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Biomedical subjects

M V Pauly

Publications and source records attributed to M V Pauly.

At least 91 records · Page 5Linked to original sources
PubMed1987

Privatization and bidding in the health-care sector.

Public provision of health care, as under Medicare and Medicaid, traditionally "privatized" major production decisions. Providers of care, largely private physicians and hospitals (but also public hospitals), made significant decisions about public beneficiaries' access to care, the quality and quantity of individual services, and the prices to be paid. The result was high access and quality/quantity, but also high program spending, which has prompted a reassertion of public budgetary control. Newly activist program administration is using various mechanisms to promote economizing. Unable and unwilling to specify standards of public access or quality/quantity too overtly, administration instead seeks to squeeze prices--mainly through administrative price setting but also through competitive bidding and voucherlike arrangements. Under such new incentives, major choices that in many non-American systems would be public are here "reprivatized" to be resolved out of the limelight by beneficiaries, traditional providers, or new intermediaries like Competitive Medical Plans.

Competitive Bidding↗
PubMed1987

Catastrophic health insurance for the elderly.

Recent proposals to provide catastrophic healthcare benefits to the elderly under Medicare are flawed by their compulsory nature of premium payments and the granting of a monopoly to the federal government to underwrite such coverage. Additionally, current Medicare policy provides an inherent subsidy to Medigap insurance reducing the incentive to purchase private catastrophic coverage. Other options include paying for such coverage by increasing copayments or increasing private Medigap coverage. The public policy implications of these proposals are discussed.

Aged↗
PubMed1986

The changing health care environment.

In 1985, the rate of growth of national health expenditures was more than twice the overall rate of growth in prices in the United States, while the percentage of health expenditures relative to the Gross National Product reached a record high of 10.7 percent. There have been almost no changes in the fraction of direct patient payments for medical care since 1980, or in the fraction paid by third parties or the government. Consequently, cost increases in the gross price of medical care are being transferred directly to the patient population. The expense associated with medical treatment and the availability of managed care systems (Health Maintenance Organizations and Preferred Provider Organizations, among others) have contributed to the increasing cost consciousness of patient and physician alike. One of the areas in which the spiralling costs of medical care are most deeply felt is in the treatment of hypertension. The direct costs for treating this condition, which affects more than 25 percent of the American population, exceed $8 billion annually. Furthermore, hypertension is a chronic condition in which the cost of treatment is continuously apparent to the patient. Moderate and severe hypertension is more likely to affect elderly and black patients, the people who are least able to pay for therapy. Difficulty in paying for therapy is becoming an increasingly important problem due to the trend among physicians to prescribe newer and more expensive antihypertensive drugs instead of the more commonly used diuretics and beta blockers. Due to the cost-conscious attitude of patients, the physician who chooses the more expensive drugs may run the risk of losing patronage among middle- and upper-income patients. In the case of lower-income patients, prescribing expensive drugs may result in noncompliance. In order to guard against incursions by managed care systems and ensure the best care for low-income patients, physicians must assume a cost-conscious attitude toward the treatment of hypertension.

Adult↗
PubMed1986

Cost and price of comparable branded and generic pharmaceuticals.

Substituting generic for brand drugs has been increasing for two decades with the expectation that it leads to important savings. We studied 891 862 prescriptions, written for 21 pairs of branded and generic drugs, dispensed between April 1, 1984, and June 30, 1984, by 1363 selected pharmacies in 39 states. The cost per pill paid by the pharmacy was always less for the generic than the branded drug. The price per pill paid by the consumer was usually less for the generic than the brand. The wide and skewed distribution of consumer prices within and among pharmacies means that consumers cannot be guaranteed the lowest cost simply by buying generic drugs. The probability that generic would be less expensive than brand varied widely across drug pairs from .33 to .99. Continued search is no guarantee that the full distribution of prices or the lowest or nearly-lowest price will be found.

Cost Control↗
PubMed1986

Estimating hospital costs. A multiple-output analysis.

This study explores a new approach to estimating the cost of inpatient and outpatient services provided by hospitals. Data from a nationwide survey of non-federal, short-term, U.S. hospitals are used to make cost estimates based on a multiple-output cost function. The results provide information on the structure of hospital costs, and include estimates of the marginal and average incremental cost of outpatient care. Because of the innovative specification of the cost function, the study is of interest for its methodology as well as empirical results.

Costs and Cost Analysis↗
PubMed1986

Bad debts and hospital rate-setting.

This paper examines the economic foundations for mandatory discounts for insurers based on differences in bad debts experience. It considers critically the arguments Blue Cross plans use in several states. On both equity and efficiency grounds, discounts for actual bad debts are shown to be inappropriate. In contrast, it is shown that there are equity and efficiency reasons to grant a discount for insurance policies which avert bad debt, but that the appropriate discount is less than the amount of bad debt averted. The appropriate discount depends on the size of the subsidy needed to bring about purchase of debt-averting coverage. In some circumstances, this subsidy equals the underwriting loss on the coverage minus any tax subsidy the insurer receives.

Blue Cross Blue Shield Insurance Plans↗
PubMed1986

Returns on equity for not-for-profit hospitals.

This study examines the circumstances in which a large third-party payer or regulator might want to set hospital prices to yield a positive rate of return on equity capital. The level of return is shown to depend on the willingness of donors to make funds available in the community relative to the (derived) demand for capital to produce output. It is shown that the appropriate price might well be set to yield a zero or below-market return, and that the return to not-for-profit firms should generally be less than that to for-profit firms, if for-profit firms are to be active in the market.

Capital Financing↗
PubMed1986

Hospital output forecasts and the cost of empty hospital beds.

This article investigates the cost incurred when hospitals have different levels of beds to treat a given number of patients. The cost of hospital care is affected by both the forecasted level of admissions and the actual number of admissions. When the relationship between forecasted and actual admissions is held constant, it is found that an empty hospital bed at a typical hospital in Michigan has a relatively low cost, about 13 percent or less of the cost of an occupied bed. However, empty beds in large hospitals do add significantly to cost. If hospital beds are closed, whether by closing beds at hospitals which remain in business or by closing entire hospitals, cost savings are estimated to be small.

Bed Occupancy↗
PubMed1983

Competition and efficiency in the end stage renal disease program.

Estimated coefficients for medical service production or cost functions are subject to a 'competitive amenity bias' which may result in the failure to identify factors that affect economic efficiency. Our investigation of productivity of dialysis facilities did indeed indicate both the likelihood of bias and some qualitative results. These results suggest that it will be difficult to estimate cost and that variation in the level of reimbursement will, in competitive markets, affect the level of amenity delivered to patients. Incurred cost, amenity, and patient well-being will all vary positively with the reimbursement level. Determining the 'right' level of reimbursement requires a policy decision on how much total amenity society wishes to deliver to beneficiaries of public programs.

Costs and Cost Analysis↗