Suchergebnisse

Managed care has been hypothesized to increase patient travel by directing patients toward network providers. The purpose of this study is to measure the effect of Medicare HMO enrollment on hospital travel time in rural areas. Hospital travel times were determined for 85,586 inpatient discharges among rural Pennsylvania residents admitted to Pennsylvania hospitals in 1998. Medicare HMO enrollees traveled up to 10.2 minutes further for acute care than Medicare fee-for-service patients (39 versus 29 minutes). Medicare HMO enrollees were 50 percent more likely to travel outside their own counties and 70 percent more likely to travel to urban areas for acute care. The distance premium associated with HMO enrollment was largest in counties with the lowest managed care penetration.

Variations in physician practice patterns have important implications for quality and cost. The purpose of this article is to explain variation in physicians' practice patterns in terms of physician personal characteristics, practice setting, patient population, and managed care involvement. Data on 2,455 primary care physicians were derived from the Community Tracking Study Physician Survey (1996-1997). Factor scores were determined based on responses to three clinical scenarios that represent discretionary medical decisions. These scenarios include a specialist referral for benign prostatic hyperplasia, prescription drugs for elevated cholesterol, and an office visit for vaginal discharge. Physician age, being a foreign medical school graduate, being a solo practitioner, and having a larger proportion of Medicaid patients were all associated with higher factor scores, a greater likelihood of ordering a service. Being board certified was associated with lower factor scores. Managed care involvement was not a significant predictor of factor scores.

The best value initiative has been designated as the key framework for improving service quality and effectiveness in UK local government. In support of the framework a number of measures have been introduced to measure effectiveness. However, there are problems with using comparative performance measures within the diverse grouping of local government services. Aims to measure the effectiveness of best value in a similar group of building control services by using a clustered benchmarking approach. The mainly qualitative research involves applying a strategic benchmarking approach to the 26 units or councils within the cluster and then comparing the cluster with the best practice UK measures for building control services. To facilitate the process a benchmarking measurement framework for building control was developed. The results indicate that the clustering approach is more beneficial than comparing the service of a single unit with best practice. Practices comparable with best practice for key measures can be identified for individual units or councils within the cluster. Moreover, there are more opportunities for generalising the findings and developing measurement frameworks within clusters. The cluster can internalise the benchmarked findings through mutually supportive programmes.