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At least 217 records · Page 12Linked to original sources
PubMed2001

Comorbidity-based payment methodology for Medicaid enrollees with HIV/AIDS.

Managed care organizations (MCOs) may be incurring financial losses from persons with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) (PWHA). This study developed a statistical model to examine which specific comorbidities are important contributors to the variations in health care costs of PWHA. Individuals were classified into cost groups to simulate biased selection in MCOs. Capitation payments for various cost groups under different methodologies were compared. The statistical model closely matched payments with the actual costs of care. Capitation payments for HIV/AIDS enrollees based on this model will better protect MCOs than the traditional risk-adjustment methods.

Capitation Fee↗
PubMedDate not supplied

Does retirement education teach people to save pension distributions?

As defined contribution pension plans have become increasingly common over the past two decades, so have lump sum distributions from those plans. Employees who elect such a distribution take the balance of their pension account with them when they leave a job. They can then choose to maintain the funds in accounts designated for retirement, invest them in other saving vehicles, or spend them. If spent pension distributions are not replaced by other savings, however, the future elderly are unlikely to be able to maintain a desirable standard of living. With employee-funded pensions expected to play an increasingly important role in financing Americans' retirement, saving these funds in essential. This article is the first to examine the relationship between retirement education--specifically, meetings sponsored by employers or by public and private institutions--and the saving of lump sum distributions. Two definitions of saving are used: one that includes reinvestment only in tax-deferred saving vehicles, and a broader one that includes tax-deferred vehicles, general saving vehicles (stocks, bonds, savings accounts, and so on), and paying off debt. The analysis also evaluates the effects of retirement education on specific groups identified in previous research as being less likely to keep their pension distributions in tax-deferred accounts: namely, women, younger persons, and persons with less than a college education. The same groups tend to be less financially secure in retirement, making the effects of retirement education on them particularly relevant. With an econometric model using ordinary least squares and data from the 1992 Health and Retirement Study, the analysis finds that retirement education does not affect the overall likelihood that employees will save their distributions, whether in tax-deferred or non-tax-deferred vehicles. The picture is more complicated for subgroups of employees. Attending a retirement meeting is associated with an increased likelihood of saving among persons age 40 and under but a decreased probability of saving among college graduates and women. No effect was found for men, individuals over age 40, or persons who did not graduate from college. The finding that retirement education increases the likelihood of younger persons' saving a distribution is reassuring, for these workers are America's future retirees. However, the finding that attending a meeting does not increase saving among some of the most financially vulnerable groups is a matter of concern to policymakers. Further study of the long-term effects of spending pension distributions is needed.

Adult↗
PubMed1992

Forecasts of the costs of medical care for persons with HIV: 1992-1995.

This study concludes that the cumulative (national) cost of treating all persons with the human immunodeficiency virus (HIV) rose considerably over the past year and will continue to rise over the next several years. It is forecast that the cumulative cost of treating all persons with HIV will increase 48% from 1992 to 1995 (from $10.3 billion to $15.2 billion). It is estimated that the average yearly cost of treating a person with AIDS is $38,300 and of treating an infected person without AIDS is $10,000. The lifetime cost of treating a PWA is calculated to be $102,000. This is the first study to use, along with other data, data from the AIDS Cost and Service Utilization Survey to estimate the cost of treating persons with the HIV. The study also projects the number of AIDS cases to be 66,300 in 1992, 76,200 in 1993, 86,800 in 1994, and 97,800 in 1995.

Ambulatory Care↗
PubMed1992

The use of formal and informal home care by the disabled elderly.

Using data from the Channeling experiment, this article analyzes the factors associated with the amount of formal and informal home care received by the disabled elderly. The amounts of formal and informal home care used increase with disability, as well as with other measures of need for care. The use of formal care increases, and the use of informal care decreases, with income. The availability of immediate family increases reliance on informal care and reduces reliance on formal care. The findings have implications for the design of proposed programs to expand publicly financed home care for the disabled elderly.

Activities of Daily Living↗
PubMed1992

Program factors that influence utilization of adult day care.

Health planners, policymakers, and providers urgently require methods and information that explain the factors that affect health services utilization. This information is especially critical for planning programs that are effective in maintaining the burgeoning elderly population in community care. In this study, correlation and regression analyses examined the characteristics of adult day care (ADC) centers that were associated with utilization as operationalized by demand for and actual attendance in 822 centers. Community, client population, services and activities, and structural characteristics were associated with demand per center whereas the social environment of the ADC center was not. The attendance rate was most strongly affected by services and activities and structural characteristics. The significance of the study, its limitations, and future directions for research are discussed.

Adult↗
PubMed2003

Prior health expenditures and risk sharing with insurers competing on quality.

Insurers can exploit the heterogeneity within risk-adjustment classes to select the good risks because they have more information than the regulator on the expected expenditures of individual insurees. To counteract this cream skimming, mixed systems combining capitation and cost-based payments have been adopted that do not, however, generally use the past expenditures of insurees as a risk adjuster. In this article, two symmetric insurers compete for clients by differentiating the quality of service offered to them according to some private information about their risk. In our setting it is always welfare improving to use prior expenditures as a risk adjuster.

Economic Competition↗
PubMed2003

Competition among hospitals.

We examine competition in the hospital industry, in particular the effect of ownership type (for-profit, not-for-profit, government). We estimate a structural model of demand and pricing in the hospital industry in California, then use the estimates to simulate the effect of a merger. California hospitals in 1995 face an average price elasticity of demand of -4.85. Not-for-profit hospitals face less elastic demand and act as if they have lower marginal costs. Their prices are lower than those of for-profits, but markups are higher. We simulate the effects of the 1997 merger of two hospital chains. In San Luis Obispo County, where the merger creates a near monopoly, prices rise by up to 53%, and the predicted price increase would not be substantially smaller were the chains not-for-profit.

California↗
PubMedDate not supplied

The economic value of nursing.

The economic value of nursing relates to the purchaser's perspective. A three-level model of nursing services purchasers is presented. Selected economic/management concepts are examined in relation to nursing's economic value and these three purchaser perspectives.

Cost-Benefit Analysis↗
PubMedDate not supplied

Nursing home costs and quality of care outcomes.

The relationship between cost and quality of care in nursing homes was examined using quality indicator measures of resident outcomes. While each individual quality measure makes only small contributions to costs, when considered across the facility, quality could have a substantial financial impact on the operations of the home.

Activities of Daily Living↗
PubMedDate not supplied

[Explanatory models on the utilization of health services: a review and analysis].

The present article begins with a conceptual review of the models which have been developed for the analysis of health services utilization. The models are: epidemiological, psychosocial, sociological and economic. The stages and/or determining factors in the procedure of health services use, are described and a cross study is made with each model by means of a contingency matrix. The starting point for the search of a model that enables (in a complete and unisolated way) the identification of the determinant factors in health service use is the cross analysis of the models under investigation. This cross analysis is also taken as a conceptual framework of reference in the unfolding investigation.

Health Services↗
PubMed2004

The impact of nurse training funds on the supply of nurses.

The number of nurses per capita in the United States increased over 100 percent during the period 1972-1983, owing largely to funds made available through the Nurse Training Act (NTA). Due to federal and state donor fatigue, from 1984-2003 nurses per capita only increased 79 percent. We studied the subsidy effect of the NTA by type of program (baccalaureate, associate, and diploma) and by type of school (public and private) using a fixed-effects analysis-of-covariance model that pooled time-series cross-sectional data from 537 schools over the three decades 1974-2003. We found that the estimated impact of the federal funds ranged from 39,600 dollars to 48,900 dollars per nurse educated. We discuss whether this marginal price per additional nurse trained is a "good buy" as a government program in the context of other current nurse labor market issues.

Empirical Research↗
PubMed2005

Tegaserod treatment for IBS: a model of indirect costs.

Irritable bowel syndrome (IBS) has been associated with substantial time lost from work (absenteeism) and reduced productivity at work (presenteeism), which are the indirect costs of illness. This article presents a productivity model demonstrating the indirect costs associated with IBS and the reduction in those costs for a cohort of female employees hypothetically treated with tegaserod, a new selective serotonin (5-hydroxytryptamine [5-HT]) type 4 (5-HT4) receptor agonist, which is approved by the US Food and Drug Administration for treating women with IBS-C. The model is based on economic and epidemiologic published literature and clinical trial results. In this model, tegaserod treatment resulted in 1882 dollars in avoided lost productivity per treated female employee. Considering only the benefits of decreased work loss and the costs of medical therapy, the model predicts a benefit/cost ratio of 3.75 in the base case. From an employer's perspective, medical therapy for IBS with tegaserod is cost-effective under a series of assumptions for the treatment of women with IBS with constipation.

Absenteeism↗
PubMed1989

The effect of Medicaid policy on mental health and poverty.

This paper examines the interrelationships between mental distress, poverty, and Medicaid eligibility policy. This is accomplished by estimating an econometric model of mental health and income. We use data from a community survey to estimate the model. Simulations of the impacts of changes in Medicaid eligibility policy are performed using the model estimates. A central finding is that while there are gains in both mental health status and earnings from changes in Medicaid, the effects on poverty are small because of the design of transfer programs. Suggestions for further research are offered.

Educational Status↗
PubMed1986

Hospital and ambulatory services for selected illnesses.

National survey data were used to describe and analyze the treatment of selected illnesses: hypertension, heart condition, hernia, gynecological infection, menstrual disorder, other gynecological conditions, pneumonia, and urinary tract infection. The number of office visits, the rate of diagnostic testing, the average charge, and the use of inpatient and outpatient hospital services were analyzed in an econometric model of treatment. Differences in the treatment of patients with similar illnesses were associated with comprehensive insurance, the availability of hospital and physician resources, and other economic considerations. There was also evidence that hospital and ambulatory services were substituted for each other, as a result of economic as well as medical considerations.

Ambulatory Care↗
PubMed1987

The impact of insurance on charges for dental care.

This study assesses the effect of insurance on charges for dental care. It is hypothesized that dental practices with higher percentages of insured patients will have higher average charges for dental visits, all other things being equal. An econometric model and ordinary least squares analysis are used to test the hypothesis, based on data from the American Dental Association's 1985 Survey of Dental Practice. For the sake of homogeneity, the study is confined to solo general practitioners. Within this group, the model is applied to two practice types categorized by whether or not the practice employed a hygienist. In solo general practices with and without hygienists, a positive association between the prevalence of insureds within a practice and charges for dental care visits is shown. Hypothetical cases are used to demonstrate that an additional 18 percent of insureds within a practice results in a 6 percent increase in the average charge for a dental visit. The analysis uncovers associations between other variables and dental charges. Of particular note is the curvilinear relation between a dentist's years of experience and his or her charges for dental care.

Appointments and Schedules↗