Twenty years of Medicare and Medicaid: covered populations, use of benefits, and program expenditures.
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Adolescent↗
Biomedical subjects
A Dobson
Publications and source records attributed to A Dobson.
Medicaid program characteristics: effects on health care expenditures and utilization.
Relationships between State Medicaid program characteristics and program outputs are analyzed in this statistical report, using 1980 cross-sectional data from a variety of sources. The year 1980 furnishes a baseline against which program changes following the Omnibus Budget Reconciliation Act of 1981 and the 1982 economic recession can be evaluated. Utilization and expenditures are modeled separately for each aid category and each major service category. This use of multiple models allows for measurement of the effect of program controls that might not appear in models of total utilization and expenditures.
Adult↗
Out-of-pocket health expenses for Medicaid and other poor and near-poor persons in 1980.
The Medicaid program (Title XIX of the Social Security Act) was designed to provide access to health services at little or no out-of-pocket expense to low-income persons who might otherwise not be able to afford them. Information was collected through household interviews in the National Medical Care Utilization and Expenditure Survey (NMCUES) on total out-of-pocket expenditures for health care by noninstitutionalized persons in the United States in 1980. This report presents data to assess the degree to which Medicaid enrollees incur out-of-pocket expenses. These levels of expenditures are compared to those experienced by other persons not eligible for Medicaid who are below or near the official poverty level. Data contained in this report were derived from the National Household Survey (HHS), a panel survey of 6,600 households representative of the civilian, noninstitutionalized U.S. population, which is only one of the three surveys that were conducted as part of NMCUES. The other two surveys are a State Medicaid Household Survey (SMHS) of Medicaid households in four States and the Administrative Records Survey (ARS), a survey of existing Medicare and Medicaid administrative records for sample households. Since data were derived only from HHS, the findings in this report are national (or regional) in scope and cannot be tied directly to differences in individual State Medicaid programs. The data on eligibility and expenditures are all self-reported and have not been verified by administrative records. One definite limitation of these data is the exclusion from the NMCUES sample of all institutionalized persons. As a result, out-of-pocket expenses for one particularly high-cost group are excluded, and total out-of-pocket expenditures for each health insurance coverage group are understated. Another potential limitation of this analysis is that, as with many surveys, limited data on key items (such as out-of-pocket expenses and income) were at times missing from respondent reports. These missing data were imputed according to standard statistical techniques (see Appendix III). A variety of findings is presented, including data on the effect of health insurance coverage, demographic characteristics, health status, and continuity of Medicaid enrollment on out-of-pocket expenses. Within insurance coverage categories, Medicaid-covered persons had the lowest out-of-pocket expenses. This was true even though they had the highest mean per capita charges for care. Among the demographic characteristics that were analyzed, age and race had the most impact on the level of out-of-pocket health expenses.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Ischaemic heart disease in Australia.
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Age Factors↗
Blood flow and absorption from the rumen.
Blood flow to the ruminoreticular epithelium varies cyclically with feeding. Within this range the absorption of rapidly penetrating solutes will be dependent on the blood flow. For HTO absorption, the most satisfactory model suggests the involvement of a countercurrent exchanger behind the epithelium. The consequences of this arrangement are presented, and are qualitatively consistent with known effects of solute absorption on net water movement. The control mechanisms for net water absorption are not fully identified. The observed blood flows in the splanchnic region raise interesting questions of functional changes in the omasum and fat.
Absorption↗
Evaluating and improving the measurement of hospital case mix.
The foundation of case-based prospective payment is the case classification system. The purpose of classification systems is to group together patients with similar treatment requirements. The systems described in this issue take a variety of theoretical and practical approaches to classification. The critical issue in comparing these systems is whether the variation in treatment requirements which is not explained by the classification system is associated with particular groups of patients, particular hospitals, or particular groups of hospitals in such a way as to result in unfair reimbursement. We suggest criteria for comparing classification systems and a research agenda for clarifying the fairness of different approaches.
Costs and Cost Analysis↗
Changes in the blood flow to the digestive organs of sheep induced by feeding.
The blood flow to the digestive organs of nine sheep was determined by the use of isotopically labelled microspheres before, during and at 2 h and 4 h after feeding. Within 3 min of the start of feeding, the blood flow to the salivary glands and to the smooth muscle of the rumen and reticulum increased three-fold. The blood flow to the epithelium of the rumen and reticulum also increased before any appreciable effect on ruminal fermentation could have occurred. This increase in flow was greater in absolute but smaller in relative terms than that to the muscle. At 2 h after feeding blood flow to the epithelium of the rumen and reticulum was two to four times greater than before food was taken, while the flow to the smooth muscle of these organs had fallen to the level found before feeding. In the more distal parts of the gastrointestinal tract, blood flow changes in response to feeding were less pronounced and, where they occurred at all, consisted of decreases at different times. Thus blood flow to the omasum decreased during feeding but recovered thereafter, while the flows to abomasum, duodenum and ileum were not changed during feeding but were significantly lower at 2 h and 4 h later. In the rest of the small intestine and in the large intestine there were no significant changes in flow during the period of observation, nor were there any changes in the blood flow to pancreas or spleen. However, the flow to the omental and mesenteric fat declined abruptly on feeding and reached its minimal value 2 h afterwards. These results are in marked contrast to those reported in other species in that the subepithelial capillary plexus of the reticulum and rumen was the only region contributing to the increased hepatic portal blood flow after feeding.
Animals↗
Six months of Medicaid data: a summary from the National Medical Care Utilization and Expenditure Survey.
This is a summary of the first report in a series of three comprehensive Medicaid program reports based on National Medical Care Utilization and Expenditure Survey data. Preliminary analyses are presented based on data from the first half of 1980 which include the personal characteristics and medical care utilization patterns of noninstitutional Medicaid enrollees and the health insurance coverage of the U.S. noninstitutionalized population. More comprehensive analyses employing full calendar year 1980 data will be available in subsequent reports. The information provided in this summary is useful in appraising the impact of eligibility, benefit package, and reimbursement policy on Medicaid enrollee health care utilization at both the Federal and the State Medicaid level.
Data Collection↗
Evaluation of the maximum allowable cost program.
This article summarizes an evaluation of the Maximum Allowable Cost (MAC)-Estimated Acquisition Cost (EAC) program, the Federal Government's cost-containment program for prescription drugs. The MAC-EAC regulations which became effective on August 26, 1976, have four major components: (1) Maximum Allowable Cost reimbursement limits for selected multisource or generically available drugs; (2) Estimated Acquisition Cost reimbursement limits for all drugs; (3) "usual and customary" reimbursement limits for all drugs; and (4) a directive that professional fee studies be performed by each State. The study examines the benefits and costs of the MAC reimbursement limits for 15 dosage forms of five multisource drugs and EAC reimbursement limits for all drugs for five selected States as of 1979.
Cost-Benefit Analysis↗
The potential use of Health Care Financing Administration data sets for health care services research.
Administrative Record Systems may be an overlooked source of data for health services researchers. Through its administration of the Medicare and Medicaid Programs, the Health Care Financing Administration (HCFA) routinely receives data on items such as its beneficiary population, providers certified to deliver care to its beneficiary population, providers certified to deliver care to the beneficiaries, the use of services and reimbursements to providers. the most important data bases that are useful for research, their relative strengths and weaknesses and the extent to which they are available to outside users.
Centers for Medicare and Medicaid Services, U.S.↗
Trends in Tennessee Medicaid acute care: use and expenditures, 1974-1978.
Because person-level data are not currently available at the Federal level, many questions regarding the use and expenditures of Medicaid services remain unanswered. This article demonstrates the capability of State Medicaid Management Information Systems (MMIS) to provide data that can address a variety of Medicaid program issues at both the State and Federal levels. Using data from the Tennessee Medicaid files, we analyze MMIS data to demonstrate the utility of person level statistics and to indicate methodologies useful for future analytic efforts, particularly in constructing utilization rates for policy and program management activities. While total Tennessee Medicaid enrollment is declining, the number of disabled enrollees and the proportion of aged enrollees are increasing. Tennessee Medicaid average covered lengths of stay exhibit a downward trend, but covered days of care rates are increasing due to higher admission rates. Medicaid payments per enrollee increased drastically, primarily due to increases in average payments per day and, to a lesser extent, increased utilization. Medicaid utilization and expenditures are highly skewed toward aged and disabled enrollees and toward those with less than six consecutive quarters of enrollment. Similarly, whites exhibit a disproportionate use of inpatient services. Analyses of diagnostic case-mix indicate stable patterns of both AFDC and disabled enrollees over time. Differences in case-mix and length of stay between the two eligibility groups are consistent with the respective characteristics of these populations.
Adolescent↗
Health care in China after Mao.
This article summarizes observations made by the author during a recent trip to China and compares these views to those of other observers over the past decade. The discussion is undoubtedly influenced by the Chinese tendency to speak in terms of the ideal rather than what exists. It was often difficult to sort out "what is" from "what ought to be," even though our hosts appeared very candid, and, for the most part, our observations confirmed what we were told. Interpretation of observations is also colored by China's new surge of leadership, which causes health care policies to be in a continual state of transition. This makes any paper on contemporary Chinese health care somewhat outdated by the time it is published. However, there appear to be larger concerns reflecting basic Chinese attitudes toward health care that have evolved during the post "Liberation" period and which underlie day-to-day policy fluctuations. The analysis which follows attempts to isolate basic trends from more transitory events to clarify the the essential aspects of Chinese health care policy.
China↗
Equal treatment and unequal benefits: a re-examination of the use of Medicare services by race, 1967-1976.
In the early years of the Medicare program, proportionally more whites than non-whites among the aged used Medicare services. This article examines the use and reimbursement of Medicare services by the aged between 1967 and 1976 to determine if racial differences still exist. To do so, three measures are studied. The first, the number of persons reimbursed for Medicare service per 1,000 enrollees, measures access to Medicare's reimbursement system. The second, reimbursement per person using reimbursed services, measures the amount of reimbursement received after persons exceed Medicare deductibles. The third, reimbursement per enrollee, indicates the combined effect of access and reimbursement and represents a measure of equity for the population at risk. Analysis of the three measures by type of Medicare service found that the disparities in use and reimbursement of services by race decreased considerably between 1967 and 1976. This trend was found both at the national and at the regional level. Overall, the decreases in the disparity measured are note-worthy. By type of service, proportionally more whites than non-whites still receive reimbursement. However, once non-whites exceed deductibles, the reimbursements per person using reimbursed services are generally comparable or higher than reimbursement to whites.
Humans↗
Towards an NHI data base: the linking of administrative record systems to national health care survey results.
The Medicare and Medicaid Program have recently been integrated within the Health Care Financing Administration. This integration provides an opportunity to improve existing federal beneficiary statistical systems. Plans currently are being developed to collect uniform data elements across the Medicare and Medicaid programs and to integrate data collection activities to the extent possible. A result of this effort will be a revamping of the Federal Medicaid Reporting System, which will make Medicaid Statistics available at the federal level more comparable to federal level Medicare statistics. Federal beneficiary statistical systems are based on the claims process and are thus limited to claims based information. These systems must be supplemented with survey data in order to acquire beneficiary and nonbeneficiary health care utilization and related expenditures that are not covered by the entitlement programs. The National Medical Care Utilization and Expenditure Survey, which will collect 1980 data, will provide this type of information and serve as a validation of claims based information. Such information will be of use in program management and have obvious relationship to debates concerning the future implementation of NHI.
Data Collection↗
The choice of models relating tritiated water absorption to subepithelial blood flow in the rumen of sheep.
1. The blood flow to the ruminoreticulum of anaesthetized sheep was varied by changing the proportion of CO2 in the gas stirring solutions confined to this organ. 2. Clearance of tritiated water was thereby varied fourfold, from 10 to 44ml./min.100 g epithelium, with negligible net water movement. 4. Subepithelial blood flow, observed with radioactive microspheres using the reference organ technique, varied tenfold, from 20 to 200 ml./min.100 g epithelium. 4. The relation between tritiated water absorption and blood water flow was approximated by a hyperbolic model, but was appreciably better described using a higher order term in blood flow consistent with a countercurrent exchange of tritiated water between arterioles and venules. 5. The distribution of blood flow between different regions of the organ and between epithelium and muscle is described.
Animals↗
Medical peer review and the PSROs: current findings on relative cost and efficiency.
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Cost-Benefit Analysis↗
The strategy of evaluating nationwide MCE impact.
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Evaluation Studies as Topic↗