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HEALTH-CARE REFORM THE INTERNATIONAL WAY

ISSUES IN SCIENCE AND TECHNOLOGY 1995年第1期12卷 34-42页

作者： WHITE, J BROOKINGS INST WASHINGTONDC 20036 USA

Two years ago, President Clinton led a charge in Washington to reform health care. One year ago, the big news was the collapse of all efforts to pass "comprehensive health care reform" in the 103rd Congress. Today, expanding access to health care is the farthest thing from our legislators' collective mind. The new agenda is how to limit the supposedly unsupportable costs of our current guarantees of care to the elderly and the poor. Some may think the switch from guaranteeing care to cutting programs was inevitable; in fact, it is inexcusable. Every other industrialized nation guarantees a high standard of care to virtually every citizen, at much lower cost than that of the U.S. system. Although there are differences in detail, the basic principles of these nations' systems are remarkably similar, so much so that they constitute an international standard.

关键词：加拿大费用控制成本及成本分析欧洲费用一览表/组织和管理卫生保健改革卫生经费支出卫生服务易得程度日本 medicaid/经济学 medicaid/组织和管理 Medicare/经济学 Medicare/组织和管理卫生保健质量美国

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HEALTH-CARE FOR THE UNINSURED

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ISSUES IN SCIENCE AND TECHNOLOGY 1991年第4期7卷 56-62页

作者： COYE, MJ JOHNS HOPKINS UNIV SCH PUBL HLTH BALTIMORE MD 21218 USA

Innovative state programs and possibilities for an effective national program. Uncompensated-care systems, medicaid expansion, state subsidies for private insurance, and employer-mandated health insurance.

关键词：保健福利计划雇员/组织和管理卫生服务研究保险住院/组织和管理 medicaid/组织和管理医疗费用无力承担/经济学贫困社会问题州卫生计划/经济学美国美国卫生和人类服务部

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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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Effect of medicaid managed care on pregnancy complications

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OBSTETRICS AND GYNECOLOGY 2000年第1期95卷 6-13页

作者： Oleske, DM Linn, ES Nachman, KL Marder, RJ Sangl, JA Smith, T Rush Univ Dept Hlth Syst Management Chicago IL 60612 USA Advocate Lutheran Hosp Pk Ridge IL USA Agcy Hlth Care Policy & Res Rockville MD USA Calif Dept Hlth Serv Maternal & Child Hlth Branch Sacramento CA USA

Objective: This study examined the impact of managed care on hospital obstetric outcomes in medicaid-sponsored women. Methods: The study sample consisted of a total of 525,517 maternal deliveries for singleton births from three payer groups, medicaid managed care, medicaid fee-for-service, and private managed care in 439 short-term-stay nonfederal hospitals in California and Florida. Quality of care comparisons were made using six indicators. Data were derived from linked computer files of birth certificates, hospital discharge abstracts, medicaid eligibility records, medicaid health care claims, and surveys of hospital characteristics. Results: The overall multivariate likelihood of an adverse maternal outcome during hospitalization for a delivery was not significantly different between medicaid managed care and medicaid fee-for-service groups in California and Florida. However, mothers in the medicaid managed care group compared with mothers in the private managed care group experienced a higher likelihood of eclampsia (California) (adjusted odds ratio = 1.26;95% confidence interval 1.05, 1.57;P=.04). Conclusion: Overall, managed care has not adversely affected pregnancy outcomes in medicaid-sponsored women. Yet, payer system changes may be insufficient to achieve complete parity of outcomes relative to private managed care patients. (Obstet Gynecol 2000;95:6-13. (C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：加利福尼亚/流行病学按诊疗收费计划佛罗里达/流行病学 Logistic模型管理医疗规划/统计学和数值数据 medicaid/组织和管理妊娠并发症/经济学妊娠并发症/流行病学妊娠结局/经济学妊娠结局/流行病学质量保证卫生保健美国女(雌)性人类妊娠

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A RANDOMIZED TRIAL TO EVALUATE THE EFFECTIVENESS OF A medicaid HMO

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JOURNAL OF HEALTH ECONOMICS 1992年第3期11卷 235-257页

作者： LEIBOWITZ, A BUCHANAN, JL MANN, J RAND CORP 1700 MAIN STPOB 2138SANTA MONICACA 90407 USA

The value of health-care services used by AFDC medicaid patients receiving care in a voluntary enrollment HMO is contrasted with that of health care services used by medicaid patients receiving fee-for-service (FFS) care. The randomized assignment of medicaid recipients to the HMO or to FFS allows the authors to conclude that the apparent lower use of HMO enrollees results from the HMO's selection of patients with lower needs for care rather than from technical efficiency. Patients had lower use while in the HMO, but disenrollees and those who refused enrollment had significantly higher use than FFS participants. In contrast to the effect of HMOs on non-medicaid populations, the medicaid HMO studied provided significantly fewer outpatient services, but the same level of inpatient services as the FFS sector. Overall, voluntary enrollment of medicaid eligibles into the HMO resulted in higher state expenditures for medicaid because of favorable selection.

关键词：门诊医疗/利用按人收费卫生服务范围/经济学卫生服务范围/统计学和数值数据费用医疗健康维护组织/经济学健康维护组织/利用卫生资源/利用卫生服务研究医院/利用 medicaid/组织和管理 medicaid/统计学和数值数据 medicaid/利用多元分析试点项目回归分析美国人类

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AN EVALUATION OF medicaid SELECTIVE CONTRACTING IN CALIFORNIA

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JOURNAL OF HEALTH ECONOMICS 1990年第4期8卷 437-455页

作者： ROBINSON, JC PHIBBS, CS UNIV CALIF BERKELEY BERKELEYCA 94720 USA

This study used 1982–1986 data on 262 private community hospitals to evaluate the effects of selective contracting for inpatient services by California's medicaid program. Selective contracting by medicaid significantly reduced the rate of inflation in average costs per admission and per patient day, while slightly increasing average lengths of patient stays. Private sector contracting also reduced cost inflation rates significantly and caused small, non-significant, reductions in lengths of stays. Hospital savings in 1986 due to medicaid selective contracting were $836 million, 7.6% of what hospital expenditures would have been in the absence of contracting.

关键词：加利福尼亚合同业务/经济学成本及成本分析/统计学和数值数据数据收集财务管理/经济学卫生经费支出/发展趋势医院社区/经济学医院社区/利用膨胀通货住院时间/统计学和数值数据 medicaid/组织和管理模型统计学方案评价回归分析

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State contracting initiatives for quality improvement in asthma care.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1998年第4期20卷 4-10页

作者： Ellenbecker, C.H. Garcia, I. Kane, M. University of Massachusetts Boston United States

This article examines the role of a state medicaid program in standardizing and implementing quality performance measures for providers. It describes the Asthma Education and Primary Care Clinician Linkages Quality Improvement Program (QIP), one aspect of the ongoing Hospital Quality Initiative in Massachusetts. In October 1996, the second year of the initiative, the Massachusetts Division of Medical Assistance requested that all contracting hospitals submit quality improvement process and outcome measures related to asthma care, including practice guidelines, patient education materials, and documentation mechanisms to facilitate patients' appropriate follow-up contact with primary care clinicians. A team of evaluators reviewed these materials to determine whether hospitals had baseline data in place for asthma QIP development. Information forums were held with three reviewers and the hospitals to discuss various programs and progress toward quality improvement in asthma care. Reviewers also worked to identify hospital programs that could be used as models and those that would benefit from assistance in meeting the state's program goals.

关键词：哮喘/治疗合同业务/组织和管理合同业务/标准疾病管理教育继续政府规划/组织和管理政府规划/标准医院管理/标准马萨诸塞 medicaid/组织和管理 medicaid/标准结果与过程评价(卫生保健) 初级卫生保健/组织和管理初级卫生保健/标准方案评价质量指标卫生保健州卫生计划/组织和管理州卫生计划/标准全面质量管理美国儿童人类

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Quantitative results.

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New directions for mental health services 2000年第85期2000卷 73-81页

作者： Lynch, F.L. Center for Health Research Kaiser Permanente Oregon Portland United States

Detailed analysis of information obtained is still under way, but initial trends appear to show stable enrollment, maintenance of minimum service levels, and lower hospital utilization.

关键词：卫生服务/利用卫生服务易得程度 medicaid/组织和管理精神卫生服务/组织和管理俄勒冈卫生保健质量州卫生计划/组织和管理美国

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HIV healthcare delivery and managed care: applications and implications from the Special Projects of National Significance Program.

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Home health care services quarterly 1998年第1期17卷 101-109页

作者： Gamliel, S. Singer, B. Marconi, K. Health Resources and Services Administration for Special Projects of National Significance Rockville MD United States

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关键词：按人收费 HIV感染/治疗管理医疗规划/经济学管理医疗规划/组织和管理 medicaid/经济学 medicaid/组织和管理模型组织管理试点项目卫生保健质量美国人类

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Measuring change: the first two years.

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New directions for mental health services 2000年第85期2000卷 65-72页

作者： Ross, K.V. Office of Mental Health Services Mental Health and Developmental Disability Services Division State of Oregon United States

A clear measurement strategy was required to offer the mental health organizations the flexibility they sought, yet ensure accountability. Early findings show mixed results.

关键词：数据收集/方法 medicaid/组织和管理精神卫生服务/组织和管理俄勒冈方案评价/方法卫生保健质量州卫生计划/组织和管理美国青少年成年人儿童人类

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