The Synthesis project. Research synthesis report最新文献

Primary care health workforce in the United States. 美国初级保健卫生人力。

The Synthesis project. Research synthesis report Pub Date : 2011-07-01

Edward O'Neil, Catherine Dower

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Medical malpractice - april 2011 update. 医疗事故- 2011年4月更新。

The Synthesis project. Research synthesis report Pub Date : 2011-04-01

Michelle M Mello, Allen Kachalia, Sarah Goodell

{"title":"Medical malpractice - april 2011 update.","authors":"Michelle M Mello, Allen Kachalia, Sarah Goodell","doi":"","DOIUrl":"","url":null,"abstract":"Although the malpractice crisis--the inability of health care providers to obtain affordable liability insurance--has abated in many states, medical liability costs and pressures remain a concern. In addition, the perceived threat of litigation spurs \"defensive medicine\"--the practice of ordering services primarily to reduce the physician's liability exposure rather than because they are medically necessary. There is wide consensus that liability pressure undermines efforts to curb overuse of health services, although there is disagreement about the magnitude of its effect. This Update reviews the evidence on the effects of medical malpractice reforms published since the Medical Malpractice: Impact of the Crisis and Effects of State Tort Reforms synthesis was released in 2006. Key findings include: Except for caps on noneconomic damages, there is little evidence that other traditional tort reforms affect medical liability costs or defensive medicine. Average awards are reduced by 20 percent to 30 percent, and premiums in states with caps on noneconomic damages rise 6 percent to 13 percent more slowly than premiums in states without caps. There is evidence that tort reforms-particularly caps on noneconomic damages-reduce health spending, but the size of the reduction is subject to debate. Because of the lack of success of many traditional tort reforms, a number of innovated tort reforms are receiving increased attention. Although they show promise in theory, they have not been widely evaluated so the evidence of their effectiveness is weak.","PeriodicalId":89508,"journal":{"name":"The Synthesis project. Research synthesis report","volume":" 21 Suppl 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40127963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Mental disorders and medical comorbidity. 精神障碍和医疗共病。

The Synthesis project. Research synthesis report Pub Date : 2011-02-01

Benjamin G Druss, Elizabeth Reisinger Walker

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Cost-sharing: effects on spending and outcomes. 成本分担：对支出和结果的影响。

The Synthesis project. Research synthesis report Pub Date : 2010-12-01

Katherine Swartz

{"title":"Cost-sharing: effects on spending and outcomes.","authors":"Katherine Swartz","doi":"","DOIUrl":"","url":null,"abstract":"As health reform drives the largest expansion of health insurance since Medicare and policy-makers grapple with how to slow the increase in health care spending, cost-sharing--the division of health care costs between patients and insurers--is considered an important tool. This synthesis reviews the evidence on cost-sharing. Key findings include: Research consistently shows demand for health care is price sensitive, but it is unlikely cost-sharing will significantly slow the growth of health care spending. Almost 50 percent of costs are associated with the 5 percent of the population facing serious medical conditions. Studies show these patients rely on their doctors to guide treatment decisions. Increased cost-sharing may shift the financial burden from insurers and public payers to patients. Patients are not able to discern between appropriate and inappropriate care in response to increased cost-sharing. For the average person, increased cost-sharing may not adversely affect their health, but for vulnerable populations, increased cost-sharing is associated with adverse health outcomes. Low-income populations are disproportionately affected by increased cost-sharing. People in poor health respond differently to cost-sharing changes than healthy people. Finally, cost-sharing is not well-targeted on low-value services making it difficult for patients to make appropriate decisions.","PeriodicalId":89508,"journal":{"name":"The Synthesis project. Research synthesis report","volume":" 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40128138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Care management of patients with complex health care needs. 具有复杂卫生保健需求的患者的护理管理。

The Synthesis project. Research synthesis report Pub Date : 2009-12-01 Epub Date: 2009-12-16

Rachel Berry-Millett, Thomas S Bodenheimer

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Cost savings and cost-effectiveness of clinical preventive care. 临床预防保健的成本节约和成本效益。

The Synthesis project. Research synthesis report Pub Date : 2009-09-01

Peter J Neumann, Joshua T Cohen

{"title":"Cost savings and cost-effectiveness of clinical preventive care.","authors":"Peter J Neumann, Joshua T Cohen","doi":"","DOIUrl":"","url":null,"abstract":"It is well established that preventive care reduces the prevalence of disease and helps people live longer, healthier lives. Analysis of the cost-effectiveness of preventive care can guide policy-makers to allocate scarce resources. This synthesis reviews the evidence on the cost-effectiveness of clinical preventive care. Key findings include: although many preventive services are a good value (defined as costing less than $50,000 to $100,000 per Quality Adjusted Life Year), only a few, such as childhood immunizations and counseling adults on the use of low-dose aspirin are widely regarded as cost-saving. Costs to reduce risk factors, screening costs, and the cost of treatment when disease is found can offset any savings from preventive care. Prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity. Whether these additional competing risk costs outweigh the savings from avoiding the targeted disease depends on how healthy people are during the added life years. Given that so few preventive services save money and that these services are already in wide use, it is unlikely that prevention can reduce health care spending. The authors question whether the emphasis on savings is appropriate and suggest it is better to focus on high value preventive care, taking into account increased longevity and quality of life.","PeriodicalId":89508,"journal":{"name":"The Synthesis project. Research synthesis report","volume":" 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40127957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Tax subsidies for private health insurance - july 2009 update. 私人医疗保险税收补贴——2009年7月最新情况。

The Synthesis project. Research synthesis report Pub Date : 2009-07-01

Len Burman, Surachai Khitatrakun, Sarah Goodell

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Emergency department utilization and capacity. 急诊部门的利用和能力。

The Synthesis project. Research synthesis report Pub Date : 2009-07-01

Derek Delia, Joel C Cantor

{"title":"Emergency department utilization and capacity.","authors":"Derek Delia, Joel C Cantor","doi":"","DOIUrl":"","url":null,"abstract":"Americans rely on emergency departments (EDs) to play a critical role in the health care safety net. But while the number of ED visits climbed significantly, the number of EDs dropped from 5,000 to 4,000 from 1991 to 2006. This synthesis examines the evidence on who uses EDs, the causes and consequences of overcrowding, and the cost of providing care in the ED. Key findings include: privately insured patients account for the largest and fastest growing segment of ED users. Low income and poor health are strong predictors on ED use. After adjusting for health status and other demographic and market factors, the uninsured use the ED at the same rate as the privately insured, while patients with Medicaid/SCHIP or Medicare had much higher utilization rates. The use of EDs for non-urgent, preventable conditions is growing due to limited access to primary care providers, although the identification of these conditions is imprecise. Patient boarding, or the inability to move patients from the ED to the appropriate inpatient unit, and a shortage of on-call specialists are major causes of ED overcrowding. The true cost of providing care in the ED is complex and not well understood. Finally, expansion of health insurance coverage is likely to increase rather than decrease stress on overcrowded EDs because the insured represent the fastest growing subpopulation of ED users.","PeriodicalId":89508,"journal":{"name":"The Synthesis project. Research synthesis report","volume":" 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40127658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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High and rising health care costs. 高昂且不断上升的医疗费用。

The Synthesis project. Research synthesis report Pub Date : 2008-10-01

Paul B Ginsburg

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Physician self-referral and physician-owned specialty facilities. 医师自我转诊和医师拥有的专业设施。

The Synthesis project. Research synthesis report Pub Date : 2008-06-01

Lawrence P Casalino

{"title":"Physician self-referral and physician-owned specialty facilities.","authors":"Lawrence P Casalino","doi":"","DOIUrl":"","url":null,"abstract":"Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as \"pay-per-click,\" time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.","PeriodicalId":89508,"journal":{"name":"The Synthesis project. Research synthesis report","volume":" 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40126797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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