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Health Care Payment Approaches

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.

Jan 1, 2004
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.

Jan 1, 2004
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.

Jan 1, 2004
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.

Jan 1, 2004
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.

Jan 1, 2004
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.

Jan 1, 2004
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.

Jan 1, 2004
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.

Jan 1, 2004
Journal Article

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

Chronic pain management in older vulnerable patients is inadequate.

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.

Jan 1, 2004
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.

Jan 1, 2004
Journal Article

Patterns of Medical Resource and Psychotropic Medicine Use Among Adult Depressed Managed Behavioral Health Patients

Patients continue receiving mental health treatment in the medical sector.

Jan 1, 2004
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.

Jan 1, 2004
Journal Article

Self-Reported Oral Health of Enrollees in Capitated and Fee-for-Service Dental Benefit Plans

Impact of different dental plan types, dental markets, premiums, out-of-pocket costs and enrollee demographics on the enrollees' oral health status.

Jan 1, 2004
Journal Article

Self-Reported Satisfaction of Enrollees in Capitated and Fee-for-Service Dental Benefit Plans

Impact of capitated, or CAP, and FFS dental benefit plans on the enrollees' satisfaction with their plans and their satisfaction with their dentists.

Jan 1, 2004
Journal Article

The Effect of Mergers on Firms' Costs: Evidence from the HMO Industry

Mergers between HMOs that produce Medicare and other products are likely to create dis-economies of scope that increase costs.

Jan 1, 2004
Journal Article

Differential Use of the CAHPS 0-10 Global Rating Scale by Medicaid and Commercial Populations

This study is a secondary analysis of CAHPS 2.0 health plan survey data collected in 1999 and 2000.

Jan 1, 2004
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.

Jan 1, 2004
Journal Article

Health-related Quality of Life as a Predictor of Pediatric Healthcare Costs: A Two-Year Prospective Cohort Analysis

The objective of this study was to test the primary hypothesis that parent proxy-report of pediatric health-related quality of life (HRQL) would prospectively predict pediatric healthcare costs over a two-year period.

Jan 1, 2004
Journal Article

The Effects of HMO Ownership on Hospital Costs and Revenues: Is There a Difference Between For-Profit and Nonprofit Plans?

Hospitals in high HMO areas experienced revenue and cost growth rates that were 21 and 18 percentage points below hospitals in low HMO areas.

Jan 1, 2004

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