Hospital utilization in the twenty first century.

The combined influence of a number of trends will determine the utilization rate of hospitals in the twenty first century. Aging of the population would suggest that hospital utilization will increase significantly over the next 40 years; however, major changes are taking place in the delivery of health services. This article examines the possible combined impact of the aging population, the increased use of alternative health insurance policies, and the growth in HMOs.

Competition and regulation: do they make a difference in hospital reimbursement?

Hospital reimbursement is undergoing a rapid evolution. The anticipated properties of an ideal reimbursement system can be postulated. Hospitals can begin implementing strategies that will enable them to remain effective under future reimbursement systems.

Administrators, boards, physicians must help change health system.

Change in the health care system is inevitable, and hospital administrators, boards, and medical staffs must learn not only to accept it but also to participate in effecting it. They must promote cooperation among hospitals, become more informed about the system's problems and pressures for change, and participate in activities of HSAs and other health-related groups that plan and influence change.

Physician characteristics and training emphasis considered desirable by leaders of HMOs.

Health maintenance organizations (HMOs) are growing rapidly and employing increasing numbers of physicians. It is important for medical educators to know what such organizations consider important physician traits and training experiences for their recruitment and retention of physicians. A survey of all HMOs in the United States in 1986, to which 44 percent responded, indicated that they want the curriculum of medical school and/or residency programs to have increased emphasis on cost-effective use of diagnostic and treatment services, utilization review and quality assurance, the role of primary care "gate-keeper," and financing of health services. The most important criteria in selection of physicians by HMOs were the physician's board eligibility, motivation, bedside manner, adaptability to a changing environment, the ability to work in a team, training being done in a U.S. medical school, and ability to relate to nonphysician staff members and the reputation of the physician's residency program.

A regional end-stage renal disease program: twelve years' experience.

As of 31 December 1978, 558 patients with end-stage renal disease had been treated with transplantation (150), home dialysis (109), and center dialysis (299). Three hundred twenty-eight patients survived--194 (59%) in center, 51 (15%) at home, and 83 (25%) with functioning grafts. The number and age of new patients continue to increase. Significantly more deaths occur among center dialysis patients than among transplant recipients or home patients. Cadaveric donors provide 71% of transplanted kidneys. The increase in new and older patients without a commensurate increase in cadaver organs results in a declining transplantation rate. Home dialysis training has not decreased. Home dialysis and transplantation can treat about 50% of all new patients. Equilibrium in the end-stage renal disease population will occur when 632 patients per million are receiving treatment. Of these, about 500 will be on center dialysis and will need about 100 stations per million population.