Showing papers in "Medical Care Research and Review in 2000"
TL;DR: A conceptual model of cultural competency’s potential to reduce racial and ethnic health disparities is developed, using the cultural Competency and disparities literature to lay the foundation for the model and inform assessments of its validity.
Abstract: This article develops a conceptual model of cultural competency's potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly.
1,014 citations
TL;DR: Multivariate analysis found that the perception of racism and mistrust of the medical care system led to less satisfaction with care and when perceived racism and medical mistrust were controlled, race was no longer a significant predictor of satisfaction.
Abstract: The authors examine determinants of satisfaction with medical care among 1,784 (781 African American and 1,003 white) cardiac patients. Patient satisfaction was modeled as a function of predisposing factors (gender, age, medical mistrust, and perception of racism) and enabling factors (medical insurance). African Americans reported less satisfaction with care. Although both black and white patients tended not to endorse the existence of racism in the medical care system, African American patients were more likely to perceive racism. African American patients were significantly more likely to report mistrust. Multivariate analysis found that the perception of racism and mistrust of the medical care system led to less satisfaction with care. When perceived racism and medical mistrust were controlled, race was no longer a significant predictor of satisfaction.
856 citations
TL;DR: The authors’ review of the health services literature since the release of the landmark Report of the Secretary’s Task Force Report of Black and Minority Health in 1985 revealed significant differences in access to medical care by race and ethnicity within certain disease categories and types of health services.
Abstract: The authors’ review of the health services literature since the release of the landmark Report of the Secretary’s Task Force Report of Black and Minority Health in 1985 revealed significant differences in access to medical care by race and ethnicity within certain disease categories and types of health services. The differences are not explained by such factors as socioeconomic status (SES), insurance coverage, stage or severity of disease, comorbidities, type and availability of health care services, and patient preferences. Under certain circumstances when important variables are controlled, racial and ethnic disparities in access are reduced and may disappear. Nonetheless, the literature shows that racial and ethnic disparities persist in significant measure for several disease categories and service types. The complex challenge facing current and future researchers is to understand the basis for such disparities and to determine why disparities are apparent in some but not other disease categories and service types.
652 citations
TL;DR: It is shown that 22 risk factors consistently predict two or more outcomes, including three that predict all four: worse performance on physical function measures not based on activities of daily living, greater illness severity, and prior hospital use.
Abstract: Long-term care resources would be allocated more cost-effectively if care planning and medical/functional eligibility decisions were grounded more firmly in extant evidence regarding the risk of nursing home placement, hospitalization, functional impairment, and mortality. This article synthesizes the studies that longitudinally assess the predictors of each of these outcomes for the 65 and older population in the United States. A database was assembled containing 167 multivariate analyses abstracted from 78 journal articles published between 1985 and 1998. Findings show that 22 risk factors consistently predict two or more outcomes, including three that predict all four: worse performance on physical function measures not based on activities of daily living, greater illness severity, and prior hospital use. Findings should help prioritize variable selection choices of those setting eligibility criteria, allocating care resources, and doing descriptive studies. Gaps are shown to exist in the understanding of outcome effects of facility, market, policy, and other system attributes.
407 citations
TL;DR: The authors find that disparities increased between 1977 and 1996, particularly for Hispanic Americans, and show that approximately one half to three quarters of the disparities observed in 1996 would remain even if racial and ethnic disparities in income and health insurance coverage were eliminated.
Abstract: This article focuses on racial and ethnic disparities in health care, describing both absolute differences and relative changes in access to care and the use of health services among whites, blacks, and Hispanics over the past two decades. Using data from a series of three nationally representative medical expenditure surveys, the authors present descriptive statistics on disparities in access and use between minorities and whites over time. They also use multivariate analyses to isolate the extent to which health insurance and income explain those disparities. The authors find that disparities increased between 1977 and 1996, particularly for Hispanic Americans. Results also show that approximately one half to three quarters of the disparities observed in 1996 would remain even if racial and ethnic disparities in income and health insurance coverage were eliminated.
391 citations
TL;DR: The magnitude of the association between limited English proficiency and number of physician visits was similar to that for having poor health, no health insurance, or no regular source of care.
Abstract: Many Latinos have limited English proficiency and this may negatively affect their use of health care services To examine this, the authors interviewed 465 Spanish-speaking Latinos and 259 English speakers of various ethnicities who presented to a public hospital emergency department with non-urgent medical problems to assess previous physician visits, sociodemographic characteristics, and level of English proficiency The proportion of patients who reported no physician visit during the 3 months before study enrollment was not related to English proficiency However, among the 414 patients who saw a physician at least once, Latinos with fair and poor English proficiency reported approximately 22 percent fewer physician visits (p = 0020 and p = 0015, respectively) than non-Latinos whose native language was English, even after adjusting for other determinants of physician visits The magnitude of the association between limited English proficiency and number of physician visits was similar to that for having poor health, no health insurance, or no regular source of care
347 citations
TL;DR: The survey found that the majority of Americans are uninformed about health care disparities—many were unaware that blacks fare worse than whites on measures susch as infant mortality and life expectancy, and that Latinos are less likely than whites to have health insurance.
Abstract: To assess the public’s perceptions and attitudes about racial and ethnic differences in health care, the Kaiser Family Foundation surveyed a nationally representative sample of 3,884 whites, African Americans, and Latinos in 1999. The survey found that the majority of Americans are uninformed about health care disparities—many were unaware that blacks fare worse than whites on measures susch as infant mortality and life expectancy, and that Latinos are less likely than whites to have health insurance. Views on whether the health system treats people equally were strikingly different by race. For example, most minority Americans perceive that they get lower quality care than whites, but most whites think otherwise. Nonetheless, more minority Americans were concerned about the cost of care than racial barriers. Efforts to eliminate disparities will need to improve public awareness of the problems as well as address racial and financial barriers to care.
310 citations
TL;DR: The authors find that both the magnitude of racial and ethnic disparity and the reasons behind it depend significantly on the state, the ethnic group, and the type of outcome measure being studied.
Abstract: Health disparities among racial and ethnic groups have a long history and continue to exist in the United States. The U.S. government has established as a goal for the year 2010 the elimination of racial/ethnic health differences in six areas. This article examines disparities in one of those areas: access to high-quality health care. Several measures of access to and use of health care services are studied both nationally and in 13 diverse states. The authors find that both the magnitude of racial and ethnic disparity and the reasons behind it depend significantly on the state, the ethnic group, and the type of outcome measure being studied. Such information can be valuable for state and national policy makers in targeting resources and in designing effective strategies for the elimination of racial and ethnic disparities.
150 citations
TL;DR: It is found that African Americans and Hispanics are more likely to be hospitalised for preventable conditions than are similar white patients.
Abstract: Using discharge data from 10 states, this study estimates the effects of race and ethnicity on the likelihood of being hospitalized for a preventable condition--an indicator of limited access to primary care. The authors find that African Americans and Hispanics are more likely to be hospitalized for preventable conditions. In particular, controlling for differences in patients' health care needs, socioeconomic status, insurance coverage, and the availability of primary care, Hispanic children, working-age African American adults, and elderly patients from both minority groups are at greater risk than are similar white patients.
125 citations
TL;DR: Evidence is strengthened that health insurance coverage has a substantial impact on ability to gain access to medical care and may affect health status and people who gained coverage showed improvement across all indicators of access.
Abstract: This study uses longitudinal data to examine the consequences of losing and gaining health insurance coverage for access to care and health. For both Medicaid and privately insured persons, compared with those who remained insured, persons losing coverage over a 2-year period were more likely to lack a usual source of care, encounter difficulty in obtaining medical care, be very dissatisfied with ability to obtain needed care, and report no physician visits in the previous 12 months. Uninsured people who gained coverage showed improvement across all indicators of access, in contrast to those who remained without insurance. The effects of changes in coverage on health were in the same direction as those for access, but did not reach statistical significance. This study strengthens the evidence that health insurance coverage has a substantial impact on ability to gain access to medical care and may affect health status.
123 citations
TL;DR: The authors find that while coverage has declined for workers in most racial/ethnic groups, the experience of Hispanic males appears to be unique in that changes in their characteristics as well as structural shifts account for their decline in employment-related coverage.
Abstract: Health insurance confers important private and social benefits. Disparities in coverage among the population remain an important public policy issue. The authors focus on the health insurance status of white, black, and Hispanic Americans in both 1987 and 1996 and identify gaps in minority health care coverage relative to white Americans. They also investigate the access of workers in these groups to employment-based health insurance. Identified are factors underlying changes in the insurance status of workers during the past decade in terms of changes in population characteristics and structural shifts underlying the demand for and supply of health insurance. The authors find that while coverage has declined for workers in most racial/ethnic groups, the experience of Hispanic males appears to be unique in that changes in their characteristics as well as structural shifts account for their decline in employment-related coverage. Structural shifts dominated the changes in coverage rates for other groups.
TL;DR: A framework for the complex series of steps involved in obtaining invasive cardiac care is presented, and differences in physician and patient race may be a particular impediment to effective communication about symptoms and preferences and to the establishment of a therapeutic partnership.
Abstract: Coronary artery disease is the leading cause of death in the United States. Blacks are more likely than whites to experience premature disease, and they have poorer prognosis after acute myocardial infarction. Multiple studies have demonstrated that blacks are less likely to be referred for certain invasive cardiac procedures. Few studies have examined the effect of race on physician and patient decision making in referrals for cardiac procedures. The authors present a framework for the complex series of steps involved in obtaining invasive cardiac care. Patient race can affect each of these steps, and differences in physician and patient race may be a particular impediment to effective communication about symptoms and preferences and to the establishment of a therapeutic partnership. The potential role of communication in race-discordant physician-patient relationships suggests a need for more research in physician decision making and for efforts to promote cultural competency as a core component of medical education.
TL;DR: Ranal failure, colorectal cancer, pneumonia, and lung cancer were the most expensive conditions per person per year and three cardiovascular conditions accounted for 17 percent of direct medical expense.
Abstract: In this retrospective cohort analysis of all adults who were members of Kaiser Permanente, Northern California, between July 1995 and June 1996 (N = 2,076,303), the authors estimated the prevalence, average annual costs per person, and percentage of total direct medical expenditures attributable to each of 25 chronic and acute conditions. Ordinary least squares regression was used to adjust for age, gender, and comorbidities. The costs attributable to the 25 conditions accounted for 78 percent of the health maintenance organization's total direct medical expense for this age-group. Injury accounted for a higher proportion (11.5 percent) of expenditures than any other single condition. Three cardiovascular conditions--ischemic heart disease, hypertension, and congestive heart failure--together accounted for 17 percent of direct medical expense and separately accounted for 6.8 percent, 5.7 percent, and 4.0 percent, respectively. Renal failure ($22,636), colorectal cancer ($10,506), pneumonia ($9,499), and lung cancer ($8,612) were the most expensive conditions per person per year.
TL;DR: It is found that HMOs still attract healthier Medicare beneficiaries, thatHMOs no longer attract healthier employees, and that H MOs attract healthier Medicaid recipients.
Abstract: Early reviews found that health maintenance organizations (HMOs) attracted healthier beneficiaries in the Medicare program and healthier employees in the market for employer-based insurance. This review finds that HMOs still attract healthier Medicare beneficiaries, that HMOs no longer attract healthier employees, and that HMOs attract healthier Medicaid recipients. This review also found conflicting evidence about whether Medicare HMOs are overpaid, no evidence that HMOs are overpaid in the market for employer-based insurance, and evidence that concerns about overpaying Medicaid HMOs have diminished because many states are adopting mandatory programs.
TL;DR: The authors analyzed data from the Washington state CAHPS demonstration, fitting hierarchical models in which coefficients of casemix variables and intercepts could vary by plan, and estimated the impact of variability in casemIX coefficients on plan adjustments and also assessed the implications for differential effects of individual characteristics at different plans.
Abstract: Responses to the Consumer Assessments of Health Plans Survey (CAHPS) are related to respondent characteristics. CAHPS procedures include casemix adjustment to remove effects of difference in respondent characteristics on comparative plan ratings, under the assumption that casemix coefficients are homogeneous across plans. The authors analyzed data from the Washington state CAHPS demonstration, fitting hierarchical models in which coefficients of casemix variables and intercepts could vary by plan. They estimated the impact of variability in casemix coefficients on plan adjustments and also assessed the implications for differential effects of individual characteristics at different plans. Estimated between-plan variability of coefficients was small, but the data are consistent with substantially larger variability. The potential impact of this variability on adjustments for plans was small relative to the magnitude of the adjustments. Comparisons between plans for individuals, however, could be affected substantially. This methodology could be useful wherever casemix adjustment is applied.
TL;DR: Among the 86 measures identified, most evaluated treatment of major mental disorders, for example, schizophrenia and major depression, and measures imposing a lower burden were more likely to be in use.
Abstract: The National Inventory of Mental Health Quality Measures was funded by the Agency for Healthcare Research and Quality to (1) inventory process measures for assessing the quality of mental health care; (2) identify clinical, administrative, and quality domains where measures have been developed; and (3) identify areas where further research and development is needed. Among the 86 measures identified, most evaluated treatment of major mental disorders, for example, schizophrenia (24 percent) and major depression (21 percent). A small proportion focused on children (8 percent) or the elderly (9 percent). Domains of quality included treatment appropriateness (65 percent), continuity (26 percent), access (26 percent), coordination (13 percent), detection (12 percent), and prevention (6 percent). Few measures were evaluated for reliability (12 percent) or validity (3 percent). Measures imposing a lower burden were more likely to be in use (chi 2 = 4.41, p = .036). Further measures are needed to assess care for several priority clinical and demographic groups. Research should focus on measure validity, reliability, and implementation costs. In order to foster quality improvement activities and use of common measures and specifications for mental health care, the inventory of quality measures will be made available at www.challiance.org/cqaimh.
TL;DR: The findings show that only about one in seven published research articles used qualitative methods, and there is no standard number of pages devoted by journals to these studies or evidence that they require more journal space on average than quantitative studies.
Abstract: There is interest in promoting greater use of qualitative methods in health care research. However, little is known about the volume or characteristics of published studies that use qualitative methods. This article explores these issues through a systematic review of 3 years (1995-1997) of articles classified as research in nine core health services research and management journals. The findings show that only about one in seven published research articles used qualitative methods. Two of the nine journals reviewed contributed 45 percent of the total number of articles using qualitative methods. Four journals contributed a combined 2 percent of this total number. The primary purposes in using these methods are description and articulating stakeholder perspectives. There is no standard number of pages devoted by journals to these studies or evidence that they require more journal space on average than quantitative studies. Most of the studies reviewed presented little or no information on methodology. The...
TL;DR: Reasons for the apparent discrepancy in the impact of national versus local/regional systems on hospital financial performance and the apparent declining ability of national systems to generate above-average returns are explored.
Abstract: While hospitals continue to join multi-institutional systems, empirical data on the benefits of system membership are ambiguous. This study examines the same 166 Florida hospitals in 1986 and 1992. System membership, in general, did not enhance financial returns (measured by operating margin, total margin, and return on assets) for the pooled data or for either year. In fact, a significant negative relationship is noted in 1986. However, when only hospitals affiliated with national systems (in this study, American Medical International, Hospital Corporation of America, or Humana) are analyzed, a positive statistically significant association is found for two of the above three profitability indicators for both the pooled data and for 1986. However, there was no statistically significant impact noted for 1992. Reasons for the apparent discrepancy in the impact of national versus local/regional systems on hospital financial performance and the apparent declining ability of national systems to generate above...
TL;DR: Comparison between health maintenance organization (HMO) and fee-for-service insurance indicates that younger although not much healthier people, racial/ethnic minorities, MSA residents, and those residing in the West and Northeast regions were more likely to have HMO coverage.
Abstract: This study provided a national profile of health insurance of certain vulnerable populations including children, racial/ethnic minorities, low-income families, non-metropolitan statistical area (MSA) residents, and those with poor health status. The study shows an increase in the proportion of uninsured nonelderly population. While public insurance helped reduce the employment- and health-related disparities in private coverage, it has not overcome other disparities related to vulnerable characteristics including race/ethnicity, wages, education, and area of residence. Comparison between health maintenance organization (HMO) and fee-for-service insurance indicates that younger although not much healthier people, racial/ethnic minorities, MSA residents, and those residing in the West and Northeast regions were more likely to have HMO coverage. To reduce significant disparities in health insurance coverage, policy makers will have to consider expanding public insurance coverage, targeting vulnerable groups, particularly those with multiple vulnerable characteristics rather than merely the economically distressed. Expecting managed care to achieve cost containment for services provided to vulnerable populations may be unrealistic.
TL;DR: Access to medical care for Asians and Pacific Islanders in the United States is examined, using a survey of patients receiving care provided by a physician group practice association concentrated on the West Coast to find out why Asians were more vulnerable to the access problems examined.
Abstract: This study examines access to medical care for Asians and Pacific Islanders in the United States, using a survey of patients receiving care provided by a physician group practice association concentrated on the West Coast. Asians and Pacific Islanders who had used their health plan in the past year had worse access to health care than whites, blacks, Hispanics, and Native American or other ethnicities. The odds that Asians reported that they had adequate access ranged from about one quarter to three quarters that of whites, depending on the measure. Cultural differences and associated communication problems may explain the access problems experienced by Asians. Interventions need to be developed to address the problems with access to services, and better translation services may play an important role in improving access to care for Asians. Future studies need to clarify why Asians were more vulnerable to the access problems examined than other ethnic groups that might experience similar barriers.
TL;DR: The results show that initiating treatment with a tricyclic antidepressant reduces the probability of antidepressant treatment compliance and initiation of family, group, or individual psychotherapy treatments increase the likelihood of compliance.
Abstract: Depression is among the most prevalent, devastating, and undertreated disorders in our society Treatment with antidepressant medications is effective in controlling symptoms, but treatment beyond the point of symptom resolution is necessary to restore functional status and prevent recurrent episodes An important step in improving compliance is to identify the determinants of antidepressant treatment compliance A broader motivation for our study is to examine compliance by patients with a chronic but treatable disease With claims data between 1990 and 1993, this study uses logistic regression analysis to examine the determinants of compliance among 2,012 antidepressant recipients The results show that initiating treatment with a tricyclic antidepressant reduces the probability of antidepressant treatment compliance Initiating treatment with a selective serotonin reuptake inhibitor and undergoing family, group, or individual psychotherapy treatments increase the probability of compliance Case management does not meaningfully affect compliance Implications for policy and clinical practice are discussed
TL;DR: Despite states’ tendencies to follow one another’s examples, Medicaid reimbursement remains diverse nationally, with wide differences in policies and rates.
Abstract: This article describes state Medicaid nursing facility reimbursement methods and rates in 1979-1997, using data derived from telephone surveys of state Medicaid reimbursement The 1980s saw shifts toward prospective methodology The late 1980s and early 1990s were characterized by adoption of casemix methods The early 1990s also saw fewer changes in methodology with a hiatus in the mid-1990s followed recently by renewed changes to methodology Medicaid per diem rates have increased faster than inflation but less rapidly than general health costs The repeal of the Boren Amendment may now allow states to institute greater cost controls or moratoria on rate increases Despite states' tendencies to follow one another's examples, Medicaid reimbursement remains diverse nationally, with wide differences in policies and rates
TL;DR: The authors present a new approach to studying the health care system in matrix form, which suggests a new set of players to be studied, emphasizes the relationships among the players, and provides a checklist of independent, control, and interactive variables to be included in analyses.
Abstract: The health care system has undergone a fundamental transformation undermining the usefulness of the typology of the health maintenance organization, the independent practice association, the prefer...
TL;DR: Results suggest that patients whose treatment is authorized in increments of 5 sessions are nearly 3 times more likely to terminate treatment at exactly the fifth visit than if their treatment is authorize in increment of 10 sessions conditional on being in treatment until the 5th visit.
Abstract: This study examines how preauthorization affects outpatient behavioral health utilization under managed care by comparing plans with similar benefits, but differing in the number of visits authorized. The authors compare plans primarily authorizing in increments of 5 visits to plans authorizing in increments of 10 visits. They analyze the likelihood of terminating outpatient service between the two groups using conditional logistic regression. Results suggest that patients whose treatment is authorized in increments of 5 sessions are nearly 3 times more likely to terminate treatment at exactly the fifth visit than if their treatment is authorized in increments of 10 sessions conditional on being in treatment until the 5th visit. The likelihood of termination peaks in both the 5- and 10-session authorization at the 10th visit, but the difference is not statistically significant. The authorization effect differs by provider type and is weaker among psychiatrists than among nonphysician providers.
TL;DR: While state premium taxation and benefits mandates were not associated with self-insurance, small-group reforms were significantly and positively associated with the probability of self-Insurance.
Abstract: Many large employers prefer to self-insure health plans offered to employees rather than purchase them from insurance companies to save costs and to avoid the burden of complying with varying state mandates. This concerns state governments because they cannot directly regulate self-insured plans. This article describes the prevalence of employer self-insurance for the nation and by state in 1993 and examines what factors, especially state policies, contribute to the national and state variation in the prevalence of self-insurance. Data from the National Employer Health Insurance Survey on 34,604 private sector establishments are analyzed. Variation in the prevalence of self-insurance was largely explained by the firm size of the establishments. After all other factors were examined, very little was added to predict the rate of self-insurance for each state. While state premium taxation and benefits mandates were not associated with self-insurance, small-group reforms were significantly and positively associated with the probability of self-insurance.
TL;DR: It is concluded that direct patient access to specialists does not necessarily result in higher physician or specialist expenditures in HMOs.
Abstract: This study compares expenditures for physician services in a closed panel gatekeeper health maintenance organization (HMO) and an open panel point of service HMO that share the same physician network. The study uses administrative files of the two study HMOs for 1994-1995 to assess differences in spending for primary care physicians’ (PCPs’) services, specialists’ services, and total physician services. When the copayments for PCP visits and PCP-referred specialist visits were $0, total physician expenditures were 4 percent higher in the gatekeeper HMO than in the point of service plan (p < .05). When the copayments for PCP visits and PCP-referred specialist visits were $10, total physician expenditures ranged from equal in both HMOs to 7 percent higher in the gatekeeper HMO (p < .01), depending on the copayment for self-referred visits. Expenditures for specialists’services were not higher in the point of service plan. The authors conclude that direct patient access to specialists does not necessarily re...
TL;DR: Since this type of research often requires a health care organization as collaborator, the authors discuss strategies for developing research partnerships and collecting data from the partner organization.
Abstract: In the past two decades, relationships among health plans, medical groups, and providers have grown more complex and the number of clinical management strategies has increased. In this context, determining the independent effect of a particular organizational strategy on quality of care has become more difficult. The authors review some of the issues a researcher must address when studying the relationship between organizational characteristics and quality of care. They offer criteria for selecting a research question, list organizational characteristics that may influence quality, and suggest sampling and study design techniques to reduce confounding. Since this type of research often requires a health care organization as collaborator, the authors discuss strategies for developing research partnerships and collecting data from the partner organization. Finally, they offer suggestions for translating research into policy.
TL;DR: An analysis of cases brought under the law suggests that discrimination claims within a particular market fare better than those challenging decisions to relocate or alter the market served.
Abstract: The history of health care discrimination as well as ongoing, extensive evidence of racial disparities argue for continued vigilance in the area of health care and civil rights. Under Title VI of the Civil Rights Act of 1964, individuals have challenged de facto discriminatory policies adopted by health entities receiving federal financial assistance. Title VI health litigation is difficult because of complex issues of proof as well as confounding problems of poverty and lack of health insurance that affect both claims and remedies. An analysis of cases brought under the law suggests that discrimination claims within a particular market fare better than those challenging decisions to relocate or alter the market served. This has important implications for claims involving discrimination by managed care organizations. Because the same potential for discrimination exists in the new health system of managed care, although in altered form, data collection and evaluation are warranted.
TL;DR: Members of the alcoholism treatment group were more likely than the comparison group to be hospitalized and to need other (nonalcoholism) medical treatment, thus incurring higher total costs.
Abstract: This study investigates whether alcoholism treatment costs are offset by reductions in other medical treatment costs by comparing people treated for alcoholism with a matched comparison group. The alcoholism treatment group is defined by diagnoses of alcohol dependence, abuse, or psychoses from health insurance claims field between January 1980 and June 1987. A comparison sample was matched on age, gender, and insurance coverage. In this primarily methodological study, expected costs for nonalcoholism treatments were calculated from standardized regressions. Offset effects were measured from the insurer's perspective through differences in expected total nonalcoholism treatment costs in the periods preceding and following alcoholism treatment. Members of the alcoholism treatment group were more likely than the comparison group to be hospitalized and to need other (nonalcoholism) medical treatment, thus incurring higher total costs. Offset effects emerged for patients with alcohol abuse and without mental psychosis comorbidities.
TL;DR: The results suggest that MCOs are responding to outside pressures to engage in QI and are reorganizing their management structures and more slowly and tentatively are building technical capacity for QI.
Abstract: This article examines the degree to which managed care organizations (MCOs) are reorganizing to take responsibility for the quality of care and service they provide. Specifically, factors prompting plans to focus on quality improvement (QI) and how they may be building the capacity to improve quality are considered. The authors' analysis is based on executive interviews with the plan medical directors, QI directors, and chief executive officers (CEOs) in a sample of 24 health plans. The overall response rate was 58.3 percent (medical director = 62.5 percent, QI director = 79.2 percent, CEO = 33.3 percent). The authors queried respondents about (1) perceived drivers and obstacles to the development of an effective QI program, (2) plan organizational structure for QI, and (3) technical capacities for data collection, management, and performance measurement. The results suggest that MCOs are responding to outside pressures to engage in QI. They are reorganizing their management structures and more slowly and tentatively are building technical capacity for QI.