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Health Care Payment Approaches

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

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-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
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

Remission, Residual Symptoms, and Nonresponse in the Usual Treatment of Major Depression in Managed Clinical Practice

Clinicians may fail to recommend continuation and maintenance treatment consistent with best practice guidelines.

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

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
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

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