Uncompensated care and hospital conversions in Florida.

Hospital conversions to for-profit ownership have prompted concern about continuing access to care for the poor or uninsured. This DataWatch presents an analysis of the rate of uncompensated care provided by Florida hospitals before and after converting to for-profit ownership. Uncompensated care declined greatly in the converting public hospitals, which had a significant commitment to uncompensated care before conversion. Among converting nonprofit hospitals, uncompensated care levels were low before conversion and did not change following conversion. The study suggests that policymakers should assess the risk entailed in a conversion by considering the hospital's historic mission and its current role in the community.     

Uncompensated emergency care in hospital markets in Los Angeles County.

A survey of hospital emergency rooms in Los Angeles County was conducted in March 1987. Analysis of the distribution of uninsured emergency care patients revealed that private hospitals play a significant frontline role in terms of entry into the hospital system for patients who are unable to pay--almost one-half of such patients were treated in the emergency rooms of private hospitals. Hospitals serving markets in which a higher proportion of residents had incomes below the poverty level provided a greater share of uncompensated emergency room services.     

Uncompensated care before and after prospective payment: the role of hospital location and ownership.

Research was undertaken to determine the effects of hospital ownership, location, and Medicare's prospective payment system (PPS) on inpatient uncompensated care. A nonequivalent group design was used with repeated measures of uncompensated care (UNCC) on 137 system hospitals taken pre- and post-PPS. Investor-owned system hospitals demonstrated the largest increase in UNCC (37 percent) under the PPS. Results suggest that not-for-profit and investor-owned system hospitals are becoming more similar in levels of uncompensated care provided and that the PPS has had a negative effect on rural hospital profitability.     

The Cochrane pregnancy and childbirth database. Implications for perinatal care policy and practice in the United States

The Cochrane Pregnancy and Childbirth Database (CCPC) is the most sophisticated realization of the meta-analytic potential within the health fields. At the core of this ongoing collaborative international project are about 600 systematic reviews of the effectiveness of specific forms of perinatal care, which have been created from a registry of clinical trials. The scale and quality of information available through CCPC are unprecedented. An examination of implications of CCPC suggests that many far-reaching changes in perinatal policy and practice are indicated. CCPC has become a model for similar work that is being organized in many other clinical areas under the umbrella of the pan-clinical Cochrane Collaboration, and the experience and implications of CCPC will be of interest to many working in other areas. The implications of these ambitious meta-analytic projects are profound; the degree to which they will be realized is less certain.     

Uncompensated care provided by private practice physicians in Florida.

While a great deal of attention has been paid in recent years to establishing the magnitude and characteristics of uncompensated care in hospitals, comparatively little research has been undertaken to study physician uncompensated care. This article reports the results of a prospective patient-specific study of uncompensated care in Florida. Of 4,042 cases examined, 26.2 percent had charges voluntarily reduced below the usual and customary charge at the time of service. However, only 13.5 percent of those reductions were attributed to charity. Overall, 10.4 percent of the total billed amount was left unresolved. When payment source was considered, it was found that self-pay patients accounted for 30.6 percent of the cases but accounted for 52.0 percent of the unresolved amounts. Further analysis indicated that the self-pay patients were 35.5 times more likely to leave an outstanding balance than individuals with some type of insurance coverage. Odds of unresolved balances were also calculated as a function of income, specialty type, practice size, and type of visit.     

A methodology for targeting hospital cases for quality of care record reviews.

We tested the efficacy of selected case characteristics in targeting quality of care problems for medical record review. The case characteristics, all of which apply to patients who die in a hospital, consist primarily of procedures and DRGs (diagnosis-related groups) for which death rarely occurs, and a set of complications of surgical care. All characteristics are obtainable from combinations of the principal and secondary diagnoses and procedures in the case, and are available from discharge abstracts. The presence of a quality of care problem is confirmed through a review of the medical record by a nurse and two or more physicians. A logistic regression model that controls for various patient and hospital variables is used as a measure of each of the proposed case characteristics. The results indicate that most of the characteristics are associated with higher percentages of quality of care problems than cases chosen at random, and that the methodology has promise as a tool for targeting cases for medical record review.     

Obstetric care during childbirth in Rio de Janeiro: hospital practices and user access

The purpose of this paper is to identify and describe Rio de Janeiro maternity hospital profiles and the route between the mother's place of residence and the hospital. Data sources were: the State Live Birth Information System (1995) and the National Survey on Medical Care (1992). Two groups of maternity hospitals were identified using multivariate cluster analysis. Group A had an extremely high cesarean rate (81%), with mothers and neonates presenting good health conditions. Cesarean rates were lower in Group B, although still high (32%), and other variables reflected worse neonatal conditions. Cesarean rate was the indicator which best discriminated between the groups, followed by proportion of adolescent mothers and mothers with a high school education. The uneven spatial distribution of maternity hospitals, which were concentrated in the richest area of the city, was a factor in the long routes used by women to reach medical care for childbirth.     

Midwives and care in childbirth

This study aimed at knowing the care in childbirths conducted by midwives by the middle of 20th century It is a study of qualitative approach using as reference the Content Analysis. Four midwives were interviewed. Five categories emerged: Motivation to be a midwife; learning to be a midwife; positioning the midwife's work; developing care; work compensation. Midwives sought this occupation for institutional and job need. They learned the work in courses and practice. At home, conditions were poor, and in hospitals, they conducted the majority of the childbirth. They took the necessary care for mother and child. They have reported to be patient so that mothers could have normal childbirth. They conducted with selflessness because social recognition was their compensation.     

孕产期少见型急腹症25例临床分析

目的分析孕产期25例少见和罕见急腹症的发病原因、诊疗过程,为临床孕产期急腹症的诊断与鉴别诊断提供借鉴与帮助。方法对甘肃省人民医院2012年7月至2017年7月孕产期25例临床少见急腹症病例进行回顾性分析。结果①25例少见急腹症病因主要为:妊娠期:腹部卒中2例,子宫肌壁间妊娠1例,胃穿孔1例,子宫破裂3例,宫内妊娠合并异位妊娠破裂2例,子宫阔韧带肌瘤变性1例,子宫浆膜下肌瘤扭转2例,卵巢囊肿扭转坏死2例,妊娠期肝内胆汁郁积症合并重症肝炎和贫血1例,急性化脓性腹膜炎1例,酮症酸中毒1例,输卵管细末小动脉破裂1例。产褥期:子宫浆膜下血管破裂2例,腹肌小动脉破裂1例,腹膜动脉破裂1例,后腹膜及侧腹膜血肿1例,子宫粘连带小动脉破裂2例。②病例不典型,但均可引起恶心、呕吐、全腹压痛或反跳痛甚至体温、血象及感染指数升高等急腹症症状或体征。③难与较常见的急腹症鉴别,易于误诊,误诊率达到11.3%,相比常见急腹症误诊率更高。结论在诊断孕产期急腹症时,不仅要想到常见和多发病种,更要与少见和罕见疾病加以鉴别,减少误诊率和提高抢救成功率。     

Supply-induced demand for hospital care.

Preliminary analysis of hospital utilization data indicates that Roemer's Law may still be operative in rural Iowa: counties with more hospital beds per capita have more hospital utilization per capita. However, when patient origin data are analyzed findings are entirely different. Bed supply is not related to utilization rates in Iowa counties. Instead, the number of unique hospital services is associated with higher utilization rates. The impact of this characteristic of hospital supply, however, is much weaker than the original Roemer effect. The contradiction of these findings with Roemer's Law is apparently a result of a methods effect: use of hospital utilization data which are not derived from actual population experience reveals a relationship which is a statistical artifact. The data also reveal that suburban counties have higher utilization rates than either rural or urban (MSA core) counties.     

Day hospital care for women with abnormal pregnancy in the Turkmen SSR

The article provides a substantiation of medicosocial efficiency and cost-effectiveness of establishing day hospitals (DH) at polyclinics and hospitals for women with abnormal pregnancy in the Turkmen SSR. The materials are provided of the requirements in DH, the norms of bed fund and norms of caseload for DH physicians are estimated.     

A study of pregnancy outcomes in a maternity center and a tertiary care hospital.

This study compares 796 pregnancy outcomes at a maternity center (BMC) with 804 hospital (TJUH) pregnancy outcomes. The samples of pregnant women from the participating institutions were matched on sociodemographic characteristics; analysis of outcomes was performed controlling for medical-obstetric risk. Differences between the institutions were found mainly among women with low intrapartum risk. For these women, neonatal morbidity and length of infant nursery stay were lower at BMC than at TJUH. The percentage of infants with one-minute Apgar scores less than 7 or requiring resuscitation at birth was greater at BMC, but the percentage of infants with five-minute Apgar scores less than 7 as well as neonatal mortality rates did not differ between the two institutions. The number of women with intrapartum or postpartum fever was too small to permit comparison. The study results suggest that care delivered at BMC is safe with regard to the evaluative criteria used.     

全程陪伴分娩对分娩期孕妇心理状态及分娩的影响

目的:探讨全程陪伴分娩对分娩期孕妇心理状态及分娩的影响.方法:随机抽取80例全程陪伴分娩组及76例未全程陪伴分娩即对照组,观察两组孕妇心理状态、分娩结局及产后出血量.结果:全程陪伴分娩组心理承受能力强、产程缩短、剖腹产率低、产后出血少.结论:全程陪伴分娩组明显优于对照组.     

Uncompensated care provided by emergency physicians in Florida emergency departments

Uncompensated emergency department (ED) visits can negatively affect patients, clinicians, and hospitals, particularly as overcrowding occurs. Florida provides a unique market to analyze uncompensated ED care due to the high percent of for-profit hospitals, which typically provide significantly less uncompensated care, coupled with the older population that is more likely to be insured through Medicare. A survey of 188 Florida hospital emergency physician groups was conducted to estimate the level of uncompensated care provided by each ED physician group in 1998. The response rate was 44 percent (eighty-three ED physician groups). All ED physician groups provided substantial uncompensated care regardless of hospital ownership type. Uncompensated care averaged 46.8 percent and ranged from 25.8 to 79.4 percent. A model was developed to predict the amount of uncompensated care using ED volume and payer mix. A rise in the percent of self-pay patients causes a disproportionate increase in uncompensated care, such that EDs with high levels of self-pay visits have markedly higher uncompensated care rates. The results suggest the need for a uniform reporting method of ED physician uncompensated care cost.