Health services research
-
Health services research · Apr 1999
Comparative StudyOut-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries.
To estimate out-of-pocket health care spending by lower-income Medicare beneficiaries, and to examine spending variations between those who receive Medicaid assistance and those who do not receive such aid. DATA SOURCES AND COLLECTION: 1993 Medicare Current Beneficiary Survey (MCBS) Cost and Use files, supplemented with data from the Bureau of the Census (Current Population Survey); the Congressional Budget Office; the Health Care Financing Administration, Office of the Actuary (National Health Accounts); and the Social Security Administration. ⋯ While Medicaid provides substantial protection for some lower-income Medicare beneficiaries, out-of-pocket health care spending continues to be a substantial burden for most of this population. Medicare reform discussions that focus on shifting more costs to beneficiaries should take into account the dramatic costs of health care already faced by this vulnerable population.
-
To study patterns of referral between primary and specialty care providers among Medicare beneficiaries and to identify correlates of the probability of referral. ⋯ Medicare referral patterns are similar to those found in other studies. Patient factors appear to be a more important factor in explaining referrals than was estimated from prior research. Additional research is needed to explain the more complex dynamics of referral patterns.
-
To examine primary care physician referral rate variations, including their extent and their stability over time and across diagnostic categories. ⋯ PCP referral rates exhibit wide variations that are independent of case mix, remain stable over time, and are generalizable across diagnostic categories. Understanding this physician practice variation and its relationship to costs and outcomes is critical to evaluating the effect of current efforts to reduce PCP referral rates.
-
Health services research · Apr 1999
Comparative StudyBarriers between guidelines and improved patient care: an analysis of AHCPR's Unstable Angina Clinical Practice Guideline. Agency for Health Care Policy and Research.
To describe common barriers that limit the effect of guidelines on patient care, with emphasis on recommendations for triage in the Agency for Health Care Policy and Research (AHCPR) Unstable Angina Clinical Practice Guideline. ⋯ Careful analysis of guideline attributes, projected effect on medical care, and organizational factors reveal several barriers to successful guideline implementation that should be addressed in the design of future guideline-based interventions.
-
To determine the effects of state legislation requiring patient informed consent prior to medical record abstraction by external researchers for a specific study. ⋯ Legislation requiring patient informed consent to gain access to medical records for a specific research study was associated with low participation and increased time to complete that observational study. Efforts to protect patient privacy may come into conflict with the ability to produce timely and valid research to safeguard and improve public health.