Birth weight manipulation has been documented in per-case hospital reimbursement systems, in which hospitals receive more money for otherwise equal newborns with birth weight just below compared to just above specific birth weight thresholds. As hospitals receive more money for cases with weight below the thresholds, having a (reported) weight below a threshold could benefit the newborn. Also, these reimbursement thresholds overlap with diagnostic thresholds that have been shown to affect the quantity and quality of care that newborns receive. Based on the universe of hospital births in Germany from the years 2005-2011, we investigate whether weight below reimbursement relevant thresholds triggers different quantity and quality of care. We find that this is not the case, suggesting that hospitals' financial incentives with respect to birth weight do not directly impact the care that newborns receive.
BackgroundRisk attitudes influence decisions made under uncertainty. This paper investigates the association of risk attitudes with the utilization of preventive and general healthcare services, work absence and resulting costs to explore their contribution to the heterogeneity in utilization.MethodsData of 1823 individuals (56.5 ± 9.5 years), participating in the German KORA FF4 population-based cohort study (2013/2014) were analyzed. Individuals’ general and health risk attitude were measured as willingness to take risk (WTTR) on 11-point scales. Utilization of preventive and medical services and work absence was assessed and annual costs were calculated from a societal perspective. Generalized linear models with log-link function (logistic, negative-binomial and gamma regression) adjusted for age, sex, and height were used to analyze the association of WTTR with the utilizations and costs.ResultsHigher WTTR was significantly associated with lower healthcare utilization (physician visits, physical therapy, and medication intake), work absence days and indirect costs. Regarding preventive services, an overall negative correlation between WTTR and utilization was examined but this observation remained non-significant except for the outcome medical check-up. Here, higher WTTR was significantly associated with a lower probability of participation. For all associations mentioned, Odds Ratios ranged between 0.90 and 0.79, with p < 0.05. Comparing the two risk attitudes (general and regarding health) we obtained similar results regarding the directions of associations.ConclusionsWe conclude that variations in risk attitudes contribute to the heterogeneity of healthcare utilization. Thus, knowledge of their associations with utilization might help to better understand individual decision-making – especially in case of participation in preventive services.Electronic supplementary materialThe online version of this article (10.1186/s13561-019-0243-9) contains supplementary material, which is available to authorized users.
Geburtsverlauf, maternale und neonatale Morbidität gelten als geburtshilfliche Qualitätsindikatoren. Fragestellung: Ziel der vorliegenden Studie war es, herauszufinden, ob ± unabhängig von bevölkerungsspezifischen Anamnese-Risikofaktoren ± Unterschiede im Geburtsmanagement von Bedeutung sind für den Zustand von Mutter und Kind. Methodik: Unsere Datengrundlage bildeten geburtshilfliche und perinatologische Routinedaten von 1991 ± 1995 aus zwei Klinikabteilungen in Solihull (England) und Ibbenbüren (Deutschland). Nach Bildung von ¹Standard-Primip-Gruppenª (Schwangere im Alter < 35 Jahre, nicht alleinstehend, ohne vorausgegangene Schwangerschaft, weiûe Hautfarbe, Tragzeit ³ 37 Wochen) zur Standardisierung der geburtshilflichen Risikoprofile untersuchten wir auf Unterschiede in Geburtsverlauf, maternale und perinatale Morbidität. Ergebnisse: Der Anteil an Vaginalentbindungen aus Schädellage, primären Sectiones (sowohl bei Schädel-als auch bei Beckenendlage), Neugeborenenverlegungen in eine Kinderklinik und Kindern mit Einsetzen regelmäûiger Spontanatmung innerhalb 1 Minute in Solihull war signifikant geringer als in Ibbenbüren; hingegen fanden sich öfter Oxytocingabe, Fetalblutanalyse, Periduralanästhesie, Episiotomie, Zangen-oder Vakuumentbindung aus Schädellage, vaginale Entbindung aus Beckenendlage, Reanimation des Neugeborenen, Blutverlust ³ 1000 ml sowie eine Plazentalösungsstörung signifikant häufiger. Schlussfolgerung: Obwohl das Geburtsmanagement unterschiedlich war, hatte dies keinen Einfluss auf eine klinisch relevante Aspyhxie der Neugeborenen, gemessen am 5-Minuten-Ap-Summary Objective: The course of labor and maternal and neonatal morbidity are indicators of quality of obstetric care. Standardized data collection permits comparisons of the quality of obstetric and perinatal care at different institutions in different countries. We measured the quality of maternal care at the unit level by comparing obstetric and perinatal data at units in England and Germany. Methods: We compared obstetric and perinatal data obtained between 1991 and 1995 at an obstetric unit in Solihull, England (16,884 deliveries), and one in Ibbenbüren, Germany (5048 deliveries). We analyzed Caucasian, nonsingle primiparas < 35 years with no previous pregnancy and a gestational age ³ 37 weeks. Results: Vaginal delivery of infants in cephalic presentation, elective cesarean delivery of infants in cephalic and breech presentation, transfer to a neonatal special-care unit, and onset of regular breathing within 1 min. were significantly more frequent at the German unit. Administration of oxytocin, fetal blood analysis, epidural anesthesia, episiotomy, forceps or vacuum delivery of infants in cephalic presentation, vaginal delivery of infants in breech presentation, neonatal resuscitation, maternal blood loss > 1000 mL, and abnormalities of placental separation were significantly more frequent at the English unit. Five-minute Apgar scores were similar. Conclusion: The differences in obstetric management did not lead to differences in rates...
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