Eric Nauenberg

Aging, social capital, and health care utilization in Canada

This paper examines relationships between aging, social capital, and healthcare utilization. Cross-sectional data from the 2001 Canadian Community Health Survey and the Canadian Census are used to estimate a two-part model for both GP physicians (visits) and hospitalization (annual nights) focusing on the impact of community- (CSC) and individual-level social capital (ISC). Quantile regressions were also performed for GP visits. CSC is measured using the Petris Social Capital Index (PSCI) based on employment levels in religious and community-based organizations [NAICS 813XX] and ISC is based on self-reported connectedness to community. A higher CSC/lower ISC is associated with a lower propensity for GP visits/higher propensity for hospital utilization among seniors. The part-two (intensity model) results indicated that a one standard deviation increase (0.13%) in the PSCI index leads to an overall 5% decrease in GP visits and an annual offset in Canada of approximately

A cost effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis

225 M. The ISC impact was smaller; however, neither measure was significant in the hospital intensity models. ISC mainly impacted the lower quantiles in which there was a positive association with GP utilization, while the impact of CSC was strongest in the middle quantiles. Each form of social capital likely operates through a different mechanism: ISC perhaps serves an enabling role by improving access (e.g. transportation services), while CSC serves to obviate some physician visits that may involve counseling/caring services most important to seniors. Policy implications of these results are discussed herein.

Cost-effectiveness Analysis of Implantable Venous Access Device Insertion Using Interventional Radiologic versus Conventional Operating Room Methods in Pediatric Patients with Cancer

To carry out a cost‐effectiveness analysis of omitting chest radiography in the diagnosis of infant bronchiolitis.

Social capital, community size and utilization of health services: A lagged analysis

PURPOSE Percutaneous image-guided techniques are associated with less tissue trauma and morbidity than open surgical techniques. Interventional radiology has received significant health care investment. The purpose was to determine the cost effectiveness of inserting implantable venous access devices (IVADs) by interventional radiologic means versus conventional operating room surgery in pediatric patients with cancer. MATERIALS AND METHODS In a retrospective cohort analysis, patients presenting with a new tumor diagnosis and receiving a first-time IVAD in January to June 2000 (operative group; n = 30) and January to June 2004 (interventional group; n = 30) were included. A societal costing perspective was adopted. Costs included labor, materials, equipment, inpatient wards, parent travel, and parental productivity losses for 30 days after insertion. Severe complications related to IVAD insertion were microcosted. Costs related to cancer therapy were not included. Incremental cost-effectiveness analysis and sensitivity analysis were performed. RESULTS Interventional patients were older (7.3 years vs 4.1 years; P = .01). There were no significant differences between groups in sex, American Society of Anesthesiologists score, or length of hospital stay. Interventional radiologic procedures were shorter (84.9 minutes vs 112.8 minutes; P = 0.01). Interventional radiologic insertion was slightly less costly than operative insertion (Can

Network Structure and Hospital Financial Performance in New York State: 1991-1995:

622,860 and Can

Future Intentions of Registered Nurses Employed in the Western New York Labor Market: Relationships Among Demographic, Economic, and Attitudinal Factors

627,005 per 30-patient group, respectively) and more effective in reducing the complication rate (two vs eight complications per group, respectively; P = .039). The results were sensitive to the cost of operating the operating room. CONCLUSIONS Interventional radiology was slightly less costly than operative IVAD insertion and resulted in fewer serious complications. It should be considered for IVAD insertions in pediatric patients with cancer.

Surveying hospital network structure in New York State: how are they structured?

OBJECTIVES We examine the relationship between social capital, community size and GP visits, and conceptualize social capital as a stock variable measured at a prior point in time. METHODS Data from the 2002 Canadian Community Health Survey and the 2001 Canadian Census are merged with GP visit data from the Ontario Health Ministry. Negative binomial regression is used to measure the impact of community-level (CSC) and individual-level social capital (ISC) on GP visits. CSC is measured with the Petris Index using employment levels in religious and community-based organizations, and ISC is measured along multiple dimensions. RESULTS The effect of social capital varies by community size. A one standard deviation increase in the Petris Index in larger communities (population>100,000) leads to a 2.6% decrease in GP visits with an annual offset in public spending of

Critical care services in Ontario: a survey-based assessment of current and future resource needs

66.4M. Tangible social support-a measure of ISC-also exhibited large effects on GP visits. In smaller communities (population 10,000-100,000), only increased ISC exhibited an impact on GP visits. Age had no effect on the association between social capital and GP visits. CONCLUSIONS Each form of social capital likely operates through different mechanisms and impact differs by community size. Stronger CSC likely obviates some physician visits in larger communities that involve counseling/caring services while some forms of ISC may act similarly in smaller communities.

Simulation of a Hirschman–Herfindahl index without complete market share information

As networks have proliferated, questions have arisen regarding which structure is optimal. To obtain an answer from the hospital perspective, the authors conducted a survey of New York State hospitals to determine how network integration, complexity, and financial risk sharing relate to measures of financial performance during the period of 1991-1995. Of the 64 hospitals indicating a network affiliation by 1995, 67.2 percent listed some network risk-sharing activity. The least integrated networks were associated with the smallest improvements in throughput, and the most complex were associated with the largest negative changes in operating margins. During the first 2 years of network membership, hospitals joining risk-sharing networks experienced operating margin gains averaging 12 percentage points higher than hospitals joining networks without risk sharing; however, this difference dissipated in later years. Networks with higher levels of integration, lower levels of complexity, and which involve some risk-sharing between affiliates are most likely to experience improved hospital financial performance during the network’s initial years.

Reconsideration of discharge data to measure competition in the hospital industry

Demographic, economic, and attitudinal factors may affect the work participation behavior of full and part-time RNs in hospital and non-hospital settings. The sample (N = 776) included randomly selected RNs from the 1997 registration lists of the New York State Department of Professional Licensing. Classical t-tests and chi-square tests were used to test for differences between hospital, non-hospital, full-time and part-time RNs. Only RNs employed in hospital settings were significantly less satisfied and less committed to their organization than were non-hospital based nurses; however these attitudes, frequently shown to be related to turnover behavior, did not result in intentions to leave. Differences in satisfaction and commitment across job settings begin to explain work participation behavior of nurses, as distinct from organizational behavior.