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Single-payer system.

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Government↗
PubMed1996

The Cincinnati Payer Initiative.

In 1991, four companies (Procter & Gamble, General Electric, Cincinnati Bell, and Kroger) located in Cincinnati, OH, decided to cooperate in a collaborative partnership with hospitals and a health care data consulting firm to get more information about the health care options available in their community. The Cincinnati Quality Initiative was formed with the goal of stimulating competition around quality and value in the health care market place. The 14 hospitals in the Cincinnati area were invited to participate in a 3-year program of investigation and analyses. The Initiative implemented the investigation in order to gather information that could be used to make health care choices for their employees. Hospitals that performed well over the 3-year period-those that improved over time-would then be selected by the Initiative. However, this selection process did not occur. Nevertheless, the 3-year evaluation proved useful because it generated valuable information about the health care options in Cincinnati and spurred competition among the hospitals. It also led to a dramatic reduction in health care costs for those hospitals that agreed to participate in the investigation.

Cost Control↗
PubMed1996

Effect of the Medicare Catastrophic Coverage Act on payer source changes among nursing home residents.

The Medicare Catastrophic Coverage Act (MCCA) of 1989 was designed to expand Medicare's post-acute care benefits, reduce copayments, and raise the asset limit for Medicaid eligibility. This analysis uses a semi-Markov transition model to estimate the effect of the MCCA on changes to Medicare coverage and the spend-down rate among 5,551 new nursing home admissions followed for an average of 2.5 years. We found that Medicare use increased in 1989 and the risk of transiting from Medicare to self-pay decreased compared to 1988. Spend-down from self-pay to Medicaid was 60% more likely in 1990. The MCCA clearly increased access to Medicare coverage of nursing home care among individuals previously paying privately.

Aged↗
PubMed1997

Whose outcomes. Patients, providers, or payers?

While it is clear that measuring outcomes is important, choosing which outcomes to measure remains unclear. Controversy exists in outcomes measurement as to which specific outcome measures should be selected. Additionally, should one set of outcome measures be used for one purpose, such as comparing overall medical outcomes and another set used for another purpose, such as comparing individual patient outcomes? While it becomes obvious that comparisons would be easier if the same outcomes were used, knowing which outcomes to choose to best measure an effect is not always an easy task. The challenge in outcomes measurement comes in selecting outcomes that are comprehensive, comparable, meaningful, and accurate in their reflection of the effects of care.

Attitude of Health Personnel↗