Postsurgical mortality in Manitoba and New England

Article Abstract:

The rate of per capita expenses for hospital care is 25 to 50 percent higher in the US than in Canada. However, it is not known if better patient outcomes are associated with higher health care costs. A community in Canada was compared with a similar population in New England; patient outcomes after 11 surgical procedures were studied. All of the subjects were more than 65 years of age. The surgical procedures were classified as low- and moderate-risk or high-risk. Mortality rates were compared at 30 days and 6 months after surgery, using records of computerized insurance databases in both countries. At 30 days, mortality for all subjects was similar, but mortality was lower among the Manitoba patients six months after low- and moderate-risk surgical procedures. Two types of high-risk surgery were performed: hip fracture repair and concurrent coronary bypass/valve replacement. Mortality following these procedures was lower in New England at both 30 days and 6 months. Coronary artery bypass surgery was performed more frequently in New England; prostatectomy and cholecystectomy were performed more often in Manitoba. Overall, the mortality 30 days and 6 months after most of the 11 procedures examined was similar in both regions. An exception was the high mortality associated with hip fracture repair in Manitoba. The results indicate that the higher hospital costs in the US were not associated with better patient outcomes after low- and moderate-risk surgical procedures. Other factors, which were not evaluated, may have influenced mortality; they include severity of illness and the underlying health status of the patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Mortality, Patient outcomes, Surgery, Health risk assessment, New England, Manitoba

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Managed health care: implications for the physician workforce and medical education

Article Abstract:

The Council on Graduate Medical Education (COGME) asserts that current Medicare graduate medical education (GME) policy fails to direct physicians into areas where they are needed, namely managed care, primary, and ambulatory settings. COGME was commissioned by Congress to evaluate physician supply and to make appropriate recommendations. Medicare GME payments are made on the basis of the number of residents serving in hospitals. Medicare pays hospitals about $70,000 per annual resident, without regard to marketplace needs. COGME believes that public funds should be directed to increasing the number of minority and general practice physicians, distributing physicians more evenly across the country, and providing training in managed care, primary care, and ambulatory medicine. The growth in managed care is expected to increase the surplus of specialist physicians, while creating a greater need for generalists.

Physicians, Medical professions

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Switching Health Plans to Obtain Drug Coverage

Article Abstract:

All proposals to provide drug benefits under Medicare should provide unlimited benefits, possibly in conjunction with a deductible. Otherwise, patients who exceed their limit can simply switch to another plan. As of the year 2000, Medicare beneficiaries can change plans on a monthly basis. Many managed care companies place limits on drug coverage. A study published in 2000 found that many Medicare beneficiaries switch to another plan right around the time they run out of drug coverage.

Editorial, Drug therapy

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