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Biomedical subjects

A J Hogan

Publications and source records attributed to A J Hogan.

29 records · Page 2Linked to original sources
PubMed1986

Evaluating reliability. A cost-effectiveness approach.

This study derives the economic costs of misclassification in nursing home patient classification systems. These costs are then used as weights to estimate the reliability of a functional assessment instrument applied to 290 Veterans Administration nursing home patients. The weighted kappa is used to measure reliability and the results were generally favorable. Use of the unweighted kappa indicated significant reliability problems. It is suggested that reliability must be redefined and remeasured with each substantively new application of an assessment instrument.

Activities of Daily Living↗
PubMed1985

Estimating debt capacity of New York State Health facilities.

A measure of the capacity to take on new debt is developed for health facilities. This measure is a function of the current financial position of the facility, future financial market conditions (interest rates and bond/loan maturities), and a policy variable (the debt service coverage ratio) to be set by state health policy makers. The quality of this measure was shown to depend on the quality of current health facility financial accounting data, on the quality of forecasts of interest rates and future cashflow, and on the appropriateness of the criterion debt service coverage ratio. Some of the limitations of the estimate are discussed. Consideration of the debt capacity estimate serves to highlight some crucial issues in imposing capital expenditure limits, namely the interrelationships between financial viability, interest rates and access to capital markets.

Capital Financing↗
PubMed1984

Long-range hospital capital requirements planning: the state of the art, a proposal for change.

A Hospital Capital Requirements Planning System is proposed to channel competition through the use of a regional planning model. This model would help to reduce the social deadweight loss arising from competition-induced uncertainty. The system would increase the internal long-range planning capacity of hospitals and improve the quality of the applications presented for Certificate of Need review. Both health systems planners and investment bankers should have better information with which to evaluate hospital capital investment proposals.

Capital Expenditures↗
PubMed1983

Competitive bidding and voucher payments for implementing the new federalism with special emphasis on programs for the aging.

Principles from the economics of decentralization are applied to the planning and budgeting of social services for the elderly. The standard model of corporate decentralized planning and budgeting is extended to allow different levels of government to pursue qualitatively different goals. A safety-net voucher plan is also proposed to protect the most vunerable population from possible termination of services due to poorly formulated local plans. Such a decentralized planning and budgeting system would make Federal and State influence on local plans proportional to their contribution to total expenditures.

Aged↗
PubMed1983

Financing long term care under Medicaid: competitive bidding, vouchers and expenditure matching in an HMO framework.

Within the framework of a Long Term Care--HMO, a series of innovative financing mechanisms are proposed to encourage efficiency, reduce cost increases and promote the quality of long term care. Competitive bidding is used to set prices for long term care. Based upon these competitively set prices, HMO enrollees are given long term care vouchers with which to purchase care. Cost savings, arising from choices of care less expensive than the value of the voucher, are shared with the enrollee and the case management team. Incentive payments to this team are made only after a quality of care review. A portion of the payment to the long term care provider is set aside as a quality assurance withhold. If quality of care is inadequate, the withhold is forfeit.

Health Maintenance Organizations↗
PubMed1982

A health maintenance organization design for long term care under Medicaid.

The rapid increase in public expenditures for long term care under Medicaid is discussed. The major cause of this increase is identified as the high and often excessive utilization of nursing home care. Health maintenance organizations (HMOs) are considered in terms of their ability to reduce health care costs by curbing unnecessary hospitalization. The HMO structure is extended to long term care, where it is argued that unnecessary nursing home care can be reduced. A health maintenance organization targeted to the Medicaid long term care population is proposed and a detail flow analysis of the HMO is presented.

Health Maintenance Organizations↗
PubMed1982

Creating an efficient market for nursing home care.

This paper reviews the theoretical foundations of the common Medicaid nursing home reimbursement systems: Reasonable cost related, fixed rate and negotiated rate reimbursement. Each reimbursement system is examined in terms of the four reimbursement system design goals: allocative efficiency, appropriateness of care, quality of care and equity of economic rewards. None of the reimbursement approaches are found to be deficient on the theoretical level, but practical problems of implementation are shown to be very difficult. As an alternative, a competitive binding system is proposed which would bring competitive market efficiency to the allocation of Medicaid funds for nursing home care. A mathematical programming model is developed to process the bidding information and to allocate Medicaid funds to nursing homes.

Economic Competition↗
PubMedDate not supplied

Regulating the cost of institutional healthcare through competitive bidding.

A system for prospective rate setting based on the theory of auctions is proposed. In order to guarantee that competition will achieve public health goals, the State Health Planning and Development Agency will issue a limited number of patient day certificates. Hospitals can obtain these certificates by offering bids in the form of rate increases. Hospitals offering low rate increases will receive patient day certificates with authorized rate increases equal to their own proposed rate increases plus a bonus. Hospitals offering high rate increases will receive only a base rate increase equal to the smallest rate increase offered by any hospital. This approach enjoys the cost minimizing benefits of competition while restraining hospital capital expenditures.

Contract Services↗
PubMedDate not supplied

HIV infection treatment costs under Medicaid in Michigan.

The Michigan Medicaid Program payment records generated in the period 1985-89 by 783 persons were analyzed for services related to human immunodeficiency virus (HIV) infection. Other data from death records and the Michigan AIDS Surveillance Registry were available for a subset of those persons. The average monthly payment in 1989 dollars for HIV-related services was $1,302.57. Services determined to be unrelated to HIV infection accounted for 12.5 percent of the total amount for health care received and another 2.5 percent was questionable. The average monthly expenditure for men was roughly twice that for women. The discrepancy did not exist among persons identified in the AIDS Surveillance Registry. Sex differences ceased to exist when Medicaid eligibility (disability versus Aid to Families with Dependent Children) was controlled for by analysis of variance. There were no significant differences between payments to those infected through male-to-male sexual contact and those infected through intravenous drug use. Payments for HIV treatments rose with age to about 40 years, and declined slightly among older adults. The sharpest rise was for those ages 19-25 years and 26-35 years. Large sex differences existed among those who received zidovudine (AZT), 61.4 percent of the men and 19.1 percent of the women. Controlling for Medicaid eligibility moderated those differences, but they remained statistically significant. Differences in zidovudine usage were not found between men and women in the subset identified in the AIDS Surveillance Registry nor among persons infected through male-to-male sexual contact and intravenous drug use.

Adult↗
PubMedDate not supplied

Analysis of Michigan Medicaid costs to treat HIV infection.

To obtain better understanding of the nature and cost of health care related to human immunodeficiency virus (HIV) infection, medical payment records were analyzed for 204 men, women, and children older than 60 months who had indications of HIV infection. The records were those of Michigan Medicaid, the General Assistance Medical Program, and the Resident County Hospitalization Program, with service dates on or after January 1, 1984, and which were processed by November 30, 1987. Patient payment records were coded according to whether the patient's condition was considered to be pre-HIV, HIV unrelated, possibly HIV related, or HIV related. Average monthly payments were found to be $150 for pre-HIV patient payment records, $114 for those HIV unrelated, $57 for those possibly related, and $1,213 for those related to HIV infection. HIV-related monthly payments rose from about $1,500 per month in the period 3 months prior to the patient's death to more than $8,000 in the last month of life. Men were found to have twice as many claims as women, and men's claims cost about three times as much. A higher percentage of women than men (91 percent versus 37 percent) received pre-HIV paid services, indicating a higher percentage of women were at least initially receiving Medicaid for reasons other than an HIV-related disability. Diagnostic categories that accounted for the bulk of the HIV-related health care utilization included infectious and parasitic diseases, acquired immunodeficiency syndrome, diseases of the respiratory system, and non-HIV-specific immunity disorders. Inpatient hospitalization accounted for more than 75 percent of the payments, followed by physician costs (11 percent), pharmacy costs (5 percent), and outpatient costs (3 percent). A total of 45, or about 22 percent of the recipients, received zidovudine (AZT) prescriptions at an average monthly cost of $404.

Acquired Immunodeficiency Syndrome↗