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18. Changes in retiree health benefits: results of a national survey

Author

de Lissovoy, Gregory, Kasper, Judith D., Di Carlo, Steven, and Gabel, Jon

Subjects
Retirement benefits -- Surveys, Health insurance -- Surveys, Retirees -- Insurance
Abstract

Employers are increasingly concerned by the cost of health benefits provided to retired workers. One reason is that the Financial Accounting Standards Board (FASB), the organization that establishes "generally accepted accounting principles," has proposed altering the way firms report expenditures for retiree medical coverage on financial statements. We recently completed a national survey of business firms offering retiree health benefits to address three issues: 1) What is the current structure of retiree health benefit plans? 2) What changes are firms planning to implement in the structure of their retiree health benefits? 3) To what extent are these changes due to the FASB proposal? The FASB reporting proposal is only one factor underlying these changes. More important is the real financial pressure on firms due to the accelerating cost of retiree health care.

Published
1990

19. Late Transitions and Bereaved Family Member Perceptions of Quality of End-of-Life Care

Author

Makaroun, Lena K., Teno, Joan M., Freedman, Vicki A., Kasper, Judith D., Gozalo, Pedro, and Mor, Vincent

Subjects
Aged, 80 and over, Male, Patient Transfer, Terminal Care, digestive, oral, and skin physiology, Palliative Care, Patient Acceptance of Health Care, Medicare, Article, Hospitals, United States, Nursing Homes, Logistic Models, Multivariate Analysis, Homes for the Aged, Humans, Family, Female, Prospective Studies, Aged, Bereavement, Quality of Health Care
Abstract

BACKGROUND/OBJECTIVE: Health care transitions in the last three days of life have increased in the United States. We aimed to examine associations between late transitions and bereaved family members’ and friends’ assessment of the quality of end-of-life care. DESIGN: National Health and Aging Trends Study (NHATS), a prospective cohort of Medicare enrollees age ≥ 65. SETTING: United States, all sites of death. PARTICIPANTS: Family members and close friends of decedents from NHATS rounds 2–6 (N=1,653; weighted 6.0 million Medicare deaths). EXPOSURE: Medicare decedents’ experiencing a transition between any location and a healthcare institution in the last three days of life. MEASUREMENTS: Multivariable logistic regression with survey weights examined the association between having a late transition and reports of perceived unmet needs for symptom management, spiritual support, concerns with communication, and overall care quality (QOC). RESULTS: Seventeen percent of decedents experienced a late transition. Bereaved respondents for decedents experiencing late transitions were more likely to report that the decedent was treated without respect (21.3% v 15.6%; adjusted odds ratio (AOR) 1.59, 95% confidence interval (CI): 1.09 – 2.33), had more unmet needs for spiritual support (67.4% v 55.2%; AOR 1.48, 95% CI: 1.03 – 2.13), and were more likely to report they were not kept informed about patients’ condition (31.0% v 20.9%; AOR 1.54, 95% CI: 1.07 – 2.23). Bereaved respondents were less likely to rate QOC as excellent when there was a late transition (43.6% v 48.2%; AOR 0.79, 95% CI: 0.58 – 1.06). Sub-group analyses of those experiencing a transition between a nursing home and hospital (13% of all late transitions) revealed such transitions to be associated with even worse QOC. CONCLUSION: Transitions in the last three days of life are associated with more unmet needs, higher rate of concerns, and lower rating of quality of care, especially when that transition is between a nursing home and hospital.

Published
2018

23. Asking about access: challenges for surveys in a changing healthcare environment

Author

Kasper, Judith D.

Subjects
Medical care surveys -- Analysis, Medical care -- Evaluation
Abstract

The need for indicators of health care access that are compatible with changing information and their implications for survey design and the increased emphasis on access problems of specific groups are discussed. Service use relative to health care need, care measure structures and consumer perspectives are identified as the indicators of health care access. The implications of expanding the role of surveys in health care program and insurance plan programs are also assessed., Efforts to evaluate "access to healthcare" have been central to judgments rendered on the success or shortcomings of health systems for many years now. Although the issue is familiar, conceptualizing [...]

Published
1998

24. Assessment of medical care by elderly people: general satisfaction and physical quality

Author

Lee, Yunhwan and Kasper, Judith D.

Subjects
Aged -- Care and treatment, Patient satisfaction -- Evaluation, Medical care -- Evaluation
Abstract

Objective. To identify personal characteristics and factors related to health and patterns of healthcare utilization associated with the elderly people's satisfaction with medical care. Data Sources/Study Setting. Data from the 1991 Medicare Current Beneficiary Survey (MCBS) on 8,859 persons age 65 and over living in the community. Study Design. Items reflecting general satisfaction with care and views of physician quality are examined and, based on factor analysis, grouped in dimensions of two (global quality, access) and three (technical skills, interpersonal manner, information-giving), respectively. The relationship of high levels of satisfaction in each dimension to personal characteristics of elderly people, and to measures of access and utilization, is assessed using logistic regression. Principal Findings. While satisfaction is high, with over 90 percent surveyed expressing some satisfaction, there is substantial variation with less likelihood of high satisfaction among those 80 or older, with less education and income and in poorer health. Longer waiting time at visits and less frequent visits are factors in lower satisfaction as well. A favorable perception of physician quality, especially regarding technical skills, appears to play a significant role in satisfaction with global quality of care. Conclusions. Studies of patient satisfaction in elderly people are rare. Some factors expected to be related to positive assessment based on earlier studies, were, e.g., better health and shorter waiting time, while others were not, e.g., increasing age. Elderly people appear to place greater importance on physician technical skills, as opposed to interpersonal dimensions, in assessing global quality. These findings suggest the need for a better understanding of how elderly people evaluate care and what they value in interactions with the healthcare system. Key Words. Elderly, patient satisfaction, quality of care, With increasing competition in the healthcare market and growing interest in assessing patient outcomes, satisfaction measures are increasingly used by healthcare providers and health policymakers in evaluating the performance of [...]

Published
1998

28. Part III: What can we realistically expect from surveys? Constraints of data and methods.

Author

Kasper, Judith D.

Subjects
*HEALTH surveys, *HEALTH services accessibility
Abstract

Focuses on the challenges in healthcare surveys in evaluating access. Classification of access indicators used in surveys; What surveys need in order to provide efficient information on access; Conclusion that surveys have not included questions about the structure of the delivery system in healthcare.

Published
1998

29. Short-term Consistency in Self-reported Physical Functioning among Elderly Women.

Author

Rathouz, Paul J., Kasper, Judith D., Zeger, Scott L., Ferrucci, Luigi, Bandeen-Roche, Karen, Miglioretti, Diana L., and Fried, Linda P.

Subjects
ACTIVITIES of daily living, FUNCTIONAL assessment of older women, OLDER people self-evaluation, OLDER people with disabilities, EPIDEMIOLOGY methodology, QUESTIONNAIRES
Abstract

The assessment of physical functioning and disability is integral to population-based and clinical research carried out among elderly people. Typically, functional status is measured through self-reported responses to questions of the form “Do you have difficulty [doing a specific task]?” Knowledge of the reliability and validity of these self-report measures is key to the interpretation of many research efforts, but data on these measurement parameters are sparse. This paper addresses this deficiency through analyses of data from the Weekly Substudy of the Women's Health and Aging Study, a cohort of Baltimore-area women aged ≥65 years with moderate to severe physical disability. Self-reported data on 20 activities, obtained weekly over a 6-month period in 1993 or 1994, were analyzed to investigate how time intervals between assessments and a subject's age and baseline level of disability influenced the consistency of self-reports of disability at both the population level and the individual level. The prevalence of self-reported difficulty increased with baseline disability and, to a lesser extent, with age group. Consistency for all items was very high over short time intervals, but it decreased substantially with increasing intervals between responses (although associations between responses remained significant at 24 weeks). Consistency did not vary with age or baseline disability. Graphic techniques and statistical methods for use with repeated binary data are also illustrated. Am J Epidemiol 1998;147:764–73. [ABSTRACT FROM PUBLISHER]

Published
1998
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30. Health status and utilization: Differences by Medicaid coverage and income

Author

Kasper, Judith D.

Subjects
Health Services Needs and Demand, Medicaid, Data Collection, Health Status, Age Factors, Health Services, Health Services Accessibility, United States, Health, Humans, Health Services Research, Poverty, health care economics and organizations, Statistical Report
Abstract

By several measures of health status, the Medicaid population is in worse health than are persons without Medicaid. In addition, poor persons without Medicaid coverage are in poorer health than those who are not poor. Use of health services among those in poor health shows Medicaid eligibles use services at a level comparable to those who are not poor and without Medicaid. Among the poor without Medicaid, the reduced likelihood of seeing a physician and purchasing a prescribed drug indicates the importance of Medicaid coverage in obtaining access to care.

Published
1986

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