Inquiry J Health Car
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Inquiry J Health Car · Jan 1995
The impact of non-IPA HMOs on the number of hospitals and hospital capacity.
Concentration in the hospital market could limit the success of health care reform strategies that rely on managed care to constrain costs. Hospital market capacity also is important because capacity affects both costs and the degree of price competition. ⋯ Using Standard Metropolitan Statistical Area (SMSA) data from 1982 and 1987, a 10-percentage point increase in non-IPA HMO market share is estimated to reduce the number of hospitals by about 4%, causing an approximate 5% reduction in the number of hospital beds. No statistically significant relationship is found between non-IPA HMO penetration rates and hospital occupancy rates.
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Inquiry J Health Car · Jan 1995
Medicaid expansions for pregnant women and infants: easing hospitals' uncompensated care burdens?
Hospitals' bad debt and charity care increased by nearly 30% between 1987 and 1990. However, beginning in 1987, federal legislation expanded Medicaid eligibility to pregnant women and infants with family incomes up to 133% of the federal poverty level, and gave states the option to extend coverage up to 185% of poverty. ⋯ Controlling for other factors associated with provision of uncompensated care, this analysis shows the Medicaid expansions reduced uncompensated care by roughly 5.4%. For hospitals with a significant commitment to maternity and infant care, the burdens of uncompensated care were 28.5% lower than they would have been without the expansions.
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We provide an appraisal of the adequacy of the aggregate supply of nurses and the appropriateness of their educational mix in view of anticipated changes in health care. We view the supply as adequate, but the educational mix as deficient with regard to nurses with baccalaureate and higher degrees who will be in greatest demand in new and expanding roles. Five priority areas are identified in which nursing can make particularly important contributions to improving health and health care: restructuring hospitals, improving primary care availability, contributing to the viability of academic health centers, improving care of the underserved, and redesigning the role of public health in a reformed health care system.