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Biomedical subjects

E K Adams

Publications and source records attributed to E K Adams.

33 records · Page 2Linked to original sources
PubMed1993

Asset spend-down in nursing homes. Methods and insights.

The issue of how many elderly are affected by catastrophic nursing home expenses is a major part of the debate over if and/or how to reform long-term-care financing. Currently, there is some discussion regarding the magnitude of this catastrophic event, referred to as "asset spend-down", among the elderly. National data suggest the magnitude is small, while state-specific studies indicate it is greater. In addition, the literature regarding asset spend-down has presented two different measures of its magnitude, further confusing the issue. These two measures, each based on different denominators, have often been presented without adequate explanation. In this study, the authors review both measures and analyze reasons for the differences observed across studies. Major reasons identified include the type of sample used, the mix of payor source at admission, the length of time covered by the data, data on payor source/Medicaid eligibility, and the ability to observe multiple nursing-home stays within the data. Using the measure based on the number of persons who are private pay at admission, these studies indicate that approximately one fourth will eventually deplete assets. The second measure, based on a count of Medicaid residents at a point in time, indicates approximately one third were private pay when admitted. Study results indicate that national studies have underestimated the extent of spend-down due to national-level data limitations, while state-specific studies inevitably refect the specific state data set available and circumstances particular to each state. More state studies and a better understanding of asset transfer are needed.

Aged↗
PubMed1992

Physician payment reform: how will medical specialties fare under the new Medicare fee schedule?

In 1989, the federal government legislated a major overhaul of the Medicare payment system for physician services, to be implemented beginning in January 1992. Under the new plan, payments will be set according to a national fee schedule based primarily on a "resource-based relative value scale." This article summarizes the development of the new payment system and explores the likely impact of its implementation on medical and surgical specialties.

Economics, Medical↗
PubMed1991

Hospital choice of Medicare beneficiaries in a rural market: why not the closest?

As part of a larger study of hospital choice, the travel patterns of more than 12,000 Medicare beneficiaries residing in three overlapping rural areas were examined. During 1986 these Medicare beneficiaries were admitted to one of 53 hospitals in an area that encompassed parts of Minnesota, North Dakota, and South Dakota. Information on ZIP code of residence, closest hospital, and hospital of admission were used to analyze hospital choices of the Medicare rural elderly residing in this area. To summarize their travel patterns, the admitting hospital was categorized based on whether it was urban or rural, its size and whether or not it was the closest facility. Findings indicated that 60 percent of these rural Medicare beneficiaries used hospital services at their closest rural hospital, regardless of its size. However, 79 percent of those whose closest hospital was larger than 75 beds used it, while only 54 percent of those whose closest rural hospital was fewer than 75 beds obtained services there. Overall, 30 percent of those residing in this rural market area went to an urban hospital. These patterns appeared to reflect an evaluation by the physician and/or individual of the relative attractiveness of the local hospital versus alternatives available, as well as the individual's characteristics. Travel patterns varied by the beneficiary's age as well as his or her relative complexity of illness, as measured by a Disease Staging methodology. Findings have implications for the provision and financing of hospital services in rural areas.

Aged↗
PubMed1991

Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness.

Previous research has confirmed that desirable hospital attributes as well as increased distance, or travel time, have an impact on hospital choice. These studies have become increasingly sophisticated in modeling choice. This study adds to the existing literature by estimating the effect of both hospital and individual characteristics on hospital choice, using McFadden's conditional logit model. Some patient characteristics have not previously been accounted for in this type of analysis. In particular, the effect of a patient's complexity of illness (as measured by Disease Staging) on the choice of hospital is taken into account. The data consist of over 12,000 Medicare discharges in three overlapping rural market areas during 1986. The hospital choice set was aggregated into seven groups of urban and rural hospitals. Results indicate that rural Medicare beneficiaries tend to choose hospitals with a large scope of service and with teaching activity over those with a lower scope of service and no teaching activity, holding other factors constant. Distance is a deterrent to hospital choice, especially for older Medicare beneficiaries. The more complex cases tend to choose larger urban and rural hospitals over small rural hospitals more often than less complex cases do.

Age Factors↗
PubMed1990

Spend-down of assets before Medicaid eligibility among elderly nursing-home recipients in Michigan.

Many elderly persons enter nursing homes as private pay clients, spend their available life savings, and then apply for medical assistance under Medicaid after their assets are depleted. However, reliable data on the size and characteristics of this "spend-down" population have been lacking. This study used Medicaid claims and enrollment data to identify the proportion of elderly Medicaid nursing-home users who originally entered nursing homes as private pay clients versus those eligible for Medicaid before or concurrent with, their nursing-home admission. The study population consisted of all elderly nursing-home users receiving Medicaid in Michigan in 1984, a total of 36,898 unduplicated recipients. Findings indicated that "spend-downers" comprised 27.2% of all elderly users. Once on Medicaid, spend downers exhibited similar nursing-home utilization patterns as other groups, but incurred lower Medicaid claims because they contributed more to the cost of their nursing-home care. In aggregate, the State of Michigan Medicaid program spent $75.4 million on nursing-home services in 1984 for elderly persons who spent down to eligibility in a nursing home. These data are relevant to state policy initiatives to reduce Medicaid spending for nursing-home care by encouraging potential spend downers to purchase long-term care insurance.

Aged↗
PubMed1990

Medicaid mysteries: transitional benefits, Medicaid coverage, and welfare exits.

The links between Medicaid and welfare exits are examined using longitudinal Medicaid program data. Few people who leave welfare get any sort of ongoing or transitional Medicaid protection. Moreover, it appears that many who are eligible for transitional benefits are not getting them. Finally, people with high expected medical costs appear to be less likely to leave welfare. The loss of Medicaid associated with leaving welfare probably does have an important deterrent effect on welfare exists.

Adult↗
PubMed1989

Utilization and expenditures under Medicaid for Supplemental Security Income disabled.

Recently available data on major disabling conditions of the Supplemental Security Income disabled are used to examine 1984 patterns of Medicaid expenditures in California, Georgia, Michigan, and Tennessee. Results indicate that 37-58 percent of these expenditures are for enrollees whose major disabling condition involves mental retardation or other mental disorders. This pattern occurs because a high proportion of disabled enrollees have these conditions, rather than high expenses per enrollee. Annual Medicaid expenditures per enrollee were highest for the disabled with neoplasms, blood disorders, and genitourinary conditions. Expenditures per enrollee were higher for younger enrollees and lower for those dually enrolled in Medicare.

Adolescent↗
PubMed1988

Malpractice premium expenses: another "crisis" and its implications.

The continuing increase in malpractice claims, the severity of these claims, and onerous insurance premiums are contributing to the persistent crisis in this area. It is unclear whether there will be another general withdrawal of insurance availability. Rather, it seems more likely that problems will be isolated in certain geographical areas and among certain specialties. There is a high probability that physicians will selectively withdraw certain services in general or for specific patient groups. Data strongly indicate that certain subgroups of physicians such as obstetricians, younger doctors in general, and those in nonsolo practice are currently bearing more of the increased costs than some of their colleagues. Clearly, those in certain states are also differentially and adversely impacted.

Data Collection↗
PubMed1986

Race and socioeconomic status in medical school choice and indebtedness.

Current and proposed cutbacks in student financial assistance may significantly reduce the likelihood that low-income and minority individuals will be able to pursue a medical career. In order to estimate the magnitude of the potential effects of these cutbacks, the authors of the study reported here examined the effectiveness of the federal health manpower programs of the 1960s and 1970s in increasing access to medical education. The results suggest that regardless of race or ethnic background individuals from families with small resources were able to enter even the most expensive medical schools without incurring substantially greater debt than individuals with more family resources. In addition, the debt burden of the minority physicians examined was not very different from that of nonminority physicians. Thus, the health manpower programs appear to have been very effective, and their elimination should have a larger adverse effect on low-income individuals than on high-income persons.

Family↗
PubMed1986

Implications of physician reimbursement reform: patient access and physicians' practice.

Physicians have been and will continue to be key agents in the health care delivery system. Their relative role and methods of practice, however, are undergoing significant change. This change has been induced by increased competitiveness, continued efforts at cost containment, and changes in reimbursement methods. While the most dramatic change in reimbursement (diagnosis-related groups, DRGs) was directed at the hospital, the reform of physician reimbursement is currently a high priority of the federal government. Changes in federal payments to physicians have significant implications for physicians and their patients. Several recent developments, indeed, may become the trends of the latter part of the 1980s. These developments include changes in physicians' practice mode, lower returns to medical education, increased diversification of physicians' activities, changes in relative earnings of physicians by specialty and age, restricted physician choice for some patients, and increased problems with overall access.

Fees, Medical↗
PubMed1986

Case-mix reimbursement for nursing home services: simulation approach.

Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.

Computer Simulation↗
PubMed1984

Physician practice patterns under hospital rate-setting programs.

Earlier studies of hospital rate-setting programs have focused primarily on their ability to contain the growth in hospital utilization and expenditures. While most analysts recognize the central role physicians play in influencing health care utilization and expenditures, regulatory programs have been directed primarily at the hospital. At this time, it is unclear what impact, if any, these programs have had on physicians. Our study presents a preliminary analysis of this issue based on data from 1978 to 1982. When we compared average incomes, fees, and utilization of physician services in states with hospital rate regulations with those in states without such programs, we found significant differences. Average net incomes grew at a 1.9% slower annual rate in states with strict hospital regulatory programs. If hospital regulation is having some impact on physicians, both the physician and hospital sector should be considered when evaluating the ability of these programs to contain health care costs.

Economics, Hospital↗
PubMed1984

Variation in the growth and incidence of medical malpractice claims.

This study analyzes the incidence of medical malpractice claims since 1976, using data drawn from the 1982 core survey of the American Medical Association's Socioeconomic Monitoring System. The data show that, on average, physicians incurred twice as many claims per year in the years 1976 to 1981 as they did during their careers prior to that period. Using Tobit analysis, we find the annual frequency of claims to be greater among surgeons, obstetricians and gynecologists (OBGs), physicians in group practice, and physicians in states which apply the legal doctrine of informed consent. In addition, we find that the number of years since medical residency is positively related to physicians' claims incidence during the first 27 years of practice, and that OBGs and medical specialists who spend more time with their patients per office visit incur fewer claims.

Data Collection↗
PubMedDate not supplied

Patterns of pharmacy participation in Medicaid: implications for enrollee access.

Little attention has been given to pharmacy participation in Medicaid and enrollee access to pharmacy services despite the potential for treatment problems if appropriate drug regimens are not followed. This study presents an economic model of pharmacy participation in Medicaid and descriptive and multivariate analyses of participation rates. A key variable was the adequacy of Medicaid payments for drugs dispensed to Medicaid enrollees. This was found to positively affect county-level pharmacy participation and, in turn, participation rates were a positive and significant determinant of the number of prescriptions per enrollee. Pharmacy location, size, and type also affected participation rates and enrollee utilization.

Health Services Accessibility↗