Health Services Research articles from April 1999

Health Services Research archives from April 1999

The effects of group size and group economic factors on collaboration: a study of the financial performance of rural hospitals in consortia.
April 1, 1999... INTRODUCTION AND BACKGROUND Rural hospitals have been more seriously affected by changes in the environments and financing of healthcare than has any other sector of the healthcare field. Between 1980 and 1990, 330 rural hospitals closed...

The adoption of provider-based rural health clinics by rural hospitals: a study of market and institutional forces.
April 1, 1999... BACKGROUND Assuring adequate access to healthcare services for residents of rural areas has been a topic: of concern for many decades. Several factors contribute to the access problems faced by rural residents, such as difficulty...

Financial and organizational determinants of hospital diversification into subacute care.
April 1, 1999... Changes in hospital market conditions, including the growth of managed care and the aging of the population, make subacute inpatient care a potentially attractive market for general acute care hospitals that wish to diversify their services....

Analysis of the rationale for, and consequences of, nonprofit and for-profit ownership conversions.
April 1, 1999... The recent increase in purchases of nonprofit hospitals by for-profit companies has generated considerable debate and public attention. Among the concerns raised about conversions are their impact on communities' charitable assets and access to...

Evaluating the sale of a nonprofit health system to a for-profit hospital management company: the legacy experience.
April 1, 1999... The U.S. healthcare marketplace has experienced unprecedented changes in the last decade, as once independent community hospitals have consolidated into ever larger corporate entities to manage risk, secure their market viability, and ensure...

Access and use of medications in HIV disease.
April 1, 1999... Early detection of human immunodeficiency virus (HIV) infection and improved drug therapies have prolonged survival in a growing number of individuals. Over the past 15 years, the clinical course of HIV disease has shifted from short and...

The role of medical problems and behavioral risks in explaining patterns of prenatal care use among high-risk women.
April 1, 1999... The benefits of prenatal care to mother and fetus, and the long-term cost-effectiveness of such care for society, have been long-standing tenets in the public health research and health policy literatures (Institute of Medicine [IOM] 1985; U.S....

Risk-adjusted outcome models for public mental health outpatient programs.
April 1, 1999... The purpose of this article is to develop and test outcomes risk-adjustment models for public mental health outpatient treatment programs. "Outcomes risk" refers to the probability of a poor outcome that clients bring to a treatment episode:...

Beyond health services research.(A Memorial to Alice Hersh)
April 1, 1999... I want to begin my remarks today with a few words about this past year at AHSR. I never imagined doing this job without Alice Hersh, and indeed had a commitment from her not to leave the Association until my year as Past President was...

Income inequality and health: pathways and mechanisms.(A Memorial to Alice Hersh)
April 1, 1999... BACKGROUND Despite being the richest nation in the world, and despite nearly a decade of sustained economic growth, the United States lags behind other developed countries on many health indicators. For instance, according to the 1996...

Low income, race, and the use of mammography.(A Memorial to Alice Hersh)
April 1, 1999... The breast is the leading site of new cancers among women and the second-leading site of cancer deaths among women. Breast cancer is an important health issue for both white women and African American women. Breast cancer incidence was about 14...

Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries.(A Memorial to Alice Hersh)
April 1, 1999... Although Medicare has long guaranteed access to health insurance coverage to virtually all persons age 65 and older, gaps in Medicare coverage can create substantial financial burdens for some beneficiaries, particularly those with low incomes....

Pressures on safety net access: the level of managed care penetration and uninsurance rate in a community.(A Memorial to Alice Hersh)
April 1, 1999... Changes in the health care system are putting a strain on the safety net and other providers of care to persons who are medically indigent. Many fear that lower payment rates to providers by managed care will result in financial pressures that...

Changes in access to care, 1977-1996: the role of health insurance.(A Memorial to Alice Hersh)
April 1, 1999... A number of the changes in Americans' health insurance coverage and health care delivery that have taken place over the past 20 years have substantial implications for the population's access to health care. These include the rise in managed...

A conflict of strategies: Medicaid managed care and Medicaid maximization.(A Memorial to Alice Hersh)
April 1, 1999... Over the past decade many states have broadened the scope of their Medicaid programs. Medicaid is no longer viewed as simply paying for health care for a defined low-income population. Instead, its roles now include protecting safety net...

Shaping the future of Medicare.(A Memorial to Alice Hersh)
April 1, 1999... Future projections of Medicare outlays and revenues are sobering. As the baby boom generation reaches retirement, the nation must make tough choices among options to assure the health and economic security of an increasing older and disabled...

Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction.(A Memorial to Alice Hersh)(health maintenance organizations)
April 1, 1999... BACKGROUND One of the hallmarks of the managed health care revolution is the use of a variety of financial incentives to influence physicians' behavior. Yet very little is known about physicians' responses to these recent developments....

Variations in primary care physician referral rates.(A Memorial to Alice Hersh)
April 1, 1999... Referral decisions made by primary care physicians (PCPs) have a significant effect on the cost and quality of care that patients receive. Referrals induce expenditures (Glenn, Lawler, and Hoerl 1987), in part because specialist care is more...

Medicare physician referral patterns.(A Memorial to Alice Hersh)
April 1, 1999... Relatively little is known about the patterns, correlates, or consequences of physician referrals in the United States (Clancy, Lanier, and Grady 1996). The referral process can have a significant impact on outcomes such as the cost and quality...

Conditional length of stay.(A Memorial to Alice Hersh)
April 1, 1999... Major changes have been occurring in the systems used to finance health care in the United States. Fee-for-service reimbursement is being replaced rapidly by a prospective, often capitated system (Goldfarb and Coffey 1992; Gabel 1997). Only in...

How much better can we predict dialysis patient survival using clinical data?(A Memorial to Alice Hersh)
April 1, 1999... End-stage renal disease (ESRD) patients have a permanent and complete loss of renal function requiring renal replacement therapy for survival. Dialysis is the dominant form of ESRD therapy in the United States, sustaining the lives of over 240...

Barriers between guidelines and improved patient care: an analysis of AHCPR's Unstable Angina Clinical Practice Guideline.(A Memorial to Alice Hersh)(Agency for Health Care Policy and Research)
April 1, 1999... Despite generally favorable effects of guidelines on patient care, guidelines often fail to achieve their objectives (Grimshaw et al. 1995; Worrall, Chaulk, and Freake 1997). The major problems with guidelines can be characterized as follows:...

Developing quality measures for adolescent care: validity of adolescents' self-reported receipt of preventive services.(A Memorial to Alice Hersh)
April 1, 1999... BACKGROUND Adolescent preventive services guidelines recommend confidential, comprehensive health screening and preventive counseling (Elster and Kuznets 1994; U.S. Preventive Services Task Force 1996; Green 1994). Current public health...

Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy.(A Memorial to Alice Hersh)(diagnosis-related groups)
April 1, 1999... The Italian Servizio Sanitario Nazionale (SSN) provides universal coverage for all 57 million citizens. The SSN, established in 1979, was modeled after the health care system in the United Kingdom (Del Favero and Barro 1996; Bevan, France, and...

Medical records and privacy: empirical effects of legislation.(A Memorial to Alice Hersh)
April 1, 1999... Growing public concern about privacy in the computer era is engendering legislative proposals to strengthen existing confidentiality protections for patient medical records. In this policy environment, questions arise about how to balance...

Health services research in workers' compensation medical care: policy issues and research opportunities.(A Memorial to Alice Hersh)
April 1, 1999... Over 95 percent of the American workforce is covered by workers' compensation (WC) insurance, which pays for medical, rehabilitative, and lost-wage expenses resulting from work-related injury and illness. Despite the prevalence of this form of...

Factors affecting bargaining outcomes between pharmacies and insurers.(A Memorial to Alice Hersh)
April 1, 1999... The medical care marketplace has changed dramatically over the last decade. In the face of escalating costs, insurers have taken a more active role in bargaining with providers over the prices of medical care services. For example, it has been...