Search results

Tests the theory that owners (hospital, physician, insurance) of vertically integrated health maintenance organizations (HMOs) might substitute towards production of their own specialty goods. Uses data from various sources in the USA. Determines the impact of ownership on factors such as average physician ambulatory services per enrollee and average hospital days per enrollee. Concludes that policymakers need to encourage the development of standard publicly available quality measures to intensify competition and eliminate excess profits accruing to provider‐owners who substitute towards production of their own goods.

Investigates the increased waiting time costs imposed on society due to inappropriate use of the emergency department by patients seeking non‐emergency or primary care. Proposes a simple economic model to illustrate the effect of this misuse at a public or not‐for‐profit hospital. Provides evidence that non‐emergency patients contribute to lengthy delays in the ER for all classes of patients. Proposes a priority queuing model to reduce average waiting times.

Work‐related musculoskeletal disorders following patient contact represent a major concern for health care workers. Unfortunately, research and prevention have been hampered by difficulties ascertaining true prevalence rates owing to under‐reporting of these injuries. The purpose of this study is to determine the predictors for under‐reporting work‐related musculoskeletal injuries and their reasons.

Multivariate analysis using data obtained in a survey of Veterans Administration employees in the USA was used to determine underreporting patterns among registered nurses, licensed practical nurses and nursing assistants. Focus groups among health care workers were conducted at one of the largest Veterans Administration hospitals to determine reasons for under‐reporting.

A significant number of workers reported work‐related musculoskeletal pain, which was not reported as an injury but required rescheduling work such as changing shifts and taking sick leave to recuperate. The findings indicate that older health care workers and those with longer service were less likely to report as were those working in the evening and night shifts. Hispanic workers and personnel who had repetitive injuries were prone to under‐reporting, as were workers in places that lack proper equipment to move and handle patients. Reasons for under‐reporting include the time involved, peer pressure not to report and frustration with workers' compensation procedures.

This study provides insights into under‐reporting musculoskeletal injuries in a major US government organization. The research indicates that current reporting procedures appear to be overtly cumbersome in time and effort. More flexible work assignments are needed to cover staff shortfalls owing to injuries. Health education on the detrimental long‐term effects of ergonomic injuries and the need for prompt attention to injuries should prove useful in improving rates of reporting.

Data are utilized collected from the American Association of Health Plans, a trade association representing HMOs, to study differences in utilization patterns between Medicare beneficiaries enrolled in Medicare risk and cost contracts with health plans. Utilization is measured by the number of ambulatory procedures performed, outpatient and emergency room visits, and acute and nonacute discharges. Compared to elders enrolled in risk plans, those in cost arrangements appear to exhibit higher inpatient and outpatient use. Members of for‐profit plans experienced greater outpatient visits, accreditation did not appear to influence utilization, and IPA arrangements resulted in a decrease in outpatient utilization. Financial and policy issues are discussed.

Estimates a total effects cost function using a national 1994 health maintenance organization (HMO) data set to examine and update findings related to HMO efficiency. The cost function controls for ownership characteristics (profit status and ownership), size, enrollment diversity, regional location, product diversity, model type, payment characteristics, and years of operation. While not explicitly controlling for quality or acuity, measures of plan and enrollee diversity help control for acuity and quality. Results show that most of the difference in cost efficiency between HMOs is explained by factors specific to the HMO, including efficiencies of scale and scope, lower levels of Medicare patients, and efficient levels of capital. The study also shows that for‐profits are more efficient than non‐profits because they rely less on withhold pools to control costs. Limitations of the study include weak controls for quality of care, and limited data related to payment characteristics.