Pub Date : 1991-01-01DOI: 10.1177/002570879104800202
M A Davis
{"title":"On nursing home quality: a review and analysis.","authors":"M A Davis","doi":"10.1177/002570879104800202","DOIUrl":"https://doi.org/10.1177/002570879104800202","url":null,"abstract":"","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"48 2","pages":"129-66"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/002570879104800202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20984737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-01-01DOI: 10.1177/002570879104800104
J Feinglass, J J Holloway
{"title":"The initial impact of the Medicare prospective payment system on U.S. health care: a review of the literature.","authors":"J Feinglass, J J Holloway","doi":"10.1177/002570879104800104","DOIUrl":"https://doi.org/10.1177/002570879104800104","url":null,"abstract":"","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"48 1","pages":"91-115"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/002570879104800104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20985305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-01-01DOI: 10.1177/002570879104800102
J B Christianson, S M Sanchez, D R Wholey, M Shadle
With the exception of Kaiser, HMOs in the 1970s were predominantly locally sponsored organizations serving limited geographic markets. National HMO firms proliferated in the 1980s so that today they compete among themselves and with local HMOs in most metropolitan areas of the United States. Along with the growth of national firms, the mid-1980s saw an increase in HMO mergers, acquisitions, consolidations and bankruptcies (Freudenheim 1988). What was once termed the “HMO movement” is now universally, and sometimes cynically, referred to as the “HMO industry” (Gruber, Shadle, and Polich 1988). The dynamics of change within the HMO industry have been chronicled in yearly published reports (or “snapshots”) and sporadic coverage of newsworthy events, such as the dissolution of Maxicare Health Plans (Pincus 1988). However, analyses of HMO industry changes have focused primarily on overall growth in enrollment and in number of HMOs (see, for instance, Gruber, Shadle, and Polich 1988). In this article, we extend these analyses, employing a population ecology framework and a longitudinal data set covering the years 1978–1989. We begin by discussing the changing environment for HMOs over the past decade and critiquing the existing literature on the determinants of HMO growth, entry, and exit. Then we present data related to the evolutions of HMO organizational demographics and market structures during this period. First, we describe the overall development of the industry, with an emphasis on HMO entries, exits, mergers, and acquisitions. We follow this with an analysis of changes over time in the distribution of HMOs, both by type of HMO (e.g., individual practice association) and by national versus local HMO sponsorship. Data are also presented concerning changes in local HMO market structures over time. A concluding discussion focuses on factors that may influence future patterns of changes in the HMO industry.
{"title":"The HMO industry: evolution in population demographics and market structures.","authors":"J B Christianson, S M Sanchez, D R Wholey, M Shadle","doi":"10.1177/002570879104800102","DOIUrl":"https://doi.org/10.1177/002570879104800102","url":null,"abstract":"With the exception of Kaiser, HMOs in the 1970s were predominantly locally sponsored organizations serving limited geographic markets. National HMO firms proliferated in the 1980s so that today they compete among themselves and with local HMOs in most metropolitan areas of the United States. Along with the growth of national firms, the mid-1980s saw an increase in HMO mergers, acquisitions, consolidations and bankruptcies (Freudenheim 1988). What was once termed the “HMO movement” is now universally, and sometimes cynically, referred to as the “HMO industry” (Gruber, Shadle, and Polich 1988). The dynamics of change within the HMO industry have been chronicled in yearly published reports (or “snapshots”) and sporadic coverage of newsworthy events, such as the dissolution of Maxicare Health Plans (Pincus 1988). However, analyses of HMO industry changes have focused primarily on overall growth in enrollment and in number of HMOs (see, for instance, Gruber, Shadle, and Polich 1988). In this article, we extend these analyses, employing a population ecology framework and a longitudinal data set covering the years 1978–1989. We begin by discussing the changing environment for HMOs over the past decade and critiquing the existing literature on the determinants of HMO growth, entry, and exit. Then we present data related to the evolutions of HMO organizational demographics and market structures during this period. First, we describe the overall development of the industry, with an emphasis on HMO entries, exits, mergers, and acquisitions. We follow this with an analysis of changes over time in the distribution of HMOs, both by type of HMO (e.g., individual practice association) and by national versus local HMO sponsorship. Data are also presented concerning changes in local HMO market structures over time. A concluding discussion focuses on factors that may influence future patterns of changes in the HMO industry.","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"48 1","pages":"3-46"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/002570879104800102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20981474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-01-01DOI: 10.1177/002570879104800103
S Topping, S R Hernandez
{"title":"Health care strategy research, 1985-1990: a critical review.","authors":"S Topping, S R Hernandez","doi":"10.1177/002570879104800103","DOIUrl":"https://doi.org/10.1177/002570879104800103","url":null,"abstract":"","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"48 1","pages":"47-89"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/002570879104800103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20981475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-01-01DOI: 10.1177/002570879104800204
R D Luke
{"title":"Spatial competition and cooperation in local hospital markets.","authors":"R D Luke","doi":"10.1177/002570879104800204","DOIUrl":"https://doi.org/10.1177/002570879104800204","url":null,"abstract":"","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"48 2","pages":"207-37"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/002570879104800204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20984738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-01-01DOI: 10.1177/002570879104800303
D W Young
{"title":"Planning and controlling health capital: attaining an appropriate balance between regulation and competition.","authors":"D W Young","doi":"10.1177/002570879104800303","DOIUrl":"https://doi.org/10.1177/002570879104800303","url":null,"abstract":"","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"48 3","pages":"261-93"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/002570879104800303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20988221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-01-01DOI: 10.1177/002570879104800305
W C McCaughrin
{"title":"Antecedents of optimal decision making for client care in health services delivery organizations.","authors":"W C McCaughrin","doi":"10.1177/002570879104800305","DOIUrl":"https://doi.org/10.1177/002570879104800305","url":null,"abstract":"","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"48 3","pages":"331-62"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/002570879104800305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20988225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-01-01DOI: 10.1177/002570879104800403
W E Aaronson
{"title":"The use of physician extenders in nursing homes: a review.","authors":"W E Aaronson","doi":"10.1177/002570879104800403","DOIUrl":"https://doi.org/10.1177/002570879104800403","url":null,"abstract":"","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"48 4","pages":"411-47"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/002570879104800403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21032064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1990-01-01DOI: 10.1177/107755879004700302
H R Rubin
We have found that patients have distinct opinions about many components of hospital care, but that little recent work has identified those components important to today's patients in the United States. Investigators have constructed reproducible scales to obtain evaluations. Patient evaluations of the interpersonal features of hospital care are influenced by interventions that physicians or nurses identify as "higher" quality of care. We do not know if patient reports and ratings of specific aspects of care accurately reflect the effects of hospital care on health outcomes--the quality standard that public agencies and payers may consider the most important. However, patient evaluations of nursing care and medical care are independently related to patients' overall satisfaction, overall assessments of quality, and intentions to recommend and return to the same hospital. More studies are needed to clarify whether other components of hospital care also contribute to these ratings and intentions and, if so, how much. Nonresponse bias affects patient surveys, making patient ratings of care in each sample more favorable than the population mean; we do not know how this affects conclusions of surveys that compare hospitals or treatments. Few studies have compared how different methods affect the reproducibility and accuracy of patient reports and ratings. Practical issues may be the most important obstacles for users of patient ratings, particularly regarding whether potential users will be able to interpret results and accept them. Finally, no comprehensive instrument or survey method in the published literature has been tested enough to be recommended as a reproducible, accurate, and interpretable quality measure: a few do, however, appear worthy of further testing.
{"title":"Can patients evaluate the quality of hospital care?","authors":"H R Rubin","doi":"10.1177/107755879004700302","DOIUrl":"https://doi.org/10.1177/107755879004700302","url":null,"abstract":"<p><p>We have found that patients have distinct opinions about many components of hospital care, but that little recent work has identified those components important to today's patients in the United States. Investigators have constructed reproducible scales to obtain evaluations. Patient evaluations of the interpersonal features of hospital care are influenced by interventions that physicians or nurses identify as \"higher\" quality of care. We do not know if patient reports and ratings of specific aspects of care accurately reflect the effects of hospital care on health outcomes--the quality standard that public agencies and payers may consider the most important. However, patient evaluations of nursing care and medical care are independently related to patients' overall satisfaction, overall assessments of quality, and intentions to recommend and return to the same hospital. More studies are needed to clarify whether other components of hospital care also contribute to these ratings and intentions and, if so, how much. Nonresponse bias affects patient surveys, making patient ratings of care in each sample more favorable than the population mean; we do not know how this affects conclusions of surveys that compare hospitals or treatments. Few studies have compared how different methods affect the reproducibility and accuracy of patient reports and ratings. Practical issues may be the most important obstacles for users of patient ratings, particularly regarding whether potential users will be able to interpret results and accept them. Finally, no comprehensive instrument or survey method in the published literature has been tested enough to be recommended as a reproducible, accurate, and interpretable quality measure: a few do, however, appear worthy of further testing.</p>","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 3","pages":"267-326"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20979096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1990-01-01DOI: 10.1177/107755879004700403
S Folland, M Stano
{"title":"Small area variations: a critical review of propositions, methods, and evidence.","authors":"S Folland, M Stano","doi":"10.1177/107755879004700403","DOIUrl":"https://doi.org/10.1177/107755879004700403","url":null,"abstract":"","PeriodicalId":79684,"journal":{"name":"Medical care review","volume":"47 4","pages":"419-65"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/107755879004700403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21042406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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