Data collection organization effect in the National Medical Care Utilization and Expenditure Survey.

The National Medical Care Utilization and Expenditure Survey (NMCUES), which has a complex survey design, was further complicated by combining two independently drawn national samples of households from the Research Triangle Institute (RTI) and the National Opinion Research Center (NORC). It is assumed that because the structures of both national area samples are similar, they are thereby compatible and allow for the derivation of unbiased national estimates of relevant health parameters. However, even though the two survey organizations operate under a common set of survey conditions with comparable samples, the actual data generated may differ across them, over and above differences due to pure sampling error. The NORC sample had a higher representation of individuals living in non-SMSA urban areas, of individuals with fair or poor health status, and of individuals incapable of performing usual activity. In addition, significantly higher mean estimates of the number of restricted activity days, of total charges for dental visits, for non-doctor visits and for hospital stays, and of overall total charges, characterized the NORC sample. The consistent directional difference in these health care estimates indicated a data collection organization effect was operational in the NMCUES. A comparison of item nonresponse rates, however, indicated the level of data quality on this dimension was generally equivalent across survey organizations. Further, the observed survey design differentials across organizations did not significantly differ in their impact on the precision in survey estimates. When a data collection organization effect is operational for a set of related survey statistics, as in the National Medical Care Utilization and Expenditure Survey, the use of more than one survey organization should be seriously considered.     

Utilization of ambulatory care studies: testing the assumptions

A linear regression procedure is usually used to estimate the effect of a set of predictors on utilization of ambulatory health care. The implicit assumptions embedded in the linear regression model have never been examined. Here, with utilization data of a sample of 48292 patients from the file of the Québec National Health Plan, four implicit hypotheses embedded in the linear regression model are tested: (1) the transition from the state of utilization to the state of no utilization, and vice-versa, depends on the level of the transition rates, (2) the effect of independent variables depends on the transitions being predicted from or to the state of utilization, (3) the transition is time dependent, and (4) the system of transitions from one state to another is not at equilibrium. The analysis shows that the first three hypotheses cannot be rejected. Thus, the use of the familiar linear regression procedure in this study to estimate the effect of a set of factors on utilization would have yielded biased estimates.     

SIPP and health care issues.

There are three major areas in health care policy which can be addressed by the data elements in the Survey of Income and Program Participation (SIPP): (1) health insurance coverage and the stability of insurance over time; (2) health disability and its relationship to socioeconomic variables, including unemployment, over time; and (3) health care utilization. The survey does not, however, include information on health care expenditures or on details of visits to providers.     

A quantitative index of access to primary medical care for health planning

The emphasis of Public Law 93–641 on numerical goals of health care, as elaborated upon by the National Health Planning Council in its guidelines, foreshadows the emergence of quantitative indices in many areas of health resources utilization and health outcomes. In the area of access to primary medical care, the guidelines spell out in detail what is considered the reasonable waiting period for an appointment, travelling time to the source of care, and in-office waiting time for individuals seeking care. An index of access is developed on the basis of these reasonable limits of waiting for health services research and planning purposes. An example of hypothesis-testing with hypothetical data is given, along with a caveat in the interpretation of the results.     

Analysis of cost and coverage of government financed primary health care services in Tanzania.

A method for cost analysis is presented and applied to Primary Health Care Services in Tanzania. Primary care utilization figures are combined with budget and cost data to arrive at estimates of per capita and per visit cost. Data for analysis of geographical coverage, health care needs, and utilization are most readily available for the MCH sector of Primary Health Care Services, the most important health care sector in LDCs, which is used in this paper as a proxy for estimating health care needs and utilization. The importance of separating appropriately identified investment costs from recurrent costs is illustrated. Speedy implementation of health care for all requires assistance for investment costs, the recurrent costs of appropriately designed Primary Health Care Services being within the reach of developing nations themselves.     

Measuring Discontinuities in Time Series Obtained with Repeated Sample Surveys

A key requirement of repeated surveys conducted by national statistical institutes is the comparability of estimates over time, resulting in uninterrupted time series describing the evolution of finite population parameters. This is often an argument to keep survey processes unchanged as long as possible. It is nevertheless inevitable that a survey process will need to be redesigned from time to time, for example, to improve or update methods or implement more cost-effective data collection procedures. It is important to quantify the systematic effects or discontinuities of a new survey process on the estimates of a repeated survey to avoid a disturbance in the comparability of estimates over time. This paper reviews different statistical methods that can be used to measure discontinuities and manage the risk due to a survey process redesign.     

Estimation of Poverty Transition Matrices with Noisy Data

This paper investigates measurement error biases in estimated poverty transition matrices. We compare transition matrices based on survey expenditure data to transition matrices based on measurement‐error‐free simulated expenditure. The simulation model uses estimates that correct for measurement error in expenditure. We find that time‐varying measurement error in expenditure data magnifies economic mobility. Roughly 45% of households initially in poverty at time t ? 1 are found to be out of poverty at time t using data from the Korean Labor and Income Panel Study. When measurement error is removed, this drops to between 26 and 31% of households initially in poverty. Copyright © 2016 John Wiley & Sons, Ltd.     

试论2011年全国儿童医院效益分析

2011年全国儿童医院呈健康、持续发展,人力资源利用率高,工作效率和医疗质量高,较好地发挥着社会效益与经济效益。但应关注资产结构,提高资产利用效率,加强成本核算,控制成本支出。     

Estimating Health Demand for an Aging Population: A Flexible and Robust Bayesian Joint Model

We analyse two frequently used measures of the demand for health—hospital visits and out‐of‐pocket health care expenditure—which have been analysed separately in the existing literature. Given that these two measures of health demand are highly likely to be closely correlated, we propose a framework to jointly model hospital visits and out‐of‐pocket medical expenditure, which allows for the presence of nonlinear effects of covariates using splines to capture the effects of aging on health demand. The findings from our empirical analysis of the US Health and Retirement Survey indicate that the demand for health varies with age. © 2015 The Authors. Journal of Applied Econometrics published by John Wiley & Sons Ltd.     

CPI revision provides more accuracy in the medical care services component.

This revision, as in the past, enabled the Bureau to update medical care service expenditure weights in the CPI, including a more complete allocation of health insurance premiums. Instead of keeping the portion of premiums that go to benefits under health insurance, the expenditure weight for each benefit category has been added to the appropriate out-of-pocket expense. The unpublished health insurance item represents only the retained earnings portion of premiums paid by households. The specific item categories included in medical care services have also been updated and expanded. A study conducted during the developmental phase of the revision indicated that the Bureau should expand the eligible priced rates for physicians in the CPI to include not only the "self-pay" rate, but also other categories of payment as well. Another study indicated that the direct pricing of health insurance is not feasible because of the difficulty of factoring out from premium changes the effect of utilization levels and modified coverage. In pricing medical care service items, as with other item categories in the CPI, BLS attempts to exclude from price movement the effect of quality changes. However, some quality changes are difficult to assess or are not readily identified, for example, a change in the ratio of nurses to patients, and such changes may be reflected as part of the price change movement in the CPI.     

ARE EMPIRICAL MEASURES OF MACROECONOMIC UNCERTAINTY ALIKE?

Abstract There is a plethora of time series measures of uncertainty for inflation and real output growth in empirical studies but little is known whether they are comparable to the uncertainty measure reported by individual forecasters in the survey of professional forecasters. Are these two measures of uncertainty inherently distinct? This paper shows that, compared with many uncertainty proxies produced by time series models, the use of real‐time data with fixed‐sample recursive estimation of an asymmetric bivariate generalized autoregressive conditional heteroskedasticity model yields inflation uncertainty estimates which resemble the survey measure. There is, however, overwhelming evidence that many of the time series measures of growth uncertainty exceed the level of uncertainty obtained from survey measure. Our results highlight the relative merits of using different methods in modelling macroeconomic uncertainty which are useful for empirical researchers.     

ESTIMATING, EXPLAINING, AND TARGETING POVERTY IN BELIZE: IMPLICATIONS FOR POLICY

This paper focuses on estimating, explaining, and targeting poverty in Belize. The analysis is based on household-level data derived from a national income and expenditure survey conducted in 1990. The paper estimates that the incidence of poverty was about 23 percent at that time nationwide, although there were significant differences in the incidence of poverty across rural and urban areas and across districts and subdistricts of the country. The analysis shows that the household head's age and education level and the household's size, number of children, and location appear to be significant explanators of the incidence of poverty; and, on the other hand, the investigation demonstrates that the head's gender, migration status, worker type, and sector of employment do not seem to explain, to any significant degree, the existence of poverty. The paper also illustrates the importance of sound targeting procedures in keeping poverty reduction costs low as a greater number of beneficiaries are included in such anti-poverty programs. In addition, the analysis shows the clear tradeoff between undercoverage and leakage errors in program implementation. Finally, the paper suggests that poverty program geographic targeting errors would probably not be reduced substantially if subdistricts were used as targets instead of districts in Belize.     

Accounting and the ‘Insoluble’ Problem of Health-Care Costs

Health service accounting reforms are frequently promoted, explained or justified with reference to aging populations, expensive medical technologies and their purported implications for the cost of health care. Drawing on Foucault’s genealogical method, we examine the emergence of concerns regarding health expenditure in the wake of the creation of the British National Health Service in 1948, and their relationship with health service accounting practices. We argue that concerns regarding the cost of health care are historically contingent rather than inescapable consequences of demographic and technological change, and that health service accounting practices are both constitutive and reflective of such concerns. We conclude by relating our analysis to current attempts to control costs and increase efficiency in the health services.     

Utilization of family-friendly policies in Hong Kong

Employees in Hong Kong, like those in many other industrialized societies, face the competing demands of work and family. Long working hours and the associated problem of work–family conflict is a serious problem for the workforce. Although a number of family-friendly policies, such as the five-day working week, paternal leave and so on, have been introduced, they are not necessarily used to their fullest extent. This paper examines the utilization of family-friendly incentives using a telephone survey of 661 employees in Hong Kong with access to such measures. Its major strength is the use of a well-established model of health care utilization, the Andersen model, to conceptualize the factors associated with the uptake of family-friendly policies. The results indicate that the Andersen model works very well in this context, and further demonstrate that access to family-friendly policies in Hong Kong is not equitable. The study makes a number of significant contributions to the literature on work–life balance and the uptake of supportive measures, and shows that enabling (such as perceived effectiveness) rather than need factors explain most of the variance in such use.     

Hospital efficiency and equity in health care delivery: A study based in China

Hospital efficiency and equity in health care delivery are two enduring research topics. Yet little research has been done to examine the relationship between them. This paper studies the impact of hospital efficiency on equity in health care delivery based on a proprietary dataset of hospital characteristics and 630,000 inpatient records from 149 public hospitals in a representative Chinese city. To measure the hospitals' efficiencies, this study takes the hospitals' operational features and case-mix indexes into account, and computes the efficiency levels using data envelopment analysis with bootstrapping. Through regressions that control for a variety of the patients’ personal characteristics (e.g., age, disease, residence, hospital visit frequency), this study shows that the gap between hospitalization expenses of urban and rural inpatients in more efficient hospitals is smaller than those in less efficient hospitals. Thus efficiency enhances equity in expenditure between urban and rural patients. But the dwindling urban-rural gap in expenditure is achieved by raising the spending of rural patients, thereby undermining their access to health care. This pattern is more conspicuous in large and sophisticated high-tier hospitals. Further analysis shows that hospital efficiency impacts equity of health care delivery by inducing different lengths of stay and uncovered parts of total expenditure for urban and rural groups. The findings imply that an efficiency-oriented health care policy may lead to social benefit loss.     

On Measuring the Quality of Survey Estimates

The quality of survey estimates is directly affected by survey errors that include sampling errors due to selecting a sample rather than the whole population, and non-sampling errors arising from data collection and processing procedures. The latter include frame error, measurement error and non-response. This paper addresses design issues related to total survey error and its components. Methods for handling frame problems and non-response are also presented.     

A multivariate analysis of the determinants of physician utilization

This study examines the determinants of health services utilization among 2168 households in five New York and Pennsylvania counties. The purpose is to identify sub-population groups with relatively homogeneous patterns of health service use behavior and to determine for each the relative importance of various predictors, categorized into three broad dimensions—the need for care, predisposing factors and enabling factors. A two stage approach using multivariate analysis technique is employed.Overall, the proportion of expenses paid by health insurance, Medicare, social class and the physician-population ratio in the country where health services are recieved are found to be important predictors of health services use. The significance of these and other predictors varies, however, from one subgroup to the next. The analytical strategy employed proves to be helpful both in understanding the differential patterns of health services utilization in subpopulations and in indentifying impediments to health care. Moreover, the predictive models of physician utilization are formulated.     

Corrections for coarsely categorized measures: LISREL's polyserial and polychoric correlations

Versions 5 and 6 of LISREL (Joreskog and Sorbom, 1981) contain procedures that estimate the underlying correlation between continuous variables on the basis of crude rank category measures. The procedures assume that the distribution of the measured variables would have been bivariate normal if they had not been categorized. Using survey data and simulations, the accuracy of these polyserial/polychoric (P/P) based estimates of the underlying correlations are compared with those based on simple equal distance scoring of the categories. The results indicate that under some conditions, e.g., nearly normally distributed variables and moderate to high correlations, the polyserial/polychoric based estimates are better. Under other conditions, e.g., a moderate to high degree of skew and kurtosis and low correlations, the equal distance score based estimates are better. Under all conditions, the amount of error decreases fairly rapidly as the number of categories is increased from two to five.     

Health information systems

The purpose of this article is to describe the definition and scope of health information systems. Specifically, the article seeks to identify the types and sources of data for health information systems, to present a sample of useful indicators derived from these data, to describe some techniques which may be used to portray and analyze these indicators and to discuss various categories of uses of health information systems. The health information system subject matter content is limited to five broad areas. These are: (1) status of community health, (2) utilization of health services, (3) general population and housing characteristics, (4) inventory of health facilities and health service manpower and (5) status of community environment.