Hospital use and mortality among Medicare beneficiaries in Boston and New Haven

Article Abstract:

Statistics were compiled regarding hospital use and mortality among all Medicare beneficiaries 65 years of age or older who where seen either in Boston or New Haven areas during a one-year period. The analysis reveals that there was a significantly increased use of hospitals by residents of Boston when compared with those of New Haven. Much of the difference between the two populations was attributed to high-variation disorders, namely those for which there is some dispute about the need for hospitalization. Discharge rates for low-variation conditions were similar. There was no difference in adjusted rates of mortality between the two populations, suggesting that practice patterns for high-variation conditions vary to such a great degree that large inconsistencies will exist when comparing different hospitals and communities. The results seem to support the view of New Haven physicians that lower rate of hospitalization and consequent decreased Medicare costs did not constitute the withholding of valuable services. Questions concerning the quality of life for a dying patient, issues of morbidity, and complication rate go unanswered by this study. The study may point to ways of decreasing the cost of Medicare without adversely affecting the welfare of patients, particularly with regard to high-variation conditions. Continued research appears to be strongly warranted from both medical and sociologic perspectives.

Aged, Elderly, Research, Evaluation, Public health, Health surveys, Hospital utilization, Medicare, Medical law

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Variations in rates of hospitalization of children in three urban communities

Article Abstract:

Hospitalization accounts for a large amount of the expenditures for child health care, and differences in the rate of hospitalization may produce critical variations in the cost of that care. The authors studied the rates of hospitalization in Rochester (NY), Boston, and New Haven (CT) in 1982. The study used the risk of hospitalization in Rochester as a score of 1.00 and assigned the risk of hospitalization elsewhere on a relative basis to the Rochester value. Boston children were hospitalized at more than twice the rate of Rochester children for most medical diagnoses (2.65). The rate of hospitalization in New Haven was intermediate (1.80). The relative risks for specific diseases in these three cities are compared. Some medical problems (fracture of femur, appendicitis, bacterial meningitis) had similar rates of hospitalization. The rates of hospitalization of children in all three communities were below the national averages in 1982. This study does not determine the reasons for the variation in rates of hospitalization, but it is possible that they were related in part to differences in socioeconomic status or access to primary care.

Medical care, Children, Hospitalization, Rochester, New York

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Benchmarking the US physician workforce: an alternative to needs-based or demand-based planning

Article Abstract:

The use of benchmarks may be a more effective way to estimate the need for physicians. Most estimates are need-based or demand-based. This means that the supply of physicians in a geographic area is estimated from the number needed to treat the diseases commonly seen or the number currently employed in the area. Benchmarking involves comparing the number of physicians in an area with the number employed by some benchmark, such as an HMO or hospital referral region. Researchers using this technique found that most regions of the US have an excess of physicians, especially specialists.

Analysis, Supply and demand, Physicians, Medical professions, Benchmarks, Benchmarking, Resource allocation

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