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Health Care Payment Approaches

Research Brief

The Managed Care Backlash: Did Consumers Vote with Their Feet?

By the late 1990s, initial consumer support for HMOs (health maintenance organizations) eroded; consumers expressed fear that needed care might be withheld, and many favored tighter government regulation.

Nov 25, 2005
Journal Article

Use of Geocoding in Managed Care Settings to Identify Quality Disparities

Tracking quality-of-care measures is essential for improving care, particularly for vulnerable populations.

Dec 31, 2004
Journal Article

Need for Eye Care Among Older Adults with Diabetes Mellitus in Fee-for-Service and Managed Medicare

Compare rates of need for eye care among Medicare beneficiaries with network-model Medicare+Choice (MC) and fee-for-service (FFS) health insurance.

Dec 31, 2004
Journal Article

Paying for Performance: Implementing a Statewide Project in California

The US health care system falls far short of providing care consistent with national standards of care and available knowledge.

Dec 31, 2004
Journal Article

Using Health-Related Quality of Life to Predict and Manage Pediatric Health Care

Increasing healthcare costs and the prevalence of managed care make population health management an imperative.

Dec 31, 2004
Report

Final Report on Assessment Instruments for a Prospective Payment System

This report discusses a design for a prospective payment system for inpatient rehabilitation facilities.

Jan 1, 2004
Report

Final Report on Assessment Instruments for a Prospective Payment System: Appendices

These appendices accompany a report that evaluates alternative assessment tools for use in a prospective payment system for inpatient rehabilitation facilities.

Jan 1, 2004
Research Brief

Inside the Black Box of Managed Care Decisions: Understanding Patient Disputes over Coverage Denials

This research provides some of the first empirical data on utilization review—the process in which initial coverage decisions are made—and patients' appeals of denials that result from utilization reviews.

Dec 31, 2003
Journal Article

Does Medicare Managed Care Provide Equal Treatment for Mental Illness Across Races?

While disparities in access to care are well documented, little is known about the quality of mental health care received by racial and ethnic minorities.

Dec 31, 2003
Journal Article

The Costs of Decedents in the Medicare Program: Implications for Payments to Medicare+choice Plans

To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life - a group that accounts for more than one-quarter of Medicare's annual expenditures.

Dec 31, 2003
Journal Article

Effect of Primary Care Visits on the Demand for Specialty Care in Health Maintenance Organizations

Health maintenance organizations (HMOs) provide low cost access to primary care physicians (PCPs) in an effort to restrict expensive specialty use.

Dec 31, 2003
Journal Article

Impact of Managed Care on the Treatment, Costs, and Outcomes of Fee-for-Service Medicare Patients with Acute Myocardial Infarction

The level of managed care activity in the health care market affects the process of care for Medicare fee-for-service AMI patients.

Dec 31, 2003
Journal Article

HMO Backlash Caused Few People to Bolt from Health Plans

A backlash of public opinion against health maintenance organizations in the late 1990s did not result in large numbers of Americans switching to health insurance plans that offer greater consumer choice.

Dec 31, 2003
Journal Article

The Volume-Quality Relationship of Mental Health Care: Does Practice Make Perfect?

The authors examined whether an analogous association exists between the volume of mental health delivery and the quality of mental health care.

Dec 31, 2003
Journal Article

Health Plan Effects on Patient Assessments of Medicaid Managed Care Among Racial/Ethnic Minorities

Health care organizations should engage in quality improvement activities to address the observed racial/ethnic disparities in assessments of care.

Dec 31, 2003
Journal Article

Primary Care Provider Perceptions of Barriers to and Facilitators of Colorectal Cancer Screening in a Managed Care Setting

CRC screening tests appear to be underused in the managed care setting examined in the current study.

Dec 31, 2003
Journal Article

Effects of Primary Care Depression Treatment on Minority Patients' Clinical Status and Employment

The response of ethnic minorities to mental health care is largely unstudied.

Dec 31, 2003
Research Brief

Quality of Health Care Received by Older Adults

Experts have developed a system for measuring the quality of care delivered to the elderly and used the system to assess the quality of care given to a group of older adults who were members of a managed care plan.

Dec 31, 2003
Journal Article

The Quality of Medical Care Provided to Vulnerable Older Patients with Chronic Pain

Chronic pain management in older vulnerable patients is inadequate.

Dec 31, 2003
Journal Article

The Effect of HMOs on the Inpatient Utilization of Medicare Beneficiaries

To determine the effect of joining HMOs (health maintenance organizations) on the inpatient utilization of Medicare beneficiaries.

Dec 31, 2003

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