Gerald L. Glandon

A Panel Study of Life Stress, Social Support and the Health Services Utilization of Older Persons.

Interest in the health care needs and medical care utilization patterns of older persons has steadily increased in recent years. The major goal of this study was to examine the extent to which specific factors moderate the relationship between life stress exposure and subsequent health services utilization. Two groups of older persons (health maintenance organization members and fee-for- service clients) participating in a multiyear panel study comprised the study sample. Time-ordered, multivariate analyses of links among life stress exposure, moderating variables, and subsequent health services utilization indicate that the process may not be direct or simple to explain. There was no indication in this study that social support had any direct moderating effects on the time-ordered relationship between life stress exposure and the utilization of medical care services. However, the interaction of high life stress exposure and low social support was consistently linked to increased rates of health services utilization.

Elderly health beliefs, attitudes, and maintenance☆

BACKGROUND Why older persons engage in varying amounts of health maintenance activity is becoming both an increasingly important policy issue and a topic of interest to health services researchers. Such activity may help the elderly to delay the onset of the health-related problems associated with aging, maintain if not improve their functional abilities, and perhaps improve their quality of life. METHODS Using a conceptual model largely based upon the health belief model, this study sought to examine predictors of variability of health maintenance activity among older persons. The project included cross-sectional data drawn from the first phase of a multiyear panel study of elderly community residents. RESULTS Results of ordinary least-squares and logistic regression analyses of seven types of health maintenance activity suggest that health beliefs are an important consideration but that other variables, namely, type of insurance plan and select sociodemographic factors, also had significant impacts. Another consistent finding was that each of the types of health maintenance activity was associated with different types of predictor variables. CONCLUSION These findings suggest that in order for levels of health maintenance activity to be increased, intervention programs need to be targeted toward specific types of health beliefs and need to take into account the importance of social differences.

An analysis of the adoption of managerial innovation: cost accounting systems in hospitals.

The adoption of new medical technologies has received significant attention in the hospital industry, in part, because of its observed relation to hospital cost increases. However, few comprehensive studies exist regarding the adoption of non-medical technologies in the hospital setting. This paper develops and tests a model of the adoption of a managerial innovation, new to the hospital industry, that of cost accounting systems based upon standard costs. The conceptual model hypothesizes that four organizational context factors (size, complexity, ownership and slack resources) and two environmental factors (payor mix and interorganizational dependency) influence hospital adoption of cost accounting systems. Based on responses to a mail survey of hospitals in the Chicago area and AHA annual survey information for 1986, a sample of 92 hospitals was analyzed. Greater hospital size, complexity, slack resources, and interorganizational dependency all were associated with adoption. Payor mix had no significant influence and the hospital ownership variables had a mixed influence. The logistic regression model was significant overall and explained over 15% of the variance in the adoption decision.

Information dissemination and the cesarean birth rate. The Illinois experience.

A study was initiated to investigate the impact of information dissemination in Illinois upon the projected rise in the cesarean birth rate over the period from 1986 through 1988. The total cesarean birth rate in Illinois had not changed significantly during this period, whereas the rate of vaginal births after cesarean sections (VBAC) increased by 58.4% (p < .001). Information dissemination may have contributed to stemming an increase in the cesarean birth rate in Illinois while promoting VBAC deliveries.

Using Ratios to Measure Hospital Financial Performance: Can the Process be Simplified?

Evaluation of a hospitals financial condition is often contingent upon the analysis of financial ratios. This study of 114 Illinois hospitals sought to simplify the financial assessment process by exploring the empirical dimensions that underlie 25 financial ratios. Results of a factor analytic solution suggest that there are five underlying factors which account for approximately 77% of the total variance. Uses of summative scaled measures in health services financial management and research are discussed.

Perceived Risk: The Link to Plan Selection and Future Utilization

Perceived Risk: The Link to Plan Selection and Future Utilization Abstract Enrollment of Medicare beneficiaries in HMOs may reduce the costs of providing health care but has raised concerns over adverse selection and how to adjust reimbursement levels to compensate for this potential. An adjustment based on an individuals perceived health and financial risk may be more accurate than proposed demographic, prior use of health services or current health status adjusters. Results suggest that those in HMOs may be more sensitive to the extreme cost of hospitalization than those with fee-for-service insurance, and therefore were attracted to the comprehensive care offered by the HMO. In addition, HMO enrollees, face fewer barriers to seeking health care, thus may be higher utilizers in future periods. Introduction In 1985, out-of-pocket health care costs for the elderly were greater in real dollars than before the 1965 Medicare legislation[7]. This phenomenon did not go unnoticed by the elderly. Realizing they were spending more and more of their budgets on health care, they began to look for insurance mechanisms with which to supplement their Medicare coverage. At the same time, the Federal government was also experiencing changes in the health care marketplace. The Federal government has seen Medicare expenses increase from

Desirable life events and physician utilization among older American men and women

4.7 billion in 1967 to

An Analysis of Physician Utilization by Elderly Persons: Systematic Differences Between Self-Report and Archival Information

64.6 billion in 1984[11]. Th is rapid increase in expenditures prompted the Federal government to expand health care delivery mechanisms for Medicare enrollees beyond the traditional fee-for-service (FFS) system through legislation supporting the enrollment of Medicare beneficiaries in health maintenance organizations (HMOs). These trends at the consumer and the payor level have resulted in the increased enrollment of Medicare beneficiaries in HMOs. In 1981, 595,000 Medicare beneficiaries (a little more than 2 percent) were enrolled in capitated systems. In 1985, the number of Medicare beneficiaries enrolled in HMO/CMP and group practice prepayment organizations reached 1,117,000 or 3.7 percent of Medicare enrollees[11]. The initial contracts between the Health Care Financing Administration (HCFA) and HMOs were structured on a cost basis. This type of contract was attractive to HMOs because it limited their risk and thus encouraged them to enroll Medicare beneficiaries. In 1985, HCFA began to move away from the signing of cost contracts with HMOs to the establishment of risk contracts [13]. Under the initial risk contracts the HMOs enrolling Medicare beneficiaries were reimbursed at 94 percent of the AAPCC (Adjusted Average Per Capita Cost). This structure gave HMOs financial incentives to provide services at lower costs (one of their claimed advantages over a fee-for-service practice). At the same time, these contracts would lower the level and increase the certainty of Federal expenditures for health care. Recently, the General Accounting Office (GAO) has recommended lowering the multiplier for the AAPCC to 89 percent[15] thus shrinking the average reimbursement and creating further pressure upon providers (HMOs) to deliver medical services at a lower rate or to exit the Medicare HMO market. Problem Statement The move to risk contracts for HMOs creates a number of concerns for the HMOs operating under these terms. The primary concern is whether or not adverse selection will occur. Adverse selection occurs when the high risk/high cost members of a population tend to disproportionately enroll in one type of insurance plan[1]. Recently, HMOs have acted as if adverse selection has occurred in their Medicare population. For example, Av-Med Health Plan Inc. in Florida, Maxicare in California, and Choice Care in Cincinnati have all withdrawn from Medicare risk contracts[14]. Their actions may be in response to adverse selection by enrollees which resulted in the costs of providing services in excess of reimbursement levels. …

Improving hospital performance: issues in assessing the impact of TQM activities.

Abstract In this article we report on a study which examined the relationship between desirable life events and outpatient physician utilization. We tested two models: (1) a model which assumed that desirable events are associated with a change in utilization, and the relationship is linear; and (2) a model which assumed that desirable events are associated non-linearly with physician utilization. Data were collected at two points in time from 346 older men and women residing in the Chicago metropolitan area. We conceptualized our models in terms of Andersen s behavioral model of medical care utilization. Our analyses suggest that experiencing desirable events resulted in a non-uniform reduction in number of physician visits. People who experienced three desirable events did not benefit as much as those who experienced one or two. We suggest that the effect of desirable events on utilization was due to the impact of desirable events on psychological well-being, and thus, on perception of health status. Furthermore, we discuss the findings in relationship to social support, its costs and benefits.