for rehabilitation services.
- Published
- 2019
9. Private Patients Dumped on Public System
- Published
- 2006
10. Early Hospital Compliance With Federal Requirements for Price Transparency.
- Author
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Gondi S, Beckman AL, Ofoje AA, Hinkes P, and McWilliams JM
- Subjects
- Access to Information, Ethics, Business, Health Expenditures, Humans, United States, Disclosure ethics, Disclosure legislation & jurisprudence, Government Regulation, Hospital Costs ethics, Hospital Costs standards, Insurance, Hospitalization
- Published
- 2021
- Full Text
- View/download PDF
11. Effect of the Affordable Care Act’s Young Adult Insurance Expansions on Hospital-Based Mental Health Care
- Author
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Ezra Golberstein, Rebecca Zaha, Susan H. Busch, William R. Beardslee, Shelly F. Greenfield, and Ellen Meara
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Adult ,Male ,medicine.medical_specialty ,MEDLINE ,Hospitals, General ,Insurance, Hospitalization ,California ,Insurance Coverage ,Outcome Assessment, Health Care ,Health care ,Patient Protection and Affordable Care Act ,medicine ,Health insurance ,Humans ,Young adult ,Medically Uninsured ,business.industry ,Mental Disorders ,Emergency department ,medicine.disease ,Mental health ,Hospitalization ,Psychiatry and Mental health ,Mental Health ,Family medicine ,Female ,Medical emergency ,Emergency Service, Hospital ,business ,Insurance coverage - Abstract
Insurance coverage for young adults has increased since 2010, when the Affordable Care Act (ACA) required insurers to permit children to remain on parental policies until age 26 as dependents. This study estimated the association between the dependent coverage provision and changes in young adults' use of hospital-based services for substance use disorders and non-substance use psychiatric disorders.The authors conducted a quasi-experimental comparison of a national sample of non-childbirth-related inpatient admissions to general hospitals (a total of 2,670,463 admissions, 430,583 of which had primary psychiatric diagnoses) and California emergency department visits with psychiatric diagnoses (N=11,139,689), using data spanning 2005 to 2011. Analyses compared young adults who were targeted by the ACA dependent coverage provision (19- to 25-year-olds) and those who were not (26- to 29-year-olds), estimating changes in utilization before and after implementation of the dependent coverage provision. Primary outcome measures included quarterly inpatient admissions for primary diagnoses of any psychiatric disorder per 1,000 population; emergency department visits with any psychiatric diagnosis per 1,000 population; and payer source.Dependent coverage expansion was associated with 0.14 more inpatient admissions for psychiatric diagnoses per 1,000 for 19- to 25-year-olds (targeted by the ACA) than for 26- to 29-year-olds (not targeted by the ACA). The coverage expansion was associated with 0.45 fewer psychiatric emergency department visits per 1,000 in California. The probability that inpatient admissions nationally and emergency department visits in California were uninsured decreased significantly.ACA dependent coverage provisions produced modest increases in general hospital psychiatric inpatient admissions and higher rates of insurance coverage for young adults nationally. Lower rates of emergency department visits were observed in California.
- Published
- 2015
12. [In Process Citation]
- Subjects
Reimbursement Mechanisms ,Insurance, Health ,National Health Programs ,Germany ,Humans ,Female ,Hospital Costs ,Radiology ,Insurance, Hospitalization ,Referral and Consultation - Published
- 2016
13. [POLISH CITIZENS' OPINIONS CONCERNING CO-PAYMENT FOR HOSPITALIZATION AND SUBSIDIES FOR NON-STANDARD BENEFITS]
- Author
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Ewa, Kemicer-Chmielewska, Iwona, Rotter, Artur, Kotwas, and Beata, Karakiewicz
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Adult ,Educational Status ,Humans ,Poland ,Health Expenditures ,Attitude to Health ,Health Surveys ,Insurance, Hospitalization - Abstract
Co-payment in the health sector operates in most healthcare systems in European countries. The aim of this study was knowledge of Polish citizens' opinions concerning healthcare services co-payment with respect to selected socio-demographic factors.The study was conducted using a diagnostic survey of 636 respondents, representing residents of the West Pomeranian region, Poland.The majority of respondents did not accept co-payment for health services.Material situation and educational background impact on decisions concerning co-payment for hospital treatment.
- Published
- 2015
14. Impact of Insurance and Hospital Ownership on Hospital Length of Stay Among Patients With Ambulatory Care-Sensitive Conditions
- Author
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Arch G. Mainous, Vanessa A. Diaz, Charles J. Everett, and Michele E. Knoll
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Length of hospitalization ,Insurance, Hospitalization ,Young Adult ,Ambulatory care ,Insurance types ,Hospitals, Religious ,Ambulatory Care ,Hospital discharge ,Humans ,Medicine ,Hospital Mortality ,Young adult ,Original Research ,Medically Uninsured ,Hospitals, Public ,Medicaid ,business.industry ,Mortality rate ,Length of Stay ,Middle Aged ,Hospitals, Proprietary ,United States ,Ambulatory ,Emergency medicine ,Female ,Family Practice ,business - Abstract
PURPOSE Some studies suggest proprietary (for-profit) hospitals are maximizing financial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients. This study examines the role of insurance related to length of stay once the patient is in the hospital and risk for mortality, particularly in a for-profit environment. METHODS We undertook an analysis of hospitalizations in the National Hospital Discharge Survey (NHDS) of the 5-year period of 2003 to 2007 for patients aged 18 to 64 years (unweighted n = 849,866; weighted n = 90 million). The analysis included those who were hospitalized with both ambulatory care-sensitive conditions (ACSCs), hospitalizations considered to be preventable, and non-ACSCs. We analyzed the transformed mean length of stay between individuals who had Medicaid or all other insurance types while hospitalized and those who were hospitalized without insurance. This analysis was stratified by hospital ownership. We also examined the relationship between in-hospital mortality and insurance status. RESULTS After controlling for comorbidities; age, sex, and race/ethnicity; and hospitalizations with either an ACSC or non-ACSC diagnosis, patients without insurance tended to have a significantly shorter length of stay. Across all hospital types, the mean length of stay for ACSCs was significantly shorter for individuals without insurance (2.77 days) than for those with either private insurance (2.89 days, P = .04) or Medicaid (3.19, P
- Published
- 2011
15. Who Pays for Agricultural Injury Care?
- Author
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Julia F. Costich
- Subjects
Poison control ,Workers' compensation ,Medicare ,Discount points ,Insurance, Hospitalization ,Suicide prevention ,Insurance Coverage ,Occupational safety and health ,Occupational Exposure ,Environmental health ,Injury prevention ,Health care ,Humans ,Medicine ,health care economics and organizations ,Inpatients ,Medically Uninsured ,Medicaid ,business.industry ,Public Health, Environmental and Occupational Health ,Agriculture ,Health Care Costs ,United States ,Hospitalization ,Workers' Compensation ,Wounds and Injuries ,Private Sector ,Health Expenditures ,business - Abstract
Analysis of 295 agricultural injury hospitalizations in a single state's hospital discharge database found that workers' compensation covered only 5% of the inpatient stays. Other sources were commercial health insurance (47%), Medicare (31%), and Medicaid (7%); 9% were uninsured. Estimated mean hospital and physician payments (not costs or charges) were $12,056 per hospitalization. Nearly one sixth (16%) of hospitalizations were either unreimbursed or covered by Medicaid, indicating a substantial cost-shift to public funding sources. Problems in characterizing agricultural injuries and states' exceptions to workers' compensation coverage mandates point to the need for comprehensive health coverage.
- Published
- 2010
16. Effects of ACA Expansion of Dependent Coverage on Hospital-Based Care of Young Adults With Early Psychosis.
- Author
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Busch SH, Golberstein E, Goldman HH, Loveridge C, Drake RE, and Meara E
- Subjects
- Adult, Emergency Service, Hospital statistics & numerical data, Female, Hospitalization trends, Humans, Insurance, Hospitalization, Linear Models, Male, Medically Uninsured statistics & numerical data, Outcome Assessment, Health Care, United States, Young Adult, Hospitalization economics, Insurance Coverage statistics & numerical data, Patient Protection and Affordable Care Act, Psychotic Disorders economics, Psychotic Disorders rehabilitation
- Abstract
Objective: Since 2010, the Affordable Care Act has required private health plans to extend dependent coverage to adults up to age 26. Because psychosis often begins in young adulthood, expanded private insurance benefits may affect early psychosis treatment. The authors examined changes in insurance coverage and hospital-based service use among young adults with psychosis before and after this change., Methods: The study included a national sample (2006-2013) of discharges and emergency department visits. Using a difference-in-differences study design, the authors compared changes in insurance coverage (measured as payer source), per capita admissions, and 30-day readmissions for psychosis before and after ACA dependent coverage expansion among targeted individuals (ages 20-25) and a comparison group (ages 27-29)., Results: After dependent coverage expansion, hospitalization for psychosis among young adults was 5.8 percentage points more likely to be reimbursed by private insurance among the targeted age group (ages 20-25), compared with the slightly older age group (ages 27-29). Dependent coverage expansion was not associated with changes in overall insurance coverage, per capita admissions, or 30-day readmission for psychosis., Conclusions: Although dependent coverage expansion was unrelated to changes in use of hospital-based treatments for psychosis among young adults, care was more likely to be covered by private insurance, and coverage of these hospitalizations by public insurance decreased. This shift from public to private insurance may reduce public spending on young-adult treatments for early-episode psychosis but may leave young adults without coverage for rehabilitation services.
- Published
- 2019
- Full Text
- View/download PDF
17. Start spreading the news: A structural estimate of the effects of New York hospital report cards
- Author
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David Dranove and Andrew Sfekas
- Subjects
Adult ,Value of Life ,Psychometrics ,media_common.quotation_subject ,New York ,Hospital quality ,Health Care Sector ,Disclosure ,Choice Behavior ,Insurance, Hospitalization ,White People ,Humans ,Quality (business) ,Coronary Artery Bypass ,Market share ,Marketing ,Negativism ,health care economics and organizations ,Aged ,Quality Indicators, Health Care ,media_common ,Information Dissemination ,Health Policy ,Public Health, Environmental and Occupational Health ,Bayes Theorem ,Advertising ,Middle Aged ,Hospitals ,Black or African American ,Patient Satisfaction ,Business ,Models, Econometric ,Report card - Abstract
Research on the effects of publicly reported hospital quality report cards on patient market shares is mixed. Higher-ranking hospitals do not consistently experience increases in market share. We argue that this may be because the report cards do not always convey "news" about quality; in some cases the rankings conform with prior beliefs about quality. We develop a structural model of the "news" in report cards and estimate the model using data from New York State in 1989-1991. We show hospitals with negative news in the original 1990 report cards experienced a decrease in market share, but that a misspecified model might continue to find no report card effect.
- Published
- 2008
18. Outcomes following pancreatic resection: Variability among high-volume providers
- Author
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Taylor S. Riall, Jean L. Freeman, William H. Nealon, Courtney M. Townsend, and James S. Goodwin
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Adult ,Male ,medicine.medical_specialty ,Multivariate statistics ,Adolescent ,Insurance, Hospitalization ,Single measure ,Nursing care ,Pancreatectomy ,Outcome Assessment, Health Care ,Risk of mortality ,Humans ,Medicine ,Illness severity ,Hospital Mortality ,Pancreatic resection ,Aged ,business.industry ,Length of Stay ,Middle Aged ,Hospitals ,Surgery ,Elective Surgical Procedures ,Insurance status ,Emergency medicine ,Female ,Skilled Nursing Facility ,business - Abstract
Background A strong volume-outcome relationship has been demonstrated for pancreatic resection, and regionalization of care to high-volume centers (>11 resections/year) has been recommended. However, it is unclear if volume alone should be the sole criteria for regionalization. The objective of this study is to evaluate variability in outcomes among high-volume hospitals (>11 resections/year). Methods We used the Texas Hospital Inpatient Discharge Database from 1999 through 2005 to evaluate variability in outcomes after pancreatic resection among high-volume hospitals in Texas. The outcome variables of interest were mortality, length of stay, discharge to a skilled nursing facility, operation within 24 hours of hospital admission, and total hospital charges. Unadjusted and adjusted models were performed. Results A total of 12 high-volume hospitals were in Texas. The number of resections at each hospital ranged from 78–608 cases for the 7-year time period studied. In unadjusted models, there was significant variability in mortality (range, 0.7%–7.7%, P < .0001), duration of stay (range of medians, 9–21 days, P < .0001), the need for ongoing nursing care at discharge (range, 0.7%–41.4%, P < .0001), operation within 24 hours of admission (range, 41%–96%, P < .0001), and total hospital charges (median range, $38,318–$110,860, P < .0001). There were significant differences in the demographics, risks of mortality, and illness severity among the 12 high-volume hospitals. Therefore, multivariate models were used to control for age group, sex, race/ethnicity, risk of mortality, illness severity, admission status, diagnosis, procedure, and insurance status. In the multivariate models, the particular hospital at which the pancreatic surgery was performed was a significant independent predictor of every outcome variable except mortality. Conclusions For pancreatic resection, there is significant variability in outcomes even among high-volume providers. Individual hospitals likely account for much of the variability not explained by hospital volume. Although the structure measure of hospital volume is easy to measure, these data suggest that it is not a reliable single measure of quality or outcomes after pancreatic surgery.
- Published
- 2008
19. Characteristics of hip fractures among hospitalized elder Mexican American Black and White Medicare beneficiaries in the Southwestern United States
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S. Liliana Oakes, Robert Wood, Jeanette Silva Ross, David V. Espino, and Johanna Becho
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Male ,Gerontology ,Aging ,Ethnic group ,Mexican americans ,Medicare ,Insurance, Hospitalization ,Patient age ,Mexican Americans ,Health care ,Southwestern United States ,Humans ,Medicine ,Aged ,Aged, 80 and over ,Hip fracture ,Hip Fractures ,business.industry ,Incidence (epidemiology) ,Medicare beneficiary ,medicine.disease ,United States ,Female ,Geriatrics and Gerontology ,business ,Medicaid - Abstract
Background and aims: Hip fractures are a major cause of morbidity and mortality in the older adult population. The evidence of the incidence of morbidity and mortality in Mexican Americans compared to other ethnic groups is mixed. This study aims to examine characteristics and utilization patterns of older Mexican Americans compared to Whites and Blacks, hospitalized for hip fracture in the Southwestern United States. Methods: Retrospective analysis of the Medicare and Medicaid claims data for the southwestern states of California, Arizona, Colorado, New Mexico and Texas. All Medicare beneficiaries aged 65 and above, hospitalized for non-pathologic hip fractures, participated in the study. Mexican Americans were directly identified from the H-EPESE database. The primary outcome measures were length of stay, total charges and number of diagnoses. Results: The total proportion of hospital encounters related to hip fractures within each ethnic group was 3.7% for Whites, 2.0% for Mexican Americans and 1.2% for Blacks. The mean patient age for the hip fracture was 82.5 years while the non-hip fractures encounters had a mean age of 76.6 years. A higher percentage of Mexican Americans who suffered fracture were female. Although length of stay for Mexican Americans was equivalent to Whites, comparative total charges for Mexican Americans were lower. Mexican Americans also have lower mean number of diagnoses at admission than the other groups (MA=5.5, B=6.2, W=5.9: p
- Published
- 2008
20. Racial disparities in the management of hospitalized patients with cirrhosis and complications of portal hypertension: A national study
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Dorry L. Segev, Paul J. Thuluvath, and Geoffrey C. Nguyen
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Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Black People ,Liver transplantation ,Esophageal and Gastric Varices ,Lower risk ,Insurance, Hospitalization ,White People ,Internal medicine ,Hypertension, Portal ,medicine ,Humans ,Portasystemic Shunt, Surgical ,Hospital Mortality ,Hepatology ,Hemostatic Techniques ,business.industry ,Endoscopy ,Hispanic or Latino ,Odds ratio ,medicine.disease ,Hospitals ,United States ,Liver Transplantation ,Surgery ,Portal hypertension ,Portosystemic shunt ,Complication ,business - Abstract
Having complications of portal hypertension is a harbinger of decompensated cirrhosis and warrants consideration for liver transplantation (LT). Racial disparities in LT have been reported. We sought to characterize disparities in the performing of surgical and endoscopic procedures among hospitalized patients with complications of portal hypertension. We queried the Nationwide Inpatient Sample from 1998 to 2003 to identify patients with cirrhosis and complications of portal hypertension. Logistic regression controlling for confounders was used to evaluate race as a predictor of undergoing a portosystemic shunt and LT and of dying in the hospital. Compared to whites, the adjusted odds ratios of receiving a portosystemic shunt were 0.37 (95% CI: 0.27-0.51) and 0.69 (95% CI: 0.54-0.88) for African Americans (AAs) and Hispanics, respectively. AAs with variceal bleeding were more likely to have endoscopic variceal hemostasis delayed more than 24 hours after admission than were whites (OR 1.6; 95% CI: 1.2-2.1). The adjusted odds ratios of undergoing LT were 0.32 (95% CI:0.20-0.52) and 0.46 (95% CI: 0.25-0.83) for AAs and Hispanics, respectively. Compared to whites, AAs experienced higher in-hospital mortality (OR 1.12; 95% CI: 1.01-1.24), whereas Hispanics had a lower risk of death (OR 0.83; 95% CI: 0.75-0.92). Among variceal bleeders, the odds ratio of death for AAs was 1.7 (95% CI: 1.2-2.4) compared to whites. Conclusion: AAs and Hispanics hospitalized for complications of portal hypertension were less likely to undergo a palliative shunt or LT than whites, which may contribute to the higher in-hospital mortality of AAs. Further studies are warranted to elucidate the mechanisms of these exploratory findings. (HEPATOLOGY 2007;45:1282–1289.)
- Published
- 2007
21. The epidemiology of infant injuries and alarming health disparities
- Author
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Richard A. Falcone, Rebeccah L. Brown, and Victor F. Garcia
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Male ,medicine.medical_specialty ,Pediatrics ,Poison control ,Insurance, Hospitalization ,Risk Assessment ,Vulnerable Populations ,Suicide prevention ,White People ,Occupational safety and health ,Asphyxia ,Trauma Centers ,Infant Mortality ,Injury prevention ,Epidemiology ,Humans ,Medicine ,Child Abuse ,Socioeconomic status ,Ohio ,Medicaid ,business.industry ,Mortality rate ,Infant, Newborn ,Infant ,General Medicine ,Hospitals, Pediatric ,Health equity ,Black or African American ,Social Class ,Socioeconomic Factors ,Pediatrics, Perinatology and Child Health ,Wounds and Injuries ,Female ,Surgery ,business ,Demography - Abstract
Injury epidemiology is the underappreciated foundation of injury prevention and control strategies. Given the substantial disparity of infant injury-related mortality between African Americans (AA) and whites in our region, we sought to better understand the epidemiology of infant injury-related mortality rates.Our trauma database was reviewed for all infant injuries over a 10-year period. The mortality rates were analyzed based on race, mechanism, and health insurance type.From 1995 to 2004, 1270 infants were identified. Sixty-nine percent were white, 26% AA, and 5% were other. Overall mortality was 4.8%. There were significant disparities in mortality comparing AA to whites: overall, 9.6% vs 2.8%*; abuse, 15% vs 4%*; suffocation, 100% vs 55%* (*P.05). Although 75% of AA vs 40% of whites were insured by Medicaid, when separated by insurance type, the disparity in mortality rates between races remained significant.African-American infants have 3.5 times increased risk of death from preventable injuries compared to white infants. This disparity persists despite controlling for type of health insurance, a surrogate for socioeconomic status. Understanding these disparities and developing injury-prevention programs targeting high-risk mechanisms of injury such as abuse and suffocation among AA is critical toward eventually eliminating these preventable deaths.
- Published
- 2007
22. Health Insurance and Access to Care among Social Security Disability Insurance Beneficiaries during the Medicare Waiting Period
- Author
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Gerald F. Riley
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Adult ,Male ,Time Factors ,Waiting Lists ,Self-insurance ,Entitlement ,Medicare ,0603 philosophy, ethics and religion ,Insurance, Hospitalization ,Health Services Accessibility ,Insurance Coverage ,Social Security ,Waiting period ,Interviews as Topic ,03 medical and health sciences ,Health care ,Health insurance ,Humans ,Disabled Persons ,Actuarial science ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Health Policy ,Age Factors ,lcsh:RA1-1270 ,06 humanities and the arts ,Group insurance ,Middle Aged ,United States ,Social security ,Logistic Models ,Health Care Surveys ,Insurance, Disability ,060302 philosophy ,Female ,0305 other medical science ,business ,Disability insurance - Abstract
For most Social Security Disability Insurance (SSDI) beneficiaries, Medicare entitlement begins 24 months after the date of SSDI entitlement. Many may experience poor access to health care during the 24-month waiting period because of a lack of insurance. National Health Interview Survey data for the period 1994–1996 were linked to Social Security and Medicare administrative records to examine health insurance status and access to care during the Medicare waiting period. Twenty-six percent of SSDI beneficiaries reported having no health insurance, with the uninsured reporting many more problems with access to care than insured individuals. Access to health insurance is especially important for people during the waiting period because of their low incomes, poor health, and weak ties to the workforce.
- Published
- 2006
23. Economics of critical care: Medicare part A versus part B payments
- Author
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Carolyn Bekes, David R. Gerber, and Joseph E. Parrillo
- Subjects
Government ,Actuarial science ,Critical Care ,business.industry ,media_common.quotation_subject ,Diagnosis-related group ,Critical Care and Intensive Care Medicine ,Payment ,Insurance, Hospitalization ,United States ,Reimbursement Mechanisms ,Nursing ,Intensive care ,Literature reviewing ,Humans ,Medicine ,Medicare Part B ,Medicare Part A ,Medicare part a ,Hospital Costs ,business ,health care economics and organizations ,Reimbursement ,Relative value unit ,media_common - Abstract
To review the effect of Medicare part A payments (to hospitals) and part B payments (to providers) on critical care in the United States.Sources included U.S. government data and published literature reviewing the impact of Medicate payments on critical care.Government data were reviewed to assess the history and status of reimbursement to hospitals and healthcare providers. These data, along with input from published literature, was used to assess the adequacy of current and projected Medicare reimbursements and the implications of these payments.Medicare payments to hospitals, particularly for critically ill patients, seem to fall short of the costs of caring for these patients. Reimbursements to providers seem more encouraging, although the opportunity exists to improve in this area as well.
- Published
- 2006
24. Hospital Payment Systems: Will Payers Like The Future Better Than The Past?
- Author
-
Ann S. O’Malley and Len M. Nichols
- Subjects
Actuarial science ,Transparency (market) ,Early signs ,business.industry ,Health Policy ,media_common.quotation_subject ,Payment ,Private sector ,Public domain ,Insurance, Hospitalization ,United States ,Reimbursement Mechanisms ,Health care cost ,Economics ,Economics, Hospital ,Payment service provider ,business ,media_common - Abstract
Unsustainable health care cost growth has forced payers to reexamine goals for hospital payment systems. Employers want simplicity and transparency, with comparative performance data available in the public domain. Insurers favor simplicity but prefer to keep the analysis of comparative performance data and pricing private. Thirty-five pay-for-performance experiments have been devised in the private sector, to reward hospitals for higher quality and move toward more effective payment systems. Definitive results are not yet known, and caveats remain, but early signs are promising. We develop three scenarios for future hospital payment systems and identify policy actions to improve outcomes.
- Published
- 2006
25. The Relationship of Insurance Status, Hospital Ownership, and Teaching Status with Interhospital Transfers in California in 2000
- Author
-
Adrienne Green, Jonathan Showstack, Deborah Rennie, and Lee Goldman
- Subjects
Patient Transfer ,Current Procedural Terminology ,medicine.medical_specialty ,Multivariate analysis ,Insurance, Hospitalization ,California ,Insurance Coverage ,Education ,Patient Admission ,International Classification of Diseases ,medicine ,Hospital discharge ,Humans ,Health planning ,Hospitals, Teaching ,health care economics and organizations ,Reimbursement ,Medically Uninsured ,Hospitals, Public ,Medicaid ,business.industry ,Ownership ,General Medicine ,Hospitals, Proprietary ,Insurance status ,Multivariate Analysis ,Emergency medicine ,Hospitals, Voluntary ,business - Abstract
PURPOSE Public hospitals and academic medical centers may admit more poorly insured transfer patients than do other institutions. The authors investigated the relationship of patient insurance status, hospital ownership, and hospital teaching status with interhospital transfers in California. METHOD In 2003, data were derived from the hospital discharge abstract database for the year 2000 from the California Office of Statewide Health Planning and Development. Hospitals were categorized by ownership and teaching status; patients were categorized as being "good" or "poor" payers depending on the level of expected insurance reimbursement. Descriptive and multivariate analyses were used to assess the number of poor payer transfers admitted by each hospital group. RESULTS In 2000, there were 58,509 transfer and 2,320,479 direct admissions. All hospital groups admitted a higher percentage of good payer than poor payer transfer patients (85% vs. 15% respectively for all groups combined). Adjusted for total number of admissions and teaching status, the number of poor payer transfer patients admitted to county-owned and University of California hospitals was significantly higher than the statewide average (both p values < .001), while the number admitted to independent teaching hospitals was significantly lower than the statewide average (p < .001). The number of poor payer transfer patients admitted to independent teaching hospitals more closely resembled that of for-profit hospitals than that of University of California teaching hospitals. CONCLUSIONS In 2000, the likelihood of a hospital admitting a transfer patient appears to have been affected by both the patient's insurance status and the hospital's ownership. In general, good payer patients were more likely to be transferred than were poor payer patients, with poor payer transfer patients more likely to be admitted to publicly owned hospitals.
- Published
- 2005
26. Increasing Breastfeeding Rates in New York City, 1980-2000
- Author
-
Melanie Besculides, Karine Grigoryan, and Fabienne Laraque
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Health (social science) ,Urban Population ,Breastfeeding ,Mothers ,Insurance type ,Breast milk ,Insurance, Hospitalization ,Article ,Hospitals, Private ,Patient Education as Topic ,Epidemiology ,Humans ,Medicine ,Obstetrics and Gynecology Department, Hospital ,Infant feeding ,Milk, Human ,Hospitals, Public ,business.industry ,Public health ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Public Assistance ,Infant Formula ,Bottle Feeding ,Urban Studies ,Breast Feeding ,Socioeconomic Factors ,Infant formula ,Female ,New York City ,business ,Breast feeding ,Demography - Abstract
Our objective was to determine temporal patterns of breastfeeding among women delivering infants in New York City (NYC) and compare national breastfeeding trends. All hospitals in NYC with obstetric units were contacted in May and June 2000 to provide information on the method of infant feeding during the mother's admission for delivery. Feeding was categorized as "exclusive breastfeeding," "breast and formula," or "exclusive formula." The first two categories were further grouped into "any breastfeeding" in the analysis. Hospitals were classified as "public" and "private," and patients were classified by insurance type as "service" and "private." Data between public and private hospitals and service and private patients were compared. Breast-feeding trends over time were compared by using previous iterations of the same survey. Of 16,932 newborns, representing approximately 80.0% of all reported live births in the city during the study period, 5,305 (31.3%) were exclusively breastfed, 6,189 (36.6%) were fed a combination of breast milk and formula, and the remaining 5,438 (32.1%) were exclusively formula-fed. Infants born in private hospitals were 1.6 times more likely to be exclusively breastfed compared with infants discharged from public hospitals (33% vs. 21%, respectively). Similarly, private patients were more likely than service patients to exclusively breastfeed their infants (39.6% vs. 22.9%, respectively) and to use a combination of breast and formula (i.e., any breastfeeding) (73.6% vs. 62.0%, respectively). From 1980 to 2000, the proportion of exclusive breastfeeding increased from 25.0% to 31.0%, the percentage of combined feeding increased from 8.0% to 37.0%, and the percentage of any breastfeeding increased from 33.0% to 68.0%. NYC has more than doubled the rate of breastfeeding since 1980. However, there is much progress to be made, and continued efforts are vital to maintain current gains in breastfeeding, improve the rates further, and prolong the duration of breastfeeding.
- Published
- 2005
27. The Association Between Hospital Readmission and Insurance Provider Among Adults with Asthma
- Author
-
Katherine D. Chung, Patrice Gregory, Shabana Ather, and Kitaw Demissie
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Chronic condition ,medicine.medical_specialty ,Adolescent ,Cost-Benefit Analysis ,Insurance, Hospitalization ,Patient Readmission ,Severity of Illness Index ,Cohort Studies ,Indirect costs ,Age Distribution ,Reference Values ,Severity of illness ,Confidence Intervals ,Odds Ratio ,medicine ,Humans ,Immunology and Allergy ,Hospital Costs ,Sex Distribution ,Retrospective Studies ,Asthma ,Analysis of Variance ,business.industry ,Incidence ,Retrospective cohort study ,Odds ratio ,Length of Stay ,Middle Aged ,medicine.disease ,United States ,Hospitalization ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Managed care ,Female ,business ,Cohort study - Abstract
Asthma is ranked as the ninth most common chronic condition in the U.S., and its annual direct costs from hospital services alone are estimated at $3.1 billion. Hospitalization rates due to asthma reveal several disparities and may be attributed to recent changes in the healthcare delivery system, including the penetration of managed care.To examine the relationship between 7-day hospital readmission and insurance provider among adults with asthma. DDESIGN: A retrospective cohort study that included patients aged 18-64 with a principal diagnosis of asthma, who were discharged from acute nonfederal hospitals in New Jersey between 1 January 1993 and 31 December 1996. In the absence of unique patient identifiers, a linkage system was used to match subsequent readmissions for the same patient to the first admission. MMAIN OUTCOME MEASURE: Seven-day readmission.Results showed a significantly increased risk of 7-day readmission for managed care patients as compared to indemnity patients (OR= 1.67, 1.10-2.53). Shorter lengths of stay were associated with greater odds of readmission (LOS=0: OR=5.17, 2.49-10.75, LOS=1: OR=2.30, 1.30-4.07).Managed care patients have shorter lengths of stay as compared to indemnity patients, which leads to an increased risk of returning to the hospital within a short period of time. In trying to provide cost-effective patient care, we may be discharging patients prematurely.
- Published
- 2004
28. Analysis of hospital charges for ischemic stroke in Fukuoka, Japan
- Author
-
Koichi Nobutomo, Yutaka Kiyohara, Yasushi Okada, Feng Tu, and Makoto Anan
- Subjects
Adult ,Male ,medicine.medical_specialty ,National Health Programs ,Insurance, Hospitalization ,Brain Ischemia ,Hospitals, Urban ,Cost of Illness ,Japan ,International Classification of Diseases ,medicine ,Humans ,Intensive care medicine ,Stroke ,Health policy ,Reimbursement ,Aged ,Aged, 80 and over ,business.industry ,Health Policy ,Medical record ,Length of Stay ,Middle Aged ,Stepwise regression ,Hospital charge ,medicine.disease ,Hospital Charges ,Radiological weapon ,Utilization Review ,Emergency medicine ,Ischemic stroke ,Female ,business - Abstract
Objectives: Stroke is a heavy economic burden on individuals, society, and health services in Japan, where health expenditures are rising rapidly. The objective of the present study was to examine medical services and demographic factors associated with increased inpatient charges for ischemic stroke in Japan. Subjects and methods: The study subjects were 316 patients with a principal diagnosis of acute ischemic stroke who were discharged from the National Kyushu Medical Center Hospital from 1 July 1995 through 31 June 1999. Demographic, clinical, and administrative data were retrospectively collected from medical records and the hospital Clinical Financial Information System (CFIS). The influence of social and medical factors on total charges was analyzed using the stepwise multiple regression model. Results: Among the total subjects, the mean (median) length of hospital stay (LOHS) was 33 (30) days (range, 2–155 days). The mean (median) hospital charge per patient was US $9020 ($7974) with a range of $336–54 509. The distribution of charges was 42% for fundamental, 17% for injection therapies, 13% for radiological test, 11% for other laboratory examinations, 3% for drugs, and 3% for operations. Stepwise multiple regression analysis revealed that LOHS was the key determinant of the hospital charge (partial R 2 =0.5993, P =0.0001). Operations ( P =0.0001) and angiography ( P =0.03) were also independent but less contributory determinants of the hospital charge. Conclusions: LOHS was strongly, positively associated with inpatient charges for ischemic stroke in Japan. This implies that significant charge reductions are more likely to rely on shortening LOHS, which probably can be achieved by altering reimbursement policies.
- Published
- 2003
29. Agreement Between Insurance Claim and Self-Reported Hospital and Emergency Room Utilization Data Among Persons with Diabetes
- Author
-
Kenneth E Johnson, David W. Lee, Andrea S. Marks, Julie Slezak, Hitesh Patel, and Jan Berger
- Subjects
Insurance Claim Reporting ,Male ,business.industry ,Health Policy ,Reproducibility of Results ,medicine.disease ,Insurance, Hospitalization ,Patient Discharge ,humanities ,body regions ,Insurance claims ,Patient Admission ,Patient Education as Topic ,Diabetes management ,Diabetes mellitus ,Diabetes Mellitus ,Humans ,Medicine ,Female ,Registries ,Medical emergency ,Emergency Service, Hospital ,business ,Aged ,Retrospective Studies - Abstract
As part of a retrospective evaluation of a diabetes management program, the agreement between self-reported and insurance claim data on hospitalization and emergency room utilization was examined. Data agreement on hospitalization or emergency room visits between the two collection modes was evaluated through the use of simple agreement proportions and the kappa agreement statistic. A total of 1,230 participant responses were studied. The proportions of patients with hospitalization or emergency room visits were indistinguishable between the self-reported and medical claims data, and kappa statistics also indicated good-to-excellent agreement between data sets. The percentages of participants whose self-reported hospitalization and emergency room utilization exactly matched data derived from insurance claims were high (89.1% and 87.2%, respectively). Furthermore, the kappa statistics of agreement for the number of hospitalizations (0.6366) and emergency room visits (0.5390) indicate good agreement between self-reported and insurance claim data. The results of this study suggest either self-reported or insurance claims data can be used to evaluate the impact of health care interventions on hospital or emergency room utilization.
- Published
- 2003
30. Overview of inpatient coding
- Author
-
Teresa Slaughter, Therese Conner, and Sherri Alexander
- Subjects
Gerontology ,Abstracting and Indexing ,MEDLINE ,Healthcare Common Procedure Coding System ,Documentation ,Insurance, Hospitalization ,Medical Records ,Chart ,International Classification of Diseases ,Medicine ,Medical diagnosis ,Reimbursement ,Insurance Claim Reporting ,Pharmacology ,Inpatients ,business.industry ,Data Collection ,Health Policy ,Medical record ,medicine.disease ,United States ,Insurance, Health, Reimbursement ,Forms and Records Control ,Medical emergency ,business ,Coding (social sciences) - Abstract
The main classification-based and nomenclature-based coding systems used in the United States, as well as the process and importance of documenting in the patient record, are discussed. Hospital pharmacists usually have limited knowledge of and exposure to coding and reimbursement in the inpatient system. Coding allows for reporting of mortality data to the World Health Organization (WHO), reporting morbidity data in the U.S., and providing data for reimbursement from third-party payers to hospitals for services provided. Coded information is also the primary source for administrative management of medical services and a source of epidemiologic and statistical data from inpatient stays. In order to better understand inpatient coding and reimbursement, this article will discuss the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding system; the Healthcare Common Procedure Coding System (HCPCS); the process and importance of appropriate chart documentation; and the development of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) coding system. Coding in the inpatient setting enables hospital billing and provides statistical data for epidemiology and financial planning. The ICD-9-CM is a clinically modified version of the international ICD-9 system used for coding both diagnoses and procedures in the United States. Coding is derived from documentation found in the patient's chart. Appropriate documentation is key for quality and continuity of care and compensation for resources utilized. In the future the ICD-9-CM will be replaced by the 10th revision, ICD-10, which is already in use in many countries in Europe.
- Published
- 2003
31. What Will Become Of The Medical Mecca? Health Care Spending In Massachusetts
- Author
-
Robert E. Mechanic
- Subjects
Academic Medical Centers ,Economic growth ,business.industry ,Health Policy ,media_common.quotation_subject ,Health Care Sector ,Information technology ,Hospitals, Community ,Medicare ,Insurance, Hospitalization ,United States ,Massachusetts ,State (polity) ,Health care ,Humans ,Medicine ,Health Expenditures ,Hospital Costs ,business ,Forecasting ,media_common - Abstract
Massachusetts has been called a "medical mecca." It has also been called the world's most expensive health care market. This paper concludes that claims of excess costs in Massachusetts are overstated. Massachusetts hospitals have lower inpatient costs than peer institutions in other states, yet the state's concentration of academic hospitals tilts the system toward higher spending. In markets like Massachusetts, there is growing pressure to demonstrate tangible benefits to justify the additional costs of academic health centers (AHCs). Applying new information technologies to proactively manage patients with expensive chronic illnesses is a critical area for future collaboration between payers and AHCs.
- Published
- 2003
32. Using a Market Model to Track Advances in Patient Safety
- Author
-
David Shulkin
- Subjects
Safety Management ,Medical Errors ,business.industry ,Health Care Sector ,General Medicine ,Track (rail transport) ,Insurance, Hospitalization ,United States ,Patient safety ,Models, Economic ,Hospital Administration ,Models, Organizational ,Health care ,Hospital Information Systems ,Humans ,Medicine ,In patient ,Operations management ,Diffusion of Innovation ,Marketing ,Market model ,business ,Reimbursement, Incentive - Abstract
The author proposes a four-stage model that may help hospitals and other health care providers recognize and anticipate market drivers of patient safety.
- Published
- 2003
33. Cost analysis of pneumonia treatment in the Philippines
- Author
-
Kehui Liu, Hengjin Dong, and Rainer Sauerborn
- Subjects
medicine.medical_specialty ,Total cost ,Philippines ,MEDLINE ,Insurance, Hospitalization ,Social Security ,Hospitals, Private ,Nursing ,Humans ,Medicine ,Hospital Costs ,Hospitals, Municipal ,Reimbursement ,Service (business) ,Analysis of Variance ,Government ,business.industry ,Health Policy ,Health services research ,Pneumonia ,Social security ,Family medicine ,Health Services Research ,Health Expenditures ,business ,Quality assurance - Abstract
The objectives of this study were to describe the cost distribution of pneumonia treatment in tertiary hospitals in the National Capital Region (NCR) and to identify variations in costs in order to provide basic information to the Philippine Health Insurance Corporation (PHIC) for quality assurance and policy development. This study focuses on 3861 reimbursement claims, which come from 22 government and 38 private tertiary hospitals. Wide variations of cost existed among the hospitals and among the inpatients. Medicine was the leading expenditure in total costs (38%), second was examinations (27%), third was beds (22%) and the last was doctors fees (13%). The same ranking ocurred for reimbursement by PHIC. The private hospitals were more expensive than the government hospitals, but also more efficient in the length of hospitalization. The member patients spent more and were reimbursed more for clinical practice than the dependent patients. However, there was no difference in the length of hospitalization between member and dependent patients. There was no difference in the length of hospitalization and expenditure between Government Service Insurance System (GSIS) in 1997 and Social Security System (SSS) patients. Clinical guidelines should be effectively implemented and PHIC should contribute more to reduce existing variations, improve cost-effectiveness and the quality of clinical practices.
- Published
- 2003
34. The Use of Expensive Health Technologies in the Era of Managed Care: The Remarkable Case of Neonatal Intensive Care
- Author
-
Steven Fox, Kelly J. Devers, Claudia A. Steiner, and Bernard Friedman
- Subjects
Cost effectiveness ,Cost-Benefit Analysis ,Health Care Sector ,Efficiency, Organizational ,Insurance, Hospitalization ,Health care rationing ,Risk Factors ,Intensive Care Units, Neonatal ,Intensive care ,Hospital Planning ,Humans ,Operations management ,Market share ,Reimbursement, Incentive ,health care economics and organizations ,Economic Competition ,Health Care Rationing ,Actuarial science ,New Jersey ,Cost–benefit analysis ,Health Policy ,Managed Care Programs ,Infant, Newborn ,Health services research ,Logistic Models ,Incentive ,Managed care ,Health Services Research ,Business ,Medical Futility - Abstract
The use of neonatal intensive care (NIC) continued to rise rapidly in the 1990s despite the concerns of observers about its cost effectiveness and its successes being mostly in facilities with high volume and capabilities. The objective of this study is to test the effects of insurance type, competition among hospitals, and market pressure from managed care plans on the supply and cost of NIC. The analysis uses logistic and linear models with techniques to avoid bias from (a) market area definitions based on actual patient flows and(b) self-selection of hospitals by patients with unmeasured risk of needing NIC. The data source contains all births in short-term hospitals in New Jersey during 1990 and 1994. Both the number of days and charges for NIC are reported. Key findings are that the decision of a hospital to offer NIC was associated with teaching status, the proportion of infants in the market area with documented high risk, and the market concentration of major competitors. The market share of managed care plans and the concentration of enrollment were not associated with either NIC being offered or with the standardized charges. Whether a particular patient was given to a NIC depended on patient risk factors and whether a NIC unit was present, but not on payer group. The results are consistent with the hypothesis that young insured parents (with the advice of their obstetricians) prefer hospitals with NIC and also are relatively profitable enrollees for health plans. In conclusion: using the results here and in other research, public and private policy makers may consider several ways to strengthen the incentives for health plans to contract for cost-effective birth-related services. The results also raise questions for a number of regulatory and payment policies and call for better public data on costs and outcomes for NIC.
- Published
- 2002
35. Perineal outcomes in NSW public and private hospitals: Analysis recent trends
- Author
-
Brett Shorten and Allison Shorten
- Subjects
Episiotomy ,medicine.medical_specialty ,medicine.medical_treatment ,Decision Making ,Health impact ,Psychological intervention ,Insurance, Hospitalization ,Hospitals, Private ,Birth rate ,Nursing ,Pregnancy ,Risk Factors ,Intervention (counseling) ,Health insurance ,medicine ,Humans ,Childbirth ,Maternal Health Services ,Caesarean section ,Labor, Obstetric ,Hospitals, Public ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,General Medicine ,Family medicine ,Regression Analysis ,Female ,New South Wales ,business - Abstract
Women using private health insurance for pregnancy care may be unaware of the impact that this choice has in increasing their risk of experiencing a range of interventions during childbirth. This paper identifies recent trends in episiotomy rates and perineal outcomes for New South Wales (NSW) public and private hospitals between 1997 and 1999. Clear and consistent differences exist in birth outcomes in NSW private hospitals in respect to greater episiotomy use and poorer overall perineal outcomes, higher caesarean section rates and higher instrumental birth rates. Given the potential health impact for women who experience intervention during childbirth, identification of clinically unjustified practices is an important step towards ensuring that women's choices provide them with optimal childbirth outcomes regardless of their health insurance status.
- Published
- 2002
36. Length of hospital stay and cost of Staphylococcus and Streptococcus infections among hospitalized patients
- Author
-
William Spalding, Sean Z Zhao, Jim Z. Li, William E. Dodge, and Charles E. Barr
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Micrococcaceae ,Adolescent ,Opportunistic infection ,Comorbidity ,medicine.disease_cause ,Insurance, Hospitalization ,Streptococcal Infections ,Epidemiology ,medicine ,Humans ,Pharmacology (medical) ,Child ,Diagnosis-Related Groups ,Aged ,Pharmacology ,biology ,business.industry ,Streptococcus ,Length of Stay ,Middle Aged ,Staphylococcal Infections ,equipment and supplies ,medicine.disease ,biology.organism_classification ,Hospitalization ,Female ,Major Diagnostic Category ,Complication ,business ,Staphylococcus - Abstract
Background: Staphylococcus (Staph) and Streptococcus (Strep) infections are important causes of morbidity and mortality worldwide. The economic burden of these infections is also significant, especially among hospitalized patients. Objective: The aim of this study was to estimate length of hospital stay (LOS) and total payments for hospital admissions for patients with Staph or Strep infection as a first (primary) or second or higher (comorbid) diagnosis. Methods: From the 1994–1997 MarketScan inpatient database, admissions with Staph (n = 2042) or Strep (n = 1401) infection (905 as primary and 2538 as comorbid diagnosis) and 89,899 control admissions without a diagnosis of gram-positive infection were identified. Crude and category-specific mean LOS and anti-log mean total payments were compared between admissions with Staph or Strep infection and admissions without a diagnosis of any gram-positive infection within major diagnostic categories and principal surgical procedures (SPs). Results: For admissions with Staph or Strep infection as first (primary) diagnosis (n = 905), the mean LOS was 4.68 days (95% CI, 4.44–4.93) and 4.78 days (95% CI, 4.35–5.26), respectively. The mean total payments were $6445 (95% CI, $6045–$6870) and $6821 (95% CI, $6149–$7566), respectively. In contrast, the average LOS and total payment for the control group were 2.99 days (95% CI, 2.98–3.01) and $6325 (95% CI, $6284–$6365). For admissions with infection as the comorbid diagnosis (n = 2538), mean LOS and total payment were 4 days longer and $6000 higher for Staph infections and 1.2 days longer and $1200 higher for Strep infections than the control group. Within each SP, LOS and total payments were substantially higher for patients with Staph and Strep infections. Conclusions: The results of this study indicate that infections with the pathogens Staph and Strep substantially increase LOS and total payments among hospitalized patients.
- Published
- 2002
37. Hospitalization for ambulatory care sensitive conditions at health insurance organization hospitals in Alexandria, Egypt
- Author
-
Rasha A, Mosallam, Wafaa W, Guirguis, and Mona Ha, Hassan
- Subjects
Adult ,Male ,Adolescent ,Cellulitis ,Middle Aged ,Insurance, Hospitalization ,Abscess ,Asthma ,Insurance Coverage ,Patient Discharge ,Diabetes Complications ,Hospitalization ,Socioeconomic Factors ,Ambulatory Care ,Humans ,Egypt ,Female ,Health Services Research - Abstract
This study aimed at estimating the percentage of hospital discharges and days of care accounted for by Ambulatory Care Sensitive Conditions (ACSCs) at Health Insurance Organization (HIO) hospitals in Alexandria, calculating hospitalization rates for ACSCs among HIO population and identifying determinants of hospitalization for those conditions. A sample of 8300 medical records of patients discharged from three hospitals affiliated to HIO at Alexandria was reviewed. The rate of monthly discharges for ACSCs was estimated on the basis of counting number of combined ACSCs detected in the three hospitals and the hospitals' average monthly discharges. ACSCs accounted for about one-fifth of hospitalizations and days of care at HIO hospitals (21.8% and 20.8%, respectively). Annual hospitalization rates for ACSCs were 152.5 per 10,000 insured population. The highest rates were attributed to cellulitis/abscess (47.3 per 10,000 population), followed by diabetes complications and asthma (42.8 and 20.8 per 10,00 population). Logistic regression indicated that age, number of previous admissions, and admission department are significant predictors for hospitalization for an ACSC.
- Published
- 2014
38. 'Voluntary' User Fees in Buenos Aires Hospitals: Innovation or Imposition?
- Author
-
Diego Novick and Peter Lloyd-Sherlock
- Subjects
Financing, Personal ,Economic growth ,National Health Programs ,Coercion ,media_common.quotation_subject ,Argentina ,Detailed data ,Insurance, Hospitalization ,03 medical and health sciences ,Politics ,0302 clinical medicine ,Health care ,Economics ,030212 general & internal medicine ,Notional amount ,Hospitals, Municipal ,Referral and Consultation ,media_common ,Finance ,business.industry ,030503 health policy & services ,Health Policy ,Financial Management, Hospital ,Payment ,Hospital Charges ,Turnover ,Organizational Case Studies ,0305 other medical science ,business ,Hospital-Patient Relations - Abstract
Voluntary user fees in hospitals in Buenos Aires, which operate outside official controls, have not featured in other studies of health care in Argentina. After providing a historical overview of different hospital funding sources, the authors focus on the activity of cooperadoras—the organizations responsible for levying voluntary fees. Using detailed data from two case-study hospitals and more general financial sources, they assess the importance of these fees, identifying sharp variations between different hospitals, serious problems of under-reporting, and potential abuses. The authors also examine the means by which fees are levied and the degree of coercion involved. Voluntary fees are not a particularly successful funding strategy: the income they generate is variable; they are almost entirely unregulated; and they sometimes conflict with other, more legitimate funding sources. Most importantly, their voluntaristic aspect is largely notional: most patients are heavily pressured to make payments. The main motivation for continuing with voluntary fees is to avoid the political fallout that would probably result from introduction of a formal user fees policy.
- Published
- 2001
39. Health Maintenance Organizations and Hospital Quality for Coronary Artery Bypass Surgery
- Author
-
Judy A. Shea, José J. Escarce, Mark V. Pauly, Wei Chen, Sankey V. Williams, and R. Lawrence Van Horn
- Subjects
Male ,medicine.medical_specialty ,Hospital quality ,050109 social psychology ,Medicare ,Insurance, Hospitalization ,California ,Coronary artery disease ,Coronary artery bypass surgery ,health services administration ,0502 economics and business ,medicine ,Humans ,0501 psychology and cognitive sciences ,Hospital Mortality ,Coronary Artery Bypass ,Intensive care medicine ,health care economics and organizations ,Aged ,Quality of Health Care ,business.industry ,Health Policy ,Public health ,05 social sciences ,Health services research ,Health Maintenance Organizations ,Contract Services ,Middle Aged ,medicine.disease ,Hospitals ,United States ,Logistic Models ,Emergency medicine ,Florida ,Managed care ,Health maintenance ,Female ,Health Services Research ,business ,050203 business & management ,Health care quality - Abstract
This study uses hospital discharge data for 1992-1994 to assess differences between HMO and insured non-HMO patients in California and Florida with regard to the quality of the hospitals used for coronary artery bypass graft (CABG) surgery. The authors found that commercially insured HMO patients in California used higher quality hospitals than commercially insured non-HMO patients, controlling for patient distance to the hospital. In contrast, commercially insured HMO and non-HMO patients in Florida were similarly distributed across hospitals of different quality levels, whereas Medicare HMO patients in Florida used lower quality hospitals than patients in the standard Medicare program. The authors conclude that the association between HMO coverage and hospital quality may differ across geographic areas and patient populations, possibly related to the maturity and structure of managed care markets.
- Published
- 1999
40. Trauma services: a profit center?
- Author
-
Lazar J. Greenfield, Paul A. Taheri, Louisa C. Griffes, Charles M Watts, and David A. Butz
- Subjects
Michigan ,medicine.medical_specialty ,Total cost ,Population ,Traumatology ,Insurance, Hospitalization ,Hospitals, University ,Injury Severity Score ,Trauma Centers ,Profit margin ,Humans ,Medicine ,Profit center ,Hospital Costs ,education ,Diagnosis-Related Groups ,health care economics and organizations ,Reimbursement ,education.field_of_study ,business.industry ,Cost Allocation ,Trauma center ,United States ,Surgery ,Emergency medicine ,Wounds and Injuries ,business - Abstract
Previous studies have demonstrated inadequate reimbursement for severely injured patients with a resultant negative economic impact for the trauma service and hospital. The purpose of this study was to assess the total cost of care for all injured patients discharged from the trauma service in fiscal year 1997, and to determine the proportion of costs for the most severely injured on total cost. In addition, we assessed the total service costs and the revenue for treatment of the most severely ill. The final result was the determination of the profit (loss) margin for the entire service.All patients discharged from our Level I Trauma Center in fiscal year 1997 were included (n = 696). The population was then stratified into 2 subgroups using the Injury Severity Score (ISS). Patient grouping was facilitated by integration of the trauma registry with the hospital cost accounting system. The population was sub-divided into 2 distinct groups. Group A represented all patients with an ISS15 (n = 192). Group B contained all patients with an ISS15 (n = 504). Length of stay and mortality of each group was recorded. Cost of care was determined by the hospital cost accounting system TSI (Transition System Incorporated, Boston, MA), which is designed to generate cost center data on a cost per patient basis. Total costs were determined for the entire population and Groups A and B. The proportion of costs consumed by each group was then calculated. Reimbursement was determined by calculating expected payments for each patient. These calculations are based on previously agreed upon allowances from each insurer and are reconciled at the end of each fiscal year to ensure accuracy.The average length of stay for the population and Groups A and B were 7.5, 9.8, and 6.7 days respectively. Mortality in each group was 9.7%, 19.3%, and 6%. Over 92% of the population sustained blunt mechanism injury and only 8% were penetrating. When controlled for length of stay, the profit margin for Group A is $1,242/day and for Group B is $519/day. Comparison of mean cost/patient between Group A and Group B was $35,727 versus $17,623, respectively.Trauma centers can be profitable. Group A is responsible for 44% of the total service cost while accounting for only 28% of the discharges. Moreover, this group is responsible for 57% of the profit, and yields the greatest return. The ability to care for the sickest patients, while enormously costly, is essential to the economic viability of the trauma center and its future growth.
- Published
- 1999
41. The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns
- Author
-
P. Van der Stuyft, W. Van Lerberghe, and Bart Criel
- Subjects
Adult ,Male ,Program evaluation ,Scheme (programming language) ,Economic growth ,medicine.medical_specialty ,Health (social science) ,Hospitals, Rural ,Population ,Distribution (economics) ,Efficiency, Organizational ,Insurance, Hospitalization ,Health Services Accessibility ,History and Philosophy of Science ,Humans ,Medicine ,Hospital utilization ,Child ,education ,computer.programming_language ,Medically Uninsured ,education.field_of_study ,Actuarial science ,business.industry ,Public health ,Equity (finance) ,Health services research ,Length of Stay ,Hospitals, District ,Hospitalization ,Utilization Review ,Democratic Republic of the Congo ,Female ,Health Services Research ,business ,computer ,Program Evaluation - Abstract
The Bwamanda hospital insurance scheme in Zaire was launched in the mid-eighties and is one of the few well-established and documented initiatives in the field of district-based insurance schemes in sub-Saharan Africa. It was established that hospital utilization in Bwamanda is significantly higher among the insured population. A higher hospital utilization is however not a goal in itself: it is a positive phenomenon if it takes place for problems where the hospital's know-how and technology are needed to solve the patient's problem. This paper investigates the effect of the insurance scheme on hospital utilization patterns. More specifically, the distribution of this higher utilization over the different hospital departments, as well as its spatial distribution in the entire district area are analyzed. The impact of the insurance scheme on the effectiveness, equity and efficiency of hospital utilization are discussed. The relevance and possible implications of these findings on the design of the Bwamanda insurance scheme are discussed. Finally, it is argued that the methods used in the present study contribute to a coherent framework for the evaluation of similar initiatives.
- Published
- 1999
42. Variation in Inpatient Resource Use in the Treatment of HIV
- Author
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Samuel A. Bozzette, Dana P. Goldman, Geoffrey F. Joyce, Martin F. Shapiro, Naihua Duan, Arleen Leibowitz, and David M. Carlisle
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,media_common.quotation_subject ,HIV Infections ,Disease ,Insurance, Hospitalization ,Acquired immunodeficiency syndrome (AIDS) ,Ambulatory care ,Humans ,Medicine ,Longitudinal Studies ,Reimbursement ,Quality of Health Care ,media_common ,Medically Uninsured ,Health economics ,Medicaid ,business.industry ,Transmission (medicine) ,Public Health, Environmental and Occupational Health ,Length of Stay ,medicine.disease ,Payment ,Hospital Charges ,Hospitals ,United States ,Underinsured ,Health Care Surveys ,Emergency medicine ,Health Resources ,Female ,business - Abstract
OBJECTIVE To estimate the impact of insurance status on inpatient resource use after adjusting for health upon admission and site of care. DESIGN Detailed patient information linked to billing records from the AIDS Cost and Service Utilization Survey (ACSUS), a longitudinal analysis of inpatient and outpatient care between March 1991 and August 1992. SETTING Hospitalizations of human immunodeficiency virus (HIV) patients from 10 US cities with high incidence of AIDS. PATIENTS One thousand, nine hundred and forty nine adolescents and adults at various stages of HIV. MAIN OUTCOME MEASURES We estimate inpatient charges, payments and length of stay as a function of patient, and provider and reimbursement characteristics for more than 1,500 hospitalizations to HIV patients. We control for patient characteristics and underlying risk factors including disease stage, CD4 percentage, mode of transmission, discharge status, type of admission, and region. We use hospital-fixed effects to control for unmeasured differences across facilities. RESULTS Unadjusted means indicate that uninsured patients or patients covered by public insurance have significantly lower charges and payments than privately insured patients with similar medical conditions. We find that those differences are substantially reduced after controlling for the hospital in which care is received. Further, we find little evidence that "underinsured" patients are discharged sooner on average. CONCLUSIONS Inpatient resource use is affected by both the hospital in which care is received and the type of patient admitted. Failure to control for unmeasured differences across hospitals is likely to overstate the impact of insurance substantially.
- Published
- 1999
43. Death By Managed Care-Denial of Hospitalization for Headache
- Author
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William B. Young
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Male ,medicine.medical_specialty ,Severe headache ,business.industry ,media_common.quotation_subject ,Managed Care Programs ,Headache ,Neurological disorder ,Middle Aged ,medicine.disease ,Insurance, Hospitalization ,United States ,Patient Admission ,Denial ,Neurology ,Detoxification ,Emergency medicine ,Humans ,Medicine ,Managed care ,Neurology (clinical) ,business ,PSYCHIATRIC FACILITY ,Psychiatry ,media_common - Abstract
A 47-year-old man with a severe headache disorder, taking meperidine injections 8 to 12 times a day and approximately 6 butalbital-containing tablets per day, was denied hospitalization for the management of headache and died while awaiting evaluation for detoxification by a psychiatric facility. The criteria for hospitalization and the implications of the denial of care by insurance companies are explored. The biases against the publication of such cases are reviewed.
- Published
- 1999
44. Hospital Length of Stay in the United States and Japan: A Case Study of Myocardial Infarction Patients
- Author
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Naoko Muramatsu and Jersey Liang
- Subjects
Adult ,Cross-Cultural Comparison ,Male ,medicine.medical_specialty ,Myocardial Infarction ,MEDLINE ,Length of hospitalization ,Insurance, Hospitalization ,Hospitals, University ,03 medical and health sciences ,Hospitals, Urban ,0302 clinical medicine ,Japan ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Aged ,business.industry ,030503 health policy & services ,Health Policy ,Course of illness ,Health services research ,Length of Stay ,Middle Aged ,University hospital ,medicine.disease ,Hospital Charges ,Cross-cultural studies ,United States ,Organizational Case Studies ,Utilization Review ,Emergency medicine ,Health Services Research ,Medical emergency ,0305 other medical science ,business - Abstract
Patients in Japan stay in the hospital significantly longer than those in the United States. This study investigates factors that may account for the difference from a sociocultural perspective. In an intensive case study on patients with uncomplicated acute myocardial infarction at a university hospital in Japan and its U.S. counterpart, the authors collected data from interviews with patients, their families, physicians, and other medical professionals and from medical, nursing, and billing records. Patients with comparable medical conditions were studied; U.S. patients stayed in the hospital for 8.8 days on average, Japanese patients for 25.0 days. The average total charge of hospitalization was 2.3 times higher in the United States than in Japan. Although length of stay is determined mainly by physicians' clinical judgment and by health care system factors, patients and their family members often actively participate in decision-making about discharge dates. This case study approach revealed how different health care systems manifest themselves in the individual patient's course of illness, which cannot be examined by macro-level comparison of nations' health care systems.
- Published
- 1999
45. Health care purchasing in Kenya: Experiences of health care providers with capitation and fee-for-service provider payment mechanisms.
- Author
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Obadha M, Chuma J, Kazungu J, and Barasa E
- Subjects
- Cross-Sectional Studies, Health Expenditures, Health Knowledge, Attitudes, Practice, Humans, Insurance, Hospitalization, Interviews as Topic, Kenya, Qualitative Research, Universal Health Insurance, Capitation Fee, Fee-for-Service Plans, Health Personnel, Reimbursement Mechanisms
- Abstract
Background: Provider payment mechanisms (PPMs) play a critical role in universal health coverage due to the incentives they create for health care providers to deliver needed services, quality, and efficiency. We set out to explore public, private, and faith-based providers' experiences with capitation and fee-for-service in Kenya and identified attributes of PPMs that providers considered important., Methods: We conducted a qualitative study in two counties in Kenya. Data were collected using semistructured interviews with 29 management team members in six health providers accredited by the National Hospital Insurance Fund (NHIF)., Results: Capitation and fee-for-service payments from the NHIF and private insurers were reported as good revenue sources as they contributed to providers' overall income. The expected fee-for-service payment amounts from NHIF and private insurers were predictable while capitation funds from NHIF were not because providers did not have information on the number of enrolees in their capitation pool. Moreover, capitation payment rates were perceived as inadequate. Capitation and fee-for-service payments from NHIF and private insurers were disbursed late. Finally, public providers had lost their autonomy to access and utilise capitation and fee-for-service payments from the NHIF., Conclusion: Through their experiences, health care providers revealed characteristics of PPMs that they considered important., (© 2018 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.)
- Published
- 2019
- Full Text
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46. Changes in charges and costs associated with hospitalisation of patients with mandibular fractures between 1991 and 1993
- Author
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Gregg T Lynam and A. Omar Abubaker
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Mandibular fracture ,Poison control ,Insurance, Hospitalization ,Occupational safety and health ,Reimbursement Mechanisms ,Personal income ,Trauma Centers ,Fracture Fixation ,Mandibular Fractures ,Injury prevention ,Humans ,Medicine ,Hospital Costs ,Reimbursement ,Average cost ,Aged ,Retrospective Studies ,Academic Medical Centers ,Medically Uninsured ,Medicaid ,business.industry ,Virginia ,Middle Aged ,medicine.disease ,Hospital Charges ,United States ,Surgery ,Hospitalization ,Otorhinolaryngology ,Emergency medicine ,Income ,Oral and maxillofacial surgery ,Female ,Oral Surgery ,business - Abstract
Purpose: The purpose of the study was to examine the changes in costs, charges, and income related to hospitalization of patients with mandibular fractures treated over a 3-year period. Patients and Methods: The study involved retrospective analysis of data on 97 patients treated by the Department of Oral and Maxillofacial Surgery between 1991 and 1993. Biographical data were obtained from the Trauma Registry, and the financial data were obtained from the Financial Services Administration. The study examined the changes in costs and charges of hospitalization, insurance status, reimbursement, total revenue, and income losses from hospitalization of patients admitted with a primary diagnosis of mandibular fracture. In addition, the study examined the changes in costs of major items involved in treatment. Possible variables such as age, gender, and cause of fracture were also recorded. Results: Twenty-nine patients were admitted in 1991, 35 in 1992, and 33 in 1993. These patients were predominantly young males. The average cost of treatment decreased by 2% in 1992 and increased by 58% in 1993. The average charge increased by 12.9% in 1992 and by 76.8% in 1993. The total reimbursement increased by 11.2% in 1992 and by 47.7% in 1993. The average payment per patient to the institution by third-party payers decreased by 7.8% in 1992 and increased by 56.6% in 1993. The loss of income to the institution (cost minus reimbursement) increased by 105.9% in 1992 and by 58% in 1993. The average institution income loss from the care for each patient increased by 70.6% in 1992 and by 67.8% in 1993. Conclusions: This study showed that there was a continued increase in costs, charges, and income loss for hospitalization of mandibular fracture patients during the years 1991 to 1993, whereas the reimbursement rate decreased from 65% to 47% of the charges. The increase in cost of supplies and use of rigid fixation, the increase in the number of uninsured patients, and the pricing practices of the institution were possible causes of these changes.
- Published
- 1998
47. Hospital Outcomes Research in Germany
- Author
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Eva Maria Bitzer, Hans Dörning, Friedrich Wilhelm Schwartz, and Reinhard Busse
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Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Insurance, Hospitalization ,Postoperative Complications ,Patient satisfaction ,Retrospective survey ,Germany ,Outcome Assessment, Health Care ,Varicose veins ,Nasal septum ,Humans ,Medicine ,Medical diagnosis ,Single-Payer System ,Aged ,Retrospective Studies ,business.industry ,General surgery ,Public Health, Environmental and Occupational Health ,Middle Aged ,Hospitals ,medicine.anatomical_structure ,Hospital outcomes ,Elective Surgical Procedures ,Patient Satisfaction ,Health Care Surveys ,Multivariate Analysis ,Utilization Review ,Emergency medicine ,Feasibility Studies ,Female ,medicine.symptom ,Elective Surgical Procedure ,business - Abstract
OBJECTIVES The authors assess the feasibility of using retrospective, indication-specific patient surveys to conduct hospital outcomes research in Germany. Surgical outcome and patient satisfaction were examined in patients who underwent common elective surgical procedures. METHODS Using the International Classification of Diseases Ninth Revision coding available in the Schwabisch Gmund health insurance data base, all patients for a defined period of time with one of the three following diagnoses were selected and questioned retrospectively using an indication-specific survey instrument: (1) varicose veins of the lower extremity; (2) nasal septum deviation; and (3) inner knee joint damage limited to patients undergoing arthroscopic meniscus repair. Survey content focused on preoperative conditions, pre- and postoperative symptoms, postoperative complications, the nature and duration of postoperative follow-up, and satisfaction with surgical outcome. RESULTS Significant postoperative improvement of preoperative symptoms was found for all three groups. Complete freedom from symptoms was found in 29.7% of patients treated for varicose veins, 24.1% of patients with meniscus repair, and in only 10.6% of patients with nasal septum deviation. Multivariate analyses indicated that postoperative impairment was the decisive variable governing patient satisfaction for all three groups. CONCLUSIONS The use of retrospective, indication-specific patient surveys constitutes a time-efficient, cost-effective, and patient-focused option for the systematic acquisition and evaluation of health outcomes in Germany. This methodology holds promise for international and domestic efforts to demonstrate the consequences of restructuring activities in the inpatient sector.
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- 1997
48. Charges and Charge Coverage in the Treatment of HIV/AIDS Patients in a Rural Southern State
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Michael J. Gandy and Nancy D. Strahan
- Subjects
medicine.medical_specialty ,Hospitals, Rural ,media_common.quotation_subject ,Geography, Planning and Development ,Population ,MEDLINE ,HIV Infections ,Insurance, Hospitalization ,Insurance Coverage ,Mississippi ,Acquired immunodeficiency syndrome (AIDS) ,Health insurance ,medicine ,Humans ,education ,media_common ,Acquired Immunodeficiency Syndrome ,Medically Uninsured ,education.field_of_study ,Medicaid ,business.industry ,Health Policy ,Medical record ,Public Health, Environmental and Occupational Health ,Health services research ,Payment ,medicine.disease ,Hospital Charges ,United States ,Family medicine ,Health Services Research ,Medicare Part A ,Medical emergency ,business - Abstract
In Mississippi it was not known where Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Disease Syndrome (AIDS) persons receive care, what type of care is available to them, and how care is financed. To ascertain inpatient treatment charges of HIV/AIDS patients, a medical record review was conducted at 10 priority hospitals distributed across Mississippi. One-hundred fifty-six (156) patient records were randomly selected from a population of persons with HIV/AIDS. A total of 3,865 patient days was recorded for all hospitals. Available overall hospital charges per paid day ranged from +401.63 to +1,261.34, with an average charge of +741.65 per day. Average length of stay was 25 days. Average charge per hospitalization per patient totaled +18,541. Concerning source of payment, 44.8% of the patients had private insurance, 29.9% listed Medicaid as their payment source, 7.8% were on Medicare, 1.3% had supplemental insurance, and 16.2% of patients reviewed had no payment source. Based on this review, it is evident that the number of AIDS patients covered by private health insurance will continue to decline and the payment responsibilities will continue to shift to public supported programs. Acquired immunodeficiency syndrome brings attention to the weakness of Mississippi's health care financing system and will continue to force consideration of alternative financing mechanisms.
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- 1997
49. A health insurance scheme for hospital care in Bwamanda district, Zaire: lessons and questions after 10 years of functioning
- Author
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Bart Criel and Guy Kegels
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Adult ,medicine.medical_specialty ,Economic growth ,Moral hazard ,Health care financing ,Context (language use) ,Insurance, Hospitalization ,Insurance ,Patient Admission ,Risk Factors ,Environmental protection ,Humans ,Revenue ,Medicine ,Africa, Central ,Child ,Health policy ,Public health ,Hospital care ,Medically Uninsured ,Inpatient care ,business.industry ,Public Health, Environmental and Occupational Health ,Subsidy ,Bwamanda ,Hospital Charges ,Congo-Kinshasa ,Infectious Diseases ,Fees and Charges ,Economic interventionism ,Costs and Cost Analysis ,Democratic Republic of the Congo ,Parasitology ,business - Abstract
A voluntary insurance scheme for hospital care was launched in 1986 in the Bwamanda district in North West Zaire. The paper briefly reviews the rationale, design and implementation of the scheme and discusses its results and performance over time. The scheme succeeded in generating stable revenue for the hospital in a context where government intervention was virtually absent and external subsidies were most uncertain. Hospital data indicate that hospital services were used by a significantly higher proportion of insured patients than uninsured people. The features of the environment in which the insurance scheme thrived are discussed and the conditions that facilitated its development reviewed. These conditions comprise organizational-managerial, economic-financial, social and political factors. The Bwamanda case study illustrates the feasibility of health insurance – at least for hospital-based inpatient care – at rural district level in sub-Saharan Africa, but also exemplifies the managerial and social complexity of such financing mechanisms.
- Published
- 1997
50. The Effect of Type of Hospital and Health Insurance on Hospital Length of Stay in Irbid, North Jordan
- Author
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Salah Mawajdeh, Raeda Al-Qutob, and Yaseen A Hayajneh
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Cost Control ,Length of hospitalization ,Insurance, Hospitalization ,Hospitals, Private ,medicine ,Health insurance ,Humans ,Child ,Socioeconomic status ,Retrospective Studies ,Jordan ,Hospitals, Public ,business.industry ,Health Policy ,Medical record ,Public sector ,Length of Stay ,Patient Discharge ,Hospital treatment ,Family medicine ,Public hospital ,Emergency medicine ,Cost control ,Female ,business - Abstract
The study aimed at examining the effects of type of hospital and health insurance status on hospital length of stay for three identified medical and surgical conditions. Medical records of 520 patients for the year 1991 were reviewed in one public and one private hospital. Comparison of hospital length of stay for the private (n = 185) versus public sector patients (n = 335) was carried out. The effect of presence of health insurance (n = 189) and the lack of it (n = 325) was also studied. It was found that the average length of stay in the public hospital was significantly longer than the private one (3.3 versus 2.7 days). In addition, insured patients had significantly longer hospital length of stay (3.3 versus 3.0 days). The results of the multi-variate analysis showed that after socioeconomic factors and clinical conditions of patients were adjusted for, the influence of hospital type and health insurance on hospital length of stay was about one day. The paper also discusses the need to base hospital cost-containment strategies on studies of hospital behaviour and performance.
- Published
- 1997
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