Eun Sul Lee

DRGs in psychiatry. An empirical evaluation.

On October 1, 1983, Medicare began paying general hospitals by a prospective payment system based on DRGs. Psychiatric settings are exempted automatically or by request. By January 1985, however, a decision is required on how to integrate psychiatric settings into this system. This article provides an empirical analysis of the current DHHS DRGs categories for mental disorders. Current mental disorder DRGs and alternate DRGs examined here explain less than 3-12% of the variation in psychiatric length of stay. This is in contrast to 30-50% explained variation for other disorders. Alternatives and policy implications are discussed.

Health Insurance and Utilization of Medical Care for Children with Special Health Care Needs

Based on analyses of the 1988 National Center for Health Statistics, National Health Interview Survey, Child Health Supplement, this study examines the insurance coverage and utilization of physicians, hospitals, and prescribed medicine among the 9.6 million U.S. children with special health care needs, defined as children who had one or more selected chronic conditions that caused them to experience pain, discomfort, or being upset often or all of the time in the last year, or who were limited in their major childhood activities (playing or going to school) as a result of these or other impairments or health problems. The findings confirmed that substantial variation in access to routine medical care exists among these children. Though health status is an important predictor of which children use services in general, poor, minority children who lived with their mother or someone other than their parents, or those without insurance or an identifiable regular medical provider were most likely to experience financial barriers to access or were less apt to seek care than other children with comparable needs. Access to routine medical care remains particularly problematic for these subsets of children with special health care needs.

The effect of a reduction in leading causes of death: potential gains in life expectancy.

The potential gains in total expectation of life and in the working life ages among the United States population are examined when the three leading causes of death are totally or partially eliminated. The impressive gains theoretically achieved by total elimination do not hold up under the more realistic assumption of partial elimination or reduction. The number of years gained by a new-born child, with a 30 per cent reduction in major cardiovascular diseases would be 1.98 years, for malignant neoplasms 0.71 years, and for motor vehicle accidents 0.21 years. Application of the same reduction to the working ages, 15 to 70 years, results in a gain of 0.43, 0.26, and 0.14 years, respectively for the three leading causes of death. Even with a scientific break-through in combating these causes of death, it appears that future gains in life expectancies for the working ages will not be spectacular. The implication of the results in relation to the current debate on the national health care policy is noted.

Tests of Hypotheses

This chapter discusses tests of hypotheses and defines key terms to help succinctly communicate the ideas of hypothesis testing. Hypothesis testing is a way of organizing and presenting evidence that helps reach a decision. There are negative outcomes associated with making a wrong decision and these have to be weighed carefully. The chapter also discusses the determination of the decision rule. The decision rule specifies which values of the test statistic, or some function of it, will cause to reject the null hypothesis in favor of the alternative hypothesis. The decision rule is based on the probabilities of the type I and II errors. The probabilities of type I and type II errors are found from the consideration of the distribution of the test statistic. A two-sided test is called such because either large or small values of the test statistic cause to question the truth of the null hypothesis. A one-sided test occurs when only values in one direction cause to question the null hypothesis.

Introduction to biostatistics : a guide to design, analysis, and discovery

Introduction. Data and Numbers. Sampling. Descriptive Tools. Probability and Life Tables. Probability Distributions. Interval Estimation. Designed Experiments. Test of Hypothesis. Nonparametric Tests. Analysis of Categorical Data. Analysis of Survival Data. Test of Hypotheses Based on the Normal Distribution. Analysis of Variance. Linear and Logistic Regression. Appendices. Index.

The health of Mexican Americans: evidence from the human population laboratory studies.

Data are presented from sample surveys conducted in 1974 (N = 3,119) and 1975 (N = 657) in Alameda County, California, by the Human Population Laboratory. Mexican Americans are compared to Anglos and Blacks on selected health status indicators; chronic conditions, disability, symptoms and a summary measure, the Physical Health Spectrum. Comparisons of crude percentages indicate that, compared to Anglos, Blacks report having more chronic conditions, more disability and more symptoms, while Chicanos generally report fewer health problems than these two groups. Controlling for the effects of age, sex, education, family income, marital status, and perceived health reduces the Anglo/Black differentials in reported health problems, primarily by reducing the rates for Blacks. However, even after adjustment the prevalence rates for Blacks remain higher. After controlling for the effects of the six covariates, the rates for Chicanos remain essentially unchanged in both samples, e.g., lower than the other groups. Results of binary regression analysis indicate that the two most powerful predictors of health status in both samples are age/sex and perceived health. Ethnicity overall is not a good predictor of health status, accounting for 1 per cent or less of the explained variance. Socioeconomic status, while predicting slightly better than ethnicity, still accounts for less than 2% of the variance in health status.

Mortality patterns among hypertensives by reported level of caffeine consumption

The effect of caffeine consumption on mortality was evaluated in a historical cohort study of 10,064 diagnosed hypertensive individuals participating in the Hypertension Detection and Follow-up Program from 1973 to 1979. Total caffeine intake level from beverages (coffee and tea) and certain medications, was estimated at the 1-year visit. No evidence was found supporting an association between increased level of caffeine consumption and increased all-cause mortality or cardiovascular disease mortality during the following 4 years. Cigarette smoking was significantly associated with mortality; the association being more pronounced among non- and low-caffeine consumers for all-cause mortality and among non-caffeine consumers for all cardiovascular mortality except cerebrovascular mortality.

Validity of the Spanish surname infant mortality rate as a health status indicator for the Mexican American population.

This study assessed the validity of the Spanish surname infant mortality rate as an index of urban Mexican American health status. Neonatal, postneonatal, and risk-factor-specific mortality rates were computed from linked birth and infant death records of the 1974-75 Harris County, Texas, cohort of 68,584 for Spanish surname White, non-Spanish surname White, and Black single live births. Infants of Mexican-born immigrants were distinguished from those of other Spanish surname parents by parental nativity information on birth records. Infants of Mexican immigrants had paradoxically low mortality rates for high birth order, high maternal age, and delayed or absent prenatal care; only infants weighing less than 1500 gm showed expected high rates. Findings suggested loss of infant death data compatible with migration and under-registration of deaths. The Spanish surname infant mortality rate may be spuriously low and does not appear to be a valid indicator of Mexican American health status even in an urban, non-border area considered to have excellent birth and death registration.

Employment, sense of well-being, and use of professional services among women.

Utilizing data from the National Health and Nutrition Examination Survey of 1971-1975 (NHANES I), comparisons were made of general well-being scores and utilization of professional services between employed and non-employed women. Employed women tend to have a higher sense of well-being and utilize fewer professional services to cope with personal and mental health problems than their non-employed counterparts. This tendency is more pronounced among non-married and less-educated women, with an indication of a counter-tendency among college-educated non-White women.

Ethnic differentials in neonatal and postneonatal mortality: A birth cohort analysis by a binary variable multiple regression method

Abstract Ethnic differentials in neonatal and postneonatal mortality in a birth cohort of Spanish surname, white (non‐Spanish), and nonwhite infants in Houston, Texas, were analyzed with legitimacy status, mothers age, birth order, and birth weight controlled separately and simultaneously. In the presence of all factors, Spanish surname and non‐Spanish white infants had a neonatal mortality risk about 13 per cent below average; nonwhite (primarily Black) infants, 30 per cent above average. Adjusted for all four factors, the risk for nonwhites was 8 per cent below average and for Spanish surname infants 2 per cent below average, while it rose to almost 5 per cent above average for non‐Spanish white infants. Birth weight and legitimacy status were responsible for most of the change. The four factors had less effect on postneonatal mortality, with legitimacy status seeming to have the greatest influence.