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July 9, 1997, Vol 278, No. 2 >
ARTICLE | July 9, 1997

Stroke Patients, "Managed Care," and Distributive Justice FREE

James R. Webster, Jr, MD; Joseph Feinglass, PhD
[+] Author Affiliations

Reprints: James R. Webster, Jr, MD, 750 N Lake Shore Dr, Suite 601, Chicago. IL 60611.


JAMA. 1997;278(2):161-162. doi:10.1001/jama.1997.03550020093045
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Article
References

In this issue of The Journal, Retchin and colleagues1 arrive at the disturbing conclusion that Medicare health maintenance organization (HMO) patients treated for stroke were significantly less likely to be discharged to a rehabilitation hospital or return home than clinically similar patients treated in Medicare fee-for-service settings, although mortality was similar. These results imply that some HMO patients may be denied optimal care as a result of their payer status. Is this another example of the new medical environment in which older individuals will be deprived of appropriate care to increase corporate profits or to reward physicians who benefit financially from withholding care?

See also p 119.

This is an especially troublesome matter because stroke is a common illness, affecting more than half a million patients annually and is a leading cause of adult disability in the United States. Stroke takes a devastating physical and emotional toll on patients'

REFERENCES

1 +
Retchin SM, Brown RS, Yeh SJ, Chu D, Moreno L.  Outcomes of stroke patients under the Medicare fee for service and managed care . JAMA . 1997;;278:119-124.
2 +
Ferrucci L, Guralnik JM, Pahor M, Corti MC, Havlik RJ.  Hospital diagnoses, Medicare charges, and nursing home admissions in the year when older persons become severely disabled . JAMA . 1997;;277:728-734.
3 +
Gresham GE, Duncan PW, Statson WB, et al. Post Stroke Rehabilitation: Clinical Practice Guideline Number 16 . Rockville, Md: US Dept of Health and Human Services, Agency for Health Care Policy and Research; 1995;. AHCPR publication 95-0662.
4 +
Kramer AM, Steiner JF, Schlenker RE,et al.  Outcomes and costs after hip fracture and stroke: a comparison of rehabilitation settings . JAMA . 1997;;277:396-404.
5 +
US General Accounting Office. Medicare Managed Care: Growing Enrollment Adds Urgency to Fixing HMO Payment Problem, 1995 . Washington, DC: US General Accounting Office; 1995;. Publication GAO/HEHS 96-21.
6 +
Kerr EA, Mittman BS, Hays RD, Siu AL, Leake B, Brook RH.  Managed care and capitation in California: how do physicians at financial risk control their own utilization? Ann Intern Med . 1995;;123:500-504.
7 +
Avorn J.  Benefit and cost analysis in geriatric care: turning age discrimination into health policy . N Engl J Med . 1984;;310:1294-1301.
8 +
Ware JE, Bayliss MS, Rogers WII, Kosinski M, Tarlov AR.  Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and feefor-service systems:results from the Medical Outcomes Study . JAMA . 1996;;276:1039-1047.
9 +
Shaughnessy PW, Schlenker RE, Hittle DF.  Home health care outcomes under capitated and fee-for-service payment . Health Care Financ Rev . 1994;;16:187-222.
10 +
Clement DG, Retchin SM, Brown RS, Stegall MH.  Access and outcomes of elderly patients enrolled in managed care . JAMA . 1994;;271:1487-1492.
11 +
Wagner EH.  The promise and performance of HMOs in improving outcomes in older adults . J Am Geriatr Soc . 1996;;44:1251-1257.
12 +
Riley GF, potosky AL, Lubitz JD, Brown ML.  Stage of cancer at diagnosis for Medicare HMO and fee-for-service enrollees . Am J Public Health . 1994;;84:1598-1604.
13 +
Franks P, Clancy CM, Nutting PA.  Gatekeeping revisited: protecting patients from overtreatment . N Engl J Med . 1992;;327:424-429.
14 +
Lefevre F, Feinglass J, Potts S, et al.  Iatrogenic complications in high-risk, elderly patients . Arch Intern Med . 1992;;152:2074-2080.
15 +
Beck A, Scott J, Williams P,et al.  A randomized trial of group outpatient visits for chronically ill older HMO members: the cooperative health care clinic . J Am Geriatr Soc . 1997;;45:543-549.
16 +
Goldstein L, Bonito AJ, Matchar DB, et al.  US national survey of physician practices for the secondary and tertiary prevention of ischemic stroke . Stroke . 1996;;27:1473-1478.
17 +
Brown RS, Clement DG, Hill JW, Retchin SM, Bergeron JW.  Do health maintenance organizations work for Medicare? Health Care Financ Rev . 1993;;15:7-23.
18 +
Davis K, Collins KS, Schoen C, Morris C.  Choice matters:enrollees' views of their health plans . Health Aff (Millwood) . 1995;;14:99-112.
19 +
Weiss LJ, Blustein J.  Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans . Am J Public Health . 1996;;86:1742-1747.
20 +
Greenfield S, Kaplan S, Ware JE Jr.  Expanding patient involvement in care: effects on patient outcomes . Ann Intern Med . 1985;;102:520-528.
21 +
Krakauer H, Bailey RC, Cooper H, Yu WK, Skellan KJ, Kattakkuzhy G.  The systematic assessment of variations in medical practices and their outcomes . Public Health Rep . 1995;;110:2-12.
22 +
Povar G, Moreno J.  Hippocrates and the health maintenance organization: a discussion of ethical issues . Ann Intern Med . 1988;;109:419-424.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Retchin SM, Brown RS, Yeh SJ, Chu D, Moreno L.  Outcomes of stroke patients under the Medicare fee for service and managed care . JAMA . 1997;;278:119-124.
2 +
Ferrucci L, Guralnik JM, Pahor M, Corti MC, Havlik RJ.  Hospital diagnoses, Medicare charges, and nursing home admissions in the year when older persons become severely disabled . JAMA . 1997;;277:728-734.
3 +
Gresham GE, Duncan PW, Statson WB, et al. Post Stroke Rehabilitation: Clinical Practice Guideline Number 16 . Rockville, Md: US Dept of Health and Human Services, Agency for Health Care Policy and Research; 1995;. AHCPR publication 95-0662.
4 +
Kramer AM, Steiner JF, Schlenker RE,et al.  Outcomes and costs after hip fracture and stroke: a comparison of rehabilitation settings . JAMA . 1997;;277:396-404.
5 +
US General Accounting Office. Medicare Managed Care: Growing Enrollment Adds Urgency to Fixing HMO Payment Problem, 1995 . Washington, DC: US General Accounting Office; 1995;. Publication GAO/HEHS 96-21.
6 +
Kerr EA, Mittman BS, Hays RD, Siu AL, Leake B, Brook RH.  Managed care and capitation in California: how do physicians at financial risk control their own utilization? Ann Intern Med . 1995;;123:500-504.
7 +
Avorn J.  Benefit and cost analysis in geriatric care: turning age discrimination into health policy . N Engl J Med . 1984;;310:1294-1301.
8 +
Ware JE, Bayliss MS, Rogers WII, Kosinski M, Tarlov AR.  Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and feefor-service systems:results from the Medical Outcomes Study . JAMA . 1996;;276:1039-1047.
9 +
Shaughnessy PW, Schlenker RE, Hittle DF.  Home health care outcomes under capitated and fee-for-service payment . Health Care Financ Rev . 1994;;16:187-222.
10 +
Clement DG, Retchin SM, Brown RS, Stegall MH.  Access and outcomes of elderly patients enrolled in managed care . JAMA . 1994;;271:1487-1492.
11 +
Wagner EH.  The promise and performance of HMOs in improving outcomes in older adults . J Am Geriatr Soc . 1996;;44:1251-1257.
12 +
Riley GF, potosky AL, Lubitz JD, Brown ML.  Stage of cancer at diagnosis for Medicare HMO and fee-for-service enrollees . Am J Public Health . 1994;;84:1598-1604.
13 +
Franks P, Clancy CM, Nutting PA.  Gatekeeping revisited: protecting patients from overtreatment . N Engl J Med . 1992;;327:424-429.
14 +
Lefevre F, Feinglass J, Potts S, et al.  Iatrogenic complications in high-risk, elderly patients . Arch Intern Med . 1992;;152:2074-2080.
15 +
Beck A, Scott J, Williams P,et al.  A randomized trial of group outpatient visits for chronically ill older HMO members: the cooperative health care clinic . J Am Geriatr Soc . 1997;;45:543-549.
16 +
Goldstein L, Bonito AJ, Matchar DB, et al.  US national survey of physician practices for the secondary and tertiary prevention of ischemic stroke . Stroke . 1996;;27:1473-1478.
17 +
Brown RS, Clement DG, Hill JW, Retchin SM, Bergeron JW.  Do health maintenance organizations work for Medicare? Health Care Financ Rev . 1993;;15:7-23.
18 +
Davis K, Collins KS, Schoen C, Morris C.  Choice matters:enrollees' views of their health plans . Health Aff (Millwood) . 1995;;14:99-112.
19 +
Weiss LJ, Blustein J.  Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans . Am J Public Health . 1996;;86:1742-1747.
20 +
Greenfield S, Kaplan S, Ware JE Jr.  Expanding patient involvement in care: effects on patient outcomes . Ann Intern Med . 1985;;102:520-528.
21 +
Krakauer H, Bailey RC, Cooper H, Yu WK, Skellan KJ, Kattakkuzhy G.  The systematic assessment of variations in medical practices and their outcomes . Public Health Rep . 1995;;110:2-12.
22 +
Povar G, Moreno J.  Hippocrates and the health maintenance organization: a discussion of ethical issues . Ann Intern Med . 1988;;109:419-424.

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