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Concerns about the cost and quality of health care have resulted in a national effort to determine the health outcomes of medical and surgical services. This report concentrates on developing criteria that risk-assessment systems should meet to permit consumers to intelligently evaluate them. It also presents a comparison of several selected mortality prediction models.
Mortality --- Forecasting --- Methodology.
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This reports presents findings from a study of design options and payment methods for a capitation payment plan for the Medicare End Stage Renal Disease (ESRD) Program. The study contributes to payment policy development by evaluating capitation as an alternative payment method to control Medicare costs while maintaining access and quality of care for ESRD patients. A capitation payment method has been developed that combines monthly capitation payments for dialysis and functioning graft patients with one-time payments for kidney transplant and graft failure events.
Chronic renal failure --- Hemodialysis --- Capitation fees (Medical care) --- Patients --- Services for --- Finance. --- Finance. --- United States.
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Kidneys --- African Americans --- Health services accessibility --- Kidney Failure, Chronic --- Kidney Transplantation. --- Health Services Accessibility --- Blacks --- Transplantation --- Diseases. --- therapy. --- United States.
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Chronic renal failure --- Physicians --- Medicare. --- Medical fees --- Government policy
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Medicare. --- Hospitals --- Prospective payment
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The authors of this study compared DRG weights calculated using the Hospital Specific Relative Value (HSRV) method with those calculated using the standard method for each year from 1985 through 1989, and analyzed differences between the two methods for 1989. They provide evidence suggesting that classification error and subsidies of higher weighted cases by lower weighted cases caused compression in the weights used for payment as late as the fifth year of Medicare's prospective payment system. However, later weights calculated by the standard method are not compressed because a statistical correlation between high markups and high case mix indices offsets the cross-subsidization. HSRV weights from the same files are compressed because this methodology is more sensitive to cross-subsidies. However, both sets of weights produce equally good estimates of hospital level costs net of those expenses that are paid by outlier payments. The greater compression of the HSRV weights is counterbalanced by the fact that more high-weight cases qualify as outliers.
Hospitals --- Diagnosis related groups. --- Economics, Hospital --- Medicare. --- Prospective payment --- Mathematical models.
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Medicare beneficiaries choosing to enroll in an alternative health plan (AHP) must make a tradeoff between restricted choice of provider and financial incentives to enroll in the plan. This study examines this tradeoff empirically by estimating a model of beneficiary plan choice using survey data in which beneficiaries were asked to state a preference between several hypothetical AHPs and their current Medicare coverage. The results show that a substantial financial incentive is necessary to attract beneficiaries. For an incentive of a given amount, plans that provide financial protection against high-cost hospitalizations or long-term care are more attractive than plans that offer additional ambulatory benefits.
Medicare. --- Health insurance --- Medical care --- Finance.
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This study finds racial and financial characteristics influence the quality of care received by acutely ill, insured patients after hospital admission. The study uses a clinically detailed data set to examine a comprehensive range of services provided to patients with one of five serious, common diseases in different types of hospitals. The report examines quality of care provided to patients who are black, make use of Medicaid insurance in addition to Medicare, and live in poor neighborhoods, as compared with subsets of patients who are not black, do not have Medicaid insurance, and do not live in poor neighborhoods. It also compares quality of care for inner-city patients and rural patients with that for urban patients who are not poor.
Poor --- African Americans --- Rural hospitals --- Poor --- African Americans --- Medical care --- Evaluation. --- Medical care --- Evaluation. --- Evaluation. --- Hospital care --- Evaluation. --- Hospital care --- Evaluation.
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This report studies patients in five selected diagnosis-related groups using a 20-percent random sample of all Medicare discharges in the 12 months ending June 1988. The report finds that female patients were more likely to use skilled nursing facilities (SNF) than men, though less likely to use rehabilitation care after a stroke; whites were more likely to use SNF care and less likely to use home health and rehabilitation care than non-whites; patients discharged from proprietary hospitals were more likely to use home health care than those discharged from not-for-profit or government-owned hospitals; and patients discharged from hospitals having a disproportionate share of Medicaid patients were more likely to receive rehabilitation care. There also seems to be a positive correlation between the prevalence of home health care use and the likelihood a patient will use rehabilitation care
Hospitals --- Medicare --- Nursing homes --- Home care services --- After care --- Utilization --- Statistics. --- Rehabilitation services
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Health maintenance organizations. --- Hospitals --- Medical policy --- Health insurance --- Medicare. --- Prospective payment.
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