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Anecdotal reports in the wake of the Balanced Budget Act (BBA) of 1997 raised concerns about restricted access to postacute nursing facility care for Medicare beneficiaries requiring costly, medically complex services. Using all Medicare Part A hospital and nursing facility claims for providers in the state of Ohio and a refined method of identifying hospitalized beneficiaries who were the most at risk, we observed only a small decrease in the proportion of the costliest patients discharged to nursing facilities in 1999 compared with pre-BBA years.

Research on health care at the end of life has focused on Medicare-financed acute care services. Much less information has been available on nursing home use in the last year of life, particularly for individuals who are dually eligible for Medicare and Medicaid. We used Medicare and Medicaid enrollment and claims data to examine nursing home admissions, odds of dying in nursing homes versus hospitals or the community, and variations in Medicare and Medicaid service use and costs by place of death.

This report presents the results of the first academic study of health purchasing practices used by large companies to address the ongoing challenge of managed care. The study achieved a remarkable 84 percent response rate among the Fortune 500.

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Trust in providers has been in decline in recent decades. This study attempts to identify sources of trust in characteristics of health care systems and the wider community. The design is cross-sectional. Data are from (1) the 1996 Household Survey of the Community Tracking Study, drawn from 24 Metropolitan Statistical Areas; (2) a 1996 multi-city broadcast media marketing database including key social capital indicators; (3) Interstudy; (4) the American Hospital Association; and (5) the American Medical Association.

Physician dissatisfaction often drives public policy, and is associated with lower quality of care and disruption of treatment relationships. Physicians expressed strong dissatisfaction with managed care, leading to enactment of patient protection laws. By 2001, almost all states enacted laws to curb alleged abuses of managed care organizations. To date, no studies have examined whether such laws improved physician satisfaction.

OBJECTIVE: To determine what aspects of patient satisfaction are most important in explaining the variance in patients' overall treatment experience and to evaluate the relationship between treatment experience and subsequent outcomes.

This paper reports the results of a survey of more than 500 health benefit specialists about the advice they would give to medium-size and large employers on offering a tax-advantaged medical savings account (MSA). About 42 percent of respondents would recommend an MSA combined with a catastrophic health plan, while a third would advise against such a plan. When presented with a specific example of an MSA package that would be attractive to a large fraction of workers, the percentage of benefit specialists favoring adding an MSA option rose to 74 percent.

Consumer Directed Health Plans (CDHPs) are new and increasingly popular insurance products in the United States that aim to increase consumer involvement in health care decision-making. Using quantitative and qualitative methods, we examine characteristics of employees in a large firm that voluntarily enroll in CDHPs. We find salaried and hourly high deductible CDHP enrollees to be substantially healthier and have higher educational attainment than Preferred Provider Organizations (PPO) enrollees. There was less favorable selection into a more popular, lower deductible CDHP.

American health care features little patient safety and too much physician silence about injuries. Preventable medical injuries are numerous, and research presents a convincing case that advancing capabilities in patient safety could greatly reduce harm to patients. Safety and silence are not unrelated, as safety analysis starts with disclosure of problems. Two main sets of factors resist patient safety and promote physician silence: internal medical culture and the external sociolegal environment of health care.

BACKGROUND: We wanted to examine how membership in a health maintenance organization (HMO) is related to delivery of preventive clinical services to patients with different educational levels. METHODS: We conducted a cross-sectional analysis of the 1996-1997 Community Tracking Study Household Survey among adults aged 18 to 64 years with private or Medicaid health insurance.