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Biomedical subjects

L F Rossiter

Publications and source records attributed to L F Rossiter.

At least 37 records · Page 2Linked to original sources
PubMed1988

Service use and costs for Medicare beneficiaries in risk-based HMOs and CMPs: some interim results from the National Medicare Competition Evaluation.

The Health Care Financing Administration (HCFA) initiated the Medicare Competition Demonstration in 1982 in anticipation of congressional intent to establish a national program. Interim results on the 1984 service use and cost experience of the health maintenance organizations (HMOs) and competitive medical plans (CMPs) participating in the demonstrations indicate that Medicare enrollees in the demonstration experienced a median of 1,951 hospital days per 1,000 person years, 57 per cent of the median of 3,432 days per 1,000 in the local markets from which the plans drew enrollment. Independent practice association (IPA) HMOs experienced higher hospital use rates than staff and group model HMOs. These comparisons are not adjusted for various risk factors, the absence of which were likely to favor the demonstration plans. Plans with lower hospital service use were federally qualified and had been operating for more than five years. The median total annual revenue per enrollee across all plans was $2,312, compared to median annual expenses per enrollee of $2,250. The distribution of median annual expenses per enrollee by major category of expense was: institutional expenses ($1,038/enrollee), medical expenses ($720/enrollee), supplemental services expenses ($154/enrollee), and administrative and other expenses ($295/enrollee). Future analysis, using beneficiary-level data, will examine the impact of the demonstration and the nature and extent of evident biased selection and will compare the quality of care in the demonstrations to that in the fee-for-service sector.

Aged↗
PubMed1987

Risk-based capitation payments for health care: a survey of the literature.

This article provides a synthesis of the literature on risk-based capitation payments for health services and a framework for understanding rate-setting methods. Benefits, timing, integration, and risk are explained as four basic dimensions of risk-based capitation payments that must be understood in setting payment rates. Issues in health care policy are explored, with an emphasis on approaches to setting payment rates. The article is intended for classroom use in courses in health economics, health insurance, health maintenance organizations, or alternative financing and delivery systems.

Capitation Fee↗
PubMed1986

The entry of HMOs into the Medicare market: implications for TEFRA's mandate.

The Tax Equity and Fiscal Responsibility Act of 1982, under rules implemented in April 1985, creates incentives for HMOs and other competitive medical plans to significantly expand their participation in Medicare on an at-risk basis. In an attempt to gauge the likely response of HMOs to the new incentives, we examined data on a census of HMOs operating in 1982 to look for differences between HMOs that entered the Medicare program at risk under the earlier National Medicare Competition demonstration and those that did not. The most consistent difference we found was that HMOs in areas with a high adjusted average per capita cost were more likely to enter the Medicare market. HMOs with prior experience serving Medicare beneficiaries were also more likely to join the demonstration, as were HMOs that were federally qualified. No other HMO characteristics appeared to significantly affect the likelihood of entry.

Catchment Area, Health↗
PubMed1984

Prospects for medical group practice under competition.

If competition proposals are to reduce the cost of medical care, they must put forth a key role for physicians. Inasmuch as most proposals focus on the market for health insurance, the means by which policies that affect insurers are transmitted to influence the behavior of physicians are largely unknown. A larger role for competing groups of physicians is hypothesized, but the effect of competition is likely to be uneven, because group practice physicians are already in the most competitive areas of the country in terms of the density of physicians, and very few are in rural areas or in other particular regions of the country. Little evidence can be found in productivity or fee level differences between solo and group practice physicians. Thus the value of promoting group medical practices rests on their ability to reduce the use of expensive medical care. It is possible that competition proposals may not hold much promise for reducing costs. Nevertheless, they may still be worthwhile if they are better able than the present system to translate the wishes of consumers into the services of providers.

Adult↗
PubMed1983

Economic advantages of board certification.

While several recent studies have examined selected characteristics of board certified physicians, none have directly and completely examined the economic advantages it conveys. Using data from a nationwide survey of physicians, estimates of the empirical relationship between income and board certification are shown. Being board eligible increases annual practice income by about $8000 and being board certified increases income by almost $13,000, holding other factors constant. The economic advantages of board certification thus appear to be substantial.

Adult↗
PubMed1983

Prescribed medicines: findings from the National Medical Care Expenditure Survey.

In 1977 the National Center for Health Services Research, US Department of Health and Human Services, undertook a survey of 40,000 individuals in the United States, soliciting information on expenditures and sources of payment for health services including prescribed medicines. Differences in the use of prescribed medicines by age, sex, ethnic/racial background, family income, and perceived health status were found across and within therapeutic categories. More than one-fifth of expenditures were for cardiovascular-renal agents. Sources of payment were similar in all but a few therapeutic categories.

Adolescent↗
PubMed1983

A reexamination of the use of physician services: the role of physician-initiated demand.

Most studies of the use of physician services have focused on characteristics of the patient to explain variations in use. This study employed data from the National Medical Care Expenditure Survey to analyze differences in the use of physicians for ambulatory care and the extent to which these differences were attributable to the physician, the patient, or both. Where differences in patients' out-of-pocket expenses and the physician/population ratio existed, physicians proved to be the sole source of utilization differences. Overall, physicians were found to be motivated primarily by medical rather than financial concerns.

Ambulatory Care↗
PubMedDate not supplied

Combining state administrative databases and provider records to assess the quality of care for children enrolled in Medicaid.

Our objective was to assess the capability of state administrative health care databases to evaluate the quality of immunization rates for a Medicaid managed care population. Data on 5599 2 year olds were obtained from a Medicaid claims database, a health department database, and the records of the children's assigned providers. The study was conducted on 1 managed care program in 1 state. Test performance ratio analyses were used to assess the relative accuracy and contribution of each source of administrative data. We found that of the 67,188 doses needed, 45,511 (68%) were documented as administered per at least 1 of the data sources. Medicaid claims data alone accounted for 18% of immunized children, while health department data used by itself accounted for 12%. Together, these 2 sources identified 34% of immunized children. Large administrative databases, such as Medicaid claims and data from a health department, while valuable sources of information on quality, may underestimate outcomes such as immunization rates. Assessments of the quality of health care should rely on a combination of administrative data and providers' records as sources of information.

Child Health Services↗
PubMedDate not supplied

Strategic hospital alliances: impact on financial performance.

Acute care hospitals have increasingly been forming local strategic hospital alliances (SHAs), which consume considerable resources in forming and may affect the competitiveness of provider markets. This research shows that SHAs and market factors, which have been perceived to be threats to hospitals, are related to hospitals' financial performance. Among the findings are that SHA members have higher net revenues but that they are not more effective at cost control. Nor do the higher net revenues result in higher cash flow. However, increasing SHA penetration in a market is related to lower net revenues per case. In addition, the penetration of private health maintenance organizations in markets is associated with lower revenues and expenses.

Cost-Benefit Analysis↗
PubMedDate not supplied

Psychopathology in medical inpatients and its relationship to length of hospital stay: a pilot study.

A composite screening instrument measuring depression, anxiety, cognitive dysfunction, and pain identified 40 percent of a sample of general medical inpatients (30% of total patients before exclusions) as having significant psychopathology or pain, a reasonable number based on clinical incidence literature. These identified patients' hospital length of stay did not differ from the length of stay for other patients. The screen identified 21 percent as very depressed, 19 percent as very anxious, 15 percent as having cognitive dysfunction, and 11 percent with high pain levels. Depression, anxiety, and pain frequently occurred together. Further study is required to refine the instrument and assess its effectiveness at targeting patients for psychiatric intervention.

Anxiety Disorders↗