Search

This study has two objectives. First, it identifies how much the presence of community hospital beds adds to the stock of physicians practicing in nonmetropolitan counties. Second, it estimates the impact hospital closures or other reductions in beds have on the net flow of physicians into rural counties. The study relies primarily on data from the 1981 and 1986 Physician Masterfiles of the American Medical Association. We find that hospital bed reductions and closures essentially do not affect the availability of physicians--they have apparently already left by the time the downsizing occurs. Further, population change and the number pf physicians already in the county determine for the most part the entry or exit of physicians.

In the United States, the proportion of physicians who are women has increased dramatically since 1970 and is expected to continue rising until the year 2010. The shift in the proportion of male and female doctors is likely to affect the profession in various ways. A study was performed to assess how the increasing number of female physicians will influence the amount and type of physician services available in the United States. Data on all US physicians were obtained from records kept by the American Medical Association. Women physicians work fewer hours than men, with average work weeks being 52.3 and 59.0 hours, respectively. Women also choose different specialties. Historically, more women have entered pediatrics and psychiatry and fewer have chosen to become surgeons, but the differences between the sexes have lessened in recent years. Female physicians are more likely to retire from practice, but because they tend to live longer than men, they have careers that are almost as long as those of male doctors. Projections showed that the growth in the supply of physicians will only drop by four percent from 1986 to 2010 as a result of the changing demographics of the physician population. (Consumer Summary produced by Reliance Medical Information, Inc.)

A study of physician migration out of the medical school's state showed that a state's ability to retain graduates to practice there is related to physician and state characteristics. The traditional assumption that state aid to medical schools helps provide physicians for the state may be less compelling today. (Author/MSE)

This study examines the association between the quality of hospital discharge planning and all-cause 30-day readmissions and same-hospital readmissions. The sample included adults aged 18 years and older hospitalized in 16 states in 2010 or 2011 for acute myocardial infarction, heart failure, pneumonia, or total hip or joint arthroplasty. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems measured discharge-planning quality at the hospital level. A generalized linear mixed model was used to estimate the contribution of patient and hospital characteristics to 30-day all-cause and same-hospital readmissions. Discharge-planning quality was associated with (a) lower rates of 30-day hospital readmissions and (b) higher rates of same-hospital readmissions for heart failure, pneumonia, and total hip or joint replacement. These results suggest that by improving inpatient discharge planning, hospitals may be able to influence their 30-day readmissions and increase the likelihood that readmissions will be to the same hospital. [ABSTRACT FROM AUTHOR]

Background: Several reports have linked the 2007–2009 Great Recession in the United States with a slowdown in health care spending and decreased utilization. However, little is known regarding how the recent economic downturn affected hospital costs per inpatient stay for different segments of the population. The purpose of this study was to examine the association between changes in the unemployment rate and inpatient cost per discharge for Medicare and commercial discharges. Methods: We used retrospective data at the Core Based Statistical Area (CBSA)-level from 46 states that contributed to the Healthcare Cost and Utilization Project State Inpatient Databases from 2005 to 2010. Unemployment data was derived from the American Community Survey. An instrumental variable two-stage least squares approach with fixed- or random-effects was used to examine the association between unemployment rate and inpatient cost per discharge by payer because of potential endogeneity. Results: The marginal effect of unemployment was associated with an increase in inpatient cost per discharge for both payers. A one percentage point increase in the unemployment rate was associated with a $37 increase for commercial discharges and a $49 increase for Medicare discharges. Conclusions: We find evidence that the inpatient cost per discharge is countercyclical across different segments of the population. The underlying mechanisms by which unemployment affects hospital resource use however, might differ between payer groups. [ABSTRACT FROM AUTHOR]

Efforts to characterize geographic variation in health care utilization and spending have focused on patterns observed with Medicare data. The authors analyzed the Healthcare Cost and Utilization Project national all-payer data for inpatient stays to assess variation in hospitalizations by age groups and, consequently, to understand how utilization of the Medicare population may differ from the population of other payers. The authors found that the correlation between inpatient discharges and costs per capita for the Medicare-eligible population over 65 and younger age groups increased from moderate to strong with age. These findings suggest examining Medicare inpatient data alone may provide a useful but not comprehensive understanding how hospital utilization and costs vary for the total population. [ABSTRACT FROM AUTHOR]

Abstract: The hours worked by physicians are affected by changes in a number of factor, including attitudes rewards labor-leisure tradeoffs, the characteristics of the physician workforce, and the level of demand for medical services. This paper analyzes changes in the hours worked per week by office-base physicians over the decade 1970-80. Overall. there has been a statistically significant decline in hours of approximately 3 per ¢ or 1.5 hours per week. This decline was fairly uniform across most physician characteristics, although the decline was greater for those in primary care specialties. Female physicians increased their average hours worked, although this increase was not statistically significant. In terms of the delivery of killed medical services, the decline in total hours was largely offset by an increase in the percentage of total hours devoted to patient care. The question of whether these trends will continue has important implications for the validity of projections of a physician surplus, in the near future. [ABSTRACT FROM AUTHOR]

Abstract: This study investigates the effect of the organization of medical practice, c.g., solo, fee-for-service group, or health maintenance organization (HMO) settings, on primary care physicians' net incomes. Using pooled data on 2,372 primary care physicians, multivariate regression analysis is used to adjust physicians' 1979 net incomes for differences, in medical specially, workload, sex, and experience before estimating the effects of the organization of medical practice. Among HMO physicians, only those in staff model HMOs were found to have significantly lower net incomes than their fee-for-service group practice counterparts. Accordingly, there is little evidence to support the popular belief that physicians practicing in HMOs consistently earn less than their fee-for-service counterparts. (Am J Public Health 1983; 73:379-383.) [ABSTRACT FROM AUTHOR]

Persons with multiple chronic conditions are a large and growing segment of the US population. However, little is known about how chronic conditions cluster, and the ramifications of having specific combinations of chronic conditions. Clinical guidelines and disease management programs focus on single conditions, and clinical research often excludes persons with multiple chronic conditions. Understanding how conditions in combination impact the burden of disease and the costs and quality of care received is critical to improving care for the 1 in 5 Americans with multiple chronic conditions. This Medline review of publications examining somatic chronic conditions co-occurring with 1 or more additional specific chronic illness between January 2000 and March 2007 summarizes the state of our understanding of the prevalence and health challenges of multiple chronic conditions and the implications for quality, care management, and costs.