Article

Differences in hospital resource allocation among sick newborns according to insurance coverage.

Department of Family and Community Medicine, School of Medicine, University of California, San Francisco 94143.
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 01/1992; 266(23):3300-8. DOI: 10.1001/jama.266.23.3300
Source: PubMed

ABSTRACT To assess whether newborns' insurance coverage was associated with differences in the allocation of hospital services.
Retrospective analysis of computerized hospital discharge data, comparing resource allocation among newborns according to insurance status, controlling for race/ethnicity, diagnoses, hospital characteristics (ownership, teaching status, nursery level), and disposition.
All California civilian acute-care hospitals.
Population-based sample, excluding out-of-hospital and military hospital births. Resource allocation was studied among all newborns discharged in 1987 with evidence of serious problems (N = 29,751).
Length of stay, total charges, and charges per day.
Sick newborns without insurance received fewer inpatient services than comparable privately insured newborns with either indemnity or prepaid coverage. This pattern was observed across all hospital ownership types. Mean stay was 15.7 days for all privately insured newborns (15.6 days for those with indemnity and 15.7 days for those with prepaid coverage), 14.8 days for Medicaid-covered newborns, and 13.2 days for uninsured newborns (P less than .001). Length of stay, total charges, and charges per day were 16%, 28%, and 10% less, respectively, for the uninsured than for all privately insured newborns (P less than .001). Resources for newborns covered by Medicaid were generally greater than for the uninsured and less than for the privately insured. Both uninsured and Medicaid-covered newborns were found to have more severe medical problems than the privately insured.
The findings cannot be explained by differences in medical need or by differences in non-medically indicated services; they constitute prima facie evidence of inequities that need to be addressed by policy changes.

0 Followers
 · 
49 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: By 1993, over 70% of all Americans with health insurance were enrolled in some form of managed care plan. The term managed care encompasses a diverse array of institutional arrangements, which combine various sets of mechanisms, that, in turn, have changed over time. The chapter reviews these mechanisms, which, in addition to the methods employed by traditional insurance plans, include the selection and organization of providers, the choice of payment methods (including capitation and salary payment), and the monitoring of service utilization.Managed care has a long history. For an extended period, this form of organization was discouraged by a hostile regulatory environment. Since the early 1980s, however, managed care has grown dramatically. Neither theoretical nor empirical research has yet provided an explanation for this pattern of growth. The growth of managed care may be due to this organizational form's relative success in responding to underlying market failures in the health care system — asymmetric information about health risks, moral hazard, limited information on quality, and limited industry competitiveness. The chapter next explores managed care's response to each of these problems.The chapter then turns to empirical research on managed care. Managed care plans appear to attract a population that is somewhat lower cost than that enrolled in conventional insurance. This complicates analysis of the effect of managed care on utilization. Nonetheless, many studies suggest that managed care plans reduce the rate of health care utilization somewhat. Less evidence exists on their effect on overall health care costs and cost growth.
    Handbook of Health Economics 01/2000; 1:707-753. DOI:10.1016/S1574-0064(00)80172-9
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A retrospective study was carried out to know the trend in utilization of health insurance at a tertiary care teaching hospital. The data was analyzed to know the proportion of insured to total inpatients.The proportion of insured inpatients in various health insurance plans, their average length of stay and expenses per admission were analyed. There is a statistically significant increase in the number of insured inpatients. The proportion of inpatients in various plans among the insured have been varying over years due to introduction of community or social health insurance. The difference in average expense per admission among uninsured and insured is statistically significant. Variations in average expense per inpatient admission among beneficiaries' of different plans are again due to choice of wards and admissions for surgical conditions. The average length of stay among insured is lesser than in uninsured.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: College and university health services have always used managed care systems, allocating services for the many but limiting services per person. College psychotherapy is also limited intrinsically by the academic calendar and students' tendency to alternate between introspection and outward exploration. As a result, the course of college psychotherapy is in most cases so extremely brief that it is not long enough to qualify as “brief therapy.” Meanwhile, the severity of college student emotional difficulties has increased since 1980 and still more severity is expected. Should college psychotherapy practice be limited even more? The history of resistances to providing any psychotherapy for students suggests that denial of need, stigma, and shortsighted financial considerations readily lend themselves to rationalizing further restrictions. We should be mindful not only of short-term economic considerations but the importance of recognizing need for longer term psychotherapy even when short term economic considerations mitigate against it.
    Journal of College Student Psychotherapy 10/2008; 9(2):7-17. DOI:10.1300/J035v09n02_03