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Agency in health care with an endogenous budget constraint.

https://arctichealth.org/en/permalink/ahliterature217989
Source
J Health Econ. 1994 Jul;13(2):231-51
Publication Type
Article
Date
Jul-1994
Author
D. Clark
J A Olsen
Author Affiliation
Department of Economics, University of Tromsø, Norway.
Source
J Health Econ. 1994 Jul;13(2):231-51
Date
Jul-1994
Language
English
Publication Type
Article
Keywords
Budgets
Consumer Satisfaction - economics
Ethics, Medical
Health Maintenance Organizations - economics
Humans
Insurance, Health - economics
Models, Econometric
Norway
Patient Participation - economics
Physician's Role
Abstract
In this paper a doctor acts as a perfect agent for a group of patients in an environment where the health service is funded by a group of contributors. The contributor group donates resources to the health sector in accordance with its split preferences about the health care services which they would like for themselves and those which they would like for others. We show that the size of the health budget is endogenous and depends on the choices made by the doctor. The focus is on the division of the budget between health enhancing and non-health enhancing health care.
PubMed ID
10138027 View in PubMed
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Angina pectoris in presumably healthy middle-aged men. Validation of two questionnaire methods in making the diagnosis of angina pectoris.

https://arctichealth.org/en/permalink/ahliterature50449
Source
Eur J Cardiol. 1977 Dec;6(4):285-98
Publication Type
Article
Date
Dec-1977
Author
J. Erikssen
K. Forfang
O. Storstein
Source
Eur J Cardiol. 1977 Dec;6(4):285-98
Date
Dec-1977
Language
English
Publication Type
Article
Keywords
Adult
Angina Pectoris - diagnosis - epidemiology
Angiocardiography
Comparative Study
Exercise Test
Follow-Up Studies
Health Maintenance Organizations
Humans
Male
Methods
Middle Aged
New York City
Norway
Questionnaires
Risk
World Health Organization
Abstract
In 2014 presumably healthy men aged 40-59 yr the prevalence of previously undiagnosed angina pectoris was assessed by two angina questionnaires: (1) World Health Organization Questionnaire (WHO-Q) and (2) Greater New York Health Insurance Plan Survey Questionnaire (NY-Q). The angina prevalence given by the questionnaires singly or in combination varied between 1.15 and 4.7% (lowest prevalence by the WHO-Q interview version (WHO-Qi) and highest by the WHO-Q self-administered version and the NY-Q in combination), indicating a considerable variation in prevalence with variation in criteria used. Validation of the questionnaires by means of (1) coronary angiography, and (2) follow-up in selected cases, indicated NY-Q superiority over WHO-Q in predicting the presence of coronary heart disease (CHD). WHO-Qi had a particularly low sensitivity without being more specific. However, CHD-risk factor patterns in subgroups of individuals classified as angina-positive or -negative by the respective questionnaires were similar.
PubMed ID
590299 View in PubMed
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Capitation begins to transform the face of American medicine.

https://arctichealth.org/en/permalink/ahliterature212598
Source
CMAJ. 1996 Mar 1;154(5):688-91
Publication Type
Article
Date
Mar-1-1996
Author
M. Korcok
Source
CMAJ. 1996 Mar 1;154(5):688-91
Date
Mar-1-1996
Language
English
Publication Type
Article
Keywords
Aged
Canada
Capitation Fee
Centers for Medicare and Medicaid Services (U.S.)
Fee-for-Service Plans - economics
Female
Health Maintenance Organizations - economics
Humans
Insurance, Health - legislation & jurisprudence
Male
Managed Care Programs - economics
Medicare
Medicine
Physician-Patient Relations
Quality of Health Care
United States
Abstract
Canadian physicians only need look to the south to see that capitation can control not only their fees but also the amount of resources they use, the amount of care their patients can expect and the way doctors and patients relate to one another. In the US, capitation is rewarding doctors for doing less and penalizing them if they do too much. "Instead of a being cash source," says Dr. John Verhoff, a family practitioner in Columbus, Ohio, "a patient visit is a cash drain." Milan Korcok looks at the ways capitation is changing medicine in the US.
Notes
Comment In: CMAJ. 1996 Jul 15;155(2):159-608800067
Comment In: CMAJ. 1996 Jul 15;155(2):1598800066
PubMed ID
8603325 View in PubMed
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Care for Canada's frail elderly population: fragmentation or integration?

https://arctichealth.org/en/permalink/ahliterature207438
Source
CMAJ. 1997 Oct 15;157(8):1116-21
Publication Type
Article
Date
Oct-15-1997
Author
H. Bergman
F. Béland
P. Lebel
A P Contandriopoulos
P. Tousignant
Y. Brunelle
T. Kaufman
E. Leibovich
R. Rodriguez
M. Clarfield
Author Affiliation
Division of Geriatric Medicine, McGill University, Montreal. mdhb@musica.mcgill.ca
Source
CMAJ. 1997 Oct 15;157(8):1116-21
Date
Oct-15-1997
Language
English
Publication Type
Article
Keywords
Aged
Canada
Community Health Services - economics - supply & distribution - utilization
Cost-Benefit Analysis
Delivery of Health Care, Integrated - economics - organization & administration
Frail Elderly
Health Care Reform
Health Maintenance Organizations
Humans
Models, organizational
Patient-Centered Care
Abstract
Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.
Notes
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PubMed ID
9347783 View in PubMed
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Client perceptions of the performance of public and independent not-for-profit primary healthcare.

https://arctichealth.org/en/permalink/ahliterature166329
Source
Scand J Public Health. 2006;34(6):598-608
Publication Type
Article
Date
2006
Author
Ritva Laamanen
John Ovretveit
Jari Sundell
Nina Simonsen-Rehn
Sakari Suominen
Mats Brommels
Author Affiliation
Department of Public Health, University of Helsinki, Finland. ritva.laamanen@kolumbus.fi
Source
Scand J Public Health. 2006;34(6):598-608
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Community Health Centers - organization & administration - standards
Female
Finland
Health Maintenance Organizations - organization & administration - standards
Health Services Accessibility - organization & administration - standards
Humans
Male
Middle Aged
Organizations, Nonprofit
Patient Acceptance of Health Care
Patient satisfaction
Primary Health Care - organization & administration - standards
Private Sector
Public Sector
Questionnaires
Trust
Abstract
To compare primary healthcare (PHC) provided by an independent not-for-profit organization (INPO) with that provided by two public municipal organizations (MO1 and MO2), in terms of clients' perceptions of performance, acceptance, and trust.
A survey using a pre-tested questionnaire to all clients visiting a health centre (HC) doctor or nurse during one week in 2000 (n = 511, 51% response rate) and 2002 (n = 275, 47%). The data were analysed by descriptive statistics and cumulative logistic regression analysis.
The INPO differed from both publicly provided services in accessibility, consistency of service, and outcomes. Clients reported lower trust in HC provided by public organizations compared with the INPO. Trust was higher if clients also reported experiencing "very good" or "moderate" organizational access--or if general satisfaction was "very high" or "moderate" or if they experienced outcomes as "very good" or "moderate" compared with the "very poor or low" situation. Women reported lower trust in HC than men. When the family doctor was included in the same logistic regression model with the service provider, only the family doctor was a significant explanatory variable. Reported acceptance of private alternative service providers among clients was similar between the study organizations.
Clients of the INPO generally rated the service more positively than clients of publicly provided services. The results indicate that trust in HC depends more on a family doctor system than a service provider.
PubMed ID
17132593 View in PubMed
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Colonoscopy and flexible sigmoidoscopy practice patterns in Ontario: a population-based study.

https://arctichealth.org/en/permalink/ahliterature162408
Source
Can J Gastroenterol. 2007 Jul;21(7):431-4
Publication Type
Article
Date
Jul-2007
Author
Susan E Schultz
Chris Vinden
Linda Rabeneck
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Canada.
Source
Can J Gastroenterol. 2007 Jul;21(7):431-4
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Aged
Colonoscopy - utilization
Colorectal Neoplasms - diagnosis - epidemiology - therapy
Databases, Factual
Female
Health Maintenance Organizations
Health Services Accessibility
Humans
Male
Middle Aged
Ontario - epidemiology
Physician's Practice Patterns - statistics & numerical data
Population Surveillance
Sigmoidoscopy - utilization
Abstract
To conduct a population-based study on the provision of large bowel endoscopic services in Ontario.
Data from the following databases were analyzed: the Ontario Health Insurance Plan, the Institute for Clinical Evaluative Sciences Physicians Database and Statistics Canada. The flexible sigmoidoscopy and colonoscopy rates per 10,000 persons (50 to 74 years of age) by region between April 1, 2001, and March 31, 2002, were calculated, as well as the numbers and types of physicians who performed each procedure.
In 2001/2002, a total of 172,108 colonoscopies and 43,400 flexible sigmoidoscopies were performed in Ontario for all age groups. The colonoscopy rate was approximately five times that of flexible sigmoidoscopy; rates varied from 463.1 colonoscopies per 10,000 people in the north to 286.8 colonoscopies per 10,000 people in the east. Gastroenterologists in all regions tended to perform more procedures per physician, but because of the large number of general surgeons, the total number of procedures performed by each group was almost the same.
Population-based rates of colonoscopies and flexible sigmoidoscopies are low in Ontario, as are the procedure volumes of approximately one-quarter of physicians.
Notes
Cites: Can J Gastroenterol. 2004 Apr;18(4):213-915054497
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Cites: J Natl Cancer Inst. 1999 Mar 3;91(5):434-710070942
PubMed ID
17637944 View in PubMed
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Community care for people with chronic conditions: an analysis of nine studies of health and social service utilization in Ontario.

https://arctichealth.org/en/permalink/ahliterature200518
Source
Milbank Q. 1999;77(3):363-92, 275
Publication Type
Article
Date
1999
Author
S. Watt
G. Browne
A. Gafni
Author Affiliation
System-Linked Research Unit on Health and Social Service Utilization, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada.
Source
Milbank Q. 1999;77(3):363-92, 275
Date
1999
Language
English
Publication Type
Article
Keywords
Canada
Chronic Disease
Community Health Services - utilization
Health Maintenance Organizations
Humans
National Health Programs
Ontario
Abstract
A series of studies conducted in the same region found that programmatic, community-based health and social service interventions have a positive impact on client well-being. These proactive interventions, designed to address the full range of health and social needs, were usually provided at the same--or even lower--costs as uncoordinated, illness-focused care. The results of this series suggest that across-the-board health care reduction, at least in a system of national health insurance, will produce poorer results, at higher cost, for people with chronic conditions living in the community. Policy planners need more research that concentrates on comparisons of outcomes between and within different models of health and social service delivery. The studies should be designed to help them determine who benefits from different service configurations carried out within a range of policy environments at various costs.
PubMed ID
10526549 View in PubMed
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A comparison of ambulatory care and selected procedure rates in the health care systems of the Province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States.

https://arctichealth.org/en/permalink/ahliterature209689
Source
Healthc Manage Forum. 1997;10(4):26-9, 32-4
Publication Type
Article
Date
1997
Author
C A DeCoster
M. Smoller
N P Roos
E. Thomas
Author Affiliation
National Health Research and Development Program.
Source
Healthc Manage Forum. 1997;10(4):26-9, 32-4
Date
1997
Language
English
Publication Type
Article
Keywords
Ambulatory Care - utilization
Coronary Artery Bypass - statistics & numerical data - utilization
Health Care Surveys
Health Maintenance Organizations - utilization
Humans
Hysterectomy - statistics & numerical data - utilization
Insurance Claim Review
Laminectomy - statistics & numerical data - utilization
Manitoba - epidemiology
Office visits - statistics & numerical data
Physician's Practice Patterns - statistics & numerical data
United States - epidemiology
Unnecessary Procedures - statistics & numerical data
Utilization Review
Abstract
To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for most of the United States, the primary payment mechanism is fee-for-service, with the patient paying a significant amount, thereby militating against preventive and early primary care. Manitoba and KP data were extracted from computerized administrative records. U.S. data were obtained from publicly available reports. Manitoba provides 1.8 times and KP 1.2 times (1.4 when allied health visits are included) as many primary care physician visits as the United States. For the surgical procedures studied, U.S. rates were higher than those in either the KP HMO or in Manitoba. We conclude that (1) the U.S. system leads to more surgical intervention, and (2) removal of financial barriers leads to higher use of primary care services where more preventive and ameliorative care can occur.
PubMed ID
10179074 View in PubMed
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A critical review of cost reduction in neonatal intensive care. I. The structure of costs.

https://arctichealth.org/en/permalink/ahliterature194902
Source
J Perinatol. 2001 Mar;21(2):107-15
Publication Type
Article
Date
Mar-2001
Author
D K Richardson
J A Zupancic
G J Escobar
M. Ogino
D M Pursley
M. Mugford
Author Affiliation
Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
Source
J Perinatol. 2001 Mar;21(2):107-15
Date
Mar-2001
Language
English
Publication Type
Article
Keywords
Accounting - methods
Canada
Cost Allocation - methods
Cost Control
Efficiency, Organizational
Great Britain
Health Maintenance Organizations
Hospital Costs
Humans
Infant, Newborn
Intensive Care Units, Neonatal - economics
Intensive Care, Neonatal - economics
National Health Programs
State Medicine
United States
Abstract
Neonatal intensive care is expensive. In the current era of intense cost containment in hospital care, neonatologists and hospital administrators are under intense pressure to find strategies for cost reduction for neonatal services. Few neonatal clinicians are trained in economics, management, or accounting, and few hospital administrators are familiar with neonatal intensive care. In this review, we describe the structure and sources of hospital costs and the accounting systems needed to isolate and measure such costs. We discuss where efficiencies might be found and consider specific issues in capitated settings such as health maintenance organizations in the United States, the Canadian health care system and the National Health System in the United Kingdom.
Notes
Comment In: J Perinatol. 2002 Jun;22(4):336; author reply 336-33712066768
PubMed ID
11324356 View in PubMed
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The doctor as double agent: information asymmetry, health insurance, and medical care.

https://arctichealth.org/en/permalink/ahliterature227834
Source
J Health Econ. 1991;10(4):411-32
Publication Type
Article
Date
1991
Author
A. Blomqvist
Author Affiliation
Department of Economics, University of Western Ontario, London, Canada.
Source
J Health Econ. 1991;10(4):411-32
Date
1991
Language
English
Publication Type
Article
Keywords
Canada
Consumer Participation - economics - psychology - statistics & numerical data
Costs and Cost Analysis - methods - statistics & numerical data
Efficiency
Health Knowledge, Attitudes, Practice
Health Maintenance Organizations - economics
Humans
Information Theory
Insurance, Physician Services - economics
Interinstitutional Relations
Models, Econometric
Physician's Role
Physician-Patient Relations
Stochastic Processes
Abstract
In a model incorporating uncertainty and state-dependent utility of health services, as well as information asymmetry between patients/buyers and physicians/sellers, two types of equilibria are compared: (1) when consumers have conventional third-party insurance and doctors are paid on the basis of fee-for-service; and (2) when insurance is through an HMO which provides health services through its own doctors. Conditions are found under which contractual or legal incentives can overcome the information asymmetry problem and bring about an efficient allocation of resources to health services provision.
PubMed ID
10117012 View in PubMed
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44 records – page 1 of 5.