Skip header and navigation

Refine By

109 records – page 1 of 11.

Access to emergency operative care: a comparative study between the Canadian and American health care systems.

https://arctichealth.org/en/permalink/ahliterature149522
Source
Surgery. 2009 Aug;146(2):300-7
Publication Type
Article
Date
Aug-2009
Author
Susan A Krajewski
S Morad Hameed
Douglas S Smink
Selwyn O Rogers
Author Affiliation
Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. susankrajewski@post.harvard.edu
Source
Surgery. 2009 Aug;146(2):300-7
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Adult
Appendicitis - pathology - surgery
Canada
Emergency medical services
Ethnic Groups
Female
Health Services Accessibility
Healthcare Disparities
Humans
Income
Insurance, Health
Male
Medicaid
Medicare
Middle Aged
National Health Programs
Socioeconomic Factors
United States
Universal Coverage
Young Adult
Abstract
Canada provides universal health insurance to all citizens, whereas 47 million Americans are uninsured. There has not been a study comparing access to emergency operative care between the 2 countries. As both countries contemplate changes in health care delivery, such comparisons are needed to guide health policy decisions. The purpose of this study is to determine whether or not there is a difference in access to emergency operative care between Canada and the United States.
All patients diagnosed with acute appendicitis from 2001 to 2005 were identified in the Canadian Institute for Health Information database and the US Nationwide Inpatient Sample. Severity of appendicitis was determined by ICD-9 codes. Patients were further characterized by age, gender, insurance status, race, and socioeconomic status (SES; income). Univariate and multivariate analyses were performed to determine the odds of appendiceal perforation at different levels of SES in each country.
There were 102,692 Canadian patients and 276,890 American patients with acute appendicitis. In Canada, there was no difference in the odds of perforation between income levels. In the United States, there was a significant, inverse relationship between income level and the odds of perforation. The odds of perforation in the lowest income quartile were significantly higher than the odds of perforation in the highest income bracket (odds ratio, 1.20; 95% confidence interval, 1.16-1.24).
The results suggest that access to emergency operative care is related to SES in the United States, but not in Canada. This difference could result from the concern over the ability to pay medical bills or the lack of a stable relationship with a primary care provider that can occur outside of a universal health care system.
PubMed ID
19628089 View in PubMed
Less detail

Alcohol-related hospitalizations of elderly people. Prevalence and geographic variation in the United States.

https://arctichealth.org/en/permalink/ahliterature6168
Source
JAMA. 1993 Sep 8;270(10):1222-5
Publication Type
Article
Date
Sep-8-1993
Author
W L Adams
Z. Yuan
J J Barboriak
A A Rimm
Author Affiliation
Department of Medicine, Medical College of Wisconsin, Milwaukee.
Source
JAMA. 1993 Sep 8;270(10):1222-5
Date
Sep-8-1993
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alcoholism - economics - epidemiology
Cross-Sectional Studies
Female
Hospitals - utilization
Humans
Male
Medicare Part A - statistics & numerical data
Morbidity
Patient Admission - economics - statistics & numerical data
Prevalence
United States - epidemiology
United States Centers for Medicare and Medicaid Services
Abstract
OBJECTIVE--To determine the prevalence, geographic variation, and charges to Medicare of alcohol-related hospitalizations among elderly people in the United States. DESIGN--A cross-sectional prevalence study using 1989 hospital claims data from the Health Care Financing Administration (HCFA). Rates were determined using (1) hospital claims records from the HCFA's Medicare Provider Analysis and Review Record (MEDPAR) database for all Medicare Part A beneficiaries aged 65 years and older; (2) county population estimates for 1985 from the Bureau of the Census; and (3) per capita consumption of alcohol by state in 1989 as estimated by the US Department of Health and Human Services. SETTING--Data include all hospital inpatient Medicare Part A beneficiaries aged 65 years and older in the United States in 1989. RESULTS--The prevalence of alcohol-related hospitalizations among people aged 65 years and older nationally in 1989 was 54.7 per 10,000 population for men and 14.8 per 10,000 for women. Comparison with hospital records showed that MEDPAR data had a sensitivity of 77% to detect alcohol-related hospitalizations. There was considerable geographic variation; prevalence ranged from 18.9 per 10,000 in Arkansas to 77.0 per 10,000 in Alaska. A strong correlation existed between alcohol-related hospitalizations and per capita consumption of alcohol by state (Spearman correlation coefficient, .64; P
Notes
Erratum In: JAMA 1993 Nov 3;270(17):2055
PubMed ID
8355385 View in PubMed
Less detail

An analysis of Medicare's Incentive Payment program for physicians in health professional shortage areas.

https://arctichealth.org/en/permalink/ahliterature180555
Source
J Rural Health. 2004;20(2):109-17
Publication Type
Article
Date
2004
Author
Leighton Chan
L Gary Hart
Thomas C Ricketts
Shelli K Beaver
Author Affiliation
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Wash., USA. leighton@u.washington.edu
Source
J Rural Health. 2004;20(2):109-17
Date
2004
Language
English
Publication Type
Article
Keywords
Alaska
Cohort Studies
Economics, Medical
Humans
Medically underserved area
Medicare Assignment - statistics & numerical data
Medicare Part B - economics - statistics & numerical data
Northwestern United States
Reimbursement, Incentive - utilization
Retrospective Studies
Rural Health Services - economics
Southeastern United States
Specialization
Urban Health Services - economics
Abstract
Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in rural and urban areas where there is a shortage of generalist physicians.
To examine the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program. We determined the program's utilization and which types of physicians received payments.
Retrospective cohort design, utilizing complete 1998 Medicare Part B data. Physician specialty was determined through American Medical Association data. Rural status was determined by linking the physician business ZIP code to its Rural-Urban Commuting Area code (RUCA).
There were 2,220,275 patients and 39,749 providers in the cohort, including 9,769 (24.6%) generalists, 21,331 (53.7%) specialists, and 8,649 (21.8%) nonphysician providers. Over $4 million in bonus payments (median payment = $173) were made to providers in HPSAs. Specialists and urban providers received 58% and 14% of the bonus reimbursements, respectively. Two million dollars in payments were not distributed because the providers did not claim them. Over $2.8 million in bonus claims were distributed to providers who likely did not work in approved HPSA sites.
The MIP bonus payments given to providers are small. Many providers who should have claimed the bonus did not, and many providers who likely did not qualify for the bonus claimed and received it. Consideration should be given to focusing and enlarging the bonus payments to specific providers, rather than rewarding all providers equally. Policy makers should also consider a system that prospectively determines provider eligibility.
PubMed ID
15085623 View in PubMed
Less detail

An economic analysis of the Ottawa knee rule.

https://arctichealth.org/en/permalink/ahliterature200748
Source
Ann Emerg Med. 1999 Oct;34(4 Pt 1):438-47
Publication Type
Article
Date
Oct-1999
Author
G. Nichol
I G Stiell
G A Wells
L S Juergensen
A. Laupacis
Author Affiliation
Clinical Epidemiology Unit, Loeb Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada. grahamnichol@earthlink.net
Source
Ann Emerg Med. 1999 Oct;34(4 Pt 1):438-47
Date
Oct-1999
Language
English
Publication Type
Article
Keywords
Adult
Cost Savings
Decision Support Techniques
Fractures, Bone - radiography
Humans
Knee Injuries - economics - radiography
Medicare - economics
Ontario
Physician's Practice Patterns - economics
Referral and Consultation
United States
Abstract
To conduct an economic analysis of the implementation of the Ottawa Knee Rule.
The decision analysis compared usual practice based on physician judgment with practice based on a clinical decision rule, which allows more selective use of radiography. The study participants were all adults with blunt knee trauma. The likelihood and cost of radiography, missed fracture, lost productivity, and medicolegal actions were defined by published data and an expert panel. Separate analyses considered US Medicare and Canadian hospital costs. Sensitivity analyses considered a range of values for each variable in the model, including costs in a US fee-for-service setting. The study outcome was the mean cost per patient.
The mean cost savings associated with practice based on the Ottawa Knee Rule was $31 (95% confidence interval 22 to 44) to $34 (95% confidence interval 24 to 47) per patient. These results were robust to reasonable changes in the values of variables in the model.
Implementation of the Ottawa Knee Rule would be associated with meaningful reductions in societal health care costs both in the United States and Canada without a reduction in quality of care.
Notes
Comment In: Ann Emerg Med. 1999 Oct;34(4 Pt 1):535-710499954
PubMed ID
10499943 View in PubMed
Less detail

Antithrombotic therapy for stroke prevention among Medicare beneficiaries hospitalized in Alaska with atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature5166
Source
Alaska Med. 1998 Oct-Dec;40(4):79-84
Publication Type
Article
Author
M E Gordian
H D Mustin
Author Affiliation
PRO-West/Alaska, Anchorage 99508, USA.
Source
Alaska Med. 1998 Oct-Dec;40(4):79-84
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Alaska - epidemiology
Anticoagulants - administration & dosage
Aspirin - administration & dosage
Atrial Fibrillation - complications - drug therapy
Cerebrovascular Disorders - epidemiology - prevention & control
Data Collection
Drug Utilization - statistics & numerical data
Female
Fibrinolytic Agents - administration & dosage
Hospitalization
Humans
Incidence
Male
Medicare
Research Support, U.S. Gov't, Non-P.H.S.
Retrospective Studies
Risk factors
United States
Warfarin - administration & dosage
Abstract
Although warfarin therapy reduces the risk of stroke among patients with atrial fibrillation (AF), the risk of hemorrhagic complications and other concerns may make clinicians reluctant to prescribe this treatment for elderly patients. Aspirin is a lower-risk alternative to warfarin but is also less effective. This study examines the use of antithrombotic therapy with warfarin or aspirin at hospital discharge among 182 Medicare beneficiaries 65 or older with chronic AF who were admitted to nine Alaska hospitals during 1996. Sixty-five percent of patients without contraindications were discharged on warfarin, and an additional 16% received aspirin. The rate of anticoagulation with warfarin was much higher among patients aged 65-74 (95%) than among those 75 or older (45%). The relatively low rate of warfarin use for very elderly patients may represent an opportunity to improve care. Although these patients have the highest risk of hemorrhagic complications, they also have the greatest potential to benefit from anticoagulation.
PubMed ID
10202404 View in PubMed
Less detail

Appropriateness of coronary angiography after myocardial infarction among Medicare beneficiaries.

https://arctichealth.org/en/permalink/ahliterature195462
Source
N Engl J Med. 2001 Mar 8;344(10):774-5
Publication Type
Article
Date
Mar-8-2001

Building on Primary Care Reforms and Indigenous Self-Determination in the Northwest Territories: Physician Accountability and Performance in Context.

https://arctichealth.org/en/permalink/ahliterature300178
Source
Healthc Pap. 2018 04; 17(4):70-76
Publication Type
Journal Article
Comment
Date
04-2018
Author
Susan Chatwood
Author Affiliation
Scientific Director, Institute for Circumpolar Health Research, Associate Professor, School of Public Health, University of Alberta, Associate Professor, Institute of Health Policy Management and Evaluation, University of Toronto, Yellowknife, NT.
Source
Healthc Pap. 2018 04; 17(4):70-76
Date
04-2018
Language
English
Publication Type
Journal Article
Comment
Keywords
Canada
Medicare
Northwest Territories
Primary Health Care
Social Responsibility
United States
Abstract
This commentary responds to Marchildon and Sherar's (2018) paper, "Doctors and Canadian Medicare: Improving Accountability and Performance," in which they explore questions around governance and physician accountability in Canada. This response situates the issues raised in a northern context by sharing experiences with primary care reform in the Northwest Territories and exploring the implications these changes have had for physician accountability and reported system improvements. Physician leadership and accountability are further explored in the northern context, where health systems for Indigenous communities include multiple jurisdictions and transitions in governance advance the self-government, land claims and treaty rights of Indigenous peoples.
Notes
CommentOn: Healthc Pap. 2018 Apr;17(4):14-26 PMID 30291706
PubMed ID
30291713 View in PubMed
Less detail

Canada medicare discriminates against dentists.

https://arctichealth.org/en/permalink/ahliterature111586
Source
J Can Dent Assoc (Tor). 1966 Dec;32(12):691
Publication Type
Article
Date
Dec-1966
Source
J Can Dent Assoc (Tor). 1966 Dec;32(12):691
Date
Dec-1966
Language
English
Publication Type
Article
Keywords
Aged
Canada
Dentists
Humans
Medicare
PubMed ID
5332782 View in PubMed
Less detail

109 records – page 1 of 11.