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Biomedical subjects

H Temkin-Greener

Publications and source records attributed to H Temkin-Greener.

14 recordsLinked to original sources
PubMed2001

PACE and the Medicare+Choice risk-adjusted payment model.

This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

Aged↗
PubMed1998

Stability of disability among PACE enrollees: financial and programmatic implications.

This article examines the experience of the first 11 Program of All-inclusive Care for the Elderly (PACE) programs. It investigates changes in functional status of participants in relation to length of enrollment in the program and individual risk characteristics. Our findings indicate that mature programs experience stable disability mix over time, supporting the rationale for the current PACE payment method. However, significant differences exist between programs, suggesting that payment rates could be more program specific. Analysis of the effect of patient characteristics at admission on the likelihood of improvement in functional status identified areas for quality improvement. The implications of this study have increasing importance in light of the expected expansion of PACE to approximately 100 sites by the year 2000.

Activities of Daily Living↗
PubMed1995

Transitions in long-term care.

This article examines transitions between the community and nursing homes among the private pay and the Medicaid eligible older (65+) persons. Discrete-time hazard functions were estimated to determine factors associated with the probability of these transitions. The analysis shows that recent hospitalizations for stroke, dementia, or hip fractures, while strongly predictive of nursing home admissions among the Medicaid elderly, were not significant (except for dementia) predictors for the private pay population. The results are of particular relevance in designing long-term care insurance, and more broadly, long-term care policy.

Aged↗
PubMed1993

Spending-down to Medicaid in the nursing home and in the community. A longitudinal study from Monroe County, New York.

Medicaid spend-down continues to be of considerable interest in public policy discussions regarding long-term care financing reforms. Yet, "measuring" of spend-down has been difficult because of data limitations. This study focuses on patterns of spend-down affecting those who become Medicaid eligible both in nursing homes and in the community. The study uses a longitudinal, person-specific, merged Medicare and Medicaid claims and eligibility file constructed for Monroe County, New York. The analyses show that 27% of those who enter nursing homes as private pay can be expected to spend-down to Medicaid while in a nursing home. The spend-downers remain in nursing homes for a prolonged time, with 63% staying for more than 3 years. On admission, spend-downers appear somewhat more likely than those who remained private pay or Medicaid throughout to have been less disabled in terms of activities of daily living (ADL). The community-based spend-down group is larger, younger, and more heavily represented by those who are poor or marginally poor, than the nursing home-based spend-down population. Their spend-down to Medicaid appears to have been triggered principally by the cost of acute medical care not covered by Medicare or another third-party payer. It is this population of the elderly that would have been the principal beneficiary of the short-lived 1989 Medicare Catastrophic Coverage Act. The results of this study indicate that neither the existing private long-term care insurance policies nor the currently circulating public coverage proposals alone are sufficient to protect older persons, at risk of spend-down to Medicaid, from impoverishment. Effective long-term care financing reform will need to create partnerships between public and private insurance, rather than look at them as competing options.

Activities of Daily Living↗
PubMed1992

The use and cost of health services prior to death: a comparison of the Medicare-only and the Medicare-Medicaid elderly populations.

Lack of data has limited research into the high cost and ethical dilemmas associated with care of the dying elderly. This study is based on a five-year, person-specific file of Medicare and Medicaid use and cost data for residents of Monroe County, New York, over the age of 65. It examines and compares utilization and expenditure patterns of the Medicare-only and the Medicare-Medicaid (dually eligible) decedents in 1988. Examination of reimbursement for nonacute services, not covered by Medicare, reveals that services for the "older old" may be less costly immediately prior to death than for younger decedents. However, when expenses in the year prior to the year of death are also counted, services for the dually eligible, older old decedents appear to be neither more nor less costly than for younger decedents. Distribution of expenses does, however, vary considerably with age. The younger decedents, aged 65 to 74, use 55 percent of their medical resources on hospital care, paid for by Medicare; the older old use 26 percent for hospital services and pay 67 percent for supportive care, reimbursed by Medicaid. The study suggests that medical intervention associated with dying is utilized more often and at a higher cost by younger decedents.

Aged↗
PubMed1991

Medicaid beneficiaries under managed care: provider choice and satisfaction.

This study describes patterns of choosing a provider and of consumer satisfaction among prepaid Medicaid beneficiaries in Monroe County, New York, and compares their level of satisfaction to that of fee-for-service Medicaid beneficiaries. Two interview surveys were conducted with AFDC and HR (general assistance) Medicaid eligibles, the first under the fee-for-service system servicing the Medicaid population, and the second 18 months after the introduction of a mandatory, prepaid managed care system for Medicaid beneficiaries. The results show significant ethnic differences in patient choice of provider and provider site. Given the choice, Medicaid beneficiaries switch from clinics as their usual source of care to private physician practice. Under prepayment, white Medicaid beneficiaries tripled their affiliations with private doctors, while "others" doubled theirs. The results also demonstrate higher levels of patient satisfaction with "humaneness of doctors" and with "quality of care" among those beneficiaries under prepaid care, than previously documented for those under fee-for-service. The evaluations of humaneness and quality of medical system may reflect the respondents' perceptions that the process of receiving care under prepaid, managed care is somehow different, no longer second class, and better that it was under the fee-for-service Medicaid.

Adolescent↗
PubMed1988

Ethnicity, gender, and utilization of mental health services in a Medicaid population.

This study examines gender and ethnic differences in mental health utilization and expenditures in a fee-for-service Medicaid eligible population in Monroe County, New York. The analyses demonstrate that Medicaid poor are not a homogeneous population in terms of mental health utilization, and that their patterns of care use are quite unlike those generally attributed to the middle class patients. For example, Medicaid eligible males are more likely to be mental health users than females, although they are less likely to use medical services. Ethnicity appears to be a strong determinant of ambulatory mental health utilization, but not of inpatient care. Whites experience significantly higher levels of psychiatric ambulatory use than do the nonwhites. Nonwhites, on the other hand experience greater utilization of alcohol ambulatory services than do the whites. The data indicate that although mental health care cost represents at least 20% of total expenditures in this population, this cost is predictable and stable from year to year. Other analyses dealing with the cost of medical care for mental health users, and with the impact of a 'gate keeper' on mental health utilization patterns, are presented. Both clinical and public policy implications are discussed.

Adolescent↗
PubMed1986

Medicaid families under managed care. Anticipated behavior.

This study reports the results of a household survey of 495 Medicaid clients eligible under the Aid to Families with Dependent Children program in Monroe County, New York. The purpose of the study has been to examine the views and to anticipate the health care choices/decisions of Medicaid clients prior to their enrollment in a new, county-wide Medicaid-managed care program. The findings indicate significant ethnic differentials among the Medicaid poor, both in the choice of care source and in the reasons offered for that choice. Forty percent of those interviewed would like to change to a new source of care, but less than 13% can actually be expected to change. Private practice arrangements were the preferred source of care, yet distance to such sources appears to represent a major stumbling block to access. This study suggests that the managed-care approach being offered in Monroe County may offer the Medicaid eligibles a new stigma-free way of affiliating with a health care provider. This is being recognized by those surveyed as an important element. The study demonstrates that the choices made by the Medicaid recipients are perfectly rational given the recipients' knowledge of Medicaid and the health care system, and the general conditions in which they find themselves. These findings have important implications for the move of Medicaid programs from the fee-for-service to the managed-care/HMO system.

Adult↗
PubMed1981

Surgical fertility regulation among women on the Navajo Indian reservation, 1972-1978.

Changes in the rates of induced abortions, bilateral tubal ligations, and hysterectomies on the Navajo Indian Reservation have been examined for the years 1972-1978. While the incidence of abortions and tubal sterilizations is still considerably lower among Navajo women than among the total United States population of women, it has risen, especially among those in the prime of the reproductive cycle, i.e., ages 20-34. The rate of hysterectomy has not changed substantially. Regression analyses performed on the data indicate that the utilization of surgery for fertility regulation in women on the Navajo Reservation, unlike other surgical procedures, is not affected by access to hospitals which provide surgery. Rather measures of involvement in the wage work economy are of primary importance. Those areas of the Reservation having the highest levels of such involvement exhibit the highest rates of such surgery.

Abortion, Induced↗
PubMedDate not supplied

Long-term care insurance underwriting: understanding eventual claims experience.

Little is known about the accuracy of medical underwriting for long-term care insurance. The lack of data on claims experience continues to be an obstacle in testing the ability of medical underwriting to identify above average financial risks. This study used actual claims data to simulate medical underwriting and to examine the risk, duration, and timing of nursing home use for people with conditions that are uninsurable. The results show that at least one older person in seven who is rejected for long-term care insurance due to underwriting may not represent greater financial risk to insurers than do those who are accepted.

Actuarial Analysis↗