Objective. To determine whether hospital mortality rates changed inNew Jersey after
implementation of a law that changed hospital payment from a regulated system based
on hospital cost to price competition with reduced subsidies for uncompensated care
and whether changes in mortality rates were affected by hospital market conditions.
Data Sources/Study Setting. State discharge data for New Jersey and New York
from 1990 to 1996.
American Journal of Medical Quality-November/December 2008
Vol. 23, No. 6
November/December 2008
Halm, E.A., Press, M.J., Tuhrim, S., Wang, J., Rojas, M., and M.R. Chassin
pp. 448-56
This was a population-based observational study to assess the impact of managed care (MC) on several dimensions of quality of surgical care among Medicare beneficiaries undergoing carotid endarterectomies (CEAs) (N = 9308) in New York. Clinical data were abstracted from medical charts to assess appropriateness and deaths or strokes within 30 days of surgery. Differences in patients, appropriateness, and outcomes were compared using chi-square tests; risk-adjusted outcomes were compared using regression.
Kincheloe, J., Brown, E.R., Frates, J., Call, K.T., Yen, W., and J. Watkins
pp. 1163-7
Health foundations, such as the Robert Wood Johnson Foundation(RWJF), make multimillion-dollar investments in programs toexpand insurance coverage. These efforts are driven largelyby estimates of the number of uninsured people derived frompopulation surveys, which might overestimate the number of uninsuredpeople if they under-count people enrolled in Medicaid.
Objective: This study examines the process by which patients search for and choose physicians.
Data Source: A survey to a random sample of individuals between the ages of 21 and 64 with employer-related health benefits, drawn from a nationally representative panel of households. STUDY
Haas, J., Udvarhelyi, S., Morris, C., and A. Epstein
pp. 61-4
OBJECTIVES--Although there has been substantial policy interest in interventions to improve the neonatal outcomes of disadvantaged women, little attention has been paid to the health status of pregnant women themselves. We therefore examined whether the provision of health coverage to uninsured low-income pregnant women affects maternal health status or the use of cesarean section. DESIGN--Natural experiment in Massachusetts. PATIENTS--All in-hospital, single-gestation births in 1984 (N = 57,257) and 1987 (N = 64,346).
Taylor Jr, D.H., Ostermann, J., Van Houtven, C.H., Tulsky, J.A., and K. Steinhauser
pp. 1466-78
Hospices have been expected to reduce health expenditures since their addition to the US Medicare benefit package in the early-1980s, but the literature on their ability to do so is mixed. The contradictory findings noted in previous studies may be due to selection bias and the period of cost comparison used. Accounting for these, this study focuses on the length of hospice use that maximizes reductions in medical expenditures near death.
Health insurance purchasing cooperatives were established in the early to mid-1990s for the purpose of making health insurance more affordable and accessible for small employers. Extensive interviews at six cooperatives reveal that while some cooperatives enrolled large numbers of small employers, most have won only small market shares and a number have struggled for survival, not always successfully. They have allowed small employers to offer individual employees choice of health plans, but none has been able to sustain lower prices than are available in the conventional market.
This study estimated the effect of mergers on health maintenance organization (HMO) premiums, using data on all operational non-Medicaid HMOs in the United States from 1985 to 1993. Two critical issues were examined: whether HMO mergers increase or decrease premiums; and whether the effects of mergers differ according to the degree of competition among HMOs in local markets. The only significant merger effect was found in the most competitive markets, where premiums increased, but only for 1 year after the merger.
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