Abstract:
OBJECTIVE: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. DATA SOURCES:Based on 1991-1993 Medicare Current Beneficiary Survey data, linked to the beneficiary's claims and area-level data on provider supply from the Area Resources File and the American Psychological Association. STUDY DESIGN:Outcomes examined included the number of psychiatric services received, psychiatric and total Medicare expenditures, the type of services received, whether or not the patient was hospitalized for a psychiatric disorder, the length of the psychiatric care episode, the intensity of service use, and satisfaction with care. We compared these outcomes for beneficiaries who did and did not receive mental health specialty services during the episode, using multiple regression analyses to adjust for observable population differences. We also performed sensitivity analyses using instrumental variables techniques to reduce the potential bias arising from unmeasured differences in patient case mix across sectors. PRINCIPAL FINDINGS:Relative to beneficiaries treated only in the general medical sector, those seen by a mental health specialist had longer episodes of care, were more likely to receive services specific to psychiatry, and had greater psychiatric and total expenditures. Among the elderly persons, the higher costs were due to a combination of longer episodes and greater intensity; among the persons who were disabled, they were due primarily to longer episodes. Some evidence was also found of higher satisfaction with care among the disabled individuals treated in the specialty sector. However, evidence of differences in psychiatric hospitalization rates was weaker. CONCLUSIONS: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.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Ettner SL,Hermann RC,Tang Hkeywords:
subject
Has Abstractpub_date
1999-08-01 00:00:00pages
737-60issue
3eissn
0017-9124issn
1475-6773journal_volume
34pub_type
杂志文章abstract:OBJECTIVE:This commentary summarizes the methods and topics addressed in the special issue of HSR focused on linkage of United States Department of Veterans Affairs (VA) and non-VA datasets. The issue illustrates that researchers are increasingly linking diverse datasets as a valuable method for obtaining outcomes, tre...
journal_title:Health services research
pub_type:
doi:10.1111/1475-6773.13081
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:To assess relationships between changes in Medicare Advantage (MA) payment rates and Medicare beneficiary hospitalizations and to simulate the effects of scheduled payment cuts on ambulatory care sensitive (ACS) and elective hospitalization rates. DATA:State Inpatient Database discharge abstracts from Arizon...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2011.01275.x
更新日期:2011-10-01 00:00:00
abstract:OBJECTIVE:To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. DATA SOURCES:Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2007.00762.x
更新日期:2008-02-01 00:00:00
abstract:RESEARCH OBJECTIVE:To assess the impact of recent Medicare prospective payment system (PPS) changes on efficiency in skilled nursing homes. DATA SOURCE/STUDY SETTING:Medicare Cost Reports (MCR), On-line Survey Certification and Reporting System (OSCAR), Area Resource Files (ARF), a Centers for Medicare and Medicaid Se...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2007.00798.x
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVE:To examine whether disparities in health care experiences of Medicare beneficiaries differ between managed care (Medicare Advantage [MA]) and traditional fee-for-service (FFS) Medicare. DATA SOURCES:132,937 MA and 201,444 FFS respondents to the 2007 Medicare Consumer Assessment of Health Care Providers and S...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2011.01245.x
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. STUDY SETTING:Six hospita...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12581
更新日期:2017-10-01 00:00:00
abstract::Does a prepaid group practice relative to comparable fee-for-service plans lead to different mental health outcomes for its beneficiaries? To answer this question, we used data from the RAND Health Insurance Experiment. We observed no statistically significant or clinically meaningful differences in mental health outc...
journal_title:Health services research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1990-10-01 00:00:00
abstract::Alternative delivery systems, such as HMOs, PPOs, and primary care case-management programs, have a long history in rural America despite significant impediments to their development. However, little is known about the effect of these systems on rural communities and their medical care delivery systems. Existing studi...
journal_title:Health services research
pub_type: 历史文章,杂志文章,评审
doi:
更新日期:1989-02-01 00:00:00
abstract:BACKGROUND:Many states have passed legislation mandating that health plans provide direct access to obstetricians/gynecologists (hereinafter "ob/gyns") for women, limiting the ability of plans to require referrals or otherwise restrict access. One benefit of these laws may be improved preventive screening rates, but no...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00646.x
更新日期:2007-06-01 00:00:00
abstract::The planning, budgeting, and controlling processes (PBCP) largely subsume all of the planning and controlling activities of an organization. This paper discusses these activities within the context of a single management control system, focusing on three topics. First, a brief historical perspective of management conc...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1979-07-01 00:00:00
abstract:OBJECTIVE:This study investigated whether unexpected length of stay (LOS) could be used as an indicator to identify hospital patients who experienced complications or whose care exhibited low adherence to normative practices. DATA SOURCES AND STUDY SETTING:We analyzed 1,477 cases admitted for one of three medical cond...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:
更新日期:1995-10-01 00:00:00
abstract:OBJECTIVE:To develop a framework that public health practitioners could use to measure the value of public health services. DATA SOURCES:Primary data were collected from August 2006 through March 2007. We interviewed (n=46) public health practitioners in four states, leaders of national public health organizations, an...
journal_title:Health services research
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1475-6773.2009.01013.x
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:To summarize the state of the art in quality improvement, review its application to care for children, and define the information that will be needed so that care for children can be further improved. PRINCIPAL FINDINGS:Health services for children exhibit numerous deficiencies in quality of care. The defici...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:
更新日期:1998-10-01 00:00:00
abstract:OBJECTIVE:To assess whether distance to services or diagnosis at a hospital-based medical center compared with a community clinic influences the receipt of psychotherapy versus pharmacotherapy for depression. DATA SOURCE:Veterans Affairs (VA) administrative data for 132,329 depressed veterans between October 2003 and ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2010.01228.x
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:To quantify the impact of multiyear utilization of preventive dental services on downstream dental care utilization and expenditures for children. DATA SOURCES/STUDY SETTING:We followed 0.93 million Medicaid-enrolled children who were 3-6 years old in 2005 from 2005 to 2011. We used Medicaid claims data of A...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12811
更新日期:2018-10-01 00:00:00
abstract::This article describes a model development process that represents a useful step in classifying populations in terms of risk of institutionalization (Inst-Risk II). A four-category risk classification system--"High risk, Some risk, Low risk, and Very Low Risk"--was developed, based on combinations of measures of funct...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1988-10-01 00:00:00
abstract:OBJECTIVE:We study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. DATA SOURCE:Uninsured U.S. citizens and noncitizens from the 2005-2006 and 2008-2009 Medical Expenditure Panel Survey. ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12193
更新日期:2014-12-01 00:00:00
abstract:OBJECTIVE:Using a socio-ecological model, this study examines the influence of facility characteristics on the transition of nursing home residents to the community after a short stay (within 90 days of admission) or long stay (365 days of admission) across states with different long-term services and supports systems....
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12340
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life-a group that accounts for more than one-quarter of Medicare's annual exp...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2004.00218.x
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:To examine the association between dialysis facility chain affiliation and patient mortality. STUDY SETTING:Medicare dialysis population. STUDY DESIGN:Data from the United States Renal Data System (USRDS) were used to identify 3,601 free-standing dialysis facilities and 34,914 Medicare patients' incidence t...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2010.01219.x
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:To examine changes in children's albuterol use and out-of-pocket (OOP) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (CFC) propellants. SETTING:Four health maintenance organizations (HMOs), two that increased copayments for albuterol ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12615
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:To assess whether participation in a state publicly financed health insurance program, Massachusetts Children's Medical Security Plan (CMSP) , which is open to children regardless of income, was associated with disenrollment from private insurance. DATA SOURCES/STUDY DESIGN:A survey of participants in CMSP w...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2001-12-01 00:00:00
abstract:OBJECTIVE:To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs). DATA SOURCES:Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Ass...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12032
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:This study is designed to assess the cost of services provided to Medicare beneficiaries by nurse practitioners (NPs) billing under their own National Provider Identification number as compared to primary care physicians (PCMDs). DATA SOURCE:Medicare Part A (inpatient) and Part B (office visit) claims for 20...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12425
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To examine the effect of Medicaid expansions on health insurance coverage and access to care among low-income adults with behavioral health conditions. DATA SOURCES/STUDY SETTING:Nine years (2004-2012) of individual-level cross-sectional data from a restricted-access version of National Survey on Drug Use an...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12411
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:To examine factors associated with Medicaid acceptance for substance abuse (SA) services by outpatient SA treatment programs. DATA SOURCES:Secondary analysis of 2003-2006 National Survey of Substance Abuse Treatment Services data combined with state Medicaid policy and usage measures and other publicly avail...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2010.01206.x
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVE:This paper analyzes whether the rise in managed care during the 1990s caused the increase in hospital concentration. DATA SOURCES:We assemble data from the American Hospital Association, InterStudy and government censuses from 1990 to 2000. STUDY DESIGN:We employ linear regression analyses on long differenc...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00601.x
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Racial and ethnic disparities in health and health care have been documented; the elimination of such disparities is currently part of a national agenda. In order to meet this national objective, it is necessary that measures identify accurately the true prevalence of the construct of interest across diverse...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:10.1111/j.1475-6773.2005.00450.x
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:To develop and test a new outcome measure, Conditional Length of Stay (CLOS), to assess hospital performance when deaths are rare and complication data are not available. DATA SOURCES:The 1991 and 1992 MedisGroups National Comparative Data Base. STUDY DESIGN:We use engineering reliability theory traditional...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVES:To assess the relative abilities of clinical and administrative data to predict mortality and to assess hospital quality of care for CABG surgery patients. DATA SOURCES/STUDY SETTING:1991-1992 data from New York's Cardiac Surgery Reporting System (clinical data) and HCFA's MEDPAR (administrative data). STUD...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1997-02-01 00:00:00