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Inquiry: a Journal of Medical Care Organization, Provision and Financing

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https://read.qxmd.com/read/30983464/limited-consequences-of-a-transition-from-activity-based-financing-to-budgeting-four-reasons-why-according-to-swedish-hospital-managers
#1
Lina Maria Ellegård, Anna Häger Glenngård
Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30983463/what-s-driving-high-disenrollment-in-medicare-advantage
#2
Eva DuGoff, Sandra Chao
Disenrollment rates are one way that policy makers assess the performance of Medicare Advantage (MA) health plans. We use 3 years of data published by the Centers for Medicare & Medicaid Services (CMS) to examine the characteristics of MA contracts with high disenrollment rates from 2015 to 2017 and the relationship between disenrollment rates in MA contracts and 6 patient experiences of care performance measures. We find that MA contracts with high disenrollment rates were significantly more likely to be for-profit, small, and enroll a greater proportion of low-income and disabled individuals...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30983455/simulation-of-quality-death-spirals-based-on-human-resources-dynamics
#3
Ali Alizadeh-Zoeram, Alireza Pooya, Zahra Naji-Azimi, Ali Vafaee-Najar
Although the hospital managers always try to improve the quality of the medical services, sometimes their efforts might affect reversely and push the system in what is so commonly called as "the death spirals of quality." The most important reason of falling into these spirals is the lack of a systemic thought that considers the feedback relationships between the numerous effective variables in the system performance, such as human resources service capacity. In this regard, the purpose of the present research is to design and simulate a dynamic human resources service capacity-based model to demonstrate the death spirals of quality phenomenon based on the service time per service and the possibility of error generation along with identifying the policies to cope with them...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30975010/does-public-health-insurance-coverage-lead-to-better-health-outcomes-evidence-from-chinese-adults
#4
Hongli Fan, Qingyue Yan, Peter C Coyte, Wenguang Yu
This article examines the impacts of public health insurance on the health of adults through use of data from the China Health and Nutrition Survey. We use the endogenous treatment effects model to infer the causal effects of public health insurance on health. We find that public health insurance significantly improves the physical and mental health status of health insurance beneficiaries after controlling for other covariates. Among the 2 types of voluntary public health insurance, the Urban Resident Basic Medical Insurance has the greater impact in improving health than the New Cooperative Medical Scheme...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30947608/medicaid-patients-have-greater-difficulty-scheduling-health-care-appointments-compared-with-private-insurance-patients-a-meta-analysis
#5
Walter R Hsiang, Adam Lukasiewicz, Mark Gentry, Chang-Yeon Kim, Michael P Leslie, Richard Pelker, Howard P Forman, Daniel H Wiznia
Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30947603/determinants-of-hip-and-knee-replacement-the-role-of-social-support-and-family-dynamics
#6
Berna Demiralp, Lane Koenig, Jennifer T Nguyen, Samuel A Soltoff
The objective of this study was to examine variations in the determinants of joint replacement (JR) across gender and age, with emphasis on the role of social support and family dynamics. We analyzed data from the US Health and Retirement Study (1998-2010) on individuals aged 45 or older with no prior receipt of JR. We used logistic regression to analyze the probability of receiving knee or hip replacement by gender and age (<65, 65+). We estimated the effect of demographic, health needs, economic, and familial support variables on the rate of JR...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30947595/the-provision-of-health-care-by-family-physicians-in-taiwan-as-illustrated-with-population-pyramids
#7
Yi-Jen Wang, Hao-Yen Liu, Tzeng-Ji Chen, Shinn-Jang Hwang, Li-Fang Chou, Ming-Hwai Lin
Family physicians serve as personal doctors for individuals and their families and also act as gatekeepers of the health care system. If no special status is accorded to family physicians, however, then the rates at which health care recipients utilize their service might be affected. In the present cross-sectional study, representative claims data sets for 2010 from Taiwan's National Health Insurance program, a health care system in which beneficiaries are not required to register with a family physician, were used to investigate the provision of health care to the population by family physicians...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30939970/factors-affecting-the-choice-of-national-and-public-hospitals-among-outpatient-service-users-in-south-korea
#8
Mi-Ryeong Gil, Cheon Geun Choi
The present study analyzed factors underlying outpatient service users' choice of national and public (rather than private) hospitals. Based on Andersen's Behavioral Model, we developed a framework that covered needs, enabling, and personal factors. Data of outpatient service usage were obtained from the Korean medical panel survey during 2008 to 2013. Logistic regression analyses were conducted, and results revealed that the rate of national and public hospital use was very low (5.57%), and our model adequately explained variance in service use...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30924696/analysis-of-the-effect-of-the-elderly-s-labor-status-on-care-cost-at-the-end-of-life
#9
Eun-Jung Kim, Seok-Jun Yoon, Young-Eun Kim, Dunsol Go, Yunsun Jung, Munkhzul Radnaabaatar
This study quantitatively analyzes the effects of employment patterns at the time of death of the elderly on the utilization of medical care before death using the cohort data from the National Health Insurance Corporation, controlling mortality to obtain more accurate results. Gender was coded as 0 for males and 1 for females, and average monthly household income was taken as a logarithm to approximate a normal distribution. Care cost at the end of life was defined as the sum of the national health insurance contributions and statutory self-contributions...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30895826/estimated-costs-of-a-reinsurance-program-to-stabilize-the-individual-health-insurance-market-national-and-state-level-estimates
#10
Coleman Drake, Brett Fried, Lynn A Blewett
Reinsurance, an insurance product designed to protect health insurers against the financial risk of covering high-cost enrollees, has attracted bipartisan policy interest as a mechanism to stabilize individual health insurance markets. Three states-Alaska, Minnesota, and Oregon-have implemented state-based reinsurance programs under the Affordable Care Act's 1332 State Innovation Waivers, and reinsurance waivers have been approved though not yet enacted in Maine, Maryland, New Jersey, and Wisconsin. In this article, we estimate the costs of implementing national and state-based reinsurance programs using health spending data from the 2007-2016 Medical Expenditure Panel Survey and state demographic and health insurance coverage data from the 2015-2017 Current Population Survey Annual Social and Economic Supplement...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30894035/reduction-in-hospitals-readmission-rates-role-of-hospital-based-skilled-nursing-facilities
#11
Shivani Gupta, Ferhat D Zengul, Ganisher K Davlyatov, Robert Weech-Maldonado
Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role in lowering readmissions. Although having a hospital-based skilled nursing facility (HBSNF) in a hospital could help in improving care for patients needing short-term skilled nursing or rehabilitation services, little is known about HBSNFs' association with hospitals' readmission rates...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30854908/the-impact-of-neighborhood-environment-on-women-s-willingness-to-have-a-second-child-in-china
#12
Hongsheng Chen, Xingping Wang, Zhigang Li, Zhenjun Zhu
In recent years, the Chinese government has changed the one-child policy that was implemented more than 3 decades ago and has began encouraging couples to have 2 children. However, this cannot quickly change people's reproductive concepts after more than 30 years of low fertility rate and birth control. In this context, the aim of our study was to assess the effect of neighborhood environment on Chinese women's fertility-willingness for a second child. Our results show that there is a statistically significant relationship between neighborhood environment and women's fertility-willingness for a second child...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30845863/a-heuristic-governance-framework-for-the-implementation-of-child-primary-health-care-interventions-in-different-contexts-in-the-european-union
#13
Peter Schröder-Bäck, Tamara Schloemer, Timo Clemens, Denise Alexander, Helmut Brand, Kyriakos Martakis, Michael Rigby, Ingrid Wolfe, Kinga Zdunek, Mitch Blair
To adopt and implement innovative good practices across the European Union requires developing policies for different political and constitutional contexts. Health policies are mostly decided by national political processes at different levels. To attain effective advice for policy making and good practice exchange, one has to take different models of governance for health into account. We aimed to explore which concepts of governance research are relevant for implementing child health policies in a European Union context...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30791853/insurance-coverage-and-having-a-regular-provider-and-utilization-of-cancer-follow-up-and-noncancer-health-care-among-childhood-cancer-survivors
#14
Michael R Cousineau, Sue E Kim, Ann S Hamilton, Kimberly A Miller, Joel Milam
The objective of this study was to assess the role of health insurance coverage on patterns of health care utilization and access to cancer-related follow-up and non-cancer care among childhood cancer survivors (CCS). Cross-sectional survey design was used. Childhood cancer survivors were from 2 large hospitals in Los Angeles County. In all, 235 were identified through the Los Angeles Cancer Surveillance Program, diagnosed between the ages of 5 and 18 in 2000-2007 with any cancer type except Hodgkin lymphoma...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30791836/social-interventions-targeting-social-relations-among-older-people-at-nursing-homes-a-qualitative-synthesized-systematic-review
#15
Anne Sophie Bech Mikkelsen, Signe Petersen, Anne Cathrine Dragsted, Maria Kristiansen
Social relations are part of the complex set of factors affecting health and well-being in old age. This systematic review seeks to uncover whether social interventions have an effect on social and health-related measures among nursing home residents. The authors screened PubMed, Scopus, and PsycINFO for relevant peer-reviewed literature. Interventions were included if (1) they focused primarily on social relations or related terms such as loneliness, social support, social isolation, social network, or being involuntarily alone either as the base theory of the intervention or as an outcome measure of the intervention; (2) they were implemented at nursing homes (or similar setting); (3) they had a narrative activity as its core (as opposed to dancing, gardening or other physical activity); (4) their participants met either physically or nonphysically, ie, via video-conference or the like; and if (5) they targeted residents at a nursing home...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30739512/high-medicaid-nursing-homes-organizational-and-market-factors-associated-with-financial-performance
#16
Robert Weech-Maldonado, Justin Lord, Rohit Pradhan, Ganisher Davlyatov, Neeraj Dayama, Shivani Gupta, Larry Hearld
High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services' (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30739511/nursing-home-quality-and-financial-performance-is-there-a-business-case-for-quality
#17
Robert Weech-Maldonado, Rohit Pradhan, Neeraj Dayama, Justin Lord, Shivani Gupta
This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to 2014. Data were analyzed using panel data linear regression with facility and year fixed effects...
January 2019: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30371128/doctors-job-satisfaction-and-its-relationships-with-doctor-patient-relationship-and-work-family-conflict-in-china-a-structural-equation-modeling
#18
Shumin Deng, Ningxi Yang, Shiyue Li, Wei Wang, Hong Yan, Hao Li
The objective of this study was to evaluate the relationship of doctors' job satisfaction with doctor-patient relationship and work-family conflict in China. The data came from a cross-sectional survey in Hubei province, which was part of China's Fifth National Health Services Survey conducted in 2013. The survey in Hubei covered 54 secondary and tertiary general hospitals distributed in 20 counties. Of the 1080 questionnaires, 908 were included into our analysis. After surviving from reliability and validity tests, structural equation modeling was applied for further analysis with SPSS 20...
January 2018: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30264626/a-quantitative-observational-study-of-physician-influence-on-hospital-costs
#19
Herbert Wong, Zeynal Karaca, Teresa B Gibson
Physicians serve as the nexus of treatment decision-making in hospitalized patients; however, little empirical evidence describes the influence of individual physicians on hospital costs. In this study, we examine the extent to which hospital costs vary across physicians and physician characteristics. We used all-payer data from 2 states representing 15 237 physicians and 2.5 million hospital visits. Regression analysis and propensity score matching were used to understand the role of observable provider characteristics on hospital costs controlling for patient demographics, socioeconomic characteristics, clinical risk, and hospital characteristics...
January 2018: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://read.qxmd.com/read/30249150/the-effects-of-medicare-accountable-organizations-on-inpatient-mortality-rates
#20
Eli Cutler, Zeynal Karaca, Rachel Henke, Michael Head, Herbert S Wong
Studies have linked Accountable Care Organizations (ACOs) to improved primary care, but there is little research on how ACOs affect care in other settings. We examined whether Medicare ACOs have improved hospital quality of care, specifically focusing on preventable inpatient mortality. We used 2008-2014 Healthcare Cost and Utilization Project hospital discharge data from 34 states' Medicare ACO and non-ACO hospitals in conjunction with data from the American Hospital Association Annual Survey and the Survey of Care Systems and Payment...
January 2018: Inquiry: a Journal of Medical Care Organization, Provision and Financing
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