Biomedical subjects

P L Pine

Publications and source records attributed to P L Pine.

9 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

Outcomes of surgery under Medicaid.

In this study, health outcomes during the 6-month period following surgery are examined for all Medicaid recipients in Michigan and Georgia who underwent selected surgical procedures between July 1, 1981, and June 30, 1982. Readmissions were somewhat more prevalent in both States for hysterectomy, cholecystectomy, appendectomy, and myringotomy. On almost all measures in both States, levels of post-surgical utilization, expenditure, and complications were higher among females, older patients, Supplemental Security Income enrollees, and those with higher levels of presurgical utilization and longer and more costly surgical stays. The results further demonstrate the utility of claims data in monitoring outcomes of surgery.

Data Collection↗

PubMed1989

Utilization and expenditures under Medicaid for Supplemental Security Income disabled.

Recently available data on major disabling conditions of the Supplemental Security Income disabled are used to examine 1984 patterns of Medicaid expenditures in California, Georgia, Michigan, and Tennessee. Results indicate that 37-58 percent of these expenditures are for enrollees whose major disabling condition involves mental retardation or other mental disorders. This pattern occurs because a high proportion of disabled enrollees have these conditions, rather than high expenses per enrollee. Annual Medicaid expenditures per enrollee were highest for the disabled with neoplasms, blood disorders, and genitourinary conditions. Expenditures per enrollee were higher for younger enrollees and lower for those dually enrolled in Medicare.

Adolescent↗

PubMed1988

Acquired immunodeficiency syndrome in California's Medicaid program, 1981-84.

In this article, Medicaid enrollment, use, and expenditures for persons with acquired immunodeficiency syndrome in California from 1981-84 are examined. The data are from Tape-to-Tape, a person-level Medicaid enrollment and claims data base. It was found that expenditures per month of enrollment decreased as length of enrollment during the year increased. Average annual expenditures increased from 1982 to 1983 and then decreased in 1984. This decrease was most pronounced in hospital services with no indication of a substitution of ambulatory services. This decline is primarily a result of a decrease in hospital reimbursement per day as opposed to changes in use, because discharge rates decreased and length of stay increased.

Acquired Immunodeficiency Syndrome↗

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

Hospital utilization and expenditures for Medicaid enrollees by major diagnosis group.

The distribution of Medicaid hospital discharges and expenditures by major diagnosis group for Medicaid enrollees in California, Michigan, and New York during 1982 are examined in this article. Although hospital expenditures represent a major component of Medicaid expenditures, the extent of variation in Medicaid inpatient utilization and expenditures across diagnoses and between States has not been previously studied. In this article, Medicaid inpatient hospital utilization and expenditure data by major diagnosis group from the Health Care Financing Administration's Tape-to-Tape data base are examined to determine whether significant interstate differences exist.

Aid to Families with Dependent Children↗

PubMed1983

A study of the "crossover population": aged persons entitled to both Medicare and Medicaid.

This study focused on persons 65 years of age and over who were dually entitled to Medicare and Medicaid in 1978. The paper examines their age, sex, and race characteristics, and their Medicare utilization and mortality rates in comparison to persons eligible for Medicare only. The study showed that the group entitled to both Medicare and Medicaid was relatively much older than those with Medicare only, with a mean age of 76.6 years compared to 73.6 years. In the group entitled to both Medicare and Medicaid, the proportion of persons of minority races was four times as great as the proportion in the remaining population. Nevertheless, nearly three out of four persons entitled to both programs were white. In the group with dual eligibility, 71 percent were women, compared to only 59 percent in the Medicare-only population. Thus, the dually covered group may be characterized as being relatively older than other Medicare enrollees, largely composed of white persons and women, and as having a higher proportion of minority persons than the general population. The study showed that a much higher proportion of dually entitled persons were users of the Medicare program than were persons eligible for Medicare only. On a per-enrollee basis, reimbursement was substantially higher for those dually eligible. The study also found differences in the diagnostic conditions of the dually entitled. The data indicate (after being standardized for age) that the death rate was 50 percent higher for the dually entitled. This difference in mortality is partly attributable to the relatively high mortality rates for the medically needy; nonetheless, the mortality rate for the dually entitled who also received cash assistance was 20 percent higher than those for other Medicare enrollees. The excess mortality among this group was notably higher for the age group 65-69, with a 50 percent excess mortality, and for the age group 70-79, the excess mortality was 30 percent. Thus, the dually entitled, in general, experience higher mortality rates than those with Medicare only, and that fact very likely explains to a large extent the higher utilization rates found for the dually entitled in this study. The paper concludes by raising some possible consequences of either Medicare or Medicaid coverage being altered or tightened.

Aged↗

PubMed1981

Analysis of services received under Medicare by specialty of physician.

This paper examines use of physicians' services by Medicare beneficiaries according to the specialty of the physician providing care. The major objectives of this study were to determine which types of physicians are most frequently used, the average charge per service by specialty, the mix of physicians (by specialty) that patients saw during the year, and the amount Medicare reimburses in relation to total physician income. Data were studied for the total Medicare population and by age, sex, race, and geographic area. Claims data for 1975 and 1977 were used from the Part B Bill Summary System. This system collects information from bills from a 5 percent sample of Medicare enrollees. Major findings from this study indicate: (1) Physicians in general practice and internal medicine provided about the same number of services and each far outranked all other types of physicians in numbers of Medicare beneficiaries with reimbursed services. (2) There were marked differences by census region in the use of certain specialists, particularly pathologists, podiatrists, dermatologists, and the specialty group otology, laryngology, rhinology. (3) Average charges per service varied considerably by specialty. Internists' charges averaged 35 percent higher per service than charges by general practitioners. Charges submitted by the surgical specialties far outranked all others and showed the greatest increase during the period under study. (4) Of the total persons with reimbursement physicians' services in 1977, 85 percent saw a primary care physician during the year, while the remaining 15 percent received services from specialists only. (5) Of the total reimbursements made by Medicare, internists received 20 percent, general practitioners received 14 percent, and general surgeons 12 percent. Medicare's payments were estimated to be 21 percent of total gross income for internists, 20 percent for anesthesiologists, and 18 percent for surgical specialties.

Economics, Medical↗