Differentiation and specialization in the California hospital industry 1983 to 1988.


:This article examines changes in the service mix of California hospitals as part of their response to shifts in the system of reimbursement between 1983 and 1988. The Hospital Discharge Data Set and the Annual Hospital Disclosure Report produced by California Office of Statewide Health Planning and Development were used in this study. Characteristics of inpatient hospital services in California before and after the introduction of new reimbursement mechanisms (including the Medicare Prospective Payment System [PPS] and the growth of selective contracting plans) were compared. The factors that influence two measures of hospital service mix, one focusing on specialization and the other on differentiation, were studied. The factors included hospital characteristics and changes in hospital reimbursement. Variables describing a hospital's service mix and the level in its market were constructed from data in the annual discharge abstracts. Data pertaining to average hospital costs and reimbursements under the Medicare PPS were drawn from a file containing a 20% sample of hospital stay records for the year of PPS. Other hospital data, such as ownership and bed size, were taken from the California Annual Disclosure Report data set. The results indicate that completion among hospitals tended to increase differentiation whereas higher financial PPS pressure is associated with increased specialization. Hospitals tend to adopt some high visibility services offered by their competitors while filling market niches selectively overall. It also appears that the cost savings expected for specialization may prevail only for narrowly defined services. Study of subsequent data sets should show whether the cost containment strategies used by the hospitals to achieve these results have been maintained over a period of sustained financial pressure.


Med Care


Medical care


Zwanziger J,Melnick GA,Simonson L




Has Abstract


1996-04-01 00:00:00












  • Improving risk adjustment for Medicare capitated reimbursement using nonlinear models.

    abstract:OBJECTIVES:This article compares a linear risk-adjusted model of medical expenditures for Medicare patients with a model that explicitly account for skewness in distribution of expenditures. METHODS:A model of expenditures and a model of the square root of expenditures, each expressed as linear combinations of risk ad...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Veazie PJ,Manning WG,Kane RL

    更新日期:2003-06-01 00:00:00

  • Identifying risk factors for racial disparities in diabetes outcomes: the translating research into action for diabetes study.

    abstract:BACKGROUND:Versus whites, blacks with diabetes have poorer control of hemoglobin A1c (HbA1c), higher systolic blood pressure (SBP), and higher low-density lipoprotein (LDL) cholesterol as well as higher rates of morbidity and microvascular complications. OBJECTIVE:To examine whether several mutable risk factors were m...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Duru OK,Gerzoff RB,Selby JV,Brown AF,Ackermann RT,Karter AJ,Ross S,Steers N,Herman WH,Waitzfelder B,Mangione CM

    更新日期:2009-06-01 00:00:00

  • Differences in the kinds of problems consumers report in staff/group health maintenance organizations, independent practice association/network health maintenance organizations, and preferred provider organizations in California.

    abstract:BACKGROUND:Little is known about the extent to which consumers have specific problems with their managed care organizations (MCOs) or whether these problems differ by type of MCO. OBJECTIVE:To estimate the prevalence at which consumers in managed care report specific problems and to assess whether rates in preferred p...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Schauffler HH,McMenamin S,Cubanski J,Hanley HS

    更新日期:2001-01-01 00:00:00

  • Physicians' response to length-of-stay profiling.

    abstract::One of the techniques adopted recently by certain hospitals to meet the competitive pressure for reducing costs is physician profiling. Profiling produces periodic reports that compare a physician's resource consumption to a benchmark figure. This study analyzes the effectiveness and implications of one hospital's int...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Evans JH 3rd,Hwang Y,Nagarajan N

    更新日期:1995-11-01 00:00:00

  • Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care.

    abstract:BACKGROUND:Primary care teams face daily time pressures both during patient encounters and outside of appointments. OBJECTIVES:We theorize 2 types of time pressure, and test hypotheses about organizational determinants and patient consequences of time pressure. RESEARCH DESIGN:Cross-sectional, observational analysis ...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: McDonald KM,Rodriguez HP,Shortell SM

    更新日期:2018-10-01 00:00:00

  • Social support and risk-adjusted mortality in a frail older population.

    abstract:OBJECTIVE:The objective of this study was to test the hypothesis that social support is an important predictor of mortality in a frail older population receiving formal long-term care services. RESEARCH DESIGN AND METHODS:The analysis is based on 3138 individuals enrolled in 28 Programs of All-Inclusive Care for the E...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Temkin-Greener H,Bajorska A,Peterson DR,Kunitz SJ,Gross D,Williams TF,Mukamel DB

    更新日期:2004-08-01 00:00:00

  • An Electronic Health Record-based Algorithm to Ascertain the Date of Second Breast Cancer Events.

    abstract:OBJECTIVES:Studies of cancer recurrences and second primary tumors require information on outcome dates. Little is known about how well electronic health record-based algorithms can identify dates or how errors in dates can bias analyses. RESEARCH DESIGN:We assessed rule-based and model-fitting approaches to assign ev...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Chubak J,Onega T,Zhu W,Buist DSM,Hubbard RA

    更新日期:2017-12-01 00:00:00

  • Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type.

    abstract:OBJECTIVE:To establish a baseline for the incidence of sepsis by severity and presence on admission in acute care hospital settings before implementation of a broad sepsis screening and response initiative. METHODS:A retrospective cohort study using hospital discharge abstracts of 5672 patients, aged 18 years and abov...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Jones SL,Ashton CM,Kiehne LB,Nicolas JC,Rose AL,Shirkey BA,Masud F,Wray NP

    更新日期:2016-03-01 00:00:00

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    abstract::While Preferred Provider Organizations (PPOs) are designed to contain the costs of health care, they may not be able to do so if sicker individuals opt not to use PPO providers. This study examined how level of mental health status and prior use of mental health services affected the decision to use or not use PPO pro...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Wells KB,Marquis MS,Hosek SD

    更新日期:1991-09-01 00:00:00

  • Review of methods to determine VA health care costs.

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    journal_title:Medical care

    pub_type: 杂志文章,评审


    authors: Barnett PG

    更新日期:1999-04-01 00:00:00

  • Mapping the SF-12 to preference-based instruments: convergent validity in a low-income, minority population.

    abstract:BACKGROUND:The profile-based SF-12 has a low respondent burden and is used widely in clinical settings to monitor health and evaluate programs. Deriving preference scores for the SF-12 health profile would permit its use in cost-effectiveness analyses. Previous mapping studies of SF family instruments to preference-bas...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Franks P,Lubetkin EI,Gold MR,Tancredi DJ

    更新日期:2003-11-01 00:00:00

  • Case mix and outcomes of nursing home patients. The importance of prior nursing home care and admission from home versus hospital.

    abstract::The authors compared the personal characteristics, measures of functional status/case mix, and discharge outcomes of nursing home patients admitted to skilled nursing facilities (SNFs) in 1984 for the first time (first admissions) to those of patients with a prior history of nursing home care (readmissions). Compared ...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Lewis MA,Leake B,Clark V,Leal-Sotelo M

    更新日期:1989-04-01 00:00:00

  • Evaluation of an Osteoporosis Outreach Program for Men With a Fragility Fracture and Their Physicians.

    abstract:BACKGROUND:Many health plans have outreach programs aimed at appropriately screening, evaluating, and treating women experiencing fragility fractures; however, few programs exist for men. OBJECTIVE:The objective of this study was to develop, implement, and evaluate an osteoporosis outreach program for men with a recen...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Pasquale MK,Sheer RL,Yehoshua A,McFadden A,Chines A,Caloyeras J

    更新日期:2021-02-01 00:00:00

  • Impact of Medicare's Nonpayment Program on Hospital-acquired Conditions.

    abstract:BACKGROUND:Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inp...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Thirukumaran CP,Glance LG,Temkin-Greener H,Rosenthal MB,Li Y

    更新日期:2017-05-01 00:00:00

  • Associations between health status and utilities implications for policy.

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    journal_title:Medical care

    pub_type: 杂志文章


    authors: Lenert LA,Treadwell JR,Schwartz CE

    更新日期:1999-05-01 00:00:00

  • Hospital Characteristics Associated With Risk-standardized Readmission Rates.

    abstract:BACKGROUND:Safety-net and teaching hospitals are somewhat more likely to be penalized for excess readmissions, but the association of other hospital characteristics with readmission rates is uncertain and may have relevance for hospital-centered interventions. OBJECTIVE:To examine the independent association of 8 hosp...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Horwitz LI,Bernheim SM,Ross JS,Herrin J,Grady JN,Krumholz HM,Drye EE,Lin Z

    更新日期:2017-05-01 00:00:00

  • Posttraumatic concerns: a patient-centered approach to outcome assessment after traumatic physical injury.

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    journal_title:Medical care

    pub_type: 杂志文章


    authors: Zatzick DF,Kang SM,Hinton WL,Kelly RH,Hilty DM,Franz CE,Le L,Kravitz RL

    更新日期:2001-04-01 00:00:00

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    abstract:BACKGROUND:Demand for surgical treatment is rising while operating room (OR) resources are limited. Requests for more resources therefore can only be partly met by repartitioning the existing sparse resources. OBJECTIVE:Our goal is to define a method to allocate OR block times among surgical disciplines in such a way ...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Vansteenkiste N,Lamote C,Vandersmissen J,Luysmans P,Monnens P,De Voldere G,Kips J,Rademakers FE

    更新日期:2012-09-01 00:00:00

  • Higher Rates of Preventive Health Care With Commercial Insurance Compared With Medicaid: Findings From the Arkansas Health Care Independence "Private Option" Program.

    abstract:BACKGROUND:A requirement of the Arkansas Medicaid Section 1115 demonstration waiver was to evaluate the level of care received for Medicaid expansion eligible beneficiaries enrolled in commercial Qualified Health Plans (QHPs) in the Health Care Independence "Private Option" Program. This allowed for a direct comparison...

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    pub_type: 杂志文章


    authors: Goudie A,Martin B,Li C,Lewis K,Han X,Kathe N,Wilson JC,Thompson J

    更新日期:2020-02-01 00:00:00

  • Patient and bystander response to medical emergencies.

    abstract::This study of patient and bystander responses to medical emergencies revealed serious shortcomings in the public's ability to respond appropriately to such situations. Decision delays at least as long as ambulance response delays were found to be the result of confusion regarding the seriousness of the emergency, conf...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Mogielnicki RP,Stevenson KA,Willemain TR

    更新日期:1975-09-01 00:00:00

  • Physicians' assessments of their ability to provide high-quality care in a changing health care system.

    abstract:BACKGROUND:With the growth of managed care, there are increasing concerns but inconclusive evidence regarding deterioration in the quality of medical care. OBJECTIVES:To assess physicians' perceptions of their ability to provide high-quality care and explore what factors, including managed care, affect these perceptio...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Reschovsky J,Reed M,Blumenthal D,Landon B

    更新日期:2001-03-01 00:00:00

  • The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence.

    abstract:OBJECTIVES:To help resolve the current controversy over the validity of early readmission as an indicator of the quality of care, the authors critically reviewed the literature using meta-analysis to derive summary estimates of effect and evaluate inter-study heterogeneity. METHODS:The authors selected reports meeting...

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    pub_type: 杂志文章,meta分析


    authors: Ashton CM,Del Junco DJ,Souchek J,Wray NP,Mansyur CL

    更新日期:1997-10-01 00:00:00

  • Using health status measures in the hospital setting: from acute care to 'outcomes management'.

    abstract::In recent years, employers, insurers, and government purchasers have paid increased attention to the measurement of patient outcomes and health status. Such interest is stimulated less by policy or quality concerns than by the need to reduce health care expenditures. Any expected benefits which might accrue from healt...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Lansky D,Butler JB,Waller FT

    更新日期:1992-05-01 00:00:00

  • Practice variation and the risk of low birth weight in a public prenatal care program.

    abstract:OBJECTIVES:Use of antepartum tests of fetal well-being is widespread even though effectiveness in preventing fetal damage or stillbirth has not been established. The study objective was to examine whether aggressive use of these tests might contribute to increased rates of other birth outcomes, including low birth weig...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Helfand M,Zimmer-Gembeck MJ

    更新日期:1997-01-01 00:00:00

  • Patient adherence and medical treatment outcomes: a meta-analysis.

    abstract:BACKGROUND:Adherence is a factor in the outcome of medical treatment, but the strength and moderators of the adherence-outcome association have not been systematically assessed. OBJECTIVES:A quantitative review using meta-analysis of three decades of empirical research correlating adherence with objective measures of ...

    journal_title:Medical care

    pub_type: 杂志文章,meta分析


    authors: DiMatteo MR,Giordani PJ,Lepper HS,Croghan TW

    更新日期:2002-09-01 00:00:00

  • Lowering generic drug prices: less regulation equals more competition.

    abstract:BACKGROUND:In Ontario, Canada, the 70/90 regulations were instituted in May 1993 to establish provincial government procurement prices for generic drugs. Accordingly, the first generic entrant's price could not exceed 70% of the incumbent's branded price. Subsequent entrants' prices could not exceed 90% of the first en...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Anis AH,Guh DP,Woolcott J

    更新日期:2003-01-01 00:00:00

  • Exploring the relationship between inpatient facility and physician services.

    abstract:OBJECTIVES:Medicare hospitalizations involve both facility and physician services. Although several studies analyze hospital-level variations in Medicare inpatient facility and inpatient physician services per admission, few studies directly explore the relationship between these services. Theoretically, inpatient faci...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Miller ME,Welch WP,Wong HS

    更新日期:1997-02-01 00:00:00

  • Changing provider behavior: an overview of systematic reviews of interventions.

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    journal_title:Medical care

    pub_type: 杂志文章


    authors: Grimshaw JM,Shirran L,Thomas R,Mowatt G,Fraser C,Bero L,Grilli R,Harvey E,Oxman A,O'Brien MA

    更新日期:2001-08-01 00:00:00

  • Measuring population health: a comparison of three generic health status measures.

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    journal_title:Medical care

    pub_type: 杂志文章


    authors: Macran S,Weatherly H,Kind P

    更新日期:2003-02-01 00:00:00

  • The rural health care workforce implications of practice guideline implementation.

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    journal_title:Medical care

    pub_type: 杂志文章


    authors: Yawn BP,Casey M,Hebert P

    更新日期:1999-03-01 00:00:00