检索结果-内蒙古大学图书馆

Declining payments for emergency department care, 1996-1998

ANNALS OF EMERGENCY MEDICINE 2003年第3期41卷 299-308页

作者： Tsai, AC Tamayo-Sarver, JH Cydulka, RK Baker, DW Case Western Reserve Univ Dept Epidemiol & Biostat Sch Med Cleveland OH 44106 USA Metrohlth Med Ctr Dept Emergency Med Cleveland OH USA Northwestern Univ Feinberg Sch Med Div Gen Internal Med Dept Med Chicago IL 60611 USA

Study objective: We describe recent trends in payments from different payer classes and assess their relative importance to the financial solvency of emergency departments. Methods: We used Medical Expenditure Panel Survey data from 1996 and 1998. The unit of analysis was the ED visit. Primary outcome measures were ED charges and payments. The independent variable of interest was payer class, and therefore, we limited our analysis to those either uninsured or covered by Medicare, Medicaid, or private insurance. Results: From 1996 to 1998, a declining percentage of total charges were paid, from 60.3% to 53.0% (difference -7.3%;95% confidence interval [Cl] -11.3% to -3.5%). Although the percentage of total charges paid by Medicaid, Medicare, and the uninsured remained constant, the percentage of total charges paid by the privately insured declined from 75.1% to 63.4% (difference -11.7%;95% Cl -16.6% to -6.7%). Overall, adjusted mean ED charge increased from $695 to $798 (difference $103;95% Cl $61 to $146). Two payer classes experienced statistically significant increases in adjusted mean charge: the uninsured, from $544 to $740 (difference $196;95% Cl $62 to $330), and the privately insured, from $658 to $813 (difference $151;95% Cl $103 to $199). Although the adjusted mean payment rate for the uninsured remained stable, the adjusted mean payment rate for the privately insured declined from 77.7% to 65.7% (difference -12.0%;95% Cl -13.4% to -10.7%). Conclusion: The ability of EDs to provide emergency care to all regardless of ability to pay is increasingly threatened by declining overall payment rates. Cost shifting to fund care for the uninsured is an increasingly untenable financing strategy.

关键词：急诊室医院/经济学急诊室医院/发展趋势卫生经费支出/统计学和数值数据保险范围/经济学保险范围/统计学和数值数据 Medicaid/经济学 Medicaid/统计学和数值数据未参加医疗保险者/统计学和数值数据 Medicare/经济学 Medicare/统计学和数值数据美国/流行病学人类

来源：评论

学校读者我要写书评

暂无评论

Results of provider self-adjudication using the prudent layperson standard compared with the managed care organization's emergency department claim review process

引用

ANNALS OF EMERGENCY MEDICINE 2000年第3期36卷 212-218页

作者： Shesser, R Holtermann, K Smith, J Braun, J George Washington Univ Dept Emergency Med Washington DC 20037 USA

Study objectives: We compare the results of a provider "self-adjudicating" outpatient emergency department claims using a "presenting symptom-based" system with the managed care organization (MCO) adjudicating the claims using a "final diagnosis-based" system. Methods: All outpatient visits from one MCO to an urban, university hospital between January 1, 1998, and February 28, 1999, were included. Each record was reviewed by 2 methods to determine whether the visit qualified for payment under the MCO's benefit structure. Under the provider adjudication, symptom-based system, all visits with nursing triage levels of immediate/emergency were approved automatically. Those with triage levels of delayed/nonurgent were reviewed by an emergency physician and approved if, in the physician's opinion, the presenting symptoms met the emergency criteria under the District of Columbia's Access to Emergency Services Act. A second claims review, blinded to the first, was performed with the diagnosis-based system used by the MCO before approval of the prudent layperson standard. This review divided the records into "approve," "deny," and "suspend" categories according to the discharge International Classification of Diseases, ninth revision code. The results of the 2 reviews were compared. Results: We reviewed 1,830 records;836 (46%) cases were triaged as immediate/emergency and 994 (54%) as delayed/nonurgent. Of the 994 delayed/nonurgent visits, physician review determined that 607 (61%) met the prudent layperson standard and 387 (39%) did not. Overall, the provider self-adjudication system determined that 1,443 (78.8%) of the 1,830 visits should be approved for insurance coverage. The MCO's system approved 966 (53%), denied 335 (18%), and suspended 529 (29%). Provider self-adjudication using a symptom-based system resulted in the immediate approval of 1,443 (77.8%) visits compared with 966 (52.7%) by a diagnosis-based system (P<.001). Excluding the 529 suspended claims, McNemar's

来源：评论

学校读者我要写书评

暂无评论

Public health care and private insurance demand: The waiting time as a link

引用

Health Care Management Science 2000年第1期3卷 51-71页

作者： Jofre-Bonet, Mireia Department of Public Health Yale University LEPH 314 New Haven CT 06510 60 College St. United States

This paper analyzes the effect of waiting times in the Spanish public health system on the demand for private health insurance. Expected utility maximization determines whether or not individuals buy a private health insurance. The decision depends not only on consumer's covariates such as income, socio-demographic characteristics and health status, but also on the quality of the treatment by the public provider. We interpret waiting time as a qualitative attribute of the health care provision. The empirical analysis uses the Spanish Health Survey of 1993. We cope with the absence of income data by using the Spanish Family Budget Survey of 1990-91 as a complementary data set, following the Arellano-Meghir method [4]. Results indicate that a reduction in the waiting time lowers the probability of buying private health insurance. This suggests the existence of a crowd-out in the health care provision market. © Baltzer Science Publishers BV.

关键词：健康态度卫生保健调查卫生服务需求/经济学卫生服务需求/统计学和数值数据健康状况收入保险范围/统计学和数值数据卫生服务使用研究未参加医疗保险者/统计学和数值数据模型经济计量学私营部门/统计学和数值数据私营部门/利用公共卫生管理/经济学卫生保健质量社会经济因素西班牙时间因素预约名单成年人老年人儿童女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

A case study of point-of-service medical use in a managed care plan

引用

MEDICAL CARE RESEARCH AND REVIEW 1999年第2-Sup期56卷 85-110页

作者： Wong, HS Smithen, L Agency for Health Care Policy and Research The Wilkerson Group

This study examines the extent of point-of-service use in a managed care plan using 1990 and 1991 proprietary claims data (excluding pharmacy claims) from a large, well-established individual practice association with a point-of-service option. Results show that approximately 12 percent of all claims were made by out-of-network providers, representing about 9 percent of the dollar value of all claims. This is about $131 per enrollee per year. While younger enrollees (i.e., 6-24 years of age) use fewer medical resources than do older enrollees, they fend to receive a greater share of their medical services from out-of-network providers. There is little difference between point-of-service use by males and females. Mental illness is the most common diagnosis for out-of-network claims, accounting for about 25 percent of the dollar value of out-of-network claims. Ninety-six percent of the out-of-network claims for this diagnosis category were made by providers with a specialty in psychiatry.

关键词：费用分担绝对免赔额与共同保险卫生服务需求/统计学和数值数据独立行医协会/经济学独立行医协会/利用保险索赔报告/统计学和数值数据保险范围/统计学和数值数据美国中西部组织状况研究病人接受卫生保健的程度/统计学和数值数据病人选择自由条例/经济学病人选择自由条例/利用女(雌)性人类男(雄)性

来源：评论

学校读者我要写书评

暂无评论

Making cents out of caring for patients.

引用

Journal of the American Pharmaceutical Association (Washington,D.C. : 1996) 1999年第2期39卷 116,118-119页

作者： Wickman, J.M. Jackson, R.A. Marquess, J.G. Clinical Assistant Professor Department of Pharmacy Practice Chairman Department of Pharmacy Administration Professor of Pharmacy Administration Director of Continuing Education and Professional Affairs Clinical Assistant Professor Department of Pharmacy Practice Mercer University Southern School of Pharmacy 3001 Mercer University Drive Atlanta GA 30341-4155 Clinical Pharmacist Women's Hospital Long Beach Memorial Medical Center Adjunct Associate Clinical Professor of Pharmacy University of Southern California Los Angeles Assistant Clinical Professor of Pharmacy University of California San Francisco 9802 Saline Drive Huntington Beach CA 92646 President CPNP c/o Albany College of Pharmacy 106 New Scotland Ave. Albany NY 12208 Pharmacist Johns Community Hospital Taylor TX

来源：评论

学校读者我要写书评

暂无评论

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案：

请选择收藏分类：

通借通还

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：