Hirsch S. Ruchlin

The Efficacy of Second-Opinion Consultation Programs: A Cost???Benefit Perspective

This study evaluates a mandatory second-opinion consultation program administered on behalf of a large Taft-Hartley welfare fund providing medical care coverage for 120,000 beneficiaries and covered dependents. During a two-year intake period (1977-1978), 2,284 individuals received second-opinion consultations for an elective surgical procedure recommended by a first-contact physician or surgeon. Of this group, 366 received a nonconfirmation of their need for surgery. Medical claims data were available for 342 individuals in this group, and they constitute the base for the current analysis. A comparable number of individuals who received a positive confirmation were randomly selected and served as a control for estimating program savings. Both groups were followed for a one-year period from the date of their consultations. Total program savings were estimated at

An analysis of smoking patterns among older adults.

534,791. Of this amount, medical care utilization savings were

Developing economic measures of hospital productivity

361,756 and productivity savings were

The long-term care marketplace: an analysis of deficiencies and potential reform by means of incentive reimbursement.

173,035. The cost of the program was

An Appraisal of Nursing Home Care

203,300, yielding a benefit—cost ratio of 2.63. These findings indicate that mandatory second-opinion consultation programs, which are consumer oriented and intervene before care is rendered, are clearly cost-effective.

Measuring hospital productivity.

UNLABELLED BACKGROUND, SUBJECTS, AND METHODS: The 1990 Health Promotion and Disease Prevention Supplement to The National Health Interview Survey was used to develop point-prevalence data about smoking for four age groups, 55 to 64, 65 to 74, 75 to 84, and over 84 and to assess the association of sociodemographics, health status, and health beliefs with a respondents smoking profile. RESEARCH DESIGN Chi-square and Cohran-Mantel-Haenszel tests were used to investigate prevalence patterns. Odds ratios generated from logistic regressions were used to indicate degree of association. RESULTS Fifty-three percent of individuals above the age of 54 smoked in the past and 17% smoked in 1990. Among these smokers, 61% tried to quit and 36% noted that their physicians never advised them to quit. Significant age group differences were noted on the various measures of smoking prevalence. Beliefs about the adverse health effects of smoking were associated with a greater likelihood of never smoking, and among smokers, a greater likelihood of being a former smoker. CONCLUSIONS Analyses of health behaviors among older adults must recognize the diversity within this age group, and measures of health beliefs should be included in subsequent studies of health behaviors among older adults. Physicians must also play a greater role in discussing smoking with their patients and advocating smoking cessation.

Medical care use in Sweden and the United States—A comparative analysis of systems and behavior: by Ronald Andersen, Bjorn Smedby and Odin W. Anderson. Centre for Health Administration Studies, University of Chicago. 174 pp.

Abstract This study presents a methodology for measuring hospital output and estimating hospital productivity. A productivity index is developed for a sample of hospitals in New York City for which information was far more detailed than in systematic national sources, and sources of differences among hospitals in productivity are investigated. Internal consistencies in the productivity relationships are examined, and the findings are compared with cost relationships derived from the same data base. The analysis suggests that much better measures for a number of service areas and improved methods for dealing with variations in quality of care will be needed before reasonably accurate hospital-wide measures of output and productivity can be attained.

6.00.

This study analyzes the institutional, economic, and regulatory deficiencies of the long-term care sector of the health industry and develops an incentive reimbursement model as a means for correcting or ameliorating some of the stated deficiencies. The reimbursement model presents a schema which attempts to match patients to facilities, needs to services, and services to cost. A capital expansion coupon program is proposed, both as a suitable vehicle for channeling incentive rewards accruing to nonprofit institutions, and as a mechanism for subsidizing the approved expansion and/or renovation plans of “efficient” providers of care.