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Publications (13)35.11 Total impact

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    ABSTRACT: At the national level there has been a desire to assure that individuals have access to effective personal medical care services. Accordingly, there has been an interest in linking policies on access to care to the health needs of diverse population groups. This article critiques three measures of access linked to health status: the Use-Disability Ratio, the Symptoms-Response Ratio, and the Episode of Illness Analysis. Their utility in determining whether a given level of health-service utilization is appropriate for the optimization of health status in a population is considered. As part of this task, we review the concept of health, its measurement, and data on the relationship between changes in utilization and changes in health status. Although the Use-Disability ratio may be a useful instrument to measure access equity, it appears less suited for the purpose stated above. Elements of both the Symptoms-Response Ratio and the Episode of Illness Analysis appear better suited for this purpose. Recommendations are provided on 1) the scope of services that should be included in a comprehensive construct designed to assess access related to health status, and 2) the required research to develop such a construct.
    Medical Care 01/1982; 19(12 Suppl):57-68. · 3.23 Impact Factor
  • M E Michnich, S M Shortell, W C Richardson
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    ABSTRACT: Formal program evaluation is an important resource for health care decision making. It is necessary in situations where traditional organizational evaluative capabilities an no longer meet the requirements of the job at hand.
    Health care management review 02/1981; 6(3):25-35. · 1.30 Impact Factor
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    ABSTRACT: Many federally financed programs have been launched to improve the access of the poor to medical care, under the assumption that this will improve their health. The effectiveness of these programs, however, has generally been measured by increased utilization rather than by improved health. The few studies which have considered health status have shown small or negative effects. Here, data are presented from a project which provided fully prepaid care to near poor families through existing sources in the community. A group of 748 enrollees was found to report worse health on four of five health indicators after one year of enrollment in the program; further, they appeared sicker on all five measures than a group without free medical care. It is suggested: 1) that the impact of health programs on the health of a population is a complex and poorly understood issue; and 2) that increasing access to health care may not be an effective way to improve health.
    Medical Care 11/1979; 17(10):989-99. · 3.23 Impact Factor
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    ABSTRACT: Mental health services were included in comprehensive benefits available with no out-of-pocket expenses to enrollees in the Seattle Prepaid Health Care Project. This study was designed to examine the characteristics of users as compared to nonusers of mental health services and to examine the possibility of lower use of somatic health services attributable to the availability of mental health services. Two enrollee groups were studied: one group included enrollees with at least one mental health service (MH-U) and the other included those with some somatic utilization but without mental health utilization (MH-NU). Results indicated that mental health users were different from nonusers based on sociodemographic, health status, and prior utilization measures. Further, the mental health utilizers consumed more somatic services than other enrollees, even controlling for background variables. The visit and admission rates for the MH-U group were 2.4 times that of the MH-NU group, and total inpatient and outpatient costs were three times as high. On all three comparisons, approximately 60 per cent of the difference was accounted for by mental health utilization and by differences in sociodemographic and health status characteristics. The remaining 40 per cent could not be explained, but there is a suggestion that the higher utilization occurred for conditions where medical care is discretionary.
    Medical Care 10/1979; 17(9):937-52. · 3.23 Impact Factor
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    ABSTRACT: Mental health services were included in a comprehensive package of benefits available to low income enrollees in a prepaid group practice plan (PGP) and in an independent practice plan (IPP) under the Seattle Prepaid Health Care Project. There were no out-of-pocket costs for enrollees. Utilization of services was studied for four years under conditions that might simulate universal entitlement. The analyses indicated that females used substantially more mental health services than males and that enrollees aged 20-44 used more services than those in other age groups. The prepaid group practice generally experienced higher utilization than the prepaid independent plan. Significant racial differences were evident with whites using more services than blacks and black males using strikingly few services. The prepaid independent plan was oriented toward physician providers and emphasized individual psychotherapy while the prepaid group practice employed a diversity of practitioners and therapeutic modalities. The data indicated that the per cent of enrollees using any mental health services was twice as great in the PGP as in the IPP. However, once access to the provider system was achieved, the number of services utilized was greater in the PGP. Inpatient services were also examined. A significantly higher proportion of IPP enrollees were admitted for inpatient care as compared to PGP enrollees. Finally, the cost of mental health services was less than ten per cent of total health service costs in both plans.
    Medical Care 03/1979; 17(2):139-51. · 3.23 Impact Factor
  • J P LoGerfo, R A Efird, P K Diehr, W C Richardson
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    ABSTRACT: The Seattle Prepaid Health Care Evaluation Project is a comparative study designed to assess the care received by persons enrolled in either a large prepaid group practice (PGP) or in a prepaid, independent practice setting in which physicians are reimbursed on a fee-for-service basis (IPP). As part of the study we assessed the patterns of surgical care for hysterectomy, cholecystectomy, appendectomy, and tonsillectomy/adenoidectomy. Overall, there were 215 such procedures with an exposure adjusted rate being five times higher in the IPP than in the PGP. After eliminating 43 per cent of procedures in the IPP and 22 per cent in the PGP which did not meet specified criteria for either necessary, appropriate or justifiable surgery, the exposure-adjusted rate differential was 3.9 times higher in the IPP with the difference in the rates being mainly attributable to hysterectomy and tonsillectomy/adenoidectomy. We conclude there were more unnecessary procedures in the IPP, but the fact that a significant difference in the incidence of surgery persisted even after elimination of such cases suggests that the differences in rates of surgery between the IPP and PGP cannot be solely attributed to a higher rate of inappropriate surgery in the IPP.
    Medical Care 02/1979; 17(1):1-10. · 3.23 Impact Factor
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    Medical Care 01/1979; 17(9):937-952. · 3.23 Impact Factor
  • W C Richardson, S M Shortell, W H Campbell
    American journal of pharmaceutical education 01/1979; 42(5):447-54. · 1.21 Impact Factor
  • J P LoGerfo, I M Dynes, F Frost, P K Diehr, W C Richardson
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    ABSTRACT: In the Seattle Prepaid Health Care Project, we studied medical records and claims information for all 97 children undergoing tonsillectomy and/or adenoidectomy in an independent practice plan from February 1971, through January 1975. Overall only 32 per cent of the procedures met commonly promulgated indications of surgery. Of 77 persons having one of these procedures performed because of recurrent pharyngeal or ear infections, 86 per cent did not meet the indications for surgery suggested by screening criteria adapted from model guidelines for PSRO use. The average number of episodes of illness was estimated to be 1.71/per year in the year prior to surgery using lenient assumptions. It is concluded that a major reduction in the frequency of these procedures would be effected by developing an audit strategy that assures the stated indications meet commonly recommended guidelines. The reduction in surgery would occur irrespective of the debate about the efficacy of these procedures.
    Medical Care 12/1978; 16(11):950-55. · 3.23 Impact Factor
  • Inquiry: a journal of medical care organization, provision and financing 10/1978; 15(3):275-80. · 0.84 Impact Factor
  • J P LoGerfo, E Larson, W C Richardson
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    ABSTRACT: As part of a comprehensive evaluation of care received by enrollees in a prepaid community health care project, we studied the process of care for enrollees reported to have a urinary tract infection. The care given to 98 patients enrolled in a large prepaid group practice (PGP) and 69 patients seen by 45 physicians in the independent practice setting (IPP) was analyzed. We found the process of care to be significantly better in the PGP, with a large part of the difference due to more appropriate utilization of urine cultures. This occurred despite a higher visit rate to internists in the IPP, and suggests that the organization of practice strongly affects the process of care received by patients even when all care is fully prepaid.
    Medical Care 07/1978; 16(6):488-95. · 3.23 Impact Factor
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    ABSTRACT: A causal model of health services which includes patient and provider variables, perceived access to care, utilization of services, continuity of care, technical quality of the care process, technical quality of the care outcome, and patient satisfaction is applied to a group of diabetic patients enrolled in the Seattle Prepaid Health Care Project. The enrollees received comprehensive health services at zero out-of-pocket cost from either a prepaid group practice plan or an independent practice plan. Surveys were periodically conducted to determine health status, satisfaction, and demographic characteristics of the enrollees; utilization of services was monitored throughout the experiment. The causal model is operationalized through the use of path analysis. Significant relationships (p less than or equal to .10) were established between satisfaction and perceived access to care, family size, sex, and professional qualifications of the provider; between outcome of care and health status, female education, and physician performance; between physician performance and professional qualifications; between continuity of care and health status and female education; between utilization and perceived access, specialty of provider, and provider system; and between access to care and provider system. The policy implications of the results are discussed.
    Medical Care 05/1978; 16(4):313-26. · 3.23 Impact Factor
  • Journal of Health and Social Behavior 07/1977; 18(2):139-59. · 2.72 Impact Factor