The impact of a pediatric practice on hospital admissions in a rural area.

The establishment of a two-man pediatric practice in a rural area of New Mexico was followed by a decrease in hospital admissions of children and an increase in average length of stay. While other factors may have been involved, The reliance of the study region's children on pediatricians rather than family physicians for primary care may have contributed to the decline in hospitalization. Further research on the relationship between source of care and hospital utilization is needed.

Mergers of Public Health Departments with public hospitals in urban areas: findings of 12 field studies.

Twelve urban centers were visited to study firsthand the organizational relationship between the local public health department and the local public general hospital. The particular focus was on mergers between these two agencies into a single health services agency. Some of the places visited had merged agencies and some did not. The objective was to determine the motivations, outcomes and implementation process of these mergers. The findings are presented and the implications for public policy are analyzed.

The public hospital and its local ecology in the United States: some relationships between the "plight of the public hospital" and the "plight of the cities".

The "plight" of the public hospital in the United States is examined from the point of view of its relationship to the "plight" of the cities. Fifty-five large cities are examined and for 38 of these cities that have such hospitals the relationships of levels of public hospital services to local demographic, government fiscal, and tax structure conditions are analyzed. The principal findings point to the existence of some strong relationships and the implications for public policy of these associations are discussed.

An approach to reducing the adverse effects of broken appointments in primary care systems: development of a decision rule based on estimated conditional probabilities.

A method is presented for adjusting the scheduling of appointments in ambulatory health care centers to reduce the deleterious effects of broken appointments. The essence of the methodology calls for scheduling and "expected number" of patients for a given clinic session. This "expected number" is calculated from estimated probabilities of appointment breaking, conditioned on patient characteristics which are deemed to be related to appointment-breaking rates, and on which number appointment within a specified time period is being made for the patient. The two ill effects of appointment breaking that are considered here are the diminution of efficiency of operation and interference with continuity of patient care. Ways of using this methodology to ameliorate each of these effects are outlined, with one of these way serving to alleviate both effects. This method is meant to be of quite general applicability, although its development was motivated by the problems of a localized particular situation.

Reorganizations of health agencies by local government in American urban centers: what do they portend for "public health"?

The major health agencies of local urban governments--public health department and public hospital--are often dismissed as "irrelevant" or attacked as "unresponsive". The rush to reform through reorganization hasn't often addressed the underlying problems of an eroded tax base, an indifferent federal policy, and intra-professional disputes. Newer corrective steps are called for if complex demands for public and personal service are to be met.

Factors associated with changes in occupancy rates of California short-term hospitals: an analysis of statewide hospital discharge data.

Decline in per cent occupancy of California short-term hospitals between 1969 and 1972 was due principally to an increase in bed supply that exceeded population growth. A lesser contributory cause--decline in utilization--was due entirely to decreases in length-of-stay. Analysis of data from Statewide one-week discharge surveys, carried out in 1968 and 1970, indicates the decrease in average stay was largely centered in Medicare and Medi-Cal (Medicaid) pay classes. Admissions, however, did not decrease. These declines in stay predated the introduction of special increased restrictions on access to medical care into the Medi-Cal program in April 1970. Principal results of the study indicate that in California, government supervision of payment for hospital care has operated to reduce length-of-stay, but thus far does not seem to have affected admission rates. Insofar as these results may hold for other States, they seem to implay certain conditions that may be expected to occur with an extension of National Health insurance to the general population. Chief among these is a further depression of occupancy ratios if bed supply is held constant or increases relative to population. They also imply that further substantial reduction in hospital utilization under Medicare and Medicaid must be sought in admission rates rather than length-of-stay.