Nursing homes -- Law and legislation -- United States.
Nursing homes -- United States -- Quality control.
Government reports indicate that
regulations have been ineffective in improving quality of care in
many nursing homes. Some analysts feel that litigation against nursing
homes may be the result of quality problems that are monitored during
the inspection process, some contend litigation merely causes quality
problems by diverting financial resources away from patient care,
and some argue that litigation is duplicating the efforts of the
inspection process. Given that the relationship between litigation
and inspection-oriented measures of quality is not clear, this article
explores the relationship empirically. When a significant relationship
is found, the empirical results suggest that litigation is associated
with a decline in inspection-oriented measured quality in the nursing
home facing the legal claim. In contrast, litigation against a chain has
a very different relationship to firm-level quality, where firms within
a chain that is being sued have higher levels of inspection-oriented
quality. Our results suggest that legal claims may result from quality
problems that go unmeasured during the inspection process. However,
more research in this area is warranted.
Mullan, Joseph T.
Nursing homes -- Law and legislation -- United States -- States.
Nursing homes -- United States -- States -- Quality control.
This study presents interview and statistical data from a
telephone and fax survey of state agency officials and statistical data
from the Centers for Medicare & Medicaid Services' Online Survey
Certification and Reporting (OSCAR) system. State survey activities for
nursing facilities were reviewed and the number and types of intermediate
sanctions issued by states in l999 were reported, along with barriers to
the use of such sanctions. Using five selected enforcement measures to
create a summary score, states were classified by quartiles based on the
stringency of their nursing facility enforcement activities. Controlling
for the number of complaints as a proxy for quality, the predictors of a
summary of state enforcement actions were: percentage of population at age
eighty-five and above, Democratic governors, higher percentages of chain
facilities, and lower facility occupancy rates. Regional differences in
enforcement patterns also were shown. Many federal policies and resource
constraints were identified as barriers to effective regulation. The
findings identified nursing facility survey and enforcement issues that
need to be addressed by policy makers.
Collective bargaining -- Physicians -- United States.
Managed care plans (Medical care) -- United States.
Medical care -- United States -- Cost control.
Medical care -- United States -- Quality control.
This article develops a framework that distinguishes
four types of competitive strategies that physicians' organizations can
adopt in their interactions with health plans. Two types of strategies
protect physicians' incomes and autonomy from incursion and control by
insurers; the other two enhance the efficiency of health care markets
by controlling costs and embedding physicians' caregiving in a community
of professionals. The mix of strategies that each organization adopts at
any given time depends on the market conditions and regulatory policies
it faces, as well as its organizational capacity. The article reviews
recent developments in the field that indicate that today's markets and
regulations create neither the pressures nor the capacity for physicians'
organizations to adopt strategies that enhance efficiency. The managed
care backlash has led to a relaxation of pressures to control costs,
and the lack of a business case for quality has discouraged embedded
caregiving. These developments instead have encouraged and enabled
physicians' organizations to adopt strategies that protect their members
from the bargaining power and micromanagement of health plans. The article
therefore proposes changes in purchasing and regulatory policies to alter
the pressures and improve the capacity of physicians' organizations to
pursue efficiency and eschew protectionism.
Brown, Margaret E.
Call, Kathleen Thiede.
Medically uninsured persons -- Government policy -- United States -- States.
Because states have primary responsibility for the
implementation of public health insurance programs, states need timely,
good quality data to evaluate programs, monitor trends in the number and
characteristics of the uninsured, and better understand the dynamics
of health insurance coverage. This article provides a synthesis of
the data sources available to states for monitoring rates of health
insurance coverage. Information was collected through a comprehensive
review of state and national health surveys and in-depth interviews with
state analysts in all fifty states. Our findings suggest that national
surveys do not meet states' needs for data, and in response, states
have initiated their own household surveys. We provide information on
thirty-six household surveys that are used to estimate state levels of
health insurance coverage. We recommend that national and state efforts
be better coordinated to facilitate efficient use of resources to achieve
good state-level date.