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Biomedical subjects

M R Meiners

Publications and source records attributed to M R Meiners.

29 records · Page 2Linked to original sources
PubMed1985

Hospital DRGs and the need for long-term care services: an empirical analysis.

The Medicare DRG-based Prospective Payment System (PPS) encourages hospitals to reduce length of stay for elderly patients. Thus, discharges to long-term care services are expected to increase. Maryland hospital data for 1980 are used to identify those DRGs which most frequently represent patients discharged to nursing home and home health care services; explores the incentive to discharge earlier under PPS those patients needing long-term care versus short-term care; and describes characteristics of patients most likely to face increased pressure of earlier discharge to nursing homes and home health programs. Because only a limited set of patient characteristics are available from Maryland hospitals, data from a study of San Diego nursing homes are used to explore further the sociodemographic and health status measures associated with unusually long stays in a hospital prior to nursing home placement. This research suggests that the DRG reimbursement system gives hospitals a strong incentive for earlier discharge of patients needing long-term care services. However, hospitals that target only long-term care patients for early discharge will not substantially gain under PPS because these patients represent a small portion of the cases treated in the hospital and a small percentage of unreimbursed days.

Aged↗
PubMed1984

Long-term care insurance. Premium estimates for prototype policies.

Private insurance has been suggested as a way to relieve the growing pressure on Medicaid budgets brought about by the long-term care needs of the elderly. This paper provides premium estimates for prototype long-term care insurance policies. Alternative specifications of services covered, amount of benefits paid per day, waiting period before benefits begin, years of coverage, age at time of purchase, administrative expenses, risk selection, and tax treatments are examined. The estimates are useful in understanding the general order of magnitude of premiums for various types of policies and assumptions. They may also be useful in deriving initial rates for new types of policies or in setting initial rates for an insurer with no access to actual experience data.

Actuarial Analysis↗
PubMed1982

An econometric analysis of the major determinants of nursing home costs in the United States.

This study presents statistical cost function estimates based on data from the 1973-74 National Nursing Home Survey. Using multiple regression techniques, multiplicative and additive models of both total cost and operating cost are presented. Findings from the analysis contribute to the growing literature on nursing home costs and provide added insight to a number of important topics. Economies to scale are indicated with an optimum size in the 300-400 bed range. Flat-rate reimbursement systems and other systems which set rates prospectively are shown to be associated with significantly lower nursing home costs when compared to the incentives of cost based systems with or without limits and the incentives of private financing. Increases in both the admission rate and the occupancy rate are associated with higher costs though only the latter relationship proves of much practical significance, with the cost savings more pronounced for facilities starting with low occupancy rates. The profit motive is confirmed as an important incentive for containing costs. Holding several important level or scope of service indicators constant, proprietary nursing homes were found to have total costs 7% lower and operating costs 11% lower than in the voluntary non-profit nursing homes. The range of therapeutic services available and the type of staff coverage of the daily shifts provided in the nursing homes are confirmed as key cost determinants. Evidence is also provided which suggests that residents with mid-level dependency are relatively more costly to treat than those who are completely dependent or independent. The usefulness of other facility descriptions and quality proxy measures as cost determinants is also explored. The results are compared to those from other recent nursing home cost function studies.

Bed Occupancy↗
PubMedDate not supplied

Paying for long term care without breaking the bank.

As the U.S. population ages and major health care reform looms on the horizon, the search for new sources of financing for long term care has intensified. A key question is whether these resources should come from greater private contributions or from an expansion in public programs. The Partnership for Long Term Care, a new, state-supported public-private program, taps both sectors to protect those in need of chronic, long term care from impoverishment. The Partnership encourages people to plan for their long term care needs and uses Medicaid as reinsurance for those who purchase a certified policy. The four states that are participating in the Partnership have introduced a new form of means testing and better long term care financing options than currently exist.

Financing, Personal↗
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↗