Inquiry J Health Car
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Inquiry J Health Car · Jan 2000
Multicenter StudyClinical and socioeconomic determinants of health care use among HIV-infected patients in the Department of Veterans Affairs.
This study estimates the impact of clinical and socioeconomic characteristics on health care use for HIV-infected patients. Data come from the Department of Veterans Affairs (VA) HIV Registry, which electronically extracts data from patients' automated medical records, and from patient interviews. ⋯ Results showed that clinical factors were the most important determinants of health care use; socioeconomic variables were seldom significant. These findings were expected, since the VA is an equal access system, providing care regardless of socioeconomic status.
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Inquiry J Health Car · Jan 2000
Measuring the effects of managed care on physicians' perceptions of their personal financial incentives.
Using data from the 1997 Resurvey of Young Physicians (N = 1,549), this study examines whether several measures of physicians' contractual arrangements with health plans are associated with their perceptions of overall financial incentives to either decrease or increase the volume of services to patients. Results indicate the following factors were significantly associated with an increased likelihood of reporting an incentive to decrease services: a gatekeeper arrangement with a compensation incentive; the perception of a high risk of plan deselection for physicians with high costs; the perception that referrals received depended on the costs of care provided; communication prohibiting or discouraging the disclosure to patients of the physician's financial relationship with the health plan; receiving capitation payments from at least one plan; and employment in a health maintenance organization. ⋯ Physicians' overall methods of compensation had a relatively small impact on their perceived financial incentives compared to other statistically significant factors. Our findings suggest that physicians' self-reported, overall personal financial incentives within their practices are a valid summary measure of the heterogeneous mix of specific financial arrangements faced by most physicians.
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Inquiry J Health Car · Jan 2000
Confirming insurance coverage in a telephone survey: evidence from the National Survey of America's families.
Until recently, most surveys of insurance coverage have classified people as uninsured if they have not been assigned some coverage in response to one of a series of questions about specific types of insurance. This "residual" approach to measuring uninsurance rates has not required respondents to either verify their insurance status or confirm that they are uninsured. Using the 1997 National Survey of America's Families, this paper examines the impact of a question confirming whether individuals for whom no insurance coverage is reported are, in fact, uninsured. The results of our analysis suggest that a confirmation question as part of a telephone-based survey works to lower estimates of the uninsured.
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Inquiry J Health Car · Jan 2000
Medicaid-eligible children who don't enroll: health status, access to care, and implications for Medicaid enrollment.
We estimate that 17% of Medicaid-eligible children in the United States are uninsured, with 27% covered by private insurance. Uninsured children have become a target for state outreach and enrollment efforts. However, the effort may not be a worthwhile use of resources if these children have sufficient access to primary care and are able to enroll in Medicaid should serious health problems arise. ⋯ Being uninsured also decreases by nine percentage points the proportion of children with any health provider visits, and increases by 12 percentage points the proportion with family out-of-pocket expenses exceeding $500. These findings lend support to the hypothesis that the enrollment process is onerous for some families. Targeted efforts to enroll uninsured Medicaid-eligible children could help in reducing the effect of barriers and reducing differences in access to care.