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Biomedical subjects

J R Lave

Publications and source records attributed to J R Lave.

At least 73 records · Page 4Linked to original sources
PubMed1986

Per case prospective payment for psychiatric inpatients: an assessment and alternatives.

Psychiatric hospitals and clinics are exempted from the Medicare prospective payment system. In this paper we examine the appropriateness of the DRG classification system for psychiatric patients and argue that, using this system as the basis of payment, two types of problems are likely to arise. We categorize these problems as "risks to hospitals" and "risks to patients" and examine the existing literature to determine whether these risks are likely to be significant. We propose a different approach to paying prospectively for psychiatric care, and suggest modifications that could be made to the structure of PPS to mitigate negative incentives embedded in the current system. Although the main focus of the paper is on the unit of payment, we also make some observations about issues arising in connection with the level of payment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

Financing graduate medical education using multiple regression to set payment rates.

There has been considerable public policy debate concerning the appropriate rate of adjustment to the Medicare prospective payment system for the indirect costs of graduate medical education. The model that we present in this paper represents one of the first times that the statistical technique of multiple regression has been used to establish payment rates for hospitals. We also review the alternative specifications of the model and conclude that factors other than educational programs are responsible for most of the higher costs in teaching hospitals. We conclude by making recommendations for reforming the Medicare prospective payment system.

Costs and Cost Analysis↗
PubMed1985

The psychiatric DRGs. Are they different?

The relative homogeneity of medical, surgical, and psychiatric diagnosis-related groups (DRGs) are examined. Using data from the State of Maryland and the Health Care Financing Administration we studied the amount of variation in resource utilization within the DRGs. The estimated coefficients of variation of resource utilization for the surgical DRGs were found to be significantly smaller than those estimated for both medical and psychiatric DRGs. The authors were unable to reject the hypothesis that the coefficients of variation for medical and psychiatric DRGs were different. These results suggest that hospitals are at substantial but equal risk under a DRG-based payment system for both medical and psychiatric DRGs.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1985

The impact of Medicaid benefit design on length of hospital stay and patient transfers.

The authors examined how the Medicaid hospital benefit structure affects the length of stay of psychiatric inpatients and transfers to state mental hospitals and nursing homes. They hypothesized that length-of-stay and discharge patterns would depend on five classes of variables: patient characteristics, diagnosis, mental health status, hospital characteristics, and benefit structure. Analysis of 976 Medicaid cases showed that the variables together accounted for only 17 percent of the variation in patient length of stay; benefit structure alone accounted for 6 percent of the variation, slightly less than the diagnostic variables. A patient's clinical status was the most important predictor of transfer to state mental hospitals, although benefit structure had a significant effect. It had no effect on patient transfers to nursing homes. The authors discuss the implications of the findings for designing prospective payment systems for psychiatric patients under Medicare.

Hospitals, State↗
PubMed1985

Cost containment policies in long-term care.

The rapidly increasing growth of the elderly population in the United States, especially the increasing proportion of the "old old" among the elderly, has thrust long-term care--its evolution, organization, and financing--into the national limelight. In this report of the effectiveness of various policies to contain the costs of long-term care, I focus on the aggregate public costs of providing this care. I also discuss the impact of public policy on access to needed services by the vulnerable population, the quality of these services, and the quality of life of the recipients of long-term care.

Aged↗
PubMed1985

Is compression occurring in DRG prices?

Many analysts believe that the prices of truly high cost DRGs are set low relative to their actual costs whereas the prices of truly low cost DRGs are set high relative to their costs. To test whether such "compression" is occurring, I examined the algorithm that the Health Care Financing Administration used to create its DRG pricing structure. I then compared the HCFA algorithm with the more refined weighting systems used by Maryland and New Jersey to create their DRG payment systems. I found that compression is indeed occurring in the Medicare system relative to both the New Jersey and the Maryland systems. This compression will assume special urgency for some hospitals when the standardized national DRG payment system is phased in or if stringent limits are placed on the overall rate of increase in DRGs.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1984

Hospital reimbursement under Medicare.

Although hospital care forms the largest expenditure under Medicare, long-term reforms in the basic reimbursement system should be approached cautiously. The effects of newly mandated changes--prospective payment and DRGs--have yet to be evaluated, but some modifications should be considered for the near term. Uniform, national payment rates and adjustments for teaching are especially critical areas.

Cost Control↗
PubMed1983

Financing the health care of the aged.

The Medicare and Medicaid programs, which were enacted through the 1965 amendments to the Social Security Act, placed the federal government in the central role of assuring access of the aged and the poor to needed medical care. In this article the trends in the sources of financing medical care services for the aged are examined. The distinction in terms of insurance coverage between acute care services and long-term care services is highlighted. The effect of the programs in terms of reducing the aged's direct financial cost of medical care, increasing their access to medical services, and improving their health status is explored. The unanticipated increase in the cost of these programs has led to a change in emphasis in public policy, from assuring access to mainstream medical care to containing the cost of providing care. The direction of new federal policies is analyzed, and it is concluded that no longer will it follow the private sector's specifications of the conditions and arrangements under which health services are provided to program beneficiaries.

Aged↗
PubMed1979

Characteristics of individuals who identify a regular source of medical care.

Having a source where medical services are regularly received is an antecedent to securing high quality medical care; it facilitates access and indicates that the individual is not alienated from the health care delivery system. In this paper we develop models to characterize individuals, both children and adults, who claim a regular source of care. The models are estimated using a logit analysis (since the dependent variable is 0-1) applied to survey data on residents of East Palo Alto, California. These data indicate that in this low-income, predominately black population the most important factor influencing whether a child will have a regular source of medical care is whether the parents have a regular source. For adults, the anticipated need for care (as measured by health status), time in community, and sex were all found to be important. The type of individual least likely to have a regular source of care is a low-income, unmarried male who is in good health and is a recent arrival to the community. The individuals most likely to need easy access to medical care and continuity of care are most likely to have a regular source of care, and vice versa.

Adult↗