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












  • Influencing behavior of physicians ordering laboratory tests: a literature study.

    abstract::There are various reasons why physicians order laboratory tests. Earlier studies have shown that in many cases test-ordering behavior lacks efficiency, resulting in excessive laboratory utilization. Throughout the years various attempts have been made to improve this situation. This review, based on the literature of ...

    journal_title:Medical care

    pub_type: 杂志文章,评审


    authors: Axt-Adam P,van der Wouden JC,van der Does E

    更新日期:1993-09-01 00:00:00

  • Methodological challenges and innovations in patient outcomes research.

    abstract::Between 1989 and 1992, the Agency for Health Care Policy and Research (AHCPR) awarded funding to 14 special projects known as Patient Outcomes Research Teams (PORTs). These large, complex projects form the centerpiece of the first generation of research under the Medical Treatment Effectiveness Program. In carrying ou...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Maklan CW,Greene R,Cummings MA

    更新日期:1994-07-01 00:00:00

  • Negligent care and malpractice claiming behavior in Utah and Colorado.

    abstract:BACKGROUND:Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of ma...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Studdert DM,Thomas EJ,Burstin HR,Zbar BI,Orav EJ,Brennan TA

    更新日期:2000-03-01 00:00:00

  • My medical care is better than yours. Social desirability and patient satisfaction ratings.

    abstract::It is well-documented that ratings of medical care received personally (personal referent) yield more favorable responses than ratings of care received by people in general (general referent). Hence general items are useful in achieving greater variation in responses to satisfaction surveys. However, the validity of g...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Hays RD,Ware JE Jr

    更新日期:1986-06-01 00:00:00

  • 27. CPHA patient care data system for long-term care facilities.

    abstract::Earlier efforts of the Commission on Professional and Hospital Activities (CPHA) to develop a patient care data system for long-term care facilities were discontinued for lack of user interest and shortage of funds; however, the facilities were encouraged to participate in the hospital data system (PAS) and to use opt...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Slee VN

    更新日期:1976-05-01 00:00:00

  • Accuracy of Medicare claims data for estimation of cancer incidence and resection rates among elderly Americans.

    abstract::To explore the reliability of Medicare Part A claims data for clinical and health services research related to the care of patients with cancer, the authors compared estimates of the incidence of and resection rates for cancer of the breast, colon, and lung derived from analysis of Medicare Part A data versus data fro...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Whittle J,Steinberg EP,Anderson GF,Herbert R

    更新日期:1991-12-01 00:00:00

  • Physician response to patient insurance status in ambulatory care clinical decision-making. Implications for quality of care.

    abstract:OBJECTIVES:Individuals without health insurance in general receive fewer health services and are more likely than insured patients to experience poor outcomes. The main goal of this research was to study whether physicians' clinical recommendations vary for insured and uninsured patients, implying that physicians' choi...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Mort EA,Edwards JN,Emmons DW,Convery K,Blumenthal D

    更新日期:1996-08-01 00:00:00

  • Variation in receipt of radiation therapy after breast-conserving surgery: assessing the impact of physicians and geographic regions.

    abstract:BACKGROUND:Among older women with early-stage breast cancer, patients with a short life expectancy (LE) are much less likely to benefit from adjuvant radiation therapy (RT). Little is known about the impact of physicians and regional factors on the use of RT across LE groups. OBJECTIVE:To determine the relative contri...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Feinstein AJ,Soulos PR,Long JB,Herrin J,Roberts KB,Yu JB,Gross CP

    更新日期:2013-04-01 00:00:00

  • Perceived barriers to mental health service use among individuals with mental disorders in the Canadian general population.

    abstract:BACKGROUND:Eliminating barriers to care is important for improving health service use. However, the barriers to mental health care have not been well investigated. OBJECTIVES:This study was designed to provide information about the barriers to mental health service use and to identify clinical factors associated with ...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Wang J

    更新日期:2006-02-01 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

  • 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

  • Assessing Residual Bias in Estimating Influenza Vaccine Effectiveness: Comparison of High-dose Versus Standard-dose Vaccines.

    abstract:BACKGROUND:Estimating influenza vaccine effectiveness using an unvaccinated comparison group may result in biased effect estimates. OBJECTIVES:To explore the reduction of confounding bias in an active comparison of high-dose versus standard-dose influenza vaccines, as compared with vaccinated versus unvaccinated compa...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Butler AM,Layton JB,Krueger WS,Kshirsagar AV,McGrath LJ

    更新日期:2019-01-01 00:00:00

  • Administrative hospitalization database validation of cardiac procedure codes.

    abstract:BACKGROUND:Although cardiac procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track cardiac procedures, but sources of such data have not been validated against clinical registries. OBJECTIVES:To examine accuracy of cardiac procedure coding in a...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Lee DS,Stitt A,Wang X,Yu JS,Gurevich Y,Kingsbury KJ,Austin PC,Tu JV

    更新日期:2013-04-01 00:00:00

  • Outcome-specific Charlson Comorbidity Indices for Predicting Poor Inpatient Outcomes Following Noncardiac Surgery Using Hospital Administrative Data.

    abstract:BACKGROUND:A need exists for adapting existing perioperative risk stratification methods such as the Charlson Comorbidity Index (CCI) for application with hospital administrative data in noncardiac surgery populations. OBJECTIVE:Develop and validate outcome-specific CCIs for predicting inpatient mortality, and cardiac...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Moodley Y

    更新日期:2016-12-01 00:00:00

  • Gynecologists in the VA: do they enhance availability of sex-specific services and policies in the emergency department?

    abstract:OBJECTIVES:To examine the association between on-site gynecology and availability of sex-specific services and policies in Department of Veterans Affairs (VA) emergency departments (EDs). RESEARCH DESIGN:Cross-sectional analysis using data from a VA national inventory of emergency services for women and gynecologist s...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Gray KE,Katon JG,Callegari LS,Cordasco KM,Zephyrin LC

    更新日期:2015-04-01 00:00:00

  • Reducing bias in the assessment of treatment effectiveness: androgen deprivation therapy for prostate cancer.

    abstract:BACKGROUND:Indication bias is the major challenge in assessing treatment effectiveness in observational studies. We explored the potential advantages of using an instrumental variable approach in the context of primary androgen deprivation therapy (ADT) for prostate cancer. METHODS:We identified 31,930 men in the link...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Kuo YF,Montie JE,Shahinian VB

    更新日期:2012-05-01 00:00:00

  • Carepartner experiences with hospital care.

    abstract:OBJECTIVES:Family members and other "carepartners" often play an important role in the care and support of patients during and after hospitalization, yet little is known about how they assess their hospital experience or the factors that may influence their perceptions. METHODS:A nationwide telephone survey of 1,800 r...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: vom Eigen KA,Walker JD,Edgman-Levitan S,Cleary PD,Delbanco TL

    更新日期:1999-01-01 00:00:00

  • Evaluation of the Department of Veterans Affairs community-based outpatient clinics.

    abstract:OBJECTIVE:This paper describes the history of the Department of Veterans Affairs (VA) Community-Based Outpatient Clinics (CBOCs), CBOC Performance Evaluation Project, and characteristics of CBOCs within the VA, and summarizes the findings and implications of the CBOC Performance Evaluation Project. SUBJECTS:There were...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Chapko MK,Borowsky SJ,Fortney JC,Hedeen AN,Hoegle M,Maciejewski ML,VanDeusen Lukas C

    更新日期:2002-07-01 00:00:00

  • Net health plan savings from reference pricing for angiotensin-converting enzyme inhibitors in elderly British Columbia residents.

    abstract:BACKGROUND:Reference drug pricing (RP) is a cost-sharing strategy commonly used to control drug expenditures. Under RP, a benefit plan fully reimburses medications that are equally or less expensive than the reference price, and requires patients to pay the extra cost of therapeutically equivalent but higher priced dru...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Schneeweiss S,Dormuth C,Grootendorst P,Soumerai SB,Maclure M

    更新日期:2004-07-01 00:00:00

  • Outcomes are Worse in US Patients Undergoing Surgery on Weekends Compared With Weekdays.

    abstract:BACKGROUND:Increasing surgical access to previously underserved populations in the United States may require a major expansion of the use of operating rooms on weekends to take advantage of unused capacity. Although the so-called weekend effect for surgery has been described in other countries, it is unknown whether US...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Glance LG,Osler T,Li Y,Lustik SJ,Eaton MP,Dutton RP,Dick AW

    更新日期:2016-06-01 00:00:00

  • Quality Enhancement Research Initiative in ischemic heart disease: a quality initiative from the Department of Veterans Affairs. QUERI IHD Executive Committee.

    abstract::Despite the dramatic fall in ischemic heart disease (IHD) mortality rates over the last 3 decades, it remains the number one cause of death in the United States, and one of the most frequent indications for care by the US Department of Veterans Affairs. National practice guidelines have been developed and disseminated...

    journal_title:Medical care

    pub_type: 杂志文章,评审


    authors: Every NR,Fihn SD,Sales AE,Keane A,Ritchie JR

    更新日期:2000-06-01 00:00:00

  • Health care coverage and access to care: the status of Minnesota's veterans.

    abstract:OBJECTIVES:The primary objective of this study was to examine veterans' reliance on health care services provided by the Veterans Health Administration (VHA) within Minnesota and estimate the potential effect on uninsurance rates if all eligible veterans relied on VHA coverage. Secondary objectives were to compare vete...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Jonk YC,Call KT,Cutting AH,O'Connor H,Bansiya V,Harrison K

    更新日期:2005-08-01 00:00:00

  • The structure of critical care transfer networks.

    abstract:RATIONALE:Moving patients from low-performing hospitals to high-performing hospitals may improve patient outcomes. These transfers may be particularly important in critical care, where small relative improvements can yield substantial absolute changes in survival. OBJECTIVE:To characterize the existing critical care n...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Iwashyna TJ,Christie JD,Moody J,Kahn JM,Asch DA

    更新日期:2009-07-01 00:00:00

  • Changes in thiazolidinedione use and outcomes following removal of a prior-authorization policy: controlled time-series analysis.

    abstract:OBJECTIVE:The aim of this study was to assess the impact of removing prior-authorization restrictions on the use of thiazolidinediones (TZDs) and outcomes. METHODS:In a controlled interrupted time-series analysis, whereby new users of antidiabetic agents over 65 years of age in adjacent Canadian provinces with differe...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Gamble JM,Majumdar SR,Johnson JA,McAlister FA,Simpson SH,Eurich DT

    更新日期:2014-01-01 00:00:00

  • Improving organizational climate for quality and quality of care: does membership in a collaborative help?

    abstract:BACKGROUND:The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. ...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Nembhard IM,Northrup V,Shaller D,Cleary PD

    更新日期:2012-11-01 00:00:00

  • The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: tests of data quality, scaling assumptions and score reliability.

    abstract:OBJECTIVE:To evaluate the psychometric assumptions underlying the construction and scoring of SF-36 scales and summary measures among clinical trial participants with arthritis. METHODS:Cross-sectional SF-36 data from the baseline assessment of adult patients (n = 1,016) participating in four placebo-controlled clinic...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Kosinski M,Keller SD,Hatoum HT,Kong SX,Ware JE Jr

    更新日期:1999-05-01 00:00:00

  • Differences in Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey Scores by Recency of the Last Visit: Implications for Comparability of Periodic and Continuous Sampling.

    abstract:BACKGROUND:Patient experience data can be collected by sampling patients periodically (eg, patients with any visits over a 1-year period) or sampling visits continuously (eg, sampling any visit in a monthly interval). Continuous sampling likely yields a sample with more frequent and more recent visits, possibly affecti...

    journal_title:Medical care

    pub_type: 社论


    authors: Setodji CM,Burkhart Q,Hays RD,Quigley DD,Skootsky SA,Elliott MN

    更新日期:2019-12-01 00:00:00

  • The hierarchical structure of geriatric patient satisfaction. An Older Patient Satisfaction Scale designed for HMOs.

    abstract::This paper describes an instrument design effort aimed at measuring patient-satisfaction among older (65 years and over) subscribers of HMOs. The study was conducted in a multi-satellite prepaid group practice in Buffalo, New York. In order to be able to construct a satisfaction measure that would reflect the interest...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Cryns AG,Nichols RC,Katz LA,Calkins E

    更新日期:1989-08-01 00:00:00

  • The disparity in access to new medication by type of health insurance: lessons from Germany.

    abstract:BACKGROUND:Drug provision within the German statutory health insurance system has undergone several reforms, including the introduction of drug macrobudgets in 1993. OBJECTIVE:The objective of this study was to investigate the extent to which statutorily (SHI) and fully privately (PHI) health-insured patients were pro...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Krobot KJ,Miller WC,Kaufman JS,Christensen DB,Preisser JS,Ibrahim MA

    更新日期:2004-05-01 00:00:00

  • Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies.

    abstract::In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation ...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Marcus AC,Crane LA,Kaplan CP,Reading AE,Savage E,Gunning J,Bernstein G,Berek JS

    更新日期:1992-03-01 00:00:00