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THE DOCTOR AS DOUBLE AGENT - INFORMATION ASYMMETRY, HEALTH-INSURANCE, AND MEDICAL-CARE

JOURNAL OF HEALTH ECONOMICS 1991年第4期10卷 411-432页

作者： BLOMQVIST, A UNIV WESTERN ONTARIO DEPT ECONLONDON N6A 5C2ONTARIOCANADA

In a model incorporating uncertainty and state-dependent utility of health services, as well as information asymmetry between patients/buyers and physicians/sellers, two types of equilibria are compared: (1) when consumers have conventional third-party insurance and doctors are paid on the basis of fee-for-service;and (2) when insurance is through an HMO which provides health services through its own doctors. Conditions are found under which contractual or legal incentives can overcome the information asymmetry problem and bring about an efficient allocation of resources to health services provision.

关键词：加拿大成本及成本分析/方法成本及成本分析/统计学和数值数据效率健康知识态度实践健康维护组织/经济学信息论保险医师工作/经济学机构间关系模型经济计量学医师的作用医生病人关系随机过程人类

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A COMPARATIVE COST-ANALYSIS OF ALTERNATIVE MODELS OF ADULT DAY-CARE

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ADMINISTRATION IN SOCIAL WORK 1993年第2期17卷 105-122页

作者： KIRWIN, PM KAYE, LW ELDER CARE SERV WAYNEPA BRYN MAWR COLL SCH SOCIAL WORK & SOCIAL RESBRYN MAWRPA 19010

An analysis of the component costs of adult day care (ADC) programs in the Commonwealth of Pennsylvania indicates widely varying experiences in terms of fiscal and contractual administrative arrangements. Medical model ADC, program-funded services, and those agencies performing their own client assessments reported higher client per diems than the social model, slot-funded, and non-ADC assessed programs. For-profits displayed cost characteristics similar to their not-for-profit counterparts. Medical and slot-funded programs more frequently turned to multiple sources for budget supplementation. All program types tended to depend on voluntary client contribution methods as compared to means-tested approaches when determining fee-for-service.

关键词：成本及成本分析/统计学和数值数据数据收集日间住院医疗/经济学日间住院医疗/统计学和数值数据残疾人筹资组织/统计学和数值数据卫生保健费用/统计学和数值数据卫生服务研究老年人保健服务/经济学老年人保健服务/统计学和数值数据宾夕法尼亚老年人人类

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Costing medical libraries: the feasibility of functional cost analysis.

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Health libraries review 1993年第4期10卷 169-201页

作者： Jones, L. Nicholas, D. North West Thames Regional Library &amp Information Service London

As a result of organizational changes in the National Health Service (NHS) there is a need for a coherent costing model for NHS libraries, particularly for the smaller libraries based in postgraduate medical centres. One possible model is functional cost analysis, whereby all costs are assigned to library functions representing services to users, such as loans from stock, interlibrary loans, enquiry services, etc. Using data from a 1991 survey of postgraduate centre-based libraries in the North West Thames (NWT) Region of the NHS, the feasibility and appropriateness of functional cost analysis is examined.

关键词：预算/统计学和数值数据成本及成本分析/方法成本及成本分析/统计学和数值数据数据收集/方法教育医学继续/经济学表格和记录管理图书馆医学/经济学图书馆医学/统计学和数值数据图书馆服务/经济学图书馆服务/统计学和数值数据伦敦规划技术方案评价/经济学方案评价/方法

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THE MARGINAL COST OF NURSING-HOME CARE - NEW-YORK, 1983

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JOURNAL OF HEALTH ECONOMICS 1988年第4期7卷 393-412页

作者： NYMAN, JA UNIV MINNESOTA MINNEAPOLISMN 55455 USA

Many believe that nursing homes exclude heavy-care Medicaid patients because their costs exceed the Medicaid reimbursement rate. This paper tests whether this was true in New York in 1983 by calculating the marginal costs of a day of nursing home care and comparing them with the per diem Medicaid reimbursement rate. Contrary to popular beliefs, the marginal cost of the most dependent SNF patient was found to be between $9 and $12 less per patient day than the average Medicaid reimbursement rate for SNF patients. This suggests that excess demand, rather than lower-than-cost reimbursement rates, was creating the heavy-care access problem in New York in 1983. Policy solutions differ depending on the cause of the access problem. The strengths and weaknesses of the different policy solutions are compared.

关键词：成本及成本分析/统计学和数值数据数据收集卫生服务易得程度/经济学卫生服务需求/经济学卫生服务研究/经济学保险健康补偿中间诊疗设施/经济学长期医疗/分类 Medicaid/经济学纽约医护疗养所/经济学支付标准制定和审核技术性护理设施/经济学

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HOSPITAL EXPENDITURES IN THE UNITED-STATES AND CANADA - DO HOSPITAL WORKER WAGES EXPLAIN THE DIFFERENCES

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JOURNAL OF HEALTH ECONOMICS 1992年第4期11卷 453-465页

作者： HABER, SG ZWANZIGER, J ANDERSON, JGM THORPE, KE NEWHOUSE, JP UNIV N CAROLINA SCH PUBL HLTHDEPT HLTH POLICY & ADMCHAPEL HILLNC 27514 HARVARD UNIV SCH MEDDEPT HLTH CARE POLICYBOSTONMA 02115 HARVARD UNIV KENNEDY SCH GOVTCAMBRIDGEMA 02138 HARVARD UNIV SCH PUBL HLTHDEPT HLTH POLICY & MANAGEMENTBOSTONMA 02115 UNIV ROCHESTER DEPT COMMUNITY MEDROCHESTERNY 14627 UNIV BRITISH COLUMBIA CTR HLTH SERV & POLICY RESVANCOUVER V6T 1W5BCCANADA

An analysis indicates that higher wages cannot explain the substantially higher hospital expenditure rates in the US compared to Canada. On the contrary, hospital worker wage rates are lower in the US than in Canada, and it appears that they reflect differences between the countries in the markets for hospital labor, particularly among the less skilled occupations. It is not known why hospital labor markets might differ across countries. One explanation might be that collectively bargained wage levels are higher and that unionization is more widespread in Canadian hospitals. The finding that wages are lower in the US than in Canada strongly suggests that the difference in hospital costs between the 2 countries is primarily in the quantity of factor outputs, as well as in output differences, rather than in factor prices. Furthermore, it appears that greater amounts of both labor and non-labor inputs are used in US hospitals.

关键词：加拿大成本及成本分析/统计学和数值数据数据收集卫生经费支出/统计学和数值数据卫生服务研究模型经济计量学人员医院/经济学人员医院/统计学和数值数据薪金和附加福利/经济学薪金和附加福利/统计学和数值数据美国

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TAX HARMONIZATION AND THE REDUCTION OF EUROPEAN SMOKING RATES

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JOURNAL OF HEALTH ECONOMICS 1992年第3期11卷 329-346页

作者： TRIGG, AB BOSANQUET, N UNIV LONDON ROYAL HOLLOWAY & BEDFORD NEW COLL DEPT SOCIAL POLICY EGHAM TW20 0EX SURREY ENGLAND

Amidst growing optimism that smoking in Europe can be greatly reduced by the year 2000, this paper simulates the possible impacts of European tax harmonisation in the context of rising incomes. A range of price and income elasticities are chosen from econometric studies which use micro information. This is justified by the aggregation problems associated with studies in the smoking literature which use aggregate data. Using micro elasticities, the simulations reported in this paper show that the aims of fiscal harmonisation are at variance with the aims of health promotion.

关键词：成本及成本分析/统计学和数值数据欧洲/流行病学费用和收费/统计学和数值数据健康行为健康促进/经济学模型经济计量学回归分析吸烟/经济学吸烟/流行病学社会经济因素税款/统计学和数值数据世界卫生组织人类

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Making the case to fund networked access to electronic information services.

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Health libraries review 1993年第1期10卷 20-30页

作者： Cox, J. Medical Library Royal Free Hospital School of Medicine London United Kingdom

The establishment of a local area network can greatly widen access to an organization's electronic information services, create improved conditions for staffing the delivery of these services and improve training and user support. Such a project is, however, expensive to fund. This article describes the approach taken at the Royal Free Hospital School of Medicine to secure funds for networking MEDLINE on hard disk and other information services. The importance of close collaboration between library and computer departments in planning and promoting a project of this nature is emphasized.

关键词：预算 CD-ROM/经济学资本筹集/方法成本及成本分析/统计学和数值数据医院信息系统/经济学图书馆医院/经济学图书馆医院/组织和管理局部网络/经济学伦敦 MEDLINE/经济学规划技术规划制订/经济学规划制订/方法

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MEASURING CASEMIX SPECIALIZATION AND THE CONCENTRATION OF DIAGNOSES IN HOSPITALS USING INFORMATION-THEORY

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JOURNAL OF HEALTH ECONOMICS 1989年第2期8卷 185-207页

作者： FARLEY, DE NATL CTR HLTH SERV RES ROCKVILLE MD 20857 USA

This paper examines the application of Information Theory to hospital discharge data. Information Theory offers a general methodology to compare sets of casemix proportions as a measure of (1) the concentration of admissions across hospitals for specific medical conditions and (2) specialization across diagnostic categories for individual hospitals. Unfortunately, Information Theory indices are difficult to interpret and subject to a potentially serious statistical bias when computed from discrete frequency counts, such as those obtained from discharge abstract data. The analysis presented here first clarifies the interpretation of Information Theory indices by relating them to formal statistical tests of hypotheses about hospital and diagnosis-specific patterns of admissions. It then documents the magnitude of the bias due to calculating indices from discrete frequency counts and proposes analytical strategies for dealing with this bias. Finally, the paper examines the empirical importance of the bias and the proposed adjustment, using data that are typical of those available for research on hospital casemix.

关键词：成本及成本分析/统计学和数值数据数据收集诊断相关患者组/统计学和数值数据医院/利用信息论模型统计学病人入院/统计学和数值数据概率随机过程美国

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A Descriptive Analysis of Health Insurance Coverage Among Farm Families in Minnesota

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The Journal of Rural Health 1992年第3期8卷 178-184页

作者： Kralewski, John E. Liu, Yuanli Shapiro, Janet China Studying Health Services Research Policy and Administration School of Public Health University of Minnesota United States Division of Health Services Research Policy of the School of Public Health University of Minnesota United States

This paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis‐St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problems. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：农业/经济学用户满意/统计学和数值数据成本及成本分析/统计学和数值数据数据收集卫生服务易得程度/统计学和数值数据保险健康/经济学保险健康/统计学和数值数据未参加医疗保险者/统计学和数值数据明尼苏达农村卫生/统计学和数值数据人类

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A RISK-BASED PROSPECTIVE PAYMENT SYSTEM THAT INTEGRATES PATIENT, HOSPITAL AND NATIONAL COSTS

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JOURNAL OF HEALTH ECONOMICS 1992年第1期11卷 1-41页

作者： SIEGEL, C JONES, K LASKA, E MEISNER, M LIN, S NATHAN S KLINE INST PSYCHIAT RES NEW YORKNY 10962 NEW YORK MED CTR NEW YORKNY 10016

We suggest that a desirable form for prospective payment for inpatient care is hospital average cost plus a linear combination of individual patient and national average cost. When the coefficients are chosen to minimize mean squared error loss between payment and costs, the payment has efficiency and access incentives. The coefficient multiplying patient costs is a hospital specific measure of financial risk of the patient. Access is promoted since providers receive higher reimbursements for risky, high cost patients. Historical cost data can be used to obtain estimates of payment parameters. The method is applied to Medicare data on psychiatric inpatients.

关键词：成本及成本分析/统计学和数值数据经济学医院/统计学和数值数据效率卫生服务易得程度/经济学卫生服务研究/方法医院精神病/经济学投资/经济学 MedicareA部/经济学精神障碍/经济学模型经济计量学预期支付系统/经济学精神病科医院/经济学危险美国人类

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