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Biomedical subjects

Bruce C Vladeck

Publications and source records attributed to Bruce C Vladeck.

12 recordsLinked to original sources
PubMed2005

Economic and policy implications of improving longevity.

With all the rhetoric surrounding the impending "entitlement crisis" produced by the "graying of America," there has been surprisingly little serious analysis of the social and economic implications of increased longevity and the doubling of the number of elderly people that will occur in this country over the next 30 years. This article identifies five critical areas in which the effect of demographic change will be significant. First, patterns of work life and labor-force participation will almost inevitably change. Second, government expenditures now financed largely by payroll and federal income taxes will increase, whereas those financed by state and local property taxes will fall, at least proportionately. Third, the post-World War II pattern of suburbanized, automobile-dependent communities will pose special challenges to serving an aging population, and new adaptations will need to be developed. Fourth, intrafamily caregiving patterns will necessarily change. Fifth, the level of disability and dependence of older people, for which the rate of change is inherently unpredictable, will have a major effect on all these and other phenomena. Whether one views the net effect of all these changes as a positive or a negative, it is necessary to begin thinking a lot harder and more systematically about all of them.

Aged↗
PubMed2004

Everything new is old again.

For more than thirty years, John Wennberg and his colleagues have been documenting variations in patterns of health care use from one community to the next, which are not explained by illness or demographic patterns. Twenty years ago Health Affairs devoted an issue to a symposium on this work, and it is striking how little some things have changed in the intervening years. In fact, there have been enormous changes in physicians' behavior and patterns of medical practice, but our cost problems seem as intractable as ever, perhaps because policymakers continue to focus erroneously on the relationship between use and costs.

Delivery of Health Care↗
PubMedDate not supplied

Where the action really is: Medicaid and the disabled.

Discussions of Medicaid tend to focus on low-income children and their mothers and the institutionalized elderly as the principal beneficiaries, but Medicaid spends more on the nonelderly disabled than on any other group. In the past two decades Medicaid has helped finance the deinstitutionalization of the mentally retarded and a growing proportion of the mentally ill, but implementation of the Olmstead decision has deflected advocates' attention from the more important issue of how managed care plans treat disabled Medicaid beneficiaries.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Ineffective approach.

Explore the source record for details and available documents.

Health Care Reform↗
PubMedDate not supplied

Avoidance of health care services because of cost: impact of the medicare savings program.

The Qualified Medicare Beneficiary (QMB) program, part of the Medicare Savings Program, provides Medicare premium and cost-sharing assistance to low-income beneficiaries but has low participation rates. We examined the potential for QMB coverage to reduce the avoidance of health care services because of cost among low-income seniors in eight states. Only one-third of eligible seniors participated. Adjusted for demographics and health status, QMB enrollees were half as likely as nonenrollees to avoid physician visits because of cost. Despite its potential to improve access to primary care, the QMB program is underused. Future policy and research efforts should address low participation rates.

Aged↗
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Medicare as a catalyst for reducing health disparities.

As the nation's largest purchaser and regulator of health care, Medicare is positioned to be a leader in reducing racial and ethnic health disparities. Its leverage was demonstrated in 1966-the year of Medicare's inception-when hospitals desegregated as a condition for receiving Medicare reimbursement. Since then, Medicare has contributed to dramatic improvement in the health of the elderly and disabled minority population, although disparities between minority and white beneficiaries remain. A National Academy of Social Insurance study panel is exploring how Medicare could use its leverage to reduce disparities, for both its beneficiaries and the rest of the nation.

Cultural Diversity↗
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Paying for hospitals' community service.

U.S. hospitals incur costs of $25-$50 billion annually in providing "community service," primarily in the form of health professions education and standby costs. They also provide approximately $30 billion in uncompensated care. Historically, such "community service" costs have been subsidized explicitly by Medicare and implicitly in the prices paid by private payers. The sustainability of that system is highly uncertain. With a growing number of uninsured patients, allocating nonreimbursable costs to paying customers can create a "death spiral," in which fewer paying customers bear a larger proportion of such costs. The obvious solutions to this problem all have serious limitations.

Community-Institutional Relations↗