Evaluation & the health professions
-
Cost is increasingly important in the evaluation of health care. Though charges are often used as a proxy for cost, some health care systems such as the Veterans Administration do little or no billing. This article describes, presents examples of, and evaluates four options for determining the cost of care within the Department of Veterans Affairs: measuring input costs, the Department's cost accounting system, the reimbursement system, and use of charges from a surrogate health care facility. Each approach is evaluated for accuracy, ability to compare the costs of different treatments, and effort required to estimate cost.
-
Comparative Study
Cost differences between hospice and nonhospice care. A comparison of insurer payments and provider charges.
Although it has been postulated that hospice care savings are "biased" when costs are measured in terms of insurer payments instead of provider charges, this claim has not been documented by research. This article examines cost differences between hospice and nonhospice care, first, by analyzing Medicare Part A payments and, second, by studying provider charges for services rendered to a population of 24 cancer patients during their last 24 weeks of life. The exploratory results of the study showed that although the cost savings derived from analyzing provider charges were about double those based on Medicare Part A payments, both approaches to the measurement of cost strongly indicated that hospice home care was less costly than nonhospice care. Further analysis showed that variations in the rates of Medicare reimbursement accounted for 22 to 42% of the differences in the derived cost savings between the two approaches to measuring cost, and that payments to hospitals played a major role in determining this outcome.
-
Comparative Study
Roles ascribed to volunteers. An examination of different types of hospice organizations.
Volunteers have been the hallmark of the hospice movement since its U. S. inception in 1973. As part of the National Hospice Study, volunteer hours and activities were reported monthly in forth participating hospices nationwide. ⋯ Overall, the level of volunteer involvement is approximately 1.5 hours per patient each day he or she spends in the hospice program. This breaks down to nearly .80 hours of direct patient care and .70 hours devoted to other activities. While the most prevalent use of volunteers is in the provision of direct patient care in freestanding hospices, volunteers also spend a large proportion of their time in the performance of administrative activities.
-
Comparative Study
Professional performance of physician's assistants: a comparison of physician's assistant and physician ratings.
Physician's assistant educational programs have used surveys of their graduates as one method of evaluating educational objectives and curricula. A concern is the validity of physician's assistant self-ratings as measures of job performance. Ratings by supervising physicians have been suggested as more valid measures. ⋯ Physician's assistants and their supervising physicians were interviewed using an interview instrument developed to cover the performance of the physician's assistant in the major activities of primary care practice. While the physicians and physician's assistants disagreed on several measures, in all cases the ratings of the physician's assistants were more conservative. Thus, the physician's assistants did not show any tendency to inflate ratings of their own performance.