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Biomedical subjects

Timothy D McBride

Publications and source records attributed to Timothy D McBride.

16 recordsLinked to original sources
PubMed2006

The effect of poverty and caregiver education on perceived need and access to health services among children with special health care needs.

OBJECTIVES: We examined the association between several variables and the use of specialist physician services, developmental therapies, and prescription medications among children with special health care needs (N=38866). METHODS: We used a bivariate probit model to estimate whether a given child needed specialized services and whether that child accessed those services; we controlled for activity limitations and severity of special needs. Variables included family income, mother's (or other caregiver's) educational level, health insurance coverage, and perceived need for specialized services. We used data from the 2001 National Survey of Children with Special Health Care Needs. RESULTS: Lower-income and less-educated parents were less likely than higher-income and more-educated parents to say their special needs children needed specialized health services. The probability of accessing specialized health services-when needed-increased with both higher family income and insurance coverage. CONCLUSIONS: Children with special health care needs have less access to health services because their parents do not recognize the need for those services. An intervention in the form of information at the family level may be an appropriate policy response.

Adolescent↗
PubMed2006

Medicare physician payments: impacts of changes on rural physicians.

Medicare payment disproportionately impacts rural physicians compared to urban. For example, 51% of rural physicians, compared to 44% of urban physicians, receive at least 38% of their payments from Medicare.1 Thus, the Medicare physician payment system is of significant rural interest. In this policy brief, we present the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Specifically, we examine the impact of creating a floor of 1.00 in the geographic practice cost index (GPCI) for work expense. We also show the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area. Our principal findings are the following: (1) Increases to the GPCI for work expense accounted for a substantial percentage of the two-year increases in total payment to physicians in rural payment areas. (2) Increases in the conversion factor (CF) (base payment) accounted for most of the increases in total payment in all but 6 of the 89 Medicare payment localities; in those 6 areas, the dominant factor was GPCI adjustment. (3) Bonus payments are a more direct means of targeting increased payments to physicians in specific areas than is a general increase in one part of the payment formula.

Humans↗
PubMed2006

Medicare Part D: early findings on enrollment and choices for rural beneficiaries.

On January 1, 2006, the Medicare program began offering prescription drug coverage (Medicare Part D) to over 42 million Medicare beneficiaries. This policy brief provides a first snapshot of enrollment in rural and urban areas across the United States and outlines the early findings from an analysis of plans available to rural persons under Medicare's Part D program. The data in this brief will be updated as new data are available from the Centers for Medicare and Medicaid Services (CMS). Key Findings As of March 18, 2006 (date of release by CMS), (1) 59% of rural beneficiaries and 67% of urban beneficiaries have creditable drug coverage. (2) 21% of rural beneficiaries were enrolled in stand-alone prescription drug plans (PDPs), compared to 13% of urban beneficiaries. (3) 3% of rural beneficiaries were enrolled in Medicare Advantage prescription drug (MA-PD) plans, compared to 16% of urban beneficiaries. (4) In non-adjacent rural areas, 22% of rural beneficiaries were enrolled in stand-alone PDPs, and 2% were enrolled in MA-PD plans. (5) All beneficiaries, including those in rural areas, can choose a PDP option that covers 91% of the top 100 formulary drugs. (6) Average monthly premiums and other plan characteristics for MA-PD plans vary significantly across states-for example (excluding Maine), 2 premiums vary from $6 in urban New Hampshire to $53 in rural Hawaii.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Researchers and policymakers: travelers in parallel universes.

Public policy, in the form of laws, guidelines, and regulations, has a profound effect on our daily lives and health status. Reasons for a lack of consistent and systematic translation of public health research into public policy is examined, including differences in decision-making processes, poor timing, ambiguous findings, the need to balance objectivity and advocacy, personal demands of the process, information overload, lack of relevant data, and the mismatch of randomized thinking with nonrandom problems. Next, several actions are suggested that should help bridge the chasm between science and policy, such as greater involvement in the process, better understanding of political decision making, building of effective teams, and development of political champions. Scientists are obligated not only to discover new knowledge but also to ensure that discoveries are applied to improve health.

Communication↗
PubMed2005

The Federal Employees Health Benefits Program: a model for competition in rural America?

CONTEXT: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created the Medicare Advantage (MA) program, which promotes the entry of private Preferred Provider Organization (PPO) plans into regions that have not previously had Medicare managed care plans. The assumption that a competitive environment will develop is based on experiences in the Federal Employees Health Benefits Program (FEHBP). PURPOSE: The authors test the hypothesis that the FEHBP has fostered an environment of competing health plans, especially preferred provider organizations (PPOs), in rural areas. METHODS: Data from the US Office of Personnel Management are used to quantify the number of FEHBP-certified plans in each US county and the number of enrollees in each plan. Data from the Area Resource File are used to measure independent variables in multivariate analysis to account for the number of FEHBP-certified health plans competing in each US county. FINDINGS: While 98% of all counties have at least 3 plans with enrollment, in many sparsely populated rural areas, only 1 of the plans is an open-enrollment plan (excludes plans for letter carriers). There is a strong relationship between the number of FEHBP plans and areas with high population counts and high population density. In many counties with low population counts (under 3,000), most PPOs are not contracting with the nearest primary care provider. CONCLUSIONS: The FEHBP is not a perfect predictor of MA plan activity because the MA program does not use the FEHBP approach of certifying regional plans that must offer local access. However, the FEHBP experience indicates that plans are attracted to areas with high population counts and high population density.

Economic Competition↗
PubMed2005

Understanding the impacts of the Medicare Modernization Act: concerns of congressional staff.

Sweeping changes to the Medicare program embodied in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), including a new prescription drug benefit, changes in payment policies, and reform of the Medicare managed-care program, have major implications for rural health care. The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects.

Aged↗
PubMed2005

Wives who outearn their husbands: a transitory or persistent phenomenon for couples?

In what percentage of married couples do wives outearn their husbands, and, moreover, how persistent are these patterns? This study systematically examined variation in point-in-time estimates across alternative measures of earnings, definitions of types of couples, and data sources and gauged the persistence of these patterns for a period of three calendar years using data from the 2000 Current Population Survey and the 1996-2000 Survey of Income and Program Participation. Among the findings are that in 19% to 30% of all married couples, wives have higher earnings than their husbands. In 60% of such couples, this arrangement persists over the three-year period; for the rest, this arrangement is transitory.

Adult↗
PubMed2004

Rural physicians' acceptance of new Medicare patients.

According to the American Academy of Family Physicians (AAFP), the percentage of family physicians accepting new Medicare patients declined from 84.1% in 2000 to 76.1% in 2003 (Trude & Ginsburg 2002). That decline coincided with projected annual decreases in Medicare physician payment announced in March 2002 and March 2003. The decline in the percentage of family physicians accepting new Medicare patients is cause for concern about Medicare beneficiaries' access to health care services. National trends for all physicians may mask different trends among rural physicians. The data in this policy brief describe the trends for urban and rural physicians who no longer accept new Medicare patients.

Forecasting↗
PubMed2002

Effect of medicare payment on rural health care systems.

Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

Aged↗
PubMed2002

Patterns of health insurance coverage among rural and urban children.

Despite the potential for the State Children's Health Insurance Program to improve the health care coverage of rural children, the expansion of public health insurance to children in rural areas may be hampered by a lack of understanding about the patterns of insurance coverage they experience. This study uses the Census Bureau's 1993-1996 panel of the Survey of Income and Program Participation to evaluate differences in the duration of, and in their entry into and exit from, uninsured spells. While the average duration of new spells was shorter for rural children and most regained coverage quickly, rural children were also more likely than urban children to experience protracted spells of uninsurance. Moreover, rural children were more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children.

Adolescent↗
PubMedDate not supplied

Patterns of individual health insurance coverage, 1996-2000.

Information about patterns of individual health insurance coverage is limited. Knowledge gaps include the extent to which individual insurance provides transitional versus long-term coverage, and participants' insurance status before and after being covered by an individual plan. In this study we use data from the 1996-2000 Survey of Income and Program Participation (SIPP) to examine how long the individually insured maintain their coverage; sources of coverage before and after enrolling in an individual health plan; and characteristics of those who rely on individual insurance coverage. Understanding the dynamics of this market will better inform federal and state insurance reform efforts.

Adolescent↗