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Strategies to increase enrollment in children's health insurance programs: A report of the New York Academy of Medicine

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JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE 1999年第2期76卷 247-279页

作者： Andrulis, DP Bauer, TA Hopkins, A New York Acad Med Off Urban Hlth Populat New York NY 10029 USA

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Probabilistic linkage of computerized ambulance and inpatient hospital discharge records: A potential tool for evaluation of emergency medical services

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 616-626页

作者： Dean, JM Vernon, DD Cook, L Nechodom, P Reading, J Suruda, A Univ Utah Sch Med Dept Pediat Intermt Injury Control Res Ctr Salt Lake City UT USA Univ Utah Sch Med Dept Family & Prevent Med Intermt Injury Control Res Ctr Salt Lake City UT USA

Study objectives: Emergency medical services (EMS) is an important part of the health care system. The effect of EMS on morbidity, mortality, and costs of illness is difficult to evaluate because hospital information is not available in out-of-hospital databases. We used probabilistic linkage to create such a database from ambulance and inpatient data and demonstrate the potential for linkage to facilitate evaluation of EMS responses resulting in hospital admission. Methods: Statewide ambulance and inpatient hospital discharge records were available for 1994 through 1946. Ambulance records indicating admission to the emergency department or hospital (165,649 records) were linked to inpatient hospital records indicating emergency admission (146,292 records) by using probabilistic linkage. Out-of-hospital data (dispatch code, treatments rendered, and ages), linkage rates, and inpatient data (discharge status, charges, length of stay, and payer category) were analyzed. Results: We linked 24,299 (14.7%) ambulance events to inpatient hospital discharges. If we had used exact linkage methods, we would have only linked 14,621 record pairs, a loss of nearly 40%. linkage rates were relatively constant between years (approximately 15%) but differed by ambulance dispatch codes. Out-of-hospital dispatch codes with high linkage rates included breathing problems (22.6%), chest pain (21.5%), diabetic problems (16.9%), drowning incidents (14.9%), falls (19.2%), strokes (32.8%), and unconsciousness or fainting episodes (16.1%). Linkage to the hospital record provided access to hospital outcome data. Inpatient mortality was 6.8%. Survivors were discharged home (60.7%), transferred to other acute-care facilities (3.6%) or intermediate-care facilities (23.3%), or discharged with home health care provision (4.9%). The median length of stay was 3 days, and median charges were $6,620;total inpatient charges were $286,737,067. Conclusion: Probabilistic linkage enables ambulance and hospita

关键词：救护车/组织和管理数据库管理系统可行性研究卫生服务研究/方法医院收费/统计学和数值数据医院死亡率信息系统/组织和管理住院病人/统计学和数值数据保险健康/统计学和数值数据住院时间/统计学和数值数据病案连锁/方法病案系统计算机化/组织和管理年患病率结果评价(卫生保健) 病人出院/统计学和数值数据病人转诊/统计学和数值数据概率存活率分析犹他/流行病学青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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The changing status of inpatient dermatology at American academic dermatology programs

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JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 1999年第5期40卷 755-757页

作者： Kirsner, RS Yang, DG Kerdel, FA Univ Miami Sch Med Dept Dermatol & Cutaneous Surg Miami FL USA Univ Miami Sch Med Dept Epidemiol & Publ Hlth Miami FL USA

Background: Changes in health care delivery financing such as the adoption of the diagnosis-related groups (DRG) in 1983 has affected inpatient services of dermatology programs across the United States. Objective: The purpose of this study was to define the present status of inpatient dermatology at academic medical centers compared with 1982. Methods: Questionnaires inquiring about the state of inpatient service were sent to the chairpersons of each dermatology residency program in the United States. Results: Of the 71 programs responding, 79% reported a reduction in inpatient activity. Nearly half of the dermatology programs with dedicated dermatology beds in 1982 reported not continuing to have these in 1997 (41 to 24). The average number of patients admitted for skin disease decreased from 119 in 1982 to 36.5 in 1997, and the average daily census decreased from 8.9 to 2.2. Conclusion: There has been a decline in the number of patients hospitalized by academic dermatology departments and a shift of some patients hospitalized to beds where the attending is other than a dermatologist.

关键词：医学科学研究中心/统计学和数值数据门诊医疗/统计学和数值数据皮肤病学/教育皮肤病学/统计学和数值数据诊断相关患者组/统计学和数值数据医院病床数/统计学和数值数据住院/统计学和数值数据保险健康/统计学和数值数据实习医师和住院医师职务病人入院/统计学和数值数据皮肤疾病/流行病学皮肤疾病/治疗美国/流行病学人类

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Urban and Rural Differences in Health Insurance and Access to Care

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The Journal of Rural Health 1994年第2期10卷 98-108页

作者： Hartley, David Quam, Lois Lurie, Nicole Rural Health Research Center University of Washington Department of Geography Seattle Washington United States Institute for Health Services Research Department of Internal Medicine University of Minnesota in Minneapolis Minneapolis Minnesota United States

This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub‐samples of 400 group‐insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies. Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P<0.01). These differences were confirmed by multivariate analysis. Rural residents with group insurance have higher out‐of‐pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment‐based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：卡方分布绝对免赔额与共同保险/统计学和数值数据地理学卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据保险赔偿费/统计学和数值数据保险健康/统计学和数值数据采访最小二乘法分析 Logistic模型未参加医疗保险者/统计学和数值数据明尼苏达多元分析农村卫生/统计学和数值数据城市卫生/统计学和数值数据成年人人类

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Changes in Health Insurance Coverage Within Rural and Urban Environments—1977 to 1987

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The Journal of Rural Health 1995年第3期11卷 169-176页

作者： Duncan, R. Paul Amey, Cheryl Department of Health Services Administration University of Florida Health Science Center Gainesville Florida 32610‐0195 P.O. Box 100195 United States

Abstract: This study examines changes in the health insurance coverage of the nonelderly population in rural and urban areas between 1977 and 1987, using data from the National Medical Care Expenditure Survey (NMCES) and the National Medical Expenditure Survey (NMES). It was designed to test the hypothesis that differences in the rates of health insurance coverage in rural and urban areas have diminished over time, and to explore the composition of changes in coverage within rural and urban environments. The data suggest that the proportions of the populations that are without health insurance in rural and urban areas have converged since 1977. Although both rural and urban settings witnessed increases in the proportion of their populations without health insurance from any source, urban regions experienced a greater increase than did rural areas. These changes occurred among most subgroups within the population. In no subgroup did the percentage of the population without insurance in urban areas exceed that found in rural areas in either 1977 or 1987. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：年龄因素大陆人口群数据收集教育程度就业保险健康/统计学和数值数据婚姻状况未参加医疗保险者/统计学和数值数据农村人口/统计学和数值数据社会经济因素美国市区人口/统计学和数值数据青少年成年人女(雌)性人类男(雄)性中年人

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Issues in the consumer choice of health care coverage plans

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Health Marketing Quarterly 1993年第3-4期10卷 163-178页

作者： Thompson, Ann Marie Kaminski, Peter F. Department of Marketing Western Michigan University Kalamazoo MI 49008-3821 United States Department of Marketing Northern Illinois University DeKalb IL 60115 United States

Developing and implementing successful marketing strategies for prepaid health care coverage plans is becoming an important issue as managers of these plans struggle to remain competitive in the market place. This paper provides insight into the reasons why consumers make choices among varying types of health care coverage plans. Some suggestions are made to plan managers for incorporating these results into the development of marketing strategies for prepaid health care coverage plans. © 1993 Taylor & Francis Group, LLC.

关键词：保险健康/统计学和数值数据模型理论回归分析人类

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The effect of health care coverage on medical cost, utilization, and well-being of the aged

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Journal of Health and Social Policy 1992年第1期4卷 1-11页

作者： Slivinske, L.R. Fitch, V.L. Department of Sociology Youngstown State University Youngstown OH 44555 United States

The relationship of medical insurance, utilization and health status indicators was examined for 463 elderly individuals. The uninsured were less well and tended to utilize the health care system more often than those with more types of coverage. Need was found to be the best predictor of utilization. A profile describing those with above average levels of well-being also was developed. Methodological issues and health care policy recommendations are discussed.

关键词：方差分析数据收集判别分析卫生保健费用老年人保健服务/利用健康状况指标保险健康/统计学和数值数据未参加医疗保险者/统计学和数值数据俄亥俄利用情况审核/统计学和数值数据老年人女(雌)性人类男(雄)性中年人

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Small business leaders’ viewpoints on health care insurance: A marketing and social perspective

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Health Marketing Quarterly 1990年第1-2期7卷 169-175页

作者： Mc Dermott, Dennis R. School of Business Virginia Commonwealth University Richmond VA 23284-4000 United States

The need to develop health care marketing strategies based on consumer feedback is of great importance. To address this need, a market research study was conducted of the small business segment in Virginia. A mail questionnaire was sent to the chief executive officers of some 1,000 firms having fewer than 50 employees. Of the 270 responses, 95% report offering a health care insurance plan to their employees. Among the remaining 5%, the primary reason for not offering a plan is cost. Other reasons include: 1. Employees are already covered through a spouse's plan. 2. Adequate coverage is perceived to be unavailable. 3. Employees do not need coverage at this time. In targeting full-time employees of small businesses, existing health care insurance plans have generated very high enrollments and a high degree of satisfaction regarding coverage and service, but a relatively low degree of satisfaction regarding cost. Since small businesses, and likely larger businesses as well, resist offering company-sponsored health care coverage for part-time employees for cost reasons, a basic-coverage, low-cost plan could be appealing to both supplier and consumer.

关键词：行政管理人员/统计学和数值数据态度用户满意/统计学和数值数据评价研究保健福利计划雇员/统计学和数值数据工业/经济学保险健康/统计学和数值数据医疗费用无力承担问卷调查弗吉尼亚

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EQUITY IN THE DELIVERY OF HEALTH-CARE - SOME INTERNATIONAL COMPARISONS

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JOURNAL OF HEALTH ECONOMICS 1992年第4期11卷 389-411页

作者： VANDOORSLAER, E WAGSTAFF, A UNIV SUSSEX SCH SOCIAL SCIARTS BLDGBRIGHTON BN1 9QNENGLAND ERASMUS UNIV 3000 DR ROTTERDAMNETHERLANDS

This paper presents the results of an eight-country comparative study of equity in the delivery of health care. Equity is taken to mean that persons in equal need of health care should be treated the same, irrespective of their income. Two methods are used to investigate inequity: an index of inequity based on standardized expenditure shares, and a regression-based test. The results suggest that inequity exists in most of the eight countries, but that there is no simple one-to-one correspondence between a country's delivery system and the degree to which persons in equal need are treated the same.

关键词：文化交叉比较卫生保健提供/经济学卫生保健提供/标准卫生保健提供/统计学和数值数据欧洲卫生经费支出/统计学和数值数据卫生服务易得程度/经济学卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据卫生服务研究收入/分类保险健康/经济学保险健康/标准保险健康/统计学和数值数据国际性模型经济计量学国家卫生规划/经济学国家卫生规划/标准国家卫生规划/统计学和数值数据回归分析社会正义/经济学社会经济因素公费医疗/经济学公费医疗/标准公费医疗/统计学和数值数据美国

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Vulnerable populations and health insurance

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MEDICAL CARE RESEARCH AND REVIEW 2000年第1期57卷 110-134页

作者： Shi, LY Johns Hopkins Univ Sch Publ Hlth & Hyg Dept Hlth Policy & Management Baltimore MD 21205 USA

This study provided a national profile of health insurance of certain vulnerable populations including children, racial/ethnic minorities, low-income families, non-metropolitan statistical area (MSA) residents, and those with poor health status. The study shows an increase in the proportion of uninsured nonelderly population. While public insurance helped reduce the employment- and health-related disparities in private coverage, it has not overcome other disparities related to vulnerable characteristics including race/ethnicity, wages, education, and area of residence. Comparison between health maintenance organization (HMO) and fee-for-service insurance indicates that younger although not much healthier people, racial/ethnic minorities, MSA residents, and those residing in the West and Northeast regions were more likely to have HMO coverage. To reduce significant disparities in health insurance coverage, policy makers will have to consider expanding public insurance coverage, targeting vulnerable groups, partiallarly those with multiple vulnerable characteristics rather than merely the economically distressed. Expecting managed care to achieve cost containment for services provided to vulnerable populations may be unrealistic.

关键词：费用控制按诊疗收费计划/统计学和数值数据卫生服务研究健康状况保险健康/统计学和数值数据 Logistic模型管理医疗规划/统计学和数值数据未参加医疗保险者/统计学和数值数据少数民族/统计学和数值数据模型经济计量学贫困/统计学和数值数据问卷调查美国青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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