Estimating health expenditure growth under managed competition: science, simulations, and scenarios

Article Abstract:

Simulation models that estimate the impact of managed competition on the health expenditure growth rate (HEGR) should include a range of estimates. Health care reform deliberations are shaped by the estimated impact of reform proposals on health expenditures (HEs). The HEGR is particularly important because it affects HEs over time. There is a lack of scientific data describing the impact of managed competition legislation and market trends on the HEGR. Modelers who developed qualitative scenarios in 1994 about future health system developments suggested that managed competition would have an imperceptible or minor impact on the HEGR. Alternative plausible scenarios based on the interaction between health system changes in 1994 and potential legislation suggest that managed competition would significantly and rapidly reduce the HEGR. Estimates of the HEGR must account for market developments and the uncertainties inherent in health care reform.

Models, Economic aspects, Medical care, Cost of, Health care costs, Managed care plans (Medical care)

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Chance, continuity, and change in hospital mortality rates: coronary artery bypass graft patients in California hospitals, 1983 to 1989

Article Abstract:

The choice of hospital may affect the outcome of patients who have coronary artery bypass graft (CABG) surgery. Certain hospitals may have a lower death rate among patients who have had CABG surgery than others. A study examined the in-hospital death rate among 132,750 patients over 18 years old who had CABG surgery between 1983 and 1989 at 115 California hospitals. Certain hospitals had a lower-than-expected death rate, and others had a higher-than-expected death rate over consecutive periods of time. Patients at hospitals with a higher-than-expected death rate were more likely to transfer to another hospital and remained in the hospital longer after surgery.

Patient outcomes, Mortality, Hospitals, Quality management, Hospital patients, Coronary artery bypass

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Volume-Outcome Relationship in Acute Myocardial Infarction The Balloon and the Needle

Article Abstract:

Angioplasty should only be done at hospitals where the procedure is done often. Studies have shown that cardiac patients who are treated at these so-called 'high-volume' hospitals have lower mortality rates. Angioplasty is used to open blocked coronary arteries.

Health aspects, Care and treatment, Editorial, Evaluation, Cardiac patients, Clinical competence, Transluminal angioplasty, Balloon angioplasty

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