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Biomedical subjects

D K Baugh

Publications and source records attributed to D K Baugh.

14 recordsLinked to original sources
PubMed1999

Trends in Medicaid prescription drug utilization and payments, 1990-97.

The rising cost of prescription drugs has caused public officials to restructure prescription drug coverage and payment policies in Medicaid. This study examines Medicaid utilization and payments for prescription drugs from 1990 to 1997. Medicaid prescription drug payments grew from $4.4 billion in 1990 to almost $12 billion in 1997, representing an average annual increase of 15.3 percent. In 1997 prescription drug payments per recipient were $1,379 for the blind and disabled, more than 10 times the amount for children. These findings will aid policymakers in setting prepaid plan rates for prescription drugs and monitoring access to care in Medicaid.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1990

Trends in Medicaid payments and utilization, 1975-89.

Trends in Medicaid payments and utilization from 1975 through 1989 are examined in this article. Medicaid payments grew significantly over the period 1975-89, but the rate of growth was uneven. Total payments grew rapidly from 1975 through 1981, but the rate of growth slowed considerably from 1982 through 1988. Recent data suggests that there may be a new discontinuity in the series; payments increased sharply in 1989. Sectors that account for growth in the costs of the program are identified by examining who are served and what types of services they receive. The dynamics of change in Medicaid payments within sectors also are explored by examining changes in the number of people receiving services and the average payment per recipient.

Adult↗
PubMed1990

Mortality following hip fracture before and after implementation of the prospective payment system.

Recent studies of patients with hip fractures from two hospitals have suggested that the marked reduction in length of stay that occurred following implementation of the Medicare prospective payment system (PPS) resulted in decreased quality of care for these patients. To assess whether this change influenced mortality, we studied patients with hip fractures aged 65 years or older from a 20% sample of Michigan Medicare enrollees. There were 2130 such patients in the 2 years preceding (October 1981 through September 1983) and 2238 in the 2 years following (October 1984 through September 1986) implementation of PPS. Although the demographic characteristics of patients with hip fractures did not change after PPS, the mean length of stay (95% confidence interval) decreased by 4.4 (4.1 to 4.7) days. However, mortality in the year following the fracture did not change: 23.2% before PPS, 23.7% after PPS; rate difference of 0.5% (-2.0 to 3.0). This finding was consistently present within subgroups defined by patient demographic characteristics. Furthermore, when the analysis was restricted to patients treated in those hospitals with the greatest reduction in average length of stay following PPS (7.5 days, or 35%), there was no significant change in 1-year mortality. For those patients who were enrolled in Medicaid and not in a nursing home at the time of the fracture, there was no increase in the rate of nursing home residence 1 year after the fracture. Thus, the findings of this population-based study suggest that the key outcomes of postfracture mortality and nursing home residence were not affected by the implementation of PPS.

Aged↗
PubMed1989

Experience of a Medicaid nursing home entry cohort.

Long-term care cost-containment policies have focused on reducing the numbers of persons entering nursing homes. To provide insight and background for such efforts, the authors studied the experience of Medicaid nursing home entry cohorts in three individual States. They found substantial interstate variation in rates of nursing home entry and subsequent patterns of discharge, suggesting the operation of fundamentally different policies for provision of Medicaid nursing home services. Analysis of the cost effectiveness and quality of care implications of these policies may provide guidance for future cost-containment efforts.

Aged↗
PubMed1988

Medicaid Tape-to-Tape findings: California, New York, and Michigan, 1981.

Presented in this report is an overview of Medicaid enrollment, utilization, and expenditures in California during 1981. The California Medicaid program, called Medi-Cal, is the largest in the Nation in terms of program beneficiaries. During 1981, California had one of the most generous Medicaid programs in the country in terms of eligibility and covered services. At the same time, there were benefit limitations and reimbursement restrictions in place that were designed to restrict program expenditures. The data in this report were provided by the State to the Health Care Financing Administration as part of the Medicaid Tape-to-Tape Project. Data from Michigan and New York are also included for comparison purposes.

Adult↗
PubMed1988

Patterns of Medicaid utilization and expenditures in selected states: 1980-84.

Data from the Medicaid Tape-to-Tape project are presented for 5 years, 1980-84, and for five States--California, Georgia, Michigan, New York, and Tennessee. These States represent a range of generous to restrictive Medicaid program characteristics. Utilization and expenditure measures are presented for most Medicaid services: hospital services, long-term care, physician services, and prescription drugs. Data are further disaggregated by major eligibility group: children and adults covered by Aid to Families with Dependent Children; aged and disabled covered by Supplemental Security Income. Previous findings of a high degree of Medicaid diversity among States are confirmed here.

Adolescent↗
PubMed1988

Medicaid expenditures for the disabled under a work incentive program.

Congress enacted Section 1619 of the Social Security Act to enable the disabled receiving Supplemental Security Income (SSI) to obtain jobs and still retain Medicaid health benefits. Congress intended this work incentive to remove the fear of the severely disabled that by obtaining employment they would lose Medicaid benefits. Based on data from 11 States, our analysis found that Medicaid expenditures for Section 1619 enrollees were relatively small and only one-half the average Medicaid expenditure for the disabled. Retaining Medicaid appears to provide a significant work incentive because Medicaid expenditures represent 13 percent of Section 1619 enrollees' earnings.

Data Collection↗
PubMed1987

Psychotropic drug use and the risk of hip fracture.

To assess the risk of hip fracture associated with the use of four classes of psychotropic drugs, we performed a case-control study of 1021 patients with hip fractures and 5606 controls among elderly Medicaid enrollees. Persons treated with hypnotics-anxiolytics having short (less than or equal to 24 hours) elimination half-lives had no increased risk of hip fracture. By contrast, a significantly increased risk was associated with current use of hypnotics-anxiolytics having long (greater than 24 hours) elimination half-lives (odds ratio, 1.8; 95 percent confidence interval, 1.3 to 2.4), tricyclic antidepressants (odds ratio, 1.9; 95 percent confidence interval, 1.3 to 2.8), and antipsychotics (odds ratio, 2.0; 95 percent confidence interval, 1.6 to 2.6). The risk increased in relation to the doses of drugs in these three classes. An analysis for possible confounding by dementia did not alter the results. Previous but noncurrent use of drugs in these classes conferred no increase in risk. Although a cause-and-effect relation was not proved, these data support the hypothesis that the sedative and autonomic effects of psychotropic drugs increase the risk of falling and fractures in elderly persons. The results suggest the need for studies of this association in other populations and for evaluation of newer psychotropic drugs with fewer undesirable sedative and autonomic effects.

Accidental Falls↗
PubMed1987

Interstate variation in elderly Medicaid nursing home populations. Comparisons of resident characteristics and medical care utilization.

Nursing home care in the United States is financed primarily through the federal-state Medicaid program. Because Medicaid nursing home programs are administered within the individual states, there may be interstate differences in the characteristics of Medicaid nursing home residents and their utilization of medical care. We used Medicaid claims and enrollment data for calendar 1981 from three large states--Michigan, California, and New York--to study this question. We found that the populations of elderly Medicaid nursing home residents in each of the three states had similar characteristics. In contrast to the homogeneity of resident characteristics, there were pronounced interstate differences in the use of medical care, particularly for the relation between nursing homes and hospitals. California was characterized by frequent turnover among elderly Medicaid nursing home residents and a high rate of transfers to and from hospitals. One third of residents entered the nursing home in the study year, 43% of enterers came from the hospital, and 51% of enterers were discharged within 180 days of admission, usually to the community. In New York, both turnover among elderly Medicaid nursing home residents and interinstitutional transfers were less frequent. However, those residents entering from the hospital had an average pre-entry hospital stay of 60 days, three to five times that of the other two states. Medicaid payments per day of nursing home care totaled +60 per day, twice those in the other two states. Michigan was characterized by patterns of medical care utilization intermediate between these two extremes. These findings suggest caution in the interpretation of single-state studies of nursing home residents, particularly for those of the dynamic relation between nursing homes and hospitals. They also suggest that further study of the experience of the individual states could provide valuable insights into the effects of different levels of nursing home reimbursement and different policies for transfers between nursing homes and hospitals.

Aged↗
PubMed1987

Impact of growing numbers of the very old on Medicaid expenditures for nursing homes: a multi-state, population-based analysis.

We utilized Medicaid data from five states which account for 39 per cent of Medicaid expenditures to study the impact of the near-trebling of persons age 85 and older (the very old) projected to occur by the year 2012 upon Medicaid nursing home expenditures. We found a one-year prevalence of Medicaid-covered nursing home residence of 20 per 100 among the very old. If this rate continues, with no changes in current levels of Medicaid nursing home payments, and if population forecasts are accurate, increasing numbers of the very old will generate an additional +6.3 billion (1982 dollars) annually of Medicaid nursing home payments by 2012: an increase of 280 per cent from 1982 levels. The stress this trend will place upon societal ability to check growth in public expenditures for medical care while maintaining basic services for other low income populations will be an important force shaping public health policy in the next 25 years.

Aged↗
PubMed1982

Trends in Tennessee Medicaid acute care: use and expenditures, 1974-1978.

Because person-level data are not currently available at the Federal level, many questions regarding the use and expenditures of Medicaid services remain unanswered. This article demonstrates the capability of State Medicaid Management Information Systems (MMIS) to provide data that can address a variety of Medicaid program issues at both the State and Federal levels. Using data from the Tennessee Medicaid files, we analyze MMIS data to demonstrate the utility of person level statistics and to indicate methodologies useful for future analytic efforts, particularly in constructing utilization rates for policy and program management activities. While total Tennessee Medicaid enrollment is declining, the number of disabled enrollees and the proportion of aged enrollees are increasing. Tennessee Medicaid average covered lengths of stay exhibit a downward trend, but covered days of care rates are increasing due to higher admission rates. Medicaid payments per enrollee increased drastically, primarily due to increases in average payments per day and, to a lesser extent, increased utilization. Medicaid utilization and expenditures are highly skewed toward aged and disabled enrollees and toward those with less than six consecutive quarters of enrollment. Similarly, whites exhibit a disproportionate use of inpatient services. Analyses of diagnostic case-mix indicate stable patterns of both AFDC and disabled enrollees over time. Differences in case-mix and length of stay between the two eligibility groups are consistent with the respective characteristics of these populations.

Adolescent↗