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Health Care Payment Approaches

Journal Article

Association Between Interruptions in Medicaid Coverage and Use of Inpatient Psychiatric Services

These findings suggest potential benefits of maintaining continuous Medicaid eligibility for beneficiaries with a severe mental illness.

Jan 1, 2003
Journal Article

Racial Variation in the Control of Diabetes Among Elderly Medicare Managed Care Beneficiaries

There is room for significant reduction in the number of patients with poor control of GHb among all races, particularly among blacks and Hispanics.

Jan 1, 2003
Journal Article

Practice Characteristics and HMO Enrollee Satisfaction and Speciality Care: An Analysis of Patients with Glaucoma and Diabetic Retinopathy

Many eye care patients prefer to be treated by specialists with expertise in their conditions.

Jan 1, 2003
Journal Article

Measuring Function for Medicare Inpatient Rehabilitation Payment

The authors studied 186,766 Medicare discharges to the community in 1999 from 694 inpatient rehabilitation facilities (IRF).

Jan 1, 2003
Journal Article

Medicare Calibration of the Clinically Detailed Risk Information System for Cost

The R 2 for the CD-RISC model is 11 percent.

Jan 1, 2003
Journal Article

Trends and Variability in Individual Insurance Products in California: Despite Changes in Insurance Products Available Between 1997 and 2002, the Actuarial Value of Coverage Has Remained Nearly Constant

This paper examines recent trends in benefits and premiums for individual health insurance products purchased by Californians.

Jan 1, 2003
Journal Article

Managing Care: Utilization Review in Action at Two Capitated Medical Groups; Prospective Denials of Coverage on Grounds of Medical Necessity Are Only a Small Part of the Overall Picture

Denials were particularly common for emergency care and durable medical equipment.

Jan 1, 2003
Journal Article

Methods for Using Medicare Data to Compare Procedure Rates Among Asians, Black, Hispanics, Native Americans, and Whites

Implementing a correction for misreporting makes Medicare data useful for all ethnic groups.

Jan 1, 2003
Journal Article

Patterns of Care for Open-Angle Glaucoma in Managed Care

Describe patterns of care for POAG and assess conformance with the American Academy of Ophthalmology's Preferred Practice Pattern (PPP).

Jan 1, 2003
Journal Article

High Out-of-Pocket Health Care Spending by the Elderly

The authors use data from the Health and Retirement Study to examine the elderly's out-of-pocket health care spending.

Jan 1, 2003
Journal Article

The Link Between Public and Private Insurance and HIV-related Mortality

It is useful to ask whether insurance has any effect on health outcomes and whether public insurance is efficacious in preventing premature death.

Jan 1, 2003
Journal Article

Charity for the Dying: Who Receives Unreimbursed Hospice Care?

Many deaths occur among persons without insurance coverage for hospice care.

Jan 1, 2003
Journal Article

Quality of Health Care for Women: A Demonstration of the Quality Assessment Tools System

Consumers, purchasers, and regulators are seeking information on quality for a variety of purposes.

Jan 1, 2003
Dissertation

Drug and Alcohol Treatment Services Among Privately Insured Individuals in Managed Behavioral Health Care

Examines the effects of various kinds of private insurance for substance abuse.

Jan 1, 2003
Report

Appropriateness of Quality Indicators for Older Patients with Advanced Dementia and Poor Prognosis

Evaluates the applicability of process-of-care quality indicators to vulnerable elders in two senior managed care plans.

Jan 1, 2003
Journal Article

Using Performance Measurement to Drive Improvement: A Road Map for Change

Performance measures and reporting have not been adopted throughout the US health care system.

Jan 1, 2003
Journal Article

Shortcomings in Medicare Bonus Payments for Physicians in Underserved Areas: Medicare's Bonus Payment Program Has Not Met Its Goal of Providing Physicians with Incentives to Practice in Rural Underserved Areas

The share of bonus payments to primary care physicians declined throughout the decade, but the share for primary care services increased.

Jan 1, 2003
Journal Article

Hospital Selective Contracting Without Consumer Choice: What Can We Learn from Medi-Cal?

In the selective contracting era, consumer choice has generally been absent in most state Medicaid programs, including California's (called Medi-Cal)

Jan 1, 2003
Journal Article

Enrollee Appeals of Preservice Coverage Denials at 2 Health Maintenance Organizations

A majority of preservice appeals disputed choice of provider or contractual coverage issues, rather than medical necessity.

Jan 1, 2003
Journal Article

Income-related Differences in the Use of Evidence-Based Therapies in Older Persons with Diabetes Mellitus in For-Profit Managed Care

Whether income influences evidence-based medication use by older persons with diabetes mellitus in managed care with same prescription drug benefit.

Jan 1, 2003

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