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Biomedical subjects

D J Chollet

Publications and source records attributed to D J Chollet.

9 recordsLinked to original sources
PubMed1999

Individualizing Medicare.

Despite the enactment of significant changes to the Medicare program in 1997, Medicare's Hospital Insurance trust fund is projected to be exhausted just as the baby boom enters retirement. To address Medicare's financial difficulties, a number of reform proposals have been offered, including several to individualize Medicare financing and benefits. These proposals would attempt to increase Medicare revenues and reduce Medicare expenditures by having individuals bear risk--investment market risk before retirement and insurance market risk after retirement. Many fundamental aspects of these proposals have yet to be worked out, including how to guarantee a baseline level of saving for health insurance after retirement, how retirees might finance unanticipated health insurance price increases after retirement, the potential implications for Medicaid of inadequate individual saving, and whether the administrative cost of making the system fair and adequate ultimately would eliminate any rate-of-return advantages from allowing workers to invest their Medicare contributions in corporate stocks and bonds.

Financing, Personal↗
PubMed1996

The cost of poor birth outcomes in employer-sponsored health plans.

OBJECTIVES: The authors examine the cost and incidence of poor birth outcomes in employer-sponsored health insurance plans. METHODS: An extensive study of national inpatient and outpatient claims data for prenatal, delivery, and postnatal care of nearly 59,000 mother-infant pairs was conducted. All maternal and infant costs incurred over a 2-year period were analyzed, and, furthermore, the longitudinal claims experience of a cohort of 20,000 mothers and infants was examined in detail. RESULTS: The study revealed that 25% of deliveries resulted in poor birth outcomes, which accounted for 40% of total costs over a 2-year period. Extrapolated nationwide, the net direct medical care cost of poor birth outcomes in employer plans has been estimated at approximately $5.6 billion for 1990, approximately 3% of aggregate after-tax corporate profits that year. CONCLUSIONS: Costs related to maternity and infant care are a major source of cost for employer-sponsored health insurance plans. Poor birth outcomes represent significantly higher cost for both the mother and infant at all stages of care-prenatal, at birth, and postnatal. To the extent that poor birth outcomes relate to maternal behavior and are preventable, their very high and protracted cost may justify substantial health promotion activity by employers and insurers.

Adult↗
PubMed1996

Redefining private insurance in a changing market structure.

This discussion on likely changes and challenges for the health insurance industry over the coming decade assumes that significant national reform of health care financing for the privately insured population will not occur--or, if it does, that it will mirror the insurance market reforms that many states already have undertaken. First, the changes in private insurance coverage during the past several years are considered, with particular attention to the erosion of employer-based coverage and to the rising influence of public insurance programs--especially Medicaid--on the private insurance market. Next is a description of the changing web of state laws and regulations governing private health insurance. At this writing, virtually every state has enacted or is considering reforms of the small group market to limit what many perceive as unfair or destructive insurer practices and to set new ground rules for competition among insurance arrangements. The changing nature of private insurance contracts in the United States is considered next. Evolving from conventional fee-for-service contracts, private insurance is increasingly a complex mixture of capitation, partial capitation, and reinsurance of capitated arrangements. Finally, this chapter discusses three issues of increasing importance in shaping the marketplace for private insurers: (1) the federal preemption of states' regulatory authority over self-insured employer plans; (2) emerging state regulation to restructure competition in the health insurance and health care markets; and (3) the growing interest of both federal and state governments in medical savings accounts to finance health insurance and health care spending.

Capitation Fee↗
PubMedDate not supplied

Hospital conversion trends.

This DataWatch presents information on the extent, geographic distribution, and other issues related to hospital conversions during the 1980s and 1990s. On average, 1 percent of hospitals convert each year. Many states experienced hospital conversions, but much of the conversion activity was concentrated in California, Florida, Georgia, and Texas. While conversions of not-for-profit hospitals to for-profit status have received significant attention, conversions of public hospitals and for-profit hospitals raise complex policy issues, as well.

Bed Occupancy↗