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Health, medicine, and ophthalmology: Facing the facts and paying the piper - LVI Edward Jackson Memorial Lecture

AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第6期128卷 673-679页

作者： Sommer, A Johns Hopkins Univ Sch Hyg & Publ Hlth Baltimore MD 21205 USA

PURPOSE: To describe the sources of tension within the health care system and methods for pursuing their solution. METHODS: Presentation of observations pertinent to patient, provider, and payer perspectives relevant to the cast, delivery, and quality of care and their impact on health. RESULTS: Societal forces, not just wealth, are major determinants of both health and the costs of health care. CONCLUSIONS: Tensions created by rising health care costs in the face of finite societal resources will increase in the years ahead. These can be resolved only by realizing new efficiencies in care, and prioritizing, through an explicit process, the care that is to be provided. (C) 1999 by Elsevier Science Inc. All rights reserved.

关键词：费用控制卫生保健提供/经济学卫生保健提供/发展趋势卫生卫生保健费用卫生人员/经济学卫生人员/发展趋势眼科学/经济学眼科学/发展趋势病人预期支付系统/经济学预期支付系统/发展趋势美国人类

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Great expectations: an analysis of four strategies.

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Medical care review 1994年第2期51卷 205-232页

作者： Bigelow, B. Arndt, M. Graduate School of Management Clark University Worcester 01610. MA United States

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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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Indicators of hospital closure under pps and blue cross/blue shield cost-based reimbursements

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Journal of Hospital Marketing 1992年第2期6卷 149-182页

作者： Oswald, Sharon Gardiner, Lorraine Jahera, John Auburn University United States

Using an adaptation of discriminant analysis on a sample of 120 hospitals in the state of Alabama, this paper illuminates characteristics of hospitals closed due to financial failure under PPS and cost-based Blue Cross/Blue Sliield reimbursement systems. The results show high debt levels, poor revenue and cost ratios, poor utilization management, and the inability to collect effectively on outstanding accounts in the year prior to hospital failure. © 1992 Taylor & Francis Group, LLC.

关键词：亚拉巴马破产/统计学和数值数据卡方分布数据收集判别分析财务管理医院/统计学和数值数据卫生设施关闭/经济学卫生设施关闭/统计学和数值数据 Medicaid/经济学所有权/经济学预期支付系统/经济学偿还途径/经济学美国

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The initial impact of the Medicare prospective payment system on U.S. health care: a review of the literature.

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Medical care review 1991年第1期48卷 91-115页

作者： Feinglass, J. Holloway, J.J. Northwestern University Medical School. United States

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Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System

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The Journal of Rural Health 1992年第2期8卷 93-105页

作者： Halpern, Michael T. Alexander, Jeffrey A. Fennell, Mary L. Department of Public Health Policy and Administration University of Michigan in Ann Arbor Michigan United States Health Services Management and Policy University of Michigan Ann Arbor Michigan United States Pennsylvania State University University Park Pennsylvania United States

The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post‐PPS era affect the likelihood of rural hospital survival;(2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival;and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival. Proportional hazards analyses indicate that system affiliation with investor‐owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not‐for‐profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals. These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor‐owned systems has occurred in the post‐PPS era. No evidence of selection into not‐for‐profit systems was discovered. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：合同业务/经济学财务管理医院/发展趋势卫生设施关闭/统计学和数值数据卫生服务研究/方法医院乡村/经济学医院乡村/组织和管理多机构系统/经济学多机构系统/统计学和数值数据多元分析所有权/经济学预期支付系统/经济学回归分析危险美国

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Capturing patient charges gains new meaning under DRG’s

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Hospital Topics 1985年第1期63卷 47-48页

作者： Fernandez, Frank Berlant, Harley University of Miami School of Medicine United States Richmond College New York United States

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关键词：成本及成本分析诊断相关患者组费用和收费器材管理医院/经济学预期支付系统/经济学偿还途径/经济学美国

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ESTIMATING THE INDIRECT COSTS OF TEACHING

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JOURNAL OF HEALTH ECONOMICS 1992年第2期11卷 153-171页

作者： ROGOWSKI, JA NEWHOUSE, JP HARVARD UNIV CAMBRIDGEMA 02138

Medicare's Prospective Payment System pays teaching hospitals using a regression coefficient in a log-log cost function. Previous literature showed that this coefficient is sensitive to the covariates included in the function, but specified teaching intensity as the logarithm of one plus the intern and resident-to-bed ratio. Provided the true relationship is log-log, adding one biases the coefficient substantially but not predicted cost. In a re-specified equation that makes this bias negligible, the coefficient is not nearly as sensitive to the inclusion of other covariates. Because further issues remain to be explored, it is premature to use our results for policy purposes.

关键词： Medicare与Medicaid服务中心(美国) 费用分配/方法费用分配/统计学和数值数据卫生设施规模卫生服务研究医院教学/经济学医院教学/立法和法学医院教学/统计学和数值数据实习医师和住院医师职务/经济学实习医师和住院医师职务/统计学和数值数据 Medicare/经济学模型经济计量学预期支付系统/经济学支付标准制定和审核/方法支付标准制定和审核/统计学和数值数据回归分析美国

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A Rural Hospital's Impact on a Community's Economic Health

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The Journal of Rural Health 1990年第1期6卷 53-64页

作者： Doeksen, Gerald A. Loewen, Ron A. Strawn, David A. Department of Agricultural Economics Oklahoma State University United States

This research illustrates the importance of a hospital to the economic health of a community. A simulation model of a rural community in Oklahoma is used to demonstrate how the implementation of the DRG reimbursement policy has impacted a rural community, and to project how the closing of the hospital would impact the economy of the community. The results indicate that rural hospitals play a vital role in the economics of their communities. The closing of a rural hospital has a devastating impact on the community, while the DRG reimbursement policy has had a significant impact on the community. Copyright © 1990, Wiley Blackwell. All rights reserved

关键词：商业社区和机构的关系/经济学就业/统计学和数值数据评价研究卫生设施/经济学卫生设施关闭/经济学医院病床数 100张以下医院医院乡村/经济学收入 Medicare 模型理论俄克拉何马人口预期支付系统/经济学统计数据税款

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THE DIFFUSION OF INNOVATIONS IN HOSPITALS - SOME ECONOMETRIC CONSIDERATIONS

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JOURNAL OF HEALTH ECONOMICS 1985年第4期4卷 373-380页

作者： LEE, RH WALDMAN, DM UNIV N CAROLINA CHAPEL HILL NC 27514 USA UNIV COLORADO BOULDER CO 80309 USA

Empirical studies of the diffusion of innovations have not addressed adequately econometric problems that are characteristic of such analyses. Reanalysis of data for five innovations using an estimator with desirable statistical properties results in a considerably revised estimate of the impact of prospective reimbursement on diffusion.

关键词：基本建设经费信息交流革新推广经济学医院医学检验科学/供应和分配模型理论预期支付系统/经济学偿还途径/经济学美国

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