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Biomedical subjects

J Holahan

Publications and source records attributed to J Holahan.

At least 19 recordsLinked to original sources
PubMed2001

Commercial health plan participation in Medicaid managed care: an examination of six markets.

This study examines six local health care markets to gain a better understanding of the factors associated with the decision by commercial plans to participate in Medicaid managed care (MMC). Findings suggest that no single factor explained why plans chose to participate in MMC in a particular market. Instead, a combination of factors--generally economic but not always--determined whether a plan participated. While rate adequacy was central, it was not the only factor. Results indicate that it is capitation rates relative to other factors (such as provider costs, administrative costs, enrollment volume, growth opportunities in other markets) that matter rather than simply the level of rates.

Capitation Fee↗
PubMed2000

Children's health insurance: the difference policy choices make.

This paper provides estimates of the cost and coverage impacts of the new State Children's Health Insurance Program (SCHIP). The estimates reflect the many choices the states are given by the legislation: whether to use traditional Medicaid or establish separate state-run programs; how far to extend eligibility up the income distribution; and how much to use premiums. We estimate the impacts of these choices on participation by the uninsured as well as by the insured--that is, the crowd-out effect--and on public expenditures. We also estimate the savings to families and firms that substitute SCHIP for private coverage. We conclude with estimates of the cost and coverage impacts of the actual initial choices that states have made.

Child↗
PubMed1999

A conflict of strategies: Medicaid managed care and Medicaid maximization.

OBJECTIVE: To examine the influence of state strategies aimed at increasing federal Medicaid matching dollars on the design of states' Medicaid managed care programs. STUDY DESIGN: Data obtained from the 1996-1997 case studies of 13 states to examine how states have adapted the design of their Medicaid managed care programs in part because of maximization strategies, to accommodate the many roles and responsibilities that Medicaid has assumed over the years. PRINCIPAL FINDINGS: Our study showed that as states made the shift to managed care, some found that the responsibilities undertaken in part through maximization strategies proved to be in conflict with their Medicaid managed care initiatives. Among other things, the study revealed that most states included provisions that preserved the health care safety net, such as adapting the managed care benefit package and promoting the participation of safety net providers in managed care programs. In addition, most of the study states continued to pay special subsidies to safety net providers, including hospitals and clinics. CONCLUSIONS: States have made real progress in moving a large number of Medicaid beneficiaries into managed care. At the same time, many states have specially crafted their managed care programs to accommodate safety net providers and existing funding mechanisms. By making these adaptations states, in the long run, may compromise the central goals of managed care: controlling costs and improving Medicaid beneficiaries' access to and quality of care.

Economics, Hospital↗
PubMed1999

The National Survey of America's Families: an overview of the health policy component.

This report describes one aspect of "Assessing the New Federalism," a multi-year research project, started by the Urban Institute in 1996, to analyze the devolution of responsibility for social programs from the federal government to the states. The project combines case studies in 13 diverse states with analyses of data drawn from a wide range of sources, including a new household survey--the National Survey of America's Families (NSAF). The NSAF, which contains nationally representative data from almost 45,000 families, was fielded in 1997 and 1999, and is planned for 2001 and again at subsequent two-year intervals. In this paper, we provide an overview of the NSAF's purpose; the sampling approach and methods; the questionnaire content, with particular emphasis on questions of interest to health policy researchers; health policy research planned by Urban Institute staff; and the timetable for public release of the NSAF data.

Family Health↗
PubMed1997

State health reform: effects on labor markets and economic activity.

Individual states are actively weighing health care reform proposals and their potential impacts on many levels, including states' own economies. This article considers the effects on state economies of two instruments of health reform: employer mandates and cost containment. The literature suggests that an employer mandate will reduce employees' wages in the long run. In the short run, however, to compensate for the costs associated with mandated health care insurance for their employees, firms may raise their prices to consumers, reduce the number of employees, or allow a drop in profit margins. By increasing health care spending and the number of insured persons, mandates would also increase states' levels of economic activity. Though cost containment may dampen the stimulative effects of expanded coverage, resources not spent on health care as a result of effective cost containment might be redistributed to other sectors in a state's economy.

Cost Control↗
PubMed1995

Insuring the poor through Section 1115 Medicaid waivers.

With the demise of health care reform at the national level, much of the attention has shifted to state-level efforts. Recently, several states have begun looking to the Medicaid program as a way to solve their health care problems. A principal way in which states are implementing health care reform is through the Section 1115 research and demonstration Medicaid waiver program. The 1115 waiver authority provides states considerable flexibility to restructure their Medicaid programs to offer health care to new populations and thus has great potential for covering large segments of the uninsured population. While it shows great promise, however, there are many obstacles states must overcome both in implementing and in maintaining an 1115 program.

Eligibility Determination↗
PubMed1995

A shifting picture of health insurance coverage.

Data from the Current Population Survey are used in this DataWatch to explore the changing composition of health insurance coverage of the U.S. nonelderly population. The authors analyze coverage trends across various subpopulations for 1988-1993. During this time significant declines in employer-sponsored coverage coincided with equally significant increases in Medicaid coverage. Thus, the increase in the proportion of nonelderly persons without health insurance appears relatively small. However, this analysis reveals that the relative stability of the uninsurance rate for the entire nonelderly population belies more significant changes in insurance coverage--and lack of coverage--among various groups. The authors also discuss the extent to which a growing level of public insurance "crowds out" (or substitutes for) private health insurance.

Adolescent↗
PubMed1994

State responses to the Medicaid spending crisis: 1988 to 1992.

In recent years the growth of Medicaid spending has been a serious state budgetary problem. Between 1988 and 1992, state Medicaid expenditures increased at an average annual rate of 21 percent. Even when accounting for funds from special revenue programs, such as provider tax and donation programs, state Medicaid spending increased by 16 percent each year between 1988 and 1992, which is far higher than in previous years. This rapid expenditure growth occurred when states were having economic slowdowns and facing fiscal pressures in many other areas. Using a case study approach, we investigated the strategies used by nine states to address the recent surge in Medicaid spending. Despite fiscal pressures, the states generally avoided large-scale cutbacks in Medicaid. Instead they implemented a wide range of budgetary actions to reduce the effect of Medicaid growth, including increment program cutbacks, constraining other budgetary sectors, shifting program costs to the federal government, and raising state taxes.

Budgets↗
PubMed1994

Strategies for implementing global budgets.

Implementing global budgets requires setting a desired level of spending as well as establishing a set of policies to assure the budget will be met. Four alternative approaches are analyzed: one relies on all-payer rate setting coupled with volume controls; the second is a system of premium regulation that controls both the levels and rates of insurance premium increase; in another system, price competition among insuring organizations limits growth in spending while incorporating a global budget that limits the aggregate costs of all premiums; finally, either managed competition or premium regulation is combined with all-payer rate setting. The fourth model is singled out for its ability to control costs. An independent policy toward capital expenditures could increase the likelihood of success under any of the strategies.

Budgets↗
PubMed1993

Measuring prices of Medicare physician services.

This study develops two sets of price indices for Medicare physician services. The first measures price changes, and the second measures geographic price differentials. The indices can be used to adjust Medicare physician spending data to examine growth or variations in the volume and intensity of services. In both instances, it is necessary to apply an index form that reflects both the rapid changes and variability in the mix of physician services received by Medicare beneficiaries and their relative importance. This suggests that an index based on a fixed basket of services (e.g., a Laspeyres index) can produce a biased measure of price. An alternative methodology based on the Fisher's Ideal Index form was used. This index allows service weights to vary over time and across areas. In the case of price change, the index is "chained" to acknowledge the introduction of new services over several years. It is concluded that the Fisher's Ideal approach is essential for cross-sectional price comparisons, in light of the high variability in service mix across areas. In measuring price changes, it was found that "chaining" was more important empirically than allowing the relative importance of services to change between years. During the 1985-1989 study period, Medicare payment rates grew, on average, by 3.5% annually. This rate varied across both time and types of services as a result of differential fee updates and explicit pricing policies implemented by Medicare (e.g., reductions in payments for "overvalued" procedures). Cross-sectionally, our results show that 1988 fees in the highest-priced areas were more than 1.5 times those in the lowest-priced areas.

Abstracting and Indexing↗
PubMed1993

Explaining the recent growth in Medicaid spending.

Medicaid spending more than doubled from 1988 to 1992, reversing a long trend of cost containment in the program. Reasons for the cost explosion are severalfold. (1) Congress expanded eligibility to more children, pregnant women, and low-income elderly persons. (2) The recession has added more people to the Medicaid rolls. (3) Growing numbers of disabled cash assistance recipients have increased Medicaid enrollment. (4) States have increased their use of federal Medicaid funds to supplement previously state-funded programs and have become more skillful in leveraging federal funds to defray the cost of their Medicaid programs. This DataWatch explores the relative impact of enrollment changes, inflation, and increased reimbursement on the increase in Medicaid spending.

Cost Control↗
PubMed1993

The impact of Medicaid adoption of the Medicare fee schedule.

In this article, the authors simulate the effects on Federal and State Medicaid expenditures of increasing Medicaid fees to Medicare fee schedule (MFS) levels. Strict adoption of the MFS by the States would increase total Medicaid spending by approximately 4 percent, $2.5 to $2.9 billion. Because Medicaid fees vary across States, so does the impact of adopting the MFS. Medicaid spending would increase significantly in some wealthy States with large Medicaid populations and in a few small, relatively poor States. Some States currently pay more than the MFS for obstetrical services. If these fees continued at higher levels for obstetrical care, total Medicaid spending would increase by $3.5 to $4.0 billion.

Adult↗
PubMed1993

Border crossing for physician services: implications for controlling expenditures.

In this article, the authors explore geographic border crossing for the use of Medicare physician services. Using data from the 1988 Part B Medicare Annual Data (BMAD) file, they find that there is substantial geographic variation across both States and urban and rural areas in border crossing to seek services. As might be expected, there is more border crossing among smaller geographic areas than among States. Predominantly rural areas tend to be major importers of services, but urban areas, on average, export services. Border crossing tends to be greater for high-technology services such as advanced imaging, cardiovascular surgery, and oncology procedures. These results suggest that expenditure-control policies applying to States or metropolitan areas should incorporate adjusters for patients' current geographic patterns of care.

Catchment Area, Health↗
PubMed1993

The future of Medicare Volume Performance Standards.

A policy of Medicare Volume Performance Standards (MVPS) was established to control the rate of growth in Medicare physician spending. The standards control spending growth by lowering fee updates when spending exceeds a preset standard, or increasing updates when spending is below the standard. Separate standards are established for surgical and nonsurgical services. This paper examines the policy's weaknesses and proposes refinements that would enhance the equity of MVPS rewards and penalties, and therefore, the policy's long-term viability. Specifically, we suggest that MVPS policy permit differentials in standards across areas when utilization rates vary geographically and for some types of services when volume growth differs significantly.

Economics, Medical↗
PubMed1992

Measuring growth in the volume and intensity of Medicare physician services.

Congress adopted a policy of Volume Performance Standards that will adjust Medicare fees downward (or upward) in direct relation to the amount that spending exceeds (or falls below) a preset target. Using data from the 1985 through 1989 Medicare Part B Annual Data (BMAD), we show there are wide differences in the rate of growth in volume and intensity across types of services, specialties, and geographic areas. This suggests the current policy that bases adjustments on two national standards for surgical and nonsurgical services could lead to inequitable fee rewards and penalties. A greater number of targets based on more homogeneous service categories could reduce these inequities.

Cost Control↗
PubMed1992

Who pays for health care in the United States? Implications for health system reform.

This paper examines the distribution of health care spending and financing in the United States. We analyze the distribution of employer and employee contributions to health insurance, private nongroup health insurance purchases, out-of-pocket expenses, Medicaid benefits, uncompensated care, tax benefits due to the exemption of employer-paid health benefits, and taxes paid to finance Medicare, Medicaid, and the health benefit tax exclusion. All spending and financing burdens are distributed across the U.S. population using the Urban Institute's TRIM2 microsimulation model. We then examine the distributional effects of the U.S. health care system across income levels, family types, and regions of the country. The results show that health care spending increases with income. Spending for persons in the highest income deciles is about 60% above that of persons in the lowest decile. Nonetheless, the distribution of health care financing is regressive. When direct spending, employer contributions, tax benefits, and tax spending are all considered, the persons in the lowest income deciles devote nearly 20% of cash income to finance health care, compared with about 8% for persons in the highest income decile. We discuss how alternative health system reform approaches are likely to change the distribution of health spending and financing burdens.

Adult↗