Health services research
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Health services research · Oct 1999
Comparative StudyUnequal access to cadaveric kidney transplantation in California based on insurance status.
To assess the impact of insurance status on access to kidney transplantation among California dialysis patients. ⋯ California dialysis patients excluded from Medicare coverage, who are disproportionately minority, female, and poor, are much less likely to enter the U.S. transplant system. We hypothesize that patient concerns with potential subsequent loss of insurance coverage as well as cultural and educational barriers are possible explanatory factors. Once in the system, however, insurance status does not influence receipt of a cadaveric renal transplant.
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Health services research · Aug 1999
Randomized Controlled Trial Comparative Study Clinical TrialEffects of the Medicare Alzheimer's Disease Demonstration on caregiver burden and depression.
Does improved access to community-based care reduce perceived burden and reported levels of depression among primary caregivers of people with dementia? ⋯ Both the fact that these programmatic differences did not translate into substantial treatment group reductions in caregiver burden or depression, and the consistency of these findings with those of prior case management evaluations suggest the need to reformulate this programmatic intervention into areas not previously tested: 24-hour care, crisis intervention, coordination with primary care, or chronic disease management.
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Health services research · Aug 1999
Comparative StudyDifferences between generalists and mental health specialists in the psychiatric treatment of Medicare beneficiaries.
To examine differences between the general medical and mental health specialty sectors in the expenditure and treatment patterns of aged and disabled Medicare beneficiaries with a physician diagnosis of psychiatric disorder. ⋯ Mental health care provided to Medicare beneficiaries in the general medical sector does not appear to substitute perfectly for care provided in the specialty sector. Our study suggests that the treatment patterns in the specialty sector may be preferred by some patients; further, earlier findings indicate geographic barriers to obtaining specialty care. Thus, the matching of service use to clinical need among this vulnerable population may be inappropriate. The need for further research on outcomes is indicated.
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Health services research · Jun 1999
Patient assessments of hospital maternity care: a useful tool for consumers?
To examine three issues related to using patient assessments of care as a means to select hospitals and foster consumer choice-specifically, whether patient assessments (1) vary across hospitals, (2) are reproducible over time, and (3) are biased by case-mix differences. ⋯ The findings indicate that patient assessments of care may be a sensitive measure for discriminating among hospitals. In addition, hospital scores are reproducible and not substantially affected by case-mix differences. If our findings regarding patient assessments are generalizable to other patient populations and delivery settings, these measures may be a useful tool for consumers in selecting hospitals or other healthcare providers.
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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.