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A microeconometric model of the health care system of the United States was estimated by applying econometric techniques to extensive data. The model treats the microanalytic behavior of individuals and institutions comprising the health care system, and is structured in terms of five submodels pertaining to consumers, hospital and physician services, physician and nonphysician manpower. In each submodel there is an economic market on which demands and supplies from the individuals and institutions interact and on which the allocation of resources is determined. A detailed treatment of participant attributes facilitates study of the distributional impacts of alternative policies. This paper presents an overview of the complete system, and summarizes the relationships used for the hospital sector.

Assesses the effectiveness of the Nurse Training Act of 1964 as a means of attracting girls into the nursing field in the United States. Shortage of nurses; Establishment of student loan funds in cooperating public and private non-profit schools of nursing; Salary of nurses. (Abstract copyright EBSCO.)

Occupational attrition estimation methods for determining personnel separation through marriage, death, retirement and transfer applied to engineering and nursing

This paper presents the Human Resources Research Center (H.R.R.C.) macroeconometric model of the health care systems of the United States and examples of its use in the study of health services and health manpower. This model contains 37 behavioral equations and identities treating both demand and supply factors in the markets for health services and health manpower. The model explains utilization rates and prices of health services, occupancy rates and beds for inpatient institutions, and employment and wages for health manpower. The model is used for structural analysis by studying estimated coefficients and implied elasticities. The paper reports estimated price, income and insurance elasticities of demand for hospital inpatient and outpatient care and for visits to medical specialists and to surgical specialists. The model is also used for policy evaluation via simulating future values of variables of the health care system under alternative assumptions as to policy variables. The paper reports analyses of two types of policy initiatives, the first involving features of various national health insurance plans and the second involving policies designed to increase the total number of physicians.

Experience in the United States with Medicare, Medicaid, and other Federal programs clearly demonstrates the need to take account of factors affecting health services demand and supply in formulating and executing national health manpower policies. The research described in this paper is part of a large effort under way at the Human Resources Research Center (HRRC) to combine economic analysis, statistical estimation, and simulation techniques to develop a microsimulation model of the entire health care system. When it is completed, the HRRC model will facilitate improw)d health manpower planning by permitting forecasts of the complex interrelations between the demand and supply for health services and health manpower. Tile paper is organized into two sections. The first presents an overview of the entire model. The second describes the physician services submodel in more detail, and plans for further research.

Empirical tests of the physician fee-screen inflation hypothesis are applied to insurance claims data for three Blue Shield plans for 1973 to 1978. A framework for physician pricing behavior is developed, which includes a two-period model of inflationary pricing based on fee-screen updating, and some alternatives, including a myopic (single-period) price formulation model. Each of these models is shown to be a testable parameter subset of the general estimation equation. The results generally conform with the fee-screen inflation hypothesis, suggesting that the current Medicare and Blue Shield UCR physician reimbursement systems encourage excessive price increases.

This article examines the impact of reimbursement on admissions by nursing homes. Low rates of payment for Medicaid patients suggest that nursing homes should prefer non-Medicaid patients. Such preferences are observable in daily admissions data from some of a sample of 18 Southern California facilities. Facilities with observable preferences tend to have strong incentives to prefer non-Medicaid patients. The statistical method used to observe preferences may have applications to studies of discrimination in other settings.