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The use of laboratory tests has more than doubled during the past decade. This study investigates the importance of several reimbursement factors in the frequency of test ordering by office-based physicians. The number of laboratory tests ordered per visit is not related to the level of the patient's insurance coverage. Despite this, more generous insurance coverage for ambulatory care would lead to an increase in total test volumes, because physician visit rates have been shown elsewhere to be strongly influenced by the amount of patient cost sharing for medical care. Physicians who control test billing are more likely to order tests than physicians who refer their patients to laboratories that bill directly. However, testing in-house and controlling test billing may be the result of a high anticipated volume of tests rather than the cause of a higher test ordering frequency. The author concludes that direct billing regulations are not likely to result in significant reductions in total health care costs. The marginal cost of the tests is far below their average costs, so that very large reductions in test volumes would be required to achieve significant cost savings.

Medical fees --- Medical laboratories --- Health insurance --- Diagnostic tests, Routine. --- Diagnosis, Laboratory --- Insurance, Health, reimbursement --- Fees --- Utilization.

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Health insurance --- Deductibles and Coinsurance --- Insurance, Health --- economics --- United States.

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This report analyzes the accession behavior of enlistees who have had prior military service either on active duty or in reserve service. The report focuses on the accession behavior of prior service reservists who served in the active Army or in the Army Reserve and Army National Guard. These reservists account for the largest number of separations, and these components have also traditionally had relatively greater problems in meeting their end-strength requirements. The authors endeavor to determine which policies appear to increase accessions among prior service personnel, placing special emphasis on reserve pay and affiliation bonuses. They investigate how skill match varies across different occupations, the timing of entry, years of service, and area demand.

Veterans --- Employment --- United States --- Armed Forces --- Reserves. --- Recruiting, enlistment, etc.

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Preferred provider organizations (PPOs), which offer some of the advantages of both fee-for-service and managed care, are becoming an important market force. This report provides empirical estimates of the effects of offering a PPO option within indemnity plans on use of outpatient mental health services. The data are from a study that examined a sample of employees who had enrolled in indemnity plans before and after a PPO option was offered by three employers in two U.S. sites. The authors found little evidence for either adverse or favorable selection of indemnity enrollees on the basis of their mental health status into use of the PPO option, either for general medical care or for mental health care. After controlling for other factors, the authors found no significant association between mental health status and intent to use PPO providers for general medical care. The pattern of results suggests that established provider relationships, rather than level of mental health status per se, determine selection of provider among users of outpatient mental health care. By the second year following PPO implementation, after controlling for sociodemographic factors and previous use of mental health services, there was no difference in probability of use of outpatient mental health services between employees who expected to use PPO providers and those who did not. But costs per user of mental health services were lower for individuals who relied primarily on PPO rather than non-PPO providers for their mental health care. Thus, despite lower cost sharing for services received from PPO providers, the PPO option appeared to lower outpatient mental health care costs with no more than a transient reduction in access to such care.

Mental health services --- Ambulatory medical care --- Preferred provider organizations (Medical care) --- Mental health insurance. --- Ambulatory Care --- Health Benefit Plans, Employee --- Preferred Provider Organizations --- Utilization --- utilization

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The 1993 Robert Wood Johnson Foundation Family Health Insurance Survey was a part of the Foundation's State Initiatives in Health Care Reform program, which provides funding and technical assistance to states developing and undertaking reforms to expand health insurance coverage. RAND and Mathematics Policy Research of Princeton, NJ, collaboratively designed the survey to investigate health insurance coverage, as well as access to and use of health services, in each of ten states. MPR was responsible for the sample design, weighting, and data collection plan and conducted the interviews; RAND cleaned the data prior to distributing analysis files to the participating states and releasing public-use files to the research community. The goal of the data cleaning was to remove some response error and to reduce bias from item nonresponse. For the benefit of other users of the data, this report briefly describes the survey, provides an overview of the objectives in editing the data and imputing for missing or edited values, and describes the specific cleaning procedures used.

Health surveys --- Insurance surveys --- Data processing.