Health Services Research articles from August 1998

Health Services Research archives from August 1998

The health sciences, health services research, and the role of the health professions.
August 1, 1998... I would like to focus on three areas that I believe are of particular importance to the Institute of Medicine and to health. First is the role that the Institute and the National Research Council can play in increasing the impact that a number of...

Insurance type and choice of hospital for coronary artery bypass graft surgery.
August 1, 1998... Managed care health insurance plans often restrict the set of hospitals and physicians from which enrollees may obtain care. HMOs, perhaps the strongest form of managed care, are particularly reliant on these types of restrictions. Because free...

A comparison of cardiovascular procedure use between the United States and Canada.
August 1, 1998... Comparative studies have demonstrated substantial differences in the use of healthcare services in the United States and Canada. Overall, American physicians use more invasive procedures and fewer evaluation and management services than Canadian...

Does hospital procedure - specific volume affect treatment costs? A national study of knee replacement surgery.
August 1, 1998... In the evolving market-driven healthcare system, third party payers have been negotiating with hospitals for price concessions in return for being included as providers in managed care networks. These reform efforts are focusing increasing...

Effects of post-hospital Medicare home health and informal care on patient functional status.
August 1, 1998... Medicare's role in financing home care for older people with acute and chronic health problems has grown dramatically in recent years (Clauser 1994). Medicare spending for home healthcare increased by 40 percent between 1988 and 1991 (Bishop and...

Analysis, assessment, and presentation of risk-adjusted statewide obstetrical care data: the StORQS II study in Washington State. (Statewide Obstetrics Review and Quality System)
August 1, 1998... BACKGROUND Motivation It is beneficial for both a hospital and the public it serves to be aware of its standing among peer institutions with respect to utilization of various medical procedures and the associated rates of success and...

The effect of managed care on the incomes of primary care and specialty physicians.
August 1, 1998... Recent healthcare reform efforts have focused attention on the perceived proliferation and excessive use of medical specialists relative to primary care physicians. Concerns about specialists have resulted in proposals to regulate medical...

Understanding the context of healthcare utilization: assessing environmental and provider-related variables in the behavioral model of utilization.
August 1, 1998... One of the most frequently used frameworks for analyzing patient utilization of healthcare services is the behavioral model developed by Andersen, Aday, and others. This conceptual framework uses a systems perspective to integrate a range of...

The role of uninsurance and race in healthcare utilization by rural minorities.
August 1, 1998... In the absence of national health reform, incremental approaches to resolving problems of access to medical services are once again being considered. Various state governments have adopted policies to create purchasing alliances of small...

Beyond coverage and supply: measuring access to healthcare in today's market.(The Concept of Access and Managed Care)
August 1, 1998... WHY THE ISSUE AND WHY NOW? Objectives of This Article and Project This article seeks to stimulate discussion within the research and policy community about the value of and issues surrounding different ways to describe access to care in a...

Healthcare organizational change: implications for access to care and its measurement.
August 1, 1998... Major health system changes have the potential to affect access to care by vulnerable HMO enrollee populations, including persons with higher-cost chronic conditions and diseases and those subject to discrimination due to income or color. This...

Reaction 1: a researcher perspective. (response to Marsha Gold, in this issue, p. 625, and Robert H. Miller, in this issue, p. 653)
August 1, 1998... The delivery system is changing rapidly. These papers highlight new issues to think about but also encourage continued attention to issues that have been with us for some time. One such "old" issue is identifying the policy goal related to...

Reaction 2: a health plan staff perspective. (response to Marsha Gold, in this issue, p. 625, and Robert H. Miller, in this issue, p. 653)
August 1, 1998... Two central comments resonated from a health plan perspective. The first was the question raised in the papers about whether access should be evaluated in terms of meeting a consumer or patient's wants, desires, or preferences, or in terms of...

Reaction 3: a government policy analyst perspective. (response to Marsha Gold, in this issue, p. 625, and Robert H. Miller, in this issue, p. 653)
August 1, 1998... My perspective is grounded in my theoretical work as study director of the Institute of Medicine project on access to care, and in the practical world of a government agency whose mission is to effect access. My key point is that we need to pay...

Measuring access to care through population-based surveys: where are we now?(The Measurement of Access - Where Are We Now?)
August 1, 1998... Policymakers and health services researchers have long relied on population-based surveys to provide a window on access to and use of healthcare services in the United States. In fact, an impressive amount of ongoing survey research, supported by...

Reaction 1. (response to Jill Eden, in this issue, p. 685)
August 1, 1998... Joel Cantor, Sc.D., United Hospital Fund The papers raise two very specific questions. The first is whether we still need extensive investments in population-based surveys that measure access to care. The second, assuming the answer to the...

Reaction 2. (response to Jill Eden, in this issue, p. 685)
August 1, 1998... Cary Sennett, M.D., National Committee for Quality Assurance The National Committee for Quality Assurance (NCQA) is a customer for work by individuals with expertise in access measurement and survey methods. NCQA evaluates and reports on the...

Asking about access: challenges for surveys in a changing healthcare environment.(What Can We Realistically Expect from Surveys? Constraints of Data and Methods)
August 1, 1998... Efforts to evaluate "access to healthcare" have been central to judgments rendered on the success or shortcomings of health systems for many years now. Although the issue is familiar, conceptualizing and measuring access remains a challenge,...

HMO data systems in population studies of access to care. (health maintenance organizations)
August 1, 1998... The dramatic growth of managed care, and of HMOs in particular, requires a new look at the way we measure access to care. With more than 20 percent of the U.S. population currently enrolled in HMOs, their members are no longer a small subset to...

Reaction 1. (response to Judith D. Kasper, in this issue, p. 715, and Raymond Fink, in this issue, p. 741)
August 1, 1998... Jack Hadley, Ph.D., Institute for Health Care Research and Policy, Georgetown University I would like to start with several fairly obvious points. First and foremost, the number of ongoing surveys that address issues of access is quite...

Reaction 2. (response to Judith D. Kasper, in this issue, p. 715, and Raymond Fink, in this issue, p. 741)
August 1, 1998... Pamela Farley Short, Ph.D., Center for Health Policy Research, Pennsylvania State University At one point, we had a very simple idea of access in mind. But as we go along, we expand that notion. We have to decide where we want to stop...

Reaction 3. (response to Judith D. Kasper, in this issue, p. 715, and Raymond Fink, in this issue, p. 741)
August 1, 1998... Lee Hargraves, Ph.D., Picker Institute The Picker Institute's mission is to promote quality improvement and quality assessment from the patient's perspective. I want to begin with an example. About a year-and-a-half ago, we were developing a...