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PubMed2002

Medicaid and indigent care issue brief: Medicaid: services covered: year end report-2002.

Medicaid provides health care insurance for low-income children, some parents who meet income thresholds, pregnant women, the elderly and the disabled. In order to receive federal funds for Medicaid, each state must offer coverage for the following health care services: inpatient and outpatient hospital services; physician services; medical and surgical dental services; nursing facility services; home health care services; family planning services; rural health clinic services; laboratory and x-ray services; pediatric and family nurse practitioner services; federally qualified health center services; nurse-midwife services; and early and periodic screening, diagnosis and treatment (EPSDT) services for individuals under age 21. States can also choose to cover certain additional services under their Medicaid plans, and these often include prescription drugs, dental services (nonmedical or surgical), clinic services, and vision and hearing services. It is up to each state to decide what optional services to include with the mandated services to create their Medicaid benefit package.

Adult↗
PubMed2003

Medicaid and indigent care issue brief: Medicaid: benefits and services: year end report-2003.

Medicaid provides health care insurance for low-income children, some parents who meet income thresholds, pregnant women, the elderly and the disabled. In order to receive federal funds for Medicaid, each state must offer coverage for the following health care services: inpatient and outpatient hospital services; physician services; medical and surgical dental services; nursing facility services; home health care services; family planning services; rural health clinic services; laboratory and x-ray services; pediatric and family nurse practitioner services; federally qualified health center services; nurse-midwife services; and early and periodic screening, diagnosis and treatment (EPSDT) services for individuals under age 21. States can also choose to cover certain additional services under their Medicaid plans, and these often include prescription drugs, dental services (nonmedical or surgical), clinic services, and vision and hearing services. It is up to each state to decide what optional services to include with the mandated services to create their Medicaid benefit package.

Forecasting↗
PubMed2004

Compliance with drug therapies for the treatment and prevention of osteoporosis.

OBJECTIVES: This study used paid claims data from real-world treatment settings to investigate the impact of hormone replacement therapy (HRT), bisphosphonate and raloxifene on patients with a recorded diagnosis of osteoporosis. METHODS: Data from a large health insurer were used to identify 58,109 osteoporosis patients who initiated drug therapy for osteoporosis. Multivariate statistical models were developed for duration of therapy, compliance at 1 year, time to discontinuation or a change in therapy, health care costs and risk of fracture over 1 year. RESULTS: One-year compliance rates were below 25% for all osteoporosis therapies. The mean unadjusted duration of continuous therapy was 221 days for raloxifene, 245 days for bisphosphonate, 262 for estrogen-only and 292 days for estrogen plus progestin. Raloxifene patients were consistently less compliant than estrogen-only patients after adjusting for differences in patient characteristics. Estrogen plus progestin patients were generally more compliant while bisphosphonate did not differentiate from estrogen-only. Compliance reduced the risk of hip fracture (o.r. = 0.382, P < 0.01) and vertebral fracture (o.r. = 0.601, P < 0.05). Compliant patients used fewer physicians services (-US dollars 56, P < 0.0001), hospital outpatient services (-US dollars 38, P < 0.05) and hospital care (-US dollars 155, P < 0.01). Bisphosphonate patients were twice as likely as estrogen-only patients to experience vertebral, Colles and other fractures and experienced higher health care costs (+US dollars 420, P < 0.01). The effectiveness of both raloxifene and bisphosphonate medications relative to estrogen-only improved significantly with the age of the patient. CONCLUSIONS: Compliance with drug therapies for osteoporosis over 1 year is poor leaving patients at risk for fractures and higher health care costs.

Age Factors↗
PubMed2000

Hospital outpatient and emergency services in rural Victoria.

Outpatient and emergency services in rural hospitals have rarely been studied. This paper analyses routinely collected data, together with data from a survey of hospitals, to provide a picture of these services in Victorian public hospitals. The larger rural hospitals provide the bulk of rural outpatients and emergency services, particularly so for medical outpatients. Cost per service varies with the size of the hospital, possibly reflecting differences in complexity. Funding policies for rural hospital outpatient and emergency services should be sufficiently flexible to take into account the differences between rural hospitals.

Data Interpretation, Statistical↗
PubMed2006

Employment status and differences in the one-year coverage of physician visits: different needs or unequal access to services?

BACKGROUND: The dichotomy employed vs. unemployed is still a relevant, but rather crude measure of status in current labour markets. Also, studies concerning the association of employment status with health have to specify the type of the employment as well as the characteristics of the unemployment. This study aims to reveal differences and potential inequalities in physician visits among seven groups in the core-periphery structures of the labour markets. METHODS: A total of 16,000 Finns responded to a postal survey in 2003. Their visits to physicians in public primary health care, occupational health care, private health services, hospital outpatient clinics and dental care services during previous year were measured as indicators of service utilisation. Participants were classified as employees having a permanent or fixed-term and full-time or part-time contract and as those experiencing short-term, prolonged or long-term unemployment. Differences in the one-year coverage of physician visits between these groups of employees were analysed using logistic regression analyses where differences in the need for services were controlled for by including demographics and self-rated health assessments in the models. RESULTS: Permanently employed respondents had visited a physician most often, and the need-adjusted regression models showed significantly lower odds ratios for a visit among fixed-term employees (OR 0.65, 95% CI 0.53-0.81) and in particular among the long-term unemployed (OR 0.21, 95% CI 0.14-0.31). A stratified analysis according to health care sector showed the lowest odds ratios in occupational health care and private physicians (ORs between 0.05 and 0.73) and also low odds ratios for dentists (ORs between 0.45 and 0.91), whereas visits to public primary health care were more common among non-permanent employees and the unemployed (ORs between 1.46 and 2.39). CONCLUSION: The use of physician services varies according to labour market status, being relatively low among the non-permanently employed and the unemployed. This underuse is emphasised when clinical need is taken into account. The main reasons for the variance evidently lie in the structures of the Finnish health service system. The result may indicate non-optimal health care of the population on the periphery of the labour market, but it may also reflect the importance of employment status as a context for need and the decision to visit a physician.

Adult↗
PubMed1979

Reorganizing ambulatory care: an administrator's view.

Citing a continuing increase in the utilization of hospital outpatient services, the authors discuss the reorganization of the ambulatory care delivery system at a 300-bed community hospital serving the Cambridge, Massachusetts area. Due to the attrition of community-based physicians, the Mount Auburn Hospital had an overburdened emergency services and an underutilized outpatient department. To improve this situation, full-time physicians and a non-physician administrator were hired for the outpatient area. In the four years following the reorganization, patient volume has increased and utilization has shifted from emergency to primary care which has required the hospital to adjust staffing in several ancillary departments. The hospital has now reached the point where growth must be carefully planned and controlled in order to preserve cost-effective, high quality care. The authors conclude that planning for hospital-based ambulatory care units should include: (1) defining the needs of the target communities; (2) marketing programs; and (3) anticipating legislation which will influence the demand for outpatient services.

Ambulatory Care↗
PubMed2005

Medicaid: Medicaid: benefits and services--2005. End of Year Issue Brief.

Medicaid provides health care insurance for low-income children, some parents who meet income thresholds, pregnant women, the elderly and the disabled. In order to receive federal funds for Medicaid, each state must offer coverage for the following mandatory health care services: (1) Inpatient and outpatient hospital services; (2) Physician services; (3) Medical and surgical dental services; {4) Nursing facility services; (5) Home health care services; (6) Family planning services; (7) Rural health clinic services; (8) Laboratory and x-ray services; (9) Pediatric and family nurse practitioner services; (10) Federally qualified health center services; (11) Nurse-midwife services; (12) Early and periodic screening, diagnosis and treatment (EPSDT) services for individuals under age 21 In addition to the required services mentioned above, states can also choose to cover additional services under their Medicaid plans, and these often include prescription drugs, nonmedical or surgical dental services, clinic services, and vision and hearing services. It is up to each state to decide what to include with the mandated services to create their Medicaid benefit package. Because of the variety of people to whom state Medicaid programs offer health insurance, states have gone back and forth on what services to include in their benefit packages. Some states offer extensive benefits with few restrictions on access to services, while others offer a minimal number of optional benefits. Cost, most often, is the deciding factor on whether or not to offer coverage.

Forecasting↗
PubMed1991

Outpatient prospective payment.

In September of this year, the Health Care Financing Administration (HCFA) will present Congress with its recommendations for developing a prospective payment system for all Medicare outpatient services. Whichever plan is ultimately adopted, this system of payment will greatly impact the structure and management of outpatient services and, in particular, reimbursement for radiology services and use of technologies. While a system is perhaps at least two years away from full-scale implementation, providers are already witnessing diminishing reimbursement as a result of incremental payment changes since the early 1980's. With the across-the-board cuts of six percent for all hospital outpatient services, authorized for the first time last year by Congress, some providers are experiencing an escalation of payment short-falls. Further, if current experience with implementation of the inpatient prospective payment system is replicated in the outpatient arena, payments will not only be less but they will be dramatically different for various providers. Since implementation of DRGs, Medicare has achieved savings of $18 billion for inpatient care. While some hospitals have reported their best years financially, others are consolidating or closing. A prospective payment system for outpatients will also have such "winners and losers," but as a single policy initiative it will probably have a greater impact than both DRGs and the resource-based relative value scale (RBRVS) combined. Because fixed payments for inpatients have proliferated the push to outpatient care, a DRG-like system for outpatients will result in capping payments for the entire continuum of services provided in hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗