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Abstract

This paper reports findings from a study of the impact of preadmission certification programs from the perspective of the hospital—a deeply affected party. A series of field studies was undertaken to explore and delineate the range of hospital responses to the challenges posed by this third-party payer man date and to identify factors associated with variation in responses. The evidence presented suggests wide variation in how hospitals chose to share responsibil ity for pre-certification with physicians and patients. The findings are broadly consistent with a proposed model that hospital response is determined by both external and internal considerations, but a larger scale hospital survey is necessary to test the hy potheses that can be derived from this study.

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References

Institute of Medicine. Controlling Costs and Changing Patient Care? The Role of Utilization Management. Washington, D.C., National Academy Press, 1989.

Gardner L. , Scheffler R. Privatization in health care: Shifting the risk. Med Care Rev 1988;45:215-254.

Eisenberg J. Doctors' Decision and the Cost of Medical Care. Ann Arbor, MI, Health Administration Press, 1986.

Young D. , Saltman R. The Hospital Power Equilibrium: Physician Behavior and Cost Control. Baltimore, The Johns Hopkins University Press, 1985.

Starr P. The Social Transformation of American Medicine. New York , Basic Books, 1982.

Restuccia J. A comparative analysis of appropriateness of hospital use. Health Affairs 1984;3:130-138.

Payne S. Identifying and managing inappropriate hospital admissions: A policy synthesis . Health Services Res 1987;22;709-769.

Hurley R. , Freund D. Utilization management: Perspectives from the Medicaid program. Paper commissioned by the Institute of Medicine Committee on Utilization Management by Third Party Payers, 1989.

Feldstein P. , Wickizer T. , Wheeler J. The effects of utilization review programs on health care use and expenditures. N Engl J Med 1988;318:1310-1314.

10.

Strumwasser I. , et al. Determining non-acute hospital stays . Business and Health. 1987;4:19-21.

11.

Mayo Clinic. The "cost" of effective utilization review programs. Statement before the IoM Committee on Utilization Management by Third Parties, 1988.

12.

American Hospital Association. Private Utilization Review. State issues Forum Monograph Series. Washington, D.C., American Hospital Association, 1989.

13.

Cook, K. , et al. A theory of organizational response to regulation: The case of hospitals. Academy of Management Review 1983;8:193-205.

14.

Pfeffer J. , Salancik C. The External Control of Organizations: A Resource Dependence Perspective. New York, Harper and Row, 1978.

Hospital Response Variation to the Demands of Preadmission Certification

Abstract

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