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Biomedical subjects

C J Schramm

Publications and source records attributed to C J Schramm.

At least 19 recordsLinked to original sources
PubMed1992

Government, private health insurance, and the goal of universal health care coverage.

The Health Insurance Association of America advocates joint efforts by federal and state governments and the private sector to achieve the goal of universal access to health care. It recommends several changes in the small employer market to provide greater predictability and protection to those insured, including establishment of private, not-for-profit reinsurance organizations authorized by the states. State risk pools for uninsurable individuals who are not part of an employer group are also proposed. The federal government role would include expanding Medicaid eligibility and exempting all insured plans from state mandated benefits. HIAA's proposal also stresses the continued growth and use of managed care programs.

Cost Control↗
PubMed1991

Health care financing for all Americans.

Access to health care financing can be achieved by using a combination of public and private initiatives aimed at every American who wants access to health care but is currently denied access. Small-employer market reforms that would guarantee the availability and affordability of coverage to small employers and their employees should be enacted. A private, not-for-profit reinsurance mechanism should be established to absorb losses for high-risk individuals and high-risk employer groups insured by carriers. State risk pools should be established to provide coverage to high-risk individuals who cannot obtain coverage through an employer. Tax assistance should be provided to small employers who make health care coverage available to their employees. The Medicaid program should be extended to cover all poor and near-poor Americans and to provide primary and preventive care for the near poor.

Cost Control↗
PubMed1990

Economics.

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMed1990

Healthcare industry problems call for cooperative solutions.

The complexity of problems facing American health care--from extending health benefits to the uninsured to caring for people with acquired immune deficiency syndrome--require cooperative solutions involving providers, insurers, and policy makers. A spokesman for the health insurance industry presents ideas about the future of health care and discusses the role of insurers in meeting the challenges ahead. Among the items on the agenda: further growth of managed care; continued attempts to control costs and utilization; and sharing the burden of risk with consumers.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Investing in the wrong future for hospitals.

The process of offering hospital debt in public markets is strongly influenced by the feasibility study. The inaccuracy of such studies may produce substantial overinvestment in hospital capital.

Capital Financing↗
PubMed1986

The comparative economic performance of investor-owned chain and not-for-profit hospitals.

We examined the differences in the economic performance of 80 matched pairs of investor-owned chain and not-for-profit hospitals in eight states during 1978 and 1980, and considered how their operating strategies might affect their relative success in a more price-conscious market. We found that total charges (adjusted for case mix) and net revenues per case were both significantly higher in the investor-owned chain hospitals, mainly because of higher charges for ancillary services; there were no significant differences between the two groups of hospitals in regard to patient-care costs per case (adjusted for case mix), but the investor-owned hospitals had significantly higher administrative overhead costs; investor-owned hospitals were more profitable; investor-owned hospitals had fewer employees per occupied bed but paid more per employee; investor-owned hospitals had funded more of their capital through debt and had significantly higher capital costs in proportion to their operating costs; and the two groups did not differ in patient mix, as measured by their Medicare case-mix indexes or the proportions of their patients covered by Medicare or Medicaid. We conclude that investor-owned chain hospitals generated higher profits through more aggressive pricing practices rather than operating efficiencies - a result not unexpected in view of past cost-based reimbursement policies. Recent changes in these policies are creating new pressures for cost control and moderation in charges, to which both types of hospitals must adapt. Neither type has a clear-cut advantage in the ability to make the necessary changes.

Capital Financing↗
PubMed1985

Interhospital differences in severity of illness. Problems for prospective payment based on diagnosis-related groups (DRGs).

We evaluated the ability of the diagnosis-related-group (DRG) classification system to account adequately for severity of illness and, by implication, for the costs of medical care. Hospital inpatients on medicine, surgery, obstetrics/gynecology, and pediatrics services in six hospitals were evaluated to provide a spectrum of patient and hospital characteristics. This evaluation was based on data from a generic index of severity of illness obtained by trained personnel from a review of hospital charts after patient discharge. Within each DRG, substantial differences were found in the distribution of severity of illness in different hospitals. Some hospitals treated larger proportions of severely ill patients and had a wide range of severity within each DRG, but these differences did not always agree with the teaching classification or the Health Care Financing Administration's case-mix index. These findings suggest that patient classification by means of unadjusted DRGs does not adequately reflect severity of illness, and they indicate that prospective payment programs based on DRGs alone may unfairly and adversely discriminate against certain hospitals.

Centers for Medicare and Medicaid Services, U.S.↗