High-intensity Services Research Articles

The relationship between service intensity and the quality of health care: an exploratory data analysis

This paper provides an empirical check of some assumptions used to define the quality of care in the health services literature. Specifically, we test (i) whether service intensity is the only important determinant of a provider's quality and (ii) whether higher service intensity always causes higher quality. Using a panel of hospitals from Washington State, we find evidence that rejects both of these assumptions. As a result, further work is needed to postulate a more general definition that does not rely on these assumptions.

National Healthcare Spending in the U.S. and Japan: National Economic Policy and Implications for Neurosurgery

Growth of national healthcare spending is a problem confronting national governments of all industrially advanced countries. Healthcare spending in the U.S. reached 13.9% of the Gross Domestic Product (GDP) in 2003, compared to only 8% in Japan. In the U.S., health insurance is voluntary, with 15% of the population uninsured. In Japan, health insurance is mandatory and virtually universal, with growth in national health costs about half the rate of growth in the U.S. U.S. healthcare costs are projected to reach 18.4% of GDP 2013. The predicted growth in health care costs is expected to cause strain on the federal budget and a growing inability of employers and employees to pay for private insurance. Different national policies are the reason for different national health care costs in the U.S. and Japan. The U.S. has higher healthcare prices for salaries, equipment, supplies, and pharmaceuticals as compared to Japan. Higher prices, higher service intensity and volume during hospitalization create higher total cost in the U.S. Price controls in Japan kept medical inflation low at 0.46%/yr from 1980-2000. Market-pricing mechanisms in the U.S. have proven ineffective in controlling national healthcare costs, while Japan's national fee and price control policies have kept national costs among the lowest within the Organization for Economic Cooperation and Development. To guide insurance coverage policy, neurosurgery and other highly technical specialties should better define the comparative health benefit of high price technical services by prospective outcome studies.

Intensity of acute services, self-help attendance and one-year outcomes among dual diagnosis patients.

This study of dual diagnosis patients examined the associations of the intensity of acute care services and 12-step self-help group attendance with substance use and mental health outcomes. Participants (n = 230; 96% men) received treatment in one of 14 residential programs and were evaluated with the Addiction Severity Index at discharge (98%) and at 1-year follow-up (80%). High service intensity in acute treatment was associated with better substance use and family/social outcomes both at discharge and at 1 year when patients' intake status was controlled. More attendance at 12-step self-help groups was also associated with better patient substance use and psychiatric outcomes, both during and following treatment. The benefits of more 12-step group attendance, however, depended on whether acute treatment was of low or high service intensity. More 12-step group attendance during treatment was associated with better alcohol and drug outcomes at discharge only among patients treated in low-service-intensity programs; and more attendance postdischarge was associated with better psychiatric and family/social functioning at 1 year only among patients receiving low-service-intensity care. We suggest potential means by which high-service-intensity acute care programs might better facilitate patients' postdischarge use of 12-step self-help groups to benefit outcomes.

Comparing provider perceptions of access and utilization management in full-risk and no-risk Medicaid programs for adults with serious mental illness.

This article compares provider perceptions of access to services and utilization management (UM) procedures in two Medicaid programs in the same state: a full-risk capitated managed care (MC) program and a no-risk, fee-for-service (FFS) program. Survey data were obtained from 198 mental health clinicians and administrators. The only difference found between respondents in the FFS and MC sites was that outpatient providers in the MC site reported significantly lower levels of access to high-intensity services than did providers in the FFS site (p < .001). Respondents in the two sites reported similar attitudes toward UM procedures, including a strong preference for internal over external UM procedures. These findings support the conclusion that through diffusion of UM procedures, all care in the Medicaid program for persons with a serious mental illness is managed, regardless of risk arrangement. Implications for mental health services and further research are discussed.

Does More Intensive Neonatal Intensive Care Unit Follow-Up Service Result in Better Outcomes? A Cost-Effective Analysis

Little is known about the relative cost-effectiveness of the many different types of early intervention services provided to medically fragile infants and their families. This study compared two intensities of services for such infants and their families: (a) a coordinated and comprehensive system of early intervention services initiated prior to discharge from the NICU and designed to transition infants to community-based services were compared with the effects of services (high intensity); and (b) a more traditional hospital follow-up consisting of medical checkups and referrals following discharge (low intensity). High-intensity services resulted in five times more community-based early intervention hours for families and infants when compared with low-intensity services. Annual costs of the high-intensity group were approximately triple the costs of the low-intensity group ($10,814 versus $3,032 per child per year), but there were only a few statistically significant differences on measures of child and family functioning between the groups at 6-, 12-, 18-, and 24months' corrected age. Implications of these findings for research and practice are given.

Accumulating resources in perinatal intensive care centers: market strategies and ethical issues.

This paper engages in the ongoing dialog on justice and the health care 'industry'1 and addresses the question of whether market strate gies are consistent with an ethical distribution of resources in health care. As it pertains to the development of perinatal services over the past twenty-five to thirty years in the United States, my short answer to this question is no. Business organization and market-oriented strategies have contributed to the creation and extensive growth of perinatal intensive care centers located in large medical centers. This growth, which has aggravated the neglect of primary care, has been incongruent with known health needs and represents an ethically questionable distribution of resources. Over the past three decades, acute care hospitals and medical sub specialists have been bundling personnel and technology into giant critical care units.2 This activity has superimposed a new level of high intensity services on the medical care system. Perinatal centers, defined in terms of highly trained personnel and complex technological equipment in an organized (hospital) unit of care,3 have participated in and contributed to this trend. They have combined subspecialties providing services around birth: perinatology,4 the obstetric sub division which provides high intensity care before and during birth, and neonatology, the p?diatrie subdivision caring for newborns. Medical care growth and development have commonly been attributed to scientific progress,5 and/or professionalization.6 But the (considerable) scientific and professional achievements have evolved within?and been shaped by?a particular economic environment.7 Influencing both professional and regulatory policies, the market has been more pervasive in determining the basic structure of medical care than commonly thought. This does not mean, however, that hospital administrators' and physicians' use of market-oriented strategies