Abstract:
OBJECTIVE:To describe how the organization and dynamics of health systems changed between 1999 and 2001, in the context of expectations from the mid-1990s when managed care was in ascendance, and assess the implications for consumers and policymakers. DATA SOURCES/STUDY SETTING:Data are from the Community Tracking Study site visits to 12 communities that were randomly selected to be nationally representative of metropolitan areas with 200,000 people or more. The Community Tracking Study is an ongoing effort that began in 1996 and is fielded every two years. STUDY DESIGN:Semistructured interviews were conducted with 50-90 stakeholders and observers of the local health care market in each of the 12 communities every two years. Respondents include leaders of local hospitals, health plans, and physician organizations and representatives of major employers, state and local governments, and consumer groups. First round interviews were conducted in 1996-1997 and subsequent rounds of interviews were conducted in 1998-1999 and 2000-2001. A total of 1,690 interviews were conducted between 1996 and 2001. DATA ANALYSIS METHODS: Interview information was stored and coded in qualitative data analysis software. Data were analyzed to identify patterns and themes within and across study sites and conclusions were verified by triangulating responses from different respondent types, examining outliers, searching for disconfirming evidence, and testing rival explanations. PRINCIPAL FINDINGS:Since the mid-1990s, managed care has developed differently than expected in local health care markets nationally. Three key developments shaped health care markets between 1999 and 2001: (1) unprecedented, sustained economic growth that resulted in extremely tight labor markets and made employers highly responsive to employee demands for even fewer restrictions on access to care; (2) health plans increasingly moved away from core strategies in the "managed care toolbox"; and (3) providers gained leverage relative to managed care plans and reverted to more traditional strategies of competing for patients based on services and amenities. CONCLUSIONS:Changes in local health care markets have contributed to rising costs and created new access problems for consumers. Moreover, the trajectory of change promises to make the goals of cost-control and quality improvement more difficult to achieve in the future.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Lesser CS,Ginsburg PB,Devers KJdoi
10.1111/1475-6773.00119keywords:
subject
Has Abstractpub_date
2003-02-01 00:00:00pages
337-55issue
1 Pt 2eissn
0017-9124issn
1475-6773journal_volume
38pub_type
杂志文章abstract:OBJECTIVE:To test the effects of state prescription contraception insurance mandates on unintended, mistimed, and unwanted births in a sample of privately insured recent mothers. DATA:We pooled Pregnancy Risk Assessment Monitoring System (PRAMS) data from 1997 to 2012 to study 209,964 privately insured recent mothers ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12792
更新日期:2017-12-01 00:00:00
abstract::In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is ...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00
abstract::Previous research has confirmed that desirable hospital attributes as well as increased distance, or travel time, have an impact on hospital choice. These studies have become increasingly sophisticated in modeling choice. This study adds to the existing literature by estimating the effect of both hospital and individu...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1991-12-01 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: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 describe the insurance status of workers at small businesses, and to describe the status of uninsured persons by the employment characteristics (employment status, firm size, and whether the employer offers insurance) of the head of household. DATA SOURCES:Data from the March and February 2001 Current Pop...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2005.00467.x
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes. STUDY SETTING:Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network. STUDY DESIGN:A retrospec...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2005.00423.x
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:To estimate the effect of a nursing home's share of residents with a serious mental illness (SMI) on the quality of care. DATA SOURCES:Secondary nursing home level data over the period 2000 through 2008 obtained from the Minimum Data Set, OSCAR, and Medicare claims. STUDY DESIGN:We employ an instrumental va...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12023
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study is to determine whether women who have been diagnosed with HIV utilize the same volume of medical care services as men who have been diagnosed with HIV. DATA SOURCES:This study uses data from the first wave of interviews of the AIDS Cost and Service Utilization Survey (ACSUS) conduc...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVE:To estimate county-level associations between in utero exposure to threatened evictions and preterm birth in the United States. DATA SOURCES:Complete birth records were obtained from the National Center for Health Statistics (2009-2016). Threatened evictions were measured at the county level using eviction c...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13551
更新日期:2020-10-01 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:OBJECTIVE:To examine the service experiences and outcomes of low-income Medicaid beneficiaries with disabilities under two different models for organizing home-based personal assistance services: agency-directed and consumer-directed. DATA SOURCE:A survey of a random sample of 1,095 clients, age 18 and over, who recei...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVE:To efficiently estimate race/ethnicity using administrative records to facilitate health care organizations' efforts to address disparities when self-reported race/ethnicity data are unavailable. DATA SOURCE:Surname, geocoded residential address, and self-reported race/ethnicity from 1,973,362 enrollees of a...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2008.00854.x
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:This study explores the impact of multiple-site practices on the distribution of physician services within a medical service region. DATA SOURCES AND STUDY SETTING:A questionnaire was mailed to all urologists (100 percent response rate) practicing in north central Connecticut (the Hartford medical service ar...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice. DATA SOURCES/STUDY SETTING:Ambulatory-based general internists in 13 states participated in the assessment. STUDY DESIGN:We assessed physician-level performance, adjuste...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2010.01160.x
更新日期:2010-12-01 00:00:00
abstract:OBJECTIVE:To compare standardized estimates of the true resource costs of outpatient health care to the allowable and billed charges for that care among Medicare Fee for Service (FFS) beneficiaries. DATA SOURCES/STUDY SETTING:Medicare Carrier and Outpatient Standard Analytic (SAF) files linked to participant data in t...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12318
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVE:To examine the determinants of postsurgery length of stay (LOS) and inpatient mortality in the United States (California and Massachusetts) and Canada (Manitoba and Quebec). DATA SOURCES/STUDY SETTING:Patient discharge abstracts from the Agency for Health Care Policy and Research Nationwide Inpatient Sample ...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2000-03-01 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: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:RESEARCH OBJECTIVE:To track response rates across time for surveys of pediatricians, to explore whether response bias is present for these surveys, and to examine whether response bias increases with lower response rates. DATA SOURCE/STUDY SETTING:A total of 63,473 cases were gathered from 50 different surveys of pedi...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2005.00350.x
更新日期:2005-02-01 00:00:00
abstract::The concept of propensity to use ambulatory care is defined as the probability that a utilization occurs in a very small interval of time, given that no utilization has been observed before. With this definition of utilization, survival analysis can be used to assess the effect of a set of predictors on utilization. T...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1988-06-01 00:00:00
abstract:OBJECTIVES:To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home. DATA SOURCES:2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12215
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVE:To examine measures of need for health care and their relationship to utilization of health services in different racial and ethnic groups in California. DATA SOURCE:Telephone interviews obtained by random-digit dialing and conducted between April 1993 and July 1993 in California, with 7,264 adults (ages 18-...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the impact of health professionals' intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. STUDY SETTING:Forty-six community pharmacies and 50...
journal_title:Health services research
pub_type: 杂志文章,随机对照试验
doi:10.1111/1475-6773.13152
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To estimate 2012 tax expenditures for employer-sponsored insurance (ESI) in the United States and to explore the sensitivity of estimates to assumptions regarding the incidence of employer premium contributions. DATA SOURCES:Nationally representative Medical Expenditure Panel Survey data from the 2005-2007 H...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12037
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVE:To examine concordance between member self-reports and the organization's administrative claims data for two key health factors: number of chronic conditions, and number of prescription drugs. DATA:Medicare Advantage plan claims data and member survey data from 2011 to 2012. DESIGN:Mailed surveys to 15,000 ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12356
更新日期:2016-06-01 00:00:00
abstract::Properties of the inverse gaussian distribution are presented with comments on fitting the distribution to lentgh-of-stay data. A conceptual framework for the hospitalization process is described; it suggests that the inverse gaussian distribution has considerable potential as both a descriptive and prescriptive model...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1975-10-01 00:00:00
abstract:OBJECTIVE:Evaluate the association between opioid therapy and health-related quality of life (HRQoL) in participants with chronic, noncancer pain (CNCP). DATA SOURCES:Medical Expenditure Panel Survey Longitudinal, Medical Conditions, and Prescription Files. STUDY DESIGN:Using a retrospective cohort study design, the ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12836
更新日期:2018-10-01 00:00:00
abstract:RESEARCH OBJECTIVE:This study examines small area variations in readmission rates to assess whether higher readmission rate in an area is associated with higher clusters of patients with multiple chronic conditions. STUDY DESIGN:The study uses hospital discharge data of adult (18+) patients in 6 U.S. states for 2009 f...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12401
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVE:To examine how plan premiums are associated with physician network breadth, hospital network breadth, and hospital network quality on the Affordable Care Act's Health Insurance Marketplaces in all 50 states and the DC in 2016. DATA SOURCES:Data on plan premiums and characteristics came from 2016 Robert Wood ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13447
更新日期:2020-08-13 00:00:00