The burdens of uninsured hospitalizations in an urban county.
CONTEXT: Few data at the level of local health jurisdictions are available to characterize health problems specific to persons without health insurance. PRACTICE PATTERN EXAMINED: Hospitalization patterns of residents of DeKalb County, Georgia, who have no health insurance. DATA SOURCE: 1996 Georgia hospital discharge records for persons living within ZIP code areas included in or overlapping with DeKalb County. RESULTS: Of 67,156 hospital discharges, 6781 (10%) were for uninsured patients. Sixty-eight percent of uninsured hospitalizations took place in publicly owned and controlled hospitals, where uninsured persons represented 45% of all discharges. Charges associated with uninsured hospitalizations amounted to $51.3 million in 1996, of which $35.3 million (69%) was claimed by public hospitals. The uninsured were overrepresented in many diagnostic groups, including diabetes, injury and poisoning, chronic liver disease, skin disease, and infectious or parasitic disease. CONCLUSIONS: In DeKalb County, Georgia, the burden of uninsured hospitalizations falls disproportionately on the public sector. Policy initiatives are needed to more equitably share the burden of uninsured hospitalization with for-profit hospitals. Because the uninsured were overrepresented in several conditions, public health initiatives aimed at preventing these conditions should also be a priority. (+info)
A relational approach to measuring competition among hospitals.
OBJECTIVE: To present a new, relational approach to measuring competition in hospital markers and to compare this relational approach with alternative methods of measuring competition. DATA SOURCES: The California Office of Statewide Health Planning and Development patient discharge abstracts and financial disclosure files for 1991. STUDY DESIGN: Patient discharge abstracts for an entire year were used to derive patient flows, which were combined to calculate the extent of overlap in patient pools for each pair of hospitals. This produces a cross-sectional measure of market competition among hospitals. PRINCIPAL FINDINGS: The relational approach produces measures of competition between each and every pair of hospitals in the study sample, allowing us to examine a much more "local" as well as dyadic effect of competition. Preliminary analyses show the following: (1) Hospital markets are smaller than thought. (2) For-profit hospitals received considerably more competition from their neighbors than either nonprofit or government hospitals. (3) The size of a hospital does not matter in the amount of competition received, but the larger hospitals generated significantly more competition than smaller ones. Comparisons of this method to the other methods show considerable differences in identifying competitors, indicating that these methods are not as comparable as previously thought. CONCLUSION: The relational approach measures competition in a more detailed way and allows researchers to conduct more fine-grained analyses of market competition. This approach allows one to model market structure in a manner that goes far beyond the traditional categories of monopoly oligopoly, and perfect competition. It also opens up an entirely new range of analytic possibilities in examining the effect of competition on hospital perfomance, price of medical care, changes in the market, technology acquisition, and many other phenomena in the health care field. (+info)
Using administrative data to identify indications for elective primary cesarean delivery.
OBJECTIVE: To develop a methodology to identify indications and normative rates for elective primary cesarean delivery using administrative data. DATA SOURCES/STUDY SETTING: All delivery discharges in 1995, as reported to the California Office of Statewide Health Planning and Development (secondary data). STUDY DESIGN: Retrospective population based study. DATA COLLECTION/EXTRACTION: Data were entered into a recursive partitioning algorithm to develop a hierarchy of conditions by which patients with multiple conditions could be sorted with respect to the binary outcome of labor or elective primary cesarean without labor. This hierarchy was examined for its clinical consistency, validated on a second sample, and compared with results obtained from logistic regression. PRINCIPAL FINDINGS: Four percent (19,664) of delivery discharges in 1995 underwent elective primary cesarean. Twelve clinical conditions contributed to the hierarchy, and accounted for 92.9 percent of all women experiencing elective primary cesarean delivery. The remaining 7.1 percent of the elective primary cesarean cases were classified as "unspecified." CONCLUSIONS: A standardized methodology (utilizing recursive partitioning algorithms) for assigning indications for elective primary cesarean is presented. This methodology relies on administrative data, classifies women with complex comorbidity patterns into clinically relevant subpopulations, and can be used to establish normative rates for benchmarking specific indications for cesarean delivery. (+info)
Universal coverage and public health: new state studies.
Recent evaluations of the California Health Service Plan (CHSP) confirmed that financing health care through a single government payer can provide universal coverage-while saving significantly on health care spending-to a degree unparalleled by alternative approaches. Public ownership of the delivery system can further provide authority and accountability for critical reforms that improve the population's health and quality of care, including coordination of the delivery system. The federal government's State Planning Grant Program provides states with funding to develop plans to cover their uninsured populations. California created a Health Care Options Project that requested proposals that could expand coverage and contracted with a financial modeler and a qualitative analyst to evaluate the resulting plans. The CHSP was one of 9 plans evaluated through this process. (+info)
Validating California teachers study self-reports of recent hospitalization: comparison with California hospital discharge data.
Determining an accurate method of obtaining complete morbidity data is a long-standing challenge for epidemiologists. The authors compared the accuracy and completeness of existing California hospital discharge data with self-reports of recent hospitalizations and surgeries from participants in the California Teachers Study. Self-reports were collected by questionnaire in 1997 from 91433 female teachers and administrators residing in California. Of the 13430 hospital discharge diagnoses identified for these women, cohort members reported 58%. Self-reporting was highest for neoplasms and musculoskeletal and connective tissue diseases and was most accurate for scheduled admissions, more recent admissions, longer lengths of stay, and less severe disorders. Hospitalizations for mental health and infectious disease were not as well reported. Among the 26383 self-reports-including outpatient surgeries, which are not captured by the hospital discharge database-confirmation was lower, as expected, especially for disorders of the nervous system and sense organs and skin and subcutaneous tissue. Confirmation was highest for childbirth admissions. The hospital discharge database was more specific, but the self-reports were more comprehensive, since many conditions are now treated in outpatient settings. The combination of self-reports and secondary medical records provides more accurate and complete morbidity data than does use of either source alone. (+info)
Capacity of state and territorial health agencies to prevent foodborne illness.
The capacity of state and territorial health departments to investigate foodborne diseases was assessed by the Council of State and Territorial Epidemiologists from 2001 to 2002 with a self-administered, Web-based survey. Forty-eight health departments responded (47 states and 1 territory). The primary reason for not conducting more active case surveillance of enteric disease is lack of staff, while the primary reasons for not investigating foodborne disease outbreaks are limited staff and delayed notification of the outbreak. Sixty-four percent of respondents have the capacity to conduct analytic epidemiologic investigations. States receiving Emerging Infections Program (EIP) funding from the Centers for Disease Control and Prevention more often reported having a dedicated foodborne disease epidemiologist and the capability to perform analytic studies than non-EIP states. We conclude that by addressing shortages in the number of dedicated personnel and reducing delays in reporting, the capacity of state health departments to respond to foodborne disease can be improved. (+info)
Quantifying the disease impact of alcohol with ARDI software.
Alcohol-Related Disease Impact (ARDI) Software has been developed for the Centers for Disease Control (CDC) to allow States to calculate mortality, years of potential life lost (YPLL), direct health-care costs, indirect morbidity and mortality costs, and nonhealth-sector costs associated with alcohol use and misuse. The mortality related measures--mortality, YPLL, and indirect mortality costs--are computed for 35 diagnoses related to alcohol use and misuse. A review of clinical research studies and injury surveillance studies was conducted to produce estimates of the alcohol-attributable fraction (AAF) for each diagnosis. For these measures, age-specific and age-adjusted rates are also calculated. Health care costs, morbidity costs, and nonhealth-sector costs are prorated from national studies to the State or locality. This multiple-measure approach to quantifying a health problem is termed "disease impact estimation." National estimates of the disease impact of alcohol use and misuse have been produced using ARDI software and State-specific estimates are in preparation. Designed to CDC specifications, ARDI is completely menu-driven and operates within Lotus 1-2-3 software as a set of linked spreadsheets. ARDI adapts national epidemiologic and health economics methods for use by State and local health agencies. ARDI produces data on the health consequences of alcohol use and misuse for use by locally based policymakers, public health professionals, and researchers, while permitting comparison and compilation of these data across jurisdictions. (+info)
The effect of disseminating evidence-based interventions that promote physical activity to health departments.
OBJECTIVES: We explored the effect of disseminating evidence-based guidelines that promote physical activity on US health department organizational practices in the United States. METHODS: We implemented a quasi-experimental design to examine changes in the dissemination of suggested guidelines to promote physical activity (The Guide to Community Preventive Services) in 8 study states; the remaining states and the Virgin Islands served as the comparison group. Guidelines were disseminated through workshops, ongoing technical assistance, and the distribution of an instructional CD-ROM. The main evaluation tool was a pre- and postdissemination survey administered to state and local health department staffs (baseline n=154; follow-up n=124). RESULTS: After guidelines were disseminated through workshops, knowledge of and skill in 11 intervention-related characteristics increased from baseline to follow-up. Awareness-related characteristics tended to increase more among local respondents than among state participants. Intervention adoption and implementation showed a pattern of increase among state practitioners but findings were mixed among local respondents. CONCLUSIONS: Our exploratory study provides several dissemination approaches that should be considered by practitioners as they seek to promote physical activity in the populations they serve. (+info)